Page 27 - Delaware Medical Journal - May 2017
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CASE REPORT
grown to epidemic proportions causing an exponential increase in accidental overdose strained health care system with direct and indirect costs associated with its use, misuse, and abuse.3 In instances where patients are suffering from the dual diagnosis of SUD/ OUD and chronic pain, the cost burden on the health care system is disproportionately high and the long-term treatment outcome
is poor.4,5 It is also well-known that these are behavioral disorders that require intervention from trained counselors.6 The optimum outcome can be expected in an integrative, multidisciplinary setting where the pain physician and the counselor are working together to improve the outcomes.
The ease of availability to all services and treatments under one roof and being able
to offer multiple treatment interventions like counseling, drug screening, physical therapy, and pain management all under one roof ensure that patient pain management care is optimized and patients are compliant with the treatment plan. Onsite counseling service offers patients all the necessary tools, strategies, and resources to abstain from using illicit drugs.
The patients in the case reports were able to achieve both abstinence from heroin and remission from OUD. We agree that there is no direct evidence that shows that these
REFERENCES
1. Walley AY, Paasche-Orlow M, Lee EC, et al. Acute care hospital utilization among medical inpatients. J Addict Med. 2012;6:50-56.
2. Becker WC, Merlin JS, Manhapra A, Edens EL. Management of patients with issues related to opioid safety, efficacy and/or misuse: a case series from an integrated, interdisciplinary clinic. Addict Sci Clin Pract. 2016;11:3.
3. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national
patients would not have achieved the same level of success if they were referred out for counseling, therapies, and pain management to different providers. Nonetheless, given that these patients could come to one facility for all their treatments reinforces that patients were compliant with their treatment plan and had better-integrated care.
CONCLUSION
Substance abuse impacts all walks of our society, starting with the individual at his home environment, to his job environment, costs associated with long-term treatment and indirect costs associated with loss of life in the event of an accidental overdose.
While interventions like counseling, Suboxone therapy, and physical therapy, can be provided in different settings, provision of such treatments in an interdisciplinary pain management setting offers the stage for best outcome for these patients with dual diagnosis of chronic pain and OUD where the onset of chronic pain preceded the development of OUD. Improvement in outcomes observed included the decrease
in the number of failed drug screens
during treatment, patient satisfaction, and integration into the workforce.
age-sex specific all-cause and cause-specific mortality for 240 causes of Death, 1990- 2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117-171.
4. Couto JE, Romney MC, Leider HL, Sharma
S, Goldfarb NI. High rates of inappropriate drug use in the chronic pain population. Popul Health Manage. 2009;12:185-190.
5. Ciccone DS, Just N, Bandilla EB, Reimer E, Ilbeigi MS, Wu W. Psychological correlates
To conclude, the success of these case presentations can be attributed to the coordinated efforts of multiple providers in an integrated medical practice with an emphasis on patient’s abstinence
and adequate pain control. By working together, the whole team helped to facilitate a continuum of care that has enhanced long-term addiction recovery in these patients.
■ PRANESH PATEL, MS4 is a certified TMS provider who is a student at St James School of Medicine with an interest to specialize in Psychiatry.
■ IMANA MELTON, MBA, MS is a medical graduate from the American University of Antigua with and interest to specialize in Pathology
■ GANESH BALU, MD is board certified in Physical Medicine & Rehabilitation and Pain Medicine. He is offering comprehensive and integrative chronic pain management in multiple locations throughout Delaware for the past 17 years.
■ DAVE PARCHER MS, LPCMH, LCPC, CAADC is a Certified Alcohol and Drug Abuse Counselor. He is the Executive director of Kent Sussex Counseling Services and has 15 years of experience in counseling.
of opioid use in patients with chronic nonmalignant pain: a preliminary test of the downhill spiral hypothesis. J Pain Symptom Manage. 200;20:180-192.
6. Center for Substance Abuse Treatment. (2005b). Substance abuse treatment
for persons with co-occurring disorders. Treatment Improvement Protocol 42. HHS Publication No. (SMA) 05-3922. Rockville, MD: Substance Abuse and Mental Health Services Administration.
CONTRIBUTING AUTHORS
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