Pain management

“The future” of pain treatment? - 08/15/2019

Some physicians, depending on the situation, are avoiding opioids to every reasonable degree, doing their part to keep patients off the drugs that killed more than 42,000 people in the United States in 2016. Fort Worth anesthesiologist Aaron Shiraz, MD, and his group, Trinity Medical Associates, are taking it to a rarely seen extreme.


You Write Scripts? You Better Sign Up With the PMP - 06/19/2019

If you don't yet have a user account set up with the state's prescription monitoring program (PMP), known as PMP Aware, now is a good time to get it done.


TMA Weighs In on Opioid-Antagonist Prescriptions - 02/11/2019

The Texas Medical Association continues to track key regulatory changes that could affect your practice, and recently submitted comments on the Texas Medical Board’s proposed rule for the use of opioid antagonists.


Questions Abound - 01/10/2018

The Texas Medical Board's new rules on inspecting clinics for failure to register as pain management clinics have provisions of potential concern for doctors.


Pharmacogenetics in Physician Practice - 09/01/2016

Chronic pain is a significant problem in the United States as more than 100 million Americans suffer from chronic pain. Opioid medications have been used to help those who suffer. Although these medications can give patients pain relief, increase their function, and improve their quality of life, their use can be risky and life-threatening. Opioid use has led to epidemic levels of unintentional overdoses in the United States.


Pain Rules Are a Pain for Doctors - 08/02/2016

While the Texas Medical Board's revised rules governing chronic pain treatment, which took effect Aug. 4, 2015, aim to thwart the proliferation of pill mills, some doctors say adhering to the rules is frustrating, onerous, and time-consuming.


A True Antidote - 07/26/2016

A new law allows physicians to prescribe an opioid antagonist to a person in danger of an opioid-related overdose or to anyone who can help the opioid user. The language essentially allows physicians to empower the user, the user's family and friends, or someone else to administer the naloxone where an overdose occurs.


Texas Medicine Inbox: November 2015 - 05/13/2016

Inbox — November 2015 I am an obstetrician-gynecologist in Houston. I read with interest the article on Texas Medical Board (TMB) rules for pain management treatment in the September issue. (See "Regs and Pains," September 2015 Texas Medicine, pages 51-55) The rules include documentation of a history and physical, test results, consultations, treatment plan, and informed consent, including risks and benefits, treatment given, medication, instructions and agreements, and follow-up.   Granted, in chart reviews for hospital peer review committees, I often come across charts with a history and physical without age, sex, last menstrual period, past history, or any physical exam beyond a cervix check. Obviously, those charts show grossly inadequate documentation. Similarly, the criteria listed in these new TMB rules list only basic, standard documentation.   The information listed in the board rules should be present on all medical records. Imagine a cardiac patient's chart without docume...


Texas Medicine Inbox: March 2016 - 05/13/2016

Texas Medicine's January 2016 article "Pain Rules Are a Pain for Doctors" makes several exaggerated claims regarding the difficulty and triviality of vigilance in opiate prescribing. As the October 2015 Texas Medicine article "A True Antidote" notes, prescription opiates caused 16,235 deaths in the United States in 2013. Opiates are dangerous medications; we physicians have a responsibility to minimize the risks of opiate overdose and diversion. The January article implies using the state's prescription drug monitoring program, Prescription Access in Texas (PAT), is onerous. On the contrary, if used regularly in one's opiate prescribing workflow, it becomes simple routine and no more difficult than checking lab work. Prescribing thyroid replacement includes routine monitoring. Prescribing antihypertensive drugs includes routine monitoring. Prescribing opiates also should include routine monitoring. Consider it a "background check" of a patient before prescribing a dangerous medication...


Feeling the Pain - 05/13/2016

On Oct. 6, hydrocodone combination products became a Schedule II drug. Some physicians oppose the change on the grounds it will disrupt care for patients in severe or chronic pain. Other doctors say the change will curb prescription drug abuse and help combat fatal overdoses.


Closed Formulary, Part Two - 05/13/2016

Legislation to reduce overuse of pain medications and other addictive and expensive drugs within the workers' compensation program appears to be achieving that goal through stepped implementation of a closed formulary. With phase two of the process set to take effect this September, leaders at the Texas Medical Association and the Texas Department of Insurance Division of Workers' Compensation say physicians should prepare now for what could be the more challenging part of the transition. Under the closed formulary, mandated by the legislature in 2005, physicians must obtain preauthorization from workers' compensation insurance carriers before prescribing roughly 90 different medications. The so-called "N drugs" not in the formulary include mostly opioids, analgesics, muscle relaxants, and antidepressants. Until now, the preapproval process applied only to patients injured on or after Sept. 1, 2011. Starting on Sept. 1 this year, physicians also must obtain N-drug preauthorization for ...