One VA doctor’s cure for opiate overprescription: diagnose first

At the Bronx VA, a bustling urban hospital eight subway stops from Yankee Stadium, Klingbeil said while the result of her department’s strategy has been a sharp reduction in opiate prescriptions, there is no crusade to cut the use of painkillers. Instead, she says, she focuses on improving the patient’s quality of life, and often that means cutting or reducing opiate intake.

“It’s hard to live and function on opiates, and in the end they stop relieving pain, too, or you end up needing more to feel the same pain relief,” Klingbeil said. To be on opiates is “to be trapped in a cycle of poor function and poor pain control.”

When new patients come to the Bronx pain clinic, they get diagnosed. If the cause of their pain is something that requires a medical procedure such as surgery, that is the first step. Klingbeil says many patients come in with years of high-dose opiate intake but no diagnosis of what is causing the pain…

Back injuries are one of the most common causes of chronic pain among veterans, so Klingbeil and her colleagues at the Bronx VA instituted a “back school,” an intensive program of four two-hour sessions, where patients learn exercises they can do at home to strengthen muscles in their back and relieve pain.

Patients are often referred to accupuncture, chiropracty and Reiki, a Japanese laying of hands technique to relieve stress. Soon they’ll add swim therapy…

She says she doesn’t keep up to date on a lot her patients because many simply don’t have the need to come back to the hospital after they get a comprehensive pain management program.

“The results have been astonishing.”

Astonishing results with surgery, acupuncture, and Reiki? That would be amazing. Have these results been published in a peer-reviewed medical journal?

“The fact that patients in both groups showed improvements suggests the presence of a nonspecific therapeutic effect,” wrote the authors, led by Paul Dougherty, DC, a staff chiropractor at the Canandaigua VA Medical Center in upstate New York…

Chiropractic care began being offered at a limited number of VAMCs in 2004; in 2009, VHA issued a directive to further integrate chiropractic care into the healthcare system based on congressional action. According to the American Chiropractic Association (ACA), that care is now provided at 47 major VA treatment facilities…

One veteran’s wife said, “the VA treats people on pain meds like the new lepers.” …

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