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Medication management
At Pacifica Pain Management Services we approach chronic pain management from a non-narcotic perspective. While some patients may benefit from enduring opiate therapy, we treat those who fail to benefit from this approach for a variety of reasons. In some instances this may be due to co-morbidities such as addiction, depression, chemical sensitivity, respiratory depression, and/or cognitive/psychomotor deficits to name a few.
In the context of an intense, round-the-clock program we may use medications in other categories to assist the patient in controlling pain and other issues. Those medication categories may include:
- Anti-depressants
- Anti-convulsants
- Anti-inflammatories
- Channel blockers
- Other medications as indicated
The list of specific non-narcotic and non-benzodiazepine medications available singly or in combination for use with chronic pain conditions is extremely large and are considered at our clinic. Our patients are usually content managing their chronic pain without the use of habit-forming medications and typically do not report any particular increase in pain intensity following detoxification.
Our detoxification process is slow (usually completed over 12+ days) using a tapering dose of a long-acting narcotic in combination with other medications to control withdrawal symptoms. Patient reports of satisfaction with our detoxification protocol are consistently high. Controlling sleep deficits, nausea and diarrhea are on-going challenges.
Once patients complete our program they fully understand the need to avoid narcotics for chronic pain for the indefinite future. Acute medical needs for narcotics (ie., post-operatively) are, of course, the exception. Wherever possible we work with the referring physician to keep patients on the right track. Coordinated care makes handling patient requests for opiates in the post-detoxification phase easier as this can be deferred to our clinic staff.
Our goal is to titrate most unnecessary medications and work within a self-efficacy model in which the patient's enhanced self-confidence, physical strength, and determination work in concert with non-narcotic medications to defeat syndrome effects and return the patient to functional stability.
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