Host: Many times you use strong narcotics to alleviate pain, is it good side? Is it bad side? Sometimes people get addicted, obviously, you are very concerned that that could happen to anyone of your patients, what do you try to do so you don't get a patient that you’re not a 100% sure that medicine is being used for the treatment of the pain but they got a little addicted to a very strong addicting type of medicine?
Glenn Babus: It is not a simple answer and I used to do talks around the country and I used to always get around, you can tell by how doctors treat patients with pain by looking at the USA today. In the 70s, we weren’t giving enough pain medications. In the 80s and early 90s, we were supposed to give as much pain medications as we could and then in 2000, it was like we were giving too much. My opinion always been from the beginning is you have to individualize every patient. I think chronic pain in next millennium will be the physicians who will be the most successful of patients are picking the right intervention when they first see that patient and you are right, some patients are not good in narcotics.
When a patient comes into our clinic, who we feel is going to need narcotics or is send by another physician already on narcotics or has a narcotic problem, is they first need to bring all their records to us; we need to review what's been done. They also will get a psychological evaluation by one of our psychologists which includes usually an MMPI, the Minnesota Multiphasic Inventory where we always do urine tox screen which sounds wow, we don't trust our patients any more but I think urine tox screens will be now become the standard of care for most pain-management physicians.
Urine tox screen serve a lot of purpose for us. 25% of our patients have no idea what they are taking, when they come into the clinic. So it helps us to figure out what kind of medications they are on. The other thing is that there are lot of patients that take narcotics, do have addiction problems, there are all kinds of addictions; there is pseudo-addiction that's going to take a whole another talk. But there are ways now of being more careful at patients so they don't get these addiction problems. People have to realize, if you put any patient on a narcotic and they are on it for three to six months and then that person has to come off a narcotic for any reason whether they are just getting better or it is not working for them are going to suffer withdrawal symptoms.
It is really common. It doesn't mean a person is addicted to the medication, it is a normal response to the body and we are running into a lot of that. We get patients who are so nervous about their medications not because they are having pain anymore; they so worried that they are going to through withdrawal symptoms and they are so busy with work and their jobs, even though their pain problem might have went away, they can't get off the narcotics. You could look now on the internet, there are hundreds of these rehab clinics are opening up. You can look in the tabloids, you can see about promises in California and all these different, we have places where the stars are going.
This is becoming a big thing because there are lot of people they have been putting on medications for the right and wrong reasons. It is been our clinic, we are really careful at the beginning where we like to trial everything else we can before we put someone on a narcotic. In some patients, narcotics are the right, take a rheumatic or Lupus patient, who is trying almost every rheumatology drug, is miserable. That patient is not a good candidate for injections, might be a good candidate for a long-term narcotic. Now a young, 25-year old Workers' comp patient, who just had a herniation, who is in a lot of pain that might not be the right person to put on the narcotic. So I think it is very individualized, you need to bring in a lot of other specialties.
I am very lucky in this clinic as my partner is physiatrist, a rehab doctor. I have psychologist right on the premises, orthopedic, physical therapist, medical assistance. I have so much back up that we are lucky that we have so many multi-modalities. In some clinics they are not as lucky, they might have a--
Host: A team approach is always the best.
Glenn Babus: Team approach is, to me, the only way to take care off a pain patient.
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