The trends to know about pain management in ASCs: 4 Qs with Dr. Eric Grahling

Eric Grahling, MD, is founder and medical director of Plainville, Conn.-based Comprehensive Pain Management, and president of the Connecticut Pain Society.

Recently, Dr. Grahling penned an op-ed on responsible pain management published in Connecticut Medicine, the peer-reviewed journal of the Connecticut State Medical Society. Here, he shares his thoughts on pain management trends, and combating the opioid crisis.

Note: Responses have been lightly edited for style and clarity.

Question: What are the trends and innovations impacting pain management in ASCs?

Dr. Eric Grahling: Interventional pain management is becoming more prevalent and more mainstream, so I think people who may need surgery who are having to go through procedures first to avoid surgery. There's an increase in pain management procedures in lower cost settings like in an ASC relative to a hospital. I think we're seeing more procedures, because [ASCs] are becoming more accepted by insurance companies and the public is becoming more aware of what we have to offer. I think given the increased focus on [price] transparency, people are now realizing to have something done in a hospital [or] an ASC, it's so much less expensive at the ASC level.

Q: What non-opioid pain medication or treatments would you recommend to other physicians?

EG: Oftentimes, the opioids are really [prescribed] by non-pain management physicians, surprisingly. We have so many other tools to use to avoid treating people with narcotics. If we see patients sooner, there are different types of therapy and different kinds of injection treatments that can fix a problem very quickly. If patients [in pain] aren't seen sooner, the primary care physician may [prescribe] narcotics and then they refer them to a surgeon, which is oftentimes unnecessary, and that surgeon will continue narcotics. When we finally see them, we see they've been on narcotics for four or five months and they're not any better. It's important when looking at the opioid epidemic that treating people sooner rather than later.

Q: How can outpatient facilities tackle the opioid epidemic?

EG: What we're seeing is that now, primary care physicians are much more hesitant to prescribe opioid medications. What happens is that more patients are being seen sooner by pain management experts and having more interventions sooner, which is more cost-effective in the end. If you can treat a condition early rather than letting it drag on, then opioid dependence and more invasive treatments can be avoided.

Q: How has pain management practice changed over the course of your career?

EG: I try to emphasize that the pain management physician is the expert in diagnosing the problem. In other words, if someone has back pain, that's not a diagnosis; there has to be a reason why. In the old days, a patient would get hurt, and a primary care physician would refer them to an orthopedic surgeon, who doesn't have the sophisticated training in pain management diagnosis like we do.

We try to represent ourselves as not only the experts at managing pain, but also diagnosing it.

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