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A Delicate Balance

Kelly Barth, D.O., pictured above, is a psychiatrist and internal medicine physician at MUSC Health who concentrates her efforts on the management of patients taking opioid medications for chronic pain.
Kelly Barth, D.O., pictured above, is a psychiatrist and internal medicine physician at MUSC Health who concentrates her efforts on the management of patients taking opioid medications for chronic pain.

America is fighting the deadliest drug crisis ever. And with Americans consuming considerably more opioids than any other country, nearly 60 percent more than Canada, the No. 2 consumer according to the United Nations International Narcotics Control Board, the problem doesn’t necessarily lie with illegal drugs. Prescribed opioid painkillers are actually at the heart of the issue. Two-hundred-fifty nine million prescriptions were written for opioids in 2012, reports the American Society of Addiction Medicine. That’s more than enough for every adult in the United States to have their own bottle of prescription opioids.

Part of the underlying problem is the fact that chronic pain is a real problem, affecting an estimated 100 million people in the U.S. alone. Physicians don’t want their patients to suffer and mean well when they write prescriptions for pain medications. Kelly S. Barth, D.O., a psychiatrist and internal medicine physician at MUSC Health who concentrates her efforts on the management of patients taking opioid medications for chronic pain, says patients with this type of persistent pain can have a worse quality of life than patients with cancer, adding that chronic pain can negatively affect their daily lives in countless ways.

Properly treating pain while not creating addiction is a delicate balance — one that has not been struck particularly well. The increase in the number of opioid prescriptions written coincides with a high number of drug overdose deaths, says Barth. Today that number surpasses the total number of gun homicides and motor vehicle crashes combined. As a result, the pendulum has swung. With data showing that Americans consume more than 75 percent of the global supply of oxycodone and 99 percent of hydrocodone, it’s no wonder that the Food and Drug Administration has cracked down on the prescribing of opioids, declaring opioid misuse, abuse, dependence and overdoses have reached epidemic levels over the past decade.

In an effort to address both problems, MUSC has launched South Carolina’s first comprehensive chronic pain rehabilitation program. With half of opioid prescriptions in the U.S. written for chronic pain, opioid misuse and chronic pain often go hand in hand. As a result, physicians and patients alike sought more inventive and targeted forms of treatment to address chronic pain and opioid addiction.

Barth brought the multidisciplinary program to fruition and now oversees it. She believes the new rehab program will provide patients with a more effective approach. Its objective is to aid patients experiencing chronic pain who have been prescribed long-term opioids to address it. Already, the program has distinguished itself from others because it focuses heavily on eliminating patients’ reliance on opioid medication that resulted from prior treatment. Barth explained that in order to address the nation’s overreliance on opioids, it is necessary to address what’s creating that reliance, which, she says, is chronic pain. The program “decentralizes” the use of opioids, while providing evidence-based non-opioid pain treatments and “giving patients the support they need to recover in a civilized way.”

The Centers for Disease Control and Prevention (CDC) recommends non-drug approaches such as physical and psychological therapy to address chronic pain. Barth said MUSC’s program not only includes opioid reduction and elimination and medication management, but also cognitive behavior therapy, physical and occupational therapy, biofeedback and nutrition education. These evidence-based treatments are modeled after those employed at a highly successful rehabilitation program in Jacksonville, Florida, and also follow CDC guidelines.

Specific goals for recovery include the reduction or discontinuation of pain medication use; education is also a major component of the program, as patients learn stress management, relaxation techniques and coping skills and improve the ability to self-manage chronic pain. Ultimately, Barth says, patients will be able to reduce their reliance on both opioids and health care professionals, moving more towards a model of “wellness rather than illness.”

To date, 20 patients have successfully made it through this new program, says Barth. Damian Millet, a patient nurse coordinator with the program, says the type of intensive approach that these patients received is particularly effective because it offers patients a hands-on experience with health care providers from multiple disciplines. They receive a lot of personal attention in group settings, he says. They make a great deal of progress in just three weeks – all patients were tapered off their opioids, saw an improvement in pain and functioning and showed a 40 percent decrease in disability due to pain. To find out more about the Pain Rehabilitation Program or to enroll, email Lynn Kimball or call 843-792-6895.