A World of Hurt

In a painkiller-abuse epidemic, pain management is precarious work

Illustration by Christopher Jones

Illustration by Christopher Jones

When the doctor touched the patient’s sore neck, she flinched in pain—ouch! And when she flinched, I flinched—eek! In fact, I would’ve sworn I felt a jolt of pain in my own neck, even though I was just sitting there in the exam room, in good health, and the patient was a total stranger.

Such is the slippery character of pain. It affects different people differently; it shape-shifts into various forms—acute, chronic, emotional, empathetic. We try to measure it—on a scale of one to 10 is it a four? A seven? We try to describe it—is it a throbbing or a stabbing or a dull ache? But even to physicians who specialize in its management, pain is somewhat elusive, an intangible but still very real challenge that can complicate or ruin peoples’ lives.

I was thinking about all of this while shadowing Dr. Daniel Burkhead at Innovative Pain Care Center in Henderson, an arrangement generously set up by the Clark County Medical Society to help the community connect with its doctors.

My interests in Burkhead’s field are many. Sales and abuse of prescription opioid painkillers like oxycontin have increased nationwide by 300 percent since 1999. A 2013 Centers for Disease Control report showed that in 2010, Nevada pharmacies sold the second-highest amount of opioid painkillers per person (11.8 kilograms per 10,000 people) and in 2008, the state had the third-highest rate of fatal overdoses from prescription painkillers (19.6 deaths per 100,000 people).

Nationwide, movements are afoot to address the epidemic by limiting opioid prescriptions to cancer patients. In fact, a new doctor at the Innovative Pain Center, Dr. Willis Wu, said that his Iowa medical residency focused on treating all non-cancer-related pain without opioids—using other analgesics and therapies. Burkhead disagrees with limiting opioid use exclusively to cancer patients, but is keenly aware of the potential for abuse—and the difficult situation in which it puts both physicians and pain sufferers. So at his practice, patients must submit to a drug-screen urinalysis and a review of their statewide pharmacy report before each appointment. If there are any red flags, he won’t treat the patient.

But it takes an experienced doctor to assess those red flags—someone who can evaluate a manifold set of factors: not just MRIs that show a bulging disc, or a medical history showing multiple doctor visits, but behavioral psychology, social influences, lifestyle cues. Communication is key.

Burkhead has been practicing in Las Vegas since 1999 and performs diagnostic and therapeutic spinal injections, among other types of pain treatments, in addition to medicine maintenance. When he and I stood in a break room reviewing a new patient’s records before seeing her, I saw that three different doctors had prescribed opioid painkillers within a couple of months after her joint surgery. And she’d been taking another opioid painkiller—initially prescribed after a different surgery—for more than a year. Was this a case of doctor-shopping—someone dependent on or addicted to opioids who was here just to pile on another prescription?

We entered the exam room, and they spoke at length. The patient said she was experiencing the shakes and sweats of withdrawals at the end of her Percocet prescription; she was saving half pills to use during the pain of physical therapy or when trying to get comfortable enough to sleep. The pain is rough, she said. But now she was afraid of the withdrawal symptoms, and ultimately wants off of the drugs.

They talked about the function of opioid receptors in the nervous system, about the poor effects of painkillers on the gastrointestinal tract, about willpower and trust.

Finally: Would she sign a form saying she would not get prescriptions from any other doctor, so that Burkhead could carefully manage a decrease in her opioid painkillers, while addressing her remaining pain with non-opioid treatments, until she was, ideally, both pain- and drug-free?

Yes, she said. Please.