Focusing on the Correct Diagnosis from the Start
Drug overdose deaths continue to impact communities in the United States as Americans and their physicians navigate pain management solutions that are effective yet safe. According to the Centers for Disease Control and Prevention, 70,237 drug overdose deaths occurred in the United States in 2017. Opioids were involved in 67.8% (47,600) of overdose deaths that year. Every death is one too many. WellStar Health System—one of the largest, most integrated healthcare systems in Georgia—is taking action to define and implement solutions that directly address opioid addiction and overdose and help keep patients and communities safe and healthy.
In 2017, WellStar Health System implemented a multi-pronged approach to managing pain and mitigating opioid dependency in their communities, which included developing an Opioid Steering Committee comprised of surgeons, anesthesiologists, pharmacists and perioperative nurses who are transforming the way acute and chronic pain is viewed, managed and treated. The committee addresses several aspects of the epidemic, such as provider and patient education; clinical initiatives focusing on care models and protocol development; and community awareness and engagement, including government relations.
Dr. Susan Orillosa is one of two interventional pain medicine physicians within the WellStar Health System network, who is championing ways to improve pain management and reduce drug misuse and addiction. She and her colleagues have found that one of the largest contributors of the ongoing opioid epidemic is poor pain management. Oftentimes, patients suffering from pain fall victim to unhealthy patterns, which may include the mismanagement of medication. To proactively mitigate opioid addiction among patients, WellStar is:
1. Operating a pain management clinic to improve pain management and reduce drug misuse and overdose
2. Placing medication take-back boxes throughout the communities
3. Partnering with state and local organizations to address addiction and recovery
4. Providing updated educational materials to patients and their families about realistic pain expectations
5. Tracking progress to continually evolve the health system’s approach to reducing and eliminating the need for opioids
“My goal is to provide my patients with pain relief in the safest way possible. By helping them maintain their independence, they can enjoy more time with their family and friends,” explains Dr. Orillosa, who joined the WellStar Vinings Health Park team in June 2017.
Dr. Orillosa and other WellStar physicians and team members are combating the opioid epidemic by improving education among doctors, patients, and family members. By implementing training programs; distributing education materials; creating withdrawal and symptom management programs; measuring opioid use across the system; and participating in and hosting opioid-related community events and national conferences, WellStar Health System is prioritizing better pain management.
Dr. Orillosa, who completed her interventional pain medicine fellowship at the University of Texas MD Anderson Cancer Center in Houston, Texas, points out that chronic pain can occur in different parts of the body, often in the neck or the back, as a result of diabetes, cancer and work- or sports-related injuries. It’s a universal problem that doesn’t discriminate, touching multiple medical disciplines and diverse populations.
“I was introduced to pain medicine as a specialty early on in medical school and truly enjoy working closely with my patients to reduce their pain,” Dr. Orillosa says. “I focus on getting the correct diagnosis from the start. I want to understand what we are treating so we can lay out a treatment plan with multiple avenues. Opioids are always the last resort.”
At WellStar, many of Dr. Orillosa’s peers also view opioids as a last resort and are prescribing non-opioid medication for pain control following complex surgeries such as joint replacement surgery.
Dr. Orillosa believes that a multimodal approach to pain management is a prime example of personalized care, a trademark of WellStar Health System. This can include physical therapy, acupuncture, adjustments with a chiropractor and more. Food modifications can impact pain levels as well.
“A lot of my patients are stuck in between a rock and a hard place,” Dr. Orillosa says. “For patients with severe osteoarthritis, a surgeon will recommend a knee replacement, but patients must fall within a certain weight range to qualify for a major surgery. And pain levels hinder their ability to exercise thus impacting their ability to lose weight.”
Two of many non-opioid, non-medication interventions used in pain management at WellStar Health System are:
+ Genicular nerve radiofrequency ablation: This minimally invasive procedure involves the use of heated probes to burn the nerves in the knee. In doing so, the pain nerves cannot transmit a signal to the brain, thus alleviating the patient’s sensation of pain. Although the nerves will regenerate in six-12 months, this procedure provides temporary pain relief, which helps patients accomplish their goals, i.e., weight loss.
+ Spinal cord stimulation: Oftentimes, patients suffering from chronic neck and back pain have already had surgery, but continue to have pain. The surgery went well, the imaging looks normal, but the pain is persistent. In these circumstances, Dr. Orillosa uses spinal cord stimulation, which is similar to radiofrequency ablation, but alters the pain pathways by blocking signals to the brain.
She also has advice for family members as well. “Suffering from pain affects everyone around you. It impacts your relationships and your responsibilities. I encourage family members to attend appointments and be involved. This can help keep the patient accountable.”
Missy and Michael Owen know that pain all too well. In 2014, they lost their 20-year-old son Davis to a heroin overdose in 2014 and subsequently founded the Davis Direction Foundation. WellStar recently co-hosted and sponsored the second annual Building Communities of Recovery (BCOR) Conference in Marietta, GA. Presented by the Davis Direction Foundation, the event brought together those impacted by addiction, including former patients, behavioral health specialists and other healthcare providers, support groups, law enforcement, government agencies and more, to share ideas and actions designed to support recovery.
For Dr. Orillosa and the entire WellStar pain management team, it’s about more than helping patients avoid opioid addiction. It’s about helping patients who are already taking opioids taper their medication use safely, to avoid painful withdrawal symptoms.
“In pain medicine, we recognize that a pain level of zero may be unrealistic. Chronic pain might not be curable, but it can be manageable. We focus on quality of life—getting you back to doing the things you love with the people you love,” Dr. Orillosa reflects, adding, “This is such a rewarding field. What we do as pain medicine physicians makes a huge difference in our patients day-to-day.”