2. Denis G. Patterson, DO Nevada Advanced Pain Specialists www.nvadvancedpain.com patterson@nvadvancedpain.com Contact Information

3. Denis G. Patterson, DO ECHO Project May 18, 2016 Current Events Involved with Opioids

5. 32 year old female is referred for neck pain by her PCP No significant past medical history Pain is 100% in the neck (no upper extremity pain) Case Report

6. MRI reveals a minimal left paracentral disc protrusion at C5/6. No neural compression noted at any level Patient claims to be on 12 Norco 10/325 mg a day Case Report

7. Patient claims to be allergic to all LAO Patient claims to have tried and failed PT in the past and will not do it again due to financial burden Case Report

8. How would you treat this patient?

9. Discussed a comprehensive treatment plan - Modalities - Role of Medications - Physical therapy - Alternative therapies - Injections - Surgery Case Report

10. Every visit is a power struggle focused on medications Final convince patient to try diagnostic cervical facet blocks Case Report

11. Patient has diagnostic facet block done Calls office the next day claiming the injection caused an “allergic rxn” Patient given an appointment to further evaluate complaints Case Report

12. Suspect patient “faked” the allergic reaction Tried to call patient’s bluff by referring her to an Allergist for further evaluation Several follow ups with no attempt to see Allergist Case Report

13. PMP report at next appointment shows several fills from PCP for the past 4 months for Norco Patient discharged over medication agreement violation Call placed to PCP Case Report

14. Conversation with PCP unpleasant I am told by the PCP that I “should have given the patient what they wanted” “These problems didn’t exist until you pain guys came to town” Case Report

16. What is Pain Management to PCPs? PCPs expectations from Pain Management Specialists? Who is a Pain Management Specialist? Perception Problem?

17. Should any PCP with no formal pain management training promote themselves as a pain specialist?

19. Nevada is in the top 5 states when it comes to prescribing certain pain pills Nevada Doctors wrote 94 prescriptions per 100 people seen in 2012 1.04 million grams of Oxycodone prescribed in 2012 (3 rd most in US) Nevada Prescribing Problems

20. 799,000 grams of hydrocodone prescribed in 2012 (3 rd in the US) These numbers are 3x the rate of the State of New Jersey which has triple Nevada’s population Nevada Prescribing Problems

22. Patients have been abandoned Physicians have gotten the “blame” Everyone’s too scared to help these individuals Nevada discussing using the PMP to police physicians Rand Fall Out

24. Questions

25. Discussion