Dr. Wayne Sebastianelli points to the emergence of pain as the “fifth vital sign” as one key factor that helped fuel the opioid crisis impacting Centre County, the state and the nation.
Some physicians nationwide have said they felt pressure to prescribe opioid painkillers to achieve higher scores in patient satisfaction for themselves and their hospitals.
But pain is not easily measured.
“You may be stoic, I may be a wimp,” Sebastianelli said. “How do you assess it?”
Pain rose to prominence as a vital sign in the late 1990s and early 2000s, taking its place alongside body temperature, pulse, respiratory rate and blood pressure.
While abuse of narcotics by patients has long been a concern in the medical community, the emphasis on rating pain helped bring the issue to a head.
As a health care industry, “in rating pain and making sure it never gets above a certain level, you create problems for individuals who have an inherent psychological tendency to use that stuff,” Sebastianelli said of opioids. “Once they get discharged, they still need a certain dose.”
A patient might have gone to multiple providers to get pills because there was no good system to track that.
“One thing leads to another and all of a sudden you get somebody addicted to medication because they’re on it for three or four months,” Sebastianelli said.
When pills become unavailable or too expensive, some turn to heroin.
“It took a while for people (in the health care field) to catch on,” said Sebastianelli, associate dean for clinical affairs, University Park Regional Campus of the Penn State College of Medicine; Kalenak professor in orthopaedics; medical director of Penn State Sports Medicine; and associate chief medical officer, Penn State Medical Group in State College.
PRESCRIPTION MONITORING
Things in the health care field are changing in response to the opioid crisis.
Pennsylvania, in August, implemented a prescription monitoring program, a statewide database that allows medical providers to check on whether a patient has received prescriptions from other doctors.
Pennsylvania was the 49th state to implement such a program.
The law now requires prescribers to check the database every time they prescribe an opioid or benzodiazepine (with some exceptions, such as in an emergency department). In addition, it requires dispensers to input prescription data into the database by the close of the next business day.
Prescriptions of opioids to minors are now limited to seven days, with some exceptions, and also require counseling on risks. Opioid prescriptions in emergency rooms or urgent care centers are also limited to seven days, with exceptions.
But greater controls are not without risk, as more people may turn to street drugs.
Sebastianelli said he is concerned that “we may see more accidental death. Drugs like fentanyl and heroin are just so available and so cheap.” Users have no idea what is in the drug, he said.
PAIN MANAGEMENT
There are also movements away from classifying pain as a vital sign. The American Medical Association House of Delegates took a stand in June opposing that classification, and the American Academy of Family Physicians’ Congress of Delegates did so in the fall, according to the global medical news site Medscape.
On ongoing concern, according to Sebastianelli, is a shortage of health care professionals in the field of pain management.
“Manpower is nowhere near where it needs to be,” he said. “We need dedicated case managers following people at risk (of abuse) or with a documented history of problems.”
The cost of treatment on the front end is far cheaper than the cost to society on the back end, Sebastianelli said.
For example, he said, there are “methadone clinics here and there, but it’s hard to get into those and people who are not following the rules are dismissed, which helps no one.
“The money that you spend on treatment is actually saving money because (people who abuse drugs) create more issues — intoxicated driving, hurting and killing others and themselves, ruining lives.
“Spend a dollar and save 10 on the back end in terms of costs to society,” he said.
