Dr. Aletta Somers-Dehaney and Dr. Stephanie Marcy are pain management providers at Great Plains Health who encourage the limited use of opioids for pain.
Somers-Dehaney is in the process of expanding her research by applying for a National Institutes of Health grant to fund a prospective ketamine treatment clinical trial at GPH.
“I would say we are very proud of how we at Great Plains Health have done such good work in getting patients that are on chronic opioids off, especially during this opioid crisis,” Somers-Dehaney said. “I have seen patients who have come in and they are on 200, 300 milligrams of morphine equivalent and, over time, we have gotten them off to zero.”
Somers-Dehaney said the patients’ pain is controlled, their quality of life has improved, they’re more active in their family life and they are contributing to society.
“It basically started when I used (ketamine) for patients who had refractory pain,” Somers-Dehaney said. “They had been on all the conventional medications, they had all the conventional procedures — nothing was working.”
She recommended the patients try ketamine infusion, in which the medication is administered directly into a vein.
“What I noticed was not only was I able to control their pain, but I was able to step-wise take them off their narcotics to nothing,” Somers-Dehaney said. “It is fantastic and so much so that I am in the process of doing a retrospective study and research on the data that we have to analyze the three years since I have been here (2016).”
Marcy said it is important to understand, as well, that providers need to treat the source of the pain and opioids simply mask the pain.
“But the cause is never actually treated by an opioid,” Marcy said. “After the whole (pain management standards) the Joint Commission came out with, I think that forced the hand of practitioners to basically identify that pain as the fifth vital sign.”
The standards set by the commission a number of years ago indicated that zero pain was the standard for providers to achieve for their patients.
“So if our number is saying zero, then we’re treating pain,” Marcy said. “But that’s not actually how it occurs from a pain management standpoint. Just because your pain number is zero doesn’t mean you are out of pain, it just means you don’t care.”
She said the opioids numb or depress the brain’s functions so it doesn’t recognize the pain.
Somers-Dehaney said, especially with chronic pain syndromes, ketamine does a great job of managing pain without the addiction component of opioids and its other side effects.
“I think this is really good news because the big push now is to try to find ways to defeat this opioid crisis,” Somers-Dehaney said. “I don’t think ketamine has been looked at that way where you can actually have the patient come in and wean them off their (opioids).”
Marcy said the fault for the opioid crisis does not lie with the patients and it basically fed off itself.
“I think of opioids as the Band-Aid for a hemorrhage,” Marcy said. “You can put a Band-Aid on, but if you’re hemorrhaging, you’re going to need more and more Band-Aid because you’re not fixing the problem.”
She said before treating her patients for pain, she does a full neurological and neuromuscular exam.
“Multimodal means treat pain where pain is coming from,” Marcy said. “You cannot separate pain physically, mentally, emotionally or spiritually — you’ve got to treat the whole picture.”