About Medications

The Hayes Center for Pain & Addiction (HCPA) is a non-interventional pain management practice which focuses on eliminating or reducing chronic pain. We use main stream therapy to treat patients including manipulative therapy, manual therapy, Trigger Point Therapy, Percutaneous Electrical Nerve Stimulation (PENS) as well as acupuncture and other non-invasive therapies. These therapies may also be used in conjunction with medication management.

There is a legitimate role for opiate therapy for the management of chronic nonmalignant pain. Traditionally, physicians have been trained in the acute pain or cancer treatment paradigm to treat pain, and when using opiates, may increase the dose until pain is abated. In other words, no ceiling for the dose was taken into consideration as are for other medications. This has resulted in a significant increase in the prescribing of opioids in twenty years. SINCE 1991, OPIOD ANALGESICS HAVE INCREASED THREEFOLD AND IS NOW THE SECOND LEADING CAUSE OF ACCIDENTAL DEATH IN THE U.S., KILLING MORE PEOPLE THAN HEROIN AND COCAINE COMBINED. VICODIN AND OXYCONTIN, BOTH OPIATES, HAVE BECOME TWO OF THE MOST WIDELY PRESCRIBED DRUGS IN THIS COUNTRY.

In response to this crisis, the White House launched a National Prescription Drug Abuse Action Plan. The plan has a four pronged approach to battle the crisis surrounding abuse, misuse, inappropriate prescribing, and diversion of prescription pain medications.

HCPA attempts to avoid strong medications to treat pain because of adverse side effects. However, medications may be appropriate in certain cases. If an opiate is indicated after a thorough medical evaluation, HCPA patients are controlled well below 60 mgs of OxyCodone or its equivalent dosage in other opiates for a total daily dose. Generally speaking, combinations of long acting with short acting medications are used. There are evidence based medical studies to show that above those doses, there are diminishing returns for the control of pain, and in fact, there is a risk of developing Opiate Induced Hyperalgesia (OIH). Medical evidence has shown that patients on doses over 100 mgs daily and/or who are using more than 10 mgs of short acting OxyCodone or its equivalent in other opioids are at increased risk to escalate their doses very rapidly because of OIH and tolerance. This results in a decrease in efficacy for pain causing patients to develop profound dependency. These patients may not necessarily be technically addicted, but they may abuse their medication.

Therefore, HCPA does not accept referred patients who are taking more than 100 mgs of OxyCodone per day or its equivalent in other opiates per day. Patients, who are significantly over 100 mgs daily, should be weaned down close to that dosage, and then HMPC may consider taking over medical management after a thorough intake evaluation of the case. HCPA may use either lower doses of opiates or none at all, or Suboxone and other adjunctive therapies which we have to offer such as acupuncture. This practice does not use high doses of short acting opiates because of risk of abuse, dependency, addiction, OIH, and diversion.

In many cases, a HCPA patient may actually be a candidate for Suboxone. Even at that point, a patient has to be at least at 100 mgs of OxyCodone or an equivalent dosage in another opiate per day ( i.e.: less than 60 mgs of Methadone daily). If they exceed this level, they may have to detox in an in-patient environment.

If you have any questions regarding a patient, please feel free to call HCPA at 610-757-1035.

JOSEPH T. HAYES, M.D., M.P.H., M.S.