Pubdate: Fri, 14 Nov 2014
Source: Florida Today (Melbourne, FL)
Copyright: 2014 Florida Today
Author: George White


Pain specialist Brian Dowdell was surprised at the recent close vote 
for medical marijuana, especially considering the lack of support by 
the medical community. Amendment 2 received 57 percent of the 60 
percent needed for passage.

"The media has portrayed medical marijuana as sort of a treatment for 
everything," he said. "There's no medical organization that actually 
stood up and advocated Amendment 2. Using the term medical marijuana 
insinuates that there's some type of medical need or that our medical 
community is struggling with treating patients appropriately because 
we don't have the ability to prescribe marijuana. That's not true."

He mentioned the drug Marinol, which is a synthetic form of 
tetrahydrocannabinols (the active ingredient in cannabis) prescribed 
to cancer patients to help with appetite, not pain management.

"There are benefits to it, but the way that the amendment was pushed 
was not clearly advocated the way it should have been. If you want to 
pass a law for recreational use, it, should have been advocated that 
way," he said.

Dowdell talked about his specialty, strict laws concerning the 
distribution of pain medications and the lasting social stigma 
suffered by patients with real pain


Has the well-publicized problem of prescription pill abuse led to 
meaningful reforms?

Dowdell: We do employ some medication management with patients, but 
unusually it's in conjunction with other therapies, whether it's 
physical therapy, weight reduction, interventional pain therapies. A 
lot of people don't understand the difference between a pill mill vs. 
a true pain facility, which is actually licensed through the 
department of health as a pain clinic and follows strict guidelines.

Those restrictions and regulations were actually brought forth by our 
own academies, because we were the ones who saw the danger in the 
community. These pill mills were giving our group a bad reputation 
and, further, it was harming the community with people overdosing on 
narcotics. We pushed for legislation that would limit the way that 
pain groups would be able to process in the state of Florida.

The pendulum has swung the other way. Even pharmacies are limited to 
how many pain pills they can deliver in a month.

Q: Do patients with real pain feel a societal stigma?

Dowdell: Absolutely, they do. They fear some type of recourse, so 
many of them suffer in pain or stay home or, in some severe cases, 
the patients have entertained suicide.

Q: What are the major causes of spinal pain?

Dowdell: There are several. The typical injuries that people are 
involved with where they get a disc herniation, it pinches the nerve 
and you get classic sciatica. That's a very common phenomenon and 
it's an epidemic in our country and other developed countries.

Then there are other disorders that effect the spine that are 
rheumatologic, such as different types of arthritis. They can all 
eventually create spinal pain. But by far, the majority of spinal 
pain is a process of degeneration that takes place.

Q: How important is communicating realistic expectations relative to 
pain relief?

Dowdell: Any time we deal with patients, you have to obtain history 
and give an exam. Based on whether it's acute or chronic. Sometimes, 
the body changes the way it perceives sensory input. At that point, 
you're now trying to control or mask the pain, whereby people can 
function relatively well-knowing that their quality of life is better 
because their pain is better controlled.

We try to set realistic expectations for patients and we also, at the 
same time, assess the patients as to whether they have realistic 
expectations. Identifying those things early on is very important in 
determining their treatment regimen.

I feel it's really important to be very straightforward with patients 
and making sure that your goals are set upfront and that your 
expectations are clearly defined. That way it minimizes potential 
problems down the road.

Q: Even in dire situations, do you leave room for hope?

Dowdell: We often have patients that have chronic pain and we're 
their last step for them. When we're their last step, if you take 
away any and all sense of hope, you're defeating that person's 
internal energy to want to be able to survive and function. 
Sometimes, there are pleasant surprises. We always try to employ hope 
in every patient, that there's something that can be done to help 
them. We always are giving pep talks. Inspiring hope is a very 
important part of the process.

Q: What is your favorite part of your job?

Dowdell: When you've impacted someone's life where you see that they 
are now smiling and enjoying their life. That gives me the greatest 
sense of gratitude.

Q: What is most difficult?

Dowdell: The most difficult thing in my practice is dealing with the 
escalating bureaucratic demands from third-party companies and 
governmental agencies. We're literally drowning in paperwork. It's 
also when we're recommending treatments and we're continuously being 
denied and have to prove that they need the treatments.

The amount of red tape is disturbing, because it limits the patients' 
access to health care and it produces an environment of increased 
suffering. When my hands are tied, I can't help patients, and it's 
sad to see that.

Brian Dowdell, 48, pain specialist

Hometown: Rochester, New York

City of residence: Indian Harbour Beach

Family: Daughters, Krystina, 18, and Brianna, 16

Hobbies: Playing sports, exercise, boating, cars

Education: Bachelor's degree in biology, Canisius College, Buffalo; 
master's degree in pathophysiology, internship in interventional pain 
management, University of Buffalo; cancer research Roswell Park 
Cancer Institute; residency at Stanford University, Palo Alto, California

Contact: Spine, Orthopedics and Rehabilitation (SOAR), 308 S. Harbor 
City Blvd., Melbourne; 321-733-0064
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MAP posted-by: Jay Bergstrom