Pubdate: Fri, 14 Nov 2014 Source: Florida Today (Melbourne, FL) Copyright: 2014 Florida Today Contact: http://www.floridatoday.com/ Details: http://www.mapinc.org/media/532 Author: George White PAIN-MANAGEMENT SPECIALIST BRINGS HOPE TO PATIENTS NEAR, FAR 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 QUESTION: 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 - --- MAP posted-by: Jay Bergstrom