Pubdate: Tue, 03 Jan 2017
Source: Courier-Journal, The (Louisville, KY)
Copyright: 2017 The Courier-Journal
Author: Beth Warren


Dr. James Patrick Murphy, a nationally-recognized pain medicine
specialist, balances guidelines meant to lessen the risks of addiction
with a patient's need for pain relief, examines Marta D. Thomas of Old
Louisville. Thomas is a volunteer at Kosair Pediatric Convalescent Center
and receives radiofrequency lesioning (which melts the covers off nerves
so they don't transmit pain for 4-6 months.) 27 October 2016(Photo: David
R. Lutman/Special to The C)

Cattle farmer Marquis Smith is in pain, but he doesn't get sick leave.

The cows must be milked and fed, even though the 57-year-old developed
arthritis and injured his back lifting feed.

"I couldn't sleep," he said. "My back would lock up on me. It was awful."

For relief, he regularly drives nearly an hour and a half from work in the
Breckinridge County countryside, between Owensboro and Elizabethtown, to a
Southern Indiana pain center.

Here, Dr. James Patrick Murphy, a nationally recognized pain and addiction
specialist, treats and monitors Smith and about 1,500 other patients a
year at his New Albany clinic, the Murphy Pain Center.

"He picks them up when they are broken," said Fay Gash, the clinic manager.

The farmer said he doesn't mind the drive to seek out care from Murphy, a
graduate of the University of Louisville School of Medicine who completed
a fellowship in pain management at the Mayo Clinic.

"He cares more about the patients, really talks to you about your
problems," Smith said.

"It's almost impossible to find a doctor who will take care of you."

Some physicians say that's due in part to tightening national and state
regulations meant to crack down on pill mills that too readily supply
patients with Xanax, Opana and other opioids, contributing to a deadly
pill addiction crisis that spread across the commonwealth like kudzu.

Under a Kentucky law passed in 2012, doctors in most situations are
required to use a prescription drug monitoring system called KASPER, short
for Kentucky All Schedule Prescription Electronic Reporting, to track all
the drugs a patient has been prescribed by various doctors to prevent
addicts from seeking duplicate prescriptions. Indiana has a similar

There were about 75 pain centers before Kentucky's bill, compared to about
40 now, said Van Ingram, executive director of the Kentucky Office of Drug
Control Policy. Doctors found to be reckless have been prosecuted.

In the aftermath, some legitimate pain sufferers fear being seen as
drug-seeking addicts. And well-intentioned doctors, many of whom received
little training on addiction prevention, fear being scrutinized -- or even
investigated -- for potentially overprescribing. Murphy has treated
patients for years, first in Kentucky and now in Indiana and has avoided
any disciplinary actions, according to both states' medical licensure

Dr. James Patrick Murphy, a nationally-recognized pain medicine
specialist, balances guidelines meant to lessen the risks of addiction
with a patient's need for pain relief. Here, he speaks with his patient,
retired Louisville Metro Police officer Rick Jackman of Fern Creek.
Jackman suffers from reflex sympathetic dystrophy syndrome (RSD), a
chronic condition characterized by severe burning pain. 27 October 2016
(Photo: David R. Lutman/Special to The CJ)

Years later, some of Murphy's patients and fellow doctors say the stigma

Murphy, former president of the Greater Louisville Medical Society, and
several of his patients recently granted the Courier-Journal access to
observe and report what it's like inside one pain center.

A grandfather who injured his back years ago just wants to feel good
enough to toss a ball with his grandson or occasionally golf. A
wheelchair-bound woman with severe rheumatoid arthritis just wants to beat
back the pain enough to function -- her husband currently bathes and
dresses her. A retired cop has so much pain in his hands, the vibration
from a lawn mower can be excruciating.

Murphy said he tries to balance the risk of addiction with patients' needs
for relief to help them obtain their best possible quality of life.

He tries a variety of things, not just pain pills, to attack pain. He
sends some to physical therapy and advises others to swim in warm water.
There's also a medicated rub that works for some. Others get epidurals.

But controlled drugs, such as opioids, may be needed, Murphy said, and
because of his special training he feels confident prescribing them.

Lexington resident Elizabeth Tiller, 60, a former nurse, said she
unwittingly ended up in a possible pill mill after suffering a back

She said that as she was walking to the patient's room to meet with the
doctor at that clinic, a nurse rushed up and immediately asked what
medicine she was on and if she needed anything stronger -- without asking
any questions.

"I was shocked," Tiller said. "My profession saved me from that doctor.
They could have started me on the path of being a drug addict."

She bolted from that clinic and eventually found Murphy.

"I trust him," she said. "You hand your life over to him. I wanted someone
who was going to treat me, not medicate me."

Gash, who has worked with Murphy for five years, helps sort out who might
be exaggerating symptoms.

But she said she tries to balance diligence with compassion, since she
personally felt the sting of judgment. That was several years ago when she
felt her cheeks flush with embarrassment after a pharmacist loudly
commented in front of other customers, "Oh my goodness, morphine and
Oxycotin? Your husband is taking a lot."

Her husband, who has since died, was in the final stages of cancer -- not
battling a drug addiction, she said. She realized others within earshot
wouldn't know that.

At the clinic, she knows some are in danger of addiction so she keeps a
watchful eye, often peering between the slats in open blinds from the
window of her office facing the parking lot.

Her co-workers call it "Fay-dar," a type of radar.

Gash said she has spotted a patient shoving a container in a purse. It
turned out to be a urine sample just in case the doctor asked for a drug
screening. Gash also watched a patient confidently stroll into the office,
then fake a limp.

Murphy recommends patients consistently go to one pharmacy to provide
another layer of monitoring besides himself. His office regularly fields
calls from pharmacies asking for clarification if something seems out of

The doctor has other checks as well, including using Kentucky and
Indiana's monitoring system from his iPad to see if a patient has received
a prescription from another doctor.

When Murphy saw that patient Lance Young, 69, had been prescribed pain
medicine by someone else, he asked for an explanation.

Young, whose right foot was encased in a boot, forgot to mention recent
foot surgery and the medicine prescribed by the surgeon.

"I don't like any surprises," Murphy told his patient. "I want you to get
the care you need always, but let me know. Keep me in the loop."

Murphy has been treating Young for back pain from an injury suffered years
ago while lifting semi-truck tires at the Ford truck plant. Even after
back surgery, pain lingered. That was exacerbated when Young fell off a
ladder putting up Christmas decorations two years ago. Murphy prescribes
pain medication and also uses a radiofrequency procedure to temporarily
deaden some of Young's nerves to block pain.

"If it weren't for the medication, I probably wouldn't be able to walk,"
Young said. "It keeps me going."

Smith, the farmer, also said treatment from Murphy has enabled him to
resume his strenuous work. "He keeps me working every day."
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