According to the National Institutes of Health, pain is the most common reason that Americans seek medical attention.
It can also be a bear to treat: The NIH lists chronic pain as the leading cause of long-term disability.
Enter the pain management specialist, an offshoot of anaesthesiology that has caught on around the country over the last two decades or so, but was slower to take root here in the mid-valley. The area’s first freestanding pain clinic didn’t open until four years ago, after a traveling pharmaceutical sales rep named Manny Cruz spotted a business opportunity.
“I lived in Corvallis, and there were no pain management physicians in Corvallis,” Cruz recalled. “Most patients were having to go to Salem or Eugene.”
Cruz teamed up with Dr. Patrick Rask, a pain management specialist from Portland who was relocating to Corvallis. He already knew Cruz from his Portland practice, and the two opened their first clinic in Philomath in March 2011, with Rask as medical director and Cruz as growth strategist.
Their timing was right.
There are now at least half a dozen pain management physicians in Corvallis and Albany, and there appears to be plenty of business to go around.
The clinic founded by Rask and Cruz, Corvallis Pain Management, has grown steadily. It now has a staff of 32 employees and offices in Philomath, Corvallis and Newport. A second physician, Dr. Dan Sudakin, has joined the practice, along with two physician assistants and a nurse practitioner.
“One of the things we decided is we wanted to be a comprehensive clinic, where we would manage the patient’s medication as well as decide whether an intervention would be helpful over time,” Rask said. “It allows the referring doctors to focus on their specialty … rather than having to deal with the pain.”
Most patients are referred to Corvallis Pain Management with chronic pain, most often of the back or neck. Other conditions the clinic treats include migraines, arthritis, phantom limb or post-surgical pain, and pain from sports injuries or car accidents.
Usually, patients already have prescriptions for pain medication when they get a referral to the pain clinic, and they’ve often tried various treatments without success.
“We usually get the people who have tried everything,” Rask said.
Most treatments involve injections with steroids to provide long-lasting pain relief. Rask also performs radiofrequency ablation, which uses radio waves to cauterize nerve endings and shut down pain impulses. And for some patients, he can perform a surgical procedure to implant a spinal cord stimulator that emits electrical impulses to manage back pain.
But a big part of the job is medication management. A shift by the national medical establishment toward more aggressive pain management in the 1990s was followed by a surge in the abuse of opioid painkillers, along with a tragic spike in overdoses. According to the Centers for Disease Control and Prevention, more than half of all fatal overdoses in 2010 – 22,134 of them – involved prescription drugs.
While Rask believes that prescription pain relievers can be highly beneficial for many patients, he also recognizes that the risk of addiction with opioids is significant. Because the experience of pain is highly subjective, it’s not always easy to tell when some patients genuinely need ongoing medication or when they’ve turned into “drug seekers” trying to satisfy an addiction.
All Corvallis Pain Management patients who are on pain medication are required to sign a “pain contract” aimed in part at curbing abuse. Patients must agree to use one pharmacy, not go to the emergency room for meds and follow the dosage instructions on their prescriptions. In addition, the prescriptions are written for only as many pills as patients are expected to need until their next appointment.
If the clinic staff suspects a patient may be abusing medication or selling it on the side, Rask may take additional steps such as doing random pill counts, performing covert drug screens or contacting their pharmacist, and the newest addition to the clinic, Dr. Sudakin, is a specialist in addiction medicine.
Occasionally, if the problem can’t be worked out, the clinic will refuse to keep treating a drug-abusing patient.
“If we feel that it’s no longer a safe environment for narcotics,” Rask said, “we will no longer prescribe narcotics.”
The need for better medication management is one reason why pain clinics are on the rise. Following the lead of a number of other states, the Oregon Medical Board has issued guidelines calling for any patient taking 120 milligrams or more per day of morphine – or the equivalent amount of other narcotic medications – to be referred to a pain clinic.
With referrals on the upswing, Cruz said Corvallis Pain Management is looking at additional expansion options. The clinic is currently recruiting for a third physician as well as another nurse practitioner or physician assistant, and Rask is planning to open an ambulatory surgery center in Albany in partnership with two other area doctors.
“There’s a high demand for it,” Cruz said.
Rask appreciates the high patient volume, of course, but he said he also gets a lot of personal satisfaction from his work.
“I used to be an emergency room doctor, and when patients came in with back pain we really couldn’t do much for them,” Rask said. “On this side of the tracks, I can really home in on what’s causing the pain and do something about it, really make someone’s life better. That’s really what I like about it.”