LEXINGTON In this age of drug diversion and abuse, legitimate pain management practices face many challenges, requiring vigilance and perseverance to provide safe, efficient treatment for patients with chronic pain.
The son of an anesthesiologist, David Bosomworth, MD, Bluegrass Pain Management, followed in his father’s medical footsteps but soon realized he preferred more interaction with patients. In 1997 Bosomworth went to work for Ballard Wright, MD, at the Pain Treatment Center of the Bluegrass (PTC), fully committing to the subspecialty of pain management. He spent seven years with PTC and served as the surgery center’s medical director, but in 2003, he opted for a smaller practice and opened his solo practice.
A significant event in 1996 was the introduction of OxyContin. A sustained release oxycodone, within two years, the drug’s popularity grew significantly due to misuse. “The sustained release component of the medication was based solely on the coating. If the tablet was crushed, it became an immediate release medication, which could be very addictive,” says Bosomworth. In the mid-90s, many physicians refused to prescribe opioids for fear of addiction. Bosomworth stopped prescribing OxyContin in 2001 because he felt the social risks outweighed potential benefits.
The abuse of OxyContin also stimulated pain management physicians to put parameters in place to evaluate patients’ social histories. In his own practice, Bosomworth daily utilizes the Kentucky All Schedule Prescription Electronic Reporting System (KASPER), which was developed during his time at PTC.
“From a philosophy standpoint, when it comes to the treatment of chronic benign pain, I would not use a malignant dose of medication to treat benign pain,” says Bosomworth. For benign patients, his treatment goal is always functionality, and for malignant patients, the goal is comfort. “One of the things I try and do is not use a dose of the narcotics that’s going to make the people dependent on the medications in the first place,” he says.
In the last 15 years, significant advancements have been made in existing treatments and new procedures. Bosomworth cites implantable therapies such as spinal cord stimulation and intrathecal drug delivery systems; kyphoplasty; epidural lysis of adhesions; and injection therapies, primarily epidural steroid injections but also facet joint injections and radiofrequency thermocoagulation. His diagnostic approach includes an in-depth patient history and MRIs, nerve conduction studies, and CT scans.
“One hundred percent of the folks I see are on a referral basis,” says Bosomworth, which is an asset in identifying legitimate patients. His primary demographic is back pain patients, ages 35 to 55. While the majority of his patients are private pay, 40 percent are Medicare patients. Bosomworth also estimates that 60 percent of his patients are from outside Fayette County, a statistic he attributes to the availability of interventional services and the desire of physicians in southeastern Kentucky to have someone trained in dealing with prescription narcotics to handle complex or problematic patients.
Identifying Qualified Providers
One of the keys to decreasing drug diversion and increasing access to legitimate pain management services lies in differentiating pain clinics with interventional pain management specialists from “pill mills.” According to Bosomworth, qualified pain management practices are physician-owned, offer individualized treatment through in-depth exams and record keeping, have advanced training in interventional procedures, are attentive to contraindications for opioid analgesics, and bill through insurance providers.
The Kentucky legislature is currently considering several items of importance for pain management, including who can call themselves a pain clinic. [Editor’s Note: See Headlines story on page 4.] The proposed legislation also includes increased funding for additional investigators with the Kentucky Board of Medical Licensure, which currently only has five investigators for the whole state. Bosomworth notes that doubling the number of investigators would be helpful, but in his opinion the DEA should take a lead role.
FOR REFERRALS ► Dr. David Bosomworth at Bluegrass Pain Management, 1760 Nicholasville Rd., Suite 503, Lexington, KY 40503-1473, (859) 275-5229, Fax (859) 977-2683