For many doctors, the management of a patient's pain becomes a time consuming proposition.
Many primary care doctors stopped treating chronic pain, and instead begun referring or outsourcing that aspect of their patient's health to clinics whose sole focus is the treatment of pain.
Until recently, patients needing such treatment were required to drive to metropolitan areas - including Tulsa or Joplin, Missouri - for care.
Earlier this fall, doctors with Pain Management of Oklahoma opened a site in Grove in order to serve patients in northeast Oklahoma.
This is the third location for the clinic, operated by Dr. Jeff Halford, D.O. and Dr. Brent Henderson, D.O.
The first, the main clinic, opened in July 2015 in Broken Arrow. The men opened satellite offices first in Sallisaw and then in Grove.
Initially, the clinic in Grove - which is housed within office space within the Physician's Building at INTEGRIS Grove Hospital - operated one Friday per month. It has since expanded to include hours every Friday.
Halford said additional hours may be added, as the client base continues to expand.
"We only focus on what we believe we are good at - managing pain," Halford said. "Some doctors do primary medicine, others do pain. We are trained in caring for chronic pain management."
Halford and Henderson work with patients - primarily referred to their practice by a primary care physician or specialist - who are 18 years or older and experiencing chronic pain. Most of their patients are 50 years and above.
They take self-referred patients rarely, and typically in the case of a patient moving to the area, and needing to transfer their chronic pain care from a previous provider.
Halford said chronic pain, in medical terms, is defined as a pain which lasts six months or more. It's considered a pain which persists beyond the "reasonable expectation of the normal healing process."
Acute pain would be the pain which takes place following an injury or surgery and heals within the expected time frame.
For example, someone with a knee injury would expect it to heal within two to four months. The pain would be classified as chronic if it persists beyond four months.
Halford said the types of patients utilize the pain management clinic, however the most common reason he sees patients stems from lower back pain.
They also see patients, who may have re-injured themselves and are experiencing acute pain which is not going away.
For example, he said, a 40 to 50 year old man, injures himself during a weekend football game. The injury aggravates a past spinal injury causing pain in his legs.
"Typically in that case we would say give it two weeks with heat and ice," Halford said. "If it's not going away in a couple of weeks [the PCP] may refer him to a pain specialist, who have the tools at their disposal to quickly manage the pain, to not allow it to turn into a chronic pain."
In the scenario with the man with a back injury, Halford said pain specialists may try using spinal epidurals and active physical therapy together, in order to strengthen the patient's body, reduce pain and help him avoid surgery.
Halford said the third type of patient who may be seen at the clinic includes those with general orthopedic chronic pain, who may have, for example, degenerate changes to the knees and hips, and are either not good candidates for surgery, refuse to have surgery or had a surgery with less than desirable outcomes.
For all of their patients, Halford said the staff strives to use a variety of methods to help patients including injections, medications and physical therapy.
In some cases, he said, a patient may need to seek professional help because of psychological issues ranging from anxiety and depression. In those instances, the patient is referred to either a counselor or a psychiatrist.
Halford said the treatment of patients with chronic pain is an "unfortunately growing" problem.
He said the increase is a myriad of layers, ranging from growing obesity epidemic, as well as the sedentary lifestyle, combined with the arrival of long-acting opioid medications.
The opioid crisis
Halford said the opioid crisis is a factor in the treatment of chronic pain, citing a study released by the Centers for Disease Control, which lists opioid overdose deaths at more than 40,000 and climbing.
Of those numbers, Halford said, at least 40 percent or 20,000 deaths, were related to prescriptions the person was taking along with their pain medication - including those for anxiety and depression.
In some cases, the patient may have obtained multiple pain prescriptions through the practice known as doctor shopping - or going to multiple doctors in order to manage their pain issues.
Halford said the decision to open in Grove came, because of the need to provide area residents with a centralized place to treat chronic and acute pain, as needed.
"We take good care of the patients," Halford said. "We also unload some of the burden primary care physicians have, managing [chronic pain care]."
The centralized care allows Halford and Henderson to develop a process, which helps reduce the instances associated with the misuse of pain medication - be related to the patient taking the medication correctly, or if the patient diverts the medication somewhere else.
"They may be diverting it away from its intended use by selling it, giving it to family members or trading it for some other drug," Halford said, adding that all other ways, beyond the intended prescription, are considered illegal or illicit uses.
Doctors at the clinic utilize multiple steps in order to ensure patients are taking the medication as directed.
The checks begin as the patient is first referred to the practice - when staff conduct an "extensive, online" background check.
Halford said this check looks for a potential criminal history, especially drug-related crimes, in order to see what the patient has done in the past.
The checks also include evaluating the patient's medical chart, to determine if the referral was appropriate - and if the patient has an accurate diagnosis.
Halford said the staff also makes a determination if they are "confident" they can manage the patient's care.
Before prescriptions are issued, the patient's records are checked within the Prescription Monitoring Program, a database organized in part by the Oklahoma Bureau of Narcotics.
This database allows medical personnel - primarily doctors and pharmacists - to monitor all scheduled drugs prescribed by any physician within Oklahoma and the surrounding states.
It also shows every prescription issued to a patient, which allows doctors to consider how the pain medication may interact with other prescriptions. Halford said this step also helps identify instances of potential doctor shopping.
During the patient's visit to the clinic, Halford said the next - most important - step takes place. This is when doctors take time to interview the patient, in order to get a complete description of the pain complaint and the patient's history.
"This is the most important piece in identifying a diverting patient," Halford said. "You can very quickly get a feel for if the patient is legitimate or not."
Ultimately though, Halford said his staff start by "trusting and believing people, until they give them a reason not to."
During the first and all subsequent visits, patients are asked to provide a urine sample which helps doctors not only if they are taking the medication, but if the medication is being taken as prescribed.
The urine screenings also tells doctors if the patient is taking anything not in their medical records - drugs or supplements which could potentially interact with the pain medication.
"This gives us a lot of comfort on the day of the appointment, that we've not only monitored the prescription monitoring program, but we have seen and evaluated the patient," Halford said. "We've made sure they are not slurring their speech, that the medication is working appropriately...and that the patients are taking the medication as prescribed."
Halford believes his staff provides a needed service.
"I think we treat our patients as customers," Halford said. "We treat them with respect. WE treat them well. They aren't looked at suspicious. We want to be known that we treat them with respect.
"We trust our patients unless they give us a reason not to. We're going to do a good job, that [treats the pain] comprehensively and safely..
In addition to Henderson, the practice employs a third physician, Dr. Keley Booth, who specializes in injectable pain management. If an agreement is reached with INTEGRIS, Booth may offer his services as part of the care team in Grove.
For more information, persons interested may visit painmanagementofok.com or call 918-794-6008.