When George Mironenko hurt his back in a work accident years ago, the constant, throbbing pain continued long after the injury itself had healed. In fact, the back pain got worse over time for the Folsom, California resident. He couldn't sit, lay down or walk without excruciating pain. His doctors prescribed drugs and even spinal surgery - but the pain persisted. Then George's problems went from bad to worse - he became addicted to pain killers.
Super: George Mironenko,Folsom Resident I got to the point where I was taking...' "...equivalent to 48 vicodins."
Today, George's pain is under control thanks to pain patches. Addiction to prescription painkillers is a growing problem across the United States. In fact, experts say abuse of prescription drugs today now outpaces illicit drug use. Vicodin, OxyContin and Demerol - narcotic pain medications that get their patients hooked even as they continue taking the drugs at prescribed levels. And yet, those same experts say doctors don't know as much as they need to about their patients' pain and how to treat it.
Super: Scott Fishman Chief, Division of Pain Medicine, UCDMC Fishman SOT: "Pain is the most common reason a patient goes to the doctor and yet it is not widely taught to medical students or to training doctors. We're not taught about what pain is, how to treat it or about the complications of the treatments."
Fishman is a leading pain medicine clinician, researcher and is the Chief of the Division of Pain Medicine at the UC Davis Medical Center in Sacramento.
Fishman SOT: "The most abused prescription drugs are opiods - they are morphine type drugs the vicodin, Percocet or hyrdrocondone or hydromorphone, morphine, fentenyal-type medications. Many other drugs are abused as well but what we have seen is a public health crisis of prescription drug abuse. As the street abusers have shifted from those to prescription drugs."
Fishman says that while celebrities who are addicted to painkillers get a lot of headlines and publicity, the problem is just as prevalent among common folks we see at work, at the store and at the gym. And these folks have another thing in common with celebrities - they collect and fill multiple prescriptions through doctor shopping.
Fishman SOT: "What we are seeing..."
"None of which are know to each other." Fishman SOT: "What we are seeing is that there is a much higher amount of doctor shopping than we ever thought ... that's multiple providers of the same prescription being sought after by patients then to be filled at different pharmacies none that of which are know to each other."
Recently, the largest analysis ever done of state prescriptions for controlled substances showed that California is home to a very high rate of patients who get the same prescription for the same painkillers from a number of doctors. They then get those scripts filled at multiple pharmacies within 30 days.
The research spurred California Attorney General Jerry Brown to tighten the state's prescription medication tracking system. The reforms will help authorities identify those who use pseudonyms and aliases to illegally obtain controlled drugs as well as the doctors who enable users.
Paul's SOT: "Some educators today say that doctors and medical students also need more training in how to diagnose and treat pain. They say that training would help reduce addiction among pain sufferers."
Insert very brief nat. sound here of Fishman working with patient - "is that the kind of pain you have normally?"
Set-up of Wilkes Walking at UCDMC that you shot of him walking inside library?? Michael talking to medical students around table Michael Wilkes has an international reputation for innovation in medical education.
Super: Michael Wilkes UCDMC Medical Education Expert "In medical school we do a great job of teaching medical students about the physiology of pain, where pain comes from, how it is transmitted, the chemicals that are involved. Your question is really do we teach about the management of pain? The answer is a very sad no."
What complicates the treatment of pain for doctors is the marketing done by pharmaceutical companies. It has been reported that drug companies spend about 5 billion dollars a year advertising prescription drugs to consumers. UC Davis research has revealed that primary care physician's say their patients often ask for a drug they see advertized on television.
Super: Richard Kravitz UCDMC Quality Care Expert (from NewsWatch) Kravitz SOT: "There is a lot of medicine practiced in a grey zone where correct decisions are really driven by patient preferences and so quite a surprising amount of clinical care is probably effected by what patients ask for of their doctors.
Wilkes SOT: " We don't want to say no because we are rated on our patients satisfaction ...that's partly how we are reimbursed. We also have this bond with our patients we don't want to disappoint them."
Kravitz SOT: "It takes time to get to know the patient and time is one thing doctors, especially primary care physicians don't have a lot of."
Show someone watching TV from couch? TV drug ads do serve a legitimate purpose according to a UC Davis expert on pharmaceutical marketing.
Super: Prasad Naik UC Davis Grad. School of Management "We need consumers to be sufficiently educated before you feed them with information that they can, on their own, learn before they go to the doctor." Cover jump: "The marketing of it is not itself to be blamed. Some doctors, some patients might abuse that privilege. Its just like having a fire that helps you cook but it also can burn."
UC Davis medical students Erin Miller and Jordan Lilienstein say they have already experienced the challenges that doctors face in knowing how to manage pain.
Super: Jordan Lilenstein UCDMC 3rd Year Medical Student "We know the physiology of it pretty well but the actual management of it is difficult and I think it varies from supervisor to supervisor and so what we learn is from them and it differs from person-to-person and so I wouldn't say it is consistent."
Super: Erin Miller UCDMC 4th Year Medical Student "Ya know the choice of medications really did depend upon what doctor I was working with and, I think it left me with not a clear idea of where my idea on how to treat pain would be."
As more training is sought, pain experts are using another effective tool to attack the problem - pain management clinics. The one at the UC Davis Medical Center sees about 12,000 patients a year. Pain management is an emerging discipline; it didn't even exist 30 years ago.
Fishman SOT: "I think what we are doing which is special is bringing in all these different doctors who are all trained in this discipline of pain medicine but come from different fields and are informed by different perspectives that are crossed fertilized."
These doctors rarely eliminate the pain entirely because
pain is tied directly to sensation and, Fishman says, sensation is necessary
for quality of life.
Fishman "When the alarm system of pain is broken that is when the symptom of pain becomes a disease in of itself. That's when chronic pain becomes a chronic disease."
George Mironenko turned the corner on pain when he went to this pain management clinic.
Fishman SOT: "George's case represents what many patients go through is that they have seen multiple practitioners who have looked at part of the problem and treated part of the problem. The problem is that part of the problem isn't enough of an answer. He required someone who would pull it all together and see that he had a problem with his spine, a problem with his muscles, he needed medical management, he needed support."
Rimma Mironenko "I have witnessed my husband laying in a fetal position for over a year. He was completely helpless and he barely could get up." "It was a change from a person who you can say a baby, completely depended on me to a person, right now enjoying life."
Within the last couple of years, the underlying anatomy of pain has become clearer and treatments have become more effective. The pain medicine of tomorrow is expected to bring lots of relief to people who are suffering today. Paul Pfotenhauer, reporting in Davis.