The trend today is to move away from writing patients prescriptions for opioid pain medications . We do still have to help patients who are experiencing pain and plan for post op pain management when performing procedures that induce tissue trauma.

Managing The Regulations

For most of us today we are required to register with our state prescription management service. These services allow all of the data from every prescriber, patient and pharmacy to be gathered and reviewed in one central database.  This information is then used to both monitor patients and prescribers, and to provide feedback information. Of course the information needs to be interpreted. I prescribe very little medication, for pain or otherwise. Probably the most common thing I write for is antibiotics, and with very few patients who need pre-med today even that is limited because of the nature of my practice. Last quarter when I got the review from the AZ prescribing service I had all these numbers in red. It turns out that I am way above the average in the percentage of my prescriptions that are opiods. If you look at the data closely this is because during the entire prescribing period being reported I wrote two prescriptions and one of them was for a pain med.

The other regulation that has taken affect in many states is the requirement for electronic prescriptions for schedule 2. Just int he last week we have been upgrading our dental software Open Dental to meet the e-prescribing prtal requirements so we can then complete the verification and be ready to go. With all of the changes making sure you are on top of whatever your state and the federal government requires is important.

Managing Pain Without Opioids

One of the things we have done with our patient sis move away from prescribing schedule 2 or opioid pain medications. I started to do this several years back after hearing Dr. Harold Crossley discuss a protocol. He recommends having your patients alternate 600mg of Ibuprofen and then 3 hours later 325mg of Acetaminophen, then 3 hours later 600 mg of Ibuprofen and so on. The protocol actually does a more effective job at managing pain then opioids. The medications work both locally and centrally so you get two different mechanisms of action.

I have the protocol written our and printed so we can give it to patients. You need to make sure they understand to use the 325mg of Acetaminophen to stay below the max daily dose of 3000mg. The protocol also requires making sure patients can take NSAID’s and aren’t on any medications that would be a contraindication. My patients have reported incredible success with pain management and no nausea, sleepiness or other side effects.