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Rethinking Pain Medication

Rethinking Pain Medication

Renee Shaw is joined by Dr. Phillip Chang, chief medical officer at UK HealthCare, who discusses efforts to tackle the opioid epidemic by encouraging doctors and hospitals to minimize prescriptions for powerful narcotics. The program is part of KET's continuing coverage of the opioid crisis.
S13 E5 Length 28:02 Premiere: 10.6.17

Reforming Pain Medication Practices

For years, it’s been standard protocol for doctors to prescribe enough narcotics to eliminate the discomfort of a patient suffering acute pain.

But as the crisis of opioid addiction continues to escalate, one University of Kentucky physician wants to change how health care professionals and patients think about pain. He wants doctors to expand their treatment options for acute pain and educate patients so that they can tolerate manageable levels of pain without resorting to a potentially addictive painkiller.

“This is one of those things where things are easier said than done,” says Dr. Phillip Chang, chief medical officer at UK HealthCare. “Actually doing it is hard, but it’s worthwhile.”

Chang appeared on KET’s Connections to explain his efforts to encourage doctors and hospitals to minimize their reliance on powerful narcotics to treat pain.

A Reliance on Narcotics
In 2013, Chang was doing back-to-back rotations at UK’s trauma center when he treated a young man who had been in a car accident. After a brief hospital stay to treat him for contusions and multiple rib fractures, the young man was released with a prescription for narcotic pain relievers.

But a week later, he was back in the trauma center, still complaining of pain and seeking more drugs. Chang says a follow-up check of the young man’s pharmacy records revealed a shocking discovery.

“When we added all the prescriptions, he had been given over 1,000 pills in about four weeks,” Chang says. “Some of them from us, some of them from another hospital and other clinics.”

A urine test proved the young man was abusing his medications, so Chang referred his patient to a substance abuse counselor within UK HealthCare who got the young man into treatment.

The incident got Chang thinking about how readily his clinic, as well as doctors and hospitals nationwide, prescribe narcotics to treat acute pain. Although they want to alleviate the very real discomfort their patients experience, in the process their over-prescription of painkillers may contribute to an addiction in those individuals.

“I do believe, at least in my institution, the intentions are all good and perhaps not well-enough informed,” says Chang.

Safer, Simpler Options
According to Chang, acute pain is defined as pain that will end once an injury has healed. He says the standard treatment for acute pain has been to administer a low dose of an opioid pain reliever such as morphine, hydrocodone, or oxycodone. If the low dose doesn’t eliminate the pain, doctors can administer higher doses or more frequent doses of the narcotic. If that doesn’t work, they try ibuprofen or acetaminophen as a last resort.

Opioids are effective for treating acute pain for three to five days, says Chang. After that, he says their effectiveness is debatable and the risk of side effects is substantial. Those can include nausea, drowsiness, and constipation or even addiction. Studies indicate that about two-thirds of people who get hooked on opioids started using them when they received a legitimate prescription for the drugs.

So why, Chang began to wonder, do doctors start pain treatment with a powerful and potentially addictive narcotic when they have other options as safe and simple as Tylenol and Advil?

“That’s the first baby step that we took in 2013, which is to recognize that there are painkillers other than opioids,” he says.

Customizing Pain Treatment
Chang began experimenting with a new pain treatment protocol for his clinic that relies on fewer opioids. First, his staff tells patients that they will reduce but not necessarily eliminate their pain. The goal is to get the pain to a level where the patient can function and be comfortable.

Then they make it clear to the patients that opioid pain relievers are still an option, but that they want to explore additional options for helping them control their pain. To his surprise, Chang says most patients have welcomed the new approach.

“They embrace this quickly,” he says. “Our patients don’t want more and more opioids. They want pain control.”

The customized pain control regimen that Chang and his staff create for their patients may not include pills at all. By partnering with the integrative medicine department at UK, Chang is exploring non-pharmaceutical approaches to pain management, including touch and music therapy, mindfulness, massage, and acupuncture. He says the anecdotal results of these customized pain control regimens have been positive.

“We are worried that patients don’t get the right pain treatment that they deserve,” Chang says. “But at the same time if we think about pain management as a totality, then we need to look at the patient holistically and figure out what it is that could work for this patient.”

Chang admits the process of exploring alternatives and developing a customized pain control plan does take longer than a routine office visit, which typically lasts seven to 15 minutes.

“The extra time we spend on day one to set expectations, to talk about the pain management regime, how we’re going to approach the pain control… is going save physicians’ time down the road, it’s going to save the patients some agony or confusion about what’s going on with their pain control,” he says. “I think it’s time well spent up front.”

Being Part of the Solution
As Chang spreads the word about this new approach, he says he’s finding a receptive audience among health care professionals. He says the key to changing how opioids are used depends on educating doctors, nurses, and pharmacists currently on the job as well as those coming up through medical schools.

He praises recent efforts to reduce opioid prescriptions, including legislation passed by the Kentucky General Assembly earlier this year that will limit most patients to a three-day supply of narcotic painkillers. The new law does give doctors the flexibility to prescribe opioids for longer durations as long as they document the reasons for that decision.

Chang contends doctors have been part of the addiction problem in the past by over-prescribing narcotics. Now, he says it’s time for them to be part of the solution.

“I don’t want us to be like some of these pharmaceutical companies [that make opioid painkillers] and say that’s not our problem. I want us to step up and say we can help with this,” Chang says.
Explore more of KET’s coverage of the opioid crisis.

Program Details

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Each week, host Renee Shaw and a variety of interesting and engaging people - including business leaders, entertainers, authors, celebrities, and more - explore a broad array of topics impacting Kentucky and the world.

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Kiley Lane Parker - S10 E29

Filmmaker Kiley Lane Parker discusses her film, Raising Ms. President, about raising the next generation of female political leaders.

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Pellom McDaniels - S10 E30

Pellom McDaniels, faculty curator of African-American collections and assistant professor of African-American studies at Emory University in Atlanta, talks about his book, The Prince of Jockeys: The Life of Isaac Burns Murphy.

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Jay Williams - S10 E33

U.S. Assistant Secretary of Commerce for Economic Development Jay Williams is a former mayor of Youngstown, Ohio. From the recent SOAR summit in Pikeville, he talks about how Youngstown recovered from the decline of the steel industry and how those lessons can apply to Eastern Kentucky areas distressed by the sharp downturn in coal jobs.

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Susan and Morgan Guess - S10 E34

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Diabetes Epidemic - S10 E20

Gilbert Friedell, MD, and J. Isaac Joyner, MPH, discuss their book, The Great Diabetes Epidemic: A Manifesto for Control and Prevention. The book advocates taking a public health approach to addressing diabetes, emphasizes prevention of diabetes-related complications, and encourages more community responsiveness.

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Cathy Zion - Zion Publications LLC - S10 E38

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Gigi Butler - Gigi's Cupcakes - S10 E39

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Andre Taylor - S10 E43

Andre Taylor has a distinguished 35-year career, building and advising businesses. He's the author of You Can Still Win! and a half-dozen other books, a frequent guest expert on ABC News, and an international authority on winning and leadership. Mr. Taylor was a speaker at the 13th Annual Lexington Bluegrass Area Minority Business Expo.

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JoAnne Wheeler Bland - S10 E44

Renee talks with transgender activist JoAnne Wheeler Bland, who in her sixties transitioned from male to female. A practicing attorney for more than 40 years, she is a former Special Justice on the Kentucky Supreme Court, former Vice-President of the Kentucky Fairness Alliance, current member of the Kentucky Council on Postsecondary Education's Committee on Equal Opportunity (the Diversity Committee), and guest speaker at Women's and Gender Studies programs at Kentucky universities.

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Faith Politics - S10 E45

Renee and her guests talk about the role of religion in politics and public policy decision-making. Guests: Rev. Nancy Jo Kemper, pastor of New Union Christian Church, and Rev. D. Anthony Everett, pastor of Wesley United Methodist Church.

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Fayette County Public Schools Superintendent Manny Caulk - S11 E2

Renee Shaw interviews new Fayette County Public Schools Superintendent Manny Caulk, who talks about his experiences in public education and his goals for the district.

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The Kentucky African American Encyclopedia - Gerald Smith - S11 E3

Renee's guest is Dr. Gerald Smith, an author and history professor at the University of Kentucky, and co-editor of The Kentucky African-American Encyclopedia: Life and Culture in the Commonwealth. The reference book contains entries on the individuals, events, places, organizations, movements, and institutions that helped shape the state's history and cultural diversity.

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Kellie Blair Hardt - S11 E5

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Jacinda Townsend - S11 E6

Author Jacinda Townsend discusses her critically acclaimed novel, Saint Monkey, a coming-of-age story set in 1950's Eastern Kentucky. The book won the James Fenimore Cooper Prize for historical fiction. Townsend is a former Hurston-Wright Award finalist and currently teaches creative writing at Indiana University.

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Bill Farmer - S10 E8

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  • Tuesday September 7, 2021 4:30 am CT on KETKY

Chris Rabb - S10 E1

  • Friday September 3, 2021 10:30 pm ET on KETKY
  • Friday September 3, 2021 9:30 pm CT on KETKY
  • Friday September 3, 2021 2:00 pm ET on KETKY
  • Friday September 3, 2021 1:00 pm CT on KETKY
  • Friday September 3, 2021 5:30 am ET on KETKY
  • Friday September 3, 2021 4:30 am CT on KETKY

Tanya Torp and Holly Houston - S9 E46

  • Thursday September 2, 2021 10:30 pm ET on KETKY
  • Thursday September 2, 2021 9:30 pm CT on KETKY
  • Thursday September 2, 2021 5:30 am ET on KETKY
  • Thursday September 2, 2021 4:30 am CT on KETKY

Frontier Nursing University - S9 E45

  • Wednesday September 1, 2021 10:30 pm ET on KETKY
  • Wednesday September 1, 2021 9:30 pm CT on KETKY
  • Wednesday September 1, 2021 5:30 am ET on KETKY
  • Wednesday September 1, 2021 4:30 am CT on KETKY

SWAG - Sisters and Supporters Working Against Gun Violence - S9 E44

  • Tuesday August 31, 2021 10:30 pm ET on KETKY
  • Tuesday August 31, 2021 9:30 pm CT on KETKY
  • Tuesday August 31, 2021 2:00 pm ET on KETKY
  • Tuesday August 31, 2021 1:00 pm CT on KETKY
  • Tuesday August 31, 2021 5:30 am ET on KETKY
  • Tuesday August 31, 2021 4:30 am CT on KETKY

Marta Miranda - S9 E43

  • Monday August 30, 2021 10:30 pm ET on KETKY
  • Monday August 30, 2021 9:30 pm CT on KETKY
  • Monday August 30, 2021 2:00 pm ET on KETKY
  • Monday August 30, 2021 1:00 pm CT on KETKY
  • Monday August 30, 2021 5:30 am ET on KETKY
  • Monday August 30, 2021 4:30 am CT on KETKY

Sarah Taylor Vanover - Early Childhood Education

  • Sunday September 5, 2021 8:00 am ET on KETKY
  • Sunday September 5, 2021 7:00 am CT on KETKY
  • Saturday September 4, 2021 4:30 pm ET on KETKY
  • Saturday September 4, 2021 3:30 pm CT on KETKY
  • Wednesday September 1, 2021 11:30 pm ET on KET
  • Wednesday September 1, 2021 10:30 pm CT on KET
  • Wednesday September 1, 2021 6:00 pm ET on KET
  • Wednesday September 1, 2021 5:00 pm CT on KET
  • Sunday August 29, 2021 6:00 pm ET on KET2
  • Sunday August 29, 2021 5:00 pm CT on KET2
  • Sunday August 29, 2021 4:30 pm ET on KETKY
  • Sunday August 29, 2021 3:30 pm CT on KETKY
  • Sunday August 29, 2021 12:00 pm ET on KET
  • Sunday August 29, 2021 11:00 am CT on KET

Judi Jennings - S9 E42

  • Friday August 27, 2021 10:30 pm ET on KETKY
  • Friday August 27, 2021 9:30 pm CT on KETKY
  • Friday August 27, 2021 2:00 pm ET on KETKY
  • Friday August 27, 2021 1:00 pm CT on KETKY
  • Friday August 27, 2021 5:30 am ET on KETKY
  • Friday August 27, 2021 4:30 am CT on KETKY

Dr. Robert Hilgers - S9 E41

  • Thursday August 26, 2021 10:30 pm ET on KETKY
  • Thursday August 26, 2021 9:30 pm CT on KETKY
  • Thursday August 26, 2021 2:00 pm ET on KETKY
  • Thursday August 26, 2021 1:00 pm CT on KETKY
  • Thursday August 26, 2021 5:30 am ET on KETKY
  • Thursday August 26, 2021 4:30 am CT on KETKY

Wil James - S9 E40

  • Wednesday August 25, 2021 10:30 pm ET on KETKY
  • Wednesday August 25, 2021 9:30 pm CT on KETKY
  • Wednesday August 25, 2021 2:00 pm ET on KETKY
  • Wednesday August 25, 2021 1:00 pm CT on KETKY
  • Wednesday August 25, 2021 5:30 am ET on KETKY
  • Wednesday August 25, 2021 4:30 am CT on KETKY

African Americans and Mental Health - S9 E39

  • Tuesday August 24, 2021 10:30 pm ET on KETKY
  • Tuesday August 24, 2021 9:30 pm CT on KETKY
  • Tuesday August 24, 2021 2:00 pm ET on KETKY
  • Tuesday August 24, 2021 1:00 pm CT on KETKY
  • Tuesday August 24, 2021 5:30 am ET on KETKY
  • Tuesday August 24, 2021 4:30 am CT on KETKY

Charisse Gillett - Lexington Theological Seminary - S9 E38

  • Monday August 23, 2021 10:30 pm ET on KETKY
  • Monday August 23, 2021 9:30 pm CT on KETKY
  • Monday August 23, 2021 2:00 pm ET on KETKY
  • Monday August 23, 2021 1:00 pm CT on KETKY
  • Monday August 23, 2021 5:30 am ET on KETKY
  • Monday August 23, 2021 4:30 am CT on KETKY

The Rise of Anti-Asian Violence

  • Sunday August 29, 2021 8:00 am ET on KETKY
  • Sunday August 29, 2021 7:00 am CT on KETKY
  • Saturday August 28, 2021 4:30 pm ET on KETKY
  • Saturday August 28, 2021 3:30 pm CT on KETKY
  • Wednesday August 25, 2021 11:30 pm ET on KET
  • Wednesday August 25, 2021 10:30 pm CT on KET
  • Wednesday August 25, 2021 6:00 pm ET on KET
  • Wednesday August 25, 2021 5:00 pm CT on KET
  • Sunday August 22, 2021 4:30 pm ET on KETKY
  • Sunday August 22, 2021 3:30 pm CT on KETKY

Chef and Activist Dan Wu

  • Sunday August 22, 2021 8:00 am ET on KETKY
  • Sunday August 22, 2021 7:00 am CT on KETKY
  • Saturday August 21, 2021 4:30 pm ET on KETKY
  • Saturday August 21, 2021 3:30 pm CT on KETKY

Dr. Timothy M. Houchin - S9 E37

  • Friday August 20, 2021 10:30 pm ET on KETKY
  • Friday August 20, 2021 9:30 pm CT on KETKY
  • Friday August 20, 2021 2:00 pm ET on KETKY
  • Friday August 20, 2021 1:00 pm CT on KETKY
  • Friday August 20, 2021 5:30 am ET on KETKY
  • Friday August 20, 2021 4:30 am CT on KETKY

Mental Health Courts - S9 E36

  • Thursday August 19, 2021 10:30 pm ET on KETKY
  • Thursday August 19, 2021 9:30 pm CT on KETKY
  • Thursday August 19, 2021 2:00 pm ET on KETKY
  • Thursday August 19, 2021 1:00 pm CT on KETKY
  • Thursday August 19, 2021 5:30 am ET on KETKY
  • Thursday August 19, 2021 4:30 am CT on KETKY
Top

Season 13 Episodes

Marcie Timmerman - Mental Health and Wellness

S13 E43 Length 28:03 Premiere Date 8.24.18

Tiffany Manuel - Affordable Housing

S13 E42 Length 27:32 Premiere Date 8.17.18

Jessica Dueñas - 2019 Kentucky Teacher of the Year

S13 E41 Length 28:52 Premiere Date 8.10.18

2018 KIDS COUNT Data Book

S13 E37 Length 28:48 Premiere Date 7.13.18

A New Task Force on Opioids

S13 E36 Length 28:07 Premiere Date 7.6.18

Shining a Spotlight on Epilepsy

S13 E35 Length 28:02 Premiere Date 6.29.18

Criminal Justice Reform

S13 E34 Length 28:32 Premiere Date 6.22.18

Jay Box - Kentucky Community and Technical College

S13 E33 Length 28:03 Premiere Date 6.15.18

Interim Kentucky Education Commissioner Wayne Lewis

S13 E32 Length 28:03 Premiere Date 6.8.18

Bob King - Kentucky Council on Postsecondary Education

S13 E31 Length 28:09 Premiere Date 6.1.18

Rachel Childress - Lexington Habitat for Humanity

S13 E30 Length 26:22 Premiere Date 5.25.18

2018 Kentucky Primary Races

S13 E29 Length 29:52 Premiere Date 5.18.18

Dr. Donna Grigsby

S13 E28 Length 28:03 Premiere Date 5.11.18

Sexual Assault Awareness and Prevention

S13 E27 Length 28:02 Premiere Date 5.4.18

Kosair Charities Face It Movement; Terry Brooks

S13 E25 Length 28:27 Premiere Date 4.20.18

Child Marriage Laws in Kentucky - Donna Pollard

S13 E24 Length 28:42 Premiere Date 4.13.18

Remembering Dr. Martin Luther King, Jr.

S13 E23 Length 29:22 Premiere Date 4.6.18

Secretary Derrick Ramsey - Apprenticeships

S13 E22 Length 28:09 Premiere Date 2.23.18

Educational Innovation

S13 E21 Length 28:45 Premiere Date 2.16.18

Gerald Smith

S13 E20 Length 28:12 Premiere Date 2.9.18

Perry Bacon Jr.

S13 E18 Length 28:02 Premiere Date 2.2.18

DV8 Kitchen

S13 E17 Length 28:37 Premiere Date 1.19.18

Silas House, New Novel

S13 E16 Length 28:03 Premiere Date 1.16.18

Tawanda Owsley

S13 E15 Length 26:32 Premiere Date 1.5.18

Sexual Harassment Issues

S13 E14 Length 28:37 Premiere Date 12.15.17

Disability Rates and Benefits

S13 E13 Length 27:27 Premiere Date 12.8.17

Good Samaritans

S13 E12 Length 28:42 Premiere Date 11.17.17

A Salute to Heroes

S13 E10 Length 26:18 Premiere Date 11.10.17

Legislative Health Policy

S13 E9 Length 28:12 Premiere Date 11.3.17

Elder Care

S13 E8 Length 29:31 Premiere Date 10.27.17

Preventing Youth Suicide

S13 E7 Length 28:17 Premiere Date 10.20.17

A Proposal for Pension Reform

S13 E6 Length 28:02 Premiere Date 10.13.17

Rethinking Pain Medication

S13 E5 Length 28:02 Premiere Date 10.6.17

Former Gov. Steve Beshear

S13 E4 Length 28:53 Premiere Date 9.29.17

Secretary Elaine Chao

S13 E3 Length 28:52 Premiere Date 9.22.17

Smoking Cessation and Pregnancy

S13 E2 Length 29:32 Premiere Date 9.8.17

Author and Journalist Sam Quinones

S13 E1 Length 28:52 Premiere Date 9.1.17

Author and Journalist Sam Quinones

Preview Length 28:52 Premiere Date 9.1.17

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