Navigating Pain Management Prescriptions In Wound Care

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Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

   The best way to combat drug seekers, suggests Dr. Lullove, is to take a thorough history, log onto the national database to check for potential abusers, and make all the patients of your practice sign a “narcotic consent and agreement use policy.” The true pill seekers will never sign the agreement, he says, since they don’t want to be held accountable for getting medications from one sole provider. As he adds, the policy also protects the practice from potential abuse by making sure that patients for whom you have prescribed medications can only refill and renew with your practice. He also emphasizes the need for closer internal control over prescription pads. Dr. Lullove emphasizes making sure the pads are under lock and key during the day, and are not left in a drawer for theft potential.

   If and when Dr. Jacobs suspects drug-seeking behavior, his response is to refer such patients to pain management “pure and simple. There is no negotiation on this matter.”

   “Every practicing physician with a DEA diversion license should worry about ‘seekers,’” says Dr. Lullove.

   Dr. Brill is the President of the BrillStone Corporation in Dallas. He is a Fellow of the American College of Foot and Ankle Surgeons, and is also a consultant in wound care and reconstructive foot and ankle surgery at the Wound Care Clinic at Presbyterian Hospital in Dallas.

   Dr. Jacobs is a Fellow of the American College of Foot and Ankle Surgeons, and a Fellow of the American Professional Wound Care Association. He is in private practice in St. Louis.

   Dr. Lullove is in private practice in Boca Raton and Delray Beach, Fla. He is a Staff Physician at West Boca Medical Center in Boca Raton. Dr. Lullove is a Fellow of the American College of Certified Wound Specialists.

   Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo.

References
1. Ziegler D, Low PA, Litchy WJ, et al. Efficacy and safety of antioxidant treatment with a-lipoic acid over 4 years in diabetic polyneuropathy. Diabetes Care. 2011; 34(9):2054-2060.
2. Ziegler D, Ametov A, Barinov A. Oral treatment with a-lipoic acid improves symptomatic diabetic polyneuropathy. Diabetes Care. 2006; 29(11):2365-70.
3. Hermanns K, Junker U, Nolte T. Prolonged-release oxycodone/naloxone in the treatment of neuropathic pain - results from a large observational study. Expert Opin Pharmacother. 2012; 13(3):299-311.

   For further reading, see “A Guide To Pain Management In Wound Care” in the November 2012 issue of Podiatry Today, “Choosing Medications For Painful Diabetic Neuropathy” in the July 2003 issue or “Case Studies In Painful Diabetic Neuropathy” in the August 2006 issue.

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