How a suburban doctor is helping improve national pain management

A suburban doctor is one of 21 public members of a national panel working to identify gaps in pain management and suggesting ways to close them as the nation battles the opioid crisis.

Dr. John Prunskis, medical director and co-founder of the Illinois Pain Institute, was named to the Pain Management Best Practices Inter-Agency Task Force, which was authorized last October under the U.S. Department of Health and Human Services.

He joins federal employees and experts in drug policy, pharmacy, dentistry, addiction treatment, addiction research and mental health on the 29-member group, known as the Pain Task Force for short. The group was required to form under the Comprehensive Addiction and Recovery Act of 2016, which aims to address overdose deaths from prescription opioids or heroin.

"We are the highest-authority body now in the U.S. to help address this problem," Prunskis said about the task force, which has been meeting since late May. "We are mandated to make a report by January of our final recommendations."

The task force also has suburban representation from Bruce Schoneboom, chief learning officer for the American Association of Nurse Anesthetists in Park Ridge. Schoneboom declined to comment about his work on the task force, and Prunskis emphasized that his statements are his own and not representative of the federally appointed group as a whole.

But Prunskis said he thinks the group's main contributions will be to establish best practices for treating pain without relying on opioids as a primary approach; to educate physicians on how to employ such practices; to ensure continued access to opioids for patients who need them; and to shield from prosecution doctors who are prescribing opioids correctly. Prunskis draws on years of experience managing pain through the group of eight practices he founded with his wife and fellow doctor Terri Dallas-Prunskis in 1992. The Illinois Pain Institute has offices in Barrington, Elgin, Elmhurst, Huntley, Itasca, Lake Barrington, Libertyville and McHenry, where Prunskis and the doctors he employs use a style of pain management now being recognized as a beneficial route.

"From Day 1 our whole philosophy of care was to diagnose the source of a patient's pain and fix it, not mask it with painkillers," he said. "Now the popular view, of course, is what we've been saying all along."

But in the 1990s, doctors were told to view pain a the "fifth vital sign" and to treat it accordingly. Prunskis said Medicare and Medicaid began to question patients about the level of discomfort they experienced during care and penalize hospitals financially if respondents reported pain.

This all led, he said, to overprescribing of opioid pain medications such as OxyContin, Vicodin or Dilaudid, in some cases to people whose pain symptoms could have been addressed through other means. Overprescribing, in turn, put more people at risk for dependence or addiction, especially if they began to misuse their prescriptions, were not properly weaned off the drugs or turned to the black market for a cheaper alternative and found heroin.

Some of the factors that led to overprescription have been addressed by measures such as the creation of a state prescription monitoring program. But Prunskis said the task force's work can take those measures further by emphasizing new norms for treating pain, focused on "establishing the diagnosis and not using narcotics," Prunskis said.

For example, Prunskis said there are six categories of medication that are less habit-forming than typical opioids and can work to address the root of the pain, instead of blocking the brain's ability to feel it:

• Ibuprofen or naproxen, commonly sold as Advil or Aleve.

• Tramadol, commonly sold as Ultram.

• Acetaminophen, commonly sold as Tylenol.

• Tylenol with codeine.

• Nerve membrane stabilizers.

• Antidepressants that jump-start the production of serotonin.

Prunskis said he and the other members of the task force are meeting electronically each week to work on recommendations for improving pain care.

He said the group's recommendations could be used to inform a future act of Congress.

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