When Dr. Scott Irvine opened Integrated Pain Associates 12 years ago in Killeen, he was the only physician. The clinic now has seven physicians and eight nurse practitioners.
“I started seeing patients with chart No. 1,” Irvine said. “We just crossed chart 23,000 a (couple of) weeks ago.”
The growth of the clinic speaks volumes about the need in the community and the nation for pain clinics, Marketing Director Lydia Bailey said.
The idea that pain needed to be managed in a fashion different from a pharmacy led to the increase of pain clinics, according to Irvine.
“When you look at things historically, primary care doctors would write a prescription here and there for low-level pain,” he said. “Often, it was for a complaint they maybe didn’t image for, just some arthritis in a 65-year-old female or hip pain in a 72-year-old male, for example.”
Then, about 20 years ago, it became a requirement for doctors to measure pain along with all of the other vital signs. The pain had to be below a certain number or there were some ramifications, Irvine said.
“I think it was a well-intended spirit of intent,” he said. “But all of a sudden, we started having an explosion of narcotics because you had to give narcotics to cover pain down to a certain level. That translated into the community, and people slowly but surely got more and more pain medication.”
The trend continued to the current reality, which is that America consumes more than 90 percent of the worldwide production of hydrocodone, despite representing less than 20 percent of the world population, Irvine said. That’s where pain clinics come in.
“Now people are saying pain clinics need to manage these patients in a multidimensional fashion,” he explained. “We do control of smoking, weight and diabetes. The primary care provider is not set up to do risk stratification; there is no way they can provide that infrastructure. But if you walk around here (the pain clinic), you’re going to see people doing pill counts and checking patient’s (medication) records, and we have a urine drug screen division.”
The clinics and their specialized care came up in the spirit of keeping patients safe but also in accordance to directives that came from the CDS (clinical decision support) that required closer monitoring, Irvine added.
Irvine named his practice Integrated Pain Associates because pain patients must be managed in an integrated fashion — the many dimensions that come with managing pain are complex.
“I don’t have a pain machine,” Irvine said. “Why is it some women can go through labor with no epidural, while some women need their epidural after one contraction? Why is that? It’s the same pain pathway. Why are some people incapacitated with a small herniated disk, then you look at other patients and wonder how they’re still working with that back (injury)?”
The subjectivity is all day, every day, Irvine said. His job is to objectify the pain process and look for supportive imaging.
He asks patients, “What is it that gives you pain and what can I do about it other than send you to the pharmacy.”
Prescriptions often used to read something along the lines of “take one to three times a day based on your pain,” Irvine said. Patients were told to go ahead and adjust their medication, and over time they got used to taking whatever they felt they needed to take, as long as they needed it.
“You wind up having these patients overtaking their medication,” he said. “There is this concept that ‘I can tinker with my pain medication to be pain free.’ Pain management is not pain free — it’s managing your pain to a level that allows you to function throughout the course of your day.”
A pain clinic gets to know patients and re-sees them often.
Irvine said the idea is to figure out where the pain is and if imaging supports the pain. If it doesn’t, then adjustments must be made with care.
Integrated Pain Associates started and grew in Killeen. Meanwhile, Baylor Scott & White has a pain clinic in the Hemingway Building on the Metroplex campus in Killeen.
Pain Specialists of Austin also has clinics in Killeen and Temple.
Irvine said having Fort Hood as a neighbor offers unique challenges to a Killeen practice. He said he regularly sees degenerate processes that are disproportionate to a veteran or active-duty soldier’s age.
“I say, ‘Wow, you’re 32 and you’ve had this 10 to 12 years,’” he said. “We do see more chronic stuff at a younger age. I say it’s the green suit effect,” referring to the Army combat uniform. “The green suit gives them an earlier disease process, just because of the nature of what they do.”
According to Irvine, there is not a more important subject in medicine right now than the one he deals with, because it’s changing so rapidly.
“We need to reframe the public’s idea of what pain management is,” he said. “It’s a huge deal. Reframing that idea is kind of like trying to un-sew a blanket.”
September was Pain Awareness Month, a fact the city of Killeen recognized by issuing a proclamation to Integrated Pain Associates.