Doctors discuss opioid epidemic

Culpeper Wellness Foundation hosted a seminar Tuesday evening for Culpeper medical professionals on a balanced approach to pain management and opioids.

Dr. Robert B. Goldstein, associate professor – anesthesiology and pain medicine, Medical Director, Pain Management Center University of Virginia, detailed why opioids have become popular among doctors for pain management, why they are useful and how they should be properly managed to help address the current opioid epidemic the nation faces.

Sharri Landry, President of the Culpeper Wellness Foundation, said that it’s important for the organization to address the epidemic and it was only fitting to bring together medical professionals to discuss how it can be addressed.

“About six months ago, a foundation friend asked the foundation to consider organizing a training for physicians to help reduce the potential for addiction in people being treated for chronic pain,” Landry said. “And our friend offered to fully fund the cost. We need to address the issue of opioid addiction from all directions.”

Goldstein said his goals were to review the principles of pain management, describe how to formulate a pain management plan, discuss opioids, recommend safe practices for prescribing them and then review non-opioid approaches.

“This is a really important topic,” Goldstein said. “I’m not an addictionologist, what I am going to do is give you different options and also tools to have conversations with your patients of some of the things to help educate them along the way and help them understand opioids aren’t the first and only choice anymore.”

Goldstein started off by explaining the principles, the five A’s of pain management – Analgesic, Medication side Affects, Activity, Aberrant behavior and Affect.

He broke down the characteristics of pain and discussed somatic versus neuropathic pain and how that ties into medication options – which can include opioids. Goldstein talked about the treatment goal of modifying and modulating the nociceptive input in a manner to decrease the perception of the stimulus as painful. Opioids have been a mainstay of practical medicine for 3,000 years but they have a series of adverse effects, which includes tolerance, withdrawal and overdose. Goldstein talked about how opioids are used to treat pain in cancer patients, but the opioids might be contributing to the progression of their disease, as studies have shown opioids could “feed” the tumors.

Goldstein talked about the role of Naloxone rescue devices and how they can help in an overdose situation and asked the medical professionals in attendance how many carried Narcan with them, about half in the room raised their hands.

Goldstein continued to talk about best practices, including education about medication disposal, securing medication boxes and PSA strategies.

Goldstein concluded the two-hour presentation talking about a foundation of non-narcotics medications from different classes to help manage pain, how sleep hygiene is critical for pain management success and focusing on function preferably over pain control, if possible.


About Jeff Say 252 Articles
Jeff Say is the editor for the Culpeper Times. He can be reached at

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