“The people I’m seeing are people who’ve had a long history of probably inappropriately or misdiagnosed chronic pain, who probably started using prescription pain medicines but when on to heroin or fentanyl use,” said Kanika Turner, M.D., a family medicine, obstetrics and addiction medicine specialist at Family Health Care Center.
Turner, who has earned statewide recognition for her medication-assisted treatment, was speaking to a group of visitors to Family Health Care Center’s Holly Hills facility on Friday, February 1.
U.S. Rep. Wm. Lacy Clay (D-St. Louis), Doug Clemens (D-St. Ann) and Thomas McAuliffe, director of Health Policy for the Missouri Foundation for Health, toured the facility to see how it is helping patients overcome heroin and opioid addiction.
Turner works with Patricia Pye, a clinical psychologist and a behavioral health consultant, to treat patients who have chronic pain or are at risk for addiction.
Pye said she delves into “the pain experience” – the underlying issues that were the source of the pain in the first place.
“The discomfort or what the patient is experiencing is more than what’s happening at the tissue level, causing their pain,” Pye said. “There is the emotional pain involved as well, so I take the approach of looking at sort of the big picture.” That includes looking at variables that are within the patient’s control, where they can make some changes and improve their overall well-being.
Pye said many other factors contribute to patient experience and their pain.
“For instance, with patients who are unable to work, there’s a whole shift now in their role as providers, their roles as head of the household,” Pye said. “Many times, people are more socially isolated due to their chronic pain, whether they are working or not. Many times, patients will turn down invitations to go out socially because they feel bad about asking people to slow down, and those sorts of things.”
Sleep quality, caffeine consumption, stress and lack of exercise or physical activity all factor into a patient’s pain experience as well.
“Oftentimes, it sounds counterintuitive to talk about exercise to people who have chronic pain, but a big portion of managing chronic pain is exercising as well and doing things in a way to pace themselves,” Pye said.
“Many times, people will talk about having a ‘good day’ and overexerting themselves, usually followed by several ‘down days.’ Then, by the time they feel pretty good again and have another good day – which means less pain – then they go and overdo it as well. So there’s this continual pattern of overexertion and underactivity.”
Pye said they take a team approach in working with patients to find that balance.
“Everyone on the team is giving the patient the same message,” Pye said. “If they can manage their stress, if they can sleep better, if they are eating healthier and foods that are not flaring up their pain – those things can contribute to an overall better outlook on life and a better management of those stressors. It’s a matter of retraining on how we approach things.”
Project Step Forward, funded by a grant from the Missouri Foundation for Health, brings a multidisciplinary team together to manage pain. “It also involves bringing in chiropractic service, physical therapy and acupuncture as well as yoga for our patients to broaden the scope of how we can treat and manage chronic pain,” Pye said.
Pye works with patients to prevent addiction while Turner helps patients who are experiencing addiction. Workers in behavioral health, nutrition services, community health and peer support are all part of wraparound services to help patients with chronic pain or who have addiction.
Turner also does advocacy work in the community regarding prevention, treatment and resources for medication-assisted treatment and changing the culture behind drug use in the black community. She offers training and speaks in churches and at professional organizations about treatment.
Turner also offers medicine services for pregnant women who are addicted and in need of treatment.
“In addition to a great obstetrical program, we can also treat some of the women who are struggling with various substances as well,” Turner said. “Anyone who is not pregnant, I use Suboxone or Vivitrol,” Turner said. “For pregnant women and women who are breastfeeding, we use Subutex.”
Their team approach meets patients where they are in their pain or addiction experience.
“We recognize that some of our patients may still take opioids and we’re going to help to monitor those, but I think education is a big piece that we are stressing to our patients and all of our providers – the whole team who touches the patient,” Pye said.
“We want everyone to have that same amount of information. So, we want patients to know that they might need this medication, and if they indeed warrant it, they will get the medication – the opioids for their pain – but we want them to be informed consumers and we also want them to take advantage of all of these services.”
For more information, visit https://familycarehealthcenters.org.
