Cancer, Opioids

Dr. Huntoon is considered a generalist, as he specializes in caring for a variety of pain conditions. He’s also an idealist and a realist, and on the hunt for the next potential breakthrough treatment. While he understands the current health care environment and its fiscal constraints, he’s been in the field long enough to know that eradicating all pain is not always possible for every patient, but getting pain under control is.

“I pride myself on having a balanced practice,” he says. “I don’t totally rely on pharmacology. I’m not a physician who relies solely on nerve blocks/procedures. I try to get the correct treatment for every patient and offer very individualized care. I think that’s what we need more of.”

Overall, Dr. Huntoon believes physicians “may have created an over-reliance on opioids to the exclusion of other potentially viable therapies.” He says, “There are more appropriate and effective therapies that are better for patients and more cost effective for the health care system.”

Dr. Huntoon has seen a dramatic increase in the medical community’s awareness of pain since he first began practicing medicine in the 1990s. At the time, pain medicine was an emerging field.

AN INNOVATIVE APPROACH

Pain medicine has come a long way since then. Currently, chronic pain affects about 116 million people in the U.S., more than diabetes, heart disease and cancer combined. Dr. Huntoon approaches chronic pain as a complex issue, involving many factors. He and his colleagues on Vanderbilt’s pain medicine team develop a personalized care plan for each patient that suits his or her needs.

As head of the Division of Pain Medicine, Dr. Huntoon leads a team that often includes anesthesiologists, psychologists, psychiatrists, and rehabilitation specialists. Patients are also shared with neurologists, orthopedists and surgeons, and any team member may be consulted to provide complete patient care.

Vanderbilt’s Interventional Pain Clinic assists people with chronic back and neck pain, cancer-related pain and neuropathic pain from multiple causes. The university also has a comprehensive inpatient pain service to help manage acute pain from injury or other causes and an outpatient pain management center.

ON OPIOIDS & A NEW INTEGRATIVE PROGRAM: EMPOWER

Cancer, Opioids

According to Dr. Huntoon, pain management is experiencing a rise in pill mills, even in his state. He callsTennessee a “battleground state for opioid addiction.” His goal? Dr. Huntoon says, “Keep the patients who need opioids on them, but for those patients who aren’t being served by them — but have become accustomed to taking a pill — get them on a more effective therapy.

He’s hopeful about a pilot program at Vanderbilt called EMPOWER, which is scheduled to roll out this summer. Its purpose is to help patients harness the power they have over their own physical, mental and emotional condition. He calls it “a pain management immersion experience for individuals in pain” and says it uses mind/body therapies, yoga and even alternative medicine to treat pain.

Early results in programs similarly constructed are promising. “We’ve taken the best aspects of other programs and assimilated them for our pilot,” Dr. Huntoon says. He calls the program good for patients, but he says it’s also an effective way to deal with practical realities. Pain management can be expensive and some times ineffective. When you can get people to use biofeedback, yoga and other similar forms of pain management, it may be a better alternative than drugs and surgery.

ON CANCER RESEARCH: THE PAIN AFTER A CURE

Along with pain management, Dr. Huntoon’s current research interest is cancer pain. While he celebrates the advances in cancer research that have allowed people to prolong their lives, he points out that even when people are “cured,” they may be trading one type of problem for another — pain.

“We’ve created a whole new problem that needs to be treated,” he says of the residual pain that can result from radiation, chemo and surgery. According to Dr. Huntoon, many patients he sees are suffering from what he calls “unrelenting chronic pain.” The issue is so urgent that he dedicates fully 50 percent of his practice to it.

ON ENDOFLIFEPAIN

While pain is often associated with bringing a life into the world, Dr. Huntoon says it’s important to consider the pain that can be associated with death. From 1999-2001, while at the University of Toledo, he served as medical director of an inpatient hospice unit and developed the medical school curriculum on end-of-life care.

“End-of -life care can be very expensive,” he says. That’s part of the reason people tend to go with low-tech therapies,” such as oral morphine. “But there are more sophisticated alternatives that can ease pain and provide a coherent end-of-life experience.

“When opioids are given orally in the near-terminal phase, many patients experience confusion and loss of awareness. If they had received higher-tech delivery systems, such as intrathecal drug delivery systems, prior to entry into the hospice system, their quality of life may have been substantially better.”

Dr. Huntoon adds, “My goal is to keep patients’ pain under control so they can have an optimum life — and ultimately, death — experience. I want them to be awake, alert and aware of their surroundings and not in a fog. They want to be able to interact with their loved ones. That’s what I want for them.”

LOOKING AHEAD

Dr. Huntoon believes pain will rightly continue to be viewed, and treated, as a chronic disease.

He envisions a future where medication won’t be the first response to pain that doctors think of or patients ask for. As always, he’s a practical idealist — thinking first of patient care, while also considering economic realities. He advocates a sensible approach to pain that doesn’t rely too heavily on medication.

“I see the future of our field as placing less emphasis on nerve blocks and pharmacological therapies and greater emphasis on functional, restorative programs,” says Dr. Huntoon. “Biofeedback and patient coping skills are the new frontier.”

The power rests with patients, he believes. Going forward, Dr. Huntoon says, “We can harness the power of the mind.”

Cancer, Opioids