Dr. SK Uppal presents a free public lecture on chronic pain management — including opioid pain medications and alternatives — from 4 to 5 p.m. Friday, Feb. 24 at his office at 103 Fair Drive. Uppal has made several presentations on this topic to the Susanville Rotary Club over the past year. File photo

Susanville physician speaks on chronic pain management


Susanville physician Dr. SK Uppal will deliver a free public lecture on chronic pain management at his office at 103 Fair Drive from 4 to 5 p.m. Friday, Feb. 24.

Reservations are required. Call 257-7773 or stop by the office to reserve your spot.

As part of a continuing effort to educate the public about the issues surrounding the use of opioid painkillers, Uppal will speak on the clinician’s dilemma – under-treated pain versus prescription drug misuse; and safe storage — proper use, proper disposal, driving and work safety.

Uppal hopes those attending the lecture will learn about the risks they take when using pain medications, how to deal with opioid overdose and how to manage their pain without drugs.

There is so much change taking place regarding opioid therapy,” Uppal said. “Patients need to be aware of what is happening.”

Uppal said back in the 2000s, doctors were encouraged to prescribe the new opioid painkillers to alleviate pain, so much so that pain became like a fifth vital sign doctors would monitor. In 2004 or 2005 the manufacturer — Purdue Pharma — advised doctors oxycotin and oxycodone were not addictive so the doctors could prescribe as much as necessary to alleviate the patient’s pain symptoms.

“At that time a few doctors got in trouble for not controlling a patient’s pain,” Uppal said. “They prosecuted at least two doctors.”

Then came “the abuse, addiction, overdose and diversion problems,” and now 45 people die everyday from opioid overdoses. According to Wikipedia, oxycodone is the most widely used recreational opioid used by more than 12 million annually. In 2010, 16,652 deaths were attributed to opioid overdose in combination with other drugs. In 2007 Americans consumed 82 percent of the drug produced worldwide.

“The rules are changing and studies are showing we need to start doing some other therapies to control pain,” Uppal said.

Some patients don’t understand the current guidelines, Uppal said, and they feel like the doctor is punishing them when the amount of the drug being prescribed is reduced.

“They start liking it,” Uppal said. “If two are making me feel good, four must be even better. They keep doubling it, that’s what happens. Some people will double up or triple up and start abusing it.”

The problem with opioids is they repress respiration, Uppal said, and that has caused deaths.

“The new trend is not to give opioids or to give very low doses for moderate to severe chronic pain,” Uppal said. “These drugs cause hypersensitivity (leading to larger and larger doses to achieve the same relief), and in some patients the opioids are no more effective than placebos. It doesn’t help some patients, but they don’t realize that.”

Uppal said some patients can use ice or heat or over-the-counter medications to treat their pain. Other alternatives include meditation, Yoga, physical therapy, pain management, pain shots, acupuncture and chiropractic.

Uppal suggested if a friend or family member sees someone misusing drugs, they should take the patient to the physician and make the doctor aware.

But Uppal said a new problem is on the horizon with changes in state law — marijuana.

“Marijuana, opioids and alcohol can lead to death,” Uppal said. “It’s a deadly combination. These marijuana parties are dangerous.”

He said another deadly combination is marijuana, Viagra and alcohol.

Uppal faces an accusation before the Medical Board of California, Department of Consumer Affairs, that he over-prescribed pain medication to his patients. At this point in the process, it is only an accusation and no determination has been made. Uppal voluntarily surrendered his Drug Enforcement Agency certificate pending the outcome of this investigation, and he has taken continuing medical education courses focusing on chronic pain management. He continues to see patients at his practice.