“Few things a doctor does are more important than relieving pain. . . pain is soul destroying.
No patient should have to endure intense pain unnecessarily.
The quality of mercy is essential to the practice of medicine here, of all places, it should not be strained.”
The primary mission at Hawaii Pain Center (HPC) is to provide high quality specialized and individualized care to our patients with the goal of making them as independent and functional as possible. All patients are personally evaluated by Dr. Tavares at each visit. He treats various chronic non-cancer pain conditions, but his preference is towards spinal related disorders, such as back and neck pain with or without limb symptoms.
‘A‘ohe pau ka ‘ike i ka hālau ho‘okāhi, all wisdom is not taught in one halau [school]. Following this Hawaiian proverb, HPC is committed to interdisciplinary care among other providers to optimize each patient’s outcome. This may include coordinating care with therapists, pain psychologists, other medical specialists, surgeons, and complementary and alternative medicine providers.
Dr. Tavares performs a multitude of interventional procedures, which have scientific efficacy for the treatment of chronic pain. The most common procedures performed include epidural injections, radiofrequency neurolysis, sympathetic blocks, and spinal cord stimulator trials and implants. Most procedures are performed under image guidance for precision treatment. All procedures, with the exception of implants, are performed safely in the office. In addition to convenience, this reduces overall healthcare costs for both the patient and the insurance company by eliminating the facility fee associated with performing the procedure in a surgical center or hospital. A facility fee is an additional cost that can be several times that of a physician’s professional fee. Upon request, IV conscious sedation under continuous monitoring is provided during the procedure for patient comfort.
Many pain clinics have come to be seen as places where patients can receive indiscriminate amounts of opioids to manage their chronic pain. We now know unequivocally that there are many short and long term complications associated with opioid use and that there is a direct correlation between opioid dosage and the risk for overdose-related deaths.¹ The Centers for Disease Control and Prevention estimates that more than 14,000 people died from overdoses involving prescription opioids in 2014.2 Due to the risks involved and the stringent requirements for monitoring patients receiving opioids, Dr. Tavares considers opioid treatment to be the most invasive and intrusive form of medical care. As a result, opioids are discouraged and are only provided to carefully selected patients who have exhausted alternative treatments and who are willing to undergo adjunct care as a component of an integrated program to maintain their function and minimize opioid usage.
After the successful treatment of chronic pain, especially with interventional pain management, many patients, in the absence of pain, come face-to-face with the reality of their opioid dependency. Many cannot function or feel “normal” without using opioids. HPC is unique among pain clinics by offering patients suboxone treatment for opioid dependency or detoxification.
HPC also provides medical cannabis recommendations for its qualified patients at no additional cost. There is growing evidence that medical cannabis is effective in treating chronic pain and neuropathic pain.3 Cannabis use was also found to be associated with 64% lower opioid use in patients with chronic pain.4 Furthermore, states with medical cannabis laws had nearly 25% fewer opioid related overdose deaths compared to states without medical cannabis access.5 Other than poorer periodontal health, a recently published study did not show any physical health problems in those with a history of up to 20 years of cannabis use.6 During a time of soaring medical costs, medical cannabis is estimated to have saved Medicare approximately $165.2 million in 2013 through reduced prescription utilization by its beneficiaries.7 The largest decrease in prescriptions was for opioids and sedatives. The Hawaii Department of Health suggests that medical marijuana cards be recommended by the provider treating the patient for the qualifying condition.
- Bohnert, A. S., Valenstein, M., Bair, M.J., Ganoczy, D., McCarthey, J.F., Ilegen, M.A., Blow, F.C. (2011). Association between opioid prescribing patterns and opioid overdose-related deaths. The Journal of the American Medical Association.
- Centers for Disease Control and Prevention. http://www.cdc.gov/
drugoverdose/data/overdose. html. Accessed September 2016.
- Hill, K.P. (2015). Medical Marijuana for Treatment of Chronic Pain and other Medical and Psychiatric Problems: A Clinical Review. The Journal of the American Medical Association.
- Boehnke, K.F., Litinas, E., Clauw, D.J. (2016). Medical Cannabis use is Associated with Decreased Opiate Medication use in a Retrospective Cross-Sectional Survey of Patients with Chronic Pain. The Journal of Pain.
- Bachhuber, M.A., Saloner, B., Cunningham, C.O., Barry, C.L. (2014). Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010. The Journal of the American Medical Association.
- Meier, M.H., et. al. (2016). Associations Between Cannabis Use and Physical Health Problems in Early Midlife: A Longitudinal Comparison of Persistent Cannabis vs Tobacco Users. The Journal of the American Medical Association – Psychiatry.
- Bradford, A.C., Bradford, D. (2016). Medical Marijuana Laws Reduce Prescription Medication Use in Medicare Part D. Health Affairs.