I see Eva Quirion FNP about once every two months or so when our paths cross within the halls of St. Joe’s Healthcare. Every time I see her I get a huge smile and a hug. This woman exudes happiness, care, compassion and an air of playful professionalism. Her patients are lucky to have her. St. Joe’s is lucky to have her.
Eva and I sat down a few weeks ago. I asked her some questions about what she does and how this epidemic Maine is living with effects her and her patients. What follows is the transcript of our chat.
Q: Why did you get into pain management?
A: First of all – I don’t like to call what I do pain management. … I call myself pain care. Pain management connotes that I am somehow going to manage your pain. … I work more as a facilitator with you to help you manage your own pain. Pain care is what I prefer because pain management over the years has come to mean simply pain pills. I got into this field because I was noticing in my community that there were a lot of people that were put on pain pills – then they would have a change in providers or their care plan changed, and they were feeling a little abandoned by their provider.
Where I used to work we would get calls from patients asking to have their pain pills refilled, and we could not help them. … I felt this was just not right, we shouldn’t be doing this to folks in the community. They didn’t prescribe these medications to themselves, and it was wrong that they didn’t have someone to help them out with this.
Q: What have the new protocols that limit opioid prescribing meant to you and your patients?
A: Over the past there years I have been working with patients to try to help them reduce and eliminate opioid pain medications from their care plan. It’s such a high-risk medicine for people to be on, and most people that I have met have not gained significant meaning and function from these medications. The cost of being on them to their health is much higher than any benefits that they might be getting from these meds.
The new prescription protocol really just applied a deadline to the work that I was already doing with my patients. It didn’t change a whole lot as the CDC had already released recommendations. We already had a lot of data stating what the law is saying to us, meaning we should not have people on high-dose opioids except for the few extreme cases.
Q: What do you want to tell the community about these new prescription protocols?
A: The main thing I want to tell the community about these protocols is that it sounds absolutely crazy that when you have a human being sitting in front of you who has problems with chronic pain that we want to reduce and eliminate the opioid pain medications from their lives. It sounds crazy. However when you think about these pain medications and the fact that they don’t really work — a lot of people are on very high doses but they’re still having an astronomical amount of pain.
Newer research tells us that opioids can actually cause pain. It activates the pain centers in the brain and the pain receptors on the cells, so it’s really, for a lot of people, making their pain worse or keeping their pain alive. There’s some real promising research about how opioids — even after just two days of use — can reactivate pain from an old injury. So you might not have pain in your ankle after breaking it 15 years ago, but you start taking opioids, and all of a sudden your ankle could start hurting.
So there’s a lot about these opiates that we don’t know, but there’s a lot that we do know, and it’s very scary to think that you’re going to be taken off your pain medications. But if it’s done in a careful and compassionate way, you will likely find that you’re going to do just as well: You’re not going to lose function, and many folks gain function.
It’s a leap of faith, you have to trust your provider to do this in a compassionate way. Just try to roll with it and know while you’re tapering your medications you probably will feel worse. You won’t feel good doing that because we’re rocking that boat, but when you come out of this on the other end, I have never seen anybody do worse when they’ve been tapered off their medication.
Q: How do you help your patients manage these changes?
A: I spend a lot of time with my patients. When they come see me for the first time, I usually spend at least an hour with them, talking to them about the dangers of opioids if they don’t already know, and talking to them about how we will go about tapering their medications, so there’s no surprise. I tell them a lot of scientific data that maybe they’ve never heard before, and I do it in a way so that they feel like they’ve been heard.
Because a lot of people have had these pains for a long time, they feel like providers are tired of hearing about their pain, so I really want to get a comprehensive review and make sure that we haven’t missed anything.
I also help them understand the rationale behind tapering. Tapering is their safety. The average life expectancy of somebody on high-dose opiates is 2.6 years. One in every 50 or so patients on high-dose opioids dies from these opioid medications. These numbers to me are unacceptable. If we had any other medication that did that we wouldn’t even use that medication. I want people to know the risk that they’re taking by being on high-dose opioids and what we can do to help them get down and off of them.
It’s not an instant change. There are incremental changes. For a lot of folks I can send them a letter detailing exactly what they can expect for refills — when they’re due and that sort of thing — it’s really just supporting them. I tell my patients that I walk beside them through this process and that I’m not going to abandon them. I’m not going to leave them alone in this process.
Q: What are the alternatives and indeed do they work?
A: Alternatives to opioid medication management is more of a wellness approach. We know a lot of things about wellness approaches as far as they help a lot of chronic diseases that we have such as diabetes, blood pressure problems and everything that obesity leads to. I work with patients individually, determining where are they are at. Are they moving? What’s their average day look like? What are their goals?
Some people want to do things very simply. If they want to walk a mile a day, I can help them with that goal to try to help them learn how to walk and live in that body with chronic pain because these folks on pain medicines are still in pain. It’s more wrapping their brain around the fact that they have pain, they will have pain and how do they still maintain some sort of function.
Alternatives — you know there’s all kinds of things. Physical therapy — yes, it does work when you get the right therapist with the right patient, kind of a Match.com thing. You also get some good benefits if you can help folks stop smoking. Smoking is pro-inflammatory, and if you try to work with anti-inflammatories you’re working uphill. If somebody is smoking it is really important to try to get smoking out of people’s lives and help them do that.
There’s also problems with people’s diet. It helps if we can help them improve their diet and eat in a more anti-inflammatory way. In ancient times food was medicine. If we can improve that, a lot of people feel better. Another alternative is making sure that any depression gets treated. Being depressed causes pain; pain can cause depression. It’s this cyclical thing, and if we ignore the brain in this whole process we’re ignoring the main body part that drives pain.
There are lots of alternatives. Yes, alternatives work but they’re not going to work to numb your brain away from your body. We need to help people engage in their lives and find things that bring them joy. If you can find that or help somebody find that, they do far better, no matter if they’re on or off for medications.
Q: How do you stay so positive and upbeat for your patients?
A: I feel that any relationship is almost like a mathematical equation: The more energy you put in, the more energy you pull out. I feel it’s my duty to stay energized for my patients because they come to me, and they’ve maybe had a lot of experiences with people who don’t want to hear that they hurt. I feel that relationship requires some energy on my part, but when I’m pulling energy out I’m taking a lot of that energy out of the relationship.
I really enjoy seeing somebody get better so when that person achieves a walk every day, I really feel the joy in that. I love seeing people get better. A lot of other things that I do is try to keep my own house clean and try to make sure that I’m pulling joy from my life and my family and the people around me. I’m also lucky enough to work in a place that I can expand my knowledge and go to conferences and surround myself with people who are supportive.