Medication Management
Coastal Spine & Pain is an interventional pain management practice. Our clinical focus is the diagnostic evaluation and procedural treatment of pain conditions — including epidural injections, peripheral nerve blocks, radiofrequency ablation, spinal cord stimulation, and related interventional therapies. Medication management exists to support that interventional model, not as a standalone service.
All prescribing decisions, including any prescriptions for scheduled medications, are made by Dr. Richard Webb personally, under his individual Drug Enforcement Administration registration and Alabama Controlled Substances Certificate, in accordance with the CDC Clinical Practice Guideline for Prescribing Opioids for Pain, Alabama Board of Medical Examiners prescribing rules, CMS/Medicare opioid safety policies, and DEA regulatory requirements.
Dr. Webb holds board certifications in both Pain Medicine and Anesthesiology, together with a Juris Doctor and Master of Laws in Taxation with a concentration in healthcare law (J.D., LL.M.) — credentials that inform a careful, regulation-aware approach to responsible prescribing in Alabama and across federal programs.
Our Approach to Medication Management
Pain is complex, and the medications used to manage it must be selected thoughtfully — with careful attention to both the underlying diagnosis and each patient’s individual risk profile. At Coastal Spine & Pain, the most effective and responsible medication management begins with an accurate diagnosis and a clear understanding of the mechanism driving the patient’s pain, whether nociceptive, neuropathic, inflammatory, or mixed.
Where procedural treatments — such as targeted injections, nerve blocks, radiofrequency ablation, or neuromodulation — can address the underlying pain generator, those interventions are our preferred first-line approach. Pharmacologic therapy, when used, is most successful as part of a multimodal treatment strategy that may also include physical rehabilitation, behavioral health support, and lifestyle modification. This approach is consistent with current federal policy direction, best-practice clinical guidelines, and the expectations of major payors including Medicare.
What Patients Should Understand About Our Prescribing Philosophy
We provide individualized, evidence-based care for patients experiencing acute and chronic pain. We recognize that many patients have been through lengthy treatment histories — sometimes involving regimens prescribed by other providers that may have included opioid medications, at various doses and for extended periods. We approach every patient with empathy and without judgment.
That said, our practice operates on a multimodal-first, function-focused model. Opioid analgesics are not our first-line treatment for most chronic pain conditions, and the fact that a patient may have been prescribed opioids by a prior provider — at any dose or for any duration — does not, by itself, establish the medical appropriateness of continuing that same regimen under our care. We will always perform our own independent clinical assessment and develop a treatment plan consistent with current evidence, applicable regulations, and the patient’s best long-term interest.
We treat a broad spectrum of pain conditions, including refractory cases where opioid therapy may be clinically appropriate after other modalities have been adequately explored. However, an expectation of a particular opioid medication, dose, or schedule — independent of clinical evaluation — is not something this practice can accommodate. Our goal is to help each patient achieve the best possible function and quality of life using the safest, most effective treatment available.
Pharmacologic Treatment Modalities
Modern pain medicine offers a broad array of pharmacologic tools beyond opioid analgesics. Our prescribing approach draws on multiple medication classes, each selected to target specific pain pathways and mechanisms. This is consistent with the multimodal approach the CDC’s 2022 Clinical Practice Guideline identifies as critical to effective pain care.
Non-Opioid & Adjuvant Medications
For many patients, one or more of the following medication classes will serve as the foundation of pharmacologic therapy — either alone or in combination with interventional procedures:
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Oral and topical NSAIDs remain among the most effective first-line treatments for musculoskeletal and inflammatory pain. Options include prescription-strength oral formulations, topical diclofenac preparations, and COX-2 selective agents for patients requiring gastroprotection.
Acetaminophen
Useful as a standalone analgesic for mild to moderate pain and as part of a multimodal regimen for post-procedural and chronic conditions. Particularly important in patients for whom NSAIDs are contraindicated.
Anticonvulsants / Membrane Stabilizers
Gabapentin and pregabalin are mainstays for neuropathic pain conditions including diabetic peripheral neuropathy, post-herpetic neuralgia, and radiculopathy. Note: gabapentin is a scheduled substance under Alabama law and is monitored through the Alabama PDMP.
Antidepressants for Pain
Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine, and tricyclic antidepressants (TCAs) such as amitriptyline and nortriptyline, have well-established efficacy in chronic pain and neuropathic pain conditions.
Muscle Relaxants
Skeletal muscle relaxants may provide short-term relief for acute musculoskeletal spasm and myofascial pain. Selection is individualized based on the patient’s condition, comorbidities, and fall-risk profile.
Topical Analgesics
Lidocaine patches, capsaicin preparations, and compounded topical agents can deliver localized pain relief with minimal systemic exposure — an important advantage for older adults and patients on multiple medications.
Corticosteroids
Short-course oral corticosteroids or targeted injections may be appropriate for acute inflammatory flares, radiculopathy, and certain joint conditions — used judiciously to manage inflammation while minimizing long-term side effects.
Emerging Non-Opioid Analgesics
The FDA’s 2025 approval of suzetrigine — the first new class of pain medication in over two decades — represents a significant advance in non-opioid treatment for moderate to severe acute pain. This and other emerging therapies reflect the direction of both clinical science and federal policy toward expanded non-opioid options. We evaluate new medications as they become available and clinically appropriate.
Acute Pain Management
For acute pain following injury, surgery, or procedural care, current evidence and federal guidelines support prescribing the lowest effective dose of an analgesic for the shortest clinically necessary duration. In most acute conditions, non-opioid pharmacologic and procedural approaches are sufficient. Where short-course opioid therapy is appropriate, prescribing is consistent with CDC and CMS recommendations regarding duration and dosing for opioid-naïve patients. The NOPAIN Act — effective January 1, 2025 — further directs CMS to provide separate reimbursement for non-opioid pain treatments in hospital outpatient and ambulatory surgery settings, underscoring the federal emphasis on non-opioid alternatives for acute pain.
Chronic Pain Management
Chronic pain conditions require a sustained, structured treatment strategy. The most effective long-term management is generally multimodal — combining targeted interventional procedures with non-opioid pharmacotherapy (such as anticonvulsants, SNRIs, topical agents, and anti-inflammatory medications) and, where appropriate, physical rehabilitation and behavioral support. When pharmacologic management of chronic pain is warranted, treatment response, functional goals, and risk profile are reassessed at regular intervals.
Cancer Pain & Palliative Coordination
Patients with active malignancy or cancer-related pain occupy a distinct clinical and regulatory category. Both the CDC guideline and the Alabama Board of Medical Examiners recognize that the risk-benefit calculus for opioid prescribing differs in the oncologic context, and certain Alabama PDMP requirements include specific exemptions for patients being treated for active, malignant pain.
Primary management of cancer pain is most appropriately handled in coordination with the patient’s oncology team and, where indicated, palliative care or hospice specialists. Coastal Spine & Pain may provide adjunctive interventional procedures — including celiac plexus blocks, intercostal nerve blocks, intrathecal pump consultations, and other targeted interventions — to support a cancer pain treatment plan led by the patient’s primary oncology or palliative provider. We do not function as a primary cancer pain prescriber.
Opioid Therapy Within an Interventional Pain Practice
Certain clinical scenarios — including severe pain unresponsive to non-opioid measures, post-procedural recovery, and carefully selected chronic pain cases — may warrant short-term or carefully monitored opioid therapy as one component of a broader treatment plan. In those situations, prescribing is guided by the principles below.
Patients whose primary expectation is opioid prescribing as the principal or sole component of their pain care are generally not well-served by an interventional pain practice. Multimodal care — anchored in procedural interventions when clinically appropriate — is the model this practice provides and the model that produces the best long-term functional outcomes for most chronic pain conditions.
Responsible Opioid Prescribing Standards at Coastal Spine & Pain
Thorough clinical evaluation. An independent history, physical examination, review of records, imaging, and diagnostic assessment is completed before opioid therapy is initiated or continued. Previous prescribing by another provider is documented and reviewed but does not determine the treatment plan.
Risk stratification. Every patient is assessed for opioid-related risk using validated tools, with attention to personal and family history of substance use, mental health comorbidities, concurrent medications (particularly benzodiazepines), and fall risk. This is consistent with the Alabama Board of Medical Examiners’ requirement for medically appropriate risk and abuse mitigation strategies.
Alabama PDMP compliance. Our practice fully complies with Alabama’s Prescription Drug Monitoring Program requirements, including the frequency-of-review thresholds established by the Alabama BME based on morphine milligram equivalent (MME) dosing.
Treatment agreements & monitoring. Patients receiving ongoing opioid therapy are expected to participate in structured monitoring, which may include treatment agreements, periodic urine drug screening, pill counts, and regular office visits. These are clinical tools intended to promote safety — not punitive measures.
Dosage guidance. CMS has implemented a care coordination threshold at 90 MME per day, and the CDC guideline recommends careful reassessment before exceeding 50 MME per day. Our prescribing practices reflect these evidence-based thresholds while recognizing that selected patients may require individualized dosing based on clinical circumstances.
Concurrent benzodiazepine use. Both federal guidance and the Alabama BME recognize the heightened risk of adverse events associated with concurrent opioid and benzodiazepine use. We exercise caution in this area and may recommend tapering or alternative anxiolytic strategies where clinically appropriate.
Naloxone co-prescribing. Where clinically indicated by dose level or risk factors, we discuss and facilitate naloxone access for opioid-treated patients as a harm reduction measure.
Medication-Assisted Treatment (MAT) for Opioid Use Disorder
Coastal Spine & Pain provides interventional pain management. We do not provide medication-assisted treatment (MAT) for opioid use disorder, and we do not transition patients between MAT and traditional opioid therapy in either direction.
Decisions to initiate, modify, switch, or discontinue MAT — whether for pain or for opioid use disorder — should be made by a qualified addiction medicine specialist in coordination with the patient’s established MAT prescriber, as these decisions require specialized training in addiction medicine that falls outside the scope of interventional pain management practice.
Patients currently receiving MAT should continue care with their established MAT prescriber, as continuity is critical to treatment success. Patients seeking transition from MAT to other opioid medications, including those relocating from out of state, are encouraged to identify a qualified addiction medicine specialist in their new area before scheduling, as we are not the appropriate provider for that transition or for MAT management.
What to Expect as a New or Transferring Patient
If you are new to our practice — or transferring care from another provider — our first priority is your safety and long-term well-being. A comprehensive clinical evaluation, including a complete review of your records, imaging, and prior treatment history, is conducted before any prescribing decisions are made.
If your prior treatment has included opioid medications, those records will be reviewed carefully and with an open mind. However, a history of opioid use at another practice does not guarantee continuation of the same medication, dose, or regimen at Coastal Spine & Pain. The treatment plan developed here will be based on current clinical findings, established standards of care, and applicable state and federal regulations — not on prior prescribing patterns alone.
Many patients find that a multimodal approach — combining procedural interventions with non-opioid pharmacologic therapy and rehabilitative strategies — delivers better long-term outcomes than reliance on any single class of medication. If, after evaluation, opioid therapy is clinically warranted as part of the treatment plan, it will be prescribed and monitored responsibly. If other modalities better serve the clinical need, those alternatives will be explained and pursued.
Patients whose primary expectation of care is the continuation of a specific opioid regimen — independent of clinical evaluation, alternative therapy, or procedural treatment — are unlikely to find this practice a good clinical fit.
Regulatory & Compliance Framework
Responsible medication management in Alabama requires adherence to multiple overlapping regulatory frameworks. Our practice maintains compliance with each of the following:
Alabama State Requirements
Alabama Board of Medical Examiners (BME) Rule 540-X-4-.08 — Establishes requirements for controlled substance prescribing, including risk and abuse mitigation strategies such as urine drug screening, pill counts, PDMP checks, validated risk-assessment tools, opiate risk education, consideration of abuse-deterrent formulations, and monitoring for aberrant behavior.
Alabama Prescription Drug Monitoring Program (PDMP) — Under the Code of Alabama §20-2-210 et seq., all dispensed Schedule II–V controlled substances are reported to the PDMP. Prescribers are required to check the PDMP at frequencies determined by the patient’s MME level. Alabama additionally schedules gabapentin, butalbital products, and certain codeine cough preparations, which are monitored through the PDMP even though some are not federally scheduled.
Alabama Controlled Substances Certificate (ACSC/QACSC) — All practitioners prescribing controlled substances in Alabama must hold a valid Alabama certificate in addition to a DEA registration.
Federal Requirements
DEA Registration & the MATE Act — The Medication Access and Training Expansion (MATE) Act, signed into law as part of the Consolidated Appropriations Act of 2023, requires all DEA-registered practitioners who prescribe controlled substances to complete a one-time, eight-hour training on opioid or other substance use disorders. Dr. Webb is fully compliant with this requirement.
CMS Medicare Part D Opioid Safety Policies — Medicare Part D plans implement safety edits including a care coordination threshold at 90 MME per day, a seven-day supply limitation for opioid-naïve beneficiaries, concurrent opioid/benzodiazepine alerts, and drug management programs for at-risk beneficiaries. Our prescribing practices align with these patient safety measures.
CDC Clinical Practice Guideline (2022) — The updated CDC guideline provides evidence-based recommendations for opioid prescribing across acute, subacute, and chronic pain. The guideline emphasizes multimodal care, non-opioid pharmacologic and nonpharmacologic therapy as preferred first-line treatment for most conditions, and careful risk-benefit assessment when opioids are considered.
NOPAIN Act (effective January 1, 2025) — The Non-Opioids Prevent Addiction in the Nation Act directs CMS to provide separate Medicare payment for non-opioid pain relief treatments in hospital outpatient and ambulatory surgery settings, reflecting the federal commitment to expanding access to non-opioid alternatives.
Conditions Treated Through Medication Management
Our medication management services support the treatment of a range of pain conditions, generally as an adjunct to interventional and rehabilitative care, including but not limited to:
Acute Pain Conditions
Post-surgical pain, traumatic injuries, acute disc herniations, fractures, and acute inflammatory conditions where short-duration pharmacologic management is appropriate.
Chronic Spinal Pain
Cervical, thoracic, and lumbar pain syndromes including degenerative disc disease, spinal stenosis, facet arthropathy, and persistent spinal pain syndrome (formerly “failed back surgery syndrome”).
Neuropathic Pain
Diabetic peripheral neuropathy, post-herpetic neuralgia, complex regional pain syndrome (CRPS), radiculopathy, and other nerve-mediated pain conditions.
Joint & Musculoskeletal Pain
Osteoarthritis, inflammatory arthritis, tendinopathies, and chronic musculoskeletal conditions of the extremities and axial skeleton.
Cancer-Related Pain (Adjunctive)
Adjunctive interventional and pharmacologic support coordinated with the patient’s oncology team and palliative care specialists. We do not function as the primary cancer pain prescriber.
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Important Notice: The information on this page is provided for general educational purposes and is not a substitute for individual medical advice. Treatment plans are developed on a patient-by-patient basis following thorough clinical evaluation. Medication availability, insurance coverage, and regulatory requirements are subject to change. Controlled substance prescribing decisions are made by Dr. Richard Webb at his sole clinical discretion, under his individual DEA registration and Alabama Controlled Substances Certificate, in accordance with all applicable state and federal law. Coastal Spine & Pain, LLC does not hold a DEA registration and does not dispense, store, or supply controlled substances at its clinic location. This page does not create a physician-patient relationship.
Coastal Spine & Pain complies with all applicable provisions of the Alabama Board of Medical Examiners rules governing controlled substance prescribing, the Alabama Prescription Drug Monitoring Program, the U.S. Drug Enforcement Administration regulations, and the Centers for Medicare & Medicaid Services opioid safety policies. Content last reviewed May 2026.