Medication Management
At Coastal Spine & Pain, medication management is one component of a comprehensive, evidence-based treatment plan—not a standalone service. Every prescribing decision we make is guided by current federal and state standards, including 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.
Our physician, Dr. Richard Webb, holds board certifications in both Pain Medicine and Anesthesiology along with advanced legal training (J.D., LL.M.), giving him a distinctive understanding of the clinical, regulatory, and medico-legal landscape surrounding 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 unique risk profile. At Coastal Spine & Pain, we believe that 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, centralized, or mixed.
Pharmacologic therapy is most successful when it is part of a multimodal treatment strategy—one that may also include interventional procedures, physical rehabilitation, behavioral health support, and lifestyle modification. This approach is consistent with the current direction of federal policy, best-practice clinical guidelines, and the expectations of major payors including Medicare.
What Patients Should Understand About Our Prescribing Philosophy
We are committed to providing compassionate, individualized care for patients experiencing cancer pain, acute pain, and chronic pain conditions. We understand that many patients have been through lengthy treatment histories—sometimes involving regimens prescribed by other providers that may have included opioid medications, sometimes at high doses and for extended periods. We recognize the difficulty this can create, and we approach every patient with empathy and without judgment.
That said, our practice adheres to a multimodal-first, function-focused model. This means that opioid analgesics are not our first-line treatment for most 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 the full spectrum of pain conditions, including recalcitrant cases where opioid therapy may be clinically appropriate after other modalities have been explored. However, an expectation of a particular opioid, dose, or schedule—independent of clinical evaluation—is not something our practice can accommodate. Our goal is to help you 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 and multidisciplinary 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 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, fibromyalgia, neuropathic pain, and central sensitization syndromes.
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 January 2025 approval of suzetrigine (Journavx™)—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 appropriate for our patients.
Cancer Pain & Palliative Considerations
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. Our practice provides individualized cancer pain management that may include opioid analgesics when clinically indicated, alongside non-opioid and interventional approaches.
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 immediate-release analgesic for the shortest duration expected to be clinically necessary. In most cases, three to seven days of analgesic therapy is sufficient for acute conditions. 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. In many cases, the most effective long-term pharmacologic management involves non-opioid medication classes—such as anticonvulsants, SNRIs, topical agents, and anti-inflammatory medications—combined with interventional procedures and physical rehabilitation. When pharmacologic management of chronic pain is warranted, we regularly reassess each patient’s functional goals, treatment response, and risk profile.
Opioid Therapy: When It May Be Appropriate
We do not categorically refuse to prescribe opioid medications. There are clinical scenarios—including certain cancer pain conditions, severe acute pain unresponsive to non-opioid measures, and carefully selected chronic pain cases—where opioid therapy is a medically appropriate component of the treatment plan. In those situations, our prescribing is guided by the following principles:
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 our 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 frequency-of-review thresholds based on morphine milligram equivalent (MME) dosing established by the Alabama BME: review consistent with good clinical practice below 30 MME/day; at least twice per year above 30 MME/day; and on the same day the prescription is written above 90 MME/day.
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/day. Our prescribing practices reflect these evidence-based thresholds while recognizing that certain 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.
What to Expect as a New or Transferring Patient
If you are a new patient, or if you are transferring care from another provider, we want you to know that our first priority is always your safety and long-term well-being. We will conduct our own comprehensive clinical evaluation before making any prescribing decisions.
If your prior treatment has included opioid medications, we will review your records 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. Our treatment plan will be based on our clinical findings, the current standard of care, and applicable state and federal regulations—not on prior prescribing patterns alone.
We ask for your patience and partnership as we work together to develop a treatment strategy that addresses your pain, improves your daily function, and does so safely within the bounds of responsible medical practice. Many patients find that a multimodal approach—combining medication management with interventional procedures and rehabilitative strategies—delivers better outcomes than relying on any single class of medication.
If, after our evaluation, we determine that opioid therapy is clinically warranted as part of your treatment plan, we will prescribe and monitor it responsibly. If we determine that other modalities better serve your clinical needs, we will explain our reasoning and work with you to pursue those alternatives.
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 daily 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. Our practice 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/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 wide range of pain conditions, including but not limited to:
Cancer Pain
Active malignancy-related pain, post-surgical oncologic pain, chemotherapy-induced peripheral neuropathy, and palliative pain management requiring individualized, often multimodal pharmacologic strategies.
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 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, myofascial pain syndrome, and chronic musculoskeletal conditions of the extremities and axial skeleton.
Centralized & Widespread Pain
Fibromyalgia, central sensitization syndromes, and chronic overlapping pain conditions where pharmacologic management with neuromodulatory agents and SNRIs may be particularly beneficial.
Ready to discuss a treatment plan tailored to your needs?
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 a thorough clinical evaluation. Medication availability, insurance coverage, and regulatory requirements are subject to change. Controlled substance prescribing decisions are made at the sole clinical discretion of the treating physician in accordance with all applicable state and federal law. 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 February 2026.