I have written about this multiple times. The extremely poor to horrendous treatment of pain patients. We have the DEA breathing down our necks as they scrutinize our doctors and their prescribing practices. We have insurance companies that deny treatments and medications to save money. Then we have the doctors and clinics that specialize in pain management. These are the worst offenders. I know a few people who are in pain management and it is amazing on how different the treatments are. There are no real standards of care. It seems to be made up as they go along.
My father in law has a messed up back. He had a pain pump until it became infected and had to be taken out. He goes to a different PM clinic than I do. Until just recently he went every other month to see the doctor. He actually saw the doctor and not a PA. Since the removal of the pain pump he has been fairly stable. The doctor makes sure his meds are working and he is having no new issues. The doctor would schedule him even less but state law and federal law has changed and he must see him every 60 days. Now his PM clinic has been bought by a doctor's group from Tennessee. Suddenly the rules have changed. They implemented a new schedule where he must go in every month. So far they have yet to start pushing shots but I am sure that will be coming along soon. I have a couple of friends in PM as well and they have told me about their experiences. One of them sees a doctor who refuses to prescribe anything stronger than Hydrocodone/Acetominophen basically Loritab. The doctor admitted to her that he was afraid of being targeted by the DEA. So who suffers ? The patients of course.
The whole point of pain management is to manage a patients pain so they can return to their daily lives. Well that is supposed to be the whole point but it isn't. Patients are being left to suffer varying degrees of pain every day. Most clinics feel that leaving a patient at a pain level of 5 is acceptable. Others like my friends clinic will not prescribe the drugs need to get a patient down to that level even and still others seem to be out to make as much money as they can off pain patients and don't really care if the patients get any real relief. There are no real treatment protocols for pain patients like there are for halting cancer or battling any disease. Well pain clinics have kind of made up the treatment protocols as they go along and then jammed everyone into that mold. Too bad not everyone's pain is the same. Not even from the same source. So how can you treat everyone the same ?
Forcing everyone into the same treatments is insane. I have a screwed up spine with nerve issues and some really fun pain that shoots through different parts of my body. How can you treat me the same as some patient who is suffering from Fibro or someone who has been in a car wreck and had their leg shattered ? There are literally hundreds of different causes for chronic pain. You can't treat them all the same. It would be like treating the flu the same as cancer yet that is what is going on. See it is much quicker and cheaper than trying to design treatments tailored to each patient. That takes time that most doctors don't want to spend with their patients.
I have to say that I just had an experience with a doctor that was really outstanding. Too bad it was not a pain management doctor. The office was huge compared to my PM clinic. The waiting room at least 3 times as big and packed. I walked in at 3:08 for my 3:20 appointment. By 3:25 I was back in the room with a nurse going through all the normal stuff, weight, BP, temp etc. She left and the doctor walked in and we talked about why I was there. He went into all the info and all the tests I had done at my last visit. He spent close to 20 minutes with me and we set up a treatment plan for the future. Total time in the office was under 1 hour. Contrast that with my PM clinic where the average wait time is over an hour and a half, the time spent with the PA, never the actual doctor, is under 10 minutes during which they do most of the talking and not much listening. The doctor yesterday answered all of my questions, putting the answers into simple, easy to understand terms. My PM clinic rarely answers my questions. Heck I am still waiting for a call back from when I called them on Tuesday, 4 days ago. I know I will not hear anything at all back over the weekend. So Monday I will call again. Maybe by next Friday I might get an answer.
So let's jump down past that orange jungle gym and look into the future, At least I am hoping it is the fuure of pain management.
I do understand that not every doctor will be like the one I saw yesterday. As in any population segment you will get the lazy, the dumb and the greedy and those who are excellent. So I know we can never really clean up every pain management clinic. What I would love to see though is some basic rules that PM clinics have to follow. I am not talking about some of these really stupid laws passed by legislatures across the country. I mean real rules like treating every patient as if they are human beings and not criminals out to get high. I am sick and tired of being treated like I am trying to do something illegal because I want to get rid of my pain. Why in the heck am I being treated like a criminal ? I thought this was the US where we are innocent until proven guilty. In pain management it is the complete opposite. Guilty until you can prove your innocence and then prove it over and over again. That is really degrading. Roughly 90% of pain patients will have no intent to get high or divert their drugs to illegal use yet the 90% are treated just like the 10% who will. You would think that 4 plus years of clean piss tests and scrupulously following their rules would convince them that I am not trying to do anything but get relief. NOPE ! Not one freaking bit. I suggested to the dragon lady on my last visit that we could do away with the piss test on every freaking visit now and she said sorry nope. So I asked if I had ever failed one test. She admitted that I had never. I asked if I had ever broken a rule and she admitted that I had been following the contract to the letter. Yet I am still a criminal in their eyes.That is just BS.
You would think that after following the rules for 4 years I would have a little trust built up with the clinic. That they might be willing to work with me to get my pain down more. Nope, in their eyes telling them my pain meds wear off after 4 hours is a flag that I am trying to get stronger drugs so I can go sell them. See I am really a secret drug dealer who sells all of his medicine. I should be locked up immediately. NOT! That must change. There is an issue with people using these drugs to get high. Yes it is a very real issue and people are being hurt by them. Heck the over dose rate among the baby boomer generation has doubled. There is a good article on that in the Daily Mail here at the link Drug ODs up But we can't coninue to punish all pain aptients to protect the few. It is truly humiliating to be denied medications that will lower my pain because the clinic is afraid of the DEA running an investigation. It is so much fun to have to piss into a cup on every freaking visit just to prove once again that I don't do street drugs and I take all of my medication. When the hell did I enter prison oh yeah it was when I had back surgery to fuse my lower spine. HELL NO. I am not a drug addict. I am not some junkie trying to sell my pills. I am a real live human being who wants his life back. Is that too freaking much to ask ? Apparently it is if you go to most pain clinics. Their philosophy seems to be screw the patients and run up the bill. I am fed up and it is way past time for a change.