HPM vs Pain Medicine

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I am not looking to start a fight. I am wondering about something. I am not trying to foment any kind of zero-sum argument ("I'm good because you're bad.")

In the EM forum, there is a thread about HPM (hospice and palliative medicine) subspec cert for EM. It's accredited and accepted, no question about that. It was what HPM docs do that I wondered. Some folks outlined some of the things they do or their thoughts, and it sounded quite like what pain docs do. In my mind, though, I divided pain and HPM between patients with a chronic but nonfatal problem, and patients who will die from their condition, and suffering from it on the way. Does that make sense?

So, not to inflame emotion and agitas, but, have you had any experience with HPM teams? Do you refer to them when you find a patient that isn't just chronic, but going downhill and going to die and not recover?

One of the strong suits of pain med is the same as HPM - that the docs are drawn from diverse fields across the board; it's not like everyone starts out "red" and then becomes another "shade of red".

Can anyone give me anything dispassionate? I have no agenda, and am strictly curious. Recall that I am not talking about someone not trained and certified, working off something they took in a weekend class in Las Vegas.

Thank you.

i believe that some palliative pain medicine is a required rotation for pain fellows.

if you look at wikipedia.org, palliative care "focuses on relieving and preventing the suffering of patients." Pain management works on "easing the suffering and improving the quality of life of those living with pain."

the one area where there is no crossover is procedures/injections, which palliative care does none. palliative care tends to be more medicine heavy, and opioid heavy. most patients get introduced to HPM while a hospital inpatient; most people go to see their first pain doc as an outpatient. Cancer pain straddles both specialties, because of what usually happens to most of these patients, but ofttimes they are treated by pain management.

There is enough pain out there that both subspecialties are needed. I for one am not that available (or good - i get too attached ) in going to a hospice or a hospital bed of someone who is probably going to die. I am compassionate, but i am also hardheaded and strict (which might not be good for a palliative care physician).

I spend my days trying help people be more functional, more active, have a better quality of life so that, when they are on their deathbeds, they can look back with as little regret as possible.

Originally Posted by Apollyon

I am not looking to start a fight. I am wondering about something. I am not trying to foment any kind of zero-sum argument ("I'm good because you're bad.")

In the EM forum, there is a thread about HPM (hospice and palliative medicine) subspec cert for EM. It's accredited and accepted, no question about that. It was what HPM docs do that I wondered. Some folks outlined some of the things they do or their thoughts, and it sounded quite like what pain docs do. In my mind, though, I divided pain and HPM between patients with a chronic but nonfatal problem, and patients who will die from their condition, and suffering from it on the way. Does that make sense?

So, not to inflame emotion and agitas, but, have you had any experience with HPM teams? Do you refer to them when you find a patient that isn't just chronic, but going downhill and going to die and not recover?

One of the strong suits of pain med is the same as HPM - that the docs are drawn from diverse fields across the board; it's not like everyone starts out "red" and then becomes another "shade of red".

Can anyone give me anything dispassionate? I have no agenda, and am strictly curious. Recall that I am not talking about someone not trained and certified, working off something they took in a weekend class in Las Vegas.

Thank you.

My biases are that I'm a PM&R guy who is subspecialty boarded in Pain Mgt. That said, I respect the work of our HPM colleagues.

Usually 'pain boarded' folks see acute pain - often of spinal origin - and perform procedures. Whereas HPM boarded folks see chronic pain in the context of cancer or endstage disease. Moreoften than non HPM folks do not perform procedures but instead, offer pain and symptom management as a component of a broader end of life care continuum.

Thank you for quick and substantial replies. Just for information, and NOT for a turf war or "****ing contest", you may check this thread for more about that which I am talking.

HPM that I saw was truly hospice, cancer & malignant pain end of life palliation

Pain: Preserve function

Palliative/Hospice: Preserve dignity

Pain: No BZD

Palliative: lots of BZD

Originally Posted by Apollyon

I am not looking to start a fight. I am wondering about something. I am not trying to foment any kind of zero-sum argument ("I'm good because you're bad.")

In the EM forum, there is a thread about HPM (hospice and palliative medicine) subspec cert for EM. It's accredited and accepted, no question about that. It was what HPM docs do that I wondered. Some folks outlined some of the things they do or their thoughts, and it sounded quite like what pain docs do. In my mind, though, I divided pain and HPM between patients with a chronic but nonfatal problem, and patients who will die from their condition, and suffering from it on the way. Does that make sense?

So, not to inflame emotion and agitas, but, have you had any experience with HPM teams? Do you refer to them when you find a patient that isn't just chronic, but going downhill and going to die and not recover?

One of the strong suits of pain med is the same as HPM - that the docs are drawn from diverse fields across the board; it's not like everyone starts out "red" and then becomes another "shade of red".

Can anyone give me anything dispassionate? I have no agenda, and am strictly curious. Recall that I am not talking about someone not trained and certified, working off something they took in a weekend class in Las Vegas.

Thank you.

I've never heard of a turf war between these two specialties.

I work with a HPM guy and am delighted to send him hospice pts, just like he sometimes asks if an intervention is appropriate for his pts. it's an incredibly important and rewarding field. But those guys are really not interventionalists and don't want to be.

When I'm on my death bed, please send the HPM guy!

Originally Posted by hyperalgesia

I've never heard of a turf war between these two specialties.

I work with a HPM guy and am delighted to send him hospice pts, just like he sometimes asks if an intervention is appropriate for his pts. it's an incredibly important and rewarding field. But those guys are really not interventionalists and don't want to be.

When I'm on my death bed, please send the HPM guy!

Check the thread in the EM forum. One resident seems to just have the wrong idea.

I sort of see it like neurology/neurosurgery or cardiology/CT surgery, or nephrology and urology (sort of, kinda sorta).

MSKCC offers one such program - HPM with pain track. You can become acgme board certified in pain after that but you don't learn any interventions. You can practice either pall. or chronic pain but mostly opiate.

From my experience, the time to enter a patient into a hospice program from pain management, is when outpt pain management is no longer economically feasible, or the pt cannot be transported to the doc's office. Hospice has better resources for funding often, and can do it in the patient's home.

I do find it interesting that something as long-term as hospice falls under EM.

Originally Posted by PMR 4 MSK

I do find it interesting that something as long-term as hospice falls under EM.

Had me scratching my head, too, until I found out that the American Board of Radiology is also a sponsor board. Then I just kind of threw my hands in the air.

Tertiary academic center. I often co-consult on cancer patients. Palliative asks for my involvement when the pt is sedated from opioids and still in pain. I offer interventions and adjunct meds, including IV ketamine and lidocaine.

I ask for palliative consults when the pt has cancer pain but doesn't know he is dying yet and the medicine team has no good discharge planning, ie home hospice or real hospice.