nyt article on pain management

[nvrsumr]

http://www.nytimes.com/2011/02/05/health/05patient.html?ref=health

"many primary care doctors provide therapies like nerve blocks, said Dr. Roland A. Goertz, president of the American Academy of Family Physicians."

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[geauxg8rs]

I am assuming they are experts in the infamous "peripheral nerve blocks" of the lumbar area. Seen a neurologist and some PCPs do these. Patients then come in and say "I have had no benefit from my nerve blockers."
I have to spend time telling them their "nerve blocker" may have at best been a trigger point injection. They say "he asked me where it hurt and injected a bunch of white stuff there." When they get over their two days of relief they then need to be referred to pain management having failed nerve blockers.

The other funny one was from a PCP who called a colleague wondering why medicare stopped paying for his "paravertebral blocks (? blind facets)." Turns out the bundling of facets with the fluoro has been weeding out guys like this who exhaust the healthcare system.
This guy also does the NCV in his own office without any training. Useless reports.
I am gas by primary training, but then when I want the patient to have an actual NCV/EMG by someone trained, the insurance won't pay because the patient already had "one."
Fraud sucks.

 

[PMR 4 MSK]

"For the last 15 years, Ernie Merritt III, 46, has been coping with the aftermath of a back injury he suffered working as a pipefitter in southeastern Maine. At the time, he thought he had just pulled a muscle. But after an M.R.I. revealed a herniated disc pressing on his sciatic nerve, he underwent the first of four operations.



Surgery has not been enough. Mr. Merritt’s back still hurts, and now he must wear a brace full time to stabilize it. He has developed carpal tunnel syndrome and shoulder problems. The nerves in his legs are damaged, and doctors cannot figure out why."


Herniated disc pressing on the sciatic nerve? How did it migrate that far south out of the spine?


4 operations - that's the problem.


Wearing a brace full time = perpetuation of the problem.


And the last sentence is yet another one from the media to show that we are all a bunch of drooling baboons. Ooh, ooh, ahh ahh.