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medicineman1

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I am very curious as to the levels on the contento-meter of those practicing pain management? More specifically- to those doing interventional- are you happy with practice dynamics, do you wish you were doing more procedures, etc? Would you go into this field again? (even if the money weren't there)

For the pros- (drusso, algos, lobel, gorback) and the relative newbies (axm, disciple)- you guys happy?

Seriously- would you do i again?

For those PM&R stars if you weren't doing pain would you be happy in physiatry?
 
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Great question...

There are rough days. You learn that "central sensitization is a bitch." The level of poor coping and absent insight in the chronic pain population is impressive to say the least. These are patients that almost every other doctor on the planet runs from (including shrinks) and you're *THEIR* doctor.

There are good days. You actually intervene in a tangible way and make a difference in a person's life. You perform a service that no one else could offer. It makes a difference in a person's life and qualify to life. You did it and you take the credit.

Pain is fascinating and it makes me philosophical about the "mind-body" connection. You have to like the "crazies" a little. Because, unfornuately, pain and crazy go hand-in-hand.

The thing that is tough about being in training is that you don't have a choice about who you have "relationships" with. As a fellow, you see whoever is on the schedule. I think it will be better when I have more control over how I define my relationships with patients. I'll defer to Algos, lobelsteve, and others about what it's like to define those relationships as an attending.

I like being a pain doctor. I find myself missing some general PM&R patients---sometimes I wish I could see a straightforward young para or amputee. I think that's why physiatry was a good fit for me. I'm sure my anesthesia colleagues miss the OR from time to time.

Get some exposure to the field before "signing the dotted line."
 

lobelsteve

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Great question...

There are rough days. You learn that "central sensitization is a bitch." The level of poor coping and absent insight in the chronic pain population is impressive to say the least. These are patients that almost every other doctor on the planet runs from (including shrinks) and you're *THEIR* doctor.

There are good days. You actually intervene in a tangible way and make a difference in a person's life. You perform a service that no one else could offer. It makes a difference in a person's life and qualify to life. You did it and you take the credit.

Pain is fascinating and it makes me philosophical about the "mind-body" connection. You have to like the "crazies" a little. Because, unfornuately, pain and crazy go hand-in-hand.

The thing that is tough about being in training is that you don't have a choice about who you have "relationships" with. As a fellow, you see whoever is on the schedule. I think it will be better when I have more control over how I define my relationships with patients. I'll defer to Algos, lobelsteve, and others about what it's like to define those relationships as an attending.

I like being a pain doctor. I find myself missing some general PM&R patients---sometimes I wish I could see a straightforward young para or amputee. I think that's why physiatry was a good fit for me. I'm sure my anesthesia colleagues miss the OR from time to time.

Get some exposure to the field before "signing the dotted line."

Spot on.

I like stabbing bpeople and burning things so this was a natural fit. I also enjoy being an amateur Psychiatrist and figuring out how these people got themselves in the messes that they are in.

Dream patients: 70 y/o man coming in for ESI for spinal stenosis 1-2 x year for 3 years. Decided to retire from work and asks for a last ESI as his walking is getting worse again. He takes no meds. He requests referral to two Neurosurgeons so he can decide who will decompress his spine. His surgery is in October so he can use up sick leave and get MC and other insurance to cover the maximum. THen there is a 32 y/o AAF s/p ankle Fx who develops CRPS. She had a cousing who was addicted to drugs and refuses anything but Lyrica but wants to try the wire thingy like Jerry Lewis has. Dual octrode array, 75% pain relief. Stops Lyrica.

Nightmare patients: 37 y/o WF, abuse problems, gets pregnant and doesn't know it. Baby spends 4 days in NICU getting detoxed. She comes back in and is disappointed she is no longer a candidate for opioid therapy due to her own irresponsibility.

45 y/o WM on IT morphine at 32mg/day. still on oral opioids for neck/arm pain, takes mothers Xanax, Soma. Doesn't work, but always has money for 2 packs per day cigarettes.
 
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Disciple

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Would I do it again it again if the money weren't there?
-Yes
-if the average salary was Pediatrician low then maybe not

Do I wish I were doing more procedures?
-Coming from PM&R, you can't get any more procedure oriented than doing interventional pain management

I've found pain medicine to be very rewarding, whether I've helped someone with a procedure, designed a useful exercise program or come up with an effective medication regimen. It's the patients with poor outcomes that are frustrating. When you've tried everything with a patient, and they continue to get worse, and the office visits become less about discussing their pain and more about their anger over attorneys, disability ratings, their troubled home life, they still think they can be cured after 7 years, etc., that makes for a long day at the office. Fortunately, if you do a good job you shouldn't have an overwhelming number of those patients.

Could I be happy practicing Physiatry without pain management?
Depends.

I could still have a fun practice with sports med/Prolotherapy, EMG, MSK ultrasound, performing arts medicine, etc.

TBI or SCI could be enjoyable as well, so long as I had residents/fellows to do the discharge papers, late/delayed admits, field calls from the nurses and talk to family members who show up at odd hours.

Happy doing General inpatient rehab?
Unlikely.
If you did a prelim medicine intern year, think back to those days. If the thought makes you cringe, then you probably wouldn't like general inpt rehab either. Sometimes it's like doing Internal Medicine without the Medicine.
 

Ligament

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I really like pain medicine. I'm just a fellow at this point, but I'll give it a 9/10 rating on the satisfaction scale.

Lots of procedures, lots of funny patients to keep you smiling. When I do a celiac block and the pancreatic cancer patient who has not been able to eat anything for days due to pain and nausea can dig into a BBQ pork sandwich that his wife delivered to him into the holding area immediately post-op...that type of thing is very rewarding!

I hate inpatient rehab. I hate inpatient pain medicine quite a bit less than rehab. Probably because I'm always the consultant and never the primary. Also because I don't have to write the scripts. I just hate inpatient everything.

The difficult pain patients, and there are a LOT of them, can be a bummer. But then I just remind myself they are in the same pain they've been in for YEARS and nobody is going to die if I don't fix the issue NOW. (with some exceptions such as new onset CRPS in which you have to move fast). And for many, many patients, the issue will never be fixed. I'm just helping them to move from A to B in a more comfortable fashion.

There is a lot of research and development in the pain world right now, so it keeps things new and interesting.

My only concern about pain medicine is the amount of radiation I'm getting blasted with, really. But I use every step to reduce the radiation. I also hope that in the near future technology will advance such that it becomes a non issue for me.
 

Disciple

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I hate inpatient rehab. I hate inpatient pain medicine quite a bit less than rehab. Probably because I'm always the consultant and never the primary. Also because I don't have to write the scripts. I just hate inpatient everything.

I bet you wouldn't have said that 8 months ago.

:eek: :D
 

Aether2000

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Generally, I am very satisfied with the career choice of pain medicine, but the clinical work in and of itself is not enough given the nascency of the field. There is much work to be done in the development of standards, evaluation of new technologies, residency development, and basic research. Therefore, my spare time is spent in those pursuits. The combination of teaching, research, and private practice is a great match for me and I am lovin' it!
 

mille125

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I agree with most of the posts. Overall I am very satisfied with the career path (I took the anesthesiology route). Every specialty has their share of difficult patients and interventional pain management is no exception (to say the least). There are many days where I feel that I have made a difference in someone's life. There are days that I want to close my clinic and never go back. Thankfully, the good days greatly outnumber the bad. I think that everyone of us has our share of bad days. If you are only in it for the money, these bad days will exert a serious toll on you. You must like what you do.
One thing that has helped me out is talking with the general practitioners. They now refer me most of their nonsurgical spine issues. Obviously, you cant help everyone. However, I feel that you have a much better chance of making a difference if you see someone 1-3 months after an injury versus 5-10 yrs. Good luck.
 

medicineman1

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I agree, great forum. Im happy to pose questions that in return lead to revealing answers and experiences from the guys that have experienced the whole process from residency selection to fellowship selection, to (life in the day reflection) to introspective stuff and predictions regarding the future of the field. Practice dynamic stuff, the ins and outs of running the business is key as well! Common guys keep it rollin'.

I like the opiod bar and chicks for free! ha ha!
 

lobelsteve

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Ok guys, quit messing with their heads and fess up.

It can all be summed up in one word -- "schadenfreude".

So the rest of you do not have to look it up:

Main Entry: scha·den·freu·de
Pronunciation: 'shä-d&n-"froi-d&
Function: noun
Usage: often capitalized
Etymology: German, from Schaden damage + Freude joy
: enjoyment obtained from the troubles of others
 

stretch210

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So the rest of you do not have to look it up:

Main Entry: scha·den·freu·de
Pronunciation: 'shä-d&n-"froi-d&
Function: noun
Usage: often capitalized
Etymology: German, from Schaden damage + Freude joy
: enjoyment obtained from the troubles of others

Thanks lobelsteve ;)
 

mehul_25

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with the limited insight of a fellow I can say that I am very happy with my decision to pursue pain medicine. I am fairly confident that I would not have been happy in general physiatry (including MSK medicine). There are always ups and downs, difficult patients and days you are unhappy but that is the case in medicine in general these days, certainly also in general PM&R. Overall the mixture of clinic and interesting procedures is hard to beat.
 
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