2win

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There is an intersting thread "anesthesia hates pain" - somehow (because of me too, sorry) - we got to the point that there are successful pain physicians that don't use opioids at all. Now - with my pain experience (4 years) I do believe that is not possible to have a a pain practice without to use all the pain treatments available (and of course narcotics).
Question for the more experienced one : can you do ONLY interventional?
It is sustainable? Of course I'm not talking about some special situations (spine surgeon + pain doc - failed - back to surgery...)
 

Tenesma

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it is possible... i am living proof and i have a few colleagues in metropolitan areas that practice without prescribing narcotics...

but I do see narcotic consults and see those patients in f/u to make titration/re-evals recs for their PCPs... i just don't rx...

98% of my referrals are from PCPs... only 2% are from spine surgeons (because they got their own injectionists)
 

Arch Guillotti

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I was contributing to the discussion in the anesthesia forum on this topic and the following quote was the one I took exception to:

Pro - there is money...in writing scripts. I will stop here - this board is a public one and there is no need for more info.
Regarding the question - interventional only versus interventional with narcotics - any (BUT ANY) real pain doc will prescribe narcotics and other drugs in order to treat pain. Please guys don't listen to some stories with pain docs that get rich doing steroid injections. This isn't the case.
Far away from me to tell you to don't do pain medicine. Do it only if you like it - again you don't gonna get rich.
 

hyperalgesia

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There is an intersting thread "anesthesia hates pain" - somehow (because of me too, sorry) - we got to the point that there are successful pain physicians that don't use opioids at all. Now - with my pain experience (4 years) I do believe that is not possible to have a a pain practice without to use all the pain treatments available (and of course narcotics).
Question for the more experienced one : can you do ONLY interventional?
It is sustainable? Of course I'm not talking about some special situations (spine surgeon + pain doc - failed - back to surgery...)
I know a solo pain practitioner in a medium sized town who converted his practice to "interventional only" about 10 years ago. He sent a letter to all his referring docs telling them as much. I worked with him for a month as a fellow and he is true to the interventional only model. But it only works because he had a VERY well-established referral network when he converted. He also has other components to his practice (medicolegal, other business ventures) so he can afford to take the risk of losing referrals. Still, if another game comes to town, it won't be easy for him. In general, I think it's not something you can count on, unless your name is Tenesma. But it sure was fun working with that guy. We'd get fibromyalgia patients demanding opiates and it was like, "Oh you must not be aware that we don't practice pharmacologic pain managment here..." :)
 

2win

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I was contributing to the discussion in the anesthesia forum on this topic and the following quote was the one I took exception to:
You're wrong again - you didn't contribute because your post was useless.
You felt that you have to say something - this is another story!
Did you practice pain medicine ONE DAY of your life or you just have fantasies about this profession???
You said that you're a fellow - please tell me - what kind of?
Regards moderator,
2win
 

knoxdoc

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The notion that you can't be a pain doc and not prescribe opioids is myopic. There are plenty of other non-narcotic treatments available. Narcotics are not a panacea (or even remotely close). They are partially effective for some patients, but they carry many risks. In my experience, narcotics have not been any more effective for controlling chronic pain than any other medications I prescribe (NSAIDS, Lyrica, Tramadol [which I leave out of the "narcotics" talk], etc. Multiple studies support my personal conclusions.
 

Ligament

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I'm a board certified and fellowship trained pain doc. I get more patients OFF opioids than on them. And I do prescribe when my expertise is needed ie. complicated titrations, strange medicines like ketamine nasal spray..etc. If the meds are easy, I just recommend back to the PCP my medication suggestions.

I know quite a few docs with interventional only practices. It is very possible.

Thats not to say I personally want an interventional only practice.
 

PMR 4 MSK

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Last week I had a wonderful "needle" day, on Thursday. 4 EMGs, 3 arthrograms and a couple joint injections in the morning, a few fluoro procedures ane a couple more EMGs in the pm. I got to stick a needle in every patient I saw. Quite a satisfying day. Wish I had more like that.

Damn, I am sadistic...
 
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There is an intersting thread "anesthesia hates pain" - somehow (because of me too, sorry) - we got to the point that there are successful pain physicians that don't use opioids at all. Now - with my pain experience (4 years) I do believe that is not possible to have a a pain practice without to use all the pain treatments available (and of course narcotics).
Question for the more experienced one : can you do ONLY interventional?
It is sustainable? Of course I'm not talking about some special situations (spine surgeon + pain doc - failed - back to surgery...)
If the patient can live comfortably without medication, we will do it.:)

Because the opiates can't be taken for a long term use, it is impossible for several considerations. In a long term use, the new pain will be to live with narcotics, the patient would even rather to skip that kind of medication to live. I am speaking about some big pain sickness, not the small ones of a surgery etc.
 

Jcm800

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If the patient can live comfortably without medication, we will do it.:)

Because the opiates can't be taken for a long term use, it is impossible for several considerations. In a long term use, the new pain will be to live with narcotics, the patient would even rather to skip that kind of medication to live. I am speaking about some big pain sickness, not the small ones of a surgery etc.

what are you talking about? huh?