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Is the multidisciplinary pain program era over?

drusso

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    Controversial and provocative idea for sure. Who will save them?

    "While I think that’s great, reading the comments on that story will help you separate a single home run result from the reality we have seen with chronic pain programs since the 90s. Scroll to the bottom of the piece and click the “Comments” in the lower right. It’s basically filled with angry patients who know their pain is quite real and were insulted by the premise of the piece and the pain program reboot. Why the hostility? Because, the people who run these programs often report that they work better than the patients that go through them."

    https://www.regenexx.com/chronic-pain-programs-rise-ashes-dumb-90s-still-dumb-today/

    vs

    The Secret Life of Pain
     
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    Ducttape

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      i "like" how he is able to subvert history to serve his opinion.

      the most remarkable quote from Centeno's article is what you posted:
      " the people who run these programs often report that they work better than the patients that go through them."

      is he talking about the Mayo rehab clinic and their patients, or his own patients? cause we know how interventional pain and regenerative medicine has singlehandedly solved the entire chronic pain epidemic in the US
       
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      drusso

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        i "like" how he is able to subvert history to serve his opinion.

        the most remarkable quote from Centeno's article is what you posted:
        " the people who run these programs often report that they work better than the patients that go through them."

        is he talking about the Mayo rehab clinic and their patients, or his own patients? cause we know how interventional pain and regenerative medicine has singlehandedly solved the entire chronic pain epidemic in the US

        Who will support the special interests of chronic pain programs? Insurers (they don't like to pay?) Workers comp? Patients (concierge and direct access?) or the Government?
         
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        drusso

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          Why do we care what this guy thinks? Other than being first in line with stem cell nothing different than 3 years ago when he was still chasing PI cases and OON patients.

          The only person or entity's opinion that matters is the one paying the bill? Are $20-30k pain programs generating the ROI that stakeholders need to keep the service viable and sustainable? If you opened a chronic pain program in your town would you thrive or die? Who would support you? Insurance, patients, or the Government?
           

          nvrsumr

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            I agree there is no way to sustain a multidisciplinary pain program. I probably shouldn't have chimed in as I did not read your link since the author is not someone whose opinion I care about.
             

            SSdoc33

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              wow, is that guy full of himself. he better be a f$cking amazing doc to be spouting off this stuff. from what i've seen, if you are REALLY good, you dont need to act this way. you dont need to brag. think about the really good docs, teachers, whomever you have met in your life. were they self-aggrandizing or were they humble?
               
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              Ducttape

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                Who will support the special interests of chronic pain programs? Insurers (they don't like to pay?) Workers comp? Patients (concierge and direct access?) or the Government?
                Doctors. it is incumbent upon us as a profession and a practice to do what is best for the patients and their community, not to kowtow to whichever interest group pays the most.

                we lost this concept years ago. we as a society need to get it back.
                 

                oreosandsake

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                  Controversial and provocative idea for sure. Who will save them?

                  "While I think that’s great, reading the comments on that story will help you separate a single home run result from the reality we have seen with chronic pain programs since the 90s. Scroll to the bottom of the piece and click the “Comments” in the lower right. It’s basically filled with angry patients who know their pain is quite real and were insulted by the premise of the piece and the pain program reboot. Why the hostility? Because, the people who run these programs often report that they work better than the patients that go through them."

                  https://www.regenexx.com/chronic-pain-programs-rise-ashes-dumb-90s-still-dumb-today/

                  vs

                  The Secret Life of Pain


                  there's no substitute for coping skills in life. it doesn't come in a triamcinolone vial or lay dormant in the stem cells, and PRP alpha granules.

                  the chronic pain rehab programs do not magic wand the pain generators away. so it depends on your perception of your primary outcome goals for the intervention. the patients who expected "magic wand, now I feel like I'm im the prime of life" are not going to get there.

                  chronic pain rehab in part is to teach people coping strategies that they never developed in life, and help unravel learned disability, fear avoidance behaviors, address comorbid anxiety and depression, chemical coping, and chemical dependency...
                   
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                  SeniorWrangler

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                    Most of the angry comments on that New York Times piece (and 235 comments is NOT a lot of comments) seem to be from people who are worried about being taken off their chronic opioids.
                    Also, weirdly, a lot of people complaining about chronic pain due to ciprofloxicin or Ehlers-Danlos syndrome.
                     
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                    lobelsteve

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                      there's no substitute for coping skills in life. it doesn't come in a triamcinolone vial or lay dormant in the stem cells, and PRP alpha granules.

                      the chronic pain rehab programs do not magic wand the pain generators away. so it depends on your perception of your primary outcome goals for the intervention. the patients who expected "magic wand, now I feel like I'm im the prime of life" are not going to get there.

                      chronic pain rehab in part is to teach people coping strategies that they never developed in life, and help unravel learned disability, fear avoidance behaviors, address comorbid anxiety and depression, chemical coping, and chemical dependency...

                      It is in the stem cells. Just gotta inject them supratentorially. With ultrasound.
                       

                      oreosandsake

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                        Most of the angry comments on that New York Times piece (and 235 comments is NOT a lot of comments) seem to be from people who are worried about being taken off their chronic opioids.
                        Also, weirdly, a lot of people complaining about chronic pain due to ciprofloxicin or Ehlers-Danlos syndrome.[/QUOTE
                        Most of the angry comments on that New York Times piece (and 235 comments is NOT a lot of comments) seem to be from people who are worried about being taken off their chronic opioids.
                        Also, weirdly, a lot of people complaining about chronic pain due to ciprofloxicin or Ehlers-Danlos syndrome.

                        Usually it's fibro and Lyme disease
                         

                        kstarm

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                          We are moving towards a more integrative pain management model at one of our clinics. Over the last year the clinic has been shown to save about $6000 per patient per year , and it directly is addressing the opioid epidemic by weaning and conversion to suboxone for appropriate patients. It does not make money, but the the data is helping drive the desire for more funding for this clinic by the interested health plans and interested community members. It will be interesting to see where things end up.
                           
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                          Ducttape

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                            Usually it's fibro and Lyme disease

                            In the past... I think it has become commonly recognized by most that fibro and lyme are best not treated with opioids. So new conditions that "necessitate" opioids need to be found.

                            In a few years, it will be gluten insensitivity/ seronegative RA/(insert dx with vague symptoms and diagnosis of exclusion)...


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