Is this a good field but stressful?

[sykosomatik]

Is that what pain medicine is like? Can you make good money? But it must be stressful to deal with chronic pain and patients that get addicted or don't get better.

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[Aether2000]

We poke fun at the extremes of patient behaviors in our practices, but do not mistake that for lack of dedication or love for what we do.
Chronic pain treatment is the management of symptoms of the disease of chronic pain over time. It involves psychosocial, financial, and functional restoration or maintenance in addition to control of the physically manifested pain. It is as much internal medicine as PMR or anesthesiology. Those going into the field with the mindset of an anesthesiologist (patient presents and after 2 minutes of interview, knock the patient out, the patient recovers, and is never seen again) then they are destined to be profoundly frustrated. Treating chronic pain is much more than standing at the plate hitting homeruns everytime you come up to bat just as you do in OR anesthesia. In treating chronic pain, if you finish with a 0.333 success rate, you are actually doing very well. Chronic pain is the treatment of a chronic disease, and the patients are not expected to be cured anymore than diabetics or cystic fibrosis patients are ever cured.
I find it to be amusing, frustrating, and enormously satisfying at the same time. No, it is not stress free, nor should it be. We did not go into medicine to be stress free. At times the field is very taxing, and vacations are a welcome retreat, but the patients are there waiting for you when you return. Sometimes treatment with narcotics can be useful, sometimes a heart to heart talk about their lifestyle and changes that need to be made, sometimes PT, and sometimes putting your arm around their shoulder while they decompensate about their life falling apart is needed. They open up windows into their lives for you so that you can better understand and empathize with their plight, and the horrible devastating effects pain has on their bodies and on their psyche. Claire Tibletti said it best at an ISIS meeting during a speech she gave a few years ago. She said over and over "have mercy on their souls" and that stuck with me throughout the years. I count it among the greatest gifts I could ever receive that I could in a small way be part of the care of the most normal looking downtrodden and beaten people in our society. We may be the only ones that believe them as they seek validation to present to the few people remaining in their lives that they are not completely nuts and really do hurt. Have mercy on their souls....

 

[Ligament]

Well said algos.

The money is very good *right now*. Probably will get worse. I don't find it very stressful, more sad than anything. Nobody is going to die today from their pain...but you do often watch them die slowly over years, kind of giving up on life and hope. But overall I really like it.

We poke fun at the extremes of patient behaviors in our practices, but do not mistake that for lack of dedication or love for what we do.
Chronic pain treatment is the management of symptoms of the disease of chronic pain over time. It involves psychosocial, financial, and functional restoration or maintenance in addition to control of the physically manifested pain. It is as much internal medicine as PMR or anesthesiology. Those going into the field with the mindset of an anesthesiologist (patient presents and after 2 minutes of interview, knock the patient out, the patient recovers, and is never seen again) then they are destined to be profoundly frustrated. Treating chronic pain is much more than standing at the plate hitting homeruns everytime you come up to bat just as you do in OR anesthesia. In treating chronic pain, if you finish with a 0.333 success rate, you are actually doing very well. Chronic pain is the treatment of a chronic disease, and the patients are not expected to be cured anymore than diabetics or cystic fibrosis patients are ever cured.
I find it to be amusing, frustrating, and enormously satisfying at the same time. No, it is not stress free, nor should it be. We did not go into medicine to be stress free. At times the field is very taxing, and vacations are a welcome retreat, but the patients are there waiting for you when you return. Sometimes treatment with narcotics can be useful, sometimes a heart to heart talk about their lifestyle and changes that need to be made, sometimes PT, and sometimes putting your arm around their shoulder while they decompensate about their life falling apart is needed. They open up windows into their lives for you so that you can better understand and empathize with their plight, and the horrible devastating effects pain has on their bodies and on their psyche. Claire Tibletti said it best at an ISIS meeting during a speech she gave a few years ago. She said over and over "have mercy on their souls" and that stuck with me throughout the years. I count it among the greatest gifts I could ever receive that I could in a small way be part of the care of the most normal looking downtrodden and beaten people in our society. We may be the only ones that believe them as they seek validation to present to the few people remaining in their lives that they are not completely nuts and really do hurt. Have mercy on their souls....

 

[Doctodd]

i find it a privilege to be let into other people's lives that i would otherwise never meet or know. Plus there is alot of satisfaction with helping others and in being selfless on this planet. The money is great and im happy to have nice things for me and my family, but making money is a sign that im successful at what i do.

plus everything algos said....;-)

T

 

[drusso]

Algos hit the nail on the head. My version of "have mercy on their souls" is "central sensitization is a bitch."

 

[drrinoo]

Algos says it well, but remember....you cannot cure a patient's perceived failure in life with pain meds....tough love is a far better approach than 'mercy'. The latter risks sanctions against your license.

 

[mille125]

You really need to like what you do or you will die in this field. If the pay was 2 million dollars and you did not enjoy deal with these patients, they would eat at your soul (slowly). There are some failures, some addicted patients, and some noncompliant patients. There are some days that you do not want to go back. However, nothing takes the place of seeing that smile on a patients face who is now pain free after many many years of a long hard road of intractable pain. Even if this state only last for a matter of months they are profoundly thankful. To me one patient like this offsets 100s of addicted or noncompliant patients. If you feel this way, then interventional pain management is definitely for you. I practice in a small medical community (a hundred docs or so). I also get a lot of feedback from referring docs who feel that I am a resource to the community. This is also a good feeling. 60-70% of my referral are from PCP's and I would not have it any other way. It allows me to see many patients at the very beginning of their symptoms (2 week history of pain instead of 20 yr history).

 

[Mister Mxyzptlk]

There are really only two ways to be. You can enjoy providing pain relief or you can be a sociopathic predator. There are plenty of both in this field. The predators make the most money but you have to have zero conscience. The guys who are in between (hooked on the money but hate what they do) are the most unhappy.

One thing you don't get in training is the long-term relationship. I have been amazed at how long it can take to cobble someone back together. There have been patients who have been horrendous problems - not just clinically but a major behavioral PITA at times - and then one day several years later you have the pain under control and depression treated and there is a whole new person there.

I tell people pain management is like golf. You might go out and double-bogey every hole, but then you hit a fantastic sweet shot and decide you'll come back next week. Pain management is like doing that every day.

I have a picture on the wall in the procedure room. It's Tim Allen as Commander Taggert in "Galaxy Quest". I superimposed the show's tag line on it: "Never give up, never surrender".

 

[Mister Mxyzptlk]

It's been 5 hours and 22 patients since I wrote this. I changed my mind. It's all double-bogeys.

 

[PainDr]

I tell people pain management is like golf. You might go out and double-bogey every hole, but then you hit a fantastic sweet shot and decide you'll come back next week. Pain management is like doing that every day.

Probably the best analogy I've ever heard!

It's been 5 hours and 22 patients since I wrote this. I changed my mind. It's all double-bogeys.

"Never give up, never surrender"!

 

[drrinoo]

dr. gorback's apropo descriptors are always useful and become more relevant as one gains more experience in the field.

I actually used a variant of 'cobble together'...I said that pain management is like sculpting....it takes time and patience to get a good relief

as an aside,

has anyone thought about mandating that a patient be nicotine and alcohol free as a criterion for their narcotic drug contracts?

there is a new etoh test (ethyl 3 glucuronide), used by the DOT?, that can detect binge drinking for the past 3-5 days.

it seems reasonable since both nicotine and alcohol are negative prognosticators for successful pain management.

 

[Aether2000]

Cigarette consumption exists in well over 50% of my patient population so it would be a non-starter. I performed a quite indepth study of the NHDUS data a couple of years ago and ran on line statistical analysis with no apparent correlation between prescription drug abuse and nicotine consumption. There is a much stronger correlation between alcohol and nicotine use and also with illicit drug use and nicotine use...

 

[Mister Mxyzptlk]

We're wandering off-topic, but the actual gateway drugs appear to be alcohol and tobacco. Use of those drugs before the age of 17 strongly correlates with adult drug abuse.

Let's face it: alcohol and tobacco meet the definition of a C-1 substance. I think the only reason these drugs are not C-1 is that they already tried it with alcohol and were afraid to try it with tobacco based on what happened during Prohibition. When they passed the CSA in 1970 they exempted alcohol, tobacco, and caffeine.

I doubt nicotine and alcohol would be negotiable in the pain clinic setting, especially tobacco. It's hard to quit, and it's pretty near impossible when you are under stress.

Rinoo, the next time you lay a horrible pun on us like that I think we should vote you off the island.