Do you guys have any clinics in town like we have here - They have fancy-sounding names, often including "Pain Management" or "Rehabilitation" in their name, advertising in the yellow pages as an MD clinic, when in reality, the MD is little more than a figurehead who sees the patients so that the treatment-go-round has a better chance of getting covered by insurance? Usually, the patient's see the MD once, and then eveyone gets the same Rx for their neck or back pain - Chirproactic treatment 5x/wk x 6-8 weeks, then 3x/wk x 8-12 weeks, and slowly weaning from there, with daily multi-level adjustments, + 5-6 units of PT (usually Hot pack + US + massage + Estim + 1 or 2 units of therapeutic exercise) with a licensed PT, plus the daily "Stretchy Machine." (I.e. some computerized form of traction such as the Vax-D). I think we have at least 4 or 5 of these clinics in the area. Whenever I drive past them, parking lots are always full. I frequently see their failures, but at least one of the clinics advertises on TV with the MD stating they have an "86% success rate." Often, by the time they see me, their yearly PT benefits are exhausted, their yearly out-of-pocket maximum is maxxed and they still hurt. When I get copies of their records, they're filled with dozens of impossible to understand tests, with wonderful impressions like "Right L1 radiculopathy, Right L2 radiculopathy, Right and Left L4 radiculopathy, Right and Left L5 radiculopathy, Left S1 radiculopathyand Right S3 radiculopathy." They get all these tests done at least weekly. I imagine the billed costs must be in the nature of $5000 - $10,000 per week. Notes are either all handwritten and illegible, or so computerized and standardized that every day on every patient reads the same. Most seem to avoid opioids, thank god. I used to be near one in my old practice that had a similar clinic nearby that did all the above + added in vicodensomaxanax for everyone, then when their benefits were exhausted, dumped them to me.