Oregon Pain Management health commission

[DrCommonSense]

Oregon Health Authority : Pain Management Commission Members : Oregon Pain Management Commission : State of Oregon

Now I can see how Oregon arrived at its whacky conclusions consisting of moo shoo medical management for "pain".

The board literally consists of mostly quacks from Chiros to "natural healers" to social workers.

Never seen a bigger clown show than this crew making "decisions".

There is literally one pain physician/PMR that was hired largely due to his hostile stance towards traditional pain management whereby he could put his stamp of approval on moo shoo medical care. Incidentally, that physician's patient ratings are the worst I have ever seen at 1.3 out of 4 of any physician I have seen online.

Maybe I should open up a Reiki establishment whereby they can smoke hashish all day to take care of their pain?

---

Members don't see this ad.

 

[lobelsteve]

I think that doc is trying to do his best but gotten beat down hard by being in the wrong place/wrong time. Repeatedly. Pity him. Im pretty sure he is trying harm reduction because of the terrible care performed around him.

 

[DrCommonSense]

I think that doc is trying to do his best but gotten beat down hard by being in the wrong place/wrong time. Repeatedly. Pity him. Im pretty sure he is trying harm reduction because of the terrible care performed around him.

I don't consider a dude that rubber stamps moo shoo witchcraft type "medicine" and is on a "commission" filled with "natural healers, chiropractors, social workers, etc" without any real pain docs or even PMR physicians to be anything but a joke to the medical profession and probably got some kind of payoff somewhere.

I suspect his scam is to take money from some governmental group in Oregon coupled with starting a new "pain program" that charges tens of thousands of dollars to do Reiki, Thai Chi, massage, a few counseling sessions and possibly another round of PT.

How is this garbage better than "injection pimps" he preaches against? In fact the costs of the above "pain" program are usually 10X that of the "injection pimps" in the equivalent period of time with zero efficacy evidence or patient satisfaction scores.

Read the patient reviews online and they strongly point towards that type of "pain program". Charge big bucks and then discharge after a few Reiki sessions and counselor visits claiming their problem has been fixed.

Its one thing to pretend to be "evidence based" then turn around and push quackery while disparaging others.

That is why I am very curious to determine his pain protocol.

 

[Ducttape]

I find it hard to accept the various assumptions you made about an individual you don't know at all or the disparaging comments you made about him. For your information, Paul is/was one of us, and he did interventional pain and traditional pain practice.

He was one of the first on this board to point out that opioids don't help.

For all your bluster, I do not see needle jockeys or block shops curing the chronic pain problem in the US.


Sent from my iPhone using SDN mobile

 

[clubdeac]

Paul's a good guy....we emailed back and forth about some stuff and he's a good person at heart. Everyone quit hatin

 

[DrCommonSense]

I find it hard to accept the various assumptions you made about an individual you don't know at all or the disparaging comments you made about him. For your information, Paul is/was one of us, and he did interventional pain and traditional pain practice.

He was one of the first on this board to point out that opioids don't help.

For all your bluster, I do not see needle jockeys or block shops curing the chronic pain problem in the US.


Sent from my iPhone using SDN mobile

You might find it "hard" but its all factual. He might HAVE been one of "us" but has changed over to moo shoo medicine that he claims is highly effective compared to traditional. Interestingly, his patient reviews don't reflect this reality though despite his persistence that he has some winning solution and everyone else is an "injection" pimp or "opioid" pimp. Lets not forget his descriptions of his fellow pain practitioners wasn't particularly flattering whereby he was ultimately claiming they are largely immoral people who are financially abusing their patients.

Surely for such a virtuous and integrity filled man, he wouldn't mind the spotlight shined the other way to determine his integrity right?

Once again, the question that occurs is how does he get paid to do his "alternative" treatment paradigm? I promise you the dude doesn't work for free. What does he offer his patients and how much does his model cost compared to the traditional methods?

From my experience with this stuff, short term moo shoo medical programs often cost in the 10s of thousands and then the patients are discharged as "magically" fixed.

Moo shoo practitioners usually repeat PT programs that have ALREADY been done by patients and couple them with some Reiki/Thai Chi for 10s of thousands of dollars while taking patients off all meds. Patients are deemed "fixed" at the end of these "programs" and dumped back onto the PCPs.

This stuff is WORSE than accusations made against "injection pimps" by that poster.


On the opioid front, like has been stated BEFORE in other posts, NO medication has been PROVEN to work for >3 months duration for pain including NSAIDs, anticonvulsants, etc. NSAIDs literally kill 10s of thousands per year as well. Lyrica has HORRENDOUS side effects in many patients.

I dont recall anyone saying opioids are the be all/end all medication either but they have their own place in the paradigm considering the dearth of evidence for ANY other medication coupled with side effect profiles.


P.S. His patient reviews claim that he does moo shoo medicine at VERY high prices and dumps the patients back off on the PCPs without helping them. It can't be a coincidence when its many people saying the same thing. So knowing his "business" model would be very helpful to determine his integrity.

 

[DrCommonSense]

Paul's a good guy....we emailed back and forth about some stuff and he's a good person at heart. Everyone quit hatin

Doesn't negate the above opinion that the only practitioner on that "commission" largely doesn't practice pain management but some kind of alternative moo soo quackery and gave credence to various other quacks that made up that group.

Also, it doesn't negate the questions about how he models his business. How does he make his money and what does it cost the patients?

Considering his very urgent concern about the costs of his fellow "injection pimp" doctors, surely he wouldn't be concerned about telling us how he charges his patients and how he takes care of them long term with high levels of success and minimal cost right?

Also, after charging his patients a very pretty penny and taking them off all opioids, does he continue to manage them long term? How much does he charge for this treatment protocol and how does he manage them?

 

[Ducttape]

I cannot speak for his practice, but on these threads, when it has been pointed out that he does continue to prescribe opioids, he does not lie or defer.

and you know about medical billing. or you should. alternative therapies and CBT and pain psychology do not pay the bills or generate the large amounts of money that procedures do. there is a reason that multidisciplinary pain clinics have an almost impossible time staying open and in business, even though that model is the most appropriate for chronic pain patients.

 

[DrCommonSense]

I cannot speak for his practice, but on these threads, when it has been pointed out that he does continue to prescribe opioids, he does not lie or defer.

and you know about medical billing. or you should. alternative therapies and CBT and pain psychology do not pay the bills or generate the large amounts of money that procedures do. there is a reason that multidisciplinary pain clinics have an almost impossible time staying open and in business, even though that model is the most appropriate for chronic pain patients.

There are MANY "multidisciplinary" pain programs that are only a few months in duration charge a LARGE amount of money for moo shoo medicine and repeated PT sessions.

According to his online reviews, this appears to be his business model.

Does he only charge an office visit level 3 every 3 months as his only income source for patients? Somehow I doubt it.

It is ENTIRELY appropriate to question his business model considering his constant disparaging statements about other's "ethics".

 

[SSdoc33]

There are MANY "multidisciplinary" pain programs that are only a few months in duration charge a LARGE amount of money for moo shoo medicine and repeated PT sessions.

According to his online reviews, this appears to be his business model.

Does he only charge an office visit level 3 every 3 months as his only income source for patients? Somehow I doubt it.

It is ENTIRELY appropriate to question his business model considering his constant disparaging statements about other's "ethics".

it is entirely INappropriate to rely on anonymous online reviews to bolster your point.

it appears as though the majority of his patients were train-wreck opioid dumps that he tried to get off the sauce. of course his online reviews will be poor.


lets take a step back, here. im assuming you don't live in oregon. why are you taking the time and anger to call out somebody you don't even know for working on guidelines which dont even affect you?

 

[Ligament]

He's not here to defend himself and I do agree with SSdoc33 that using online reviews is entirely worthless. I also do not think anybody on this forum should be exposing the real names of members who wish to remain anonymous.

 

[NJPAIN]

Don't know him personally; however, we trained in the same institution (albeit mine though anesthesiology and his through PM&R) only a few years apart. Many of the same people trained us. These were some REALLY good people with unpopular opinions regarding both opioids and interventions that I think in the long term proved to be correct for many (not all) hardcore chronic pain patients. His outlook is very much true to his roots and I commend him for that and for sticking to his guns despite the mud thrown in his direction. I wish him well and hope he makes a difference for the people of Oregon.

 

[lobelsteve]

He's not here to defend himself and I do agree with SSdoc33 that using online reviews is entirely worthless. I also do not think anybody on this forum should be exposing the real names of members who wish to remain anonymous.

Agree. Hope no one guesses my name. I'd be ruined.

 

[NJPAIN]

Agree. Hope no one guesses my name. I'd be ruined.

Too late Portenoy

 

[drusso]

For whatever it's worth: I've been around here a long time (ie since The Beginning). People have different preferences for their degree of transparency versus anonymity. That should be respected. Freedom of speech should be respected too. I have concerns about professionalism when attacks turn personal. It doesn't really matter, "who started it first." Keep the decorum professional. Not everyone is a total *****, pimp, drug-dealer, tool, @sshat, idiot, quack, sellout. Most of us are just a little of all of these things...

You may now return to your regularly scheduled **** show...

 

[lobelsteve]

For whatever it's worth: I've been around here a long time (ie since The Beginning). People have different preferences for their degree of transparency versus anonymity. That should be respected. Freedom of speech should be respected too. I have concerns about professionalism when attacks turn personal. It doesn't really matter, "who started it first." Keep the decorum professional. Not everyone is a total *****, pimp, drug-dealer, tool, @sshat, idiot, quack, sellout. Most of us are just a little of all of these things...

You may now return to your regularly scheduled **** show...

Dr. Usso. Darn you.....

 

[drusso]

Dr. Usso. Darn you.....

yep...this guy...

DR. Usso (@DrUssoMD) | Twitter

 

[DrCommonSense]

He's not here to defend himself and I do agree with SSdoc33 that using online reviews is entirely worthless. I also do not think anybody on this forum should be exposing the real names of members who wish to remain anonymous.

I never "exposed" anyone. Someone claimed it was him.

I only posted about the Oregon commission.

 

[DrCommonSense]

it is entirely INappropriate to rely on anonymous online reviews to bolster your point.

it appears as though the majority of his patients were train-wreck opioid dumps that he tried to get off the sauce. of course his online reviews will be poor.


lets take a step back, here. im assuming you don't live in oregon. why are you taking the time and anger to call out somebody you don't even know for working on guidelines which dont even affect you?

The dude has been posting that anyone who practices traditional IPM is basically an "opioid" or "needle jockey" pimp.

Ergo, its not like he has been above "name calling".

However, when it goes back in the other direction, I find it amusing that he can't handle the heat and all the snowflakes come out of the woodwork in defense. Now we are can only speak "nicely" huh?

Where were the snowflakes when he was calling people opioid or need pimps?

Oregon "matters" considering the overtly hostile tone the moo shoo practitioners take towards traditional IPM physicians with bogus "evidence based medicine" on their own.

Its not like moo shoo boys are offering anything with evidence to counter.

 

[DrCommonSense]

Don't know him personally; however, we trained in the same institution (albeit mine though anesthesiology and his through PM&R) only a few years apart. Many of the same people trained us. These were some REALLY good people with unpopular opinions regarding both opioids and interventions that I think in the long term proved to be correct for many (not all) hardcore chronic pain patients. His outlook is very much true to his roots and I commend him for that and for sticking to his guns despite the mud thrown in his direction. I wish him well and hope he makes a difference for the people of Oregon.

Its easy to throw stones at others but I find it disgraceful that he offers cover for moo shoo "medicine" while bashing others on FAR WORSE scientific evidence for his junk.

Furthermore, I find it laughable if he charges top dollar for the moo shoo medicine as well.

Attacking opioids is FAR from being "unpopular" these days despite NSAIDS killing more people than legally prescribed opioids. Go back and read my posts.

 

[DrCommonSense]

I cannot speak for his practice, but on these threads, when it has been pointed out that he does continue to prescribe opioids, he does not lie or defer.

and you know about medical billing. or you should. alternative therapies and CBT and pain psychology do not pay the bills or generate the large amounts of money that procedures do. there is a reason that multidisciplinary pain clinics have an almost impossible time staying open and in business, even though that model is the most appropriate for chronic pain patients.

Also, you are making that assumption they are all opioid people.

Many are complaining about him charging top dollar for moo shoo medicine without mentioning opioids and being pissed that it wasn't helping whereby he would condescendingly talk to them.

What evidence do you have that his moo shoo medicine has any efficacy or quality studies to back up his "evidence based" claims?

 

[lonelobo]

Take a Xanax....

 

[NJPAIN]

Glad I'm a snowflake. I could have been a Q-tip.

 

[BobBarker]

Dude. You sound like Trump. Repeating the same thing over and over doesn't help your argument.

 

[lobelsteve]

Dude. You sound like Trump. Repeating the same thing over and over doesn't help your argument.

Trump never had as many coherent thoughts.
Hail to the chief.

 

[DrCommonSense]

Dude. You sound like Trump. Repeating the same thing over and over doesn't help your argument.

I say the same thing that is accurate and has yet to be refuted over and over.

Trump is usually right about the media bias too though.

 

[DrCommonSense]

Glad I'm a snowflake. I could have been a Q-tip.

Liberal snowflakes are always up in arms when someone speaks to them like they speak towards others.

Kind've sucks huh?

 

[SSdoc33]

Liberal snowflakes are always up in arms when someone speaks to them like they speak towards others.

Kind've sucks huh?

if you want to pick a fight for no reason at all, just find a boxing gym and spar with the biggest dude there.

your points are valid, but why be such _______ (insert derogatory noun) about it?

come back when you learn how to be civil.

 

[Ducttape]

I say the same thing that is accurate and has yet to be refuted over and over.

Trump is usually right about the media bias too though.

What you are spewing is more consistent with this quote misattributed to Einstein:
"The definition of insanity is doing the same thing over and over again and expecting different results."


Sent from my iPhone using SDN mobile

 

[Ducttape]

To close the loop, I will make one last (lengthy) comment.

In my opinion, the Hippocratic Oath remains supreme. We are to do no harm.

With regards to opioids and using them for subjective symptoms of chronic nonmalignant pain, it is irrefutable that opioids are harmful, much more harmful than PT, CBT, HEP, or most procedural interventions. Opioids are more dangerous than any other class of meds outside of NSAIDs.

In my experience and with the available information out there, the risks of opioids do not (*) outweigh the benefits of these medications for chronic nonmalignant pain.

(*) = typo struck out
Sent from my iPhone using SDN mobile

 

[DrCommonSense]

To close the loop, I will make one last (lengthy) comment.

In my opinion, the Hippocratic Oath remains supreme. We are to do no harm.

With regards to opioids and using them for subjective symptoms of chronic nonmalignant pain, it is irrefutable that opioids are harmful, much more harmful than PT, CBT, HEP, or most procedural interventions. Opioids are more dangerous than any other class of meds outside of NSAIDs.

In my experience and with the available information out there, the risks of opioids do not outweigh the benefits of these medications for chronic nonmalignant pain.


Sent from my iPhone using SDN mobile

Yet I don't see any major "NSAID" crisis being mentioned right? Considering legal NSAIDS kill more people than legal opioids, why don't we have a CDC guideline on strongly eleminating these medications?

We haven't counted all the deaths from Lyrica or Cymbalta due to increased chances of suicidal ideation, increased drowsiness increasing car accidents (particularly when mixed with benzos and other meds), etc. If we counted all the "deaths" of any patient that died of suicidal ideation that were taking these meds or died operating cars while mixing it with other medications, you'd be surprised the number of deaths that could be attributed to these medications.

"In my experience and with the available information out there, the risks of opioids do not outweigh the benefits of these medications for chronic nonmalignant pain"

Sounds like you're a fan of opioids now huh since the risks dont outweight the benefits lol

 

[DrCommonSense]

if you want to pick a fight for no reason at all, just find a boxing gym and spar with the biggest dude there.

your points are valid, but why be such _______ (insert derogatory noun) about it?

come back when you learn how to be civil.

You don't like it when I cast nasty assertions towards 101N when that dude made it a HABIT of calling anyone he disagreed with an opioid pimp or needle pimp?

Why are the snowflakes who dish it out are so fragile in taking it back?

If the dude approached the discussions in a civil manner that didn't cast negative assertions towards others characters that practice IPM, then your argument that we should be "nicer" would be more valid. However, that guy wasn't particularly "nice" when describing doctors who practiced in a manner he disagreed with.

Kind've hard being "nice" towards a guy that made a habit of literally calling IPM practitioners crooks and criminals.

Ergo, whats good for the goose is good for the gander.

 

[SSdoc33]

You don't like it when I cast nasty assertions towards 101N when that dude made it a HABIT of calling anyone he disagreed with an opioid pimp or needle pimp?

Why are the snowflakes who dish it out are so fragile in taking it back?

If the dude approached the discussions in a civil manner that didn't cast negative assertions towards others characters that practice IPM, then your argument that we should be "nicer" would be more valid. However, that guy wasn't particularly "nice" when describing doctors who practiced in a manner he disagreed with.

Kind've hard being "nice" towards a guy that made a habit of literally calling IPM practitioners crooks and criminals.

Ergo, whats good for the goose is good for the gander.

101n hasnt made a post here in 6 months or so.

and when he did, they didnt include ad hominem attacks.

everyone i entitled to their opinions regarding the best way to help our patients. but, that opinion needs to be expressed in a non-offensive way. there is a reason stim4u/stim4me got banned twice. dont tread down that path. be a decent person -- be a decent colleague and people may actually listen to your arguments and try to digest them, rather than summarily ignoring them because of their source.

 

[Ducttape]

Sounds like you're a fan of opioids now huh since the risks dont outweight the benefits lol

1. that was my typo. sorry, I corrected it in the original post.

2. in terms of your point about NSAID or antidepressants - straw man. a diversionary distracting argument that has no bearing to the cdc guidelines regarding opioids.


3. I don't like you making aversions to someone who is not around to defend himself, who contributed to this board in significant ways, and using the most paltry and demeaning "facts" - by pointing out their patient satisfaction scores. big man, able to talk about someone behind their proverbial back, eh? even worse, on the internet behind an alias. reminds me of one of my high school bullies growing up.

we all know those satisfaction scores are inversely proportional to the quality of care they provide when it comes to pain.

let me remind you - candymen get great satisfaction scores. they also kill people with their careless medical care.

(I would take you to task if you bad mouthed stim, too, even though I disagreed with him 50 70 99 % of the time.

 

[SeniorWrangler]

Agree. Hope no one guesses my name. I'd be ruined.

Isn't your real name Marshall Mathers?

 

[DrCommonSense]

101n hasnt made a post here in 6 months or so.

and when he did, they didnt include ad hominem attacks.

everyone i entitled to their opinions regarding the best way to help our patients. but, that opinion needs to be expressed in a non-offensive way. there is a reason stim4u/stim4me got banned twice. dont tread down that path. be a decent person -- be a decent colleague and people may actually listen to your arguments and try to digest them, rather than summarily ignoring them because of their source.

You dont think calling pain docs "opioid pimp" or "needle jockey" an ad hom attack?

Maybe you should go back to read his comments then champ.

Why should I speak more respectfully towards a physician that literally called his colleagues "opioid" pimps or "procedure pimps" or some other nonsense pretending he is some kind of saint compared to his evil colleagues while selling snake oil/moo shoo medicine for HUGE profits?

Also, my "ad hom" attacks are VERY mild comparative towards his statements towads his fellow docs.

 

[DrCommonSense]

1. that was my typo. sorry, I corrected it in the original post.

2. in terms of your point about NSAID or antidepressants - straw man. a diversionary distracting argument that has no bearing to the cdc guidelines regarding opioids.


3. I don't like you making aversions to someone who is not around to defend himself, who contributed to this board in significant ways, and using the most paltry and demeaning "facts" - by pointing out their patient satisfaction scores. big man, able to talk about someone behind their proverbial back, eh? even worse, on the internet behind an alias. reminds me of one of my high school bullies growing up.

we all know those satisfaction scores are inversely proportional to the quality of care they provide when it comes to pain.

let me remind you - candymen get great satisfaction scores. they also kill people with their careless medical care.

(I would take you to task if you bad mouthed stim, too, even though I disagreed with him 50 70 99 % of the time.

1) Okay I noticed that

2) its not a "strawman" when they are offering them as ALTERNATIVE treatment options for patients in AHRQ documents with ZERO evidence.

3) If patient satisfaction is TOTALLY irrelevant towards being a physician when determining pain/functional benefit, then what do we use to tell if he is doing a good job?

Surely, if his moo shoo medicine worked so well, there would be TONS of positive reviews as well claiming that their 30 grand they dropped for yoga, thai chi, etc was a miracle cure for them.

You can't have it both ways. When you do "studies" on patients, the usually have some kind of pain/functional metric that is used to determine efficacy.

Moo shoo practitioners or "evidence based" moo shoo supporters will consistently harp on about "clinical significance" of pain/functional benefit in "long term studies" when scrutinizing traditional pain docs while simultaneously ignoring these metrics for themselves/moo shoo treatments?

Yet now we dont care about patient's pain/functional/satisfaction scores when it comes to moo shoo medicine because he is lighter on opioids? How can we determine if his moo shooo medicine is worth the ridiculously high charges he uses for his patients?

 

[lobelsteve]

You dont think calling pain docs "opioid pimp" or "needle jockey" an ad hom attack?

We are opiate pimps and needle jockeys. It is in the "Journal"
Lighten up, Francis.

The Physiatrist Newsletter

 

[Arch Guillotti]

Keep it professional or the thread will be closed. Thanks!