Pain Management rotation by Psych dept

[chrisv]

Hi, I'm interested in doing a Pain Managment rotation that is offered by the Psychiatry dept. Does anyone know of any such site? Please let me know!

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[notdeadyet]

Hi, I'm interested in doing a Pain Managment rotation that is offered by the Psychiatry dept. Does anyone know of any such site? Please let me know!

Since Pain Management is traditionally the domain of Pain Management/Anesthesia dept's, is there any reason why you're looking for something psych-specific? Are you only interested in the psych components of pain or actually in pain management as a whole?

 

[whopper]

IMHO pain management is something that is not taught well enough. Several PCPs throw opioids at patients without warning them of the possible dangers. It's gotten to the point where several states are developing anti "pill-mill" legislation because there's data showing that this is happening too much.

http://www.dailymail.co.uk/news/art...g-20-years-making-3-8m-painkiller-racket.html

http://www.dispatchpolitics.com/liv...-step-up-pill-mill-fight-in-ohio.html?sid=101

http://www.claytodayonline.com/content/3352_1.php

IMHO, doctors need to pursue non-opioid methods to treat pain, and pain is highly related to anxiety and depression.

Tricyclics, NRIs, seizure medications that reduce pain, lidocaine injections, and psychotherapy to deal with chronic pain should be taught as options. Since many of these are medications that psychiatrists typically use, and given that pain is connected with mental health, I do think there is space for this type of curriculum.

 

[st2205]

Since Pain Management is traditionally the domain of Pain Management/Anesthesia dept's, is there any reason why you're looking for something psych-specific? Are you only interested in the psych components of pain or actually in pain management as a whole?

I don't want to speak for the OP, but one reason that I would (and have) thought of doing a pain medicine rotation is 1. it's not specifically psychiatry and 2. it could count as an audition rotation. What I mean is that, since I know I want to do psych, I want to use my electives on things that will be relevant to my career rather than loading up on psych rotations that I'll get in residency anyway. If the pain elective is run by the psych department it could also count as audition with that program, so you're getting two birds with one stone. That's just my take, though.

 

[loveoforganic]

Several PCPs throw opioids at patients without warning them of the possible dangers. It's gotten to the point where several states are developing anti "pill-mill" legislation because there's data showing that this is happening too much.

Based on the links you posted and what I've previously read of the matter, this seems like a bit of a non sequitur. The practices in question leading to the legislation are far from "uninformed practice" - they're DEA #'ed drug dealers catering to seekers.

I can't comment on normal PCP opioid-prescribing practice

 

[whopper]

I can't comment on normal PCP opioid-prescribing practice

Every single patient I have on an opioid, I've asked the question, did the doctor prescribing this discuss with you the risks and benefits of use of opioids?

Less than 5% of those on it have told me the doctor discussed this with them. The overwhelmning majority told me it usually was a simple matter of "I told them I had pain and he gave me a prescription of percocet, then walked out of the office."

The above is not an exaggeration. The only few patients where they told me the doctor actually discussed the risk/benefits, I asked the patients to give me the name of the doctor, and whenever I have a patient with chronic pain, I'll only refer these patients to the doctor who seems to discussing the risks/benefits.

The following is an article that was from a google news headline.
http://www.latimes.com/health/boostershots/la-heb-internet-drug-abuse-20110513,0,5119985.story

Add painkiller abuse to the list of vices for which the Web can potentially be blamed. A new study finds that admission to treatment facilities for prescription drugs has grown in step, roughly, with the spread of high-speed Internet.

 

[strangeglove]

Every single patient I have on an opioid, I've asked the question, did the doctor prescribing this discuss with you the risks and benefits of use of opioids?

Less than 5% of those on it have told me the doctor discussed this with them. The overwhelmning majority told me it usually was a simple matter of "I told them I had pain and he gave me a prescription of percocet, then walked out of the office."

The above is not an exaggeration. The only few patients where they told me the doctor actually discussed the risk/benefits, I asked the patients to give me the name of the doctor, and whenever I have a patient with chronic pain, I'll only refer these patients to the doctor who seems to discussing the risks/benefits.

The following is an article that was from a google news headline.
http://www.latimes.com/health/boostershots/la-heb-internet-drug-abuse-20110513,0,5119985.story

And then there's this:

http://www.nytimes.com/2011/05/13/technology/13google.html?_r=1&hpw

 

[393656]

I am sorry whopper but your posts above scream of naivity. First off have you ever worked in a pcp clinic? I worked in one for the past year along side IM docs in a busy university clinic for both insured and uninsured people with a HIGH volume of pain patients. These people are ruthless and relentless. Every pcp is aware of the problem and most have explicit pain contracts that the patients break all the time however they do not give up and cause so many issues legally and taking it up the food chain with complaints etc that it is so much grief to the poor doctors. They dont have time to deal with everyones anxiety and such in addition to their pain and other medical problems. They are no different than if you had a borderline patient and only 15 minutes every time to see them. You do your best with what you have and such is life.

Second you are giving patients way too much credit. Patients must pull the wool over your eyes left and right. You ask patients and only 5 percent tell you the "truth"? First off even dedicated non-pain patients who take notes do not remember 10 percent of a conversation in a doctors office. Second if you take opioid addicts or users that usually only have 1 thing on their mind which is keeping the opioid train running, what do you think they are going to tell you being a doctor "Oh ya doc, my pcp told me all the horrible things these do but I keep taking them and do not wanna stop" Of course they play dumb. Hopefully you dont believe all your patients who tell you they dont touch alcohol or drugs too.

Your general posts are a bit too idealistic and naive.

 

[notdeadyet]

First off have you ever worked in a pcp clinic? I worked in one for the past year along side IM docs in a busy university clinic for both insured and uninsured people with a HIGH volume of pain patients. These people are ruthless and relentless.

Yeah, that's been my experience as well. I wonder who these PCPs are that give out rx's for opiates so easily? Older private practice folks who haven't kept up with training maybe?

 

[393656]

If anyone is to blame it is the ED

 

[OldPsychDoc]

We're all to blame.
It takes 30 seconds to say "yes" and 30 minutes to say "no".


Had a 30-some year old mom come in today wanting to up her ativan because "it's just not working". I reluctantly agreed to try it last month because she "just couldn't function". It was a 5 pm add-on appointment, I still have 16 notes to write, and I have 4 kids having to be 5 different places when I get home...

OK--so it's not working, so you want more? Oh, and by the way, I heard you drove your car off the road last week--what's up with that? Yeah--I got home late, but no--she's done with benzos from me. My RN won't be happy next week, though, when I'm on vacation and she's answering the desperate phone calls.

 

[Sneezing]

I know its a little late to respond to this thread but here it is anyways.

Look for programs that have Chronic Pain REHABILITATION Programs. I remember Cleveland Clinic and Mayo Clinic have one and I think there are a few others out there, too. I remember they emphasize the mental health component of pain.

 

[strangeglove]

A number of Addiction Psychiatry fellowships include rotations in a pain clinic.

 

[nitemagi]

There's also specific pain fellowships that accept psychiatrists (sad that it's not all, since psychiatry started the damn field).

 

[MDchouette]

I believe Johns Hopkins has an inpatient pain service on one of its psych floors. I think there's a partial, too.

Here's a link to a program description:

http://www.hopkinsmedicine.org/psychiatry/specialty_areas/pain/

 

[Isles7]

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