Pain versus cardiac fellowship?

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AKMD_1984 said:
Watched it at 1.5 speed
Guy takes his time and talks very slow
Interesting that he pushes a plant based diet for spinal disorders and microcirculation
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He has a later video where he explains that he may have been talking slowly because he was baked in his earlier videos 😂. Says he has since stopped using marijuana but he still likes plants and still talks slowly.
 
nimbus said:
He has a later video where he explains that he may have been talking slowly because he was baked in his earlier videos 😂. Says he has since stopped using marijuana but he still likes plants and still talks slowly.
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I wonder when his neurosurgeon backed positive vibes weed company will roll out?
 
abolt18 said:
I am yet to see a C-section that didn't result in a baby being delivered! (Not talking about collateral damage here)
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I mean honestly

Even 70% pain relief with a certain therapy is an over reach

It’s more like 30% injection
30% PT
30% mood control
10% meds

You combine all of them you’ll get somewhere with a patient long term

But in my experience injections and procedures itself is not the answer
 
nimbus said:
He has a later video where he explains that he may have been talking slowly because he was baked in his earlier videos 😂. Says he has since stopped using marijuana but he still likes plants and still talks slowly.
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I tried plant based diet for 6 weeks. It wasn’t for me. I never felt full…
 
sevo00 said:
Appendectomy cures appendicitis 100% of the time
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Here comes double o sevo with some more timeless wisdom.

Yea cures appendicitis but often can lead to peritonitis. Can rarely lead to air embolism, bowel ischemia, etc etc. I have personally treated ilioinguinal/genitofemoral neuralgia/CRPS caused by a trochar going through these nerves.

How often does a neurosurgeon do a fusion and the patient is in pain for the rest of their life? Would you call that 100% successful?
 
TeslaCoil said:
Here comes double o sevo with some more timeless wisdom.

Yea cures appendicitis but often can lead to peritonitis. Can rarely lead to air embolism, bowel ischemia, etc etc. I have personally treated ilioinguinal/genitofemoral neuralgia/CRPS caused by a trochar going through these nerves.

How often does a neurosurgeon do a fusion and the patient is in pain for the rest of their life? Would you call that 100% successful?
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Pain is a sham field. Sorry
 
sevo00 said:
Pain is a sham field. Sorry
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I see your point.

But I won’t necessarily call it a sham field. I would say that it’s fantasy to think that we will inject and do procedures and cure patients. Unfortunately many pain docs think that.

For every “working stimulator”, I see three “used to work but it doesn’t work anymore and I no longer want injections or surgery. I’m tired, frustrated, getting fat- please help me”.

That’s chronic pain for you.

Certain aspects of pain mgt are necessary - like palliative care, acute pain mgt, cancer pain mgt, med mgt of patients on dual anti platelets and managing legitimate painful conditions like RA, ankylosing spondylitis etc. I think it’s rewarding. And it’s something you never experience in anesthesia. My office was showered with Christmas gifts and cards in December.

You never get that as an anesthesiologist and in fact more and more we are being viewed as replaceable cogs (the only thing that’s saving us is volume of surgeries and labor shortage currently). Feeling appreciated and a known irreplaceable entity is a pleasant change.

But when I go on linked-in and see every other “pain doc” posting there fluoro pictures where the needle is no where near the target I really wonder what they’re doing.

I don’t know.

I really battle with why I even did a fellowship after a decade in practice.

Anesthesia currently offers tremendous compensation, flexibility, ability to travel and design your own schedule and walk away when work is done. Very few jobs offer that.

And I guess that’s why this thread is here. These discussions are good.
 
sevo00 said:
Pain is a sham field. Sorry
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You’re truly not very intelligent judging by these comments. Sorry. Heres a link to a text that Ive read cover to cover several times. You wont read it, but if you even took a look in it, you will find out very quickly that pain management is not a sham field. The literature is there. Is it curative? No. Many of these conditions have no cure. We provide what relief we can and help restore quality of life by multimodal means. Thats real, modern pain management. Calling it a sham field is very revealing, once again, of how ignorant you are. Are radio-frequency ablations a sham? Cancer pain management? Intrathecal pumps? Managing peoples CRPS? I think you should be a little more specific than “pain is a sham field”, to avoid making yourself look like an ignoramus.

I invite you to come to my clinic and speak to my patients. You can ask them if they think its a sham.

Heres the link: Amazon.com
 
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AKMD_1984 said:
I see your point.

But I won’t necessarily call it a sham field. I would say that it’s fantasy to think that we will inject and do procedures and cure patients. Unfortunately many pain docs think that.

For every “working stimulator”, I see three “used to work but it doesn’t work anymore and I no longer want injections or surgery. I’m tired, frustrated, getting fat- please help me”.

That’s chronic pain for you.

Certain aspects of pain mgt are necessary - like palliative care, acute pain mgt, cancer pain mgt, med mgt of patients on dual anti platelets and managing legitimate painful conditions like RA, ankylosing spondylitis etc. I think it’s rewarding. And it’s something you never experience in anesthesia. My office was showered with Christmas gifts and cards in December.

You never get that as an anesthesiologist and in fact more and more we are being viewed as replaceable cogs (the only thing that’s saving us is volume of surgeries and labor shortage currently). Feeling appreciated and a known irreplaceable entity is a pleasant change.

But when I go on linked-in and see every other “pain doc” posting there fluoro pictures where the needle is no where near the target I really wonder what they’re doing.

I don’t know.

I really battle with why I even did a fellowship after a decade in practice.

Anesthesia currently offers tremendous compensation, flexibility, ability to travel and design your own schedule and walk away when work is done. Very few jobs offer that.

And I guess that’s why this thread is here. These discussions are good.
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I have a problem with your response. YOU are a pain doctor? What point do you see of his? There is nothing “sham” about pain medicine if practiced correctly. If you are placing stimulators for axial back pain, then yea, you’re a sham. If you’re giving out steroids and steroid injections like candy to rake in the cash, yea. Quack. Loading people up with 500+ MME’s per day of opiate? Criminal. If you understand multimodal pain management and actually apply it, you will achieve results and change patients lives. Dont agree with that *******. Even remotely. Of course its not curative. Thats not the point.
 
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TeslaCoil said:
I have a problem with your response. YOU are a pain doctor? What point do you see of his? There is nothing “sham” about pain medicine if practiced correctly. If you are placing stimulators for axial back pain, then yea, you’re a sham. If you’re giving out steroids and steroid injections like candy to rake in the cash, yea. Quack. Loading people up with 500+ MME’s per day of opiate? Criminal. If you understand multimodal pain management and actually apply it, you will achieve results and change patients lives. Dont agree with that *******. Even remotely. Of course its not curative. Thats not the point.
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Hey man. Easy there.
I don’t do any of these and I find your approach and content of posts quite repulsive, uneducated and purposely dishonest as you are not familiar with how I practice.

You refuse to acknowledge the limited efficacy of pain procedures. I don’t. I don’t take it personally because it is what it is - it seems that you do. So I treat them as such.
Perhaps injecting everyone is the only way you earn an income. I don’t know. If so, that’s sad.

Let’s get one thing right mister: I personally don’t care if “you” have a problem with my response.
You can take your problem and shove it somewhere. Makes no difference to me.

I answer to TMB, DEA and my patients
And community physicians.

FYI

My max opioid limit for chronic non malignant pain is 50. I don’t rx anything besides tramadol and hydro codone for that. No one gets meds on first visit without an evaluation and records review. I do surprise visits and pill counts along with uds for patients on opioids.

I’d be more than happy to forward you my letter to Texas Medical Board when I applied for starting a pain clinic. They ask for protocols, approach, credentials before registering one. So I’ll leave it at that.

I believe I did mention that only way to manage pain patients is multimodal and multidisciplinary pain Mgt. Look 4 posts above. Read first before responding.

And no I don’t believe that stimulators are without headache. They absolutely are. Data suggests it. They are not equivalent in efficacy of pacemaker and AICD that have a defined and specific function for cardiac pathology. Unfortunately pain physicians portray scs as that that’s it’s for spine, to convince the patients but chronic lbp from fsbs or refractory radicular pain as you should know is typically multi factorial. Yes they’re great for crps or even Diabetic neuropathy but not every patient. And you’d be lying to yourself if you think that part of it is not industry driven.

I don’t do any stims for axial lbp.
I don’t do implants. I stick to bread and butter interventional Procedures only.

How about you stay in your lane and I’ll stay in mine. And let studies, research, data guide our management specific to that particular patient. Thanks
 
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TeslaCoil said:
Here comes double o sevo with some more timeless wisdom.

Yea cures appendicitis but often can lead to peritonitis. Can rarely lead to air embolism, bowel ischemia, etc etc. I have personally treated ilioinguinal/genitofemoral neuralgia/CRPS caused by a trochar going through these nerves.

How often does a neurosurgeon do a fusion and the patient is in pain for the rest of their life? Would you call that 100% successful?
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That’s irrelevant and tangential.

Seriously, you’re comparing the need to remove an appendix for hot appy with scs???

One is urgent/emergent and curative surgery with minimal risks and other is country specific and industry driven elective treatment of pain?!? Trochar through II and GF nerves and persistent neuropathic pain is not the same as failed scs that never should have been placed.

Comparing scs to pacemakers and aicd would be more reasonable and accurate. Compare the efficacy, usefulness of aicd/pm vs scs. I don’t see unhappy patients with aicd/ pm. Do you? Why is that?
 
TeslaCoil said:
You’re truly not very intelligent judging by these comments. Sorry. Heres a link to a text that Ive read cover to cover several times. You wont read it, but if you even took a look in it, you will find out very quickly that pain management is not a sham field. The literature is there. Is it curative? No. Many of these conditions have no cure. We provide what relief we can and help restore quality of life by multimodal means. Thats real, modern pain management. Calling it a sham field is very revealing, once again, of how ignorant you are. Are radio-frequency ablations a sham? Cancer pain management? Intrathecal pumps? Managing peoples CRPS? I think you should be a little more specific than “pain is a sham field”, to avoid making yourself look like an ignoramus.

I invite you to come to my clinic and speak to my patients. You can ask them if they think its a sham.

Heres the link: Amazon.com
Click to expand...

I ain’t reading all that. You’re a snakeoil salesman and nothing more. When you go to bed at night just remember you bring zero value to society.
 
AKMD_1984 said:
Hey man. Easy there.
I don’t do any of these and I find your approach and content of posts quite repulsive, uneducated and purposely dishonest as you are not familiar with how I practice.

You refuse to acknowledge the limited efficacy of pain procedures. I don’t. I don’t take it personally because it is what it is - it seems that you do. So I treat them as such.
Perhaps injecting everyone is the only way you earn an income. I don’t know. If so, that’s sad.

Let’s get one thing right mister: I personally don’t care if “you” have a problem with my response.
You can take your problem and shove it somewhere. Makes no difference to me.

I answer to TMB, DEA and my patients
And community physicians.

FYI

My max opioid limit for chronic non malignant pain is 50. I don’t rx anything besides tramadol and hydro codone for that. No one gets meds on first visit without an evaluation and records review. I do surprise visits and pill counts along with uds for patients on opioids.

I’d be more than happy to forward you my letter to Texas Medical Board when I applied for starting a pain clinic. They ask for protocols, approach, credentials before registering one. So I’ll leave it at that.

I believe I did mention that only way to manage pain patients is multimodal and multidisciplinary pain Mgt. Look 4 posts above. Read first before responding.

And no I don’t believe that stimulators are without headache. They absolutely are. Data suggests it. They are not equivalent in efficacy of pacemaker and AICD that have a defined and specific function for cardiac pathology. Unfortunately pain physicians portray scs as that that’s it’s for spine, to convince the patients but chronic lbp from fsbs or refractory radicular pain as you should know is typically multi factorial. Yes they’re great for crps or even Diabetic neuropathy but not every patient. And you’d be lying to yourself if you think that part of it is not industry driven.

I don’t do any stims for axial lbp.
I don’t do implants. I stick to bread and butter interventional Procedures only.

How about you stay in your lane and I’ll stay in mine. And let studies, research, data guide our management specific to that particular patient. Thanks
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And I dont give a damn what you find. You’re lending absolutely too much credit to this imbeciles nonsense. Hes calling us snake oil salesmen. You’re making it seem as though there is hardly any efficacy at all to stim and the other procedures we do. Thats not true at all. And Im not gonna sit here and agree with you. Do I agree that some patients lose efficacy, yes. In my clinic its probably in the 25% range. Most of my patients do very well. Maybe you’re doing something wrong? I have several patients on their second battery, who claim they wouldn't want to live without one.

This is my lane buddy. You keep lending credence to these claims that you’re a snake oil salesman. And I’ll keep defending how much value we can actually bring.
 
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AKMD_1984 said:
That’s irrelevant and tangential.

Seriously, you’re comparing the need to remove an appendix for hot appy with scs???

One is urgent/emergent and curative surgery with minimal risks and other is country specific and industry driven elective treatment of pain?!? Trochar through II and GF nerves and persistent neuropathic pain is not the same as failed scs that never should have been placed.

Comparing scs to pacemakers and aicd would be more reasonable and accurate. Compare the efficacy, usefulness of aicd/pm vs scs. I don’t see unhappy patients with aicd/ pm. Do you? Why is that?
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I didnt compare anything. Your pal sevo over here did.
 
TeslaCoil said:
And I dont give a damn what you find. You’re lending absolutely too much credit to this imbeciles nonsense. Hes calling us snake oil salesmen. You’re making it seem as though there is hardly any efficacy at all to stim and the other procedures we do. Thats not true at all. And Im not gonna sit here and agree with you. Do I agree that some patients lose efficacy, yes. In my clinic its probably in the 25% range. Most of my patients do very well. Maybe you’re doing something wrong? I have several patients on their second battery, who claim they wouldn't want to live without one.

This is my lane buddy. You keep lending credence to these claims that you’re a snake oil salesman. And I’ll keep defending how much value we can actually bring.
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why dont you call ALL the patients you have put stims on and see how's that working out for you and them, not the 3% patients on second battery change. Get all the data and not just "many" patients or whatever you think you are doing right in your fantasy world. Maybe the rest of us are idiots and you are the greatest stim guy on this planet.
 
www.aafp.org

Despite Weak Evidence, Spinal Cord Stimulators Are Big Business

American Family Physician Community Blog, Despite Weak Evidence, Spinal Cord Stimulators Are Big Business, written by Kenny Lin, MD, MPH.
www.aafp.org www.aafp.org

Key point:

"However, in a 2020 letter to health care providers, the FDA reported that over the preceding four-year period, it received “a total of 107,728 medical device reports related to spinal cord stimulators intended for pain, including 497 associated with a patient death [representing 428 deaths], 77,937 with patient injury, and 29,294 with device malfunction.”

That seems like an unacceptably high rate of unintended effects for a device with modest benefits."
 
www.sydney.edu.au

Spinal cord stimulation doesn t help with back pain says new review

www.sydney.edu.au www.sydney.edu.au



quote from the article:

Professor Chris Maher, Co-Director of Sydney Musculoskeletal Health, said:

“Our review found that the clinical benefit of adding spinal cord stimulation to treat low back pain remains unknown. When coupled with the reality that these devices are very expensive and often break down there is clearly a problem here that should be of concern to regulators.”
 
AKMD_1984 said:
why dont you call ALL the patients you have put stims on and see how's that working out for you and them, not the 3% patients on second battery change. Get all the data and not just "many" patients or whatever you think you are doing right in your fantasy world. Maybe the rest of us are idiots and you are the greatest stim guy on this planet.
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Firstly, stim is a relatively small part of what we do if you’re doing it correctly. So dont wash the baby out with the bathwater.

I dont see much data coming out of you either. And Im not about to waste my day digging it up for you. There is efficacy in stim if patients are correctly chosen and skillfully implanted.

For the record, I am published several times over in this subject.
 
What does publishing have to do with anything in this matter? Im glad you're published. Good for you I guess. Then you should have the ability to be more critical and analyze data deeply.

How do you answer current patient outcome data and overall skepticism of this device from respected authorities?

Alternatively, despite you being the world's greatest stim implanter and patient selector as per your own admission, how would you defend poor outcomes and a lawsuit when the opposing attorney asks you about FDA complaints and cost/ benefit analysis as well as evidence behind this therapy over all. What do you think is going to happen next? After FDA complaints, typically class action suits are initiated and there is risk of lawsuit against device manufacturers and any and every other party responsible (including physicians who implanted these). SCS Trials at least are not permanent. But you really think that its a safe place to be in if there is a angry chronic pain patient with a non working SCS implant? LOL.

Holistically, I do not think it's a defensible position at all at this time.

For you it may be, but for me, I would rather focus on alternative treatments, and its not worth the headache for me. Alternatives may not be effective either but at least they are far more conservative and there is nothing permanent in the body.
 
AKMD_1984 said:
What does publishing have to do with anything in this matter? Im glad you're published. Good for you I guess. Then you should have the ability to be more critical and analyze data deeply.

How do you answer current patient outcome data and overall skepticism of this device from respected authorities?

Alternatively, despite you being the world's greatest stim implanter and patient selector as per your own admission, how would you defend poor outcomes and a lawsuit when the opposing attorney asks you about FDA complaints and cost/ benefit analysis as well as evidence behind this therapy over all. What do you think is going to happen next? After FDA complaints, typically class action suits are initiated and there is risk of lawsuit against device manufacturers and any and every other party responsible (including physicians who implanted these). SCS Trials at least are not permanent. But you really think that its a safe place to be in if there is a angry chronic pain patient with a non working SCS implant? LOL.

Holistically, I do not think it's a defensible position at all at this time.

For you it may be, but for me, I would rather focus on alternative treatments, and its not worth the headache for me. Alternatives may not be effective either but at least they are far more conservative and there is nothing permanent in the body.
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I would call on my patients who have successful implants as witnesses to begin. And I would collect the data available within my practice for absolute sure. In my time doing this I have had very few patients request an explant of the device and every time they do, I oblige. And half the time after they were explanted it was almost immediately regretted by the patient. Often times patients come in claiming its not working so I give them a vacation from it by turning it off. Sure enough most of them almost immediately want it turned back on.

In either case, almost ALL patients have great efficacy for many months to years before losing efficacy. I will agree that the reason for efficacy loss should be examined, and attempts to achieve better results should be made. For patients who lose efficacy its probably due to lead migration. For those who had efficacy with trial and fail permanent implant its probably due to improper lead placement.
 

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Not arguing anything.
I’m telling you that it’s not a home run so it shoujd not be presented and manipulate the patient to be such.
 
AKMD_1984 said:
Not arguing anything.
I’m telling you that it’s not a home run so it shoujd not be presented and manipulate the patient to be such.
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I never, ever manipulate my patients to convince them of anything. Of course its not a home run. Its a last ditch effort to provide relief to desperate patients who have no other options. Thats how I utilize SCS. Its more like “oh, neurosurgeon destroyed your life botching a fusion? You still have intractable radicular pain? Well there is this device which can offer some hope but it doesn't always work, but we try to mitigate that by performing a trial first.”
 
And you can look at the other two links along with plethora of others taking a stance against stims.

And to answer your question as to why the discussion on stims.

Anesthesiologists seek fellowship training to be able to do this procedure as it’s highly reimbursable and allows you equity in asc.

Skill in scs management is directly linked to perceived increase in compensation.

Being able to implant means able to do procedures in asc and get facility fee.

When this tool to earn a high comp is debatable and controversial it certainly will affect choices.
 
AKMD_1984 said:
And you can look at the other two links along with plethora of others taking a stance against stims.

And to answer your question as to why the discussion on stims.

Anesthesiologists seek fellowship training to be able to do this procedure as it’s highly reimbursable and allows you equity in asc.

Skill in scs management is directly linked to perceived increase in compensation.

Being able to implant means able to do procedures in asc and get facility fee.

When this tool to earn a high comp is debatable and controversial it certainly will affect choices.
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Hmm. Personally Id rather be doing MILD procedures than stim implants. Stim implants take quite a bit longer. Too long in fact, to be a top target for reimbursement, if we’re talking about money.

Going back to your legalism point, If the FDA approved these devices to begin and then turn around and ban them, they are equally culpable. Man do you have any idea how many failed procedures surgeons perform per year? And what investigation and class action lawsuit comes of that?
 
TeslaCoil said:
Hmm. Personally Id rather be doing MILD procedures than stim implants. Stim implants take quite a bit longer. Too long in fact, to be a top target for reimbursement, if we’re talking about money.

Going back to your legalism point, If the FDA approved these devices to begin and then turn around and ban them, they are equally culpable. Man do you have any idea how many failed procedures surgeons perform per year? And what investigation and class action lawsuit comes of that?
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Surgeons can perform whatever they want. Why is their choice influencing your practice?

Since when did surgeons become moral gold standard?

This sound childish - “well he did it so I’ll do it too”. Their behavior does not justify an extrapolation into unabated pain mgt procedures with marginal evidence.

My point about scs was simply that there is a reason many people call pain a “sham” field. Many experts and regulators are on the cusp of getting scs bsnned.

Also let’s be honest, it’s certainly not the most respected specialty for these reasons. It’s certainly not pediatric neurology or ophthalmology.
 
AKMD_1984 said:
Surgeons can perform whatever they want. Why is their choice influencing your practice?

Since when did surgeons become moral gold standard?

This sound childish - “well he did it so I’ll do it too”. Their behavior does not justify an extrapolation into unabated pain mgt procedures with marginal evidence.

My point about scs was simply that there is a reason many people call pain a “sham” field. Many experts and regulators are on the cusp of getting scs bsnned.

Also let’s be honest, it’s certainly not the most respected specialty for these reasons. It’s certainly not pediatric neurology or ophthalmology.
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You’re missing my point. The point is that not all medical procedures can or should be expected to work 100% of the time. When you consent somebody do you not include procedure failure as part of the process? I guess in a way it does have something to do with morality, but only insofar as to be sure not to mislead the patient. Thats literally it.

Frankly I dont care what practitioners in other fields think. Most of them have no clear understanding of what we do. Its the same way people bash derm all day long even though they save countless lives. I know that my patients have seen great benefit. There are bad practices out there in any field, but to make blanked statements about pain management entirely is pretty fallacious and insulting. And I don't understand how, if you’re a pain physician, you dont have a better outlook on your own field. Respect is about perspective, and these other practitioners have little. Every time I see a dejected patient come through my door on the verge of suicide it reminds me that I can make a difference. And I do. Fact.

If Im supposedly so un-respected, why is my referral base stronger than ever? From every orthopedist, neurosugeon, rheumatologist, neurologist, PCP in my city. These practitioners most definitely see value in sending me their patients. Its really sad that you’re a pain doc and see such limited value in yourself. I wonder if this has some impact on the care you deliver.
 
TeslaCoil said:
You’re missing my point. The point is that not all medical procedures can or should be expected to work 100% of the time. When you consent somebody do you not include procedure failure as part of the process? I guess in a way it does have something to do with morality, but only insofar as to be sure not to mislead the patient. Thats literally it.

Frankly I dont care what practitioners in other fields think. Most of them have no clear understanding of what we do. Its the same way people bash derm all day long even though they save countless lives. I know that my patients have seen great benefit. There are bad practices out there in any field, but to make blanked statements about pain management entirely is pretty fallacious and insulting. And I don't understand how, if you’re a pain physician, you dont have a better outlook on your own field. Respect is about perspective, and these other practitioners have little. Every time I see a dejected patient come through my door on the verge of suicide it reminds me that I can make a difference. And I do. Fact.

If Im supposedly so un-respected, why is my referral base stronger than ever? From every orthopedist, neurosugeon, rheumatologist, neurologist, PCP in my city. These practitioners most definitely see value in sending me their patients. Its really sad that you’re a pain doc and see such limited value in yourself. I wonder if this has some impact on the care you deliver.
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"Little value in myself" LOL. No.
Pragmatic and realistic. Yes.

Perhaps you have these views because you have given up on your primary specialty (not sure if you're PMR or anesthesia). I have not. So I derive a lot of "value" (whatever that means to you) from that.
 
AKMD_1984 said:
"Little value in myself" LOL. No.
Pragmatic and realistic. Yes.

Perhaps you have these views because you have given up on your primary specialty (not sure if you're PMR or anesthesia). I have not. So I derive a lot of "value" (whatever that means to you) from that.
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I have done no such thing. Im anesthesia. I could go back to that today. And probably make more money these days. I practice hyperbarics concurrently. Lemme guess, that has limited efficacy as well?

No offense intended but from where im sitting simply based on what you’ve said here I think your “realism” crosses quite a bit over into pessimism.

No matter the case there, you do an excellent job at inciting skepticism aimed at your own field. No doubt about that.
 
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TeslaCoil said:
I have done no such thing. Im anesthesia. I could go back to that today. And probably make more money these days. I practice hyperbarics concurrently. Lemme guess, that has limited efficacy as well?

No offense intended but from where im sitting simply based on what you’ve said here I think your “realism” crosses quite a bit over into pessimism.

No matter the case there, you do an excellent job at inciting skepticism aimed at your own field. No doubt about that.
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Well I won’t call it skepticism. You call it that.
I call it being honest and realistic and having introspection.

Secondly, your point about the consent - why would you even consent a patient for a procedure that has limited utility backed by evidence and data?

To quote a poster on this thread - isn’t that classic oil salesman like behavior?

Would your plan change if that procedure paid only $100 vs $10000? Would you still proceed?

You can call my questioning skepticism and maligning our specialty, but I call it thought provoking and cost effective ethical practice.
 
AKMD_1984 said:
Well I won’t call it skepticism. You call it that.
I call it being honest and realistic and having introspection.

Secondly, your point about the consent - why would you even consent a patient for a procedure that has limited utility backed by evidence and data?

To quote a poster on this thread - isn’t that classic oil salesman like behavior?

Would your plan change if that procedure paid only $100 vs $10000? Would you still proceed?

You can call my questioning skepticism and maligning our specialty, but I call it thought provoking and cost effective ethical practice.
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Your notion is absurd. Firstly, lets put this into context. These are patients who essentially have little hope of pain relief to begin with. I’ll put myself in the scenario to illustrate as clearly as I can for you. Lets say I have failed back syndrome. The surgeons would-be cure has failed (as is very common). Im now in intractable radicular pain, 6/10+ intensity, cant work, cant sleep, cant have sex with my wife. Im depressed and desperate for relief, or else I may just end it all. Or end somebody else. (If you’re really a pain physician then you know we see this everyday.)

I go to the doctor and he tells me there is a procedure that offers some level of hope, lets assume for the sake of your argument it has a 25% success rate. And if that doesn’t work, there are more invasive procedures, such as an intrathecal pump, which could possibly get the job done, but again not without risk of failure.

Is what you’re saying that I should not even mention or offer this procedure? And that if I do, that I should not inform the patient of the risks of failure of the therapy?

Wheres the snake oil exactly?

If I were discussing snake oil, my discussion would begin with the example of surgeons not fully disclosing risks of continued pain and disability due to procedure failure. Which again, both you and I know is very common.
 
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Esi or vegetarian diet?

He opted for a vegetarian diet for cervical radiculopathy. No injections…no surgery…

Achieved complete resolution

For those of you who don’t know- Virat Kohli is one of the greatest cricketers EVER. He’s in the same league as Ronaldo or Messi in his respective sport.

Makes you wonder…and supports views of that stoned spine surgeon 😃😂😃
 
AKMD_1984 said:


Esi or vegetarian diet?

He opted for a vegetarian diet for cervical radiculopathy. No injections…no surgery…

Achieved complete resolution

For those of you who don’t know- Virat Kohli is one of the greatest cricketers EVER. He’s in the same league as Ronaldo or Messi in his respective sport.

Makes you wonder…and supports views of that stoned spine surgeon 😃😂😃
Click to expand...

I discuss lifestyle change with every patient I see. To include dietary changes and activity. Number 1- that also has a chance of working as well as not working. And Number 2- some patients are deaf to it. IF you are a pain physician then you should know this as well.

I really hope you never find yourself in a position to eat your own words.
 
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AKMD_1984 said:


Esi or vegetarian diet?

He opted for a vegetarian diet for cervical radiculopathy. No injections…no surgery…

Achieved complete resolution

For those of you who don’t know- Virat Kohli is one of the greatest cricketers EVER. He’s in the same league as Ronaldo or Messi in his respective sport.

Makes you wonder…and supports views of that stoned spine surgeon 😃😂😃
Click to expand...

he's not at the same level as ronaldo or messi, he's probably more at the level of theirry henry
 
TeslaCoil said:
I discuss lifestyle change with every patient I see. To include dietary changes and activity. Number 1- that also has a chance of working as well as not working. And Number 2- some patients are deaf to it. IF you are a pain physician then you should know this as well.

I really hope you never find yourself in a position to eat your own words.
Click to expand...
Lol I find it quite hilarious that you take frank discussions on sdn so personally and resort to attacks.

The YouTube clip has nothing to do with you. I wasn’t responding to you. Merely presented an “alternative management” that worked for an elite athlete but you had to get your panties twisted in a knot lol 😂

Have a nice day
 
AKMD_1984 said:
Lol I find it quite hilarious that you take frank discussions on sdn so personally and resort to attacks.

The YouTube clip has nothing to do with you. I wasn’t responding to you. Merely presented an “alternative management” that worked for an elite athlete but you had to get your panties twisted in a knot lol 😂

Have a nice day
Click to expand...
Whats hilarious is how you see a defense as an attack. I could resort to real attacks. This is nothing. A defense against the dark arts of your cacophony.

Bye, bye!
 
AKMD_1984 said:


Esi or vegetarian diet?

He opted for a vegetarian diet for cervical radiculopathy. No injections…no surgery…

Achieved complete resolution

For those of you who don’t know- Virat Kohli is one of the greatest cricketers EVER. He’s in the same league as Ronaldo or Messi in his respective sport.

Makes you wonder…and supports views of that stoned spine surgeon 😃😂😃
Click to expand...


Speaking of stoned, any idea what percentage of pain doctors incorporate medical marijuana in their practice?


 
nimbus said:
Speaking of stoned, any idea what percentage of pain doctors incorporate medical marijuana in their practice?


Click to expand...
Idk haven’t really explored it

But I used to know a pain doc in PA that was a big proponent of this. His only requirement was that no opioid or benzodiazepines while taking marijuana.

He used to say marijuana is a plant out of earth - there shouldn’t be regulation on that. How much can you regulate? And why?

Interesting
 
TeslaCoil said:
If Im supposedly so un-respected, why is my referral base stronger than ever? From every orthopedist, neurosugeon, rheumatologist, neurologist, PCP in my city. These practitioners most definitely see value in sending me their patients.
Click to expand...

Maybe it's because they
1) need a dumping ground for their failed backs
2) would rather someone else prescribe the opioids
3) need to check another "nonoperative management" tic box between "advised weight loss" and "did two months physical therapy" before they can in good conscience sign them up for another surgery

🙂

I don't know the first thing about your particular pain practice. I don't doubt that you do a lot of good for a lot of patients. I believe you when you say you're not doing the sketchy things so many pain clinics do to keep the procedure and rx machine running in maximum profit mode.

The pain clinic at the hospital where I was a resident was quite ethical. Essentially never prescribed any opioids for non-cancer pain. Did a bunch of procedures - and even if a majority only offered minimal or temporary relief, there's something to be said for that. Everyone was salaried and there was no possible incentive for anyone to do anything slimy for monetary purposes. They had a captive referral base from within the military system so they could do what they thought was best for patients without having to worry about dissatisfied patients going back to their PCMs and complaining about anything. This kind of pain clinic is, in my experience since then, just about unicorn-common of outside captive referral systems like the military and VA.

It was super gratifying to see the rare patient who was really, truly long-term helped by a procedure though.

There are ethical used car dealers out there too. But stereotypes exist for a reason.
 
pgg said:
Maybe it's because they
1) need a dumping ground for their failed backs
2) would rather someone else prescribe the opioids
3) need to check another "nonoperative management" tic box between "advised weight loss" and "did two months physical therapy" before they can in good conscience sign them up for another surgery

🙂

I don't know the first thing about your particular pain practice. I don't doubt that you do a lot of good for a lot of patients. I believe you when you say you're not doing the sketchy things so many pain clinics do to keep the procedure and rx machine running in maximum profit mode.

The pain clinic at the hospital where I was a resident was quite ethical. Essentially never prescribed any opioids for non-cancer pain. Did a bunch of procedures - and even if a majority only offered minimal or temporary relief, there's something to be said for that. Everyone was salaried and there was no possible incentive for anyone to do anything slimy for monetary purposes. They had a captive referral base from within the military system so they could do what they thought was best for patients without having to worry about dissatisfied patients going back to their PCMs and complaining about anything. This kind of pain clinic is, in my experience since then, just about unicorn-common of outside captive referral systems like the military and VA.

It was super gratifying to see the rare patient who was really, truly long-term helped by a procedure though.

There are ethical used car dealers out there too. But stereotypes exist for a reason.
Click to expand...
It may be those reasons for some. I have grown a solid reputation for effective, ethical care. All of the practices where Ive worked are this way. So I dont think they are as rare as you claim. Anyone can do it. There may be a stereotype but at the end of the day thats all it is. If this stereotype applies to pain management it applies to any field in medicine. There are good and bad doctors in every field and in every city.

In this thread, i have been called a snake oil salesman and a sham. Im here to say thats nonsense, and I stand by my argument. There is a wealth of information supporting that in the text I linked above.

Attempting to dissuade incoming applicants by calling an entire specialty a sham is uber ignorant.

And btw the military base and VA in my area refer to me almost exclusively.
 
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