Thoughts on pain management

[frank51]

I was told by a couple of doctors and a few other people familiar with the medical profession, that patients seen by pain management specialists are very hard to deal with. They told me that most of these patients have already been seen by other primary care doctors for a long a period of time with regards to their pain, and are referred to pain specialist because the primary care doctor has done everything possible to alleviate their pain but has been unsuccessful. Also, I’ve heard that because many of the patients seen by pain specialists are in pain due to various surgical procedures (high rate of complexities) there is a high chance that pain specialist may get sued as a result of something that the surgeon may have done. I haven’t had the opportunity to speak to pain managements doctors regarding these issues, can anyone shed some light on these issues.

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[Idiopathic]

I would agree with everything. As far as the lawsuit potential, I would imagine that it would be a risk, but generally, since they did not do the harm, they would not be subjecty to legal action. However, this should certainly impress upon those interested in tertiary care specialties to have excellent records, detailing events prior to and since seeing that patient.

 

[Nikiforos]

I was told by a couple of doctors and a few other people familiar with the medical profession, that patients seen by pain management specialists are very hard to deal with. They told me that most of these patients have already been seen by other primary care doctors for a long a period of time with regards to their pain, and are referred to pain specialist because the primary care doctor has done everything possible to alleviate their pain but has been unsuccessful. Also, I’ve heard that because many of the patients seen by pain specialists are in pain due to various surgical procedures (high rate of complexities) there is a high chance that pain specialist may get sued as a result of something that the surgeon may have done. I haven’t had the opportunity to speak to pain managements doctors regarding these issues, can anyone shed some light on these issues.

As a fully trained anesthesia-based pain management specialist, I agree with much of your post. A significant number of patients seen in pain clinics are among the most obnoxious, argumentative, and deceitful people in the entire population of patients seen in all of medicine. Many are on Worker's Compensation for "injuries" (usually back and spine) allegedly suffered on the job. Others are "victims" of motor vehicle accidents (lo and behold, always the other driver's fault). These patients lead to a slimeball atmosphere in many pain clinics. These chronic pain patients are generally detested by physicians in most specialties.

It is true that most patients referred to pain clinics have already been seen by several other physicians without satisfactory results. Most chronic pain patients have very significant psychiatric comorbidity. In many cases their psychiatric problems preceded their development of chronic pain issues. Maybe complaining of "pain" and being "treated" for it is a socially acceptable way for them to have their psychiatric issues addressed.

On the other hand, patients with acute post-op pain and cancer pain are generally very rewarding to treat.

 

[Thromby]

As a fully trained anesthesia-based pain management specialist, I agree with much of your post. A significant number of patients seen in pain clinics are among the most obnoxious, argumentative, and deceitful people in the entire population of patients seen in all of medicine. Many are on Worker's Compensation for "injuries" (usually back and spine) allegedly suffered on the job. Others are "victims" of motor vehicle accidents (lo and behold, always the other driver's fault). These patients lead to a slimeball atmosphere in many pain clinics. These chronic pain patients are generally detested by physicians in most specialties.

QUOTE]

This is where many Doctors fails those they are swore to help. Many Doctors have been beaten down by pain themselves--and this is where they finally realize how wrong they were.

The mental problems come from the repeated torture of Pain--not the other way around. Torture alters the personality and encountering Doctors with your infintile mentality maginifies their problems.

Many studies have found that because we cannot comprehend the precise cause of pain on film--we simply cannot except that it is real. So complicated is the pathways of pain that it may well be a thousand years before we can see why it affects so many.

Obviously you are young arrogant, and ignorant. Not unlike I was. The good news is you will change--either through your own pain or someone close to you.

 

[gaslord]

I heard that Pain mgt can be stressful, and that some people will "hate" seeing they're patients bc they feel like the patients are abusing the system to get drugs. I've also heard of clinics refusing to do triple scripts for oral pain meds to help screen out the drug seekers, thereby focusing they're time on procedures for people that really need them.

Has anyone heard the same or have any other opinions?

 

[Nikiforos]

As a fully trained anesthesia-based pain management specialist, I agree with much of your post. A significant number of patients seen in pain clinics are among the most obnoxious, argumentative, and deceitful people in the entire population of patients seen in all of medicine. Many are on Worker's Compensation for "injuries" (usually back and spine) allegedly suffered on the job. Others are "victims" of motor vehicle accidents (lo and behold, always the other driver's fault). These patients lead to a slimeball atmosphere in many pain clinics. These chronic pain patients are generally detested by physicians in most specialties.

QUOTE]

This is where many Doctors fails those they are swore to help. Many Doctors have been beaten down by pain themselves--and this is where they finally realize how wrong they were.

The mental problems come from the repeated torture of Pain--not the other way around. Torture alters the personality and encountering Doctors with your infintile mentality maginifies their problems.

Many studies have found that because we cannot comprehend the precise cause of pain on film--we simply cannot except that it is real. So complicated is the pathways of pain that it may well be a thousand years before we can see why it affects so many.

Obviously you are young arrogant, and ignorant. Not unlike I was. The good news is you will change--either through your own pain or someone close to you.

Your ineloquent and inelegant post lends strong support to what I say. Thank you for your support. I suggest that you learn to read critically.

 

[gasdoc]

I am a graduating CA-3 doing a pain fellowship next year. Frankly, I am looking forward to the pain clinic vs. the OR. Although its true that pain pt's can be deceitful and drug seekers, there are also those who have real pain that you can help to speed up recovery, as w/ low back pain. We have 2 large pain clinics in our program and I have done 2 months of pain rotation, 1 in the mostly interventional pain office and the other in a combination of narcotic/medication and interventional pain. In general, the 5 pain doctors in our program either specialize in pain blocks (3 of them) or write triplicates (2 of them). If one gears themselves to doing blocks, then they generally have a lot less of the addicts and drug seekers. Also, the high reimbursement is in doing the blocks. The great thing about pain management is that you deal w/ one or 2 issues, and not have to deal w/ the heart failure and diabetes besides the pain taht the PCP has to deal with. I frankly enjoy the pain clinic very much, and can tolerate even the drug seekers reasonably well.

In terms of the future of pain management, it can only grow and get improved as more and more of the public is demanding better pain care from their doctors. So, pain doctors will be in the forefront of the pain revolution. Pain anesthesiologists tend to focus on more of the blocks, as they are specialists in that area. Neurologist and PMRs can also go into pain, but my experience is they are not as comfortable w/ blocks. In case you are wondering about reimbursement, the interventional pain doc can make a lot more than the general anesthesiologist. Just look at any physician reimbursement list. Also, don't forget the nicer lifestyle of the pain docs, usually 8-4 or 5 schedule. Of course, pay is commisserate w/ your work load.

 

[GMO2003]

I am a graduating CA-3 doing a pain fellowship next year. Frankly, I am looking forward to the pain clinic vs. the OR. Although its true that pain pt's can be deceitful and drug seekers, there are also those who have real pain that you can help to speed up recovery, as w/ low back pain. We have 2 large pain clinics in our program and I have done 2 months of pain rotation, 1 in the mostly interventional pain office and the other in a combination of narcotic/medication and interventional pain. In general, the 5 pain doctors in our program either specialize in pain blocks (3 of them) or write triplicates (2 of them). If one gears themselves to doing blocks, then they generally have a lot less of the addicts and drug seekers. Also, the high reimbursement is in doing the blocks. The great thing about pain management is that you deal w/ one or 2 issues, and not have to deal w/ the heart failure and diabetes besides the pain taht the PCP has to deal with. I frankly enjoy the pain clinic very much, and can tolerate even the drug seekers reasonably well.

In terms of the future of pain management, it can only grow and get improved as more and more of the public is demanding better pain care from their doctors. So, pain doctors will be in the forefront of the pain revolution. Pain anesthesiologists tend to focus on more of the blocks, as they are specialists in that area. Neurologist and PMRs can also go into pain, but my experience is they are not as comfortable w/ blocks. In case you are wondering about reimbursement, the interventional pain doc can make a lot more than the general anesthesiologist. Just look at any physician reimbursement list. Also, don't forget the nicer lifestyle of the pain docs, usually 8-4 or 5 schedule. Of course, pay is commisserate w/ your work load.

general anesthesiologist already make 300-400k...can pain docs make high 6 and even low 7 figures?

 

[placeboy]

general anesthesiologist already make 300-400k...can pain docs make high 6 and even low 7 figures?

i don't know if this would help out everyone who "is not going into a field bc of what it pays" http://www.allied-physicians.com/salary_surveys/physician-salaries.htm. like many others, i feel money is a big deal, but i hope most will also go into a field, primarily, for what they like about it, and then worry bout what it pays--not the other way around...anyway...

from what i've heard, pain can get paid 500+, but there are some things to keep in mind: 1. it really depends on where you work...if you are working in a big city, your salary can be much lower (check out www.gaswork.com) regardless of what you do (and the living expenses in that city are so high, that it really is a hit); 2. malpractice for pain is, from what i hear, higher (anyone else who more familiar w/ the topic should probably give you a better range, but for exsmple ORS - spine on that last first link shows those docs making around $1.3 mill, but they have by far, the highest malpractice insurance); 3. so far, based on my psych rotation, i have to agree with some of the posts above that many ppl don't want to deal with chronic pain pts...best way to think of it is w/ normal referrals, there is a filter screen as to who sees the specialist in that field...but w/ pain, bc there are few ppl (neurologists, psychiatrists) that want to deal w/ the population, its like an opened floodgate of pts without any screening as to who sees the pain specialist. much of your pain career will be sorting out who really needs treatment and who doesn't.

i'm not saying pain is not a worthwhile career to pursue (i personally am still entertaining the idea of pursuing it), but its not all butter hope this helps

 

[GMO2003]

i don't know if this would help out everyone who "is not going into a field bc of what it pays" http://www.allied-physicians.com/salary_surveys/physician-salaries.htm. like many others, i feel money is a big deal, but i hope most will also go into a field, primarily, for what they like about it, and then worry bout what it pays--not the other way around...anyway...

from what i've heard, pain can get paid 500+, but there are some things to keep in mind: 1. it really depends on where you work...if you are working in a big city, your salary can be much lower (check out www.gaswork.com) regardless of what you do (and the living expenses in that city are so high, that it really is a hit); 2. malpractice for pain is, from what i hear, higher (anyone else who more familiar w/ the topic should probably give you a better range, but for exsmple ORS - spine on that last first link shows those docs making around $1.3 mill, but they have by far, the highest malpractice insurance); 3. so far, based on my psych rotation, i have to agree with some of the posts above that many ppl don't want to deal with chronic pain pts...best way to think of it is w/ normal referrals, there is a filter screen as to who sees the specialist in that field...but w/ pain, bc there are few ppl (neurologists, psychiatrists) that want to deal w/ the population, its like an opened floodgate of pts without any screening as to who sees the pain specialist. much of your pain career will be sorting out who really needs treatment and who doesn't.

i'm not saying pain is not a worthwhile career to pursue (i personally am still entertaining the idea of pursuing it), but its not all butter hope this helps

I saw that website...how the phuck can a friggin anesthesia assistant make >100K? WTF? that just makes me sick

 

[proman]

I came across an ad from my hospital that paid 140K for 40 hours/week CRNAs or AAs.