New Pain Treatment Model

[MSW1963]

I came across an article about a MS patient struggling with pain treatment medicine.

Her Pain Specialist offered some interesting insight about the transition currently taking place in the the practice of pain management treatment.

Procedures are billable. And at a much higher cost than for example billable office that results inwriting a rx and taking a monthly urine sample.

Procedure driven practices are transforming pain management. Whether that turns out for the benefit of patients, MS patiens in particular, I guess we'll find out eventually.

[J-Bo]

Interesting...I ran across a "pain management" outfit about 8 years ago that similarly had quite the money-making operation going. They put you in group physical therapy with a bunch of other people all with totally different problems with different body parts affected, and somehow, we would all benefit from this group "therapy" because something something something. The doctor got mad when I asked too many questions about how this would work, and showed me the door.

And oh, they offered pain meds right up front...guess that was the incentive to get the revenue streams, I mean patients to participate in this nonsense.

Wonder if there will be a proliferation of this sort of thing.

[Jules A]

The real issue imo is debunking the myth that pain is the 5th vital sign and a score of 0 is the goal. The reason there are more initiatives to pursue alternative treatments other than opiates is due to the increasing numbers of death and additions from these medications which were never shown to be effective as long term treatment for pain.

I recently read a physician's blog that noted "Diseases have been discovered that have no signs and with pain as the only symptom". I find that rather frightening especially when I suspect people with personality disorders and substance abuse disorders are receiving these diagnosis in numbers larger than the general population.

http://www.physiciansweekly.com/pain-5th-vital-sign/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280073/

[MSW1963]

Pain as the 5th vital sign sounds like theory from a completely different area in medicine, possibly during a time when it was mutually beneficial for a pharmaceutical rep and a physician to prescribe pain meds to otherwise healthy patients who simply asked for them for an aching back.

That ara is in the past for decades now for reputable physicians. Pill mills that still exist is something outside of my experience.

What reports/studies I've read regarding efecify of long term use of opioids are contradictory. Some studies not effective, others yes effective, and others mixed results, even a study that included analysis of nerve pain had mixed results.

I am obviously out of my league debating these issues. I only have the questions, and only as they relate to me. I have none of the answers.

[Jules A]

Pain as the 5th vital sign sounds like theory from a completely different area in medicine, possibly during a time when it was mutually beneficial for a pharmaceutical rep and a physician to prescribe pain meds to otherwise healthy patients who simply asked for them for an aching back.

That ara is in the past for decades now for reputable physicians. Pill mills that still exist is something outside of my experience.

What reports/studies I've read regarding efecify of long term use of opioids are contradictory. Some studies not effective, others yes effective, and others mixed results, even a study that included analysis of nerve pain had mixed results.

I am obviously out of my league debating these issues. I only have the questions, and only as they relate to me. I have none of the answers.

Lol, I don't think anyone has the answers!

To the best of my knowledge the initiative of pain as the 5th vital sign was introduced in 1996. As you noted I'm sure some of it had to do with the pharmaceutical companies making money but it also came about from organizations concerned that patients' pain wasn't being properly addressed and a such it became referenced by JCAHO, which influences hospital reimbursement. Pain became considered the 5th vital sign, when in fact it isn't a sign at all but a symptom. Medical professionals felt pressure to adhere to the mantra that pain was whatever the patient reported which resulted in providers prescribing whatever medication patients demanded in an effort to meet satisfaction scores with minimal limits set. This pain as the 5th vital sign is, imo, largely responsible for much of the opiate epidemic we are now facing. That combined with our society in general which now thinks everything should be perfect, everyone gets a trophy and pain should be zero. Just my opinion though.

[MSW1963]

J-Bo

Good to see you posting. The something something something, a good one, lol. I've heard a few of those highly technical medical explanations myself over the years. Although like you it didn't sound very convincing.