re: Legit chronic pain people

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This is another facet of it. The only legitimate pain management MDs left are anesthesiologists for the most part and they are pressured.

A. To make money by performing procedures. Nerve blocks and steroid injections.

B. To stop prescribing narcotics.

Gone are the days of pain docs who weren't performing procedures. The vast majority of them were pill mills. And they needed fo go, but I believe there is a place for docs who manage these patients and do not do procedures. They suggest and refer. But for the most part they need to responsibly manage these patients. I believe this can happen with the laws that are in place now.

Docs out there and other prescribers. They made Vicodin a triplicate and now you all have to carry a triplicate pad and are watching it more closely but?

A. Is there a number? Is there a number that is too much? They're watching but with no guidelines given I assume you can write what you want as long as there is no outright fraud? I.e. Not seeing patients but billing for exams.

B. Does the hassle of dealing with pain management patients make them so unattractive that they are not worth your time unless you are working the system?

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We can blame personal injury lawyers for the abuse of pain management clinics. When an MRI doesn't show a herniation, bulge, etc., that's when the pain management doctors get the call. I mean, you're in pain? Must be a facet issue. You're going to need RFAs and steroid injections for the rest of your life, despite the MRI indicating not a single thing is wrong with you. At $10k per ablation, at 3 times a year for 7 years, that's about at least $210k in future meds and there is not even any scientific evidence to support you needing these procedures, other than you saying your back hurts and a pain management doctor who sees 100's of personal injury lawyer's clients a year who has no reason to say your not in pain -- when he's making about $3.5M a year from the personal injury folks. What a joke.

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Not all procedures are unnecessary.

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I know. A lot are though.

Great thread... has anyone discussed how to handle TMJ/TMD pain? shite is debilitating..

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If the US would switch back to cannabis for arthritic conditions

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Recent studies have found marijuana to be roughly equivalent to benadryl for pain. So it's essentially crap

Meditation, relaxation techniques, exercise, all things that take effort, which most people aren't willing to do. They'd rather take a pill.

If you've ever noticed, when you're stressed, shite just hurts more.

what is the purpose of a piriformis injection?

my recent thoracic injection has been surprisingly effective. my lower back is killing me and doc is suggesting we try another round of RFA.

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Fractures, shingles, burns, OBVIOUS dental abscesses, kidney stones? These folks used to get norco. Now lucky to get a Tramadol.

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That's just your ED providers being pansies. There is no reason you can't prescribe people with those particular pathologies, narcotics. There are still a lot of fractures that don't NEED narcotics, but you'd be justified in writing for them. I write surgical patients for narcotics. You just have the balls to tell them "no" when it comes to refills. Its not hard.

Piriformis was spasming and choking my sciatic.... Plus is a diagnostic test to rule out piriformis syndrome. That what the pain doc said anyway. Tomorrow he is injecting si joint... Moving his way up I guess lol.

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There is no real evidence showing that opiates improve their function and are associated with a lot of potential harms.

There are a number of other therapies. Pain is a symptom, the cause should be treated. Opiates should be reserved for cancer and acute pain (sparingly).

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C-5/C-6 complete spinal cord injury here, with an emergency spinal fusion done almost 17 years ago. I have had every kind of physical/occupational kind of therapy you can imagine, tried acupuncture, TENS units, a baclofen pump (later removed because it did more harm than good), slowly started on muscle relaxers and nerve pain, then over the years have become maxed out on baclofen and tizanidine for muscle spasms, maxed out on lyrica, am on 5mg of valium, all prescribed by a spinal cord specialist, and praise god for opiates because without them I would never get to leave my bed because of muscle spasms wrecking through me from head to toe while my entire legs and hands feel like they are on fire and getting stuck with a million needles at the same time. ALL of my causes have been treated, yet I'm still a 10 on the pain charts, so explain your logic there. I would've offed myself long ago because of the pain and not being able to live my life up in a chair with the rest of my family/society. Been using weed from Colorado for almost two years and it has been amazing to help me not take as many pain pills, although I still have to take a couple because I am dependent on them, NOT addicted. So glad medical marijuana has passed here in AR and people I care about are no longer in jeopardy of being arrested for trying to help ease my pain. If my choice was being on opiates for the rest of my life or just muscle relaxers, I would choose opiates every time. Whoever said they decrease your quality of life, trade places with me for a day and get back to me with how accurate that is.

Regarding tramadol, it's basically a useless painkiller. It has the qualities of an antidepressant with a small amount of pain relief, so it technically does nothing to numb the pain, the "happy pill" aspect of it makes you feel better. I can give my 15 year old, 15 pound dog half a tramadol for his arthritis when it flares up and it's perfectly safe and helps him.