The perversion of pain.


Rebloogging because it’s still relevant. I now work in the same doctor’s office where I precepted. I work on a straight percentage of the billing collections for patients I see.

This is as true as it ever was. The doctor still prescribes too many narcs, now he’s under investigation by the board for it. I myself have discharge many of these patients for noncompliance – I now have a reputation in the community such that the narcotics patients, for the most part, don’t want to see me because they know I will hold them accountable for getting tests to document their supposed pain.

I stand by what I said. Fibromyalgia may be a billable diagnosis per ICD10, but that doesn’t make it a real disease. It’s a syndrome, meaning a collection of symptoms. There’s SOMETHING WRONG, people. Whether it’s pure depression, gluten intolerance, gallbladder, bone cancer (seen that recently) liver failure (seen that recently) giant cell arteritis (seen recently too) that other providers have, quite frankly missed because they just want to throw a narcotic prescription at someone instead of figuring out what’s wrong. So go ahead, take your narcs and sit on the couch and be sedated. Don’t worry if you end up going blind (arteritis untreated), overdosing on your narcs to numb the psychic pain (depression), suffer with joint pain and abdominal bloating for a lifetime (gluten intolerance), start bleeding from every orfice and dying (liver failure), get pancreatitis and end up dying (gall bladder), die of untreated cancer, or whatever else fires your imagination. There is ALWAYS a reason for the pain. ALWAYS. Fibromyalgia is still doctor speak for I can’t find anything wrong with you and I don’t care to try anymore so go away with this nice little narcotic prescription and leave me alone until it’s time to refill it.

It might interest some of you to know that the man who originally created the dignosis of fibromyalgia has since stated publicly that he wishes he had never done so, saying (paraphrase becaseu I can’t remember the exact quote) We all have pain and depression at certain times of our lives, it’s a natural part of life. So there you go.

The Tin Foil Hat Society

oxycontin

In the late 80’s some brilliant (sarcasm in use here people) doctor, who I assume later took a position with one of the companies who manufacture hard core narcotic pain medications, or at least was paid a significant ‘renumeration’ by them, decided that “pain is whatever the patient SAYS it is” and if patients were in pain, then medical and nursing staff were not doing their jobs properly.  This, regardless of whether the patient got better, or even had a medical problem that necessitated pain medication.

Once upon a time, drugs like oxycontin were reserved for patients who were dying of cancer, or in some other profound end-of-life type of pain.  Never used for maintenance.

And now, 30 years later, we have a positive epidemic of patients who are in chronic pain – it even has official diagnosis codes:  338.2 – chronic pain (can’t get paid for diagnosing this one…

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7 responses

  1. Towards the end of this past summer, I had surgery on my shoulder. The surgeon emphasized before and immediately after the surgery that pain would have to be my guide; and that a freshly operated shoulder was not like a freshly operated knee, in that pain in the freshly operated shoulder indicated that the shoulder had already been overworked. At the same time, the hospital where I had the surgery done was passing around morphine tablets like candy at a Hallowe’en party – people seemed shocked when I refused to take any kind of pain killer (while in recovery, I stopped a nurse before injecting me by asking her what she was getting ready to hit me with – when she said ‘morphine,’ I told her I wanted no part of it and she was really shocked). A day later, I asked the surgeon just how I was supposed to let pain be my guide if I couldn’t feel anything, to which he had no real answer. I did accept anti-inflammatory meds – it made sense as they actually had a beneficial job to do, besides depriving me of my wits and will to get up and start moving around.

    I think pain relievers really are getting passed around too much. I’m not in a position to judge when it comes to fibromyalgia; but I’m quite fond of what the neurosurgeon, Dr. Oliver Sacks, had to say about there being no such thing as cookie-cutter people or disorders. Slapping a label on a group of symptoms where the cause is not clearly understood, and accompanying that with a symptom management (I hesitate to use the word ‘treatment’) regimen that risks an addiction without actually curing the underlying cause of the symptoms is, in my opinion, reckless and irresponsible. I have also had experience when it comes to this mentality in the psych side of things. Both types of medications are being passed around so much that they are starting to find higher concentrations of them in local groundwater supplies.

    It might be more expensive to approach medicine the way you are advocating – testing and actually trying to pinpoint an underlying cause, as opposed to creating addictions where they may not be needed, and glutting an already-bloated pharma industry. It might be that some of the underlying causes do not rest with the individual; but with the individual’s reaction to sickening work schedules, poisonous toxins released in the air, the over-availability of unhealthy foods and ceaseless marketing campaigns aimed at making the unhealthy en vogue. Healing all that might take a whole different breed of doctor – but it would still count for something if the majority of the medical community would push for the creation of this kind of healer, rather than just dispense pills. In this case, I think the pills are only slightly more logical than applying a band-aid to a ruptured appendix.

    If it makes any difference, I’d rather seek healing from someone with your mentality than from someone who seems less interested in healing, and more interested in symptom management with a bottle of pills. Thank you very much for sharing your experiences and perspectives!

    • Thank you. Sometimes all it takes is really LISTENING to what the patient is saying. Very often they tell you what is wrong just by giving you the history (if they’re honest and most are). But listening takes time, something which I am willing to give because I don’t work for a corporate master who is demanding I see a patient every 15 minutes. I’ll never get rich, but most of these people live in my community of under 4000 people and it honestly matters to me whether or not they are as healthy as they can be.

      There are always the drug seekers, there always will be.

      • For my comment? You are quite welcome – for being the type of healer who is interested in actually healing, rather than getting rich by dispensing pro-passivity pills, I think we all owe you (and others of your mind – important to point out here is that you are thankfully not all alone) a great debt of gratitude.

        The drug seeking … a symptom itself. Again, causes for this may lie beyond the individual and with the society surrounding the individual.

    • Oh, and yes to all of your prospective causes!!! Yes yes yes. Pills aren’t going to fix our cultural and societal problems. They’re just making it much much worse than it has to be.

      • To my mind, it all contributes to a general pacification of society – to me, one of the greatest social ills of all time. Whether or not you see it the same way, I’ll say that I’m pleased to have made the acquaintance of someone who is actively disinterested in contributing to this pacification 🙂

  2. Don’t be too hard on docs who over-prescribe narcotics folks. When I read that my first thought was “is that me?” I agree that “fibromyalgia” probably isn’t a real disease, that as a society we use far too many narcotics, and that patients should take more responsibility for their own health including sensible diet and more exercise. But here’s the view from the other side of the couch:

    Patient comes in complaining of chronic pain. I take a history and do an examination: no apparent cause for the pain. I do investigations including bloodwork, x-rays and ultrasounds – still no convincing cause for the pain, although the radiologists always muddy the waters by finding numerous nodules, cysts, pockets of fluid, irregular surfaces, partial tendon or meniscus tears, etc. of dubious clinical relevance. So then we do an MRI scan: still no convincing cause for the pain. We try acetaminophen, NSAIDs: they don’t work. We send the patient to the pain clinic: that doesn’t work either. And the patient keeps coming back, week after week, month after month, with their pain, until they get their narcotics, and that seems to settle most of them.

    In an ideal world I would send them for CBT, or spend time with them exploring their psyche and trying to figure out whether there’s a psychological reason for their chronic pain. But unfortunately, we don’t live in an ideal world: their benefit plan doesn’t pay for CBT, they only have a 15 minute appointment with me, and in that 15 minutes, as well as dealing with their chronic pain, I also have to deal with their diabetes, their ingrowing toenail, their hypertension, their irritable bowel, and their pigmented skin lesion which is clearly a benign pigmented nevus, but they don’t trust me to make the diagnosis (after all, I’m just a grunt, what do I know) so they want me to refer them to a dermatologist.

    So, although I really wish that as a society, we weren’t so narcotic dependent, when you take into account all this other stuff which is going on in the background, you can see that sometimes docs end up prescribing narcotics out of sheer exhaustion.

    • Oh, I know. The pressures of quantity over quality. And there area always the patients that you describe, who probably do have nothing wrong, who simply want a legal way of getting high. Like a few of my patients. Who are trying desperately to convince me they are in dire pain and in ABSOLUTE need of oxycodone. But who will not get them. Several transferred to this clinic thinking they would get in to see the doc (who is under investigation for over-prescribing narcs now) because he has a reputation as being ‘easy’ with the scripts. Unfortunately for them he is no longer taking on new patients if they take any narcotics at all, or if they are asking for them either. So I get them.

      We’re narcotic dependent because we’ve been brainwashed into thinking pain is bad and no one should be in any pain at any time – mental or emotional pain included, pure discomfort rather than pain included, lack of utter comfort included. That and the sense of entitlement that is so common now. Very frustrating.

      In my part of the country, the insurance plans for the indigent usually don’t pay for any of the things you mention either, but they’ll pay for ridiculous quantities of narcotics – enough to drop a narcotic naive elephant!

      And even the pain clinics are getting away fr0m prescribing narcs in favor of other treatments that might cost more but are actually effective in dealing with the pain. We get at least one patient per month who has been discharged from pain management who has heard about our doc who thinks they will just come to us and they won’t have to do whiz quizzes any more or be held accountable for responsible use. They are politely examined and then told they will get nothing from us for their pain though I’ll be happy to care for their other medical needs. Funny but they never have any other needs it seems. They leave and never come back.

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