Pain practitioners are pulled in many directions.
-First our obligation is to care for our patients TO THE BEST OF OUR ABLITY, give them a medically sound and scientific treatment. Unfortunately pain is closely linked to emotions. Plus a significant amount of medications for pain relief also stimulate our pleasure, gratification and addictive centers. This generates a secondary effect on the patients using opioid pain medications. Their pleasure/addictive centers get stimulated by the opioids creating a craving for more. This makes the situation difficult because patients are blurred into using more and more opioids, in the name of still having PAIN. It has only been recently that we have been able to clearly understand this conflict unfortunately at the expense of having created many iatrogenic (medical) addicts.
-Then, we are monitored by the DEA (drug enforcement administration) with rules and regulations that we prescribers HAVE to follow. An important group of our available pain medications (opioids) are not only very powerful in diminishing pain but also very addictive and craved by users, so needles to say very lucrative in the black market. This creates a tense environment between prescribers and their pain patients.
-Also insurance companies are directly targeting pain practices. They are cutting re-imbursement for needed procedures, visits, tests and refusing to pay for a lot of the safer medications that we consider more effective and appropriate.
Multiple “masters” to try and please. No winners, just losers creating a lot of tension between us (doctors) and our patients. The gap between us has gotten wider, and full of roadblocks and conflict generating demands.
Post By: Cesar A. Euribe, M.D.