Pain Medicine and the Modern Society

Recently, in the state of Florida, the laws changed as to the usage of pain medication. These changes greatly altered how most legitimate pain physicians operate. Prior to 2010, we generally only were involved in difficult medication management cases and most of our time was involved in procedures. With the law changes, the state has made it quite difficult for primary care doctors to management controlled substances. This has lead to a significant increase in patients requiring our services since most primary care doctor were worried about further prescribing. Initially, I didn’t particularly like that we, anesthesiology pain doctors, were selected as the providers who could provide these medications. It took time away from what I would rather be doing, I.e. injections and surgeries. But after going to a DEA task force meeting and listening to the assistant attorney general speak, I realized the unfortunate truth. He told the audience that they didn’t have problems with Anesthesiologists and that the doctors that they had the most issues with we’re primary care doctors who were accepting cash and especially D.O.’s. there are still primary care doctors who prescribe controlled substances but it has been greatly reduced. The interesting thing is that I was getting referrals for evaluating pain patients, I began to realize how many of these patients were on excess pain medications. I was also amazed at how many of these patients never had anything done to try and resolve their pain issues. Many of them didn’t even have a MRI. I would evaluate people with herniated discs and ask if they ever had physical therapy, seen a surgeon, or had any suggestions other than pain medications. I was amazed at the number who said that all they were offered was just pain medications. I was also amazed at the amount of pain medications that these people were on considering nothing was ever done to correct their problem. I began to realize that many doctors were not really familiar with how to utilize pain medications in people who were not dying. I now understand why the government wants better control over these medications. The government wants people who legitimately need pain medication to get it but that is the rub, legitimate patients. Having pain doesn’t qualify you to be on chronic pain medications. I have to explain that to patients all the time. If there is a solution to your problem then we need you to do that. Being on pain medications is not the solution when your problem can be resolved. It is one thing if you have had numerous spine surgeries and your spine is a disaster and thus you need chronic pain medications but when you have a herniated disc and you haven’t been treated for that then chronic pain medications are not appropriate unless the surgeon feels that surgery is not warranted. Thus, pain medications are not the solution unless there are no solutions. Pain medications are either to keep you comfortable until your problem is resolved or because your problem is not resolvable. Personally, I feel that if a primary care physician has a patient that requires more than four lortab per day then they need to be referred out. I also notice that primary care doctors tend to escalate the patients too rapidly on their pain medications. Instead of constantly increasing them, refer them to a specialist, get their problem resolved. It is so frustrating when a doctor refers me a patient that is on some outrageous amount of pain medications because they kept increasing them and then they got nervous about what the patient was on and expect me to deal with it. Then I have to tell the patient that I’m not going to give them what the other doctor gave them. The new system in our state is working well. We went from being the pill mill state to being one of the hardest to get pain medications at. But, if you truly need them, you can get them. It is just more regulated now and it needs to regulated when more people die of overdoses than in car accidents. Obviously, there is a societal issue that needs to be addressed since no other developed nation has these issues but until then the object should be to keep controlled medications controlled so that those who need them can get them and those who don’t need them can’t get them.

One Comment

  • Be critical, you say?How would you criiqtue the fact that 85% of doctors have considered quitting medicine if Obamacare is implemented in full?SO it is a good thing that there will be 30,000,000 more patients demanding medical services from a dwindling supply of doctors?This is more than wanting to provide medical help for everyone. This is devious. This is evil. This looks a lot like someone wanting to give America its due. To take that bitter pill that America is not what it is touted to be.That is why liberals need to be defeated at the ballot box as soon as possible. Hopefully, this is the year.

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