A Warning for Pain Management Physicians

A warning for doctors:

“Be afraid.”

No matter what you have learned in medical school, if you are prescribing opioids in doses that seems high to narcotics agents and prosecutors, you are at risk of a trial. And once you enter the courtroom, anything can happen.

Federal prosecutors who aren't licensed to practice medicine are increasingly substituting their own judgment for that of doctors who, in the opinion of the Justice Department, are prescribing too many pain pills to their patients. John Tierney explains why physicians who take an aggressive approach to pain management should not

... feel safe until doctors’ prescribing practices are judged by state medical boards, as they were until the D.E.A. and federal prosecutors started using criminal courts to regulate medicine. The members of those state medical boards don’t always make the right judgment, but at least they know that there is more to their job than counting pills.

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    Pain management is a joke (2.00 / 1) (#2)
    by Dadler on Thu Jul 05, 2007 at 11:48:09 AM EST
    Read "Healing Back Pain" and "The Divided Mind" by Dr. John Sarno -- a longtime NYU Medical Center physician -- to understand how modern medicine has and continues to commit malpractice every day when it comes to pain and the treatment of it.  By rejecting psychosomatic medicine -- by rejecting the brain's role in health -- modern medicine has sent millions of people down a road of misdiagnosis and continued suffering.

    All because they fail to accept that the most powerful organ in the body, the one that controls the body, could initiate pain for psychological purposes.  Post WWII, much research was done in this area, and many strides were made, only to be abandoned in the era of take a pill and solve your problems.

    I spent more than a quarter of a decade believing all my pain, back pain mostly (and surgery didn't solve it), was due to me being a machine with a defective part.  When what the correct diagnosis was psychosomatic.

    This is a huge and neglected part of the debate about health care in this nation.

    Um, that should read (none / 0) (#4)
    by Dadler on Thu Jul 05, 2007 at 11:50:42 AM EST
    "I spent more than a quarter of a CENTURY..."

    This is a serious problem (none / 0) (#1)
    by TomK on Thu Jul 05, 2007 at 11:41:15 AM EST
    Opiate medications are actually quite under-prescribed.  I have seen families of people on hospice advocate against morphine for terminally ill family members because of drug connotations.  

    Which is not to say.... (none / 0) (#3)
    by Dadler on Thu Jul 05, 2007 at 11:49:33 AM EST
    ...that I don't think there are people being undermedicated, but simply that there are far too many people being overmedicated.

    I sympathize with doctors, but at the same time have a great problem with many of them and their medical paradigms.

    Yeah, (none / 0) (#5)
    by HeadScratcher on Thu Jul 05, 2007 at 11:51:40 AM EST
    Because none of us have ever heard of doctors over-medicating people...

    Locking them up should help (none / 0) (#7)
    by roy on Thu Jul 05, 2007 at 12:59:55 PM EST
    There's a difference between "doctors over-medicating" and "doctors dealing drugs".  The first can be dealt with by licensing, education, and the occasional massive lawsuit.  The second seems to be largely a bogeyman so some politician can brag about being tough on crime.

    Wish your pain away... (none / 0) (#6)
    by BlueCollarHeresy on Thu Jul 05, 2007 at 12:37:05 PM EST
    So basically Dadler something in your life was wrong and your brain decided to take it out on you.  Sorry, but many (and I would say most) people don't have your problem.  

    You may have been able to pray/wish/meditate/whatever your pain away but for people who have terminal cancer, arthritis, or chronic pain-causing diseases like Multiple Sclerosis opiates and other strong pain killers are a godsend.  The fact that there are federal prosecutors out there who are too thick-skulled to tell the difference between a medical pain patient and a junkie looking for a high and thus treat them both equally is a travesty of justice.  The fact that they're prosecuting doctors and patients for their legitimate medical practices is nothing short of criminal.

    criminal? (none / 0) (#9)
    by Jen M on Thu Jul 05, 2007 at 02:08:00 PM EST
    certainly immoral, mean, downright sadistic - and in the cases where pain patients commit suicide after pain clinics shut down: murder

    and all for personal gain. (advancement, votes, what have you)


    My friend (none / 0) (#23)
    by Dadler on Fri Jul 06, 2007 at 12:02:52 PM EST
    Your paraphrasing of my post is unfortunate.  That is not what I wrote or suggested.  I wrote that there are certainly people with definte and serious physical injuries (I am one of them, by the way, which I will elaborate on later), and painkillers have their place in certain cases.  But my point was about the millions of people suffering and being debilitated by pain that medicine can find no real cause for.  If they could find the cause, logically, then a real treatment and healing cure could ensue.  But the brain, the organ that CONTROLS EVERYTHING IN THE BODY, and the emotions it creates, are not considered any real factor in causation.  Oh, they'll tell you stress can make pain worse, but that your brain can do no more than that.  Even though, say, when you get embarrassed, what happens?  You blush or perspire -- an emotional feeling is immediately physicalized.  A similar thing is at work in Dr. Sarno's diagnosis.

    (And, since you tried, here's one way in which it works: the sub-cortex will restrict the flow of oxygen to a certain part of the body, in order to create pain to distract the person from subconscious rage, thoughts, emotions.  That's it.  The subconscious (which is what the sub-cortex is) views dealing with pain as better than dealing with overwhelming emotional and mental sh*t.  And that sh*t could be anything from real trauma to simple stress at work, and the pain ensuing can be just as serious or as relatively minor.)  

    As for my physical injury, I have a paralyzed lower leg and foot from blowing out my back -- basically the most serious result of a ruptured disc.  I understand what a serious injury is.  As does my brain.  A year ago, I could not have stood up for more than ten minutes without being in so much pain I would start to shudder (and this was three years AFTER surgery).  I suffered from a myriad of pain sydromes that were all debilitating at one point or another.  And I had suffered like this since I was a child.  From back, to ulcer pain, to headaches, allergies, you name it.  I was healed because I finally found the CORRECT DIAGNOSIS.  This is not alternative medicine, it is medicine period, that is concerned with treating the CAUSE of them pain, not simply the pain (symptom) itself.  That this diagnosis was not even considered by regular doctors and medicine is, to me, inexcusable.

    You see, here's the thing.  When I had back surgery, my surgeon remarked in the recovery room to me how truly ugly it was in there.  It looked like I'd had disk herniations and ruptures in the dozens over the years, with tons of calcified disc material in there.  And that's the rub.  You can find that material in people who have never had any back problems, and you can find it in people like me, who suffered for decades.  There's no real correlation.  And there was no real correlation between all that damage and my back and the pain I had felt and which had debilitated me.  But while ulcers were the fad in the in the mid 20th century, bad backs are the rage now.  But, as Dr. Sarno says, the human spine has evolved over millions of years, is the strongest most durable part of the human body, it has to be, and it has served us well -- but we're supposed to believe that in the last twenty or thirty years, the human spine has just fallen apart?  

    And don't even start me on Fibromyalgia, which modern medicine is clueless and cruel about -- with its bullsh*t "secondary gain" paradigm, which teaches patients that the pain is all physical but that they are also gaining something from it which makes it continue -- sympathy, break from work, whatever.

    That is malpractice of the worst kind.

    Take a look at Sarno's work.  Look at his experience and credentials.  Read up on psychosomatic medicine and its history.  Read up on the brain.  Specifically the sub-cortex, which controls things like the autonomic nervous system, the autonomic peptide system, and the like.  And read Freud, who more than a hundred years ago was doing his own research and came incredibly close to figuring it out.  

    Most unfortunately, too many people have been brainwashed into thinking they are frail and helpless, that their emotional and mental lives are simply not a factor in the causation of pain or other maladies, when in reality they are just the opposite.  Too many people reject this diagnosis because it does not fit their paradigm -- that every physical pain or malady is just a function of humans being machines with broken parts.

    We are more than machines with parts, we are emotional creatures.  And those emotions, and the subconscious mind that stores the most unbearably painful of those, is a powerful organ.  The most powerful in the body.  

    And that's a fact.  But we treat it like fiction.


    So, a certificate from the FLETC is as good as a (none / 0) (#8)
    by SeeEmDee on Thu Jul 05, 2007 at 01:32:40 PM EST
    doctor's degree? (That's FLETC, as in Federal Law Enforcement Training Center, where Fed cops get their training.) That's interesting; I thought medical school took years to complete, not a few weeks. And it was ruinously expensive. Is there some sort of program where DEA Agents can become doctors overnight? Wow! Must be some really top-notch, super-duper educational system they have in FLETC to make instant medical experts out of cops. They know all about pain management, huh?  (end snark)

    Really, this is what happens when you let government have control over something that should be between you and your doctor. Or, for that matter, control about what you may or may not put into your body. Prior to 1914, with the first fed drug laws, we never had the kinds of problems that we have to day: cartels, drive-by shootings,etc. The insertion of government-as-Big-Daddy with the Harrison Narcotics Act changed all that, and the present evils such as this originated with the bureaucracies that these ill-crafted laws spawned.

    The bureaucrats know full well they can't do diddly about the inflow of illicits into this country, when tons of the stuff are interdicted and the price, purity and availability suffers nary a blip. But to assuage the public that they're dependent upon for their paychecks, in order to appear that they are 'doing something', they target doctors treating intractable pain and then crow they've taken down major drug traffickers. Grandstanding, nothing less than political grandstanding.

    All the more reason to oppose (none / 0) (#10)
    by sarcastic unnamed one on Thu Jul 05, 2007 at 02:23:22 PM EST
    Really, this is what happens when you let government have control over something that should be between you and your doctor.
    national health care.

    Regarding pain meds, I certainly don't want the gvt to get in the way of docs, but, like Dadler, I would like to see some more progressive methods of doctoring people with pain.

    Pain meds don't just mask pain, they often help turn the user/patient into what the office staff of one of wife's old clients (a pain doc) referred to as "carrots."

    A Bit Cotton Headed Today Sarc? (none / 0) (#12)
    by squeaky on Thu Jul 05, 2007 at 02:46:56 PM EST
    Really, this is what happens when you let government have control over something that should be between you and your doctor.

    That is your argument against national health care??? Non-sequitur with some spin added.

    The DEA would not be the one's regulating a National Health Care Program.

    Now we have US government regulators and insurance co's regulating doctors. One regulator is better than two.


    And (none / 0) (#13)
    by squeaky on Thu Jul 05, 2007 at 02:49:26 PM EST
    Losing the Insurance co's would be a big step to eliminating roadblocks that MD's face preventing then from treating their patients.

    And a NHC wouldn't roadblo, er, regulate (none / 0) (#16)
    by sarcastic unnamed one on Thu Jul 05, 2007 at 03:13:32 PM EST
    what its docs could or could not do?!



    As I Said (none / 0) (#18)
    by squeaky on Thu Jul 05, 2007 at 03:16:00 PM EST
    Better one than two. And better that the one who is regulating based on greed factor be cut out.  

    Good sound bite, catchy even, (none / 0) (#19)
    by sarcastic unnamed one on Thu Jul 05, 2007 at 03:23:36 PM EST
    but the reality is it'll be a(nother) gvt bureaucratic nightmare.

    Nirvana, thy name is most assuredly not NHC.


    national health care (none / 0) (#20)
    by Jen M on Thu Jul 05, 2007 at 06:11:36 PM EST
    worked fine and dandy where I lived thank you very much.

    Like the DEA condeming chronic pain patients to a (sometimed greatly abreviated) lifetime of no relief is BETER ? Cause, thats Bush's idea of government NOT interfering?????????????????????

    You fearmonger against a system that works in many countries but ignore the HUGE BLACK MARK OF EVIL against what this country is doing?


    oh yeah
    thats logical


    Thank God for that squeaky, (none / 0) (#14)
    by sarcastic unnamed one on Thu Jul 05, 2007 at 03:10:30 PM EST
    The DEA would not be the one's regulating a National Health Care Program.
    because - except for the DEA - all our gvt agencies work so guuuuude!

    Cotton headed today? Why yes, a bit earlier though, not so much now. Thanks for asking.


    But (none / 0) (#15)
    by squeaky on Thu Jul 05, 2007 at 03:13:22 PM EST
    You speak as if MD's are not already regulated by the gov.

    Hope your 4th was fun, guessing that you had a blast.


    Thanks, it was, (none / 0) (#17)
    by sarcastic unnamed one on Thu Jul 05, 2007 at 03:14:37 PM EST
    hope yours was as well.

    When the only reason you're.... (none / 0) (#11)
    by kdog on Thu Jul 05, 2007 at 02:36:32 PM EST
    seeing your doctor is to re-up your script, you are basically seeing a drug dealer.  Check that...you're seeing the guy whose signature is required by law to then go see the pharmacist aka drug dealer.  Great for the doctor, raking up the office visits when all you need is a signature....sucks for the patient, just an extra expensive hassle.

    As SeeEmDee pointed out, in 1913 all you had to do was go to the pharmacist/dealer and get what you needed.  

    We had it right in 1913, imo...before the state decided to start being our collective nanny.