So we are in an era where the pendulum is swinging back to the other side with full force.
In the past physicians were prescribing opiates liberally and for every hangnail and now they wont prescribe for even the most legitimate patient. Why is this?? short and simple: fear!. There is literally no training in medical schools on how to treat pain and prevent dependency in patients. As physicians we simply learn this stuff “on the fly” and usually from other colleagues who are also not doing it well. Its the blind leading the blind. How have I learned it then you might ask? I became board certified in Addiction Medicine and became certified Medical Review Officer.
By learning to treat patients who have become severely dependent by the hands of other physicians I have learned what these patients do and dont need. I came to discover that many patients actually are really truly good and legitimate patients with true needs for pain control. Its just that they got made so dependent on narcotics and the narcotics became so tolerant that nothing was working despite very hi doses.
The more you take the less it works. (More is NOT better).
Its a bad spiral and a very slow one where the physician really wants to help and the patient just wants a “tiny” increase in the pain meds and then slowly over time those “tiny increases” start adding up and you get someone on 500mg oxy/day!… OH and its mixed with some xanax for anxiety and some soma for sleep and some this and some that… (this is the cocktail of death we have seen for years).
-ABOUT 40,000 DEAD BODIES/ YEAR
So I have patients that I initially classify as “pain management gone bad”. They have legitimate issues that have spiraled out of control and physicians kept throwing more pain killers at them. Doing the same thing over and over, week after week and month after month (this is the definition of insanity: doing the same thing over and over and expecting a different result !!!) .
Why do they do this?
Its because they haven’t been trained in the use of all of the other pain management tools out there. This will be an upcoming topic soon. What other options are out there? Do those meds work? Can I get 100% pain relief (spoiler- the answer is no BUT we can make life more manageable and help you learn how to cope better with it )