A medical doctor shares his frustration with treating pain. A problem that plagues in the box medical thinking on pain.

A medical doctor shares his frustration with treating pain. A problem that plagues in the box medical thinking on pain.

It must be frustrating to try to understand pain thinking of it clinically without having the tools to adequately evaluate and treat it other than using medication. A doctor who wrote this column in the NY Times faces a professional crisis where on one end, people who are taking off the shelf medication may not get adequate relief while others, become addicted to opioid based meds that require a detox program to get off of.

Another option exists but it does not seem that he even noticed that a profession called chiropractic may have the tools necessary to help these patients stay off meds. Commonly, patients who are sent for pain management who never visit a chiropractor become addicted to medications since the doctors do not learn how to evaluate the musculoskeletal system appropriately. Instead of understanding why the person hurts, their attention is pointed toward where, and usually an injection or a medication in a hit or miss regimen is the recommended solution.

Most people would like to go through life being lucid, and chronic use of pain meds begets other problems such as addiction and organ damage. Why are these patients not offered other alternatives and instead, being placed on medications that cannot possibly work to resolve mechanically based problems, the most common reason for chronic pain?

While this doctor is concerned with an ethical obligation to his patient, wouldn’t it be more ethical to refer the patient to someone who really can help this person feel better and avoid medication?

Read the article here

Hard Cases: The Traps of Treating Pain

I hadn’t seen Larry in a dozen years when he reappeared in my office a few months ago, grinning. We were both grinning. I always liked Larry, even though he was a bit of a hustler, a little erratic in his appointments, a persistent dabbler in a variety of illegal substances. But he was always careful to avoid the hard stuff; he said he had a bad problem as a teenager and was going to stay out of trouble.

It was to stay out of trouble that he left town all those years ago, and now he was back, grayer and thinner but still smiling. Then he pulled out a list of the medications he needed, and we both stopped smiling.

According to Larry’s list, he was now taking giant quantities of one of the most addictive painkillers around, an immensely popular black-market drug most doctors automatically avoid prescribing except under the most exceptional circumstances.

“I got a bad back now, Doc,” Larry said.

Doctors hate pain. Let me count the ways. We hate it because we are (mostly) kindhearted and hate to see people suffer. We hate it because it is invisible, cannot be measured or monitored, and varies wildly and unpredictably from person to person. We hate it because it can drag us closer to the perilous zones of illegal practice than any other complaint.

And we hate it most of all because unless we specifically seek out training in how to manage pain, we get virtually none at all, and wind up flying over all kinds of scary territory absolutely solo, without a map or a net.

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