Pain Management?

in Pain
There comes a point when the doctor seems to run out of ideas. He or she has been treating an injury or disease for months. All that can be done, has been done. The only problem is the pain. No matter what is tried, nothing seems to relieve it. At this point you realize this has stopped being a case of injury or disease. The pain itself has become the equivalent of a disease in its own right. As such, you should therefore transfer from the original doctor to someone specializing in pain management. Except that does not happen. Why not?

In part, the answer is political. People in hospitals and other larger organizations build up empires. Their reputations depend on the amount of fee income they generate. So if they are too quick to hand over their patients to other departments, this is giving away earning capacity to rival empires. The second issue is potential legal liability. So long as you keep all your patients under your care, you can hide any possible mistakes. But if you hand patients over to others, there's a risk they may find errors in the diagnosis or treatment. Remember these are rivals. If they can quietly undermine the public reputation, they may get more patients and more status. It also gives them a lever if they find evidence of medical negligence or malpractice. Just think how many favors a pain management specialist might be owed if all the evidence was buried. Yes, doctors really do cover for each other.

If this was an ideal world without attorneys lurking, doctors would routinely refer to each other for second opinions. This would always be for the benefit of the patients. A new pair of eyes can often see something different. But the sad reality is that hospitals are very reluctant to establish pain management clinics. They are seen as threatening the established pecking order for the traditional departments. Worse, they are more labor-intensive. The "efficient" departments see large numbers of patients on a conveyor belt. Pain management clinics put teams together to help individual patients. When you make the patient the focus of everyone's attention, the results are always better than the traditional take-a-number-in-the-queue approach. Not only do patients feel empowered. At last, someone is listening to them. But you also get more comprehensive treatment. Physical therapy improves mobility, Cognitive Behavioral Therapy teaches people how to recover their quality of life, and counseling improves the mood. As a package, this is all good for the patient.

In this, prescription drugs do have a part to play. Tramadol and other painkillers are a useful option. But the main pain management strategy is to teach people how to make the best of their lives without becoming dependent on any medication. This keeps cost down - pills are a continuing expense - and avoids problems of withdrawal should you try to stop after a long time. This is not to say you would not take Tramadol if there was a sudden flare up of pain. But as soon as the pain is back under control, you phase out the drug and go back to general pain management strategies.
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Pain Management?

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This article was published on 2011/02/19