Most if not all pain management physician’s websites talk about interventions for treating back pain. Few if any discuss medication management. This is a complicated topic, but one which needs to be addressed. All physicians in this field should prescribe medications for chronic pain, but not all do. First of all, it can be time consuming, and patient’s can be demanding at best, deceptive at worst. Second, it may not be cost effective. And third, the prescribing of opoid medication for certain chronic back pain and other conditions remains controversial.
The management of chronic pain with opoid medication was highly regarded in the last decade. But the pendulum has swung the other way during the last few years. There is unfortunately a lot of drug diversion and abuse occurring today. This therefore puts a physician who prescribes pain medication under some scrutiny, and can put patients on the defensive. Of course the best defense is a good offense.
I do practice medical management for chronic pain. This has led me to adopt a strict philosophy and office policy. The optimum patient will say “do whatever you can do to help me with my pain”. I have had patients who have trialed interventions that I have recommended, but still have a degree of pain. In these patients, if other options are limited or risky, I will discuss medications (even if they have never asked about it). I hate to fail in treating someone. So I will do whatever it takes, including prescribe medication. Sometimes this is successful, and does improve their pain and quality of life (the goals of all therapies). I have also seen patients only seeking someone who will prescribe pain medications for them. In some I have told that there may be treatments which can help them besides pills. But if a patient blatantly refuses what may be beneficial treatments, it makes them not seemingly genuine in wanting to get better. Nevertheless, a good physician must also take patient’s needs and desires into account, when coming up with a treatment plan.
A chronic pain patient must be prepared to undergo several steps before obtaining medication. He/she must obtain at least several months of previous notes from previously treating physicians. It should be expected that those physicians will be contacted. Also, they will need to undergo both physiologic and psychological testing. This is recommending in the field, to evaluate for depression and other ailments related to chronic pain. Only after such testing has been completed, may pain medication be prescribed. However, I never prescribe such medication on the first visit.
I am dedicated to treating all patients in pain. However, one must realize that such a relationship is a partnership, whereas both doctor and patient must understand each others issues and desires. Medical management of chronic pain is not popular (no one advertises this), is somewhat controversial, and is certainly labor intensive. However, it remains an important treatment in patients who otherwise have limited options.