Few Gains on Chronic Pain Treatment

Angie's List member Jill Biller has suffered from lower back pain for a long time. When she moved to Palm Coast, Fla., from Virginia, she just wanted a refill of the prescription painkiller hydrocodone. Instead, she says, the doctor "treated me like a junkie."

Biller is among the estimated 100 million sufferers of chronic pain in the United States, according to a 2011 report from the Institute of Medicine. Nearly 60 percent of Angie's List members who took a 2011 online poll say they suffer or have suffered chronic pain. Like many of them, Biller finds empathy, much less help, hard to come by.

Health care providers in the pain management category garner negative reviews at twice the average of other Angie's List categories - 20 percent of the 1,900 reviews filed in the past three years have C, D or F grades. Members report their health care provider didn't take their problem with pain seriously, and in an Angie's List online poll, 21 percent of respondents say they haven't found a good approach to managing their pain.

A common, costly ailment

Chronic pain differs from acute pain in that it lingers long after an injury has healed. In some cases, it starts with no definable injury at all. Headaches, lower back pain and joint pain are the most common complaints, according to the Centers for Disease Control and Prevention, with joint pain the only one clearly associated with an underlying disease - osteoarthritis.

The pain can't be seen, felt or heard by anyone other than the patient, but one thing that can be measured is its cost - up to $635 billion a year in medical treatment and lost productivity, according to the study by the IOM.

"Pain is a disease," says Melanie Thernstrom, a chronic pain sufferer in Portland, Ore., author of The Pain Chronicles and a patient representative on the IOM committee. "It causes damage in the nervous system and in the brain over time. It is dangerous not to treat pain."

Treatment can involve medical management; physical, psychological or interventional therapies; and alternative treatments. Yet pain remains untreated - or improperly treated - in many cases, due to a range of factors that include doctors' lack of training and insurance companies' reluctance to pay for the most effective treatment, the IOM reports.

Expertise in pain management

Only 22 percent of 133 accredited U.S. medical schools teach chronic pain management, and even then it's part of a broader course, according to the Association of American Medical Colleges. It adds up to 11 hours of pain education in four years of training. In a 2009 American Medical Association survey, doctors ranked their pain management education 2.65 out of 5.

Board certified anesthesiologists, neurologists, psychiatrists or physchologists can pursue certification in a pain medicine subspecialty by participating in a one-year fellowship in pain management and passing a written exam. About 3,400 of the approximately 130,000 specialists nationwide hold the pain medicine subspecialty certifications recognized by the AMA. Groups, such as the American Board of Pain Medicine and the World Institute of Pain, also offer certification, but lack of certification doesn't prohibit a doctor from specializing in pain management.

Experts say subspecialty certification doesn't guarantee quality care, but it typically indicates more in-depth knowledge. The IOM reports that medical boards in some states, including California and Florida, recognize only the AMA-approved or ABPM subspecialty certification, which allows doctors to receive insurance reimbursement at specialty rates.

Dr. Dan Carr, an anesthesiologist and founding director of the Tufts University School of Medicine's pain research, education and policy program in Boston, says people may complain more frequently about pain management because doctors - even those holding a subspecialty in pain medicine - are trained to focus on objective measures and procedures, yet pain also has social and psychological aspects many doctors don't know how to handle.

Numerous studies, Carr says, show pain sufferers feel better when somebody listens. "There is an enormous social component to pain," he says. "Patients will be more satisfied if they feel they have been cared for. That has more to do with their satisfaction with pain control than the actual intensity of their pain."

Other doctors are quick to prescribe pain medicine, rather than taking time to understand why a patient is suffering, says Dr. Loren Fishman, a highly rated rehabilitative medicine specialist with Manhattan Physical Medicine and Rehabilitation in New York. "In many cases doctors don't know anatomy well enough to find the causes," he says. "I prefer to find the cause and eliminate pain." About 90 percent of the time, he's able to wean his patients off medicine, he says, by using a multidisciplinary approach that could include surgery, yoga therapy and Pilates.

Seeking effective pain treatment

Dr. Perry Fine, an anesthesiologist and president of the American Academy of Pain Medicine, says patients should find another doctor if they feel like they aren't being heard or not making progress. "There is inadequate training and knowledge and understanding of pain," he says. "Consumers have to be a little more assertive than they have been in the past."

At the same time, "zero pain" is not a realistic expectation, he says. Instead, patients should expect treatment that will allow them to live with a "reasonable amount of pain with minimal disruption of daily life."

However, patients should expect to be taken seriously, Fine says. The doctor should answer questions about treatment, likelihood of improvement and consequences. In turn, he says, they should listen to the doctor who may suggest a multidisciplinary approach that may include exercise, physical therapy and mental health counseling.

In particular, counseling meets resistance with chronic pain sufferers. "They say, 'You don't believe me. You think it's all in my head.' Well, in fact, pain lives in the brain," Fine says. By definition, chronic pain doesn't go away, he adds, so sufferers need to learn healthy ways to combat the depression, anger and frustration that often go hand-in-hand with it.

Vicki Cambridge of Wildomar, Calif., has seen at least seven medical professionals - including an acupuncturist, neurosurgeon, chiropractor and rheumatologist - since hurting her back four years ago in a car wreck. And because of the pain, the 52-year-old can no longer work her IT job. Instead, Cambridge focuses on finding a cure. "I'm not going to live the rest of my life being disabled," she says. "I know there is someone or something that can help me."

Biller says she's found relief through hydrocodone and cortisone shots thanks to highly rated Dr. Elena Stanescu with The Physicians Pain Center in St. Augustine, Fla. But she's still upset with how she says Dr. Vinod Malik, a board-certified anesthesiologist, treated her like a junkie and cut her off cold-turkey from hydrocodone instead of weaning her off it.

Malik, owner of PRC Associates Interventional Pain Management with locations in Daytona Beach, Fla., and several surrounding cities, has an overall negative grade based off Biller's report. Malik says he focuses on the surgical aspects of pain management such as epidural steroid injections and lumbar decompression. "All she needed was medication management, and we opted not to do it," he says. "Sometimes you cannot make everybody happy."

Costs of pain treatment

Biller and Cambridge say insurance pays for most of their treatments with a few exceptions. Cambridge paid the full cost of spinal decompression, about $3,000, she says, and $45 a session (reduced from $60 because of her insurance) for twice-a-week acupuncture for two months. Biller's copay includes $80 per cortisone shot and $20 per office visit.

Both regimens rely heavily on medical procedures, which experts say insurance companies favor even though research indicates chronic pain responds best to a multidisciplinary approach.

Dr. Judy C. Lane, highly rated neurologist and medical director of the Head Pain Center in Englewood, Colo., says chronic pain, particularly her specialty of chronic migraines, requires a cognitive approach. New patient consultations can take up to two hours as she tries to understand their medical history. "If I bill that to insurance, that time would not be compensated," she says, adding that she no longer accepts insurance.

Instead she charges $725 for the initial evaluation and $175 for a follow-up visit and doesn't file insurance claims. Some insurance plans reimburse her patients who submit their own claim, others don't. But once she finds a regimen that works, she says patients can return to a family physician for care.

Fishman encounters the same problem in his treatment of back pain: Insurance companies won't pay for yoga, which he says effectively manages or eliminates pain in many of his patients. "If I teach a patient something in the office that's classified as yoga, I can charge for it," he says. "But if I send a patient to a yoga therapist, there's no way insurance would cover that."

Susan Pisano, spokeswoman with America's Health Insurance Plans whose 1,300 member companies cover 200 million Americans, says insurers make their own decisions, but in general, alternative therapies are covered only when there is evidence they are safe and effective for a specific condition. "Some therapies may work for some conditions but not others," she says.

In its report, the IOM committee exhorts the insurance industry to make further strides. "There are some simple approaches that are not well-covered by insurance," says Dr. Philip A. Pizzo, committee chairman and dean of the Stanford University School of Medicine. "This is as simple as physical therapy or rehabilitation therapy that may be appropriate and necessary for certain pain conditions."

Ultimately, Pizzo says his committee sees a need for cultural transformation in the health care industry toward people with chronic pain. "Their suffering is not something they should be blamed for or their pain viewed as something they have made up," he says. "All too often in the absence of knowledge there is an attribution of blame. We need to get over that."


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Comments

I've worked as a nurse in pain managment for 5 years and this field is absolutley draining. I work for legitimate wonderful, sympathetic and caring physicians and they are more than often victims of pill seekers. Majority of our patients are non-compliant, they over take their pills, takes friends and family member pills, we get calls about our patients selling there pills etc. And these are the same patients who are in office complaining of the most famous "low back pain". Don't get me wrong the patients have abnormal imaging studies but a mild to moderate bulging disc or herniated disc does not necessarily always is contribute to pain. Sciatica is not constant and daily it's episodic and can be managed with stretching and injections. Oh and no one wants therapy, therapy is always a fail. Unless you are dying or recovering from cancer I don't believe any human being needs to be on high doses of narcotics. Matter of fact we have cancer patients who are on LESS narcotics than the average neck and back complainers and they are our compliant patients. We never have problems out of our cancer patients it's always the joint, lbp, neck all the folks with the non-life threatening illnesses. People are not honest and will over exaggerate their pain to get medication increases and or more drugs. I see it everyday. If you are questioned as pill seeker thats because you have in some way exihibited some form of abbverherent behavior. Florida is full of people with legitimate pain problems who are addicted and or are selling their meds and that's reality.

my wife has had pain more severe than you will ever know. Most of the pain came after Quad. bypass in 1990 she now suffers from Diabetes, Arthritis and a number of other pains brought on by the heart surgery so I was told. I have been married to my wife for 49 years and I see the pain she go's through every day. and I can tell you it is not fake or any of the other reasons you seem to think you know because you work with a doctor. I only wish you could suffer some of the pain she suffers but then I would be like you and think all people who take narcotics for pain are addicts. If I had my way people like you would be ran out of the nursing business. My wife was given a 10mg. prescription to be taken up to 4 times a day period and has never gone over. Some times I tell her to take the 4th one when she is hurting so bad she is crying. She has never taken more the prescribed or given or sold any. and I would not let that happen because she need them. I can't understand how some people think they know what pain is and who is faking pain to get pills. If you haven't walked in their shoes don't judge just because you work with or are a doctor. Thank you for letting me post a reply. Tony

i agree with you , Tony. my woman has had severe pain in her back also, she has been treated as a addict, which is so irratating makes me want to smack the doctor and nurse for their smug actions. i understand there a alot of others who take advantage of their meds, which make it dam near impossible for someone who genually needs meds. i agree those who prejudge people should have their licenses revoked. my woman has also cried herself to sleep or the pain is to intense the she passes out from it, sad that it the only relief she can get. i agree it they have not walked in their shoes do no judge. if u play dr or nurse on tv keep your stupid opinions to ur self and do your dam job. they took oath to help people no matter what, not to set themselves above others as judge and jury. wonder how they would like it if shoe was on other foot. thank you for you for letting me reply to this. RAY

WARNING: THIS IS A LONG POST, BUT WORTH THE READ I THINK I read your comment today and I am appauled. Let me tell YOU something about pain. I was a nurse. I say was because I lost the fight against chronic pain. I have had pain since I was a child. A CHILD of 7. They couldn't figure out what was wrong with me. That was 40 years ago. My arms would swell like popeye, and the pain in my legs was unbearable. The test were all inconclusive. Maybe Rhuematic fever, "we just don't know". Then the pain of endometriosis began. Not when I was in my 30's like all the literature stated...NO it hit me when I was 17. The pain from the endometriosis and the other unknown pain would have me crawling on my hands and knees to go to the bathroom. I worked thru it all. Took occasional narcotics and nsaids. The nsaids didn't help and it would be 30 years before I found out why. At 18 I was diagnosed with osteoarthritis in my hips, knees, shoulders, SI Joints and spine. I wasn't over weight, I didn't overuse my joints as osteo normally results from. So, I go thru life in chronic pain from many different pain causing issues. I get my nursing degree, work for 6 months in a wonderful facility. One night, I bent down to crank a bed up and my back stuck. I took me nearly 15 minutes to be able to straighten back up. after awhile, I start noticing that I am hurting everywhere. After 6 months of test after test, doctor after doctor i finally got the diagnosis of Fibromyalgia, Myofascial pain syndrome, chronic fatigue syndrome, etc, etc etc. It was all I could do to walk from one room to another. I started taking narcotics. I NEVER took more then what I was allowed. Never gave it away, never sold it. Why you ask? Since in your so called experienced eyes that all pain patients are drug addicts, drug dealers and drug seekers. Because it worked. It allowed me to be able to get out of bed and be a minor participant in my family life. Could I work any more? No. the pain medication never allowed me to be pain free. Just managable. So that I could take care of my self and my children to the best of my ability. So now, back to my previous mention of why I found out why the nsaids didn't work. Medicare started asking patients for voluntary DNA testing to see if they were able to metabolize certain medications properly. This to be used as a tool for the physician when prescribing medications. I found out that I was a poor metabolizer for the nsaids which means that my body doesn't clear the medication out of my body fast enough. This explains why when I took celebrex, vioxx, bextra, and all the others that it constricted my renal arteries to the point that I began to swell with edema so bad that it caused more pressure and more pain. Oh, and physical therapy? After a couple sessions they refused to perform even passive therapy on me because my pain was too high and it would exacerbate the pain. Come to find out I have a condition called Dercums Disease. This is a condition where multiple lipomas grow and put pressure on the nerves causing ...yes....more pain. So now you have a glimse into a real chronic pain patient. A chronic pain patient who has to fight every day with pain you could never imagine. And now I have to fight to receive the one thing that works for ME...Pain medication. You don't deny a diabetic insulin even if you believe that their diabetes could be controlled by diet and exercise. You don't deny a cancer patient cancer medications because well, it may not be able to shrink the tumor enough. Medicine doesn't deny any other patient any medication that has been proven to improve their quality of life. Well, that was until recently when I was refused my pain medication because the pain management physician resigned with no replacement and there is a fear of the DEA knocking down the door of any physician that prescribes pain medication. So now none will prescribe it. Look, I realize this is a huge reply, but I feel it is necessary that pain patients have a voice especially when people like you, and I use that work loosly, rant and rave about something that they have absolutely no clue about. Yes there are those that are addict looking for a fix or drugs to sell. But there are those of us and we are many, that suffer every day of our lives. Make that every MINUTE of our lives in misery. And we deserve to be treated as human beings. Not abandoned by our physicians of 30 years because of fear. And as for your attitude....you are either not who you say you are because if you were really a nurse you would know from your education that pain is the #1 most undertreated and under recognized disease. And yes it is a disease. And as nurses it is our duty to the patient to make sure that pain is recognized and treated appropriately. If you truly are a nurse then you most definately have nurse burnout and it is time to find another job.

1) I was under the care of a physician in a pain management clinic. I did believe my life was saved; that was 6 years ago. Recently, that very 'life saving doctor' pulled a stunt that defies reason - it doesn't deserve commentary here. It resulted in me needing to find someone else to assist me with pain management and help me find a way OFF Fentanyl. I have subsequently been searching and discovered that the field of Pain Management is overwhelmed with caution. A few of the losers who abuse the system have absolutely ruined this life saving process for those of us who truly need help. More patients need to band together to form some way of getting insurance companies, physicians and the DEA/government to accept our diagnosis. BTW after nearly 5 months I still don't have a pain management doctor...REALLY FOLKS???? My diagnosis is over 12 years old and quite likely was there for many more years. 2)What is up with the DEA? Well we should all know the rules did change, and not in way that helps the chronic pain patient, in October of this year. I fear that as the government continues its steady path to assume our lives, we will not be able to go to restroom without permission. I for one learned how to go potty by myself over 55 years!!! I say again, to the PYSICIANS and PATIENTS can we not work together to find a solution for a legitimate diagnosis? I will offer to spend 2 hours daily working with other folks interested in pursuing this matter. 3)Finally, DETOX. I decided all by myself about a year ago that I wanted to get off the opiates. My clinic continued to offer me more...Most recently, while looking for a new clinic I was required to visit a Physiatrist and then after insisting that I was sincere about trying find a way to reduce or stop the Patches I was advised by mail the I "didn't fit in to the clinics PARADIGAM????? Really???? Oh, and BTW the Psychiatrist didn't find anything in particular 'wrong' with me, except perhaps a bit of ADHD. I believe that this response was due to 2 things: first, the DEA and their stinking attack on physicians and secondly, on what I wanted to do. The Pain Management industry is not without fault in this issue. I don't want Schedule II/III drugs, I wanted to try weaning myself down and if I got really lucky off and use other drugs for my conditions, like Cymbalta. I also suggested that I wanted to try hypnosis for an additional therapy. But who would have guessed that our medical world would find me some kind of crazy for looking at the whole body?!!! In conclusion, I really did nearly take my own life because of the pain, the resulting changes to my life (I had been so very active). The subsequent lack of sleep, weight gain, and difficulties in my marriage. The disease I have isn't just in my mind, it doesn't go away and certainly should be under control. In the world I live in now these basic rights, human rights are sadly missing. So where do I sign up? Who can I talk to? Where can I donate my time to remedy this unfortunate circumstance? Please PLEASE let me know. PS: No ranting intended, I'm just passionate about feeling well again aren't you?

Thank you so much for this reply to the previous post! I could not have said that better. I'm still fightin and struggling to be a mother to my children due to real chronic pain that is still going untreated due to unacceptable insurance. My family has always came first and still do but because I am NOT ABLE TO STAND for hours or sit comfortably due to spasms that cause me to black out cause of the pain! So again, thank you. Not everyone is after drugs but it feels nice to be somewhat comfortable...

If I were you I would choose another line of work! I've been a surgical P.A. for thirty years and your attitude towards pain patients is unacceptable!I've had two failed fusions and I can tell you first hand that you have no clue ! I'm seriously doubting That you are even an R.N! i WAS LABELED A DRUG SEEKER BECAUSE i KNEW TOO MUCH ABOUT MEDICATIONS! No one bothered to read my occupation on the chart. I had legitimate pain and knew which medications that I could take or which didn't work. Your labeling of patients as pill seekers will come back on you one day when you are defending yourself to the nursing board. you will not have your license very long after that! And you can be sued for slanderous remarks! And H.IP.P.A. violations!

I read your comment today and I don't think you have the right to talk about pain patients the way you do. My husband has had chronic back and leg pain for years due to an accident. His primary care physician and the physician that gave him his injections told him that he would always have to be on some form of pain medication so not everybody that deals with pain is a junkie. That might not be what you are saying but it sure sounds like it. If you don't go through the pain day after day you don't know what it is like and don't tell me you do just because you work in the field. You need to better at listening to patients about how they feel instead of telling them how they feel. How would you like to ho to the doctor with an ailment and have them tell you no I don't think you feel that way. The saying goes treat others as you want to be treated. It seems to me that you go to work everyday just to get a paycheck. Why don't you try going to work with a caring attitude and care for your patients instead of saying I guess I have to go in today so I can get a paycheck. It is very sad to have doctors or nurses like you.

Good for you, I could not have said what you said, better!!! Shame on the "nurse" expressing what is clearly a bias and personal opinion! I have been weaning off of the medication I've been taking for 7 + years, because I'm tired of being on this hamster wheel called "Pain Management!" I am also tired of being treated like a drug addict! I believe not all Pain Doctors are in this field for the right reason.

I live in a small town in Idaho, previously Seattle. I too have Fibromyalgia and osteoarthritis as well as 3 neck surgeries from a camper explosion. Both knees have torn meniscus and the pain is getting worse. I have been on pain meds since 1995, same dose and nothing else seems to help me through each day. I took part in a fibromyalgia pain study at the University of Washington (1 year) tried exercising and biofeedback and the tens machine. I do go to a water therapy, the pool is very warm and has a treadmill machine in it; it allows me to exercise without hurting myself. Nothing works, just the opioids...consistently. I've been to 3 orthopedics trying to get help for arthritis and all they notice is I am on drugs. At that point they right me off. Amazingly in order for me to get a GP in this small town I finally decided to write a resume so she could see how hard I worked. I own my own business and deal with dealers and distributors. I could not deal with my business without the help of the drugs. She did accept me as a patient but will not fill my opioids. I saw a Rheumatologist (2) and they would not continue with my long standing Seattle Drs. plan, sadly he recently retired. He did recommend 3 doctors in the same clinic (large clinic) and I picked one. This doctor did not read my history and so he too decided I was a drug seeker; if he took the time to read my history he would know I was a model patient and did what my Rheumatologist asked. After seeing him several times he realized that I was not a drug seeker. I have to go 6 hours away to Seattle quarterly and he prescribes what I need. All the doctors are so scared to take pain patience because they are scrutinized closely and must fill out reams of paper work for each patient. Their practices are on the line for us because of the government and those who don't know anything about pain and what works for us. I wish all these doctors could walk in our shoes for a month and see how they deal with the pain. I know that people with FM usually are depressed but I have never been, thank god. Oh, I am a 68 years old women and have been in pain since the mid 90's; FM runs in my family. Sorry for the long post....I am scared and mad, I don't see any light at the end of this tunnel do you? We need to ban together. I don't see any blog about Drs. in my area, I wish there were so we could let people know about the Drs. who are unwilling to do their job...I do feel sorry for them but sorrier for us. If we could let the world know through blogs (an be fair and not wine and complain but just tell others what to expect) I know I would feel like I was doing something to help all of us.

I agree with these people and think it is downright shameful the way people in pain are treated nowadays. I am and have been mad for years at the way we are treated and dismissed after a new doctor knows we must take opioids just to maintain a semi pain free existence. After relocating from the D.C. area to rural Virginia I have been turned away by a half a dozen drs with a simple "we don't prescribe pain meds". Well It isn't that simple. Who does then? I have been on them for about a dozen years and the pain is never going to go away. Surgery is not an option, had one, although it allowed me to walk again it did nothing to ease my pain of 9 ruptured discs not to mention trauma site osteoarthritis and a fibromyalgia. I was told by my pain management dr that I would only get worse from these degenerative issues and that I would be on pain meds for life. ok, fine. I have adjusted to that fact but now thanks to the government interference everyone who needs pain meds is treated by medical professionals like junkies or people who have post surgical pain med addiction issues (not the same thing at all). Yes, we are addicted but it is a small price to pay to live your life out of bed as long as we can be treated with respect and compassion. But we are also in big trouble if we need to move out of town or our doctor retires. The government and the media have no business interfering with medical decisions and medical professionals unfamiliar with chronic permanent pain problems have no business passing judgment on us or our previous doctors. Neither are being irresponsible. We are just trying to survive with our daily chronic pain the only way we can and to keep a roof over our head and food in our bellies since most of us can no longer work and have lost everything. Please leave us our self respect by not making us beg for medications that were designed for the very purpose for which we intend to use them. Is it morally right that we should live in constant fear of not being able to get our medications? Or that we will have to face both pain and withdrawal if we either have no money or cannot travel the insane distances that have become necessary to get to the few Doctors that are not afraid to prescribe the meds we need. The whole issue has become insane. We cannot get medicine that was available over the counter in one form or another until just the last half of the last century.

I have been in chronic pain since I broke my leg in 1991 and developed fibromyalgia. I was not diagnosed until 1997. My pain is never ending but is managed with Percocet and muscle relaxers. I also see a psychiatrist for the depression. My current pain doctor also gives cortisone shots and synvisc shots every six months. i also recieve shots in my back for digenaritve discs. I have been told if I do not have these injections they will not fill my prescription. I feel like I'm being black mailed. The prescription is the only thing that helps. I am treated like a drug seeker and its humiliating.

I suffer from chronic pain and I am practicing a personal wellness program based on the education and training I have received from three physical therapists and a program that dealt with the pain from a multidisciplinary approach. I resigned from my job in FL three years ago and returned to the city where I grew up so that I could move closer to the teaching and research hospital near family. I can't condense all that I have gone through over the last few years in attacking this life-altering condition in this short time. I can only say that once all the tests were completed, all the results were in, I realized that if I didn't see a pain management specialist, I would be like so many - dealing with docs who don't want to prescribe pain medication. Through the 10 week [one day a week] multidisciplinary program, I learned how to address my pain medically, psychologically, socially, and physically. I am so blessed that this program also has begun "booster" [that's what I call them] programs wherein you participate over three weeks in a "booster" for your personal pain management plans; address unmet needs, review previously taught techniques, examine psycho-social welfare, assess prior goals, regain and retrain lost methods and make changes where needed based on any new health/pain issues. Fitness is a HUGE factor - but not only physical fitness - psychological fitness MUST be addressed. The brain is the part of the body that tells the self it has pain and interprets the pain. The brain is also the part of the body that contains personality, temperament, mood, etc. EVERYONE'S pain is different because each person perceives it differently. My recommendation is search for pain management programs like I have described even if you have to travel to them. In my case, they have affected my quality of life tremendously and inspired me so dramatically that I am presently seeking a degree in psychology with an emphasis in pain management. God bless you.

that may work for you but may nto for someone else some people just need their bloody morphine. its all a scam. they are paranoid of the dea these docs

Not only do I have chronic pain in the form of arthralgias, neuropathy and migraines caused by cryoglobulinemia, I treat chronic pain. No, I'm not a neurologist, anesthesiologist or physiatrist. I am a residency trained, board certified Family Medicine SPECIALIST! The biggest obstacle to my mind is a narcophobic state board. I am very careful to follow the state boards regulations, including writing what they want in the chart, having contracts and drug screens and doing prescription monitoring through our state program. I have pretty much weeded out the drug seekers and I spend the time talking to my patients. I don't do any interventional stuff except trigger point injections. If I think something interventional might help I refer out but they come back to me. I have had patients crying just because I listen to them and don't treat them like junkies and it makes me angry that any physician would do otherwise. Chronic pain is just that, CHRONIC! Would a doctor cut someone off of their diabetes, blood pressure or heart medications because "they've been on it long enough"? I don't think so. When I send patients to a counselor I tell them the pain didn't start in their head but it got there, too. I hand out yoga DVDs because you can start that from your bed if you can't get up and down from the floor yet. I am the only doctor for 30 miles who treats chronic pain and I don't get many drug seekers because a new pain patient has a print out from the prescription monitoring program on their chart before I get to the room. Do I get compensated fairly? Hell no! My compensation is excellent care of my patients. All of them.

I read your article and certain things you stated is exactly what i go threw. I have had 3 back surgeries, 2 were spinal fusions. Ive been told that i have failed back syndrome, i have nerve damage in my legs and my upper back down my left arm. I also have neuropathy pain, arthritis throughout my back, and several other problems. I have been going threw this since 1998, and my doctor that i was seeing for almost nine years retired. It has been down hill for me since then. There are some days the pain is so bad i can barely walk even with the cane i use. I have been treated horribly by several doctors that don't want to continue the medication ive been on for years. Ive recently had a doctor stop giving me my medication with no suggestions of where to go or what to do. Im tired of being treated like a drug seeker when all i want is to try to function as best as i can and not be in unbearable pain everyday. I was just recently declared disabled and unable to work due to the multiple back problems i have. I would like to find a doctor that would listen and help me manage my pain and not be dismissed. I liv e in new york and can not seem to find a doctor willing to helpme. I don't know what to do or where to turn. Any advice or suggestions would be greatly appreciated.

I alao am a low back pain patient, i wpould just like to say doctors are left in a position of trying to determine a patients intentions in one visit, this to me would be very tough. Although unfortunetly there are alot of drug seekers, and people selling pills on the street which makes it diffucult not just on doctors but patients to, my advice would be try to listen what the doctor is offering turning down proven methods of pain control does not look good. Most doctors do not prescribe on first visit, they shoulf do urine screen first, So try to find a good primary care and go from there. good luck

I would do anything to have a doctor that listened to the patient and cared about what was best for the patient. I remember when I was little, doctors used t spend an hour with me. Now I have to beg and plead for more than 5 minutes of a doctor's time. How can you properly treat a patient if you don't talk to them? I'm so tired of living with chronic pain. I would do anything to be pain free. Thank you for being a caring doctor. Gives me hope of finding one here in Northern California

I would give anything to have a kind, caring doctor like you that listened to me!!

in 2003 after 3 ear nose throat speacialists said i need a septoplasty for allergy relief cause of a deviated septum i had the surgery done. the moment i awoke from the surgery I was in Excruciating Pain in the septum area. the nurse gave me Dilaudid once, then again then she said no more despite the overwellming pain. so i see dr. and tell him it hurts like hell & he says it will heel soon. 1 week goes by & no relief at all ! so he gives me a script 4 Roxicet & says i need 2 see my G.P. Dr. for the pain. so the meds run out & three weeks later my app. day is finally here with my G.A. I tell him what happened & he's sympathetic & helps me by a script for Oxycontin. 5 years later he says he can't help me anymore! WTF!!!!!!!!!!! I'm still suffering with painful surgical nerve damage they call T.A. Trigenemal Nueralgia but all the nerve meds iv'e taken over the years don't help at all only the narcotic meds give me enough reliefe 2 live my life... I need real help PLEASE !!!

Does anyone have any experience with ozone injection therapy for the treatment of chronic back pain?

What I have found over many years of chronic pain, and after many injections and three cervical spine surgeries, is that doctors are afraid of the DEA and will not prescribe pain medications, at least for long term use. Even my Neurosugeons would not. The Pain Management doctor that had given me the injections became the ONLY doctor that would help me with meds. This is after seeing at least a dozen doctors, like Neurologists nad family practice, Neurosurgery, etc. Even my long time Primary care doctor will not prescribe them. I take Lyrica, MS Contin,and Cymbalta regularly, and Hydrocodone, as needed. I have a life now, and am sure if I had not found help I would have killed myself due to the unbearable pain. Thank goodness there are some doctors who understand. But it is very unfair for them to take all the risks. I have to see my doctor monthly, have tests for levels of drugs in by system every six months. He really has to cover his ass and I know he resents the way the other doctors have turned their backs on patients. He has told me so. And I also know he is taking a risk and is scared of the DEA too. It's such a shame that our government, which is supposed to be "by the people, for the people singles out pain management doctors. Ironically, the other doctors, who are too afraid to prescribe, aren't even being monitored. Shame on them.

I've been a lower back pain patient since 2008. It started as a random spasm that lasted for only a week and was treated with ati-inflammatories, valium, and massage. since then I've had on and off pain with a massive increase in the last years. In that time I've become intolerant to NSAIDs and Tylenol. I've tried the few random non-narcotic medications, I've had local anesthetic and steroid injections, and I had a radiorequency nerve ablation that left me in the hospital for days w/ an epidural for pain control. In the last 3 months I've had 6 ER visits and one overnight hospitalization for pain management. I've done CBT, Acupuncture, PT, massage thereapy,hypnotheraphy...everything my pain guy and I could think of. He is out of ideas. I'm on heavy narcotics that make percocet look like candy and muscle relaxers that are part of an anesthetic protocol in animals. I'm now trying to get into the Rosomoff Center in Miami which is an intensive pain management hospital that does medical management, interventional treatments, and all the various other modalities including psychotherapy. I'm at the point where it is my last hope, I don't know where to go after this.

Dr Fine- is of course misguided in suggesting people not receiving adequate pain care. It would be better for government all doctors to have education in pain care and to meet an adequate standard of care. The European Union now requires such. And Dr Fine- and other doctors should approach states and the federal government to require all doctors to have education in pain care -so that people in pain-who have enough to deal with shouldnt be forced to go doctor dancing to obtain adequate pain care. Until medicine takes people in pai seriously it is unlikely we will see progress in pain care anytime soon-and more and more will unfortunately not just suffer from poor pain care-and thats the sad truth

Great article! I've been suffering with Chronic back pain for years and have been on many pain medications. Pain has been very depressing for me and has affected my once active lifestyle. I've never heard of the natural product that they mentioned, but will definetley looking that one up. It's hard to work as a nurse when on pain medication and try to concentrate on your work and not your uncontrolled pain.

Nopalea is marketed as a natural pain reliever that also reduces swelling in joints and muscles, but anybody who makes these claims is LYING! Nopalea is marketed as being a miracle drink that solves almost every problem and those types of products that seem too good to be true ARE too good to be true. There are no scientific studies or medical reviews that show that Nopalea does anything to improve your help. We know that Nopalea is good for you, but that's no different than saying that grapes are good for you, and you don't see people advertising grapes as a miracle cure! In the end it's a marketing ploy where people make up a bunch of health benefits to try to sell you a product. In this case this is especially obvious because Nopalea is being sold as a MLM product, which means that the people at the top are making tons of money off the people below trying to sell a product that doesn't work. Nopalea is probably reasonably healthy for you, but it doesn't do anything like what is being advertises. It doesn't prevent joint and muscle pain, it doesn't 'detoxify' you (there really is no such thing), and it doesn't do anything major to improve your fatigue. Don't get scammed into believing that Nopalea is a miracle drink and don't fall for the MLM aspect of Nopalea either, it just is not worth it, so you should definitely avoid them. If you talk to your doctor and mention Nopalea they are not going to recommend it, and probably haven't heard of it, because it's the equivalent of selling snake oil. If you truly do have problems that Nopalea 'pretends' to cure, ask your doctor for suggestions!

I have chronic pain since 2003 and rely on stong opiates to feel half-way normal and get through the day; however, cudos to Robert H. /George. I also have been on Nopalea and would never have believed anything like that could help but I am getting some relief after three weeks and will be ordering more; however, we don't get validation and this Dr. Oz show was very helpful to not feel alone and please take time to watch...only suffer through some commercials. These four excerpts from Sept 28th show are not more than 5 minutes each....He said there are 160 million suffering with this very misunderstood condition. New discoveries in the field of pain management suggest that chronic pain is an actual disease. Dr. Oz explores why doctors dismiss patients with pain and what you can do to get relief. www.doctoroz.com/videos/your-chronic-pain-disease-pt-1 www.doctoroz.com/videos/your-chronic-pain-disease-pt-2 www.doctoroz.com/videos/your-chronic-pain-disease-pt-3 www.doctoroz.com/videos/your-chronic-pain-disease-pt-4

I've been struggling with chronic back pain since failed spinal fusion surgery seven years ago. I'm luck to have found good physicians, but am also intolerant to opiates and have been unable to take anything except minimal dosages. Even so I've been treated like a criminal when trying to fill prescriptions, and one doctor expelled me from her practice when I needed a prescription refill and my pain specialist was out of town. Only recently have medications become available that combine pain relievers with anti-nausea medications, enabling me to finally take enough medication to get pain relief. A great deal of research is needed to develop new pain drugs, and much public education in the medical community to teach that people in pain are human beings experiencing genuine suffering, not drug-seeking addicts! Thank you again for featuring this subject in your magazine.

John Ware makes a good point, the heavy bias that threads the needle of understanding towards Chronic pain, as evidenced by the article above, often fails to include the very professionals who stand in the best position to make a powerful difference to that pain. I speak here of Physiotherapists ( Physical therapists ). Extensive research , common sense effective therapy and the ideals of "do no harm" make PT's an ideal resource for those suffering chronic pain. New developments in the understanding of pain physiology and treatment, made possible and indeed led by providers of manual therapy, have opened the door to ways to view chronic pain, that often does not fit the models taught to and constructed by medical practitioners.Doctors of medicine spend inordinate amounts of time in a usually vain search after peripheral drivers of the pain experience. A more brain/neurophsiological/central processing POV is often more successful, while reducing reliance on drugs, surgery and the potential for sufferers to be lured by quackery.

There are many types of injuries that can give you inflammation and swelling. This is an area the doctors receive an F on, in my case. During a cardiac ablation Don Phom accidentally burned a hole in my heart, in an emergent effort to save me life he accidentally stabbed me in the lung. Trying to remove the fluid from my pericardial sack. At that time, an infection set in. I was alergic to sulpher, so that only left prednizone. Totally ineffective. Pain took over my life. Pain patches and pain meds were given and were just destroying my life. I finally decided I had to get off or die, even if my blood pressure exploded completely, which it was doing anyway. That's when I found a good, licensed homeopath, after treatment with pharmacopia from Hahnemann Labs, a new pysical therapy from Australia called Bowen, plus calendula oil taken iternally, and a regimen of careful nutrition, what finally bought my pain to a controllable level (also my nose ran like a water fountain, it was painful and beyond embarrasing; all allergy treatments failed and caused side effect, peeling skin etc.) I found GIA wellness products. The preventive products and finally the soothing water, taken internally and sprayed externally for the burn that's like a burning ember in the back of my chest. I now have a manageable life, I was able to work again, at least when there were jobs available. Unfortunately I am now in my 50's and it is very hard to get a job. That now, is my largest problem. I have lost alot to the health care system, mostly I felt humiliated and more hurt by the treatment I received. The medical system has a lot to answer for. I find it unbelievable the the past administration gave them an easy out, quite often they deserve to be sued, even though I was to sick to sue them for the longest time, the average person just pays and pays and if you complain to much, they will hang a label on you so no one will ever listen to you again. They can and will take over your life!

I am Marley Tarlton from Lake City,Fl,I am a patient of the Dr. Charlar Nach (wasn't even a doctor) he messed my back up so bad that I have have a total of 5 back surguries and still in pain.The state toke his licwnses,but a little to late,when he had alreay messed up 97 people around here,and 26 down in Clearwater,Fl.I live with back,neck,shoulders,and wrist pain everyday of my life,and the dpctors here think you don't need anything...I WISH THEY WERE IN MY SHORS....THANKS

Thank You for that message and information. I will look into this anti-inflamatory natural plant! Thank You! Have a B lest Day!

I was reading an artical on Angie's list and thought how great it would be if we all tolde our insurance companies about helping us pay for exercise facilities such as spectrum Gold's ect. Insead of all of there highly addictive drugs. Not saying there not needed as we all know if you have surgery as I have, but these insurance companies should alsopay for health clubs to help us maintain our health instead of killing us with drugs were using daily. The only way this country can make a change inn that area is what Mr. Bob Marley sang Stand Up For Your Rights. I do believe his message was to mankind!!!! Not the money hungry insurance compamies all over this world! Why is the USA always enveloped in try to help other countries if we are so looked at with such hated by so many were trying to help!! This ism the same thing these US Pharmaceutical Co. are doing to the people of the USA with there money hungry ways . They are no better.

IOM's report may be the best thing to come from Obama's Health Care Reform-Patient Protection and Affordable Care Act. The four main findings point to problems we have in our current health care system: we need to make a transformation and see chronic pain as a public health challange, care for people in pain is currently inadequate, educational challenges exist along with research challenges that need addressed to improve our current level of understanding and care. Hopefully this report will help start to move the needle on the importance of better care for patients in pain. Interesting perspective we need to consider as a society: 18.6 million people have had a cancer diagnosis currently, 116 million people are burdened by chronic pain. Where do we spend more money on cancer or chronic pain? If you had a neighbor with cancer or chronic pain, which one would you more likely help rake their leaves this fall?

I too moved to Florida and find doctors here are paranoid about prescribing any type of narcotic for pain relief. I have been totally disabled by trigeminal neuralgia. I was treated I Pennsylvania with Percaset the best pain reliever I have used. I never abused it taking itnon an "as needed" basis. The doctors in Florida have been trying a variety of painful cortisone injections and central nervous system suppressants that cause many side effects. Those of us who are clearly not abusing drugs should be given the best pain control possible. Because of those who have given these drugs a bad reputation, we are denied the treatment we so badly need. Trigeminal Neuralgia is not a joke. The nerve suppressants were created for the treatment of epilepsy and have serious, unnecessary dysfunction than a simple pain reliever. Florida is the worst state for illegal drug trafficking resulting in doctors withholding drugs from the most needy. In nearly two years I have not found a doctor who will write a prescription for Percaset. I continue to try these awful seizure medications on higher and higher doses that seem far more dangerous than an occasional pill when needed. The medical community, the government law enforcement, and general public needs to recognize that there are people who need these drugs and who do NOT use them them recreationally!

A good article overall and I can relate to it. My wife and I both suffer from chronic pain. We are both healthcare professionals as well. I had my had closed in a door while at work on the ambulance and had it folded back. My wife is a RN and had a patient break her neck and have to have several dics replaced. We are both in pain daily but we both continue on with our lives. I do not take any medications, I have learned to live with it with the Lords help. My wife though continues to be in alot of pain though and has to have meds for it. Like one of the others though, they treat her like she is a drug seeker. My wife would rather be out of pain than take anything. The doctors dont listen and I think that is the main thing.

I am a pain patient and finding a trustworthy doctor is so difficult, but not impossible. The problem, which you might have to be a patien to really understand, is that some doctors end up with every junkie in town trying to game them out of ever more drugs. If you end up in one of those practices (easily picked out by looking at the other patients in the waiting room) there's a good chance they are going to treat you like a junkie. Also, one of the biggest problems facing pain patients is one not mentioned here - sleep. Pain and its attendant meds wreck your sleep. As to the article - it's one of the best I've read. I wish it had been in the New York Times where more people would have read it.

1/3 of americans suffer from chronic pain? IS there any actual data to back that up? besides peopel who make money spouting the figure and selling the quackery de' jour?

the Quackery is about ridiculous....read this book, read that book, do some yoga, hug a tree ,get this all natural stuff,get that holistic stuff, go see this head doctor that head doctor ....some of you quacks ever consider the pain is real??.....almost sounds as hypocritical as blaming doctors for doing this or that ...coukd it be that what works for one person doesnt work for another because not everyone is the same ...i've had four back operations i have degenerative disc disease and bursitis in my hips....I'm not having any more surgeries I'm tired of it ....what works for me is and gets me through my days and nights so i can provide for my family is some stretching and a monthly prescription for lortab...but the stigma and looks people get for that sickens me

I'm the same way....have had two doctors, one wanted to do injections at $3000.00 a pop that insurance would not cover. He put me on Lortab and after a couple of months told me "I'm not a pill doctor". So in other words he makes more money off of his injections and doesn't want to help the patients that can't afford them. I have a crooked spine, lost 2 and a half inches in height and degenerative disc disease. Every doctor you talk to wants to try this or that and with the cost of medical insurance I can't afford the cost (out of pocket) of what MIGHT work. Call me a pill head if you want, but that's what gives my lower back, hips and knees relief so I can live my life. I'm not a criminal and don't appreciate being treated like one.

I too suffer from chronic pain due to a failed back surgery. I have found it VERY Difficult to even find a Dr to take me on for chronic pain. I have found what works for me and its Hydromorphone. I am NOT a seeker I simply want to live my life as pain free as possible. No Hydromorphone does not take all my pain away. It does however make my daily life bearable. I recently moved and have just begun the game of finding a Dr wiling to take me on as a patient. I am a simple pain management case, I have tried almost every kind of treatment without meds and all have failed. I finally settled with taking narcotics to live with the pain, they work for me and I use them only when needed. Again I cannot find a Dr in the new town to take me on. What do Dr's think that we get hooked on pain meds on purpose, that we want to take them and ruin our health with who knows what kind of side effects of long term narcotic use. I simply want someone willing to help me live as normal as possible. I am currently on Disability but want to work, but due to the pain I cannot, even on narcotics I am limited in any physical activity because it may cause me to be down for a few days at a time if I over do it at any particular thing. So what to do, i do not have the answer but I know that people in true Chronic pain do not want to take drugs, nor do we want to be treated like criminals either. Please understand that true chronic pain suffers are just wanting what they once had, to live as painless a life as possible. And if that takes narcotic to do it then so be it.

I agree with you 100%. My husband has had chronic back and leg pain for years. He had a doctor , however all of a sudden she felt he was "med seeking: and treated him like a junkie because he asked to be put on a different pain med because of "breakthrough pain." He was not asking to be put on permanently, just for her to try it short term as she had done it before and it worked. He asked for 1 Percocet a day. Taking 40mg Methadone for pain management currently. He was especially upset that she wrote he was med seeking in file when he told her he no longer wanted to be seen by her and asked for a referral. She is only on twice a week and he always has to wait for an appt for weeks if he needs to be seen. I feel very bad for him and all the other chronic pain sufferers out there that are treated like this. He also wants to live a life as normal as possible and be able to work again, off disability. He does not like having to take these meds due to side effects and possible long term health problems they may cause. We need a better system and also for doctors to have more compassion. How would they feel if they couldn;t work due to chronic pain? Husband just wants to find a doctor willing to adress this pain with him and look for possible solutions. He is willing to try any procedures. He has been down 9 days and stil has not found new doctor willing to take on a chronic pain patient. Dont; know how his doc now will wean him off Methadone now that he wants new doctor, I feel she has it in for him and will make it difficult. He does not abuse his meds at all, what recourse do we have? 006

Your article has a decidedly medical bias to it for the treatment of chronic pain, but it skirts the issue of how poor medical management of persistent pain problems has been over the last several decades. Much of the problem lies in an inadequate biomedical model for treating disease, and this model has led to tremendous expenditures on interventional procedures and surgeries that have resulted in very little if any improvement in patient’s long term pain. In many instances, such as certain spinal surgeries, the costs are astronomical and patients end up permanently maimed. Dr. Fishman’s comment about physicians not knowing their anatomy well enough to treat the “cause” of pain exemplifies the profound misunderstanding many physicians have regarding how chronic/persistent pain actually works. The vain search for a peripheral cause- or as many interventionalists will refer to as a “pain generator”- has not resulted in improved outcomes for patients with chronic pain problems. Notwithstanding the “poor” reimbursement for radiofrequency ablations, a procedure directed towards a specific “pain generator” usually in a spinal joint, these procedures and many other interventional procedures continue to be performed daily despite the lack of significant improvement in long term outcomes for patients. Fortunately, Dr. Carr from Tufts mentioned alluded to the biopsychosocial nature of the lived pain experience, and that most physicians do not know how to address the whole person’s lived experience of pain. Until medical and other health professional schools decide to broaden the paradigm to include a more accurate model that includes current neurobiology and neurophysiology of pain, then we will continue to see costs for chronic pain conditions skyrocket while patients continue to suffer.

John, you must be in the medical field, you have a real understanding of our pain not matter where it is. I've been through many of the treatments you mentioned. I posted 9/18/13 and explain about my case. I know that doctors can now see the pain in scans and they are learning about nerve endings and more. Too late for me I think. Pain patience need to get together in some way to make a difference by getting the "pain" word out. Thanks for your post.

I spent years trying to get my back pain (not an ache, but an absolute bonfire in my backside after an ergonomic nightmare at my desk, that I was not allowed to alter. It took me five minutes to figure out it met all the features of an annular tear, but MRIs were normal, and my injury denied. Finally went to Dr. Jamrich at Rocky Mountain Spine, and begged for a discogram (also denied by my employer, happy with the normal MRI, all-in-your-head" diagnosis. Discogram and CT showed annular tears at T8/9 and T10/11. Ditto for a car accident four years later, that put me back in agony in the lumbar region this time, again the exact symptoms of annular tears which allow the spinal fluid to leak out and travel down the nerve endings into your posterior and hips, and then feel like you've been torched with gasoline. Drs. in Billings, MT, refused discogram, and again had several MRIs, all normal. A female neurologist asked if I would take Class III narcotics. I said no. She demanded a drug test. I asked, "Do you KNOW a lot of drug addicts who would refuse an offer of narcotics?" I worked with a disabled lady, and needed my brain intact. Denver Pain Management--Drs. Brandt, Wright and Allen. My heros with SNRB injections for my back, & radioradiofrequency rhizotomy for the sciatica. At least some relief. Since I was uninsurable 10 years before Medicare, Drs. accepted half for immediate payment on a credit card.

Many great results are being experienced with a natural product called Nopalea.

This article failed to mention a remarkable natural product that has benefitted my wife and myself with chronic pain. This product is Nopalea and is provided by the 12 year old company Trivita which has been in business since 1999. The active igredients in Nopalea are the betalains contained in the Sonoran dessert. There have been over 200 scientific papers done on the anti-inflamatory properties of these betalains. This product is helping 1000s all over the world and can be found at the following website: http://www.trivita.com/Web/US/content/products/product-detail.aspx?id=3918

I recommend anyone who is suffering from chronic pain read The Divided Mind by Dr. John Sarno. It changed my life. There is a reason all the treatments for chronic pain rarely work. The diagnosis is incorrect. I had a herniated disc and was in the worst pain I had ever felt for three long years. After physical therapy, spinal injections, tens, you name it, I finally decided to have surgery. That failed too. That's when I decided to do some research on my own. I found Dr. Sarno's book, Healing Back Pain and finally began my recovery. I recommend this book as well. The Divided Mind is his most recent work, however. If this helps even one person, this message was worth my time.

I have spent years having my degenerative disc diagnosed and managing the pain. This article is another verification of what we face. Thank you!

As chronic pain patient I found it difficult to get the psychological help necessary to aid in the transition after my accident. In speaking to many other chronic pain patients I found this to be a much neglected area of pain management. The transition from "healthy" to chronic pain, no matter the cause, is a difficult one to make and the lack of professional understanding makes it more so. The medical and and mental health professions need to work hand in hand in order to fully treat those with chronic pain as well as the family members and caregivers of chronic pain sufferers. No one professional is qualified to treat every aspect of this difficult condition.

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