Notes from the office: pain management

While you all are no doubt goofing off or sleeping in or raiding hamlets* Urs Truly at a two day weekend long conference, powwowing with his fellow wizards, learning the latest on this, that, or the other.

Today’s topic is pain. We will hear the latest on what is it, how to properly diagnosis and address it, and the updates on the controversies around opioid analgesics A.K.A. as pain pills. Unless you’ve been hiding under a rock you know the latter topic is a hot topic A.K. A. ‘The opiate crisis.’  Society and medicine are trying to come to grips with ‘how on earth did we get here” situation we are in and what to do about it. As is often the case, people/politics/physicians all want simple scapegoats and solutions.  Fat chance of that. It’s a morass of awful gunge consisting of many, many factors. Frankly it’s a tangle and will take time to sort through the matters.

I don’t specifically treat pain but I see a lot of psych patients who are dealing with chronic pain. Most folks with pain also have depression/anxiety; it’s like a coin with two side: pain and mood. Overall they are not doing well.  Most come in to see me quite remonstrative and disconsolate** about their pain management physician.  There are four common themes to suggest they are not just whining or seeing things wrong:

1. The management of pain is inadequate

2. They are treated/seen as manipulator drug seeking scoundrels rather than patients.

3. The doctors are more concerned about them not taking pain meds than how they are doing.

4. The system went woefully wrong and they are the ones being ‘punished’ for it viz. can’t get proper treatment viz. can’t get pain meds. 

I find it hard to polish my side of the coin when the other side is not being well addressed.

One of my greatest challenges for pain-full patients are thems taking long time opioid-based pain medications and tranquilizers now being told by their pain docs ‘it is one or the other”  viz. get off the valium or they will no longer prescribe the Percocet, that sort of thing.  Ironically, it often would be a very good thing for chronic pain/anxiety sufferers to lay off these types of medications in favor of alternative treatments that show better help – but you try telling them that.  They resemble an orchestra of scorched cats as they lament these four matters listed. Poor sods. They too have to redo their paradigm and approaches as do the physicians. 

The three hour lecture on these matters is about to commence. After it concludes I will add a post-script for thems interested in updates and news and such. 

Spo-fans who are dealing with chronic pain: I am curious to hear from you if you find it difficult to get help with such. 

 

*Guess who’s doing that today. 

** Many are positively irate.