Dec
There’s been a very confusing and rather sad development in some parts of the country. Whereas you would always hope the words, “pain management clinic” would mean a place devoted to helping people deal with pain, the words now quite commonly label a front for pill mills. For example, in Florida where the regulations are somewhat lax, you will often see clinics with queues of people gathering outside. The mission of these people is simply to collect their supply of legal highs – the prescription drugs abused to produce a pleasurable experience. Many of these clinics come and go within a few months as enforcement officers catch up with them. It’s a tragedy in slow motion as our society grows ever more dependent on drugs, both street and prescription.
If you go to other countries, pain management clinics are always respectable and usually attached to the larger hospitals. As a point of contrast with us, only five of the courses to teach the next generations of doctors make “pain” a compulsory subject. This means only a tiny percentage of our new doctors qualify with any formal academic or practical training in pain management. In other parts of the world, it’s a specialism in its own right with every college and university teaching course having pain management on the curriculum, usually as a compulsory subject. This feeds knowledge and understanding into every level of the profession, matching it with academic courses for nurses, therapists and the others who team together to provide the healthcare services.
The result is teams of people with expertise in pain management based in all the main hospitals and also providing outreach services to people in the community. This outreach can be simply by telephone contact or by regular visits. In other words, foreign health services do not abandon people when conventional doctors have run out of options. Teams of multidisciplinary experts take general responsibility for each individual. They discuss all the options with the patient. This begins with a practical assessment of the ability to work and live in the home. This usually involves visits to the workplace and home to consider what changes might improve the quality of life. It may be, with proper physical therapy and directed exercises, the patient can rebuild strength and resume work. This is vital both for self-respect and to keep a paycheck coming in. Changing the design of the home can also vastly improve morale by enabling the patient to move around more easily and adjust to new physical limitations. Then it’s down to the cognitive behavioral therapists to teach coping strategies to help people get the best possible results.
When you put all it together, this patient-centric approach has all the evidence showing how effective it is. When the patient feels the hospital cares, investing time and effort into improving the quality of life, most people do improve. Our healthcare service simply prescribes more Tramadol and sends patients away. Under the circumstances, it’s hardly surprising so many of us end up with a drug problem. Of course, Tramadol is one of the better less-addictive drugs but, even when you take lower doses, over time dependence builds up. It’s just delaying the onset of the problem. Proper pain management with less use of drugs is better.