Here is one I am dealing with now. I have a patient who has had a chronic TMJ issue with 2 prior surgeries and ongoing pain. I had been extremely vigilent in monitoring her pain meds. She develops low back pain in the interim and MRI really fails to demonstrate any significant pathology, certainly nothing to explain her level of professed back pain. I added Cymbalta and she continued to report her pain was intolerable. She has always sought pain meds and benzodiapines for one thing or another at every encounter over the last 18 years and I always managed to convince her that adding more was not in her best interest. We also discussed other issues in her life which I thought might be contributing overall to her poor pain control. But, with her back pain, she continued to complain and I think well, maybe I am not being fair and she really does need more evaluation. So, I send her to a local Pain Management Center hoping perhaps some physical therapy, local back therapy, etc. might give her some relief. She returned to my office this week after not being here in 8 months (we called her and requested she come in for a follow-up). Guys, this patient was ZONKED!!! She could barely walk, could not carry on a logical conversation, kept talking about the best places to buy vacuum cleaners if you have a pet in the house...yada, yada, yada. When I reviewed her record there was not one note to me from the Pain Center regarding their assessment, treatment plan, nor her progress. She is now taking 90 mg MS Contin daily, Oxycontin Q8 hours, Lorcet plus, Xanax Q8 hours and Cymbalta!!!! All prescribed by these "Pain Specialists". This woman is now totally fried, dysfunctional and addicted, all because of some minor disc bulging in the lumbar spine. Needless to say I was upset. I called the place but none of the treating physicians were present but I did speak with the one M.D. there and gave him a piece of my mind. I also spoke with the patient about my concerns but, hey, she is happy as a lark, and has no desire to reduce her meds. So now, what do I do? I have charted my concerns, I have told the patient that I will not refill any of her pain meds, I have offered to refer her elsewhere, I have expressed my concerns with a physician at the center and the only thing accomplished is that she is ticked with me and says she will not be back. This actually is fine with me but the problem still exists. I definitely will not refer any more to that Pain Center but, should I do anything else?
