Chronic pain management will likely drive me into an insane asylum.
When I started practice (1975) you could lose your license or be severely punished if you gave an elderly patient a Tylenol #3 at bedtime for arthritis.
A couple of decades later we were giving "back pain" patients 80mg of methadone per day if they were on Medicaid (that was the only drug they would pay for).
Now we are swing back to the 70's.
Pain patients are all different, all pains are different, but as far as the CDC is concerned, it's all the same thing -- except "cancer".
I have never understood why some loggers can be completely smashed to smithereens and not need chronic narcotics, while others with the same injuries become chronic users and some become addicts.
Or why some people with no discernable injury at all develop "fibromyalgia" and have to have truckloads of drugs.
I resent having to be a policeman -- how do I know what people do with their drugs -- I can't follow them around. And its even worse when the patient is elderly and can't speak for him/herself -- but you are pretty sure that some or all of their drugs wind up with family or caregivers. What am I supposed to do about that?
I certainly try hard not to get involved with any more chronic pain patients -- but they just come out of the woodwork, and they have such sad stories. The "pain specialists" aren't any help at all. They just want to do expensive procedures on people who have insurance.
