# Up onto the scaffold, pain "management" clinic **URL:** \ **Category:** The BBQ Pit\ **Created:** [January 20, 2009, 2:52pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132 "2009-01-20T14:52:26Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![VinylTurnip](https://avatars.discourse-cdn.com/v4/letter/v/b2d939/32.png) [@VinylTurnip](https://boards.straightdope.com/u/VinylTurnip)\ **Post date:** [January 20, 2009, 8:45pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/21 "2009-01-20T20:45:30Z")
Thank you for the suggestions. Thankfully, today she found an unfilled, but still valid prescription from a different doctor that should take care of her for a while, so I can unclench. ---
**Author:** ![DoctorJ](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/doctorj/32/2904_2.png) [@DoctorJ](https://boards.straightdope.com/u/DoctorJ)\ **Post date:** [January 20, 2009, 8:48pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/22 "2009-01-20T20:48:04Z")
> [@](#): > > “Great,” I foolishly thought—from what I’d heard of pain clinics, they were strictly regulated and monitored their patients carefully, but in turn were allowed to prescribe stronger (or greater amounts of) pain medication than a “regular” doctor might feel comfortable with. As a primary care doctor, I’m “allowed” to prescribe anything that a pain clinic can prescribe, provided I document appropriately and show appropriate diligence. In my area, where prescription drug abuse is epidemic, the level of diligence required is so high that I end up sending a lot of patients to the pain clinic; they’re better equipped to monitor the patients for abuse than I am. Everyone thinks there’s a bright line between “legitimate patients in obvious pain” and “obvious criminals”, but those groups make up about 10% each of the patients who request pain meds from me. The other 80% have no outward criminal tendencies, nonspecific complaints, no objective findings whatsoever, and yet claim to be in tremendous and debilitating pain that requires chronic narcotics. These are the ones I tend to let the pain clinic sort out. The obviously legit patients I can treat just as well as they can, and the obvious criminals I can kick to the curb just as well. You say your mom was referred from the surgeon to the pain clinic. Does she not have a primary care physician? ---
**Author:** ![Contrapuntal](https://avatars.discourse-cdn.com/v4/letter/c/e274bd/32.png) [@Contrapuntal](https://boards.straightdope.com/u/Contrapuntal)\ **Post date:** [January 20, 2009, 9:54pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/23 "2009-01-20T21:54:14Z")
> [@alice\_in\_wonderland](#): > > This is a totally bullshit post. This doctor is in the business of pain management. His _JOB_ is to ensure that his patients experience less pain - if he’s prescribed something that hasn’t worked it’s his responsibility to ensure that the patient has something that does work, and not make them wait 11 days to see him. Exactly. My vet is ten times more aggressive in treating pain when my dogs need it. ---
**Author:** ![VinylTurnip](https://avatars.discourse-cdn.com/v4/letter/v/b2d939/32.png) [@VinylTurnip](https://boards.straightdope.com/u/VinylTurnip)\ **Post date:** [January 20, 2009, 10:17pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/24 "2009-01-20T22:17:34Z")
> [@DoctorJ](#): > > You say your mom was referred from the surgeon to the pain clinic. Does she not have a primary care physician? I presume she does, as she’s under an HMO. I’m not sure where he fits into things—it’s possible that the PCP is the one who referred her to the pain clinic, but my understanding is that it was the surgeon after she went for her one-month follow-up visit. I get the impression that she’s generally fed up with doctors at the moment and will just ride things out on the meds she has remaining. I could understand distrust on the doctor’s part if, as you say, she presented with ambiguous complaints and no discernable symptoms other than pain, but she’s got huge surgical scars across her chest. I’d expect most doctors in that case to err in favor of the patient, if anything. ---
**Author:** ![crowmanyclouds](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/crowmanyclouds/32/19884_2.png) [@crowmanyclouds](https://boards.straightdope.com/u/crowmanyclouds)\ **Post date:** [January 20, 2009, 11:57pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/25 "2009-01-20T23:57:33Z")
> [@VinylTurnip](#): > > … JACK SHIT: some anesthetic patches and an anticonvulsant drug … Just curious, exactly which jack shit anesthetic patch and anticonvulsant drug? CMC fnord! 'Cause I really want to see if my guesses are correct. ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [January 21, 2009, 12:15am UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/26 "2009-01-21T00:15:34Z")
> [@Ferret\_Herder](#): > > Hijack: Did I miss a medical care meeting in which it was decreed that this is the proper way to refer to the doctors you work with? I hear that All The Freaking Time when I call other medical offices. “I can consult with Doctor and get right back to you,” and so on. WTF. That is not their given name, as much as some of them seem to think so at times. Please use “a doctor,” “the doctor,” “Dr. [Lastname],” and other conventional, accepted phrases in American English, thank you. At least no one in my department uses that weird-ass phrasing. Whenever I’ve come across this, it’s usually an older woman whose tone of voice reminds me of a rabbi’s reverence for God. She thinks angels descend from heaven so “Doctor” can use their wings to wipe his ass, but this assumes that “Doctor” has to do something as mundane as take a shit like us mere mortals. It makes me stabby. Robin ---
**Author:** ![Lynn\_Bodoni](https://avatars.discourse-cdn.com/v4/letter/l/e47c2d/32.png) [@Lynn\_Bodoni](https://boards.straightdope.com/u/Lynn_Bodoni)\ **Post date:** [January 21, 2009, 3:11am UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/27 "2009-01-21T03:11:41Z")
I think that I’d complain to the HMO, too. Tell them that the pain management clinic is not managing pain in a timely fashion. ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [January 21, 2009, 5:37am UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/28 "2009-01-21T05:37:47Z")
> [@Contrapuntal](#): > > Exactly. My vet is ten times more aggressive in treating pain when my dogs need it. this is a meaningless comparison ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [January 21, 2009, 5:39am UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/29 "2009-01-21T05:39:35Z")
> [@VinylTurnip](#): > > Thank you for the suggestions. Thankfully, today she found an unfilled, but still valid prescription from a different doctor that should take care of her for a while, so I can unclench. FYI, your pain management doctor may consider this a breach ---
**Author:** ![Lynn\_Bodoni](https://avatars.discourse-cdn.com/v4/letter/l/e47c2d/32.png) [@Lynn\_Bodoni](https://boards.straightdope.com/u/Lynn_Bodoni)\ **Post date:** [January 21, 2009, 6:47am UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/30 "2009-01-21T06:47:57Z")
> [@outlierrn](#): > > FYI, your pain management doctor may consider this a breach I consider his nontreatment of her pain a breach, too. ---
**Author:** ![outlierrn](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/outlierrn/32/3005_2.png) [@outlierrn](https://boards.straightdope.com/u/outlierrn)\ **Post date:** [January 21, 2009, 7:31am UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/31 "2009-01-21T07:31:21Z")
> [@Lynn\_Bodoni](#): > > I consider his nontreatment of her pain a breach, too. I was refering to her contract to not seek pain meds from other sources ---
**Author:** ![Lynn\_Bodoni](https://avatars.discourse-cdn.com/v4/letter/l/e47c2d/32.png) [@Lynn\_Bodoni](https://boards.straightdope.com/u/Lynn_Bodoni)\ **Post date:** [January 21, 2009, 7:44am UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/32 "2009-01-21T07:44:12Z")
This contract would be valid if she had received effective treatment from the clinic, IMO. Since they didn’t hold up their end of the bargain, I can’t really blame her for trying to find other ways to get relief. If she called them up and said, “Hey, that stuff you prescribed me didn’t work”, and the response was, “Well come on in this afternoon, bring in the remainder of your meds, we’ll try you on something different”, then the contract would be in force. Instead, she’s told to just suck it up for 11 days. Pain management is not about sucking it up. Pain management is about getting some relief in a timely manner. One of the new ideas in medicine is that patients have a right to pain relief. Obviously this doctor, the gatekeeper, and the clinic have not yet received the memo. The doctor might be overworked and underpaid by the HMO. He certainly seems to have rushed through his visit with the OP’s mother. Whatever the reason, he’s not managing her pain. He’s not even attempting to do so. I’ve certainly noticed a great attitude change in the medical profession when it comes to pain. When the nurse or aide or whoever asks me about my symptoms, I’m asked about pain, how I’m dealing with it, if I need more help with it, etc. Doctors seem to be willing to hand out Vicodin if I rub my forehead twice. In the past, I’ve been told to suck it up. I find this new attitude to be very welcome, and I hope that the OP’s mother gets some sort of satisfaction with this clinic, or finds another one. ---
**Author:** ![VinylTurnip](https://avatars.discourse-cdn.com/v4/letter/v/b2d939/32.png) [@VinylTurnip](https://boards.straightdope.com/u/VinylTurnip)\ **Post date:** [January 21, 2009, 4:09pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/33 "2009-01-21T16:09:21Z")
> [@crowmanyclouds](#): > > Just curious, exactly which jack shit anesthetic patch and anticonvulsant drug? I don’t know for sure the type of patch; my mother said it contained lidocaine. The drug is Neurontin, which (so the infallible Wikipedia tells me) is indicated for some kinds of post-surgical nerve pain. I don’t fault the doctors for trying it or taking a conservative approach, but nonetheless feel they should’ve been more responsive to alternatives when it clearly wasn’t working. I’m personally somewhat leery of the class(es) of antiseizure drugs prescibed for for pain, insomnia, anxiety, bipolar disorder, and seemingly whatever else ails ya, having briefly taken a similar drug as a "mood stabilizer"and adjunct to SSRI therapy back when I still thought my “mood” was salvageable—I found it to be a really nasty chemical and couldn’t get off it quickly enough. Mileages may vary. ---
**Author:** ![Contrapuntal](https://avatars.discourse-cdn.com/v4/letter/c/e274bd/32.png) [@Contrapuntal](https://boards.straightdope.com/u/Contrapuntal)\ **Post date:** [January 21, 2009, 5:34pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/34 "2009-01-21T17:34:20Z")
> [@outlierrn](#): > > this is a meaningless comparison To you, perhaps. Just because \*you \*can’t find meaning doesn’t mean it isn’t there. ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [January 21, 2009, 6:05pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/35 "2009-01-21T18:05:33Z")
> [@Wiggie](#): > > Bullshit. She can, and should, seek care elsewhere RIGHT NOW. Your physician CANNOT forbid you from seeing another physician. Of course they can forbid you from getting medication from another physician. She will be hard pressed to find any pain management doctor that will not have the patient sign this type of form. The pain management practice doesn’t care if the patient sees a different doctor every day.. As long as they are only getting pain medications from one of them. ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [January 21, 2009, 6:08pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/36 "2009-01-21T18:08:09Z")
> [@Contrapuntal](#): > > Exactly. My vet is ten times more aggressive in treating pain when my dogs need it. Because your dog isn’t selling his medication to Spot and Fluffy on the corner. ---
**Author:** ![Contrapuntal](https://avatars.discourse-cdn.com/v4/letter/c/e274bd/32.png) [@Contrapuntal](https://boards.straightdope.com/u/Contrapuntal)\ **Post date:** [January 21, 2009, 6:16pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/37 "2009-01-21T18:16:25Z")
> [@Foxy40](#): > > Because your dog isn’t selling his medication to Spot and Fluffy on the corner. So? What does have that do with treating pain aggressively? I guarantee you that if I told my vet that the medication wasn’t working, I would not have to wait 11 days for an appointment. Hell, I wouldn’t have to wait 11 minutes. I would be told to come right in and get an alternative prescription. ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [January 21, 2009, 6:24pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/38 "2009-01-21T18:24:26Z")
> [@Lynn\_Bodoni](#): > > This contract would be valid if she had received effective treatment from the clinic, IMO And you are correct as long as she never goes back to the doctor she found ineffective. She signed a pain management contract and by taking something not prescribed by him she has just voided their agreement. If Mom was given Duragesic that is for moderate to severe pain. She really shouldn’t be taking another opioid that she has laying around on top of that. Different people have different tolerances to pain and medication. Pain management doctors don’t have a miracle cure that will work for every patient. It is a trial and error process. Of course when someone is in pain they want it to go away RIGHT NOW. That isn’t always possible. As far as the OP. I have had associations with pain management doctors for years and they all seem to run their practice exactly like described. Yes, and most are cynics. Correction, they all are cynical as hell. One said that he started a policy of drug testing many of his patients that have been on pain management drugs for over one year. His figure was 90% were not talking the medication as prescribed. It was either not in their system at all, not taken in the correct manner or taken with other drugs not prescribed by the clinic. That seems so high but he did tell me that he was mainly testing people he had grown suspicious so I guess that makes more sense. The staff even has a list of red flags… Patients that pay cash. Patients that say that only ABC drug works for them and they have tried everything else. Patients that left their ID home and will bring it back next time. Patients with cold watered down urine. Patients with clear urine…thinking that gallons of water will flush out the cocaine I guess. The list went on. I guess the specialty must be rewarding on occasion but to have patients lying to you and the DEA breathing down your neck constantly, I can’t imagine it would be worth it. ---
**Author:** ![Foxy40](https://avatars.discourse-cdn.com/v4/letter/f/a9a28c/32.png) [@Foxy40](https://boards.straightdope.com/u/Foxy40)\ **Post date:** [January 21, 2009, 6:27pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/39 "2009-01-21T18:27:23Z")
> [@Contrapuntal](#): > > So? What does have that do with treating pain aggressively? I guarantee you that if I told my vet that the medication wasn’t working, I would not have to wait 11 days for an appointment. Hell, I wouldn’t have to wait 11 minutes. I would be told to come right in and get an alternative prescription. So what other patient should Dr Feelgood displace so that her Mom can come in 11 minutes later? ---
**Author:** ![Contrapuntal](https://avatars.discourse-cdn.com/v4/letter/c/e274bd/32.png) [@Contrapuntal](https://boards.straightdope.com/u/Contrapuntal)\ **Post date:** [January 21, 2009, 6:39pm UTC](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132/40 "2009-01-21T18:39:44Z")
> [@Foxy40](#): > > So what other patient should Dr Feelgood displace so that her Mom can come in 11 minutes later? That’s a false equivalency, as well as an _ad hominem_ attack, and I suspect you know it. But just for the hell of it, I’ll dissect your argument. There is a middle ground between 11 days and 11 minutes. In terms of responding to an immediate medical problem, the former is too long. Considerably. Why must he be Dr. Feelgood? The patient is in extreme pain. It’s not about feeling good. It’s about making it through the day. He’s not a dealer. He’s a physician. Who said anyone had to be displaced? He’s already examined her. All he has to do is write a prescription. Again, with my vet as a reference, she usually has a back-up plan if the first medications are ineffective. It has never happened that I have come in with an emergency or urgent situation and another patient has been turned away as a result. No self respecting doctor would do that. If she can uphold that standard of care with respect to animals, why can’t a doctor who treats humans do the same? [Previous page](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132.md?page=1) [Next page](https://boards.straightdope.com/t/up-onto-the-scaffold-pain-management-clinic/482132.md?page=3)