No Fellowship for Pain Physicians

Pain is the number one reason people see a physician. Yet pain management is not a recognized medical speciality, it's a sub-speciality of several other medical specialities, but there's no fellowship for physicians to learn how to treat pain. 

Any physician can hang out a shingle and treat pain. Most give out pills, but don't ask patients the right questions, or treat the side effects of the opioid's they prescribe.

An old adage says, the physician who writes the narcotic should write the prophylactic for constipation. Physicians should ask patients each visit about constipation, excess sweating, changes in energy levels, sleep, depression, changes in sex drive, or relationship problems.

Almost every patient taking opioids will suffer from constipation. Problems from acid reflux to colon cancer can be caused by chronic constipation.

Opioids can cause excessive sweating. This can be a problem anywhere, but here in Arizona where temperatures can reach 120 degrees, it can be deadly. Excessive sweating can cause the loss of electrolytes like salt and potassium. My wife had a life-threatening heart arrhythmia because her potassium was too low.

Changes in energy levels, depression, changes in sex drive, can point to low testosterone. This isn’t just a sex hormone, it controls muscle growth, mood, energy and so much more in male patients. 

Yesterday at the imaging center while I was getting an MRI, my wife Jean was talking to a young mother of three. She told Jean she thought her husband was cheating on her because he wasn't as close as used to be.

Jean ask her if he got teary eyed at some movies, had less energy, and no interest in making love anymore? When she said yes, Jean smiled, then explained about our relationship and testosterone. She said his family doctor had just tested his testosterone levels because of a family history, not his opioids. Jean told her once he gets his testosterone levels back up to normal, she should have her husband back. 

Relationship problems can be a precursor to a patient abusing or selling their medications. Physicians need to be as much a psychiatrist as a medical doctor if they treat pain.

This brings us back to testosterone. When a guy’s testosterone is very low, it's like when he was 8 years old. He doesn't think girls are icky, he just has no interest in playing with them. Like the young wife above, the spouse either thinks the guy is cheating or he doesn't love her anymore.

Neither one is good for the relationship, and can be a precursor for abusing their medications. Physicians who treat pain need to listen their patients, and learn from each other.

DEA Getting It Right

I'm glad to see DEA is changing the way they do investigations into the diversion of pain medications. DEA has always focused on physicians who treat pain patients, and many times physicians were blamed for the actions of their patients. 

Here in Arizona DEA has a tip line to report People who are selling or abusing their medications. You can text a tip to TIP411, or go to www.DEA.gov This is something new for DEA, and a step in the right direction. Hopefully this will be used to identify patients who have problems.

Some will be abusing, or selling their medications, but others others will be legitimate patients who are under medicated. The majority of patients are grateful for the pain relief they receive, a few create the problems for others.

There are bad physicians out there, but most physicians try to follow the law. If a physician does their best to detect patients who may abuse their medications, do a good medical history, do needed tests to identify and document the cause of the patients pain, and treat the side effects of opioids, then don't arrest them, educate them. 

Patients should try alternative methods and physicians need to document these attempts of pain relief before turning to opioids. In my case I tried every antiinflamatory, antidepressant, and anything else they could think of, I tried physical therapy, a 30 day pain clinic, and finally surgery. 

So with millions of Americans suffering chronic pain, we need to do something different, I wish I knew what it was.