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.