I wrote mine out somewhere .. can anyone find it? I can't!

Welcome pain_doctor :)

SO! You're a pain doctor. It's nice to see an actual physician take the time to get on a forum such as this. I (think) this indicates that you care enough about your pts to see what feedback is coming from SCS recipients.

I find your post rather interesting....and a bit difficult to comprehend what it is that you are trying to get across.
It appears to me that you are catagorizing 'These Folk' e.g. hypochondriacs, narcissistic, etc to be the ones who 'Invariably' present with 'problems' and demand some sort of satisfaction.....and wanting immense amounts of meds and weekly visits in clinic.

I think we should rewind a bit here and go back to the initial visits during the 'sales pitch' of these devices. It is repeatedly stressed to the patients that we should NOT expect to get more than 50% pain relief.
THIS ISSUE seems to somehow go by the wayside after the doctor receives his VERY LARGE financial kickback. It is at THIS point (perhaps the 4 months you speak of)"that something may go wrong and they demand some sort of satisfaction.....and wanting immense amounts of meds and weekly visits in clinic" - your words quoted....

Shouldn't it go unspoken that a PAIN PATIENT will be receiving BT meds for the 50% of pain relief that the SCS might not cover?
And WEEKLY visits seem a bit far-fetched......perhaps MONTHLY.
I'm sensing a bit of resentment coming from you, a PAIN doctor. I would think it would be understood from DAY ONE that a PAIN doctor will be prescribing PAIN meds to a PAIN patient.

Are you very familiar with RSD? Neuropathy? I'm thinking yes because a diagnosis must accompany the paperwork in doing the SCS procedure and most patients have conditions such as these. Are you aWARE of what it is like for a patient to have these conditions?
When you signed up to be a PAIN doc, did you not take into account that patients with these horrible chronic conditions WILL be needing 'chronic care' from you?
......hypothetical questions here. You aren't on a witness stand. :o

Some of what you say sort of reminds me of MY pain doc. He takes at least 6 vacations a year. He really doesn't seem to give a HOOT about the ongoing care to the patients he sees for intense chronic pain. He only seems interested in doing the HIGH COST procedures with his BIG needle. And oh yes how he LOVES to do the SCS implants. But guess what? He won't even consider doing pain pumps. Guess why? Because "Then I'd have to 'marry' those patients" (his exact words).

Anyway, it'd be GREAT if you stick around. I'd love to try to understand you further.

Rae

Thanks Rae re pain_doctor
 

It would be fairly easy to read pain_doc's muse from a pejorative perspective, and yet under the standards of care relevant to implant of scs units in chronic pain scenarios, BOTH to discern the patient who may have psychological proclivities toward such procedures out of a sense of attention as tends to be demonstrated by the DSM diagnoses of psychoses, and to discern the patient who may have deep set fear relevant to implant of artificial devices within the body. I have a relative in the generation more senior to me who VERY CLEARLY would present as a patient for whom SCS should not be performed, the psychoses are very nearly written in bold letters on their face. Such tremendously expensive surgery performed for such a patient would readily descend into ultra-dissatisfaction once the pity factor had worn off and the patient realized perhaps a less than perfect outcome.

Perfect outcomes; namely, the situations in which a patient is able to withdraw completely from dependence upon pain management meds is anomalous to the statistical realities of SCS implant scenarios. Truly, the ratio of pain relief nearing achieved success in has been spoken to and written of as a 50% to 75% pain remediation. I am anomalous as one who has fully withdrawn from meds.

One fantastic truth about my scenario from the beginning has been that my physiatrist [aka pain doc] is Board Certified and Fellowship Trained in this specialty. He is readily acknowledged in the local medical community as a careful conservative physician who recommends SCS in a last resort treatment context after having weighed cautiously the patient response to other therapies.

One thing my physiatrist also presents is deep knowledge and experience with patients who both qualify for SCS treatment and their statistical success in post surgical remediation of the pain profile. Unfortunately, some out there do pretend to carry sufficient knowledge or credentials as would qualify them as a field expert who might opine whether a patient is ripe for SCS treatment and the anticipated post surgical result. I encountered one such so called expert in court the other day, who, in his studied professional opinion rendered a negative commentary on my presentation and status despite his admitted complete lack of experience with ANY SCS patient and despite cross examination which yielded his concurrence with my physiatrist upon each and every scintilla of standards conformity of my body condition. This so called expert planted his foot firmly in the way of retroactive disabiltiy payments which would have assisted me and my family.

I cannot but imagine that if this so called expert pain doctor could Overtly Erroneously apply standards to my case, there are others flung across the AMA who for lack of better supervision leap to SCS as a means to treat without adequately weighing a patient need. Rae speaks of these as physicians unduely motivated by profit over care. Surely, this happens from time to time. After my court experience, with a lackey professional expert, surely there are those who profess knowledge to gain profit that is misplaced.

Standards based care which carefully takes a good many steps to fully understand the patient and develop as complete a picture of likelihood of success of a procedure seems most appropriate. I, too, would entertain Pain_Doctor's continued dialogue here as one who may prove to be solidly grounded on the perpetuation of standards based care. So, Pain_Doctor, care to chime in?

Thank you,
Mark56

This was an interesting NPR show on Diane Rehm the other day..I found myself shouting at the radio at times..

http://thedianerehmshow.org/shows/20...on-painkillers

hope you can listen to the podcast...:grouphug: