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 I am anomalous as one who has fully withdrawn from meds.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...