No one in this interaction [doctor and patient] seems to require a higher degree of justification, such as some degree of probability that a therapy will be effective. The possibility of effectiveness, rather than then probability of effectiveness, is good enough
This state of affairs leads to scenarios like those of patients I see everyday. Working in chronic pain rehabilitation, we tend to evaluate patients after they have exhausted countless pharmacological, interventional, and surgical options – no matter how remotely likely they were to have been effective.
His description of what pain patients go through in their journey to relieve their pain is chilling:
The typical patient we see:
- is in their forties or fifties and has had chronic pain for more than five years.
- They have been managed on opioids for most of these years. …by the time they get referred to us, our patients have trialed a number of opioids and have become tolerant to even very high doses.
- They typically have been to two or more interventional pain clinics, where over the years they have had ten to twenty spinal injections and
- have had three or four repeated radiofrequency neuroablations.
- They commonly have had three or more spine surgeries.
I am not exaggerating
Overtreatment in chronic pain management is exceptionally common.
I suspect that some providers in chronic pain management won’t think it is problematic at all. Spine surgeons and interventional pain providers profit greatly from the current fee-for-service practice patterns
Instead of obtaining care that professional organizations agree is the most effective, patients continue to obtain MRI or CT scans, interventional procedures, and spine surgeries at increasingly high rates (Deyo & Mirza, 2006; Deyo, et al., 2009; Hrudey, 1991; Ivanova, et al., 2011; Mafi, et al., 2013; Pham, et al., 2009). Such less than optimal tests and procedures constitute some of the most over-utilized assessments and treatments in our healthcare system.
Take the time to teach patients about what therapies are most effective.
It takes time to teach patients why orthopedic treatments for chronic pain, such as spine surgeries and interventional procedures, are commonly ineffective. The prevailing zeitgeist remains that chronic pain is an orthopedic condition. Initially, it often doesn’t make sense to patients why rehabilitation therapies are more effective.
Support policies and organizations that encourage effective care over profitable care
Support organizations such as the following:
- Institute for Chronic Pain
- Body in Mind Foundation for Ethics in Pain Care
- International Association for the Study of Pain
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