Please refer back to the past two blogs to find the background material for todays blog. Although the number of CARF approved pain centers in the US halved, the number of outpatient pain centers mushroomed. The services provided however focused on two areas:

  1. Medication management
  2. Nerve blocks and other invasive procedures.

Although many patients could be helped with one or both of these approaches, many patients in need of physical therapy and psychological services that were integrated with the overall treatment plan, would no longer receive optimal treatment. Reimbursement would be the driver of care rather than the needs of the patient. Centers could not stay in business and provide care that insurance companies would not cover. The shift toward procedures became an accepted standard of care and new organizations of pain physicians were formed whose membership focused predominantly on invasive procedures.

The emphasis on medication management was in part fueled by the belief that most patients with persistent pain could be treated successfully and safely with strong pain medications, such as opioids like morphine and oxycodone. Actually, some patients had problems managing their medication resulted to two significant issues: 1. Strong pain medications not only treats pain but also affects mood, so that if you are anxious and or depressed, as many patients with or without pain are, the pain medications provide emotional relief so you might take them for mood rather than pain and 2. Prescribed pain medication became more popular than street drugs for people who were drug abusers and some patients feigned pain and sold the prescribed pills for a handsome profit.

The cost of services for the treatment of , now with many less comprehensive multi-disciplinary centers, has nonetheless continued to rise at an alarming rate . Some of the increased cost is because of more numerous and complicated surgeries  . The bottom line is that we are spending more money each year on neck and back pain in the US, approximately the same as we spend on Cancer, and not getting good results.

The standard of care suggested in the guidelines of the American Pain Society and the American College of Physicians , although very thoughtful and comprehensive, overlooks the most common cause of back (and neck) pain, strains and sprains of soft tissue (muscles). Muscle pain is frequently related to stress and tension and finding painful muscles as a pain source may lead the patient and doctor to uncover emotional conflicts in the patient that when addressed relieve the pain.  We ignore the number one cause of most pain, provide procedures that are costly, often ineffective and sometimes damaging, and provide medications that are frequently misused or diverted to illegal uses. It is no wonder the system costs too much and produces sub-optimal results.

The next series of blogs will focus again on patients who have been attempting to find relief from their pain and where muscles were the overlooked cause.
If you have had persistent pain without finding relief, please share your experience in a blog response so that I can comment and other patients can see that they are not alone and that relief may still be obtained even if the pain has been present for years.

~ Norman Marcus, MD
Norman Marcus Pain Institute, New York NY
 
“Your New York City Doctor”
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