The emphasis on procedures vs. cognitive and non-interventional approaches is a driving force in producing unsustainable costs of care in all areas of American Medicine. A recent study in JAMA Internal Medicine revealed that some procedures are reimbursed 3-5X more than cognitive services. The insurance industry appears to have inadvertently affected the delivery of care for patients in pain by incentivizing expensive interventional procedures and shortchanging all others.
In the past 40 years the field of Pain Medicine has shifted dramatically. A Thermidorian Reaction has occurred in the pain treatment community. The failure of surgical interventions for many chronic pain problems was the foundation for the original mission of clinicians treating these patients. We were aware that focusing on a putative pain generator in the periphery or relying on opioids to minimize pain and suffering, often produced sub-optimal results. We have reverted to the position against which we originally revolted. The platinum standard of care, the multi-disciplinary pain treatment center has been supplanted by high tech expensive interventions, often of questionable value (cost divided by effectiveness).
How can we take advantage of technological innovation in Medicine whilst at the same time continue to value what is simple and works well? This will require a shift in how we pay for medical services. As we have seen when there is a large disparity between pay scales in different medical disciplines, human nature will oblige many new graduates to avoid the least reimbursed fields. Ultimately society suffers. If exercise can eliminate back pain in some patients who appear to have an operable lesion how can we improve the chances that it will be tried first? If we do not collectively come up with an effective solution, someone else will. What are your thoughts?
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