I didn’t become a pain doctor to write prescriptions. I did it because like most doctors I wanted to help people. And I did it during a time when patients were not in the habit of gaming the system the way they do now, realistically imitating chronic pain symptoms,nor in a time when there was an opioid epidemic, nor in a time when people with chronic pain are forced to go “doctor shopping” to find relief.
I know you realize that most ethical doctors go into practice to heal people. But you’ve also heard of the few outliers who are shills of Big Pharma, making money for writing prescriptions. In the back of the minds of everyone I meet is now a little grain of doubt: “is he really legit.” Try living with that.
We pain specialists are in an almost impossible dilemma. We’re caught between patients who try to deceive us to get the drugs they need for their addictions, and patients who may look like deceivers and addicts, who actually suffer from a chronic pain condition. We have to thread the needle to find the “right” patients.
I’ll give you an example of this. A young patient came into my office with a pain in his foot. It had been going on for quite a while, and he had been to several other physicians and even to the emergency room without a diagnosis. He had had standard x-rays taken and they had revealed no reason for the pain, which was getting worse.
My patient was then dismissed as a malingerer or an addict. He became unable to work or even to continue going to school because of the pain. Theoretically at the beginning of his life and career, his chronic pain cut him off from all his options.
So of course he went further doctor shopping as many chronic pain patients do, and doctor shopping looked even worse on his record. But he was looking for a solution.
Finally he got to our practice and we took a chance and did some further imaging, which revealed that he indeed had a neuroma on his foot that was causing the pain. Surgery did remove the neuroma, but by this time the pathways in his nervous system had been forged by the pain and he had what’s called “chronic regional pain syndrome,” which continued to cause him pain after the original neuroma had been removed. It’s somewhat like phantom limb pain, in which the limb is amputated but the pain remains.
What to do as a doctor? I had already been taken to task in the newspapers for prescribing opiates because I have been a speaker for one of the pharmaceutical companies. That now makes you an immediate suspect. Having a large practice full of chronic pain patients makes you a further suspect.
Many pain specialists are in my position and have chosen not to take patients who present problems with chronic pain for which opiates are indicated. But I didn’t get into practice to turn people away. I got into practice to heal them. My parents brought me up to be in a healing profession and they had high expectations that I would do some good in the world.
So I took this patient and I stabilized him on a combination of opiates and non opiates even at risk to my own reputation. He is back in school and able to hold a job and he is a functioning member of society. And of course he is eternally grateful.
I have made a decision to continue doing this. It is my calling and my life’s work.