It might ruffle some feathers, especially coming from a Nurse Practitioner, but the disparity in how chronic non-malignant pain and procedural interventions are viewed in pain management is hard to ignore. We readily dismiss chronic opioid therapy (COT) for chronic pain patients, often seeing them as a burden. Yet, we enthusiastically embrace a range of equally, if not more, questionable and costly procedures for almost every patient who walks through our doors.
After years in pain management, working alongside numerous pain physicians, the reality is stark: our success rates are underwhelming. The few genuine success stories are what keep us going, but the prevailing attitude is unsettling. It’s disheartening to witness the reluctance to even consider a consultation for a chronic pain patient managing on a low dose of opioids, like 5 oxycodone a day. There’s often no interest in exploring options, even if that option is a carefully managed taper.
However, when “Not-on-Opioids-JaneDoe’s” lumbar radiofrequency ablation (LRFA) fails – not once, but repeatedly – the response is entirely different. Let’s repeat the LRFA! When that inevitably doesn’t work, let’s try a Sprint Peripheral Nerve Stimulation system. Still no relief? Suddenly, there’s radiculitis! Time for transforaminal epidural steroid injections (TFESI). Never mind that they only provided two weeks of relief before; this time, we’ll do two in a row! Fast forward two years, and the patient is undergoing a Vertiflex procedure. And after all this, we’re sending her to collections because she’s behind on her $4,000 out-of-pocket ketamine infusion bills.
This approach feels intellectually dishonest. It raises serious questions, especially for those training to be doctors – the Pain Student Doctors – who are entering a field where financial incentives can seem to overshadow patient-centered care. It’s a system where the eagerness to perform high-dollar procedures sometimes appears to outweigh the commitment to truly effective and sustainable pain relief.
For my own loved ones, my health advice is simple: 1) Eat healthily and don’t smoke. 2) Be wary of incompetent practitioners. 3) Approach new treatments and medications with caution. 4) Assume, until proven otherwise, that any procedure recommended by a specialist is primarily for their financial gain. This cynicism is born from observation, and it’s a perspective that pain student doctors should critically consider as they navigate their careers. The challenge lies in ensuring that patient well-being, not financial gain, remains the guiding principle in pain management.
