Wednesday, March 14, 2007

The pain management Procedure mills.

Every day in this country, people are walking into the office of a doctor that claims to be specialized in pain management. As for as I am concerned it is a joke!!! The only thing that is not funny about it is the cost. It is very expensive. Many people end up with more pain as a result of these injections. I am one of those people. The majority of these doctors are anesthesiologists. My primary care doctor wanted me to go to one and even though I had been down this road before, I agreed.

As usual he wanted to do an epidural shot which I knew was coming. They usually want to do a series of three which will cost you about $2,500.00 per shot. After I sat down with him and shared my complete medical history with him, he decided that he didn't want to put a needle into my spine, not that I would have let him anyway. To make a long story short, here I am a patient with pain level of 9-10 on a 10 scale. This so-called pain management doctor lets me walk out of his office without offering to prescribe anything for pain. Why? It is an increasing medical "scam" and they are nothing but "procedure mills" as far as I am concerned. It is very profitable. While I will not name names, I have heard these same feelings and frustrations expressed by doctors especially Primary Care Doctors, because when they finish with their injections, they send you back to your primary Dr. for him to prescribe pain medications, if he is willing to.

I have had 4 surgeries but I have nothing to show for it but more pain. After my last surgery I bitterly vowed that I would educate myself on pain and procedures of the spine and that I have done exactally that. An Epidural shot is more that just the name of an injection. The Epidural is the first of 3 very thin linings that surround the delicate nerves and cerebral fluids in the spine and brain.

This is a quote from a well known Neurosurgeon. I will not use his name because I don't have permission.

"Any substance injected into the epidural space near a prior dural puncture site will inevitably find its way into the subarachnoid space. It would be inappropriate to risk bathing a segment of the spinal cord in ethylene glycol, or any depo-corticosteroid solution". Believe it or not, "ethylene glycol" is one of the primary ingredients in "automobile anti-freeze.

Bottom line, if you have a new injury in your spinal column before you run out and start having injections or surgeries, you better educate yourself, or you will end up like me and 60 million others with nothing to look forward to but a life of Chronic Pain.


Anonymous said...


Anonymous said...

This is the same story my husband has. It is a nightmare for everyone involved.

Anonymous said...

Not all anesthesiologists who have a pain management practice, are procedure mills. There are some wonderful pain management docs that are anesthesiologists out there who do practice medicine,with medications, including opiates. I have a wonderful doc who has done everything in his power to try to get me to be more comfortable. He does prescribe opiates as needed, and warranted. You are not pushed to your primary care physician. I have been going to him for over 5 years now, and will continue to see him as long as I need to see him. Yes there are some unscrupulous doctors out there, but you can not say that all anesthesia based pain management practices will do this to you.

duke63 said...

I am glad you found a good pain management doc. I'm sure there are some good ones out there. My experience with four different anesthologists were the same. They wanted to do epidural injections. The last one did not want to treat me at all, when he found out that I had Adhesive Arocnoditis. He referred me back to my primary care physician. I am glad you have had a better experience.

Jenna P. said...

I concur with EVERYTHING you wrote. In fact I found this page when trying to find out if other people have had the same problems that I did.....I guess so unfortunately. My story is very similar to yours, how sad.

I have Lupus that has caused excruciating pain for the past 4-5 years. I've gone through everything starting with Advil and darvocet to (thankfully!) now the fentanyl patch (which made me really nauseous) and now Oxycontin (which is getting pounded so hard in the media from the drug addicts that abuse it, which scares the pants off of me for what will become of it and similar medicines in the future that I depend on to get through each and every day - still in pain).

My Neurologist is absolutely GREAT. He is the best and most helpful and understanding doctor I've ever seen, and has helped me tremendously. About 6 months ago, I was still in pain though and self-referred myself to a pain specialist at the request of my boyfriend. Heck, the title, "Pain Specialist" sounded like exactly what I needed, my disease was being treated as well as it could be, but the pain was the debilitating factor that remained. Luckily I had insurance that paid for most of this, but in all the "pain doctor" (the fraud doctor is more fitting I believe) was paid more than $2,000 for my 3 visits....

The first appointment, which I was really hoping and praying would be my lifesaver, was just a 8-10 minute meeting. He recorded it all on tape, which I understand being in that business, but made me feel like a street junkie. After 10 minutes at most, he said see how things go and come back in a week. Um - he didn't do *anything*. What the heck was a week going to show - I've been in pain for years, and he didn't even do anything different - no new medicine, no voodoo, no nothing. This appointment was nearly $800 billed to insurance. Yes, that's $800 for 10 minutes of nothing.

So I came back the next week. He then said he wanted to try "trigger point injections". I said ok (couldn't hurt, right?) and made the appointment for about 2 weeks later. I had no idea what those were, so I looked up online. They didn't seem like something that would help pain that was all over my body - my pain (plainly explained to him) was definitely not specific to 1 or 2 sites on my body. *Everything* hurts. He said I would need them every few months - for the rest of my life most likely to deal with the pain. Trigger Point Injections appear to be sometimes helpful for pain that is very localized in a certain small part of your muscles (not my problem at all).....

Luckily I met with my Rheumatologist and Neurologist a few days before my injection appointment. They both said NO! A big big No from both of them. They strongly agreed that it wouldn't help a bit. Mind you, the injections were estimated to be around $1,000 from the Dr., which would have been "just a few injection sites".

I called to cancel my injection appointment. The receptionist quickly because oddly rude. Whatever. So I scheduled 1 more appointment (I know, I should've learned. But I was in dire need of help to relieve the darn pain). He was very short and irritated at the fact that I cancelled the injections. He said that if "I would let him help me, he couldn't do anything". I even told him about my 2 other specialist doctor opinions, he just turned even more condescending.

So I asked what else he could do to help, what my other options were medication-wise. He again snapped back that "medications aren't enough" and that I "obviously wasn't willing to work with him", and that all I wanted was the "easy way out".... Um no. All I want is some pain relief from a Pain Specialist - whatever that takes, be it medicine, yoga or amputation of every limb. If there's a valid and scientific basis that it will work, I am ready to try just about anything viable. So I basically left and that was that.

I saw my Neurologist shortly after that again, and he actually was very mad and annoyed at the fact that that was what happened, and the Pain Specialist wouldn't even deal with ongoing medicines (which he attested that is definitely part of their job and that they have knowledge of pain medications more than any other specialist). He even went so far to say that it was what he actually expected when I told him I went to a pain dr., but was hoping otherwise. He also said flat out that he is getting very sick of the new trend of pain specialists in particular just trying to rake in every last cent they can doing only the most expensive procedures, so that they don't have to deal with the hassles of writing ongoing controlled medicine prescriptions. In his words, he said about them, "More and more over the past 10 years, pain specialists that I deal with are continually dropping patients and/or referring them back to their primary care doctors for prescriptions while only keeping the ones that agree to costly injection-type procedures". He said he is seeing more and more of this every year and is very annoyed with the entire situation.

So my Neurologist was gladly willingly to try other pain medicines with me to find something that works. He's a great doctor, but as he agrees, a Pain Specialist should and would know much more about the intricacies of each medication.

Wow that was really long. Sorry. Although I doubt anyone will actually read that, I felt that I needed to share my experience. Hope you are doing better after your experience and are as pain-free as possible! Thanks for the info and posting your experience.


Jerry said...

Just read your story. If you have a Dr. that is helping you now stay away from the so-called pain management specialists, especially the anesthesiologists. I had 2 appointments with one in January, no shots and just 3 days of physical therapy if you could call it that. This guy keeps billing and to protect my credit I have to pay. It is unbelieveable.


Anonymous said...

I just had the same experience yesterday. This pain management doctor was nice to me as long as I used his physical therapists, his massage therapists, day spa, injections and etc...but when the disk continued to bulge more and the pain suddenly got worse, he was rude to me when I requested some pain killers to, you know...kill the pain! He accused me of not wanting to get better! He said that his practice wasn't the place for prescriptions. [Pain management doctors are usually the ones to see for pain meds!] I also told him that I was not sleeping because of the pain and he said that he couldn't give me anything for that either! I was stunned. In the past [I recently moved here], my not sleeping due to pain has been addressed/corrected right away. He said that he wouldn't do anything about it.

I got the feeling that it was about appt for meds doesn't bring in as much as injections do! I figure he will care about a patient's sleep problems when he opens a sleep clinic!

Anyway, I have had 2 neck surgeries, and I've been treated with chiro/natural/pt/etc...and now I have another ruptured disk. Another surgery has been recommended. I went to him to avoid it. He recommended an epidural injection without requesting the imaging report from my primary care doc. [Is that standard?] I refused the injection until I got the MRI and the report, but he was willing to do it anyway! I thought it was odd, but I was in so much pain, I just stayed there. The first pain doc I called wouldn't even let me have an appt because my pain doc from another city had never faxed my stuff and my surgeon's report alone wasn't good enough. So, I took what I could get. They know we're desperate.

Well, at least I'm not alone.

Good Luck to all of you in getting help!

Jerry said...

Don't waste your money on epidural shots. First of all they are dangerous and second, if they work at all it will be for about 2 weeks. These procedure mills are the biggest "cash cow" in medicine and they are nothing but a medical disgrace. Lyrica and ultram is also a waste. I would advise trying to establish a relationship with your primary doctor.
It make take a while, but some of them will eventually help you. One thing that will help, is taking your spouse with you, or a close relative if you aren't married.

Good Luck

Anonymous said...

About a year ago I noticed that some lower back pain I’d had for a few months was getting progressively worse. I basically ignored it as much as I could and used a heating pad at night, which seemed to give a small amount of temporary relief. I was at work one day and turned in my chair to reach for a file and was literally brought out of the chair and to my knees with sharp, stabbing pain in the lower back region. I was taken to the hospital via ambulance and given an MRI. The results revealed that I had a condition called degenerative disk disease. The doctor said that a disk in my lower back was basically crumbling. He prescribed a pain medication, 10 mg. percocet, twice a day until I could get in to see my primary doctor. The results were actually amazing. The pain subsided almost instantly after I took one. When I went to see my primary doc she took me off the percocets and put me on loritab, 10 mg, 3-4 times a day and referred me to a neurosurgeon. He continued the loritabs and put me on steroids. The steroids caused my heart to race very fast and the loritabs did not help the pain like the percocets did. Plus I didn’t like having to take 3-4 a day (500 mg of acetaminophen with each pill – not good for the liver) just to get a little relief. I asked the neurosurgeon to put me back on the percocets and he looked at me like I had just crawled out from under a rock. He absolutely refused to do it, even though I told him it was the only relief I had gotten. He tried me on a different steroid with the same result, a very fast heartbeat (178 beats a minute). He also said that surgery for my condition was not an option. When I asked him why he wanted to continue to see me if that was the case (he is, after all, a neurosurgeon), he got very belligerent with me and slammed a file down on the desk. I think he would have been quite happy seeing me once a month for the rest of my life, keeping me on loritabs and collecting payment from my insurance company. So I fired him and went BACK to my primary doc, who then referred me to a pain management clinic. I specifically asked her (my primary) about a TENS unit because I had a friend who was getting relief from one. She said the pain management doc would talk to me about it. When I got to the pain management clinic the first thing they handed me was a sheet of paper that said they DO NOT continue to prescribe any narcotics that my primary had me on. I then met with a physicians assistant who told me that I was a good candidate for a Facet Block (a series of shots into the spine). I asked about the TENS unit and he ignored me. He was like a used car salesman trying to sell me the Facet Block shots. I told him that my primary had me on Loritabs for pain and he said I would have to continue getting them from her. I explained to him that my last prescription was due to run out in 2 days and he seemed absolutely unconcerned. He also said that the primary benefit to Facet Blocks was the steroid component in the shots. When I reminded him that I was allergic to steroids (it was in my medical questionaire that I filled out for them), he switched gears like an oily used car salesman and said that they would then use an “herbal” alternative. Yeah, OK. So I left there, without seeing an actual doctor, with no continuation of my pain medicine, scheduled for a procedure that I’m not even sure I want to have done. So I had to call my primary doc again to get a refill on the pain meds and they tell me she is in Greece. Her nurse practitioner said that when they refer out to a pain management provider that they stop supplying pain medication. She finally agreed to give me just enough pain meds to get me through until my Facet Block procedure (after getting records of my consultation faxed to them from the pain management clinic because apparently they don’t trust me). SO……..I’m scheduled for Facet Block this Monday and I’m scared to death. I’ve read more negative than positive. And my pain is just getting worse. It doesn't seem right that I'm having to deal with all this crap while I'm in a real vulnerable place with my pain. Just wanted to share my story.

Anonymous said...


I am an anesthesiologist and pain management physician.

It upsets me to hear the stories of mistreatment that many of you have had to endure.

I suggest that you never go to a pain management physician who "just does procedures". That is a sure sign of someone who is trying to make lots of money by just performing procedures, which pay much more than an office visit.

That being said, many patients do benefit from procedures such as epidural steroids or facet blocks, but these are not cures. They are just a different and more effective means of getting medication to the place it belongs. And remember, no medicines you take can cure your illness except antibiotics and chemotherapy drugs. Every other drug just controls the symptoms of your illness.

And regarding narcotics, you should understand that EVERY physician who tries to help patients with chronic pain must also weed out those who are addicted to narcotics or are making a living by illicitly selling narcotics. We may seem overcautious, but it is because we have ALL been burned before by slick addicts. We like taking care of patients in pain, but we abhor it when we have unknowingly supplied a junkie or drug dealer with narcotics for no legitimate purpose.

Thanks for listening.

Jerry said...

Thank you Doctor for your interesting and truthful comments. I know there are many good Doctors like you out there and I have stated so in many of my posts. I know you guys have to walk a tight rope because there is a drug addiction problem in this country. I have been to pain management specialists myself though that do nothing but procedures. The people who are drug addicts only make it harder for people like me. There needs to be more education on chronic pain in this country.

Thanks again


Adam said...

Very good post's to all who have taken the time to share their thoughts. I too have been in a struggle, I have been seeing my PCP for almost a year now with no avail, since the first time I walked into his office I had complained about pain in my back that shoots down my leg causing pain and numbness as well as the bain in my lower back. At first he seemed concerned and wanted to be helpful but I noticed this was just an act. He sent me to a quack of a neurosurgeon who was convinced the problem was in my knee (even tho the MRI I had clearly showed a messed up disc at L5,S1). When I returned to my PCP and told him I wanted to see a different neurosurgeon he gave me a mean look, and said thats the only one he could refer me to. I kept going to PT and following all my doctor's instructions, however I did not recieve any relief from the pain (9-10 on a pain scale daily). I tried to get him to switch my medication to something new ANYTHING that would bring me relief, but he told me the 5 mg vicodins he was giving me was "potent enough" and even suggested trying to take an alieve pill once a day to ease the pain (as if). The last straw was when I told him I wanted a referal to a pain clinic because I felt he was undermedicating me and basically taking my money to do nothing, he sent me to a pain management clinic that does not prescribe any sort of medication period. ALl they would do is give you cortizone shots in your back, I went to this pain doctor got the shot, and now am in worse pain than before. The pain now travels down both of my legs instead of just one. I went back to my PCP and asked for something for the pain again, yet he gave me the regular 30 vicondin for 3 months, and said I should keep going to physical therapy. Needless to say if your not going to listen to me and say "i think that medication is potent enough" im not going to even waste my time arguing. I would love to see him deal with the pain I do, and let me tell him the medication is potent enough for him. Needless to say I have changed my PCP and now am going to treat my doctors like the scum that some of them are. Sad how the greatest nation in the world could be so uneducated and ridiculous over helping people in pain.

P.S. the post were very informative and if I would have taken the time out to recognize the pain mgmt place that I was refered to was a "procedure mill" I would not have wasted my health, time and money.

Anonymous said...

I am married to a Pain Physician and also an Anesthesiologist. Most of them tend to have that background because its a fellowship associated to that specialty. Actually look more closely at the doctor who is doing Pain Management and is not to be sure.

It is true that Pain Management is being pushed heavily on procedures. My spouse has always been struggling to run a truly comprehensive practice with other supporting areas such as physical therapy, psychology, acupuncture, and the likes, but it is difficult to compete with those that are either pushing drugs, pushing procedures, or pushing pain pumps... Where the big bucks are!

My recommendation is similar to that of a previous doctor who posted here, but always check the philosophy of the Pain Management doctors. In school, they are taught to have a multidisciplinary approach, but after school many of them just push drugs and procedures.

I have heard stories of doctors seeing 66 patients in one day. I also know of docs who own pharmacies that feed them their medications.

My spouse has been criticized for not having a "medical based" approach and so not making enough money. Read "procedures, procedures, procedures!". Hospitals are businesses and mostly are looking at the bottom line.