Ron Rosenbaum, Writer

April 18, 2009

Pain Management: Don't Let Them Deny You

Filed under: Uncategorized — ronrosenbaumwriter @ 2:51 pm

Well you could think of all of life as “Pain Management” if you were so inclined (and I often find myself so inclined). But I’m referring here to the medical subdiscipline that has become such an important part of your experience in and out of hospitals.

As someone recently recovering from surgery, I probably had a similar experience to many–the first night after the operation in particular. Too much pain, not enough attention to actually relieving suffering, reliance on that idiot chart of ten smiley and frowny faces to indicate levels of pain (extremely objective!), and hospital personnel utterly unsympathetic to, or suspicious of genuine, readily available means to ease suffering.

Most of the latter attitude, I find comes from the old guard nursing establishment within hospitals and the inattentive residents who spend five seconds with each postoperative patient, each visit without stopping to listen to questions or complaints. Too overburdened, too much of a hassle.

I could go on about the misplaced puritanism that seems to consider post-operative pain to be a necessary part of the surgical procedure in some repressed sadistic way. Or the government’s vicious and cruel persecution of doctors and pain management specialists, a crusade that manages to criminalize or at least demonize prescribing effective pain relief because there are those who abuse pain killers.

But instead I’ll stick to the practical. Most hospitals now have a Patients’ Bill of Rights, most of it devoted of course to circumscribing your rights, but some parts of it an advance. One in particular is the requirement in most of these that if you don’t think your pain is being attended to adequately you have the right to call upon a “Pain Management Team” to evaluate your situation.

I’ve found hospital personnel resist compliance with this, don’t want to have the red tape or black mark that repeated Pain Management consults result in, and so they will say “we’ll adjust your pain medication and if that doesn’t work we’ll call in Pain Management”. This generally means you’ll get what you need–or better than what you had–but it violates your “Patient’s Rights” and you shouldn’t be intimidated from insisting on the consult regardless of whether they temporarily improve things. Because if they think they can escape notice by giving you a little bit more they will. And then they’ll take it away on whim of some arrogant resident. If the add-on doesn’t improve things enough, insist on having a written record made of your request to see Pain Management put in your chart and tell every intern, resident, and doctor involved in your case that you want the consult. The results may not always be entirely satisfactory, but it makes them take your needs seriously. It’s no guarantee that they’re going to do better but you won’t know if you don’t try.

Patients who don’t speak up and choose to live silently with their pain so as “not to make a fuss”, not only hurt themselves, they hurt others in pain whose suffering is thereby marginalized.

No one should suffer needlessly because of a medical procedure or condition in or out of the hospital. No one should suffer needlessly because of the insufferable arrogance of doctors. I was fortunate in having one of the new breed sensitive to the pain question, and I thought at one time, the arrogance factor was diminishing in the rest of the profession. But in fact there are still too many who treat patients as inferior human beings and take advantage of the patient’s vulnerable position to indulge in shameful narcissistic power displays. They react with barely suppressed rage and impatience at being questioned, still consider themselves inerrant deities, although statistics on idiot medical mistakes by doctors keep going up).

But allowing pain to go unmanaged out of some “principle” is frankly, as bad as deliberate torture and it’s time we called it that.

I’d be interested in hearing the experiences of others with “pain management” practices.

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11 Comments »

  1. My own experience was very different, but then I’m in Australia.

    A pain management specialist came to see me the day before my surgery, and we discussed painkillers. He decided on morphine.

    The day after my surgery, a kindly nurse not only filled me with opiates, but loaned me a book by William Burroughs — most appropriate reading!

    Unfortunately, I decided that I was enjoying this too much, and feared addiction — so the next day I said I didn’t want any more morphine. Bad move!

    It turned out that without a prescription, all I could get was paracetamol, and that definitely wasn’t strong enough. The next few days were miserable.

    Of course, I don’t know whether my experience was typical, or if I was just lucky in going to a good hospital. If there’s a next time, I’m going to follow the pain management specialist’s advice.

    Comment by Evil Pundit — April 18, 2009 @ 4:11 pm | Reply

  2. I have to say, in my own experience, there are few things more annoying than well-meaning medical professionals denying pain management drugs when they are sorely needed due to addiction fears.

    Comment by Rob — April 20, 2009 @ 4:04 am | Reply

  3. I was in New York Hospital in 2003 in intensive care for a week. I have no quarrel with he staff there, as they saved my life. My only advice is that you don’t have to take the mandatory blood thinner shots they give you every morning. Also, if you want a painkiller, you have to ask for it, usually more than once. The reduction in pain medication is solely due to fears of litigation. Hospitals are now charged to get you out on the street as fast as possible, for insurance and “rotating bed” purposes. As I discovered in dealing with some of my relatives, this often means that “incurable” patients, however well-insured, are often discharged back into nursing homes before all necessary care is administered. An efficiency system has replaced the doctrine of doing everything possible to save the elderly. We have a medical system that peforms miracles on the one hand and subscribes to creeping Kevorkianism on the other. Get well, Ron, mitigating the pain. You are courageous even to post under these circumstances.

    Comment by charlie finch — April 20, 2009 @ 8:27 am | Reply

  4. Yeah Ron it is painfully obvious that you don’t deny yourself. What is your poison?

    Comment by aloysiusmiller — April 20, 2009 @ 11:29 am | Reply

  5. Ron,
    Very often it isn’t laziness on the part of the physicians. The same government that “encourages” the physician to take proper care of pain patients can be extremely threatening to a physician who actually does prescribe enough pain medicine. Doctors nowadays will not even write a prescription for, say, percodan because of fear of government investigation and license renewal problems. This problem is very very real.

    Comment by Mark Schiffman MD — April 22, 2009 @ 12:45 pm | Reply

  6. Dude, you rock. Get well. Myself, and like 10 people I know are missing the Slate columns.

    Comment by Tim Rinaldi — April 22, 2009 @ 11:01 pm | Reply

  7. Mrk Schiffman is absolutely right. It is time to legalize vice in this country and tax the hell out of it; that means, drugs, gambling and prostitution. Making illegal workers citizens on the spot and handing out the TARP/stimulus in the form of $80,000 to every man, woman and child in the country, while forgiving all mortgage debt would send us all on the economic boom of a lifetime. But even Obama is fundamentally too right wing and too beholden to “the Charlie Rose elites” to do any of it.

    Comment by charlie finch — April 23, 2009 @ 10:11 am | Reply

  8. This is really out there, but if you want a stylish as hell movie that puts the absurdity of it all in just the best perspective film can do, watch “Death Proof,” Tarantino’s half of Grindhouse, the best horror movie of the century so far–Dazed and Confused meets Ballard.

    Comment by Tim Rinaldi — April 26, 2009 @ 2:17 am | Reply

  9. Ron,
    I have lupus and my regular rheumatologist at Hospital for Special Surgery recommended I go to a “Pain Management” doctor because he did not want to continue giving me pain medication unless I was given the go ahead by a specialist. So, I now go to Beth Israel Pain Mgt center in Union Square – a clinic featuring of every type of human specimen in NYC. I was taking Percoset – a great pain med, but my new doctor, a fantastic Brazilian MD who is easy to talk to, recommended I take Oxycontin. I was at first frightened to take it because of the bad press but I must tell you, it has saved my life. With Oxy, I take 3 – 4 a day; they are long lasting and I rarely need to take more drugs. I have Percoset as a back up.
    I have really bad pain and achiness – I feel as if someone is pulling my arms and legs. But with controlled use of the drugs, I continue to work and enjoy life. It also relieves the anxiety, as these drugs are opiate derivatives – and Who cares? Why should I be miserable.
    I asked and Every one of my doctors told me that if we have Universal health care – it will be a nightmare of unbearable proportions. People with weird illnesses like lupus and other autoimmune diseases (arthritis/fibromyalgia) will suffer. I almost died a few years ago when I suffered an infection that led to open heart surgery out of the blue! Hospitals are hotbeds of infections – and even if this is politically incorrect – the many illegal aliens are contributing to the high infection rate both in hospitals and in our cities. Cornell-Weill, the hospital I was in, had Legionnaire’s Disease floating around when I was there two years ago; we weren’t allowed to drink the water.
    The insurance companies, the gov’t, and especially some of the Press do not understand pain. They infantilize those of us who have to take medication. If someone who is not liberal has a problem taking too many pain medications (think Rush Limbaugh and Cindy McCain) they demonize them again and again.
    When you aren’t in pain, it is difficult to understand why others aren’t strong enough. And when it happens to you, then you are able to empathize with others. The point is, adults should be able to get the care and pain meds they need – without begging doctors, the government, or insurance companies. And I do not relish the thought of begging the gov’t if I need additional pain meds in the future. I want my doctor and myself to make decisions about my pain – not gov’t agencies. If the insurance will not pay for it, I would be willing to pay for the relief of pain.
    And – I do not need crackpot writers (as you know, there are very few real journalists today, Mr. Rosenbaum) telling me what’s appropriate for those of us in pain. They say pot is fine, but opiates like Oxycontin and Percoset and Vicodin are dangerous. Pot doesn’t really help me.
    We do not need the gov’t to save us from ourselves. We have so many laws on our books borne out of fear, desperately trying to keep us “safe.” Meanwhile, our borders are open and our country is not physically safe from our enemy. But hey, let’s prosecute pain doctors, they are really ruining this country.
    Take care, Ron, do what you do best – expose hypocrisy. Even if I do not dig Obama and Big Gov, I think you are a great writer.

    Comment by Marilyn — April 26, 2009 @ 9:56 am | Reply

  10. You are an inspiration, Marilyn. All of us have had to deal with pain and the drugs which alleviate pain with ourselves and our parents and other relatives. What is mazing is the puritanical alliance which has emerged between “liberal” Democrats and the right on restricting, demonizing and criminalizing the use of pain medication.

    Comment by charlie finch — April 28, 2009 @ 5:22 pm | Reply

  11. My boyfriend had a benign brain tumor removed 3 days ago. The tumor is called “acoustic neuroma”. They were giving him codeine and valium as “pain relief” right after surgery. He was clenching in agonizing pain for the past 3 days until I spoke to the doctor and used the word “malpractice”. The doctor then changed him to a bit of a stronger medication, although it is still not relieving his pain. I asked the neurosurgeon why he was only prescribing codeine. His answer was “to preserve his neurological status”. I have researched for hours on this subject. My boyfriend came out of the surgery the same man he went into the surgery as, minus a small brain tumor. It was obvious to the doctors and myself that my boyfriend has not suffered any neurological impairments, but they still insisted that “this is what they do for all acoustic neuroma patients”. I am shocked and appalled that this largely known hospital system in Philadelphia, PA denied pain management. When asked what his pain level was, my boyfriend said a “10″. I have seen my boyfriend snap his ankle in half while playing football, and still have a smile on his face. He has a very high pain tolerance, and for a patient to reply with a “10″ and the hospital staff not do a single thing disgusts me. I do not know which path to take with this subject. I do not know if talking to a legal representative would do any good at this point. He is being discharged tomorrow or the following day. I can only hope they do not deny future patients of the right to pain management.

    Comment by amy — June 21, 2009 @ 4:24 pm | Reply


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