I continue to be amazed at the number of pain patients, both mine and others that I meet who do not understand the use and power of their medications.  Pain medications, either opiate or anti-inflammatory in nature can only do so much for the patient with chronic pain.  Patients seem to be in continual pursuit of better and better pain control, at least until they are placed on opiate medications.  They then seem to believe that their pursuit is finished and somehow believe that the answer lies in the pills alone.  The most any medication can do is lower your pain levels by 1 or 2 steps on a pain scale of 1 to 10.  In other words, if your pain is a level 8 on the average on a scale of 1 to 10, the most a medication can do is lower it to a 6 on the average.  With this much help, perhaps the patient can become more active to the point where they can work on conditioning themselves, becoming more active, or continue working.  But they will not achieve a pain level of zero, no matter how much medication they take.

Too many patients though do not use the medication to their advantage.  Pain, after the time of acute injury, is a useless warning sign.  Originally it is useful to the brain to warn it of the new injury.  But once the injury has healed (3 to 12 months depending on the injury) pain becomes a useless symptom.  It no longer is a warning to the brain, but instead is just a reminder of injury.  Too many people place great value on their symptoms however and allow them to constrict their daily activities.  Instead of pushing through it and working to better their lives, they give in to the pain and become even less conditioned and more disabled.  I believe a lot of this is due to our modern lifestyle.  In today's environment we are easily allowed to become disabled and remove ourselves from activity.  This only makes the pain more emphatic as we remove ourselves from the distraction of work or family activities.

For years I sympathized with the patients thinking I could gently remind them and cajole them into further activity.  Too many patients took this attitude as one of  being overly sympathetic with their pain, and used it to justify their own further inactivity.  Dealing with my own chronic pain from a herniated disk and degenerative disease in my neck and back perhaps made me too sympathetic.  It was hard though on the days when I came to work bent over and "disabled" myself with difficulty even walking from exam room to exam room to be more sympathetic with the patient's complaints.  I knew for myself that work and activity was distracting from my pain, and became frustrated with the patients who simply were using their pain as an excuse to remove themselves from society and or activity.

The human brain is capable of incredible feats of control.  We have seen this in our athletes and warriors for generations.  Pain is simply one of many signals to the brain and our thought processes are fully capable of  placing pain into it's own compartment where it can be ignored and worked around.  I have been trying to come up with a way to teach this idea to patients to allow them to work around their own pain.  But it seems too many of them have allowed pain to wrap them up in it's enveloping embrace. 

Now I am recomending meditation, or a meditation based yoga practice to perhaps allow the patients to learn how to separate their thinking process from their emotional reactions to their pain.  There are many teachers out there, and patients should seek their own in their local community.  But for the pain patient to simply take their pills, and assume that is the best they can do, has become ultimately so frustrating to me as a practitioner that I have become to think that I am an enabler instead of a physician trying to help people.  I know there is a better path, and that the medications are simply one step towards finding that path.  My ability to convince patients of this path has been frustratingly poor however.  For now I will continue to work to find a solution for each patient, but the task is frustrating and is wearing on my own abilities at times.  Perhaps it is easier to take the path of least resistance, and instead of crusading for improved care I should rejoin with the massed doctors out there in a group and return to assembly line medicine.  It is frustrating to not see patients seek improvement in their chronic conditions day after day after day.

I thought I would start this blog with an apology to any of my patients who read this.  For the last month I had been a little scattered in the office as I dealt with a lawsuit.  The suit is settled now, for a loss of $40,000 to prevent going to court on a case where a patient died with no autopsy. I was being sued because the family felt that the pain medications killed the patient.  This despite the fact that the patient was stable on her dosing for 1.5 years with no changes, and there was no medical evidence that the medication had killed her in any way shape or form.

Several patients have assurred me that they would never sue.  I am sorry to say this, but in our society that is so much hogwash to even mention.  All I need to do is piss someone off about their care and I have been threatened with lawsuits in the past.  Of course I drop those patients in a hurry, but in this case, the patient was dead, and the family wanted some free money.  They are not out anything, the lawyer who sued me gets $13,200, and the family gets $26,800 for several hours of work.  I am sorry the patient is gone, and noted that she was a "good patient" whose family "would never sue".  So again, if I act bitter, or plan at some point to quit medicine early, I hope you understand.  The lawyers have made it known to the doctors that we have to be perfect in every way, and since we are only human, with our individual human faults, that is impossible.  I had hoped to be able to bring humanity back to my small piece of the treatment world, but my lawyer pointed out that by letting the patient get by with some dosage changes and some "lost" or "stolen" medications, etc, then I was placing myself and my practice at risk.  I am intelligent enough to realize that being a humanist in my approach to medicine is what I am personally being punished for.

So I hope all of the patients understand.  I cannot afford this kind of medicine anymore.  I have just lost 1/10th of my income every month for the next 9 years to trying to be a good doctor.   I will never intentionally hurt any patient, but I for sure am going to continue to tighten up on patient visit times, refills, and clinic rules.  Those that need more laxity in their care are free to go elsewhere for their care like always.  And I will do my best to regain my optimistic and cheerful attitude at work, while realizing that every single patient visit has to be viewed through the eyes of "how will this look on the witness stand".

Dr. Klos MD