Pain Management and Telemedicine

I do think there are pain management practices that could provide quality healthcare to chronic pain patients in rural areas. And the telemedicine pain doctors might do a lot to help these patients be better able to function. But…..

I know when I have a pain (and thankfully I don’t have any that is chronic), I want it to stop hurting. Narcotic painkillers can help overcome pain, but they are only supposed to be a temporary solution. We all know why – they are addictive. Constant use causes other physical problems like constipation.

My experience as an employee of a state medical board was an eye-opener. Unless a physician can determine what is causing the pain – the pain generator – these drugs don’t correct the problem, they just cover it up. I watched a number of physicians be disciplined and saw some of them lose their medical licenses because all they did for their pain patients was prescribe narcotics. Some of them were naive; but most did it for the $$$. Just about all those who got in trouble with the medical board were general practitioners in outlying areas who had minimal training, if any, in pain management.

This doesn’t mean that we should withhold medications from people who live with incredible chronic pain for which there are no treatments or procedures. They are the legitimate victims when a physician in a rural area loses his or her license for falling below the standard of care in not identifying the pain generators and working out a treatment plan for their patients. But narcotics should be wisely, not widely, used.

The benefits of medical care must outweigh the dangers to the patient. So, I’m torn when the subject of using telemedicine for chronic pain patients comes up as it does in a blog post by Dr. Ryan Holzmacher, a triple board certified MD specializing in pain management. Primary care doctors don’t do surgery without training. They certainly shouldn’t do pain management without accredited training. I believe, as does Dr. Holzmacher, that telemedicine can help pain patients as long as doctors do more than prescribe narcotics and approve refill after refill without checking to see if the treatment plan is working for the patient. When it comes to pain management, I agree with him that “only specialized doctors should be treating [pain] patients.” How the medical board would state it would be “competent and qualified,” and unfortunately that’s way too ambiguous and invites trouble.

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