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Author: Murray J. McAllister, PsyD
Date of last modification: 4-24-2014
It’s an interesting fact about the field of chronic pain management that there is a safe and effective alternative to the use of opioids for chronic pain, but relatively few people know about it. The alternative to opioids is an interdisciplinary chronic pain rehabilitation program.
Correlation doesn’t imply causation. It’s a commonly expressed caution in the health sciences. What it means is that two things can tend to go together without necessarily causing each other.
It’s common to be upset when you’ve been told that you have degenerative disc disease. It’s an awful sounding diagnosis. It sounds like you have a disease that is deteriorating your spine. And on top of it all, it doesn’t sound like there’s much you can do about it. The spine, it seems, is inevitably degenerating.
What is your relationship to your chronic pain? At first thought, it seems like an odd question. But, if we stop to reflect on it, couldn’t we have a relationship to pain? Don’t you already have one?
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Author: Murray J. McAllister, PsyD
Date of last modification: 1-26-2014
It might be easy to conclude that anyone who wants to reduce the role of the profit-motive in healthcare must be either an extremist or a fool. Upon reflection, however, it becomes clear that we are experiencing an era of overtreatment in healthcare (see, for example, Dr. H. Gilbert Welch’s piece here) and one area where it is particularly apparent is in the management of chronic pain. While there are likely many causes of overtreatment, one of them surely is the profit-motive that occurs within a fee-for-service model of reimbursement.
In the last post, we looked at the influence of money on your healthcare providers’ recommendations. We saw that in a fee-for-service model of healthcare, which is the predominant model in the U.S., individual providers, clinics and hospitals get paid based on the number of patients they see and the number of procedures and tests they perform. In other words, the more patients a provider, clinic, or hospital sees or the more procedures or tests they perform, the more they get paid. As such, a fee-for-service model of healthcare incentivizes productivity – providing more care leads to making more money.
One of the more common sentiments that patients express to me is that they have come to the conclusion that money influences healthcare recommendations. After reflecting on all the years of chronic pain and all the years of failed treatments, many of which were tried multiple times, they have concluded that the business side of healthcare played too much of a role in their own care. They are now disappointed, angry, and jaded about how much they trust healthcare providers.
The third of three reviews of research on spinal surgery for neck pain was recently published by a group of well-known pain experts (van Middelkoop, et al., 2012; van Middelkoop, et al., 2013; Verhagen, et al., 2013). The investigators undertook the reviews of the research on different aspects of neck surgery because the most recent previous studies, done as Cochrane reviews (Fouyas, et al., 2002; Nikolaidis, et al., 2008), were now outdated. So, they systematically reviewed the latest published research on different types of spinal surgery for neck pain to determine whether and how such surgeries are effective. What they found was that spinal surgery for neck pain is not any more effective than other, less invasive, therapies.
It’s not uncommon to exclaim, at the beginning of a pain flare, “I’m not going to be able to stand it!” Another might express, “Now, I’m not going to be able to do anything today!” Yet, another takes it as a given that the increased pain is an indicator that the underlying health problem is getting worse. From this assumption, it’s easy to start thinking about how the future holds nothing but increasing disability, wheelchairs, and suffering.
These sentiments are examples of catastrophizing.
“Why do you guys always want to know how much stress I have?” While the patient who asked this question the other day had fibromyalgia, she could have had chronic low back or neck pain, chronic daily headaches, complex regional pain syndrome, or any other chronic pain condition. She was expressing a sentiment that I often hear in one form or another.