July 2019 Edition. Volume XIX

For patients afflicted with disabling and incapacitating chronic pain the existence of effective treatment programs can be a godsend.  The rehabilitation of these patients is typically challenging and may entail, in conjunction with appropriate programs, minimally invasive and surgical procedures as well as implanted devices.  Of all of the chronic pain syndromes those patients experiencing clinically significant adhesive arachnoiditis and regional complex pain disorders involving causalgia and reflex sympathetic dystrophy are the most difficult to manage medically.

Through the efforts of pioneers such as Dr. John Bonica, who established one of the first pain rehabilitation programs at the University of Washington in Seattle in the 1950s, pain management has become a medical specialty.  Dr. Bonica, and many of his colleagues, were also instrumental in founding the International Association for the Study of Pain.  Due to these endeavors many Chronic Pain Management Programs based on the University of Washington model have been created throughout the United States.

Unfortunately pain management has also become “big business.” This has been reflected by the sprouting of a plethora of procedure mills, representing themselves as “Pain Clinics” throughout the country.  Many physicians have engaged in these primarily as a lucrative opportunity.  Practitioners unskilled and uninformed in assessing and managing pain problems and untrained in the safe performance of special procedures have now become a serious blight on the medical scene.  The term “feral” practitioners has been coined as describing these individuals who prey on unsuspecting patients and misrepresent their activities.  The worst example of “feral” practice has been the “blind” administration of potentially toxic drugs into the epidural space as a means of treating low back pain and producing a chemical meningitis in the process.

“Feral” practitioners are a disgrace to the medical profession.  Their programs typically consist of  cursory and unskilled examinations resulting in no specific diagnosis, a standard series of minimally invasive procedures (designed for maximal reimbursement) and, if these fail in improving the patient, to begin the prescription of dangerous and addicting narcotic medications.

When the the upper limit of narcotic use has been reached the “feral” practitioner will then turn the patient away with the disclaimer that “no further treatment is possible.”  Even Mary Shelley, the author of Frankenstein, could not have imagined the great number of clones being produced in the United States today by this sad process. It is sad to report but often the only means of bringing these “feral” activities to the attention of the public is only through the legal process and not by the medical profession doing their own “house cleaning.”

The heartbreaking reality which is the subject of this report makes clear that patients, hospitals, and government need to become better informed, discerning, and more vigilant. There do indeed exist many legitimate pain management and chronic pain rehabilitation programs staffed by experienced and caring health care professionals.  Searching these out requires “due diligence” on the part of the patient, something which is not always an easy task.

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