A Letter Released to Physicians on September 8, 2006

Doctor Shopping & Your Patients with
Chronic Pain

More than 2/3 of patients suffering from chronic, non-malignant pain have consulted four or more physicians.¹ A study published recently in Spine noted that back pain patients who were not receiving active, multi-disciplinary coordination were four times more likely to independently find other therapies without consulting their primary care providers.² In many cases, there was no coordination and the primary care providers were not aware of the other interventions until they specifically asked the patients. Clearly, this scenario can have negative consequences for patients when drug therapies and other care is not well coordinated. In addition, there is no reason for primary care providers to lose patients over chronic pain. When you have patients suffering from chronic pain, please consider a referral to the private practice of Neal S. Taub, MD, ABPM&R – board certified in pain medicine.

Chronic pain is not merely a symptom. It rises to the level of a potentially fatal disease process in and of itself. An estimated 15% of Americans live with chronic pain, so you may have several patients who could benefit from a referral to a specialist. Ten percent of chronic pain sufferers have contemplated suicide as a means of pain control.⁴ Chronic pain can cause impaired pulmonary function, impaired GI function, insomnia, increased metabolic rate, impaired immunity, impaired healing, and increased blood clotting. Psychological effects include depression, anxiety, isolation, and impaired family function. The common comorbidities of depression, anxiety, and insomnia complicate pain management strategies. When you have patients not responding to pain management, a quick referral to the private practice of Dr. Taub may help practitioners keep patients satisfied with their primary care and help the patient in terms of coordination of other productive, medically sound therapies.

Dr. Taub will provide treatments and care coordination specific to the reason for referral while coordinating with all involved practitioners and leaving the patient under the general care of the primary care provider. Pain management programs from the private practice of Dr. Taub can include:

• Prolotherapy
• Facet Blocks
• Injections for Chronic Headaches
• Coordination of a multidisciplinary team which may include physical therapy, occupational therapy, behavioral therapy, and/or surgery as indicated. As a private practice physiatrist and the Medical Director at Carolinas Rehabilitation at Mercy, Dr. Taub is highly experienced in closely coordinating multi-disciplinary teams, especially those involving therapy.
• Prescription, monitoring, and adjustments to synergistic combinations of pain, neuropathic, and/or psychiatric medications
• Opioid therapies that are both ample for patient needs and compliant with current legal considerations. All patients receiving potentially addictive drugs complete periodic drug screens. Research suggests that patients who will eventually abuse opioids cannot be identified by pre-screening using indicators including history of drug or alcohol abuse, drug and alcohol abuse screening tests, severity of pain, patient’s self-perceived need for opioids, or coexisting depression.³
• Medical Acupuncture

References:

1. McCarbert B, Dachs R. Managing Pain: Dispelling the Myths. CME Program. Leawood, Kan: American Academy of Family Physicians, Jan 2003; p 2.
   
2. Wright A, Lloyd-Davies A, Williams S, et al. Individual Active Treatment Combined with Group Exercise for Acute and Subacute Low Back Pain. Spine. 2005; 30 (11): 1235-1241.
   
3. Chabal C, Erjavec MK, Jacobson L et al. Prescription opiate abuse in chronic pain patients: clinical criteria, incidence, and predictors. Clin J Pain 1997; 13: 150-5.
   
4. Fitzgibbon DR. In: Loeser JD, Butler SH, Cahpman CR, et al. Cancer Pain: Management. Philadelphia, Pa: Lippincott; 2001: 1745-50.