A reader writes:
I'm board certified in anesthesiology and pain medicine. The idea of treating chronic pain is asinine because pain is not a disease. Pain is a symptom of some underlying anatomic pathology. Our job as pain specialists is to diagnose what that pathology is and address it. Whether that involves opioids, physical therapy, injections, surgical consultation, or a tincture of time is dependent on the problem.
So in short, opioids are but one solution to treating pain. The question that I ask daily is, what's the cause of the pain? Because the pain as a disease model is passé. I have no idea what Balko is talking about.
There is no disagreement about the training of pain doctors. Pain Medicine is a subspecialty of anesthesiology and requires an extra year of training in fellowship. There are currently about 250 fellows in training each year in the US. We have our own pain medicine societies such as the International Spine Intervention Society, the American Academy of Pain Medicine, and many more.
Currently the field of pain medicine is evolving because it's a newly formed specialty. Most of the legit board certified pain doctors are anesthesiologists. But any Joe Schmoe can claim that mantle with a prescription pad and they have been loose with it. Almost all of these pill mill doctors are primary care physicians looking for an extra buck.
I for one applaud these new legislations. I don't know of a single legitimate pain doctor who has left the specialty. Conversely, I know plenty of shady family docs who are sitting in jail for operating pill mills. Since the passing of more restrictive laws here in Florida, I have been seeing more of these pill mill patients showing up in my office. And frankly, they don't need oxycontin or percocet. Portenoy is a well known drug pusher in New York, so I take what he says with a grain of salt. No one dies from a lack of pain pills, but people will surely die from its overuse.
Finally, for the record, I'd rather my patients smoke the wacky tobacky than pop pills.
The Dish 