No Pain No Gain$$

The “No Pain No Gain” adage is commonly used by coaches and teachers in sports and in arts. It implies a certain amount of physical suffering and perseverance, with a touch of mental catharsis, to improve ones performance. This is usually the stuff that Olympians and virtuosi are made of. Of course with that level of achievement usually come more $$ and rightfully so.

My use of this adage here is merely satirical aiming to raise awareness. Assessing pain levels is a true obsession nowadays in medical facilities with charts on all the walls, depicting frowny faces of various degrees, and numbers from 1 to 10 out of 10 (VAS, Visual Analog Scale) or otherwise.

Often I felt as a clinician that assessments and complaints of pain were exaggerated in as much as they were not supported by any other observations, i.e. physical and physiological findings. It is hard to have a 10/10 pain level if your pulse and blood pressure are quite normal. In part this exaggeration occurs because it often leads to some sort of compensation and reward: “Squeaky wheel gets the grease!” When I was a volunteer with Orthopedic Overseas in Ethiopia in 1985, every time I mentioned back pain in this country of 45 million, they looked at me as if I was from Mars. I saw little old ladies carrying heavy loads of wood on their backs for long distances or younger people sitting on the floor crouched for hours in the marketplace. My own back could not stand the rides on buses with busted shocks. I had a grimace the whole way. The Ethiopians are not made differently…they just complain differently: few if any lawyers around and no pill-popping mania. They were too preoccupied by mere survival and fighting real illnesses to pay any attention to something as westerly mundane as back pain. Be that as it may, the latter cost more than $50 billion a year in the US alone.

PI lawyers do instruct their clients to duly complain of pain every time they see the doctor, to pad their case. Patients often tend to inflate their proclaimed pain level to help convince the doctor they need more drugs. It is not uncommon to see a patient waltzing into your office with no assistive devices, having driven themselves there, yet complaining of a totally unrealistic 10/10 pain level (bedridden pain level). Pain is indeed quite subjective this way so clinicians simply have to dig further to establish the true level, if they would bother. Many do not. For an average $50 a visit (and discounting), they will gladly give you an Rx and send you on your merry way, with a smile, and you will surely come back. That is all the time they can afford to spend. Unfortunately many an addictive personality has been encouraged this way.

Every time I argued with a patient about their true pain level and the unsustainable amount of narcotics they were taking and/or demanding, I created a true enemy who went and slandered me on the internet or worse. It is hard to try to do the responsible thing in a land that stopped condoning it.

I had a patient who would give me a 10/10 pain level at every visit so I decided her pain medication was not working and needed to be changed. She became extremely distraught and admitted she inflated her pain level because she was told that is how she would convince me to prescribe more pain medication. Hmmm!

A doctor acquaintance of mine called me from CT about 3 years ago all upset. One of his patients on disability was selling his Oxycontin prescriptions for about $11,000 a month and he was caught. So much for unemployment benefits! This doctor was a bit of a scrooge and got played, but some doctors actually fuel and participate directly or indirectly in the prescription drug trade. Watch for Pain Clinics open daily till 1:30 am where only cash is accepted!

In America, more than any country in the world, including Western Europe has developed a whole gamut of cottage industries around PAIN. From getting monetary compensation (the grossly abused pain and suffering) to selling ones pain medications on the street. As a matter of fact 70% of Rx narcotics are prescribed in the USA. I have been seeing patients in Lebanon, Armenia,Africa, etc. They only take Panadol (a form of Tylenol) for pain and they are as human, bleed the same red blood, and suffer the same injuries and diseases that we do. Go figure!

A huge amount of healthcare dollars is used simply to try to prove or disprove pain, because the patient is too often not to be trusted and secondary gains run the show instead of the actual symptoms. This state of affairs has crippled the all too liberal New York State Workers’ Compensation system. I have seen patient on full Workers Compensation benefits for more than 20 years after a simple lumbar strain with not even a single MRI finding. This kind of dependency becomes a mode of life that is extremely hard to reverse. Statistics have shown that after 1 year of being out-of-work the chances of return fall to 25%.  It just so happens that after not working for 12 months, the claimant can now apply for Social Security Disability to boot and have Medicare coverage soon after.

From dependency stems entitlement and the vicious cycle continue.

 

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