After surgery, patients complain of chronic pain. They are kept on narcotics, and there are no measures available. THey are then referred to one of several pain clinics.
This is a major concern. If the referral to a pain clinic is meant to be a discharge of the patient, it is not interpreted that way. The patient expects that when/if the pain center does not resolve the pain, the patient will return to see you. If you have nothing more to offer the patient, you need to state that, release the patient MMI with a PPD rating. Some patients, unfortunately, will have chronic pain for which there is currently no resolution.
Secondly, patients in pain do not sleep well when prescribed narcotics. They become habituated to the narcotics, their sleep architecture is impaired, they awaken during the night, they are in more pain when sleep deprived, and they are reactively depressed. There are antidepressants that, even in low dosages, assist with establishing normal sleep patterns, enabling the patient restful/restorative sleep, assist with the depressed mood, and enable more effective coping with pain.
Most importantly, treatment is not defined as one more referral, one more prescription, one more procedure, etc. There is a point, often earlier than we admit, beyond which current care is not going to evoke change. The patient has a right, and we have a responsibility, to inform the patient and family of this reality. Maintaining them on addictive agents and/or referring them to care that effects no change is not _treatment_, it is turfing the patient, and has become too common.