A patient is either not a surgical candidate or surgical options have been exhausted. The patient is still in pain. The pain is moderated by a small drug regimen that leaves them functional enough to enjoy parts of their day and be a viable member of their family. They are not, and cannot, return to work.
Rather than release MMI with a PPD rating, they are referred to an office where they are then prescribed numerous and ever increasing/changing medications that make them decreasingly functional. They sleep away much of the day, cannot concentrate, remember, decide or readily verbally relate.
They go through a series of injections which provide minimal or no relief, and after months or years, there is no end in sight.
How did this occur? My belief is three fold:
a. The surgeon did not take the responsibility to made the MMI and PPD determination and instead punted the case to someone else
b. The pain management center had no gatekeeper who determined the patient_s goals, pain tolerance and (if any) concurrent mental and physical problems
c. There is no specific treatment plan individualized for this patient, and, thus, there is no endpoint to care.
A patient last week said that she felt sitting in the office waiting for injections, listening to the other patients (some of whose complaints she doubted) _was a good way to learn how to look like you are in pain and score some good drugs._ That is, of course, the other concern.
The important things to do are:
1. Work closely with the surgeon and be certain he understands the patient_s needs (not just the cause of pain) and whether a pain center is truly what is indicated.
2. For any pain center, be certain that there is a gatekeeper, preferably external, who screens these patients for their appropriateness for treatment
3. Work with pain centers that have specifically stated protocols and timeframes so that the patient_and you_know how treatment will progress and when it will end.