The Pain Pendulum

I have been in medicine for almost 30 years. I have seen the same idiots in charge claim we were NOT doing enough to treat pain. That’s when the 5th vital was created, with the help of the Joint Commission. JCAHO made up cards with those smiley faces and those cards coincidentally had Purdue Pharmaceutical at the bottom. Then things changed. Pill mills and narc seekers came out from under the rocks. Instead of clamping down on them, the same idiots in charge blamed us again. Their answer? Restrict our ability to give pain meds to those truly in need. Now pharmacies are stopping real doctors from doing their jobs. This is ridiculous. Even the CDC is trying to push the pendulum back again:

Last month, the CDC clarified its position, saying the response to the opioid crisis went too far. In a New England Journal of Medicine editorial, a panel of experts cited examples such as inflexible thresholds on dosages, abrupt tapering and misapplication of the guidelines for people with cancer, sickle cell disease or recovering from surgery.

Did this fix things? NO!!! Individual states are trying to show how they are stopping the opioid crisis so they are passing laws. The state boards of medicine are salivating at a new way to punish doctors and meet their quotas. This is insane!

Here is what I would do:

  • Put all “pill mill” doctors in jail. They are easy to find. When it is questionable then send in a fake patient to prove it. Look at the picture at the top. This is what was going on!
  • Put all narc seekers in jail. The ones that truly have a problem and are using the meds themselves can go to rehab. If they sell it then they need to go to prison.

Too harsh? Then what do you think?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  11 comments for “The Pain Pendulum

  1. Jerry Bullard
    August 7, 2019 at 6:12 pm

    It’s the patients, they have no self worth.

  2. Pat
    August 7, 2019 at 4:04 pm

    I have written on this site for years, and restate: NONE of this will be fixed. The only rational solution is to end the idiotic, self-defeating War On Drugs. Fake patients are a chilling answer we should oppose as more Big Brother that will harm innocents as well as the guilty.

    But there are too many far too emotionally, financially, religiously, politically, or financially invested to do it.

    This shit is all anti-individual as is being demonstrated, and doctors as instruments of the state – and we all are – are being used to erode individualism. This is depressing, and will not end.

    • Sir Lance-a-lot
      August 7, 2019 at 10:25 pm

      Dead-on as always, Pat.

      The individual is a troublemaker and a pain in the ass.

      If you just polish off the rough edges, like the Chinese do, all of society will run much more smoothly.

  3. Jaclyn S Nadler
    August 7, 2019 at 2:29 pm

    Agree, the government and media need to quit blaming “doctor” for this problem. I’m so glad you brought up the 5th vital sign and the expectation doctors should make patients pain free or we were doing a bad job. Our last governor in FL passed idiotic legislation only allowing 3 days for acute pain meds, or 7 if we checked the right box. So what am I supposed to do for my elderly or CKD patient with a rib or spinal compression fracture that required longer narcs. Doctors are always getting set up with the need to provide unnecessary documentation and now we can’t even decide what is best for our patients. Our new governor implemented a handout we are required to give with any narcotic prescriptions offering alternatives to include chiropractic treatment. I can assure you I’m not giving that to my frail elderly person. To add to the problem pharmacies are now on the hook and questioning most scripts or sometimes refusing to fill them. I’m overly conservative with pain medications and am still being impacted. Just another example of our broken system.

  4. Thomas David Guastavino
    August 7, 2019 at 1:54 pm

    Yes, definitely go after the outliers. Create a better database of a patients narcotic history that providers can access easier. Then GET THE GOVERNMENT OUT OF THE PHYSICIAN-PATIENT RELATIONSHIP.
    PERIOD !!!!

    • Michele
      August 7, 2019 at 6:39 pm

      Just give Tylenol (oh wait there’s a liver toxicity and the latest gem IV acetaminophen is absurdly expensive).
      Just ibuprofen (until the stomach and kidneys crump)
      Just gabapentin (oh no that’s abused and controlled now too)
      Just tramadol (nope there too)
      Just ice/heat and meditation YES!

      • Randy
        August 7, 2019 at 9:06 pm

        This is one of my pet peeves – the idea that these are all benign meds. Some people do fine with gabapentin while others have severe sedation and also edema. NSAID’s have the renal problems, worsen edema, and I really don’t like mixing them with plavix, warfarin, etc. I think Tylenol is pretty safe but 90% of people coming to see you with pain have already tried it and it didn’t work.

  5. Randy
    August 7, 2019 at 1:24 pm

    While I like the idea of putting these Pill Mill docs in jail, I doubt the government could write a definition that wouldn’t put legitimate docs in jail as well.

  6. R Stuart
    August 7, 2019 at 12:55 pm

    Start with putting all the members of the JC in the clink.

    They are the truly evil ones.

    • Thomas David Guastavino
      August 7, 2019 at 1:56 pm

      JC is not going to able to escape retribution for much longer.

      • mamadoc
        August 8, 2019 at 10:30 pm

        If only!

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