I did two presentations to the UW telepain today. The first one I filled out the formal paperwork. The second one was more about an addiction case. UW used to have a pain and addiction telemedicine on Fridays, but it was poorly attended and went away.
But a comment was made that floored me. The pain specialist running the conference said, "Is this person in pain?"
I thought, what?
He said, "Where does the patient hurt? This is a pain conference. I don't treat addiction patients."
Um. So here is my reply. It's taken me part of the evening to get over being appalled at his attitude and frankly appalled by the university specialists.
Dear Dr. X:
In my experience, all addiction, mental health and dual diagnosis patients are in pain. Chronic pain and horrible pain. The addiction patients are often belligerent, frightened, try to use charm or threats, but the drug is out of their control. My goal as a rural family doctor is to be able to help treat or find help for anyone who walks in my door. This means I treat high blood pressure, heart disease, foot pain, broken bones, depression, domestic violence, grief, alcoholism, mania, pregnancy, newborns and drug addiction and just about anything else you can think of. I have diagnosed two patients with guillain barre, a 1:10,000 occurence, I've diagnosed rheumatic fever, followed up a heart nuclear study where a rib lit up to diagnose multiple myeloma. But in addiction and mental health, I am not just treating a patient in pain. I am treating a family and a community. The person's parents are in pain, the spouse, the siblings and most of all the children. I have drawings from children thanking me for treating their parents and stabilizing them. The pain of a person caught in addiction is like quicksand, is like a tarpit, is like falling in a deep hole and realizing that it is slowly filling with water and trying to climb out up slippery mud and falling back over and over. When I treat and help one of these people I am treating and helping whole families and my community.
So yes, I would say that that my addiction patient has chronic pain.