General Practice to Pain Management, How?

[AngelfireRN, MSN, RN, APRN]

Hi, all.

My current practice is a general medicine clinic, with a strong emphasis on pain management. The doctor I work for is leaning towards becoming a pain clinic. The location could not be better, there is no pain management facility for a good 50-60 miles.

Since no one in the practice has a lot of experience in this, I thought I'd see what my favorite bunch of medical minds could offer in the way of information.

Some points I'd love clarification on...

* If the designation of the clinic is strictly pain control, could a patient be treated for anything else, sinus infections, thyroid trouble, etc.?

* Are pain medications all that may be prescribed? The reason I ask, most of our patients who are prescribed pain meds are also on some form of benzodiazepine.

* Are there requirements for the length of time that can elapse between visits? 30 days, 60 days, etc.?

* Do requirements vary from state to state?

Any other pertinent details, I'd be grateful. Thank you all in advance!

[BlueDevil,DNP, DNP, RN]

I have no idea what the "rules" are, check with the division that regulates pain clinics in your state. We have 2 pain clinics in our company. They only do chronic pain issues and certainly would never address medical issues such as sinusitis, etc. They prefer to do procedures try to stay away from medication management as much as possible. They do not do benzos at all to my knowledge. They won't take patients with fibromyalgia (in my experience pain management specialists don't believe it is "real") , won't see the professional pain patients or those thought to be drug seekers. Referring patients to pain management is difficult here. They vet them all thoroughly and decide whom they will accept. They pull their board of pharmacy and if they don't like what they see, they refuse them. It's irritating. They mostly want spinal and joint pain that can be injected (trigger point, intrathecal, etc). It is also a huge cash cow.

[AngelfireRN, MSN, RN, APRN]

The cash cow thing, I knew. We do a version of the 'vetting' thing as well, when we accept new patients. Part of that vetting includes a visit to our state's controlled script database. We do require drug screening and will employ pill counts if we suspect a problem. If we were to make the switch, those practices would definitely be remaining.

The closest pain clinic to our area requires payments in the hundreds of dollars, and also offers 'concierge' services, for closer to the thousand-dollar mark. That kind of money boggles my mind.

Thanks, Blue Devil.

[traumaRUs, MSN, APRN]

I live near a suburban area and when I refer to one of two pain clinics - they are both operated by anesthesiologists/CRNA. In IL, we have a database of everyone in the state who receives a script for a controlled substance. The pain management folks run a cash for service business around here. They will take Medicare pts but they make their business in injections and procedures. None of them prescribe narcotics for anything other then a short term and none prescribe benzos either.

As BlueDevil says above, there are very specific cases our pain management specialists will accept too.

If your MD goes to a pain management practice, I would certainly up my malpractice insurance if I were you. Huge liability in prescribing narcotics to everyone. That is not pain management IMHO, but rather patient appeasement.