Monday, April 7, 2008

The Needle and the Damage Done

Most people locally consider me to be a needle guy. I have aquired a reputation as somebody who gives everybody who comes into the clinic some type of needle. I think that is unfair. I do a lot of nerve blocks of various types for patients most of whom come in for repeat injections. Most of these people seem to be happy with their treatment (the other ones post on RateMDs). I also do a lot of medication management including narcotics and methadone. Most of these patients once stabilized I see infrequently and some have been transferred back to their GP.

I still however feel guilty everytime I stick a needle in somebody. I attend all these pain meetings and I know I should be sending them to non-existent multidisciplinary programs. In fact I actually now work in a so-called multidisciplinary pain clinic and almost 100% of the internal referrals are to stick a needle in somebody.

I also do acupuncture. I took a long course which involved some training in traditional Chinese medicine but like most people I just stick the needle where it hurts. Quite frankly I consider acupuncture to be an equivalent treatment to trigger points, however when I do acupuncture I am an open minded practitioner of complementary medicine whereas when I do trigger point injections, I am a money grubbing needle guy.

On the weekend past, I attended a course on fluoroscopically guided injections. I have never done a lot of these mainly due to the inability to access fluoro which the radiologists guard jealously here as if they paid for those expensive machines out of their own pocket. I will be getting more access in the future so I decided I better actually get some training.

At the meeting we learned all kinds of different blocks. What disturbed me was the whole time, I was thinking, "How many of these can I do in a day and how much can I bill for them". (When you go to American Meetings, there is usually about half a day devoted to billing, further some interventional textbooks have chapters on billing). More disturbing was that everybody else taking the course was thinking the same thing.

Now I have been treating chronic pain for over 15 years (longer if you include my 3 years of general practice) and I still haven't figured out what causes back or neck pain, nor what is the best way to treat it. My more recent training has not enlightened me on this.

I can only hope the way I treat back and neck pain will be governed by what I think is best for the patient, and not how much I can get paid or how many fluoro slots I have to fill.

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