This all leads to the question as to why chronic pain is such a problem and why treatment is not easier to obtain. The answer lies in both the medical community and the federal government. Chronic pain is often, but not always, treated with some form of narcotic. While very important and effective for many pain conditions, this class of drug comes with many concerns from a health and societal standpoint. The majority of patients prescribed narcotics are sick patients who need them and are also law-abiding citizens who treat them properly. The majority of patients do not become “addicted” or have adverse reactions to them. Unfortunately, there is the minority who give the medications a bad name. There are persons whom seek these drugs out for their own recreation or to sell them for others usage. There are crooked pharmacies and doctors who supply these drugs as well for financial gain. Then there are those who use them improperly, become addicted and often die as a result of the use of narcotics.
All of this has led to very tight government scrutiny on the distribution and prescriptions for narcotics. Fines, jail time and loss of medical license can happen if the government believes a pharmacy or doctor is prescribing the medication incorrectly. As you can imagine, this has led to a tremendous apprehension on the part of physicians to treat patients with chronic pain. If they do treat a patient it is usually with under treatment and inadequate pain relief because of fear of government intervention. Even if all patients they are treating legitimately need the medicine, the fear exists. In the end, there are few doctors willing to do everything for a patient to treat their pain. This has led to patients being left without treatment.
There is a medical specialty called “pain management.” This consists of physicians who have done extra training above and beyond their normal training to become pain specialists. They not only know how to treat patients but understand and are comfortable with the issues related to narcotic use. The unfortunate reality for most patients is that these specialists are few and far between. Large cities may have several but then you can travel to numerous rural communities and find no access to one. Complicating the matter is that with pain management comes frequent office visits. In part, this is to ensure the patient is treated properly and the concerns discussed above regarding governing rules are met. Now imagine you live two hours from the nearest pain specialist and have to return every month for an evaluation. This can be burdensome and intrusive on the goals you are trying to achieve by treating your pain, i.e. improved quality of life and getting back to work.
A recent and novel approach to seeing patients is emerging. This is called “telemedicine.” This is a well-recognized way to see patients. Initially, it was used for patients in only rural communities but now it is being adopted by many medical clinics as a way to decrease the number of patients sitting in the waiting room and allow quicker access of patients to the doctor. Telemedicine consists of a visit to the doctor via phone or video conferencing. This becomes a regular visit and becomes part of your medical record. In certain situations insurance and even Medicare reimburse for the visit. Online pain management has become very useful for patients with chronic pain. Now patients who need to visit with their doctor monthly don’t have to travel and sit in a waiting room for hours every month. The visit can be done via telemedicine with in-office visits at less frequent intervals. All the things a physician needs to accomplish by seeing the patient in the office can be done by phone or teleconference. This provides patients in rural community’s access to doctors via online pain management.
Overall the goal of telemedicine and online pain management will be to have more patient access to care. More convenient care leading to a better quality of life will get patients back on track. More patients will be employed. Healthcare costs and ER visits will decrease and the social and financial burden on society will improve. Like anything with pain management telemedicine needs to be scrutinized. Only specialized doctors should be treating patients. Doctors should be comfortable with government regulations and be diligent with patients ensuring the patients are taking the medications correctly and not becoming a burden on society by diverting the medication. With this scrutiny in place, however, online pain management via telemedicine will be the opportunity many patients need to find treatment for their chronic pain.
By: Ryan Holzmacher, MD