In Search of the Best Pain Clinic in LA: Introduction & Terminal Cancer

By | August 29, 2011

Before my consultation Natalie had languished in pain for months, a virtual prisoner in a local hospital. Within 2 weeks an intrathecal pain pump had been implanted and the patient had been discharged home in good condition.

Today we will begin to look for the best pain clinic in Los Angeles.  In order to save time and gasoline this will be a virtual search.  We will consider what are the distinguishing features of this palace of pain palliation and its paragon practitioner.  As many of our regular readers have already guessed, this humorous hunt will consist of my setting up a number of propositions, straw-men if you will and then knocking them down.  I hope that you will make regular (or if you wish highly irregular) comments about the individual arguments and then at the end we will conduct a reader’s poll to find out what you think, because in the end that’s what really matters.  The best pain clinic in L. A. is chosen by you everyday with your feet and your co-pays.  So lets get started.

A fairly standard proposition made by many patients and referring physicians, is that the quality of a pain clinic is best measured by how they care for the most severe pain.  In this case we will choose the pain of terminal cancer patients as our example to be discussed, but will return to consider other severe pain syndromes in future blogs.

While we at Schlesinger Pain Centers treat a large number of cancer patients and quite successfully I might add, it turns out that this is not the best group of patients to look at because the care of these terminal cancer pain patients is in some senses easier than that of most patients.  Because their life expectancy is short, many of the long-term side effects and complications of therapy can be ignored entirely and many side effects will be tolerated by these terminal patients that would not be tolerated by more active individuals.

This is not to say that nothing can be learned from the care of terminal cancer patients.  Many physicians feel that the best way to treat the pain of terminal cancer is with ever-larger doses of powerful narcotics.  In my opinion this is malpractice.  As an example, about 6 weeks ago I was called to consult on a woman, lets call her Natalie, with advanced uterine cancer who was suffering terribly in a local hospital.  I walked into her room to find a nearly comatose woman, moaning and at times screaming in pain, a disturbingly common reason for consultation.  Natalie had already suffered many of the complications of excessive narcotic therapy, delirium, nausea, vomiting and aspiration pneumonia.  Within 2 weeks of meeting this woman, we had placed an epidural trial catheter, successfully implanted a Medtronic Synchromed II intrathecal pain pump and discharged the patient home.  She is awake and alert and largely pain free.  Natalie has already lived longer than anyone thought she would.  She visits with friends and family daily and recently celebrated her 45th wedding anniversary.

Although much can be learned about a pain clinic by whether and how they treat terminal cancer pain, I hope you see that it is a limited and imperfect discriminant.  Tomorrow we will look at some mild pain syndromes to see if they are more helpful in finding “The Best Pain Clinic in LA”.

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