In Search of the Best Pain Clinic in LA: Rare Disorders & Comorbidities

By | September 9, 2011

When you hear hoof beats, sometimes you should think of both a horse and a zebra.

Over the years, in her search for the best pain clinic in Los Angeles, Tami had been seen at a number of second rate ones and the only consistent treatment was an ever-increasing dose of narcotics , which she said did not really relieve the chronic pain but only served to dull it and mask it a little. I asked her if anyone had ever given her a TENS unit and she told me that she had three of them and that they only made her pain worse. When I asked her if anyone had ever shown her where to apply the electrodes and how to program unit, my question was met with a blank stare. I told Tami that both of her injuries usually respond very well to transcutaneous electrical nerve stimulation, TENS, but that if you didn’t use the unit correctly it was likely that it would make her pain worse.

I noticed that although she listened attentively to what I was saying Tami seemed ill at ease. My staff had told me that Tami had recently ended her relationship with the pain clinic that had been supplying her with pills and that she was almost out. They had told her prior to making the appointment that I did not prescribe narcotics on the first visit. When I questioned her on the subject Tami would not tell me why she had left this clinic other than to say that her relationship with the doctor there had become strained. She said that she had been to a local ER and had gotten a week’s worth of pills and then had become so desperate that she had gone to one off the cash only pain clinics in an attempt to buy a prescription. Fortunately or unfortunately, the DEA (Drug Enforcement Administration) had raided the clinic and arrested the physician while she was there and so she had not received any medication. Tami told me that she had been stretching out the pills as far a she could but that she was already starting to go into withdrawal.

While I could not prescribe medication for her I told her that I was sympathetic to her plight. The medical system had let her down. She had sought treatment from two physicians whom I know personally. Both had failed to make the correct diagnosis with respect to her right ankle and both had failed to institute effective treatment for her left arm. Instead they had given her an entirely new and unfortunately increasingly common problem, prescription drug dependence. I use the word dependence instead of addiction because Tami was using the medication only for its prescribed purpose and had not yet broken any laws in the acquisition of her pills. I told Tami that if she cared to wait my staff would call around to see if we could find her a physician who would prescribe her the medication she needed. After over and hour and nearly a dozen phone calls we secured Tami an appointment with a physician in Santa Clarita who did prescribe narcotics on the first visit for the next day. Furthermore I told her that if she cared to return, I was certain that I could treat her pain more effectively with either TENS or spinal cord stimulation, SCS and eventually get her off the narcotics entirely.

As Tami was leaving I thought back to some of the things I had learned in medical school. “Primum non nocere! First of all do no harm!” Several physicians had done just that, by performing unnecessary operations, withholding appropriated treatment and getting her hooked on narcotics that weren’t really helping her anyway. “This is not law school. You are here to treat the patients, not judge them.” Although problems of drug dependence are not my favorite part of pain management, I have no right to turn my back on a patient in need. At Schlesinger Pain Centers, if we cannot provide a service or a form of treatment, we feel that it is part of our job to make an appropriate referral to a physician who will see the patient in a timely manner. Finally when you hear hoof beats, sometimes you should think of both a horse and a zebra.

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