Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 Dr. Fuchs: As a DC I specifically tell my patients that while they may have decided to see my because of a particular pain, I do not treat pain. I strive to determine the cause of the pain and hopefully by treating the cause the pain is alleviated. We do not have access to powerful pain meds for acute pain. I have the benefit of working in an interdisciplinary office, so when a patient would benefit from such there is access. My personal philosophy does not bar such care (medication). This is where I think drugs have the most powerful positive impact (now for health, that’s a whole ‘nuther can of worms). In this particular case I don’t think the issue is pain control, but rather poor triage and substandard evaluation and management. And btw, a 90 year old with a blown disk? I don’t think so, leather this old ain’t too juicy! Seitz, DC Tuality Physicians 730-D SE Oak Street Hillsboro, OR 97123 (503)640-3724 From: [mailto: ] On Behalf Of Sharron Fuchs Sent: Friday, November 10, 2006 3:11 PM Subject: RE: Re: Pain control In the case that I describe the saying 'if all you have is a hammer, everything looks like a nail' keeps chirping in my head.I really think in this instance ,along with good diagnostic work up, the patient deserved the mercy of pain relief in the form of medication. sharron fuchs dc From: [mailto: ] On Behalf Of Shad McLagan Sent: Friday, November 10, 2006 2:57 PM Subject: Re: Pain control Dr. Kierstyn " You are absolutely right....as a new practitioner, you do that with all of your patients. Once you have been in practice for 10 - 20 years and one of your long term patients comes in, you know them well, you've seen them through a number of exacerabations, " this is probably just another " is often the first - and the correct- impression. So the usual routine is skipped over to see how they fare (or to trust that they will fare as they usually do) with a good adjustment. " I send my patients out for further imaging when it is warranted. In this case, it is. This should be obvious whether you are a new practitionor or have been practicing for " 10-20 years " . It doesn't matter if it is an existing patient or new patient. When someone walks into your office with " severe onset of low back and leg pain. Pain becomes agonizing, excruciating and she is unable to walk, drags the leg and must use crutches in order to ambulate " , you send them out, regardless. An exacerbation of symptoms (ie, increase in pain) is different than " unable to walk, drags the leg and must use crutches in order to ambulate " . This has nothing to do with how long I have been out in practice. Experience does not mean you are a good doctor, even if it is " 10-20 years " . Shad McLagan D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 I meant no offense ... and I did make an assumption about you being new to practice strictly based on the fact that your name is new to our listserve. Please accept my apologies if I offended you. I was simply attempting to define some treatment approaches in this scenario. The question that Sharon has posed :The idea of a 'duty' to pain control in our business and 'responsibility' beyond the physiologic and practice/technique goals and parameter is a avenue that I have not considered. My job is to eliminate pain to the degree I can within the circumstances presented by the patient. My responsibility is to stay within practice and technique parameters. What is my 'duty' within that picture and is it the same as my responsibility? Right now I'm not sure. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 344- 0509; Fx; 541- 344- 0955 From: "Shad McLagan" <shadmac11@...> Subject: Re: Pain controlDate: Fri, 10 Nov 2006 22:57:06 -0000 Dr. Kierstyn"You are absolutely right....as a new practitioner, you do that with all of your patients. Once you have been in practice for 10 - 20 years and one of your long term patients comes in, you know them well, you've seen them through a number of exacerabations, "this is probably just another" is often the first - and the correct- impression. So the usual routine is skipped over to see how they fare (or to trust that they will fare as they usually do) with a good adjustment."I send my patients out for further imaging when it is warranted. In this case, it is. This should be obvious whether you are a new practitionor or have been practicing for "10-20 years". It doesn't matter if it is an existing patient or new patient. When someone walks into your office with "severe onset of low back and leg pain. Pain becomes agonizing, excruciating and she is unable to walk, drags the leg and must use crutches in order to ambulate", you send them out, regardless. An exacerbation of symptoms (ie, increase in pain) is different than "unable to walk, drags the leg and must use crutches in order to ambulate". This has nothing to do with how long I have been out in practice. Experience does not mean you are a good doctor, even if it is "10-20 years".Shad McLagan D.C. Try the new Live Search today! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 The patient certainly needs that option, that is a statement I can agree with. Too many times the medication causes side effects beyond pain control ... many patietns are presenting today aware of those effects and not wanting to encounter them. That is different than not having the option. Seems to me, most all people in our American world are aware of the availability of pain meds ... and their limitations. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 344- 0509; Fx; 541- 344- 0955 From: "Sharron Fuchs" <sharronf@...>< >Subject: RE: Re: Pain controlDate: Fri, 10 Nov 2006 15:11:07 -0800 In the case that I describe the saying 'if all you have is a hammer, everything looks like a nail' keeps chirping in my head.I really think in this instance ,along with good diagnostic work up, the patient deserved the mercy of pain relief in the form of medication. sharron fuchs dc From: [mailto: ] On Behalf Of Shad McLaganSent: Friday, November 10, 2006 2:57 PM Subject: Re: Pain control Dr. Kierstyn"You are absolutely right....as a new practitioner, you do that with all of your patients. Once you have been in practice for 10 - 20 years and one of your long term patients comes in, you know them well, you've seen them through a number of exacerabations, "this is probably just another" is often the first - and the correct- impression. So the usual routine is skipped over to see how they fare (or to trust that they will fare as they usually do) with a good adjustment."I send my patients out for further imaging when it is warranted. In this case, it is. This should be obvious whether you are a new practitionor or have been practicing for "10-20 years". It doesn't matter if it is an existing patient or new patient. When someone walks into your office with "severe onset of low back and leg pain. Pain becomes agonizing, excruciating and she is unable to walk, drags the leg and must use crutches in order to ambulate", you send them out, regardless. An exacerbation of symptoms (ie, increase in pain) is different than "unable to walk, drags the leg and must use crutches in order to ambulate". This has nothing to do with how long I have been out in practice. Experience does not mean you are a good doctor, even if it is "10-20 years".Shad McLagan D.C. Stay in touch with old friends and meet new ones with Windows Live Spaces Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 Fragility of a person is obviously important to judge ... and - playing devil's advocate here - many times they can still be adjusted with the low force techniques. There have been many times I have been able to approach, serve, treat and adjust a person that other DCs have walked away from. This care kept them out of the pharmaceutical realm, allowing their mind to hold sway a few more years or months longer. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 344- 0509; Fx; 541- 344- 0955 From: "Sharron Fuchs" <sharronf@...>< >Subject: RE: Re: Pain controlDate: Fri, 10 Nov 2006 13:44:54 -0800 I totally agree with you. I too am concerned about the order of things and I am sure if things would have happened in the correct order that pain medication would have been brought on board sooner. I firmly believe this patient could have benefited from pain control - especially this age of patient - they can be so fragile. sharron fuchs dc From: [mailto: ] On Behalf Of Shad McLaganSent: Friday, November 10, 2006 1:10 PM Subject: Re: Pain control Question: What is our duty as a Chiropractic Physician?Answer: First, to be a Physician. Second, to apply Chiropractic treatment.As a Physician we need to use our tools of evaluation and examination to properly diagnose a patients condition. A couple of obvious tools this DC should have used on the first visit, with the 90 year old patient, should have been immediate plain film x-rays followed by a lumbar MRI. The correct progression is: examination, diagnosis, then treatment. It seems as though, unfortunately, this DC went in reverse order. "My main concern and question is - in the very beginning and in theacute, acute stage should the patient have been referred out to get on top of the severe, agonizing , excruciating, debilitating pain so the patient could undergo DC treatment?"I understand your main concern regarding the patients pain, but, it is our "duty" to first examine and find the source of pain/irritation. Once this has been established, and a diagnosis has been made, then appropriate care can be determined (whether it be from a DC or not).Dr. , please don't kick me off for having an opinion. Thanks.Shad McLagan D.C.> > > > > Drs., An MD can be disciplined for failure to provide> adequate pain control. What duty does a DC have to assure adequate pain> control in a patient ? > > sharron fuchs dc> > > > > > > > > > > ________________________________> > Stay in touch with old friends and meet new ones with Windows Live> Spaces <http://g.msn.com/8HMBENUS/2740??PS=47575>> Stay in touch with old friends and meet new ones with Windows Live Spaces Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2006 Report Share Posted November 10, 2006 SHOULD HAVE BEEN REFFERED in the first week..... Bob W. Pfeiffer,DC,DABCO P. O. Box 606 Pendleton, Or 97801 541.276.2550 Re: Pain control Date: Thu, 9 Nov 2006 18:37:22 -0800 Hi Sharon, Thinking about the 'duty ... to assure adequate pain control' on part of DCs doesn't bring much to the surface for me. Not that the question isn't germane, just that so much of what we do is related to pain control. It is by far the leading reason that patients come to my office. Even the yoga students start out looking for pain control/management/abatement. I would suggest that free market economics demonstrate how successful DCs are at pain control. I use a formula that Weil MD recommends and that I've mentioned here before: 500 mg caps of ginger root powder and curcumin/turmuric powder swallowed down with 3 oz of purple grape juice x 3/day will reduce MS pain by 30-40% in most patients. This is anti-inflammatory food, so it has to be in the body to be effective. Maximum relief can be expected after about a month of use, although results should be apparent sooner than that. I like the idea of using foods for medicine as they produce the least iatrogenic effects usually. Pain control is also a function of daily activities. Learning basic skills for reducing chronic pain patterns have the added benefit of empowering patients to have greater control over their own health and well-being. In this regard, I've found simple open-chained resting postures very helpful. Combined with breath control protocols, patients can feel in the moment how their actions can beneficially change the way they feel. Moving patients in the direction of active care is powerful long-term strategy for dealing with the inevitabilities of pain. In short, a DC that can't control pain in patients will have a hard time staying busy. Sears NW PDX On Nov 9, 2006, at 12:11 PM, Sharron Fuchs wrote: Drs., An MD can be disciplined for failure to provide adequate pain control. What duty does a DC have to assure adequate pain control in a patient ? sharron fuchs dc ________________________________ Stay in touch with old friends and meet new ones with Windows Live Spaces <http://g.msn.com/8HMBENUS/2740??PS=47575> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 I love it! (chucklechucklechuckle) Quit mind mucking....break through....do it NOW! Great voice of reason. Thanks for the reality check! Sunny ;'-'))) Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 344- 0509; Fx; 541- 344- 0955 From: " W. Pfeiffer" <drbob@...>"'Sharron Fuchs'" <sharronf@...>CC: < >Subject: RE: Pain controlDate: Fri, 10 Nov 2006 20:25:59 -0800 SHOULD HAVE BEEN REFFERED in the first week.....Bob W. Pfeiffer,DC,DABCOP. O. Box 606Pendleton, Or 97801541.276.2550-----Original Message-----From: [mailto: ] On BehalfOf Sharron FuchsSent: Friday, November 10, 2006 12:08 PMCc: Subject: RE: Pain controlPlease think on this as I really meant 'duty'. I should have explained a bitmore so in the right context an answer would come...First off this is not a malpractice issue that I am considering it is apractice question and a concern to me :90 year old woman has sudden severe onset of low back and leg pain. Painbecomes agonizing, excruciating and she is unable to walk, drags the leg andmust use crutches in order to ambulate. DC does no imaging - does the'treatment' - pain continues as severe, excruciating, agonizing........a fewweeks later plain films are taken by an FP - femoral heads ok and DJD andDDD determined. Reflexes ? I don't know. Given Hydrocodone which gives somepain relief but upsets stomach as does all the ASA and supplements andpatient loses 7 pounds. After 4-6 weeks there is improvement - eventuallyable to walk uses a cane but cannot walk normally or the distance they wereable to prior to problem. Now the patient (2 1/2 months from onset) willget an MRI and see if a cause can be determined. Current MD says may haveblown a disc and if patient was in his care prior they would have been putin the hospital due to the severe uncontrolled pain and then a workup ASAPwould have ensued. Now, a disc may be the true diagnosis - could be a bulge or minor somethingor it could be something significant that now has nerve damage along withit. Maybe surgical or may not be. My main concern and question is - in the very beginning and in the acute,acute stage should the patient have been referred out to get on top of thesevere, agonizing , excruciating, debilitating pain so the patient couldundergo DC treatment ?Is there a duty to do this ? Call it responsibility or whatever but shouldthis be addressed and the patient be given the benefit of other care inaddition to the DC care ?sharron fuchs dc________________________________From: sunny Kierstyn [mailto:skrndc1msn] Sent: Friday, November 10, 2006 11:45 AMdm.bonesmac; Sharron FuchsCc: Subject: Re: Pain controlThanks for starting this thread, and for asking the question,Sharon. It really pinged my brain and I have spent more than severalmoments thinking about it since you posed it. It is the word 'duty' thathas me intrigued .... what is our 'duty' about it? It is certainly our'job' but I never thought of it in the context of 'duty' or responsibility. And - at the risk of being a tease - I will have more time over the weekendto expound on this. To be continued .....SunnySunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 344- 0509; Fx; 541- 344- 0955________________________________From: Sears <dm.bonesmac>Sharron Fuchs <sharronftdcinjurylaw>CC: Subject: Re: Pain controlDate: Thu, 9 Nov 2006 18:37:22 -0800Hi Sharon, Thinking about the 'duty ... to assure adequate pain control' onpart of DCs doesn't bring much to the surface for me. Not that the questionisn't germane, just that so much of what we do is related to pain control.It is by far the leading reason that patients come to my office. Even theyoga students start out looking for pain control/management/abatement. Iwould suggest that free market economics demonstrate how successful DCs areat pain control. I use a formula that Weil MD recommends and that I'vementioned here before: 500 mg caps of ginger root powder andcurcumin/turmuric powder swallowed down with 3 oz of purple grape juice x3/day will reduce MS pain by 30-40% in most patients. This isanti-inflammatory food, so it has to be in the body to be effective.Maximum relief can be expected after about a month of use, although resultsshould be apparent sooner than that. I like the idea of using foods formedicine as they produce the least iatrogenic effects usually.Pain control is also a function of daily activities. Learning basicskills for reducing chronic pain patterns have the added benefit ofempowering patients to have greater control over their own health andwell-being. In this regard, I've found simple open-chained resting posturesvery helpful. Combined with breath control protocols, patients can feel inthe moment how their actions can beneficially change the way they feel.Moving patients in the direction of active care is powerful long-termstrategy for dealing with the inevitabilities of pain.In short, a DC that can't control pain in patients will have a hardtime staying busy. SearsNW PDXOn Nov 9, 2006, at 12:11 PM, Sharron Fuchs wrote:Drs., An MD can be disciplined for failure to provideadequate pain control. What duty does a DC have to assure adequate paincontrol in a patient ? sharron fuchs dc________________________________Stay in touch with old friends and meet new ones with Windows LiveSpaces <http://g.msn.com/8HMBENUS/2740??PS=47575> Stay in touch with old friends and meet new ones with Windows Live Spaces Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 I agree with the idea of treating cause not 'pain' per se. But pain control while treating cause can be helpful. I have had neurosurgeons tell me that indeed older patients can have herniated discs. Something certainly is causing the nerve pressure hopefully the MRI will be revealing. sharron fuchs dc From: [mailto: ] On Behalf Of SeitzSent: Friday, November 10, 2006 4:06 PM Subject: RE: Re: Pain control Dr. Fuchs: As a DC I specifically tell my patients that while they may have decided to see my because of a particular pain, I do not treat pain. I strive to determine the cause of the pain and hopefully by treating the cause the pain is alleviated. We do not have access to powerful pain meds for acute pain. I have the benefit of working in an interdisciplinary office, so when a patient would benefit from such there is access. My personal philosophy does not bar such care (medication). This is where I think drugs have the most powerful positive impact (now for health, that’s a whole ‘nuther can of worms). In this particular case I don’t think the issue is pain control, but rather poor triage and substandard evaluation and management. And btw, a 90 year old with a blown disk? I don’t think so, leather this old ain’t too juicy! Seitz, DC Tuality Physicians 730-D SE Oak Street Hillsboro, OR 97123 (503)640-3724 From: [mailto: ] On Behalf Of Sharron FuchsSent: Friday, November 10, 2006 3:11 PM Subject: RE: Re: Pain control In the case that I describe the saying 'if all you have is a hammer, everything looks like a nail' keeps chirping in my head.I really think in this instance ,along with good diagnostic work up, the patient deserved the mercy of pain relief in the form of medication. sharron fuchs dc From: [mailto: ] On Behalf Of Shad McLaganSent: Friday, November 10, 2006 2:57 PM Subject: Re: Pain control Dr. Kierstyn"You are absolutely right....as a new practitioner, you do that with all of your patients. Once you have been in practice for 10 - 20 years and one of your long term patients comes in, you know them well, you've seen them through a number of exacerabations, "this is probably just another" is often the first - and the correct- impression. So the usual routine is skipped over to see how they fare (or to trust that they will fare as they usually do) with a good adjustment."I send my patients out for further imaging when it is warranted. In this case, it is. This should be obvious whether you are a new practitionor or have been practicing for "10-20 years". It doesn't matter if it is an existing patient or new patient. When someone walks into your office with "severe onset of low back and leg pain. Pain becomes agonizing, excruciating and she is unable to walk, drags the leg and must use crutches in order to ambulate", you send them out, regardless. An exacerbation of symptoms (ie, increase in pain) is different than "unable to walk, drags the leg and must use crutches in order to ambulate". This has nothing to do with how long I have been out in practice. Experience does not mean you are a good doctor, even if it is "10-20 years".Shad McLagan D.C. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 I am certainly not advocationg creating a patient to be on chronic pain meds. But while they are in agony not eating etc. an otherwise hale and hearty elder can be thrown in to a downward spiral that they might not recover from. This is what I mean by fragility - not in the sense of being unable to take an osseous adjustment. sharron fuchs dc From: sunny Kierstyn [mailto:skrndc1@...] Sent: Friday, November 10, 2006 4:42 PMSharron Fuchs; Subject: RE: Re: Pain control Fragility of a person is obviously important to judge ... and - playing devil's advocate here - many times they can still be adjusted with the low force techniques. There have been many times I have been able to approach, serve, treat and adjust a person that other DCs have walked away from. This care kept them out of the pharmaceutical realm, allowing their mind to hold sway a few more years or months longer. Sunny Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C Eugene, Oregon, 97401 541- 344- 0509; Fx; 541- 344- 0955 From: "Sharron Fuchs" <sharronf@...>< >Subject: RE: Re: Pain controlDate: Fri, 10 Nov 2006 13:44:54 -0800 I totally agree with you. I too am concerned about the order of things and I am sure if things would have happened in the correct order that pain medication would have been brought on board sooner. I firmly believe this patient could have benefited from pain control - especially this age of patient - they can be so fragile. sharron fuchs dc From: [mailto: ] On Behalf Of Shad McLaganSent: Friday, November 10, 2006 1:10 PM Subject: Re: Pain control Question: What is our duty as a Chiropractic Physician?Answer: First, to be a Physician. Second, to apply Chiropractic treatment.As a Physician we need to use our tools of evaluation and examination to properly diagnose a patients condition. A couple of obvious tools this DC should have used on the first visit, with the 90 year old patient, should have been immediate plain film x-rays followed by a lumbar MRI. The correct progression is: examination, diagnosis, then treatment. It seems as though, unfortunately, this DC went in reverse order. "My main concern and question is - in the very beginning and in theacute, acute stage should the patient have been referred out to get on top of the severe, agonizing , excruciating, debilitating pain so the patient could undergo DC treatment?"I understand your main concern regarding the patients pain, but, it is our "duty" to first examine and find the source of pain/irritation. Once this has been established, and a diagnosis has been made, then appropriate care can be determined (whether it be from a DC or not).Dr. , please don't kick me off for having an opinion. Thanks.Shad McLagan D.C.> > > > > Drs., An MD can be disciplined for failure to provide> adequate pain control. What duty does a DC have to assure adequate pain> control in a patient ? > > sharron fuchs dc> > > > > > > > > > > ________________________________> > Stay in touch with old friends and meet new ones with Windows Live> Spaces <http://g.msn.com/8HMBENUS/2740??PS=47575>> Stay in touch with old friends and meet new ones with Windows Live Spaces Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 11, 2006 Report Share Posted November 11, 2006 I totally agree ! sharron fuchs dc Re: Pain control Date: Thu, 9 Nov 2006 18:37:22 -0800 Hi Sharon, Thinking about the 'duty ... to assure adequate pain control' on part of DCs doesn't bring much to the surface for me. Not that the question isn't germane, just that so much of what we do is related to pain control. It is by far the leading reason that patients come to my office. Even the yoga students start out looking for pain control/management/abatement. I would suggest that free market economics demonstrate how successful DCs are at pain control. I use a formula that Weil MD recommends and that I've mentioned here before: 500 mg caps of ginger root powder and curcumin/turmuric powder swallowed down with 3 oz of purple grape juice x 3/day will reduce MS pain by 30-40% in most patients. This is anti-inflammatory food, so it has to be in the body to be effective. Maximum relief can be expected after about a month of use, although results should be apparent sooner than that. I like the idea of using foods for medicine as they produce the least iatrogenic effects usually. Pain control is also a function of daily activities. Learning basic skills for reducing chronic pain patterns have the added benefit of empowering patients to have greater control over their own health and well-being. In this regard, I've found simple open-chained resting postures very helpful. Combined with breath control protocols, patients can feel in the moment how their actions can beneficially change the way they feel. Moving patients in the direction of active care is powerful long-term strategy for dealing with the inevitabilities of pain. In short, a DC that can't control pain in patients will have a hard time staying busy. Sears NW PDX On Nov 9, 2006, at 12:11 PM, Sharron Fuchs wrote: Drs., An MD can be disciplined for failure to provide adequate pain control. What duty does a DC have to assure adequate pain control in a patient ? sharron fuchs dc ________________________________ Stay in touch with old friends and meet new ones with Windows Live Spaces <http://g.msn.com/8HMBENUS/2740??PS=47575> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 I'm pleased to see that we have moved on to more productive conversation. Let us always question theories and ideas, albeit with tact and mutual respect. Dr. ph Medlin D.C.Spine Tree Chiropractic1627 NE Alberta St. #6Portland, OR 97211Ph: 503-788-6800c: 503-889-6204 Re: Pain control Hi Sharon, Thinking about the 'duty ... to assure adequate pain control' on part of DCs doesn't bring much to the surface for me. Not that the question isn't germane, just that so much of what we do is related to pain control. It is by far the leading reason that patients come to my office. Even the yoga students start out looking for pain control/management/abatement. I would suggest that free market economics demonstrate how successful DCs are at pain control. I use a formula that Weil MD recommends and that I've mentioned here before: 500 mg caps of ginger root powder and curcumin/turmuric powder swallowed down with 3 oz of purple grape juice x 3/day will reduce MS pain by 30-40% in most patients. This is anti-inflammatory food, so it has to be in the body to be effective. Maximum relief can be expected after about a month of use, although results should be apparent sooner than that. I like the idea of using foods for medicine as they produce the least iatrogenic effects usually. Pain control is also a function of daily activities. Learning basic skills for reducing chronic pain patterns have the added benefit of empowering patients to have greater control over their own health and well-being. In this regard, I've found simple open-chained resting postures very helpful. Combined with breath control protocols, patients can feel in the moment how their actions can beneficially change the way they feel. Moving patients in the direction of active care is powerful long-term strategy for dealing with the inevitabilities of pain. In short, a DC that can't control pain in patients will have a hard time staying busy. Sears NW PDX On Nov 9, 2006, at 12:11 PM, Sharron Fuchs wrote: Drs., An MD can be disciplined for failure to provide adequate pain control. What duty does a DC have to assure adequate pain control in a patient ? sharron fuchs dc Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2006 Report Share Posted November 13, 2006 I asked Dr. Tunick about treating stenosis - with his permission here is his reply which I thought was great. sharron fuchs dc Re: Pain control > > > >Dr. Kierstyn > > > > " You are absolutely right....as a new practitioner, you do that with > >all of your patients. Once you have been in practice for 10 - 20 > >years and one of your long term patients comes in, you know them > >well, you've > > >seen them through a number of exacerabations, " this is probably just > >another " is often the first - and the correct- impression. So the > >usual > > >routine is skipped over to see how they fare (or to trust that they > >will fare as they usually do) with a good adjustment. " > > > >I send my patients out for further imaging when it is warranted. In > >this case, it is. This should be obvious whether you are a new > >practitionor or have been practicing for " 10-20 years " . It doesn't > >matter if it is an existing patient or new patient. When someone > >walks into your office with " severe onset of low back and leg pain. > >Pain becomes agonizing, excruciating and she is unable to walk, drags > >the leg and must use crutches in order to ambulate " , you send them > >out, > > >regardless. An exacerbation of symptoms (ie, increase in pain) is > >different than " unable to walk, drags the leg and must use crutches > >in order to ambulate " . This has nothing to do with how long I have > >been out in practice. Experience does not mean you are a good doctor, > >even if it is " 10-20 years " . > > > >Shad McLagan D.C. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2007 Report Share Posted July 9, 2007 Hello , Thanks for asking this question in this forum. Facing the same restrictions, I've had a couple of recent incidents that were challenging in that regard, although I've been promised at least MS in the next supply order. Recently, I had a scaffolder suffer an inversion fracture of his right ankle. Due to travel restrictions, we had to wait until the next morning to medevac him, however successfully managed his pain with a combination of IM injection of diclofenac sodium and oral administration of acetaminophen with codeine. Like you, I have also had moderate success with the combination of tramadol and anti-inflammatories, but for more chronic type pain, such as a gentleman here who has suffered a spinal fracture many years ago. Excellent question. I look forward to reading the other responses. Wachtel Nigeria ------- Original Message ------- From : Dawdy[mailto:jdawdy@...] Sent : 7/8/2007 10:35:33 PM To : Cc : Subject : RE: Pain Control I woud like to solicit some opinions and experiences in managing pain in the remote environment. I think for most of us, the biggest problem deals with the importation or procurement of narcotic analgesics. Some countries have staggeringly strict requirements for importation of opiates, to the point where they are rarely used in medical practice, the only exception being in the surgical theater. Probably the most useful analgesic I have found is ketorolac. Being non-narcotic, it is generally easy to obtain and, pain wise, gives you fair bang for the buck. I have used tramadol, but it seems to be at best so-so. We have started giving 100mg of tramadol along with ketorolac for severe pain, and this seems a fairly effective combination. Another alternative I have tried with one patient is sub-anesthetic doses of ketamine (0.2mg/kg). The effect was similar to morphine, in that the patient seemed to have good analgesia, and became relaxed enough to sleep (as is typical with patients treated with morphine). The duration of effect is quite short if given IV (about 20 minutes), but it can also be given IM or SQ (0.5mg/kg). I have not used Nubain or Stadol or Talwin. I am not sure how strictly these are regulated in most countries. Ketamine, despite its potency and street use, seems to be fairly easy to get. Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2007 Report Share Posted July 9, 2007 Seems to be the same everywhere hard to get pain meds of the narc type. Have had good luck with toradol especialy with hemmriods and tooth pain. tramadol is rubbish so is nubian in my opinon. Have " smuggled " is MS in the shaving kit. Not that I would recomond breaking your host countries laws! You host country knows a lot more about patient care and patients interests than medical professionals in fact some can even read! Cheers Tom >From: " swachtel@... " <swachtel@...> >Reply- > >Subject: RE: Pain Control >Date: Mon, 9 Jul 2007 05:15:50 -0400 > > >Hello , > >Thanks for asking this question in this forum. Facing the same >restrictions, I've had a couple of recent incidents that were >challenging in that regard, although I've been promised at least MS in the >next supply order. > >Recently, I had a scaffolder suffer an inversion fracture of his right >ankle. Due to travel restrictions, we had to wait until >the next morning to medevac him, however successfully managed his pain with >a combination of IM injection of diclofenac sodium >and oral administration of acetaminophen with codeine. > >Like you, I have also had moderate success with the combination of tramadol >and anti-inflammatories, but for more chronic type >pain, such as a gentleman here who has suffered a spinal fracture many >years ago. > >Excellent question. I look forward to reading the other responses. > > Wachtel >Nigeria > > >------- Original Message ------- >From : Dawdy[mailto:jdawdy@...] >Sent : 7/8/2007 10:35:33 PM >To : >Cc : >Subject : RE: Pain Control > > >I woud like to solicit some opinions and experiences in managing pain in >the remote environment. > >I think for most of us, the biggest problem deals with the importation >or procurement of narcotic analgesics. Some countries have staggeringly >strict requirements for importation of opiates, to the point where they >are rarely used in medical practice, the only exception being in the >surgical theater. > >Probably the most useful analgesic I have found is ketorolac. Being >non-narcotic, it is generally easy to obtain and, pain wise, gives you >fair bang for the buck. I have used tramadol, but it seems to be at >best so-so. We have started giving 100mg of tramadol along with >ketorolac for severe pain, and this seems a fairly effective combination. > >Another alternative I have tried with one patient is sub-anesthetic >doses of ketamine (0.2mg/kg). The effect was similar to morphine, in >that the patient seemed to have good analgesia, and became relaxed >enough to sleep (as is typical with patients treated with morphine). >The duration of effect is quite short if given IV (about 20 minutes), >but it can also be given IM or SQ (0.5mg/kg). > >I have not used Nubain or Stadol or Talwin. I am not sure how strictly >these are regulated in most countries. Ketamine, despite its potency >and street use, seems to be fairly easy to get. > >Jim > > > _________________________________________________________________ Local listings, incredible imagery, and driving directions - all in one place! http://maps.live.com/?wip=69 & FORM=MGAC01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 11, 2007 Report Share Posted July 11, 2007 I use a lot of Ketamine for analgesia. My experience with ketamine is that its generally better than morphine head to head. It has its limitations - even in analgesic doses (0.2-0.3mg/kg - repeated to effect) - it can still cause dissociation and a number still get dysphoric even with relatively low doses - that does limit its wider use in my opinion. In my experience it is much easier to import / travel with - except in the West! It is also useful in patients who have severe pain after significant amounts of opiates - but at a lower dose - 0.1mg/kg - titrated to clinical effect. For burns, long bone fractures and entrapment I go usually go straight to ketamine. Otherwise I start with morphine and add in ketamine if required. It almost universally causes an increase in HR and BP - I tend to avoid it in patients where increased cardiac work isnt welcome. cheers Craig Emergency Physician (and occasional remote site/expedition doc) RE: Pain Control Hello , Thanks for asking this question in this forum. Facing the same restrictions, I've had a couple of recent incidents that were challenging in that regard, although I've been promised at least MS in the next supply order. Recently, I had a scaffolder suffer an inversion fracture of his right ankle. Due to travel restrictions, we had to wait until the next morning to medevac him, however successfully managed his pain with a combination of IM injection of diclofenac sodium and oral administration of acetaminophen with codeine. Like you, I have also had moderate success with the combination of tramadol and anti-inflammatories, but for more chronic type pain, such as a gentleman here who has suffered a spinal fracture many years ago. Excellent question. I look forward to reading the other responses. Wachtel Nigeria ------- Original Message ------- From : Dawdy[mailto: jdawdyrunbox (DOT) <mailto:jdawdy%40runbox.com> com] Sent : 7/8/2007 10:35:33 PM To : <mailto:%40> Cc : Subject : RE: Pain Control I woud like to solicit some opinions and experiences in managing pain in the remote environment. I think for most of us, the biggest problem deals with the importation or procurement of narcotic analgesics. Some countries have staggeringly strict requirements for importation of opiates, to the point where they are rarely used in medical practice, the only exception being in the surgical theater. Probably the most useful analgesic I have found is ketorolac. Being non-narcotic, it is generally easy to obtain and, pain wise, gives you fair bang for the buck. I have used tramadol, but it seems to be at best so-so. We have started giving 100mg of tramadol along with ketorolac for severe pain, and this seems a fairly effective combination. Another alternative I have tried with one patient is sub-anesthetic doses of ketamine (0.2mg/kg). The effect was similar to morphine, in that the patient seemed to have good analgesia, and became relaxed enough to sleep (as is typical with patients treated with morphine). The duration of effect is quite short if given IV (about 20 minutes), but it can also be given IM or SQ (0.5mg/kg). I have not used Nubain or Stadol or Talwin. I am not sure how strictly these are regulated in most countries. Ketamine, despite its potency and street use, seems to be fairly easy to get. Jim Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 12, 2007 Report Share Posted July 12, 2007 Craig, Thanks for the comment. I suspected as much from my reading of the literature and very limited personal experience. I attended a surgery in a local hospital yesterday, as my company is donating a Propaq and I had to inservice the anesthesiologist on how to use it. They had never seen anything more complex than a BP cuff. No O2 in the hospital. Ketamine is their primary form of anesthesia, and the surgery was interesting: a 60 year old pt with hemmoroids was placed on the table, and a syringe stuck into the AC. They bolus him with 200mg of Ketamine, and about half way through the surgery, when he started to wake up, they swapped out the syringes (leaving the metal needle in the arm) and bolused another dose of Ketamine. Premedication was IM atropine and epam. IV? We don't need no stinking IV. Oxygen? We don't HAVE no stinking oxygen.... As I was getting ready to hook up the Propaq, I said the most important thing to remember was to always take a baseline set of manual vitals. " Whats his BP now? " got me a bunch of hemming and hawwing until someone whipped out a BP cuff and actually took the guys BP: 140/90. After the Ketamine bolus, the Propaq showed 200/118, which caused them to check the guys BP again and in the right (opposite) arm it was 180/110. Everybody nodded and said, " Ketamine " . The guys sats dropped to 88%, which is typical for just after being induced. I explained if they had oxygen, now would be a good time to give it. I asked if they had OPAs and they said no- had never seen one. Their method of airway control was either the anesthesiologist doing a jaw thrust, or else passing an ET tube. I'm supposed to assist with an open choly this week and in anticipation of this they showed me their ventilator. It was apparently state of the art back in the 60's. They use Sux and Ketamine boluses. Hopefully I will introduce them to the magic of Buretrols, Vecuronium, and Midazolam. And portable oxygen. Jim Craig Ellis wrote: > > I use a lot of Ketamine for analgesia. > > My experience with ketamine is that its generally better than morphine > head to head. > > It has its limitations - even in analgesic doses (0.2-0.3mg/kg - > repeated to effect) - it can still cause dissociation and a number > still get dysphoric even with relatively low doses - that does limit > its wider use in my opinion. > > In my experience it is much easier to import / travel with - except in > the West! > > It is also useful in patients who have severe pain after significant > amounts of opiates - but at a lower dose - 0.1mg/kg - titrated to > clinical effect. > > For burns, long bone fractures and entrapment I go usually go straight > to ketamine. Otherwise I start with morphine and add in ketamine if > required. It almost universally causes an increase in HR and BP - I > tend to avoid it in patients where increased cardiac work isnt welcome. > > cheers > > Craig > Emergency Physician (and occasional remote site/expedition doc) > > > RE: Pain Control > > > > > Hello , > > Thanks for asking this question in this forum. Facing the same > restrictions, I've had a couple of recent incidents that were > challenging in that regard, although I've been promised at least MS in > the next supply order. > > Recently, I had a scaffolder suffer an inversion fracture of his right > ankle. Due to travel restrictions, we had to wait until > the next morning to medevac him, however successfully managed his pain > with a combination of IM injection of diclofenac sodium > and oral administration of acetaminophen with codeine. > > Like you, I have also had moderate success with the combination of > tramadol and anti-inflammatories, but for more chronic type > pain, such as a gentleman here who has suffered a spinal fracture many > years ago. > > Excellent question. I look forward to reading the other responses. > > Wachtel > Nigeria > > ------- Original Message ------- > From : Dawdy[mailto: jdawdyrunbox (DOT) <mailto:jdawdy%40runbox.com> > com] > Sent : 7/8/2007 10:35:33 PM > To : > <mailto:%40> > Cc : > Subject : RE: Pain Control > > I woud like to solicit some opinions and experiences in managing pain in > the remote environment. > > I think for most of us, the biggest problem deals with the importation > or procurement of narcotic analgesics. Some countries have staggeringly > strict requirements for importation of opiates, to the point where they > are rarely used in medical practice, the only exception being in the > surgical theater. > > Probably the most useful analgesic I have found is ketorolac. Being > non-narcotic, it is generally easy to obtain and, pain wise, gives you > fair bang for the buck. I have used tramadol, but it seems to be at > best so-so. We have started giving 100mg of tramadol along with > ketorolac for severe pain, and this seems a fairly effective combination. > > Another alternative I have tried with one patient is sub-anesthetic > doses of ketamine (0.2mg/kg). The effect was similar to morphine, in > that the patient seemed to have good analgesia, and became relaxed > enough to sleep (as is typical with patients treated with morphine). > The duration of effect is quite short if given IV (about 20 minutes), > but it can also be given IM or SQ (0.5mg/kg). > > I have not used Nubain or Stadol or Talwin. I am not sure how strictly > these are regulated in most countries. Ketamine, despite its potency > and street use, seems to be fairly easy to get. > > Jim > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 30, 2008 Report Share Posted January 30, 2008 I was wondering if any of you know of a pain control medication that works and will continue to work. I have migraine like pain with additional stabs of pain every day. I've been on Ultram ER for about 6 months and it worked great, but I think it is wearing off now. I started counting my stabs of pain again and it's as bad as it was a year ago, 116 in one day, this morning 24 in 1/2 an hour (worst ever). Also does anyone know of any help for medical costs? I'm an unemployed adult with no children so I don't know of any programs I qualify for. I actually had people suggest that I go out and get pregnant so that I would qualify for medical assistance. I'm starting the process to apply for disability but I'v heard that they are 3 years behind on applications and I at least need help until then. Thank you Crystal Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2009 Report Share Posted August 23, 2009 I am about to head up to bed. I have to say this detox of Ativan is taking forever. I am down to .6mg now. Five years I have been on this drug. Too long. I am helped by what Dr. gave me to help my body through the detox and I did not wake every fifteen minutes last night. Still I am very jittery and nervous. Anxiety is at about at an constant seven to an eight. I don't even want the t.v on. It grates on my nerves. Handling it well though. Using those DBT skills. I wanted to share that the drops Dr. made me are working great for pain. I am floored. She had told me that they might not work since the combination of herbs do not work for everyone. I avoided a migraine today because of them. Yipee! Helps my body too. So I am off to bed. Hope everyone has a peaceful night. hugs, Sue__________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 24, 2009 Report Share Posted August 24, 2009 Sue, Ativan is one of the worst drugs to get off of. It took me a year. JacquieDogs come when they are called; cats take a message and get back to you.- Bly From: Urbanczyk <featherednst@...>Subject: Re: Pain control Date: Sunday, August 23, 2009, 11:16 PM I am about to head up to bed. I have to say this detox of Ativan is taking forever. I am down to .6mg now. Five years I have been on this drug. Too long. I am helped by what Dr. gave me to help my body through the detox and I did not wake every fifteen minutes last night. Still I am very jittery and nervous. Anxiety is at about at an constant seven to an eight. I don't even want the t.v on. It grates on my nerves. Handling it well though. Using those DBT skills. I wanted to share that the drops Dr. made me are working great for pain. I am floored. She had told me that they might not work since the combination of herbs do not work for everyone. I avoided a migraine today because of them. Yipee! Helps my body too. So I am off to bed. Hope everyone has a peaceful night. hugs, Sue____________ _________ _________ _________ _________ __ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.