Tuesday, November 20, 2012

Chronic pain patients interviewed in hospital closet

CTV British Columbia
Published Tuesday, Nov. 20, 2012 4:43PM PST
Last Updated Tuesday, Nov. 20, 2012 7:24PM PST

Chronic pain sufferers are being interviewed in a supply closet and asked to wait years for treatment at one Vancouver clinic, a CTV News investigation has revealed.

Anesthesiologist Jill Osborn works in the acute and chronic pain division at St. Paul’s Hospital, one of few non-private providers of multidisciplinary assessment, consultation and treatment in the Lower Mainland.

But Osborn said a lack of funding has led to wait lists of between one and three years at the facility, depending on the severity of a patient’s condition.

“They are suffering and it’s not acceptable for them to be waiting that long for treatment,” she said, adding that extended periods of pain can affect a person’s emotions, social life, family and career.

“By the time a person’s had chronic pain for six years they are very depressed and have many social issues as well.”

Adding insult to injury, when patients arrive at St. Paul’s hospital for an assessment they have the option of being interviewed within earshot of other patients or, if they prefer privacy, being sat down at a wood table in a narrow supply closet.

“If nurses need something from the closet, they will knock on the door and the interview will be interrupted,” Osborn said. “They will go in and get what they need and they’ll leave and then we’ll start the interview again.”

“My concern is that we are not providing the right message to the patient – that they’re important to us – when they’re interviewed in a closet.”

Osborn said the hospital’s in-patient psychiatrists and rehabilitation medicine specialists also use the closet for interviews.

The problem for chronic pain patients extends far beyond the South Coast as well, as resources are even scarcer in B.C.’s Interior.

Eighty-three-year-old Sture Kallman recently drove eight hours to access a specialist at St. Paul’s after spending years on a waiting list.

“Two to three years seems like 10 to 15 years,” Kallman said. “It would have been nice if I would have been able to get in sooner… and maybe things would be better for me today.”

Different studies have pegged the number of Canadians suffering from pain disorder at anywhere from 10 to 44 per cent of the population, but B.C. doctors say their funding is falling far behind patients’ needs and there aren't enough specialists trained in the area of chronic pain.

Health Minister Margaret MacDiarmid acknowledged the “extremely difficult” wait time for pain patients and said the province is working on a solution.

“There have been some additional financial resources put in for the doctors who practice in this area… and some of that may be able to go to this,” MacDiarmid said.

She also said the planned redevelopment of St. Paul’s Hospital could result in shorter wait times and, potentially, a larger space that would eliminate the need for closet-space consultation.

“The end of that development is years away, but it will get started, and as the site is redeveloped there will be some moving around as services,” she said.

The minister could not say with certainty that chronic pain patients would be moved to a better facility, or when the move might take place.

MacDiarmid added that while the physical space at St. Paul’s may be lacking, “the standard of care that’s being provided is fantastic.”

With a report from CTV British Columbia’s Mi-Jung Lee

If you have a tip for CTV’s Investigators, call  604-609-6333  or email investigate@ctv.ca

Click Here To Read More, Watch Videos, and See Pictures of Closet.

MD Trainees Wary of Ordering Opioids for Chronic Pain

by Dana Hawkins-Simons

Many physicians-in-training are reluctant to prescribe opioid analgesics for long-term pain management, a recent study has found.

“Most surveys are done with family medical practitioners,” said Ike I. Eriator, MD, MPH, professor of anesthesiology and pain management at the University of Mississippi Medical Center in Jackson, who led the study. “But if we look at how physicians-in-training think, it gives us a clue as to what a practitioner of the future might do.” The study results were presented at the 2012 annual meeting of the American Pain Society (abstract 242).

The researchers queried 93 trainees from the areas of emergency medicine, general surgery, psychiatry, internal medicine, family medicine and neurology, as well as 16 medical students about their pain treatment practices. Nearly half (45%) said they treated chronic pain on a regular basis. Twenty-one percent of respondents stated they felt comfortable treating chronic pain, whereas 34% felt it depended on the situation. However, 81% reported feeling uncomfortable prescribing long-term narcotics for chronic pain patients.

There was no significant relationship between treating chronic pain on a regular basis and comfort with prescribing long-term narcotics among the physicians. Women were more likely than their male colleagues to feel uncomfortable prescribing long-term narcotics. Trainees who felt comfortable managing chronic pain also were significantly more likely to feel comfortable prescribing long-term narcotics.

The most common concern with prescribing long-term narcotics was the risk for chemical dependency or addiction (37%), closely followed by escalating opioid doses (35%); 3.4% of respondents cited legal considerations.

“A few decades ago, the legal environment was the main impediment to prescribing opioids,” Dr. Eriator said. “Maybe that has changed because law enforcement has relaxed its prosecution over recent years of medical practitioners who prescribe opioids.” 

Dr. Eriator said the results of the study could be used to help focus pain management training in the areas where residents are most deficient.

“At an anesthesiology meeting several years ago, we presented data that showed residents’ knowledge of acute pain treatment varied across specialties,” he said. “For instance, orthopedic residents were more likely to attribute increasing requests for medication to the development of tolerance, while family medicine residents would attribute it to addiction. We could focus their education on the areas where they need more knowledge.”

Dr. Eriator said he would like to use the same questionnaire to survey medical students on their comfort level and concerns regarding pain management and how it changes when they become physicians.

A healthy respect for how complicated it is to treat pain is a good thing, said Steven Passik, PhD, professor of psychiatry and anesthesiology at Vanderbilt University School of Medicine in Nashville.

“Medical education on pain and addiction is sorely lacking, and training about the interface between pain and addiction is virtually nonexistent,” he said. “We should teach the physicians-in-training to use their discomfort to seek training throughout their career.”

Anesthesiology News 

Thursday, November 8, 2012

Wanted to share with you all ....

Hello everyone,
I am having a superb morning so far and I want to share with everyone a way that you can have a superb morning....every morning!!

Morning Prayer

Now I wake me up to live
I'll give life all I have to give

If today I face a test
I'll cope & pray & do my best

With each breath & step I take
Be with me Lord for heavens sake.


I also want to invite you all to listen to my radio program today at 1:00pm CST.
Our guest is Carl E David author of "Bader Field - How My Family Survived Suicide". Around this time of year with all the stress of gifting for Christmas there are so many who become overwhelmed and choose to leave this world before their time. Carl's brother committed suicide and left no note or any reason for him making that decision, but Carl and his family made it through all the difficulty it caused in their realm. So I sincerely hope you join us to hear the way they survived as well as things you can do to help someone you know and love is showing signs of being at the breaking point where you are concerned they may make the same choice.

Here is the info & link for the show:

Show Name:  Winning Life Through Pain
Show Link:  www.rsdcoachlive.com 
Show Time:  1:00pm CST

Hope to see you all there!

**Make It An Amazing Day .... Every Day!**

~God Bless!~
Coach Marla