“Comprehensive” chronic pain management…

Chronic pain management 7Dr. Michael J. O’Connell, New Hampshire, commented that many pain managers across the nation claim to provide “comprehensive” chronic pain management, yet this term has not been defined by any of the pain societies.  This is unfortunate since the pain patient should know before accessing services, or wasting a good deal of money on one type of ineffective treatment, and other potentially successful types not mentioned or offered.  Even the dictionary definition of “comprehensive” is uncertain, alluding to the inclusion of “many” or “all.”  Which is it?  Such vagueness is not helpful.

So it would seem that “comprehensive pain management” should include most, if not all services generally considered as useful treatment for pain.  Enter another problem…how is “useful” or “effective” measured or characterized?  Dr. O’Connell notes that historically this problem has been addressed by research, and scientific study.  Pain management as a discipline in itself, and is historically very “new” compared with other specialties such as general surgery, cardiology or neurologChronic pain management 10y.  Hence, chronic pain management has not been subjected to rigorous study, and therefore its underpinnings are fragile if not precarious.

For example, the use of opioids in chronic conditions has been advocated by icons in pain management such as Lyn Webster, MD, former president of the American Academy of Pain Medicine, and Russ Portenoy, MD of New York’s Beth Israel Medical Center and former president of the American Pain Society.  Both of these renowned figures have been tarnished if not disgraced by accepting immense pharmaceutical funding to advocate for opioids, and with precious little clinical support for effective long term outcomes.  Webster has come under scrutiny by the DEA for over 20 ODs among his patients and has left clinical practice (despite having developed an assessment tool to root out abusers, both men named in a recent suit brought by the city of Chicago and several counties of California against the pharma that funded these men in promoting opioid use for chronic pain).

Another tool of the chronic pain manager, targeted steroid and anesthetic injections, has been subjected to a huge volume of studies by Lax Maschikanti, MD of Kentucky.  Chronic pain management 11While he professes to be heavily involved with face to face treatment of patients in his private practice, he apparently had enough time to produce more than 100 studies over the past few years, looking at the effectiveness and safety of such injections, many printed in peer reviewed journals.  In addition, Dr. Maschikanti is reportedly heavily involved with the politics of pain and health care, the primary motivator behind a PAC advocating for the field of pain management.  All these activities makes one question whether he sleeps, and the quality and reliability of his innumerable research articles.

Other tools of the chronic pain manager include behavioral medicine, psychotherapy, non opioid medications, physiotherapy, neurostimulation, chiropractic and alternative care with massage therapy, herbs, etc.  Not one of these modalities has been subjected to rigorous scientific analysis of efficacy, not just short term, but long term.  Not one randomized controlled study with significant numbers of patients has been produced on any.

So you can see that to answer the question, what is comprehensive pain management?, is to question the answer. Until questionable research can address the efficacy of each modality, the definition of comprehensive care cannot be entirely articulated.

About Dr. Michael J. O'Connell, New Hampshire
Dr. Michael J. O'Connell of Barrington, New Hampshire, has forged a distinguished career spanning over three decades, as entrepreneur, physician, businessman, philanthropist and healthcare consultant. As former owner, administrator and CEO of a 225+ employee multi-specialty medical practice, Dr. O'Connell has dedicated his entire professional life to helping patients with family medicine and especially those experiencing chronic pain and all aspects of addiction. Since selling his family of healthcare businesses, he has never once contemplated retirement despite his rich and fulfilling journey, but instead has turned his focus to consulting in an industry starved for courage and creativity. Having weathered many political, technological and legal challenges, there is hardly a storm he has not confronted, a tempest he has not quelled, an urgent need he has not met. While the talking heads and self-proclaimed experts in the field have assumed the conventions and standards of the times, Dr. O'Connell does not believe in merely reflecting the herd mentality, but rather in leading the charge. Eschewing political correctness, Dr. O'Connell says and does what needs saying and doing, and not what the mindless masses expect. In addition to the continual education afforded by his variegated life experiences, Dr O'Connell earned his BS in Biochemistry at the University of NH in 1975, his Medical Degree from Dartmouth College in 1981, interned at Walter Reed Medical Center in 1982, Residency/Fellowship at UCSF in1986, and finished his Masters in Healthcare Administration at UNH in 1995. Dr. O’Connell enjoys many outdoor activities, including rock climbing, snowboarding, hiking, and golf. Through the decades Dr. O'Connell has supported many non-profit charities to include the St. Charles Home in Rochester NH, the Tri City VNA and Hospice, Hyder House, and Cocheco Valley Humane Society. To the latter organization alone Dr. O'Connell has donated over $180,000 and pledged another $250,000 in the “Bring-Us-Home” campaign for a new building. His “Matching Donations Christmas drive” has generated over $175,000 in charitable giving from the community. In addition Dr. O'Connell has participated in many dozens of other volunteer and donation efforts locally as well as in Africa and the Dominican Republic. For a listing of how I gave back to the community during my career and continue to do see: https://michaeloconnellmdnh.wordpress.com/

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