Pain Management Can Be a Pain – do you do it yourself?pitcher plant

I have noticed that at our national meetings there are more exhibitors and programs dealing with pain management.  I am fascinated by the subject of pain as you can probably tell by past postings. It is so personal – what is noxious to one person is imperceptible to another; what is bone shaking pain to another is settled by a couple of aspiring by yet another person.

Sarraceniacea Pitcher Plant, the source of this medication

Pictures from Wiki-Pedia photos

But although I am fascinated by the science of it, I never wanted to be the one MANAGING a patient’s chronic pain if it took more than NSAIDs or a Medrol Dose Pak.

I recently became aware of a new, very old drug. What I mean is that it is just now being marketed to most physicians, having been a “secret” in the pain management world for a long time. The company that makes it exhibited at the APMA national meeting this summer. It has been around for so long that, I was told, it was grandfathered into the FDA. I had never heard of such a thing.

The drug is Sarapin® and is developed from the Pitcher Plant. Its use is for nerve injections – spinal and peripheral. I “ran” into this drug last year when I had a difficult to control brachial plexus pain and a physician gave me a nerve block with Lidocaine/Marcaine mix and Sarapin. I thought I knew most medications but this one was new to me. He explained that it would enhance and prolong the effects of the Lidocaine/Marcaine mix. I hadn’t had this type of injection before so I can’t tell you if it prolonged it but I know the expected length of effect of Lidocaine and Marcaine and this pain was resolved for days rather than hours and when it returned it was mild and soon resolved enough to get back to work. Interesting. Of course it could also be  that the interruption of the pain reset the nerve (gate theory of pain). pitcher plant 2

I am wondering how it would work with a PT block or neuroma injection? Anyone have any experience with it out there in the foot world?

By the way, the plants are carnivorous…..they survive on ants and other bugs that wander into the pitcher portion of the plant, which has downward-pointing hairs and waxy sides that prevent the unfortunate insects from climbing back out.  When I read about this plant I couldn't help but think about the famous carnivorous plant featured in Little Shop of Horrors..."Feed me, Maurice! FEED ME!" LOL.

Nepenthaceae, another genus of the plant and not the source of medication.

Do you do your own pain management for patients, prescribing opioids and doing peripheral nerve injections? Or, do you refer those patients who need chronic pain control?

 

Do you do your own pain management protocols for patients requiring medication for a chronic problem or do you refer them to a pain management specialist?
I manage patients' chronic pain myself.
50%
(2 votes)
I refer these patients to a pain management specialist.
50%
(2 votes)
  • Comments (24)
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  • Quote:

    It is called a Court of Law not a Court of Justice.

    One does not want to be dragged into problems with the DEA/ DEA  Diversion or local law enforcement.  They have no interest in the opinions of doctors.

    Then treat the pain appropriately. Do not enable the addiction. It is not illegal to provide pain relief to an addict with a traumatically broken bone. Some would call that to be callus, even malpractice.

    Providing narcotics to an addict for the purpose of providing an addict narcotics [which your law citations state] is illegal and one would deserve the legal sentence they get.

    If a doctor is not comfortable providing pain relief to an addict they should refer that patient to someone who does. or, as I've been told in the past, to your best enemy.

    Dave Gottlieb, DPM personal opinions only

  • It is called a Court of Law not a Court of Justice.

    One does not want to be dragged into problems with the DEA/ DEA  Diversion or local law enforcement.  They have no interest in the opinions of doctors.

  • Thank you Richard for you prove my case by the exams you quote.

    Prescribing opiods to an addict for the purpose of aiding that addicts addiction is not legal.

    Prescribing opiods appropriately for the relief of pain in an addict is legal.

    They are two different things and I for one would never condone aiding and abetting an addict's addiction.

    I repeat my statement, which is merely the restatement of the American Academy of Pain Management as well as the pain control policy of pretty much all hospitals: Addicts deserve appropriate management and relief of pain. If you are not comfortable doing that then find someone who is.

    Dave Gottlieb, DPM personal opinions only

  • It is unlawful to Rx controlled meds to addicts.

    In Linder v. US, the United States Supreme Court showed that the lower court had charged the Jury as follows:  "If you are satisfied beyond a reasonable doubt thta the defendant knew that this woman was addicted by the use of narcotics, and if he dispensed these drugs to her for the purpose of catering to her appetite or satisfying her cravings for the drug, he is guilty under the law..."

    In United States v Rosenberg, the Court documents showed that the lower court had charged the jury with the following instructions, "The jury must look into a practitioner's mind to determine whether he prescribed the pills for what he thought was a medical purpose or whether he was passing out the pills to anyone who asked for them"

    US v Hayes  (9th Circuit 1986)

    US v Alerre  ( 4th Circuit 2005)

    US v McIver ( 4th Circuit 2006)

     

    Doctors are found guilty for any of the following:

    1.  Doctor prescibed to an addict who did not have a bona fide disease

    2. Doctor prescribed for maintence treatment to an addict

    3  Doctor prescribed narcotics in quantities and dosages that have the potential for misuse, abuse and diversion

    4. Doctor prescribed controlled drugs to undercover agents

    5. Doctor doled out drugs to someone who requested refills

    6. Doctor was perceived to be reckless

    7. Doctor had prescribed the medication that was implicated in the death of a patient.   My observation is to use extreme caution in Rx'ing to any patient with mental or emotional disorders.

     

    The DEA does not care about the Physician's Standard of Care. 

     

    General observations and not legal advice.  We urge everyone to consult with a health care lawyer.

    Richard Willner

    The Center for Peer Review Justice

    "Doctors are our Patients"

     

  • RW,

    It is not unlawful to Rx pain meds to addicts. Doing so may be unwise but it's not illegal.

    Addicts have the same right to pain control as all other patients. You don't have to be the one doing the pain control if you are uncomfortable with it [that's the generic 'you' by the way] but some one should. Where I work the surgeon is expected to take care of all acute pain issues. There is a Chronic Pain Service to take care of chronic pain.

    Dave Gottlieb, DPM personal opinions and experiences only

  • Will,

    I am not a lawyer, don't play one on TV and do not even give legal advice. 

    I am the founder of The Center For Peer Review Justice where Doctors are our patients.

  • ALL GOOD POINTS, RW.  AS A DPM & JD, THANX MUCH FOR THE KEY POINTS OF INPUT THERE X 2.

    VERY GOOD TO BE COGNIZANT OF ALL OF THOSE.

    ALL THE MORE REASON TO ATTEND PAIN CME'S, AND WHY I HAVE HOSTED SEVERAL BY EXPERTS, AS WELL AS HAVE STUDIED THIS PHENOM (CLINICAL ENTITY AT NO SHORT LENGTH), AND ALSO HAD QUITE A BIT OF EXPERIENCE WITH THIS PATHOLOGY DURING THE GWOT IN THE 2000'S.  PATIENTS AS HUMAN BEINGS CAN BE THE FUNNIEST AND MOST CHALLENGING PART OF THE EQUATION.

    MAINLY, STICK TO CLINICAL TREATMENTS AND TOPICALS.

    WG

    P.S.  AS THE SAYING GOES:  "FOOL ME ONCE, SHAME ON YOU; FOOL ME TWICE, SHAME ON ME."

     

  • Kathleen, I was just rereading you first post when the phrase 'grandfathered into the FDA' lept out. Many medications, pills and topicals, were grandfathered in. Think Panafil or Accuzyme. The FDA is slowly reviewing them all for both safety and efficacy.

    The problem with these grandfathered drugs is that frequently no one knows when the review of a category is occurring and the drugs are so old there is little, if any, good quality EBM published. This results in the medication being withdrawn. I don't know the situation with Sarapin.

    Dave Gottlieb, DPM personal opinion only
  • Some interesting facts:

     

    Dont Rx to a mentally unstable pt as they are more likely to commit suicide with pills and that can lead to a charge of murder.  To put in other words, if the meds one Rx is in their gut at the time oerf death, hire a Criminal defense lawyer.

    Depressed pts are more likely to attempt suicide.

    Anxious pts tend to self-medicate which can lead to overdose

    Pts with mood disorders will use meds in unpredictable manner

    Schizophrenics are too confused to handle their meds...

     

    - one can not Rx to a preggo patient.  21 USC 861

    - one can not Rx within 1000 feet of a school.  21 USC

    - one can not Rx to an underage patient

    - the SOC is the public interest, not the patient's interest.

    - it is unlawful to Rx meds to an addict  ( Harrison Law 1914 )

     

     

     

  • The big problem in dealing with patients in pain is the reality that if one is angry with the doctor for any reason and that includes that he breaks his pain contract, or if the pill count is wrong, or if he is refused drugs for any reason, expect that patient to report the doctor to the State Board. And expect major grief, even if  the doctor is 100 percent right.

     

    How do you pick out drug seaking patients?

    Pts who call for very early or very late appointments,

    pts who want assurance that if they pay, they will get their meds.

    pts who are rowdy and talkative in your waiting room

    pts who claim they are in more pain then others and demands to be seen immediately

    pts who claim they have no ID

    pts who have insurance but refuses to use the card

    pts who request samples of controlled meds

    pts who have PO boxes as their addresses

    pts with out of town addresses

    pts who say their docs are out of town

    pts with frequent ER visits'

    pts who forgot their meds

    pts referred by pts who are on pain meds

    pts who have problems in getting their old charts

    pts unemployed who pay in cash

     

    this list is endless....

     

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