The US healthcare system is often torn between conflicting forces. On a professional level, doctors are supposed to place the interests of their patients first. So, it is reasonable for the profession to respond to a shortage of proper pain management facilities in the hospital sector by establishing “pain clinics”. In theory, these clinics will provide short-term care with mixed teams of doctors, physical and psychological therapists, and nursing professionals able to counsel and advise people on how to manage their pain. Unfortunately, the medical profession is strongly for profit. It would be good if there was a major stream of altruism running through the modern ranks of healthcare professionals. Unfortunately, an increasing number of doctors are abandoning general practice in favor of employed status in clinics and hospitals. This gives stability of earning with the least possible work commitment. It also enables the management to run their facilities to generate the most income from the lowest cost base. Thus, the reality of many pain clinics is they are “pill mills”, i.e. their main function is to supply people with every possible painkiller with the least possible time spent in expensive face-to-face contact between doctors and the people. Such clinics are characterized by long queues of people waiting to see a doctor to collect prescriptions. Doctors are on a quota target to see a minimum number of patients every day. This maximizes the claims to the health insurers by the volume of people seen. For those not on a health plan, it is a cheap consult system since no treatment is involved.
This is not to deny that some clinics are attempts to offer a professional service to those in genuine need. But such beacons of light are few and far between. How do we know this? Because there is an explosion in the number of pain clinics opening across America. In some areas, the local government is trying to control the problem. At least, there are political calls for the profession to rein in these fast prescription services. At best, there are local bans on the approval of new clinics. Sadly, the lobbying power of the medical profession means there are very few state-wide limits either on the establishment of clinics or on the practice of writing prescriptions for hundreds of pills at a time. Some local politicians are proposing ordinances to prohibit clinics from prescribing pain medication except in emergency situations and then only offering a 72-hour refill, expecting the individuals to return to their regular doctors for proper care. Their chances of being able to control the problem are slim without the support of state governments and the medical profession.
This is a tragic situation. There is a real need for professional pain management services at both a local and county level. Unfortunately, the medical profession is exploiting the public and feeding their growing addiction to pain medications. People, being practical, take pain relief in whatever form is available. If that means endless supplies of drugs, they take it. The best practice standards in other countries with public healthcare services does provide mixed teams of pain management specialists who focus on training people to cope using only low level painkillers like tramadol. Because the higher labor costs are absorbed by the taxpayers, a significantly better service results. Because tramadol is not habit-forming to the same degree as more powerful drugs, this is a safer system for managing pain.