Pain clinics: how did such a fresh idea turn sour?


Such a sad state of affairs and certainly descriptive of what I have seen in the ACT over the last 13 years

drjustincoleman

EnDONE by Ben Frost EnDONE by Ben Frost

A report from the NT coroner this week about an opioid-related death raises a question I started asking after my very first referral to a pain clinic: what is the point of referral if the patient comes back on the same — or an even higher — dose of opioids?

The coroner’s case involved a Darwin mother with chronic pain and an opioid addiction. Every doctor involved found the interaction difficult, and the patient’s use of the system repeatedly thwarted attempts at reduction.

Each time there was a plan to reduce her dose, a new acute pain event or crisis occurred.

Other medications started creeping in — a benzodiazepine, and pregabalin (Lyrica), which seems to have somehow marketed itself as the high-dose alternative for desperate situations.

One of the frustrated GPs referred the patient to a pain specialist.

If I was designing my ideal pain clinic…

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