So-Called “Pain Management Clinics”

November 22, 2013

So-Called “Pain Management Clinics”

I couldn’t agree more, based on MAPS in Minnesota’s pivotal failure to even be willing to treat pain, which started the avalanche I’m buried in. 

Dr. Julian Ungar a/k/a/ Ungar-Sargon

May 2, 2009

Dr. Kobza’s official removal from the list leaves a vacuum, as she was the inaugural, because timely, Sadistic Doctor.  Who should you NOW avoid at all costs if you seek relief from chronic migraine pain?

Julian Ungar, M.D., PhD. a/k/a Dr. Julian Ungar-Sargon, M.D., PhD.

That’s him.  Calls his practice “Neurology and Pain Management.” Educated at the University of London’s medical school and a former member of the Harvard Medical School faculty, for some reason he now runs a little one man show in the humble town of Renssalaer, Indiana (for potential reasons I’ll explore below). Incidentally, all of his staff are wonderful, friendly, helpful people, though that’s no comfort when the doctor ruins your life.

I did a lot of research when Dr. Kobza left me pain-stranded and in deathly fear of losing my job (which, thanks to Unger-Sargon, I eventually did, just as I had in prior similar circumstances, and just as I explained to the good dr. in person and in print).  During my research, Unger-Sargon suckered me in with his web marketing which, cruelly enough, targets chronic pain patients by a web site (www.drungarneurology.com) on which he’s placed, right on that front page, an article he’s written, purporting to explain his philosophy. The following are the highlights of this piece of false advertising:

Perspectives in Intractable Pain Management
An analysis of current diverging viewpoints

Introduction

Across America, two opposing attitudes or paradigms of thinking currently exist in regards to medical management of intractable pain. Empirical, long-range medical research has brought light into the darkness of the Old Paradigm. However, despite the studies that support the New Paradigm, millions of people in our country continue to suffer needlessly because safe, medical treatment is denied to them by regulatory agencies and healthcare professionals. The Old Paradigm ignores three decades of international studies that support pain treatment in cancer pain patients and severe intractable pain patients.

The Old Paradigm believes:

  • It is not safe or prudent to prescribe pain medication on a continual basis.
  • Opioid pain medicine is addictive and can cause long-term damage to internal organs.
  • Pain patients should be tough and learn to live with pain.
  • When pain patients continue to ask for increased pain medication, they are exhibiting addictive behavior. ….

The New Paradigm knows (supported by three decades of empirical medical research):

  • Less than 1% of chronic pain patients become addicted or experience long-term physiological damage as a result of prolonged, controlled opioid pain treatment.
  • When pain patients receive adequate pain treatment that relieves their chronic pain and associated depression, patients can lead relatively normal, productive lives. Their friends and families frequently give positive reports of an increased “quality of life,” previously thought impossible.

What is intractable pain?

Intractable pain is a pain state in which the cause of the pain cannot be removed or otherwise treated and which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts including, but not limited to, evaluation by the attending physicians and surgeon and one or more physicians and surgeons specializing in the treatment of the area, system, or organ of the body perceived as the source of pain.

What are the ailments often associated with intractable pain?

The following is a list of ailments that may result in intractable pain:

  • ….
  • Tension and migraine headaches

So, Ungar-Sargon is a champion of this New Paradigm?  He’s not like the string of ubiquitous Old Paradigm doctors who have cost me my job and my marriage in the past?

He in fact reeks of Old Paradigm and must know it, as he didn’t include this article or any similar New Paradigm truth (as far as I can tell) on the new, oh so inviting, You Tube-enriched, web site he was developing when I was his patient (www.drungar.com).  Must still like our business though (he made thousands out of testing me) as HE HAS NOT REMOVED THE OTHER SITE FROM THE WEB (www.drungarneurology.com).

After all the glowing testimonials he had (now including You Tubers), I was eager at my first visit to talk with a doctor who actually cared.  You can sense that with a doctor, even independent of their medical treatment of you.  But Ungar-Sargon was staccato and brief, and upon seeing my current and longest-term proven medication regimen of an average 40 mg per day of hydrocodone, he burst out as “fact” his opinion that if a patient requires opioid treatment for 10 years, they’re just a medical junkie, and he wouldn’t contribute to anyone being a “medical junkie”.  If you go up and look at his article again, you’ll see that his spoken words to me (repeated at our subsequent visits, which are my fault as I should’ve seen immediately that he was irredeemable)—anyway, that his spoken words to me are in direct contrast to his written words he uses as a web sales pitch for his “services”.

So the Dr. who is on the record as beatifically stating, “No doctor should ever make you feel shame for an illness” (see http://jewishwhistleblower.blogspot.com/2005/07/part-of-rabbi-jeremy-hershy-worchyori.html) calls me a “medical junkie” on my first visit, without even having yet had the benefit of seeing my voluminous record. Presumptive? Sadistic?

I saw him a few times, sending him gobs of research between visits (even of his mantra-like “evidence based, peer reviewed” modality), but he never budged a nanometer.

He never once asked about my pain or how to treat it while his lengthy testing took place—apparently he expected me to take off work for several months while getting my new MRI, a couple of brief massages by his admittedly excellent masseuse, some electro-diagnostic testing (which did go beyond the testing any prior neuro had invested in me), and an experimental nerve block which didn’t work.  He didn’t even ask about prescribing my needed triptans, which had fortunately not run out.

This is from my last attempt at reasoning with him, after he’d not merely closed his ears to my personal experience, but closed his eyes to all the stacks of medical research I’d sent him (including his own article).  (I’m at attorney and research happens to be my strength.) He had continued to dogmatically claim his blind faith that opiates are not an evidence-based treatment for intractable, debilitating migraine pain. So I sent this:

Enclosed with this letter is what I anticipate to be the last of the evidence-based medical literature I’ll send you.  It’s a Practice parameter of the American Academy of Neurology, current as of October 21, 2008, titled “Evidence-based guidelines for migraine headache (an evidence-based review)”.

Table 1, on page 5, “opiate analgesics” are recognized as one of the more effective treatments for migraine headaches.

Specifically, “Butorphanol nasal spray” is recognized to have an effect that is “statistically significant and far exceeds the minimally clinically significant benefit.” Pp. 5, 10.

It is also recognized to be “very effective: most people get clinically significant improvement.”  Id.

The quality of evidence supporting this conclusion is “Grade A. Multiple well-designed clinical trials.”

Did it make a dent? Not in his thinking. He’s one of those Old Paradigmers whom science won’t convince until they get their own reckoning with intractable, debilitating pain of some sort.

Therefore, Dr. Julian Ungar a/k/a Dr. Julian Ungar-Sargon is hereby listed as a Sadistic Doctor as defined by this site, in order that this knowledge may help to lessen the string of unsuccessful doctors that potential pain patients must suffer through before finding solace, hope, and strength in a real doctor belonging to what Dr. Ungar-Sargon calls “the New Paradigm” of pain management.

One last thing. Why IS London educated, former-Harvard Medical School faculty Dr. Ungar-Sargon in a little one man shop in Renssalaer, Indiana? Certainty is not ours, but I did find a Boston Globe article from February 28, 1990 which could explain why he’s not still at Harvard at least.

“DOCTOR FINED $390000 FOR ILLEGAL PRESCRIPTIONS”

In what authorities say is the largest civil fine imposed on a doctor for illegal drug distribution, a Brookline neurologist agreed yesterday to pay the federal government $390,000 in penalties.

Dr. Julian Ungar-Sargon, a former member of the Harvard Medical School faculty, has been ordered to pay the penalty to settle a complaint alleging he illegally prescribed Percodan and Percocet from the Manomet Medical Center, which he owned and operated in 1985 and 1986. The complaint alleges he left hundreds of presigned prescriptions for patients to pick up during visits of five minutes or less.

Authorities said the case represents a growing trend in the illegal drug market, as increasing numbers of doctors, pharmacists and other medical professionals with access to drugs are found illegally distributing them for their own profit.

“It’s a serious and growing problem,” said John J. Coleman, the head of the Drug Enforcement Administration in Boston yesterday. “We are alarmed at the number of practitioners who become involved in providing abusers with these drugs.”

Said US Attorney Wayne Budd: “What this says to the medical community is that street dealers are not the sole targets of this office.”

But defense attorney Nancy Gertner yesterday angrily criticized federal authorities’ characterization of this case. “There is no charge of illegal drug distribution at all,” said Gertner, who represents Ungar-Sargon. “There are a host of complicated regulations he did not follow. But what he did was legitimately prescribe drugs as part of a legitimate practice.”

Gertner said Ungar-Sargon, in agreeing to the settlement, admitted only to the fact that he failed to get the appropriate state and federal licenses to prescribe drugs in Massachusetts. He held those licenses in other states.

“We negotiated in good faith and they obviously didn’t,” Gertner said yesterday, alluding to the US attorneys’ office.

Members of the medical profession also disputed assertions by federal authorities that people licensed to prescribe drugs increasingly are involved in illegal drug distribution.

“Almost all physicians are honest and try to use these drugs safely and appropriately,” said Dr. Errol Green, a spokesman for the Massachusetts Medical Society, which represents about 14,000 physicians. He added of Ungar-Sargon: “If he was doing it, we are glad he was caught. But he is the exception.”

Authorities said yesterday that Ungar-Sargon, of Heath Hill in Brookline, committed more than 200 violations of the federal Controlled Substances Act during the two-year period. A provision of that act governs how doctors can prescribe drugs.

Hundreds of illegal prescriptions were authorized by Ungar-Sargon, officials said. He either illegally authorized persons not licensed to prescribe drugs to give out the prescriptions, authorities said, or issued prescriptions himself, although authorities allege he was never licensed to prescribe controlled substances in the state by the DEA.

He also violated the law by signing and filling out prescription forms in advance of the day they were issued, authorities said.

But Gertner said only qualified medical personnel issued prescriptions and that Ungar-Sargon simply failed to get the correct authorization in Massachusetts to prescribe drugs. “He just didn’t dot his i’s and t’s. This is a bona fide practice by a highly qualified neurologist.”

Federal authorities said many of the prescriptions were for drugs such as Percodan, a painkiller that makes its users feel “euphoric.” The street value for the drug obtained illegally is about $8 per tablet, compared to the price of less than a dollar paid for a tablet with a legal prescription. “There is a vast illegal market for these controlled substances,” said Jeffrey S. Robbins, the assistant US attorney who handled the case.

Yesterday’s civil penalty, approved by US District Judge Andrew Caffrey, settled a civil case brought by the US attorneys’ office under the federal Controlled Substances Act against Ungar-Sargon. Until yesterday, the highest fine paid to the US government in such a case was $350,000, paid by a Baltimore drug company in 1989.

“A penalty of $390,000 sends the signal that this is serious business,” Budd said in an interview yesterday.

Criminal charges also were brought against Ungar-Sargon by the Plymouth County District Attorneys’ office. But in 1989, a jury acquitted him of violating state drug laws.

Initially charged in the state case with Ungar-Sargon was Melvyn Smullen, an employee of the Manomet Medical Center, and Ann Durkee, the center’s manager. Smullen has pleaded guilty to charges of practicing medicine without a license and Durkee pleaded guilty to two counts of unlawful possession of a controlled substance.

Asked why they chose to levy a civil penalty against Ungar-Sargon yesterday, officials at the US attorneys [sic] office emphasized that they were pursuing civil charges because state authorities had been pursuing criminal charges.

Nationwide, 133 federal indictments were brought in fiscal 1989 for violations of the drug diversion provision of the Controlled Substances Act, which governs those licensed to prescribe drugs, according to the DEA. That is more than double the number of indictments brought in fiscal 1987, according to George Festa, an assistant special agent in charge of the DEA in Boston.

Festa said that civil fines collected for the violations were also on the rise, soaring from $565,167 in fiscal 1987 to $1,708,994 in fiscal 1989.

According to sources and court records, Ungar-Sargon was a well-respected doctor with excellent credentials. He was educated at the University of London’s medical school. A spokesman for Harvard Medical School confirmed that Unger[sic]-Sargon was on the university faculty while lecturing at Children’s Hospital from 1984 to 1986.

He was also on the staff of Brigham and Women’s Hospital at the time he was operating the Manomet Medical Center, according to court records. Ungar-Sargon is currently a neurological consultant in Pennsylvania and New Jersey. His license to practice in Massachusetts is under review.

Hmm. Personally, I think the jack-booted DEA thugs have no business practicing pain medicine without a license themselves. So I sympathize with Dr. Ungar-Sargon on this front. But even if this explains his pathological reluctance to prescribe narcotics, it does NOT explain his fraudulent marketing that misrepresents him as a doctor who knows (from three decades of scientific research, remember?) that even long-term opiate treatment is safe in chronic pain patients—when, of course, he his in fact resolutely hostile to long-term opiate treatment of anyone, and to any opiate treatment of migraneurs (in spite of that category’s inclusion on his list of intractable pain causes that may require said narcotic treatment). Plus, he cost me my job, knowingly. I reiterate: he knew my job was at risk.

I did check out his Indiana medical license and he was prohibited from prescribing narcotics for several years after getting his Indiana license, but since then has been approved to prescribe the feared “medical junkie”-creating substances.

Dr. Kobza Absolved.

May 2, 2009

I no longer believe Dr. Katherine Kobza, of Josephson-Wallack-Munshower (JWM) Neurology in Indianapolis and Carmel, IN, should be on the Sadistic Doctor list.  Although she abruptly canceled our doctor-patient relationship without explanation, she did care for my migraine pain almost ideally for several years, and such a doctor is hard enough to find (in Minnesota or Indiana, at least) as it is.  I have a hunch that the powers that be at JWM Neurology forced her hand due to their own pain bigotry and sadism.  So, of course, I still would steer very clear from JWM Neurology if your migraines cause chronic, debilitating pain.  But perhaps Dr. Kobza herself is not entirely to blame for ending her care of me–I actually liked her as a person, and she was always generous with free samples of triptans when my finances and/or insurance were in a bad state due to the chronic migraine pain.

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Do doctors undertreat pain? or, The Prayer of Maimonides

October 30, 2008

“Freud thought that medicine attracts people with relatively strong sadistic impulses …. of course, to the extent that sadism is about power over weaker, dependent people, sadists have the simpler device of stinting on the pain-killers they control.”

(Bioethics 11:3/4 (July/October 1997) Oxford/Boston: Blackwell Publishers)

 Thanks to new guidelines, large conferences, and publicity, physicians are beginning to see how much ‘information’ about morphine and opioid toxicity, tolerance, addiction, and depression of vital functions is myth. Likewise, they are learning that lower doses are needed when patients are allowed to administer their own analgesics at will, especially before the onset of pain. Moreover, research is beginning to show that unrelieved pain has itself deleterious effects on vital functions, for example, on the immune system and hence on healing.”
 
(Id.)
 
Do doctors undertreat pain?[1], by William Ruddick,
Bioethics 11:3/4 (July/October 1997) Oxford/Boston: Blackwell Publishers

At graduation, some North American medical students repeat the Prayer of Maimonides

An image of a 1901 examination in the faculty ...

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“never to forget that the patient is a fellow creature in pain, not a mere vessel of disease.”[2] How could a physician ever forget that a patient is in pain? Don’t physicians confront constant reminders­moans, groans, winces, and other obvious manifestations of pain? ….

 

Physicians and nurses have various familiar ways to forestall or discount patients’ pain reports and requests for more pain relief. In advance of a painful procedure, they minimize the pain that a patient may experience. (‘This may sting a bit,’ ‘You may have some headache for a short time after the lumbar puncture.’) Their clinical rationale is to reduce a patient’s fear and resistance, as well as the pain both may enhance. But these understatements also teach patients the acceptable linguistic parameters for their subsequent complaints. In general, when patients try to speak of pain, physicians and nurses routinely translate their reports into talk of discomfort and distress or even tenderness, the mere possibility of “distress.”

Given clinicians’ control of language and general authority, patients may begin to question their own pain-reports. They may begin to wonder, “Am I really in as much pain as I think?”­-a seeming exception to what philosophers call the “incorrigibility” of pain, that is, the impossibility of being wrong about the existence or severity of one’s own pain.

Whatever the effects of clinician understatement on patients, this linguistic discounting helps clinicians forget how much or how often their patients are suffering, and thereby it helps clinicians distance themselves from the pain they continually encounter and often produce in the course of diagnosis and therapy.[3] For such self-protective distancing to succeed, however, there must be clinical rationales that disguise this function­and they abound. Most common are such routine saws as i) Patients with a history of drug abuse are exaggerating their pain in the hope of getting enough drugs for a hospital high; ii) Patients identified by their ethnic affiliations are engaging in “typical Italian histrionics” or “the usual Jewish kvetching;” and, more sweepingly, iii) All patients tend to be “cry babies,” regressing toward childhood under the strain of illness and hospital routine.

Such generalizatons and stereotypes may be based on little evidence, or none at all in the case of particular patients. But given their value for rationalizing clinicians’ self-protective underdescription of patient pain, evidence is not at issue.

…. From the outset students are trained to regard pain relief as a secondary concern. They are taught to regard pain as useful symptom for diagnosing disease and, accordingly, to respond not by relieving but by observing and exploring the pain, even if that involves enhancing it through palpation of soft tissues and manipulation of joints.[4] ….

Likewise, students learn how helpful pain can be in following the course of a disease, stages of healing, or the efficacy of drug therapy. More seriously, they learn the many ways in which analgesics, especially morphine and opioids, complicate therapeutic protocols. …. Critics charge that the risk and severity of these side-effects are greatly exaggerated, in our Puritanical, anti-drug culture. ….

In short, from the outset physicians learn to think of pain relief as a complication or hindrance to their diagnostic and therapeutic efforts, not as an integral part of therapy. They early adopt the policy First diagnose and treat; then relieve within limits.

There are, however, exceptions to this implicit policy­-most notably in the case of patients who are terminally ill or in chronic pain with no discoverable organic causes. But these are “exceptions that prove the rule”-­the very patients of whom physicians say or think: “I’m afraid there is nothing more we can do for you.” There is, of course, something more they could do, namely, to provide palliative care. But, significantly, once they are certain of these diagnoses or prognoses, physicians often relegate that task to hypnotists, acupuncturists, biofeedback specialists, hospice nurses, or other non-physicians. The modern physician’s proper work is curing or at least arresting disease, not providing comfort.

Not all physicians, however, transfer patients once they are judged to be terminally ill or suffering from pain without a discoverable organic cause. Some are willing to shift from curative efforts to pain relief, including opioids in high and increasing dosages as needed for full relief. In so doing, however, these physicians often provoke their colleagues’ charges that they are overdosing or, even, engaging in unprofessional conduct bordering on homicide.

In their self-defense, physicians so charged may invoke one of several familiar ethical principles­for example, the Principle of Double Effect (“Even if we foresee that death may result, it is relief of pain not death that we intend”), the Principle of Patient Autonomy (“I providing the care that my patient has competently and freely chosen”), or the Principle of Humane Aid (“I am relieving intolerable pain”). But these replies will not persuade critics whose standards of pain relief derive from a conception of Medicine as essentially curative and life-preserving. For them, knowingly to cause, or even risk the death of a patient for the sake of patient comfort is to forsake the defining goals of modern Medicine. By so doing, physicians forfeit the right to call themselves “doctor,” not unlike Jack Kevorkian.

I’ll come back shortly to such heated claims about “the Goals of Medicine.” There is, I think, an underlying, more subtle issue, namely, the appropriate concept of pain. What, I suggest, physicians’ training produces is a new, clinical concept of pain that tends to replace their prior lay concept of pain. As a result, what physicians in their training and practice come to forget is this prior, ordinary concept that most of their patients continue to hold. … it is this forgetting of patients’ concept of pain that sets physicians apart from their “fellow creatures in pain.” .

Concepts of pain: private, privatized, and social

….. I think that the difference between physician and lay concept of pain is more than degrees of precision and sophisticated inference. And it lies not in physicians’ better inferences but in their peculiar trained responses to a patient’s pain.

Normally we do not infer someone’s pain from their behavior, rather, we respond to people’s pain ­ the pain manifest in their facial, vocal, and bodily expressions.[5] Pain is indeed a sensation but a sensation that is expressed in these various ways, subject to our respondents. In infants, pain manifestations are initially nonvoluntary. Crying is as natural as the suckling that relieves hunger, and so, too, within a culture, are parental responses.[6] With time, a child’s pain-manifestations become more selective. Even before speech, infants modulate their crying, accentuating or suppressing it in the light of the appearance or absence of recognizable relief-givers (and pain-causers).[7] We early learn who will and will not respond, and the circumstances in which no one will respond, and cry accordingly. Our crying becomes largely limited to those situations in which relief is expectable­including, of course, the relief of crying in private.

In extreme cases, suppression may become virtually total and habitual as with the “warehoused” infants who live in cage-like cribs without responsive attendants. Just so, patients may learn to privatize their pain­to “suffer in silence,” to “keep their complaints to themselves,” to “put on a good face” or a “good act.” This may be prompted by clinicians’ routine verbal discounting of pain-reports mentioned above, or by their routine pseudo-inquiries, “How are we feeling today?”­-a perfunctory greeting, not a request for information. Or patients, like good soldiers, may not want to trouble their superiors. Or they may wish to avoid further painful investigations that honest revelation of pain would provoke. But, clearly, even such “privatized” pain is response-relative: patients suppress manifestations of pain in order to prevent impatient, or dismissive, or investigative responses of their caretakers.

….

… in learning to substitute one kind of response for another to patients’ manifestations of pain, physicians are acquiring a different concept of pain. In the presence of physicians who exhibit and subtly impart their learned clinical concept of pain, some patients may themselves come in time to take the same distanced curiosity in their pain that their physicians show, coming to regard their own groans and winces, not as demands for immediate relief, but as symptoms for assessment. To that extent, they will have themselves taken on the physicians’ clinical concept of pain, even in the midst of their own pain. But the majority of patients are not so acculturated: their expressions of pain continue in hope of sympathetic efforts at relief. Hence, they see doctors and nurses who fail to respond appropriately, according to this ordinary concept of pain, as insensitive or worse. [11]

Sadism and callousness

To patients who have not become medically acculturated, their physicians and nurses may seem sadistic or callous. Freud thought that medicine attracts people with relatively strong sadistic impulses, but not as a way of acting on these impulses, but as a way of suppressing them through “reaction formation.” Admittedly, our advance rescue techniques (CPR, ventilators, open heart surgery, toxic chemotherapies) may provide “undefended” sadists with more opportunities than the physicians of Freud’s day enjoyed. And, of course, to the extent that sadism is about power over weaker, dependent people, sadists have the simpler device of stinting on the pain-killers they control.

….

Callousness is a far more serious worry. If, as I suggest, physicians learn to forget their patients’ concept of pain, they will find it easy to ignore their patients’ expectations of pain relief. What counter-measures might be taken? Vivid films[13] or stories[14] about patient suffering and physician callousness may help; so, too, physician-patients accounts of their own suffering at the hands of other physicians.[15] Another corrective for callousness might be to require graduating medical students to spend some time as hospital patients. Claiming to have vague symptoms, they would at least undergo some of the painful diagnostic tests that they will routinely impose on their own patients, as well as the hospital delays and indignities that increase patient suffering.[16]

But if I am right about the causes of physicians’ “forgetting that their patients are fellow creatures in pain,” then the underlying therapy/palliation contrast must be challenged directly. Indeed, a variety of just such scientific and social challenges are underway. Thanks to new guidelines,[17] large conferences, and publicity, physicians are beginning to see how much “information” about morphine and opioid toxicity, tolerance, addiction, and depression of vital functions is myth.[18] Likewise, they are learning that lower doses are needed when patients are allowed to administer their own analgesics at will, especially before the onset of pain. Moreover, research is beginning to show that unrelieved pain has itself deleterious effects on vital functions, for example, on the immune system and hence on healing.

….

Moreover, even when there is “something more” physicians can do to try to cure, or at least arrest a debilitating or degenerative disease, patients or their insurers increasingly are unwilling to “fight to the end.” In such cases, palliation or “comfort care” becomes a therapeutic option, or even “the treatment of choice”-­not an admission of clinical failure or fatigue. ….

It remains to be seen whether these social changes, along with more precise knowledge of pain’s harms and analgesia’s manageable side effects, will give pain-relief greater status in clinical training and practice. …. But there is reason to believe that the current contrast I have drawn between physicians’ concept of pain and patients’ concept of pain will shrink. If so, then the Prayer of Maimonides may become more than ceremonial and physicians will more easily remember that their patients are “fellow creatures in pain, not just vessels of disease”. …. Were physicians to remember their patients’ concept of pain as demanding relief and act accordingly, then, of course, they would reduce the amount of pain they would need to “forget” by self-protective misdescription and dismissive stereotypes.

Departments of Philosophy and Psychiatry, NYU


Notes

1. A revised version of a paper read at the panel, “Mismanaging Pain,” III World Congress of Bioethics, San Francisco, California, on November 24, 1996.

2. Attributed to the 12th century physician-philosopher Maimonides (Rabbi Moses ben Maimon, or RamBam) but possibly of 18th century origin.

3. Other self-protective euphemisms: surgeons “lose” patients, oncologists detect “growths,” infants are born “with problems.” Even acronyms and eponyms may play a euphemistic role: ‘ALS’ and ‘Lou Gehrig’s disease’ seem less dire than the fully descriptive ‘amyotrophic lateral sclerosis.’

4. This diagnostic response to pain is caught by the old medical school joke:

Q. “What are the five classical signs of infection?”

A. “Rubor, calor, tumor, dolor — and clamor.” Pain (dolor) and its expression (clamor) are assimilated to redness, heat, and swelling-all signs or symptoms useful for diagnosis of their pathological causes.

5. Ludwig Wittgenstein:”….(Pity, one may say, is a form of conviction that someone else is in pain.)” Philosophical Investigations I, para.287. Readers of Wittgenstein will appreciate that my remarks are variations on his general attack on the view that psychological terms are to be thought of as names for private sensations, rather than as tools whose meaning is given by uses in what he called “forms of life,” “the stream of life.”

6. For us, parental comforting of a crying baby seems as natural, or spontaneous as the crying itself. Parents, especially mothers, who do not so respond are thought to be abnormally depressed, exhausted, or otherwise distracted. Observers of other cultures-and honest reporters of our “deviant” responses-show how culturally defined the interaction of sufferer and respondent may be.

7. Wittgenstein: “A child discovers that when he is in pain for instance, he will get treated kindly if he screams; then he screams, so as to get treated that way. This is not pretense. Merely one root of pretense.” Last Writings, Volume I, para.867 (Blackwell 1982).

….

11. The conflict between the relief-response concept of pain and the clinician-response concept is especially acute in neonatal matters, partly because the relations between causes, manifestations, and effective relief of pain are too tenuous and variable for clear definition. Hence, the counter-charges between “heartless” surgeons and “sentimental” lay critics. See Nancy Cunningham Butler, “Infants, pain and what health care professionals should want to know — an issue of epistemology and ethics,” and Dr. Neil Campbell’s response in Bioethics 3:3, 1989, 181-210.

….

13. For example, “Dax’s Case,” a film about a severely burned patient treated over months against his will. During his excruciatingly painful tubbings and debridements the paramedics keep their radio blaring. In commenting on his case, his physicians can seem almost as unhearing. Also, The Right to Die?: The Dax Cowart Case New York: Routledge CD ROM 1996.

14. In Ernest Hemingway’s “Indian Camp,” a physician tells his young son that he does not hear the screams of the Indian woman on whom he performs a Caesarian section without anesthesia. Nor does he hear the empathetic cries of the woman’s husband in the bunk above her-a suicide by the end of the ordeal.

15.In a Leg to Stand On, Oliver Sachs recounts his often callous treatment for a painful leg injury (New York: Harper & Row 1984). .

16. See the film, “The Doctor” (dir. Randy Haines 1991) about a physician (William Hurt) who required hospitalization as part of his medical students training after the humiliations of hospital treatment he himself had recently suffered.

17. E.g. U.S. Department of Health and Human Services, Acute Pain Guidelines Panel. Acute Pain Management: Operative or Medical Procedures and Trauma. Rockville, MD, 1992.

18. Cf. David Joranson, et al. “Opioids for chronic Cancer and Non-Cancer Pain: A Survey of State Medical Board Members. Bulletin of the Federation of State Medical Boards of the United States, June 1992: 15-49.

 

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A migraneur recounts the definition of “sadism”.

October 30, 2008
Migraine Incidence by Age, Gender, Type

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From the American Heritage Dictionary, Fourth Edition:

sa-dism n. 1. Psychol. The association of sexual gratification with infliction of pain on others. 2. Delight in cruelty. [After the Marquis de Sade.] ~ sa’dist n. ~sa-dis’tic adj. ~sa-dis’ti-cal-ly adv.

Doctors?

Yes, the majority (not entirety) of doctors who purport to treat migraneurs (those of us cursed to suffer the disabling, stigmatizing, isolating wasteland of a migraine life) do, in point of fact, purposefully withhold safe, easily achieved, and highly effective relief from the excruciating, career-destroying, family-wrecking agony barely endured by the migraneur.

I cannot verify definition 1 of sadism, in relation to such doctors, because I’ve no idea of or interest in their sexual gratification.

But after suffering under the so-called “care” of too many of these doctors’ glib, condescending, zero-morality, zero-compassion refusals to relieve my pain, which willful torments have directly injured my dearest children’s well-being by shredding the fabric of my family, I have no hesitation in proclaiming that the aforementioned arrogant men and women in white do, with impunity, “delight in cruelty”.

My own story is long, and ongoing, and this is not the time. And there are many, many others’ stories. Feel free to post yours. Although this blog is devoted to undertreated migraine pain, it is relevant to

Drug ampoules

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any non-cancer chronic pain sufferers. We’re the ones they try to sweep under the rug, refusing to treat us, causing our suicide rate to be twenty (20) times that of the general population. Forseeable homicide, given the statistics, given the facts regarding the most numerous candidates for physician-assisted suicide; yes, most of Kevorkian’s potential clients were patients whose pain no doctor would treat. THOSE doctors were the killers.

I am going to point out peer-reviewed medical literature that supports our treatment yet is ignored by the Sadistic Doctors.

And I am going to name names, both good and bad. And I hope for a lot of help from you, fellow travelers, with this task specifically. We need to get it out there in the open for our brothers, our sisters, and ourselves: who might we seek treatment from? Who shouldn’t we bother with? Who should we avoid like the plague? I would be particularly interested in any pain management clinics that actually manage pain. I’ve yet to come across one that does so; they like risky, interventional (needles in the spine) treatments with low chances of success, and they like non-medical niceties like therapy and positive thinking, but I’ve yet to see one that isn’t flatly opposed to relieving pain by the quickest, obvious, safest, least-expensive, and most-researched methods available.

I said I’d name names. Here’s one to avoid. Dr. Katherine Kobza of Josephson Wallack Munshower (or JWM) Neurology (in my experience, that means avoiding the whole practice group) of Indianapolis, IN. She just fired me as a patient, with no explanation. I have no way of knowing if I’ll be able to get the medicines I need before my legal career (and family life) goes down the drain again due to the abject ignorance, opiophobia, and oligoanalgesic sadism of the most Indiana doctors. I’m trying. But she may as well have tied a noose around my neck and kicked a chair out from under me.

If I can keep flailing, I’ll post again.

(I’d like to request God, the Universe-Consciousness, the Void, and/or any other listening parties

Neuroimaging sheds light on the seat of suffering

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to inflict upon all doctors who mistreat migraines [the vast majority] their very own incurable migraines of a severity equal to the sum of all of their migraine patients’ combined pain severity. Then let us see if sadism persists.)

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