From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: bypass surgery and postoperative pain control protocol
Date: 27 May 1998 06:52:50 GMT

In <1998052705034900.BAA17731@ladder03.news.aol.com> blue60611@aol.com
(Blue60611) writes:

>First mistake: If you are really concerned about post-op pain control,
>talk to the ANESTHESIOLOGIST as opposed to the surgeon. There are many
>surgeons out there who are aware of pain control methods, but truly, with
>many their first concerns are with the surgery. The anesthesiolgist is
>more likely to have a better grasp of modalities with regards to pain
>control.


   Indeed, nearly all hospitals have pain managment teams, often headed
by an anaesthesiologist.  All you have to do is twist your attending
doctor's arm (the surgeon in this case) to order a consult.  And if he
won't, there are two little power words in medicine which get good
responses from attendings: "You're fired."

                                     Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med
Subject: Re: pain clinics
Date: 13 May 1999 21:01:47 GMT

In <7hf8im$s9u$1@knot.queensu.ca> Emma Chase VanCott
<7elc@qlink.queensu.ca> writes:

>blades@novagate.com wrote:
>: I suspect psychological testing is a not subtle attempt to tell you "it's
>: all in your mind"..  the all encompassing excuse when physicians don't
>: know what's wrong.
>
>	And they're somewhat redundant. Any "normal" person, with enuf
>pain will develop depression and anxiety. (Duh.) There's some
>methodological problems there...
>
>	(My first degree is in PSYC, fyi.)



    This is one of the reasons history is important.  Was the person an
anxious depressed person before the physical problem?  There is lots of
evidence that people who develop post traumatic stress disorder are
high strung people to begin with.  Whatever your medical problem is,
your underlying temperment acts as overlay-- as either amplifier or
minimizer.  Psych tests, if they are done well, can suggest whether or
not anxiety and depression are large components, so that they can be
psychologically and/or chemically treated.  It's really no good giving
the person Xanax who was calm before his/her physical problems began,
and who is pretty calm even now (though in pain).  All that does is
make them sleepy and dysphoric.  High strung people, however, are
helped by Xanax or Clonazepam plus or minus SSRI drugs or MAOI's as
well as if they were getting a certain amount of morphine.  What they
have "left over" after treatment of depression and anxiety, is what you
use NSAIDS, neurontin, etc--- and if necessary, even morphine for.