One aspect of this issue that never seems to get attention is the profusion of "pain clinics" in the US that began in the early 1990s and accelerated over the next 25 years, particularly in conjunction with the explosion in orthopedic and neurosurgical extensive spinal surgeries with implanted hardware. These surgical procedures were often done with marginal indications, sometimes for back pain only in the absence of any neurologic or anatomic deficits, and the surgeons were exceptionally quick to transfer their post op patients ( most of whom continued to have intractable back pain) to "pain management" as it was then euphemistically called. These were anesthesiologist-administered pain clinics. Opioids were the initial treatment modality, along with steroid injection therapy. This was a very lucrative game. In this time frame, hundreds of thousands of failed-back surgery patients became addicted to a variety of opioid narcotics.
One aspect of this issue that never seems to get attention is the profusion of "pain clinics" in the US that began in the early 1990s and accelerated over the next 25 years, particularly in conjunction with the explosion in orthopedic and neurosurgical extensive spinal surgeries with implanted hardware. These surgical procedures were often done with marginal indications, sometimes for back pain only in the absence of any neurologic or anatomic deficits, and the surgeons were exceptionally quick to transfer their post op patients ( most of whom continued to have intractable back pain) to "pain management" as it was then euphemistically called. These were anesthesiologist-administered pain clinics. Opioids were the initial treatment modality, along with steroid injection therapy. This was a very lucrative game. In this time frame, hundreds of thousands of failed-back surgery patients became addicted to a variety of opioid narcotics.
M Robert Weiss, MD