Dr. Mark Ibsen

Subject: Pain Management.

Thanks for brainstorming with me about this. Your concerns are well founded.

We need a revolution in pain management. And in our profession Generally. Pain is in the purview of all of us. There are simply too many patients in pain to relegate care to specialists, in the same way that cardiologists cannot possibly care for all chest pain Or GI/ Gen surgery cannot care for all abdominal pain.
Scary talks about narcotics overdose deaths truly endorse safe and sane treatments such as mmj(nobody dies)PtExerciseCognitive behavioral SupportTransformational conversations. Also, we must keep in mind the suicides( pain related) and deaths from heroin. And I ask: where do we want patients who are struggling with pain and dependence and low life skills?Doctors office or .....?The law enforcement folks are on a missionPharmacists too. They all think pain patients are criminal drug seekers. I say: so what if they are?They hurt. They have been trained to seek narcotics by US. We all are responsible. We can address pain by impacting expectations and conversations in the culture in general. That's why I pushed for the Pain articles in the Independent Record. Since no one is actually providing pain management in Helena, I have endeavored to serve those "narcotic refugees" that have showed up on my doorstep. The deepest philosophical question is:"What do you do with /for patients who have nowhere else they can go?As an ER doc I kicked the pain can down the road: "go see your doctor- here's some clonidine"Well-now that direction doesn't relate:"your doctor" doesn't "DO" pain. So, I'm it. Or We're it. This cannot be relegated or delegated. We do pain. We save lives and relieve suffering. Hippocrates says so. Bringing transformation/breakthrough technologies as well as recovery distinctions has been highly rewarding emotionally, if not financially or politically. Listening AS contribution alone has transformed many of the lives of our patients, and I know you use the same ways of being. SoKeep the faith. The Pain Monster grew over the last 15 years. We can sanely work to reduce narcotic overuse. Diversion is a law enforcement issue. We don't lock up car dealers when their customers drive fast or create carnage. Thanks for inspiring this communique I guess this issue has taken me over. No going back.

Chapter one

"Pain is a Terrorist"

Night shift, it's 6:30 AM and I get off at seven. All of a sudden I feel a twinge right between my legs. "I wonder what that is? "Five minutes later I am peeing blood and in agony. I only have to make it 25 minutes more until the next ER doc comes on for the morning shift. It's difficult to focus but fortunately all my patients are cared for tucked away with therapies in place.The nurses start an IV, I puke a few times, but I'm not taking anything on board that would alter my consciousness in case another patient comes in. On time at 7 AM Dr. King walks in takes a brief history looks at my misery and orders morphine. 30 mg of intravenous morphine later I'm finally getting comfortable.I get admitted to the hospital for pain control and they put me on a PCA pump. PCA stands for patient controlled analgesia. If I'm still in pain I get to press the little button and get more morphine. They set it for 8 mg an hour. Turns out that 8 mg is not enough. I'm still writhing the doctor won't increase the dose and I'm screwed. I'm bargaining, negotiating, getting louder, I'm a real pain in the ass to the nurses. Then I begin to feel inadequate like a wimp. I'm a downhill adventure telemark skier,cross country ski marathoner. What's the matter with me?I'll tell you what's the matter: I've got a 7 mm asteroid coming down my ureter. And it sure has my attention.Of course this experience with a kidney stone transforms my relationship to kidney stones and acute pain. From this day forward my goal is to have the morphine on board before the vital signs are complete on anybody who has a kidney stone.The inadequate dose of the PCA pump has me scrambling in my backpack for my Percocet. It's clear to me now that I will do anything, anything to get that pain relieved. I feel like I'm in that book Lost horizon and I'm trying to get back to Shangri-La. I cannot think of anything else.I had that particular stone for 10 days before it passed. I have had them since, in fact my most recent stone was a marathon of 31 days. Interestingly, I only took three Percocet during 31 days of more moderate agony. I'm thinking it's because "I've had these before I know what I'm doing and this too shall pass". There's been progress in medicine last 25 years: I'm taking ibuprofen Flomax and high dose Kava Kava recommended by my colleague Angela the naturopath next-door. After 31 days of trying to pass that thing I had pretty much given up filtering and when it clicked into the toilet I was ecstatic! I lit a candle and build a little shrine to that thing. The pain clearly had me bowing down to some type of internal Idol, begging pleading supplicating for relief. Nirvana, enlightenment, heaven occurred when that thing passed. I am moved by how spiritual these events occurred to me. The passing of that stone brought more blessed than any mountain peak or meditation or spiritual adventure I've ever had.Waking up after surgery, surviving my angioplasty, and the birth of my children bring similar waves of ecstatic gratitude to my mind and heart. This awareness: pain like this owned me for 31 days while I worked slapped and performed all kinds of contortions to get relief. This has me knowing, without a doubt, why people are driven relentlessly to get their pain relieved. It's also quite interesting to me how one stone needed boatloads of morphine, and my most recent stone I found myself prepared for. It was almost a command performance following several dress rehearsals. Being pretty sure what was going on relieved the amount of anxiety that I'd had during previous episodes. I'll talk about anxiety and pain in another communication. For now I know this: pain is a freaking terrorist. It has had me "by the balls" whimpering and sniveling enough for me to comprehend that no one can escape its clutches. I also realize I can never ever ever interpreted patients pain for them. PAIN IS COMING FOR US. It's either been here, it's here now, or it's coming.....We had best choose as a culture how are we going to be with this phenomenon called pain