Violence against Pain Care Providers

Violence against Pain Care Providers

As the debate over access to pain medication intensifies, apparently violence against chronic pain care providers is a prevalent and serious issue, a new study in Pain Medicine reveals.

One wouldn’t think  that being a pain care provider is dangerous business, but the data sure paint a different picture.

Authors Kim David, Daftari Anuj and Sibai Nabil from Henry Ford Hospital in Detroit conducted a survey of the members of the American Society of Interventional Pain Physicians (ASIPP) to collect data on demographics, rates of violence, types of violence, injury, risk mitigation, and the context of violence.

The results would have most chronic pain care providers ready to increase security.

  • 51% have received threats
      • 7% of those threats involved a gun
  • 64% have had to call security
  • 2.73% have been physically injured

What steps do chronic pain care providers take to mitigate violence?

  • 85% discharge the patient
  • 16% use protective equipment
    • 54% of those carry a gun for protection

Some other findings from the study include:

  • Opioid management was the highest context for violence (89.9%; P < 0.0001).
  • Those who practiced part-time were more likely to be harmed (P = 0.0290).
  • Females were less likely to be threatened (P = 0.0507).
  • Anesthesiology was the most threatened vs. other specialties (P = 0.0215).
  • Urban practices were less likely to move or close the practice (P = 0.0292).

The study authors wrote in their conclusion, “Chronic pain care providers were at high risk for violence. Risk factors were older age, male, working part time, and anesthesiology. Risk was highest in the context of opioid management and disability. Discharging patient was the most common risk mitigation. A significant number of physicians carried firearms.”

The US Labor of Statistics says that healthcare workers experience violence more so than any other industry, and that patients were responsible for the highest percentage of non-fatal workplace assaults.

There have been several media reports about violence in healthcare – many very sad and some heroic.  This Scientific American article is a good in-depth look into the issue of violence against hospital workers and nurses. While this article from American News Report gives a good example as to why healthcare providers are increasingly carrying guns as a means of protection.

It’s inordinately sad that those pain care providers who dedicate their careers to helping people in chronic pain are at increased risk of violence from the very people they are trying to help.

At the same time, what some observers call the breakdown in the delivery of chronic pain care is contributing to this troubling trend.

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Authored by: Staff

There are 11 comments for this article
  1. Sandy Auriene Sullivan at 11:03 am

    BL
    Sorry for the late reply to your comment. Luckily for her this place had flat screen tvs in the exam rooms. Her back was turned so she saw nothing! And I said nothing at the time – instead grabbed her hand and we ‘ran’ as fast as we could to the car.

    She shows no signs of ‘over-sexualization’ that would show now as she is a young teen. [12] Her grades are high and steady. She doesn’t dress like so many young girls her age. Though she is ‘trendy’ again that overt sexualization isn’t there. If it was? I would have her in counseling.

    My eldest has had BPD and showed signs at 6yrs of age. He had been kidnapped from me during a custody dispute. When the Aussie Feds were able to recover him safely – he was completely unaware of what my ex-husband was telling me on the phone. So I am intimately familiar with signs traumatized children exhibit. She’s not showing those. *there for the grace of god go I* on that one. LUCKY.

    As for me – well my ex in Australia was a large part of why I have PTSD today [along with the accident; I couldn’t sit in a car without shaking and having full blown panic attacks at every light – for YEARS; today I can sit in a car normally. Panic attacks are few, doesn’t take much to cause me to shake which is why I have to keep Klonopin on hand – like a rescue inhaler for anxiety]. I do see a counselor and psychiatrist for several reasons.

    Also trust my current doctor and feel comfortable in the room alone with him now – took time. On days that Im struggling – I take in a family member for support. My doc’s RN who helps with injections is an amazing woman that helps make my appointments smoother too. Both are aware of my history. [yes injections work; but don’t last. He uses a short acting cortisone in my spine; long acting one in other areas like bursitis sacs on side of thighs or when nerve is pinched in shoulder – that’s lasted 2yrs now. I believe in multimodal therapy but need PT within reach; the co pays alone along w/other docs keep PT out of reach for me. Massage helps significantly but doesn’t last. Massage injections + PT = possible reduction in medications or stabilize current dose. If I could get that done 2x a month too]

    I think the stalking my ex did after leaving him; and one final act against me by him – which is why we left Australia and came to the US; where my parents are caused more emotional damage to me than the one doc’s ‘staff-showing’ staff member. [not without a protracted court battle in Family court Brisbane to be allowed to take the boys out of Australia first…].

    I didn’t have the energy to fight the doctor’s office handling of the situation and I did report it to a detective in my county who said the doctor was being investigated. The energy to go up against the system just didn’t exist in me. All I wanted to do was move on.

    Not without warning women and men that we patients are vulnerable as all it takes is *one* jerk to ruin our lives. [especially if one has no support in their family or understand the law]

    They have the power to label us ‘drug seekers’ and on that end? I did fight. Had the detective talk to my primary doctor and inform him that I had done nothing wrong. *NoTHING* was in my med records about it. My lawyer and I tried to get my med records from that offending doc and they simply ‘cannot find it’ was never a patient?! This was as I said nearly a decade ago so it would be harder to do today in Florida. [scripts are not handwritten. My current doc of the last 6yrs uses the database, prints his scripts out and my pharmacy also uses the database. It works if everyone does use it. Apparently it’s not mandatory YET]

    It’s important we keep abreast of what is written in our files. It costs to get our medical records [my car accident records in total? Paid some 800$ for them. Just the records!!]

    Thank you for your comment and concerns. My main reason for mentioning it is to inform others. Take someone you trust with you no matter what – that helps also just to remember everything a doc has said just as it shows the doctor your family support you.

  2. BL at 10:50 am

    Sandy Auriene Sullivan, I am so sorry that this happened to you. If you haven’t receive counseling for it, you really need to think about it. You also need to watch your daughter for signs of how it might have affected her when she gets a little older, that aren’t visible now. Don’t talk about it or allow others to talk about it around your daughgter. You can contact your local Rape Crisis center and explain to them what happened and ask if they provide counseling. Most people think that a person has to be raped, but that isn’t true. Anything that is forced on you that is of a sexual nature usually meet the criteria for counseling. Some times Rape Crisis centers that aren’t in a large communinty don’t have many resources. If you can’t find help at first please don’t give up. Things like this often impact a persons life in ways that they often aren’t fully aware of until years later. I have worked with victims of sexual assualt and many of them try and deal with the tramua on their own for years before getting help. You Will Be Believed. Counselors at these centers are Not like others that you have dealt with. You are right about taking someone with you to drs exams. These types of things happen to men as well as women and adults as well as children.

    It is standard procedure to make a copy of prescriptions before they are given to the patient. It is primarily done to prevent prescriptions from being tampered with and to provide evidence if they are. But, it is also protection when a dr or staff employee says a prescription was given when it wasn’t or if there was a error.

    Federal law now states that a patient has the right to get a copy of their medical records for the cost of copying, except in certain mental health cases.

    Your Medical Records-
    http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/medicalrecords.html

  3. Bob Schubring at 9:38 am

    Several ASIPP members present spine surgery as the only treatment option, even in patients who can be titrated to effect with opioids and have no adverse reaction to them.

    Essentially, compelling people to submit to a surgical intervention, is a use of Force.

    The physician is violently restraining the patient from obtaining the pain relief that works, to compel the patient to “consent” to the surgical intervention.

    Violent coercion can never be peaceful.

    Like an antebellum Southern plantation serving as a movie set, the master-slave relationship, at first blush, appears nonviolent, but it only appears that way, because every actor on the set is being paid to pretend that slavery didn’t make slaves very angry nor require them to remember the terror of punishment.

    The violent crime of slavery was officially tolerated in British America for over 140 years and never prosecuted. After the Revolution, slavery went on being tolerated in several states for another 90 years…ending in war.

    90 more years elapsed, during which time Jim Crow laws made the freed slaves and their freeborn children, into a separate society excluded from the mainstream.

    What made the entire period of American racial intolerance horrific, was that the threat under which Africans had been brought here and under which their children were held, was unending and usually unspoken. Black Americans feared White violence because they’d known it all their lives. Non-black Americans never truly grasped what that terror was like. Hence, at first we had trouble realizing what was making our Black neighbors so angry…if I personally never screamed at a Black person, why did strangers. who were Black, seem to fear my presence? It took me years to realize that I was being stereotyped. Other people who looked a little like me, actually had done harm to someone they personally knew, which led them to perceive me as a potential threat. When visiting Canada, a nation that never knew legalized slavery, I meet people whose ancestors were part of the African diaspora, and none of them fear me as a potential whip cracker…the terror never happened there.

    What’s happening with interventional pain management, is that patients are being compelled by force, to accept treatment choices that are unacceptable. Outsiders who don’t realize that this process is inherently violent, have trouble wrapping their minds around the concept.

    Just as Martin Luther King taught Black Americans to speak out about the everyday violence that was Jim Crow, and America gradually learned the truth of it, pain patients need to give their pain a voice, so that the violence of compulsory surgery can be ended.

  4. Mark ibsen at 8:35 am

    Violence:
    I have heard many upset people who have been dropped or under treated by members of ASIPP.

    They offer invasive procedures.
    They claim to be Pain specialists.
    But
    When the procedures ceased
    They refused to take a palliative approach, released the patient or fired them.

    People get upset when they are
    Lied to
    Abandoned
    Betrayed
    Lied about

    I have been severely threatened by violence and violent acts have been taken against me. Not by patients, but by the state Board of medical examiners and Vague threats from agents from various federal agencies.
    My apprehension is off the scale, and I have stop seeing pain patients for the most part.

    Interestingly, my practice also veered toward the poor and the “criminal”. In my state it is not allowed for patients on probation or parole to use medical marijuana they are hooked into the opiate merry-go-round.
    I also discovered too late to save my business, that pain causes poverty. The poor can only afford what they are minimal insurance will cover and that is opiates

  5. Sandy Auriene Sullivan at 8:33 am

    Female Chronic Pain patients are also at risk. I was sexually assaulted by a doctor’s staff member who was his step son. They *knew* he was a problem. It happened in front of my 4 yr old daughter. [exposing self, inappropriately touching me during exam etc!]

    I ran from the office [well not a sprint….] my daughter still remembers that part and the staff chasing me to my car. I reported it to my regular doctor [this was for an exam my reg doc wrote my scripts] then I was carried off in *CUFFS* as that office said they gave me a script and I was a drug seeker!

    Oh hell no. Cooperated with police as I knew I hadn’t filled anything but only to a point. They had me in the car for 4hrs; without arresting me. Just yelling at me and telling me I was a liar. Fed up after they searched for that prescription they never found filled I told them “either you release me now or arrest me and I want a lawyer” [in most cases one shouldn’t say anything else to the police]

    When my lawyer wanted my file from that day they never sent it over. When I went to physically get it with a family member [no way going alone] I magically was NEVER a PATIENT!! He’s still open and I’m still so afraid to go into any doctors office alone.

    My old doc didn’t protect me and in fact allowed the other doctor to get away with it. My current doc for 5 years hasn’t always been an easy one but at least I feel SAFE with him.

    Women please, take a trusted person with you to appointments! Men too it helps to have support.

  6. Scott michaels at 1:01 pm

    Alnother farce article. Detroit is the capital of violence. Banks robbed, pharmacies robbed etc. These are criminals.
    These are not actual chronic pain patients causing this harm.
    In 99.9 of the country this does not happen. More bs amunition toake us look like addicted criminals

  7. brenda myers at 8:02 pm

    well I totally understand why patients who need help and recieve a load of bull instead get angry-we are already on the verge-pain has us on a ledge and many many many chronic pain patients will commit suicide because of the withdraw of needed pain medications. I have never acted on it-but when I went to multiple MD’s trying to get REAL help-I felt like taking a baseball bat and smashing their spine then asking if they wanted a pain pill. This so called drug war is punishing innocent people. We are hurt and angry and on our last legs.

  8. dfwmom at 2:15 pm

    You can’t have it both ways. If you want to enjoy the protected status of a neutral medical service provider who is an advocate for the patient, then the care provider must remain politically neutral and advocate for the patient. Care providers who allow themselves to be placed in the role of enforcer of government drug policy, allying themselves with the government against the patient, lose their protected status in the eyes of patients. You are viewed as a soldier in the Drug War, fighting with the government, against the patients — and, so, the patients fight back, against you.

    If the medical community wants to retain their traditional protected status in society, they must fight to regain their political independence. If the medical community insists on acting as the policing arm of an authoritarian government, then this is what your future as a medicla care provider looks like — becoming the target for all of the rage that such authoritarianism engenders in the population.

  9. Jake at 1:56 pm

    And on the other side of the fence, doctors who continue to use things like epidural steroid injections, myelograms, spinal taps, etc with reckless abandon injure their patients on a daily basis and those patients often don’t even know the risks of things like Epidural Fibrosis, Adhesive Arachnoiditis, Meningitis, etc prior to having these procedures done (even though the doctors know that in many cases the relief provided by such things are extremely short, will need to be repeated, and can provoke reactions even when administered correctly).

    I’d love to have seen more investigation into the patients that made threats to find out if they’d been the subject of one of these complications. However my guess is -most- of the patients making threats are desperate for relief either for pain or addictions.

    Our current system, which forces patients to see YET ANOTHER doctor for long-term pain management (and often rejects them even when they have severe problems) rather than allowing our primary specialists like neurologists, orthopedists, physiatrists, etc to treat our pain, and forces people in many states to jump through hoops like having to hand-carry a prescription every 30 days … which is a huge burden for people who are often in enough pain that they are bed-ridden much of their time … is at least partially at fault for adding pressure on already pressured patients.

    I’m NOT condoning violence or even threats against physicians in any form. However I do think this article is yet another reinforcement of the bias building against pain patients who are being constantly locked down by a system that believes it can fix addiction issues tightening the screws on an already over-managed system instead of trying to work on the problems of addiction and over-prescription with methods that are proven to work in other countries.

  10. Heather Jacoby at 1:32 pm

    As a chronic pain patient, I am sad to hear this. Very sad to hear!

    Many of us would never conceive of threatening our doctors or nurses or staff. Some of us have been frustrated.

    I wrote a letter when I was frustrated. I chose to avoid focusing on how upset I was, but try to state what happened and let them know how I was doing after I received adequate treatment (which I believe at the time was mobic, flexeril, trazodone and physical therapy). It was later years when the doctor prescribed ultram 50mg (I take it 2-3 times a day — often only in the morning to help reduce my pain for bathing, dressing, etc. and once in the evening so that I sleep better). I also have arthritis in my neck, feet, knees, hips and other joints so the tramadol gives me a much improved quality of life.

    The letter I wrote explained that I had been diagnosed by fibromyalgia by a rhuematologist who failed to tell me of my diagnosis. It explained that I saw that my primary care doctor was notified and she failed to inform me of my diagnosis as well. I explained that I was diagnosed by an out-of-town doctor after a car accident and that that doctor was familiar with my mother’s medical history. I said that an earlier diagnosis would have led to expedited treatment. I truthfully said that my employment had been impacted by the delayed diagnosis. I explained what my treatment was and that I was doing very well.

    I wrote this letter because the doctor had been pushing anti-depressants on me and telling me I was “just depressed.” She asked me if I was done with my “little list” that I brought with me (because I was having cognitive issues and needed help remembering!) and then she shut the door to the exam room and left while I was mid-sentence. I wrote it because I was pretty certain that the doctor was angry and wrote that I was DEPRESSED in my chart and NONCOMPLIANT or something of the sort (maybe not as professional as that) and I wanted something added to my chart to explain the situation and my eventual diagnosis.

    That’s how I reacted when in truth I was very, very hurt. I’d felt abandoned and fearful that I’d lose my job. NOTHING justifies threatening a doctor or their staff. NOTHING. Seek a family advocate, write a CALM letter… Dear God… do NOT threaten another human being! So very sad!

  11. BL at 12:33 pm

    This is a disgrace ! I certainly hope that these patients are arrested and either successfully complete addiction treatment or have to serve jail time. This is another reason why the cost to see some pain drs is so much higher than with other specialties.