More & more I am becoming dismayed with Medscape and its journal of pharmacy and rheumatology. So many of these problems can be solved with dietary & nutrition changes. Even where drugs are required, what is recommended seldom exceeds what is still on patent & most profitable, and often it is the things least likely to help the patient. This is especially true in areas of pain care. Outside of neuropathy, antidepressants are not analgesics, and even in that application they are often quite poor.
I fear we are going to have yet another generation of doctor condemning patients to needless suffering, needless suppression & damage to their immune system with drugs that are extremely expensive, and seldom effective. Real answers to many of these problems are there, and even the research area is tainted by corporate funding ends - if Uncle Sam or the corporates can not make a profit (or hinder claims) with it, it just doesn't get funded, no matter how beneficial to the patient. The quackery in this field, as in the standard practice, has now reached levels that make even snake oil salesmen look good.
So many of the common causes of pain have real tangible physical causes, and real physical cures. Yet they are continuing to lump them into inappropriate DX's. Myofascial pain being one of the largest areas of curable pain and probably the most often misdiagnosed, but I have also seen several with lymph node drainage problems that can also be cured with simple physical therapy, and they have virtually no chance of getting a correct diagnoses from anyone outside of a very well informed oncologist. Someone they are very unlikely to see. Instead they will probably end up on high strength muscle relaxers risking long term heart damage, or worse, sent for a psychiatric referral and subject to the whole range of brain altering drugs they misuse in their arsenal. I would sooner recommend one see a voodoo practitioner than to subject someone like that to psychiatry.
I've spent enough time on both sides of the fence to realize this system is so broken that only making them liable for not treating pain will fix it. When you have the ability to help, and you fail to do it, and that failure is nearly guaranteed to lead to irreversible damage to the nervous system that the patient will suffer lifelong, you are responsible. You know it too.