|Year : 2014 | Volume
| Issue : 1 | Page : 1-2
Second opinion pain clinic
R Gurumoorthi1, G Das2
1 Consultant Pain Physician, Dr. Gurus Pain and Palliative Care, Kauvery Pain Clinic, Trichy, DARADIA - The Pain Clinic, Kolkata, West Bengal, India
2 Editor, Indian Journal of Pain, Ex-Chairman: World Institute of Pain Section (India), Kolkata, West Bengal, India
|Date of Web Publication||15-Mar-2014|
Consultant Pain Physician, Kauvery Pain Clinic, No: 1, K.C Road, Tennur, Trichy - 620 017, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gurumoorthi R, Das G. Second opinion pain clinic. Indian J Pain 2014;28:1-2
Prevalence of chronic painful conditions is on increasing trend in India and is more prevalent among the low and middle class people, who comprise the majority of population. With increased awareness and availability of adequate training centers on pain management, skilled and qualified pain practitioners are available in almost all cities. With fast growing information technology and awareness among general people, more single disciplinary practice mode and availability of pain physicians, it is not uncommon to see patient or physician seeking advice from another physician, which is termed as second opinion pain practice and the clinic is termed as second opinion pain clinic.
A second opinion is a visit to a physician other than the one a patient has previously been seeing in order to get more information or to hear a differing point of view. Second opinion may be initiated either by the patient or doctor or sometimes by insurance bodies. In an online survey,  regarding second opinion for medical problems, around 29% of the patients sought second opinion. Among these, 50% of the patients sought second opinion to get much information as possible, 38% of the patients thought that the diagnosis was very serious, 34% of the patients were not confident about the initial diagnosis, in 34% of the patients, the doctor who made the initial diagnosis suggested a second opinion, 24% of the patients were in search of several treatment options to choose from, 16% of the patients did not trust the doctor who made the initial diagnosis, 13% of the patients thought that the initial diagnosis was confusing, 10% of the patients as health insurance required a second opinion and 9% of the patients due to some other reason. Though the survey was done for all medical problems, it may be applicable for pain problems. Even the percentage of people seeking second opinion may be higher due to the complexity in etiology for pain and the need for multidisciplinary pain management.
Now it is time to think whether second opinion has impact on treatment and care. Survey  had showed that 54% of second opinions had confirmed the initial diagnosis and recommended treatment and in 46% cases second opinion was different. Among the differences in second opinion, 30% of the patients had different treatment or care from what it would have been without the second opinion and 16% of the patients had same treatment and care even though opinion was different. There was no study to say whether that different second opinion and treatment can cure or palliate in comparison to primary treatment. With no clear criteria for second opinion, following questions are faced by practicing pain physicians, Why, when and where to refer?
Why to refer
Getting a second opinion will help the patient and physician to know more about the disease, treatment options and increases confidence in primary management.
When to refer
It is better to get second opinion whenever the present line of management is not working out, complex pain source is suspected, line of management is expensive for patient and they request for another type of management, line of management is beyond the scope of primary clinic and there is no better understanding between patient and physician.
Where to refer
It is better to refer the patient to physician who is more expertise and experienced in that case scenario and have facilities to manage it. Nowadays online facilities are available for second opinion, which can be more cost effective.
Though second opinion has more advantages, it also has some disadvantages. This can increase the cost of care, drug seeking behavior, medical shopping, delays treatment, and misunderstanding between the primary physician and patient and sometime with second physician. Though there is no explicit study-based evidence to discuss regarding second opinion pain clinic and practice, it is the experience of primary pain physician in due time which helps in utilizing this option 'second opinion pain clinic and practice'.
Though interventional pain management is part of pain management, concept of second opinion can be viewed in a different angle. Interventional pain procedures had some procedure related complications than conservative management,  but less when compared to surgical complications. Despite the reports, the published rate of complications in interventional pain procedures is often 1% or less, but the source of that information appears anecdotal.  Over the last several years, the number of interventional procedures performed has risen dramatically, as the number of malpractice claims. , As these procedures have complications and medicolegal issues, these procedures which are selected should be evidence based and optimal for each patient. This can be achieved by either on years of experience or having second opinion  with fellow colleagues who have more experience in managing that painful condition. This can be done online or by direct consultation, latter one is better preferred.
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