At what point do you refer patients to see a pain specialist?

Great question. In these instances, where the patient comes in for palliative RT for painful bone mets, for example, I tend refer back to the 'involved' palliative care professional or the pain specialist.

In the last few years, I have rarely had to become involved with directly prescribing opiates these days. My practice has been to refer the patient back to the MD who prescribed their most recent dose of opiates, and let them together with the family, handle the matter. Even if they come in w/o a specific PAIN manager, I will consult the relevant specialist(s), when needed. I also tend to use more 400cGyx5 or 800cGyx1, a lot since these dosing schemes have been proven efficacious in clinical trials, even when compared to longer dose sche...