Montana Doctor Sounds the Alarm

Montana Doctor Sounds the Alarm

A new patient named Vicky came to see me. She was pretty desperate. She had fallen down a flight of stairs a month ago, breaking her collarbone, several ribs and her pelvis.

Prior to falling, she was in chronic pain from degenerative disc disease and fibromyalgia. She has multiple other medical problems. Vicky spent three weeks in the hospital and a week in a nursing home after this fall. When she was discharged she was referred to a pain management doctor in our town.

Health Care ChallengeGiven that Vicky was on a large amount of pain medications prior to the fall, it was a bit surprising to me that the she was given a low dose fentanyl patch and no medication for breakthrough pain.

Within 10 days she appeared in my clinic in agony. Her previous provider had retired right around the time of the fall, so it seemed to make sense to the hospital doctors that Vicky should be referred to pain management.

Based on the amount of medication she was on prior to her fall, the fractures and surgical repair of her clavicle — one can tell that she would fail on the low dose patch she was given.

When I prescribed a narcotic pain pill for her to take for breakthrough pain, her pharmacist immediately told her she would be fired from the pain doctor’s practice. Apparently they communicate quite closely.

This patient had such high complexity and I’m so overwhelmed by an influx of patients in similar circumstances that I told Vicky I could not manage her pain since she already has a pain doctor. She was tearful and disappointed, but she tried to go back to that pain doctor and indeed she had been fired. So she returned to me. She was quite concerned what she should do next. I told her I would do my best to help, and I called her pain doctor.

Here’s how it went:

“Hello Doctor, this is Dr. Ibsen and I’m taking care of Vicky a patient who was recently in the hospital. I’m sure you’re familiar with her. She’s in a lot of pain and it seems like her pain is more acute and chronic. I’m wondering if you would take her back at a higher pain medication dose since the medication she was on was not covering her pain?”

“No.”

“If I work very hard to stabilize her pain and got her on an actual stabilized pain regime, would you be willing to take her back then?”

“Probably not. She violated her pain contract. She has a long history of narcotic use. (Her previous doctor) was giving her 224 tablets a month of hydrocodone, which in my mind is inappropriate.”

“So you saw her once and determined what her pain needs might be based on your own formula and since she did not follow that she’s now fired?”

“That’s right.”

That’s it, that’s how the conversation went. A lady with multiple complex medical and physical problems is referred to a doctor to manage her pain. He sees her once and then fires her.

Words cannot fully describe how embarrassed I am to be colleagues with someone who could treat a patient in pain so callously and heartlessly.

What has happened to this honored profession I have been a member of since 1980?

I must admit I’ve been pretty depressed lately about the prospect of going to work seeing patient after patient with high complexity chronic pain issues coming to see me because their doctor has dropped them. Well, just for today, my depression is better — only because my anger and outrage are off the charts.

I don’t know what to do. I don’t know who can help me or these patients, but it sure seems like an epidemic in my world. If I was seeing 50 influenza patients a week it would be an epidemic and it would be newsworthy. If I was seeing 50 cases of gonorrhea a week it would be kept secret of course, especially since the legislature is in town. But given that these 50 pain patients I see each week don’t have a “communicable disease” the state epidemiology lab cannot help me. My state medical society has been pretty slow in taking this issue on.

I’m kind of at my wits end. I’ve tried to interest local and national news outlets. I don’t really know what can be done to create the response to this ongoing tragedy that I feel is required. Perhaps the same kind of infomercial shown in the early morning about starving African babies could be shown about Americans being tortured.

Harm is being done. Great harm to vulnerable people who have a difficult time advocating for themselves due to the severity of their pain and the disempowering nature of their circumstances.

I guess all I can do is keep sounding the alarm.

Dr. Mark Ibsen

Dr. Mark Ibsen

Editor’s note: Mark Ibsen, MD, is the owner of an Urgent Care Plus clinic in Helena, Montana. In a previous column, Dr. Ibsen wrote about the many pain patients he was seeing who were unable to find doctors willing to treat them.

Dr. Ibsen is currently being prosecuted by the Montana Board of Medical Examiners for over-prescribing narcotic pain medications and keeping substandard medical records. A decision by the board on whether to revoke his medical license is expected soon.

The information in this column is not intended to be considered as professional medical advice, diagnosis or treatment. Only your doctor can do that!  It is for informational purposes only and represents the author’s personal experiences and opinions alone. It does not inherently or expressly reflect the views, opinions and/or positions of National Pain Report or Microcast Media.

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Authored by: Dr. Mark Ibsen

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I think what needs to be done is to give the people in Montana, and the entire country an outlet to “tell” their stories related to pain. The families of people who have committed suicide, the people suffering due to being “fired” or refused pain medication, everything related to pain. If there is an email address for an appropriate agency to get these stories out I think it would help tremendously. Pain is a very “lonely” condition”. Only those who are there know how debilitating it can be!! We need to do this immediately!! Anyone with ideas please post!!

Sophie

Why is it only the narcotics that ring alarm bells when patients become dependent? I have had bouts of depression where the antidepressants caused as much, if not more, problems both while taking them and when discontinuing them, than any narcotic I’ve ever taken. I have chronic pain relieved, in part, and caused, in part, by neurosurgery. The hydrocodone makes me a little aphasic, so I asked to try neurontin. Holy moly. That was even worse. I asked to try tramadol, but found that even though it SEEMS like it doesn’t interfere with thinking, it’s much worse than the hydrocodone in that regard. Taking small amounts of this narcotic, along with PT and exercise, makes it possible to live a productive life. I think to the narco-busters, narcotic pain relief is the “nail” to their “just say no” hammer.

Sandy

In response to:
Dave Edmisotn, M.D. says:
January 24, 2015 at 5:23 pm

Doctor Edmisotn, fantastic that you are able to go to the homes of patients and help be more comprehensive about increasing quality of life. If my doctor could come into my home and talk with my family and my parents [they live in another state] they would hear praise and the only concern, I’m not quite managed as well as we’d all prefer. [tolerance. 8yrs same dose.]

I am able to remain on a fairly stable dose of opiates simply due to MMJ once a day. Towards the end of the day the neuropathic pain is quite severe and despite that gabapentin helps to a large degree [it also helps me maintain a better sleep schedule!] the addition of a very small amount of MJ really helps neuropathy 90% completely regardless of the root cause. [if only that was my only trouble!]

My elderly parents who have neuropathy pain from issues completely different to my own both have expressed a desire to ‘see if it helps them’ neither are smokers and they do not at this time live in a medical state.

If it wasn’t for family they would be on their own dealing with the black market.

Thankfully, we are a close family that tries to avoid negative and judgemental stereotypes. I suggested to local family to help them make edibles and/or obtain a vaporized method.

[both parents will avoid pain tablets at all cost and are adverse to prescription medications for personal reasons; despite being in complete support of my opiate therapy. They see the difference in me for the better]

Sandy

JJ said ” Can you take them and just stop and live a normal life I am guessing no. Not because of the pain as much as the dependency to not have pain or the addiction of feeling better than the natural or normal good regardless of the pain level on or off the meds.”

Let me make an attempt at explaining dependency v addiction [without going into I’m not going to rob someone to obtain them]

IF by some miracle, all my issues were cured tomorrow. No I couldn’t stop and lead a normal life. I would have to do so with medical supervision and like thousands of other medications [that are not narcotics!] you should never stop them suddenly because your body will have a negative reaction.

However, I am quite confident that once weaned off slowly and remember that magical cure is in the equation too – I would then be able to lead a happy ‘normal’ life without them. First the cure, then stopping with medical supervision. Yes. I would be thrilled to be able to do just that too.

Sandy

BL

I understand exactly what you are saying but you seemed to have really missed my comment “@Sandy says:
January 23, 2015 at 12:28 pm”

I was facing possible surgery. My CP doctor is also my primary care. [he’s a specialist first]. He is a stickler for protocol. As stated in that comment.
He said *post surgical pain medications could be prescribed by either him or the surgeon* But here’s the *key* to that statement, my doctor would be aware of it and *they* would communicate and decide who prescribed me what/when and how. I even notified my pharmacy of the possibility of post surgical scripts in the near future, while I was already in there.
I believe very much that my specialists, pharmacist and primary [who is my CP doc too] are my ‘TEAM’ and that everyone needs to know what is going on and be in communication.
My reference to the ER was in a situation where I couldn’t communicate that I am a CPP. Although, my family certainly would if I couldn’t and here in Florida it would pop up as my doctor does use the database as does my pharmacy. I am blessed to have a team working for me.

Oh and my doctor has stated many times, I can go to another pharmacy if unable to obtain my medications at the one listed on the contract as long as obtaining them from another pharmacy was done on ‘good faith’ [not scamming the system!]
Thanks. Hope that clarifies what I had said.

LouisVA

Terri Anderson,

Very well written piece on Dr. Tennant you wrote on January 24, 2015 at 7:49 am. He is my doctor, as well, and has literally saved my life. I also have the CYP gene and am a poor metabolizer so he simply titrated me to a point where I am comfortable. An ultra-high-dose but I’ve not had to ask for an increase in almost 5 years and am having the highest quality of life right now at age 65 than in my entire adult life.

Nice POST !!!Thank you for sharing with us .

Coonhound

Hello friends. Despite its frequency lately it was still hard to read the conversation between Dr Ibsen and Vicky’s PM doctor. While this doctor’s position seems extreme it is by no means uncommon. This is but one of many ‘reasons/excuses’ why many doctors dismiss patients like ‘Vicky’ or keep them and just dismiss their complaints regarding reported symptoms of pain. I wanted to find out why there are so many NARCOTIC refugees out there and why they cannot find help. (A whole other thread could be dedicated to those poor souls who are either newly diagnosed (w/out a regular pharmacy or physician),those relocating/moving to another state/region, or those w/ medical conditions that the science of medicine cannot fully ‘prove’ w/ all their infinite knowledge, [fibromyalgia]. Many forget that it wasn’t too long ago that many recognized diseases like lupus, RA, etc were unknown and untreated, and lumped together as ‘rheumatism’ Were the patients or their disease(s) any less ‘real’ then? I particularly feel empathy for those poor souls who are still seeking or have just received a diagnosis. I can’t imagine having to start off w/ new doctors and pharmacies as many simply won’t take new patients w/ pain ‘issues’ now. Some docs don’t want to be burdened by all the extra paperwork, monitoring and the hassles (hoops) now required for patients to receive NARCOTICS. W/out hiring extra office workers and adding another PA or NP most doctors would only be able to see a fraction of the patients they do now. (Add 8-10 extra appts for each CPP minimum each year, just to receive hydrocodone). A nurse told me that the SMALL practice she worked at needed to hire another office worker just to keep up w/ all the paperwork and phone calls dealing w/ insurance approvals/exceptions and scheduled medications. Scrutiny, fear, hassle of dealing w/ extra work involved, less patients being seen equaling less income, etc were all reasons I expected to find when I started searching. We get the patient’s perspective here at NPR and on many other fine advocacy blogs like pharmacisteve’s and Dr Fudins paindr.com . We also hear alot from the pharmacist’s perspective.BUT what of the doctors and THEIR ideas on how to ‘deal w/’ their patients, new or long time patients, in this climate of fear, lying, misinformation, labeling, and scapegoating. What I found surprised me. A lot of the problem was a general lack of concern for their patient’s well being. Some even mocked them. Notice in the poster’s question he asked how to refuse those suffering from WELL DOCUMENTED diseases known to cause pain!!! I wanted to share a thread w/ everyone here who follows these topics on NPR as a typical example of may doctor’s and their current attitudes. It’s about a physician, fresh out of residency, just getting started w/ his practice as a PCP and his concerns w/ his patients w/ chronic non-cancer pain. It is rather startling. May wish to view on an empty stomach or have… Read more »

BL

The percentage of chronic pain patients that become addicted to their pain meds is very, very low. As has been said by others here, dependency and addiction are not the same thing.

Lori

Thanks for speaking out as this is really a horrible situation that these pain clinics follow. The worst in my mind is that it’s not mandatory to do genetic testing of the P450 enzymes. It wasn’t until I did this that it was finally revealed why I didn’t feel help from pain meds. Now we know which ones by body can or can’t metabolize. Go to genelex.com it’s where my test was done. Pain suffers demand it!

LouisVA

JJ said on January 25, 2015 at 3:25 pm

“My comment was not to imply or judge. However, the statement has been made about dependency vs addiction. . . I guess what I’m getting at here is just because you aren’t stealing or killing for medications that you need more of that are not prescribed or are prescribed doesn’t mean your not an addict or that you are. That’s the hard part only the patient knows for sure. You know if your an addict or have a dependency.. . Why because I’ve seen people completely destroy everything good in there life over pain pills. Ok. Does that happen to everyone that takes them of course not. Are there numbers on this subject? Im sure there is and I willing to bet that the % of shitty decisions comes from addiction not dependancy. However based on what I’ve read here dependancy just means that you didn’t do something bad to obtain them? . . . Can you take them and just stop and live a normal life I am guessing no. Not because of the pain as much as the dependency to not have pain or the addiction of feeling better than the natural or normal good regardless of the pain level on or off the meds.”

JJ, I do not think you yet understand the difference between dependency vs. addiction. Allow me to restate that addiction is a loss of control where one lives and breathes for their next fix. These are the folks that you see with ruined lives. Dependency is simply a biological phenomenon where if a person suddenly quits without slowly weaning off of the meds, they will experience withdrawals. I once went off of my meds by weaning and I had no discomfort except for the return of terrible pain. You seem to imply that everyone that uses pain meds must feel GREAT and that is not the case. I have NEVER experienced any euphoria from pain meds – only relief. I have not been in excruciating pain for about 5 years and I am 65 years old. Can you imagine being in that kind of pain, day after day, 24 hours a day, seven days a week, when there is an alternative? These medications have given me my life back and I would be willing to bet that if you met me, you would have no idea that I even take them. They allow me to be productive and participate in a social life.

Kerry

JJ, you are right, this is so controversial. You hit the nail on the head when you said it seems to be all about money. What doctors do not know is say after a certain amount of neurological procedures and surgeries, how has it irreversibly changed a patient to where they have to live out their remaining life here on earth taking pain medicine? We know that the brain can change back and forth but what happens when nerves have been damaged due to all of the surgeries? Then it becomes a case of managing pain.

This too gets a money thing because if they could screen a person and find out they will not do well from the surgery and it would only create more pain, then you would think Dr.s would refrain from the surgery. But no, they continue to find things out that they confidently tell you will take away the pain and it makes it worse.

As well, studies are proving more and more that the mind has some tools to help in managing pain, but do you think Dr.s are going to help in this kind of healing? NO! We need a national pain patient bill of rights where we as patients are not subjected to the kinds of things that dehumanize us, pain contracts that bind us to the care of a doctor only if it is meeting their needs, and more extensive testing to understand how opiod use affects each person to prevent some of the dependency and addiction that happens. It is such a complicated issue for each individual and sadly no one has our backs.

JJ

My comment was not to imply or judge. However, the statement has been made about dependency vs addiction. I have been addicted to let’s say nicotine. But since I didn’t rob my grandmother for her cigarettes. You would say that I had a dependency to nicotine. I guess what I’m getting at here is just because you aren’t stealing or killing for medications that you need more of that are not prescribed or are prescribed doesn’t mean your not an addict or that you are. That’s the hard part only the patient knows for sure. You know if your an addict or have a dependency. So I’m the bias guy? Why because I’ve seen people completely destroy everything good in there life over pain pills. Ok. Does that happen to everyone that takes them of course not. Are there numbers on this subject? Im sure there is and I willing to bet that the % of shitty decisions comes from addiction not dependancy. However based on what I’ve read here dependancy just means that you didn’t do something bad to obtain them? My point was that certain drugs at certain doses for certain amounts of time almost guarantee one or both of these conditions. Can you take them and just stop and live a normal life I am guessing no. Not because of the pain as much as the dependency to not have pain or the addiction of feeling better than the natural or normal good regardless of the pain level on or off the meds. I get it this is the most controversial subject in the universe. Here is the thing. People are people. If you need help you should be able to get help. Drs, the government, patients, everyone involved has to be on the same page or nothing will save us. Chemicals are killing the people. They are more than just pain pill related chemicals too. It’s bigger than pain addiction/ dependency. It’s really about $$$$$$$ everyone’s getting paid on every aspect of this process. So how can we judge what I just wrote. You see it goes on and on and on. Bottom line there needs to be a better program period. It’s consumed the people. I am not sure I see a way back.

LouisVA

JJ said on January 24, 2015 at 3:41 pm:

“let me get this straight. If you are injured and are in pain there are medications to mask pain until you heal. Most would say correct here. However if you are injured and the pain is never healed and only a pain mask is available to you for the rest of your life, then the obvious occurs. A dependency. Now quality of life is the issue here. Unfortunately more medication is needed to continue to mask the pain.”

Hi JJ,
Many chronic pain conditions are un-curable at this point in time; thus, controlling symptoms is the only thing that can be done. I am 65 years old and have had chronic pain for over 40 years. For the last five years I’ve been on opioid therapy and as a consequence, I’m experiencing the highest quality of life I’ve ever had. In addition, I am on the exact same dose that I started on. Dependence is often confused with addiction and they are NOT THE SAME. Dependence means that if I suddenly stopped my meds, I would have withdrawals; whereas, addiction is a loss of control where a person’s life revolves around getting the next fix. Dependence occurs with many medications such as anti-depressants, heart meds, and blood pressure meds just to name a few, yet no one would suggest these patients should get off of their meds. Please look objectively at this issue and do not judge until you have walked a mile in my shoes. Pain patients are victims of bias and attitudes such as yours is what fuels this bias.

Pen Morrison

It seems that many doctors are brushing cases off too quickly. Every person’s pain situation is different, and needs to be evaluated carefully. People hooked on pain meds who don’t have pain have made it very difficult for people who do indeed need the medication who the pain meds were made for. Slow down, and look at each person’s situation before judgement is passed.

Kimmie in hell

He violated her HUMAN RIGHTS.

T Hanson

I suffer from cronic pain and had been to 6 Dr before I was referred to Dr Ibsen by a friend. He was the only one that believed in me and didn’t treat me as if I was a drug seeker. He treated me like I was a person and had so much compassion. If it weren’t for Dr Ibsen I don’t know or think I could handle the pain I would endure everyday. Thank you Dr Ibsen for taking care of so many people that these horrible Dr’s turn away on a daily basis!

Kimmie in hell

I went through 4 neuros not helping me. I finally found a good one and after 4-5 months of awful progressive symptoms, my left side has lost function. 3 possibilities of what’s going on..tumors, MS, or I had small strokes with TN pain..NO ONE HEARD MY CRIES nor would they treat me…until now. After fighting so hard I found a neuro. Only because I refused to give up. EEG and cat scan in the next couple weeks. Seizures..I told I was lying..I’m in the middle of a medical nightmare. I pity you for being in your profession Dr.Ibsen. Death of patients is now acceptable to incompetent, uncaring, cold hearted drs. I begged, I pleaded….I was told I had “Somataform” disorder. It’s in my chart. So is severe neuropathy, Sjögren’s syndrome, numbness, now loss of function on much of left side. One neuro literally yelled at me before I said anything he was not giving me pain meds. I didn’t want any. I was in the middle of a TN attack. He walked out of my appointment I literally sat there stunned and could barely get out of the office. I collapsed right outside. No care if I lived or died. Gross failure to dx. There is very little healthcare anymore. Yes, I have BCBS.

Dave Edmisotn, M.D.

For the last 21 months, I have been blessed with the opportunity to come into the homes of mostly senior citizens, interview them, and try to make their lives better medically, psychologically, socially, and spiritually. 

Ninety minutes ago, I was in the home of John, who is 63 y/o and who is in severe pain 24 hours a day. He can only sleep 2 hours a night, is constantly up and walking around, can not rest – because of his excruciating back pain… 

He has seen the Pain Specialist in Lexington and is currently receiving a Fentanyl patch + heavy duty opiate narcotics. His pain is constant… His pain is severe… His pain is preventing him from being part of life and being part of a wonderful marriage.

I spoke with John and his wife about additional narcotics, a stronger pain patch, and even hypnosis to reduce the pain. 

I also told them that I have personally interviewed more than thirty persons in significant pain who have had tremendous pain relief from a medication that is not addicting, has no significant side effects, and is NOT a gateway drug in the 24 states that have recognized the value of medical marijuana.

Their pain relief has ranged form significant to complete. There have been no problems. To my knowledge, none of the injured coal miners, 85 y/o women, or young women with terminal cancer have expressed a desire to try ‘hard drugs’.

The pain relief has allowed them to live their lives in a normal way – to interact with others, attend church, share laughs, and love others and their spouse in the way God wants all of us to do.

The pain relief has changed their lives forever…

House Bill 3 introduced in Kentucky by House Speaker Greg Stumbo would allow physicians to prescribe medical marijuana for 21 conditions. It could be consumed as a liquid, pill, or vapor “where combustion of the cannabis does not occur.”

It can not be smoked… And it would be tracked through the Kentucky prescription drug electronic reporting system. 

If you are a true Christian who is following God’s Word to help others, please open up your mind, remove possible prejudices, and let tens of thousands of fellow Kentuckians live a few moments without debilitating pain…

– Dave Edmiston M.D.

Judi

Dr. Stowers how gracious and generous to offer your support to Dr. Ibsen, may others follow.

Well said JJ! Well said!!!

Kerry

JJ, for the most part you are right. Say for example, you end up having 21 surgeries and procedures and none of it stops the pain like I have. Xrays, MRI’s, CT scans, all say that I have issues that is making this pain what it is. But everytime surgery is done or a procedure, it doesn’t work. So I continue to live in pain.

Now granted, there are some things that I do that lowers my pain pill consumption but I still need it. The thing that angers so many of us is that we have no one, accept for the few that are in the boat with Dr. Ibsen, the very few, who are willing to spend time with us and use anything necessary to help with our pain. Very very few doctors are given any type of education or classes on the use of opiods so they or we do not fully understand what is going.

Some of us do become addicts. An addict is someone that does anything to get pain medication. Most of us however do not and we become dependent because outside of legal opiods, the only other thing that can help in terms of a substance, is alcohol or illegal drugs. We are not treated as a patient. We are herded in and out, told what we will take, nor is there time spent really evaluating our individual systems for how the medicine will affect us. And if we have a day of breakthrough pain, pain that breaks through the pain treatment we have and we need something else, we are screwed!

So much is unknown and until more research is done, this is what is happening to us. I pray that you will never have to deal with chronic pain and struggle with how in the world you can survive each day, to love, to live, to dream because there are a lot of us out there that do. Too many as a matter of fact.

Its getting very hard for a chronic pain sufferer to get real help.

Gary

If a doctor will not prescribe opiates to pain patients he has no business practicing medicine. If he does not see the need to offer help to someone in pain like this young woman who developed adhesive arachnoiditis after a botched epidural steroid injection he should be run out of town.
:https://www.youtube.com/watch?v=mwcKwsI5pNo

“Why does Montana lead the nation in invasive spinal procedures even though they are so dangerous”
http://www.dartmouthatlas.org/downloads/reports/Spine_Surgery_2006.pdf
Could it be because some are in such terrible pain that they will accept even the worst odds for a chance to feel better ……if their doctor is even telling them what the risks are. ( If they won’t prescribe opiates just makes me wonder )
And then when they end up like the young woman above with no doctor who will treat their pain?
Well……..That is one reason why Montana also leads the nation in suicides as well
Thank you Dr Ibsen for for putting the patients well being ahead or your own. You are the kind of doctor I respect and will go to.

JJ

let me get this straight. If you are injured and are in pain there are medications to mask pain untill you heal. Most would say correct here. However if you are injured and the pain is never healed and only a pain mask is available to you for the rest of your life, then the obvious occurs. A dependency. Now quality of life is the issue here. Unfortunately more medication is needed to continue to mask the pain. So your telling me that because of a systematic approach to try and heal and or comfort one based on medicine ultimately over a period of time doctors with different opinions on what is or isn’t enough or too much etc can decide the quality of life in an individual with the stroke of a pen. How is this ok. I pray to God that I never get physically hurt to the point that a dr can turn me into an addict and then kick me to the curb to suffer in pain without medications. Now I understand that there are all kinds of different variations of how this happens or why it happens. Thing is if there is an agency hunting down the physicians that are trying to clean up the mess from another physician. I say to that agency are you chasing down the right dr? Shouldn’t there be a better monitoring plan of pain in the beginning of this terrible process they call medicine. It just makes me sick.

BL

Dr.Ibsen, did you get a copy of Vicky’s medical records from her previous physician, the hospital and the nursing home ?

Ariela Marshall

Dr. Ibsen:

Keep Sounding The Alarm. Keep on being that voice for people in Chronic Pain. Keep staying true to your Hippocratic Oath of “Doing No Harm” and Keep being a Stand for “The Healing Beings When They Walk Thru The Door”. You are an inspiration and a Gift to those who live in the Helena Area and beyond that seek you out to address what other Physicians are not willing to. Thank you.

David Marshall

Yet another shining example of following the guidelines when the guidelines, not the patients, are what are really in trouble. If you go by the book and you still fail, is it possible that the book is wrong?

This blog has, before this reply, 18 responses. What a great start! But who is seeing these responses- how do we know if any decision makers are seeing responses to these blogs? Is it possible to send these blogs and these replies to our legislators?

Has any pain doctor ever treated any legislators in pain, and have any pharmacists ever refused to fill prescriptions for legislators?

Ryan Lankford

Thank you for doing G-d’s work, Dr. Ibsen.

kevin

thanks dr Ibsen for taking a stand for the chronic pain patients there needs to be more doctors like you that would actually care about their patients i wonder if the people fighting against pain management how they would feel if they broke their back and were given anti depressants for the pain i bet their opinion would change very quickly

LouisVA

BL says:

“I can understand drs having guidelines, especially with this type of medication. I can also understand one dr not wanting another dr to decide the meds that they are to prescribe to or a patient. When a dr is dealing with prescribing pain meds, their entire livelyhood is on the line. The dr that continued to do the prescribing would be the one at risk not the one who recommended it.”

I do understand your point of view and I also abide by the contract I had to sign; however, I find many of the contracts to be an invasion of personal privacy, and demeaning to the patient. When I view a contract, I feel that the doctor does not trust me and it creates a situation where I, once again, feel victimized.

Ken "Rosy" Rosenbaum

I have had chronic back pain that progressed over 35 years following a helicopter crash in Vietnam, 1970. The continuous exposure to vertical vibrations as a career pilot resulted in a medical retirement in 2004. Since then I have been prescribed two 5mg hydrocodone daily. I am responsibly sticking to my doctors advise. This pain management works. I cannot function without these meds. They enable me to function and to put off probable back surgery. They do not erase all my pain but reduce the pain significantly. Certainly patients need to be honest reporting pain. And more importantly should not expect total pain relief. Every patients situation is unique that stints should not be subject to the restrictions of well meaning but sadly ignorant naysayers. The motivation of doctors everywhere must be left to the professional discretion of individual doctors. Government medical experts should limit their influence to reinforcing guidelines. They should not attack individual doctors prescription care for their patients. The courtroom attacks against a prominent Doctor Mark Ibsen are inflammatory and theatrical performances by individuals not open to constructive consideration of Dr. Ibsens response. Guilty until proven innocent. Being forced to defend under threat of tremendous career loss is a shame on our system. Across America and our growing within our self righteous government watchdogs is an attitude of “you don’t understand” to patients, “we (government) are the authority”. That’s really scary.

Terri Lewis PhD

Dr. Ibsen,
My son was visiting Montana last summer. He experiences chronic pain and depression as the result of 3 fusions, arachnoiditis and centralised pain syndrome. You saw him and talked with him about his options. Nobody has had this conversation with him in a way that placed him in charge of his decisions about treatment. He appreciated it.
As a rehabilitation practitioner who works with many injured persons, I completely understand your frustration. The problems the current system of care have generated have lessened our effectiveness and created a vast new system of injuries visited upon patients. Thank you for your concern and care.
Times have changed. We have to lead this change by getting out in front of it and transparently addressing the issues. I’d love to help you.

John C. Stowers, MD.

Mark, Thank you for pushing this important crisis to the forefront and providing a means for meaningful dialog. I have always admired your passion to use your education and talent to better the lives of others (even at the expense of your own). However the best quarterback (leader) on the field can not win a game along, he needs the support of a team. Clearly there has been an outpouring of support from your patients and I think its time to recruit the support of your medical colleagues. As a Montana physician and someone who admires and respects you I would like to offer my support and would be willing to help recruit others. Please consider adding me to your team and letting me help you recruit others. As one who has taken on challenges like this, I know how lonely and depressing it can be, and without the support of others you and your concerns will be marginalized and eventually discredited. As they say “No Good Deed Goes Unpunished”,,,,,,,,,,,,,,John C. Stowers, MD.

Terri Anderson

Dr. Forest Tennant is a leading expert on intractable pain conditions. He sponsored the California Pain Patients Bill of Rights and we urgently need a bill to protect chronic pain patients in Montana. Tennant has explained to me that physicians need to differentiate between centralized and peripheral pain conditions before they treat.

This article describes Tennant’s view on centralized pain:

http://www.hcplive.com/conferences/pain_week2012/Acceptance-of-the-Concept-of-Centralized-Pain-is-a-Game-changer-in-Diagnosis-and-Treatment-of-Chronic-Pain

He is appalled when interventional pain doctors coerce the wrong patients into more invasive procedures. Once patients have undergone trauma, surgeries, repeated epidural steroid injections, etc. then caution is advised when undergoing more invasive procedures because the risk is that relatively “simple” peripheral pain problems (such as radiating leg pain caused by a bulging or herniated lumbar disc) are likely to transform from peripheral, extremity pain to more complex pain problems which impact the entire central nervous system.

Interventional pain physicians are focused on pushing profitable epidural steroid injections, spinal cord stimulators, and pain pumps (esp., for failed back surgeries) — which can lead to these complex centralized pain conditions including Adhesive Arachnoiditis. Once permanently injured by these invasive procedures, the medical community has very limited options to treat these complex intractable pain conditions, except long term opioid therapy. The real problem is that procedures pay out too well, and now physicians such as Dr. Ibsen are up against the establishment – just like the chronic pain patients.

Interventional pain physicians who push procedures over opioid therapy are aligned with the DEA and the federal government in their views, which is basically a war on chronic pain patients and honest physicians who treat them with appropriate medications.

Western Montana (esp. Missoula) cranks out a high rate of spinal surgeries and epidural steroid injections when compared to other states. We lead the nation in suicides – and chronic pain is a major factor in this problem.

Interventional pain physicians have no tools to treat centralized pain. Instead, they coerce patients to undergo more invasive procedures instead of prescribing opioids. This is making Montana’s chronic pain problem much more complex:

http://missoulian.com/lifestyles/hometowns/ravalli-county-residents-take-epidural-warning-to-fda/article_b45c9d85-c265-5f16-a6b2-31adeb21f053.html

There is no steroid approved by the FDA for the epidural route of administration, and yet patients are never given this important fact to help them make better choices in the management of their pain.

We believe “interventional” pain physicians, along with the State Medical Board’s actions, are adding to Montana’s chronic pain and suicide problem:

http://www.sprc.org/sites/sprc.org/files/Preliminary%20Report%20from%20the%20Montana%20Suicide%20Mortality%20Review%20Team.pdf

The only viable option for treating patients who suffer trauma (including slips, trips and falls) – and central pain conditions – is to prescribe opioids.

Thank you Dr. Ibsen for staying the course and doing the right thing when the deck is stacked against you.

Mark Ibsen

BL:
The patient did not violate the pain contract.
THE PAIN CONTRACT VIOLATED HER.
Sorry I did not include the fact that she was refused a visit to the doctor.
Also, her case manager referred her to me, because she was in agony with no other options.
Having been hospitalized 3 weeks, her current pain medication requirements were available and ignored. The doctor she was referred to is a specialist in Physical Medicine and Rehabilitation.
“She violated her pain contract”
Maybe.
He violated his Hippocratic Oath. For sure.
And
The AMA code of ethics.
I have to find a way to video these poignant stories of abandonment

Kerry

Dr. BL, you are not seeing the forest for the trees. Here is the problem with what happened to Vicky and it all could have been taken care of by a simple conversation between the doctors and with Vicky. The doctor felt that he could arbitrarily break the “contract” over the actions of the patient.

This thing they call a “contract” is not a contract at all. It is a one way edict that says if we do not do what they say then we will forfeit our rights to see that doctor. That is not a contract by any means and it needs to be stopped. A contract is negotiated between two parties. One strike and you’re out is not a viable option for anyone and this has to be stopped!

The attitude by your profession needs to be changed. Go to school and learn how opiod usage affects people. Create a strategy to help individual patients deal with their chronic pain, CHRONIC PAIN! This is a disease and you all need to understand this!! Your attitudes found within your comments reflect the standard misunderstanding that is found within the medical community for we chronic pain patients!

ginbug

DR. Ibsen, Welcome to the chronic pain world where patients are “Suffering of Silence” (s.o.s)!
I am a patient advocate that also happens to be a life long chronic pain patient of 44yrs.! Your story is way too common as 1000’s of patients are being abused & tortured on a daily basis, by docs & pharms!
The only way to change this is for patients, docs, pharms, & any other people who are forced to watch their loved ones suffering a 24/7 nightmare of pain, to work together to spread awareness to this huge epidemic of HORROR!!
Here in fl. even if you are lucky enough to find a doc willing to treat you, it is almost impossible to find a pharm. to fill your rx for pain meds.! How many more hoops do they expect us to jump through? Enough is ENOUGH!!! It is obvious that no one w/ the power to change things is going to help & therefore we HAVE TO help ourselves by speaking up & DEMANDING that something is done!! In this day & age, NO ONE should SUFFER OF SILENCE!! PLEASE check out my in progress facebook page called criminally inpain where we can connect w/ others in hopes of organizing ideas to spread awareness & support, a place to get & share info & meet others that are going through the same thing! Please feel free to make suggestions about what else you would like to see on this page made by pain patients for pain patients & their loved ones!!!

BRENDA MYERS

I am in pain hell-my MD is afraid to increase my meds and I am in constant pain. The dose Im am on does not lower it enough. I am usually at a 7-9 on the pain scale. I have no life. I hurt too bad to even leave the home anymore. The DEA has scared the crap out of all the pain doctors. It has left many of us suffering-and thats wrong. I am considering suicide.

gordon brody

Give the acute and chronic pain patients their meds right now you azzhole dr’s and pain management clinics, where is the outrage when a child is raped, nowhere, where is the Outrage when an animal is being abused or murdered, nowhere, but yet you so called humans fixate on narcotics like insanely…none of you azzholes should have your medical degrees anymore……BUNCH OF SCUMBAGS !!! AND NO I AM NOT A PAIN PATIENT AT ALL, I AM JUST STICKING UP FOR THE ONES WHO ARE !!!

BL

Brenda Alice, do you have a revised statue reference for your state law that forbids your dr to prescribe pain meds for chronic pain ? I know many dr are choosing to not do it, but that is not the same as a state having a law on the books that says they can’t.

Sandy, when another dr wants to prescribe us pain meds, we contact our dr we have the contract with Before we accept a rx. Then the dr we have the contract with can tell us what to do or they can call the other dr and discuss it with them.

How sad.
Keep me posted.
I am going to ask for an epardermal shot next month.
Not spelled right.
Reta

BL

The majority of pain dr start you out in the lowest dose and go from there. If I understand it correctly, it appears that Vicky hadn’t been a patient of the pain management dr but maybe a few weeks. Nothing is said about her returning to the pain managment dr and explaining that the dose she is on isn’t sufficient. She did what she agreed not to do which is see another dr for pain. If I read this correctly, patients like Vicky are the reason we have to sign pain contracts and they are also the reason we have tigher restrictions.

Physicians have gone to school for many many yrs and have unbelieveable debt. Practicing medicine is the way they support their families. They can’t take a chance on lossing all of that because a patient doesn’t want to go by the rules if they are rxed pain meds.

Sandy, An ER dr may or may not tell a dr that their patient has sought treatment for their pain or that they received a rx for pain. But, the state Prescription Monitoring Program will have the info of any pain meds and certain other meds that have been prescribed. In most states dr are required to look patients up in the PMP before rxing pain meds.

Brenda Alice

Thank you again for helping another patient with chronic pain. It has to be a hard job because most people in pain aren’t all smiles while pain doctors everywhere have targets on their backs. I share some of the shame as a disabled R.N. with several chronic painful diseases. I could never believe that suffering and attitudes go together. Obviously this poor patient was under-medicated, the doctor judgemental and determined not to admit to being wrong. People are fortunate to find a caring doctor like you. My primary care is great but can’t prescribe narcotics because the state won’t let him do what he can to help. There is a great short clip by Ken Mckin on utube. I am so tired of being discriminated against. Blessings. Clip is persecution against the chronic ill.

Emily Ullrich

Dr. Isben,

I am a chronic pain sufferer and Ambassador to the US Pain Foundation. The world needs more doctors like you. Like your town, the state of Kentucky is in a crisis over chronic pain. We are treated like criminals by the community.and doctors, alike.cIt is a slap in the face, when you realize that if you don’t fight every day of you already incredibly difficult life, you will quickly be swept under the rug and left to die, because you are now seen as a worthless member of the community. Thank you for being one of the brave and compassionate few, who give us hope. Please don’t stop your good work. Your community is LUCKY to have you…whether you know it or not!

Kerry

I think BL doesn’t quite get it here. Why could the pain doctor and Dr. Ibsen work together instead of having such an extreme measure taken against the patient? This is the problem I have with it. Who has made the stipulations so rigid? The medical profession? The Feds?

And why did the pain doctor prescribe such a low amount of pain meds to help the patient? Was the pain doctor giving the highest dose possible to Vicky that he could? And why, if Vicky was being treated by a pain management practice, did they not bring her in immediately to help? See if something happens to me inbetween my scheduled pain management appointment, I have to go to the emergency room to get any kind of help.

And why? Herein lies the problem. It is the way we pain patients are being treated and we have not one advocate accept it seems Dr. Ibsen! Thank you Doc Ibsen!

Sandy

I should add that while we sign a contract stating we will not take medications from another doctor – no one explains to the patient “what to do when another doctor may have to prescribe medicine for you”

As I stated, I talked to my chronic pain doctor, my pharmacy all *before* any surgery.

I think that is one of the biggest hurdles, the right information is not getting to the patient. Sure they sign the contract but now they have acute pain from a break or fall or whatever life throws at you and what that patient should do.
What we have here is a failure to communicate. :/

Sandy

Yes, the contract we all sign requires us to only get our meds from one doctor. However, as mentioned in my other post, there are exceptions to it but you *must* let your CP doctor know. Root canal? Tell the doctor. I mean go in there if you have to.
With the exception of ER care, who tell your doctor anyway. I cannot stress enough how important it is to communicate any issues that could have another doctor prescribing a controlled substance on top of what your CP doc does. Usually, if your doctor knows before hand they don’t feel as if you’re gaming the system. Same with the pharmacy.

If only more doctors cared as much about the sick and hurting as much as you do. I’m so tired of suffering. Some doctors and pharmacists are just heartless anymore. And some doctors that actually do care, Carr more about what the pharmacy or the possibility of DEA harassment than they do managing their patients care. And unless a patient has cancer, no one thinks they’re in any real pain. Although cancer pain can pale in comparison to many painful medical conditions, like Cushing’s Disease for example, fibro it’s sometimes worse than cancer, burn victims, I could go on and on.

BL

I can understand drs having guidelines, especially with this type of medication. I can also understand one dr not wanting another dr to decide the meds that they are to prescribe to or a patient. When a dr is dealing with prescribing pain meds, their entire livelyhood is on the line. The dr that continued to do the prescribing would be the one at risk not the one who recommended it.

Pain contracts are meant to be gone by. If the patient signs the agreement the patient is stating that they agree to those terms in order to be prescribed pain meds by that dr. If the patient breaks the contract the patient is saying that they will do what they want to do without regard to what they have already agreed to. How can a dr trust a patient who does what they choose to do and not what they promised they would do ? There may have been a way for the patient to receive treatment and not be dismissed from their pain dr, or maybe not. But, by not valuing the rules the pain dr laid out and that the patient agreed to, they will never know.

Dr. Ibsen, I mean no disrespect by my reply. I’m just voicing a different opinion and view point.