Editor’s Note: Gary Snook lives in Lolo, Montana and is 100% disabled with lumbar adhesive arachnoiditis. He used to own a specialty contracting business that worked on commercial construction.
We are amazed at the sheer ignorance of uncaring and uninformed health care providers who have never experienced intractable, unrelenting, 24/7 pain: Pain that shatters your life, steals your career sometimes along with spouses and family, pain that definitely alters, if not destroys hopes and dreams – and tragically for some who could no longer cope with the magnitude of loss and unimaginable pain – chose to end their very lives. The uninformed public often heaps all pain patients into one giant category, for which they are not qualified to assess.
Many intractable pain conditions do not respond to rehabilitation or further intervention. How can the general public, or even some uncaring physicians, possibly judge patients when there are limited tools to measure pain?
We continue to be amazed by ignorance which includes medical professionals. The foundational problem is that the methods to evaluate and measure pain are lacking, and the 1 to 10 pain scale rating (and smiley face pain scale) needs to be replaced with methods that are more meaningful, another discussion in itself.
The Institute of Medicine estimates that 100 million Americans are dealing with chronic pain, and we think it is time that pain is given federal and state resources as this is affecting families, communities – and the Nation.
The overwhelming majority of pain patients are NOT addicts/abusers. Instead, many are legitimate chronic pain patients “dependent” on medication, which is much different than addiction.
However, due to government bureaucracy intervening to weed out the small percentage of true addicts and abusers, serious harm is being done. As a result, we have a lack of reasonable approaches leaving chronic/intractable pain patients misunderstood and shunned. Practitioners who treat pain patients should focus on the ethical treatment of their patients, but unfortunately, treating pain patients without billing for procedures does not pay out too well.
Both patients and honorable doctors alike are operating in a constant state of fear and panic as patients fear for their lives, and physicians fear losing their licenses or being shut down by the DEA.
The distinguished Dr. Lynn Webster, Past President for the American Academy of Pain Medicine, writes in his article entitled, “DEA Inflicts Harm On Chronic Pain Patients”, “Controlling the abuse and overuse of pain killing drugs is necessary to keep patients safe, but the importance of decreasing drug abuse does not outweigh the needs of millions of people who suffer from chronic and depleting pain.”
Who’s ultimately suffering? Over 100 million chronic pain patients! In the meantime, many interventional pain physicians (IPPs) have capitalized on this windfall opportunity by utilizing every means available to take advantage of the current system of chaos and fear. Many IPPs have successfully used their political influence to lobby Congress as well as bring about higher reimbursements for their procedures from Medicare/Medicaid (CMS), while implementing lucrative “alternative treatments” all under the guise of “treating the chronic pain patient”.
Courageous and compassionate doctors, like Dr. Mark Ibsen of Helena, expose themselves to more scrutiny as they continue to treat discarded pain patients who have been abandoned by their own doctors, especially “pain” physicians, many who often seek maximum reimbursement.
One study published in the Journal of Neurosurgery: Spine found the costs per patient for each Spinal Cord Stimulator (SCS) to be $32,882 under Medicare and $57,896 under Blue Cross Blue Shield, with annual maintenance per patient of $5,071- $21,390, depending on whether complications are present, which is often the case.
The “standard of care” for the treatment of pain is often established by CMS/Medicare reimbursement schedules, and currently there are over 9 million epidural steroid injections (ESI’s) administered each year and they typically cost approximately $2000 per injection. Federal Work Comp will usually pay top dollar around $2000 to $2500 per injection. When combined with SCSs, intrathecal pain pumps, and other procedures, interventional pain has become a lucrative multi-billion dollar industry capitalizing on desperate people.
Pain patients need to understand that interventional pain societies are powerful lobby organizations. They have influenced high levels of government (FDA, CMS) and manipulated the practice of medicine and the “standard of care” without appropriate clinical trials and studies founded on improper data collection and irresponsible, inaccurate analyses. To make matters worse, the adverse event reporting system with the FDA is broken.
What is the more unethical treatment? The doctor who comes up with multiple thousands of dollars in testing, invasive procedures and excessive, unreliable urine drug screens? In addition to holding their pain patients hostage after mandating that they sign a “contract” for treatment that stipulates they must agree to abide by ALL treatment recommendations or else be potentially dismissed from care for non-compliance when they question, ask for a second doctors opinion or have misgivings about a dangerous and or expensive procedure like an epidural steroid injection, pain pump or TENS unit that has been “recommended” as a part of their treatment plan? Or is it the local doctor who reasonably discusses treatment plans, goals and options with his/her patient based on what’s appropriate and affordable, guided by each patient’s specific disease or injury, financial situation, and actual concerns?
“To ensure patients have access to their necessary medicine”… In our experience, what is happening instead is a complete paradigm shift in treating the chronic pain patient that says in many IPPs clinics: no pain medicine if it is an opioid; We’ve decided FOR YOU that our “alternative treatments” are the best available options, regardless of whether they are affordable, have been proven effective, or are even safe – and lastly, regardless of whether they go against the “Gold Standard” treatment template for the last three decades by the World Health Organization (WHO).
As one of the foremost respected pain practitioners in our country having treated pain patients for over forty years, consulted for the FDA & DEA, Dr. Forest Tennant, MD, DrPH, writes in a recent article, “Editor’s Memo: The WHO Pain Treatment 3-Step Ladder Still The Gold Standard for Pain Management”… “To me, one development that has obscured good pain treatment perhaps more than anything else is the wide-scale promulgation of opioid treatment guidelines, laws, and regulations”….”The WHO 3-step ladder remains the pain treatment standard. It is not a specific opioid guideline but a template that provides a practical roadmap for pain treatment. Its essence has endured, simply because it makes practical, clinical sense, and provides effective, humanitarian care…” “A key element to the WHO 3-step ladder is that opioids are to be added to, not substituted for, an existing regimen of non-opioid pharmacologic agents and adjuvants.”
In this new era of pain management, the chronic pain patient has no rights in many states, and now it appears they have no recourse against discrimination. The DEA, FDA and CMS are influencing opioid prescribing, not based on decades of proven medicine. Pain patients are now subjected to coercion and abuse by “pain” physicians which results in increased pain, additional injuries from invasive procedures, mental anguish, and financial hardship. The Voice of the chronic pain patient continues to be misunderstood and misrepresented.