Bedford Ramblings
Steve Mills

What is the real reason for the crack down on pain medicine?

Posted Saturday, July 22, 2017, at 3:34 PM
View 17 comments
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    Steve, the reason for the crackdown is because the government can't stick to building roads and protecting the border. Instead of following the idea of " don't just do something, stand there", they follow the idea of "don't just stand there, do something". Then when the rule of unintended consequences kicks in, they do something more and make things worse. Years ago the government thru the Joint Commission for Accreditation of Hospitals decided people were not getting adequate treatment for pain. They made up the 10 point pain scale and called it the 5th vital sign. I'm certainly not saying anything about you, but it didn't take people long to learn to play that game. People with a sprained ankle, sore throat, or hangnail soon started saying that was a 10/10 pain. Many while smiling and playing or talking on their phone. Actually some claim a 20 or100. Truly tho, a 10 could legitimately be used if you had a bone sticking out or just landed on your back on concrete after falling from the roof. And since it is the patient that decides what their pain level is and the customer is always right, more and more narcotics were prescribed. Naturally, more and more people began to abuse them and become addicted. Then along comes obama and he ties reimbursement to patient satisfaction and that adds fuel to the fire. Now there is an epidemic of deaths from "accidental" overdose on legal and illegal narcotics. So here comes the government again to fix the problem they caused. I don't see much hope for improvement until the pendulum starts back the other way in several years. What really needs to happen is get the government out of healthcare. Completely. But that won't happen. Next best would be to get them to just deal with the finances and leave the medical decision making to the patient and provider. That won't happen either, but if enough people get ticked off enough about this, we could get a fresh batch of legislators in office and at least make it better.

    -- Posted by fair share on Mon, Jul 24, 2017, at 8:35 AM
  • Curious about this fair share "reimbursement to patient satisfaction" What is meant by that?

    Also, what do you think will start the pendulum back the other way"?

    Do you know the stats on overdoses from prescription pain medicine compared to illegal?

    Having a prescription for pain meds has not made me want to "buy off the street" and with regular blood tests, office visits and STRICT refill policies by the pharmacies,I am not sure how I could cheat.

    Yes, I could take my whole prescription at the beginning of the month (maybe) and commit suicide, but that would not be unintentional or an accident. Suicide should not be counted as a reason to restrict everyone.

    I made sure to ask my doctor about addiction. He assured me that at my levels and with his monitoring, he would not let me get addicted.

    If I was getting meds from "another" source because I had become addicted, those blood tests would show an unusual level in my system. With the controls they have on the drugs now, it would take a smart thief or very lax policing to let someone get rich off prescription meds.

    I believe it is the illegal or "dark web" network that is creating the problem. Put the emphasis there instead of pressuring doctors to not help those with pain.

    -- Posted by stevemills on Mon, Jul 24, 2017, at 1:28 PM
  • By the way, I am not taking your thoughts personally. I appreciate the dialog.

    -- Posted by stevemills on Mon, Jul 24, 2017, at 1:29 PM
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    Most hospitals and doctors get a significant portion of their payments from the government thru Medicare and Medicaid. The feds (Medicare) set standards then the states (Medicaid) and insurance companies tag along. Buried in the Unaffordable Care Act is a change in the way payments are calculated. Historically they paid a set amount for various codes of procedures, diagnoses, and other encounters. Now they plug patient satisfaction scores into a formula along with other "quality measures" to come up with what they pay. Therefore, those with lower patient satisfaction scores get less for doing the same thing than those with more satisfied patients. That added to the pressure to prescribe more pain meds. But it came along around the same time the overdose problem started making the news. Now the government is pressuring the medical community to cut back on narcotics. Seems to me the guvment is schizophrenic. Or multiple personality.

    I think the pendulum will start back the other way when too many people have to suffer due to lack of decent treatment and the ones that make the rules realize adequate, appropriate treatment of chronic pain is a whole different thing than drug addiction.

    Sorry, I don't know the stats. They are probably on the CDC website. A lot of legal drugs are used illegally. Some people obtain them fraudulently then sell them on the street.

    I agree that it's the illegal/dark web use that is the problem. I also agree intentional or unintentional death from OD isn't a legitimate reason to restrict appropriate use.

    Now for my opinion about pain clinics. Some are good, some aren't. Some are anesthesiologists that seem to just want to do nerve blocks. If you happen to have a nerve that needs blocked they would be fine. But the multidisciplinary pain clinics tend to get the best results. If they can figure out the cause of the pain they may be able to cure or control it with less or no narcotics.

    -- Posted by fair share on Tue, Jul 25, 2017, at 2:00 AM
  • I agree about pain clinics. In searching for one I keep coming up with vague specialties or spine and neck.

    I may not be a doctor but have been in this body long enough to have very strong opinions about what my pain is NOT. I've had spinal and neck oriented pain and this is not it.

    Already had neck surgery for injury to several vertebrae. The doctor was surprised I was walking but this was not causing the pain for which I was seeking relief.

    Possibly the Vanderbilt clinic is what I seek but I was less than pleased with their results and even more displeased with their accessibility. I've expressed that several times so I suppose I am the "pain" in the relationship for them . ;-)

    Finding a legitimate pain clinic and finding one closer than Nashville is now MY pain and I would bet that I am Far from being alone in this. All because a few non-medical people want to "feel"'good about "doing something"?

    -- Posted by stevemills on Tue, Jul 25, 2017, at 7:02 AM
  • It's not just pain killers....most normal age pains like osteoarthritis or wear and tear pain like knees, back and shoulders, can be eased with natural remedies these days. I for one would use Hemp oil without the euphoria effects called CBD if it didn't test positive for marijuana usage which in turn risk cancelling my insurance! As long as a doctor can get you back in the office your billable, whither it's for med refills or follow ups. Doctors are in the business to make money like any profession, so some (not all) become number processers. Have you ever gone to an appointment with 4 others in your same time slot? When I experience that I stop going!

    A large amount of pain clinics popped up when it was discovered there was a lot of money in centralizing and processing people all day! Not to mention it also takes the risk away from regular GP's from getting investigated.

    Most pain clinic doctors that I have encountered are anesthesiologist that specialize in back injections and sports medicine. I can't blame them for centralizing narcotics all to one spot or office, I'm sure it helps to also have all addicts documented and under controlled watch! It saves lives, so there are good and bad points to it I guess, but this is just my opinion!

    It takes a longer search these days to find a good doctor, one that's hands on so to speak! I went through a few that were scared to cut a body tag off without referring you to a dermatologist. I'm sure a few malpractice suits probably made doctors kinda skittish to be too hands on, but I have been to several that would not even listen to your heart or ask you how you feel....they expected you to just tell them what you wanted and definitely mentioned "I'll need to see you in a month"!

    For those that have to deal with chronic pain constantly in their lives it can be a nightmare just trying to hang on to what is working for pain relief. The patient is the one that now has to follow up on everything from making sure the correct prior authorizations are in, calling the insurance company time after time to cover it etc., all the while feeling like they have been driven over by a steamroller.

    Like anything, a few bad actors have made it very difficult for those who seriously need the help and abide by the rules!

    Since legalizing marijuana in some states, they have now seen drug overdoses decrease and science has found CBD usage helps with pain and many illnesses like nausea from chemo in cancer and epilepsy. CBD's are legal with zero THC content and are available at Walmart these days, but that's a whole discussion by itself! However, I have known many people that get relief from pain by smoking or ingesting pot, I will not be one of them until the law catches up with the need and it becomes legal. I try to be a stickler for doing it the right way I reckon! But, I can't say I haven't been tempted! As it stands now, one can't even risk testing positive for even CBD's, if they are prescribed certain meds!

    -- Posted by chefgrape on Tue, Jul 25, 2017, at 9:13 AM
  • I don't mind if we get off topic a little since I would like to know more about the CBD product. I quickly searched and found too much information. :-/

    Do you know anyone using it and what for what they use it? My pain is not centralized but all over so I am pretty sure I would need to ingest it not use it topically.

    There seems to be several versions of ingested product but all varying in CBD from 10% up to 38% but does processing really improve it. Does a person start out at 10% and go up as they are trying to determine the right product or....?

    I have not found a good site yet that is not selling, so if you know an unbiased source, I would love to read it.

    You know my email so if you feel more comfortable that way, please don't hesitate.

    -- Posted by stevemills on Tue, Jul 25, 2017, at 10:40 AM
  • Amazon has the largest selection, I was told to start with the drops, quality is a factor as well! There are two processes of extracting, chemical and infusion, you don't want the chemical extracted type. Start with 1000mg at first then to what ever milligram your comfortable with. There are several review sites that tell you which companies have been rated the best and most effective. If I remember correctly one that had the gold label brand was top rated. Just wish I could use them but for now I can't so oh well!

    -- Posted by chefgrape on Tue, Jul 25, 2017, at 6:09 PM
  • If I do, I'll let you know how it goes. Gotta see what the cost is first.

    -- Posted by stevemills on Tue, Jul 25, 2017, at 7:48 PM
  • Initially had come to the paper to check on the problems posted about muslims.

    But in viewing this about crack downs about pain relief, felt I needed to respond.

    My experience involves C-3,-4,-5,-6,7-and repeat of -5 that was stuck and pulled away dura matter and exposed the cord. These were individual surgeries from 1989 through 2004. The one where the cord was exposed had repair a month later where the plate was removed, the fusion chisled out, artificial matter placed over the cord for protection, re-fused, re-plated and closed....with a stroke occurring. I have also had operations on my elbow, appendix, throat-cyst, and have many other painful conditions...torn tendons, large bakers cysts, lupus, RA,, multiple falls. At any rate, I had gotten to the point that I would simply lie in the bed in fetal position trying to find a comfortable position to sleep.

    Heard of a pain clinic in Memphis through my pharmacist. His brother was one of the doctors. Called to make an appointment. He was out of town, but his partner had an appointment that was available . Had my husband take me. This other doctor and I hit it off right away. He listened, he examined, he reviewed MRI's, x-rays, all medical papers available. He then worked out a plan for me which included Lortab as well as anti-seizures which augment. I could have 4 Lortab a day and had the ability to have 2 Dilaudid a day if the Lortab was insufficient. This was 12 years ago. I take a Lortab at supper. If I have fallen, I might take one more. I think in this dozen years, I have had a total of 3 Dilaudid.

    I do not have an "opiod dependency" as this targets PAIN. I am fortunate to have a day where my "pain level" is below a "7", but it is tolerable. Now, if there is a fresh injury, an ACUTE pain, then that changes the situation and oh my.

    I do not wish my pain upon any other soul.

    Now I find I have ruptured discs in my thoracic spine which causes even more pain. But they do not occlude the cord and are not in the operative stage yet. But the pain from that is much more than I have had in years. Now I have to up something. My doc has ordered Marinol, but the battle with the insurance has begun.

    Tennessee, get on the ball and legalize medical marijuana. It is a natural plant. The side effects are not anything compared to man made pills. I do not wish to be a cripple. This now with my torn Achilles is about to do me in. My mind refuses to allow. I may be 66. But I have a special need 16 year old son who needs an active mom.

    -- Posted by Oxirish on Wed, Jul 26, 2017, at 2:39 PM
  • I started hurting just reading this Oxirish. Yeowch!

    I would love to try medical marijuana. Tried the other back in the 60's and don't have a need for the recreational kind.

    I had to visit my doctor every other month and get a physical/paper prescription every month so you do have a good doctor if he was able to circumnavigate that crap.

    -- Posted by stevemills on Wed, Jul 26, 2017, at 3:07 PM
  • That is a lot to deal with Oxirish....I had to stop a career that I dearly loved which hurts almost as bad as I do some days! I guess I'm just lucky to be alive and manageable still! I literally hate being captivated or slave to anything! I'm sure most would agree, but I would rather be working 24/7 like I was and feeling good about being productive out in the world! When you have illness it gets much more complicated just trying to maintain!

    One thing marijuana can help with is withdraws from opioids when your trying to wean yourself off so much, to keep from increasing the dosage. That's the problem with pain meds, you have to balance what your taking somewhat or you find yourself with no or little relief and needing stronger doses.

    Tennessee is behind on legalization and I'm sure there are many that disagree, but as Steve stated it's not necessarily the euphoric effects like in the 60's, (for me the late 70's) that one would want it's just relief of any kind.

    I never cared much for being stoned back then and even more so now! It takes a whole brain to deal with myself these days and others as far as that goes, but I do know what pot is and how it makes you feel, so in my opinion only, I do think the benefits for some outweigh having to deal with pain meds. If it was legal and it helped I can't say that I would not try it over any pain med. I know of personal accounts of many friends who are finding relief from the CBD's alone without the high.

    I watched a documentary just the other night about a rehab that is using concentrated amounts of oil to ease the symptoms of withdraw from heroine and meth addicts. It is a successful program because most rehabs use other opioids like methadone to wean one off such things which kind of defeats the purpose of "cold turkey", so they were saying. It actually reacts with the natural THC in the body to control sicknesses, pain, and mental withdraw agony.

    I also think there is still a lot to be studied about it all and there are a lot that would totally disagree with any part of it. I was one of the bad kids back in the day I reckon, well until age set in and I had to at least act sain! Science and trail and error will show us soon enough, but so far there is some help it has for those who choose!

    I think I recall reading an article about what's before state legislatures recently and if I'm not mistaken legalization is being considered this year! There are definitely some pushing for it however, like everything else we will be the last, we do good just to get potholes fixed on the roads as it is!

    -- Posted by chefgrape on Thu, Jul 27, 2017, at 4:47 PM
  • I have some questions about the crackdown,does it deal with the meth problem?Are people selling said painkillers on the street?I am just curious about the situation at hand.

    -- Posted by beau maverick on Sat, Jul 29, 2017, at 8:31 PM
  • I have not heard it connected to Meth but if it is being sold illegally, Would bet meth is being sold by similar folk.

    -- Posted by stevemills on Sat, Jul 29, 2017, at 11:22 PM
  • I know a person at work who got busted selling pain medication on the streets.

    -- Posted by beau maverick on Sun, Jul 30, 2017, at 8:29 PM
  • As much as it costs legally, I presume the pain Med was made illegally? Either that or people pay a high price I. The street.

    I could barely afford it with insurance so off the street would keep me an honest citizen.

    I've weaned myself, not that that part of it was tough. Now everyone has to live with my moans and groans.

    Barely got around this weekend but pushed it since we had family in town. I can't wait to see how bad it will be tomorrow. No, come to think of it, I can wait. :-(

    -- Posted by stevemills on Sun, Jul 30, 2017, at 9:36 PM
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