Re: Effective Therapies for Pain Control

[Guest guest]

Steve, All,

This comes from over thirty years in medicine and unfortunately perceptions that

are not appropriate but still exist. Just like having tattoos, long hair, and

other " types " that might be treated worse because of the verbiage they use.

I kid I am the over fifty, fat, and whiney patient perception you hear those

young beautiful girls behind the counter that talk about patients so loud the

patients can hear

That is one of my pet peeves and I actually will say " Do you know we can hear

you and that it violates HIPAA laws and they might want to talk about the

patient in private behind closed doors "

I have learned the drug seekers as they call them back and the patients run out

pissed so to speak and I heard the receptionist say, Her pharmacy records have

red flags all over them.

Now, I don't know if anyone asked this but one of the reason I speak of the

subject I said and have done research is my previous doctor (who passed away

bless his heart) was one of the few path blazer along with Dr. Forest Tenent,

author of Pain Management and Survival Guide for the Intractable Pain Patient,

and they advocated for their patient to have high doses of pain medication if

needed (like you Steve) and he was the one that gave me the actiq and fentora,

but he also made his patients keep a pain dairy and functional assessment and

turn in every month.

He spoke before the DEA Drug Enforcement Agency and

http://www.opiophobia.blogspot.com/, and

http://doctordeluca.com/wordpress/category/pain-crisis-pub-health/opiophobia-chi\

lling-effect

Washington state restrictions were fought by another non profit he guidelines,

which apply only to treatment of chronic pain, not acute pain, cancer pain or

hospice care, recommend a total daily dose of opioids should not exceed 120

milligrams of morphine or its equivalent if both pain and physical function are

not improving.

Reynolds said such guidelines do not take into account the needs of individuals

and make doctors afraid to give larger doses when necessary.

D. , a Eugene, Ore., attorney representing Dr. Merle Janes, a

board-certified pain specialist, and a (class action) group of Washington

residents being treated for pain, compared the prescription guidelines to

setting a limit on how much insulin a diabetic could be prescribed.

Although the guidelines apply only to Washington state, they have been used by

insurance companies, prisons, worker’s compensation boards and other agencies

all over the country as a starting point for their own rules, said,

claiming that Washington’s guidelines have become defacto regulations across the

nation.

The Guidelines (not law NOR factual) were stated with milligram limits much less

than the manufacturers stated patients could have. Morphine 120 mg even in a

timed dose over a 24 hour period, and these guidelines are ONLY directed at

chronic pain patients.

Knowing the difference is essential, if you have pain 24/7 you have INTRACTABLE

pain and getting this placed in your medical records is essential so that if

some time during your medical history, dispensing of a medication depends on

this and you have chronic pain, you will not get it.

http://orthopedics.about.com/od/medicate/p/medications.htm has some good small

definitions of pain medications

http://www.mdjunction.com/forums/chronic-pain-discussions/general-support/32755-\

what-is-acute-chronc-and-intractable-pain discusses acute ,chronic, intractable.

I went ahead and copied and pasted this as most people will not click and read

them.

Dennis (1978) suggests that acute pain is normally associated with a well

defined cause (such as a burned finger or ruptured appendix), typically has a

characteristic time course and goes away after the person has healed. This type

of pain may be slight and last a minute such as a wasp sting, or it may be

severe and last for weeks or months such as a burn.

Chronic pain is a pain state where there is persistent pain lasting a minimum

off6 months and usually the cause of the pain cannot be removed, found or

otherwise treated.

Black (1973) suggests that the most important distinction between acute and

chronic pain is that the pain is no longer serving as a warning signal but has

become and end unto itself and that the patient suffering from chronic pains

lifestyle has been significantly altered due to the disorder. Chronic pain

lingers beyond the “normal” time of healing,. It not only causes physical pain

and tissue damage, but also places severe emotional, functional, social and

spiritual stresses on the individual who is suffering. Although the pain may

have started as acute pain, other types of pain often develop slowly, making

this type of pain difficult to treat. Chronic pain can also result from diseases

such as shingles or diabetes, from trauma surgery or without a specific known

injury or disease.

Chronic pain ranges in severity from mild to disabling and can be felt daily 7

days a week for 24 hours daily or can be experienced intermittently with times

when the pain is not perceived. This type of pain is no longer valuable and used

as a warning to indicate harm or potential danger to the body. Usually the whole

person suffers. Intractable pain is a more severe form of chronic pain. It is

extremely different from acute pain but differs slightly from chronic pain. The

definition of chronic pain does not take into account treatments already

attempted, those that have helped or failed or even the prognosis for the person

suffering.

Intractable pain is pain which is extremely severe in nature, unremitting,

incurable and of such severity that it dominates virtually every conscious

moment, produces psychological and physical debilitation and may produce such

depression in the individual that they may wish to end their lives for the

purpose of extinguishing the pain. Intractable pain is considered to be

extremely severe, unremitting, and to date no cure can be found to relieve the

pain problem.

The mechanics that cause chronic or intractable pain are very complex. There

usually is tissue damage or a disease process, which causes chemicals such as

serotonin, histamine, bradykin and prostaglandin to be released in the human

body. These chemicals cause the nerves to become more sensitive to pain. As time

progresses a chemical called substance P is released from the peripheral nerve

endings. This substance carries pain signals. The more substance P that the

nerves release, the more sensitive the person becomes to pain.

There are numerous medical conditions, which commonly cause chronic or

intractable pain. Some of these conditions are: arachnoiditis, back injuries,

failed back surgeries, migraine

headaches, fibromyalgia, adhesions and scarring from previous surgeries,

rheumatoid arthritis,osteoarthritis, cancer, systemic lupus erythematosus,

reflex sympathetic dystrophy, myofascial

pain, spinal stenosis, referred pain, neuropathic pain, endometriosis,

interstitial cystitis, irritable bowel syndrome, neck pain, carpal tunnel

syndrome, etc.

After my records were reviewed by this doctor I saw, I was given a card that

stated I was certified with intractable pain and he had his name on it to call

him 24/7 with any questions such as if I had to go to the ER for meds or in a

wreck and told them my pain amounts.

The reason I am so animate about this as if we do not advocate for ourselves, we

will indeed be told what dosage we can have. Each state has Pain Dosage Laws and

you should read yours.

Also there is the http://www.ampainsoc.org/advocacy/monitor/ National Pain Act

that the American Pain Foundation did a tremendous amount of work in getting

passed along with others . What can you do? Just signing their petition and

joining their site for e newsletters as they send out Community pain letters

each month also.

Here is an exert about the founder:

An Interview with M. Fishman, M.D., Chairman and President, American Pain

Foundation

Editors’ Note

Dr. Fishman is Chief of the Division of Pain Medicine and Professor of

Anesthesiology and Pain Medicine at the University of California, . He was

formerly Medical Director of the Massachusetts General Hospital Pain Center at

Harvard Medical School. His medical degree is from the University of

Massachusetts Medical School. His formal clinical training is in Internal

Medicine and Psychiatry. He completed Pain Medicine fellowship training through

the Department of Anesthesia and Critical Care at Massachusetts General

Hospital. Fishman has received board certification in Internal Medicine,

Psychiatry, Pain Medicine, and Palliative Medicine. He is Senior Editor of the

journal Pain Medicine and has authored The War on Pain, Listening to Pain, and

Responsible Opioid Prescribing, and edited Bonica’s Management of Pain and

Essentials of Pain Medicine. Fishman is President and Chairman of the Board for

the American Pain Foundation. He was recently ranked by U.S. News & World Report

as one of the “Top Doctors” in America.

Organization Brief

The American Pain Foundation (www.painfoundation.org; APF) is an independent

nonprofit 501©3 organization that serves people affected by pain. Founded in

1997, APF speaks out for people living with pain, caregivers, health care

providers, and allied organizations, working together to dismantle the barriers

that impede access to quality pain care for all.

What is the role of the American Pain Foundation and the key areas you’re

focused on?

DR Fischer answers:

The American Pain Foundation was formed to ensure that the consumer’s voice was

represented in the growing movement to resolve the serious public health problem

of undertreated pain in America.

It was formed during the early days of recognizing this serious problem with the

vision that consumers would play a substantial role in the effort to fight their

pain and that an organization supporting those consumers could help greatly in

turning the tide on undertreated pain in America.

Is there an effective understanding of how significant the problem of

undertreated pain is?

The problem of undertreated pain is well established. Members of the APF Board

of Directors were part of the recent congressionally-mandated IOM review of Pain

in America that reported 116 million Americans are in chronic pain. That is more

than the number of people who have diabetes, cancer, and heart disease combined.

This is estimated to cost $635 billion dollars each year, which substantially

contributes to excessive health care costs.

THIS IS IMPORTANT POINT DOCTORS SHOULD HAVE TO DO A MANTRA EVERY DAY * MY

VIEW

Pain is the most common reason a patient goes to a doctor and surprisingly it’s

barely covered in medical schools – doctors are not adequately trained to

evaluate and treat it. We’re dealing with a scourge of pain-related drug use in

America that, at least in part, is underscored by poor education of doctors on

this subject.

It also reflects that our medical institutions have become a cure-focused force

for increasing quantity of life, but we haven’t done nearly as well in improving

quality of life.

In my Nursing course they had a woman come in as a volunteer for Doctors to exam

that had painful tumors all over the body and most would not touch her because

of the inability to know how to acess pain. Pain and nutrition are given a week,

how many doctors ask us about our diet or exam us every time for spasm ? It has

been found that anti inflammatory diets decrease pain and my doctor gave me a

list and there are many anti inflammatory food lists along with the research.

Check this out.

How many of our Doctors exam us when we go or just let us draw on the paper body

and circle some pain descriptions ? Point made. Also, insurance companies pay

on this part of an examination and when I audited charts I had to take that

money back from the doctor as they were charging for maximum amount of visit

which has to include vital signs and specific length of time and doctors need to

know this is a federal offense if they don't. I was auditing military charts and

the memoradum that doctors have with the military insurance Tricare requires

this and the doctor agrees to accept the amount of charge they receive but many

doctors try to get you sign a form that you will pay above what your insurance

allows. This is illegal as they already have signed a memorandum in place they

accept the insurance charge.

I am so sorry this is long but as I said please take the time even when you do

not feel like it to check out the few sites I found easy to read and helpful and

others know of some.

The American Pain Foundation (Publication Section has a pain dairy-journal

called Target notebook, pain patient bill of rights, resources, etc. Manned by

Physician Assistants, Nurses

and will help you with locator) PainTopics.org (Resource section has over two

hundred links about specific pain conditions, pain information).Dr Forest

Tenants Survival Guide for Intractable Pain Patients (he also authors Pain

Management Journal, another article on hormones is interesting,

http://www.prescription2000.com/Interview-Transcripts/2010-07-07-forest-tennant-\

pain-hormones-_transcript.html *Dr. Forest Tenent has changed his guides name

and it can be downloaded at paintopics. org The Intractable Pain Patient's

Handbook for Survival.

I also love adding for kids at the end of a subject I am researching and I get

readable subject. http://faculty.washington.edu/chudler/pain.html

is a great site for neuroscience which includes pain, pain gate theory,what

causes pain, the brain, functions of the brain, and parts of the brain.

Fun site with great illustrations.

All the moderators here have made sure there is an archive of searchable

subjects and many members have contributed to them and the arachnotitis

information helped me to present factual and peer reveiwed information. Spine

Universe and Spine Health are good sites but remember the contributors may be

anethesothesologists that only believe in one way so make sure you search both

sides of the subject.

Hope you are better and got my personal, run-on e-mail with interesting make

your own actiq at compounding pharmacy : ) Bennie