04.21.09
Posted in Chronic Pain at 7:52 am by sra
Those who have chronic pain often have trouble explaining their pain .. especially the high flux of the intensity of their pain… to those who have “never been there”. Good days… bad days… low activity days.. high activity days… good weather days .. bad weather days… the pain is there - for sure .. but the intensity is - at best - unpredictable.
The hunger that we all have can be somewhat related to pain intensity. If a non-chronic pain person can visualize having to eat the same/fixed number of calories each and every day and they are REQUIRED to eat at a fixed time each time. Can they anticipate that their “hunger” will be satisfied EACH AND EVERY DAY… OF COURSE NOT!
Our “hunger” varies from day to day and various times during the day - and sometimes at night… just like the intensity of a chronic pain patient.
The same analogy could be applied to our need for water… being allowed to drink only a fixed amount at specific times… to satisfy one’s thirst. Some days, one’s thirst would be taken care of… but … others?
Our bodies are DEPENDENT on FOOD/WATER.. just like a chronic pain patient can be DEPENDENT on using opiates to help control their “out of control” pain.
Sure, some people will never “get it” and cannot associate the difference between our body’s dependence on food/water and other needs to adjust/compensate for biological functions that have went astray.
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04.05.09
Posted in Dealing with insurance at 9:31 pm by sra
I am hearing more and more from patients that their medication(s) and other procedures are being denied by their insurance companies. First of all the easiest - & cheapest - thing for an insurance company to do is say NO! For the cost of producing a form letter and maybe a postal stamp.. they have at least a 50%-50% chance of not having to pay the claim…
They know that at least 40% of the people will accept the NO… and either not take the medication(s) and/or pay for it out of pocket. Either way .. they can save MILLIONS with this low cost tactic.
The insurance company has no legal obligation to tell you that you have rights to appeal their decision… UNLESS you ask how you appeal the decision.Then they are obligated - by law - to provide you with the steps that are available to you. IF … they tell you that you have no rights to appeal .. ask them to produce that part of your policy where that is stated.. Most likely .. THEY CAN’T !
The appeal process may include many steps, each with a specific time frame in which the appeal must be completed/submitted.
If you work for a large company, they may be self-insured and the “insurance company” just manages the payment of the medical bills for the employees. The employer typically has the final say as to what is paid or not paid. Taking your appeal to the head of HR, may be the quickest path to getting your approval
Don’t forget your state’s Insurance commissioner dept for help/assistance !
The “experimental trap”… virtually all insurance policies have a clause excluding the payment for experimental medication or procedures. It would appear that more and more insurance companies are stretching the original intent of this clause. It appears than many are applying this clause to any drug - particularly expensive drugs - that are prescribed “off-label”.
In the case of chronic pain .. that means any pain med that is approved by the FDA for treating cancer pain … is being prescribed “off-label” when it is prescribed for chronic pain for any other reason.
The bottom line .. appealing cost little/nothing more than time… and until you reach the final appeal process - usually a outside review panel… you have a 50%-50% chance of getting your medication paid for.
If your quality of life.. is at stake.. if you don’t get your medication.. the short term costs in time.. may be priceless in the longer term.
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03.26.09
Posted in Chronic Pain at 5:24 pm by pharmacist.steve
There is a company (http://www.appriss.com/MethCheckRX.html) selling its services to local/state bureaucrats to help them track the sale of pseudoephedrine - a ingredient needed to make “METH” (methamphetamine).. this system is a real time on-line database. If the person attempting to purchase pseudoephedrine (PSE) and they have purchased the same at another store which exceed the state’s limits there is a “DECLINE”.. and the store if bound NOT TO SELL THE PRODUCT TO THIS PERSON.. This company entices the local/state bureaucrats to require all stores to use this system by providing the system “for free” for up to a year… after that … each store is to pay $25/month.. service fee to the company and no way of passing this overhead on to the customers..
Then there are ~ 30 states that have a controlled substance prescription database.. some states for as long as nearly 20 yrs… These databases are as much as 7 days out of date.. no healthcare provider is required to check it before writing a prescription for a controlled substance.. very few software vendors have provided a simple way to “cut/paste” data from the provider’s software to the controlled substance database to make it easy to get a report back.
The majority of Corporate Pharmacies prohibit their pharmacy staff from accessing the internet… which is the way you access these controlled substance databases..
Could it be that the only way for us to get real time data on controlled substances dispensed for particular patient .. is to get a for-profit entity involved?.. or does HIPAA prohibit compiling such a database?
Because PSE is OTC… it is exempt from HIPAA ?
Is the desire of those bureaucrats in charge of state/fed DEA - controlled substance databases more interested in collecting data and maintaining the status quo… rather than using the technology in place to track this information readily available in real time… and helping healthcare professional address the flow of controlled substances from legit channels to illegal use/abuse.
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03.18.09
Posted in Chronic Pain at 8:14 pm by pharmacist.steve
http://www.reviewjournal.com/lvrj_home/2005/Jul-14-Thu-2005/news/26879278.html
http://drugtopics.modernmedicine.com/drugtopics/Chains+&+Business/Nevada-Supreme-Court-considers-pharmacy-liability-/ArticleStandard/Article/detail/586166?contextCategoryId=47443
HIPPA makes your personal health records private ..but.. it would seem that the states are establishing databases that tracks all controlled substance Rx filled and those with special authority within the State/Feds.. can mine this data to “screen out” those that MAY BE drug abusers based on certain criteria…
Some 30 states have some sort of N.A.S.P.E.R. program.. to the best of my knowledge Nevada is the first state to take a pro-active stance in sending out notices to healthcare professionals about what they believe/determined the person MAYBE a “drug abuser”
According to the article… NONE of the pharmacies or docs, that had been notified, did not do ANYTHING !!
From the over-view of what was reported.. this person had a serious chronic pain issues and/or abuse issues and either it was a gross issue of “let George do it”… ” if I don’t fill it … others will … and the store will lose revenue…)
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03.15.09
Posted in Chronic Pain, Medical System could kill you at 9:16 am by pharmacist.steve
If you start a seeing a “pain doc” and they claim that they don’t prescribe opiates or pain meds… BEWARE!
Typically they have four “tricks” in dealing with treating chronic pain. The first is injecting into your spine/spinal area with a cortisone and lidocaine type products.. the second is injecting BOTOX type product into various areas and then you have radio frequency ablation .. which “burns” a nerve path to prevent the transmission of the pain signal. The final is an implanted pain pump.. which inject various drugs into your spinal fluid.
The first three CAN BE BOTH a good treatment for some conditions as well as a good diagnostic tool. If your doc performs one of these procedures.. he/she will tell you that you should expect relief for “x” number of weeks. If however, the procedure doesn’t provide relief or the relief last less than half the estimated time frame… then most likely your condition is not going to benefit from this particular treatment. If the treatment is repeated and you experience the same or less period of relief.. then further treatments will most likely not provide any long term relief.
If after a couple of cycles of treatment and with the same or lessen time frame of relief and your doc shifts to “.. we can do this again in “x” weeks .. because that is as soon as the insurance will pay for it…”
Your doc has now turned your temporary relief from these treatments into a “medical ATM”… pumping your body full of drugs and his/her practice a bunch of cash!
After a couple of years of these treatment then the idea of a implanted pump will probably come up in a discussion. The major supplier of implanted pumps is Medtronics http://www.medtronic.com/your-health/chronic-back-and-leg-pain/device/drug-pumps/our-drug-pumps-for-pain/synchromed-ii/index.htm
Here is where we get back to the “medical ATM”. There is only one FDA approved drug to be used in the pump Infumorph (morphine) by Elkin-Sinns. Fluids that go into the spinal fluid must be both STERILE & PRESERVATIVE FREE. Medtronic’s has done stability studies and Infumorph is stable for SIX MONTHS.. in an implanted pump.
Many docs (some say a majority) will not try Infumorph only into a pump to confirm/deny that it will produce a satisfactory pain management. Instead they will use a mixture of morphine and a lidocaine type product… Why you ask? .. Because there is not a commercially available product and they can “justify” having the meds to be placed into the pump compounded by a pharmacy. Since it is ILLEGAL for a pharmacy to compound a commercially available product.. this technicality get them around the law .. even though.. the lidocaine product added to morphine will normally provide little/no additional pain management.
Why you ask? Because they can purchase these compounded product for 10%-25% of the cost of Infumorph AND most compounding pharmacies will not stand behind the stablity of their products for more than 30 days… So instead of having to refill a pump TWICE A YEAR.. when using the commercial product.. the doc gets to charge for filling the pump EVERY 30 DAYS.
Filling the pump is a invasive procedure - remember this fluid is going into your STERILE SPINAL FLUID.. each procedure has some risk of contamination of the spinal fluid.
I idea is for the patient to gain optimum pain management.. Medtronic got FDA approval for - what they call a Personal Therapy Manager (PTM) http://www.medtronic.com/your-health/chronic-back-and-leg-pain/device/drug-pumps/our-drug-pumps-for-pain/personal-therapy-manager/index.htm
Since the intensity of a patient’s pain will vary from minute to minute - hour to hour - day to day and without the PTM.. the patient gets the same amount of meds EVERY DAY… so some days may be TOO MUCH and some days will be TOO LITTLE. Why docs are reluctant to provide chronic pain patients with such a tool to help them “modify” the amounts of meds they use each day to help them better manage their pain… who knows!!! The PTM is programmed by the doc to place limits on how many times and how far apart the patient can “push the button”.
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03.14.09
Posted in Dealing with insurance at 5:14 pm by pharmacist.steve
Many “drug cards” have or soon will implement step therapy on all new prescription therapies. Basically step therapy is an attempt to make sure that the patient gets appropriate therapy for the lowest cost. The drug card/insurance company will want the patient to start therapy using a OTC (over-the-counter) medication - which the insurance company escapes any financial liability .. and/or starting with a generic drug. Which generally will attain the desired outcome some 80% of the time. Once the patient fails to respond to the first medication, they will be required to take/try the next more costly medication.
What the insurance companies won’t tell you is that some of the initial drugs in the step therapy may be contraindicated in certain patients due to their co-existing disease states. Generally, step therapy protocol concerns itself with substituting a drug of lesser cost from a THERAPEUTIC CATEGORY.
Most/all insurance companies have an appeal process and required to respond to the appeal in 24-72 hours (3 business days). Often the insurance company uses the fact against the patient that the patient doesn’t have proof that the medication prescribed by their doctor will produce a positive outcome for this particular patient. If the patient can afford to pay out of pocket for 1-2 months to document a positive outcome… it should help the appeal process.
It is become more and more common for the insurance company to issue an automatic denial when a medication is prescribed “off-label” A insurance is doing this under the clause in most/all policies that prohibits them from paying for “experimental drugs “.. since the drug being prescribed is “off-label”.. it is virtually an automatic denial under the “experimental drug” clause in the contract.
Insurance companies are not required to tell you your appeal rights - UNLESS YOU ASK!.. then they are required to furnish you the details in how to file an appeal
More than HALF of all people who appear a denial, will get it approved for payment. The easiest/cheapest thing for an insurance company to do is send out a denial notice.. For a couple of dollars - the cost of generating the denial notice - they stand to save hundreds or even thousands of dollars.
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03.13.09
Posted in Chronic Pain at 10:04 pm by pharmacist.steve
I have been very neglectful in posting and I am going to try and improve that as well as expanding the content to how our medical system can or with changes or potential changes… harm or kill you.. if you are not paying attention…
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06.25.08
Posted in Chronic Pain at 3:10 pm by pharmacist.steve
A number of states have NASPER type databases http://www.nasper.org/facts.htm that collect and make available to law enforcement and health care professionals the on-line capability to check/verify a patient’s controlled substance prescriptions that they have filled in that particular state.
It has been brought to my attention that in one particular state, two of the largest chain pharmacies will not allow their pharmacists the ability to access the internet to have access to this database. Could it be that these corporate pharmacies do not want to lose the revenue from filling any/all prescriptions presented or they don’t want the staff to waste their time checking the database, which may result in no revenue.
It has also been reported that some rural hospitals in this particular state refuse to allow their ER Physicians from accessing this database because of fear of losing revenue, by turning away “drug seekers” on nights and weekends.
Likewise, this state level agency is being provided a federal grant to fund time/resources to make health care professionals aware of the availability of this database. Few professional organizations will put these speakers on their meeting agenda.
So if you are a legit chronic pain patient and having your prescriptions filled at one of those big national pharmacy chains. The Pharmacist may have no way to confirm or deny that you are only getting your prescriptions filled at one pharmacy and written by one doctor. So if you feel you are being treated/judged unfairly… this might help to explain it.
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11.03.07
Posted in Chronic Pain at 7:00 pm by pharmacist.steve
In the small town of Grangeville, ID (pop ~3500) , http://www.grangevilleidaho.com/community/index.htm
which is the county seat of Idaho county (pop ~15,000). http://www.idahocounty.org/idaho/index.htm
Idaho county claims to be the largest county in the country - as large as the state of New Jersey.
http://www.idahocountyfreepress.com/IFPNews6.shtml
http://www.idahocountyfreepress.com/ArcStoryPage.asp?Database=Story&StoryID=13145
If you look at a couple new articles from the local newspaper gives some in-site into the mind set of the people in power in this area of our country.
Their US representative votes AGAINST a bill outlawing dog fighting and a teacher found guilty of sexual abuse of one of his students given PROBATION!
Then it would come to little surprise that the county’s only district judge runs his court like a dictator over a small fiefdom.
This judge presides over both the county’s mental health court and felony drug court.
There are a number of chronic pain people before his court that have mandated that they abstain from all pain meds - including OTC’s. It has been reported that this judge has even went as far as to mandate that a person undergo a root canal procedure without any post procedure pain meds.
One particular gentlemen who has been diagnosed with schizophrenia, PTSD, Bi-polar and chronic pain. Because for many years he chose to self-medicate his chronic pain with MJ.. he has been labeled an ADDICT.
This poor soul is on Medicaid and Medicare disability with a income of ~ $400/month. He has been living with family friends, because the family friends have been advocating for him… getting his story out … the judge has demanded that any more people contacting his office.. because of their advocacy… he will put this poor soul in jail … This judge has now passed a decree that this poor soul must move out of his friend’s house and establish his own residence. $400 a month won’t go far in providing for his needs, and while he is capable of managing his own personal needs it is doubtful that he will be able to have the energy or pain management to do the necessary housekeeping chores.
If one person intentional inflict pain on another person .. it is called TORTURE.. here we have a judge that is INTENTIONALLY causing elevated pain on this poor soul and 2 or 3 others just like him.
As a society, we condemn those who would use “torture” on terrorists .. who would harm us or our society, but those who are “in power” particularly in remote locations… are free to act like a “school yard bully” without consequences.
US representatives approving of dog fighting, teachers who sexually molest their students getting probation, judges torturing residents… can genocide be far behind?
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07.02.07
Posted in Chronic Pain at 9:37 am by pharmacist.steve
Tips For Dealing With People In Pain
1.People with chronic pain seem unreliable (we can’t count on ourselves).
When feeling better we promise things (and mean it) when in serious pain; we may not even show up.
2. An action or situation may result in pain several hours later, or even the next day. Delayed pain is confusing to people who have never experienced it.
3. Pain can inhibit listening and other communication skills. It’s like having someone shouting at you, or trying to talk with a fire alarm going off in the room. The effect of pain on the mind can seem like attention deficit. Disorder. So you may have to repeat a request, or write things down for a person with chronic pain. Don’t take it personally, or think that they are stupid.
4. The senses can overload while in pain. For example, noises that wouldn’t normally bother you, seem to much.
5.Patience may seem short. We can’t wait in a long line; can’t wait for a long drawn out conversation.
6. Don’t always ask, “How are you” unless you are genuinely prepared to listen it just points attention inward.
7. Pain can sometimes trigger psychological disabilities (usually very temporary). When in pain, a small task, like hanging out the laundry, can seem like a huge wall, to high to climb over. An hour later the same job may be quite OK. It is sane to depressed occasionally when you hurt.
8. Pain can come on very quickly and unexpectedly. Chronic pain people appear to arrive and fade unpredictably to others.
9. Knowing where a refuge is, such as a couch, a bed, or comfortable chair, is as important as knowing where a bathroom is. A visit is much more enjoyable if the chronic pain person knows there is a refuge if needed. A chronic pain person may not want to go anywhere that has no refuge (e.g. no place to sit or to lie down).
10. Small acts of kindness can seem like huge acts of mercy to a person in pain. Your offer a pillow or a cup of tea can be a really big thing to a person who is feeling temporarily helpless in the face of encroaching pain.
11. Not all pain is to locate or describe. Sometimes there is a body wide feeling of discomfort, with hard to describe pains in the entire back, or in both legs, but not in one particular spot you can point to. Our vocabulary for pain is very limited, compared to the body’s ability to feel varieties of discomfort.
12. We may not have a good “reason” for the pain. Medical science is still limited in it’s understanding of pain. Many people have pain that is not yet classified by doctors as an officially recognized “disease”. That does not reduce the pain, - it only reduces the ability to give it a label, and have you believe us.
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