The Pain Pendulum

http://abc7chicago.com/health/the-pain-pendulum/2654223/

Imagine being in excruciating pain and not being able to get the relief you need, or any relief at all. Patients suffering from chronic pain say while the country is taking steps to battle the opioid epidemic, they are being victimized.

Sufferers of chronic pain told the I-Team the national crackdown on opioids is affecting their ability to get the narcotic medication they have been using effectively and responsibly for years, and they are scared.

Maria Pollock suffers from a connective tissue disorder called Ehlers-Danlos Syndrome. She said she’s been diagnosed with a genetic polymorphism, a condition that makes her resistant to many pain medications.

Pollock said the opioid drug that worked for her has been taken off the market due to abuse concerns. Now she’s having trouble finding a pain specialist willing to take her on as a patient.

Annette Delgado battles crippling pain attacks brought on by sickle cell disease. She sees a team of sickle cell experts at the University of Illinois Hospital in Chicago. Delgado said doctors there are doing their best to keep her pain in check, but said the long-acting morphine that keeps her functioning is now being denied by insurance.

Jenni Grover, an ambassador for the U.S. Pain Foundation and a chronic pain advocate, said the stories of desperation she hears are heartbreaking. She said patients tell her they’re being treated as if they are criminal drug addicts, and doctors are abandoning them because of new regulations and possible scrutiny by the medical community and federal regulators.

Grover, who also runs the website ChronicBabe.com, said many in the pain community are reporting their doctors are either refusing to prescribe opioids or notifying them that they will no longer be patients in their practice. She said this is a challenging and complicated issue for millions of people in the United States.

State and federal leaders, as well as medical practitioners and other providers, are using multiple strategies to address the opioid crisis; curtailing the opioid supply is one of them. Drug abuse experts say between 2001 and 2011 there was a huge increase in prescriptions for drugs such as morphine, codeine and hydrocodone. They say these pills flowed too freely to the wrong kind of patient, causing unnecessary and deadly addictions and helping fuel the drug epidemic.

Government data shows the number of prescriptions written for opioids has been falling since 2012.

The Centers for Disease Control and Prevention produced guidelines in 2016 recommending shorter durations for opioid prescriptions and the use of non-drug treatment for pain.

CLICK HERE for the CDC’s 2016 opioid guidelines

Some physicians insist opioids are not the best choice for chronic pain even if they seem to work. They said prescribing practices need to be re-balanced, but even as they try to address the problem they are also facing a troubling backlash.

Police said this past July in Mishawaka, Ind., Michael Jarvis became enraged when Dr. Todd Graham, a Northwestern Medicine graduate and physical medicine and rehabilitation specialist, refused to prescribe opioids to Jarvis’s wife for back pain relief. Police said Jarvis gunned down Dr. Graham before taking his own life.

Now federal agencies, lawmakers, even corner drug stores are putting opioid guidelines and restrictions in place.

New analysis from the National Conference of State Legislatures shows 24 state governments taking action.

CLICK HERE for the NCSL analysis

Most of the legislation limits first-time prescriptions to seven days. Some states are also setting dosage limits. As of right now, Illinois has no mandated restrictions.

The president of the Illinois State Medical Society said the group will continue to lobby against regulation.

But, Dr. Kern Singh, a spinal surgeon with Midwest Orthopaedics at Rush University Medical Center, said the reality is it’s very difficult to get insurance coverage for the non-narcotic, safer alternative treatments because they are so expensive.

Working with other pain specialists at Rush, he said they have created an effective approach to surgical pain that uses fewer opioids, but is frustrated because most insurance companies refuse to cover the safer, more expensive medication.

In the meantime desperate chronic pain patients can only wonder what they will have to resort to if they’re left with no options.

In a statement America’s Health Insurance Plans, an association representing the health insurance community, said, “Health insurance providers will continue to work with doctors, hospitals and state and local leaders to provide people with better pathways to healing – without putting their lives in danger because of opioids.”

Last week the Illinois Legislature passed a measure that would require medical providers to check the state’s Prescription Monitoring Program before writing an opioid prescription. Supporters said it’s designed to make it harder for patients to obtain prescriptions from multiple doctors, a practice known as doctor shopping.

FULL STATEMENT FROM THE AHIP

I think we can all agree that we’re dealing with a very serious, very pervasive epidemic in this country. Every 2.5 weeks we lose as many lives as we did during the attacks on September 11th as a result of the opioid crisis. America’s health insurance providers have been on the front lines of this emergency for some time and have seen firsthand the harm and disruption it has caused to their customers, their families and their communities.

No one should live with the consequences of opioid addiction. But no one should have to live with pain either. Health plans work closely with doctors and nurses on the safest, most proven, and most effective approaches to pain management. This includes practicing more cautious opioid prescribing, limiting overall dosages, and identifying alternative forms of pain management. Further, plans are encouraging the use of evidence-based care through medical management practices including non-narcotic medications, which research has shown can provide just as much relief as opioids. Many are also exploring and improving access to non-pharmacologic pain treatments that have been proven effective in reducing pain, depending on the individual (e.g., cognitive therapy, acupuncture, etc..). However, it’s important to note that treating pain is not a one-size fits-all – every patient is different and every situation is different.

AHIP and its member plans will also continue to support and promote the CDC Guidelines for Prescribing Opioids for Chronic Pain. These Guidelines articulate when and how to prescribe opioids – which include prescribing non-opioid treatments first, limiting both the dosage and the duration of prescription opioids, and reviewing a patient’s medical history to look for risks of addiction. AHIP also recently launched a new Safe, Transparent Opioid Prescribing (STOP) Initiative, — an industry-wide commitment to ensuring wide-spread adoption of these guidelines. The Initiative includes the introduction of the STOP Measure, which will enable health plans and providers to work together to more effectively improve adherence with the CDC Guidelines, significantly improving patient safety and reducing the risk of opioid misuse.

Health insurance providers will continue to work with doctors, hospitals, and state and local leaders to provide people with better pathways to healing – without putting their lives in danger because of opioids.

We have several resources on this issue, including our work with the President’s Commission on Combatting Drug Addiction and the Opioid Crisis: https://www.ahip.org/issues/opioids/

Filed under: General Problems