Monday, December 31, 2007

What is your Doctor really writing in your health record?

I often wonder how many Chronic Pain Patients lives have been destroyed because of a doctor putting, not what you are telling him, but what he perceives that you are saying, in your medical records. As a person who has lived in Chronic pain for 25 years, the last 5 years being absolute torture and has been down this road many times, I can tell you, it happens every day. It has happened to me and if you are living in Chronic Pain, I can just about promise you that it has happened to you. Do you have a copy of your medical records now. If not and especially if you have been to several different doctors seeking treatment as most of us have, I would strongly advise you to obtain and keep as many of your records as possible. You might want to prepare yourself to be shocked!!, as to what you may find in them.

While a doctor's office should be a haven for the sick, that is no longer the case, especially for the person suffering from Chronic Pain. They still take your money, as they always have, and they will prescribe you anti-inflamatory, antidepressants, etc, but the minute you mention something stronger, for example, some type of opioid, you have just entered into an aggressive, non trusting relationship with your doctor. All of a sudden, you have become a drug addict, just looking for drugs. Never mind that you are in so much pain that you don't feel that you can go on any longer. Opioid phobia has just kicked in with your doctor and you have committed the unpardonable sin of asking for the only thing that will control your pain, especially if it is at the levels of mine.

Its not enough that people like you and me have to go through this demeaning process with the medical profession trying to find someone with the compassion and education to help us, we usually end up with junk and outright lies placed in our medical records that will haunt us the rest of our lives. Maybe that is one of the reasons that approximately 17,000 people suffering from Chronic Pain kill themselves every year.

Even though this happens everyday all over America, and even though it is a violation of Federal laws, State laws, its unconstitutional and certainly a violation of "human rights" it keeps happening. Why? Because in 1999 some accountant in the GAO reported that opioids especially
Oxycontin was being prescribed to much. Now what in the hell some accountant knows about what is to much to prescribe a person in Chronic Pain, I will never understand , but the committees and sub-committees in congress started holding hearings and hence President Bush and John Ashcroft started the "War on Drugs" with the help of the DEA.

Of course the doctors are now afraid to prescribe any type opioid for fear of the DEA. So what is going to happen to people like you and me? Nothing until we all get together and start demanding our rights. So do you want to be part of the solution or spend the rest of your life in pain. Personally, I hate doing this blog, because its talking about a subject that is my life, and I sit up late at night to write it and I am in pain. I spend a big portition of my life writing congress, working with advocacy groups and writing this blog. You may not be in pain now, but all it takes is an auto accident, a fall and you will find yourself in my world. So step up. We need you!!

Sunday, December 16, 2007

Are you "Chemically dependent or "Addicted"?

Two of the most misunderstood terms in taking opiate or opiate-like drugs is Addiction vs. Chemical Dependency. Doctors, especially the News Media and even Chronic Pain patients themselves often misuse the terms. As a Chronic pain patient you have a duty to educate yourself on these things. Its not fair to you and it is certainly not fair to other Chronic Pain patients who are "fighting for our rights." So educate yourself!!

In writing this blog I want to be fair and present the other side. I just wish the "News Media" would do the same. If you take powerful Opiates or Opiods because you live with a level of Chronic Pain that is intolerable, sooner or later you will become chemically dependent on them. This is normal and if at some point you feel you no longer need them, slowely start reducing your dosage until you are completely off of the drug. I would suggest consulting with your Doctor and make sure he is aware of what you are doing. He will probably advise you at what rate you should reduce the medication. If you continue to take them after you no longer need to and make no effort to get off of the pain medications then you have become Addicted. At that point it is time to seek out an Addiction medicine specialist.

When opiates are prescribed by a physician for the treatment of pain and are taken in the prescribed dosage, they are safe and there is little chance of addiction. However, when opiates are abused and taken in excessive doses, addiction can result.

The brain itself produces endorphins that have an important role in the relief or modulation of pain. Sometimes, though, particularly when pain is severe, the brain does not produce enough endorphins to provide pain relief. Fortunately, opiates, such as morphine are very powerful pain relieving medications. When used properly under the care of a physician, opiates can relieve severe pain without causing addiction.

Feelings of pain are produced when specialized nerves are activated by trauma to some part of the body, either through injury or illness. These specialized nerves, which are located throughout the body, carry the pain message to the spinal cord. After reaching the spinal cord, the message is relayed to other neurons, some of which carry it to the brain. Opiates help to relieve pain by acting in both the spinal cord and brain. At the level of the spinal cord, opiates interfere with the transmission of the pain messages between neurons and therefore prevent them from reaching the brain. This blockade of pain messages protects a person from experiencing too much pain. This is known as analgesia.

Opiates also act in the brain to help relieve pain, but the way in which they accomplish this is different than in the spinal cord.

There are several areas in the brain that are involved in interpreting pain messages and in subjective responses to pain. These brain regions are what allow a person to know he or she is experiencing pain and that it is unpleasant. Opiates also act in these brain regions, but they don't block the pain messages themselves. Rather, they change the subjective experience of the pain. This is why a person receiving morphine for pain may say that they still feel the pain but that it doesn't bother them anymore.

Although endorphins are not always adequate to relieve pain, they are very important for survival. If an animal or person is injured and needs to escape a harmful situation, it would be difficult to do so while experiencing severe pain. However, endorphins that are released immediately following an injury can provide enough pain relief to allow escape from a harmful situation. Later, when it is safe, the endorphin levels decrease and intense pain may be felt. This also is important for survival. If the endorphins continued to blunt the pain, it would be easy to ignore an injury and then not seek medical care.

There are several types of opiate receptors, including the delta, mu, and kappa receptors. Each of these three receptors is involved in controlling different brain functions. For example, opiates and endorphins are able to block pain signals by binding to the mu receptor site. The powerful new technology of cloning has enabled scientists to copy the genes that make each of these receptors. This in turn is allowing researchers to conduct laboratory studies to better understand how opiates act in the brain and, more specifically, how opiates interact with each opiate receptor to produce their effects. I just hope it is soon, because personally I hate taking opiods or any medication for that matter. I, like most people in chronic pain just want a life.

Monday, December 3, 2007

Spine surgery and all of the new "devices"

Every MONTH it seems like another new DEVICE OR PROCEDURE for Spine Surgery is approved. There are new and less invasive ways to fuse different levels of the spine, especially the lumbar and cervical discs. There are new tools, devices and procedures. The only problem is after all the surgery and the pain of fusions most patients are no better off and in most cases worse than before. How do I know? I have been there done that, I have researched it for 20 years and I receive comments and e-mails of people just like me, a living mass of pain.

Since I believe that man was created by a higher power, if he had meant for the spine to be rigid, he would have made it that way.

Now enter the Charite' artificial disc which was first developed in Berlin, Germany almost 20 years ago with dismal results. Depuy Industries owned by Johnson and Johnson purchased the company that owned the disc and of course got it pushed through the FDA with a short clinical trial, spine surgeons started implanting the device in the USA, in the L4-L5 area of back patients.
"Seven months later, on May 13, 2005, the, reported that Dr Charles Rosen, an associate clinical professor of spine surgery at the University of California at Irvine, was calling for an immediate recall of the Charite, pointing out fundamental flaws in J&J's study design.

He told the Street that J&J compared the Charite to BAK cages in spinal fusions, a failed procedure that had not been performed in years. According to Dr Rosen, the comparison is "the worst possible operation to compare these things to."

J&J responded by saying the BAK was the standard treatment for degenerative disc disease at the time of the study.

According to the Street, Dr Rosen said J&J ignored the first patients who underwent the surgery, and that exclusion of such a significant portion of the sample size can seriously compromise the quality of statistical data.

Dr Rosen, who is also the founder of the UCI Spine Center, told the Orange County Register on April 12, 2006, that the Charite can cause more pain than it cures.

Forty-five year old, Dane Titsworth, from a hospital bed at UCI Medical Center, recovering from his fourth back surgery, told the Register, that the pain he experienced with the Charite he had implanted in May 2005, was like driving a big rig over your legs.

After the Charite surgery, Mr Titsworth said the pain became unbearable and cost him his job with State Farm Insurance, and nearly his marriage.

Dr Rosen fused the part of his spine where another surgeon had implanted the disc.

The Charite does not absorb shock like a healthy disc or mimic natural motion, Dr Rosen told USA Today on July 25, 2006, and a dislocation or fracture of the disc can also cause problems, he said.

In March 2006, Dr Rosen says, eight more patients like Mr Titsworth contacted him, who have more pain in their back with the Charite than without it.

In May 2006, Medicare decided to stop paying for the device in patients over 60, noting that the $30,000 to $50,000 surgery had not been sufficiently tested for long-term affects.

Blue Cross and Blue Shield also determined that more research was needed over a longer period of time, although insurance plans in each state determine coverage decisions individually, according to USA Today.

On October 20, 2005, the Bagolie Friedman law firm announced the formation of the "International Charite Artificial Disc Practice Group," based on a belief that numerous people in the US and abroad, "suffer Charite artificial disc failure," and that "Johnson and Johnson is responsible for manufacturing a medical device they knew or should have known was unreasonably dangerous in an attempt to capture some of the lucrative multi billion dollar back surgery market."

"We will be reviewing potential cases from the United States, Australia and Europe," said Mr Bagolie.

On June 5, 2006, the reported that Chicago-based attorney, Pete Flowers, has more than 200 clients who have complications from the Charite and who are seeking reparations from DePuy Spine.

Twenty-eight lawsuits have been filed, Mr Flowers told the Street, and he expects an additional 40 to 50 more to be filed this month. Dane Titsworth is a client of the firm.

Mr Flowers' clients claim the Charite is defective and that J&J improperly marketed the device and did not adequately warn of the disc's dangers.

"Most of these people are between 25 and 45 years old," he told the "A lot of them have lost their jobs, their spouses, their families, their houses -- everything."

Since the disc was approved in the US, more than 5,000 people have received the implant, says DePuy Spine's Bill Christianson, vice president of regulatory affairs, according to USA Today on July 25, 2006."

Lawsuits Multiply