I Was Fired for Being in Pain

By Deann Goudy, Guest Columnist

I'll start with all of my health issues, every one of which causes pain.  

I was first diagnosed with sciatic nerve pain, followed by scoliosis, degenerative disc disease, spinal stenosis, arthritis, and bone spurs in my neck. I also have ulcerative colitis, irritable bowel syndrome, and ulcers in my intestines, stomach and all the way up to my throat.  

The ulcers were caused by taking over-the-counter pain medication.  I was in constant pain at work and took bottles and bottles of Aleve and Advil. Sometimes I'd mix ibuprofen with Tylenol, hoping it would help the inflammation and pain.  Nothing helped.

I never realized anything over-the-counter could cause such damage to my stomach, until one day I fell out of my chair while at my desk, bleeding.  The next day I was in emergency surgery to get the bleeding to stop.  I was given orders to only take Tylenol.  I knew that would not help, so I went to a pain doctor to find out why I hurt so much. 

That is when they found my back and neck problems. Degenerative disc disease does not get better over time, only worse. 

I went through several steroid shots, physical therapy, and was put on hydrocodone.  The shots made matters worse. The pain management doctor would only give me shots in my cervical area and refused to help with my lower back.  Later I found out you are only supposed to have no more than 3 of those shots a year and if they do not work you should consider other options.  I was given 7 shots in one year. 

The shots accelerated the degenerative disc disease in my neck.  That is when the bone spurs grew and started pinching off the nerves in my neck, which were already being crushed by the spinal stenosis. 

DEANN GOUDY

DEANN GOUDY

I was put on every medication they could think of, including Lyrica, gabapentin, tramadol and Suboxone. I wanted to die due to the side effects, mostly from the gabapentin and Lyrica.  I passed out, saw colors, and felt dizzy and disorientated.  The tramadol gave me so much anxiety I thought my heart was going to burst.  I was shaking uncontrollably. 

I quit taking all of them and found another pain management doctor, who told me he would do one shot in my lumbar. If that did not work, then I would have to rely on pain medication. I went through with the shot and, as hopeful as I was, it still did not take. 

I was referred to an internal medicine doctor who actually listened to me.  He got me on a regimen of half the medications, mostly taking only hydrocodone and oxycodone for severe pain.  This finally gave me my life back.  I was able to go back to work.  I was no longer immobilized and struck down by pain so hard core I would lose control of my bladder. 

I was not completely out of pain, but it was tolerable, and I was finally able to have some quality of life. 

Then a pharmacist decided to cut my opioid medication in half without permission from me or my doctor. It took 3 months to fix this and find a pharmacy to fill my medication. I couldn’t control the pain and was recently fired for taking too many breaks while at work. All I was doing was getting up to walk and stretch to relieve some pain and pressure, and to calm the spasms down.

Now I’m being forced onto disability. It’s hard enough for a chronic pain patient to get a job without being discriminated against. 

I am not addicted or feel withdrawals or cravings, I am just in intense pain.  If my medications are taken away, I will not resort to the streets.  I will ask everyone in my family to not be selfish and let me go.  All I am doing is breathing and being a burden. I'd rather be dead and ask God to understand and forgive me. 

Our government has decided to play God and take away all our rights and pick on the weak and innocent.  They’ve demonized and tortured us.  For the first time in my life, I'm ashamed of the country I live in.  The corruption is everywhere, the money-making schemes, the fake opioid crisis, the lies and deception. 

I say get the facts straight before you make life altering decisions for thousands of chronic pain patients. Do a better study of where the problems are, not fake your data to make yourself look good and cash in on our lives.

Just remember lawmakers, you are only one accident away from this happening to you too.  What will you do when you’ve gotten rid of the medication that could save you?  Or do the same laws even apply to you?

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Deann Goudy lives in Texas.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Spinal Injection Bill Would Raise Healthcare Costs

By Pat Anson, Editor

Republicans and Democrats often claim that reducing the cost of healthcare is one of their major goals. But a bipartisan bill that is sailing through Congress with little debate will do just the opposite, raising the cost of some epidural, facet joint and other spinal injections used to treat pain by as much as 25 percent for Medicare beneficiaries.

Critics say the legislation is little more than a money grab by doctors who perform the procedures, under the guise of preventing opioid addiction.

The “Post-Surgical Injections as an Opioid Alternative Act” (HR 5804) is one of nearly 60 bills to combat the opioid crisis approved last week by the House Energy and Commerce Committee. It moves to the full House for a vote.

The bill would partially reverse a decision made by the Centers for Medicare and Medicaid Services (CMS) in 2016 to cut the Medicare reimbursement rate for epidurals and other injections.  The interventional procedures – which do not involve opioids -- can cost several hundred dollars per injection.

The American Society of Interventional Pain Physicians (ASIPP) lobbied unsuccessfully to get the reimbursement cuts overturned – until it found two Illinois Republican congressmen willing to sponsor HR 5804, Rep. John Shimkus and Rep. Raja Krishnamoorthi.

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“We first went to the CMS, then HHS, with no success in reversing draconian cuts for interventional techniques. CMS and the administration told us that it requires an Act of Congress,” ASIPP says on its website. “As a first step toward this, Shimkus and Krishnamoorthi have introduced H.R. 5804, which reverses some of the cuts for Ambulatory Surgery Center procedures. This is only the beginning. We have many other cuts to be reversed.”

According to OpenSecrets.org, Shimkus and Krishnamoorthi have both received $10,000 in campaign donations from ASIPP. The organization has spent over $500,000 on lobbying and donations so far in the 2017-2018 election cycle.

‘I Find It Hard to Trust CMS’

Shimkus introduced the ASIPP bill on May 15th and two days later helped shepherd it through its first and only hearing before the House Energy and Commerce Committee.

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During the hearing, Shimkus claimed that by cutting the cost of spinal injections, CMS created a disincentive for doctors to perform the procedures and encouraged them to prescribe opioids instead.

“A lot of us were surprised to see CMS reduce the reimbursement rate for non-opioid pain treatments like epidurals for post-surgery pain,” Shimkus said. “I find it hard to trust CMS when those of us in this arena think their cut has led to more opioid use.

“A lot of us believe the inability to use epidurals to treat pain and prescribe opioids is not healthy for our country.”

To be clear, the CMS reimbursement cuts do not prevent any doctor from performing injections – it only made the shots less profitable. And Shimkus offered no evidence that the lower reimbursement rates encourage more opioid use – although he convinced many of his colleagues that they did.  

“I do think it's important in this crisis to be specific with CMS to make sure that we are not discouraging the use of non-opioid alternatives based on reimbursement-related issues,” said Rep. Larry Bucshon, MD (R-IN), who is a cardiologist. “In my experience over the years, CMS makes reimbursement decisions based on the financial incentives to do so, not necessarily, in my opinion, based on what is the appropriate therapy.”

“I don't agree that epidurals are not an alternative (to opioids) already. They are. They are. I just had a conversation with a surgeon about that. So that's not so,” said Rep. Anna Eshoo (R-CA).  “Imagine being able to manage pain without taking an opioid. We could do 20 other things together and it wouldn't equal that."

Rep. Frank Pallone (D-NJ) wasn’t buying any of it.

“I don’t think we have gotten any objective criteria to suggest that what CMS did is going to lead to more people taking opiates,” Pallone said. “I don't think there is any evidence to suggest that this legislation will lead to decreased opioid prescribing or a decreased prevalence of addiction.

“I think we are setting a bad precedent with the bill. I don't think that we, as Congress, are in a good position to pick and choose winners amongst therapies and procedures. I just don't think we know enough to understand the consequences of doing that to understand the relative value and the efficacy of different therapies and procedures on the market.”

Despite those concerns -- and after just 30 minutes of debate that included no public testimony -- committee members overwhelmingly supported the bill by a vote of 36 to 14. Nine Democrats joined with all Republicans on the committee in voting yes.

“What we are doing is temporarily reversing cuts to non-opioid treatment that we all agree save money and lives, then collecting to help ensure we are reimbursing providers at the most appropriate levels possible,” Shimkus said.

“That’s ASIPP talking,” says Terri Lewis, PhD, a researcher and longtime advocate for the pain community. “What does Shimkus know? Shimkus doesn’t know anything. There is no data to support that.”

Health Risks of Spinal Injections

There was no discussion by the committee about the effectiveness of epidurals and other spinal injections -- or of the health risks associated with their use.

Epidural injections have long been used to relieve pain during childbirth, but they are also increasingly being used to treat back pain, despite reports there is little evidence the shots are effective.

The FDA has also warned that the use of steroids in spinal injections – a procedure that’s never been approved by the agency -- “may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.”

“Here we have a procedure that they’re trying to slip under the swimming pool fence that is not FDA approved, that relies on materials that are not regulated and/or contraindicated, and they’re trying to pull a fast one. And they could very easily do it in this climate of opioid hysteria,” said Lewis.

As PNN has reported, some pain management experts believe spinal injections are overused – in part because they’re more profitable for doctors than using opioids or other procedures.  

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“Probably everything that gets compensated well is over-utilized because it’s the compensation system. It’s a reimbursement system that pays more for treatment procedures than outcomes,” said Lynn Webster, MD, a past president of the American Academy of Pain Medicine.

A 2012 report by the General Accounting Office – a report requested by Rep. Pallone – found that unsanitary injection practices in ambulatory care clinics expose thousands of patients every year to blood borne pathogens such as hepatitis and HIV.  A perfectly sanitary needle can also go astray and puncture sensitive membranes in the spinal cord, leaving patients with serious and sometimes permanent injuries.      

“When it comes to spinal injections after surgery the risk to the patient, related to adverse events, increases substantially because spine surgery comes with risks of dural tears and accidental cuts,” says Terri Anderson, a Montana woman whose spine was damaged after receiving steroid injections for a ruptured disc in her back.  She now suffers from adhesive arachnoiditis, a chronic inflammation in the spinal membrane that causes severe pain.

“It is unconscionable that harmful injections would be pushed on unsuspecting pain patients,” Anderson said in an email to PNN. “It looks like the large hospital corporations and interventional pain professional societies have been busy lobbying our congressional representatives.  Apparently our healthcare system has become a profitable venture that indirectly contributes to many election campaigns in the U.S.”

No date has been set for a full House vote on HR 5804. To become law, it must pass both the House and Senate and then be signed by President Trump.  There is little opposition to the bill because many critics only recently learned that it was even being considered by Congress. 

“If this is allowed to stand, we have a problem,” says Lewis. “Another thing is Congress directing the practice of medicine. We’ve had just about enough of that.”

Steroid Injections Provide Little Relief for Back Pain

By Pat Anson, Editor

Steroid injections provide only short term relief for patients suffering from chronic low back pain, according to a new study funded by the French Ministry of Health that was published in the Annals of Internal Medicine.

Researchers evaluated 135 patients with discopathy – degenerative disc disease -- who were being treated at three different clinics in France. Half the patients were assigned to a control group and the rest received a single glucocorticoid (steroid) injection into their lower back.

A little over half of the patients who received the injection reported positive effects on back pain after one month. But the effect was only temporary and decreased over time, with no differences in back pain intensity after 12 months when compared to the control group.

“Given these findings, the researchers question the efficacy of glucocorticoid injections as a treatment for chronic low back pain,” the American College of Physicians said in a news release.

The French study adds to a growing body of evidence questioning the effectiveness and safety of steroid injections into the spinal area.

A 2015 report by the Agency for Healthcare Research and Quality (AHRQ) found little evidence that epidural steroid injections were effective in treating low back pain. Researchers said the injections often provide immediate improvements in pain and function, “but benefits were small and not sustained, and there was no effect on long-term risk of surgery.”

A 2014 study by the AHRQ also found that epidural injections did little to relieve pain in patients with spinal stenosis.  

Epidural injections, which have long been used to relieve pain during childbirth, are increasingly being used as an alternative to opioids in treating back pain. The shots have become a common and sometimes lucrative procedure at many pain management clinics, where costs vary from as little as $445 to $2,000 per injection.

The Food and Drug Administration has never approved the use of steroids to treat back pain, but several million epidural steroid injections are still performed “off label” in the U.S. annually.

The American College of Physicians (ACP) recently released new guidelines saying there was little evidence that steroid injections are effective as a treatment for low back pain.

“Moderate-quality evidence showed no differences in pain between systemic corticosteroids and placebo and no to small effect on function in patients with radicular low back pain,” the ACP said.

Lower back pain is the world's leading cause of disability. Over 80 percent of adults have low back pain at some point in their lives.