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Avatar universal

Chronic Back Pain Relief

I have been searching for some help.  I had a worker's comp injury in 1995, four subsequent back surgeries and a fusion, have acurrent protuding disk, have had shoulder repair, broke my foot and severely tore tissues from a fall 4 months ago, but that is healing.  I have been on time-released OxyContin since the last back surgery in 2004.  Working with my doctor, we reduced the use of OxyContin from the 240 mg daily (80 mg 3 x day) to a maximum of 120 (3 - 20mg upon rising, 2 - 20 mg afternoon, 1 - 20 mg at bedtime) daily with 1-2 (usually 2) of Oxycodone as needed for breakthrough pain.  He also prescribed Lidocaine patches to help manage the deep back and leg pain, which is particularly difficult if I sit, stand, or ride for a period of time.  I generally used these 1-3 times a week with a maximum allowed of 3 per day (if severe, running down buttock to thigh).  This made my back/leg pain tolerable, but it never goes away.  Other meds were Lexapro for anxiety-depression, which, according to my doctor helped handle the tension and leg pain.  I was doing pretty well on this medication routine.

I have never had a "high" and do not understand or know what that is.  But, if I do not take the OxyContin, I in such severe pain that I cannot stand upright.  I feel like my back is breaking in two.  Prior to the 4th surgery, my surgeon said I was undermedicating and should take more of the pain medications.  I explained to him I was not looking to be completely pain-free, but for functionality.  I have been afraid of addition ever since seeing the black and white films shown to my freshman high school class back in the 50's about heroin -- I just want to be functional.

Long story short, my doctor left to practice in another state and Worker's Comp assigned me to a pain management clinic for the past year and 8 months.  Several months into the pain clinic treatment, which was essentially the same as what I had with the other doctor, Comp began denying the Lidocaine and Lexapro (I was awarded lifetime medical).  The PAs disagreed with Comp's decision, but were not good advocates.  They began prescribing epilepsy drugs for the leg pain, but they caused funny things to happen in my brain and even black-out periods.  I stopped taking them.  Then they prescribed Cymbalta, which made me lythargic--I quit taking it.  The PAs then recommended I consider fentynol patch.  I agreed to research and come back at next monthly meeting to discuss.  When I arrived, a different PA (never seen before) informed me with no prelude that I was going to be put on Suboxone--no explanation, no warning, no reason for switching gears.  Simply handed me a "patient's guide" and said you will get no more medications except this.  Appointment did not go well.

So, the doctor who owns the practice (whom I had seen only once before on the day I started - 1-2-08 - comes in and tells me it is a done deal--he has decided, and if I don't like it, get another doctor.  I attempted to discuss how and why we were going to this treatment.  He said the reason was I have indicated increased pain over the past 3 months (I fell and tore tissue and broke my right foot.  The break was not identified for a month and then was in a soft cast for about 2-1/2 months after identification.) and he was not going to give me more opiods.  I tried to tell him I had not asked for increased, but, in fact, meds were decreased with no patches.  I asked him how Suboxone was indicated for my back pain and he responded that I would not need pain meds once on Suboxone.  The patient handbook says Suboxone is not indicated for pain treatment. I asked about the addictiveness of Suboxone and he said he would "taper" me off after 18 months or so and there would be no need for pain medications.  Like I said, I am afraid of addition and he is scaring me to death.  Now, he has received authorization from Worker's Comp to do "Suboxone Induction" without my approval.  

I appealed to Comp to NOT TAKE SUBOXONE, but can find very little information about it and why a doctor would want me to go this way.  I am not a recreational drug user, never have been, am not an alcoholic, and am never without pain.

Input is appreciated.



This discussion is related to oxycocntin vs ...........
16 Responses
547368 tn?1440545385
Hi France,

Welcome to the Pain Management Forum. I am so sorry that you have experienced since a traumatic injury and now are dealing a PM practice that appear unwilling to communicate with with honestly.

I assume that you are bound to the physicians and workers compensation directives. Understand that WC wants to spend as little as possible on yours or any one's case. Suboxone is far less expensive that the other medications you were being prescribed. So they are not going to be your advocate.

I don't know if I am missing something here but it does not make sense to me that suddenly your PMP has basically decided you no longer need pain medications but need to be detoxed. I doubt he is going to going to change his mind. You have a right to know what what facts he used to make this decision. Ask for a copy of your medical record for the past six months and that may give you a clue. You have the right to know.

In my opinion you have little choice but to find another PMP or stay with the current medical practice and go on the Suboxone therapy. Others will post with their suggestions.

Please let us know what you decide and how you are progressing. I wish you the very best.  

Take Care,
Tuck
Avatar universal
Thank you for your thoughtful analysis.  I am coming to this conclusion that it is basically about money--isn't everything?

As for getting my records, that is the first thing I requested when the doctor said do this or get out.  He refused to turn them over.  In CA you have to go through Work Comp, who have, at times, refused to release records, "for the good of the patient" apparently holding the position that there are things said in evaluation that might upset the patient.  I ran into this early on when they insisted on a psychological evaluation before surgery was authorized, denied the surgery, and then refused to give basis except the "secret" report.  Took an attorney to get access.  Will probably require one now.

I am desperately seeking a new physician--but am concerned about what may or may not be in the records about me--true or not.  

I am glad I found this forum because it has real people who have experienced challenges that the rest of my family and friends have not.  The resource is greatly appreciated.
1017213 tn?1301774873
Hello and wow, I am so sorry that you are having so many back problems and then on top of it, having to deal with worker's comp!  I had no idea that it would be so hard to get your files from them!  Isn't that like, illegal?  I'm not an attorney...it just seems like your medical records should be Yours!!!

Is there any way you can get off of worker's comp and onto like, medical or disablity...that way you can get your records some other way?  You should Always be able to edit your medical records, there is a way to do that.

I also think it sounds like you need to find a new doctor ASAP.  Any doctor who doesn't listen to his patients, isn't the kind of doctor to be going to!  I hope that you get your records and get the heck out of that office!

Also,  I have had chronic back pain for 6 years.  It's not gone, just more manageable...and I have found relaxation and massage to be of great benefit.  I hope you can explore other ways to manage your pain as well.

Mellowscout...best of luck.  
Avatar universal
I have to get an attorney to get my records, which I am in the process of trying to do along with the pain I am going through.  I am desperately trying to find a doctor that will take Worker's Comp.  I have been on disability medicare for 8 years and medicare will not pay for any work-comp injury.  Kind of a catch 22.  Thank you for your advice.  And, yes, it probably is illegal to withhold my records, but they are doing it just the same.
1017213 tn?1301774873
Hello,

Wow, I just can't believe that you can't get your records.  I'm so sorry that you have to deal with two things at once.

So if medicare with not pay for any work-comp, is there any way to get off medicare and try to get insurance?  I'm just wondering, I have never had to deal with worker's comp so I'm sure it's not that simple.

Also you said, "Several months into the pain clinic treatment, which was essentially the same as what I had with the other doctor, Comp began denying the Lidocaine and Lexapro (I was awarded lifetime medical).  The PAs disagreed with Comp's decision, but were not good advocates."  So if you have to get an attorney to get your records, then your attorney should also make sure that you get the lifetime medical that you were awarded.  This happened to my dad and he fought and won lifetime medical for some prescriptions he was awarded that got cut off when his doctor retired.

Don't give up hope!

Mellowscout...best of luck.
Avatar universal
I don't know the details of your situation beyond what you have stated, but it would seem to me that an arrangement has been made to deny you the healthcare that you are entitled to. At the very least, a complete and frank statement as to the reasons for the decision should be provided to you. In your situation, if you need to go through legal channels to obtain the case notes, you should probably also try to find out if you have been "blackballed" by the pain guys. If you have then other doctors will be very wary of taking you on as a patient, as I understand it. Perhaps one of the other contributors here can provide more accurate advice concerning the way that blackballing seems to happen in USA.

All the best and don't lose heart,

Regards,

OtisDaMan
1056593 tn?1254220491
It is really happy to hear some people like Mellowscout have cured from back pain. Similarly my brother(insane biker) was suffering from severe lower back pain. Even though he stopped his biking he had the problem. Then he got some back pain treatment & now he feels good. If you can too try, thats why I replied as soon. Thanks

Avatar universal
You have made a very good point about being possibly blackballed.  I just found out today that there is a low probability that another Comp doctor will take me because of what has been written in my records--which I have not seen.  Now another issue to deal with on getting the records plus finding a doctor.  The one Comp referred me to has refused to take me so maybe I am blackballed.  Who knows what this guy wrote about me that he has refused to let me see.
547368 tn?1440545385
What kind of state law denies a patient access to their medical records? I am far from an attorney, or any kind of expert but those are your records, regardless of who paid for your care. Write to your congressman, your senator and anyone you can think of in authority. This is a ridiculous law, that in my opinion could have only been made to protect physicians and insurance companies. Few things surprise me anymore but this one certainly does.

In my state, Wisconsin, you have a right to each and every medical record rather it is through workers comp or not. And I had no idea that Medicare will not pay for a pre-existing condition after a period if time. The federal government will not allow private insurance companies to have an unlimited amount of time on a pre-existing condition but it's acceptable for Medicare? That does not sound feasible to me either.

And how will one pay for an attorney when they are on Medicare? None of this makes sense to me. I am so sorry that you are caught in this nightmare of ridiculously unfair laws to say nothing about invasion of privacy where all medical facilities and W.C. insurance and staff have access to your records but you.  
547368 tn?1440545385
I've done a lot of searching regarding your right to medical records in CA. I also searched W.C. in your state. I cannot find anything that says you must retain an attorney to obtain your medical records.

HOW CAN I OBTAIN MY OWN MEDICAL RECORDS?

You have a right under California law to access complete information about your medical condition and the care provided to you.2
  
You have the right to provide a health care provider with a written statement up to 250 words regarding any information contained in your medical records that you believe to be incorrect or incomplete. This statement will become part of your medical record and must be included whenever your medical records are disclosed by your health care provider to a third party.
  
  
From Health Care Providers
Health care providers, such as doctors, HMOs, and hospitals, must permit you to inspect your medical records during business hours within five working days after receiving a written request from you. You are required to pay reasonable clerical costs associated with locating the records and making the records available for your inspection.3

Your health care provider must provide copies of the records for not more than $.25 per page, or $.50 per page for records copied from microfilm.4 Your health care provider does not have to give you copies of X-rays if they provide them to another health care provider upon your written request within 15 days after receipt of the request, specifying the name and address of the health care provider to whom the records are to be delivered.5

This web address will provide you with more information:    http://www.calpatientguide.org/iii.html

I think they may just be giving you the run around. By law you have a right to your medical records regardless if they are based on a Workers Compensation injury or not. Good luck to you.
Avatar universal
Thank you for the research you did.  If you could give me websites it may help.  Yes, by law we are allowed access to our records just like we are entitled to adequate pain relief.  The rub comes in when an agency, this case State Compensation Insurance Fund, decides they do not have to follow the law.  About 6 years or so ago (my injury was in 1995), CA changed the laws for work injuries substantially--in the process they removed any financial penalties for the Comp people not responding or doing their jobs, i.e. delaying treatment, refusing it, late payments, generally sloppy work, etc.  It took about 2 years before this showed up substantially for we injured people.  The Comp people have no consequences for their arrogance and inaction.  Also, they have a regulation (not part of original law, but rules written to implement the law after concept was passed--kind of like what is going on with national healthcare--the details of which were not decided when the law changed--that they interpret broadly.  It says if the information may cause harm, i.e. stress, misunderstanding, change in mood, etc., the reports may be withheld from the patient.  So, when a mental health worker writes the patient is aggressive and possibly violent and so labeled, that note may be withheld from the patient.  Then, the patient never knows why he is or is not being treated in a certain way.  The only way this gets released to the patient is through a court order.  So much for openness.  I encountered this some years ago when I asked a hospital what pills they were giving me--they said the same as you had before you checked in, but they looked different.  When I insisted I have the information, they put in my chart that I was uncooperative, combative, and appeared to be "seeking unwarranted additional pain medication" -- totally shocked me to read that when the records were inadvertently left in my room unattended and I read them.

Too long of post--sorry--venting my frustration about what we think our rights are and what they actually are unless we are rich and can afford all the legal clout to get what we are supposed to get.
547368 tn?1440545385
I did give you the website. Here it is again.
I called it the web address:  http://www.calpatientguide.org/iii.html

What a same that your laws have been changed. Is there nothing that can be done besides hire an attorney? It just seems so unfair.

Ppl would be surprised to learn what is in their medical records. I think it has gotten better over time in most facilities. I was a long time member of the medical community I have seen unbelievable (and untrue) statements written by various medical providers. Some times it was an error but most times it was a personal opinion.

My own medical records from a former PCP were extremely slanted and riddled with mis-truths. It was so obvious that this physician did not like me and had a personal vendetta that even an untrained eye could pick up on it.  I never guessed because I trusted him so very much. As soon as I read them I changed PCP immediately but damage was done that took years to undo in some instances. I encourage everyone to request copies of their medical records from every provider that they see....but I digress.
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