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The CA WC Opiod Panac
#1
Interesting this physician believes the same as I do about this topic. First time reading an article where he places the important information on how opioids effect the brain and also WHY patients are being limited to pain medication, with the great CA WC UR and IMR system that blocks and/or limits alternative treatments such as PT, aqua therapy and message.

I want to include part of this topic that was not included in this article and that is what can happen to the brain when an opioid is stopped after long time use. If the brain has stopped production of Dopamine due to long term opioid use, this can place a patient into a state of severe depression if the medication is stopped without proper weaning. It can also happen when the patient is weaned appropriately. Every patient is different and some may not be as affected as others. It can take time for the brain to recover and start to naturally produce these chemicals again, and for some it can be weeks or months and for some it can take up to a year for their brain to fully recover. Things like exercise can speed up this process, however exercise can be difficult for those with substantial injuries. This on top of increase in pain can cause feeling of suicide in some patients. I want patients to know who may be having these feelings that this state is temporary and to contact their doctor if they are feeling this way.

I have come to realize in California they want to stop ALL treatment they can and they have done an excellent job doing so. Instead of a benefit delivery system, they are a benefit denial system. Medicare and private insurance is picking up the tab IF the patient is lucky enough to have alternative coverage.


http://politicsofhealthcare.blogspot.com...+Report%29


The Weinmann Report


OPIOID PRESCRIBING AND PANIC
Posted: 13 Aug 2017 10:48 PM PDT

   The mechanism of opioid action
is through a receptor mechanism that we all have, namely, mu, delta, and kappa receptors. Human opioid receptors are endogenous and can be activated by endogenous peptides such as the enkephalins, dynorphins and endorphins. These substances are released by neurones and are thereby made available for pain modification. Endogenous opioid peptides comprise a class called endorphins.  

  This class of neurochemical stimulation is available to injured persons and can be mobilized into action without prescribing the likes of vicodin, oxycodone, oxycontin, or similar controlled substances (or illegal non-controlled substances). This level of neurochemical stimulation can be triggered to release endogenous substances in the human body that relieve pain.  For instance, physical therapy, aquatic therapy, or massage can have this favorable effect. When this method doesn't work, analgesic medication including opioids may then  be prescribed.

  The trouble is that in the case of injured workers covered by workers compensation, these alternative methods to opioid prescribing are often rejected by Utilization Review (UR). Then that rejection by UR gets rubber-stamped by anonymous Independent Medical Review (IMR) doctors whose prejudices cannot be addressed since their names are kept secret. When the PTP or Primary Treating Physician's attempt to prescribe an alternative to analgesic relief is denied authorization, the next step is pharmacological, often opioids. That's when the bureaucratic howling begins. What should happen instead is that the UR and IMR doctors who denied treatment by physical therapy or massage should be relieved from duty. 

"Turn the Tide," a publication of The Office of the Surgeon General, discloses resources for the proper prescribing of opioids for pain, chronic pain in particular. For instance, once opioids are prescribed, they should only be continued if "meaningful improvements in pain and function without significant risks or harm" can be documented. Interestingly, the brochure distributed by The Office of the Surgeon General, states in red capital letters, "Start Low and Go Slow."

In fact, in The Weinmann Report, 6/26/17, "Opioid Denials and Obstruction of Alternative Treatments," we discussed how The Washington Post in 2001 made a front-page headline about a doctor in California who was being sued for not prescribing enough pain medication. We also cited a peer-reviewed reference from HEADACHE that stated that opioids were useful in pain management but that that its use had to be slow, slow, slow -- this advice was 17 years ahead of "Turn the Tide" and 10 years before Paduda's original article. 

In a panic-ridden piece entitled "Narcotic use is rampant in workers compensation," we are told that "the problem is showing up in a doubling of emergency room admissions due to prescription drug abuse, driven primarily by oxycodone, methadone, and hydrocodone." This particular article makes no reference to the Utilization Review denials for physical therapy, massage, and alternative treatments that force patients into the pharmaceutical stream.

On the contrary, Dr. John Torres recommended massage therapy on MSNBC with moderator Craig Melvin on August 1st, 2017. It isn't clear whether or not Dr. Torres knew he was recommending a treatment often rejected by workers comp Utilization Review. Since we  had the privilege of evaluating just this kind of patient recently, we'll what happens if and when the PTP asks for overturn of the denial of massage therapy.

Readers should not be surprised. Since the emphasis now placed on evidence-based-medicine, the reliance on the winds of fashion and bureaucracy has only increased. see

References

The Weinmann Report, 6/26/17, "Opioid denials and obstruction of alternative treatments"

"Controversies in headache medicine," summer, 2000, HEADACHE, V. 11, # 2, Lawrence "Robbins, MD (opioids can be used:  "when they are not overused, the opioids are a safe medication")

"Doctor's  duty to ease pain at issue in Calif. lawsuit," Susan Okie, Washington Post, 05/07/2001

"Oregon Board disciplines doctor for not treating patient's pain,"  New York Times, 09/04/99

"Narcotic use is rampant in workers compensation," Joseph Paduda, October, 2010

"Prescribing Opioids for Chronic Pain," TURN THE TIDE, Office of the Surgeon General, CDC

Commentary by Dr. John Torres, 1 August 2017, MSNBC TV (recommends massage for pain relief) 
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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The CA WC Opiod Panac - California_Help - 08-14-2017, 12:11 PM

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