The Pain Code; Walking Through the Minefield of the Health System
When it comes to living, the best life you can when faced with a chronic care condition every person has choices. It is a matter of finding the right fit for you. The patient can either let the disease run them or sort through the system and take control of the disease. Coping with a chronic condition takes hope and self-awareness. Through the author’s struggles and finding her way through the health system for the past 10 years, she gained knowledge that she passes on to the readers of this book. Getting organized is very important. It will take work in the beginning but it gets easier as you go. You can also save yourself more pain and challenges down the road by being organized with your approach to treating your chronic medical issue. Topics covered include types of pain, depression, become an expert on your illness, organize your healthcare, treatment options, financial challenges, disability resources, challenges with insurance, finding community, create your oasis, and living well with chronic pain.
Barby Ingle
One of my top 5 books of all time is Atlas Shrugged. Yes it is long, it took me 6 months to get through the whole book, it is so worth it, It teaches about social interaction. This is one of the bestselling books of all time, but brings about controversial views, most love it or hate it. It covers: property rights, theory of sex, government and business, sanction of the victim, and philosophy. When I started reading, I thought I was Hank Reardon, but after chapter 3, I realized I was not, I am actually John Galt… who are you? http://www.atlasshruggedmovie.com/ There is a characters for everyone in this book (being made into a movie (part I is out), (part II comes out in Oct), and (part III comes out next year). After reading this book I have referred back to my highlighted and pinned notes in the pages multiple times for advice. I highly suggest you reading it as well!
Here is the Ketamine Infusion Protocol I use and has worked for me
Here is the Ketamine Infusion Protocol I use and has worked for me.
April 11, 2012 at 2:48pm
Here is the protocol I use
Ketamine Infusion Information
This is based on Barby’s treatments as well as many other patient references. Keep in mind that every patient is different and your doctor is the one to determine what will work best for you.
Pre K-Infusion
Testing
Laboratory
Cardiac
Psychological evaluation
Hospital-based infusions
Five-day in-patient stay
An intravenous (iv) line is inserted
Dosing starts at 20mg of Ketamine per hour, which is increased by 5mg increments to a maximum of 40mg per hour
Clonidine, 0.1 mg (per FDA)
Lorazepam (Ativan®), 1-to-2 mg, for any dysphoria or hallucinations
Other medications are utilized to treat such problems as nausea and vomiting, headache etc.
Outpatient protocol
Initial 10 day outpatient care
Five days on, 2 off, five days on
70mg to 200mg of Ketamine per day in titrating doses over the 10 days and then start the outpatient booster program
Most patients are given 2 mg of Midazolam and sleep through the procedure
Other medications are given as needed for side effects such as nausea and headache
Booster Protocol
Following discharge from the hospital or 10 day outpatient care, patients enroll in an outpatient infusion booster program
The booster program consists of two consecutive outpatient treatments a week every other week for one month, then two consecutive treatments one month later, then two consecutive treatments at three months.
Outpatient visits are then monthly, or at 3-month intervals. This is done in two or more consecutive days. Exact protocol depends on the patient and varies at times.
Barby’s outpatient dose of Ketamine is 200mg each day.
Here are a couple of my videos:
SB1385 -We need as many groups & people to let Sen. McComish know there is wide support for this bill among patients & providers
SB1385 -We need as many groups & people to let Sen. McComish know there is wide support for this bill among patients & providers
February 4, 2012 at 9:14pm
Update: 2/17/2012: Unfortunately, Senator Smith decided not to vote yes on this bill and it died. We will try again for the Prior Authorization bill in the next session. A new number will be assigned. We need your support to show that the legislation is wanted by the pain community!
UPDATE 2/8/12: THANKS to our writing and emails… “Sen. McComish did agree to put the SB1385 bill on the agenda next week. I am going to send out an email later today when the official comes out. We will need everyone to sign in support.” Thanks for your help and support. It looks like we have 3 solid yes, 1 soft yes and 2 no votes coming next week. The person we need to concentrate on is Senator Smith (the soft yes). We need him to vote yes and know that there is community support behind this bill. Also, for those of you in AZ… there vote takes place next tues. Feb. 14th. We are looking for people who support the bill to meet us down at the state senate offices to attend the meeting. We will be gathering at 1-30-1:45pm. Please let me know if you can make it. If you want to do something and you cant make it in person… keep writing and calling! Sen. Steve Smith – stsmith@azleg.gov – phone (602) 926-5685 especially, but you can call all of them and email them again before Tuesday 2/14/12.
Feb 4th, 2012: As most of you know, there are only two more weeks to hear bills in Standing Committees in the house of origin for the state of Arizona. SB 1385 is not on the agenda next week in the Senate Banking and Insurance Committee which means, at least for now, there is only one more week after that to hear bills. I think the health insurers have all talked to Sen. McComish, Chair of the Senate Banking and Insurance Committee, and I don’t think he is inclined to hear the bill.
In order to try to persuade Senator McComish, we need lots of groups and people to weigh in. Sen. Reagan is interested in moving the bill but she thinks that in order to get it moving we need to amend the bill to remove the language that allows the prior authorization request to be approved if the health insurers don’t respond within the five day time period.
We need as many groups and people to let Sen. McComish know there is wide support for this bill among health care providers and patient groups.
In addition to contacting Sen. McComish it would be helpful to contact the other members of the Senate Banking and Insurance Committee. The members of the Senate Banking and Insurance Committee are:
Sen. John McComish – jmccomish@azleg.gov – phone (602) 926-5898
Sen. Michele Reagan – mreagan@azleg.gov – phone (602) 926-5828
Sen. Linda Gray – lgray@azleg.gov – phone (602) 926-3376
Sen. Robert Meza – rmeza@azleg.gov – phone (602) 926-3425
Sen. David Schapira – dschapira@azleg.gov – phone (602) 926-3028
Senator Steve Smith – stevesmith@azleg.gov – phone (602) 926-5685
Without your help and support this issue will not be heard. Please tell other groups and people who support this bill to contact Sen. McComish and the other members of the Senate Banking and Insurance Committee. Thanks in advance for you assistance.
Below are some talking points on the Prior Authroization Isuee and Bill
SB 1385 – Prior authorization; prescription drugs; form
Talking Points for SB 1385
Prior authorization is a common cost containment method used by health insurers that significantly delays medication accessibility for patients and imposes high costs that negatively impact operating margins for health care providers.
In recent surveys by the Arizona Medical Association and the Arizona Osteopathic Medical Association:
At least 98% of MD’s and DO’s agreed that the prior authorization process interrupts patient care and that a more simplified process is needed.
73% of the staff spends between 10-40 hours per week obtaining prior authorization and at least 48% expressed difficulty in obtaining prior authorization on prescription drugs on at least 25% of prescription drugs.
Additionally, at least 88% would prescribe an alternate drug if it meant avoiding prior authorization.
This proposal streamlines the prior authorization process and improves access to prescription drugs by creating a standardized form for health care providers to use when making a request for prior authorization and for health insurers to accept and use when determining whether or not to approve the prior authorization request for prescription drugs.
Summary
This bill would:
Requires health care insurers and health care providers who prescribe prescription drugs to use the standardized form for all prior authorization requests beginning on January 1, 2014.
Direct the Department of Insurance to establish a committee of nine members including representatives of health care insurers, health care professionals who have the authority to prescribe prescription drugs, a pharmacist and a member of the public to develop a standardized prior authorization form for prescription drugs by September 1, 2013.
Specifies that the form cannot exceed two pages and must be electronically available and transmittable.
Specifies that authorized agents of the health care provider (employees of the provider, contract employees or pharmacists who are authorized by the provider) may confer and consult with the health insurers regarding the prior authorization request on behalf of the health care professional.
Hawaii HB 1741 – SUPPORT Prior Authorization Legislation – Send your comments before 2/14/12
Hawaii HB 1741 – SUPPORT Prior Authorization Legislation – Send your comments before 2/14/12
February 10, 2012 at 3:03pm
HAWAII
HB 1741 – SUPPORT Prior Authorization Legislation – Send your comments to http://www.capitol.hawaii.gov/emailtestimony Thanks so much for your help with this critical patient access issue.
Sample Letter:
Representative Robert Herkes
Hawaii State Capitol
Honolulu, HI 96813
RE: HB 1741 – SUPPORT
Dear Representative Herkes,
I support HB 1741, which streamlines and simplifies the Prior Authorization (PA) process for patients. Under the guise of cost containment, Hawaii health insurers have implemented procedures and protocols such as prior authorization that threaten the doctor-patient relationship and interfere with effective patient care by denying or delaying access to treatment.
Prior- and pre-authorization policies – when an insurer requires a doctor to obtain authorization from the insurance carrier before the carrier will agree to cover the cost of medication or treatment – deliver costly bureaucratic hassles that take a physician’s time and attention from patient care. The fact that each health plan has its own distinct prior authorization form only compounds the problem and adds to the time physicians must spend navigating the managed care maze in order to get patients access to the treatments they need.
The PA process is currently highly complex, lacks transparency, and the criteria and processes vary significantly among health plans. Health plans in Hawaii have differing preauthorization, appeal, benefit advisory, and admission notification requirements; and these differing requirements create training and logistical complexity for providers, as their staff tries to keep track of the various requirements and the different methods of communicating the information.
HB 1741 institutes patient protections for PAs that will preserve the provider-patient relationship.
Should you have any questions please contact me at xxx-xxx-xxxx.
Sincerely,
xxxxxx
Help get AZ SB 1401 passed. Arizona Patients Need Your Help!
February 9, 2012 at 1:51pm
Update: 2/17/2012: SB1401 will likely go the the senate floor next week. We need you to write or call to the senators before Tuesday 2/21/12. .
SENATOR Phone Email Party District
PIERCE, Steve 602-926-5584 spierce@azleg.gov R 1
JACKSON, Jack 602-926-5862 jjackson@azleg.gov D 2
GOULD, Ron 602-926-4138 rgould@azleg.gov R 3
BURGES, Judy 602-926-5861 jburges@azleg.gov R 4
ALLEN, Sylvia 602-926-5219 sallen@azleg.gov R 5
KLEIN, Lori 602-926-5284 lklein@azleg.gov R 6
BARTO, Nancy 602-926-5766 nbarto@azleg.gov R 7
REAGAN, Michele 602-926-5828 mreagan@azleg.gov R 8
MURPHY, Rick 602-926-4444 rmurphy@azleg.gov R 9
GRAY, Linda 602-926-3376 lgray@azleg.gov R 10
DRIGGS, Adam 602-926-3016 adriggs@azleg.gov R 11
NELSON, John 602-926-5872 jnelson@azleg.gov R 12
GALLARDO, Steve 602-926-5830 sgallardo@azleg.gov D 13
MEZA, Robert 602-926-3425 rmeza@azleg.gov D 14
LUJAN, David 602-926-5058 dlujan@azleg.gov D 15
LANDRUM TAYLOR, Leah 602-926-3830 llandrumtaylor@azleg.gov D 16
SCHAPIRA, David 602-926-3028 dschapira@azleg.gov D 17
LEWIS, Jerry 602-926-5760 jlewis@azleg.gov R 18
CRANDALL, Rich 602-926-3020 rcrandall@azleg.gov R 19
McCOMISH, John 602-926-5898 jmccomish@azleg.gov R 20
YARBROUGH, Steve 602-926-5863 syarborough@azleg.gov R 21
BIGGS, Andy 602-926-4371 abiggs@azleg.gov R 22
SMITH, Steve 602-926-5685 stevesmith@azleg.gov R 23
SHOOTER, Don 602-926-4139 dshooter@azleg.gov R 24
GRIFFIN, Gail 602-926-5895 ggriffin@azleg.gov R 25
MELVIN, Al 602-926-4326 amelvin@azleg.gov R 26
CAJERO BEDFORD, Olivia 602-926-5835 ocajerobedford@azleg.gov D 27
ABOUD, Paula 602-926-5262 paboud@azleg.gov D 28
LOPEZ, Linda 602-926-4089 llopez@azleg.gov D 29
ANTENORI, Frank 602-926-5683 fantenori@azleg.gov R 30
Arizona Patients Need Your Help!
The Cost Sharing/Out of Pocket Cost bill that the Arizona Alliance for Chronic Care Coalition (chaired by the AZ Hemophilia Association) has been working on for the past year is up in the Senate Banking and Insurance Committee on Tuesday, February 14 at 2:00 PM. SB 1401 does the following:
Health plans are not able to change biologics or plasma derived prescription drugs to a higher drug tier during the term of the evidence of coverage. If during the next open enrollment a biologic or plasma derived therapy does have a tier increase health plans must give the patient 60 days notice.
If a health care service plan contract requires co-insurance, requires a co-payment or provides for a limit on the annual out-of-pocket expenses, the enrollee’s out-of-pocket costs of covered prescription drugs and major medical shall be included in that limit.
If a health care service plan contract provides for a limit on the annual out-of-pocket expenses, the total out-of-pocket costs for major medical and prescription drug coverage in a policy year shall not exceed $3,000 per individual and $5,000 per family.
Hoping you can write letters of support, make support calls and/or testify at the hearing. Since AZ is such a pro-business, heavy Republican state it may help if business/economic arguments are made similar to the attached letter of support from the Neuropathy Action Foundation. The Committee Member contact info is as follows:
____________________________________________________________________________
Here is a sample letter. PLEASE UPDATE IT TO YOUR LIKING!
RE: SB 1401 – ASKING FOR YOUR SUPPORT
Dear Honorable Senator,
I support the SB 1401, which makes access to biologics and plasma therapies more affordable, accessible and predictable by prohibiting insurers from increasing drug tiers during a contract period and requiring a sixty-day notice to patients if a drug is reclassified. SB 1401 also clarifies that the total out-of-pocket costs for major medical and prescription drug coverage in a policy year shall not exceed $3,000 per individual and $5,000 per family.
I am showing my support for the SB 1401 bill because it will prohibit insurers from increasing out of pocket costs for patients’ mid-year unpredictably and arbitrarily. This bill will better allow Arizonans to predict that their out of pocket cost will be at the time they enter into the contract. This will allow patients to budget for healthcare costs and better communication with their providers on treatment issues related to financial aspects.
SB 1401 addresses the problems of step therapy by specifically focusing on patients to highlight the inadequacies of the practice because a patient can tell immediately whether a medication is working or not, and they should not be forced to stay on medicine which does not improve their condition. Passing SB 1401 will help hard-working insured Arizonans obtain needed medications. The state will avoid increased emergency room visits, hospitalizations, lost wages, unemployment and medical debt. Maintaining affordable medication costs helps keep Arizonans healthy enough to work and contribute to their families and the state’s fiscal health.
(your story)… (ex: If this bill doesn’t pass I will be forced to go on state access to get my monthly medications that keep me out a wheelchair and out of the hospital, costing the state an increased financial burden.)
I am also supporting SB 1401 to shed light on the unethical treatment of pain patients, especially women, minorities and economically disadvantaged patients, whom studies have shown are either disproportionately undertreated, or go untreated for pain. I urge you to also support SB 1401 when it comes up for vote in the Senate. Should you have questions please contact me at xxx-xxx-xxxx.
Sincerely,
xxxxx
Please help Stop New Mexico’s SB 159 bill. Write to the Senators by 2/10/12
Please help Stop New Mexico’s SB 159 bill. Write to the Senators by 2/10/12
February 8, 2012 at 2:00pm
2/17/12- update – Thank you everyone who wrote letters for this! New Mexico’s SB 159 was tabled in committee so it looks like the advocacy support was effective! As I understand it a letter that was sent in from a patient advocate was read aloud at the hearing and was very moving and SB 215 passed on the floor -that is the bill for the Pain Management Advisory Council
2/9/12- update – Senator Sanchez pulled the bill from committee today for input and a revision of the language. A new bill is expected shortly; will likely make it to the Labor and HR committee later this week and the next committee this weekend. Please right your letter showing you dont support this bill!!!!!!
2/8/12- UpdateNew Mexico’s SB 159 bill is harmful to pain patients getting relief from opioids, check it out for yourself, read the NM SB 159 Bill. New Mexico’s SB 159, was introduced by Senator Bernadette Sanchez. If passed, this bill would mandate a series of new procedures and restrictions related to the prescribing of opioid medications for the treatment of pain.
Please help Stop New Mexico’s SB 159 bill. You can do this by emailing or calling. We need to get this bill postponed until next year to give all interested parties (those representing concerns about opioid abuse and those representing under treatment of pain), the time to come together to develop a consensus about what policy changes will protect people affected by pain while helping those abusing opioids.
We cannot let them create more barriers for people with pain in New Mexico. Like the rest of the country’s people in pain, they already face undertreated/inappropriate pain care. This bill, as it is currently written, is going to create new challenges that are harmful to pain patients. Patients will have to expect time delays as well as a financial increase in their already burdened situations. These changes will affect prescribers’ practices and in pharmacies in a negative way by confusing them. Prescribers will avoid prescribing opioids, which would be the fastest, easiest, and least costly way to comply with these restrictions. The 2011 Institute of Medicine estimates 116 million adult Americans have chronic pain and only 1.64% meets diagnostic criteria for a prescription opioid addiction. This will clearly affect the pain patients who are not abusing medications. We should not punish the masses that are following the rules and doing what is asked of them, for a minority of abusers.
Senate Judiciary Committee
Senator Richard C. Martinez, Chair, rcmartinez@email.com, 505-986-4487
Senator Peter Wirth, Vice Chair, peter.wirth@nmlegis.gov
Senator William H. Payne, Ranking Member, william.payne@nmlegis.gov, 505-986-4703
Senator Eric G. Griego, eric.griego@nmlegis.gov, 505-986-4862
Senator Clinton D. Harden, charden@theosogroup.com, 505-986-4369
Senator Linda M. Lopez, linda.lopez@nmlegis.gov, 505-986-4737
Senator Cisco McSorley, cisco.mcsorley@nmlegis.gov, 505-986-4389
Senator Sander Rue, sanderrue@comcast.net, 505-986-4375
Senator John C. Ryan, johnchrisryan@yahoo.com, 505-986-4373
Senator Michael S. Sanchez, senatormssanchez@aol.com, 505- 986-4727
Senator Lisa K. Curtis, lisa@curtislawfirm.org
For more information:
Read the bill: http://www.nmlegis.gov/Sessions/12%20Regular/bills/senate/SB0159PAS.pdf
Please also read the State Pain Policy Action Coalition (SPPAC) analysis by the American Academy of Pain Management. Their summary is “We hope this bill analysis illustrates how complicated these issues are, and how important it is to involve all stakeholders in designing solutions to address them. Input from experts in substance abuse treatment, overdose prevention, and pain management all must be considered in order to arrive at policies that present the greatest opportunity for benefit and the least opportunity for unintended consequences that harm people. The issues this bill seeks to address are very real and very important, and we are committed to helping find solutions for them. We also know that the kinds of changes likely to result from this specific legislation will disproportionately affect people with pain, and we are committed to not allowing that to happen. More time is required to do this than is available in the current legislative session.”
What’s coming up… so much is happening in the understanding of RSD… what could that mean for us as patients.
What’s coming up… so much is happening in the understanding of RSD… what could that mean for us as patients.
February 8, 2012 at 10:41pm
There has been a lot information about Reflex Sympathetic Dystrophy Syndrome (RSD)/Complex Regional Pain Syndrome (CRPS)/ Causalgia (and the other 20+ names this disease has gone through in the last 150 years). Until 2007, we didn’t know the biomechanical makeup of the condition and therefore it was classified as a syndrome. A syndrome is the association of several clinically recognizable features, signs (observed by someone other than the patient), symptoms (reported by the patient), phenomena or characteristics that often occur together, so that the presence of one or more features alerts the healthcare provider to the possible presence of the others. As all things in the medical field, it is taking time to get the new information out to the healthcare professionals on the front line, but organizations such as American Academy of Pain Management, American Academy of Pain Medicine are forging the way in healthcare provider’s education.
According to Dr. Prager, the International Study of Pain Association is currently working on an update of the classification of RSD and anticipate having that information available on our website by mid-March. He is currently the Chair of the Pain and the Sympathetic Nervous system (PSNS) Complex Regional Pain Syndrome Group of the International Association for the Study of Pain (IASP).
Now that we know that RSD is a disease not a syndrome there has been a bit of buzz about a name change. Neuro Inflammatory Disease is the name being reported to the Power of Pain Foundation by multiple researchers and scientists in the RSD community. We have been talking about this name change since September, 2009 and it only makes since that the more we learn, the more accurate in naming the disease, diagnosing the disease, and treatment options that are more specific, will make leaps and bounds. I actually stopped the printing of my second book, on RSD entittled ReMission Possible, due to the new information that came out right as we were going to press. I wanted to be sure to include it before printing. A great article in Pain Practicinar interviews Dr Cooper (who’s daughter has RSD and he is a board member of rsdsa) talks a lot about the advancements that are being made in this area as well. http://www.rsds.org/pdfsall/conference%20speakers%202011%20pdfs/Pain%20Practitioner.pdf
We now know that when you have RSD you have glial activation or Neuro Inflammation in your spine and brain. Glial cells, sometimes called neuroglia or simply glia, are non-neuronal cells that maintain homeostasis, form myelin, and provide support and protection for neurons in the brain, and for neurons in other parts of the nervous system such as in the autonomic nervous system.[1] In the human brain, there is roughly one glia for every neuron with a ratio of about two neurons for every glia in the cerebral gray matter.[2]
Neuroscience currently identifies four main functions of glial cells: to surround neurons and hold them in place, to supply nutrients and oxygen to neurons, to insulate one neuron from another, and to destroy pathogens and remove dead neurons. For over a century, it was believed that they did not play any role in neurotransmission. That idea is now discredited;[3] they do modulate neurotransmission, although the mechanisms are not yet well understood.[3][4][5]
Studies done by Dr. Linda Watkins demonstrate the glia activation that occurs in RSD patients. http://www.rsds.org/pdfsall/watkins.pdf. Dr. Bonati from Australia, was the first doctor I have heard of to bring to light the F-MRI being used in RSD patients and can be used as a way to determine if a patient has RSD. I am not sure if he is the first doctor to discover it, but he has been instrumental in it. Dr. Joshua Prager says F-MRI’s are widely available instruments and increasing applied technology, no radiation is involved, better spatial and temporal resolution than PET or SPECT scans, Anatomic and functional imaging performed at same setting, and F-MRI’s are a practical and unique tool for assessing neurological disorders. More from Dr. Prager can be found at http://www.rsds.org/pdfsall/CRPS%20%20for%20RSDSA_Prager.pdf. Another study w/ published results on F-MRI reveals distinct CNS processing during symptomatic and recovered complex regional pain syndrome in children done by David Borsook, MD, PhD, P.A.I.N. Group, McLean Hospital, can be found at http://www.rsds.org/pdfsall/Lebel_Becerra_Wallin.pdf.
There is also talk of RSD being an autoimmune condition after a recent paper was published by Pain® printed by IASP published this past April, 2011. According to this article, researchers have found that some CRPS patients had functionally active autoantibodies against the muscarinic 2 receptor(M2R) and the beta2 adrenergic receptor (b2AR). Intriguingly, their initial investigations did not target the nervous system, but eventually they returned to it. Here their objective was to identify the autoantigens to the antibodies and to assess the functional activity of the antibodies. Theoretically, the agonistic M2R antibodies found in the CRPS patients should thus be protective and should counteract the pathological process in CRPS. Of course, the effect of M2R antibodies may be different in in vitro and in vivo settings. For this reason, any conclusions drawn must be considered tentative. In particular, before treatment is directed at the autoantibodies, more information as to their function, i.e. whether they are pathogenic or potentially protective,, should be collected. I have posted the full article at https://www.facebook.com/note.php?note_id=10150348483394860. This is exciting news and we again, have been told by reliable sources that since this paper was published, that more advancements have been made and that they are projecting that a blood test be available in the United States for RSD by the end of 2012.
As we all know, it takes time to get any changes to our medical diagnosis, treatment option coverage and education of healthcare professionals and patients. Please keep looking for more and more info on these issues because it will be developing over the coming years. Health journals and publications are slow to put out new information as well, but as the next few years go by we can only hope that what is being reported to us is accurate and will come to light, giving even more hope to everyone affected by RSD/CRPS or whatever else it is being called.
_______________________________________________________________________________
Jessen, Kristjan R. & Mirsky, Rhona Glial cells in the enteric nervous system contain glial fibrillary acidic protein Nature 286, 736 – 737 (14 August 1980); doi:10.1038/286736a0
a b c Azevedo FA, Carvalho LR, Grinberg LT, Farfel JM, Ferretti RE, Leite RE, Jacob Filho W, Lent R, Herculano-Houzel S. (2009). Equal numbers of neuronal and nonneuronal cells make the human brain an isometrically scaled-up primate brain. J Comp Neurol. 513(5):532-41. PubMed
a b Swaminathan, Nikhil (Jan-Feb 2011). “Glia—the other brain cells”. Discover.
Gourine AV, Kasymov V, Marina N, et al. (2010-07-15). “Astrocytes control breathing through pH-dependent release of ATP”. Science 329 (5991): 571–575. doi:10.1126/science.1190721. PMID 20647426
Wolosker H, Dumin E, Balan L, Foltyn VN (2008-06-28). “Amino acids in the brain: d-serine in neurotransmission and neurodegeneration”. FEBS Journal 275 (14): 3514–3526. doi:10.1111/j.1742-4658.2008.06515.x. PMID 18564180
The Power of Pain Foundation is working on a bill in AZ to help correct the practice of Prior Authorization abuse by insurers
The Power of Pain Foundation is working on a bill in AZ to help correct the practice of Prior Authorization abuse by insurers.
January 6, 2012 at 4:18pm
The article below was done by Dr. Todd Levine. We are working w/ him and Senator Michelle Reagan to get a Prior Authorization bill passed in Arizona in the 2012 session. More info to come, but I wanted to share this piece from the Phoenix Business Journal.
1/6/12 My View: Prior authorizations should be rethought in 2012 – Phoenix Business Journal
http://www.bizjournals.com/phoenix/print-edition/2012/01/06/my-view-prior-authorizations-should.html
My View: Prior authorizations should be rethought in 2012
I read with great interest the recently published health care innovation section published in the Phoenix Business Journal, and for me it inspired further reflection on other opportunities for improvements. Certainly given the economic climate, enhancements are in demand, as every business is simplifying and streamlining its methods as a consequence of the recession. Physician practices are no different, which is why burdensome processes such as “prior authorizations,” as they work now, do not fit today’s environment.
Prior authorizations require physicians to get approvals from the insurance carrier to cover certain medications or treatments before the care can be given. They are like a heavy anchor dragging down the productivity of doctors’ offices everywhere. They add significant financial burden to physician practices and delay health care delivery to patients.
It is a tactic designed by health plans and third-party administrators as a cost-saving strategy that ambushes staff time — as much as 10 hours a week, according to separate surveys by the Arizona Osteopathic Medical Association and the Arizona Medical Association. Not only are prior authorizations an administrative burden, they are a barrier to optimal patient care. The same surveys revealed that more than 80 percent of the physicians who responded reported they would prescribe an alternate drug if their first choice required prior authorization. It also delays important diagnostic testing such as MRI scans, CT scans and sleep studies, among others.
This can be interpreted to mean physicians are being manipulated to prescribe drugs that don’t require prior authorization because of the burden on them and their staff. Prior authorizations often are managed by nonmedical personnel who serve as gatekeepers tasked with rejecting requests with the idea that physicians will not take the time to fight the process. This places patient care second. Physicians who do engage in prior authorizations experience delays in response. Respondents of the AOMA and ArMA surveys reported that more than 48 percent and 66 percent, respectively, had difficulty obtaining approvals on at least 25 percent of their drug requests.
In a recent case of mine, a patient who had shortness of breath required prior authorization to have an overnight oximetry to ensure they were breathing effectively, and the insurance company said it could take 15 days to approve. Meanwhile, there was the risk of significant medical complications from not having enough oxygen in the body.
In addition, the prior authorization process can be daunting because of the multitude of forms, as every insurer’s form is slightly different. Knowing this, it is easy to understand why more than 90 percent of those surveyed agreed that when it comes to prior authorizations, a new, streamlined process was important.
Certainly, prior authorizations also violate the patient-doctor relationship: To have the first and best recommendations second-guessed compromises the trust between the patient and physician. Worse, the disruptions caused by the prior authorization has the potential of hurting adherence to a prescribed treatment, which if not followed can lead to more complicated, costly therapies and expensive hospital stays. Improving this administrative process would go a long way toward improving patient care and increasing efficiencies in physician offices across the state. And it’s clear that there is support for change. At a time of reflection about resolutions for the new year, it is opportune to start to rethink and to innovate prior authorizations.
Bisphosphonates and RSD – updated
January 1, 2012 at 11:04pm
12/21/2013 note update – In light of the recent double blind study done by USCSD I decided to repost this and see if any of you with RSD have tried this type of infusion treatment and if so, what did you think? – http://www.thblack.com/links/RSD/TherClinRiskMngmt2013_9_139_newBisphosphonate-Neridronate.pdf
I have questions:
- The study said patients with “82 patients with CRPS-I at either hand or foot” were tested… does that mean it was not tried on full body patients, like myself and/or type 2 (nerve injury patients)?
- Will it also help in cases where there is a nerve injury/type 2?
- How long had the patients in the study had CRPS?
- Can people who have kidney problems such as chronic kidney stones use this treatment?
- Zometa is in the same Bisphosphonate class as Neridronate
- The FDA says “Due to the risk of clinically significant deterioration in renal function, which may progress to renal failure, single doses of Zometa should not exceed 4 mg and the duration of infusion should be no less than 15 minutes [see Warnings And Precautions (5.2)]. In the trials and in post marketing experience, renal deterioration, progression to renal failure and dialysis, have occurred in patients, including those treated with the approved dose of 4 mg infused over 15 minutes. There have been instances of this occurring after the initial Zometa dose.”
- It also said that women can get birth defects from it on unborn babies and not to use it on children, and it may or may not be transmitted through breast milk. So, does the patient need to not want to have children, or be done having children when it is administered?
- It doesn’t mention that there were any side effects in the 82 patients who got it? Do you know what if any other side effects there could be?
1 year no symptoms is amazing, but is that a ‘cure’ or ‘remission’. Could the auto-antigens just be tricked into ‘being good’ as they are w/ the ketamine infusions and have symptoms return on future injuries/traumas?
Original note posted on Jan. 2, 2012: At the hospital recently my internist doctor was talking about Bisphosphonates (also called diphosphonates) and using them in the treatment of RSD. Bisphosphonates are a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases. They are called bisphosphonates because they have two phosphonate (PO3) groups and are similar in structure to pyrophosphate. With RSD you can have bone loss. According to Wikipedia; Evidence shows that they reduce the risk of osteoporotic fracture in those who have had previous fractures. However, they do not reduce fracture risk in those with osteoporosis who have not previously had a fracture. Apparently, Bone undergoes constant turnover and is kept in balance (homeostasis) by osteoblasts creating bone and osteoclasts destroying bone. Bisphosphonates inhibit the digestion of bone by encouraging osteoclasts to undergo apoptosis, or cell death, thereby slowing bone loss. The uses of bisphosphonates include the prevention and treatment of osteoporosis, osteitis deformans (“Paget’s disease of bone”), bone metastasis (with or without hypercalcaemia), multiple myeloma, primary hyperparathyroidism, osteogenesis imperfecta, and other conditions that feature bone fragility. You can read more about it at http://en.wikipedia.org/wiki/Bisphosphonate. Let me know what you think about this and if you have tried it.