Many pain patients are searching for anti-drug programs to relieve their constant discomfort without the chance of addiction or dependence. I mean, we’re not asking for much, people.
As a type one diabetic and recovering drug addict, these aren’t just words on a paper. They are my reality. And because there are literally over 100 million Americans forced to live with chronic pain —a disease that has no cure, an illness most people don’t understand, a lifestyle far too easy to judge —our day-to-day obstacles normally involve pain and trying to uncover new ways to ease that pain.
Yeah, I live that too.
At the same time, our nation is simply overprescribed. One way or another, we’re all addicted to these damn opioids. Yeah, they feel good going down but they cause more harm than good in the long run. I mean, big pharma created these pills to kill long-term pain, yet, it’s not killing our pain, it’s killing us. There’s an uproar in overdose deaths and substance abuse in general for a reason.
So, here’s one woman’s story of how finding an opioid alternative changed her life as our nation struggles to do the same.
“I can’t believe it. I had an appointment with my pain doctor begging him to taper me off opioids. I’ve been on prescription painkillers for over a decade,” says herniated disc patient Lana K. from Key West, Florida. “What started as a short-term pain management plan —following spinal fusion surgery —is now a never-ending cycle of withdrawal and more pain.”
Last week, she posted this in an online pain forum that I subscribe to. “My doctor was actually really supportive of the idea to get off narcotics. I’ve heard great things about medical marijuana and CBD oil,” she adds.
What Lana thought was a great appointment quickly brought her to tears when she found out her insurance company will not approve any form of opioid alternative. “I would have to go out of pocket if I want a more holistic approach,” Lana describes.
What this chronic pain patient details are the unfortunate counterparts of our chronic pain lifestyle —whether we like it or not. There are the insurance denials then appeals, which can be draining by itself. And since there’s no cure, relieving our daily pain becomes a top priority. Hence why a majority of our nation is addicted to painkillers or at least knows someone who is.
Like Lana, many people are trying to find anti-drug programs to relieve their discomfort without the chance of addiction or dependence. I know I am. As a result, I dug a little deeper to find out why so many insurance companies are rejecting opioid alternative treatments.
So let’s find out what these online experts have to say.
The Big Picture
The medical director of a Massachusetts-based pain-management center, Complete Pain Care and the secretary of the Massachusetts Society of Interventional Pain Physicians, Dr. Janet Pearl, spoke about the dilemma doctors face when treating chronic pain patients.
Pearl explains, “Every year, pain interventions go to the chopping block, and doctors have to figure out how to provide that treatment and make ends meet.” Lana can attest to that.
According to Pearl, these circumstances are not uncommon. She clarifies that coverage corporations are pulling back or completely cutting previously approved treatments —based on the fact that several doctors and researchers have not yet established the alternatives’ true “efficacy.”
Insurance companies prefer black and white results from opioids alternatives but things can’t be as clear-cut as they would like because chronic pain means life is a permanent gray area. Many people like Lana have to look into their own wallets if they want to explore other non-pharmaceutical approaches (sometimes that’s possible and others it’s not).
Looking at the National Level
Lana did her research —remember guys, a knowledgeable patient is an empowered one.
Anyway, she says that she found an organization called the American Society of Interventional Pain Physicians (ASIPP), which is a stellar force of pain management doctors that provide guidance for the use of opioids when treating chronic non-cancer pain.
In the January issue of Pain Physician, the ASIPP pointed out that the “draconian cuts” to numerous alternative pain treatments by commercial insurers —including Medicare —are dangerously halting the recovery of chronic pain patients.
So let’s say you have chronic lower back pain from a sciatica diagnosis like Lana and your doctor assesses that epidural injections will help your daily discomfort.
He or she would then suggest you pursue this treatment. Next, your insurance company would come back and say yes or no. “I remember waiting weeks to find out if my provider would approve the injections,” the nervous patient recalls. If they say yes, the treatment in question is covered. You can proceed without breaking your bank.
However, if they say no, you either forgo the therapeutic option or pay for it yourself. “I’ve regrettably learned that most opioid alternatives are extremely costly without insurance approval,” Lana estimates. This may be why so many of us are turning to opioids and becoming addicted. “It’s a vicious cycle, a constant back and forth,” she offers.
After doing my research, I found out that reimbursement cuts for epidural injections range from 19 percent to 56 percent, as reported by the Centers for Medicare and Medicaid Services (CMS). This means a majority of patients are denied this treatment.
Back to the chopping block. “This is my reality,” Lana answers.
Months later, a comparable association of pain experts from the Pain Management Center of Paducah, in Paducah, Kentucky, published an article recounting the recent developments on insurance approval for epidural injections. Needless to say, it’s not just patients who are suffering.
“Interventional pain physicians are struggling to keep their practices open and survive into the future,” Dr. Laxmaiah Manchikanti, lead physician at the Paducah Center writes to the CMS. “This is because of the multiple challenges of expensive expansion of information technology requirements, increased regulations, investigations, and continued increases in practice expenses.”
Even with 65,000 letters to members of Congress from pain doctors and patients alike, over 10,000 letters to the CMS, 40 letters from congressional leaders, and multiple personal calls from members of Congress to administration officials, there was little change to the treatment regulations.
Two Steps Forward
The efforts did make a statement, but immediately following any positive action, the CMS introduced another set of factors that brought us back to the same spot as we were before.
“As if things couldn’t get worse,” the Key West native (Lana) offers.
“Thus, this unfortunate action by [the] CMS can be described as two steps forward, and one step back,” Manchikanti continues. “This is an allusion to the anecdote about a frog trying to climb out of a water well: for every two steps the frog climbs, it falls back by one step, making its progress synonymous with the efforts of interventional pain physicians, which may also be described as being similar to that frog in a well.”
There has to be a better way. Lana and I sure would like to know. If patients want an alternative treatment, it may be worth it to consider switching insurance plans to one that will cover the therapy regimen.
But I get it —more times than not, this is impossible to do because of financial burdens or maybe you receive insurance through an employer.
In theory, you’d think it would push the non-approving companies to say yes if everyone left their plan and went to another.
Once again, it’s not that simple, more food for thought than anything else while experts search for a solution.
One Step Back
Well, this past January, another physician, Dr. Thomas Frieden of the American Society of Anesthesiologists (ASA) re-introduced these issues within a collective email to the Centers for Disease Control and Prevention (CDC) —at least we’re trying, people.
The letter reads, “A major challenge in incorporating the Guidelines into daily practice is that some of these recommendations may not be covered by the patient’s insurance, which inhibits physicians’ ability to treat patients using non-opioid approaches.”
In the CDC Guidelines for Prescribing Opioids for Chronic Pain, the CDC affirms, “Interventional approaches such as epidural injection for certain conditions (e.g., lumbar radiculopathy) can provide short-term improvement in pain and function that can facilitate exercise therapy.”
“However, evidence has not demonstrated long-term benefit, and epidural injection has been associated with rare but serious adverse events, including loss of vision, stroke, paralysis, and death,” the guidelines state.
Rebutting the fallacy in their guidelines, Frieden goes further sharing that there have only been serious complications in limited isolated cases, and we cannot take them at face value. These alternative treatments actually afford “short-term and long-term improvement” —more so than opioids themselves.
Furthermore, he emphasizes that these treatments are not weighed equally against opioids, heeding that while alternative treatments are required to bestow a 50 percent or greater pain improvement in the patient’s pain levels, opioids are only required to exhibit 30, which is kind of like comparing apples to oranges. How unfair is that?!
“In a time where we are supposed to not be prescribing opioids, the options to treat pain are narrowing. They need to be broadening,” Frieden concludes.
I reached out and received an update from Lana. She was determined to get off painkillers come hell or high water. Fortunately, with the help of medical marijuana and massage therapy paired with physical therapy, Lana has not needed her narcotic medication for the past 30 days (thanks to an opioid tapering program created by her general physician).
“My life has changed —for the better,” Lana finishes. “I do have to go out of pocket to pay for the alternative treatments but for my health and sanity, they really are worth every penny.”