Chronic Pain

[Steppenwolf]

Yesterday 25 May 2007 my congressman held a 2 hour town meeting for Veterans. The meeting was attended by approximately 60 or so veterans and a few family members. Most of the Vets were WWII veteran which I found interesting since they are probably the fewest by number in the VA system. I don't know this as a fact but like my Dad most are in their 80's or older.

There was one vet from the current war, a few from the Korean war and a few Nam vets.

During the Q&A session most of the questions came from the WWII guys who had questions about their own issues, ie why they can't get Lipitor at the local VA when it's available at other facilities. The Iraq vets wife spoke about PTSD. And I spoke about the contract which the congressman had never heard about; he was not happy that the VA would try to execute their own form of policing narcotic medications especially without a VA form number.

I gave him a copy of the contract. He said he would look into it.

It was also obvious that a few of the older guys thought that I was complaining about the system that has served them well. I see how this can be interpreted that way since it only applies to people with chronic pain who need narcotic medications. The VA probably knows that for the majority of their patients this contract does not apply so the number of complaints are automatically limited by the nature of the conditions concerning the contract. Well in my opinion illegal is illegal whether it effect 1 person or a million.

[Steppenwolf]

I am treated a VAMC Tucson, AZ. I receive 240 tablets of oxycodone each month. I have never been asked to sign anything concerning this prescription. Up until about two years ago, I would receive three months worth at a time. My PCP told me that the system would not allow three month prescriptions for narcotics anymore-either by mail or pick up at the pharmacy. Every other prescription is still filled in three month quantities.

I have read some pain management plans which require contracts but only if a drug use problem is real or suspected. Many years ago, the VA switched PCPs for me and the second one told me that if I wanted to continue receiving Percodan, I would have to sign a form agreeing to the label of "drug addict". I responded very angrily I would sign nothing agreeing to any label and futher that if I was, in fact, addicted to Percodan it was the VA's fault (with him included) for not accurately diagnosing and properly treating my condition which would rise to the level of malpractice. He backed off and apologized and that was the last I ever heard of it.

The VA has gone through a number of cycles with regard to narcotics. At one point, they gave them out like candy, then you couldn't get a presciption without a number of cosigners on the script. Now, it seems to be somewhere in the middle. I have no complaints about the availability of narcotic prescriptions, but then again I have never had to sign a contract or defend my use of them. I have never been screened for drugs either to my knowledge

Regarding the use of weed for pain reduction, I have been advised by several doctors (although unoffically and never in my medical records)over the years to try it. One was the Chief of Neurology at a leading medical school. She was willing to try anything to relieve my pain, even driving 100 miles in her own auto to deliver a massive sedative to knock me out until we could come up with a different plan. The local pharmacy(civilian) would not honor a phoned in prescription for this type of drug.

Studies have consistently shown that people requiring narcotics for chronic pain are the very last to abuse them. Also studies show that chronic pain is one of, if not the, most undertreated condition in the US. A google search for both might arm you with enough facts to counter the resistence you are currently facing.

I certainly know how badly untreated chronic pain can damage a person physically and mentally. Fight the good fight and don't give up!

Good letter Jim, This helps show the inconsistancy of the VA medical System.

I'd like to hear from everyone who has dealt with pain management and narcotic drugs.

Thanks

[betrayed]

Change the subject a little, any of you who have chronic pain have a rating for 9422 Pain Disorder

Here is part of my appeal I finished yesterday.

Chronic pain.

This is being appealed because it has been ignored since the beginning. I understand that only one mental condition can be rated. My depression ratings’ earliest effective date is 50% on 7/25/05 and raised to 70% effective 09/29/06. It is my belief that I should have been granted a minimum of a 70% rating for 9422 Pain Disorder effective 06/01/04.

Reasons for Decision (Rating Decision dated May 2, 2005):

Not addressed.

Reasons and Bases (Statement of the Case dated February 13th, 2006):

Not addressed.

a.) I listed Chronic Pain on my VAF 21-256 dated 1/21/2005 and when the rating decision was received there was no mention of chronic pain. I stated in my June 15th, 2005 NOD that it should have been included. When the Statement of the case was issued, there was no mention of chronic pain.

b.) As indicated on my C&P Report Dr. XXXXXXX diagnosed chronic pain.

c.) As indicated on my C&P Report Dr. XXXXXXX XXXXXX diagnosed my depression, and under Axis I it states “secondary to Pain Syndrome”. Under Axis IV it states “Serious pain syndromes.”

d.) Dr XXXXXXXXX Urologist stated on 5/16/02 “I think some of the pain that he is having may be causalgia type pain possibly due to the large number of lithotripsies he has”.

e.) Doctor XXXXXXXXXXXXX Professor of Medicine University Alabama Medical School, Nephrologist stated on 6/12/2002 “Mr. XXXXXXXXX has chronic Nephrolithiasis associated with renal colic and substantial discomfort as a result. He has required numerous amounts of pain medication, and this problem has definitely been life altering”.

f.) DR XXXXXXXXX treated me for chronic pain from July 2002 to November 2003. Doctor XXXXX prescribed 20 mg oxycontin twice daily and tylox for break through pain. Doctor XXXXXX diagnosed me with Chronic pain Syndrome on 11/13/2002.

g.) I have been treated for pain in the Pain Clinic at the VAMC Ann Arbor. XXXXXXXX stated on 8/18/2005 “He does have local neck pain with neck extension and rotation as well as axial compression with extension and rotation.” And “he should continue his current does of vicodin, stay as active as possible and continue with his outside management with cervical manipulation.”

On 10/6/2005 Dr XXXXXXXX stated “He has pain with end of range of motion of the cervical spine. He has limitation of side bending to the left. I recommend continuing the vicodin

and trazadone (for sleep) and encouraged stretching on a regular basis.”

h.) Dr XXXXXX treated my neck pain with cervical manipulations 14 times in 2005 and prescribed 10 lbs of cervical traction three times a day.

i.) I currently take Oxycodone and use fentanyl patches prescribed by XXXXXXXXXX Ann Arbor VAMC for pain management. My pain causes depression (as diagnosed by DR . XXXXXXXXXXXXX during a C&P exam) and anxiety, fatigue /weakness, and muscle pain and stiffness.

j.) The Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) includes a specific category for somatic symptoms related to psychiatric origins called the somatoform disorders. Specific somatoform disorders include pain disorder. Pain disorder is marked by the presence of severe pain as the focus of the patient's concern. This category of somatoform disorder covers a range of patients with a variety of ailments, including chronic headaches, back problems, arthritis, muscle aches and cramps, or pelvic pain. In some cases the patient's pain appears to be largely due to psychological factors, but in other cases the pain is derived from a medical condition as well as the patient's psychology.

k.) I request that I receive a rating for 9422 Pain disorder. I believe under the Schedule for rating for mental disorders my condition warrants a 70% rating effective 06/01/04.

[Steppenwolf]

Change the subject a little, any of you who have chronic pain have a rating for 9422 Pain Disorder

I tried changing the subject to add "Chronic Pain" but could find out how to do it.

[betrayed]

I am treated a VAMC Tucson, AZ. I receive 240 tablets of oxycodone each month.

I used to get that many, now I get 180 a month and ten 75 mcg/h fentanyl patches every month.

Have ypu given any thought to applying for 9422 Pain Disorder ?

[MarineDog]

I have received 180 Darvocet and 60 Percoet monthly for 4 years, and I've never heard of this form.

This is ordered by my PCP, and 2 shrinks. I suffer from CPS, back, migraines, etc.

I have never been to a "pain clinic" before; however,I have been on the waiting list for a "pain clinic"

for 1 year now and every time I call to check, she just says it hasn't been scheduled yet.

Can anyone suggest anything I can do to get my appoitment set? Please..