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VA ER fails to address severe pain. Advised to take Tylenol

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FloridaNative

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I am a 100% disabled vet. I am also a retired registered nurse. Last year I went to the ER at a VA facility when I had a severe exacerbation of chronic lower back pain and siatica. The CT scan revealed severe Foraminal Stenosis in one area along with multiple herniated discs. I was told to take Tylenol and make an appointment with my primary care physician. The pain was so severe I could barely walk. I had to use the rail on the wall to get to and from the ER. I spent the next 3 days in bed with excruciating pain unable to do much of anything.  Just getting in bed caused tremendous. I was unable to extend my right leg without severe pain. The solution according to the VA was physical therapy. I was in too much pain to particate. Several months later after seeing VA pain management I was sent to acupuncture which has helped considerably. I was still not given medication to relieve some of the pain. After doing some research I discovered multiple studies that indicate Tylenol is NOT appropriate for severe pain. I saw a VA pain management pharmacist who recommended pregabalin which I agreed to. It was my understanding they were going to recommend it to my physician. A week later I discovered the recommendation was not made. I was told since the acupuncture was helping they were planning to wait. Acupuncture is not going to correct the structional problems in my back. The surgeon I saw didn't want to operate even though the procedure would have been minimally invasive. I explained to the pharmacist that after my prior experience with the ER I feared another exacerbation. If that occurs  I expect I would be treated in the same manner as the last visit. Basically we don't care how much you hurt we are not going to treat it on a timely basis. I will be seen again in a month to discuss starting the pregabalin. The VA has become so fearful of appropriately treating pain that they send veterans home without treatment. I did further research into veteran suicide and as I suspected chronic pain is a significant cause. There have even been successful malpractice lawsuits filed by survivors of persons with severe chronic pain who committed suicide after their medication was cut. No every veteran who goes to the ER complaining of pain is malingering. From the attitude and care I saw I strongly suspect the physician thought I was malingering.  I am afraid to go to the ER for any reason after the episode because I suspect I will not be take seriously by the physicians.  Has anyone else had a similar problem getting chronic pain addressed? 

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This is a familiar problem with both the VA and private doctors.  In a nutshell, the government is "going after" doctors who prescribe too much pain medications (aka vicodin, oxy, etc, the real pain meds), and, in response the doc's pretty much quit writing pain med prescriptions except for 3 instances:

1.  If you see a pain clinic, who monitors carefully your use with frequent blood checks to make sure you are not getting it also from other docs.  

2.  If you have had surgery, your surgeon will prescribe pain meds (opiates) on a limited basis for post surgical pain.  

3.  When you are in the hospital.  

    

     Its a huge problem.   A few years ago, VA handed out Vicodin as if it were candy.  Problem was, people became addicted, and often turned to street drugs when docs cut them off.    Some Veterans have turned to edible marijuana, such as gummies, as it tends to offer "some people" pain relief for some conditions, and, its legal in most states now.  I checked and Florida is one where medical marijuana is legal.  

That, too, is problematic.  Even tho marijuana is legal in "way over half" the states" it is still Federally illegal, so VA generally wont prescribe or dispense it.  However, I did read about a pilot program where its being tested at the VA, but dont hold your breath.  

      THE BIGGEST PROBLEM:  Since doctors wont prescribe pain meds, it drives people to obtain street drugs and those are often dangerous and even deadly, since many are laced with fentanyl.  

      For ME, what I do is use (legal) herbal supplements which are often superior to chemical pills.  You would need to either see a herbal specialist, read a bunch online, and/or sometimes health food stores can be very helpful, at least some of them.  Herbal supplements are not without risks, however, and you do not to be careful there too..there are scams.  

     In my opinion there are scams with BOTH herb supplements AND pharmaceuticals.  The Vicodin fiasco was a famous one, and, if "FDA approval" was so good, how come drugs get approved, then removed from the market sometimes just a few years later?  Did they not do a good job with studying it the first time?  

    Herbs mostly come "out of pocket".  But they are generally far less expensive than many/most pharmaceuticals, and often safer.  Its your life, and you make your own choices, but whenever I have a choice, I choose supplements first, and only then will I turn to pharmaceticals.  And, I try more than one supplement, too.    My health care is generally a "blend" of pharmaceuticals and herbs.  Remember, tho:  Doctors dont like Herbs, and Herbalists dont like pharmaceuticals.    Medical schools are mostly funded by pharmaceutical companies.  FDA generally does not approve herbs, in no small part, because herbs can not be patented.  So, a company wont spend 100,000,000 dollars to reseach say, Pau D' Arco because anyone can sell it.  Its sad that more research is not there for herbs, but the law does not allow a plant (herb) to be patented.  

    Some pharmaceuticals extract the main ingredient of plants and research those, sometimes combined with other stuff.  

    Its a big reason health care is a mess in America.  Prescription drugs are the third leading killer of people in the USA, according to at least one site:  Its not "just" pain meds, either.  

https://www.riscassi-davis.com/blog/2022/april/death-from-prescription-drugs/

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Here is an article on one patient's sucide. The physicians lost that one to the tune of seven million dollars. While physicians might be terrified that the DEA will come calling that is no excuse for treating a patient like crap. I didn't mention in my original post when I reviewed my medical records from that visit I discovered that they charted I had a pain level of 2 which is not what I told them. I raised hell about that and suddenly it was changed to 6. You can make material changes to a medical record without preserving the original. Unfortunately I trusted the VA system and didn't copy the original. 6 is not what I told them. They pulled that number out of the air. Meanwhile that behavior is responsible for veteran suicides when it becomes apparent the VA doesn't care about pain. The Washington Post did an investigative article on veteran suicide after the FDA issued the 201 guidelines. Unsurprisingly it increased substantially. The FDA has since issued new guidelines meant to improve physician flexibility when it comes to treating pain. Unfortunately it appears the VA ignored the change. 

 

https://www.statnews.com/2021/11/22/her-husband-died-by-suicide-she-sued-his-pain-doctors-a-rare-challenge-over-an-opioid-dose-reduction/

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Back around 2000 the VA was handing out dope like candy.  Now I can't even get an increase in the little pills that are 5% Oxycodone.  At one time I had a script for Morphine and Oxycodone.  It turned my guts to concrete and I told the VA to back off with the Morphine.  Then they put me on Fentanyl strips.  That was ineffective as well.  When I complained they reduced everything.

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Veterans have a right to amend their medical records if there are errors.  You should exercise such a right, if applicable.  The regulation follows:

https://www.law.cornell.edu/cfr/text/38/1.579

In relevant part:

Quote

a) Any individual may request amendment of any Department of Veterans Affairs record pertaining to him or her. Not later than 10 days (excluding Saturdays, Sundays, and legal public holidays) after the date or receipt of such request, the Department of Veterans Affairs will acknowledge in writing such receipt. The Department of Veterans Affairs will complete the review to amend or correct a record as soon as reasonably possible, normally within 30 days from the receipt of the request (excluding Saturdays, Sundays, and legal public holidays) unless unusual circumstances preclude completing action within that time. The Department of Veterans Affairs will promptly either:

(1) Correct any part thereof which the individual believes is not accurate, relevant, timely or complete; or

(2) Inform the individual of the Department of Veterans Affairs refusal to amend the record in accordance with his or her request, the reason for the refusal, ...

 

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As explained above, if one or more VA employees/providers wrote down the incorrect pain level, then you could/should have it corrected.   Its my opinion you are better off not to "attack" the individual involved, but instead simply explain that you did not make yourself clear; your pain level was a level xx not a level a, as indicated by the medical records.  

The pain level, is a level judged "by you",  not by others.  

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Posted (edited)

There is a problem with pain level reporting.  I first define my pain level.  And how long I can go with it without committing suicide for relief.  I have to explain that depression is used to suppress the pain level which means my face does not show it the way the addicts fake it to work them for meds.  5 continuous for weeks is enough to drive you over the edge from there it only shortens the time before you are looking for that finale exit.

Fortunately for me, Keppra, my seizure medication enhances my pain medication as well as reducing pain.  I have not had a level 5 since I began taking more than twice.  The longest lasting once was when I fell and fractured my knee cap.  It took a day before I started feeling the fracture pain and because it was a broken bone, I got more than I needed.  I will have to throw the left over away in another year or so.

As the suicide rate rises again, there will be a new look at whether it is better to occasionally give an addict his fix rather than miss someone who really need the pain med.  Yes the problem with back pain is that the source is not always seen on radiographic reports.

I have MRI reports two weeks apart on my neck.  The one done by a resident in training and signed off by his supervisor showed a lot of stenosis as the source of my pain.  The other, read by a VA contractor showed no stenosis on an MRI of the neck by a different VA only a week later because the neurosurgeon wanted his on MRI to look at and the earlier one was not in the record yet.  The problem with the readings may only be how much the two different sources pay for their software.  The better the software the more you can see.

In Japan the software is Nationalized.  The research is done at state Universities.  And every level of physician has the best software.  Not so here in the land of the big Px.  Most clinics cannot afford the best and the only time you get the best reading is if you go to a VA that works in association with a land grant university medical school.

Edited by Lemuel
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