SIS and other experts advocate for Oregon patients

[drusso]

SIS and 10 other medical societies have warned the Oregon Health Authority (OHA) that a cascade of unintended consequences can be expected from their significantly flawed coverage decision on corticosteroid injections for low back pain. The multi-society response highlights significant flaws in OHA’s coverage guidance methodology, includes citations on the effectiveness of injections, and warns of expected negative consequences of eliminating access to interventional spine procedures including: unnecessary suffering, additional drug dependency, unnecessary surgeries, increased utilization of more expensive therapies, and additional work disability.

http://c.ymcdn.com/sites/www.spinal...mgr/advocacy/MPW_Comments_-_Corticosteroi.pdf

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[101N]

Good on the OHA. However, if they really care about population health, they will take the savings and invest in early-life skill development.

 

[willabeast]

SIS and 10 other medical societies have warned the Oregon Health Authority (OHA) that a cascade of unintended consequences can be expected from their significantly flawed coverage decision on corticosteroid injections for low back pain. The multi-society response highlights significant flaws in OHA’s coverage guidance methodology, includes citations on the effectiveness of injections, and warns of expected negative consequences of eliminating access to interventional spine procedures including: unnecessary suffering, additional drug dependency, unnecessary surgeries, increased utilization of more expensive therapies, and additional work disability.

http://c.ymcdn.com/sites/www.spinal...mgr/advocacy/MPW_Comments_-_Corticosteroi.pdf

what if the OHA does not rank clinical outcome as all that important? i ran into this a while back - many admins have discovered that clinical outcome is very difficult to measure, and does not seem to correlate well with patient satisfaction. since patient satisfaction and cost are the primary drivers of admin decision making, there really is very little incentive to fund most interventional spine procedures. for example - from a patient's perspective, having a quick diskectomy is preferable to multiple visits for injections, PT, medications, evaluations which may lead to a diskectomy anyway. now we all suspect that 10 years later that patient would have been much better off without a quick lami but the OHA is not going to see it that way - 10 years is equivalent to 70 years in municipal years.

 

[willabeast]

Good on the OHA. However, if they really care about population health, they will take the savings and invest in early-life skill development.

if only early-life skill development worked...

 

[101N]

I think, and hope, it does. http://heckmanequation.org/content/scandinavian-fantasy-american-opportunity-promote-upward-mobility

 

[Disciple]

However, if they really care about population health, they will take the savings and invest in early-life skill development.

Probably beyond the purview of the OHA don't you think?

 

[101N]

I disagree. The OHA is interested in population health. In OR CNP and iatrogenic opioid addiction are by and large rural problems.
Those of us who have to face CNP every day know that the most severely effected - the working-aged adult with CNP that lead to work
disability - inevitably got there from the sum total of genes, life experiences and SES. In all honesty a 'disabled' FMS patient, is for all
intents and purposes, unrehabable. Ergo, it's worthwhile to think about prevention. These folks are the same ones dying from drug
an alcohol overdoses. Since we can't 'cure' a 44y/o CNP patient all we can do is reduce the harms and costs of their care. The distress we
have been treating with opioids is a complex mix of under-eduction, childhood neglect, migration of jobs to the urban environment,
and - here at least - a political majority that is smug and self-righteous and frankly doesn't care about this problem because they look
down on these "Trump" people.

If you look at a geographic map of MED in OR you will see that the highest dose counties are rural, red, poor and they voted for change. It's
easy to portray that - and the liberal elite regularly do - as evidence of stupidity. But that ignores the legitimate distress in this large
cohort of people - that we really can't help - but who vote. To his credit Tom Vilsak saw this coming, but the rest of the democrats
didn't care because poor whites don't matter to them. I came from poor whites, so it matters to me.

http://heckmanequation.org/content/resource/lifecycle-benefits-influential-early-childhood-program

 

[SeniorWrangler]

Jesus 101N, what happened to your avatar? The problem with your idea is that the pain patients aren't going away and won't stop seeking relief for their pain by whatever means necessary.

 

[DrCommonSense]

I disagree. The OHA is interested in population health. In OR CNP and iatrogenic opioid addiction are by and large rural problems.
Those of us who have to face CNP every day know that the most severely effected - the working-aged adult with CNP that lead to work
disability - inevitably got there from the sum total of genes, life experiences and SES. In all honesty a 'disabled' FMS patient, is for all
intents and purposes, unrehabable. Ergo, it's worthwhile to think about prevention. These folks are the same ones dying from drug
an alcohol overdoses. Since we can't 'cure' a 44y/o CNP patient all we can do is reduce the harms and costs of their care. The distress we
have been treating with opioids is a complex mix of under-eduction, childhood neglect, migration of jobs to the urban environment,
and - here at least - a political majority that is smug and self-righteous and frankly doesn't care about this problem because they look
down on these "Trump" people.

If you look at a geographic map of MED in OR you will see that the highest dose counties are rural, red, poor and they voted for change. It's
easy to portray that - and the liberal elite regularly do - as evidence of stupidity. But that ignores the legitimate distress in this large
cohort of people - that we really can't help - but who vote. To his credit Tom Vilsak saw this coming, but the rest of the democrats
didn't care because poor whites don't matter to them. I came from poor whites, so it matters to me.

http://heckmanequation.org/content/resource/lifecycle-benefits-influential-early-childhood-program

You ain't fixing this lol

But hey, Oregon "Health" has money for transgendered surgeries to cut off male's genitalia based upon "evidence" they somehow have determined.

Interesting how that works right?

Also, they have money for "Chiropractic care", "Acupuncture" and "CBT", none of which have any objective evidence for improving functional outcomes in the above population of "disabled" patients.

 

[101N]

The avatar is James Heckman I think it would have been better if Wolfe et al had dared not to speak it's name. But, here we are.
Now that it's here I think we can learn a lot from it in that it serves as a cautionary tail. For example, it doesn't respond to opioids.
It tends to cluster in lower SES families. Those with a high penetrance of the disease - more fibromyalgianess - tend not to
regress to the mean. Patients with the condition tend to fare less well following a variety of common surgeries.

Since this syndrome is so hard to treat we need to think about prevention. Heckman views this as a cohort of people with low
'human capital'. Who settles for SSDI @ 35 for FMS if they have the 'capital' to make $100K/yr? The key is preventing this
'syndrome'. In so doing we will be addressing a lot of problems that face our nation, increasing our international competitiveness,
reduce inequality in wealth/education in the US, and preventing suffering, addiction, and over dose deaths.

 

[bedrock]

Who settles for SSDI @ 35 for FMS if they have the 'capital' to make $100K/yr? The key is preventing this
'syndrome'. .

The key is not to make SSI at 35 years old an option for BS diagnoses. We need to rewrite the rules under trump so that disability is only given to the truly disabled such as a quad, severe stroke, ALS, Etc.

If all the whiny wimps with only lumbar DDD, FMS, headaches, etc, were denied SSDI, so that they were effectively given a choice of working or starving, I expect they would shut up, buck up, and work to support themselves.

The handholding and enabling is what needs to stop, so these people are made to work and not leach off the toil of others.

 

[101N]

Building skills in a widening underclass isn't hand holding, it's prevention. Read Heckman, he wants to move away from wealth transfers later in life and
toward skill building early in life. http://heckmanequation.org/content/scandinavian-fantasy-american-opportunity-promote-upward-mobility

 

[DrCommonSense]

Building skills in a widening underclass isn't hand holding, it's prevention. Read Heckman, he wants to move away from wealth transfers later in life and
toward skill building early in life. http://heckmanequation.org/content/scandinavian-fantasy-american-opportunity-promote-upward-mobility

What if these people don't want to "build skills" but just remain on the dole while getting paid "disability" for BS diagnoses?

Ever think of that?

This is the problem with pie in the sky academics who solve nothing in the real world. They can't fathom a large segment of the Medicaid population just don't want to work and will find ANY excuse to avoid working with the most BS of diagnoses.

Restricting IPM for "chiropractic, acupuncture, etc" won't solve any of these problems or decrease healthcare costs.

Unless disability isn't given for BS diagnoses, Oregon won't be saving any money by restricting IPM among their medicaid population.

As it was, Oregon wasn't really paying for any of this anyway as per previous discussions.

 

[101N]

What if these people don't want to "build skills" but just remain on the dole while getting paid "disability" for BS diagnoses?

Ever think of that?

Um, yes. That is basically Landerso and Heckman's thesis in the Scandinavian fantasy. Denmark is often held as the beacon of success in
promoting income equality. They have a very liberal welfare state and a free higher education system. But, what Heckman and Landerso
uncover is that the liberal welfare system undermines the incentives for higher education. Consequently, Denmark is pardoxically increasing
income inequality. Only the wealthy elite kids seize the opportunity to get a college degree.

 

[DrCommonSense]

And your solution is to "help them build skills" how?

More money for schools that are the most overfunded per capita in the industrial world?

You have no solutions.

 

[101N]

 

[drusso]

Somewhere in a pain clinic in Central Oregon...


Oregon pt: I have this pain my neck following a fall. It's dull and achey, sometimes sharp, and shoots down to my elbow. Sometimes my fingers go numb in the right hand.

Oregon doc: The problem is here hereditary. Pick someone in your family you like the least and blame them.

Oregon pt: But, it's really "pinchy" when I turn my head and my finger tips feel numb. I can't grip my car keys to start the ignition

Oregon doc: Your PSC is 30 and your FSQ is elevated. Have you considered psychotherapy?

Oregon pt: No, not really. Can I talk myself out of dropping my car keys? Maybe we can get a MRI or do a nerve study or something?

Oregon doc: ABSOLUTELY NOT. An MRI will only show "gray hair" of the cervical spine and age-related degenerated changes. It's a risk for future health care expenditures. Electrodiagnostic testing is operator dependent and might further "medicalize" your subjective complaints of altered comfort. Let me show you some pictures of a human brain. This thingy here is your amygdala...

Oregon pt: Medicalize my subjective what? I can't feel my fingers and my neck hurts. Especially at night. I can't sleep. Can you give me something to help me sleep at least? Is something wrong with my "amy-dig-ala?"

Oregon doc: ABSOLUTELY NOT. Getting a prescription will only further validate your illness narrative, somatic focus, and neurotic obsession about altered comfort that you're experiencing.

Oregon pt: My illness narrative? I fell and hurt my neck, it cricks and pinches, my arm hurts and fingers go numb. I can't focus at my job because I can't sleep.

Oregon doc: How long have you harbored ill feelings toward your employer?

Oregon pt: What?

Oregon doc: You're only 45 and want to stop working and get on disability.

Oregon pt: Well, I'd like my neck to work right and sleep better...

Oregon doc: Can you recall any traumatic childhood experiences?

Oregon pt: Isn't everyone's childhood traumatic? I mean we did grow up poor...Dad wasn't around because he worked a lot...he was strict.

Oregon doc: Do you have re-occurring dreams about your childhood trauma? When did he stop beating you?

Oregon pt: Well, he wasn't afraid to use a belt from time to time I guess...

Oregon doc: Your problem is that you're catastrophizing; you're a neurotic; your personality is malformed. You're resistant to any information that doesn't condone your disability-seeking, functionally-somatic focused narrative. You're not performing at your fullest human potential because you were "baked wrong" from the start: You can't unboil an egg. You can't polish a turd. You can't un-ring a bell. You can't turn back time. You're demoralizing and you're demoralizing me. You're a waste of a human being and a waste of money.

Oregon pt: Gee, I was just hoping I could get a shot for my neck...

Oregon doc: Too bad. Recent medical policy based upon meta-analysis endorsed by your insurance company determined that is not a benefit to you. You can see a chiropractor, an acupuncturist, a naturopath, do yoga, or learn how to reprogram your amygdala.

Oregon pt: But, my friend had similar problems and got a shot in the neck and got better. He didn't have to have surgery.

Oregon doc: That was a placebo effect. It's impossible. Our time is up. You must go now. Try to learn to live a normal life despite your altered comfort, malformed personality, poor heritage, and limited human capital value to society.

Billing: Level 5; 60 mins, greater than 80% counseling. Plus HOPD facility fee.

 

[lonelobo]

It amazes me you guys have the time to post all these charts, graphs, studies, and diatribes....but usually entertaining to read.

 

[Ligament]

Somewhere in a pain clinic in Central Oregon...


Oregon pt: I have this pain my neck following a fall. It's dull and achey, sometimes sharp, and shoots down to my elbow. Sometimes my fingers go numb in the right hand.

Oregon doc: The problem is here hereditary. Pick someone in your family you like the least and blame them.

Oregon pt: But, it's really "pinchy" when I turn my head and my finger tips feel numb. I can't grip my car keys to start the ignition

Oregon doc: Your PSC is 30 and your FSQ is elevated. Have you considered psychotherapy?

Oregon pt: No, not really. Can I talk myself out of dropping my car keys? Maybe we can get a MRI or do a nerve study or something?

Oregon doc: ABSOLUTELY NOT. An MRI will only show "gray hair" of the cervical spine and age-related degenerated changes. It's a risk for future health care expenditures. Electrodiagnostic testing is operator dependent and might further "medicalize" your subjective complaints of altered comfort. Let me show you some pictures of a human brain. This thingy here is your amygdala...

Oregon pt: Medicalize my subjective what? I can't feel my fingers and my neck hurts. Especially at night. I can't sleep. Can you give me something to help me sleep at least? Is something wrong with my "amy-dig-ala?"

Oregon doc: ABSOLUTELY NOT. Getting a prescription will only further validate your illness narrative, somatic focus, and neurotic obsession about altered comfort that you're experiencing.

Oregon pt: My illness narrative? I fell and hurt my neck, it cricks and pinches, my arm hurts and fingers go numb. I can't focus at my job because I can't sleep.

Oregon doc: How long have you harbored ill feelings toward your employer?

Oregon pt: What?

Oregon doc: You're only 45 and want to stop working and get on disability.

Oregon pt: Well, I'd like my neck to work right and sleep better...

Oregon doc: Can you recall any traumatic childhood experiences?

Oregon pt: Isn't everyone's childhood traumatic? I mean we did grow up poor...Dad wasn't around because he worked a lot...he was strict.

Oregon doc: Do you have re-occurring dreams about your childhood trauma? When did he stop beating you?

Oregon pt: Well, he wasn't afraid to use a belt from time to time I guess...

Oregon doc: Your problem is that you're catastrophizing; you're a neurotic; your personality is malformed. You're resistant to any information that doesn't condone your disability-seeking, functionally-somatic focused narrative. You're not performing at your fullest human potential because you were "baked wrong" from the start: You can't unboil an egg. You can't polish a turd. You can't un-ring a bell. You can't turn back time. You're demoralizing and you're demoralizing me. You're a waste of a human being and a waste of money.

Oregon pt: Gee, I was just hoping I could get a shot for my neck...

Oregon doc: Too bad. Recent medical policy based upon meta-analysis endorsed by your insurance company determined that is not a benefit to you. You can see a chiropractor, an acupuncturist, a naturopath, do yoga, or learn how to reprogram your amygdala.

Oregon pt: But, my friend had similar problems and got a shot in the neck and got better. He didn't have to have surgery.

Oregon doc: That was a placebo effect. It's impossible. Our time is up. You must go now. Try to learn to live a normal life despite your altered comfort, malformed personality, poor heritage, and limited human capital value to society.

Billing: Level 5; 60 mins, greater than 80% counseling. Plus HOPD facility fee.

Fantastic drusso, one of the best written posts I've seen on SDN.

This, in particular, is a powerful spell to cast on those pesky patients:

"Your problem is that you're catastrophizing; you're a neurotic; your personality is malformed. You're resistant to any information that doesn't condone your disability-seeking, functionally-somatic focused narrative. You're not performing at your fullest human potential because you were "baked wrong" from the start: You can't unboil an egg. You can't polish a turd. You can't un-ring a bell. You can't turn back time. You're demoralizing and you're demoralizing me. You're a waste of a human being and a waste of money."

 

[drusso]

Fantastic drusso, one of the best written posts I've seen on SDN.

This, in particular, is a powerful spell to cast on those pesky patients:

"Your problem is that you're catastrophizing; you're a neurotic; your personality is malformed. You're resistant to any information that doesn't condone your disability-seeking, functionally-somatic focused narrative. You're not performing at your fullest human potential because you were "baked wrong" from the start: You can't unboil an egg. You can't polish a turd. You can't un-ring a bell. You can't turn back time. You're demoralizing and you're demoralizing me. You're a waste of a human being and a waste of money."

Many patients have told me that they've heard a version of that spell incanted to them.

 

[lobelsteve]

Many patients have told me that they've heard a version of that spell incanted to them.

Guilt by proximity.

 

[101N]

As have many told me that they stayed in their previous IPM practice for the opioids and they were well aware of, and resented, the constant subtle coercion to undergo repeated, costly, unnecessary, and unhelpful procedures that didn't see to 'last' or effect either their function or opioid use. Most also complain about not seeing a doctor, but only the PA/NP, except when it's time for another series of injections.

 

[lobelsteve]

First rule about OR fight club, is this the private forum.

 

[drusso]

First rule about OR fight club, is this the private forum.

First OR, then GA...pay your SIS or ASIPP dues...

 

[drusso]

First rule about OR fight club, is this the private forum.

 

[Disciple]

Somewhere in a pain clinic in Central Oregon...


Oregon pt: I have this pain my neck following a fall. It's dull and achey, sometimes sharp, and shoots down to my elbow. Sometimes my fingers go numb in the right hand.

Oregon doc: The problem is here hereditary. Pick someone in your family you like the least and blame them.

Oregon pt: But, it's really "pinchy" when I turn my head and my finger tips feel numb. I can't grip my car keys to start the ignition

Oregon doc: Your PSC is 30 and your FSQ is elevated. Have you considered psychotherapy?

Oregon pt: No, not really. Can I talk myself out of dropping my car keys? Maybe we can get a MRI or do a nerve study or something?

Oregon doc: ABSOLUTELY NOT. An MRI will only show "gray hair" of the cervical spine and age-related degenerated changes. It's a risk for future health care expenditures. Electrodiagnostic testing is operator dependent and might further "medicalize" your subjective complaints of altered comfort. Let me show you some pictures of a human brain. This thingy here is your amygdala...

Oregon pt: Medicalize my subjective what? I can't feel my fingers and my neck hurts. Especially at night. I can't sleep. Can you give me something to help me sleep at least? Is something wrong with my "amy-dig-ala?"

Oregon doc: ABSOLUTELY NOT. Getting a prescription will only further validate your illness narrative, somatic focus, and neurotic obsession about altered comfort that you're experiencing.

Oregon pt: My illness narrative? I fell and hurt my neck, it cricks and pinches, my arm hurts and fingers go numb. I can't focus at my job because I can't sleep.

Oregon doc: How long have you harbored ill feelings toward your employer?

Oregon pt: What?

Oregon doc: You're only 45 and want to stop working and get on disability.

Oregon pt: Well, I'd like my neck to work right and sleep better...

Oregon doc: Can you recall any traumatic childhood experiences?

Oregon pt: Isn't everyone's childhood traumatic? I mean we did grow up poor...Dad wasn't around because he worked a lot...he was strict.

Oregon doc: Do you have re-occurring dreams about your childhood trauma? When did he stop beating you?

Oregon pt: Well, he wasn't afraid to use a belt from time to time I guess...

Oregon doc: Your problem is that you're catastrophizing; you're a neurotic; your personality is malformed. You're resistant to any information that doesn't condone your disability-seeking, functionally-somatic focused narrative. You're not performing at your fullest human potential because you were "baked wrong" from the start: You can't unboil an egg. You can't polish a turd. You can't un-ring a bell. You can't turn back time. You're demoralizing and you're demoralizing me. You're a waste of a human being and a waste of money.

Oregon pt: Gee, I was just hoping I could get a shot for my neck...

Oregon doc: Too bad. Recent medical policy based upon meta-analysis endorsed by your insurance company determined that is not a benefit to you. You can see a chiropractor, an acupuncturist, a naturopath, do yoga, or learn how to reprogram your amygdala.

Oregon pt: But, my friend had similar problems and got a shot in the neck and got better. He didn't have to have surgery.

Oregon doc: That was a placebo effect. It's impossible. Our time is up. You must go now. Try to learn to live a normal life despite your altered comfort, malformed personality, poor heritage, and limited human capital value to society.

Billing: Level 5; 60 mins, greater than 80% counseling. Plus HOPD facility fee.

Point well taken.

And now for 101N's version?

 

[lobelsteve]

Dessert has two toppings.

Subtitles.

 

[101N]

Prevention is likely more effective and definitely less costly than treatment

J Pain. 2016 Dec;17(12):1334-1348. doi: 10.1016/j.jpain.2016.09.003. Epub 2016 Sep 15.
The Association Between a History of Lifetime Traumatic Events and Pain Severity, Physical Function, and Affective Distress in Patients With Chronic Pain.
Nicol AL1, Sieberg CB2, Clauw DJ3, Hassett AL3, Moser SE3, Brummett CM3.
Author information

Abstract
Evidence suggests that pain patients who report lifetime abuse experience greater psychological distress, have more severe pain and other physical symptoms, and greater functional disability. The aim of the present study was to determine the associations between a history of lifetime abuse and affective distress, fibromyalgianess (measured using the 2011 Fibromyalgia Survey), pain severity and interference, and physical functioning. A cross-sectional analysis of 3,081 individuals presenting with chronic pain was performed using validated measures and a history of abuse was assessed via patient self-report. Multivariate logistic regression showed that individuals with a history of abuse (n = 470; 15.25%) had greater depression, greater anxiety, worse physical functioning, greater painseverity, worse pain interference, higher catastrophizing, and higher scores on the Fibromyalgia Survey criteria (P < .001 for all comparisons). Mediation models showed that the Fibromyalgia Survey score and affective distress independently mediate the relationship between abuse and pain severity and physical functioning (Ps < .001). Our mediation models support a novel biopsychosocial paradigm wherein affective distress and fibromyalgianess interact to play significant roles in the association between abuse and pain. We posit that having a centralized pain phenotype underlies the mediation of increased pain morbidity in individuals with a history of abuse.

PERSPECTIVE:
This article examines the associations between a history of lifetime abuse and affective distress, fibromyalgianess, pain severity and interference, and physical functioning in chronic pain patients. Our findings support a novel biopsychosocial paradigm in which affective distress and fibromyalgianess interact to play roles in the association between abuse and pain.

Copyright © 2016 American Pain Society. Published by Elsevier Inc. All rights reserved.


http://www.nature.com/articles/s41562-016-0005

Is this multiple-high-cost population segment a priority prevention
target? They made up only 22% of their age cohort born in
one year in one city. However, they left a big footprint on costs of
service delivery (Fig. 4a). By age 38 years they used 66% of the birth
cohort’s welfare benefits; accounted for 77% of fatherless child years
in the next generation; smoked 54% of the cohort’s tobacco
cigarettes; carried 40% of the cohort’s kilograms of excess weight;
occupied 57% of their cohort’s hospital-bed nights; filled 78% of all
prescriptions; were convicted for 81% of the crimes charged to the
cohort; and even made a disproportionate number (36%) of injury
claims. In contrast, the data also reveal a substantial segment of
the cohort (30%) who did not belong to the high-cost group in any
sector. Figure 4b shows that this group has left an unusually small
footprint on their society so far.

 

[drusso]

Prevention is likely more effective and definitely less costly than treatment

http://www.nature.com/articles/s41562-016-0005

Is this multiple-high-cost population segment a priority prevention
target? They made up only 22% of their age cohort born in
one year in one city. However, they left a big footprint on costs of
service delivery (Fig. 4a). By age 38 years they used 66% of the birth
cohort’s welfare benefits; accounted for 77% of fatherless child years
in the next generation; smoked 54% of the cohort’s tobacco
cigarettes; carried 40% of the cohort’s kilograms of excess weight;
occupied 57% of their cohort’s hospital-bed nights; filled 78% of all
prescriptions; were convicted for 81% of the crimes charged to the
cohort; and even made a disproportionate number (36%) of injury
claims. In contrast, the data also reveal a substantial segment of
the cohort (30%) who did not belong to the high-cost group in any
sector. Figure 4b shows that this group has left an unusually small
footprint on their society so far.

"This research yielded two results. First, the study uncovered a population segment that featured as high cost across multiple health and social sectors. This illustrates the potential discovery value offered by integrating the data of multiple longitudinal administrative databases and electronic health records. Without such data, this population segment would have remained hidden. Second, by linking administrative data with individual-level longitudinal data, the study provides the strongest effect sizes yet, measuring the connection between an at-risk childhood and costly adult outcomes in the population."

http://www.independent.co.uk/news/w...lance-big-data-score-censorship-a7375221.html

"The ambition is to collect every scrap of information available online about China's companies and citizens in a single place – and then assign each of them a score based on their political, commercial, social and legal “credit.” The government hasn't announced exactly how the plan will work – for example, how scores will be compiled and different qualities weighted against one another. But the idea is that good behaviour will be rewarded and bad behaviour punished, with the Communist Party acting as the ultimate judge. This is what China calls “Internet Plus,” but critics call a 21st-century police state."

 

[lobelsteve]

After hearing statements on February 2nd from physicians (including SIS members), patients, and experts, the Oregon Health Authority’s (OHA) Evidence-based Guidelines Subcommittee (EbGS) has elected to reconsider its initial ruling, and explore more thoroughly the research that demonstrates lumbar radicular pain relief provided by transforaminal epidural steroid injections.

On July 1, 2016, without awaiting release of the coverage guidance under development by the OHA’s Health Evidence Review Commission (HERC), OHA eliminated coverage for epidural steroid injections, leaving thousands of patients covered by Oregon Health Plan without access to any interventional spine procedures. Most no longer have access to surgery and none have the option of palliative care with long-term opioid treatment. OHA currently recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and yoga as the only viable treatments for back pain. On November 8, 2016, the HERC issued draft coverage guidance strongly recommending against coverage for epidural, facet joint, medial branch, and sacroiliac joint corticosteroid injections for low back pain regardless of etiology.



On December 8, 2016 SIS and 10 other medical society members of the Multisociety Pain Workgroup (MPW) warned about the likely negative consequences from the flawed coverage guidance and inappropriate coverage determination. SIS would like to thank the MPW societies for supporting these procedures and signing-on to several comment letters this past year.

A special note of gratitude to the physicians and patients who attended the OHA meetings to advocate for access to these invaluable procedures. Your voices were heard and we hope the message you conveyed will be instrumental in regaining access to interventional spine procedures.

SIS remains committed to preserving patient access to safe and effective procedures, and with the support of SIS members, we will continue to advocate for patients and physicians in Oregon State and wherever coverage is threatened.

 

[drusso]

After hearing statements on February 2nd from physicians (including SIS members), patients, and experts, the Oregon Health Authority’s (OHA) Evidence-based Guidelines Subcommittee (EbGS) has elected to reconsider its initial ruling, and explore more thoroughly the research that demonstrates lumbar radicular pain relief provided by transforaminal epidural steroid injections.

On July 1, 2016, without awaiting release of the coverage guidance under development by the OHA’s Health Evidence Review Commission (HERC), OHA eliminated coverage for epidural steroid injections, leaving thousands of patients covered by Oregon Health Plan without access to any interventional spine procedures. Most no longer have access to surgery and none have the option of palliative care with long-term opioid treatment. OHA currently recommends acupuncture, manipulation, massage, medications (excluding long-term opioid treatment), cognitive behavioral therapy, physical therapy/occupational therapy, and yoga as the only viable treatments for back pain. On November 8, 2016, the HERC issued draft coverage guidance strongly recommending against coverage for epidural, facet joint, medial branch, and sacroiliac joint corticosteroid injections for low back pain regardless of etiology.



On December 8, 2016 SIS and 10 other medical society members of the Multisociety Pain Workgroup (MPW) warned about the likely negative consequences from the flawed coverage guidance and inappropriate coverage determination. SIS would like to thank the MPW societies for supporting these procedures and signing-on to several comment letters this past year.

A special note of gratitude to the physicians and patients who attended the OHA meetings to advocate for access to these invaluable procedures. Your voices were heard and we hope the message you conveyed will be instrumental in regaining access to interventional spine procedures.

SIS remains committed to preserving patient access to safe and effective procedures, and with the support of SIS members, we will continue to advocate for patients and physicians in Oregon State and wherever coverage is threatened.

Did Roger Chou show up and testify?

 

[lobelsteve]

I just got the email.

 

[onewithpain]

Patients, Physicians, and Experts Succeed in Oregon Call for Reconsideration of Guidances
for Low Back Pain: Corticosteroid Injections

Thanks in part to efforts by AAPM, Academy members in Oregon, and the professional societies of the Multisociety Pain Workgroup, the Oregon Health Authority’s Evidence-based Guidelines Subcommittee (EbGS) elected to reconsider its initial ruling and explore more thoroughly the research that demonstrates lumbar radicular pain relief provided by transforaminal epidural steroid injections, now referred to as “Low Back Pain: Corticosteroid Injections” for future discussions.

Members in Oregon were alerted to the opportunity to testify on the issue by the Academy last month.

The Oregon EbGS is scheduled to meet next on April 6. Watch the Oregon Health Evidence Review Commission site for information as the next meeting approaches.


If they decide to allow transforaminals then it would leave them in a position where they have to argue against all of the other treatments that Dr Chou found don't work. They still look at PA requests on a case by case basis, but now I can get them to say that they are considering allowing an injection before I agree to see the patient. I just did a lumbar sympathetic block on a woman with OHP who had a labral repair on her hip and then in follow-up her ortho surgeon thought that she had CRPS. She called a couple hours after the injection to say that she felt that she might have some relief but it was hard to tell because she was in the ER being treated for a UTI. If someone is on OHP then they almost certainly need a multi-modal program, not just for pain but for life skills.