Tell Medicare Not to Limit Intracept

[drusso]

New criteria would require psych eval and create other hurdles for those suffering from Modic changes.

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[bedrock]

View attachment 376575

New criteria would require psych eval and create other hurdles for those suffering from Modic changes.

Such BS.

How about noridian starts requiring psych eval before authorizing a lumbar fusion !

 

[buddababa]

crap like this is what makes me want to retire asap

 

[Dr. Ice]

What exactly is the rationale behind psych evaluation in general, even scs? Who came up with it?

Was thinking the idea is the screen out instability as it relates to management vs curative treatment..but surgery is also just management. Why don’t people get that?!

 

[MitchLevi]

No requirements for L2-S1 decompression and fusion.

 

[Dr. Ice]

No requirements for L2-S1 decompression and fusion.

Cause it’s “curative”

 

[Baron Samedi]

What exactly is the rationale behind psych evaluation in general, even scs? Who came up with it?

Was thinking the idea is the screen out instability as it relates to management vs curative treatment..but surgery is also just management. Why don’t people get that?!

I absolutely agree. As physicians we have a broader scope of practice than any psychologist and should be able to make the determination if a patient is appropriate or not.

 

[MitchLevi]

Cause it’s “curative”

I see...














...but what about when it isn't?

 

[Agast]

SIS advocacy is a thing? Where were they when RFA of sacroiliac joint went away. That would help me way more.

 

[Ducttape]

maybe because pain is more multifaceted with psychological overlays compared to a supposedly pure medical issue?

while i think we should have more involvement with pain psychology as a whole, not for "clearance"...

 

[drusso]

maybe because pain is more multifaceted with psychological overlays compared to a supposedly pure medical issue?

while i think we should have more involvement with pain psychology as a whole, not for "clearance"...

If someone told me that my Modic changes were all in my head, I'd be pissed.

 

[Ducttape]

where do you sense/percieve the pain?

 

[drusso]

where do you sense/percieve the pain?

Most days, my soul.

 

[kstarm]

Has anyone actually had a psychologist not give clearance? I have been amazed at some of the people who have gotten through.

 

[Dr. Ice]

The reality is that the standard of medical practice is often, in the public eye, determined by fix or not fix, cure or non cure. Most people equate this to surgery. As well all know in the spine world, there IS only management despite surgery. The people that make these decisions are not us. So we are stuck getting psych evals for stim trials, but the spine surgeon can say failed epidural x 3 and therefore needs surgery gets the benediction because he/him/they/it will “fix” it…

Sorry about the pronouns..****ty day..had to throw it in

 

[Dr. Ice]

Has anyone actually had a psychologist not give clearance? I have been amazed at some of the people who have gotten through.

Nah cause they paid to do it homie, and the circle jerk of reality continues…humans are animals at the end of the day except when life is treating them well and they decide to be “moral”

 

[Agast]

Has anyone actually had a psychologist not give clearance? I have been amazed at some of the people who have gotten through.

Yes. The guy here won’t clear anyone who takes pain medicine and has a glass of wine at night.

 

[drrosenrosen]

I've had one denied because pt had "active illegal drug addiction" . . . aka smokes pot once a month

 

[MitchLevi]

Pain Psych is BS.

I trained at the best pain psych facility in America...It's a farce, even before you get into insurance coverage and cost.

They should have zero input on anything I do.

 

[Ducttape]

Most days, my soul.

and where does your soul reside?

Pain Psych is BS.

I trained at the best pain psych facility in America...It's a farce, even before you get into insurance coverage and cost.

They should have zero input on anything I do.

coming from someone so jaded, of course it wont work.


i have had a number of denials, and for the most part, i agreed with their assessment.

 

[drusso]

and where does your soul reside?


coming from someone so jaded, of course it wont work.

Duh, the lungs and sperm. Even Aristotle, the Stoics, and ancient Hebrews knew that the soul resided in the lungs and male sperm...

"The pneuma in its most rarefied and fiery form serves as the animal soul (psychê); it pervades the organism, governs its movements, and endows it with powers of perception and reproduction. This concept of pneuma is related to Aristotle's theory that the pneuma in sperm conveys the capacity for locomotion and for certain sensory perceptions to the offspring."

Relatedly, that's why masturbation is a sin. You're doing damage to your soul. So, all that KOL bukacke is not just self-indulgent, but actually evil...

 

[MitchLevi]

coming from someone so jaded, of course it wont work.

How does my personal opinion have any input on Mr. Smith's outcome?

I used to get sooooooo annoyed by the pain psych ppl we worked with in fellowship.

It's a cult, and these are the pain psychologists who write all the papers yall see posted in this forum from time to time, the videos, books...

They're clueless about what goes on in the exam room when the pt sees you or me. They live in a fantasy land.

Anyone who thinks it's a great option for pain is either a pain psychologist or a physician with no experience.

 

[Ducttape]

Relatedly, that's why masturbation is a sin. You're doing damage to your soul. So, all that KOL bukacke is not just self-indulgent, but actually evil...

not for Wiccans.

and i believe society for socrates and aristotle actually approved of prostitution, but masturbation might have been self-emasculating. so ******* might have been "approved"...

How does my personal opinion have any input on Mr. Smith's outcome?

what does pain psychology have to do with your personal opinion?

I used to get sooooooo annoyed by the pain psych ppl we worked with in fellowship.

It's a cult, and these are the pain psychologists who write all the papers yall see posted in this forum from time to time, the videos, books...

They're clueless about what goes on in the exam room when the pt sees you or me. They live in a fantasy land.

so are we.

all our injections always work. 100% of the time. its only a matter if dex or depo or PRP is better.

 

[MitchLevi]

what does pain psychology have to do with your personal opinion?

Wut?

so are we.

all our injections always work. 100% of the time. its only a matter if dex or depo or PRP is better.

Nope.

False comparison.

Next time you're sitting on a red hot L5 radic with a trashcan in front of you full of vomit, try guided imagery and tell me how it works for you.

 

[callmeanesthesia]

Wut?



Nope.

False comparison.

Next time you're sitting on a red hot L5 radic with a trashcan in front of you full of vomit, try guided imagery and tell me how it works for you.

Gotta have something to do while insurance takes 15 business days for the prior auth.

 

[MitchLevi]

Gotta have something to do while insurance takes 15 business days for the prior auth.

IM Toradol 60mg
"Better days comin' soon Mr. Smith."

 

[Ronin1]

I have used the same guy for the past 25 years for clearance. 100% approval so far!! Conservatively 500 trials……

 

[deleted131481]

Pain Psych is BS.

I trained at the best pain psych facility in America...It's a farce, even before you get into insurance coverage and cost.

They should have zero input on anything I do.

What does 'best pain psych facility' mean?

We have a pain psychologist in the office and she is helpful for select patients. Well-adjusted patients don't need her. Those with co-morbid anxiety, depression, catastrophizing can and do benefit from CBT. But they need enough insight to be motivated and willing to go through the process. Of those I talk to about referring, I take about 30 seconds discussing it and let them decide. I certainly don't push it and only about 10-15% will accept and make an appointment. Those that are motivated tend to improve.

 

[MitchLevi]

What does 'best pain psych facility' mean?

We have a pain psychologist in the office and she is helpful for select patients. Well-adjusted patients don't need her. Those with co-morbid anxiety, depression, catastrophizing can and do benefit from CBT. But they need enough insight to be motivated and willing to go through the process. Of those I talk to about referring, I take about 30 seconds discussing it and let them decide. I certainly don't push it and only about 10-15% will accept and make an appointment. Those that are motivated tend to improve.

I trained where the pain psych dept is comprised of the biggest names in that field.

Not impressive at all. People who are motivated to get better and live fuller lives do it regardless.

It's BS.

 

[Baron Samedi]

The worst employee I've ever had is a Pain Psychologist. And I've worked in fast food before.

 

[Agast]

The worst employee I've ever had is a Pain Psychologist. And I've worked in fast food before.

Hm lemme guess...

Hardee's?

 

[deleted131481]

I trained where the pain psych dept is comprised of the biggest names in that field.

Not impressive at all. People who are motivated to get better and live fuller lives do it regardless.

It's BS.

Same could be said for anxiety, depression, PTSD, but a good psychologist can help. Do you think CBT is BS for those too?

'Best pain psych' doesn't mean anything clinically, just that they crank out books and chapters. I don't think I'd be overly impressed watching Manchikanti or Tim Deer do an ESI. We've had two psychologists come through, and the second has been much better. A good 'pain psych' just needs to be a good psychologist with a basic understanding of chronic pain.

 

[MitchLevi]

Same could be said for anxiety, depression, PTSD, but a good psychologist can help. Do you think CBT is BS for those too?

Different clinical entity entirely. Of course for those ppl I'm in favor.

Golf ball facet joints with 3 level listhesis and advanced stenosis is not in any way similar to a broken childhood with sexual abuse, two divorces and an estranged relationship with your children.

'Best pain psych' doesn't mean anything clinically, just that they crank out books and chapters. I don't think I'd be overly impressed watching Manchikanti or Tim Deer do an ESI. We've had two psychologists come through, and the second has been much better. A good 'pain psych' just needs to be a good psychologist with a basic understanding of chronic pain.

It means I trained where PP was featured prominently in pt management, and was done by individuals who know the field inside and out, and they create the articles you read.

AKA, I have no idea why it would suck there but not in other places.

 

[deleted131481]

Different clinical entity entirely. Of course for those ppl I'm in favor.

Golf ball facet joints with 3 level listhesis and advanced stenosis is not in any way similar to a broken childhood with sexual abuse, two divorces and an estranged relationship with your children.


It means I trained where PP was featured prominently in pt management, and was done by individuals who know the field inside and out, and they create the articles you read.

AKA, I have no idea why it would suck there but not in other places.

Maybe we see different patient populations. My patients with advanced stenosis usually also have anxiety, depression, insomnia, etc that is heavily intertwined with their catastrophizing. They can respond to CBT, although as I mentioned it's the minority.

Those that don't have co-morbid issues, are well-adjusted, have strong social support and are motivated to keep active - these are atypical patients for me and I don't send them to pain psych. Maybe some Butrans if they've failed other treatments.

 

[Ducttape]

Wut?



Nope.

False comparison.

Next time you're sitting on a red hot L5 radic with a trashcan in front of you full of vomit, try guided imagery and tell me how it works for you.

who said that pain psychology was for acute pain syndromes?

hint: not me.

although... telling this patient that their acute pain most likely will improve with time can be very reassuring and helpful

Different clinical entity entirely. Of course for those ppl I'm in favor.


Golf ball facet joints with 3 level listhesis and advanced stenosis is not in any way similar to a broken childhood with sexual abuse, two divorces and an estranged relationship with your children.

you are equating behavioral health treatment with treatment such as emotional awareness and acceptance. completely different fields. it similar to comparing trigger points to Intracept.

that in and of itself suggests that the place you trained didnt really teach you about pain psychology.

It means I trained where PP was featured prominently in pt management, and was done by individuals who know the field inside and out, and they create the articles you read.

AKA, I have no idea why it would suck there but not in other places.

some of us do not get the luxury of seeing only hot radics or other acute pain processes.


im pretty sure that after a couple of days in my practice, you will be giving out tons of pain psych referrals.




or maybe getting one for yourself....

 

[MitchLevi]

who said that pain psychology was for acute pain syndromes?

hint: not me.

although... telling this patient that their acute pain most likely will improve with time can be very reassuring and helpful

you are equating behavioral health treatment with treatment such as emotional awareness and acceptance. completely different fields. it similar to comparing trigger points to Intracept.

that in and of itself suggests that the place you trained didnt really teach you about pain psychology.


some of us do not get the luxury of seeing only hot radics or other acute pain processes.


im pretty sure that after a couple of days in my practice, you will be giving out tons of pain psych referrals.




or maybe getting one for yourself....

I think you missed my point entirely.

I said PP is a cult, and you said:

"so are we. all our injections always work. 100% of the time. its only a matter if dex or depo or PRP is better"

You made that flippant and sarcastic remark, and I made the comment about the radic bc that's clearly an anatomical problem that our treatments without Q or debate are successful at treating, whether or not the patient buys into it or believes in it.

PP requires a specific type of person to buy into it and participate in it.

I treat men and women in their 70s and 80s who actively farm 7d/week. They won't go...

That's before you even get into cost and insurance issues.

I've recommended YouTube videos to patients. Buy some books off Amazon.

Pain doctors talk about pain psych as if we're on social media talking about racism or trans rights. It's a virtue signal.

 

[Ducttape]

um...

Pain Psych is BS.

I trained at the best pain psych facility in America...It's a farce, even before you get into insurance coverage and cost.

They should have zero input on anything I do.

i fail to see the caveats you now place on your former comment.

i then responded that you were jaded, and of course that would influence your perspective on pain psychology. i did not put any caveats on the people i believed it might help.

you then said it was a cult.

to which i replied as above. again with no caveat about the clinical condition or pain condition.

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now you state that "PP requires a specific type of person to buy into it and participate in it." and you now state that you tell people to buy books or check youtube videos.


with these statements i agree with you. but i disagree that it has no role in pain management, which you have so disparaged, prior to this statement.

yes, there are costs associated with pain psychology.

im sorry if your training program mandated pain psychology by a board-certified psychologist.

i daily suggest people purchase books or audiobooks on pain psychological approaches to chronic pain.

i have seen significant gains and improvement in quality of life and functionality with this introduction to organized pain psychology, including stopping opioids, particularly in the older population with chronic pain.

 

[Laryngospasm]

I see...














...but what about when it isn't?

You mean the other 70% of the time?