Kaiser's New Pain Management Policy

Discussion in 'Fibromyalgia and ME & Chronic Fatigue Syndrome' started by RadTech55, May 31, 2013.

  1. RadTech55

    RadTech55 Member

    Hello to all:

    I am a Kaiser Permanente patient and have been in their Pain Management
    Program for almost 13 years. I am being treated with Sched II Opiods for
    Fibro and also 3 verterbral compression fractures,(T2, T3, T4) and a failed
    diskectomy & fusion surgery at T9-T10.

    My PM doc of 12 years retired and I got a new one who at firct continuedmy opiod
    regimen. (I have been on the same dose for 10 years). Two months ago he told
    me that because of new laws being introduced into the California Legislature to
    very strictly control Sched II Opiods, that Kaiser revamping their Opiod Therapy
    Program. (They are afraid if the new proposed laws, like CURES, pass, that
    DEA and others will come after their PM Docs). He says he is going to "slowly"
    take down the dose that has been effective incontrolling my pain down to %20 (or less!)
    of what it was for 10 years! In fact, during a visit yesterday he had the temerity to
    ask me if I wanted to go into "Inpatient Detox" instead of slowly tapering my meds
    down. (I have never, EVER in 13 years of PM there been accused of abuse, asked
    for meds early, gone to ER seeking meds, or shown any illegal drugs or inappropriate
    levels of prescribed meds in urine and blood tests). For the the first two years in PM,
    my doc would even call me in unannounced and count my pills to make sure I was
    taking them correctly, and of course I have signed a PM Contract.

    My Spinal Injuries stemmed from a motor vehicle accident in 1991 and I was unable
    to work for several years, and later also developed fibromyalgia. (Yes, confirmed diagnosis
    of fibro by two rheumatologists). When my chronic pain was finally under control
    by Opiod Therapy, I was able to go back to Full Time Work, and did so for 10 years
    before retiring. My PM Doc says the new Kaiser Opiod policy and lowering my meds
    has NOTHING to do with me personally or my retirement or situation. I need this
    medication (a time release opiod) in order to even function normally retired.

    Any thoughts, advice, or rumors you have heard are appreciated.
    Are there lawyers that act as advocates for Pain Management Patients?
    And if so, would they even take on a billion dollar For-Profit HMO like Kaiser?

    Thanks and God Bless All,
    Rad Tech55

    My Question:
    Has any other Kaiser PM Patients on Opiod Therapy been told of thisnew Kaiser policy?
    Is this policy even LEGAL under the California Pain Patient Bill of Rights, the Pain Patient Protection Act, and, nationally, (Senate) The Patient Protection and Affordable Care Act?
  2. Summer123

    Summer123 Member

    Good morning: I am a Kaiser Permanente patient, residing in Southern CA. I was in Pain Management up until about six months ago when my pain management physician transferred out of the area. After he left, I was told to work with my GP for my methadone and percocet RX's.

    I met with my GP yesterday. He didn't mention anything about a new opiate therapy/policy at Kaiser, but that doesn't mean it doesn't exist. One of the reasons he may not have discussed it was, I told him I wanted to go to medical detox. Prior to my pain management physician leaving, it had always been my goal to go through detox. I am six months behind my timeline of being opiate free.

    About a year ago, I remember my Kaiser PM doctor telling me there were changes to CA state laws as they relate to opiates. He didn't mention much. As I think back, I remember my old PM (not a Kaiser doctor) telling me physicians in the state of CA are required to treat pain. Now, that's a pretty loose statement and as you know any physician can get around that very easily. Here is a link I found that may be helpful or at least get you going in the right direction: http://www.anapsid.org/cnd/pain/calpainlaws.html.

    Also, you can always ask to see a different pain doctor, if another one exists in your area.

    Hope this helps!
  3. stick2013

    stick2013 Member

    I don't live in Ca, and don't know the laws there. What I "think" you new Dr is talking about is this..... After being on pain meds for 10 yrs, your body has now become dependent upon them. Tapering is going to be difficult, and painful, and I think he/she felt that you would do better in a controlled setting, where there're would be help for you.

    I'm sure that your Drs know that you have not abused your medication, but again things are getting tough with Drs and handing out pain meds. I have a hard time getting Fieoricet (spelling?) for my migraines. I MUST make an appointment top see my neurologist to get a script, even though he has been treating me for yrs for migraines.

    Good luck in whatever path you choose.
  4. RadTech55

    RadTech55 Member

    Hi Summer123:
    Thanks for your comments and the link. I wish you good luck in your
    goal of being opiate free.That is commendable,I just happen to chose
    the other course of teatment as I know it works for ME. I have been through
    Epidurals, facet point injections, TENS units, Steroids, hypnosis, bio feedback,
    relaxation therapy, guided imagery.....all of it. Opiods work for me and I
    have no side effects. Unfortunately I cannot see a Pain Management
    doctor outside of Kaiser. And another Kaiser Pain Doc would tell me the
    same thing. ALL the Kaiser docs are running scared. My wife broke
    hip in January and had replacement surgery. She first took Oxycontin,
    then went down to Norco. At her last appointment with the surgeon, he
    said that NORCO would probably be a Schedule II drug in CA by the
    end of the year! But he is an ass anyway.

    I just got a favorable Diability Appeal ruling, and may be eleigible
    for Medicare sooner than I thought. Maybe I can get away from Kaiser
    at that time. My doc so far has taken me down %2o down FROM my original
    dose and I do notice the difference. That he wants eventually to take me
    down to %20 OF my original dose scares me to death. It will make me a cripple.
    Yes, I am aware of those laws you sent the link for, which makes me wonder
    how Kaiser can legally be doing this. (Blanket across the board reducing
    and trying to eliminate Opiod Therapy). One of the new laws, the CURES
    Bill (that Kaiser points at as threatening them) was recently axed in the
    legislature. They are lacking funding and trying to get the pharmaceutical
    companies to pay for it, and they are a very powerful lobby, and CA is dead
    broke.
    I have been looking online for a Pain Advocate Group that is
    organizing to fight this new policy of Kaisers.
    I WISH some lawyer would organize and reresent Kaiser Pain
    Management Patients and file a Class Action Lawsuit against
    Kaiser for violating the current pain laws and Pain Patient Bill of Rights.
    (Those exact ones in the link you posted).
    Maybe I will start a website and start searching for a
    lawyer willing to take this on Pro Bono as a Class Action
    Suit for now. I will contact my niece who is an attorney and
    see what she says, though she does Internationcal Contract Law.

    Thanks again and Be Well everyone.
    RadTech55
  5. Quki73

    Quki73 Member

    @RadTech55
    I am also a very angry pain patient with kaiser baldwin park. My dr "went per diem" last October 2012, new dr refused to continue opiate meds. My options were methadone or suboxone referral to addiction med. at the time I didn't care as long as I would still receive pain management. Once I started taking suboxone I've been treated like a leper. Please. I would love to fight with you against the poor treatment we receive under kaiser. I was also diagnosed with FMS and have had no care. Unless you consider 4 antidepressants. Since I've been in suboxone I Non FUNCTIONAL! I regret not standing up for myself. I filed a complaint against my new pain mgmt dr (a very young women) and I received a call asking me to reconsider. Because if I file I will be seen as a "troublemaker" and no dr will want to treat me!! This is the first complaint I've EVER made at kaiser!!
    I thought I was the only one that had been diagnosed with fibromyalgia at kaiser baldwin park, so cal & not getting any medical care. My pain management dr went as far as to verbally tell me FMS is not a real diagnosis on the phone but later recanted in an email. I am so confused by my treatment at kaiser. I filed a complaint against my pain management dr in sept after I received a caudal steroid epidural for chronic lower back pain. I was not told anything in pre op about procedure because I ran late to my appt. And my pain dr gave me injection without any local anesthetic. It was horrible! Customer claims called and told me to reconsider complaint because I'll look like a troublemaker and no dr will want to treat me! It's so unfair! I've NOT ECER complained about any other dr. I just don't want hostile inexperienced jerk Drs treating us poorly! I was hoping that going to another clinic would help. What kaiser do you go to? Who's your dr. If you are not comfortable discussing this here- please email me: quki@me.com
    Xo
    Anna
    Ps. Pain mngt sent me to addiction med. I've been on suboxone a whole year. It's been the worst year of my life. I have no ambition and all I want to do is sleep. I get very sick & nauseous. Now I'm physically hooked on this crap and need to taper. It's hell!!
  6. IanH

    IanH Active Member

    Unfortunately opiates are a bad choice for FM however quite a lot of people were put on opiates in the nineties but it has tailed off in the last 5 years. The situation is quite different if you have more severe spinal injury such as compression fractures. (Most people with FM will have some spinal involvement and this needs ascertaining early on so that the management plan looks at both problems). Any Dr. worth his salt will know that FM will exacerbate the pain from the spinal stenosis and increase the frequency and intensity of inflammatory bouts.
    This exacerbation can worsen the condition of the spine over the years. Unfortunately our experience is that opiates also worsen this. At the same time effective medication is needed.

    The key is to think positively about an alternative plan for total health not just pain management. Lowering the opiates or eliminating them will benefit overall health and help improve the FM disease itself.

    Instead of eliminating the opiates a first stage can be to take a potentiator along with a lower level of the opiate you take e.g. amitryptinline + fentanyl patch. Amitryptiline is a useful potentiator, there are others you could discuss with your pain specialist.

    A second approach can be through the use of exercise. Exercise is obligatory with FM especially if on opiates. Anyone not regularly exercising their whole body will have accentuated pain needing ever increasing doses of opiates. Some people do manage on low dose opiates and I think that is fine but this is rare. We have taken people on opiates and used the pain killing power of the drug to enable increasing exercise levels then later start reducing the opiates. The increased exercise allows this. It takes a while but works. I know many people with FM are very resistant to exercise because it can induce post exertional malaise with nausea, fatigue and some vertigo. If done right there is no need for increased pain as a result of exercise. Also PEM does no harm it just feels bad but again can be mostly avoided.
    Last edited: Nov 17, 2013
  7. Mikie

    Mikie Moderator

    Kaiser was the first major HMO. The problem with them is that they hold all the marbles because they own everything and everyone is a Kaiser employee. With other models of HMO's and PPO's the patients has more choices. The DEA is cracking down here in FL on pain clinics which are nothing more than sham drug dealers. Unfortunately, this hurts the legitimate patienst as well as the users.

    When my FMS was really bad, I took Morphine and other opiods but decided that once I felt better, I needed to find a treatment which didn't cause physical dependency and tolerance. The Guaifenesin Protocol worked for me but, like everything else, it doesn't work for everyone. It's a demanding treatment and most failures are due to not following the protocol to the letter. It requires patience and commitment and is a long-term treatment.

    There are patients who control their pain effectively with opiods and who need them. It's cruel to withhold pain meds if there is no other alternative. In fact, federal law states that patients are entitled to relief from pain. On the other hand, if alternatives exist, it might be a good time to look into them.

    I've been on Klonopin (clonazepam) for 13 years at the same dose. It's not for pain but so I can sleep. I am physically dependent on what I call, Special K. If I reduce the dose, even slightly, I get so jittery I can barely stand it. My doc thinks it one of the best meds for what ails me and has no problem with it. It's in the Benzo family and Medicare has only just decided to cover it. I've pretty much decided I'll be on it for the duration.

    Love, Mikie
  8. Willow77

    Willow77 Member

    I am a Northern CA Kaiser pt. I have been on methadone for pain for a few years. The only change I have had is that when my Dr. left Kaiser, my new Dr. was reluctant to refill my muscle relaxers. She had no problem with the methadone or ambien. Once I saw her in person and signed a pain contract I have had no problems.

    A few years ago I had been taking Norco for pain and started getting severe side effects. My Dr. at that time said my choice was Oxycontin or Methadone. I told him I didn't want something I would become dependent on and he could chose what he thought was best so that is why I am on methadone now. I started at 1/2 the usual dose and found that instead of taking it twice a day it worked better for me if I took it three times a day. On days I have more pain than the methadone can take care of I add an Advil and Tylenol and just use heat or ice to get through. Most days I don't need anything extra.

    I really like the methadone for pain because it is very subtle. Except for the first 2 days it does not make me groggy or feel funny in the head. I have no pain some days since starting an exercise program. I have tried lowering the dosage on the methadone but it is not worth the extra pain and since it is working so well for me I have decided to just stick with what is working. Some days I even forget to take a dose and feel fine without it.

    I have Fms, IC, IBS and neuropathy. It has helped the nueropathy the most. I don't have the back problems that you do though. My Drs wont do anything but an x-ray and I know a lot of things dont show up unless you have an mri but my Drs won't approve one and I do have a lot of low back pain and cannot sit for long. I prop myself up with pillows on the couch to use the computer but have to get up and walk around ever hour or so as long as I get up and move around, do a few light chores every 1/2 hour to 1 hour it seems to not be too bad.
  9. JaciBart

    JaciBart Member

    Going thru same thing in Oregon and Washington

    I am having the same problem, have been for past year. I lived for years in Tri Cities, Wa. Had fibro since May 19-2002. Started Opiates approx. 6 mo into illness after finding a PA here, his name was "Madwolf" here on this forum and he practiced Pain Management approx. 3.5 hour drive from me, just out of Spokane, Wa. I started seeing him, was put on Fentanyl patch, low dose morphine sulphate for incidental and also the fentanyl lollipop. All was going well until he suddenly disappeared into thin air after treating me for a few yrs, he and the Doc he worked under just all of a sudden closed up shop.....took me years to learn why.

    Anyway, since then I have been the "perfect" patient like most of you, never asked for early refills, never "lost" my meds, always used same Pharmacy, etc. We all know the drill. Found a local Pain Specialist, easier to get one once I was on opiates, had a proven track record of perfect use....

    Fast forward several years, I leave a marriage that was abusive, isolate with my beloved dog for 2 yrs......pull myself together and finally get back into life, still on opiates all these years, I do have a high level of spine damage, neck, nerve damage, osteoarthritis, etc.

    Found love again at 50 yrs old, move to be with him after getting engaged 30 miles away and across border into Hermiston, Oregon. Stupid me, chose to try to have a Pain Specialist in new location, as the 30 miles is across a mountain, hard drive on me. In this new location it has been the worst nightmare I could ever imagine with the Medical Community. Long story short, I am the "new" one here with "issues" and I quickly earn the title from local Hospital ER Docs of "Munchhausen".....scary thing to all of a sudden have that in your records, The one practicing "Pain Management Center" here is only here on Fridays, they are out of Hood River, Oregon.

    Their big thing was to "offer me addiction help" and switch me over to suboxone, I was put thru a very difficult experience. Side effects were unbearable. Intolerable and I was promised pain relief with this new regimen.....none. After them trying 2 different dosage routines and my spending hundreds of dollars, I felt like an addict. I have never been treated so poorly as I am in this town. My GP is decent and treats me with respect. He is the only one I can count on that with. All this suboxone nightmare I was going thru just this past 2013 Xmas, and we had just gotten married on Dec 17, 2013. I am just finally with a new Pain Spec as my prior one from Tri Cities would not take me back after seeing all the new stuff in my chart, all of a sudden I am an addict. MY new Doc only willing to use opiates to taper off, on only 30 mg morphine sulphate and I can expect a decrease each visit every 30 days until I am off completely. His plan is to treat my pain with water therapy. Yipeeee. Makes me think of medical marijuana, and a whole lot more ugly places.

    All of us on opiates are going thru the same thing, it appears to me.

    Scary, I certainly do know after all these years it is not a 'cure' but I do get relief from the opiates. Sick of living in my recliner.

    Any help from anyone living near me would be appreciated, Walla Walla is close to me. Portland is a difficult 4 hour drive away. Seattle 4 hours, across mountains.
    At a loss myself, so sorry for all of you going thru same thing as I am.....

    Take care,
    Jaci with new last name
    Last edited: Jan 8, 2014
  10. RadTech55

    RadTech55 Member

    @jaci with a new last name....

    Thanks for sharing your experiences here with us on the board.
    I am so happy that you have found true love, a gift frm God, but I am sad,
    and yet not surprised, at your poor treatment at those who call themseleves Pain Management
    specialists.

    I have seen the emergence of Suboxone lately in the "treatment" of chronic pain.
    It is inappropriate, wrong, an unethical, IMHO.
    Suboxone was NEVER intended to treat pain, chronic or otherwise. It was developed, and is used for
    the treatment of opioid *addiction*. There is a HUGE difference between a *pain patient
    on opioid therapy* and an ADDICT. An Addict does not medically require opioids and takes
    and abuses opioids in order to GET HIGH. A pain patient uses opioids to relieve pain. The
    opioids he or she takes act directly on the opioid receptor cites in the brain. In the absence
    of pain, or in too high of a dose, opioids act on the euphoria receptor cites. Some opioids,
    such as hydrocodone (Norco, Vicodin) act on BOTH euphoria and pain receptor cites,
    whatever the dose. While hydrocodone might be good for short term pain, like a badly sprained ankle,
    it is a horrible chronic pain drug.

    Suboxone DOES contain an opioid component. This ONE component only acts on one specific opioid
    receptor site in the brain. It's purpose it to ease the symptoms of withdrawal. The other
    components of suboxone BLOCK ALL OTHER opioid receptor sites in the brain. So if an
    addict is placed on suboxone and uses some other opioid, it will NOT work at all. Sort of like
    Narcan but not as intense and with fewer side effects.
    (Narcan is used for life threatening opioid overdoses...and works very, very well.)

    I have met and spoken to several pain patients who were SNOOKERED by their doctors
    into going off of pefectly good opioid pain regimens and onto Suboxone, including my sister.
    Just like Jaci, it lowered their quality of life, raised their pain level, and does not control their pain.
    A WARNING TO OPIOID REGIMEN PAIN PATIENTS:
    *****DO NOT LET YOUR DOCTOR PUT YOU ON SUBOXONE****
    If you have to raise your voice and make a "scene" in the office, DO IT!
    (The squeaky wheel gets the oil!...As my dad used to say!)
    Do NOT roll over and play dead and take your doctor at their "word".
    Do NOT believe him or her when they say "Well....let's TRY Suboxone
    and see how it works for you. If it doesn't work, we'll try something else".
    THEY LIE!!!!!!!!!!!!!!!!!!

    If you are placed on long term opiod therapy, you WILL become physically dependent.
    OOOO! Scary words! But what do they really mean?
    It means that if you take your medicine AS PRESCRIBED.......
    NOTHING WILL HAPPEN!
    You won't go through withdrawals, you won't
    be "addicted", you are certainly not an "addict". Look at all the medication
    advertising on TV and in the papers. Look at how many of them say:
    "Do Not Discontinue This Medication Without The Consent of your Doctor"
    Heart meds, blood pressure meds, cholesterol meds, diabetes meds, insulin....
    the list goes on and on. Pain meds are just another type of medicine that you should
    NEVER discontinue without the care of a physician. Period. And tolerance????
    PHOOEY!
    The ONLY people who develop tolerance to pain meds are ADDICTS!
    THEY
    need more and more in order to GET HIGH.
    THEY need more and more in order to get the meds to the brain's EUPHORIA receptor sites!
    Taken as directed, tolerance to opioids is a NON ISSUE.
    It is a SCARE TACTIC used by the ignorant,

    As an update on my PM situation with Kaiser, I have had a pyrrhic victory of sorts.
    Originally they told me they were going to reduce my opioid regimen BY %80 to %20
    of what I had taken daily for 10+ years (Years in which I earned my Masters Degree and worked
    for 8 years full time while on opioid therapy, MS Contin. I am now stabilized at %50 of
    the MS Contin I had been taking all those years, **plus** 30mg/day of Methadone.
    While not as effective as the regimen I was on for 10 years, and there are some things
    I am no longer able to do (some gardening, and unable to play in a band for as long
    as before,unable to take reasonable walks, etc) it IS better than it would have been under the original plan.

    I attribute the change in plan to the noise I generated at Kaiser. I complained
    to Member Services, the head of the Pain Management Program, the head of
    the Aesthesiology Dept (which runs the PM Dept) amd the head of the Physical
    Medicine Dept. Complaints were made both in person and by Registered Letter.
    At one point I was escorted out of the hospital by Security after I refused to leave
    after a doctor who agreed to see me turned me away when I showed up for my
    *scheduled (in writing) appointment*. This prompted me to file complaints with the
    California Medical Association, the American Medical Association,
    The California Department of Public Health, and Medicare.

    I have concluded from these experiences that YOU MUST BE YOUR OWN HEALTH
    ADVOCATE. At one time I entertained fantasies of an online group of disgruntled
    Kaiser Pain Patients (and other pain patients) building a grass roots movement
    and perhaps even a Class Action Lawsuit against Kaiser for violating the California Pain
    Patient Protection Act and the Pain Patient Bill Of Rights. I realize now how naive I was.
    You MUST GET UGLY to get what you want.
    You MUST be an asshole and a pain in the ass to your HMO or PPO.
    You DESERVE pain relief under the law.
    Just because a person has an MD after his/her name does
    NOT mean he/she can tell you otherwise!
    Last edited: Jan 9, 2014
  11. Quki73

    Quki73 Member

    Radtech55. So glad you finally got somewhere with kaiser. My last appt with my second opinion in pain management told me that I am fat, lazy, stay at home mom that got hooked on pain killers- their fault- but not the issue. I have a psychological problem. There is nothing they can do. His advice heat packs every 20 minutes for ..? Swimming. No muscle relaxers.. There was a fourth but just as useless. I've been in bed for 3 days this week. Two days last. Suboxone does not work for me. I don't want to waste any more time and money being told that this disease is my fault. Yes. I'm depressed. I have no where to turn. I'm sick, in pain, tired. I do not want to live like this and I do t want to die. I'm only 40! I can't get out of bed. I'm so happy you could be your own advocate- but I can't even get up to take a shower daily.. How am I going to fight a bunch of arrogant assholes that think I'm a drug seeker??