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Appendix B: Summary of Written Public Testimony
Pages 293-300

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From page 293...
... Health care professionals confirm this perspective, often describing patients who have had difficulty finding adequate treatment, but their responses also illuminate the difficulties providers themselves face in providing good pain treatment -- especially concerns about the impact of drug enforcement policies on pain care and the difficulty of treating a multifaceted problem such as pain within the current health care delivery system. Yet for all the ways cited by both pain sufferers and health care professionals in which the current system fails to deliver the best possible care, they are united 293
From page 294...
... Question 5: Experiences Providing Pain Treatment If you are a health care professional, please tell us about your experiences in trying to provide quality pain care for your patients and problems you encounter. Please indicate if you are a primary care clinician or specialist (and what specialty)
From page 295...
... Yet it is with me 24/7 and has changed my life completely so that I am very limited in my ability to function compared to before my illness." Pain sufferers indicate a longing for objective documentation, but in its absence, experience pain as a deeply isolating state. Perhaps as a result, one of the most characteristic experiences described by respondents -- one quite different from experience with other serious diseases -- is simply "not being believed" by health care professionals and others.
From page 296...
... or post-herpetic neuralgia can benefit from selec tive nerve blocks, if treated within the first (roughly) 6 months of symptoms, but many times it is years before a patient is referred to a specialist." One patient writes a plea to health care professionals: "Take the issue of pain serious[ly]
From page 297...
... "These patients, who have specialists in pain control in their regular lives, and who probably spent years arriving at a regimen that works, are then taken off of those drugs and told to ‘suck it up.' It is very hard to watch." Another respondent writes how there is a common misconception among health care providers concerning dangers "in the utilization of long acting opioids for the management of chronic pain and the misconception that prescribing short acting opioids is ‘safer' and less of a risk." A psychologist writes, "the difference between an opiate addict who does not have pain and a pain patient receiving proper opiate medication for pain management is night and day, yet these two types are ap proached similarly by physicians under the scrutiny of the DEA, especially on the East Coast. This is unfair to doctors and cruel punishment to patients.
From page 298...
... to see a physician simply to get a 30-day prescription for pain medication. One man describes how his physician "was constantly trying to force me to come into the clinic, which is about fifty miles south of my home, for things like a random urine test, despite my having told him that we were extremely poor, and that there was no one to leave with my bed-ridden wife." REIMBURSEMENT POLICIES Some health care professional respondents noted that insurance provides perverse incentives, reimbursing for invasive procedures and high-risk surgeries while failing to reimburse for the multidimensional treatment of pain (particularly physical therapy and behavioral health treatment)
From page 299...
... multidisciplinary pain treatment is not well-developed throughout the country." Another pain specialist -- and director of a pain clinic -- decries how "cost cutting has led to limited access to modalities such as injections, neuromodulation, chiropractic care, mental health care, massage, and acupuncture for chronic pain." An internist notes, "it seems easier to get help with chronic diabetics or heart failure patients, but not the same kind of support for chronic pain patients." There were some reports that providers justify invasive procedures to patients by convincing them that structural abnormalities in MRIs require surgical intervention, despite the extensive evidence that MRIs reveal many abnormalities in people who have no pain and that surgical interventions often are unnecessary and even harmful. A pain specialist writes, "The main problem I encounter are patients who have .
From page 300...
... "We need better drugs, particularly those which act on the NMDA receptor pathways, substance P antagonists, etc.," a provider writes. "One of the biggest problems with chronic pain, is that it isn't a single disease with a few neat endpoints.


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