Discussions that mention tylenol

Pain Management board


Hey Horton, I can empathatize with being stuck in the comp system. The doctors are contracted by the insurance carrreer and are insurance friendly. If their return to work rate is too low or or they spend too much on diagnostics like doing a fresh MRI, CT, Meylogram or discogram, the comp carrier frowns upon it and if they don't have a high enough return to work rate with denial of legitimate claims they loose their lucrative comp contracts. Comp will pay for some things such as the type of pain management you recieved, which was either trigger point injections which are a numbing agent and an anti inflamatory or you had SI joint injections with a numbing agent and steroids or a non steroidal anti inflamatory.

I went through the same crud, it's all in your head, your just a drug seeker, pain management boot camp, 7 hours a day 5 days a week for a month in which every single patent was cured and returned to work, some with minmimum restrictions some with none. I thought it was pretty amazing that any doc or clinic had a 100% success rate. Hmmm Statistically impossible. :rolleyes:

You either go with the flow, or fight it and risk losing your salary benefits, it's there little way to enforce compliance when they say your ready to return to work, If you don't they just cut off the checks. They will continue the medical but it becomes a waiting game to see who's going to go BK first, and I'm pretty sure they can outlast you when it comes to income .

After 9 months, It's even hard to be treated as an acute patient if you go through your own insurance or pay cash. They can do lots of TP injections, epidural steroid injections and nerve blocks but if you have a nerve compression, all the injections will do is numb you and give temporary relief.
The way I got comp to move was to get my own independent medical eval. IT cost about $350 10 years ago, but worth every penny. I traveled 3 hours to Duke university and saw the chief NS . He spent about 3 hours doing a complete exam, and showing me everything that was wrong. Without the IME, I would still be loosing bowel function when I go over a speed bump and still feel like I'm standing in either ice water or boiling water and comp would be telling me I'm fine.

The IME surgeon drew all over my MRI's, CT's and meylo outlining and showing every problem which made it very dffficult for the local docs to say there was nothing wrong. I've seen comp set up IME's for people but if comp is paying they are sending you to another one of there docs which will not disagree with anythig another comp doc says, so it's not exactly an independent eval.

It's the dfference between employer friendly or patient friendly when it comes to their diagnostic abilities. Back and neck pain are one thing but radiculopothy, loss of reflexes, atrophy and muscle wasting caused by a nerve impingement and foot drop is something completely different from a muscle strain. The sad thing is , you could have been their best and most productve employee, but when faced with a 80k surgery and months of rehab, all the good stuff is forgotten and you are now looked at as a liability.

Once you hire an attorney, the relationship between you and your company and their comp carrier becomes advisarial. With an attorney, the insurance company can't/won't even speak to you about the simplest thing. If they cut your pay off, you have to have your attorney fight for reistatement.

You do have the Industrial commsion on your side or whatever your states version of the industrial commision is, They become the mediator between your attorney and the company and their carrier. The commision can and will reinstate your pay if they find you have been unfairly denied your benefits. However your are still stuck with their surgeons if you need surgery. You do have the right to another opinion, hopefully somebody that's not a golfing bud of the first doc that claims there is nothing wrong and you will never need surgery.

It's a nightmare sytem but better than no system you find in other countries.
My advice is try to cooperate with comp the best you can and get your own surgical opinion outside their loop of docs. Then present them with the findings and ask how can you not see a problem when anyone not paid by the comp carrier can. It borders on neglagence and mal practice to completely ignore something any other doc can easily see.

If you have a nerve compression, which can usually be found by one of several diagnostic tests, the likleyhood of succesfully relieving the impingement is better than the likely hood of the surgery relieving back or neck pain, But the nerve pain is much harder to manage and doesn't respond as well to conventional therapy. Basically because there is a mechanical problem that needs to be adressed so you can only numb it or mask it for so long.

The problem with long drawn out cases if you do need surgery, is the longer you wait, the less likely you are to have a positive outcome from surgery. There are many new methods to correct a disc bulge or nerve impingement that were not available 12 years ago. Micro discectomies and endoscopic surgery aren't as invasive as open surgery wth a laminectomy to remove the spinous process to get to the problem.

The most important thing at this point is to find out what is really wrong. If a disc was going to receed and relieve an impingement, the therapies and modalities tried would show some sign of improvement, if your getting worse, what occurs is engraining of the pain signal into nerve pathwatys, the change from acute pain to chronic pain which is controlled by a different part of your brain and different nerve pathways and different neurtransmitters that aren't involved in acute pain.

The changes that occur are part of the gateway theory of pain. basically you have pain, it's transmitted through neuro transmitters in one direction, to a specific apart of your brain, interpreted and your body starts a cascade of response to the injured area, like muscle spasm to brace the injured area, a flood of natural antiinflamaotires and some other physical and biochemical responses.

With acute pain, pain that goes beyond 4-6 months, the gate basically stays open, neurtransmitters no longer only flow in one direction to the same part of the brain. Transmission occurs in both directions leaving the gate open and engraining the pain signal into nerve tissue. Even different neuro transmitters deveolop and start activating which actually makes things worse.

At this point, I would get another surgical opinion, use their doc, and if he comes up with the same low back pain DX with no exam of your neck and no complete neuro exam, withut additional diagnostics. It's time to spend your own money to find out what's going on and find someone well outside the comp loop of docs and get an IME from a doc you chose and you pay for.

If thier docs dispute the results, then you will have to hire an attorney, take the evidence of injury and the IME and that docs recomendations to the industrial comission and get the problem fixed if you have a doc willing, that thinks it's possible and that uses the least invasive method you can find. If endo and micro surgery doesn't work, they can always slice through every back muscle and clip away bone to get to he problem. But with the newer less invasive techniques, recovery time is quicker and hoptaliazation is often a simple 24 hour stay, verses days of IV opiates to manage invasive surgery and months of rehab to strengthen and release the scar tissue caused by open surgery.

The neurologic symptoms are the more important symptoms and can be documented in several ways, first simple neuro evaluation, then an EMG which measures conductivity of specific nerves, If you have an impingement, it shows a difference in the number of mili seceonds it takes for a small amount of electricity to travel from ponint A to point B and back to A again, then they compare the time it took for curent to travel comparing one side to the other. IT's really not a terrible test but can be useful to know the results.

There is no easy solution to comp. After one surgery that I waited 8 months for and a year of rehab and PM bootcamp where you wouldn't get a tylenol 3 on your worst day I was so sick of dealing with docs that lied and said you willnever need another surgery again and yoit's all in yourhead and you have a drug problem. I thought settling would eleviate so much anxiety and stress That I did settle.

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