How good intentions– can cause piss poor medical outcomes

I have been trying to advocate for the chronic pain community for abt 10 yrs.. The community seems to either be functioning under Eistein’s definition of insanity or a very bad “ground hog day” scenario

There has been too many years between now and Biochemistry class for me.
Today, I tend to rely on observations and my common sense to see things that seem abnormal.
I see chronic pain pts making statements that when they have had their pain meds involuntarily/forced reduction that their blood pressure goes into what I would call “stroke territory” – many north of 200/100.
Pts state that they may be taking up to 4 different categories of BP meds and their blood pressure doesn’t change little or none at all.
Apparently some practitioners just ignore their elevated BP, and can’t see – or don’t want to see the relationship between cutting the pt’s opiates and elevated BP.
Even those pts being put on up to 4 different categories of BP meds, their pressure will not return to what is considered acceptable 135/85 range.
Apparently, there is some physiological process effecting their blood pressure that is totally separate and distinct from what all of those different categories of BP meds have been targeted by clinical trials in controlling hypertension.
Since most opiates are generic, and there seems to be a near mass hysteria over the fear of addiction. There is probably little chance of some pharma to look at this issue.
My common sense suggests that there has to be one or more measurable components of our blood or urine that is raised or lowered and would indicate that the pt’s intensity of pain is elevated, maybe even capable of indicating just how high/intense it is.

Just look at line one on this chart on the effects to the human body from under/untreated pain. many/most of those items involved with the Endocrine system should be able to be measures with a simple blood or urine test. It is – or should be – common knowledge that any pts dealing with under/untreated pain for an extended period of time will end up with Addison’s disease – basically the adrenal glands have “quit/failed” while trying to compensate for the body’s stress and Addison is a disease that should not be ignored and not treated.

Hypertension from under/untreated pain is very common – ideal target for BP is 135/85 – but often pts who have had their opiate meds involuntarily reduced/eliminated will have a hypertensive crisis – with pressure often times north of 200/100 and that is STROKE TERRITORY.

What is even worse is – pts have told me that their practitioners will either ignore their hypertensive crisis and/or put them on as many as 4 different categories of blood pressure meds – and often their blood pressure will be reduced little to none.  There must be a whole separate physiological body function separate and distinct from what the blood pressure meds that we now have addresses.

Several years ago, Medicare/HHS/CMS started a program to monitor pt’s compliance with medications for blood pressure, diabetes, cholesterol.  They put the Medicare Advantage & Part D providers in charge of enforcing this program. Here is how it apparently works… the practitioner writes a Rx for pt to treat one or more of those medications…  Those insurance prgms start tracking the pt, the pharmacy and the practitioner … if the pt doesn’t refill the prescribed medications on a timely basis – based on the last fill/refill date submitted to the insurance program –  the insurance program will send out notices to the pt, pharmacy, practitioner – that the pt is NOT IN COMPLIANCE… the pharmacy and practitioner can get “financially dinged ” if more than a certain percent of their pts are no in  compliance.  

The ELEPHANT IN THE ROOM is that the insurance providers are apparently working under the belief that the pt’s lab values for those three disease states are being kept within “normal range”… In the case of under/untreated pain pts… taking 4 different blood pressure meds but their BP is still in “stroke range”.  As far as Medicare/HHS/CMS is concerned … all the “i’s” are being dotted and “t’s are being crossed, but the original intent of this program – lowering cost to medicare because the pt is being compliant with their medications is either a mirage or an illusion.

I have no idea how large this subset of chronic pain pts with hypertension, who have had their pain meds involuntarily/forced reduction or eliminated, and whose blood pressure in above recommended levels – especially those who are being prescribed- and regularly taking – blood pressure meds – that are not lowering their BP… HHS/CMS/Medicare is working under the false pretense that the practitioner has got the pt’s BP under control…

Perhaps this is a issue that is better about talking to your member of Congress about…  Congress or HHS put this program together to help Medicare folks to  optimize their QOL and OF COURSE – to save Medicare money !  After all, high blood pressure has always been referred to a the “SILENT KILLER”.  With that subset of chronic pain pts there can be a lot of other compromising QOL issues that high pressure will compromise – and cost Medicare MORE MONEY – before it kills you.

This chart pretty simply explains the potential adverse health consequences to a pt with long term high blood pressure.  A stroke may not kill you … could make you bed confined, could make you a paraplegic and in a wheelchair, heart attack doesn’t have to kill you, can cause a lot of different disabilities and if you are on Medicare you are “too old” for a heart transplant.

Kidney damage and you will end up on dialysis and again if you are on Medicare, you are “too old” for a transplant

How would losing your eye sight affect your day to day living and QOL ?

And who is going to pay for all of these medical services that you need ? Medicare will only pay for so many days in a nursing home and then you will be liable until you only have $2000.00 and a car and if you have a house.. they may sell it for you to keep paying your nursing home costs and then you will get on Medicaid…. and the care that you received will be dictated by Medicaid

This is just one example of how good intentions by Congress, HHS. CMS, Medicare could be costing our healthcare system unnecessary costs and costing pts unnecessarily having their QOL compromised because all those involved are only looking at part of a pt’s health issues.  It is also pathetic, that there could be all sorts of pt’s data points (lab tests) in Electronic Medical Records (EMR) that could verify and document a chronic pain pt’s intensity of pain.

Because NO ONE IS LOOKING at the data that is right under their noses !





2 Responses


  2. You are, of course, absolutely right, Steve. I am in that category of chronic pain patients. I have had new and severe issues since being forcibly tapered, including dangerous BP levels and other cardiac changes. As a matter of fact, just a few years ago, it was being discussed that we should start looking at measuring pain patients levels of Substance P, since elevated levels are well understood to go hand in hand with increased pain. Unfortunately, that conversation apparently crept away quietly in the night to die on it’s own. It wouldn’t have been a perfect system if they had used it, but it would have been a hell of a lot better than the non-existent concessions that we have right now. It would have been SOMETHING in a realm with a whole lot of nothing.

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