The chart below is the possible adverse effects to the human body if a pt’s pain is under/untreated.
I have listed below 5 different chronic health issues and the consequences to the pt if they are not properly treated. I have put in RED three of the chronic health issues that Medicare Part D & Medicare-C monitor how compliance the pt is in taking their medications for those chronic health issues. They monitor to such a degree that if all the prescriber’s or pharmacy’s pts are determine to be out of compliance – I think that it is – on average – the pts are not taking 85% of their prescribed medications. That puts the STAR RATING of the prescriber & pharmacy at risk and that means that the reimbursement for caring for those pts will get “dinged”, and those practitioners will be getting “warning letters” from Medicare. So, the fact that Medicare is encouraging all practitioners to limit, reduce or eliminate adequate opioid therapy on chronic pain pts, is apparently counter productive in their “bean counting” if pts are taking their prescribed medications regularly and as prescribed. Since 1935 there has been a law that prohibits any Federal employee interfering with the practicing of medicine. A lawsuit against the 3 largest drug wholesalers by the vast majority of state AGs. Where they agreed to sell less controlled meds to community pharmacies. https://www.pharmaciststeve.com/pharma-prescribed-opioids-to-pts-with-valid-medical-necessity-0-022-pts-odd/kaiser/
The DEA, on a annual basis reduces the controlled med production quotas https://www.pharmaciststeve.com/proposed-aggregate-production-quotas-for-schedule-i-and-ii-controlled-substances/
Is it just me or is the DEA/DOJ doing their best efforts to prohibit chronic painers from getting their pain management therapy prescribed and/or pharmacies can’t get pain medication(s) from their wholesaler and all of this direct/indirect denial of care could be impacting the pt’s co-morbidity issues that CMS is following how/if the pt’s co-morbidity issues are being properly managed.
All of this push-pull with the DEA/DOJ & CMS involving how/if pts get appropriate care, could possible cause the pt to be falsely labeled as a PHARMACY SHOPPER and get more push back from practitioners and pharmacies because of the pt’s high Narxcare score, which they do not deserve, but could get punished all the same.
Below I outlined the adverse effects that pts may experience due to under/untreated pain, with other critical chronic health issues the pt is already dealing with or cause the pt to develop some other chronic health issues because of their under/untreated pain?
42 USC 1395: Prohibition against any Federal interference
https://uscode.house.gov/view.xhtml?req=(title:42%20section:1395%20edition:prelim)
From Title 42-THE PUBLIC HEALTH AND WELFARE CHAPTER 7-SOCIAL SECURITY SUBCHAPTER XVIII-HEALTH INSURANCE FOR AGED AND DISABLED
§1395. Prohibition against any Federal interference
Nothing in this sub chapter shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
(Aug. 14, 1935, ch. 531, title XVIII, §1801, as added Pub. L. 89–97, title I, §102(a), July 30, 1965, 79 Stat. 291 .)
Statutory Notes and Related Subsidiaries
Short Title
For short title of title I of Pub. L. 89–97, which enacted this subchapter as the “Health Insurance for the Aged Act”, see section 100 of Pub. L. 89–97, set out as a Short Title of 1965 Amendment note under section 1305 of this title.
Protecting and Improving Guaranteed Medicare Benefits
Pub. L. 111–148, title III, §3601, Mar. 23, 2010, 124 Stat. 538 , provided that:
“(a) Protecting Guaranteed Medicare Benefits.-Nothing in the provisions of, or amendments made by, this Act [see Short Title note set out under section 18001 of this title] shall result in a reduction of guaranteed benefits under title XVIII of the Social Security Act [42 U.S.C. 1395 et seq.].
“(b) Ensuring That Medicare Savings Benefit the Medicare Program and Medicare Beneficiaries.-Savings generated for the Medicare program under title XVIII of the Social Security Act under the provisions of, and amendments made by, this Act shall extend the solvency of the Medicare trust funds, reduce Medicare premiums and other cost-sharing for beneficiaries, and improve or expand guaranteed Medicare benefits and protect access to Medicare providers.”
If a patient’s high blood pressure (hypertension) is not properly controlled, it can lead to a wide range of serious and potentially life-threatening complications affecting multiple organ systems:
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Cardiovascular system: Uncontrolled hypertension damages blood vessels, leading to heart attack, stroke, heart failure, angina, atherosclerosis (hardening and narrowing of the arteries), and aneurysms (which can rupture and be fatal)
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Kidneys: High blood pressure can cause the blood vessels in the kidneys to narrow, weaken, or harden, leading to chronic kidney disease and potentially kidney failure
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Brain: Hypertension increases the risk of stroke and can cause vascular dementia or other cognitive impairments due to reduced blood flow to the brain
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Eyes: Damage to the small blood vessels in the eyes can result in retinopathy, leading to vision loss or even blindness
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Sexual function: 
High blood pressure can cause erectile dysfunction in men and reduced libido or arousal issues in women
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Metabolic syndrome: Uncontrolled hypertension can contribute to a cluster of conditions including increased waist size, high triglycerides, low HDL cholesterol, and high blood sugar, which increase the risk for diabetes, heart disease, and stroke
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Other complications: These can include memory loss, fluid in the lungs, and, in severe cases, aortic dissection (a tear in the wall of the aorta)
Harms of Untreated Blood Sugar Abnormalities
When blood sugar is not properly managed—whether too high (hyperglycemia) or too low (hypoglycemia)—it can lead to serious, sometimes life-threatening complications. Below are the key risks associated with untreated blood sugar problems:
Untreated High Blood Sugar (Hyperglycemia)
Short-Term Complications:
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Diabetic Ketoacidosis (DKA): A dangerous buildup of acids (ketones) in the blood, which can cause coma or death if not treated promptly.
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Hyperosmolar Hyperglycemic State (HHS): Severe dehydration and very high blood sugar, leading to confusion, seizures, and coma
Long-Term Complications:
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Heart and Blood Vessel Disease: Increased risk of heart attack, stroke, and poor circulation
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Nerve Damage (Neuropathy): Tingling, pain, numbness, and loss of sensation, especially in the feet, which can lead to ulcers and amputations
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Kidney Damage (Nephropathy): Can progress to kidney failure, requiring dialysis or transplantation
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Eye Damage (Retinopathy): Can cause vision loss or blindness
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Poor Wound Healing and Infections: Increased risk of skin, urinary tract, and other infections due to impaired immune function and circulation
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Gum Disease and Tooth Loss: Higher risk of dental problems
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Cognitive Impairment: Increased risk of memory loss and dementia
Long-Term Risks:
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Brain Damage: Repeated or severe episodes can cause lasting cognitive impairment, especially in older adults
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Increased Risk of Heart Disease: Episodes of severe hypoglycemia are linked to higher rates of cardiovascular events and mortality
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Hypoglycemia Unawareness: Over time, the body may stop producing warning symptoms, increasing the risk of severe, unnoticed low blood sugar
If high cholesterol goes untreated, it can have significant and potentially life-threatening consequences for patients. The main risks stem from the gradual buildup of cholesterol-rich plaque in the arteries, a process known as atherosclerosis. This buildup narrows and hardens the arteries, restricting blood flow and increasing the risk of several serious conditions:
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Coronary artery disease (CAD): Plaque accumulation in the arteries supplying the heart can lead to chest pain (angina), heart attacks, and heart failure. CAD is the leading cause of death in the U.S., and many people do not realize they have it until they experience symptoms or a cardiac event
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Stroke: If plaque builds up in the arteries that supply the brain (such as the carotid arteries), it can reduce or block blood flow. A ruptured plaque can also trigger a blood clot, which may travel to the brain and cause a stroke. Strokes can lead to long-term disability or death
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Peripheral artery disease (PAD): High cholesterol can cause narrowing of arteries in the limbs, particularly the legs, leading to pain, numbness, and, in severe cases, tissue damage or loss. PAD increases the risk of infections and poor wound healing
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High blood pressure: Plaque buildup makes arteries less flexible and narrower, forcing the heart to work harder to pump blood, which can contribute to or worsen hypertension
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Chronic kidney disease: Studies indicate that abnormal cholesterol levels double the risk of reduced kidney function over time. This can progress to chronic kidney disease, requiring dialysis or transplantation if not managed
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Other complications: High cholesterol is often associated with diabetes, which further increases cardiovascular risk. It can also interact with other conditions (like thyroid disease or chronic inflammation) to worsen overall health outcomes
High cholesterol is typically asymptomatic—most people do not feel any different until a major event (like a heart attack or stroke) occurs
. This “silent” nature underscores the importance of regular screening and proactive management, especially since the risk increases with age and other factors such as genetics, diet, and lifestyle
In summary: Untreated high cholesterol significantly raises the risk of heart attack, stroke, peripheral artery disease, kidney disease, and death from cardiovascular causes. Early detection and treatment—through lifestyle changes and, if needed, medications—are essential to reduce these risks and improve long-term health outcomes
Low thyroid (T4) blood levels indicate hypothyroidism, a condition where the thyroid gland does not produce enough thyroid hormone. This deficiency slows down many of the body’s metabolic processes and can cause a wide range of physical problems
The main physical problems associated with low T4 levels include:
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Fatigue and weakness: People often feel unusually tired and lack energy, even after adequate rest
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Weight gain: Metabolism slows, leading to unintentional weight gain despite no change or even a decrease in appetite
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Cold intolerance: Increased sensitivity to cold temperatures is common due to reduced heat production
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Dry skin and hair: Skin may become dry, rough, and pale; hair can become dry, brittle, and thin
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Constipation: Slowed digestive processes can lead to persistent constipation
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Muscle and joint pain: Muscle aches, stiffness, cramps, and joint pain or swelling are frequent complaints
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Slow heart rate: The heart may beat more slowly, and in severe cases, hypothyroidism can contribute to heart failure or pericardial effusion (fluid around the heart)
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Elevated cholesterol: Hypothyroidism can increase total and LDL cholesterol, raising the risk of heart disease
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Menstrual and fertility issues: Women may experience heavier, irregular periods and fertility problems due to disrupted ovulation
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Peripheral neuropathy: Long-term untreated hypothyroidism can damage peripheral nerves, causing numbness, tingling, or pain in the limbs
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Mental health changes: Depression, slowed thinking, memory problems, and decreased interest in activities can occur
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Goiter: The thyroid gland may enlarge as it attempts to compensate for low hormone production, sometimes causing visible swelling in the neck and difficulty swallowing
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Myxedema: In severe, untreated cases, swelling of the skin and tissues (myxedema) can develop, and in extreme cases, lead to a life-threatening myxedema coma
In infants and children, untreated hypothyroidism can cause serious physical and mental developmental problems, but early diagnosis and treatment can prevent these outcomes
In summary: Low T4 levels slow down metabolism and can cause a range of symptoms affecting energy, weight, temperature regulation, skin, hair, heart, muscles, nerves, and reproductive health. If untreated, hypothyroidism can lead to significant complications, but it is generally treatable with hormone replacement therapy
Consequences of Long-Term Untreated SaO₂ ≤ 85%
When a patient’s arterial oxygen saturation (SaO₂) remains at or below 85% for an extended period without intervention, it leads to chronic hypoxemia. This condition can have severe and potentially irreversible effects on multiple organ systems.
Immediate and Short-Term Effects
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Cognitive Impairment: Low oxygen levels can cause confusion, irritability, drowsiness, and visual changes. Severe hypoxemia can lead to loss of consciousness, seizures, or even coma.
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Cardiorespiratory Symptoms: Patients may experience shortness of breath, rapid breathing, increased heart rate, and abnormal heart rhythms
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Cyanosis: A bluish or grayish tint to the skin, especially when saturation drops below 75%, indicating dangerously low oxygen delivery to tissues
Long-Term Consequences
1. Neurological Damage
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Brain Injury: Prolonged hypoxemia can result in irreversible brain damage, cognitive decline, and increased risk of stroke. Brain cells are highly sensitive to low oxygen and may die within minutes to hours of severe hypoxia
2. Cardiovascular Complications
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Pulmonary Hypertension: Chronic low oxygen levels cause constriction of pulmonary arteries, leading to increased pressure (pulmonary hypertension)
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Right-Sided Heart Failure (Cor Pulmonale): The right ventricle works harder to pump blood through the lungs, eventually leading to right-sided heart failure
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Arrhythmias: Hypoxemia can trigger abnormal heart rhythms, increasing risk for sudden cardiac events
3. Hematological Changes
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Secondary Polycythemia: The body compensates for low oxygen by producing more red blood cells, which thickens the blood and increases the risk of clotting and stroke
4. Multi-Organ Dysfunction
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Organ Damage: Chronic hypoxia can irreversibly damage vital organs such as the brain, heart, kidneys, and liver, ultimately leading to organ failure
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Reduced Exercise Tolerance & Quality of Life: Muscle dysfunction, fatigue, and reduced stamina are common, limiting daily activities
5. Increased Mortality
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Higher Risk of Death: Studies show that persistently low oxygen saturation is independently associated with increased all-cause mortality, especially from pulmonary and cardiovascular diseases
Summary Table: Major Consequences
| System Affected |
Consequence |
| Brain |
Cognitive decline, seizures, coma, brain death |
| Heart & Lungs |
Pulmonary hypertension, right heart failure, arrhythmias |
| Blood |
Secondary polycythemia, increased clot risk |
| Organs (multi-system) |
Irreversible organ damage, failure |
| General |
Increased mortality, reduced quality of life |
Key Points
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SaO₂ ≤ 85% is a medical emergency and requires prompt intervention.
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Untreated chronic hypoxemia leads to progressive, often irreversible, multi-organ damage and significantly shortens life expectancy
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Early recognition and treatment are critical to prevent these severe complications.
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