The Problem With Prior Authorizations in Medicine

January 12, 2015 / Thomas Cohn, MD

The health insurance industry has developed a tool to control their costs and drive the providers and patients nuts. Originally the concept was used to help reduce the use of tests that were duplicates or unnecessary to provide good medical care. Now it has invaded into every corner of medicine, greatly increasing the cost to the medical provider in order to get approval for any test, procedure or medicine. To the patient and the provider, it just seems to be a nice way for the insurance companies to block care.

For patients with pain, many medications and procedures require prior authorization. It’s a timely process, filling out forms, calling a variety of people at insurance companies, writing down a number and making sure everyone has dotted the”I’s” and crossed the “T’s”. It certainly does not save any money and it costs a great deal of time. From a medical point of view, good practitioners tend to know what is appropriate and are not out to run up medical costs for their own profit. However, the rules always seem to favor the insurance company so they can keep more of your money.

Authorization Rules

Many of the rules that now exist surround the use of medications. The rules are usually written by a pharmacist and are based on drugs having similar modes of action. One generally assumed rule is that a patient must take a cheaper drug and the drug must fail in its use before a different drug can be used. The first problem with this is that professionals who do not treat patients and are not allowed to prescribe medications write the rules. They have no experience with patients, side effects and the need to run additional tests to check for problems. Many of the drugs recommended for pain, and are to be used first, are not even approved by the FDA for the specific condition. Some of the drugs have significant dangers, and may even be deadly. The state of Oregon required the use of Methadone, and suddenly the death rate from the drug skyrocketed. Pain experts warned against the move, but those who controlled the money did not listen.

The cost of medicine in the United States is a problem. Prior authorizations are really not the answer to control medical costs. Improved science and better knowledge would be a start. Furthermore, more control of the big pharmaceutical industry is necessary. They are making record profits, and on average they increased drug costs by at least 25% while inflation was 2%. The most important item would be a uniform medical record system, and all information on every person be kept in the same place. This simple tool would eliminate duplicate studies, questions about medications, and greatly ease and improve quality of care. It also would make it extremely easy to study particular diagnoses and solutions.

Chronic Pain: The Benefits of Exercise

January 8, 2015March 18, 2016 / Thomas Cohn, MD

Chronic pain is tough to deal with, and oftentimes it can seem like and endless cycle of pain, medications, and failed treatments. Since your chronic pain can be caused by hundreds of different issues, pinpointing the problem is key, and what works for some may not work for others. But one thing that most pain management specialists agree on is that exercise is beneficial for treating chronic pain.

Now you might be saying, “How is running going to make my chronic back pain any better? Staying still is pailful, moving is only going to make it worse!” We’re not saying you need to get off the couch and run 10 miles, but moderate exercise has been shown to lessen chronic pain symptoms. Just check out this study. As individuals exercised, their pain tolerance increased. While they still felt similar amounts of pain, their ability to cope with it improved.

Another reason exercise is beneficial is because it kickstarts your body’s release of endorphins. These endorphins help decrease discomfort during a workout, and their effects can linger after your exercise is complete. This process is known as “exercise-induced hypoalgesia.”

Regular Exercise

As I mentioned in my post “Practicing What You Preach,” I suffer from spondylolisthesis that affects the nerves in my back. I suffer back pain from time to time, but I know the best way to control it. Time and time again the best way to keep back pain from slowing me down is to incorporate aerobic exercises into my daily routine. It’s gotten to the point where my back aches if I don’t find time to exercise.

Stretching and exercise can alleviate chronic pain problems, so it’s important to find a workout that works for you. I can no longer run or jog, but I’ve found that long walks or a half hour on the elliptical works wonders. I pair the workout with anti-inflammatories, but I know there is no magic pill that will cure my pain without me putting in effort. Just like diet pills, you can’t lose weight simply by popping a pill, you need to pair it with nutrition and exercise.

There are a lot of reasons to avoid exercise, especially if you have chronic pain; you’re in too much pain, you don’t know what exercises to do, you don’t have the right equipment or you simply find it easier to stay seated. If you are truly interested in alleviating chronic pain, it starts with taking care of your body. Modern medicine is great, but it’s only one prong of the multifaceted approach. You can’t always cure chronic pain, but with exercise, you can help control it.

Many Nurses Suffer From Lower Back Pain

January 6, 2015 / Thomas Cohn, MD

Researchers in India say nearly 90 percent of nurses across 21 different healthcare facilities in Mumbai and Thane complain of back pain and other muscloskeletal disorders, and nurses in the US may not be much better off.

Researchers at the Nirmala Niketan College of Home Science decided to interview nurses to see how the rigors of keeping others healthy impacts their own health. Nursing isn’t typically considered a physically demanding job, but when you consider how nurses often lift, roll, turn and transfer patients to administer services, you can see how their bodies can wear down.

About 89 percent of nurses surveyed complained of lower back pain or muscloskeletal pain stemming from overuse or misuse of a body part.

“While a majority complained of back pain, others complained of wrist and leg pain. Nurses have a physically demanding job, as they are expected to reposition patients which strain their body also,” said Roopa Rao, an Ergonomics specialist.

As we mentioned above, constant, forceful and repetitive lifting is going to take its toll on body tissues over time. Some hospitals provide nurses with lifting devices to aid in the movement of patients, but not all. The study went on to note that eight out of ten nurses said their pain hindered or interfered with their ability to preform their job duties.

Long Hours

Another issue that may contribute to back problems in nurses is the fact that they often work long hours. Sometimes nurses are called on to work 12-, 14-, 16- and even 18-hour shifts. These long hours take a toll on the body, even if limited lifting is involved. Rao added that the job constraints don’t always allow for regular scheduled breaks. Instead, nurses take their break when there is a lull in the action.

“They are also deprived of a planned break,” said Rao. “Most of their breaks are when there are no duties related to patients to be performed.”

We need to do a better job of taking care of own our. Nurses put so much time and effort into healing others that they may be hurting their own bodies. Nurses and other healthcare workers would benefit from more lifting devices and scheduled breaks, but it’s difficult given budget constraints and patient workload.

Related source: Hindostan Times

Control Chronic Pain With Healthy New Year’s Resolutions

January 2, 2015 / Thomas Cohn, MD

Every New Year’s Day, many of us make resolutions of what we like to change in our lives. When making New Year’s resolutions, we should work on changing things that would improve our lives. If we are like 40% of Americans who have pain, then there are many things in our lives we can do improve our quality of life.

The first resolution is that you can “manage” your pain and move forward in life. Pain has physical and psychological components, and we can control the cognitive, interpretative parts. When pain becomes chronic, there are normal sensory signals going to the brain that are being perceived as pain. The pain does not change, and you feel it regardless if you are moving or if you are doing nothing. Stop doing nothing, move forward, and get busy. If you are busy, you will not have time to worry about the pain, and you will feel better.

The second resolution is part of the first; get regular exercise. Start slowly and work up to a significant level. Two things must be done, stretching and strengthening, and aerobic conditioning. To tolerate more activity, having adequate muscle strength is essential. Core muscle strength is necessary. These are the muscles of the trunk including your abdomen, along the spine, and those about the pelvis and hips. These are muscles that we normally do not specifically work on and most everyone needs guided training to get started. With strengthening, stretching the muscles daily keeps them from becoming too tight and allows them to maintain normal function. Cardiac health is also necessary. This is done through traditional exercises, like walking, running or biking, in order to increase the heart rate. Aerobic exercise helps burn more calories and control weight.

The third resolution is to lose weight and get close to your ideal body weight. Excess weight stresses the body, especially the muscles and joints. Fat also has been shown to produce compounds that cause inflammation, and those who have pain already do not need to promote more pain within their bodies. If we eat healthier, we tend to feel better and have more energy. Mentally, being close to ideal body weight also promotes a better self image. We can control what we eat, and if we eat healthier, there are many rewards.

It is a new year. Step forward and start taking control of your life. Choose wisely and start doing the things that will improve the quality of your life. Stop making excuses for your behavior and change the bad and reward yourself for the right stuff. Start tracking your diet and exercise, and stick to the plan. Use a fitness tracker and pay attention to diet. If you need help, work with your health care providers. Start now and make positive changes in your life.