I'm a chronic pain sufferer, with among other problems, degenerative disc disease affecting my S1, L4 and L5 joints bilaterally. I've been through several rounds of the denervation procedure, which essentially burns off the nerve endings of the lumbar facet joints, so that the pain is diminished for the period of time it takes for the nerves to regenerate. The procedure consists of placing needles deep into the affected joints, positioned via flouroscope, then having electrical current passed through the joints to destroy the nerve endings. The amount of time that this procedure benefits me is about three to six months, during which my pain level is reduced from a 5-6 on a daily basis, down to about a 2-3, with a corresponding improvement in my ability to accomplish the most basic of daily tasks.
Unfortunately for me, the closest Pain Management Center that I can get this procedure done at is over an hour away from my home, and is at a "teaching hospital", which I have found to be the LAST PLACE any chronic pain sufferer should have to go for treatment. I have found that "teaching hospitals" treat the patients like guinea pigs, while catering to the needs of the "students" learning to be doctors. I've come to this conclusion over a period of time, based on my own experience, and by observing the same procedure being performed on several different medical television programs I've seen in the past few months.
Before the actual procedure can be done, patients must first be put through a testing procedure, which consists of using a temporary anesthetic and a steroid in place of the electrical current, to see if the patient experiences any relief from a brief numbing of the joints. Once it has been determined that relief can be achieved, the actual procedure can be done. From the research I've done, and via personal experience, I've realized that patients getting this procedure done in a "teaching" environment are treated in a positively barbaric manner.
Basically, compared to the other people I've seen that have this procedure done, I'm totally getting screwed in this process. First, the Pain Management Center I go to won't prescribe pain meds for me, insisting that my primary care physician handle that aspect of my care, but they do recommend that I receive the least level of medication possible. Thus, I am expected to function on #30 5/500 Lortab, 3 per day, and have to call my DR. for a refill EVERY TEN DAYS, because I am not given any refills. I also get #50 50mg Tramadol, no more than 4 per day, and have to do the manual refill thing every 30(!) days. The other patients I've seen on television that have need for the LFJ denervation procedure have their daily pain managed with everything from Methadone, Fentenyl patches, Oxycontin...nothing less than higher dosages of Oxycodone. Clearly, I'm being expected to handle my pain with a lot less pharmacutical help that people with my equivalent condition. If I was functioning at an acceptable level, and my pain was tolerable, I could understand, but that's not the case. If the PM Center isn't going to prescribe my meds, I don't think they should be dictating to my PCP what I should be receiving.
The second thing that disturbs me about my situation is that because of this "teaching environment", I don't receive a good continuity of care, as the student doctors are constantly cycling through the program. I see someone new practically every time I have an appointment. Even the "supervising" staff fluctuates from visit to visit. Additionally, because the protocol includes the testing step be completed prior to the procedure being done, each time I need to repeat the denervation, the Pain Management Center wants me to have the test redone so the student doctors can see the full process, step-by-step. I know the procedure works, so I shouldn't have to be retested every time, and my insurance company sure shouldn't have to pay again for unnecessary tests.
The biggest problem I have with getting this procedure done in a "teaching environment" is that I am expected to undergo this extremely painful procedure wide awake with no anesthesia...nothing to make the procedure less tramatic. In watching the procedure being done on various television shows, the patients are always knocked out, and have the portions of their anatomy being worked on numbed up so they don't feel any discomfort. With the student doctors, they want the patients wide awake so that they can receive immediate feedback when they do the needle placement in the joints and when they start to apply the electric current. This is really cruel and unusual punishment for the patient, since they doctors have instruments and machines that automatically provide this information, and will be what they rely on once they become practicing specialists. I am made to cry out in pain multiple times during every procedure, as the pain is often excruciating. During one procedure, I actually had a student doctor tell me that my screams were "not productive" since they didn't provide any "constructive" information! I about came up off the operating table from a combination of agony and anger, because not only was the comment insensitive, it's not like the jerk had been asking me for any specific feedback. He was just jabbing huge needles deep into the extremely painful joints of my spine! ARRRGGGH!!!
I guess the really telling thing about this painful process is that during one of my procedures, I was making so much noise from the pain in the procedure room, a very large, football player-sized man had to be pursuaded not to leave the premises, as he was scheduled to have a denervation immediately following me. Apparently, I had him scared half to death! I do have to say that the nursing staff is very sympathetic to my plight, and if it weren't for them, I know I never would be able to endure the process which does provide me with a measure of pain relief for a period of time. I really think I'm going to beat the bushes one more time to see if I can find a Pain Management Center that isn't a teaching institution. I don't think I can bring myself to go through this miserable procedure knowing that other people don't have to suffer in the same way.
Thanks for listening. Any feedback is appreciated.