Toxicology Exam : The Medical Necessity Of Opioids, Addiction, Or Poor Pain Control

A visit note from Gregory Carico, MD (Internal Medicine), dated 01/23/2017, indicated that the claimant presented with a history of depression. She was involved in a motor vehicle accident on December 9th. She was relieved from work duties from 12/09 to 01/04 and was able to return to work on 01/10. She was again off work on 01/12 for therapy. She had pain in the thoracic part of the back and lower neck to middle back. She was diagnosed with a sprain of ligaments of the thoracic spine. An

Opioids are a class of drugs that are designed to relieve pain. They are synthetic forms of the naturally occurring opiate opium along with morphine and codeine, which are parts of the opium poppy. Prescription opioids include the painkillers hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), fentanyl (Duragesic), meperidine (Demerol), and hydromorphone (Dilaudid), amongst others. Opioids of this variety are prescribed for a variety of reasons ranging from severe acute pain resulting from injury to post surgery pain relief. Illicit opioids include heroin and any opioids that are not taken are prescribed. While helpful in treating pain that needs immediate attention, prescription opioids are not ideal to treat chronic pain. Opioids, both prescribed and illicit, are highly addictive and potentially dangerous.

Based on the latest medical report dated 04/08/16, the patient presents for follow-up of his lower back pain. He is status post radiofrequency facet on the left that initially helped with left sided lower back to 60%. He stated that PT was stopped by insurance for the past 2 weeks. Since he started PT, he has been having increased spasm across his lower back with pain into the left lower extremity. IW feels that PT

In the United States, more than 2 million people suffer from substance abuse disorders that correlate with use of prescription opioid painkillers. Over the past 15 years, overdose deaths due to prescription opioids have more than quadrupled. One of the underlying causes is the over prescription of pain relievers by physicians. This was demonstrated in 2013, with the writing of 207 million prescriptions for opioid pain relievers.

The patient is a 50 year old male construction worker who sustained a work-related injury while lifting heavy boxes of metals. In an office visit dated 12/14/13, patient complaints of intermittent severe low back pain which radiates to bilateral lower extremities. The claimant had an epidural injection, which significantly alleviated right leg pain for a short period of time. Unfortunately pain has returned. It is in the right leg as well as severe pain in the lower back. The claimant wishes to consider surgical intervention due to severity of pain. Objective examination reveals weakness in the right extensor halucis longus and anterior tibialis which are 4+/5. The claimant has diminished sensation along the dorsum of right foot. The claimant has a positive straight leg raise.

DOI: 9/30/2011. Patient is a 41-year-old male information technology computer support specialist who sustained injury while he was walking through a lobby when he slipped and fell. Per OMNI, he was initially diagnosed with lumbar intervertebral disc syndrome, myofasciitis and right arm strain. He underwent a right shoulder surgery on 07/16/13 and 12/22/15.

DOI: 6/23/2016. Patient is a 42-year-old female registered nurse who sustained injury to her neck/left shoulder when she twisted to keep the attachment from falling to the floor. Per OMNI, she was initially diagnosed with strain to multiple body parts.

10/30/15 Medical Evaluation reported neck, low back, and left sacroiliac pain. Physical examination of the lumbar spine revealed decreased ROM on

Based on the latest follow-up evaluation progress report dated 03/02/16, the patient complains of right shoulder pain and stiffness. He states that his shoulder feels sore. He states that his pain is aggravated by the cold weather and over activity. The patient has not attended physical therapy for some time due to travel outside of the country. He is using an analgesic cream.

As of 2012, overdose deaths involving prescription painkiller abuse, have increased to almost 17,000 deaths a year in the United States (CLAAD.org). A pain killer is a drug or medicine for relieving pain. It is estimated that 2.1 million people in the United States abuse painkillers. This is a growing problem in the United States, but who’s fault is it really? Prescription painkiller abuse is very dangerous and is the fault of the consumer and the physician.

The opioids produce analgesic effects no matter is endogenous or synthetic, including morphine, codeine and methadone. (3)Endogenous opioid peptides such as endorphins, enkephalins and dynorphins activate opioid receptors including mu-receptors (mainly), delta-receptors, kappa-receptors and ORL1 receptors to produce different effects. One of the non-analgesic effects is the disruption of sleep-wake behaviour by the opioids’ actions on the ventrolateral preoptic nucleus (VLPO). The differences of the pharmacokinetic properties between the 3 opioids mentioned and the possible mechanisms of sleep-wake regulations will be discussed below.

The x-rays of Plaintiff’s spine showed normal alignment, no swelling, no fracture or dislocation and normal lordosis of the cervical and lumbar spine. Plaintiff’s left knee x-ray also showed no fracture or dislocation, but moderate decrease in the meduial articular joint space. Plaintiff was given a general diagnosis of neck pain, back pain, low back pain and left knee pain. Plaintiff was prescribed 3 sessions per week for 6 weeks of physical therapy.

The term “opioid” refers to the family of chemicals which are semi and fully synthesized from the opium poppy. These substances bind the opioid receptors not allowing pain signals to get to the brain, making these drugs the most advanced treatment in pain available in the country. Currently, the United States is facing one of the biggest epidemics in history related to substance abuse. Abusing opiates could end up in physical and psychological dependence (fancy words for addiction), in addition I have to clarify that drug addiction is a disorder not a disease. Drug addiction disorder is the cause of a lot of the deaths annually in the world. According to the United States Department of Health and Human Services. (2014), “78 daily deaths are

Objective Functional Improvement shows that the patient is now able to get dressed with minimum assist. He is also now able to navigate 2 flights of stairs without pain, same as prior, now able to walk for 8 minutes, same as prior, can now lift 6.5 lbs. of weight, improved from prior, and push 6 lbs. of weight, same as prior. Therapy goals for this patient in the next 4 weeks are to reduce inflammation from moderate to minimal and increase cervical and lumbar spine flexion and bilateral rotation by 3 degrees. The patient in the next 4 weeks will be able to get dressed easier, navigate 2.5 flights of stairs without pain, walk 9 minutes from 8 minutes, lift 7 lbs. of weight, and push 7 lbs. of

DOI: 06/04/2007. Patient is a 66-year-old male baggage service agent who felt pain in his right shoulder after lifting bags. As per OMNI notes, patient is status post right shoulder decompression. Per the Orthopedic AME Supplemental report dated 11/05/19, IW has 3% whole person impairment rating for his bilateral shoulders. Per OMNI payment screen, last PT session was on 07/28/16.