Current methods of fraud detection used by insurance companies are not cost effective. This presentation describes the inaccuracy of the MMPI, and presents a new test, which can predict who will had medical test abnormalites with 95% accuracy, and who wil not have medical test abnormalities with 85% accuracy (the fakers). Available in English and Spanish at www.MarylandClinicalDiagnostics.com
This document discusses PRN pain medication administration and management. It outlines objectives around offering PRN medications consistently based on evidence, using sedation and nonverbal pain scales, and properly documenting PRN medication administration in the Excellian system. Key recommendations include administering pain medications regularly to maintain therapeutic levels and using PRN medications for breakthrough pain. Proper documentation and timely administration of PRN medications can help effectively control pain.
This document discusses the challenges of treating chronic pain and opioid dependency. It notes that prior to 2011, addiction rates associated with prescription opioids were believed to be much lower than later studies found them to be. It also discusses the overprescription of pain medications and the high rates of illegal drug use and worse health outcomes among chronic pain patients prescribed opioids. The document advocates for more specialized treatment of chronic pain and opioid dependency as diseases, and notes the medical profession's unwitting role in exacerbating the problems.
a. Understand the prevalence and nature of pain concerns in returning combat veterans.
b. Understand that pain issues are part of a complex group of co-occurring and inter-related issues.
c. Describe a collaborative, bio-psycho-social approach to address pain issues.
d. Understand the stepped-care, collaborative approach in VA.
e. Understand how to implement collaborative pain care on PACT teams - a nuts and bolts approach
This two-part class will begin by highlighting collaborative pain care in Primary Care using real-life scenarios that address the complex issues and needs of returning Veterans and then move on to address how to apply a nuts-and-bolts approach within a Patient Aligned Care Team in the VA.
Psychological correlates of acute post surgical pain.Paul Coelho, MD
This systematic review and meta-analysis examines relationships between presurgical psychological factors and acute postsurgical pain (APSP). Fifty-three studies were included. Pain catastrophizing, optimism, expectation of pain, neuroticism, anxiety, negative affect, and depression were found to be likely associated with APSP, while locus of control was unlikely associated. Meta-analyses showed pain catastrophizing had the strongest link to APSP. Patients reporting lower levels of pain catastrophizing and higher optimism/expectations tended to experience less APSP.
This randomized clinical trial tested the effectiveness of stellate ganglion block (SGB) treatment compared to a sham procedure for reducing posttraumatic stress disorder (PTSD) symptoms over 8 weeks. 113 active-duty service members with PTSD symptoms were randomly assigned to receive either 2 SGB treatments 2 weeks apart or a sham procedure. The primary outcome was change in PTSD symptom severity scores measured by the CAPS-5 scale from baseline to 8 weeks. Participants receiving SGB had a greater reduction in symptoms scores compared to the sham group, with adjusted mean decreases of 12.6 vs 6.1 points respectively, indicating SGB treatment may help reduce PTSD symptoms.
This study surveyed behavioral health clinicians with experience using stellate ganglion block (SGB) as an adjunct treatment for trauma-related disorders like PTSD. Of the 23 respondents, 95% would recommend SGB to colleagues. Respondents rated SGB as at least as useful as the highest rated standard PTSD interventions. SGB was seen as most helpful for reducing arousal/reactivity symptoms. The majority would refer patients for SGB at any stage of therapy, including before starting other treatments.
- Ms. P is a 64-year-old woman diagnosed with fibromyalgia who experiences widespread muscle pain and fatigue. Her pain is aggravated by touch and relieved by rest and heat.
- She has tried numerous medications for fibromyalgia but most resulted in adverse effects. Her current treatment includes acupuncture, pregabalin, hydrocodone, and cyclobenzaprine.
- Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue, memory problems, and sleep disturbances. It affects 2-8% of the population and is considered a centralized pain state involving central nervous system pain amplification.
This document discusses PRN pain medication administration and management. It outlines objectives around offering PRN medications consistently based on evidence, using sedation and nonverbal pain scales, and properly documenting PRN medication administration in the Excellian system. Key recommendations include administering pain medications regularly to maintain therapeutic levels and using PRN medications for breakthrough pain. Proper documentation and timely administration of PRN medications can help effectively control pain.
This document discusses the challenges of treating chronic pain and opioid dependency. It notes that prior to 2011, addiction rates associated with prescription opioids were believed to be much lower than later studies found them to be. It also discusses the overprescription of pain medications and the high rates of illegal drug use and worse health outcomes among chronic pain patients prescribed opioids. The document advocates for more specialized treatment of chronic pain and opioid dependency as diseases, and notes the medical profession's unwitting role in exacerbating the problems.
a. Understand the prevalence and nature of pain concerns in returning combat veterans.
b. Understand that pain issues are part of a complex group of co-occurring and inter-related issues.
c. Describe a collaborative, bio-psycho-social approach to address pain issues.
d. Understand the stepped-care, collaborative approach in VA.
e. Understand how to implement collaborative pain care on PACT teams - a nuts and bolts approach
This two-part class will begin by highlighting collaborative pain care in Primary Care using real-life scenarios that address the complex issues and needs of returning Veterans and then move on to address how to apply a nuts-and-bolts approach within a Patient Aligned Care Team in the VA.
Psychological correlates of acute post surgical pain.Paul Coelho, MD
This systematic review and meta-analysis examines relationships between presurgical psychological factors and acute postsurgical pain (APSP). Fifty-three studies were included. Pain catastrophizing, optimism, expectation of pain, neuroticism, anxiety, negative affect, and depression were found to be likely associated with APSP, while locus of control was unlikely associated. Meta-analyses showed pain catastrophizing had the strongest link to APSP. Patients reporting lower levels of pain catastrophizing and higher optimism/expectations tended to experience less APSP.
This randomized clinical trial tested the effectiveness of stellate ganglion block (SGB) treatment compared to a sham procedure for reducing posttraumatic stress disorder (PTSD) symptoms over 8 weeks. 113 active-duty service members with PTSD symptoms were randomly assigned to receive either 2 SGB treatments 2 weeks apart or a sham procedure. The primary outcome was change in PTSD symptom severity scores measured by the CAPS-5 scale from baseline to 8 weeks. Participants receiving SGB had a greater reduction in symptoms scores compared to the sham group, with adjusted mean decreases of 12.6 vs 6.1 points respectively, indicating SGB treatment may help reduce PTSD symptoms.
This study surveyed behavioral health clinicians with experience using stellate ganglion block (SGB) as an adjunct treatment for trauma-related disorders like PTSD. Of the 23 respondents, 95% would recommend SGB to colleagues. Respondents rated SGB as at least as useful as the highest rated standard PTSD interventions. SGB was seen as most helpful for reducing arousal/reactivity symptoms. The majority would refer patients for SGB at any stage of therapy, including before starting other treatments.
- Ms. P is a 64-year-old woman diagnosed with fibromyalgia who experiences widespread muscle pain and fatigue. Her pain is aggravated by touch and relieved by rest and heat.
- She has tried numerous medications for fibromyalgia but most resulted in adverse effects. Her current treatment includes acupuncture, pregabalin, hydrocodone, and cyclobenzaprine.
- Fibromyalgia is characterized by widespread pain and is often accompanied by fatigue, memory problems, and sleep disturbances. It affects 2-8% of the population and is considered a centralized pain state involving central nervous system pain amplification.
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
The document discusses the leading causes of death worldwide due to illnesses like heart disease, malignant neoplasms, and cerebrovascular disease. It then covers various risk factors for cancer and heart disease, including smoking and diet. The rest of the document details cancer treatment methods such as staging and surgery, as well as principles of chemotherapy, radiation therapy, hormonal therapy, immunotherapy, and molecularly targeted agents. It provides examples of cancers that may be cured through chemotherapy alone or in combination with other treatments.
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
This document summarizes a study on racial and ethnic differences in medication adherence among patients newly prescribed antihypertensive medications. The study found that after controlling for factors like income and health status, black, Asian, and Hispanic patients were more likely than white patients to not fill their initial prescription or refill later prescriptions. However, differences in long-term adherence between white and non-white patients decreased when the model accounted for medication costs and use of mail-order pharmacies. The authors conclude that improving access to medications may help reduce persistent gaps in medication use between racial and ethnic groups.
Carle General Surgery Grand Rounds presentation on palliative care symptom management, specifically pain, nausea, constipation, and malignant bowel obstruction.
The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness. The hospice physician recommends anticoagulants to allow a more peaceful dying process rather than prolonging suffering, as surgery could do. Alternatives include trying anticoagulants first and reassessing, or determining Helen's wishes, as prolonging her life may conflict with her goals. Patient autonomy and minimizing suffering should guide the decision.
1) The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness, to provide a more humane dying process.
2) The hospice physician recommends anticoagulant therapy to allow a more peaceful death, while the ER physician wants surgery.
3) The best alternative is to ask Helen her preference, or if unable, her next of kin, and administer anticoagulants as the hospice physician advocates, to avoid prolonging her suffering from her terminal illness.
1) The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness, to provide a more humane dying process.
2) The hospice physician recommends anticoagulant therapy to allow a more peaceful death, while the ER physician wants surgery.
3) The patient's wishes should be determined and respected, through discussion with her, her family, and spiritual advisors, considering her right to refuse treatment.
Nathan Goldstein-Palliative care making the case jewishhome
Palliative care aims to improve quality of life for patients with serious illnesses and their families. Nathan Goldstein argues that hospital-based palliative care is growing in the US for four key reasons: 1) It improves clinical quality by better managing pain and symptoms. 2) It better aligns with patient and family preferences for comfort and honest discussions. 3) It is well-suited to address the growing population of older adults with multiple chronic conditions. 4) It can reduce costs by facilitating decisions to leave the hospital or withhold treatments not achieving patient goals.
This document summarizes research on nutritional support and hydration for patients near the end of life. It finds that while patients have autonomy to choose artificial nutrition/hydration, such interventions often provide little benefit and can cause harm. Studies show artificial nutrition does not improve outcomes or quality of life and may increase risks like infection. Near death, most patients experience reduced hunger and intake, with few reporting hunger until death. Non-invasive comfort measures usually meet nutritional needs better than medical interventions in the dying process.
Ambulatory Mental Health Visits and Use of Psychotropic Medicines by Cancer S...HMO Research Network
The document examines the utilization of mental health services and medications among cancer survivors' spouses. It finds that younger spouses of cancer survivors use ambulatory mental health services and psychotropic medications at higher rates than spouses of non-cancer individuals. A cancer diagnosis within the past year significantly predicts higher utilization of mental health services. However, cancer diagnosis and factors are not significant predictors of prescribed psychotropic medication use. The study is limited by a lack of data on cancer stage and treatment, as well as spouses' prior mental health.
La campagna “The Painful truth” è nata dalla collaborazione tra organizzazioni internazionali impegnate nella lotta al dolore come Action on Pain UK, la Spanish Pain Association (EFHRE Sine Dolore) e la German Pain League (Deutsche Schmerzliga), con l’obiettivo di creare una maggiore consapevolezza sui problemi che devono affrontare coloro che soffrono di dolore cronico. In particolare, vuole evidenziare l’importanza di riconoscere e diagnosticare adeguatamente il dolore e informare i cittadini sull’assistenza fornita dal servizio sanitario e le possibilità di trattamento più innovative per curare questa malattia. Il report di questa indagine, condotta in 5 Paesi europei (Francia, Italia, Spagna, Germania e Regno Unito) su 1.010 pazienti tra i 18 e i 64 anni, non solo rivela nuovi dettagli sull’impatto del dolore cronico sulla vita del malato ma evidenzia anche i bisogni ancora insoddisfatti legati al trattamento ottimale della patologia.
Fonte: Boston Scientific
http://www.bostonscientific.com/templatedata/imports/HTML/painful-truth/dl/NM-114704-AA_INTL_Painful_Truth_Survey_Report_Final_UK.pdf
“Qualsiasi immagine/tabella/parte di testo riprodotta è riportata ad esclusivo scopo didattico/informativo gratuito. Qualora necessario, siamo disponibili al riconoscimento dei diritti di copyright agli autori, alle fonti citate e agli aventi diritto”.
Palliative care is about providing well-being and the highest quality of life to patients with serious, progressive, chronic life-limiting illness, including during the dying process.
Palliative care aims to improve quality of life and relieve suffering for patients with serious illnesses. It can be provided along with curative treatment or on its own for comfort care. Total dyspnea involves physical, psychological, social and spiritual factors causing breathing distress. Signs that a patient is actively dying include profound weakness, disorientation, changes in breathing, and vocalizations like grunting.
A 78-year-old male patient presented to the emergency department with symptoms of a stroke, including left-sided weakness and slurred speech. Diagnostic tests confirmed he had a stroke. The patient's medical history included previous transient ischemic attacks and cardiovascular risk factors. He inquired about whether rehabilitation could help regain his strength. A review of evidence found that early rehabilitation is effective for motor recovery after stroke, though intensive therapy was not clearly superior to conventional programs. Rehabilitation was advised to help the patient gain back motor function and support his participation in daily activities.
How to prevent acute pain developing into chronic pain,
How to treat pain without resorting to opioids
How genetics, diet, and lifestyle all influence a person’s pain and whether it will become chronic.
How patterns of gene expression predict pain
How Big data can tell us about why people transition from acute to chronic pain
The hospice medical director recommends anticoagulant therapy rather than surgical intervention for Helen, who has a terminal illness. The anticoagulants may provide relief from her DVT and allow for a more peaceful dying process, while surgery could prolong her suffering without changing the inevitable outcome. The medical director believes Helen's wishes and avoiding unnecessary pain should be prioritized over interventions aimed at prolonging her life.
Carle Palliative Care Journal Club 1/15/2020Mike Aref
A journal club review and criticism of J Natl Cancer Inst. 2019 Dec 17. pii: djz233. doi: 10.1093/jnci/djz233 Emergency Department Visits for Opioid Overdoses Among Patients with Cancer by Jairam V, Yang DX, Yu JB, Park HS.
The Power Point reviews various methods used for fraud detection, and points out that many are erroneous or not cost effective. It offers information about an Internet test which has been admitted as evidence in many court cases in many states
Course 5 psychological aspects of chronic painNelson Hendler
The Power Point outlines the many attempts to explain the co-existence of chronic pain and psychological issues. It list various psychological tests used to assess chronic pain, and compares them.
Course 5 psychological aspects of chronic painNelson Hendler
The document discusses psychological aspects of chronic pain, noting that patients typically experience 4 stages (acute, sub-acute, chronic, sub-chronic) as a normal response to pain. It also discusses using the Minnesota Multiphasic Personality Inventory (MMPI) to evaluate chronic pain patients, but notes flaws in assuming the MMPI cannot change over time or be used to determine if a patient is faking their pain. The document also describes different types of chronic pain patients (objective, exaggerating, mixed).
The paper lists the correct method of diagnosing chronic pain, and matching the proper medication to tissue damage without the use of narcotics or opioids.
A cancer diagnosis and cancer treatment can be traumatic. An experience with cancer can lead to serious psychological distress that should be addressed. In this webinar, Schuyler Cunningham, Clinical Social Worker, talks about what trauma is, how to identify it, and what steps to take next.
The document discusses the leading causes of death worldwide due to illnesses like heart disease, malignant neoplasms, and cerebrovascular disease. It then covers various risk factors for cancer and heart disease, including smoking and diet. The rest of the document details cancer treatment methods such as staging and surgery, as well as principles of chemotherapy, radiation therapy, hormonal therapy, immunotherapy, and molecularly targeted agents. It provides examples of cancers that may be cured through chemotherapy alone or in combination with other treatments.
Three hour slide deck for basics of palliative care including what is palliative care, symptom management (pain, dyspnea, nausea, constipation), goals-of-care, family meetings, comfort care, and issues around artificial nutrition.
This document summarizes a study on racial and ethnic differences in medication adherence among patients newly prescribed antihypertensive medications. The study found that after controlling for factors like income and health status, black, Asian, and Hispanic patients were more likely than white patients to not fill their initial prescription or refill later prescriptions. However, differences in long-term adherence between white and non-white patients decreased when the model accounted for medication costs and use of mail-order pharmacies. The authors conclude that improving access to medications may help reduce persistent gaps in medication use between racial and ethnic groups.
Carle General Surgery Grand Rounds presentation on palliative care symptom management, specifically pain, nausea, constipation, and malignant bowel obstruction.
The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness. The hospice physician recommends anticoagulants to allow a more peaceful dying process rather than prolonging suffering, as surgery could do. Alternatives include trying anticoagulants first and reassessing, or determining Helen's wishes, as prolonging her life may conflict with her goals. Patient autonomy and minimizing suffering should guide the decision.
1) The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness, to provide a more humane dying process.
2) The hospice physician recommends anticoagulant therapy to allow a more peaceful death, while the ER physician wants surgery.
3) The best alternative is to ask Helen her preference, or if unable, her next of kin, and administer anticoagulants as the hospice physician advocates, to avoid prolonging her suffering from her terminal illness.
1) The dilemma is whether surgical intervention or anticoagulant treatment is best for Helen, a hospice patient with a terminal illness, to provide a more humane dying process.
2) The hospice physician recommends anticoagulant therapy to allow a more peaceful death, while the ER physician wants surgery.
3) The patient's wishes should be determined and respected, through discussion with her, her family, and spiritual advisors, considering her right to refuse treatment.
Nathan Goldstein-Palliative care making the case jewishhome
Palliative care aims to improve quality of life for patients with serious illnesses and their families. Nathan Goldstein argues that hospital-based palliative care is growing in the US for four key reasons: 1) It improves clinical quality by better managing pain and symptoms. 2) It better aligns with patient and family preferences for comfort and honest discussions. 3) It is well-suited to address the growing population of older adults with multiple chronic conditions. 4) It can reduce costs by facilitating decisions to leave the hospital or withhold treatments not achieving patient goals.
This document summarizes research on nutritional support and hydration for patients near the end of life. It finds that while patients have autonomy to choose artificial nutrition/hydration, such interventions often provide little benefit and can cause harm. Studies show artificial nutrition does not improve outcomes or quality of life and may increase risks like infection. Near death, most patients experience reduced hunger and intake, with few reporting hunger until death. Non-invasive comfort measures usually meet nutritional needs better than medical interventions in the dying process.
Ambulatory Mental Health Visits and Use of Psychotropic Medicines by Cancer S...HMO Research Network
The document examines the utilization of mental health services and medications among cancer survivors' spouses. It finds that younger spouses of cancer survivors use ambulatory mental health services and psychotropic medications at higher rates than spouses of non-cancer individuals. A cancer diagnosis within the past year significantly predicts higher utilization of mental health services. However, cancer diagnosis and factors are not significant predictors of prescribed psychotropic medication use. The study is limited by a lack of data on cancer stage and treatment, as well as spouses' prior mental health.
La campagna “The Painful truth” è nata dalla collaborazione tra organizzazioni internazionali impegnate nella lotta al dolore come Action on Pain UK, la Spanish Pain Association (EFHRE Sine Dolore) e la German Pain League (Deutsche Schmerzliga), con l’obiettivo di creare una maggiore consapevolezza sui problemi che devono affrontare coloro che soffrono di dolore cronico. In particolare, vuole evidenziare l’importanza di riconoscere e diagnosticare adeguatamente il dolore e informare i cittadini sull’assistenza fornita dal servizio sanitario e le possibilità di trattamento più innovative per curare questa malattia. Il report di questa indagine, condotta in 5 Paesi europei (Francia, Italia, Spagna, Germania e Regno Unito) su 1.010 pazienti tra i 18 e i 64 anni, non solo rivela nuovi dettagli sull’impatto del dolore cronico sulla vita del malato ma evidenzia anche i bisogni ancora insoddisfatti legati al trattamento ottimale della patologia.
Fonte: Boston Scientific
http://www.bostonscientific.com/templatedata/imports/HTML/painful-truth/dl/NM-114704-AA_INTL_Painful_Truth_Survey_Report_Final_UK.pdf
“Qualsiasi immagine/tabella/parte di testo riprodotta è riportata ad esclusivo scopo didattico/informativo gratuito. Qualora necessario, siamo disponibili al riconoscimento dei diritti di copyright agli autori, alle fonti citate e agli aventi diritto”.
Palliative care is about providing well-being and the highest quality of life to patients with serious, progressive, chronic life-limiting illness, including during the dying process.
Palliative care aims to improve quality of life and relieve suffering for patients with serious illnesses. It can be provided along with curative treatment or on its own for comfort care. Total dyspnea involves physical, psychological, social and spiritual factors causing breathing distress. Signs that a patient is actively dying include profound weakness, disorientation, changes in breathing, and vocalizations like grunting.
A 78-year-old male patient presented to the emergency department with symptoms of a stroke, including left-sided weakness and slurred speech. Diagnostic tests confirmed he had a stroke. The patient's medical history included previous transient ischemic attacks and cardiovascular risk factors. He inquired about whether rehabilitation could help regain his strength. A review of evidence found that early rehabilitation is effective for motor recovery after stroke, though intensive therapy was not clearly superior to conventional programs. Rehabilitation was advised to help the patient gain back motor function and support his participation in daily activities.
How to prevent acute pain developing into chronic pain,
How to treat pain without resorting to opioids
How genetics, diet, and lifestyle all influence a person’s pain and whether it will become chronic.
How patterns of gene expression predict pain
How Big data can tell us about why people transition from acute to chronic pain
The hospice medical director recommends anticoagulant therapy rather than surgical intervention for Helen, who has a terminal illness. The anticoagulants may provide relief from her DVT and allow for a more peaceful dying process, while surgery could prolong her suffering without changing the inevitable outcome. The medical director believes Helen's wishes and avoiding unnecessary pain should be prioritized over interventions aimed at prolonging her life.
Carle Palliative Care Journal Club 1/15/2020Mike Aref
A journal club review and criticism of J Natl Cancer Inst. 2019 Dec 17. pii: djz233. doi: 10.1093/jnci/djz233 Emergency Department Visits for Opioid Overdoses Among Patients with Cancer by Jairam V, Yang DX, Yu JB, Park HS.
The Power Point reviews various methods used for fraud detection, and points out that many are erroneous or not cost effective. It offers information about an Internet test which has been admitted as evidence in many court cases in many states
Course 5 psychological aspects of chronic painNelson Hendler
The Power Point outlines the many attempts to explain the co-existence of chronic pain and psychological issues. It list various psychological tests used to assess chronic pain, and compares them.
Course 5 psychological aspects of chronic painNelson Hendler
The document discusses psychological aspects of chronic pain, noting that patients typically experience 4 stages (acute, sub-acute, chronic, sub-chronic) as a normal response to pain. It also discusses using the Minnesota Multiphasic Personality Inventory (MMPI) to evaluate chronic pain patients, but notes flaws in assuming the MMPI cannot change over time or be used to determine if a patient is faking their pain. The document also describes different types of chronic pain patients (objective, exaggerating, mixed).
The paper lists the correct method of diagnosing chronic pain, and matching the proper medication to tissue damage without the use of narcotics or opioids.
The Power Point reviews
various methods used for detecting malingering,
and points out that many are erroneous or not cost effective.
It offers information about an accurate and cost effective Internet test used to detect malingering, which has been
admitted as evidence in many court cases in many states
Malingering accounts for millions of dollars lost in the workplace. This chapter, from the past president of the American Academy of Pain Management, and former Johns Hopkins Hospital staff member, appeared in a book edited by Dr. Kathy Foley from Cornell. It tells an attorney or insurance adjuster how to spot a malingerer or a faker, and how this differs from other disorders. It also recommends an Internet test at www.MarylandClinicalDiagnostics.com, which can identify malingerers with 85% to 95% accuracy and can be used in court.
This chapter establishes the differential diagnosis between patients who are faking and malingering versus patients who are misdiagnosed, and mistakenly thought to be malingering because they are not getting well. Psychological myths about conversion are dispelled.
Diagnosis and Management of Chronic pain associated with depression.pptxssuser40df77
Chronic pain and depression are often comorbid conditions that can mutually exacerbate one another through shared neural pathways and neuroplasticity changes in the brain. Approximately half of patients with depression report chronic pain, while 30-60% of individuals with chronic pain meet criteria for depression. Regions implicated in both chronic pain processing and mood regulation include the insular cortex, prefrontal cortex, anterior cingulate, thalamus, hippocampus and amygdala. Greater functional connectivity between the nucleus accumbens and prefrontal cortex in patients with sub-acute back pain has been found to predict transition to chronic pain. Effective treatment of depression may help alleviate chronic pain.
The document discusses knowledge and attitudes about pain management. It outlines what people need to know about pain, including pain as a human right, differences between acute and chronic pain, and effects of unrelieved pain. It examines knowledge of healthcare providers and patients. It suggests addressing gaps through surveys of provider attitudes and knowledge, as well as improving education about chronic pain conditions, undertreatment of pain, and the impact of pain on quality of life. Phenomenological studies highlight how chronic pain affects patients' sense of self, relationships, and coping strategies.
Predicting Medical Test Results and Intra-Operative Findings in Chronic Pain ...Nelson Hendler
The Pain Validity Test can predict which patient will have abnormal medical test results with 95% accuracy, and surgical abnormalities with 94% accuracy. This on-line questionnaire takes only 5 minutes of staff time to administer, and takes only 15 minutes of patient time.Results are available immediately. This test can be used to document "medical necessity" for insurance pre-authorization for testing and surgery.
Psychogenic Pain : Psychosomatic Point of ViewAndri Andri
This presentation was presented in "Medical Approach in Holistic Management to Relieve Pain" 13 Des 2015 at The Sunan Hotel, SOLO.
Since Pain is always subjective, Psychogenic pain is very related to psychiatric problems and very often it does not recognized by physicians in their practice.
Mrs. Imen Pane, a cognitively impaired resident with a history of arthritis and hip fracture, was exhibiting increased agitated behavior including moaning and rubbing her right hip. A pain assessment was completed which found no obvious cause of pain on examination. The nurse addressed Mrs. Pane's potential unmet needs and administered a hot pack and music, which provided temporary relief. A breakthrough dose of an opioid analgesic further reduced her agitation and discomfort. Accurately assessing and treating pain in cognitively impaired individuals often requires integrating information from multiple sources and a trial of analgesic interventions.
This study compared chronic pain patients whose symptoms were considered medically unexplained (cases) to those whose symptoms had clear medical explanations (controls). The key findings were:
1. Medically unexplained symptoms were associated with higher rates of psychiatric morbidity, including a 3.4 times higher odds of any psychiatric diagnosis.
2. Cases reported more potential iatrogenic factors like over-investigation and over-treatment from healthcare providers compared to controls.
3. There were no significant differences between cases and controls in rates of medication abuse or dependence.
iCAAD London 2019 - Mel Pohl - CHRONIC PAIN AND ADDICTION: HOW WE MISSED THE...iCAADEvents
The document discusses chronic pain and addiction. It notes that while all pain is real, emotions drive the experience of chronic pain. Opioids are often ineffective in treating chronic pain and can actually make pain worse. The goals of pain management should be to maintain or improve function rather than just reducing pain. Non-medication treatments like exercise, massage, and mindfulness can be effective alternatives or supplements to medication for chronic pain.
This chapter describes the normal psychological response to pain, over time. The stages mimic the psucholoigcal response described by Kubler-Ross in her book on death and dying. Hendler documents that it is normal to get depressed from chronic pain, usually by the 6th month, and this depression can last 3-8 years.
Ethics of Pain Care: what duties do we have to patients with chronic pain?Mark Sullivan
In this presentation, I ask: what duties do we have to patients with chronic pain? I examine the case of Daniel, a 48-year-old man with chronic back, neck and head pain after a motor vehicle accident 8 years previously. I argue that our foremost duty to patients with chronic pain is not to reduce their pain intensity but to improve their health. Titrating opioid doses to a pain level may reduce pain and at the same time make it harder for a patient to live his or her life.
This document discusses ethics and interventions for pain management. It acknowledges biases around pain management and explores themes in acute, chronic, and palliative pain settings. The four principles of ethics - autonomy, beneficence, non-maleficence, and justice - are applied to clinical cases. The principle of double effect and limits to intervention are also examined. Effective pain management is framed as a moral duty to relieve suffering.
Principles for more cautious and selective opioid prescribing for chronic non...Group Health Cooperative
Presentation was originally done at Group Health Cooperative’s National Summit on Opioid Safety: http://www.ghinnovates.org/?p=3502
Presentation by: Jane C. Ballantyne, MD FRCA, with the Department of Anesthesiology and Pain Medicine at UW Medicine.
This document discusses pain management in cancer patients. It covers the pathophysiology of pain, assessment strategies, drug and non-drug treatment options, managing special populations, patient education, and Joint Commission standards. The key aspects are conducting a comprehensive initial pain assessment, developing an individualized treatment plan using the WHO analgesic ladder as a guide, treating breakthrough pain, managing side effects, and employing multimodal therapies including pharmacological and nonpharmacological options.
This document provides an overview of pain assessment and management strategies. It defines pain and describes the physiology and types of pain. Components of a comprehensive pain assessment are outlined, including history, physical exam, functional assessment, and use of pain scales. Both pharmacological and non-pharmacological approaches for pain management are discussed. The WHO analgesic ladder is presented as a framework for treating pain with medications. Considerations for using opioids and other pharmacological therapies are also reviewed.
Third Party Reporting of Patient Improvement.docxNelson Hendler
Reproting of outcome studies is often subjective. This collection of real leterrs, emails, and Facebook posting provides third party documentation and validation of the efficacy of treatment, without the subjective bias of the party doing the treatment.
Johns Hopkins Hospital doctors report that 40%-80% of chronic pain patient are misdiagnosed, and that MRIs and CTs miss pathology 56%-78% of the time, Therefore, during extensive chart reviews of current medical data will produce a classic case of GIGO-garbage in giving garbage out. The need for accurate diagnoses and testing is critical for AI to work.
Top_Down_or_The_Bottom_Up to Save Money.pdfNelson Hendler
The article describes the need for a more "granular:" assessment of workers' compensation claims, rather than the typical approach of insurance carriers which average large numbers, which causes the loss of valuable data.
The former head of HR for Burger King, British Petroleum, and Walmart, and former Assist. Prof. of Neurosurgery from Johns Hopkins Hospital describe methods to save 54% on workers' compensation using on-line "expert system" questionnaire from Johns Hopkins Hospital doctors
40%-80% of auto accident claimants have overlooked diagnoses. The most commonly overlooked are thoracic outlet syndrome, cervical disc damage mistakenly called sprain or whiplash, post-concussion syndrome, slipping rib syndrome, Tietze syndrome and Tempro-mandibular joint syndrome. This article tells readers the clinical sign and symptoms of each and the correct medical tests to use, which are employed by doctors at Johns Hopkins Hospital. It also described an on-line questionnaire at www.DiagnoseThePains.com which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors.
This paper shows how thermography can be used to disprove the misdiagnosis and over used diagnosis of "psychogenic pain." in a group of chronic pain patients.
This article outlines the differences between the anatomical and pharmacological differences between acute and chronic pain. This has significant implications for treatment, since they really are separate disorders.
This study compares the effect of benzodiazepines to narcotics on EEG, memory quotient, and WAIS testing. Valium, Librium, Dalmane and other benzodiazepines produced EEG and cognitive abnormalities in 70% of the patients, while only 30% of patients on narcotics had cognitive impairment.and EEG abnormalities.
Bi-polar patients who were having side-effects from lithium were given spironolactone to control mood swings. Five the 6 had good control for 1 year. The mechanism of membrane stabilization compared to lithium are discussed.
Emg vs. thermography to diagnose crps and radiculopthyNelson Hendler
This large clinical trial (803) patients compares the accuracy of thermography to EMG studies to see which one was a better diagnostic tool for each disorder and the degree of overlap between testing.
Valuable info for orthopedic and neurosurgeons specializing in spinal injuriesNelson Hendler
Reports from Johns Hopkins Hospital doctors document that 40%-80% of patients labeled as soft tissue injury, whiplash, sprain or strain are misdiagnosed. Use of an Internet expert system provides diagnoses with a 96% correlation with diagnoses of former Johns Hopkins Hospital doctors, resulting in a 192% increase in interventional testing, and a 50%-63% increase in surgery in previously misdiagnosed patients, 93% of whom report good to excellent improvement after surgery. .
Headache diagnostc paradigm from former Johns Hopkins Hospital staffNelson Hendler
The medical literature reports that 35%-70% of patients diagnosed with migraine headache do not have this order. The Internet based "expert system" developed by former Johns Hopkins Hospital staff, including the past president of the American Headache Society and American Academy of Pain Management provides an Internet based "expert system" which gives diagnoses with a 94% correlation with diagnosed of these doctors.
Missed Diagnoses association in Rear end collisions Nelson Hendler
There are a number of overlooked diagnoses which occur after a rear-end accident. This paper shows an attorney how to convert a misdiagnosed 'soft tissue injury case" into damaged cervical disc,TMJ, thoracic outlet syndrome,and post concussion syndrome using a diagnostic paradigm to get diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This improves patient care and increases recovery.
This list is all of the researchers who have published articles on the Pain Validity Test and Diagnostic Paradigm from www.MarylandClinicalDiagnostics.com
This document lists the authors of articles on the Pain Validity Test and the Diagnostic Paradigm and Treatment Algorithm. It includes current and former physicians, researchers, and administrators from Johns Hopkins University, Helsinki University, Sapienza University of Rome, and other medical institutions. Some authors held roles like department chairs, professors, and organization presidents.
This is a simplified instruction manual, with screen shots, which will teach staff members how to administer the on-line questionnaires from www.MarylandClinicalDiagnostics.com. It will take any staff member only 15 minutes to review the handbook. Once they have reviewed the handbook, it will take only 5 minutes of staff time to set up a patient to take the tests from www.MarylandClinicalDiagnostics.com
Three Dimensional CT Imaging in post-surgical "failed back" syndromeNelson Hendler
A team of physicians from Johns Hopkins Hospital document that a regular CT misses pathology 56% of the time compared to a 3D-CT. However, if the patient has had previous surgery, the CT misses pathology 76% of the time compared to a 3D-CT. The 3D-CT can be used to combat misdiagnosis of "psychogenic pain patients."
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In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Fraud detection
1. Fraud Detection in
Workers Compensation and
Auto Accident Cases
Nelson Hendler, MD, MS
CEO of www.MarylandClinicalDiagnostics.com
Former Assistant Professor of Neurosurgery
Johns Hopkins University School of Medicine
Past president –American Academy of Pain
Management
Former Clinical Director –Mensana Clinic
2. California Does a Poor Job of
Combating Worker’s Comp Fraud
(Workers Compensation Report, Vol 15, No. 11, p.206 May 17, 2004)
• State Auditor Elaine Howle says the $30,000,000 annual
assessment to combat fraud may be wasted.
• Insurance companies cannot measure the effectiveness of
their efforts using IMEs and surveillance.
• The companies are relying on antedotal testimony from
stakeholders in the workers compensation community,
unscientific estimates, and description of local cases
involving fraud.
• The fraud division publishes statistics showing the number
of investigations, arrests, convictions, and restitution, but
cannot show if anti-fraud efforts are cost-effective.
• See www.MarylandClinicalDiagnostics.com
3. Types of Chronic Pain Patients
Hendler, Diagnosis and Non-Surgical Management of Chronic Pain, Raven Press, ‘81
• There are Two broad Categories of Chronic
Pain Patients
• Objective Pain Patient: Good pre-morbid
adjustment, objective findings, and goes through
the 4 stages of pain (case study: Car Exec.)
(87%-94% of all chronic pain patients)
• Exaggerating Pain Patient: poor pre-morbid
adjustment, minimal findings, and absence of
depression (case study: hysterical scoliosis).
• (Between 6% to 13% of all chronic pain patients)
4. What is a Normal Response to
Documented Severe Chronic Pain?
• We need to study what normal is before
we can understand what abnormal is
• This is the same reason medical students
study anatomy before pathology.
• If you know what a normal response to a
documented severe chronic pain is, you
can appreciate that any deviation from that
response is suspicious and abnormal
5. Objective (Valid) Pain Patient
Case Study: A 56 year old executive for a Big Three auto maker was married
for 25 years, had three children all of whom were in college, and was earning
over $1,000,000/year. He was working on his boat, when the engine fell, and
traumatically amputated his thumb. He went to work the next day, and
continued to work, and he expected the pain to subside. However, after two
months, the pain in his thumb became so severe, that he could not
concentrate, nor sleep. He was diagnosed with a neuroma in the stump of the
thumb. Any sensation to the stump would cause severe pain to shoot up his
arm. When he was seen at a hospital in Baltimore, he had been suffering for
two years. He scored 14 points on the Maryland Clinical Diagnostics Pain
Validity Test, putting him the Objective Pain Patient category. He was suicidal,
sleeping only two hours a night, and was on three types of narcotics, sleeping
medication, and diazepam. He wanted to divorce his wife because he felt like
a burden to her. He was severely depressed and had never been depressed
before the onset of pain. He was so desperate to get rid of his pain that he had
a thalamic stimulator put into his brain. Unfortunately, this gave him only partial
relief. Eight years after the onset of his pain, he was less depressed, was off
narcotics, and sleeping medication, and was getting four hours of sleep a
night. He still had pain, but had adjusted to the pain. He had retired from the
auto company. (Hendler, Diagnosis and Non-Surgical Management of Chronic Pain, Raven
Press, New York, 1981).
6. 4 Stages of Chronic Pain in an
Objective Pain Patient
(Hendler, in Diagnosis and Treatment of Chronic Pain, Edited by Hendler, Long
and Weiss, Wright-PSG, ’82)
• Chronic pain patients go through 4 stages remarkable
similar to the 5 stages a patient experiences when dying
(Kubler-Ross-’69), just like the example.
• Acute Stage 0-2 months –Pt. expects to get well, so no
psychological changes (MMPI is normal).
• Sub-acute stage-2-6 months- Pt. had anxiety and somatic
concerns develop (MMPI scales 1 & 3 are elevated)
• Chronic stage 6 months-8 years- Pt. is depressed (MMPI
has elevated scale 2, called a pain neurosis by Blumer,
pain prone patient by Pilling, low back loser by Sternbach)
• Sub-chronic stage-3-12 years Pt. resets goals-adaptation
(MMPI scales 1 & 3 elevated, hypochondriasis and
hysteria)
7. Exaggerating Pain Patient
A 43 year old woman was hospitalized in Baltimore, complaining of marked
scoliosis, that had just developed, in the past year. Further evaluation did not
verify the typical radiological findings seen with a constant scoliosis. She scored
24 points on the Maryland Clinical Diagnostics Pain Validity Test, putting her in
the Exaggerating Pain Patient category. A trial with an Amytal (truth serum)
interview failed to resolved the scoliosis, but when the patient was anesthetized,
the scoliosis resolved temporarily. Further Amytal interviews revealed the patient
had a stormy marital relationship, and she avoided sex with her husband,
because he was abusive. The patient was reassured she need not have sex with
her husband if he was abusive. The next day, she walked upright, and continued
in this posture, until her husband visited. The day of the visit, the scoliosis
returned. Additional Amytal interviews revealed she had been abused as a child.
She had a she had been afraid to seek divorce from her husband, but with social
worker intervention, she found the support to do so. The scoliosis resolved. On
five year follow-up, she was divorced, and remained free of scoliosis. (Hendler, N,
Filtzer, D, Talo, S, Panzetta, M, and Long, D, Hysterical Scoliosis Treated with Amobarbital
Narcosynthesis, The Clinical Journal of Pain, 2:179-182, 1987).
8. MMPI (Minnesota Multiphasic
Personality Inventory) lack of
predictive capabilities
• Hagedorn et al from Mayo Clinic (Pain,
’84) followed 50,000 patients for 25
years. This is the only prospective study.
• They all received the MMPI when they
first entered the Mayo Clinic system.
• 68 of them had back surgery.
• No difference in pre-surgery MMPI
between those who did do well or didn’t
do well with surgery.
9. The MMPI Cannot Validate the
Complaint of Pain
• MMPI is not consistent in predicting the
presence or absence of organic
pathology. Not one single scale ever
correlates, consistently, with the presence
or absence of organic pathology (Hendler
et al, Pain, ’85, Hendler et al J. Occ.
Medicine,’88, Hendler et al J. Neurolog &
Ortho. Med. & Surgery, ’85, Hendler
Clinical Neurosurgery, ‘89)
10. Longitudinal Studies on Depression
A study of 83 patients admitted to Mensana
Clinic
77% of the chronic pain patients were
depressed, as confirmed by Beck scores.
However, 89% had never been depressed
before the onset of their pain ( Hendler,
Clinical Neurosurgery, ‘89)
After six months or more, chronic pain
produces depression (Hendler, J. Clinical
Psych, ’84)
11. Overused Psychiatric Diagnoses in
Chronic Pain Patients
Malingering: No statistics about frequency (Hendler
and Talo, Current Therapy of Pain, edited by Kathy
Foley and Richard Payne, BC Decker, ’89).
Pain Disorder is defined as a pain for which is there is
no medical explanation. However, since 40%-67%
of chronic pain patients are misdiagnosed medically,
then these patients receive a faulty psychiatric
diagnosis, because of a poor medical diagnosis.
Depressive Equivalents: Depression causes pain.
Circular logic in the diagnostic criteria in DSM-IV for
somatoform disorder, pain disorder, and depressive
equivalents. With a poor medical work-up, these
“diagnoses” becomes self fulfilling prophecies.
12. Suicide and Pain
Chronic pain patients commit suicide at a
higher rate than the general population
(Fishbain et al Clin. J. of Pain, ‘91).
White males with pain complete suicide at a
rate 2X higher than the general population.
White females with pain complete suicide at a
rate 3 X higher than the general population.
White males with pain, involved in workers
compensation litigation complete suicide at a
rate 3 X higher than the general population.
13. Mensana Clinic Approach
• Patients can have both psychiatric disease
and organic pathology co-existing
• Schizophrenics get brain tumors, and
hysterics get disc disease. Psychiatric
disease does not confer an immunity to
medical disease.
• Treat each patient as if they have organic
pathology.
• Give patient the benefit of the doubt.
• See www.MarylandClinicalDiagnostics.com
14. What are the Questions?
• Does the patient have a valid complaint of pain?
• Variables: pre-existing psychopathology,
resultant psychopathology, negative tests,
positive tests that do not correlate with the
anatomical complaint of pain (i.e. L5-S1 disc on
MRI: pain in top of thigh = L2-L3)
• KEY Concept: Severe chronic pain produces
consistent psychological and sociological
responses in a patient, regardless of pre-existing
or co-existing psychiatric disease.
• If the response to pain is normal, believe the
patient, not the tests, and keep looking.
15. Available Help
• Pain Validity Test is available on Internet to
validate pain, and improve diagnostic
accuracy, as a screening tool to help get
an accurate diagnosis, and supplement the
use of IMEs, and surveillance.
• Preliminary studies (next slide) show an
average cost savings of $1,654/case for
answering the question – “Is the pain
valid?” using Pain Validity Test for $300.
• Average $97,000/case cost containment
for “What is the diagnosis and treatment?”
(Appendix A) using Diagnostic Paradigm.
16. Spotting Fraud
• National Council on Compensation Insurance
(NCCI) published a report Assessing Pain, Real
and Imagined(11/29/98)
www.NCCI.com/painreal.html
• Hendler reports that 6% of non-litigant patients
are exaggerating pain patients, 10% of LTD, and
13% of workers compensation.
• For $300, The Maryland Clinical Diagnostics
Pain Validity Test can identify exaggerating pain
patients (www.MarylandClinicalDiagnostics.com)
• Average savings of $1,654/claim by eliminating
IMEs, surveillance, and nurse case reviewer in
the objective pain patient, and focusing the
resources on the exaggerating pain patient.
17. The Pain Validity Test*
• An Internet questionnaire, available in
English and Spanish
• Results are emailed to the requesting party
within 5 minutes of completion of the test.
• The Pain Validity Test can predict with 95%
accuracy who will have an abnormality on
objective medical tests, and predict with 85%
accuracy who will not.
*Hendler, N. and Baker, A., An Internet questionnaire to predict the presence or absence of organic
pathology in chronic back, neck and limb pain patients, Pan Arab Journal of Neurosurgery, Vol. 12,
No. 1, pp: 15-24, April, 2008
• Costs $300 at www.MarylandClinicalDiagnostics.com
18. Scattergram of Computer Scored MCD Pain Validity Test.
On the left, 3* is a severe abnormality, 2 a moderate abnormality, 1 a mild abnormality,
and 0 is no abnormality on at least one objective medical test. At the bottom, 8-25
represent the score on the MCD Pain Validity Test. 17 or less is an Objective Pain
Patient, 21 point or higher is an Exaggerating Pain Patient
*3
65/69 = 94%
2 Exaggerating
Objective Pain Patient Pain Patient
1
11/13 = 84%
0
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
19. Efficacy?
• Do you have statistics?
• A literature search using Google, Jeeves,
National Library of Medicine, National
Council of Compensation Insurers, AOL,
Yahoo, etc. never revealed an article
documenting the cost effectiveness of IMEs,
surveillance, P.T., Functional Capacities
Evaluations, and Case Reviews. There were
lots of case reports.
• 54 cases reviewed for “XZY” insurance had
an average of 3.8 IMEs (1-7), and cases
were still active, out of work an average of
3.9 years (1.5-12).
20. Richard Pimentel at National Council on
Compensation Insurance Symposium,May 6,’04
(Workers’ Compensation Report Vol. 15, No. 11, p. 206, May 17, 2004)
• Insurers hold the key to reducing claims duration
with effective Return to Work Strategies
• Currently: Worker goes to doctor, Worker files a
claim with insurer, Worker doesn’t want to return to
work, Insurance company contacts employer for a
job description, and send RTW form to doctor, who
fills out form and sends it to insurance carrier, who
contacts the employer to to to get worker to RTW.
• His plan: remove the insurer from the equation.
• Having a supervisor of the worker from the
company go to the doctor with the worker saved
$1,400/claim.
21. Conclusions
• The current methods of assessing fraud (IMEs,
FCE, surveillance) are not cost effective, and not
accurate.
• Misdiagnosed patients cost insurance
companies much more than fraudulent cases.
• The www.MarylandClinicalDiagnostics.com
Pain Validity Test is a reliable method for
detecting fraud.
• Physical therapy has not been documented as
cost effective in chronic pain patient treatment.
• Insurance carriers should demand Evidence
Based Medicine = proof of efficacy of treatment.