Health Advocate Helps Man Cure Chronic Pain, Drug Addiction

LifeSpan Care Management was consulted by the father of 21 year old Larry, who was in constant, debilitating pain after having suffered a motor vehicle accident when he was 18 years old. The accident caused a compound fracture of his left arm. This arm was operated on and apparently healed, but three months later the pain started again and became so bad that he could not continue his college work, and was on large doses of Oxycontin and Fentanyl for pain. He could not hold a job or drive a car due to his pain. His doctors thought he was a drug addict and did little for him other than to write for additional pain medication. He was diagnosed with Regional Complex Pain Syndrome (what was formerly called RSD or Reflex Sympathetic Dystrophy).

The LifeSpan Care Manager reviewed the records and treatments of the past. She had him see a different doctor, who did an nerve conduction study (EMG) and found that the pain was not neurogenic (i.e., due to nerve disruption). An x-ray of the fractured bone was unclear, due to a confluence of white material around the fracture site. However, one of he screws that was used to fasten the plate to the broken bone was itself fractured. This usually indicates that the old fracture itself has not healed. The Care Manager assisted in presenting the case to the auto insurance carrier for payment of a CAT scan to the affected arm, and an eventual re-operation of the site. As it turned out, the bone had re-fractured, and was the cause of the pain. The bone was re-fitted with a new plate and screws, and the cast was removed within 2 months to begin physical therapy.

After the operation, the pain medication was gradually reduced, but it became apparent that the pain medication was very difficult for Larry to stop. Part of this was a physical addiction, part was due to Larry’s fear of re-entering the normal demands of life. The Care Manager advocated for him to the insurance company again (with the assistance of his personal injury attorney) to get help from a psychiatrist with special expertise in addictions. Within 10 weeks Larry was off all medication, found employment and eventually went back to college.

Care management in this case not only assisted Larry in getting back to living a normal life, but assisted his family in understanding  and coping with the difficulties of his behavior. The Care Manager made sure he got to his doctor appointments and spoke on his behalf to the physicians, who were hesitant to take on a patient who was obviously impaired by the medication he was taking for pain. Care management in this case also proved beneficial to the auto insurance carrier, who was paying thousands of dollars per month for pain medication.