And Pain Psychologist says....................

Well guys and gals today was the day for my psych Evaluation for the trial on the Spinal Cord Stimulator. Spent 3 hours doing their tests.....and then headed off to have lunch with my son before my appointment with the Psychologist. I had a very nice time with my son and I will miss him lots with him going to TX and all. Anyway...when the psychologist and I were talking, hubby was patiently waiting in the atrium downstairs with bated breath.


Ok so here is how it went; he says that I am still repressing some mental issues with my pain, but that he thinks that if I go and see a pain psychologist that these issues can be worked out. I thought I had everything pretty much figured out but I guess not. Anyhoo it isn't going to be a mandatory thing, he says that if I feel comfortable with it that he thinks it will help bunches and I have to agree with him. Now he would not tell me what his decision was going to be but I did get a hint....in his exact words "you won't be upset with me in anything I write in my report and after that a smile. Of course I asked what he meant and he said that he thought that the other two eval's were not a definite no but that at that time I had some more issues to deal with.

Now, do I think that he is going to brand me "Good to go for the SCS"?? No clue. But I think there was a hint of good news in his voice and I think that just maybe I now have a little more hope!

Hugsssssssssssssssssss

Scarred

Scarred,
Congratulations on getting through it!! It sounds to me like he's not going to block your way!

Of course you're repressing some mental issues that probably relate to your pain; look at all you've been through recently! I wouldn't let that worry you much, and talking with a therapist is probably good for all of us.

Anyway, glad it's over and it went well!

PaLady

Congrats for surviving the eval, Scarred! I can only imagine how never racking it must have been! Sounds like you're probably on your way to getting the SCS! Glad everything went pretty well. I'll say a prayer for you! (((((hugs)))))).

Skeye

Thank you all so much! Your posts have given me so much inspiration over the last few months and weeks. If it was not for each of you with all the support that you all gave me I probably would have been a wreck yesterday and maybe barely gotten through it. For this I am eternally grateful to each of you and if I could reach out and give you all hugs I would! But for now ((((((((((((((((((((((Hugs)))))))))))))))))))

Susie; I was amazed that this guy had both of my last evaluations at hand and looked each of them over right there in front of me. He told me that neither evaluation actually said that I was not approved but that I needed to re-evaluate my priorities at that point and time. My first eval I had no clue what to expect from the SCS device and I had unrealistic goals for what the SCS would do. I was also very submissive with my treatments and medical things. I have changed so much over the years that I have actually dealt with this and I am now quite active with my disease. I think it was my need to decrease my pain and get off some of the medications that helped with the evaluation and I am pleased with my results. BUT (and I hate to say this) I am still having problems feeling like I am weeks or months away from this decrease. Workers comp has already said no to two evals that have supported me getting the SCS and I can't help but think that it will happen again. The only thing that keeps me going with this is the fact that I have a very aggressive doctor and I think that he will fight like hell to get this done.

My son.....he is not actually moving to Fort Worth TX but is headed tomorrow into federal custody and will be the resident of a federal corrections facility.


How long will it be?? Hopefully not long!

Hugs,

Scarred

Scarred>>>I knew you could do it!!! Good for you! Here's a pat on the back for you>>
PAT>PAT>PAT!!! Thats great news! I'm sure he wouldn't have said anything at all if he wasn't going to OK it for you! It wouldn't make sense! I'm so happy for you, it's been a long haul and now you're almost there! YIP>>EEE!!
HUG>PAT>HUG>PAT>HUG!!!
Pete

PA your correct in all aspects, but it is also a requirement for all patients seeking a Neurostimulator. It does not matter if you've got BC/BS or Work Comp or your paying cash. All doctors require a Psych Eval before a patient gets the SCS device.

Unfortunately I have been through gobs of hoops with WC PA and I am so tired of their games that I would pay cash for this darn thing if I thought I could get away with it. I know that not only is the surgery expensive but too the replacement batteries are 50 grand a pop every 7 years if you don't get the rechargeable one. It's outrageous that WC has to be so stuck on "The SCS devices do NOT work on ANYONE" that any one has to go through so many hoops when dealing with Ins. and the likes that its frustrating for all of us.

PA; On a side note....if they refuse it I will be taking their butts to court to get this done. Period. Done playing with them. If this psych eval says its a go and WC denies it they can just see me in court.

Hugsssss

Scarred

You know Frances I agree! I did mine and it came back as I was totally psychotic the first time! I don't understand why a psychologist is required or how he/she is a proper person to diagnose CP or whether a person should have any surgeries. Some Neuro's are requiring that a person go through a psych eval before they can ever be touched by a scalpel for back surgery! I could not believe that when I heard about that! How can someone who works mainly with your emotions and mental state be the proper person to look to when it comes to surgery? Isn't that profiling? It is in my books!!

PA-
I don't totally disagree with you. Certainly, emotional health can affect perception of pain & our ability to manage it. While I'm not opposed to taking that into consideration during any treatment, what I am opposed to is using the MMPI to do so. It may well have been that the original two exams that I took over a decade ago were the first version of the test -- I really just don't know. But many people insist that even the most current MMPI is designed to differentiate between various mental disorders, and not to determine whether or not a person is mentally healthy. The interpretation has everything to do with the goals, training & experience of the administrator and can easily enough be skewed even by an administrator with no financial incentive to "fail" the person taking the test. It concerns me that it is so rapidly being accepted without question by many in the insurance & medical community as a valid test for determining whether a person demonstrates any of the markers for hypochondria, malingering or general inability to adapt when there has not been sufficient research to demonstrate whether they are helpful to identify those characteristics in physically ill patients nor has there been extensive research to show whether the tests are weeding out the right people (i.e., whether certain responses on the MMPI actually equate to a failed SCS implant).

I certainly meant no disrespect for your field. I just feel that there needs to be a lot more research done on whether the MMPI tests administered for these purposes are actually accomplishing what they set out to accomplish. In my case, answering truthfully disqualified me for the implant. "Cheating" the test got me my SCS & my life has vastly improved as a result. Do I still have some issues resulting from past abuse? Sure, from time to time it still gets to me, but the way that it affects me is unrelated to my pain. Without the MMPI there was no indication at all that I had failed to sufficiently adapt. I held a good job. Had my own home. Had many healthy friendships & had otherwise done very well for myself. I took more pain meds than I'd have liked to in order to accomplish those things & after hearing that the SCS could cut my meds by 25-50%, I was eager to give it a shot. I wasn't very hopeful it would work, but as it turned out, the SCS well exceeded my expectations & after lengthy reprogramming, my case resulted in being just as "successful" as most people who legitimately passed the test. There are other tests out there & while some of them seem more promising to me than the MMPI at present, I will reserve judgment on them until more studies come out showing their efficacy in accurately clearing patients for these procedures.

I wish I had a quick fix for this issue, but I honestly believe that our best hope is to do what we can to encourage medical professionals, MH professionals, CP advocates & actuaries to support, fund & conduct research in this area. I only want what's best for my fellow CPers. God forbid the MMPI is what's best, I will get behind it, but I haven't seen anywhere close to enough proof to make that case. I do appreciate your input on this issue & greatly respect your views & opinions. I hope you will continue to share your views on this critical issue b/c we can all benefit by being more aware of all the angles & perspectives out there.

peace,
frances

You know I think that this is a good discussion for those that are thinking of getting the SCS device or have been told by their doctors that it is a viable option. It gives them that added insight into the actual things that go on when it comes to the psychological Evaluation that they will, if they choose to go this route, encounter.

When I did mine yesterday there was not only the MMPI that I was tested on. There was in all 6 tests that I was required to do. One was something to do directly with my pain, the MMPI 1 another shorter test that was alike to the MMPI 1 and three others that helped the guy get a full picture of my mental make-up. I don't remember doing all of these tests the last time I did this and maybe they are re-evaluating their testing procedures, but I do know that the abuse that I suffered many years ago apparently did have some factors in how the guy interpreted the tests. I have appropriately dealt with these issues in my life and I really do not understand how something that happened 27 years ago could have any impact on my current pain issues (if you understand what I mean).

I would gladly welcome any suggestions into this and I look forward to hearing what each of you have to say.

Hugs

Scarred

I should know by the time I see my pain doc in April. If WC decides to fight me on this they will have a huge fight on their hands. It surprises me that some people that are qualified for the SCS are turned down because of the Psych evaluation. I am going to find out from WC whether they will allow me to do some counseling as hubby and I feel that it will help and two show WC that I am willing to do whatever it takes to decrease my pain and the medications that I am on. I know that many that have gotten the SCS that I have talked to have had to fight tooth and nail to get their ins or WC to pay for anything past the implant. Which means if I have to fight them that means I have to fight them each time I have to have a battery implanted or a lead replaced. I might be able to get my attorney (if I have to go that direction) to fight to get them to continue the coverage but I'm not holding my breath. According to WC when the SCS is implanted that is end game they don't pay for anything more including Medications.

We shall see.

Scarred

That's what I thought susie. I was told my doc that all patients are required to go through the eval. I mean susie that as far as they are concerned and this is what I was told that "Once the SCS is implanted......its End Game. We will pay no more for any medical." Funny that she would say that though and I have talked to others that have dealt with Wyoming WC and they find the same problems when the SCS or pain pump are implanted. WC cuts you off completely!

Scarred,
Susie makes a good point that if your attorney hasn't already reviewed the policy language that he should do so before you have the implant. Nonetheless, in some states that is the case & if it is in the policy there isn't much to be done to contest it. You could possibly sue your former employer for the costs of continuing care, but it really is a tough deal. Since it usually costs upwards of $40K to get this thing implanted & then another $5K or so every ten years when you need the battery replaced, the insurance people get sneaky about writing in what they will or will not include for payment of your case beyond that. It's unlikely it just outright states that continuing care after an SCS is not covered. It could be above your maximum lifetime payout or, more likely, that the contract language does not include coverage for SCS implants & therefore the insurance companies can say that if they are going to cover it that you must agree to new terms & conditions (e.g., that you will not receive any further payments from them on this claim). In some state, they are allowed to do that if the original contract does not cover the costs of SCS implant.

The law is incredibly complex and while it is important to be involved in your case & follow up on every opportunity, do understand that there are many scenarios where the insurance company would not need to pay. If they won't cover continuing care, it is important to come up with a plan to get your meds covered before you get the implant. Recovery is quite painful & you will definitely need something in the short term to be sure, if not for the rest of your life. I don't know how much your medication normally runs, but just do a comparison of which way would be better for you -- staying on meds, or getting the implant. Also, in many cases if you have had continual health insurance coverage for your condition for the previous 12 months, a new health insurance company is required to cover you for that condition. Maybe that would be worth looking in to. Can your husband's insurance cover you? Do you qualify for any other type of health insurance that you could get? Maybe you could contact your state's department of insurance to see what options you might have going forward. Obviously, the best option would be if you can keep getting your care covered by WY Worker's Comp, but if that isn't possible, just wanted to encourage you that there likely are other options out there & you just need to look for them. :)


Susie,
It may have been just another hoop for you to jump through, but there are others like Scarred & me who have endured all kinds of nightmares trying to prove we're not dangerous killers as a result of a test supposedly administered to determine whether or not we should have an SCS implant. I'm glad you didn't ever have any issues with the test, but there are plenty of other people out there who have had traumatic childhoods, abusive marriages or crimes committed against us & while I believe that the MMPI is not even normed properly for diagnosing healthy people in general, from what I've seen it is especially skewed against people who've come out of those situations.

This test is becoming more & more common every year. My NS is now mandating any patients of his in on-going litigation take the MMPI before he will agree to do surgery -- even if the defendant doesn't require it. If a surgeon feels a patient is malingering, it is certainly within his rights to refer that patient for counseling. What I don't feel is right is giving them a test normed entirely against people in psych hospitals. What few studies that have been done have shown that there are plenty of reasonably well-adjusted individuals in mainstream society both with and without chronic pain who would "fail" the MMPI (i.e., be diagnosed with one or more mental disorders which could be used to deny coverage of a medical procedure). Until it is both normed for mainstream individuals & studied for efficacy in determining who makes a good candidate for SCS surgery, I will continue to raise every objection to its administration.

I don't protest the hoops we go through too much. I can't see how most of them can be misused. Yes, there are some U/A tests that are inadequate to give accurate results & I'm not okay with that, but short of that I understand the hoops. They at least give accurate information. They are not open to interpretation. The MMPI is being treated as if it is a medical test with a positive or negative result. In reality, two people can give the exact same answers on the test, have the exact same administrator, and be given two entirely different interpretations. For example, my psychologist explained that the same answers I gave which resulted in me being labeled a "sociopath" had I not had a background of being brutally beaten as a child, would have gotten me labeled "unusually honest & deeply religious". What the heck?! I don't get how that even makes the slightest bit of sense.

In fact, the only way to make any sense of it is to realize that the way those labels were developed was by interviewing thousands upon thousands of people locked up in psych wards & prisons about their histories. Then they made some changes after years of post-grad psych students taking the test themselves as practice. Certain changes were made as a result, but last I checked post-grad psych students were not reflective of society as a whole. So it ends up that the rest of society is measured by whether they are closer to a post-grad psych student, or closer to a psych patient/prison inmate. Sadly, since very few psych students endured abuse vs. a decent percentage of the patients/inmates, I ended up more closely matching the profile for an inmate. And it seems something similar may have happened to Scarred. Well, I'm sorry, but I think that sucks. And I stand behind my statement -- this is not just another hoop; it is a misuse of a test that can easily enough result in keeping people from getting needed medical treatments.

Frances,

 

I read you post and I agree with everything you said on the MMPI. I truly did not understand how some of those questions would relate as to whether I had normal thoughts on what the pump would do for my pain. I can understand testing a person like the pain part of the test I took. That in itself should have taken care of any issues on whether or not I would be a good candidate.

 

This is something that really needs to be improvised and revamped terribly as far as I am concerned. I had a horribly rotten childhood, very dysfunctional family, but what in the hell would that have to do with my pain? Back then there was no word such as dysfunctional,lol.

 

There are other tests that can be done to rule out malingering, oh, I hate that word. Or if there is a monetary motivation point. I know this for a fact because we had back in the 80's a big pain clinic type program that hit town. It was ran by a group of physical medicine drs that came out of the woodwork along with their inhouse psychiatrist. It was so biased and was pathetic. Alot of people with worker's comp claims were sent there for an eval. of course the drs always wrote malingering and in it for money. They even asked on their questionaire of the person had a lawyer. What difference would that make. They had an inpatient program and an out patient program. It was nothing more than a ins racket and scam. They eventually left town.

 

There is no cap on medical benefits paid dollar wise on comp claims. Thats just applies to health insurance. Let me say if it is state workers comp. Now some employers elect to buy an Occupational Accident policy which is not regular worker's comp ins. Those have all sorts of clauses.

 

Scarred's atty needs to see a copy of the comp's ins policy for sure. In some instances even tho its work related, if you are covered under a health ins plan, they will sometimes kick in and pay what comp refuses.

 

Susie