ANOTHER VOICE: State should take broad look at fibromyalgia status

A national petition having gone viral garnering more than 600 signatures (http://chn.ge/1aua7js), highlights a concerted effort by clinicians, patients and advocates who are asking a subcommittee of the Oregon Health Authority’s Health Evidence Review Commission to allow Oregon Medicaid to cover diagnosis and treatments for fibromyalgia. Oregon is the only U.S. state that excludes Medicaid coverage of fibromyalgia.

Dr. David Russo of Hood River presented this statement Thursday to the OHA:

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I’m writing in response to Oregon Health Authority/HERC Value-based Sub-Committee’s biennial review of fibromyalgia syndrome (FMS) and to offer a critique of the committee’s current priority scoring of the condition.

I am one of five pain management providers at Columbia Pain Management PC.

Grounded in a team-based physiatric (physical medicine and rehabilitation) model of care, our mission is to provide state-of-the-art comprehensive (pharmacologic, non-pharmacologic and behavioral) care to residents in rural areas suffering from acute and chronic pain conditions.

Under-served rural Oregonians are routinely referred to our Center for consultation and recommendations for the long-term management of chronic wide spread pain syndromes such as fibromyalgia.

Due to lack of awareness, limited provider-training opportunities, and/or misperceptions about the nature of fibromyalgia, it is not uncommon for us to see fibromyalgia patients who have been misdiagnosed as malingering, drug-seeking, or suffering from somatoform disorders; have been mismanaged by being inappropriately started on chronic opioid therapy; or have received duplicative and redundant medical services.

It is imperative that the committee incorporate new scientific data about the pathophysiology of FMS in order to recognize it as a serious chronic neurological disease and not a nonspecific soft tissue disorder.

The current classification still reflects an earlier understanding of FMS as a soft-tissue disorder. This has been demonstrated to be false. There is no soft tissue lesion. There is no biological marker of soft tissue inflammation or disruption.

Recent basic and translational neuroscience unequivocally demonstrates that FMS is a primary neurological disorder.

Early detection of FMS in the natural history of the disease coupled with appropriate longitudinal care prevents downstream complications such as depression, disability, and unnecessary medical care (laboratory investigation, diagnostic imaging, etc). Early detection and treatment of FMS depends upon a variety of rehabilitation interventions and lifestyle modification — just like diabetes, asthma, hypertension, bipolar/schizophrenia and other conditions classified in the same category.

Moreover, it is imperative that the committee understand that the pathophysiology of FMS is molecularly, neurologically and conceptually distinct from other common co-morbid conditions and should not rely upon happenstance to ensure that patients with fibromyalgia can access medical service for FMS via other prioritized conditions or that patient’s with FMS are merely patients with depression who “hurt all over.”

In summary, FMS is a primary chronic neurological condition that presents with diffuse wide-spread pain. Absent early detection and longitudinal monitoring, patients with FMS are at risk for development of significant secondary psychiatric and disability-related complications.

The effective treatment of FMS requires a disease management paradigm, conscientious care coordination, specific rehabilitation interventions and longitudinal surveillance in order to slow or reverse the burden of disability.

Every state Medicaid Program, except Oregon, has made FMS a covered condition for its beneficiaries. As such, I hope that the committee will take affirmative action and re-score FMS.

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CPM is a regional comprehensive and interventional pain management center based in Hood River, with satellite facilities in The Dalles, and Hermiston, serving over 70,000 people in five counties bordering the Columbia River.

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Parkdale third graders sing "12 Disaster Days of Christmas"

Welcome to your sing-able Christmas gift list. What follows is an emergency rendition of “12 Days of Christmas” – for outfitting your home or car in case of snow storm, earthquake, flood or other emergency. Read it as a simple list, or sing it to the tune of “12 Days” – you know, as in “ … and a partridge in a pear tree…” Not to make light of it, but the song is a familiar framework for a set of gift ideas that you could consider gathering together, even if the recipient already owns items such as a bunch of coats, tire chains and flashlights. Stores throughout the Gorge are stocked up on all these items. Buying all 12 days might be prohibitive, but here are three ideas for checking any of the dozen off your list (notations follow, 1-12.) The gift items needed to stay warm, dry and safe are also coded to suggest items in your abode (A) in your car (C) or both (B). 12 Gallons of Water (A) 11 Family meals (B) 10 Cans of propane (A) 9 Hygiene bags (B) 8 Packs of batteries (A) 7 Spare coats (B) 6 Bright red flares (C) 5 Cozy blankets (B) 4 Tire chains (C) 3 Flashlights (B) 2 cell phone chargers (B) 1 And a crush-proof first aid kit (B) Price ranges? Here’s a few quotes for days Three, Two, Four and Nine: n A family gift of flashlights (three will run $15-30, Hood River Supply, Tum-A-Lum) n Cell phone chargers (two will run $30-60) n Tire chains (basic set, $30, Les Schwab, returnable if unused for the winter) n Family meals ($100 or so should cover the basics for three or four reasonably well-fed days) n The home kit should be kept in a handy place near an exit, and remember that water needs to be replenished every few months. If you have a solid first aid kit already, switch out the gift idea with “and-a-sto-o-u-t- tub-for it-all …” Otherwise, it’s a case of assembling your home or car kits and making sure all members of the family know what the resources are and how to use them (ie flares and propane). Emergency situations are at worst life-threatening, at best deeply uncomfortable if you and your family are left without power for an extended period, or traveling and find yourself in a situation where you need to wait out a storm, lengthy traffic delay, or other crisis. Notes on the 12 gift ideas: 12 – Gallons of water: that’s one per person in a four-member family to last for three days, the recommended minimum to be prepared for utility outages. 11 – Easy-open packaged goods, energy bars, dried food and nuts are good things to include for nutrition. Think of what your family of four needs for three days to stay fortified and hydrated (see number 12). Can-opener also recommended 10 – If you have a propane camping stove, keep extra fuel handy. 9 – Hygiene bags: put packaged moistened towelettes, toilet paper, and plastic ties in large garbage bags (for personal sanitation) Resource list courtesy of Hood River County Emergency Management, Barbara Ayers, manager/ 541-386-1213. The county also reminds residents to Get a Kit, Make A Plan to connect your family if separated, and Stay Informed. See www.co.hood-river.or.us to opt-in for citizen alerts. Enlarge



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