The Pain Relief Network

As high school sweethearts, Florence and Joe Vigil used to dream of all the things they would do together. But, now in their 50s, their world doesn't extend much past the living room of their northern New Mexico home.
 
In defiance of the old adage “lightning doesn't strike twice in the same place,” the two have endured the kind of mishaps and surgeries that most people hope they never endure even once. The result is that the Vigils now live on disability payments and hope their prescriptions for pain relievers won't be cut off.

“Most people think you're an addict if you need pain medication,” said Joe, whose troubles started as a young man when he was working in a uranium mine near Grants.

Joe narrowly missed being hit by a derailed locomotive while working underground. But the 50-ton locomotive did crush his feet.

“When he didn't get well right away,” said Florence, “all our family started saying he was an addict. He was so upset, he wouldn't take the pain medication. It was hard — I would see him crying because he was in so much pain.”

Florence's problems started with a bad fall that necessitated surgery, and there were subsequent problems related to that.

The Vigils — who didn't want their current home village to identified in this article, fearing break-ins by people looking for drugs — say that no one understands pain medication unless it affects a family or friend.

Governor's reception

“When we heard that Gov. (Bill) Richardson was backing marijuana (for medical purposes), I said, 'He must have a family member who's sick and needs it,'” recalled Florence.

But members of the New Mexico Pain Support and Advocacy Group say Richardson's recent reactions to their plight has not been sympathetic.

Bill MacLeod, of Socorro, said that, when some 13 pain patients from the group went to see Richardson on Aug. 8 during open office hours in Albuquerque, the governor didn't seem to understand their problem.

“My wife was spokesperson, and she was trying to explain how all of us were patients of Dr. Joan Lewis,” said MacLeod of Lewis, a pain management doctor in Albuquerque. “He pointed to his head and said, 'Is this mental?'”

The governor's spokesman Allan Oliver said Richardson met with some 75 constituents during the afternoon session in question.

“He doesn't recall the specifics of the conversation with this group, but does recall meeting this group as well as receiving their letters,” said Oliver. “Governor Richardson recognizes these individuals are in great and serious pain, and has directed his staff to work with the New Mexico Medical Board to look into the situation.”

That's good news for the Vigils, because they are part of some 400 patients of Albuquerque physician Joan Lewis — all part of the New Mexico Pain Support and Advocacy Group — who are trying to reverse the actions of the New Mexico Medical Board in regard to Lewis. Effective Sept. 1, Lewis has been ordered by the board not to treat her patients' chronic pain conditions for more than 30 days. The order states that, if Lewis breaches the conditions, her license to practice as a physician in New Mexico could be immediately suspended.

In 2001, Lewis was charged with “injudicious subscribing” of narcotics by the board. The board served notice in September 2000 that it had evidence of six cases in which she prescribed controlled substances in quantities above what was considered medically indicated. Lewis was ordered to undergo additional education in pain management and have her practice monitored by another physician or a panel of physicians.

New type of program

But Lewis and her patients say her pain protocol is part of a pioneering program. In dealing with her patients, Lewis said she has documented a pattern of initial relief after starting them on pain medications, followed by a return of the pain. At that point, Lewis increases the dosage until the patient finds relief again. Most patients then find they reach a plateau where they still have some pain but they can carry on in their lives. Then Lewis begins to wean them from the medications by gradually reducing the dose, which allows the body to step in and carry on its own pain management. But she said some pain patients will always need some level of medication.

“Like insulin,” said Lewis, “opiates have to be adjusted to the patient's need.”

Lewis' patients have to sign a contract agreeing to not drink alcohol or use street drugs or pain medications prescribed by any other doctors; undergo random urine tests to make sure they're clean of all the items they've agreed not to use; and undergo regular liver function and other tests to make sure the body can safely metabolize the medication.

Still, as most pain patients know, suspicions lingers. “Many in the public seem to think that if you take drugs like OxyContin for pain, you do it to get high, no matter what your reasoning for taking it,” said Siobhan Reynolds, co-founder of national Pain Relief Network based in Santa Fe.

“If you're in pain and take OxyContin, you don't become high. There's a saturation of the pleasure centers in the brain — you build tolerance. It's mostly sedating.”

Reynolds said that “somewhere, somebody is having a good time on OxyContin,” but it isn't pain patients. Reynolds said that chronic pain is a disease in itself and that it changes the chemical and anatomical makeup of the spinal cord. When it goes untreated, it increases in intensity and spreads to areas that weren't previously affected.

Board's response

Both Lewis and the New Mexico Pain Support and Advocacy Group have written the Medical Board asking that the order against her be set aside. In her letter, Lewis wrote: “I feel I was unfairly and substantially coerced into agreeing to this order.”

Lewis said it cost her $60,000 to defend herself against the board in 2001. Reynolds said the burden is put on the practitioner to defend the lives of their pain patients. “Pain docs don't make any money,” said Reynolds. “Medicare doesn't pay, insurance companies refuse to pay …they (pain patients) cost pain docs time, money and bureaucracy costs.”

Lynn Hart, executive director of the New Mexico Medical Board, said the board now pays for its own costs instead of requiring that a targeted doctor assume those expenses.

“There are some other things that were alleged she (Lewis) was led to believe, that she might lose her license,” said Hart. “But much of this was a discussion between her attorney and the prosecutor, and nobody else was privy to those conversations.”

Hart said the board has approved putting Lewis' case on the agenda at its next meeting, Aug. 21. “The board is going to listen to Dr. Lewis and consider setting aside the settlement she signed, and we'll go from there,” Hart said.

Advocates for pain patients are becoming much more proactive throughout the country, said Reynolds. The Pain Relief Network recently filed suit in federal court to challenge restrictions on how much pain medicine doctors can prescribe in Washington state.

In the meantime, pain patients wonder who will fill their prescriptions come Sept. 1.

“There's not much for us to look forward to any more,” said Florence Vigil, other than visits from f
amily and their two young grandchildren, who know they need to be especially careful around Grandpa these days.