Here is how to find a Medical Biling Advocate in your State who can help you keep from being taken advantage of by Hospitals.  Keep in mind these Advocates may charge fees.  Medical Billing Advocates of America.

Note:  We are in no way associated with this company nor are we paid referral fees.  We have not used these services, but you might want to consider them.

First edited and published by the Hospital Accountability Project of the Service Employees International Union. This project is a health care justice initiative of the Service Employees International Union. SEIU, America’s largest health care union, aims to make quality health care more accessible and affordable for all.
Look Before You Pay

Hospitals are an essential public service. Every day hundreds of thousands of Americans go to hospitals for everything from life-sustaining minor surgeries, to life-changing child births, to life-saving emergency treatment. We need hospitals. We are the grateful recipients of their services. We are also, eventually, recipients of bills for their services.

Those bills are the topic of this article. Americans spend more on health care than any other people in the world. Ten percent of our gross national product goes into health care, the fastest growing industry in the nation. And every year we spend more; for the past 20 years health care costs have risen at twice the inflation rate. Dramatic increases in hospital charges are a major contributor to those rising costs.

Hospital bills are extremely problematic—and not just because they are high and can be very difficult to understand. They are problematic because they are, most of the time, wrong. The U.S. General Accounting Office estimates that 99 percent of bills from hospitals have overcharges. (New York Times, Jan. 27, 1993). The insurance industry, which hires private audit companies to review bills for accuracy, has also found a high level of hospital billing errors. The largest audit company used by insurers, Intracorp, estimates that 80-90% of hospital bills contain errors. When these audits are done, they generally result in striking reductions of the hospital bills.

This article explains how hospitals overcharge. While most of the information presented here has been used by the Legal Assistance Foundation to argue against illegitimate hospital charges against uninsured patients, all patients have grounds to fight these charges. All health care consumers should be aware of this information.

This article was adapted from a much longer manual designed for attorneys who are representing clients who have been sued by hospitals. If you are being sued by a hospital for unpaid medical bills, you should consult with an attorney. In almost every case where patients fight back in the courts, charges are reduced or eliminated. Of the 184 hospital debt cases handled by the Legal Assistance Foundation between 1983 and 2001, for example, 128 (or 70 percent) had their debts completely eliminated. Of the remainder, all but one had their charges dramatically reduced.

But even if you, or your insurance company, can pay the bill, you shouldn’t be paying for services that the hospital has no business billing you for. Nor should you be paying for services that are overpriced.

The burden is on the hospital to prove that services are reasonably priced. Most hospitals provide services without a written contract or even verbal agreement. Illinois law makes it clear that under these circumstances, there is an agreement to pay a “reasonable price” for the services delivered. Specifically, the hospital must establish the following:

* The delivery of each good and service
* The method of pricing each good and service
* The reasonable value of each good and service

This is a tough task for hospitals because when held up to scrutiny, nearly all hospital bills contain errors. And the mistakes usually favor the hospital and overcharge you, the patient.

To check for the errors listed in this article, you need more information than just the hospital bill. As is aptly observed in Take This Book to the Hospital With You, “Translating the cuneiform carvings on the Rosetta stone was a lot easier than deciphering a hospital bill”. Besides that, your bill doesn’t tell the whole story.

You need to obtain the following from the hospital, which you absolutely have a legal right to do:

* An itemized bill
* Your medical record
* Your pharmacy ledger or record (an itemized list of all of the drugs you were provided)

With these documents, you can check for some of the discrepancies listed in this article. Health care is a service that you purchase, whether directly with cash or through your insurance. Those who provide that service must be accountable to you, the consumer. This article is designed to help you achieve that accountability.
The Top 20 Ways Hospitals Overcharge Patients:

1. Billing for Services not Rendered

You can be billed for many procedures that are never actually performed. This is where it is important to have all the medical and pharmaceutical records and itemized bills from the hospital. For example, the medical records may show results of six blood tests while you are being charged for nine.

Any billed procedure that is not reflected in the medical records can be challenged. Examine the bill for charges that make no sense, such as a charge for circumcision of a newborn baby girl. Look over the procedures listed and make sure they were all actually performed. For example, if you are charged $300 for a blood transfusion, did you actually receive this treatment?

2. Duplicate Billings

A frequent error is a duplicated billing in which you are billed twice for a service rendered but once. A slip of a finger on the computer keyboard can cause this problem.

3. Shoddy Testing

You shouldn’t have to pay for an X-ray that was botched. If two chest X-rays were administered in two days, find out if the second X-ray was needed because the hospital erred in the first test.

4. Phantom Charges

Some hospitals automatically bill for certain items ordinarily associated with particular services. Their computer program may automatically impose a wide variety of charges for a particular procedure. So if you are charged for a childbirth, for example, there should be no charges for sedation unless you actually received the sedative drugs.

5. Quantity Errors

Have you been charged for 200 facemasks rather than two? Again, a slip of a finger on a keyboard could cause such an error. A frequent error of hospitals occurs with respect to intravenous solutions that are administered on the day of admission. The hospital computer will bill you for a full day’s worth of IV solutions—for example, $189 for an IV ampicillin antibiotic solution. That is the daily rate. But if you are admitted late in the day, you may only receive four hours worth of solution and you should not have to pay for a full day’s rate. There may be several hundred dollars worth of IV solutions that the hospital did not actually provide.

Hospitals often charge patients for the use of operating rooms on an hourly basis. If there is a billing for eight hours in the operating room, verify this in the medical records.

6. “Unbundling” Related Charges

Proper billing procedures (and Medicare law) require the hospital to “bundle” related charges for a particular medical procedure. For example, the charge for removing an appendix will include the operating room, the operating utensils, and all other goods and services normally related to this operation. “Unbundling” occurs where the hospital separates some of the charges that should be included in the “global” charge for the appendectomy, thus duplicating some of the charges. For example, a bill for an appendectomy may wrongly include separate charges for the pre-operative physical, such as drawing blood, cardiogram, and interpretation of the cardiogram.

7. Excessive Mark-ups

When reviewing your itemized bill, look for specific charges that seem vague or too high, such as $75 for a laxative, $30 for a “thermal therapy kit” (plastic bag of ice cubes), $10 for a “urinal” (plastic cup) or $8 for a Coca Cola. Outrageous mark-ups are frequent and have been well documented. A December 1994 article in Money Magazine, for example, offered this illustration: “Dr. James is busy replacing a 64-year-old knee. He traces a line on her leg with a disposable skin-marking pen that costs the hospital less than $1, then tosses it aside for my sake with a flippant ’28 bucks’. That’s what the insurer will be billed for it. The plastic sheet on her leg: 59 bucks. Cost: $8. It’s a racket”.

Drug charges, in particular, are the target of excessive mark-ups. Modern Maturity, in its May/June 2001 issue, reported that “markups of 200 to 400 percent are common, but some drugs and small items are marked up as much as 5000 percent. A hospital can buy a Cepacol throat lozenge wholesale for 4.5 cents, then turn around and bill you $2.25 or more per lozenge”. In the same article it is reported that a hospital charged a patient nearly $14,000 for a used pacemaker which the hospital purchased for $6,700.

One useful technique to gauge the reasonableness of drug charges by the hospital is to compare their prices to those paid by Medicaid and Medicare. Medicaid and Medicare reimbursement rates for drugs are based on the “AWP” (average wholesale price). The AWP is the average price that wholesalers give to retailers for a given medication. Each year an “AWP Red Book” is published that lists AWP’s for thousands of drugs. If the AWP for a Tensilon tablet (10mg) is $1.09, the hospital shouldn’t be charging $56 for it.

8. Exceeding “Comparable Charges”

Some hospitals charge much more for the same services than other hospitals in the same market. The 1999 “Illinois Hospital Price Survey Report,” published by the Illinois Health Care Cost Containment Council, stated that Provident Hospital in Chicago charged $630 for a semi-private room while Illinois Masonic Hospital charged $1,053 for a semi-private room. Chest x-ray charges varied from $79 at Bethany Hospital to $226 at the Illinois Masonic Hospital. If you have been charged $220 for a chest x-ray, you should be able to use the information in this report to argue that the price was unreasonably high. Also, you can get a range of information on comparable hospital charges by filing a Freedom of Information Act request with the Illinois Department of Public Health.

9. Mis-coding the “DRG”

Mis-coding or inappropriate coding occurs when a hospital uses the wrong DRG (diagnostic related grouping) code to label—and therefore bill—for a procedure. For example, a patient who is coded as having a urinary tract infection has a much shorter authorized length of stay than the patient whose illness is coded urinary sepsis. Coding these procedures differently could result in a higher bill. Some hospitals hire specialists who are “talented” in selecting codes that maximize hospital reimbursement. Many hospitals have faced criminal or civil penalties for wrongfully “upgrading” the coding of procedures and illnesses. You will need to inquire into the DRG coding of your bill to investigate this possibility.

10. Unnecessary Staffing

Hospitals sometimes pad bills by unnecessarily overstaffing a surgical procedure. Find out if the surgical assistant—for whom you were billed $1,400—was necessary in the particular surgery performed. Medicare regulations, for example, will not allow costs related to assistant surgeons in many procedures.

11. Delays That Lead to Longer Stays

This is a delay that causes your hospital bill to increase as a result of some error or mistake of the hospital staff.

The most dramatic example of this is in the number of days you spent in the hospital—particularly where some of these days resulted from a hospital blunder. A study of about 1,000 hospital patients in the Boston area was reported in Medical Care, February 1989. A full 30 percent of the patients studied experienced delays averaging almost three days in their hospital stays. These delays amounted to a whopping 17 percent of all hospital days in the study. (See numbers 12 through 15).

12. Test Re-scheduling Delays

The main reason patients spent unnecessary days in the hospital is because the hospital erred in its test scheduling. Typically, a patient would be admitted on a Monday, for example, with a pre-surgery test scheduled for the afternoon and the surgery scheduled for Tuesday. But the hospital may have overbooked the particular test for Monday, resulting in re-scheduling the test for Tuesday. This means the surgery is pushed back to Wednesday—if possible—and you spent a needless and anxious extra day in the hospital. Then the hospital bills you for that day as if no mistake had been made.

13. Test Result Delays

Test result delays are a similar problem. The hospital may have a typical eight-hour lag to get the results of a particular lab test from the pathology department. But if pathology is running late or if they lose the results of the test and it has to be done over, you are going to have to pay for the hospital’s mistakes that lengthen the hospital stay. They will even have the nerve to bill you for two tests when they lost the results of the first test.

14. Surgery Delays

Another common foul-up is surgery delay caused when the hospital sets too many elective surgeries for one day. You may get bumped to the next day and have to pay for this even though the hospital was negligent in its scheduling.

Surgery may be delayed because a scheduled consultation visit by a consulting doctor does not occur when the hospital forgets to notify the consulting doctor. You can often find these problems described in the medical charts; you should not have to pay for the extra day caused by the hospital’s mistake.

15. Teaching Hospital Delay

One of the worst abuses regarding delays in discharge is where you are a patient in a teaching hospital and happen to have a rare disease or an unusual predicament. The medical staff of the teaching hospital may want a large number of the residents to have an opportunity to review your case; it may be their only chance to see this particular affliction during their residency. The hospital stay may drag on needlessly long to give every resident an educational benefit.

16. Late Checkout Effect

Some hospitals charge a late charge or even a whole day’s charge if the patient is discharged after noon. If you were discharged at 2 p.m. due to some hospital screw-up, you should not have to pay the extra charge.

17. Paying for Wasteful Hospital Practices

In December 1994, Money magazine published “Undercover in a Hospital”. The author exposes how most hospitals are extremely wasteful in that they use disposable, as opposed to reusable, supplies and instruments. The article notes that some operations call for the use of more than $1,000 worth of disposable materials and makes the point that many hospitals are now using re-usable goods and instruments to cut costs. Patients should not have to pay for expensive, disposable items when that is a result of wasteful hospital practices. These charges can be challenged.

18. Hospital-caused Infections

Another type of overlooked hospital negligence is hospital-caused infections. These are infections acquired during a hospitalization and produced by microorganisms that dwell in the hospital. It is not an infection that was present in the patient at the time of admission.

Between 5 and 10 percent of all hospital patients contract an infection during their hospital stay. A recent Chicago Tribune investigation by reporter Michael Berens found that, nationwide, roughly 103,000 deaths in 2000 were linked to hospital-caused infections. While most patients survive these infections, they pay handsomely for this “gift” from the hospital.

The average hospital-caused infection adds four extra days to a hospital visit at an average cost of $800 a day. Hospital-caused infections account for 15 percent of all hospital charges and end up adding between $2.5 and $4 billion to the annual American health care bill. In the November 1986 issue of American Journal of Surgery, it was estimated that surgical wound infections alone add an average of seven days to some patients’ hospital stays and $10 billion annually in direct and indirect costs. Hospital-caused infection rates have been found to be higher in large teaching hospitals than in non-teaching institutions, because the teaching institutions have more people floating around the hospital thus increasing the chances for the spread of infection.

Pneumonia is the most common hospital-acquired infection. Sometimes pneumonia is introduced into the lungs by contaminated respiratory therapy equipment, or by medical personnel coughing in close quarters like intensive care units. Other hospital-caused infections can be spread by improper preparation of hospital equipment or the failure of hospital personnel to engage in simple sanitary precautions such as frequent washing of the hands.

Find out whether your hospital stay was extended by reason of a hospital-caused infection. If so, you should take the position that you should not be asked to pay for costs that were probably generated as the result of the hospital not taking adequate sanitary precautions. Inquire whether the hospital has an active Infection Control Committee. If it does not, you will be able to argue that the hospital has not taken all possible steps to prevent the infection you contracted.

19. Padding Hospital Surplus

If you are interested in going beyond the particulars of your bill to make a more systemic critique of hospital charges, you may want to find out how much “surplus” (otherwise known as profit) your hospital generates. Get a copy of the hospital’s Statement of Patient Revenue and Operating Expenses or “revenue and expense statement.” Determine whether the hospital had “surplus revenue” for the fiscal year in which you were billed. For example, the non-profit Evanston Hospital had a $9 million “profit” in 1985 on total revenue of $147 million. This information could be used to argue for a percentage reduction of your bill. Non-profit hospitals are required by the Internal Revenue Service to file a Form 990 Report that lists sources of support, expenses, revenues and executive compensation. Federal law requires that the 990 be available for public inspection. You can probably access the hospital’s reported revenue statement at the American Hospital Directory under “free services”.

20. Discriminatory Billing

If you do not have health insurance, you could be a victim of discriminatory billing. This is also known as cost shifting or variable pricing. These terms refer to the policy of shifting hospital costs away from third-party payers (such as Blue Cross and Medicare/Medicaid) and onto the shoulders of self-payers. Whatever this policy is called, it amounts to this: different payers pay different prices for identical services. “So-called cost shifting then results in higher charges to individuals who personally pay for all or a portion of their hospital confinement,” says a report of the Illinois Health Care Cost Containment Council. Thus the poor, who do not have insurance, pay more for the same medical treatment than more economically advantaged patients do.

Here is how the New York Times reported this situation in an April 2, 2001 article:

“It’s horribly ironic,” said Paul Menzel, a professor of philosophy at Pacific Lutheran University in Tacoma, Washington. The care of the poor was once supported by the wealthy and the insured, but now the opposite is happening, he said. “It is the people who are most provided for, not the people who are least provided for, who get the benefit of cost-shifting,” he said.

Most patients paying the full fare have no idea that their bill may be many times that of the people next to them in the doctor’s waiting room.

For example, in an August 1979 report, Illinois Masonic Medical Center listed a three-tier charge system, whereby Medicare/Medicaid paid an average $279 daily patient fee, Blue Cross patients averaged $389 daily, and self-payers (the uninsured), averaged $463 daily. Discriminatory billing is the consequence of the practice of all hospitals of entering into reimbursement agreements (or “provider discount agreements”) with different third-party payers that call for differing reimbursement amounts to be paid for the same services. The more powerful the third-party payer—such as the government or Blue Cross— the greater the discounted prices they are able to negotiate with the hospital. All hospitals enter into these agreements with payers.

And don’t let semantics misguide you: many hospitals try to claim that they charge every payer the same amount. While they may “charge” the same amounts to all payers, the hospitals will accept as full payment from third-party payers amounts less, often far less, than the full charges.
Demand Accountability

We in the United States spend more than enough on health care—10 percent of our gross national product, to be exact. This care costs plenty even without the little “extras,” such as paying for services we haven’t received or paying for the hospitals’ mistakes.

As consumers who depend on hospitals, and as community members who support them through sizable tax breaks, we have every right to demand a higher level of accountability from hospitals. Using the tips in this article to scrutinize your hospital charges is one small way to demand such accountability.

For more information on actions being taken to hold Chicago hospitals more accountable to their communities, their patients, their employees and their charitable missions, contact:

Hospital Accountability Project
Service Employees International Union
40 N. Wells, Suite 300
Chicago, IL 60606
(312) 541-9566
Fax (312) 541-9650
Appendices
Appendix A:
Summary of Legal Assistance Foundation Cases Defending Those Who Have Been Sued by Chicago Hospitals, 1983-2001

Between 1983 and 2001, the Legal Assistance Foundation of Metropolitan Chicago defended 184 cases where individuals were sued by hospitals for back debt.

The following are statistics of those cases:

* 28 (or 69.5%) had their debts totally eliminated
* 55 (or 29.8%) had their debts decreased
* Of the cases where the debts were decreased, the reductions ranged from 26 to 94 percent
* In 48 of the 55 reduction cases, the reduction was at least 50 percent of the bill
* In all 184 cases, the total amount being sought was $852,617. After these cases were litigated, the total amount collected was $53,329.

Appendix B:
Resource List for Consumers with Hospital Debt
Legal Assistance Foundation (LAF) of Metropolitan Chicago

LAF provides free legal counsel on matters of civil (non-criminal) law for low-income people. LAF attorneys have represented many clients who have been sued by hospitals over unpaid medical bills, and usually gotten the debt either eliminated or greatly reduced. Attorney Alan Alop has written a manual for lawyers defending clients sued by hospitals for medical debt. LAF operates from the following locations:

Downtown/ Administrative Offices
111 W. Jackson Blvd., Suite 300
Chicago, IL 60604
(312) 341-1070

South Side
10 W. 35th St.
Chicago, IL 60616
(312) 949-5390

Harvey/ South Suburban Office
15325 S. Page Ave.
Harvey, IL 60426
(708) 339-5550

Westside Office
3333 W. Arthington
Chicago, IL 60624
(773) 638-2343

Northwest Side Office
1279 N. Milwaukee Ave.
Chicago, IL 60622
(773) 489-6900

Evanston Office
828 Davis St.
Evanston, Illinois
(847) 475-3703

SSI Advocacy Project
407 S. Dearborn
Chicago, IL 60605
(312) 427-5200

Public Benefits Hotline
Toll-Free: (888) 893-5327
Bankruptcy Lawyers

The following two firms are both dedicated exclusively to bankruptcy law. They each offer a free initial consultation. The Chicago Federation of Labor refers them as reputable firms.

Melvin Kaplan & Associates
14 E. Jackson Blvd.
Chicago, IL 60604
(312) 294-8989

Robert J. Adams & Associates
125 S. Clark St., Suite 1810
Chicago, IL 60603
(312) 346-0100
Workman’s Compensation Attorney

Farhan Younus
Louis G. Atsaves, LTD
200 W. Jackson Blvd., Suite 1050
Chicago, IL 60606
(312) 322-0001
Consumer Credit Counselors

Consumer Credit Counseling Service
70 E. Lake St., Suite 1115
Chicago, IL 60601
(312) 849-2227

Catherine Williams
Vice-President of Education
Toll free: (800) 698-6512

24-Hour Counseling Hot-Line
Toll free: (800) 762-2271

CCCS of Greater Chicago is a non-profit community service organization providing credit counseling services, debt management, and money management education at centers throughout the metropolitan area. CCCS is a division of Money Management International, the largest full-service credit counseling organization in the nation.
Medical Bill Analysts

Professional services are available to examine hospital bills to look for errors and overcharges. One study found that 98% of all hospital bills contain overcharges. Bill analysts charge a fee that varies depending on the size of your bill and the type of review they conduct. The Hospital Accountability Project may be able to review your bills at no cost. Professional service providers include:

Claim Relief, Inc.
2647 W. Morse Ave.
Chicago, IL 60645
(773) 274-0647

Claim Relief Inc. can analyze bills, advocate for you with insurance companies and medical creditors, and appeal claims.

American Medical Bill Review (AMBR)
1123 Hilltop Drive
Redding, CA 96003
(530) 221-4759

AMBR is headquartered in California, but offers services in all 50 states.
Other Sources of Help

Metropolitan Family Services – Legal Aid Bureau
(312) 986-4200

Office of Consumer Health Insurance
(877) 527-9431

Office of the Illinois Inspector General, Fraud & Abuse Hotline
(800) 447-8477
(800) 377-4950 (TTY)

Article Source:  Illinois Legal Aid

1. Do I really need this test?

“Doctors often adhere to a better-safe-than-sorry philosophy, ordering tests just to protect themselves in the event of a lawsuit,” says David Sandmire, MD, co-author of Medical Tests That Can Save Your Life.

A full 16 percent of prostate-cancer screenings, for example, are unnecessary, say Harvard researchers. Since 80 percent of PSA results are false positives, thousands of men undergo needless biopsies each year. Another overused procedure: CT scans. The radiation from these tests causes an estimated 5,695 cancer cases a year, say British researchers.

2. Where would you send your spouse or children?

Like our tax code and the judicial system, medicine is supposed to treat everyone equally, but it’s clear that some people receive better treatment than others. “General practitioners who work within a particular system routinely refer patients to specialists within that health-care system,” says Kevin Soden, MD, co-author of Special Treatment: How to Get the Same High-Quality Health Care Your Doctor Gets. “However, oftentimes the best surgeon is in a completely different facility on the other side of town, and you can bet that’s where your doctor would send his family.”

3. How many surgeries do you perform each year?

Nowhere is the saying “practice makes perfect” more applicable than in the operating room. Urologists who perform more than 40 prostatectomies a year, for example, experience 50 percent fewer complications than those who perform fewer than 40. The same goes for hospitals performing more than 200 coronary bypass surgeries a year, according to a report in the journal Circulation. Bottom line: Your health hinges on your surgeon’s experience.

4. Can I schedule my surgery for the morning?

Arrive early and you’ll get the undivided attention of an alert medical staff. A recent study of 90,000 surgeries by researchers at Duke University found that patients who had operations in the morning were four times less likely to have anesthesia complications — nausea, post-op pain, fluctuating blood pressure — than those who had them in the afternoon.

5. If I get sick, will you see me in the hospital?

In the past 10 years, the number of hospitalists, a new breed of physicians who specialize in inpatient care, has grown from a few hundred to nearly 20,000. “So if you require hospitalization, odds are your primary-care physician won’t be at your bedside,” says Evan Scott Levine, MD, author of What Your Doctor Won’t (or Can’t Tell You). “You’ll be dealing with a new doctor who doesn’t know you or your medical history.” Make sure your GP makes hospital calls.

6. Do you earn bonuses based on performance?

Before you schedule a surgery, check the hospital’s physician reward system. Insurance companies reimburse hospitals based on the type of treatment provided, not the length of your stay. As a result, “Many hospitals pay their physicians bonuses based on how quickly they move patients out the door,” says Dr. Levine. “Quality of care is sacrificed in the interest of increasing patient turnover.”

7. When did you graduate from medical school?

In an analysis of 62 studies, researchers at Harvard Medical School discovered that doctors who have been out of medical school for more than 20 years were up to 48 percent less likely to stay up-to-date on developments in their fields. They are equally likely to be unaware of current treatment guidelines, such as prescribing aspirin to treat angina (chest pain caused by decreased blood flow to the heart). If you don’t want to ask your doctor directly, check out how long it has been since he graduated at healthgrades.com.

8. What the hell does that say?

No doctor would prescribe Zoloft for high cholesterol, but that’s what you might end up with if your pharmacist can’t read Zocor in your doctor’s chicken scratch. Poor penmanship isn’t just an old stereotype; it’s responsible for up to 61 percent of medication errors and more than 1.5 million patient injuries per year, according to a recent report from the National Academies of Sciences’ Institute of Medicine. “If you can’t read a prescription, chances are your pharmacist can’t either,” says Dr. Soden. “Get your doctor to print out the name of the medication.”

9. Will you remove that wedding ring?

When scientists at Rush University Medical Center, in Chicago, analyzed the hands of 66 nurses, they found that those with wedding rings had 10 times more bacteria than those without. “Bacterial infections are the leading cause of death in American hospitals; about 98,000 people die from them each year,” says Dr. Soden. “That means you can contract a secondary infection at the hospital.”

10. What else can I do to treat my condition?

Recent studies suggest that diet and exercise are essential for treating and preventing everything from heart attacks to prostate cancer, yet only one in six doctors discusses how to use nutrition to prevent disease, according to a study in the American Journal of Clinical Nutrition. Researchers in Colorado, meanwhile, found that only 28 percent of doctors mention exercise to their patients. Many primary-care physicians work with dietitians and trainers who can help treat patients with lifestyle-influenced health problems, such as type 2 diabetes. So even if your doctor doesn’t have answers regarding nutrition and exercise, he likely knows someone who does.

5 Painful Facts You Need to Know

First off, let’s set the record straight: Pain is normal. About 75 million U.S. residents endure chronic or recurrent pain. Migraines plague 25 million of us. One in six suffer arthritis.

The global pain industry peddles more than $50 billion in drugs a year. Yet for chronic pain sufferers, over-the-counter pills are typically little help, while morphine and other narcotics can be addictive sedatives.

An overview study published last month in the Journal of General Internal Medicine looked at multiple studies of pain and found “researchers don’t yet know how to determine which [treatment] is best for individual patients.” From studies of drugs to surgeries and alternative medicines, “We have found that there are huge gaps in our knowledge base,” said Dr. Matthew J. Bair, assistant professor of medicine at the Indiana University School of Medicine.

So what is pain and why do so many suffer so long?

Pain is felt when electrical signals are sent from nerve endings to your brain, which in turn can release painkillers called endorphins and generate reactions that range from instant and physical to long-term and emotional. Beyond that, scientific understanding gets painfully fuzzy.

Here’s what’s known:

Fact 1 – Scientist Don’t Understand Pain

When you’re in pain, you know it. But if scientists could fully grasp how pain works and why, they might be able to help you more. The American Academy of Pain Medicine defines pain as “an unpleasant sensation and emotional response to that sensation.” Some pain is the result of an obvious injury. Other times, it is caused by damaged nerves that are not so easy to pinpoint. “Pain is complex and defies our ability to establish a clear definition,” says Kathryn Weiner, director of the American Academy of Pain Management. “Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation.”

Fact 2 – Chronic Pain Shrinks Brains

If you have chronic pain, you know how demoralizing and debilitating it can be, physically and mentally. It can prevent you from doing things and make you irritable for reasons nobody else understands. But that’s only half the story. People with chronic backaches have brains as much as 11 percent smaller than those of non-sufferers, scientists reported in 2004. They don’t know why. “It is possible it’s just the stress of having to live with the condition,” said study leader A. Vania Apkarian of Northwestern University. “The neurons become overactive or tired of the activity.”

Fact 3 – Migraines and Sex Go Together

It may not eliminate the phrase “Not tonight, honey …” but a 2006 study found that migraine sufferers had levels of sexual desire 20 percent higher than those suffering from tension headaches. The finding suggests sexual desire and migraines might be influenced by the same brain chemical, and getting a better handle on the link could lead to better treatments, at least for the pain portion of the equation.

Fact 4 – Women Feel More Pain

Any man who has watched a woman having a baby without using drugs would swear that women can tolerate anything. But the truth is, guys, it hurts more than you can imagine. Women have more nerve receptors than men. As an example, women have 34 nerve fibers per square centimeter of facial skin, while men average just 17. And in a 2005 study, women were found to report more pain throughout their lifetimes and, compared to men, they feel pain in more areas of their body and for longer durations.

Fact 5 – Some Animals Don’t Feel Our Pain

Animal research could offer clues to eventually relieve human suffering. Take the naked mole rat, a hairless and nearly blind subterranean creature. A study this year found it feels neither the pain of acid nor the sting of chili peppers. If researchers can figure out why, they might be on the road to new sorts of painkilling therapies for humans. In 2006, scientists found a pathway for the transmission of chronic pain in rats that they hope will translate into better understanding of human chronic pain. Lobsters feel no pain, even when boiled, scientists said in a 2005 report that is just one more salvo in a long-running debate.

What You Can Do

Meanwhile, exercise is a useful remedy for many types of chronic pain.

In an Italian study detailed in the May issue of the journal Cephalalgia, office workers did relaxation and posture exercises every two to three hours. Over an eight-month period, they kept diaries, which were then compared to those of a control group that did not change habits. In the end, the group that exercised reported that headaches and neck and shoulder pain decreased by more than 40 per cent, and their use of painkillers was cut in half.

“Physical activity is actually a natural pain reliever for most people suffering from arthritis,” concludes another study published in the Arthritis Care and Research journal in April. “Even minor lifestyle changes like taking a 10-minute walk three times a day can reduce the impact of arthritis on a person’s daily activities and help to prevent developing more painful arthritis,” said Dr. Patience White, chief public health officer of the Arthritis Foundation. “Physical activity can actually reduce pain naturally and decrease dependence on pain medications.”

Treatments I list on this page are those I have not investigated throughly. I have not tried these treatments, some mainstream, some alternative. I list them only so that those of you who are visiting the site may have additional access to possible therapies. it’s hard to say I’ve tried everything when there are so many therapies “Out there”. The real problem is not every therapy works for every person. So with that being said I give you this list.

Intrathecal Drug Delivery (Pain Pumps) – This is heavy duty, you do not want this… only the very worst cases may need this treatment.

Spinal Chord Stimulator -Surgically implanted pain treatment devices similar to Intrathecal except they deliver low voltage electrical stimulation instead of drugs.

Radiofrequency and Pulse Radiofrequency – Electromagnetic energy is delivered via a needle to treat nerves for pain.

Phoresis – High frequency sound waves are used to push a steroid medication through the skin. Lontophoresis uses a small machine to produce a mild electrical charge to carry the medicine through the skin.

Spinal Chord Stimulator -Surgically implanted paint

Therapeutic Ultrasound – I’m still learning about how this works. I’ve had both hot and cold Therapeutic Ultrasound and the hot felt great, but I don’t know the side effects if applied improperly. Most of the mainstream medical community would agree there is not real evidence to support this treatment.

The body is designed for movement and movement aids healing, just don’t over do it! You have to remember there is no blood flow to the discs so if you do not move, the spinal fluid does not move!

Your road to recovery will be much slower or non-existent without some form of gentle to moderate exercise. I’ve had Doctors tell me for Cervical Problems not to swim, but others have said it’s good. I like to swim and while I don’t do anything specific for very long, I believe just the buoyancy provided such incredible relief there are immense benefits in aqua therapy even if all you do is walk through the water. This allows me to relax and stretch and move around and it feels great.

Yoga

The benefits of movement and stretching can not be understated unless directly contradicted by your condition. Give yoga a try I’m still working on my personal yoga experience and I think the benefits are making my pursuit worthwhile.

Beautiful Yoga Movements

Yoga is for everyone. I show you this video to show how incredible movement of the Human Form can be. You do not have to be flexible to start Yoga. The whole point is you are working towards your own goals at your own pace. If you never are able to touch your toes, that’s fine. That’s not the point. The point is to get your body moving and stretching with gentle, relaxing, and peaceful movements.

Tai Chi

Gentle movements and motions many have touted to have brought about relief from spinal pain throughout the back and neck. I have not been to an instructed class on Tai Chi, but from what I’ve read I would like to start.

Tai Chi Fundamentals for Taiji Beginners

The cervical spine and associated muscular support of the head interwoven with vessels and nerve supply in the head and upper extremities, compose a complex structure with many sites for the generation of pain. A reduction in the space in which nerves pa ss through or lie can result in pain and loss of function. If the pressure is acute, pain is more likely to occur. Loss of function is generally the result of more prolonged and continuous pressure.

The sites of nerve compression in the neck are the intervertebral foramina, the spinal canal, the interscalene space and the course of the occipital nerves through the trapezius muscle at the base of the skull. Impairment or free movement at the joints, discs or ligaments may lead to irritation of sensitive structures of the joints and soft tissue of the neck. Reflex muscle spasms resulting from this irritation can produce continuous tension on the periosteal insertion of muscles. It is common for head and neck pain to originate with stress on the cervical musculature. Tension headaches are the result of sustained muscle contraction which produces both irritation at muscle insertion points and ischemic pain of the muscle itself.

Irritation of the cervical nerve roots at any point from their origin of the spinal cord to their paths to the occipital muscles can result in pain referred to the head and neck or upper extremity. Common sources of such irritation are the degenerative changes associated with osteophytes. As the degenerative process progresses, the spinal canal decreases in all diameters causing pressure on the long ascending and descending tracts as well as the cervical nerve roots. The most frequent complaint of the patient with cervical spondylosis is cervical, occipital or atypical facial pain due to irritation of the C2, C3 and C4 nerve roots. The continued irritation of these roots as they exit from the intervertebral foramina produce an inflammatory response i n the root with secondary edema.

As the greater and lesser occipital nerves pierce the trapezius at the base of the skull they are subject to pressure by cervical muscles and spasm. The result, an occipital neuralgia, produces further cervical spasms leading to a reflex perpetuation of occipital pain. Carcinoma and tumor invasion of the cervical spine and soft tissues of the neck may cause destruction as well as encroachment in cervical nerve roots or invasion of branches of the cervical plexus. These malignant forms of cervicogenic headache will not be discussed.

Treatment

The purpose of this discussion is to describe those injection techniques that have been found useful in the treatment of muscle tension and cervicogenic headaches. These procedures include: trigger point injections, occipital nerve blocks, anesthetic blocks of the cervical nerve C2-C5, facet joint blocks at C2, C3 and cervical epidural steroid injections.

Occipital Nerve Blocks

To understand how a blockade of the occipital nerve is efficacious in the treatment of headache, a review of the anatomy will be presented. The greater and lesser occipital nerves are sensory nerve which enter into the second, and to some extent the thir d cervical segments. The nerves enter the spinal cord via the Tract of Lissauer to terminate in the substantia gelatenosa of the upper cervical cord where they synapse. The infratentorial intracranial structures are innervated by the upper three cervical nerves. Sensory cutaneous distribution in the occipital nerve is over the back of the head anteriorly to the borders of the innervation of the first division of the trigeminal nerve. The C2 component is a more medial band extending form the superior nuch al line to this boundary. C1, when present, innervates an overlapping area more posteriorly. The greater occipital nerve passes over the superior nuchal line midway between the mastoid process on the occipital protuberance just lateral to the insertion of the nuchal ligaments. The lesser occipital protuberance is just lateal to the insertion of the nuchal ligaments. The lesser occipital nerve passes laterally to the greater occipital nerve over the nuchal ridge.

The greater occipital nerve runs transversely and then turns at right angles to run posteriorly. It then emerges through the aperture above the aponeurotic sling between the trapezius and the sternomastoid. This fact renders untenable any speculation t hat it may be compressed by spasm in the trapezius. Similarly, the nerve is not vulnerable to bony compression between the posterior arch of the atlas and the lamina of the axis. How the occipital nerve becomes sensitive to the diverse headache condition described is still a matter of speculation.

Occipital nerve blockade has been used for the treatment of diverse headaches for decades. The most effective position for greater occipital blockade is sitting or lateral decubitus with the chin flexed upon the chest. A short 25 gauge needle is inserted through the skin at the level of the superior nuchal line so as to develop a wall of local anesthetic surrounding the posterior occipital artery. The procedure should be done under strict aseptic conditions. The artery is commonly found approximately one-third of the distance between the external occipital protuberance and the mastoid process on the superior nuchal line. Injection of 3-5 ml of local anesthetic in this area with or without depo-corticosteroids will produce satisfactory anesthesia. Due to the superficial nature of this block complications are infrequent but may include hematoma, infection and paresthesia. Occipital nerve blockade will local anesthetic may also be used as a prognostic tool to determine if rhizotomy is warranted in refr actory cases. Occipital rhizotomy may be performed surgically or using a cryoprobe.

To learn more and read the complete article please visit Dr. Lichten’s Website.

Cryoanalgesia is a pain-relieving technique which uses cold to treat nerve pain. It’s been around for centuries, and in its crudest form, uses ice to numb nerves. The more sophisticated, current type of cryoanalgesia uses a needle-like probe to deliver very, very cold sensation and thereby incapacitate nerves.

Detailed Description of Cryoanalgesia

Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of – 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions.

The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact.

Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis.

Regardless of your religion at a molecular level we are all atoms, beings that are electro chemical. Faith, energy, our brains, mood, stress, all play a role in healing. When we are emotionally stable and emotionally healthy we feel better, and we can heal faster.

Practice your religion, follow your faith; if you pray – then pray, if you meditate – then meditate. You will find some interesting information by searching online for “Violet Flame”, “Archangel St. Michael”, “Archangel St. Germaine”, “Buddhism”, “Higher Self”, etc. Find a doctrine that makes sense to you and explore. At the very least you will educate yourself to the fact that we as human beings are not alone.

What matters is you find your core belief system, you then practice it. Keep an open mind as there is much to be learned from all religions. And the “right” religions is merely the one you believe.