Danger of “Fail First” Treatment Plans for Pain

Former radio personality Radene Marie Cook rues ‘fail first’ treatment plans for chronic pain | Drug Store News

This is a sad story exposing the further harm caused by “fail first” policies for pain treatment after an injury.

Radene Marie Cook had two complimentary careers: she was a professional actress, dancer and singer in southern California, and she enjoyed a 16-year run as an on-air radio personality  But on March 16, 2000, all that changed. While working, her aircraft was hit by a “microburst,” a wind shear event known for being especially violent and often deadly.

Placed in the workers’ compensation system, Cook said all of her care was “determined not by myself or my doctors, but by what benefits could be listed behind my case number.”

“But where my injuries started was nothing compared to where I ended up after four-plus years of ‘treatment’ under the bureaucracy of workers’ comp and ‘fail first’ treatment policies that continued to injure me despite protests,” Cook said.

Though her assigned spinal doctor recommended surgery to stabilize a fissure found at L5-S1 in November of 2000, surgery was not allowed until she “failed” at physical therapy, she says. Although her doctor assured workers’ comp staff that Cook had indeed “failed” at physical therapy and warned that if stabilization was not given, untreatable nerve damage may occur, the workers’ comp system still did not approve further treatment until July of 2001

Surgery was finally approved but was too late; there were damaged nerves that the stabilization surgery could not fix. Two more surgeries failed to provide relief as well.

“In the four years I was under treatment through workers’ compensation insurance, which adhered to ‘fail first’ policies rigorously, more damage than healing occurred,”

Though ineffective after the first injection, she had to continue to “fail” at the injections or she would receive no other treatment,

Over time, her injuries deteriorated, and she received diagnoses of adhesive arachnoiditis in her low back and neck; central pain syndrome; complex regional pain syndrome-type II; cauda equina syndrome; and severe epidural fibrosis. “The pain was constant and hellishly brutal,

Fed up, Cook, her husband and family decided to leave the workers’ comp system, which they say was literally killing her by denying her doctor-recommended pain treatment. Luckily, they were able to obtain private insurance.

A new pain doctor with expertise in intractable pain told Radene that … “Without treatment for the pain itself, the heart can arrest and the brain will stroke in a short sustained time”.

A multi-modal treatment regimen with high-dose opioids as its base finally began to offer her some relief.

“Although I am still in pain, my life is improving significantly,” Cook said. “It is because I have access to the opioid treatment appropriate for me and because of the individualized treatment plan worked out between me and my doctor that I can again have a quality of life that overshadows the pain — something I could not have when left to ‘fail first’ treatment plans.”