Breezy -

Agree with what people are saying. This is so far over the top on so many levels, it just boggles my brain. Legal, ethical, medical, you name it.

For starters, on the medical/legal level, not only are they COMPELLING you to undergo surgeries but they are making you go cold turkey in exchange for technology which may or may not be appropriate. Check out the Research and Clinical Articles page of the RSDSA cite under the heading Spinal Cord Stimulation and Neuromodulation http://www.rsds.org/2/library/articl...index.html#SCS paying particular attention to van Eijs, Smits H, Geurts JW, et al, Brush-evoked allodynia predicts outcome of spinal cord stimulation in Complex Regional Pain Syndrome type 1, Eur J Pain 2010 Feb;14(2):164-9 Epub 2009 Nov 25 FREE FULL TEXT AT http://www.rsds.org/2/library/articl...t_Barendse.pdf

SCS has evolved as a clinical application of Melzack and Wall’s gate-control theory (Melzack and Wall, 1965). The general mechanism of pain relief by SCS is still understood in these gating terms. The pain alleviating effect is generally seen to be caused by activation of large-diameter afferents in the dorsal columns. The fact that chronic neuropathic pain patients, even those with severe hypoesthesia, can still show a successful response to SCS might be explained by the presence of remaining intact large fibers in the dorsal column which can be recruited for stimulation. Pain in an affected extremity provoked by the normally non-painful stimulus of a brush is regarded as a sign of central sensitization (Vaneker et al., 2005). Our results show that brush-evoked allodynia seems to be associated with a lower chance of achieving long-term pain reduction with SCS treatment. This phenomenon is probably due to central sensitization which makes it difficult to suppress the total experienced pain, both spontaneous and evoked, even when stimulating the spinal cord dorsal columns. Central sensitization on spinal level occurs in the dorsal horn and is probably caused by repetitive high frequency stimulation of peripheral C-fibres leading to an amplification and prolongation of the response of the dorsal horn neurons, a phenomenon called ‘wind up’. This process may be linked to increased release of substance P and the excitatory neurotransmitter glutamate, mediated through voltage gated N-calcium channels, leading to postsynaptic N-methyl-D-aspartate (NMDA) receptor interaction and hyperexcitability. Furthermore the amount of inhibitory neurotransmitter Gamma-aminobutyric acid (GABA) and GABAergic interneurones within the spinal cord may increase or decrease the output of the dorsal horn. These mechanisms cause increased sensitivity to pain (hyperalgesia) and input from non-nociceptive Aß-fibres to be perceived as pain (allodynia) (Baron, 2009; D’Mello and Dickenson, 2008). So far, neurochemical and electrophysiological evidence from experimental studies has suggested that the effects of SCS on the dorsal columns are mediated centrally in the dorsal horns of the spinal cord, by altering the release of neurotransmitters (e.g. increased release of GABA) and suppression of hyperexcitable Wide Dynamic Range neurons (WDR) (Cui et al., 1996). In experimental SCS the amount of pain relief is related to the severity of allodynia (Smits et al., 2006; Yakhnitsaet al., 1999). The non-response to SCS in animals with severe allodynia may well relate to a severe form of central neuropathic derangement and may imply a disability to produce appropriate amounts of GABA, either alone or accompanied by the increased loss of inhibitory interneurons. In this scenario modulation of dorsal horn neurons by SCS could have either little or no effect. Other animal studies showed that the combination of SCS with pharmacological therapy, in rats not responsive to SCS, can become effective when combined with intrathecal or intravenous medication like baclofen, adenosine, gabapentin and pregabalin (Wallin et al., 2002). [Emphasis added.]

So, by any chance is your skin sensitive to light touch? Then SCS may not be right for you.

But of course they disclosed this risk to you, right? Let's just take a look at Wisc. Annot. Statute 448.30 :

Information on alternate modes of treatment. Any physician who treats a patient shall inform the patient about the availability of all alternate, viable medical modes of treatment and about the benefits and risks of these treatments. The physician's duty to inform the patient under this section does not require disclosure of:

(1) Information beyond what a reasonably well-qualified physician in a similar medical classification would know.

(2) Detailed technical information that in all probability a patient would not understand.

(3) Risks apparent or known to the patient.

(4) Extremely remote possibilities that might falsely or detrimentally alarm the patient.

(5) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment.

(6) Information in cases where the patient is incapable of consenting.

And how is this interpreted? Well, we have this recent case from the Wisc. Supreme Court: Bubb v. Brusky, 2009 WI 91, ___ Wis. 2d ___, 768 N.W.2d 903, FREE FULL TEXT AT http://www.wicourts.gov/sc/opinions/07/pdf/07-0619.pdf

Summary
This section requires any physician who treats a patient to inform the patient about the availability of all alternate, viable medical modes of treatment, including diagnosis, as well as the benefits and risks of such treatments. Although the jury determined a physician was not negligent in his standard of care for failing to employ an alternative when treating the defendant, that did not relieve the physician of the duty to inform the patient about the availability of all alternate, viable medical modes of treatment.

Now, referring to an issue Dubious raised, what happens when a surgeon oerform an operation without full informed consent? Although here I didn't find any Wisconsin authority immediately available, we have the general rule expressed by the great Justice Benjamin Cardozo, when he sat on the New York Court of Appeals, in Schloendorff v the Society of the New York Hospital, 211 NY 125, 105 NE 92, (1914):

Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages.

For a great article on point with all sorts of helpful stuff, check out, Timothy J. Paterick, Geoff V. Carson, Marjorie C. Allen, and Timothy E. Paterick, Medical Informed Consent: General Considerations for Physicians, Mayo Clinic Proceedings March 2008 vol. 83 no. 3 313-319, FREE FULL TEXT AT http://www.mayoclinicproceedings.com.../83/3/313.long

Abstract
Medical informed consent is essential to the physician's ability to diagnose and treat patients as well as the patient's right to accept or reject clinical evaluation, treatment, or both. Medical informed consent should be an exchange of ideas that buttresses the patient-physician relationship. The consent process should be the foundation of the fiduciary relationship between a patient and a physician. Physicians must recognize that informed medical choice is an educational process and has the potential to affect the patient-physician alliance to their mutual benefit. Physicians must give patients equality in the covenant by educating them to make informed choices. When physicians and patients take medical informed consent seriously, the patient-physician relationship becomes a true partnership with shared decision-making authority and responsibility for outcomes. Physicians need to understand informed medical consent from an ethical foundation, as codified by statutory law in many states, and from a generalized common-law perspective requiring medical practice consistent with the standard of care. It is fundamental to the patient-physician relationship that each partner understands and accepts the degree of autonomy the patient desires in the decision-making process.

All that said, while the abstracts I've seen in PubMed become aomewhat murkier on the questions of compelled treatment if someone is deemed "an addict," no where can I find authority for the proposition that a CPRs patient on Methadone, a strong NDMA-receptor antagonist, should be required to drop it overnight in favor of a SCS that may not work!

So, in addition to what Pete and Dubious have already suggested, I would offer two thoughts.

First, do you have a friendly doctor? Specialty or lack thereof is immaterial. If so, I would call her/him immediately, explain what's going down and have you go in and sign a request for the immediate turnover of all your patient records, including treatment notes to your favored physician. There's got to be good stuff in there. (While you probably have the right to get that all yourself, either under state law or HIPPA, you're more likely to get an "unexpurgated" copy, delivered faster, if the request comes from another doctor.) Hopefully you can at least use these records to find another pain doctor sooner rather than later if your GP is unable to prescribe the pain meds you need.

To that end, you can also use a remarkable little search engine, showing the names, addresses, etc. of those pain management specialists who have been board certified by the American Board of Pain Medicine (ABPM), a certification that is only given after the doctor completes a formal residency or fellowship in pain medicine and then sits for an 8 hour written exam. (This is in contrast to another "certifying" organization that requires no formal training in the field.) Here's a link that lays out who they are http://www.abpm.org/about/index.html and here's the search engine http://www.association-office.com/ab...dir/search.cfm

Finally, with your records in hand and with at least with some pain management services available to you, even if you have to go slightly out of your way to connect with another group, you might want to actively seek out the services of an agressive medical malpractice lawyer in your area (the kind that begins selective suits with a press conference for the benefit of the local television stations) and isn't afraid to shout CONFLICT OF INTEREST and BREACH OF FIDUCIARY DUTY from every rooftop in town. This one just smells rotten to the core.

Just some thoughts, but I hope you find something useful in them. Apologies for going on so.

Mike