3 Day scripts a good idea?
With Governor Hogan’s Heroin and Opioid Prevention, Treatment and Enforcement Initiative being announced in early 2017 there has been a lot of talk recently about the appropriate number of days a narcotic prescription should been written for.
An informative and timely article, dated January 28 2017, written in the Frederick News Post by Frederick physician Dr. Julio Menocal, addressed many of the issues relating to narcotics and opioids prescribing he suggested that a 3 day rule be instituted. One of our Frederick and Leesburg based pain doctors Dr. Chirag Sanghvi and our senior staff have pondered this suggestion.
The opioid epidemic is a very real concern. As the Surgeon General pointed out in his letter to physicians dated August 25 2016, “Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed.”
However, expecting your internal medicine/ primary care physician to have the tools to manage genuine long-term chronic pain is unreasonable considering the huge variety of ailments they skillfully treat and juggle daily.
What are the unintended consequences of the 3 day narcotic/ opioid script?
There are many complexities involved in treating pain responsibly. The proposed three-day rule certainly addresses the need for increased monitoring of opioid and narcotic prescriptions.
However, will this rule itself achieve the desired outcome?
With the assumption that terminally ill patients, such as patients with cancer, would not be subjected to the three-day restrictions we must also look at the unintended consequences this rule may trigger:
- Large burdens on waiting rooms and provider schedules as patients fill the books with prescription refill, UDS screen and pill count appointments,
- Additional monthly cost for patients who pay co-pays for every visit,
- Increase in overall health care costs (which may be passed on to all patients eventually),
- Emotional stress on genuine patients who feel they are being treated like drug seekers.
For those who are drug seeking there are other potential consequences to keep an eye out for:
- Potential for increased incidences of “doctor shopping” in neighboring states
- Potential increased theft of medications and break-ins,
- Increase in use of heroin and alternative drugs as opioids become more difficult to obtain.
The three-day rule is certainly a conversation to be had, but perhaps equally as relevant is exploring alternative pain treatments.
Are we taking the right approach?
Many people do not realize that pain management is a specialty itself and is offered as a separate board-certification.
Unfortunately, most people seek specialist pain management care after having suffered with chronic pain for a long time and seeing physicians whose therapies are limited to pain medications.
Chronic pain along with prolonged use of narcotics causes multiple changes in the body such as changes in normal levels of circulating hormones and sleep cycles. These chronic physiologic changes can cause mood changes along with changes to how our bodies perceive pain.
The good news is that there are many alternative pain treatments available. In most cases successful pain management utilizes an integrated approach that encompasses a combination of treatments.
As physicians we recognize that the opioid epidemic is a very real and serious situation. As board-certified interventional pain specialists we also recognize there is a need to treat genuine pain responsibly.
We therefore recommend;
- Using non-surgical, interventional procedures to immediately and effectively reduce pain levels.
- In cases where medication management is necessary; reduce reliance on pharmacologic substances, maintain low doses and do not limit “pain medicine” to strong opioids & narcotics,
- Outline a detailed and carefully designed treatment plan that takes a multi-modal approach to include: weight-loss, chiropractic, physical therapy and/or counselling.
Interventional pain management procedures often enable patients to participate in and get the most out of other alternative treatments such as exercise, physical therapy or chiropractic manipulation.
These therapeutic interventions (procedures) work extremely well at the onset of pain when other physiologic changes have not yet occurred in the body and there is less damage to reverse.
Therefore, the earlier a patient seeks specialist care for their pain the less likely that patient is to be placed on a long-term medication schedule.
Winter and the holidays is an exciting season. Most of us are spending time with family and friends, rushing around and putting up or taking down decorations for the changing holidays.
It’s at this time of year we see an increase in accidents and injuries that have potential to develop in to acute or chronic pain conditions. Conditions such as disc herniation, pinched nerves, and lower back or knee injuries can develop from accidents caused by common actions we take during the holiday season. Therefore, we urge our patients to take extra caution. Here we offer a few things to remember when fulfilling your holiday cheer.
Improper lifting technique can harm both your knees and lower back.
Remember to keep a wide base, bend at the knees (squat), slowly lift, use your feet and lead with your hips.
For more info on proper lifting technique visit:
Pain during the Holidays
Pulling out items from above your head can put tremendous strain on the shoulders and cervical spine if done in a haphazard fashion.
Beware of over stocked boxes, they may be heavier than you think.
Be sure when you are pulling items from above your head you have someone or something beneath to help you catch them.
Holiday light stringing and removing increases the risk of falling from heights.
Falls can range in severity causing minor bruises to broken bones or vetebral fractures leading to spinal instability.
Make sure to use an appropriate ladder or step ladder and that it is placed on a firm and sturdy surface.
Be wary if you are helping someone bring down decorations as you could be at risk for items falling from an attic or off the top of a roof or ladder.
If you’re not careful dropped items that cause injury can lead to a chronic pain condition.
Raking leaves and shoveling snow:
Improper raking and shoveling techniques can harm both your knees, upper and lower back. Avoid injury by using proper shoveling technique.
For a video on shoveling techniques visit:
Snow Shoveling Techniques
Pain is often misleading. It can radiate and travel throughout the body leaving a patient unsure of the actual source of pain or injury this is the case with cervical radiculopathy.
Impingement of a nerve in the cervical spine (neck) can often cause cervical radiculopathy or cervical radiculitis.
This type of pain is particularly deceiving as it may present as shooting pain, tingling, numbness and muscle weakness and may be felt in the neck, upper back, shoulders, arms, hands and/or fingers.
Cervical radiculitis usually occurs as a result of some underlying condition affecting the cervical discs or vertebrae. Such conditions may be; herniated disc in the neck, spondylolisthesis, or a buldging disc for example. In some cases the cause of these conditions is due to an injury or trauma of some kind, however, very often cervical pain is due to degeneration in the spine. Age, poor body mechanics, smoking, and genetics are all factors that contribute to neck pain.
Treatment of cervical radiculopathy
Radiating pain can mask the underlying cause or source of pain which could lead to an inaccurate diagnosis and mistreatment of the pain.
Therefore it is imperative that patients seek the medical attention of a qualified pain specialist who can perform appropriate diagnostic tests and order MRIs or XRAYs to pinpoint the true source of their pain.
The conservative, non-surgical and minimally invasive treatments offered by interventional pain specialists often solve the pain associated with cervical radiculitis at the source of the problem.
Interventional pain management offers advanced injection based procedures that reduce the need for medications, provide longer term pain relief and reduce the likelihood of expensive surgeries with long recovery times.
Procedures designed specifically for the cervical spine include:
The Surgeon General, Vivek H. Murthy, M.D., M.B.A. recently sent out a letter to all American physicians urging us to do everything in our power to address the opioid epidemic.
The opioid epidemic is a very real and serious situation, so too is the need to treat pain responsibly.
Newbridge Spine & Pain Center is one of the Greater Washington area’s premier interventional pain management facilities dedicated to treating pain. Our physicians are Anesthesiologists with sub-specialty training in pain management.
There are many misconceptions about the ‘pain management’ specialty resulting from the mismanagement and over-prescribing of addictive painkillers. However, our specialization, interventional pain management, addresses both the rising opioid epidemic and the need to treat pain.
Treating pain in a conservative, responsible manner is our daily commitment.
We do this by:
- Utilizing non-surgical, interventional pain procedures to quickly and effectively reduce pain levels.
- In cases where medication management is unavoidable, we aim to reduce reliance on pharmacologic substances, opioids & narcotics by maintaining low doses and outlining treatment plans that take a multidisciplinary approach to include; weight-loss, physical therapy and/or counseling for example.
The Newbridge team spends a significant amount of energy encouraging our fellow healthcare providers to refer to interventional pain management before prescribing or laying out a treatment plan. This is because our therapeutic procedures work at the onset of pain as well as for chronic pain conditions.
We firmly believe that the sooner a patient can be treated by a pain specialist using interventional methods the less likely that patient is to be prescribed a long-term medication schedule.
Most pain complaints relate to pain originating throughout the spine, however, an interventional pain doctor can treat acute and chronic pain all throughout the body to include the limbs and joints in the peripheral body.
Statistics show that chronic pain affects more Americans than diabetes, heart disease and cancer combined (Source:http://www.painmed.org/patientcenter/facts_on_pain.aspx).
These statistics indicate that treating pain responsibly is a major health concern and demonstrate the need for ethical, qualified and specialized practitioners in the field.
The term “pain management” is likely to conjure thoughts of dangerous medications and drug addiction. The mismanagement and over prescribing of addictive pain killers has certainly become a major problem in today’s society making it no longer appropriate or appealing for your family practitioner to treat pain.
A relatively misunderstood and underutilized specialty called interventional pain management has emerged from the well-publicized opioid epidemic and the genuine need to responsibly and effectively treat pain.
The role of a good interventional pain management physician is to provide improved quality of life and enable patients to participate in activities such as; pick up their child, walk the dog and participate in physical therapy sessions for example.
An interventional pain management specialist could be a physical medicine and rehabilitation (PM&R) physician or, as is the case at Newbridge Spine & Pain Center, a highly skilled, board certified anesthesiologist sub-specialized in pain management procedures and techniques.
There are many misconceptions about what an interventional pain management physician actually does and few people know the full scope of procedures available to responsibly and effectively treat pain.
Firstly, an interventional pain specialist does not just write prescriptions, in fact, this is at the bottom of their toolkit. The interventional pain doctor performs procedures either in an office or ambulatory surgical center (ASC) setting.
These procedures range from a simple trigger point injection, epidural steroid injection, or a nerve block to radiofrequency ablation or spinal cord stimulation for example. Many of these procedures can help patients avoid an opioid or narcotic medication schedule altogether.
Learn more about interventional pain management at newbridgespine.com
View Doctor bios at http://newbridgespine.com/our-providers
Southern Maryland’s premier medical facility exclusively dedicated to pain management, has added a new Nurse Practitioner to their team, Ms. Felicia DePina.
Ms. DePina is a native of Chicago’s south side. She is a military vet who served her country in both peace time and war as a combat medic; achieving the prestigious Army Accommodation Medal for military service.
During her military tenure she saw first-hand the benefit of and need for responsible short and long-term pain treatment.
Following an honorable discharge from the US Army Ms. DePina attended the University of Alaska Anchorage where she received a baccalaureate of science in nursing.
Ms. DePina enjoyed a full and satisfying nursing career of more than 15 years, before deciding to take her nursing experience and education to the next level. She pursued an advanced master of science in nursing degree, ultimately becoming a Nurse Practitioner.
Ms. DePina is board certified nationally as a Family Nurse Practitioner, through the American Academy of Nurse Practitioners. She is a Certified Registered Nurse Practitioner in the state of Maryland, currently holding states licenses as a registered nurse in Georgia, Maryland, North Carolina, and Texas.
As the newest member of the Newbridge Spine & Pain Center team in Southern Maryland she will see patients suffering from chronic pain primarily at the practice’s Waldorf location. There she will join a well-established team including; Physician Assistant, Singh Bhurji and CRNP, Celia Gramsky all assisting board-certified interventional pain management physicians, Dr. Madhavi Chada and Dr. Majid H. Ghauri.
September is Pain Awareness month!
Chirag Sanghvi M.D. now seeing patients in Leesburg, Virginia
Leesburg, Virginia – July 26, 2016 – Newbridge Spine & Pain Center, Loudoun County’s specialist pain management facility added physician Chirag Sanghvi, M.D. to head their Virginia team.
Dr. Chirag Sanghvi is board certified in both Anesthesiology and Pain Management and completed his fellowship in Pain Management at the Cleveland Clinic in Cleveland, Ohio.
Dr. Sanghvi was the lead physician at the Prince Frederick, MD branch of Newbridge Spine & Pain for over 4 years until his recent move to Northern Virginia. After several months in Loudoun County patient feedback for this physician has been outstanding;
“[He is] very knowledgeable and professional. He listens and explains the causation and treatment plan for my condition thoroughly. I have the utmost trust in his decision making.” states current patient Kevin K.
The complexity of treating pain has never been more evident than it is today.
Due to this Dr. Chirag Sanghvi urges patients to come to pain management as early as possible, “to prevent pain from progressing into a debilitating hindrance it needs to be treated appropriately. Patients come to me after years of improperly dealing with pain and perhaps having seen many physicians. I cannot emphasize enough that the earlier I can treat a patient with interventional procedures the less likely they are to have long-term pain and the need for long-term treatment”
Pain is one of America’s largest health challenges and can have a devastating impact on a person’s ability to do every-day-things. As a firm believer in the multidisciplinary approach most of Dr. Sanghvi’s treatment plans incorporate other modalities such as physical therapy.
This fact makes Dr. Sanghvi’s goal all the more promising as he takes the Leesburg practice under his wing, “my goal is not only to help reduce pain but to optimize my patient’s ability to perform their daily tasks, pursue their hobbies and live a happy, active lifestyle.”
Newbridge Spine & Pain Center is open 5 days a week and is located at 161 Fort Evans Rd NE, Suite 340, Leesburg VA 20176. View Dr. Sanghvi’s bio at http://newbridgespine.com/doctor/sanghvi/
Sports injuries are common and no doubt you’ve heard the saying in competitive sports, “no pain, no gain”. As pain specialists, however, we wouldn’t recommend subscribing to this theory.
As with any pain there are acute and chronic injuries. According to the National Institute of Health [NIH.gov] signs of an acute injury may include:
- Sudden, severe pain
- Not being able to place weight on a leg, knee, ankle, or foot
- An arm, elbow, wrist, hand, or finger that is very tender
- Not being able to move a joint as normal
- Extreme leg or arm weakness
- A bone or joint that is visibly out of place.
Many acute injuries can easily be treated using home remedies beginning with the RICE method (Rest, Ice, Compression, and Elevation). But, if pain symptoms get worse or do not improve you could be at risk of developing a chronic injury.
Chronic injuries will continue to cause pain after you’ve played a sport or participated in exercise for a long time. The signs of a chronic injury may include:
- Pain when you play
- Pain when you exercise
- A dull ache when you rest
Interventional procedures are well suited to aide recovery from many chronic and acute sports injuries. Since they are outpatient procedures they require little recovery time and often result in immediate pain relief or at the least moderation of pain.
Procedures range to treat shoulder injuries, tennis elbow (bursitis), knee pain, back injuries and neck injuries. The best course of treatment for sports injuries is often a multi-disciplinary approach.
Interventional procedures coupled with rehabilitation exercises, such as physical therapy will help patients recover faster, regain range of motion and strength.
A few of the procedures commonly used to treat sport related injuries include:
For people with bad back pain participating in summer time activities and exercises can be daunting. On the other hand, many symptoms of bad back pain can be relieved to some degree with physical activity.
Loads of developments offer a pool as part of the HOA amenities but local YMCAs are a good option too. In many cases your local Y will also offer swimming lessons and water based exercise classes. Water is great for rehabilitation as it helps take the pressure off the joints and enables patients to break a sweat while also taking a load of weight off the body.
If classes seem like a bit of a stretch at this point in your rehabilitation schedule then simply wading water at your own pace might appeal to you.
Caution beach-bound vacationers: Easing into a water exercise regime by going to a swimming pool is usually better than jumping straight into the ocean as tides and waves could put unwanted strain on your joints and muscles.
Yoga has many benefits including improved breathing, strength and flexibility. Contrary to popular belief yoga is not just for the ultra fit or flexible it is for those aiming to achieve mindfulness in physical activity and awareness of the mind and body connection. The fitness benefit is an added afterthought.
Summer is a great time to start yoga if you’ve never tried it before because there are plenty of free outdoor yoga classes offering beginner sessions. Here are a few places to check out what’s going on yoga wise:
Southern Maryland yoga on the wharf. This free activity can be taken at your own pace.
Frederick in partnership with Sol Yoga do free classes with “Yoga on the Creek” Thursday mornings during the summer.
Low impact exercises are the key. You’ll get the most benefit from these summer exercises by ensuring you listen to your body and take every exercise at your own pace.
*Always talk to your doctor before starting a new exercise regime.