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.
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
September is Pain Awareness month!
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.
Barbara presented to our Frederick office with post-laminectomy syndrome (aka failed back surgery syndrome) causing lower back pain that radiated down her legs.
Read Barbara’s Q&A.
What was the nature/cause of your pain?:
I had lower back and leg pain due to complications from back surgery.
How did your condition affect your life?:
I couldn’t sit or stand up for more than 10 minutes. I experienced throbbing pain while standing up. I was forced to retire from teaching as I was unable to stand the 6 hours a day I had to. I couldn’t sleep more than 4 hours as the pain was waking me up. I had no sexual desire, no social life due to pain, and buttock pain also.
How did treatment improve your life?:
Spinal injections, along with the pain medication gave me relief.
How would you describe your experience with Newbridge Spine & Pain Center?:
All front office assistants, office manager, nurses, Drs. and Carlton McClellan are my God-saviors with their marvelous support, understanding, attention, and patience that I don’t see at other places.
What advice would you give someone else with your condition or symptoms?:
Be honest and speak up. Firmly explain your frustration with pain and be sure to give a weekly summary of what you have been doing and how you try to work through the pain in order for the doctors to understand you better.
Don’t wait too long to take your medication if pain is intolerant. Of course, follow the pain dosages as prescribed.
If you experience similar pain due to complications after back surgery we can help contact us to arrange an appointment with one of our experienced physicians in your local area.
If we’ve helped you please share your success story.
As pain providers we see a significant number of patients experiencing knee pain. One of the most common causes of persistent knee pain is osteoarthritis.
Osteoarthritis is a form of arthritis that affects the joints and the cartilage of the joints, it impacts flexibility and can result in painful bone spurs.
The general symptoms of this type of arthritis are stiffness, pain and swelling of the affected joints is also common.
X-rays and MRI scans can confirm a diagnosis. Sometimes called degenerative joint disease, osteoarthritis cannot be cured, however, pain can often be relieved without the need for invasive surgery.
Pain caused by osteoarthritis in the knee can be alleviated a variety of ways. Newbridge physicians offer injections of corticosteriods which have proven to help inflammation of swollen joints, however, additional options are also available and are commonly used to relieve knee pain.
Supartz injections are specifically designed to help osteoarthritis of the knee joint. Supartz is a solution made of purified sodium hyaluronate. Hyaluronan is a chemical naturally found in the joint tissues and the fluid that fills your joints.
Genicular nerve blocks and radio-frequency. The genicular nerve block procedure is performed to both diagnose the source of pain ascertain effectiveness of an RFA treatment. A successful nerve block procedure generally qualifies a patient for radio-frequency ablation (RFA) of the same nerve this treatment has proven to be an extremely popular and effective long term pain solution.
Neck pain is the second most common complaint among our patients second only to lower back pain of course.
There are myriad reasons that pain in the neck can occur. Sometimes the cause is obvious, a patient has had an accident or injury resulting a physical trauma that causes pain in the neck or cervical region. However, other times you may not be able to pin point a specific incident or don’t understand what happened to actually cause the pain you are experiencing. In medical terms this is called idiopathic pain which can be more difficult to treat.
Your neck is made up of ligaments muscles and bones. The cervical spine (the upper vertebrae of the spine) goes from the skull to the torso between each vertebrae are discs that act as shock absorbers between the bones.
Injury, inflammation and a range of abnormalities to any of the above can cause neck pain and stiffness.
Types of neck pain and possible causes
Pain going down your neck through your shoulders or arms is called radiating neck pain or cervical radiculopathy. If you experience this you may be suffering from either a cervical herniated disc spinal spinal stenosis or degenerative disc disease.
Cervical radiculopathy is commonly associated with an injury near the nerve root and is often called a “pinched nerve”. Radiating pain may be accompanied by numbness or tingling down the arm.
Spinal stenosis is the narrowing of the spinal canal. As the spinal canal narrows it puts pressure on the nerves which in turn may cause pain. Foraminal stenosis is the narrowing the cervical disc space due to the enlargement of a joint in the spinal canal. In some cases this condition may require surgery.
Degeneration of the disc, where the space between the individual vertebrae becomes smaller and the disc becomes less spongy and therefore less capable of absorbing shock, is also a very common cause for neck pain.
In some case muscle stiffness may be the cause of neck pain. In these cases trigger point injections can help by encouraging blood flow to the region by igniting the body’s inclination to self heal.
If you are experiencing neck pain that persists your pain management specialist can order Xrays and MRIs to discover the root cause of this pain and develop a multi-modal treatment plan to combat pain and help you regain your quality of life.
As much as we would love to take a vacation from our pain the reality is that our chronic pain will vacation with us.
Here are are few suggestions for those suffering from severe, persistent or chronic pain while preparing for your summer vacation.
- Check out the digs before you go. Sleeping on a hotel or guest bed is trying for anyone; however, for those dealing with chronic pain this could mean the difference between sleeping at all and being able to walk the next day. Prepare yourself by calling ahead find out about the size, age and quality of the mattress you’ll be sleeping on. If need be bring your own mattress topper (you can buy a Tempur-Pedic mattress topper online for the price of one nights stay in a hotel) and remember your own pillow if you suffer from neck pain.
- Find out where the local urgent care, internal medicine, PT and/or massage therapist is at your destination. You may need to make a visit to one of these providers so having their contact details on-hand will avoid wasted time in the event you may need their services. You may wish to call each of these places to check their office hours and keep in mind that booking a mid-vacation visit to the local massage therapist before you get on the road might be necessary if they are popular.
- If you’re travelling long distances be sure to prepare your vehicle for optimum comfort. There is nothing worse than feeling the onset of that pinched nerve or nagging sciatica when you’re only 1 hour in to a 5 hr drive.
- If you are travelling by car bring a cooler with an ice-pack ready to go and any topical pain relievers you may wish to use. Plan out your route and take time at rest stops to stretch and move around,
- If you are travelling by air be sure to pack light / use a rolling bag to avoid any unnecessary lifting and request an aisle seat so you can get up when and if you need to move around.
Either way you travel taking a warm bath right before you leave the house can help relax your muscles and prepare you for a long trip too.