The Opioid Crisis in 2019

Could this be the year that turns the tide of the opioid crisis?

Opioid overdose deaths, which reached 47,600 across the nation in 2017, continue to ravage many parts of the country. New laws and new ways of looking at pain management are offering glimmers of hope.

The use of opiate drugs continues to skyrocket; however, healthcare and law enforcement agencies aim to stem the opioid crisis by finding alternatives to pain medication, expand treatment and stop overdose deaths. So far, there are only patchwork solutions, but they show promise.

Many addictions start in the physician’s office. PPOA distinguishes itself by focusing on interventional pain management procedures, and such minimally invasive procedures as laser spine surgery and SI joint injections.

For patients who come to PPOA clinics already taking opioids for chronic pain, PPOA has long relied on medication management and pharmacogenomics, a drug-genes test that ensures each patient gets the right dose of genome-compatible medication.

Drug genes testing is now being used by other respected healthcare operations like Mayo Clinic and Cleveland Clinic.

Legislation to fight opioid abuse

As of October 2018,  at least 33 states have enacted legislation related to opioid prescription limits. Different communities around the nation are taking different approaches to stem the tide of addictive painkillers.

Last July, Florida lawmakers enacted stiffer rules governing prescriptions, and allocated $60 million toward treatment resources and a wider availability of the opioid antidote naloxone. Read more about the law.

In Texas, prescriptions now contain advanced security features to prevent fraud during the filling process. As of June 1, 2019, doctors will have to order new prescription forms and join the states’ prescription monitoring program (PMP), known as PMP Aware. This allows physicians to check a patient’s prescription history for information related to drug abuse and doctor shopping.

In Ohio, the Cincinnati area has cut opioid deaths by over 30 percent in six months since widely handing out Narcan, a nasal spray form of the opioid antidote Naloxone, to the public.

While naloxone remains controversial – it doesn’t prevent addiction – its use has increased around the nation. PPOA offers it with every painkiller prescription. In Burlington, Vermont, the mayor and police chief have teamed up to arm law enforcement, emergency workers and the public with the antidote.  The state is also focusing on long-term treatment, as are others.

In Rhode Island, a program providing recently released inmates with medication-assisted treatment has cut overdose deaths by more than 60 percent.

Finally, the federal government has taken steps to fight the opioid crisis. The SUPPORT for Patients and Communities Act, passed Oct. 3, 2018, took effect Jan. 1. Among other measures, it creates grants for more addiction recovery centers, expands naloxone access, and focuses on best practices in prescribing.

While it’s too early to tell which approach will work, PPOA continues to lead the way by focusing on non-opioid pain treatments and personalized medicine.

 

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PPOA Pilots New Endoscopic Camera

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The MIDASVu endoscopic camera is used for joint surgery and regenerative medicine

 An age-old problem with some types of joint surgery isn’t one that patients hear much about: for the surgeon, finding the target area isn’t always precise.

“Forty percent of knee injections are not in the knee. Even with people who know what they’re doing, it’s easy to miss the capsule,” says Dr. Abraham Rivera, Chief Medical Officer of Physician Partners of America.

Knowledge and experience are critical to a specialist’s success, but PPOA has taken patient safety a step further. It has becoming a pilot center for a device called MIDASVu. This next-generation endoscopic video camera can see what a live x-ray, or fluoroscope, can’t.

MIDASVu is an 18-gauge needle with an endoscopic camera attached to the tip. The creator, IntraVu Medical, Inc. of California, developed the device for a number of applications. These include arthroscopic surgery and regenerative medicine procedures.

“It’s an amazing piece of equipment. The endoscopic camera allows us to make certain that the needle is exactly inside the joint to deliver the medication or stem cells exactly in the right place inside the joint. It’s one order better than the fluoroscope,” Rivera says.

“Additionally, a physician can now quickly and easily check on healing and progress following a procedure with a simple, in-office needle stick using the MIDASVu,” Rivera says. “That’s something which previously required another visit to the MRI.”

MIDASVu is available in all PPOA locations.

Watch a demonstration here: https://vimeo.com/223131450

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Overlooked Causes of Lower Back Pain

Sacroiliac joint problems are common but misunderstood

 

Lower back pain afflicts one in ten people at some point in their life. One of the most overlooked causes of back pain is sacroiliac joint dysfunction. The right diagnosis and treatment are crucial for alleviating this chronic pain condition and allowing sufferers to live a full life.

What is sacroiliac joint dysfunction?

If you’ve looked at an x-ray or a spine model, you’ll recognize the sacrum as the triangle-shaped bone at the base of the spine and above the tailbone. Sacroiliac – or SI – joints connect it on either side to the iliac bones in the hip joints. The sacroiliac joint is what transmits the forces of the upper body to the pelvis and the legs.

Part of the reason sacroiliac joint dysfunction is an overlooked cause of lower back pain is its similarity to herniated discs. Most common in young and middle-aged women, SI joint problems may be the result of a misalignment of the joint, and either too much or too little movement: Too much movement can result from pregnancy or spinal fusions of adjoining vertebrae. This can create loose ligaments. Too little movement can result from arthritis and other degenerative joint diseases.

No matter the cause, the result is a painful inflammation known as sacroiliitis.

sciatic nerve

sciatic nerve

Symptoms include:

  • Pain the lower back, groin, pelvis or buttocks
  • Pain along the sciatic nerve in one or both legs (see image, right), but rarely radiating all the way to the feet
  • Stiffness or numbness in the pelvis area
  • Pain when standing up from a sitting position

Treatments for SI joint pain

Minimally invasive, nonsurgical treatments can offer significant relief for sacroiliitis, one of the most overlooked causes of back pain. Many physicians prescribe physical therapy and specific exercises first. Chiropractic manipulation of the joint can provide temporary relief. If stability is an issue, a special pelvic belt can be worn. Medications, such as acetaminophen, anti-inflammatories and muscle relaxants provide relief in some cases, but this is not recommended.

For longer term relief, sacroiliac joint injections are among the most helpful treatments. First, they can be used to diagnose the condition. This is important because the symptoms of SI joint disease can mimic other conditions. As a treatment, SI joint injections deliver medication for pain and inflammation directly into the joint. This is an advantage over oral medications because it eliminates the side effects of systemic medicines.

SI joint fusions for chronic lower back pain

Fusions are used to stabilize vertebrae and relieve pain. Unlike open-back surgery that takes weeks or months of recuperation, minimally invasive SI joint fusions are done through a magic marker-sized tube. Through the tube, tiny instruments spread muscle instead of cutting and tearing, leading to a fast recovery from SI joint dysfunction, one of the most overlooked causes of lower back pain.

To learn more about SI joint treatment options, call Physician Partners of America at 844-542-5724 or go to our website and chat with us online.

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PPOA Offers Continued Pain Care for Snowbirds

Outpatient treatment makes vacations more enjoyable for long-term pain patients –

Just because someone is living with long-term pain, it doesn’t mean they have to forego their winter vacation. Insured seasonal visitors to Florida and Texas can get continued pain management care without worry at Physician Partners of America. PPOA accepts out-of-state identification for patients suffering from chronic pain and helps them with tailored treatment plans.

PPOA specialists can make arrangements with the patient’s home-state pain physician to receive the patient’s medical records in advance of a visit. Its partner doctors can perform a variety of cutting-edge interventional treatments.

[Watch Dr. Chad Gorman discuss your options .]

All treatments are minimally invasive and performed outpatient, so most patients can walk out the same day and enjoy their vacation time. They include nerve blocks, radiofrequency ablation (RFA) and trigger point injections. The company also offers neuromodulation and laser spine procedures.

Offering cutting-edge pain care for snowbirds

Based in Florida, a top tourism state, Physician Partners of America has a unique understanding of the so-called snowbird population — another name for long-term winter visitors. The Sunshine State welcomed 118.5 million visitors in 2017 and expects a 6 percent increase this year. Dallas-Fort Worth sees an annual 44 million visitors each year, including nearly 3 million from foreign countries.

PPOA clinics accept any commercially insured patient with a legitimate, commonly recognized form of identification. This includes a driver’s license or identification card issued in any state, in addition to military IDs and U.S. passports.

The company’s 14 pain relief clinics in Florida and nine in Dallas-Fort Worth also accept Medicare and Tricare.

“We don’t like the idea of pain patients miss out on the fun of snowbird life,” says Josh Helms, Chief Operating Officer of Physician Partners of America. “If we can improve their quality of life while they are away from home, we are happy to help.”

About PPOA:

Physician Partners of America (PPOA) is a national healthcare organization focused on strengthening the doctor-patient relationship, improving patient outcomes and leading the fight against the opioid crisis. Founded in 2013 and headquartered in Tampa, Fla., PPOA and its affiliates share a common vision of ensuring the wellbeing of patients through interventional and minimally invasive treatments, primary care, orthopedics and laser spine procedures. Its model allows its physician partners to focus on patient care in the face of increasingly complex administrative requirements. For more information about Physician Partners of America, visit www.physicianpartnersofamerica.com.

 

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4 Tips for Healthy Holiday Meals

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Healthy holiday meals start with planning and smart choices –

Getting ready for the holidays but dread blowing your diet? Whether you want to keep your weight down or avoid aggravating inflammation, here’s good news: you certainly can enjoy the bounty of the season in a healthy way. Here are four tips for striking the right balance.

1. Limit portions

First of all, good nutrition is always about two things: what we eat and how much.  Let’s start with Thanksgiving.  There’s overwhelming evidence that a Mediterranean-style diet is the healthiest, which means eating mostly vegetables and fruits and whole grains; but there’s nothing wrong with eating some turkey, or mashed potatoes, or even pecan pie.

2. Choose wisely

The key is to not make traditional holiday foods the base of the eating pyramid.  In other words, the majority of your food choices and calories should come from green salads and low-fat vegetable dishes, with small servings of meat, refined carbohydrates, and sweet desserts. Think of meats and starches as the side dishes or garnish to a plant-based meal.

3. Make smart substitutions

If you’re hosting dinner, get creative without sacrificing traditional favorites. It’s easy to switch out whole-grain breads for the white dinner rolls, healthy vegetable dishes instead of the high fat, creamy bean casseroles, and make a healthy sweet potato casserole instead of the heavily sugared, high-calorie version. Do a search for some healthier versions of your family’s favorites; they’re easy to find.

4. Get some exercise

Almost as traditional as turkey and pumpkin pie is fighting for couch space after dinner. It’s a myth that turkey makes you sleepy. While the meat is rich in the sleep-inducing amino acid tryptophan, research shows it’s the combination of carbs, overeating and alcohol that makes us feel tired. Instead, gather the family and take a walk after the meal.

Food will always be the centerpiece of the winter holidays, but it only takes a few changes to start a new tradition and create healthy holiday meals that are just as memorable and satisfying.

Ronald Stern, M.D., is an interventional pain management specialist at Physician Partners of America’s Melbourne, Florida. location. He is also the author of fact-based health and wellness books, including his most recent, Meals, Movement and Meditation: Using Science, Not Myth, for Healthfulness. It’s available on Amazon. 

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4 Money-Saving Tips for End-of-Year Health Insurance Costs

Don’t miss a money-saving opportunity –

The clock is ticking on your health insurance costs and expenses for the year. Have you met your deductible? Have you used up your FSA or HSA? On Jan. 1, many insurance plan deductibles – the amount you’re responsible for paying before your insurance plan picks up the bill – reset to $0. You have just a few weeks left to “use it or lose it.”

If this applies to you, here are four health insurance tips to help you make the most of your healthcare dollars.

Have you met your deductible?

If you have or are close to it, schedule a visit to a primary care doctor for those tests you’ve been putting off. If your goal is to get pain-free in the new year, schedule an appointment with an interventional pain management specialist or laser spine surgeon. Physician Partners of America offers fast appointments at its pain management, laser spine and orthopedic practices.

To get a handle on health insurance costs, it’s also a good idea to refill prescriptions and schedule lab work and imaging before year’s end if insurance is likely to pick up the tab. Of course, it’s important to check your plan, as your coinsurance must also be factored in.

Still have a way to go to meet your deductible?

You should not put off seeing a doctor for serious or nagging conditions; but if you’ve only used up a fraction of your deductible, any major expenses in November and December will likely come out of your pocket. If you have chronic spine pain, here’s good news: You can schedule a second opinion with a laser spine surgeon in Texas or Florida, and have the procedure when your deductible resets in January.

Do you have a Flexible Spending Account (FSA)?

Flexible Spending Accounts let you set aside tax-free money at the start of each year to pay for certain healthcare expenses. The downside? What you don’t use by Dec. 31, you lose. It’s important to get everything you need now. The list of eligible expenses is long and surprising: it includes prescriptions, imaging, and even travel expenses related to medical treatment for patients and certain caregivers. Pain patients eligible for laser spine procedures by renowned specialists Dr. James St. Louis and Dr. Phillip Kravetz may be able to get reimbursement for airfare, meals and lodging.

What if you have a Health Savings Account (HSA)?

Unlike the FSA, Health Savings Account dollars roll over from one year to the next. There is no pressure to spend it by the end of December. If you are young and in good health, some financial advisors suggest putting any leftover HSA funds in a tax-free investment like mutual funds to increase its value.

Good health and more money top the list of New Year’s resolutions. Get a start on both by using your end-of-year health insurance dollars wisely.

 

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Powerful DSUVIA Painkiller- Effective or Ripe for Abuse?

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The controversial DSUVIA painkiller is poised to upend the opiate market. Reportedly, 500 times more potent than morphine, DSUVIA is formulated to dissolve instantly, allowing it to act more quickly than other opioids. It was recently approved by the FDA despite reservations.

Acelrx, the company behind DSUVIA, believes that this drug represents an “important non-invasive acute pain management option.” Others are somewhat skeptical of the new drug.

“I find it truly surprising that in the midst of this nation-wide opioid problem, a new product is being considered for release that appears to be the ideal formulation for abuse of a very high potency narcotic with very little obvious clinical indication,” said Christopher Creighton, M.D., Physician Partners of America pain specialist in Richardson, Texas. He weighed in a few days before the FDA’s decision on DSUVIA.

Last year, the FDA rejected the drug’s approval. There were concerns that the drug could be administered improperly if it wound up in the wrong hands. This year guidelines have been included that require the drug to be administered only by trained healthcare professionals.

In the midst of the current opioid epidemic, lawmakers have serious concerns about the potential for misuse. Sen. Edward Markey (D-Mass.) believes that the FDA’s consideration of this new drug “makes no sense.” In a statement, Markey noted, “Even in the midst of the worst drug crisis our nation has ever seen, the FDA once again is going out of its way to approve a new super-charged painkiller that would only worsen the opioid epidemic.”

Pain management expert  and Chief Medical Officer with Physician Partners of America Abraham Rivera, M.D. echoes these concerns. He points out that DSUVIA is not a new drug. “It’s actually an oral formulation of Sufentanil. This drug was invented in the late 1950’s… It’s a ‘cousin’ drug to Fentanyl, Alfentanyl, Remifentanil, Carfentanyl, and a few others.”

When asked about the effectiveness of the drug as a pain management treatment, Rivera readily admits that it is extremely potent. However, he goes on to say, “In my opinion, it brings very little to the armamentarium of a pain management practitioner. It has a serious potential for abuse and misuse.”

Physician Partners of America has long focused on interventional pain management techniques that do not rely on opioids as a primary course of treatment.

Like Senator Edward Markey and others in the healthcare and political arenas who have seen firsthand the devastating effects opioid addiction has had on the community, Drs. Creighton and Rivera worry that people who want to abuse DSUVIA painkiller will find creative ways to accomplish their goals — regardless of the safety precautions the medical community or pharmaceutical companies put in place.

This is especially worrisome considering the potency of the drug. Dr. Rivera states: “This particular drug packs such a punch that I am afraid the recreational street chemists will get their numbers wrong and write their mistakes on gravestones.”

Non-oral forms of the DSUVIA painkiller are already being used in the operating room as an adjuvant anesthetic. In this setting, it has excellent cardiovascular stability at high doses, Rivera says.

He summed up his feelings about introducing DSUVIA to the market like this: “Taking this drug out of the operating room and putting it in an oral formulation reminds me of the making of small nuclear weapons. In times of conflict, some people thought that it would be a good idea. Drop a small nuke here and there and save money on bullets. Good thing somebody disagreed.”

 

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Proposed Federal Opioid Law Aims to Tackle Growing Problem

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Bill Has Rare Bipartisan Support –

Update: President Trump signed the bill into law Oct. 24.

A proposed federal opioid law addressing the opioid crisis would increase access to treatment for addiction, open the door for non-opioid therapy, and limit over prescription of narcotic painkillers.

On October 3, in a rare show of bipartisanship, Congress passed the SUPPORT for Patients and Communities Act. The bill was approved by a vote of 98 to 1 in the Senate and 393 to 8 in the House of Representatives. The opioid legislation is expected to be signed into law by President Donald Trump and take effect Jan. 1.

With an opioid-related death toll at 700,000 and rising since the 1990s, Physician Partners of America (PPOA) applauds the proposed federal opioid law.

“Pain management specialists are at the forefront of combating this national problem,” said Abraham Rivera, M.D., chief medical officer of Physician Partners of America. “We embrace the actions of congress and will incorporate the resources the law provide for the welfare of our patients.”

The company stresses its interventional pain management approach, which treats the root of  pain problems, over masking symptoms with opioid medication.

The far-reaching legislation package is aimed at changing the way the United States approaches the addiction issue. Provisions include:

  • Creating a grant program for opioid recovery centers to address treatment and recovery
  • Allowing more health care practitioners to prescribe opioid addiction medications
  • Expanding the availability of naloxone, a medication that reverses overdoses, to first responders
  • Allowing government agencies to pursue addition and pain research projects
  • Educating a wider group of health care providers about best practices in pain management

The new federal opioid law aims to limit overprescription of opioid painkillers to Medicare and Medicaid recipients, and expands access to addiction treatment within those programs

“The Centers for Medicare & Medicaid Services’ reimbursement for common pain management procedures are also going up because of this,” said Luis Nieves, M.D. PPOA’s Hurst, Texas pain management specialist.  “Hopefully private insurance will follow and improve access for all patients.”

 

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Arachnoiditis Pain Causes and Treatment

PPOA Treatment Can Ease Back Pain from This Rare Disorder

Arachnoiditis has nothing to do with spiders, but its symptoms can be pretty scary. Difficult to diagnose and difficult to treat, this rare nerve inflammation can trigger excruciating lower back and leg pain. It is a progressive and debilitating disorder that can cause some people to become bedridden and unable to work.

What is Arachnoiditis?

The condition affects only about 11,000 people a year, according to the National Organization for Rare Disorders.  It is almost always caused by a medical procedure.

It starts in the web-like arachnoid membrane that protects the spine and brain. When the membrane becomes inflamed, it can cause the nerves to fuse together. This causes them to malfunction. The resulting scar tissue can press against the nerve roots that exit the spine, causing severe pain.

Arachnoiditis pain usually affects the lower back and legs and causes a variety of sensations.

  • Tingling or “creepy-crawly” feelings on the skin
  • Muscle cramps, twitching and spasms
  • Shooting, “electric shock” pain
  • Bowel, bladder and sexual problems

“It causes a number of symptoms and they can vary in the same individual,” said Dr. Abraham Rivera, chief medical officer of Physician Partners of America.

What Causes Arachnoiditis?

This condition has many causes. The majority are related to contaminants that accidentally get into the dura – the fluid surrounding the spinal column – during certain medical procedures like epidurals and spinal taps.  These contaminants include preservatives or impurities. Long ago, oil-based chemicals used in contrast dye tests, like myelograms, were blamed for some cases of arachnoiditis.

How is Arachnoiditis Diagnosed?

This disorder is so uncommon that most doctors rarely see it in their practices, making detection difficult. Fortunately, Physician Partners of America Pain Relief Group has the expertise to identify it and attempt to treat the pain.

The most helpful diagnostic tests are MRIs (magnetic resonance imaging) and CAT scans (computerized axial tomography). Another test, an EMG (electromyogram), uses electrical impulses to determine the extent of damage to nerve roots. PPOA specialists can perform this test.

What is the Best Arachnoiditis Treatment?

Unfortunately, there is no cure for this condition, but Physician Partners of America offers the hope of relief from arachnoiditis pain.   “One common treatment is oral pain medication, but it doesn’t tend to work well,” says Dr. Rivera. “The pain can be managed for some people with a spinal cord stimulator.”

Spinal cord stimulators are minimally implantable devices that send electrical signals to targeted areas of the spinal cord to treat specific pain conditions. It is a minimally invasive procedure that PPOA physicians perform routinely.

Stems cell therapy for arachnoiditis is only in the experimental stage and has not yet been proven helpful.

“We are keeping our eye on the latest research to treat this debilitating condition,” says Dr. Rivera. “Not every current treatment works for everyone, but we make every effort to treat the pain and help sufferers lead a more normal life.”

 

 

 

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Tiger Woods Back Surgery – How Does Golf Affect the Body?

He’s had four procedures in four years

Golf legend Tiger Woods’ back surgery saga has gained as much attention as his game and his personal life. His recent PGA Tour Championship performance marks his 80th win. It’s a stunning comeback after a five-year hiatus – and even more significant because he has undergone four operations for chronic pain.

Woods has suffered from pain in his lower back, known as the lumbar spine, and had discectomy surgery to relieve a pinched nerve in 2014. A discectomy removes a small piece of a vertebral disc that is pressing against pain-causing nerves.  This surgery does not affect range of movement.

One year later, he had to withdraw from the Wyndham Championship and undergo a second procedure to decompress another pinched nerve. One month after that, he has a third surgery to relieve pain from the second operation.

The golfer brushed it off as an occupational hazard. “It’s one of those things that had to be done,” he recently told People magazine.

Does Golf Cause Back Problems?

What is it about the game of golf that triggers back pain? Physician Partners of America pain management specialist Dr. Chad Gorman has a background in sports medicine and is a golfer himself.

“While golf is a beautiful sport that requires precision and eye coordination, strength, endurance and focus, there are many common injuries that golfers are prone to getting,” he said.

It’s well known that years of powerful swinging motions can cause tendonitis and “golfer’s elbow,” technically known as lateral epicondylitis.

Tiger Woods’ back surgery history shows that golfers are also prone to chronic lower back pain. “The amount of force that can be created while swinging a golf club puts golfers at increased risk of acute disc herniation, stress fractures and other common causes of back pain,” says Dr. Gorman, who practices in PPOA’s New Port Richey, Fla. location.

Disc herniation occurs when the soft center of a disc that separate spinal bones pushes out and presses against surrounding nerves. It can result in pain, numbness and weakness in an arm or leg.  Woods complained of severe leg pain after his third back surgery, and had to undergo a fourth in 2017. That specialized procedure, known as an interior lumbar interbody fusion, welds unstable vertebrae together so they heal into a single, solid bone.

Lower Back Pain Treatments

Woods recently told People that he is now pain-free, but has to make some adjustments to his swing. “He has had to change his spinal rotation significantly due to the fusion in his back,” Dr. Gorman observes.

For weekend golfers, surgery is not always necessary. Some benefit from aggressive physical therapy. Epidural steroid injections (ESI) and platelet-rich plasma and stem cell therapy can also help ward off surgery in some cases.

Physician Partners of America Pain Relief Group physicians offer ESI, regenerative medicine and other interventional treatments. In cases of pinched nerves or disc disease, the PPOA Minimally Invasive Spine Group offers laser-assisted procedures that can be done in one day with minimal downtime.

 

 

 

 

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