Dr. Taufiq Ahmed on Changes in Opioid Laws

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Opioid laws are changing around the nation – tightening the amount and duration of prescriptions doctors can write. Congress has allocated $6 billion towards the epidemic for 2018 and 2019, but it’s unclear how the money will be spent at this point.

Florida’s bill would limit opioid prescriptions to three days, though seven-day supplies would be permitted if a physician deems them medically necessary. The restrictions wouldn’t apply to patients suffering pain related to cancer, terminal illness, traumatic injuries or palliative care.

The goal of the new law is to help prevent people from getting addicted to prescription opioids. Earlier restrictions on prescriptions, and higher costs, have been shown to lead to some patients to switch to cheaper, more plentiful street drugs like heroin and fentanyl.

The impact of the new law is a hot topic among pain management physicians and their patients. Taufiq Ahmed, M.D., principal pain specialist at Physician Partners of America Pain Relief Group – Orlando, recently talked with Spectrum My News 13 in Orlando about the sweeping changes in Florida’s opioid laws. While he understands the need for more regulation, Dr. Ahmed and his peers are concerned about the unintended consequences that legitimate chronic pain sufferers could face.

“It’s been a little frustrating for us pain providers as well because we realize not every injury is a three-day or a seven-day situation,” he said.

Ahmed, an anesthesiologist as well as a pain management physician, gets to the root cause of the pain in the PPOA tradition, and treats it with a number of modalities. This may include injections, radiofrequency ablation, nerve blocks and spinal cord stimulator implants. He also incorporates alternative methods to help reduce the chance a patient develops a dependence on opioids.

“Everyone has good intentions in mind, and to be frank the issues with the amount of heroin and opioid overdoses we’re seeing in Florida is staggering,” he said.

 

Read the full article: SPECTRUM NEWS 13: Florida’s opioid legislation causes concern amongst pain sufferers

 

 

 

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Surgeon General – and PPOA – Recommend Naloxone for Pain Patients

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“No way! I’m not an addict!” That’s what many patients offered naloxone by their Physician Partners of America doctors say when offered the fast-acting opioid antidote along with a prescription for pain killers. Despite being legitimately prescribed opioids for chronic pain, these patients feel stigmatized, even insulted, by the idea they could overdose.

This week, U.S. Surgeon General Jerome Adams issued an advisory that encouraged more people to routinely carry naloxone: “We should think of naloxone like an EpiPen or CPR,” he announced April 5. “Unfortunately, over half of the overdoses that are occurring are occurring in homes, so we want everyone to be armed to respond.”

PPOA has written prescriptions for naloxone with every opioid prescription since 2004. Even though the medication can be free or low-cost with insurance, PPOA has discovered many patients refuse prescriptions for the antidote when they pick up their pain medication prescription.

“They feel they don’t need it. As pharmacists, we try our best to stress the importance of having naloxone in the home while on opiate therapy,” said Samantha Dangler, vice president of Operations – Ancillary Division for Physician Partners of America. “With the opioid crisis at an all-time high, it is imperative that when a physician writes a prescription for an opiate and an antidote, that the patient follows through and fills the prescription for the antidote.”

While the company’s pain management providers focus on interventional – that is, non-medication – modalities to treat debilitating chronic pain, some patients come to its practices already on the drug. For those patients, naloxone medications, such as Narcan, Evzio and Naltrexone, are highly recommended until they can be weaned off the opiate.

Emergency rescue workers, police and other agencies have carried the antidote for a while. But many overdoses occur in the home. The risk of accidental overdose, even by compliant patients, is high. According to the Centers for Disease Control and Prevention, around 46 people die every day from overdoses involving prescription opioids and more than 40% of all U.S. opioid overdose deaths in 2016 involved a prescription.

Read the Surgeon General’s full announcement.

 

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PPOA Joins Opioid Discussion at ASIPP 20th Annual Meeting in Orlando

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Hot topic: new advances in pain management

The American Society of Interventional Pain Physicians ended its 2018 ASIPP 20th Annual Meeting on March 18. Physician Partners of America (PPOA) had a strong presence at the conference, which focused on the opioid crisis and new medical technology.

ASIPP has been the voice of interventional pain physicians since 1998. Conference co-chairs and guest speakers from around the country gathered at the world’s largest Marriott for three days of workshops at the Orlando World Center.

The conference theme of “Excellence in IPM: Education, Research, Advocacy” attracted more than 1,000 attendees. They were offered a choice of 75 educational lectures. The event was held in partnership with the Florida Society of Interventional Pain Physicians and the Society of Interventional Pain Management Surgery Centers.

PPOA President  and COO Tracie Lawson, MBA, MSN, ARNP-C, and PPOA founder Rodolfo Gari, M.D., MBA answered in-depth questions from physicians. Attendees learned how the fast-growing national healthcare company can strengthen the doctor-patient relationship and manage medical practices. Chief Development Officer David Wood, Vice President of Sales and Operations – Ancillary Division Samantha Dangler, and Vice President of Business Development Chrissy Infinger were also on hand to answer questions at the PPOA booth.

Opioids: give patients what they need, not what they want

The most well-attended session of the ASIPP conference was “Best Practices in Pain Management in the Context of Addressing the Opioid Epidemic,” and it’s easy to see why. Opioid overdoses are now the leading cause of death in people under age 50, killing about 64,000 Americans in 2016. No fewer than six leading authorities addressed the topic. Anita Gupta, D.O., PharmD, reports that “opioids aren’t going away” and stressed the importance of a “holistic approach.”

Gupta continued: “What we do for a living is an art and requires a balanced approach.  Pills kill. Pain doesn’t.” She offered the “SHARE” approach: seek patient’s participation, help patient explore and compare treatment options, access patient’s values and preferences, reach a decision with the patient, evaluating the patient’s decision.

ASIPP moderator Peter Staats, M.D., said pain physicians should always listen to the little voice in their heads that asks “is it worth the risk?” whenever prescribing. He added that “patients should be given what they need, not what they want.”

PPOA medical chief will host Florida opioid conference

Abraham Rivera, M.D., chief medical officer for PPOA, will continue the discussion at the Florida Academy of Pain Medicine Opioid Update Summit. It will take place in Clearwater, Fla on April 28. Dr. Rivera is an FAPM board member and the workshop coordinator. He will give the keynote lecture during the event. “This conference will change the behavior of those in attendance,” Rivera said. “Expert speakers will change the practice of the average physician who attend this event.”

 

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The Opioid Crisis – Where Are We Now?

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Opioid overdoses are now the leading cause of death in people under age 50, killing about 64,000 Americans in 2016.

While short on specifics, President Donald Trump addressed this “national emergency” in his first State of the Union address, saying, in part, “My administration is committed to fighting the drug epidemic and helping get treatment for those in need. The struggle will be long and difficult — but, as Americans always do, we will prevail.”

What pain management physicians must do to treat chronic pain is to retrain patients’ – and even practitioners’ – thinking that narcotic painkillers are the first course of action.

“To fight the opioid epidemic, you need to dissuade people from using them in the first place,” said Abraham Rivera, M.D., chief medical officer for Physician Partners of America (PPOA). He will address this subject at the Florida Academy of Pain Medicine at an April 28 Opioid Update summit in Clearwater, Fla.

Interventional pain management, a core practice of PPOA, remains a little-discussed part of the solution. Rivera points out that not everyone in the healthcare community understands the meaning of that key word, interventional. “Our providers get to the root of the problem,” he said. “We don’t just mask the pain with medication. That is at the heart of what we do.”

Interventional pain management, as practiced by PPOA physicians, focuses on minimally invasive procedures such as nerve blocks, radiofrequency ablation, injections, spinal cord stimulators and pain pump implants to treat the pain at its source.

Laser-assisted Spine Surgery

PPOA recently launched laser-assisted, minimally invasive spine surgery. This outpatient procedure, reserved for cases that interventional techniques may not be able to address, are not like open-back surgeries of the past.

  • It requires incisions that are less than one inch long
  • Muscles surrounding the spine are gently spread with small dilating instruments instead of being cut and retracted
  • Narrow endoscopic instruments, guided by tiny video cameras that project magnified images onto a screen, further spare tissue trauma
  • Patients can get back to work or activities in days or a few weeks, not months

Physician Partners of America is actively adding spine specialists to its team, including James St. Louis, D.O., surgical founder of Laser Spine Institute in Tampa.

Cutting-edge Orthopedic Procedures

Orthopedics is another interventional aspect of PPOA’s medical services. Led by PPOA physicians Brian McGraw, D.O., and Chad Gorman, M.D. in Florida, our services help patients with trigger point injections and other minimally invasive procedures, PRP (platelet-rich plasma) therapy to aid in soft tissue recovery, and stem-cell regeneration.

Preventing Pain

Interventional pain management also seeks to lessen the likelihood of pain that traditionally requires oral medication. To this end, PPOA physicians routinely use intraoperative neuromonitoring, a real-time monitoring of the nervous system during surgical procedures. This offers nerve-damage protection to a degree that neither a physician nor fluoroscopy can detect with accuracy. The result is usually minimal pain and reduced risk of temporary or permanent nerve damage.

Another interventional tool is used at the clinical level: test can determine which medications are safe, unsafe or ineffective based on the individual patient’s genome.

“Cutting-edge technology, such as intraoperative neuromonitoring and drug genes testing, ensure patient safety and reduce pain,” said Dr. Rivera.

As word gets out about interventional methods of controlling and avoiding pain, the goal is for patients to ask for it – instead of opioids – by name, and for primary care physicians and specialists alike to refer patients to an interventional pain management specialist.

This lesser-known area of medicine is a key to solving the opioid crisis, and will, to use the president’s words, prevail.

 

 

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Alejandro G. Tapia, M.D., Joins Physician Partners of America Pain Relief Group – Boynton Beach

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Physician Partners of America Pain Relief Group is pleased to announce that Alejandro G. Tapia, M.D., will join its Boynton Beach location, serving patients in the Boynton Beach and Wellington areas, starting Monday, Dec. 11.

Dr. Tapia is a board-certified and fellowship-trained interventional pain management physician. He brings extensive medical knowledge and experience in minimally invasive techniques to treat spinal pain.

Dr. Tapia earned his medical degree from Universidad Central del Este Facultad de Medicina in San Pedro, Dominican Republic. He completed his Anesthesiology residency training at the University of Miami, and completed his internship at the Department of Surgery at the University of South Alabama.

He completed his residency at the University of Miami Department of Anesthesiology, and his fellowship training in Interventional Pain Medicine at the University of Michigan. He most recently worked at The Medical Group of South Florida, Inc.

Dr. Tapia is a member of the International Spine Intervention Society, Diplomat of the American Academy of Pain Management, American Society of Regional Anesthesia and the Florida Society of Interventional Pain Physicians.

Bilingual in English and Spanish, he is known for bringing compassion, a warm sense of humor and medical expertise to his practice.

Patients seeking an appointment with Dr. Tapia can call (844) 542-5724. The clinic is open from 8 a.m. to 5 p.m. Monday through Friday. Same-day appointments are available.

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Physician Partners of America: Fighting the Opioid Crisis in the Surgical Suite

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The Commission on Combating Drug Addiction and the Opioid Crisis found that in the last 17 years, the number of opioid overdoses in the U.S. has increased four-fold, aligning with the number of opioid prescriptions sold. That’s no coincidence.

While opioid abuse remains a complex and burgeoning problem, the fallback solutions are avoiding the need for opiates in the first place and curtailing the amount a physician can prescribe. In addition, nearly every state has adopted a medication management program that allows regulators and doctors to track the number of opioids prescribed.

Another solution that flies under the public radar is familiar to surgeons: a piece of equipment that works quietly in the corner of many an operating suite, known as intraoperative neuromonitoring (IONM).

Neuromonitoring for Interventional Pain Procedures

IONM monitors electrical potentials from the patient’s nervous system during surgery involving the brain, spine and other parts of the body. In real time, the certified IONM technician can monitor and evaluate the function of the patient’s brain, spinal cord and nervous system. Intraoperative neural monitoring offers a set of eyes more accurate than the standard visual and x-ray assisted methods. It can detect nerve injuries before they reach a level that could lead to prolonged or permanent damage.

How Intraoperative Neuromonitoring Reduces the Need for Opioids

Specifically, IONM helps the surgeon avoid injuries that can cause postsurgical problems such as muscle weakness, hearing loss, paralysis, and loss of normal body functions. Many of these conditions can cause pain that in some cases indicates use of narcotic pain relievers.

In study after study, IONM has been shown to reduce the need for opioids post-surgery, because it reduces nervous system complications, pain and hospital readmission.

Neuromonitoring for Safer Surgeries

As a company that puts patient safety first, Physician Partners of America has embraced this technology to become a leader in performing IONM in many types of surgeries. In the past eight months, its certified technicians have monitored more than 400 operations related to interventional pain relief alone, making PPOA a leader in this application. The company is in the process of gathering case studies for pain-related surgery monitoring.

Along with medication management and pharmacogenomic testing, IONM is one more way Physician Partners of America is leading the charge in ensuring patient safety and battling the opioid crisis.

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PPOA’s Response to the National Opioid Crisis

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At Physician Partners of America, we are as concerned as the rest of America about the escalating opioid crisis, and applaud the president for recognizing it as a national emergency. And we are proud to provide solutions to stem this epidemic.

We understand that some patients have come to rely on opioid medication to manage unbearable chronic physical pain. About 11 percent of Americans live with chronic pain. They need carefully prescribed medications just to get through each day. The stories we hear daily are heartbreaking, and we understand most are committed to taking medications as carefully prescribed.

Still, while they offer a proven and effective therapy for chronic pain management, opioids have highly addictive properties and can be dangerous in large quantities, or when mixed with certain kinds of medication.

Our safety-focused interventional pain management specialists create patient-specific treatment for medication management. We rely on several tools to help us walk the fine line between use and abuse.

Medical DNA Testing

When appropriate, our physicians find safe pain medication substitutes through pharmaceutical DNA testing. About 45 percent of response to medication is determined by a patient’s unique genome. A simple cheek swab determines what medications are safe and unsafe for an individual, and lists safer substitutes.

Screenings

We utilize qualitative and quantitative drug screenings that are more sensitive and comprehensive than the average UA (urine analysis). We use them in both our Florida and Texas practices.

Guidelines

PPOA practices follow the latest Centers for Disease Control and Prevention guidelines when a situation calls for prescribing opiate-based medications.

Treating Pain and Depression

The two conditions often go hand in hand. PPOA’s MoodLift program, currently available at our Texas Health and Counseling Group practice in Hurst, uses a revolutionary treatment called TMS (transcranial magnetic stimulation). It is a gentle, drug-free treatment with minimal side effects.

At Physician Partners of America, our foremost goal is patient safety. As interventional pain management physicians, we are passionate about pinpointing the root of each patient’s pain and using a tailored range of modalities to treat it. In doing so, we help our patients move toward a pain-free life.

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Dr. Abraham Rivera Discusses Spinal Stenosis

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Spinal stenosis, the narrowing of the bony canal that cradles the spinal cord, is most common in people over age 50. Their search for relief from back pain often follows a predictable path, from NSAIDS and opioids to chiropractic and alternative medicine. Sometimes, this trial-and-error process can take years and many thousands of dollars. Too often, the sufferer is forced to cut back on work or pain management specialistdrops out of the workforce completely long before he or she is ready to retire. The real tragedy? Most of these patients would find relief early on if they knew where to turn: an interventional pain management specialist.

Download article here or pick up on newsstands now!

Pain Free Living September 2017 Article by Dr Rivera

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Dr. Jorge Leal Talks About the Effects of Mental Pain on Our Bodies

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Interviewer: I’m sure a lot of you out there know it well. You’re in mental pain, which causes physical pain which, in turn, causes more mental distress. It’s a vicious cycle. When does it end? Dr. Jorge Leal from Florida Pain Relief Group joins us now to talk more about this. Dr. Leal, great to have you here.

Dr. Leal: Thank you.

Interviewer: Oftentimes, when you have people come in that are just mentally and physical exhausted because of their pain, is it sometimes because of something that’s happening inside their minds?

Dr. Leal: It is very common that you see a lot of mental abnormalities in people who suffer with chronic pain. It is sometimes difficult to tell which one was first, but you have to definitely emphasize both aspects. The physical and emotional aspect of pain and suffering are intertwined. Not infrequently, people that suffer from chronic pain also suffer from sleeplessness. And if you don’t sleep well, your day does not go well and your pain can be intensified by the lack of sleep, lack of concentration, anxiety, causing a release of catecholamines which basically are adrenaline. Response to chronic stress can also make you more sensitive to pain, more susceptible to pain and it just, indeed, becomes a vicious cycle.

 

 

Interviewer: Can depression cause pain too?

Dr. Leal: It can intensify pain and sometimes it is associated with chronic pain, very commonly.

Interviewer: So what’s more important? Treating the mental side first or treating the physical side first?

Dr. Leal: Well, you have to treat both. One without the other will not be effective so you have to emphasize in treating both aspects of the pain experience, the psychological aspect and the physical aspects as well.

Interviewer: I’m curious to know how you go about that.

Dr. Leal: In our center, we have a comprehensive approach to the treatment of pain and we identify, by certain psychometric tools that we have available, to gauge when is someone susceptible to psychological problems. We identify if they have any kind of depression or any other psychological condition that might interfere in the management of pain. And we identify it, and then we seek appropriate treatment in terms of referral to the appropriate mental health specialist, counseling and so forth.

Interviewer: I think it’s important that you mention a lack of sleep can cause all of these problems. That it’s not necessarily something wrong with your brain, it’s something physically that’s happening to you and then it’s affecting your whole body.

Dr. Leal: Absolutely. And as you will know, this is very common in our day of life. Lack of sleep is extremely common and has tremendous negative consequences in our health. It’s now becoming more and more talked about, and we have to deal with that. That being said, pharmacological treatments for insomnia are fraught with their own problems, including addiction to sleep aids. So a very good sleep hygiene is extremely important and we do emphasize that in our practice.

Interviewer: And you can help people get off the pills and figure out a great way to just remedy their sleep.

Dr. Leal: Indeed.

Interviewer: Okay. Good stuff. Dr. Leal, thank you very much. You can visit their website,  or give them a call at 844-KICK-PAIN to schedule your same-day appointment. We’ll be right back with more Daytime, so don’t go away.

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Dr. Abraham Rivera Talks Pain From Weekend Activities and Best Ways To Treat It

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Interviewer: Well, when the weekend finally rolls around, besides everybody saying, “Woo-hoo,” we all want to do activities we usually enjoy before heading back to work on Monday, but some of those activities, as you might experience, golfing, tennis, even gardening, can cause you pain. Dr. Abraham Rivera from Florida Pain Relief Group joins us now with a solution for all you weekend warriors out there. Now, Dr. Rivera, welcome.

Dr. Rivera: Thank you.

Interviewer: Let’s talk about what kind of pain that we’re zeroing in on here: bursitis, tendinitis, arthritis, all of the itises.

Dr. Rivera: Correct, correct. I mean, this is like you say, the weekend warriors. They go out there. They have very sedentary occupations. Now, it’s the weekend. They want to go out and play 18 holes of golf.

Interviewer: Right.

Dr. Rivera: Or they want to play a couple tennis matches. Of course, they come and see me Monday or Tuesday because they are sore, you know, to be expected. Now, many times when I talk to these patients, I find out that there is a problem with their technique. They have the wrong grip on the tennis racket or they have the wrong clubs. Often, they have shoulder disease, and they’re trying to hit that ball like when they were 22, and they’re 50 now. You can no longer hit that ball that way. So just believe it or not, by going over their technique, many times you solve the problem right there.

 

 

Interviewer: So I assume you’re a good golfer?

Dr. Rivera: Heavens no, but I do play with quite a few, and I see when they pay the price the next day.

Interviewer: So how do you fix, say, for instance, shoulder pain because a lot of people do like to get out there and hit the tennis ball around or play a round of golf. How do you treat them so they can go back to work without the pain?

Dr. Rivera: Yeah, many times, it’s just a case of acute tendinitis. They’re rubbing the tendon that goes over the shoulder joint against a spur that they have in their shoulder, and we typically diagnose that. We can prescribe some topical medication. We can give them some anti-inflammatory. Sometimes we have no resort but to inject the joint with cortisone. It’s something we can do in the office very quickly.

Interviewer: Now that’s something because I’ve had… I have rheumatoid arthritis in my knee, and I’ve had cortisone shots in my knee, but I was told you have to stop them after a while. Is this correct?

Dr. Rivera: Yeah, cortisone is a very seductive drug because it works.

Interviewer: Yes.

Dr. Rivera: You can only get so many of these so many times a year.

Interviewer: Right.

Dr. Rivera: It can have side effects. It can weaken the tendons. It can cause osteoporosis.

Interviewer: So what’s the next level then after that? I’m asking for myself.

Dr. Rivera: Yeah, I hear you. I hear you. You know when patients have disease in their joints, the thing I try to tell them, make them clear they understand, is they cannot travel that joint. By traveling that joint to the full range of motion, they’re wearing it out more. So try not to move it.

Interviewer: Yeah, hard to do. I’m a very active individual, but I was told that stem cell therapy might actually help.

Dr. Rivera: Well that certainly holds a promise. It is… the data is very promising, very tantalizing. It is an alternative. Unfortunately, it’s not covered by most insurances, but it’s certainly an alternative.

Interviewer: And real quickly for the gardeners out there, what can you do about their sore, stiff hands after they’re out there on a Saturday or Sunday?

Dr. Rivera: Preventive. I tell those patients to, number one, take an anti-inflammatory up front, a simple aspirin, Glucosamine, something over the counter. There is a lotion they can put on that contains some anti-inflammatories, and finally, I tell them to avoid impact. Okay, hammers, things that wack.

Interviewer: Right.

Dr. Rivera: Don’t want vibration.

Interviewer: Yeah, don’t hammer your flowers into the ground. Only if they’re dead. Okay, Dr. Rivera thank you so much. If you need to see Dr. Rivera or any of the other great doctors at the Florida Pain Relief group, just hit up their website  or give them a call, 844-KICK-PAIN to schedule your very same day appointment, which is very, very good to be able to get in there right away, right, when you have the pain? All right, Dr. Rivera, thanks again. We’ll be right back.

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