Make Pain a Thing of the Past – management – Physician Partners of America

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Common Misconceptions about Pain Management

Every day millions of people across the country see pain management specialists for help with their chronic pain conditions.

However, there remain many misconceptions about what pain management is all about. In an effort to dispel some of those misunderstandings and misconceptions, Dr. Rodolfo Gari, Medical Director of Florida Pain Relief Group in Tampa, FL, answers some of the more common questions people have about pain management.

“Doesn’t pain management just involve patients taking a lot of pills?”

Dr. Gari: “The needs of people suffering from chronic pain are ever-evolving, and pain management has evolved along with it. For some patients, medication management may be the best course of action. However pain management and pain relief is far from one-size-fits-all. At Florida Pain relief Group we take a comprehensive approach to pain management. This approach involves physical therapy, nerve blocks, minimally invasive procedures and also include medication management.”

“Aren’t pain management doctors like chiropractors?”

Dr. Gari: “At Florida Pain Relief Group, unlike chiropractors, our physicians attended medical school and have specialized training following medical school. This specialized training involves a one year internship in a field such as Internal Medicine or General Surgery, a three to four residency in a field such as Anesthesiology and another year called a fellowship in the field of pain management. This medical training amounts to about nine years of medical training after graduating from college.”

“All pain management doctors are the same.”

Dr. Gari: “At Florida Pain Relief Group our physicians are interventional pain management physicians. Unlike other pain management physicians that can only prescribe medications, our
physicians perform nerve blocks, spinal cord stimulators, intrathecal pump implants, rhizotomies, and other minimally invasive pain management techniques to lower your pain level, thereby reducing your dependence on opiates and other strong medications to control your pain.”

Do you have a question about pain management that wasn’t answered here? Contact us today!

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Facet Joint Arthritis – A Common Cause of Low Back and Neck Pain

What is Facet Joint Arthritis?

Facet joint arthritis is a very common cause of low back and neck pain in adults.  It is a condition in which the small joints, called facets, in the back of the spine become arthritic and painful, similar to the way arthritis in the knee or hip is painful. Facet joint arthritis is also known as facet arthropathy or spondylosis.

What are Facet Joints?

Facet joints connect the vertebral bodies, or bones, in the spine to one another and help keep the spine stable with normal movement. Facet joints are lined with cartilage, contain a small amount of joint fluid, and are encased in a joint capsule. There is a pair of facet joints at each level, and they are named for the vertebral bodies they connect. For example, the L4/5 facet joints connect the lumbar 4 and lumbar 5 vertebral bodies.

How does Facet Joint Arthritis develop?

Each facet joint is lined with cartilage, and over time the cartilage may thin and wear out. As a result, the joint will become inflamed and develop bone spurs, enlarging the joint.  This is also called facet joint hypertrophy. These changes can be due to a variety of factors, but typically anything that puts greater strain on the facet joint over time, such as manual labor, obesity, lack of exercise and deconditioning, will lead to degenerative changes in the joint. Genetic factors may also play a role even in the absence of these factors.

Where does Facet Joint Arthritis occur?

Facet joint arthritis commonly occurs in the low back or lumbar spine. It also occurs in the neck, or cervical spine, and to a lesser extent in the upper back, or thoracic spine. The lower lumbar facet joints, such as L3/4, L4/5, and L5/S1, are the most common location of facet arthritis because they carry the greatest weight compared to other areas of the spine.

What are the symptoms of Facet Joint Arthritis?

In the lumbar spine, the symptoms are typically lower back pain, which may be accompanied by radiation of the pain to the buttocks or the back of the thighs. In the cervical spine, the symptoms are typically neck pain, which may be accompanied by radiation to the shoulders, upper back or to the back of the head. Leaning back and rotating the spine typically worsens the pain. Decreased spinal flexibility and muscle spasm frequently accompany the pain.

How do you diagnose Facet Joint Arthritis?

A proper history and physical exam may suggest facet arthritis. X-ray, CT scan or MRI may confirm the presence of arthritis; however, facet joint arthritis is just one potential cause of low back or neck pain. If interventional treatments are planned, diagnostic injections with local anesthetic are required to confirm that the source of the pain is the facets.

What are the initial treatment options for Facet Joint Arthritis pain?

Anti-inflammatory pain medications, muscle relaxers or other pain medications, activity modification, weight loss, physical therapy, and regular exercise all may be helpful at reducing pain.

What are the options if conservative treatments fail?

Because back and neck pain may have multiple causes, first one must confirm that the facet joints are the source of pain. To determine if the facet joints are causing pain, a diagnostic injection of local anesthetic can be performed, either into the facet joint, or around the nerves that sense pain in the facet joint. These nerves are called the medial branch nerves. If pain is reduced by this diagnostic injection, then a procedure called a rhizotomy is performed. A rhizotomy uses radiofrequency energy to heat the facet joint nerves so that they can no longer sense pain. In cases where an enlarged arthritic facet joint is causing nerve compression or spinal stenosis, referral to a spine surgeon may be indicated.

How do you keep Facet Joint Arthritis pain from returning?

Intermittent flare-ups are common with chronic back and neck pain. The best long-term pain management strategy consists of regularly participating in exercises that restore spine health and stability. With the assistance of a Physical Therapist, participating in a home exercise program that focuses on increasing strength, endurance and flexibility will be the best defense against chronic pain.

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Minimally Invasive Pain Procedures

What is Minimally Invasive Surgery?

Minimally invasive surgery (“MIS” to those in the know – which now includes you!) often refers to three main aspects: small incisions, fewer stitches, and less downtime. However, things can be even less intrusive when talking about minimally invasive pain management where the doctor simply uses a small needle to inject relief medication. In this article, we will highlight a few minimally invasive non-surgical techniques and show why “minimally invasive” is extremely beneficial to your recovery and overall health.

Minimally Invasive Pain Management

If you’re not familiar with the phrase “minimally invasive pain management” you soon will be because here at Florida Pain Relief Group we are perfecting the art of pain relief with our advanced techniques and procedures. Gone are the days when back pain, neck pain, knee pain, ANY kind of pain relief procedures force you to be cooped up for weeks while you recover. Our techniques are out-patient procedures and often let you get on living a pain-free life the very same day!

“Minimally Invasive Begins Here!”

Our founder, Dr. Rodolfo Gari, says it best: “We are experts in pain.” That other quote above is also one of Dr. Gari’s that goes right to the heart of what Physician Partners of America is all about: minimally invasive procedures, maximum pain relief. We understand your pain is no picnic and having to worry about additional pain from surgery doesn’t make sense to you – nor does it to us. You want relief from the pain, not to have it compounded. We understand that and it is the reason why we’re the Texas and Florida leaders in minimally invasive procedures.

Below are 3 minimally invasive pain management options to consider:

  1. Trigger Point Injections. These injections temporarily numb the pain and relax the muscle, allowing for increased stretching to promote and increase blood flow.
  2. Lumbar Epidural Steroid Injections. Epidural steroid infusions can be used to treat pain experienced in the lower back, neck, and mid-spine area.
  3. Facet Joint Injections. A facet injection can temporarily relieve neck or back pain caused by facet joints that have become inflamed.

The pain relief procedures above are simply a selection of the various treatments and therapies we offer at Physician Partners of America. We invite you to browse the rest of this website and see the full gamut of pain relief therapies we offer, as well as read about our company and mission.

If you are in pain today and don’t want extensive and intrusive surgery, and our minimally invasive options appeal to you and your desire to be pain-free, please contact us to set up a same-day appointment.

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Tampa Pain Management Doctors

Pain Management in Tampa Bay

A bad back. A sore neck. A throbbing knee. A twisted ankle. What do these things have in common? For one, they are uncomfortable, and two, they often require medical attention because an ice pack isn’t always a magic cure-all. Nope, for real relief, you need to call on the Tampa pain management doctors at Physician Partners of America.

We’re experts in pain.

Our founder, Dr. Rodolfo Gari, says it best when he says that Physician Partners of America are “experts in pain.” The minimally invasive treatments and therapies we offer at our Tampa pain relief centers are as innovative as they are effective. Pain relief and management is the aim and we always hit our target. If you’ve been suffering from constant, nagging, chronic pain and need a solution, we offer a way out. Our pain specialists are on a mission to eliminate pain and give people their lives back.

These are the doctors you are looking for.

It stands to reason that you are searching for a way to relieve the pain that you couldn’t find with standard OTC (over-the-counter) medications or the various homemade remedies being touted online. Your pain is unique to you, so your treatment should be as well. Our pain management doctors in Tampa are the doctors you’ve been looking for. They have your pain management solution. All you have to do is call or come by to schedule a same-day appointment. Pain relief is at hand!

Tampa Locals Helping Tampa Locals

We aren’t located in a galaxy far, far away. Our pain specialists are located right here in the Tampa Bay area just like you. There’s no need to take a road trip (or rocket ship) for pain relief when we’re in the neighborhood. There’s also no reason to subject yourself to unnecessary surgery when our pain relief techniques are designed to be minimally invasive and highly successful.

If you’re in pain and done with the endless suffering, contact Physician Partners of America right now. Our pain specialists are available at Tampa pain relief centers in East Tampa, North Tampa and Carrollwood.

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5 Ways to Stop Hurting Your Back

Are you the cause of your back pain?

Back pain usually doesn’t pop up out of anywhere and typically has a cause that begins and ends with what you’ve done. We’re not here to point fingers and ridicule, but if you learn the following five ways people hurt their back then perhaps you can stop the behavior and do yourself a favor.

5 Actions That Kill Your Back

  1. Your commute to work (and back home again.) A lot of people sit for a lot of time in morning traffic on their way to the daily grind, and in evening traffic on their way home. While this isn’t necessarily something to blame yourself for, there are things you could be doing to lessen the potential for pain in your back. Items like a heated massage cushion for your car could not only provide a nice massage on the way to and from work – like a traveling spa day, every day – it could also loosen those back muscles that get stiff and tense being stuck in the same position for so long.
  2. You sit at your desk for too long. Most nine-to-five office jobs force people into tiny cubicles with uncomfortable chairs and the bosses somehow expect to see productivity skyrocket in this environment. If you simply took your back massage cushion out of the car and into work, you’d be much more relaxed all day which could not only lead to less pain in your back but perhaps a better job performance. Alternatively, standing up and stretching every couple of hours could help blood circulation and relieve any back muscle cramps in addition to allowing your spine to stretch.
  3. You lift heavy objects the wrong way. You’ve heard “lift with your knees” a thousand times, but for some reason bending over with stiff legs to grab a heavy box is the norm. This is very typical and quite often the reason someone experiences lower back pain. Too much stress on the spine without using the legs to help evenly distribute the weight of the package can and will cause back issues. Just remember that if an old saying is still around, there’s a reason for it.
  4. You’re sleeping on a bad mattress. They say you should replace your mattress every 8 years because, quite honestly, at that point, it has collected quite a bit of your sweat and the number of dust mites is now holds is extremely unhealthy. On top of that, the springs or whatever mechanism used to balance and carry your weight have long since gone out and you are no longer getting the proper support your body needs – and your back gets punished for it. When selecting a new mattress, make sure you give it a test run to make sure it provides both the comfort and protection your back needs.
  5. You’re a “Weekend Warrior.” Hey, who doesn’t love a good game of football or pickup game of basketball on the weekend with friends? It’s a great way to shake off the stress of the work week and unwind while getting that much-needed exercise. However, the spin moves and slam dunks aren’t going over so well with your unconditioned back that is more used to that office chair than the end zone. You have to be careful when playing sports or getting too physical if you’re also not hitting the gym and getting your body into game time shape.

Now, this isn’t meant for you to sell your car, quit your desk job, or stop playing sports on the weekend – all that is great. This article is meant to simply make you aware of some of the things you might be doing (unintentionally or unaware) that are causing unnecessary pain in your back. That said, if you are experiencing pain in your back on a constant basis and have yet to find relief, Physician Partners of America specializes in minimally invasive pain therapy right here in Tampa.

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Overcoming Arthritis Pain during the Winter Season

Find Arthritis Relief with Alternative Pain Management

While arthritis pain can be unbearable during any time of the year, many who suffer from arthritis particularly dread the winter season. Though there is little research on the effects that the winter season actually has on arthritis, there are a few theories as to why colder temperatures can intensify arthritic pain in the joints. In cooler weather, air pressure tends to be lower, which can cause tissue around the joints to expand, putting pressure on them and causing pain or stiffness. It is also possible that the cold can cause tissue to contract, pulling on joints and further intensifying pain.

No matter the cause of this increased pain, there are many treatments for arthritis pain that exist outside of prescription drugs or pain medications. At our pain relief centers, we offer a number of alternative pain management techniques designed to effectively relieve arthritis pain.

Massage Therapy

Many studies have found that massage therapy can relieve the pain that is associated with arthritis. Moderate pressure applied to muscles stimulates the nerves that send pain-reducing signals to the brain. It is important to note that applying pressure does not always help to relieve arthritis, but when done properly by a certified therapist, a periodic massage can assist in greatly decreasing pain.

Acupuncture

Similar to massage therapy, acupuncture can help loosen the tight muscles that cause arthritis pain. Muscles are especially tightened in cold weather, making acupuncture an ideal treatment during the winter season. In addition to loosening the muscles, acupuncture has been seen to help regulate the nervous system, which can help the body release endorphins that combat pain

Botox

Though many view Botox only as a cosmetic procedure, recent studies have begun to explore Botox as a treatment for pain associated with arthritis, migraines, and other forms of chronic pain. Our migraine specialists in Texas and Florida use Botox to block the signals that nerve cells send to muscles, which stops muscles from contracting. This allows Botox to block the transmission of signals between pain receptors and the brain, relieving the pain of arthritis. Pain relief from Botox can also last for a few months, meaning that it does not need to be a daily treatment for pain relief, unlike traditional painkillers.

Spinal Cord Stimulation

A spinal cord stimulator is a device used to send electrodes throughout the body. Electrodes are placed on areas of pain, and electricity is carried to nerves in the back or neck (or wherever the pain is occurring), helping to block nerves from sending pain signals to the brain. The treatment is often used by those who suffer from chronic upper and lower back pain, but it can also help to lessen the pain that is caused by arthritis.

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The Benefits of Botox for Chronic Pain Relief

Despite its reputation as a beautifying procedure, Botox – or botulinum toxin – has recently found a second purpose as a tool for chronic pain management. Doctors have found that for a person suffering from chronic back pain, neck pain, facial pain, or even chronic migraines, a visit to Botox specialists in Texas and Florida can yield surprisingly fast and effective relief from pain that just doesn’t respond well to other treatments.

How Does Botox Treat Chronic Pain?

Botox, or botulinum toxin, is one of modern medicine’s most fascinating treatments. A protein produced by certain types of bacteria, botulinum toxin, in its natural form, is one of the most toxic substances known to man. Decades of research and careful refinement of the toxin has allowed scientists to start using this substance for good, and today Botox is used safely in millions of procedures, both medical and cosmetic. The toxin itself works by blocking a neurotransmitter called acetylcholine, which forces muscles to relax; in large doses Botox causes parts of the body to shut down completely, but when administered in small doses by a trained professional, it relaxes muscles safely and locally to smooth out wrinkles and to target muscular sources of chronic pain.

What Conditions Can Botox Treat?

Because it relaxes muscles, the pain management doctors at our clinics in Texas and Florida find that Botox is particularly effective at treating chronic pain that is muscular in origin. Whiplash, TMJ, and lower back pain, for example, respond well to treatment with Botox because the pain often results from stress and tension in the muscle fibers, which in turn put stress on nearby tendons and joints. In these cases, Botox forces the muscles to relax, allowing joints to return to their natural position without pain. The same muscle relaxation makes Botox an effective treatment for post-mastectomy pain: when temporary fillers are implanted under the skin in preparation for post-mastectomy reconstruction, the muscle often contracts painfully, making maintaining the implants long enough to expand the skin sufficiently for a natural-looking breast too painful for some. Botox injections target the muscle contraction, allowing patients to recover quickly and with much less pain.

Botox is also FDA approved as a treatment for chronic migraines. Regular injections at specific sites around the head and neck can create long-term relief for patients who suffer migraines more than 14 days out of the year. Injections to treat chronic migraines are usually administered once every 12 weeks by our pain management doctors in the Dallas-Fort Worth area, and, as with other Botox-treated pain, patients usually start to feel positive effects within a few days.

Who is a Good Candidate for Botox?

Whether a person is a good candidate for Botox to treat chronic pain is a decision that has to be made by an experienced pain management doctor, like those at Physician Partners of America in Texas and Florida. Someone who is in generally good health aside from their chronic pain can usually be treated with Botox, but certain pre-existing conditions, like myasthenia gravis, Lou Gehrig’s disease, and severe nerve disorders increase the risks of dangerous side effects when being treated with Botox. For a healthy individual, however, side effects are rare and usually mild, and Botox can be a quick, effective, and minimally invasive source of chronic pain management.

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Physicians Conduct Profiling to Prevent Patient Opioid Abuse

Identifying patients with traits that are high risk for drug abuse is becoming important

Prescription opioid abuse has become an epidemic in the United States

Because of this, pain management physicians are faced with finding ways to prevent abuse before it can happen.

An increasingly popular method of detection is patient profiling to determine risk factors.

Critical to identifying those most likely to abuse pain medicines are risk factors such as social dynamics and a patient’s family history.

What are non-pharmacological treatments for chronic pain?

Depending on the severity, location, and length of time you have experienced your chronic pain, we may suggest one or more of the following alternative pain management solutions:

  • Acupuncture: This ancient Eastern practice involves inserting several small needles into the skin at different pain centers to change the flow of energy in the body. Acupuncture allows the body to self-heal by releasing energy from main trigger points, thereby reducing or eliminating inflammation, pain, and nausea.
  • Chiropractic Treatment: Regular chiropractic adjustments are an attractive method of chronic pain management for patients struggling with neck, spine, and lower back pain.
  • Massage Therapy: Deep tissue, Swedish, and hot stone massages are just some of the alternative management techniques we can use to reduce pain and inflammation.
  • Physical Therapy: Regular physical therapy sessions help you regain strength in areas weakened by an accident or illness.
  • Transcutaneous Electrical Nerve Stimulation: We use this low-voltage electric stimulation to relieve pain by connecting two electrodes to the closest nerve fibers.

How can I find out about my risk factors?

The physicians at Physician Partners of America recognize that not every patient fully realizes their own potential for becoming dependent on opioid-based pain medications.

To provide the complete picture of a patient’s psychological tendencies, our physicians rely on the services of Dr. Michael Caruso of the Texas Health & Counseling Group.

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Study Finds Patients with Fibromyalgia Consider Opioid Treatment First

Patients less likely to follow recommended medications for treatment

A new study into how patients choose to treat their fibromyalgia within the first six months of diagnosis has brought to light some interesting conclusions.

The study by Optum was published in PAIN Practice. It included almost 100,000 patients newly diagnosed with fibromyalgia, over a period from January 2008 to February 2012.

A look at the medication prescriptions for those people during that period revealed that almost 60% of the prescriptions were for short and long-acting opioids, which are not considered guideline-recommended medications for fibromyalgia.

Once a patient starts treating pain from fibromyalgia with opioids, it becomes a challenge to successfully transition them to away from an opioid to a guideline-recommended medication treatment plan.

Nonpharmacologic Treatment of Fibromyalgia is Key

Alternative pain management can be defined as a medical treatment, therapy, or intervention that exists outside the realm of conventional medical practices.

Here at the Physician Partners of America, we strive to avoid the use of prescription drugs when possible and rather focus on finding the best form of alternative pain management for the patient. We offer nearly two dozen drug-free treatment options to help you experience pain relief for chronic pain.

Learn More About Your Chronic Pain Treatment Options

Our staff is happy to answer your questions about our chronic pain relief treatment methods as well as the types of conditions we treat using natural therapies. Please complete this form or contact your nearest office for more information or to schedule an appointment.

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Opioids Not The Way to Treat Chronic Pain

CDC recommends sharp reduction in prescriptions of opioids

The Center for Disease Control and Prevention (CDC) has entered the national conversation around the use of opioids to treat chronic pain.

The United States has seen a sharp increase in the use and abuse of pharmacological pain management medications that are prescribed to treat chronic pain.

As a result, the CDC has issued a number of guidelines for physicians. The main recommendation is the use of non-pharmacological treatment and therapy as the preferred method for treatment of chronic non-cancer pain.

What are non-pharmacological treatments for chronic pain?

Depending on the severity, location, and length of time you have experienced your chronic pain, we may suggest one or more of the following alternative pain management solutions:

  • Acupuncture: This ancient Eastern practice involves inserting several small needles into the skin at different pain centers to change the flow of energy in the body. Acupuncture allows the body to self-heal by releasing energy from main trigger points, thereby reducing or eliminating inflammation, pain, and nausea.
  • Chiropractic Treatment: Regular chiropractic adjustments are an attractive method of chronic pain management for patients struggling with neck, spine, and lower back pain.
  • Massage Therapy: Deep tissue, Swedish, and hot stone massages are just some of the alternative management techniques we can use to reduce pain and inflammation.
  • Physical Therapy: Regular physical therapy sessions help you regain strength in areas weakened by an accident or illness.
  • Transcutaneous Electrical Nerve Stimulation: We use this low-voltage electric stimulation to relieve pain by connecting two electrodes to the closest nerve fibers.

When is opioid treatment appropriate?

The CDC states that use of opioids to treat chronic pain should only be used if the benefit of pain relief outweighs the potential risk of patient addiction/dependency and overdose.

According to data released by the CDC, in 2013, more than 16,000 people died in the United States from overdose related to opioid pain relievers, four times the number in 1999.

Learn More About Your Non-Pharmacological Chronic Pain Treatment Options

Our staff is happy to answer your questions about our chronic pain relief treatment methods as well as the types of conditions we treat using natural therapies.

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