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

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On average, 130 Americans die every day from an opioid overdose. From 1999 to 2017, more than 700,000 people have died from a drug overdose. The opioid epidemic has been an ongoing struggle since the 1990s and although agencies are working hard to prevent these issues, we have yet to figure out how to greatly reduce these staggering statistics. At Physician Partners of America (PPOA), we do what we can to provide our patients with opioid alternatives so they can live their best and healthiest lives.

Howard Dedes, M.D., of PPOA’s Fullerton, CA clinic, is an advocate for his patients’ well-being. PPOA’s physicians have great knowledge on the subject of opioids and hope to be a part of combating the opioid epidemic. Below are opioid facts from Dr. Dedes.



What are opioids?

Opioids are very strong pain medications that, when properly managed, work well for certain types of pain and short-term use. Treatment for broken bones, burns, severe injuries and cancer are examples of pain that respond well. In recent years, there has been a great increase in the use of prescription opioids for the treatment of conditions like chronic, non-cancer pain such as back pain or osteoarthritis.


Opioid effectiveness

Although opioids might mask the pain for a bit, serious risks are involved and there is lack of evidence about their long-term effectiveness. The problem is that if you use them for a while, it is difficult to get the same effect as you did when you first started the medication. There have been long term studies following patients with chronic back pain who have been given increasing amounts of opiates, and others who were not on long-term opiate courses. The researchers found no long-term benefit to the extended use of opiates.

“That’s not to say that people with chronic pain may not have the need for pain medicine if their pain flares up,” says Dr. Dedes. “It’s just that the high doses of opioids that were once expected are becoming rarer.”


The opioid epidemic

In the late 1990s, pharmaceutical companies began encouraging opioids at greater rates due to reassurance from the medical community that patients would not become addicted to opioid pain relievers. This led to the extensive misuse of these medications before it became clear that they could, in fact, be highly addictive.

“I believe the opioid crisis is real, and it’s a difficult topic when dealing with patients who have been given increasing amounts of opiates for several years,” says Dr. Dedes

Medication increased at a high level can have the opposite effect. It’s called OIH (opiate induced hyperalgesia), which makes the pain actually worsen despite increasing the opiate strength or frequency. This leads to the body becoming physically dependent to the opiate medication. If this occurs, as the body feels the amount of medication lowering in its system, there is an increased craving for the medication and a feeling of pain.

Then there are patients who try and stop immediately after hearing about the opioid crisis. Unfortunately, this is not beneficial, as they can feel sick and then restart the medicine and after that are afraid to reduce the amount of opiates for fear of getting sick again, from the opiate withdrawals.


Risks and reducing opioids

In order to reduce their use of opiate medications, patients must be committed to their health. This includes wanting to get better without being dependent on a medication – specifically a medicine that at high doses has been linked to dependence, addiction, mood changes, low testosterone, respiratory depression, or even death.

“If they are committed,” says Dr. Dedes, “I will work just as hard to help them lower their daily opiate amount, while still allowing them to be functional.”

Although pain control is good, quality of life can suffer when someone constantly feels “foggy” and tired from the pain medication. Dr. Dedes makes it a point to focus on a patient’s function and ability to do the things he or she want to do – garden, golf, sit through a movie with grandkids, for example – and then focus on controlling the pain to achieve this.

To help manage a patient’s pain opioid-free, Dr. Dedes will usually start by suggesting daily exercise to help improve flexibility or strength, and in turn, combat the source of pain. Exercises can range from mild to intensive, initially with a therapist and then on their own. It is important for patients to start at a level they are comfortable with and increase intensity from there.

When a more aggressive approach is needed, Dr. Dedes specializes in the ability to perform minimally invasive procedures that target the patient’s specific pain. He tailors treatment plans to each individual because he understands all pain is different.

“The truth is that the intervention has to be specific to the individual,” says Dr. Dedes. “Pain varies between individuals even if they have similar looking MRI reports.”

There are many new procedures and conservative treatments that can be done to reduce the need for opioids. It is Physician Partners of America’s goal to battle opioid addiction by offering interventional solutions to chronic pain. If you would like to learn more about how we can help, please visit us at


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Sharing Stories of Pain and Hope

“Everything I enjoyed caused me intense pain. It affects every aspect of your life,” says J.B., 49, one of our Texas pain patients. “Not until you get treatment do you realize you can live with less pain.”

More than 12,000 patients walk through our doors each month seeking pain relief treatment. J.B.’s is one of the many personal reflections we will share during September, which is Pain Awareness Month.

According to the American Chronic Pain Association, which organizes the annual event, about one in three people lives with intractable pain. Helping them manage and overcome it has been the mission at Physician Partners of America since 2013. We hear stories daily of people like J.B., who live with all types of chronic pain: degenerated discs, spinal stenosis, migraine, fibromyalgia, arthritis, cancer pain and diabetic neuropathy, among others. It is our goal to help each patient seek a path of pain relief.

How Many People Live with Chronic Pain?

During Pain Awareness Month, we are reminded of the startling numbers related to chronic pain:

  • It is the number one cause of adult disability in the U.S.
  • It affects 50 million Americans
  • It costs $100 billion per year in lost workdays, medical expenses and other benefit costs.
  • It is a social issue. As you will see from the stories we will present to you each day on social media, unmanaged chronic pain is isolating. It causes people to withdraw from friends, family and communities.

Interventional and Integrative Pain Management Approaches

Physician Partners of America practices interventional pain management. That means getting to the root cause of the pain and treating it as its source. Some types of pain can be relieved to a degree and others can be eliminated. Our pain management doctors work with our orthopedics and laser spine divisions to find the best course of treatment for each patient.

What about Opioids for Pain Treatment?

As Pain Awareness Month illustrates, the debate over opioids for pain continues to heat up. Nearly 2 million Americans have a disorder related to prescription painkillers, according to the National Survey on Drug Use and Health.

It’s important to remember that the opioid crisis stems from treatment of acute pain, the type that lasts less than three weeks. Historically, opioid medications were prescribed for short-term pain because they are effective.

“Opioids are very seductive drugs, but they work. You give opioids to somebody in pain and believe me, the pain goes away, but it only works for so long,” PPOA Chief Medical Officer Abraham Rivera, M.D., told a recent televised opioid town hall. “In the acute setting, they are phenomenal drugs. After that, the patient gets hooked on them. They’re extremely addictive.”

Strict prescription limits are now in place in many states as a result.

Physician Partners of America has long recognized the dangers of opioid addiction and uses effective options to treat the root cause of the pain versus masking it. They include:

  • Interventional pain management as a preferred treatment
  • Opioid antidotes prescribed along with every opioid-based prescription.
  • Medication management
  • Intraoperative neuromonitoring to avoid accidental nerve damage during surgery
  • Drug-genes testing to determine the right medication for each patient

New Prescribing Laws

Restrictive new laws are aimed at people with acute pain. PPOA’s pain management doctors specialize in chronic pain, which lasts more than three to six weeks. We do write prescriptions for opioid medications in select cases. Usually, these are patients who have been taking these medications for years just to function normally. However, we manage these types of prescriptions carefully.

PPOA doctors believe in reducing dosages wherever possible. PPOA founder Rodolfo Gari, M.D, MBA, recalls many successes. “I’ve had some really gratifying stories over the past 30 years – patients who come in with mega-doses of opioids and you wonder how they walked into your office.”

Pain Awareness Month is Just the Beginning

Neurostimulators and minimally invasive laser spine procedures are just some of the cutting-edge treatments PPOA uses in severe pain cases, along with nerve blocks, injections and minimally invasive laser spine procedures.

While we have seen many success stories, there is still a long way to go. The Food and Drug Administration held the first of several planned hearings with chronic pain patients in July. The agency aims to shape new guidelines to address concerns that some feel have been muted in addressing the opioid crisis.

PPOA will be watching with interest. We will keep key issues top of mind through Pain Awareness Month. We will continue to find a balance between patient safety and humane guidelines, practice interventional treatments, and wage a battle against chronic pain, one patient at a time.






“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.