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

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Telemedicine pain clinic

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Physician Partners of America Offers Telemedicine Option

For patients worried about leaving home to see their pain management doctor, Physician Partners of America (PPOA) is offering a solution: telemedicine. It allows patients to talk to their regular PPOA physician and order prescription refills.telehealth pain clinic

“We understand some people are under stay-at-home orders, and others are too high-risk to venture out, so we are using technology to bring our doctors to them,” says Josh Helms, COO of PPOA.

Some chronic pain patients may carry a higher risk of contracting the virus. For others, the dry cough associated with COVID-19 may aggravate some neck and spine pain. Patients should consult a primary care physician for testing and diagnosis. Current PPOA pain patients seeking guidance or medication management are encouraged to use our telemedicine option.

PPOA’s telemedicine service is simple to use. There is no complicated software to install. All that’s required is a telephone. Our scheduling team will handle all the details and paperwork through the HIPAA-compliant electronic medical records (EMR) system, just as they do for office visits. A team member will contact patients to confirm their phone call with the doctor, and the doctor will call at the pre-arranged time.

“Our telemedicine service can take the place of an in-office visit in many cases,” says Helms. “It’s an easy and HIPAA-compliant way to ensure our patients are getting what they need to ease their pain during this uncertain time.”

Visit our home page, click on Schedule Appointment, or call  888-412-6958, and set your telephone appointment today.

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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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For Some, Topical Medications Can Replace Opioids

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Doctors have known for years that topical pain medications – those applied to the skin – are effective for some pain patients. Recently, however, they were surprised to learn that those creams, patches and ointments are more helpful than previously thought.

In fact, half of patients taking oral opioids stopped them after trying topicals, a recent study shows. Another 30 percent were able to quit using all types of pain medications and switch to topical analgesics.

The study, published in Clinical Focus: Pain Management Fast Track, surprised even its authors. “As a clinician active in the pain world, I have seen it [discontinuation of opioids] but certainly not at this magnitude,” study leader Jeffrey Grudin, M.D., told Practical Pain Management. Grudin is director of pain management and palliative care at Englewood Hospital and Medical Center in New Jersey.

About the Topical Pain Medications Used

The study followed 121 chronic pain patients. After treatment with topical analgesics, 49 percent of those followed after three months and 56 percent of those followed up at six months said they had stopped using opioids altogether.

Another 31 percent followed up at three months, and 30 percent reporting at six months, said they were not taking any more pain medications. This included nonsteroidal anti-inflammatory drugs (NSAIDS), which target the inflammation   that causes most neck and back pain.

The patients who took part in the study suffered moderate symptoms of neuropathy, arthritis, radiculopathy, myofascial musculoskeletal or tendonitis pain.

The Most Effective Topical Pain Medications

The topical analgesics used in the study included diclofenac, ketoprofen and flubiprofen. Other topical pain medications readily available through pharmacies are also shown to be effective. They include baclofen, ketamine (3-5%) and lidocaine (7-8%).

More Research Needed

It is clear that more research needs to be done. The study was small, and 67 of 121 study participants dropped out before the six month follow-up. Still, the study shows this is one opioid alternative that holds promise for people suffering from chronic pain.

“Topical analgesics are effective for a variety of types of pain,” Dr. Grudin, the study leader told Practical Pain Management. “Our study supports the fact that we can eliminate opioid use in a certain percentage of patients with chronic pain conditions.”

 

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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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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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