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

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Teresa Alvarado: Practice Manager, Keller, TX-

Our employees are all patient care champions, but some go the extra mile and we want to give them the recognition they deserve. They embody the PPOA values known as S.I.T.E. – Safety, Integrity, Teamwork, Empathy – which informs our service to patients and the community through high quality health care.

PPOA’s Practice Manager of the Keller clinic, Teresa Alvarado has gone that extra mile. This pandemic has been tough on everyone but instead of letting it get the best of her, Teresa has gone above and beyond to make sure everything continues to run smoothly. She represents all of the values we have here at PPOA.

Teresa was born in McAllen, Texas surrounded by beautiful palm trees in the Rio Grande Valley. Ironically she grew up in Muscatine, Iowa surrounded by cold snow and dead trees, but still loved that Midwest charm. She studied Health Information Management at Black Hawk College in Moline, Illinois. Eventually she made her way back to Texas and has been there for about 5 years now.

Teresa has worked in the medical field for 25 years. She started her journey as a Medical Assistant for pediatrics for about 9 years and then continued as a Medical Assistant for another 3 years in family practices. She then expanded her healthcare knowledge into the insurance field. She was a medical insurance manger for 3 years and then went into coding and billing for 4 years.

Finally Teresa made her way to the PPOA family in August 2016. She originally applied to work as a Medical Coding specialist but was hired as a Practice Manager for the Keller location instead. As a Practice Manager Teresa has many duties. Some of her duties include assuring patients are correctly scheduled, reaching out to patients regarding procedures, clinical visit requirements, issues or concerns, assisting with the check-in/out process, addressing any concerns or tasks providers or medical assistants may have, and she even helps triage patients.

She has been an asset to the Keller team, “Teresa works very closely with Dr. Heil and the staff at Keller and goes out of her way to make sure all patients have a great experience. The past few weeks as the clinics have been short staffed Teresa has stepped in and assisted in patient triage while also managing the clinic and ASC schedule very efficiently. There isn’t a task that Teresa won’t take on. During the COVID19 crisis Teresa remained diligent and focused on the success of the Keller clinic,” says Rhonda Boysen, Regional Director Clinic Operations.

Teresa holds herself at a high standard for patient care, “It is an honor to have someone trust me with their health, it is a privilege and I always keep that in mind. Providing care with true empathy is hard to find, I make it my mission to make each and every patient feel that they are a person, not just a dollar sign walking into our office,” Teresa says.

PPOA applauds Teresa for her hard work and thanks her for all that she does. She is truly a Patient Care Champion.

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.


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 here.]

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


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.”



Our employees are all patient care champions, but some go the extra mile and we want to give them the recognition they deserve. They embody the PPOA values known as S.I.T.E. – Safety, Integrity, Teamwork, Empathy – which informs our service to patients and the community through high quality health care.


Enrique Covarrubias is the practice manager of our Frisco, TX pain management location. He is universally known for delivering compassionate care to patients and helping the office run smoothly.

“Enrique has been an integral part at our Frisco clinic team for the last four years,” said Dr. Prasad Lakshminarasimhiah, the physician Enrique works with. “During these years he has demonstrated commitment to the success of our clinic in many, many ways.”

“I went into the medical field because I love helping people,” says Enrique, a Los Angeles native.

His decision, however, is rooted in tragedy. He witnessed his best friend shot to death on the notoriously rough streets of South Central L.A. He moved to Texas shortly after that.

After graduating from high school in 2000, Enrique went on to earn his CMA and X-ray technician’s license. He worked as a laboratory manager for a large company for five years, earning his location a franchise of the year award in 2011 and a consistent no. 1 or 2 ranking out of 150 locations. “I’m pretty competitive,” he says.

That drive and a superior ability to solve problems caught the eye of PPOA in 2014. He began his career here just six months after Dr. Gari opened the first clinics in Texas. “Back then, we were called clinical coordinators,” he says.

“Enrique is always the first to respond on any and everything that is presented by the company. He always has a go-getter personality and is always willing to help a patient or the staff,” says Terica Cox, Regional Clinical Supervisor.

One recent example: a patient was waiting for a procedure, but the doctor was delayed. Instead of sending the patient home, Enrique tracked the doctor down at the surgery center and made sure the patient was taken care of right away.

“He goes the extra mile in every situation for the best possible outcome for our patients,” Dr. Prasad says. “He coordinates extremely well with other staff and departments with the ultimate goal of providing the best care for our patients, and at the same time making it very easy on them. We appreciate him for all the effort he makes to maintain a positive attitude even under challenging situations.”

PPOA COO Josh Helms agrees. “Enrique defines what good service and dedication look like at PPOA. We are blessed to have him on our team and appreciate his dedication and empathy toward the patients we serve.”

For his part, Enrique says he enjoys his coworkers and being part of a high-growth company like PPOA.

“My time here has been amazing,” he says. “There’s been a lot of growth and a lot of changes. It’s exciting to be a part of it.”




Michael Lupi, D.O., has joined Physician Partners of America Pain Relief Group in its newest location in Jacksonville as a pain management physician.  He is an innovator in spinal cord and genicular nerve stimulator implants, as well as a longtime fighter against the opioid crisis.

Dr. Lupi comes to PPOA from Pain Associates of South Georgia, where he served as medical director. He has practiced interventional pain management for nearly 25 years and specializes in the treatment of spine pain, as well as musculoskeletal and neurological disorders. He has advanced training and certification in spinal cord stimulator placement, peripheral nerve stimulation, radiofrequency ablation, percutaneous electrothermal treatment, and advanced EMG training at Harvard Medical School.

He recently implanted the nation’s first peripheral nerve stimulator of the genicular nerve as a treatment for chronic knee pain.

“I was attracted to this field because it is procedure-oriented,” he says. “One procedure can be life-changing.”

Dr. Lupi is also certified as an independent medical examiner and a medical review officer. He is an expert witness in the areas of physical medicine and rehabilitation, pain medicine, and toxicology.

He earned his medical degree from Des Moines University College of Osteopathic Medicine in Iowa and completed his internship at Northlake Regional Medical Center in Atlanta. He then completed his residency at Emory University, Atlanta Department of Physical Medicine and Rehabilitation.

His longtime interest in stemming the opioid crisis aligns with PPOA’s mission to use interventional pain management techniques and tighten prescribing guidelines. “We have known for a long time how addictive opioids are,” he said. “We need to promote alternatives and come up with more guidelines for prescribing for chronic – as opposed to acute – pain patients.”

Dr. Lupi has traveled to Washington D.C. several times in an effort to generate federal interest in a pilot project using artificial intelligence to fight the opioid epidemic. It has been well-received. He is a fellow of the American Board of Physical Medicine and Rehabilitation with board certification in the subspecialty pain medicine. He also serves as clinical instructor at Philadelphia College of Osteopathic Medicine.

Patients can make appointments with Dr. Lupi at the Jacksonville office, 11705 San Jose Blvd., Suite 110, Jacksonville, FL 32223 between 8 a.m. and 5 p.m. The phone number is (904) 579-1365. Same-day appointments are available.


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.