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All posts by Integrated Pain Associates

Walmart tightens its opioid prescription policies

Walmart is making its opioid policy more strict, limiting the duration of such prescriptions and requiring that they be filled electronically.

The company announced on Monday that within 60 days, it will only fill first-time acute opioid prescriptions for seven days or less nationwide, and it will limit the dosage to 50 morphine milligram equivalents, or MMEs, per day. The CDC publishes MME conversion guides to help pharmacists figure out the right dosage for each type of prescribed opioid.

 There are more than 5,300 Walmart (WMT) and Sam’s Club locations in the United States.
The new restrictions follow recommendations from the Centers for Disease Control and Prevention. A CDC study found that people who were prescribed at least one day of opioid therapy had a 6% chance of being addicted a year later — but for those prescribed eight or more days of treatment saw that chance spiked to 13.5%. The CDC also notes that patients who are prescribed higher dosages are more likely to die from an overdose.
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Chronic Pain and Intimacy

Eight Ways to Improve Your Sex Life with Chronic Pain

If you suffer from chronic pain, you may feel that intimacy with your partner isn’t possible or sometimes even desirable. Chronic pain can affect mobility. And fatigue and depression make it hard to get in the mood. Often it’s easier to simply mourn the loss of this part of your relationship. But don’t do that just yet.

You’re not alone:
Sexual desire and functioning are difficult for many people with pain. More than half of the respondents in one study said that pain placed limitations on their sex lives. They reported pain and fatigue as having the biggest effects. According to experts, both men and women with pain commonly experience a downturn in their sex lives.

Roadblocks to desire:
Emotions related to pain and sex are complex. You may feel fear or anxiety for a number of reasons. Pain or reactions to medication may make you question your ability to become aroused, perform sexually, or have an orgasm. Limited mobility or painful joints can prompt feelings of unattractiveness or discomfort about your body. Perhaps a previous attempt to have sex with your partner didn’t go smoothly, and you’re afraid it will happen again. Or you may be dealing with a combination of these obstacles.

Ways to help:
The good news is that you can have a fulfilling sex life with chronic pain. It requires a bit of planning and maybe some new foreplay and positions, but pleasure is possible. You may even experience a break from your discomfort and pain: orgasms release chemicals called endorphins that are natural pain and stress fighters.

To bring more intimacy into your relationship, consider trying a few of the following:

     Take a warm bath:A soothing soak can relieve pain. If you’d like, ask your partner to join you. Sex needn’t follow. Just relaxing together can be a sensual first step to reintroducing intimacy into your relationship.
     Plan for “least-pain” times:Your pain may feel worse at certain times of day. Sex in the morning or afternoon may be better than at nighttime. Set your alarm clock a little earlier, or plan a quiet weekend afternoon with your partner. Also, get to know when your pain medication kicks in. By becoming more aware of when you have the most pain relief, you can time intimacy to when you’re feeling your best.
     Play with positions:Some sexual positions may be more comfortable for people with arthritis. And don’t forget foreplay. Massage, oral sex, and other alternatives to intercourse can help take attention or pressure off of parts of the body that are painful to move or touch.
     Rule out depression:If you feel as if your sex drive has dropped, talk with your healthcare provider about whether you might have depression. Lack of desire can be a symptom.
     Fight fatigue:Keep your energy level up by getting eight hours of sleep, building good nutrition into your diet, and practicing stress-reduction techniques like yoga or meditation.
     Get moving: Regular workouts will help to keep joints more mobile and boost your energy, mood, and positive feelings about your body. Gentle exercises before sex also can improve range of motion.
     Monitor medications: The medications that you take to control pain or other symptoms may affect sexual function. For example, some antidepressants can decrease your ability to experience orgasm. Consult your healthcare provider or pharmacist about possible side-effects.
     Go slowly: Give yourself permission to nurture intimacy at a comfortable speed. Kissing, cuddling, and other gestures of affection will convey love and let your partner know that you value being close.

Source: https://www.painaction.com/eight-ways-improve-sex-life-arthritis-pain/

In addition, the utilization of opioid medications significantly reduce testosterone levels in both men and women which can have a huge impact on sexual desire and performance. Reduced testosterone levels are also associated with decreased muscle mass, increased fat deposition, reduced bone density, and increased pain levels. Eliminating opioids from your medication regimen will help restore more normal sexual desire and function and can actually reduce current pain levels says Dr. Benjamin Lowry.

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TRICARE Insurance

ATTENTION: TRICARE PATIENTS
On January 1, 2018 there were many changes to the Tricare program. These changes include an increase in copays for office visits and outpatient procedures and could impact you. Please read the attached material and visit the Tricare website to learn more. https://tricare.mil/Changes
#knowyourbenefits #insuranceupdate #Tricare #noticetopatients#painstopshere #IPAclinic

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Patient Portal Guide for Patients

Do you ever wish you could just send a message directly to your provider or an IPA staff member?

Well, now you can! IPA has a secure Patient Portal where you can send messages to your provider, request an appointment, pay your bill online, and so much more. The Patient Portal is an easy, convenient way to access your IPA care team without the hassle of calling, leaving a message, and waiting for a response. With the portal, your message goes directly to a member of our team who will begin working on a solution and will have an answer for you, in most cases, the same day.

If you provided your e-mail address when you established care at IPA, you should have received an e-mail with the Patient Portal instructions and your username. If you do not have access to the Patient Portal please call our office at (254)245-9175 and one of our staff members will help you get set up.

Our goal is to provide faster, easier, and more convenient access for our patients.

Please visit the link below to see the Patient Portal User Guide for instructions on how to navigate the Portal.

https://ipaclinic.com/patient-portal/patient-portal-guide/

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DRG Therapy: A Different Approach to Pain Relief

DRG Therapy: A Different Approach to Pain Relief

Dorsal root ganglion (DRG) therapy is a new type of neurostimulation therapy designed to manage difficult-to-treat chronic pain in specific areas of the lower body, such as the foot, knee, hip or groin. If you suffer from this kind of pain, DRG therapy may work where other therapies have not—or may have provided only partial relief.   Benjamin Lowry M.D.  at Integrated Pain Associates is one of the few physicians in the area trained to perform this procedure.

DRG therapy is for patients whose pain is limited to a specific area of the body. The DRG corresponds to specific anatomical locations in the body and relays information, such as pain signals, to the brain.

The Dorsal root ganglion is a nerve cluster that regulates signals and sensations as they travel to the brain. Stimulation of the DRG can modify the pain signals getting through resulting in pain reduction.

The following short video explains what DRG stimulation is and how it works.

https://www.sjm.com/en/professionals/resources-and-reimbursement/video-and-media/nm-overview-of-dorsal-root-ganglion-stimulation

Patients suffering from chronic nerve pain due to the following conditions may be candidates for this procedure:

  • Groin/ Perineal Pain
  • Lower Extremity Pain
  • CRPS
  • Hyperalgesia/ Allodynia
  • Post-surgical Neuropathic Pain
  • Phantom Limb Pain
  • Peripheral Polyneuropathy
  • Intercostal Neuralgia
  • Postherpetic Neuralgia

Studies have shown that DRG Stimulation has a significantly greater efficacy over traditional spinal cord stimulation. In a double-blind study, over 50% of the participants experienced pain relief with an average pain reduction of over 80%.

Please take the time to view this DRG presentation by Benjamin Lowry, MD

Dorsal Root Ganglion Stimulation- For PTs

If you’re suffering from focal lower extremity pain, complex regional pain syndrome, or other forms of painful nerve disorders, then DRG may be very helpful at reducing your pain. Please call us at (254)245-9175 to learn more about how this new pain management technology is changing lives.  Our staff at Integrated Pain Associates looks forward to hearing from you and discussing how neuromodulation may help you.

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Temple – Ribbon Cutting

As you know Integrated Pain Associates has been serving the Central Texas community for 10+ years. Since we opened for business, the support of our patients and referring providers has helped us grow tremendously.

Due to the continued growth of our practice we recently opened a new clinic located at 5244 South 31st St. in Temple. We are excited about our new office and proud to be able to better serve your community.

Our goal is to accommodate our growing patient base and provide easier access to care for our patients’ pain management needs.

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Pain management growing, evolving

When Dr. Scott Irvine opened Integrated Pain Associates 12 years ago in Killeen, he was the only physician. The clinic now has seven physicians and eight nurse practitioners.

“I started seeing patients with chart No. 1,” Irvine said. “We just crossed chart 23,000 a (couple of) weeks ago.”

The growth of the clinic speaks volumes about the need in the community and the nation for pain clinics, Marketing Director Lydia Bailey said.

The idea that pain needed to be managed in a fashion different from a pharmacy led to the increase of pain clinics, according to Irvine.

Read More: http://kdhnews.com/living/pain-management-growing-evolving/article_ff6455e0-ab94-11e7-aad5-8b73c30cc717.html
Source: KDH News

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Opioid commission unveils new partnerships, drug supply limits to stop epidemic

New Jersey Governor Chris Christie held the third formal meeting of President Trump’s ongoing Commission on Combatting Drug Addiction and Opioid Crisis, where officials in the pharmaceutical industry and government detailed new partnerships and efforts in the hopes of limiting the use of opioid prescriptions for combatting pain and recommending new treatments for pain management without the use of addictive substances.

National Institutes of Health Director Dr. Francis Collins advised the commission that the agency is looking to build partnerships with researchers across academia, government, prescribers and patients to “cut in half the time needed to make available prescriptions that are non-addictive.”

He said areas like developing “potent but non-addictive drugs” for pain relief and offering new avenues for treatment would become a top priority for the partnership.

Source: CBS News
Read More: https://www.cbsnews.com/news/opioid-commission-unveils-new-partnerships-drug-supply-limits-to-stop-epidemic/

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Smoking and its Effect on Pain

Smoking and its Effect on Pain

Kristian Delgado, M.D.

The question of how smoking affects pain is complicated and multifactorial. It is true that patients who smoke are more likely to develop low back or other types of chronic pain. Additionally, those that smoke are more likely to report higher pain levels, they are also more likely to use higher levels of analgesic or pain medicines, and their pain is likely to have a greater impact on their daily life. Several studies have shown links between moderate to heavy smoking (one or more packs per day) and disability related to pain. Several Finnish studies found teenage smoking was a significant risk factor for developing pain, this trend was also dose responsive. People that smoked more were more likely to develop pain than those who smoked less.

There are several epidemiological studies that show trends within the population. We now know that those who smoke are at risk of developing painful conditions. Smoking is a risk factor for osteoporosis, lumbar disc disease and poor bone healing. We also know that smoking impairs wound healing, thus those that smoke take longer to heal following injury and may have associated chronic pain. In addition to increasing the risk for painful conditions, people who smoke were found to have a greater intensity of pain as well as more areas of pain within their body, in comparison to non-smokers. Smokers are more likely to report functional and life impairment related to their pain and appear to have worse outcomes in terms of disability related to their pain.

Some people report that smoking a cigarette can decrease their immediate pain. In fact, it has been shown that the nicotine found in cigarettes has been shown to temporarily decrease pain. Several studies have shown that giving patients nicotine before surgery led to decreased pain and decreased use of opioids in their post-operative period. These studies were based on non-smokers only. The effect was not seen in those who were already using cigarettes on a regular basis. Those who smoke regularly may have a reduced sensitivity to the effect of nicotine on pain. Smoking long term is problematic for controlling pain due to the development of tolerance. The nicotine levels in the body are only steady for about one hour, meaning someone would need to keep smoking continuously to help with pain. Over time this would have less and less effect even if they continued to smoke hourly. Lastly those withdrawing may experience depressed mood, anxiety, stomach upset and irritability.

Smoking has also been shown to be an independent risk factor for opioid use. In smoking patients being treated for pain, opioids were more likely to be used. Additionally, those already on opioids were more likely to need higher doses of their medication to control their pain than non-smokers. What this amounts to is that while the nicotine found in cigarettes may provide some initial benefit for pain control in non-smokers, overall it will make pain much more difficult to treat.

There is evidence that smoking is not directly related to the perceived pain level. It is associated with increasing levels of depression. Depression is highly associated with chronic pain and vice versa, chronic pain is associated with higher levels of depression. Among those with depression, the rate of smoking is significantly higher than the rest of the population, as high as 45%. Like smoking, depression has been found to be associated with increased chronic pain conditions including low back and neck pain.

Smoking is associated both with developing pain and seems to have a greater impact on pain in those who develop chronic pain. We know that those who smoke are more likely to have some level of depression, and those with depression are more likely to have pain. Those using chronic pain medications are also more likely to need more medicine to treat their pain and are less likely to improve with treatment. We know from a physical standpoint smoking interferes with the body’s ability to heal itself, and lastly we know that smoking has been associated with higher use of narcotic or opioid prescriptions which have their own risks and complications.

A recent analysis looked at data from 2 universities with over 5000 patients who were being seen for spine related pain. Those patients who stopped smoking before beginning therapy for their pain or quit during the course of treatment had lower overall pain scores and greater functional improvement. Those who continued to smoke were unlikely to have improvement in pain or function and were more likely to have disability related to their pain.
Some people are able to quit just by making up their minds to do so. For most, this is difficult and they may need additional resources. The first conversation you may want to have is with your primary care physician. Having that partnership may provide you the support and resources you need to quit. Many people may feel that if they stop and start again, that they have failed, but it is important to remember that many people need more than one attempt at quitting. Your doctor may be able to provide you with a medication that could help. There are nicotine replacement strategies with gum and/or patches. There are also plans that help with cutting down and stopping in a gradual process. Online and phone resources for support are www.smokefree.gov/ or through the CDC website http://www.cdc.gov/TOBACCO/quit_smoking/how_to_quit/ or the American Lung Association website http://www.lung.org/stop-smoking/how-to-quit/

At Integrated Pain Associates, we successfully treat many types of chronic pain through a targeted, multi-disciplinary approach. We are conveniently located throughout Central Texas with locations in Killeen, Waco, and Temple. Contact us for more information or to schedule an appointment.

References:
Shi, Yu, Toby N. Weingarten, Carlos B. Mantilla, W. Michael Hooten, and David O. Warner. “Smoking and pain: pathophysiology and clinical implications.” Anesthesiology 113, no. 4 (2010): 977-992.
Hooten, W. Michael, Yu Shi, Halena M. Gazelka, and David O. Warner. “The effects of depression and smoking on pain severity and opioid use in patients with chronic pain.” Pain 152, no. 1 (2011): 223-229.
Behrend, Caleb, Mark Prasarn, Ellen Coyne, MaryBeth Horodyski, John Wright, and Glenn R. Rechtine. “Smoking cessation related to improved patient-reported pain scores following spinal care.” The Journal of Bone & Joint Surgery 94, no. 23 (2012): 2161-2166.

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CVS Pharmacy Will Limit Prescriptions for Opioids

With the 64,000 deaths from opioid overdoses last year alone, the medical community is struggling to contain the out-of-control opioid epidemic. Now, CVS, one the nation’s largest pharmacy benefit managers that oversees prescription drug benefits for 90 million people through its CVS Caremark plan, is attempting to address opioid abuse by no longer reimbursing opioid prescriptions beyond the first week for people filling these prescriptions for the first time.

Beginning in February, the company announced, it will adhere to the Centers for Disease Control and Prevention’s (CDC) guidelines for prescribing opioids that limit doses and duration of the drugs prescribed by doctors. The CDC recommends prescribing the painkilling narcotics, which can be highly addictive, in as low a dose as possible for as short a time as needed. Not only will CVS Caremark only reimburse for seven days of prescriptions, but for first-time opioid prescription-fillers it will also dispense short-acting, rather than extended release, versions of the drugs for these patients.

Read More: http://time.com/4952176/cvs-pharmacy-opioid-epidemic/

Source: Time.com

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