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All Posts in Category: Health Basics

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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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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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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National Pain Awareness Month

NATIONAL PAIN AWARENESS MONTH
Pain Awareness Month was created to increase awareness about the effect of pain and to educate citizens about the advanced treatment options available to help alleviate pain.

WHAT IS NATIONAL PAIN AWARENESS MONTH?
September is Pain Awareness Month.
This busy month is marked by a variety of different initiatives and activities all with the goal of promoting education, advocacy and awareness about chronic pain in order to break down the barriers to effective pain management.

PAIN IS MORE THAN A SYMPTOM
Undertreated chronic pain significantly impairs quality of life, and can be severely physically, psychologically, and socially debilitating.
• Pain affects more Americans than diabetes, heart disease and cancer combined.
• Workers lose an average of 4.6 hours per week of productive time due to a pain condition.
• An estimated 20 percent of American adults report that pain or discomfort disrupts their sleep a few nights a week or more.
• 80 percent of people in the United States will experience back pain at some point in their lives.
• Besides the common cold, back pain is the number one reason people visit their family doctors.

EDUCATION & AWARENESS
The adoption of pain as the “fifth vital sign” in 2001 has helped increase the legitimacy of pain as not just a symptom but a serious detriment to quality of life, requiring proper medical attention. It also helped further the notion that every person has a right to timely and effective pain management.
Pain does NOT mean pills — There are many interventional pain management options available.
A major aim of Pain Awareness Month is to foster partnerships among individuals and organizations, with a common goal of effecting positive change in the state of pain management. By promoting education, awareness and advocacy, the goal is to recognize and address these barriers to pain management.
In recognition of Pain Awareness Month, there are a variety of different ways that Integrated Pain Associates can promote pain education and awareness – among patients, other providers, and the general public.
Education and awareness are two prominent themes of Pain Awareness Month, and they both undeniably represent a key component of improving the state of pain management. Pain Awareness Month serves as a powerful means to convey the compelling message that millions of people continue to suffer from something that deserves proper management. It is an opportunity for those who suffer from an “invisible” illness to finally have their voices heard, and incite much-needed change.

Interventional Pain Management Techniques
The basis of interventional pain management is to block the production and/or transmission of pain signals to the brain through methods including nerve blocks, spinal steroid injections, radio-frequency ablations, spinal cord stimulation or injection of an anesthetic.
Goals of these interventional techniques include pain reduction, improving and maintaining mobility, and minimizing medication use. The administration strategies enable pain management specialists to selectively target injured and painful body regions while minimizing complications such as infection, bleeding, further injury, and sympathetic crisis.

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Holding hands to comfort loved ones does help reduce pain

Holding hands to comfort loved ones does help reduce pain, US study shows

Holding the hand of a loved one to comfort them really does help reduce pain, a US study has shown.

Dr Pavel Goldstein, a postdoctoral pain researcher in the Cognitive and Affective Neuroscience Lab at the University of Colorado Boulder was inspired to conduct the research after witnessing the birth of his daughter four years ago.

He said: “My wife was in pain, and all I could think was, ‘What can I do to help her?’ I reached for her hand and it seemed to help.

Source: The Telegraph

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