Archive for category News/Press Releases
Not only a provider of pain relief but I am a pain patient
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on July 7th, 2010
I am now not only a provider of pain relief but I am a pain patient. On the 16th of June 2010 I underwent a partial knee arthroplasty, or a knee replacement that was done to two out of the three compartment of the knee joint, therefore partial, or unicompartmental, knee replacement. I will not go into the difference between a total versus a partial knee replacement as that is the responsibility of an orthopedic surgeon. But I will go into some of the thoughts of a pain patient as I now have a better empathy for the need to relief pain, the thoughts that go through the minds of someone in constant pain, and the understanding that you are not alone.
As a pain patient we constantly wonder if we will have enough medication to relief our pain since the doses we as physicians only have your response to our questions to guide our dosing habits and medications used. What happens if the dose utilized is not high enough? What happens if the dose utilized is too high? What happens if the medication does not work? What happens to us as pain patients when we run out of pain medication since our provider usually will only prescribe and see us once a month? All these questions run through our minds from the time we arise until the time the bed calls our name? I wonder some times because my pain gets so high if a take an extra “dose” of medication? In that scenario in order to reach the months end I will have to forgo a dose or two and our physician may from us from the program since we did not follow his/her directions for taking, for example, one tablet every 4 to 6 hours. But what do those directions mean anyway? We have a medication prescribed 1 tablet every 4-6 hours, that can be 4, or 5 or 6 pills in a 24 time period but our prescription for the month is a 112 tablet, therefore if I take 5 pills some days, some days 6 pills because therapy was extra hard that day, and some days 4 tablets? My pain remains uncontrolled since I do not have enough medication and cannot get additional medication before my next scheduled visit. I am sure in a messy situation calling for one of two responses only; take more medication to control my pain and hope the pain is controlled adequately the last week of the month or take the prescribed 4, of 4-6 hours, and me in pain the rest of the time that is throbbing constantly, sharp at times and radiating at other times. All these situations do exist for the patient in pain. Why does a physician feel that surgery is necessary to relieve a medical condition and than as a patient who has just “knifed” as in an alleyway robbery dosed not feel it is necessary to prescribe adequate pain control medication after the surgery? I cannot answer those questions at this time I can hope that the Lord above places pain patients in my path that I will be able to understand and control their pain. And as a final though; I DO feel your pain, 24 hours a day and 7 days a week.
Anxiety from Chronic Pain
Posted by Dr. Epstein in News/Press Releases, Pain Management on December 9th, 2009
Approximately 7 million Americans suffer with generalized anxiety disorder or GAD. This condition often accompanies chronic pain since the pain patient understandably gets anxious over the lack of treatment of their pain or the difficulty they have finding a pain management physician to treat their pain, especially if they are tired of tried and failed invasive techniques and the consequences that may follow them.
The Food and Drug Administration has recently taken a major step forward in the treatment of generalized anxiety disorder by the approval of Cymbalta for that condition. From the pain physicians aspect this will help us achieve a lessened anxiety state in many of our patients and that will lead to lessened pain since they do go hand in hand. Previous to Cymbalta’s approval for GAD most of the anti anxiety agents available to use were benzodiazepines class medications. These medications, benzodiazepines, are effective in appropriate doses but the higher the dose of these medications the greater the chance of respiratory depression. The opioid class of medication often utilized to effectively treat our patient’s pain is also a respiratory depressant in many doses. Those two medications combined had additive effects and in rare instances death could, and would, occur. With that in mind the patient often had to make a chance of what was worse their pain or their anxiety since it was difficult to safely treat both concomitantly.
With this new treatment option it will be safer for the pain management physicians to treat both a patient’s pain and their anxiety over their pain and its effect on their quality of life. Quality of life improvement is the major goal of the treatment of pain today. Since this new approval of Cymbalta I stress that those of you suffering from anxiety over your pain and its adverse effects on your quality of life tell your treating physician of your concerns and allow him to decide if you are a candidate for additional therapy safely.
Thank you for reading our website. Remember “Pain is inevitable but suffering is not!”
Trust is the foundation between physician and patient
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on December 9th, 2009
Trust a key word and a staple in the relationship between doctors and
patients, especially when treating pain management. When a patient
first comes to see a physician for pain management, they must realize
that the history they express to the physician, usually, at that visit
anyway, is totally invalidated and a scheduled medicine is more often
than not being requested or being thought of as appropriate by the
prescribing physician, physician’s assistant, or nurse practitioner.
Often at a first office visit a patient will have very little
information other than names, very occasionally addresses and phone
numbers of other practitioners, and some recent x ray or MRI results.
The patient does not realize importance, legally in today’s society,
of the present provider contacting: past physicians, past pharmacies,
past hospitals, and past diagnostic testing facilities for faxes of a
patient’s previous visits. Often also ignored is the fact a computer
wise patient can go on a computer, do a little research on a medical
condition and create false imaging reports. Do not laugh because it is
frequently done. It is done as often as a patient bringing in
duplicate urine from a ‘clean’ person and substituting it for their
own. That also frequently happens. The funnier part is when patients
think that their charades are original; I can tell you in doing
medicine for 36+ years, very little of the fantasy tales have not been
tried on my practice.
Then the patient must trust me as a physician. All medications taken
in a way other than as directed can result in serious injury, an
emergency room visit, or in some cases resulting in death. It may be
a consequence of the self prescribing dosage, a dangerous combination
of medication taken, or an allergy reaction based on the prescription
being taken or used in the wrong manner. The medicines utilized in
pain management not only can injure or kill a patient but it can do so
when the abuse is even minimal. A minimal prescribed dose of
alprazolam (Xanax) combined a “little” illegally obtained Oxycontin or
methadone can put someone to sleep, and they may never wake up. This
is your accidental overdose. This is the question that surrounds the
deaths of Elvis Presley, Michael Jackson, Anna Nicole Smith along with
a multitude of others. The amounts of these legally prescribed
medication necessary to kill someone is minimal in the right
combinations and doses. Example is Xanax and Oxycontin, both abused in
the world by people who cannot face their own problems, are both
respiratory depressants, taken together in an abusive manner without
following your physician directions can cause a person to stop
breathing. That is why most, but by no means all, overdose deaths
involve multiple drugs. Now do not feel: “well I can utilize one drug
and get high and live,” because utilizing an Oxycontin 40mg, one of
the most abused medications in America today, for one person will have
minimal adverse effects, and then for metabolic reasons the next
person who does the same medication, in the same dose winds up
stopping breathing and sleeping into eternity. You never know when
that will happen or to whom it will happen.
The above all being said the key message is: number one do not take
medication purchased or obtained illegally and that can be pills
prescribed for someone in your family and in your own medicine
cabinet, number two is that if you utilize a practitioner who limits
their medical practice to pain management take the medication only as
prescribed and give it to no one else unless you can live with the
thought you may have killed someone. Besides the fact your giving one
controlled substance pill to another person can bring a felony charge
of trafficking in narcotics against you, whether the person lives or
dies and the person may well be an undercover policeman/woman. And you
never know when the pain management practice you obtain your
medication from works closely with local and/or federal law
enforcement.
Therefore be truthful and take all medication prescribed for you by
you in the manner prescribed and help save you or your friends life!
Low-Level Laser Therapy May Be Helpful for Chronic Neck Pain
Posted by Dr. Epstein in News/Press Releases, Pain Management on December 9th, 2009
December 1, 2009 — Low-level laser therapy (LLLT) may be helpful for chronic neck pain, according to the results of a review and meta-analysis reported in the November 13 Online First issue of The Lancet.
“Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects,” write Roberta T. Chow, MBBS, from the Nerve Research Foundation, Brain and Mind Research Institute, University of Sydney in Australia, and colleagues. “…LLLT is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain.”
The reviewers searched computerized databases for studies in patients with acute or chronic neck pain comparing the efficacy of LLLT using any wavelength vs placebo or vs active control (eg, exercise). Pain intensity was the main endpoint of the study, with effect size defined as a pooled estimate of mean difference in change in millimeters using a 100-mm visual analog scale.
The search yielded 16 randomized controlled trials enrolling a total of 820 patients. Two trials in acute neck pain showed that relative risk (RR) for pain relief with LLLT vs placebo was 1.69 (95% confidence interval [CI], 1.22 - 2.33).
For chronic neck pain, the RR for pain relief with LLLT was 4.05 (95% CI, 2.74 - 5.98) in 5 trials reporting categoric data. In 11 trials reporting changes in the visual analog scale score, mean reduction in pain intensity was 19.86 mm (95% CI, 10.04 - 29.68).
In 7 trials in which follow-up continued for 1 to 22 weeks after treatment completion, short-term pain relief persisted in the medium term, with reduction of 22.07 mm (95% CI, 1742 - 26.72). Compared with placebo, LLLT was associated with adverse effects that were similar and mild.
“We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain,” the study authors write.
Limitations of this review include lack of accepted terminology for laser therapy and heterogeneity of conditions underlying neck pain and LLLT treatment protocols.
“Whatever the mechanism of action, clinical benefits of LLLT occur both when LLLT is used as monotherapy and in the context of a regular exercise and stretching programme,” the review authors conclude. “In clinical settings, combination with an exercise programme is probably preferable. The results of LLLT in this review compare favourably with other widely used therapies, and especially with pharmacological interventions, for which evidence is sparse and side-effects are common.”
In an accompanying comment, Dr. Jaime Guzman, from the University of British Columbia in Vancouver, Canada, notes that the number of trials sponsored by the maker of the laser devices is unclear but that there appeared to be no major publication bias.
“Today’s findings on…LLLT indicate that this non-invasive treatment provides pain relief in the short and medium term for people with neck pain,” Dr. Guzman writes. “This evidence is more solid than that for many current interventions. Although mechanisms of action and effects on function and occupational outcomes are not clearly understood and warrant further impartial study,…LLLT is an option worthy of consideration for management of non-specific neck pain.”
New Pain Medicine Introduced
Posted by Dr. Epstein in News/Press Releases, Pain Management on July 23rd, 2009
New news for patients who suffer with chronic pain. A new medication was introduced to the market place approximately 2 weeks ago. It is so new that many pharmacies do not stock the medication yet but usually can order and receive it within 24 to 48 hours.
This new medication is called Nucynta, generic name is tapentadol. It is used every 6 hours and as of this time there is not a long acting version of the drug. I am of the opinion that a long acting form of this medication will be available in the not too distant future. Patients would rather live their lives and take a medication when the arise in the morning and than before they go to bed at night rather than having to take a medication three to four times a day. This tapendatol is a totally new molecule in the pain management genre of medication. It is both a mu opioid receptor blocker, fancy name for a substance that blocks the transmission sites that are agitated during the sensation of pain, and a norepinephrine reuptake inhibitor. The latter part of the previous sentence means that the substances in our brain that absorb, like a sponge, the enzyme norepinephrine are blocked from doing so. Therefore the norepinephrine in your systems stays in the bloodstream and that helps to mediate the pain sensations we all suffer. Tapentadol is the first new product acting in two ways to control pain in a patient. It works in the way the some physicians add antidepressants to the pain medication patients are on to augment the pain blocking sensation of the opioid a patietn maybe on. These medications are known as selective norepinephrine reuptake inhibitors or SNRI’s.
So far testing of this medication demonstrated less side effects and less withdrawal symptoms that some of the more commonly used older medication.
Ask your pain mangement or primary care physician if you maybe a candidate to switch over to this new medication. We are doing so with some of our patients and results are coming back favorable.
Dr. Sanford M. Epstein
Health and Pain Management of Florida
“Pain is inevitable, bit suffering is optional”
Understanding your bodies response to opioid medication
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on June 3rd, 2009
A correct defining of terms is essential to understanding the use of opioid type medications. Prolonged or chronic use of opioid medication will cause one of four types of responses by your body. These 4 responses are dependence; tolerance; addiction or pseudo addiction.
Dependence is a physiological response of the body to medication. This means the physiology of the body gets used to seeing this particular, whatever it maybe, drug in the blood stream and adjusts to it. Therefore, the sudden cessation of the medication will cause the beginning of a withdrawal syndrome as the levels of the drug decrease.
Tolerance is similar to dependence in that both are physiologic body responses. Tolerance just means that the body once again gets used to, and adjusts to, a certain consistent blood level of a medication in the bloodstream. Since this level of medication is consistent the body adjusts to it and then more medication is needed to achieve the same effect as a smaller dose once did. This not only happens with opioid medication but can happen with insulin or blood pressure medication.
Addiction is a drug craving and its continued use even though the person realizes the continuing use of the drug may, or many times, has already hurt them. The drug controls their life and they will do anything to obtain it no matter the consequences. This is a biological physiological and genetic response to the drug. The important thing to remember is that a drug maybe addicting yet may cause dependence. Remember dependence will cause a withdrawal syndrome as it is suddenly removed. Well cocaine is one of the most addictive drugs available, yet it does not cause dependence. I find that very interesting.
The last thing that may happen is called pseudo-addiction? The person will demonstrate all the characteristics of an addict, control; craving; consequences; and continued use in spite of harm, but is not addicted to the medication. What happens here is that the patient starts on a dose of medication that is too low or tolerance develops quickly and the pain is not adequately controlled. So in an attempt to control his or her pain the patient displays addictive behavior. The interesting and satisfying aspect of pseudo addiction is that once the pain medication level, usually an opioid, is raised to adequate blood levels all the addictive characteristics leave the patient and they maintain productive lives at that point.
Are you fitting into any of these categories? If you feel you maybe, or just have uncontrolled pain or an already developed opioid dependency problem please contact Health and Pain Management of Florida at your earliest time. Remember that “Pain is inevitable; suffering is optional!”
Advances coming for pain management!
Posted by Dr. Epstein in News/Press Releases, Pain Management on April 30th, 2009
Patients in pain have major changes to look forward to over the coming months. There are two major companies that supposedly have new products ready for release.
The makers of Oxycontin, Purdue Pharmaceuticals, told me that two new major developments are right around the corner. I would suppose that one would be a better delivery system of the long acting medication making diversion and abuse more difficult. If that is the case, it would ease the availability for the real patients in need of aid. In my humble estimation, easier since division and abuse would be harder.
The other major new development is a new drug for treating pain. This new drug is generically called tapentadol. It will be a short acting medication taken 3 to 4 times a day or every 6 to 8 hours. It is the first entirely new chemical molecule for the treatment of pain since 1984.
I anticipate all these changes to male pain management more exciting than ever before!
Truthfulness is supreme!
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on April 15th, 2009
Truthfulness is supreme!
In a pain management medical practice mutual trust must be established between patient and the physician. On occasion patients feel that their answering questions about past behavior honestly will exclude them from a physician’s care. In our practice it works just the opposite.
We at Health and Pain Management of Florida live by two mottos: the first is “pain is inevitable, but suffering is optional”; the second is “today is the first day of the rest of your life”. I need to feel that I can trust the patient with medications that may potentially cause the loss of life. Of course any medication, including aspirin, can cause the loss of life, it is just the prescribed opioid medications that may do that quicker. And the patient must have complete trust in me because I am prescribing potent and potentially lethal forms of medications. So you can understand that this trust and confidence issue is one that runs from patient to physician and the physician to patient.
So please remember whatever the past, whatever the problems, tell your physician. A patient may have something in their past such as misdemeanor; a felony drug charge; a short or long prison confinement; etcetera tell the physician. Those problems may require the physician the monitor you more closely when you start medication but they should not keep the physician from treating your pain. Honesty is always the best policy! That is because when we as physicians find questionable activities in your past, via computer searches or previous medical records, instead of directly from you as our patient, we are less likely to be understanding and more likely to discharge you from our practice since the bond of trust has now been violated.
Thank you and remember “pain is inevitable; suffering is optional!”
Gulf Breeze News Article
Posted by Travis Talley in News/Press Releases on February 19th, 2009
Health and Pain Management of Florida was recently featured in the Gulf Breeze News Community Newspaper. Here is a short excerpt from the article:
“…Health and Pain Management of Florida was developed to fill a unique niche of medical care absent from the Gulf Breeze, Navarre, and Pensacola areas. The mission of the medical center is to aid patients in need of non invasive control of chronic pain conditions. These conditions include such illness as; fibromyalgia, failed back syndrome, chronic back pain, osteoarthritis conditions, chronic neck pain…(read more - direct link)”
Head over to the Gulf Breeze News website to read current and archived news.