Edgewood, Kentucky : Phone: (859) 331-4159
A MULTIDISCIPLINARY PAIN TREATMENT CENTER

There is enough evidence that multidisciplinary approach in managing chronic pain has a better short term and long-term outcome.

A systematic review of comparative effectiveness of Non-Invasive Non-Pharmacological Treatment for Chronic pain (Number 209) conducted by the Agency for Healthcare Research and Quality, Department of Health and Human Services, USA reviewed several high-quality publications. In one study it found multidisciplinary rehabilitation compared with non-multidisciplinary physical therapy to be associated with lower short-term pain intensity and disability. Another study found Multidisciplinary rehab to be associated with lower long-term pain intensity and function and greater likelihood for return to work. In one trial it was found that massage with exercise therapy is superior than only exercise therapy in short-term and intermediate-term pain relief. None of the RCTs showed any harmful effect of exercise therapy, massage therapy or behavioral therapy. A systematic review found exercise therapy to be associated with greater pain relief versus no exercise in short term and intermediate term.

‘Intensive multidisciplinary program involving psychotherapy might be more effective in treating chronic pain patients similar to those in this study than outpatient treatment without psychotherapy’ concluded by Lipchik GL, Miles K et al. in their article titled ‘The effect of multidisciplinary pain management treatment on locus of control and pain believes in chronic non-terminal pain. Clinical Journal of pain. Curr opin Urol. 2013 Nov; 23(6): 554-559.

Ambrose Kirsten, Golightly Y et al in their article titled ‘Physical Exercise as non-pharmacological treatment of chronic pain: Why and when published in Best Pract Res Clin Rheumatol. 2015 Feb; 29(1):120-130* concluded that ‘Despite studies of varying quality, results consistently support the effect of physical activity for treatment of chronic pain, both alone and as part of a multimodal program with pharmacotherapy and cognitive behavioral therapy. Chronic pain patients tend to be most successful when physical activity is tailored to their needs and limitations. Any amount or type of movement is advantageous over sedentary behavior, allowing for significant latitude in prescribing activity. Engaging chronic pain patients in a lifetime of physical activity to improve their pain, physical activity to improve physical function, and quality of life is a classic illustration of the art and science of medicine.’

At the APTC a multidisciplinary group meeting is conducted to discuss patients who did not respond to the conventional treatment.


In line with the above, Advanced Pain Treatment center offers multidisciplinary approach to chronic pain management by encouraging patient participating in Medical Exercise therapy, Behavioral therapy coupled with appropriate evidence-based diagnostic and therapeutic interventions.

OUR SERVICES :

1. Evidence based Interventional Pain management / New patient evaluation.


Each new patient is evaluated in-depth. Patient is required fill out a detailed background questionnaire. Relevant tests including imaging modalities are reviewed and discussed with the patient and finally a detailed appropriate treatment plan is formulated. Combination of interventional (evidence-based) and or medical management is offered. Validated tools such as PDQ, Roland Morris Questionnaire, PHQ 9, COMM etc. are administered at a baseline level and thereafter, during the follow-up period to evaluate, validate diagnosis, to monitor and document progress. Appropriate referral is made in house or to an outside specialist as warranted. Cutting edge treatment option is often offered including option to participate in clinical research.


2. Osteoporosis Center

The center will perform Screening, Diagnosis, Management, and long term follow up of the Osteoporotic patients or who is at risk of developing Osteoporosis per American Association of Clinical Endocrinologist and American College of Endocrinology, Clinical Practice Guideline for the Diagnosis and Treatment of Postmenopausal osteoporosis – 2016.Osteoporosis impacts quality and quantity of life.

Osteoporosis is a bone disease characterized by loss of bone calcium resulting loss of strength, predisposing to increased risk of bone fracture. It is estimated that Osteoporosis causes over 1.5 million fracture annually and most commonly vertebral fractures followed by hip fractures (300,000 annually) and pelvic fractures. Vertebral fracture at the most common fracture. They are associated with increased mortality, pain and spinal kyphosis. In the United States at least 20 percent of men and women over the age of 50 years have one or more fractured vertebra, white women aged 50 years and older who do not receive estrogen replacement have a 46 percent risk of sustaining an osteoporotic fracture during the remainder of their lives.

The introduction of this service to the community is to reduce the risk of osteoporosis-related fractures and thereby to improve the quality of life of the people with osteoporosis. The guideline uses the best evidence and need for effective evaluation and treatment of postmenopausal woman with osteoporosis. Treatment and follow up will be individualized. Fracture risk will be assessed based on history and PE, FRAX score, DEXA scan and Lab tests evaluating bone formation and bone resorption markers.


3. Clinical Research

Otrimed Clinical research is a subsidiary of Advanced Pain Treatment Center, is dedicated to bringing better treatment options to the patient population it serves. The center focuses on clinical research for the treatment of
  • Intractable headache (migraine)
  • Chronic intractable low back pain from degenerated disc (internal disc disruption), Sciatica pain
  • Neuropathic pain (diabetic, post-traumatic and idiopathic, Complex Regional Pain Syndrome or Reflex sympathetic dystrophy (RSD)
  • Non-specific low back pain
  • Depression (Major, Bipolar, Post-Partum, etc).
  • Substance-Induced Disorders
  • Neurocognitive disorders
  • Regenerative therapy using Stem Cells for repairing or arresting progression of degenerative joint or disc disease etc.

Participation in clinical research allows participants to benefit from potentially better treatment options than the current available one. All currently available medicine have undergone successful clinical trials and have obtained FDA approval. Clinical trials are conducted to find out the efficacy and safety of the medicine or treatment options. All clinical trials are monitored by Institutional Review Board (IRB), a panel of expert physicians, and other professionals to ensure safety of the participants. Before participation in a clinical trial, a detailed informed consent is obtained from the participant. A research physician or a research staff reviews in-depth with the participants about the risks, and benefits of participation in the specific clinical trial. All participants remain anonymous. HIPAA laws are strictly followed at the Otrimed Clinical Research.


4. Behavioral Therapy:

Behavioral therapy plays a central role in a multidisciplinary clinic in managing chronic pain patients. 90% of chronic pain patients suffer from depression*. There are multiple high quality to support utilization of behavioral therapy in managing chronic pain patients. A fully trained behavioral therapist will evaluate patients with chronic pain and formulate patient-centric specific plan.

Cognitive behavioral therapy is effective in treating chronic pain patient. Relaxation technique, coping techniques with the day to day pain, positive affirmation, relapse prevention technique, operant behavioral technique, biofeedback, meditation, are various options that will be utilized in treating chronic pain patients. Several validated tools will be used in the process of evaluation of the patient as well as to monitor their progress during the course of treatment. Tools such as BDI, BPI, PHQ 9, MMPI -II will be utilized based on the indication.


5. Medical Exercise, Message Therapy and Dietary Counselling

The center offers individually designed exercise programs, home exercise with therapist follow up, group and personally supervised exercise delivery strategies, high-intensity exercise program. Center will also provide individualized dietary counseling and post counseling follow up using appropriate APPs available online.

Hayden JA, Mauritis W et al in their Systematic Review of Strategies for using Exercise Therapy to Improve Outcomes in Chronic low back pain, published in The Ann Intern Medicine 2005;142:776-785, stated that the most effective strategy seems to be delivering individually designed exercise programs in a supervised format (for example, home exercises with regular therapist follow-up), encouraging adherence to achieve high dosage, and adding other effective conservative treatments. Stretching and muscle-strengthening exercises seem to be the most effective types of exercises for treating chronic low back pain.

In one trial it was found that massage with exercise therapy is superior than only exercise therapy in short-term and intermediate-term pain relief (A systematic review of comparative effectiveness of Non-Invasive Non-Pharmacological Treatment for Chronic pain (# 209) AHRC.


6. Opioid Use Disorder Treatment with Suboxone:

According to the DSM-V criteria the opioid use disorder diagnosis is made when: A problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least 2 of the following occurring within 12 months period.
  1. Opioids are often taken in larger amounts or over a long period than was intended.

  2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use.

  3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects.

  4. Craving, or a strong desire or urge to use opioids.

  5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work school or home.

  6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids.

  7. Important social, occupational, or recreational activities are given up or reduced because of opioid use.

  8. Recurrent opioid use in situations in which it is physically hazardous.

  9. Continued opioid use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.

  10. Tolerance, as defined by either of the following:
    • In need for markedly increased amounts of opioid to achieve intoxication or desired effect.
    • A markedly diminished effect with continued use of the same amount of an opioid.
    Note: This criterion is not considered to be met for those taking opioids solely under appropriate medical supervision.

  11. Withdrawal, as manifested by either of the following:
    • The characteristic opioid withdrawal syndrome is present when
      • Either of the following is present:
        • Cessation of or reduction in opioid use that has been heavy and prolonged (that is several weeks or longer), and
        • Administration of opioid antagonist after a period of opioid use).

      • Three of the following developing within minutes to several days after meeting criteria A above.
        • Dysphoric mood
        • Nausea or vomiting
        • Muscle aches
        • Lacrimation or rhinorrhea
        • Pupillary dilatation, piloerection, or sweating
        • Diarrhea
        • Yawning
        • Fever
        • Insomnia

      • hese signs or symptoms in criteria B causes clinically significant distress or impairment in social, occupational, and other important areas of functioning

      • The signs or symptoms are not attributable to any other medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.

    • Opioids or a closely related substance often taken to relieve or avoid withdrawal symptoms.
      Note: The criteria are not considered to be met for those individuals taking opioids solely under appropriate medical supervision.

    Goal of pharmacotherapy with suboxone for opioid use disorder includes prevention or reduction of withdrawal symptoms, opioid craving, prevention of relapse to the use of addictive opioid and restoration towards normalcy of any physiologic function disrupted by chronic opioid use. We use only Suboxone for such treatment. The dose that is given for maintenance is not for analgesia or pain relief. Before Suboxone treatment is initiated, a full detailed physical examination is performed. Our in-house behavioral therapist performs detailed evaluation. Suboxone treatment is induced only when a patient is in withdrawal state (symptoms of withdrawal are nervousness, anxiety, shaking, goosebumps in the skin, abdominal cramps, diarrhea with or without vomiting etc.). Patient is administered Suboxone under supervision and if necessary, with appropriate monitoring (continuous EKG, Pulse Oximetry and Noninvasive BP every 3 minutes) and the patient is observed in the monitored recovery area during induction of the treatment. The dose is titrated until patient’s withdrawal symptoms are controlled. Patients are followed up until they are weaned off suboxone. Typically, a long-term treatment is anticipated in treating Opioid use disorders. Patients are required to sign an opioid agreement. Maintaining confidentiality is a top priority in this center.


    7. Independent Medical Evaluation:

    This service is provided to the patients applying for disability determination. The IME is performed based on the latest edition of the Guides to the Evaluation of Permanent Impairment published by the AMA. We identify, as stated in the preface of the guidelines, the severity of an illness or injury considering four basic considerations such as diagnosis, resulting functional disability, physical findings and clinical studies. Functional limitations resulting from the disease or injury is evaluated and documented as precisely as possible. PT or in-house Exercise therapist is consulted for determining the functional capacity. If necessary, our Behavioral therapist will be consulted to determine psychosocial issues in determining the disability state.

    Please call 859-331-4159 or email at info@aptcmd.com for an appointment.


    8. Second Opinion:

    Second opinion service is provided for chronic pain patients scheduled to undergo any therapeutic interventions or for ongoing conservative pain management. Call our office (859)331 4159 to schedule an appointment or email us at info@aptcmd.com.
Appointments by Phone
Calls may be monitored or recorded for quality purposes.

Edgewood, Kentucky
162 Barnwood Drive
Edgewood, KY 41017
(859) 331-4159 • Fax (859) 331-4163

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