OUR SERVICES
A MULTIDISCIPLINARY PAIN MANAGEMENT CENTER
There is enough evidence that multidisciplinary approach in managing chronic pain has a better short term and long-term outcome. At Advanced Pain Treatment Center, a multidisciplinary group meeting is conducted to discuss patients who did not respond to the conventional treatment.
A systematic review of comparative effectiveness of Non-InvasiveNon-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. Curropin Urol. 2013 Nov; 23(6): 554-559.
PHYSICAL ACTIVITY TO IMPROVE PAIN RELIEF
01 - Evidence based Interventional Pain management / New patient evaluation
As a center of excellence, a pain management center must be more than a successful clinic. At Advanced Pain Treatment Center, we strive to practice evidence based medicine.
Evidence based medicine is a conscientious, explicit, judicious and reasonable use of current best evidence in making decisions about the care of individual patient (1). There is no cook book approach to pain management. At the Advanced Pain Treatment Center, we integrate external validated evidence with individual clinical expertise in formulating appropriate care for each individual patient. We access and apply valid and relevant summaries of research evidence (evidence based guidelines and systematic reviews). We evaluate the strength of the evidence based on the below given classification of evidence:
1a. Evidence obtained by meta-analysis of several randomized controlled research (RCR)
1b. Evidence from only one RCR
2a. Evidence from well-designed controlled research RCR
2b. Evidence from one quasi experimental research.
3. Evidence from non-experimental studies (comparative research, case study), according t some, for example Text books.
4. Evidence from experts and clinical practice.
02 - 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.
03 - 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:
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.
04 - 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 technique with 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 on as needed basis.
05 - Medical Exercise, Message Therapy and Dietary Counselling
The center offers individually designed exercise programs, home exercise with therapist follow up, group and individually supervised exercise delivery strategies, high intensity exercise program. Center will also offer individualized dietary counselling and post counselling follow up using appropriate APPs available on line.
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 designedexercise programs in a supervised format (for example, home exercises with regular therapist follow-up), encouragingadherence to achieve high dosage, and addingother effective conservative treatments.
Stretching andmuscle-strengthening exercises seem to be the most effectivetypes 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.
06 - Opioid Use Disorder Treatment with Suboxone
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 inhouse behavioral therapist performs detailed evaluation.
Suboxone treatment is induced only when a patient is in withdrawal state (symptoms of withdrawal are nervousness, anxiety, shaking, goose bumps 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.
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.
DSM-V Criteria
1. Opioids are often taken in larger amounts or over a long period than was intended2. There is a persistent desire or unsuccessful efforts to cut down or control opioid use3. A great deal of time is spent in activities necessary to obtain the opioid, use the opioid, or recover from its effects4. Craving, or a strong desire or urge to use opioids5. Recurrent opioid use resulting in a failure to fulfill major role obligations at work school or home6. Continued opioid use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of opioids7. Important social, occupational, or recreational activities are given up or reduced because of opioid use8. Recurrent opioid use in situations in which it is physically hazardous9. 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 substance10. Tolerance, as defined by either of the following: a. In need for markedly increased amounts of opioid to achieve intoxication or desired effect b. 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:a. The characteristic opioid withdrawal syndrome is present when A. 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)B. 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● InsomniaC. These signs or symptoms in criteria B causes clinically significant distress or impairment in social, occupational, and other important areas of functioningD. 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.b. 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.
07 - 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 inhouse Exercise therapist is consulted for determining the functional capacity. If necessary, in house Behavioral therapist will be consulted to determine psychosocial issues in determining the disability state.
Please call (859) 331-4159 or email at moc.dmctpa%40ofni for an appointment.
08 - 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 or email at moc.dmctpa%40ofni for an appointment.