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States have tried to respond to the opioid overdose epidemic, and one of the more recent innovations has been a focus on dosage thresholds and subsequent triggers. Once a chronic pain patient, for example, reaches 120 mg morphine equivalency per day, it triggers a particular action or recommendation...
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It’s been said that patients who are on higher doses of morphine equivalence per day are at higher risk of opiate induced respiratory depression and death. But the truth is that patients who are on very high doses of opioids may be very much sicker and they may be at a higher risk of death for other...
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Ancillary services, such as pharmacy or clinical laboratory, can be a lifeline to a provider, and there’s nothing wrong with having them in your office, but there’s some due diligence that needs to be done, both on your own, and probably with an attorney. If you’re going to wear all the hats of...
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Chronic low back pain doesn’t necessarily have to be just one thing or another; there can be a variety of reasons why people have it Facet-mediated pain is considered one of the more frequent things that we see when it comes to chronic low back pain reasons, accounting for anywhere from 15 to 45...
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With the institution of the Affordable Care Act, we really don’t know what’s going to happen to the future of federal funded medicine. And with the implementation of ICD-10, reimbursement to pain practitioners may be delayed by as much as three to six months with a reduction in the income of the...
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The relationship between addictive behavior and prescription pain medication is a really complex one. It’s almost always hard to predict. There are some obvious clues, like a previous history of substance abuse, or potential clues such as a family history of substance abuse, or maybe some...
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Methadone is not just your classic opioid. It also has NMDA receptor activity which has been postulated to help decrease the development of opioid tolerance. It’s also postulated to have more of a benefit in patients with neuropathic pain. Methadone is available in tablet or solution formulations...
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There’s a large focus right now on drug testing and claims for clinical laboratory services related to drugs of abuse testing. The payers are interested in this area because there’s been quite a significant amount of fraud and abuse identified through payer investigative techniques. So the payers...
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There’s a robust body of literature on the comorbidity of depression, anxiety and chronic pain. Approximately 50 percent of patients who suffer from chronic nonmalignant pain suffer from some degree of depression. With respect to pain patients and suicidal ideation the prevalence is anywhere between...
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Low Risk, High Reward for Musculoskeletal Pain and Tissue Injury
Simply defined, prolotherapy--short for proliferation therapy--is a treatment that stimulates the repair of painful areas. It has been around since the 1930’s and in a nutshell it’s an injection treatment that stimulates repair of...