Our Contemporary Approach is Featured in 2015 Washingtonian Top Doctors Issue

We're very excited to bring our contemporary treatment approach to the DC-metro area and be featured in the latest issue of Washingtonian Top Doctors!  See below for a snapshot of the feature.  Thank you to the wonderful doctors and patients who refer to us and congratulations to all of the 2015 Top Doctors!

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Why We Support Non-Narcotic Treatment for Pain Management

The goal of chronic pain treatment is to maximize function while providing pain relief.  There is a global epidemic surrounding chronic pain with its related disability, opioid use, and resulting fatalities.  A report from the United Nations Office on Drugs and Crime states that 90% of global consumption of opioids registered in 2009 occurred in Australia, Canada, New Zealand, and the U.S.  Also, the U.N. report illustrates that the U.S. population constituting 4.6% of world's population consumed 83% of world's oxycodone and 99% of the world's hydrocodone in 2007.  Sales of opioid analgesics quadrupled between 1999 and 2010. The data also shows an increase from 96 mg of morphine equivalent per person in 1997 to 710 mg per person in 2010.

At Advantia Health, we recommend multimodal and multidisciplinary treatment.  What does this mean?

Multimodal Treatment

When a physician uses a multimodal approach, they prescribe a combination of non-narcotic pain relievers, physical therapy, spinal injections, yoga, acupuncture, meditation, guided imagery, etc.

Multidisciplinary Treatment

Multidisciplinary treatment means getting the appropriate specialist recommendation such as an orthopedic surgeon, spine surgeon, podiatrist, psychiatrist, neurologist, chiropractor, physical therapist, or other health professional for treating a patient’s painful condition.

Does a multimodal, multidisciplinary approach actually work?

Can we truly achieve better pain control and improve functionality through a multimodal, multidisciplinary approach?  Yes, and here are some fun facts that support this approach:

  1. In a study from Denmark, where opioids were prescribed liberally for chronic pain, it was demonstrated that in patients receiving opioids, pain was worse, healthcare utilization was higher, and activity levels were lower compared to matched chronic pain patients who were not using opioids.
  2. In a study published in 2010 evaluating the role of opioids, it showed that the odds of recovery from chronic pain were almost 4 times higher among individuals not using opioids compared with individuals using opioids. Moreover, strong opioids were associated with poor quality of life and higher risk of death.
  3. Pain medications that are used strictly on an as-needed basis allow pain to escalate and require more medication for future pain control.

Here are some conclusions that we can draw from these facts:

  1. Opioids prescribed for chronic back pain may be effective for short-term pain relief.  To date, however, there are no high quality studies that demonstrate any long-term efficacy of opioids after 16 weeks.
  2. There is no significant difference in effectiveness or adverse effects between long and short acting opioids.
  3. There is limited evidence for opioid rotation.
  4. Improvement in quality of life is fair with short-term opioids but limited for long term opioids.

Bottom Line: No Opioids Needed

Non-narcotic pain treatment can and should be a first-line approach.  Multimodal, multidisciplinary treatment should be tailored to suit a patient's needs, and it may include interventional treatment with injections for pain relief, physical therapy, acupuncture, aquatic therapy, and even a regular exercise regimen, which can stimulate the body's natural pain relief system to release endogenous (produced naturally in the body) opioids, such as endorphins. 

The path to true long-term relief from chronic pain is not through the use of narcotics.

Do Epidural Steroids Improve Lumbar Spinal Stenosis (LSS) Pain?

A New England Journal of Medicine Study Raises Some Questions
 
In the search for better alternatives to manage LSS pain, some patients undergo excessive epidural steroid injections (ESIs) and obtain sustained relief. ESI use in Medicare patients increased almost 300% between 1994 and 2001. However, the results from a double-blind, randomized study published in The New England Journal of Medicine suggest little benefit of ESI in aging baby boomers. LSS is an abnormal narrowing of the center of the lumbar spine (called lumbar canal), which produces compression of the traveling leg nerves, resulting in standing discomfort and leg achiness, decreasing the patient’s ability to walk.

When are they effective?

In his published commentary at the same journal, Dr. Stephen Atlas, from the Practice-Based Research and Quality Improvement Network at the Massachusetts General Hospital, says that to treat patients with uncontrolled LSS pain, a brief curse of ESIs to reduce inflammation of the lumbar nerves may be appropriate before letting the patient undergo physical therapy.
 
“A few weeks of pain control would lead the patient to a healthier lifestyle, by increasing physical activity, reduce stress, use an anti-inflammatory diet may lead to longer pain relief and reduced healthcare costs,” says Dr. Gonzalez-Cota, Director of the Advantia Health Spine-Sports & Pain Center. “I don’t expect long-term benefits of ESIs without undergoing significant lifestyle changes.” If this approach does not result in pain control, a patient might be screened better for spine surgery since, as a general rule, we favor less invasive procedures in medical practice.
 
Empowering Patients
 
If patients were better informed about their spinal condition -- why it hurts when walking, expectations, risks from the ESI procedure -- fewer ESIs for LSS would be performed in the Medicare population. At Advantia Health, physicians follow the best practices in interventional spine medicine. By empowering patients and explaining their spine problems in simple language, a more informed decision takes place in partnership with their pain physician.

Reference
Friedly JL, et al. New England Journal of Medicine 2014.

Exercise and Osteoarthritis of the Knee: Recommendations to Get You Moving

Did you know that every extra pound of body weight adds 4 pounds of stress to your joints?  Achieving and maintaining your optimal weight by combining a healthy diet with an exercise program can help reduce the stress to your joints. 

Exercise is wonderful for joint health and overall health, but not all exercises are right for those with osteoarthritis of the knee.  If you're just starting a new gym routine or workout regimen, it's not uncommon to have some joint pain; however, if the pain lasts longer than 2 weeks, you should consult a physician.

I’ve compiled a short list of exercise recommendations here to get you moving!

Types of Exercises

In general, patients with osteoarthritis of the knee should employ lower-impact, aerobic type activities such as walking, cycling, yoga, elliptical training, or water-based exercises.  Of all the options, swimming and water aerobics are some of the best activities.

Walking is also good, but it may be too difficult for individuals with advanced osteoarthritis. Another thing to keep in mind is that walking or running on concrete or asphalt is a bad idea when you suffer from knee pain because these surfaces have no shock absorption.

Avoid high-impact activities. Basketball, tennis, racquetball, squash, soccer, and football are hard on the knees because they involve sudden starts, stops, and turns, as well as jumping. Zumba is a good cardio workout but may be high impact for knees.

Remember to Stretch

Stretching is often neglected in our workouts, but it’s really important. Here are 2 quick and easy stretches:

  1. Hamstring Stretch: place an extended leg on a slightly elevated surface (like a curb) and reach your opposite arm to your knee or ankle. Hold for 10-15 seconds and repeat on the other side.
  2. Quadriceps Stretch: standing straight, bend your knee and grab the top of your foot behind you; gently pull your heel towards your buttocks. Keep your chest up the whole time. Hold for 10-15 seconds and repeat on the other side.

Warm Up

The purpose of warming up is to get blood flowing to your muscles and to raise your body temperature. Warmed up muscles will behave more elastically and are less likely to be injured or strained. A warm-up can be simply 1-2 minutes of calisthenics like jumping jacks, running in place, or a brief ride on a stationary bike.

Practice Good Nutrition

And don’t forget to follow your exercise routine with a good diet, rich in antioxidants like freshly squeezed vegetable and fruit juices (kale, spinach, ginger, lime, blueberries). Remember: you need a combination of good nutrition along withexercise to achieve your goals.

Enjoy your workout!