Every 14 seconds in the United States, someone dies from a prescription drug overdose. Approximately 20,000 individuals die annually from narcotic overdoses, a lot of which are from prescription drug medication.
Along with those alarming statistics comes an unfortunate reality. One third of the United States suffers from either acute or chronic pain. when you look at that number and the evolving mentality regarding pain over last 20 years, it plays a large part in putting us in the current situation.
Starting in the 1990s, there was a huge push on the medical
community to recognize patients in pain, then properly and humanely treat their pain. Physicians started prescribing
more opioids in an attempt to make those in pain obtain relief.
Along with that, the Veterans Administration began a large push to have pain be looked at as the "fifth vital sign".
Between the years 2000 and 2010 opioid prescriptions in United States quadrupled. The CDC reported that for every narcotic fatal overdose, there were 32 times more individuals who visited an emergency room for a nonfatal narcotic overdose. This means that over 600,000 individuals annually end up in an ER with a near death experience.
A concerted effort is now under way between Congress, the DEA and State medical boards to make opioid management safer. Studies show that 75% of individuals who take narcotics inappropriately obtain the medication from either a family member or a friend.
Pain management practices are more often practicing responsible opioid prescription management. This entails performing physical examinations on every patient with appropriate documentation of the painful region, imaging studies and documented responses that prescribed medication is working.
Along with this, most Arizona pain management clinics require urine drug testing along with opioid agreements. These usually require patients to only obtain medications from one doctor and to abide by the dosing and submit to drug testing.
In those states with pharmacy board monitoring systems, it can be easier to catch patients who are doctor shopping. It is not a fool proof system though, as there are delays between the filling of prescriptions and when it shows up in the database.
Over the last few years, there has been a growing problem in this country of drug shortages. Mostly, these are drugs that have come off of patent and are not generic. The most common drug shortages are occurring with injectable medications.
Typical examples of medications that have seen drug
shortages include lidocaine, which is a very common numbing agent use for pain
management injections and a lot of other purposes. In addition, a significant
amount of chemotherapy medications have run into drug shortages over last
This can present a serious problem for individuals with cancer where only one type of chemotherapy has been shown to be useful. obviously, chemotherapy during cancer is a time sensitive matter, and if the drug is not available then patient longevity could be at stake.
There are two primary reasons why the drug shortage problem
has become a major issue over the last few years. The first is increasing
government regulation by the FDA. There was a leadership
change in the FDA approximately 3 years ago. Since that time, the number of
regulatory warning letters from the FDA has basically tripled.
What a significant amount of manufactures decide to do is to stop making the drug altogether and shift over to more profitable drugs. I will explain why this occurs with reason number two.
Last year, a Congressional oversight committee looked at this problem and found that the FDA alone was contributing to at least 30% of the drug shortage problem. When the FDA sends an agent out to monitor a drug manufacturing facility, there's basically a check list that agent runs through to make sure everything is in compliance. If there any issues and a warning letter is put together, the agent was not looking at the end result of having the warning letter sent. According to the oversight committee reports, the agents were simply sending the warning letters and were not working with the companies to avert shutdown or really thinking about the consequences of that letter.
The second problem of why the drug shortage is occurring is
due to the lasting results of the Medicare Modernization Act back in 2004.
Without going into too much detail, the law was put into place to try and save
Medicare money and limit the pricing that drug companies could charge for
medications. In theory, the act was a good idea.
But in reality, what it did was ruin the free world economy process as it pertains to medications. It limited a price increase on medications to no more then 6% every six months. If a drug shortage was on the horizon, in a free world economy the price of that drug would go up based off of a decrease supply. But with government regulation in place, that price cannot go up more than 6% every six months.
So the incentive for a manufacture to ramp up the supply of that medication is not as great due to the fact that the price cannot increase. Another byproduct of the act is that a lot of drug manufacturers have closed up shop. Only those who have large manufacturing facilities and who can make a significant amount of the drug can actually make profit off of manufacturing.
What this means is that for a drug like lidocaine, it is now so inexpensive that only a few manufacturers still make the product. If one of those decides to get out of the business, that is going to leave a significant shortage and in fact that is exactly what happened.
When a drug goes off the patent, over the next six months one competitor is allowed to make the generic product. After that, it's pretty much a free-for-all for anybody that wants to make the generic product. The price of the drug over the course of that year plummets typically losing over 80% of its previous market price.
This is a normal phenomenon, and if the manufacturer is large and has significant economies of scale, they can make a profit even with a generic drug. However, with government regulation in place, pricing can only increase so much even with a shortage and margins are small. Therefore the manufacturer has other options of what to make in place of the impending shortage, and basic economic principles say that it will go that route.
A result of the drug shortage is that no reform is occurring with the Medicare Modernization Act. The FDA denies that it caused the drug shortage problem, but it has decided to institute safeguards to try and prevent shortages. The president recently signed the Drug Safety Innovation act, which says that drug companies should give a six-month notice if they're going to have a shortage in place. That will give the FDA time to either work with that manufacturer, get other manufactures to start making the drug, or work with a foreign drug company to make the drug.
Once the specifics of the innovation act are fleshed out, hopefully the drug shortage problem will become less of a phenomenon. The one of the real things it needs to be fixed is the Medicare Modernization Act which has put a severe damper on free world economy by limiting pricing.
The best Arizona pain clinic is Arizona Pain Specialists, with pain management doctors in Arizona who are Board Certified and Award Winning. The clinics offer chiropractic, medications, interventional treatments, acupuncture and spinal decompression therapy.
Call (602) 507-6550 for treatment today.
In the first 10 years of this decade, narcotic prescriptions
increased threefold in America. This was after a large push in the 1990s to
treat pain responsibly. In the late 80s, there was also a large push to treat pain
as the "fifth vital sign". As a result, pain management as a field extrapolated incrediby to help patients. Arizona pain centers such as Arizona Pain Specialists offer medication management, procedures, and other types of treatments.
Unfortunately, along with the benefits of narcotic medications come significant risks. Along with the risks such as constipation and mood or sleep alteration, there are some very significant risk factors including tolerance, addiction or fatal overdose.
A recent LA Times story elucidated that over 15,000
Americans die of narcotic prescription overdoses annually. Over 30 times that
amount, or close to half a million, have nonfatal overdoses treated in
emergency rooms across the country every year as well. That is a truly amazing statistic.
How are the doctors supposed to responsibly prescribe opioid medications for patients in need? Although if it is impossible to maintain complete safety, there are plenty of mechanisms and approaches that pain clinics put into place to keep things as safe and responsible as possible.
First and foremost, those pain clinics that maintain a comprehensive approach to pain relief are able to minimize the amount of narcotics necessary for pain reduction. This includes options for interventional pain management, nonnarcotic medications, physical therapy possibly, and maybe alternative treatments such as chiropractic, spinal decompression therapy, acupuncture, massage and more.
This was the exact approach recommended by the Institute of Medicine in its recent report on effective pain management. Along with the comprehensive approach to pain management,
clinics also institute narcotic agreements between patients and physicians.
This lays out the concrete expectations to facilitate compliance with the
For instance, it will state that the patient's narcotics will only be obtained from one physician, and that patients will comply with the written dosages and not sell or share their medications with others. Although these may sound like common sense, the overt agreement essentially helps the patient realize that if the agreement is broken, he or she can be let go from the practice.
Along with the opioid agreement, most pain physicians utilize urine drug screens in the practice to check for illicit drugs along with the medications being prescribed. The results of urine drug screens and studies have shown that over 30% of patients show up positive for nonprescribed drugs or for illicit substances.
In some states, there are prescription monitoring databases which can help to see if the patient is receiving narcotic medications for multiple doctors. This is known as doctor shopping, and the database can help prevent it from occurring.
The pain clinics in Arizona that have instituted these safeguards for their patients see significant beneficial effects with pain reduction, while maintaining responsible ovulated prescribing habits.
Arizona Pain Specialists practices responsible narcotic medication management and offers comprehensive options. If you or a loved one is dealing with a pain issue, acute or chronic, call the best AZ pain centers in the Valley at (602) 507-6550.
One of the most impressive inventions in pain management over the last 20 years has been radiofrequency ablation. It has helped to solve one of the biggest problems being addressed by Arizona pain doctors, which is providing a longer duration of pain relief than the rest of today's available treatments.
Exactly how well does radiofrequency ablation in the lumbar spine work? In the lumbar spine, studies have consistently shown radiofrequency ablation works much better with regards to pain relief duration than the usual steroid injections. While a steroid injection often provides 3 weeks to 3 months of pain relief, radiofrequency ablation often provides over a year!
The technique for radiofrequency ablation typically involves heating up a catheter around the arthritic and painful spinal joints for 90 seconds to approximately 80°C. The idea is to deaden the tiny little nerve endings supplying sensation, and therefore pain, to the arthritic joint.
Those tiny little nerve endings are called the medial branches Success with lumbar radiofrequency ablation in various studies ranges between 60 to 90%. One study showed that 21% of patients had complete pain relief and another 2/3 reported moderate pain relief. That means that over 85% in that study had moderate to complete pain relief, which is great. Studies have shown that after a year From having the procedure performed, over 60% of patients still had a minimum of 80% pain relief. This is very impressive.
Between the one and two year mark, the tiny little nerve endings will often regenerate and the pain may come back. Thankfully, the RFA procedure can simply be repeated. There was a study in Spine looking at repeat radiofrequency neurotomy in the lumbar spine. The study showed that patients can expect the same amount of pain relief with another RFA procedure. The success rate was well over 80%. The duration of pain relief was slightly under 11 months which is a little bit shorter than the study of primary RFA procedures.
Usually prior to having a radiofrequency ablation procedure in the lumbar spine, patients undergo an initial injection of numbing medicine around the joints called a medial branch block. If that injection provides over 50% pain relief, most insurance companies will approve the radiofrequency procedure. Interestingly, studies have shown that the duration of pain relief with a simple medial branch block may be upwards of three months by itself.
Based on successful results that have been seen with lumbar radiofrequency ablation, it should definitely be considered as part of a long-term pain relief strategy for those suffering from painful arthritis in the lumbar spine.
If you live in Arizona and are dealing with back or neck pain on a chronic basis, RFA can most likely help you considerably. Arizona Pain Specialists has multiple Valleywide locations serving Phoenix, Scottsdale, Mesa, Chandler, Glendale, Gilbert, Surprise, Peoria and more.
The pain clinics in AZ accept most insurances and have an Award Winning, Board Certified team of pain management doctors in Arizona and chiropractors. Call (602) 507-6550 for one number scheduling today.
1. Lord, S, Bogduk, N. Radiofrequency procedures in chronic pain. Best Practice and Research Clinical Anesthesiology Vol. 16, No. 4, 597- 617.
2. Mikeladze, Espinal, et al. Pulsed Radiofrequency application in treatment of chronic zygapopyseal joint pain. The Spine Journal 3 (2003) 360-362.
3. Niemisto, Kalso, et al. RF Denervation for Neck and Back Pain: A Systemic Review Within the Framework of the Cochrane Collaboration Back Review Group. Spine Vol 28, Number 16, pp 1877-1888.
4. Sluijter, M., Racz, G. Technical Aspects of Radiofrequency. Pain Practice, Vol 2, Number 3, 195- 200.
There is a 90% chance that during a persons life, he or she will develop back pain at some point. It may be pain that goes away within a few days, but chances are pretty high of it happening.
The good news is that over 90% of the time, the persons back pain will go away within six weeks no matter what treatment is received, if any.
Why does back pain occur and what can be done treated?
Let's go through some of the most common causes first and then finish up with the unusual causes of back pain.
1. Most commonly, the person develops back pain due to degenerative arthritis. If you look at the sheer numbers, tens of millions of Americans are affected by degenerative osteoarthritis, and the back is no exception to the joints being affected. So most commonly, a flareup of arthritis causes back pain that may just stay in the back, or the pain may radiate into the buttocks or hip area as well.
2. Another common cause of back pain is a muscle strain or a ligament sprain in some part of the back. It may be that the person was injured in a sporting activity, or pick something up that was very heavy or from an awkward position. Or it could be something very simple such as a sneeze that throws out a person's back.
3. When a person is in their 20s to 50s, the intervertebral disc can be a common source of back pain. If the disc degenerates and develops a tear in its outer portion, it can cause considerable back pain. Most people cannot point to one particular incident that sparked up the pain. It may be something as simple as bending over to pick up a small object or it may just come on one day after person gets out of bed. Pain from degenerative disc disease is not dissimilar than arthritic type pain, where there are usually exacerbating episodes and then times the pain is not so bad.
4. When a person has associated leg pain along with the back pain, often times a nerve is being pinched. This may be due to a herniated disc, or it could be due to spinal stenosis where bone spurs and overgrown soft tissue are pinching on nerve roots causing the sciatica pain.
5. One less common reason for a person's back pain includes a fracture such as a compression fracture due to osteoporosis. There also could be a fracture due to a car accident or a significant trauma. If a person has a significant history of trauma and associated persistent back pain, professional assistance should be sought for a work up.
6.. Outside of fractures, back pain could be due to an infection and unusual circumstances. This could be an infection due to IV drug abuse, immunosuppression such as in a kidney dialysis patient, or any number of reasons where is the disc itself is infected or another area around the spine or even inside the spinal canal which is called an epidural abscess. If one is having back pain associated with fever and chills, professional assistance should be sought emergently. Waiting too long can result in neurologic deterioration.
7. Another reason for back pain may be a tumor. Obviously this is way down the list, but if a person is having night sweats, fevers, pain that is fairly constant, then a doctor should be seen for a work up of imaging, examination and blood work.
As one can see, there are reasons back pain develops that are not so worrisome, and then some that should cause alarm due to potential long term consequences. Thankfully it's usually the former! Over 90% of back pain gets much better no matter what the treatment.
If you live in AZ and are experiencing back pain, Arizona Pain Specialists can help you. With multiple AZ pain clinics and Board Certified pain doctors and chiropractors, you can get help right away and get the pain under control. Most insurance is accepted, along with Personal Injury and Worker's Compensation.
For one number scheduling, call (602) 507-6550.
Last month, a fungal
meningitis outbreak began in United States after contaminated steroid
medication was injected for pain management in multiple states from a source in New England that
had three lots contaminated with fungus.
Today, over 14,000 individuals have
received epidural steroid injections with the medication and are potentially at
risk of developing meningitis. To note up front, no patients at all in Arizona
have been exposed to contaminated medication. In fact, none of the contaminated
medication was even shipped to Arizona. Of the 76 clinics around the country that received the contaminated medication, none were AZ pain centers.
As of this week, 282 patients had contracted meningitis and there have been 23 deaths. The source of the contamination has been linked to the New England Compounding Center in Massachusetts. The compounding pharmacy has stopped all operations.
Once contracted, meningitis
is not contagious and is treatable with antifungal medications. However,
those medications can have complications themselves and it may not be prudent to
start them prophylactically. If the antifungal medications are given in high doses they can cause liver and kidney problems, abnormal heart rhythms or
If the infection is found early though, antifungal medication can be given as pills which have less side effects. The incubation period for the fungus can include a week upwards of a few months. In those states where patients received the injections from the contaminated vials, patients are being advised to closely monitor symptoms and get tested with a spinal tap as soon as they develop.
Once again, no patients in Arizona received medication from the contaminated source. For those that did in other states, it is an extremely unfortunate situation as it will take months to fully know if in fact infection will develop.
Initially, critics came out with concern over whether or not the risks of epidural steroid injections outweigh the benefits. Pain societies and pain management doctors refuted these assertions as the benefits of epidural steroid injections are tremendous. They can help patients avoid surgery along with allowing them to continue to work and enjoy social and recreational activities. Success rates for an epidural steroid injection is between 75 and 85% in numerous studies.
For now, if you are a pain management patient in Arizona or need help with acute or chronic pain, Arizona Pain Specialists can help you.
They have multiple locations around the valley with Board-Certified and Award-Winning pain management doctors in Arizona and chiropractors. They take most major insurances along with Medicare, Medicaid, Personal-injury, Worker's Compensation and self-pay.
For one number scheduling call 602-507-6550 today.
In United States, chronic pain affects over 100 million
individuals which is about a third of the population. For this reason, pain
management is a booming industry in America today. And with good reason.
Modern pain management is often able to alleviate chronic pain conditions and get patients back to working, playing with their kids and socializing. However, there are two main problems with modern pain management that need to be addressed with new research and technology moving forward.
The first major problem with pain management today is a
limited duration of efficacy for pain management medications and procedures. Steroid injections for spinal arthritis provide pain relief for anywhere from a
few days to a few months. Most medications provide relief for a few hours at a
time and there are some extended release medications which can provide upwards of
12 hours duration.
When it comes to procedures, pain management longs for techniques that can provide many months to over a year of relief. One revolutionary procedure that has come about over the last 10 years is radiofrequency ablation. the procedure has been shown to be excellent for treating arthritis in the neck as well as in the low back, and can provide anywhere from 6 to 24 months of pain relief.
When steroid medication is used, if the pain doctor injects steroid medication with a lot of particulate matter it can stick around for quite a while. But too much particulate matter can cause complications, so there is a fine line between longer pain relief and higher risk. Hopefully modern research will formulate medications that can provide longer lasting relief.
The second major problem in pain management today is that treatments are not curative. Pain treatments today act as a proverbial Band-Aid, providing temporarily for such conditions as sciatica, arthritis, or degenerative disc disease. Steroid injections for instance, do not cure the problem in a joint or soft tissue. rather, they provide pain relief due to the anti-inflammatory medication for weeks to months.
One substance that is showing excellent promise in pain management are stem cell injections. Stem cells act as a precursor to specialized cells such as cartilage, bone, skin and muscle. They are showing some promise for helping with arthritis and cartilage loss.
Pain management technology has seen incredible strides over the last 10 years. Hopefully over the next decade, treatments that will provide longer pain relief along with regenerative technology will be produced and become mainstream.
If you live in the Phoenix and Scottsdale metropolitan area, and are experiencing acute or chronic pain in your neck, back, arms or legs, let Arizona Pain Specialists help you.
The practice has multiple clinics throughout the valley and serves Phoenix, Mesa, Scottsdale, Glendale, Chandler, Gilbert, Mesa, Tempe, Surprise, Goodyear and many other areas.
Arizona Pain has an Award-winning and Board-Certified doctors and chiropractors. The practice accepts most major medical insurance, along with Personal-Injury and Worker's Compensation.
Same day appointments are often available with the Phoenix chiropractors at the clinics, and pain management doctors can often be seen within a week.
Call 602 507-6550 for easy one number scheduling.
As an individual ages, the disc begins to lose water which normally comprises 80% of the disk space. Because of this, a person may end up having severe low back pain as a result of the damage.
When a person reaches the age of 40, there is over a 40% chance that there will be significant degenerative disc disease. Most individuals, though, have no back pain due to degenerative disc disease. When it does occur and is debilitating, do steroid injections work?
There are different types of steroid injection's to treat degenerative disc disease. The first is steroids being injected directly into the disk space. These have some limited research to back up their effectiveness. There was a study in the 2004 issue of Spine showing that there are some benefits of injecting steroids into the disc for disc degeneration. Some times doctors utilize these injections routinely, whereas others do not feel they have a place in the management of degenerative disc disease.
Additional type of steroid injections utilized for DDD are epidural injections. With significant degenerative disc disease, this may begin to tear the outer portion of the disc and irritate the nerves that are surrounding the area. This can cause sciatica and pain down a person's legs.
An epidural injection can help treat the area of the bulge or tear and relieve some of the back pain and leg pain associated with the problem.
One additional type of steroid injection performed by pain management doctors in Arizona is facet injections. Due to the degeneration of the disk, a person may start to have abnormal spinal motion which can lead to arthritis in the joints and back of the spine which are called facet joints. Because of this, they may have additional back pain associated with that joint problem. So an injection of steroids into the facet joints can help relieve a significant amount of the back pain.
Between the epidural injections and facet injections, it may be possible for pain doctors to alleviate over half of an individual's pain that way.
Additional treatments with physical therapy, chiropractic treatment, spinal decompression therapy, and medication management may be able to relieve over 80 to 90% of the person's pain.
Arizona Pain Specialists offers comprehensive pain management treatment for lumbar degenerative disc disease. By utilizing individualized treatments consisting of those mentioned here, they're able to help avoid surgery in over 95% of patients with degenerative disc disease.
If you or a loved one is suffering from low back pain, degenerative disc disease may be the culprit. Call 602-507-6550 to get help today from the best in the business, Arizona Pain Specialists. They have clinics throughout the Valley and accept all major medical insurance along with personal injury, workers compensation, Medicaid plans, and self pay.
Dealing with pain management problems after an auto accident can be a real hassle when combined with a damaged car and having to miss time from work. Being able to obtain treatment quickly is vital to giving yourself the best chance of a pain free long-term outcome.
Arizona Pain Specialists is now offering same-day appointments at each of its Valley locations. This includes a free chiropractic consult and treatment may begin if the person desires based on that consult.
If treatment with one of the Award-Winning, Board-Certified Arizona pain doctors is necessary, that can usually be started within a few days.
It is unusual to find pain clinics in Arizona that accept auto accident claims and has comprehensive options including pain management treatment, chiropractic treatment, acupuncture, physical rehabilitation and spinal decompression therapy.
After a car accident, it may take more than one treatment option to get you back to work and minimize the resulting pain. Over 3 million whiplash injuries occur every year in America, and 15% of those end up with chronic neck pain. the chances of chronic neck pain can be minimized with quick treatment at a cutting-edge pain center such as Arizona Pain Specialists.
Along with accepting personal-injury liens, Arizona Pain Specialists also accepts most major health insurance along with Medicare, Medicaid and AHCCCS plans such as Mercy Care and APIPA. Arizona Pain has multiple clinics around the Valley serving Phoenix, Scottsdale, Glendale, Mesa, Peoria, Surprise, Goodyear, Avondale, Tempe, Laveen, Gilbert, Chandler, Queen Creek and more.
For one number scheduling after your auto accident, call Arizona Pain Specialists at 602-507-6550 to get started today.
Over the past few weeks, there has been an outbreak of fungal meningitis that has been linked to a steroid medication being used in epidural injections for pain management. As of this week, 170 patients have been infected with fungal meningitis, and there have been 14 deaths in 12 states.
The steroid medication is called methylprednisolone and it is
the most common used medication for epidural steroid injections. The medication has been linked to the New England Compounding Center, which is a compounding pharmacy in Framingham, MA. It is not for certain, but one of the vials tested from the company tested positive for the fungus.
Just to be clear, Arizona has had no cases at all.
The 12 states involved include Tennessee with the most cases, Virginia and Michigan each with about 25 cases, Minnesota has a few along with Florida, Maryland, North Carolina, New Jersey, Idaho and Indiana. (there are 2 others I can't recall).
The incubation period for fungal meningitis is between one
week and a month. Therefore, the CDC thinks that many more people could become
infected, as over 13,000 people received injections from these 2 recalled lots of medication. There were 76 clinics and surgery centers who received the medication. Interestingly, Nevada received a considerable amount, but all of it was recalled prior to any use.
The injections can take place into the knee or any joint, along with soft tissue such as for tennis elbow. Those would typically not lead to meningitis, but could lead to a localized fungal infection. With an epidural steroid injection, the medication is placed so close to the spine it makes it easier to reach the spinal fluid and cause meningitis. If individuals are extremely concerned, they can receive antifungal medication from their doctor.
The core of the problem is that the medication has been linked to a compounding pharmacy. The pharmacy, called the New England Compounding Center, essentially takes medication from manufactures and mixes them on its own. Compounding pharmacies are not subjected to the strict regulations that the FDA imposes on manufacturing facilities.
Once again, there have been no cases in Arizona reported. Arizona Pain Specialists has issued a press release detailing that they do not use methylprednisolone and have had no cases of the meningits. All three of their Arizona pain center clinics have been cleared of risk factors.
If you are in pain in AZ and need treatment, call Arizona Pain Specialists today at 602 507-6550.