America’s deadliest Opioids problem: From Pain specialist view

Pain is one of the most significant problems from which a person suffers. Chronic pain alone has affected more than 100 million US adults at present. With pain, you tend to lose your normal routine life and it costs more than $560-635 billion annually to people living in the United States.

Why US residents fail to seek effective pain treatments?

US residents fail to seek effective pain treatments

Los Angeles pain clinic and their specialist have found out that a large number of Americans have received inadequate pain prevention, assessment and treatment because of various financial incentives that work against the best provision for personal care. The unrealistic expectations of a patient and lack of valid pain assessment measures make US residents fail to receive a proper pain treatment.

The clinicians in the pain management clinics often look after the patients to help them gain day to day control on their pain killer addiction, but many health professionals lack proper training to perform this supportive role. If we look into the primary care, it is always the first stop for the patients suffering from chronic pain. However, this primary care is often missed and hence the pain specialists cannot perform comprehensive treatments.

How Opioid has risen in America?

Opioid has risen in America
Figure 1 – Opioid Prescriptions Dispensed by US Retail Pharmacies IMS Health, Vector One: National, years 1991-1996, Data Extracted 2011. IMS Health, National Prescription Audit, years 1997-2013, Data Extracted 2014.

Drug Use rate in USA
Figure 2 – Growing Evidence suggests that abusers of prescription opioids are shifting to heroin as prescription drugs become less available or harder to abuse. For example, a recent increase in heroin use accompanied a downward trend in OxyContin abuse following the introduction of an abuse-deterrent formulation of that medication (dashed vertical line)

Relation between Use and Death
Figure 3 – Trend in Prevalence of Heroin Use and Heroin Related Overdose Death in the US (1999-2012)

Methadone Pre and Post

The rise of the opioid analgesics indicates both a medical hint and an abuse. Therefore, their prescribing, dispensing and administration is directly under the control of the government including treaties and US federal and state laws. The policies as directed control drug movement and prevent abuse or prescription medicines. However, there are many opioids that are important to control pains and for that, governments must make sure that there is adequate supply.

Why pain specialist prefers to use Opioid to treat chronic pains?

From mild to acute, pain could be often cured with physical interventions such as common application of the ice, transcutaneous electrical nerve stimulation (TENS), massage or bracing etc. But along with that the specialists in Los Angeles pain clinic also make the use of mild analgesic such as an NSAID. However, a severe pain demands opioid therapy. With the help of the skilled clinicians, they can able to treat nerve blocks and spinal infusions to control the severe acute pain to a high level.

Clinicians should look into the proper medication and treatment and must carefully analyze how everything can synchronize. We strictly follow this and also our pain management clinic in Los Angeles carefully supervise short-term use of opioids in the context of treatment of short-term pains compared to those documented pains that has been severe down the years.

However, a number of barriers continue to be there in America according to the viewpoint of the pain specialists. The health professionals at times hold negative attitude towards people who report about the pain and may not pay much attention. However, it is the duty of the clinicians to attend the patients no matter how much debilitating or controllable the pain might be. However, without the prescription it is not advisable to prescribe medicines of opioids to the sufferers, so its claims immediate attention of pain specialists of the Los Angeles Pain Clinic.

A detailed information About Acute Pain Management

Acute Pain Management

Pain is an unpleasant experience which may arise from an existing damage or a potential threat to the body. In order to schedule a proper pain management plant, physicians first need to determine the nature of the pain. Pain can be acute, chronic, neuropathic or psychogenic. Acute pain refers to a sudden burst of sharp pain which might be difficult to diagnose and treat. A number of events and circumstances may trigger such symptoms which may last for hours,days or weeks. The factors that may lead to symptoms of acute pain include:

  • Surgical procedures
  • Fracture, muscle tears and other forms of tissue injury and inflammation
  • Dental problems
  • Burns and cuts
  • Labor pain
  • Underlying diseases

Acute Pain Management Strategies

Doctors at pain clinics like the Los Angeles pain management clinics will be able to assist you in resolving your acute pain problems.The first step in any pain management strategy is the diagnosis of the root cause of the painful condition. First, the doctors will ask you to describe the nature and of the symptoms you are experiencing and whether you have knowledge of any underlying problem that may be causing such symptoms. You might also be asked to fill out a questionnaire to assess the intensity and possible cause of your pain. After recording your full medical history, if deemed necessary, you may be asked to undergo a thorough physical examination and certain diagnostic tests.The diagnostic tests might include one or more of the following:

  • Blood tests
  • Imaging studies like X-ray, MRI, CT scan or ultrasound imaging.
  • Nerve conduction tests and electromyography to detect abnormalities in the nervous systems.
  • A myelogram to detect any abnormalities in the spinal nerves or a diskogram for identifying spinal disc dislocation or other types of damages.

Treatment of acute pain

Treatment of acute pain

After a conclusive diagnosis of the root cause of acute pain, the next step involves the mapping of treatment schedules that will work best for your condition. Some basic therapies (first tier) to alleviate the effects of acute pain include:

  • Taking sufficient rest may heal an injured area and result in resolving the painful symptoms
  • Application of heat or ice therapy to the affected area could provide temporary relief from pain. Heat and ice assists in reducing the swelling and inflammtion resulting from tissue injuries like muscle sprains, strains, etc.
  • Pain medications: Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, muscle re-laxants, opioid medications like codeine or morphine, acetaminophen, etc. may be used to rescue you from acute pain.

If the first tier therapies fail to provide signifiant results and your pain still lingers, then the second tier of pain management strategies can be brought into action.This includes stronger and more effective treatment modules like:

  • Administration of anticonvulsants.
  • Steroid injections administered to reduce tissue inflammation.
  • Use of local anesthetics called nerve blocks to desensitize nerve ending in the affected area to diminish the sensation of pain.
  • Trigger point injections to treat muscle spasms.

Alternative treatment strategies like acupuncture, chiropractic, etc, might also be adopted by your Los Angeles pain management doctors to further alleviate the symptoms of acute pain.


Read more articles on Acute Paine :-

How to get the right diagnosis for numb fingers?

Numb fingers can have many underlying causes like rheumatoid arthritis, carpal tunnel syndrome, cervical radiculopathy or other disorders. Often, one may mistaken for the other and the wrong treatment is delivered. So, before starting any treatment schedule for treating numb fingers it is important to diagnose the underlying cause first.

numb fingers

A common misdiagnosis

Some of the common disorders that lead to numbness in fingers are discussed here:

  • Carpal tunnel syndrome: Here the median nerve entering the palm through the wrist tunnel is com-promised resulting in numbness in the thumb, middle and index fingers.
  • Carpal tunnel syndrome

  • Cervical radiculopathy: If a nerve exiting your neck towards the hand gets irritated at the point of exit due to compression or inflammatory conditions, it may result in numbing the fingers of the hand. Cervical radiculopathy may result from a number of conditions like cervical degenerative disc disease, spinal stenosis or cervical herniated disc. The symptoms of this disease are similar to that of the carpal tunnel syndrome affecting the same areas of thumb, middle and index fingers.
  • Cervical radiculopathy

  • Rheumatoid arthritis (RA): An autoimmune disorder characterized by painful, swollen joints, RA can actually lead to carpal tunnel syndrome if the tendons in the wrist undergo inflammation.
  • Rheumatoid arthritis (RA)

Besides these common causes of finger numbness, a number of other disorders, injuries and traumas may lead to numbness in the fingers. They are:

Causes of finger numbness

Neurological causes: diabetic neuropathy, stroke, alcoholism, lead poisoning, hypothyroidism, peripheral neuropathy, spinal cord injury or tumour, etc.

Circulatory causes: Peripheral artery disease, frostbite, Renaud’s syndrome

Orthopaedic causes: Cervical spondylosis, bone fractures, neck injuries

Other causes: Trauma to the hand, snake bites, beriberi, poisoning, malnutrition, rabies, Guillain-Barre syndrome,etc.

Getting an accurate diagnosis

Once you visit a specialized physician like the Los Angeles pain management doctors, with a complaint of finger numbness, your physician will ask you a few questions to build your case history. The most important questions usually asked are:

  • Which region of your fingers are feeling numb?
  • When did the numbness start?
  • Is the feeling chronic or acute?
  • Are you engaged in any activities that may result in finger numbness?
  • Are there any accompanying symptoms like pain, itchiness or burning?

After noting your medical history, the physician may physically inspect your fingers and other areas for signs and symptoms of disease. To confirm a diagnosis, however, further tests need to be performed. Some of the common tests recommended for numb fingers are:

  • Nerve conduction velocity tests. This study can help confirm or eliminate carpal tunnel syndrome as the underlying cause of numb fingers.
  • Imaging studies like X-rays, MRI and CT scans which may help confirm cervical radiculopathy.
  • Electromyography
  • Nerve Biopsy
  • Blood tests

Since the causes of finger numbness are many, an accurate diagnosis becomes a difficult task. Only specialized doctors like Los Angeles pain management doctors, who are trained to diagnose and treat conditions like finger numbness, will be able to deal with your case quickly and efficiently. Do not ignore finger numbness and visit a doctor as soon as possible to detect the underlying cause.

General Medication of Fibromyalgia by Pain Clinic Los Angeles

Fibromyalgia can rapidly affect a person’s life personally and professionally. The symptoms do not only include widespread pain, but also lead to other problems, such as depression, inadequate sleep, fatigue and irritability. The reasons and causes of the condition vary from patient to patient, hence choosing the correct and effective treatment can be challenging.

Today, we list down some the general medication used to treat Fibromyalgia.

Tricyclic antidepressant

Tricyclic Anti-depressants:

Tricyclic anti-depressants include Amitriptyline (Elavil), Nortriptyline (Pamelor), and Doxepin (Sinequan). Amitriptyline is considered to be the most effective and is known to enhance stage 3 and 4 sleep. The drug significantly improves the quality of sleep, morning stiffness helping patients to get rid away of the pain in a short span of time. The medicines, however, do cause side effects including morning sedation, dry mouth, confusion and urinary retention.

Cyclobenzaprine

Muscle Relaxants:

Muscle relaxants such as Cyclobenzaprine (Flexeril) and Orphenadrine Citrate (Norflex) have been found to be effective in the treatment of fibromyalgia. With tricyclic chemical structure, Cyclobenzaprine can be used as a short-term muscle relaxant. The drug is also helpful in improving the quality of sleep and pain score, with reduction in tender points and muscle tightness. Cyclobenzaprine, however brings many side effects, hence it’s a must to seek a doctor’s advice before using them.

Sedative Drug

Sedative Drugs:

Most of fibromyalgia patients report about their lack of sleep. This is the very reason doctors may recommend the use of sedative medications to enhance the sleep among the patients.

Some of the sedative drugs include Temazepan (Restoril), Flurazepan (Dalmane) and Triazolam (Halcion). These are Benzodiazepine agents used to treat insomnia for a short-term period. These medicines however do cause side effects, such as excessive drowsiness, confusion, nausea, tachycardia and nightmares. In some cases, the long term use of these sedative drugs has reported to cause major symptoms such as glaucoma and (paradoxically) insomnia.

 

Non-steroidal Anti-inflammatory Drugs:

Non-steroidal Anti-inflammatory Drugs (NSAID’s) are most commonly used for their anti-inflammatory and analgesic properties to combat pain and stiffness.

 

 

 

Anti-seizure drugs

Anti-seizure drugs:

Anti-seizure drugs such as Gabapentin (Neurontin, Gralise) and pregabalin (Lyrica) has been proven helpful in reducing fibromyalgia symptoms.

 

Please remember that each drug offers in the risks it poses and must be used with caution. These drugs have been on the market for more than 15 years. The medications differ substantially in price and the monthly cost for these drugs ranges could range anything in between $6 to more than $500.

Also, understand that medication is just one part of the treatment approach to fibromyalgia. According to pain management doctors what could actually help in treating the condition ways is a combination of medicine for pain and sleep with treatment of overlapping conditions such as migraines and irritable bowel syndrome, and combination of water therapy, massage and yoga.

Pain clinic Los Angeles suggests that getting involved in everyday physical activities including walking, jogging, biking, stretching and other exercises can also be helpful in treating the symptoms related to fibromyalgia.

Wishing you best recovery!

Knee Arthroscopy Surgery With Pain Management Specialist Losangeles

What is Knee arthroscopy?

Physical therapy Los AngelesKnee arthroscopy is a kind of keyhole surgery carried out on inside of your knee joint to discover symptoms such as, irritation or a harm. You may opt for treatment of knee arthroscopy where your physiotherapist may repair or remove any harmed tissue and ligament. Your physiotherapistmay take little tissue tests (biopsies), which can be used to analyze the situation and identify the main cause of knee arthroscopy.

Arthroscopy is used to analyze several knee problems, such as, torn meniscus (kneecap), or repair ligaments in joint. Knee problems are accompanied by severe pain which patients must be aware of. Your recuperation time and visualization will rely upon the seriousness of the knee problem and the unpredictability of how long it may last.

Why Prefer Knee arthroscopy?

The following are the major reasons why knee arthroscopy is recommended:
• Torn meniscus. Meniscus is defined as a ligament that pads the space found between the bones in the knee. It can be repaired through Surgery.
• Damaged anterior cruciate ligament (ACL)
• Swollen or injured covering of the joint. This coating is known as the synovium.
• Misalignment of the kneecap.
• Small pieces of damaged ligament up the knee joint
• Removal of Baker’s lump. The swelling takes place at the knee where liquid has been filled. Now and then the issue happens if swelling and painexist for different reasons, similar to joint inflammation
• A few fractures of the knee bones.

How are Knee Arthroscopy Performed?

Knee pain treatmentKnee arthroscopy is generally performed under broad sedative, though it can be done under spinal anesthesia, or analgesic. During this procedure, antibacterial liquid is used to clean the skin on the affected joint. A small entry point, a couple of millimeters long, is made so thatthe arthroscope can be inserted. One or more extra cuts will also be made so that an examining test can be done and other fine surgical instruments can be inserted. The doctor may fill the joint with a clean liquid to extend it and make it easier for viewing. Doing so will help the doctor see the inside of your joint using aneyepiece.This present a good chance where the doctor will repair any harmed regions and remove any undesirable tissue.

The doctor will further carry out more tests using arthroscope and, if necessary, remove or repair any areas affected with the help of surgical instruments embedded through the entry points. After the procedure, the arthroscope and any other instruments are removed, alongside any excess liquid from the joint.

How do Knee arthroscopy Relieve Pain?

The doctor recommends that you take your pain management medication at the onset ofpain. This will help relieve pain before it becomes acute. You may also prefer to have a nerve square, which is a pain reliever after surgery. Ensure you take the recommended medication to help relieve pain in the nerve.

Are there Risks Associated with Knee arthroscopy?

While knee arthroscopy is highly recommended for treatment of knee injuries, there are a few dangers that patients ought to be aware of. Upon undergoing the knee arthroscopy, patients may experience incidences such as swelling, solidness of the joint, dying, blood clusters, and other diseases that are effects of knee problem.All these should be reported to the doctor so that you can get the best advice on what to do.