Pain Management Myth Busters

What to look for in a Pain Management Job?

My Journey through Anesthesia

After graduating from my pain management fellowship at NYU in 2007, I wrestled with the idea of going into a full-time pain practice or anesthesiology/pain management hybrid position.

After going on multiple job interviews I realized that I did not want to be a full-time anesthesiologist for the rest of my career.  So, I wound up taking a position in the anesthesiology department at Maimonides Medical Center.  I opted for this position, as I was offered the chance to build a pain practice from scratch.

I started with one afternoon per week in the pain office and otherwise functioned as a full-time anesthesiologist.  I took a call like everyone else.  In fact, my first call was on my birthday in the same OB ward where I was born.  My parents even kept the anesthesia bill from 1976.  They were charged $88.  

Anyway, I did it all.  Peds (which I dreaded), ruptured AAA repairs, ECT, endoscopy, all while building a pain practice and seeing pain consults between, before and after my OR cases.  With the help of my chairman, vice-chairman, and the orthopedics dept., I had the opportunity to build a regional anesthesia service, test out Onc Q pumps, Exparel, learn TAP blocks, Quadratus Lumborum Blocks and more.

The first week of my attending job

Money is not how I measure success. Don’t get me wrong, money is quite important, but it’s not everything. I learned this during my first week as an anesthesiology attending.   We were short-staffed and I had to take extra- call, then stay late working the post-call day.  This went on while having an Anesthesiology Oral Examination and Pain Managment Board Certification Exam looming in the back of my head.  In addition, I had a 1-year old that was allergic to sleep and was coming out of a pain fellowship in which I did not administer anesthesia to anyone for a full year.   Did I mention that all 3 of us lived in a  studio apartment?

HOW TO CHOOSE A PAIN MANAGEMENT PROFESSIONAL

When it comes to musculoskeletal pain, professional care can replace pain medication as your first line of defense. Hands-on healthcare professionals such as physical therapists, chiropractors, occupational therapists, massage therapists and athletic trainers are the experts in the assessment, correction and prevention of musculoskeletal dysfunction and the treatment of acute and chronic pain. Not only do they have the knowledge to guide you through the full range of options for muscle and joint pain relief and the associated risks and side effects, but they have access to the best, professional-grade products to complement their care. In fact, research shows working with hands-on healthcare professionals can result in better outcomes for musculoskeletal pain

PHYSICAL THERAPY FOR PAIN

According to the American Physical Therapy Association (APTA), physical therapists are “highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility – in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects.”

WHEN TO SEEK OUT A PHYSICAL THERAPIST FOR PAIN RELIEF

The APTA defines the role of a physical therapist as:

Diagnosing and managing movement dysfunction and enhancing physical and functional abilities

Restoring, maintaining, and promoting not only optimal physical function but optimal wellness and fitness and optimal quality

 of life as it relates to movement and health

Preventing the onset, symptoms and progression of impairments, functional limitations and disabilities that may result from

 diseases, disorders, conditions or injuries.

WHERE TO FIND A PHYSICAL THERAPIST

Physical therapists can be found in a variety of settings, including outpatient clinics, hospitals, private practices, home health care, extended care, occupational environments, fitness centers and more. Use the Professional Finder to search for physical therapists in your area!

CHIROPRACTIC FOR PAIN RELIEF

According to the American Chiropractic Association (ACA), chiropractic is “a healthcare profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health.” Furthermore, the ACA promotes that chiropractors “practice a hands-on, drug-free approach to health care that includes patient examination, diagnosis and treatment.”

How to Choose the Safest Over-the-Counter Painkiller for Older Adults

If your mother has been complaining, you’ll want to make sure she gets a careful evaluation from her doctor. After all, frequent pain can be the sign of an important underlying health problem that needs attention. You’re also more likely to help your mom reduce her pains if you can help her doctors identify the underlying causes of her pain.

That said, it’s a good idea to ask what over-the-counter analgesics are safest for older people. That’s because improper use of OTC painkillers is actually a major cause of harm to older adults.

What’s the safest OTC painkiller for an older parent?

For most older adults, the safest oral OTC painkiller for daily or frequent use is acetaminophen (brand name Tylenol), provided you are careful to not exceed a total dose of 3,000mg per day.

It is processed by the liver and in high doses can cause serious — sometimes even life-threatening — liver injury. So if an older person has a history of alcohol abuse or chronic liver disease, then an even lower daily limit will be needed, and I would strongly advise you to talk to a doctor about what daily limit might be suitable.

The tricky thing with acetaminophen is that it’s actually included in lots of different over-the-counter medications (e.g. Nyquil, Theraflu) and prescription medications (e.g. Percocet). So people can easily end up taking more daily acetaminophen than they realize. This can indeed be dangerous; research suggests that 40% of acetaminophen overdoses cases are accidental.

Tips to control patient pain

A number of studies and surveys on pain management have all come to the same conclusion: Despite strides in therapies to ease pain, too many inpatients experience significant levels of continuous pain during the course of their treatment. A recent report from the World Health Organization, for example, found that at least 25% of all cancer patients who die in a hospital die without adequate pain relief.

The good news is that several other studies have shown that physicians can manage pain effectively in most patients by using some relatively simple strategies. Of particular interest to inpatient physicians, researchers say that pain management plays a critical role in the recovery process.

Assessing pain

At the Heart Hospital of New Mexico in Albuquerque, hospitalists follow an institution-wide pain management model that relies on two basic elements: regular assessments of patient pain and ongoing adjustments to reflect patient input.

Every patient room, for example, has a pain intensity chart with both a numeric scale and a color scale. Physicians re-assess the patients on an ongoing basis, and they respond immediately to any change in the level of pain

To determine what kind of pain management is appropriate, you need to start with an assessment. A popular tool is an intensity scale that asks patients to rate pain from 0 to 10. Pictorial scales are particularly good for patients with low literacy levels.

Choosing The Right Shoes For Back Pain

Back pain is one of the most common ailments in the United States and affects eight out of 10 people at some point throughout their life. Back pain might be a small sharp pain or a dull ache that persists all day. Many different factors can cause back pain from poor posture to lack of exercise. However, sometimes back pain is linked to sore feet and uncomfortable shoes.

If your feet are causing or contributing to back pain, a change in shoes might make a huge difference. The right pair of shoes can provide the support you need for your back while you’re at work, at the gym or running errands. The wrong pair can cause or exacerbate back pain symptoms.

How do you know which shoes are best for back pain relief? In this post, we will show you how to pick the best shoes for back pain and the factors you need to consider when shopping for new shoes. Once you have the right shoes for your feet, you may notice reduced back pain right away.

Why Shoes Are Important For Back Pain

Your feet provide the base for the rest of your body. When you wear uncomfortable shoes, they create a chain reaction on your ankles, knees, hips and ultimately, your back. Your feet need adequate support to prevent pain while you stand, walk or run. Without proper support, you might adjust your gait or posture and set your spine out of alignment to compensate for the lack of support in your shoes. You also need shoes that absorb impact as your foot hits the ground so that other parts of your body do not have to bear the force of the impact.

Overall, a good pair of shoes improves and stabilizes the position of your feet, which, in turn, improves your gait and posture. Good posture helps prevent muscle strain and pain in the back because it keeps everything in correct alignment and allows muscles, bones and joints to work efficiently