louisiana pain quarterly - Louisiana Pain Specialists

LOUISIANA PAIN
QUARTERLY | Winter 2014/2015
CREATING
HAPPY
HOLIDAYS
Coping with Stress and Chronic Pain
during the Holiday Season
FRITTATA
RECIPE
NEW PRESCRIPTION PARTNERSHIP
DRUG REGULATIONS WITH TULANE
A healthy way to clear out
the fridge from our friends
at Good Eggs
Learn about how they may affect you
Louisiana Pain to provide chronic
pain care at Downtown Hospital
CONTENTS
WINTER 2014/2015
Editor: Lucey Wright
Design: Addie Mirabella
Published by: Xanthus
If you are interested in a magazine for
your practice contact Nick Ryan at
[email protected]
01
02
03
WELCOME
04
06
07
08
NEW PRESCRIPTION DRUG REGULATIONS
13
PUZZLE
The holiday season is here already!
FRITTATA RECIPE
A healthy way to clear out the fridge from our friends at Good Eggs
HAPPENINGS THIS QUARTER
Check out events happening in the New Orleans area for late
Fall and early Winter!
How the changes may affect you
TREATMENT FOR CHRONIC KNEE PAIN
A solution for providers and patients
PARTNERSHIP WITH TULANE
Louisiana Pain to provide chronic pain care at Downtown Hospital
CREATING HAPPY HOLIDAYS
Coping with Stress and Chronic Pain during the Holiday Season
By Dr. Mark Skellie, Psy.D.
Check out the winter word search!
Winter 2014/2015 | LOUISIANA PAIN QUARTERLY
1
WELCOME
The holiday season is here already!
We hope it is full of joy and fun with
your family and friends.
hile there are many reasons to love the holidays (Great food!
Family visits! Giving and receiving gifts!), it can also be a
difficult time for those managing chronic pain. Remember to
take some time for yourself during the hustle and bustle of
the season. Whenever possible, schedule in some relaxation. In this issue of
Louisiana Pain Quarterly, you can read about why stress can be more of an
issue for some people during the holiday season and what you can do about
it (pg. 8).
Be sure and check out a delicious frittata recipe from our friends over
at Good Eggs (pg.2) and ‘Happenings This Quarter’ (pg. 3) for events from
November through January. Get informed about new prescription drug
regulations that might affect you (pg. 4). You can also learn about a cuttingedge treatment for knee pain that we are now offering (pg. 6) and our new
partnership with the Tulane Medical Center (pg. 7).
We wish you and your family happy holidays and we hope you enjoy this
issue!
W
Dr. Tarun Jolly
From our families to yours,
Dr. Tarun Jolly and Dr. Firas Hijazi
Founders of Louisiana Pain Specialists
Dr. Firas Hijazi
LOUISIANA PAIN SPECIALISTS LOCATIONS:
KENNER
231 West Esplanade Avenue, Suite B
Kenner, LA 70065
NEW ORLEANS EAST
5621 Read Boulevard
New Orleans, LA 70127
NEW ORLEANS
3439 Prytania Street, Suite 501
New Orleans, LA 70115
MARRERO
4520 Wichers Drive, Suite 205
Marrero, LA 70072
LAPLACE
502 Rue De Sante, Suite 303
LaPlace, LA 70068
TULANE MEDICAL CENTER
1415 Tulane Avenue, 4th Floor
New Orleans, LA 70112
CONTACT US: 504-434-7750 or LouisianaPain.com
LOUISIANA PAIN QUARTERLY | Winter 2014/2015
GOOD EGGS FRITTATA
rittatas are a quick and healthy way to
start the day. They’re also a great way
to clear out (and enjoy) any lingering
vegetables from the back of your fridge!
Simply saute some veggies, pour in some beaten eggs,
cook on the stovetop and then finish it off under the
broiler. Think scrambled eggs poured over a medley of
vegetables, meats and cheeses. Simple!
F
Ingredients:
•
•
•
•
•
•
•
2 tbsp of butter or olive oil
4-5 pastured eggs
1 lb. winter or summer squash
½ onion, diced
1 cup chopped tomatoes
¼ cup feta cheese
2 tbsp. fresh or dried herbs
Cooking Directions:
1. Saute onions & tomatoes in butter or olive oil until
softened.
2. Whisk eggs, salt, pepper, and a splash of milk
(optional) together before pouring over the onion &
tomato medley. Add in fresh or dried herbs if desired
and sprinkle with feta cheese.
3. Cover and cook until the eggs have set. Remove the
pan from the stovetop and place inside the oven to
broil for 1-2 minutes before serving.
About Good Eggs:
Good Eggs combines the goodness of the farmers
market with the convenience of an online grocery store.
With free delivery to your door!
Shop direct from more than 100 local farmers,
fishers, dairies, butchers, bakers and more, and your
groceries will be made or harvested to order and
delivered to your doorstep for free!
Order up something good: www.goodeggs.com
Photo by Colin Price
2
Winter 2014/2015 | LOUISIANA PAIN QUARTERLY
3
HAPPENINGS
THIS QUARTER
November
T
he 7th Annual New
Orleans Fringe
Festival is a weird,
wacky, and avantgarde fall diversion! Happening
November 19-23, Fringe Festival
will be host to over 300 shows
featuring over 70 theater groups in
30 venues, including a beautiful old
church, a former funeral home, and
a retired firehouse.
www.nofringe.org
If you are one of the many people
who love po-boys (who doesn’t?!),
check out this year’s Oak Street
Po-Boy Festival in New Orleans on
Sunday, November 23, 10AM-7PM.
The festival is free and features
plenty of po-boy vendors and two
stages of music.
www.poboyfest.com
Home Saints Games
November 9: 49ers
November 16: Bengals
November 24: Ravens
December
he spectacle of
Celebration in the
Oaks is a must-see for
the holiday season!
It seems that all of City Park is
aglow this time of year with light
displays scattered throughout its 13
beautiful acres. The two mile train
ride through the park is a fun way to
see it all. The 2014-2015 season
lasts from November 28 to January
3. Tickets $8, train ride $4.
www.neworleanscitypark.com/
celebration-in-the-oaks
T
It’s a little less than an hour and a
half drive to seafood, oranges, arts
and crafts, live music, children’s
activities, carnival rides, and a 5K
run at the Plaquemines Parish Fair &
Orange Festival in Buras, Louisiana,
December 5-7. Entry is free!
www.orangefestival.com
Home Saints Games
December 7: Panthers
December 21: Falcons
January
edieval history geeks,
those interested in
New Orleans’ French
heritage, and people
who just enjoy watching a parade
wind its way through the French
Quarter will get a kick out of the
Krewe de Jeanne d’Arc Parade on
January 6.
www.joanofarcparade.org
M
Whether you’re a long-time
runner competing or just there for
moral support, the New Orleans
Rock ‘n Roll Marathon can be
an exhilarating way to spend the
day. The event starts with the
free Health and Fitness Expo at
the Morial Convention Center,
January 23-24, culminates with
the marathon and half marathon on
January 25, and ends with the postrace concert at the finish line.
www.runrocknroll.competitor.com/
new-orleans
4
LOUISIANA PAIN QUARTERLY | Winter 2014/2015
NEW PRESCRIPTION
DRUG REGULATIONS
Tighter Rules Established on Certain Painkillers
Lucey Wright, M.S.
he Drug Enforcement Agency has
enacted tighter regulations on the most
commonly prescribed painkillers in the
U.S. Hydrocodone combination drugs such
as Vicodin have been reclassified into
Schedule II, the category of medical substances that are
most likely to cause harm.
The decision is meant to reduce opioid abuse
that is rampant across the United States. According
to federal data, in 2010, more than 16,500 people
died from opioid-based painkiller overdose, more than
all other classes of drugs combined. Regarding the
new regulations, DEA Administrator Michele Leonhart
T
explained to the Wall Street Journal, “[This] action
recognizes that these products are some of the most
addictive and potentially dangerous prescription
medications available.”
Louisiana Pain Specialists’ Dr. Nomen Azeem
supports the new regulations. “The new classification
of hydrocodone combination drugs will discourage
the over-prescribing of them, which was a major
contributing factor to addiction and abuse. I am a firm
believer that if a patient needs long-term treatment with
opioids, they should be seeing a board certified Pain
Medicine physician. Pain Management practices like
Louisiana Pain Specialists offer a safe and reputable
Winter 2014/2015 | LOUISIANA PAIN QUARTERLY
option for care for those in chronic pain and their
primary care providers.”
Among the new regulations, patients will be
required to obtain a new prescription for these types
of painkillers every 90 days, and prescriptions can only
be written for a 30-day supply of the drug. Dr. Firas
Hijazi, of Louisiana Pain Specialists, outlines additional
regulations, “Prescriptions for the drug must be hard
copy, and cannot be called in, faxed in or e-prescribed.
The prescriptions cannot include refills and cannot be
filled early or partially filled, and expire 21 days after
they are written. The change will also mean more
restrictive paperwork and rules for pharmacists, which
may sometimes make it more difficult for patients to
get their prescriptions. However, we will work with our
patients to provide the best care possible in spite of the
new restrictions.”
Another common pain medication, tramadol, has
also been reclassified as a controlled substance, but in
a less regulated class than hydrocodone combination
drugs. Previously, a prescription written for tramadol
would be valid for 12 months, with no restriction on the
number of refills, and it could be transferred between
pharmacies as many times as necessary. Under the
new regulations, all prescriptions written for tramadol
and products containing tramadol may only be refilled
five times within a six month time period, will only be
valid for 6 months, and can only be transferred between
pharmacies once.
The physicians at Louisiana Pain Specialists
recognize the risks as well as the need for some patients
to use opioid-based medications, and it is very important
to them that the patients to whom they prescribe opioid
medications for pain are using them safely and correctly.
A 2013 study of a sample of 240 Louisiana Pain
Specialists patients demonstrates that LPS physicians
utilize a unique and comprehensive strategy for pain
management for each patient. The study showed that
5
35% of patients never received opioid prescriptions
from Louisiana Pain Specialists. Of the 65% of patients
receiving opioid prescriptions, 59% had a decrease or
no change in medication between their initial and most
recent office visit. Meanwhile, patients who underwent
any type of procedure with Louisiana Pain Specialists
achieved over a 57% improvement in their pain.
To ensure the safe use of opioid medications, every
patient who is prescribed these medications signs a
contract in which they agree to use the medications
as prescribed, and to avoid filling opioid medication
prescriptions from other providers. Louisiana Pain
Specialists also employ the help of Dr. Mark Skellie,
Psy.D., a Psychologist specializing in Clinical and Health
Psychology, to help ensure the safety of their patients
prescribed opioids.
If you are suffering from chronic pain and are
worried about the new regulations or the addiction
potential of opioid medications, one of the physicians
at Louisiana Pain Specialists can help. Call 504-4347750 or visit LouisianaPain.com for more information.
6
LOUISIANA PAIN QUARTERLY | Winter 2014/2015
A NEW TREATMENT FOR
CHRONIC KNEE PAIN
A Solution for Providers and Patients
hronic knee pain
is a very common
complaint in the
United States. The
typical conservative treatments for
knee pain are physical therapy and
over-the-counter pain medicines.
The next step in treatment can
call for injections, with steroids
or viscosupplementation such as
Synvisc/Euflexa treatment, along
with prescription pain medications.
Beyond that, knee replacement
surgery has been a common
solution to chronic knee pain due to
osteoarthritis.
The doctors at Louisiana
Pain Specialists are excited to be
offering a new type of treatment
for their patients who suffer from
chronic knee pain; called a knee
radiofrequency ablation. This
procedure can help patients to
delay or even avoid surgery, and
can also provide pain relief to
patients who have already had knee
replacement surgery.
Knee radiofrequency ablation
is an outpatient procedure, which is
carried out in two steps. In the first
procedure, which is diagnostic, a
C
medication is injected into the nerves
around the knee, called the genicular
nerves. This medication serves to
temporarily block the pain signals.
If a patient gets pain relief
from the diagnostic procedure, the
doctor will move forward with the
second step, which is the actual
knee radiofrequency ablation. In this
procedure, a specialized needle is
used to apply heat directly to the
genicular nerves of the knee. After a
genicular nerve is heated in this way,
it is unable to continue sending pain
signals to the brain. The pain relief
from this procedure can last six
months or more. While this is a new
type of procedure, radiofrequency
energy has been used in medical
procedures for over 75 years and is
very safe.
Dr. Satvik Munshi, of Louisiana
Pain Specialists, is excited to be
able to offer this treatment. He says,
“The genicular nerve block and
radiofrequency ablation of the knee
has been a great option for several
of our patients who suffer from
chronic knee pain.”
One of those patients, Eric
Rotts, 48, is happy with the results
he has achieved so far, a week
after his procedure. “I’ve had knee
pain since I was 14 or 15 years old,
when I destroyed my ACL. I’ve had
at least five ACL replacements and
many scopes. Nothing provided
me with any pain relief, aside
from drugs. I would say that this
procedure has provided 95 percent
pain relief so far. It has definitely
helped my quality of life.”
If you are suffering from chronic
knee pain, you might be a candidate
for a knee radiofrequency ablation
procedure. For more information about
this procedure, to refer a patient, or to
schedule an appointment, call 504434-7750.
Winter 2014/2015 | LOUISIANA PAIN QUARTERLY
7
ANNOUNCING NEW PARTNERSHIP
WITH TULANE HOSPITAL
ouisiana Pain
Specialists is proud to
begin its partnership
with the Tulane
Medical Center, which has been
a cornerstone of New Orleans
healthcare since 1834. Louisiana
Pain Specialists will be bringing
expertise in pain management and
an outstanding level of patient care
to the Neurosurgery and Spine
Center at Tulane Medical Center
Downtown.
In regards to the new
partnership, Louisiana Pain
Specialists’ Dr. Nomen Azeem,
who will be treating patients at
the Neurosurgery and Spine
Center said, “We at Louisiana Pain
Specialists are honored to be the
only private pain management
group in New Orleans to be
affiliated with the well-respected
academic institution of Tulane
Medical Center.”
Dr. Manish Singh, the CoDirector of the Neurosurgery and
Spine Center believes that this
partnership will have a positive
impact on patient care. “Typically
less than 25 percent of patients
L
with spine problems really need
surgery, while many of them need
other treatment modalities. We as
neurosurgeons are not set up to
do long term pain management,
and offering pain management is
integral to running a spine center in
a comprehensive way.”
Dr. Singh thinks that Dr. Azeem
is equal to the task. “He is an
accomplished pain doctor who is
an expert in chronic pain care and
various types of interventions. The
procedures he offers are diagnostic,
in which he can discover where
the patient’s pain is coming from,
and also interventional, in which he
can treat pain so that patients may
avoid surgery. Even for patients
who have run out of other options
for their pain, he can carry out a
Spinal Cord Stimulator trial to see
if they may get relief. Having a
pain management clinic within our
Center with a pain expert is really
going to help the overall outcomes
and improve in patient care.”
The physicians at Louisiana
Pain Specialists are focused on
improving the quality of life for
their patients. They have been
successful in caring for patients with
challenging conditions, for whom
other treatment plans have failed.
They look forward to providing
quick access to accurate diagnosis
and comprehensive treatment
within the Tulane Medical Center for
those who suffer from chronic and
acute pain.
8
LOUISIANA PAIN QUARTERLY | Winter 2014/2015
CREATING
HAPPY
HOLIDAYS
Coping with Stress and
Chronic Pain during the
Holiday Season
By Dr. Mark Skellie, Psy.D.
S
“
tress” is a term that is frequently used and
sometimes overused by people, because
we tend to live highly stressed lives. As
defined by engineers, stress is pressure
or tension from force applied to a solid object. Similarly,
emotional or psychological stress is a state of mental
strain resulting from unpleasant or highly demanding
life circumstances. With this definition of stress, chronic
pain fits the bill, as it is a very unpleasant problem
that demands attention unlike many other things in a
LOUISIANA PAIN QUARTERLY
9
sharp pain. External stressors can come in the form of
threats, demands, or the ways your pain makes your life
narrower.
The stress response is how the body and mind
react to the stressor. Physically, the nervous system
winds us up in a complex hormonal and neurochemical
dance called the “fight or flight response”. The stress
response can cause a lot of symptoms, particularly
when problems in life lead to a chronic stress response.
Typical symptoms of the stress response are irritability,
headaches, shaking or trembling, impatience, problems
with appetite and/or digestion, chest pain, sweating,
dizziness, emotional fatigue, concentration problems,
Stressors, which are the triggers or
sources of stress, can come in many
forms. There are internal stressors,
which can be psychological or physical.
Internal psychological stressors are
feelings such as guilt or shame, while
internal physical stressors could be that
dull ache you’ve been living with or an
unexpected sharp pain.
person’s life.When trying to manage stress related to
chronic pain, it is helpful to fully understand this complex
psychological phenomenon. Stress can be separated
into three categories: the stressor, the stress response,
and coping. Stressors, which are the triggers or sources
of stress, can come in many forms. There are internal
stressors, which can be psychological or physical.
Internal psychological stressors are feelings such as
guilt or shame, while internal physical stressors could be
that dull ache you’ve been living with or an unexpected
increased blood pressure, decreased productivity,
mild memory problems, confusion, unexplained aches
and pains, and higher sensitivity to pain in general.
For individuals who live with chronic pain, a vicious
cycle often occurs over time, in which pain becomes a
major trigger for the stress response, and the way the
body responds to stress can make the pain even more
challenging to live with. This in turn makes the pain even
more stressful. But the good news is, the way you cope
or react to both the stressor and the stress response
makes all the difference.
10
LOUISIANA PAIN QUARTERLY | Winter 2014/2015
Stress, Interrupted
When under stress, everybody does something to
cope, or reduce the stressor’s impact on their life, by
trying to eliminate the stressor or reduce the stress
response in the body. There are both healthy and
unhealthy coping strategies. Both of these may reduce
the unpleasant symptoms of the stress response.
However, while unhealthy coping, such as using alcohol
or tobacco products may have long term negative
consequences, healthy coping strategies have no long
term negative consequences. Using healthy coping
strategies, such as talking to a close friend or family
During the holiday season, most people
report that their stress levels actually
increase, despite the fact that many
people look forward to the holidays
all year. Interestingly, women typically
find the holiday season to be more
stressful than men, likely because women
traditionally shoulder a greater portion
of the responsibility of preparing for the
holiday celebrations.
member, laughing, exercising, doing an activity that
you enjoy, playing with children, journaling about
your thoughts and feelings, or carrying out relaxation
techniques (see the Deep Breathing Exercise on page
12) allow you to get through difficult situations without
letting stress build up or result in stress overload.
Obviously, none of these strategies eliminate the source
of stress, but they all work to reduce the stress response
in the body.
The stressors of contemporary life tend to be
complex, like chronic pain or financial troubles.
Therefore, a tool box approach to coping with stress
must be developed, by learning a variety of different
strategies that work. Learning healthy coping strategies
can dramatically improve your quality of life, while
engaging in unhealthy coping strategies tends to start a
spiral of negative behaviors or health consequences that
can themselves become new sources of stress later.
Holiday Stress
The holiday season is a busy time for people in
the United States. Just when you think your life is
stressful enough, managing everyday stressors such
as working long hours or accepting the fact that pain
makes you unable to work, caring for aging parents,
Winter 2014/2015 | LOUISIANA PAIN QUARTERLY
and paying the bills, the holidays arrive, adding an
additional layer of stressors. Depending on how well
you cope with stress, the added responsibilities of the
holidays can have a long-lasting impact on your body
and mind. During the holiday season, most people
report that their stress levels actually increase, despite
the fact that many people look forward to the holidays
all year. Interestingly, women typically find the holiday
season to be more stressful than men, likely because
women traditionally shoulder a greater portion of the
responsibility of preparing for the holiday celebrations.
Also, individuals with fewer financial resources tend
11
to find the holidays to be a source of stress due to the
commercialism and expense related to gift giving, as
well as concerns that other family members may be
judgmental if they do not buy expensive gifts. Another
major source of holiday stress that many people do
not expect is increased awareness of family members
who are no longer a part of traditional holiday
celebrations, whether it is because they have passed
away, or simply moved a great distance. This can
add to the already emotionally charged period and
some people with unresolved grief may experience
unexpected sadness. Another challenge of the holiday
season is that many people fall into unhealthy coping
strategies such as increased sedentary behavior,
alcohol use, and comfort eating.
The good news is that the vast majority of
Americans experience the holiday season as a time of
happiness, love, and high spirits. Seeing distant family
members and reconnecting with loved ones can be
an amazing way to reduce stress. The best advice
for balancing positive feelings and stressors over
the holidays is to simply take time to savor the extra
moments with family. If you allow yourself to focus
on enjoying what you love about the holiday season,
while sharing the burdens of planning and organizing
celebrations, and not forgetting about your healthy
coping strategies, this time of year can be one of the
best times for families. In addition to practicing regular
or newly-learned coping strategies, the holidays are a
great time to focus on helping others. Participating in
volunteer activities is a great healthy coping strategy
that can reduce holiday stress. It doesn’t have to be
anything formal, even the busiest person can take time
to do simple and free things to help others, such as
calling or visiting a lonely friend or family member who
may not have the family support they need during this
time of the year.
12
LOUISIANA PAIN QUARTERLY | Winter 2014/2015
Deep Breathing
When pre-historic humans were in danger of
attack, their muscles tensed and their breathing
became rapid and shallow as they prepared to fight
or flee. This high level of tension was and is helpful in
preparing for optimal performance. Today, the causes
of stress are different and quite varied. Modern
humans are often not in a position to fight nor to flee
and thus our tension has no release and the stress
response continues to build.
One way to counteract the stress response is to
learn to breathe slowly and deeply— the opposite of
how people breathe under stress. When presented
with a deep breathing exercise many people roll their
eyes thinking, “I know how to breathe!” But if you
take a moment to pull breathing away from the other
automatic processes of your body, you can bring the act
of breathing into conscious awareness and thus, control.
It may sound simple, and it is. Most people, however,
do not breathe deeply under normal circumstances. It is
therefore helpful to consider the mechanisms of deep
breathing and how it can help with relaxation. Think
about the way a baby breathes, with his belly moving
in and out. This deep breathing is not typical in adults,
who mostly breathe from their chest. Chest breathing is
shallower, so less oxygen is taken in with each breath.
As a result, the blood is forced to move through the
system rapidly so that enough oxygen gets to the brain
and other tissues. Higher blood pressure and rapid
heart rate are the result.
Deep breathing can reverse the negative effects of
stress. By helping you let go of tension, deep breathing
can help relieve headaches, bodily aches and pain,
anxiety, and sleeplessness. It leads to the release of
the body’s own painkillers, called endorphins, into the
system. It allows blood pressure to return to normal
and is good for your heart. Deep breathing can also
allow your emotions to be soothed and become less
distressing, so your emotional health may also benefit
from deep breathing.
Take some time to practice deep breathing each
day, especially when you are experiencing stress. You
can be sitting, standing, or lying down, and it helps
to wear loose, comfortable clothing. It is best to keep
your back as straight as it is the optimal position to
take in air. Begin by focusing your attention on your
breathing and insuring that your belly is expanding
with each breath so your diaphragm and your lungs
are fully engaged. Breathe deeply and slowly, without
strain, in through your nose and out through your
mouth. The breathing should not require any strain
or exertion, but be fluid, natural, and healing. After
you have relaxed your breathing to a slow and steady
pattern, try to get your breathing into a rhythm. Each
breath in and each breath out should take about four
seconds. Pause for about two seconds while holding
your breath and before taking a new breath. If you
can’t take in enough air or blow out enough air for four
seconds, don’t worry, just move at a natural, slow pace
using as much air as you can.
Breathe in….four seconds
Hold it…two seconds
Breathe out…four seconds
Pause…two seconds
If thoughts intrude, do not dwell on them; allow
them to pass on and return to focusing on your
breathing. If you have difficulty remaining focused,
repeat a relaxing word in your mind such as “calm”, or
focus your attention on the sensations in and around
your nostrils that are caused by each breath. Deep
breathing, also called Diaphragmatic Breathing, is one
of the easiest and most powerful relaxation tools that
you can learn.