Estimates of Pain Prevalence and Severity in Adults

A new analysis of data from the 2012 National Health Interview Survey (NHIS) has found that most American adults have experienced some level of pain, from brief to more lasting pain, and from relatively minor to more severe pain. The analysis helps to unravel the complexities of a Nation in pain. It found that an estimated 25.3 million adults (11.2 percent) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain. Those with severe pain are also likely to have worse health status. The analysis was funded by the National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) and was published in The Journal of Pain.

“The number of people who suffer from severe and lasting pain is striking,” said Josephine P. Briggs, M.D., director of NCCIH. “This analysis adds valuable new scope to our understanding of pain and could inform the National Pain Strategy in the areas of population research and disparities. It may help shape future research, development, and targeting of effective pain interventions, including complementary health approaches.”

Pain is one of the leading reasons Americans turn to complementary health approaches such as yoga, massage, and meditation—which may help manage pain and other symptoms that are not consistently addressed by prescription drugs and other conventional treatments. For this reason, NCCIH research priorities include the study of complementary approaches to determine their effectiveness for treating symptoms such as pain.

Read more here: http://www.nih.gov/news/health/aug2015/nccih-11.htm

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How to Successfully Implement a DME Program into Private Practice

We often hear from physicians that there are several challenges to implementing Durable Medical Equipment programs into their practices. In this post, we address four common areas of concern and show that when you work with the right supplier, it can be a win-win for both your office and your patients.

First and foremost, quality products are a must. The market is fraught with that products that are poorly designed and constructed. Patients will return cheap products if they’re not satisfied with the results or there are durability issues. Second, find a quality provider with a proven track record. Ask for referrals from their current clients and seek out providers that have commissioned outcome studies to measure the efficacy of their products. In our latest outcome study, Meditech had a product return rate of <1%.

It’s important to understand the payers, especially Medicare Local Coverage Determinations (LCD’s), which are decisions on whether a service is considered reasonable by a Medicare Administrative Contractor (MAC). These fiscal intermediaries often determine the national denial rate, which can vary across products and services, but in a recent jurisdictional review of claims for Lumbar-Sacral Orthoses (HCPCS L0631 and L0637) for claims processed from December 2014 through February 2015 there was a claim denial rate of 83% for the 899 claims reviewed. Based on review of the documentation, the following were the primary reasons for claim denials: claims had a missing or incomplete detailed written order, claims had medical record documentation issues, or claims had proof of delivery issues.

Read the full article on meditech.us and don’t hesitate in contacting us today to learn more about best practices in implementing  DME program into your practice or clinic: http://www.meditech.us/successfully-implement-dme-program-private-practice/

Osteoarthritis Update: 2015

Osteoarthritis (OA) is one of most common causes of chronic pain and a major cause of reduced activity in middle aged and older patients. It is estimated to affect between 20 and 30 million Americans, but these numbers may be deceiving.

Up to 85% of people older than 65 years of age have radiographic evidence of OA, and autopsy studies indicate evidence of OA in weight-bearing joints in almost all persons by the age of 45 years.Based on these statistics, it is no wonder that it feels as if every patient being treated for chronic pain has OA as a primary or contributing factor. Osteoarthritis (OA) is a common cause of pain and disability in adults. Approximately 27 million Americans have clinical OA, which translates to nearly 14% of those over age 25 and 33% of those over 65 years of age. OA is a disease of the entire joint involving the cartilage, joint lining, ligaments, and underlying bone. The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands.

There is a highly heritable component associated with OA. In fact, there is a genetic contribution to OA for 60% of women. Among the genes that have been linked to OA are several that are involved in the development and maintenance of joint shape, including members of the Wingless and bone morphogenetic protein families. Important genetic markers for the development and progression of the disease are under research.

OA impacts quality of life and increases health-related expenditures. For example, OA of the knee is one of the 5 leading causes of disability among non-institutionalized adults. About 80% of patients with OA have some degree of movement limitation and 25% cannot perform major activities of daily living; 11% of adults with knee OA need help with personal care and 14% require help with routine needs. About 40% of adults with knee OA report their health as “poor” or “fair.”

According to the Centers for Disease Control and Prevention, OA costs $3.4 to $13 billion per year.9 The average direct cost of OA per patient is $2,600 per year,and the total annual cost is $5,700 per person. Treatment for OA focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, medications, and, perhaps eventually, total joint replacement. Hospital expenditures for total knee and hip joint replacements in 2009 were estimated to be $28.5 billion and $13.7 billion, respectively.

Read the full article here: http://www.practicalpainmanagement.com/pain/myofascial/osteoarthritis/practical-overview-osteoarthritis

Genomics: The Future Gold Standard of Medicine?

Personalized medicine, with care tailored to the unique genetic blueprint of each patient — perhaps once thought of as science fiction — is becoming a strategic imperative across the entire health care field. At NorthShore University HealthSystem, in the north Chicago suburb of Evanston, Ill., integrating genetics into everyday care has become its driving force, says President and CEO Mark Neaman. Personalized medicine touches on so many of the hot-button issues that keep hospital executives tossing and turning at night — meeting the demands of consumerism, treating the health of patient populations and preventing hospital readmissions, to name a few.

“It’s what’s next in the practice of medicine,” he says. “We’re positioned to make this next move, but you can’t just put up a sign and say, ‘We’re into personalized medicine.’ It takes so many other components, including the talent and the commitment, the technology, and the underlying electronic health record system. You’ve got to have all of these building blocks.” NorthShore patient Sivan Schondorf has a history of breast  cancer in her family, and initially had genetic counseling in 2000. With a simple blood test in 2005, she found she had a mutation of the BRCA1 gene, meaning an 87 percent chance of developing breast cancer, along with a higher risk for ovarian cancer. After years of genetic counseling and monitoring, she decided to have a double mastectomy in 2009. Since moving back to the Chicago area in 2011, Schondorf has worked with doctors at NorthShore to develop a genetic care plan and has visited every six months or so for screenings to ensure that she doesn’t develop ovarian cancer.

The idea of tailoring care to each individual based on his or her genetics isn’t new, but it’s picked up steam with several advancements in recent years, says Kathy Hudson, deputy director for science, outreach and policy at the National Institutes of Health, which is spearheading the president’s initiative. Those include improved cost-effectiveness of collecting genetic information from patients, expanding knowledge on how to analyze data at a precise molecular level, and the ability to mine details from electronic health records and mobile devices to gain further insights into a patient’s health, she says. Already, NIH has convened a panel of experts to figure out the course to making precision medicine a reality. As part of the initiative, President Obama earmarked $130 million toward gathering genetic, environmental, lifestyle and behavioral data from 1 million people across the country — which Hudson acknowledges is an “audacious endeavor.” The work group is slated to deliver a preliminary report to the president in September.

While the Center for Personalized Medicine isn’t yet a revenue generator, Khandekar believes it will have a direct impact on the bottom line in soon. “This is the investment that you make for the future,” he says. “I was speaking at one hospital recently and one of the first questions was, ‘So how much money do you make?’ I said, ‘I don’t think we make any direct money at this time,’ but in a very short time, if we don’t do this, we will lose a lot of money because patients will leave us.”

Read the full article here: http://www.hhnmag.com/Magazine/2015/July/NorthShore-genomics-personalized-medicine

Examining Treatment Options for Knee Osteoarthritis

Osteoarthritis (OA) is a crippling condition with the majority of cases taking place in the knee – but what’s the best form of treatment? Many physicians often recommend a combination of treatments for knee OA, including pharmaceuticals and therapy. However, until now, there has not been evidence to support the clinical benefits of the approaches.

Researchers from Copenhagen University Hospital, Denmark conducted a study to determine whether administering corticosteroid injections before exercise therapy improved patients’ pain outcomes. The findings were published in JAMA Internal Medicine. “The participants had radiographic confirmation of clinical OA of the knee, clinical signs of localized inflammation in the knee, and knee pain during walking [at least a 5 on a 0 to 10 pain scale],” the authors wrote. Taking place between October 1, 2012 and April 2, 2014, the randomized study included 45 patients who received corticosteroid injections while the other 44 were given a placebo in their knees.

Using the Pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, they gathered scores from 0 to 100 noting that the higher the number the better the outcome. So what were the results? “We found no statistically significant group differences in any of the secondary outcomes at any time point,” the team confirmed. The biggest difference between the groups was witnessed at week-14, which marked the end of the exercise program. Even then the outcomes were not statistically significant. The corticosteroid group had an average KOOS Pain subscale score of 13.6 while the placebo group was only slightly higher at 14.8 – only a 1.2 point difference. This report suggests that there is no benefit to administering corticosteroid injections before exercise therapy in knee OA.

Read the full article here: http://www.hcplive.com/journals/internal-medicine-world-report/2015/june-2015/knee-osteoarthritis-corticosteroid-injection-exercise-therapy-combo#sthash.ZEzymEkc.dpuf

New Study Highlights the Hazards of Prolonged Standing at Work

Research on the health risks of prolonged sitting at work have been prominent in the headlines recently, but nearly half of all workers worldwide have to stand for more than three quarters of their working day, say researchers who warn prolonged standing can result in fatigue, leg cramps, and back ache – problems that not only cause discomfort but also affect work performance and productivity. In the longer term, this type of sustained muscle fatigue can lead to more serious joint problems and back pain, they note in a report of a study published in Human Factors, the journal of the Human Factors and Ergonomics Society.

According to the Canadian Center for Occupational Health and Safety (CCOHS), working in a standing position on a regular basis can lead not only to fatigue and lower back pain but can also cause other health problems such as sore feet, swollen legs, varicose veins and stiffness in the neck and shoulders. These are common complaints among workers whose jobs require them to stand for long periods, such as assembly-line workers, sales people and machine operators.

In February 2015, Medical News Today reported another study led by the University of Sydney in Australia that found performing manual tasks involving awkward postures can increase the chance of low back pain by as much as eight times. Writing in the journal Arthritis Care & Research, the team also identifies some triggers that can be modified to prevent acute episodes of low back pain.

Read the full article here: http://www.medicalnewstoday.com/articles/296769.php

When Back Pain Means More Than a Back Problem

Pain in your lower back. Cramps shooting down your leg. That “pins and needles” feeling. When you have these symptoms, you may assume you have a problem with your spine.

“The problem with assuming is that we often see people who have medical issues that are mistaken as only a spine issue, when it could be a medical issue on its own — or a combination of the two,” says physical medicine/rehab specialist Tagreed Khalaf, MD.

For example, lumbar spinal stenosis is a nerve problem and peripheral arterial disease is related to blood flow, but the two have many symptoms in common. So do spinal stenosis and diabetic neuropathy, or nerve damage in the legs and feet. And disc issues can feel a lot like inflammatory arthritis.

When the back is the usual suspect

Spinal stenosis is one of the most common causes of spinal pain not related to injury. This narrowing of the space around the spinal cord puts pressure on the nerves. If you have the following symptoms, spinal stenosis may be to blame:

  • Pain in the lower back
  • Cramping in the legs
  • A heavy feeling in the legs, which may lead to trouble walking
  •  Increased pain going downhill
  • Symptoms that get worse with activity
  • Relief from the “grocery cart” position — bending forward like you’re leaning on a shopping cart

However, Dr. Khalaf notes how common “false positives” are. “Around 21 percent of asymptomatic people over age 60 will show signs of spinal stenosis on an MRI,” she says. “And sometimes spinal stenosis and peripheral arterial disease co-exist. That’s why you need a physical exam, and possibly other tests, to get a clear diagnosis.”

If you do have spinal stenosis, there are ways to find relief:

  1. Try physical therapy. Stretching and strengthening can help support your back, improve your balance and ease the pressure on your nerves.
  2. Ask your doctor about medications. Nonsteroidal anti-inflammatories and muscle relaxers may help. Some patients also find success with anti-seizure drugs such as Neurontin — also used for neuropathy.
  3. Consider steroid injections. Corticosteroids can reduce the inflammation and irritation that cause symptoms. They’re usually not a first resort because they can weaken bones and tissue over time.
  4. Know that surgery is an option. When more conservative treatments do not work, certain procedures can reduce symptoms.

“It’s so important to look at all of your symptoms and history and do a thorough examination,” Dr. Khalaf says. “It’s how we can tell the difference between a back issue and a medical condition.”

Read the full article here: http://health.clevelandclinic.org/2015/07/when-back-pain-means-more-than-a-back-problem/