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FIRST CHOICE PHYSICIANS SPECIALIZE IN THE TREATMENT OF INTRACTABLE PAIN:

Florida Statute 458.326 Intractable pain; authorized treatment.

(1)  For the purposes of this section, the term  " intractable pain  "  means pain for which, in the generally accepted course of medical practice, the cause cannot be removed and otherwise treated.

(2)  Intractable pain must be diagnosed by a physician licensed under this chapter and qualified by experience to render such diagnosis.

(3)  Notwithstanding any other provision of law, a physician may prescribe or administer any controlled substance under Schedules II-V, as provided for in s. 893.03, to a person for the treatment of intractable pain, provided the physician does so in accordance with that level of care, skill, and treatment recognized by a reasonably prudent physician under similar conditions and circumstances.

•THE MAJORITY OF PATIENTS ACCEPTED FOR TREATMENT AT FIRST CHOICE PAIN CARE ARE THOSE THAT SUFFER FROM INTRACTABLE PAIN. MOST HAVE HAD SURGICAL AND / OR INTERVENTIONAL PAIN TREATMENTS WHICH HAVE EITHER HAVE HAD LIMITED SUCCESS, RUN THEIR EFFECTIVE COURSE OR HAVE SIMPLY FAILED. IN MANY OTHER CASES PATIENTS CANNOT AFFORD THE SURGERIES OR PROCEDURES.

Examples of failed pain treatment modalities:

Interventional Pain treatment limitations #1

The usefulness of some of these therapies may be doubtful. A systematic review of interventional therapies for low back and radicular pain concluded: “Few non-surgical interventional therapies for low back pain have been shown to be effective in randomized, placebo-controlled trials” (Chou et al., 2009a, p. 1078). A systematic review of 18 randomized controlled trials found no strong evidence for or against using injection therapy to treat subacute or chronic low back pain (Staal et al., 2008). However, the reviewers suggest that some specific types of patients might benefit. That said, a review of 30 trials determined that corticosteroid injections (and traction) were not found to be beneficial and are not recommended for lumbosacral radicular syndrome (Luijsterburg et al., 2007). Finally, a global discussion of pain treatments notes that the implantation procedures of spinal cord stimulation and intrathecal drug delivery systems—so-called “pain pumps”—require routine monitoring, replacement of devices over time, refilling of drug reservoirs, and a balancing of high costs and maintenance requirements against benefits (Turk et al., in press).

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research 2011 / Chapter 3-16

Committee on Advancing Pain Research, Care, and Education / Board on Health Sciences Policy; The National Academies.

Interventional Pain treatment limitations #2
On June 4, 2010 in sworn testimony at the Board of Medicine hearing on pain clinic standards a well respected fellowship trained interventional pain physician stated that after all interventional “other treatments” were tried that 75% of his patients were returned to narcotic therapy exclusively.

Dr. Jason Rosenberg: “Doctor, what percentage of your patients are solely on narcotic therapy?

Dr. L.F.: “Solely on narcotic?”

Dr. Rosenberg:” Right.  After you’ve gone through all the other options with them, physical therapy, nerve stimulators, et cetera, what percentage of your patient load is just on narcotic therapy management?”

Dr. L.F.: “I would say probably 75 percent of patients would be on narcotic therapy, and that could be as little as Darvocet or as strong as Oxycontin.” 
Board of Medicine Rule hearing 6-4-10  P28 L21- P29 L8

Interventional Pain treatment limitations #3
Two well known sub-specialty board certified pain physicians that specialize in interventional pain management stated to the St. Petersburg Times that 50% or more of their patients are treated with long term opioid painkillers which is indicative of the significant limitations and/or failures of interventional pain treatments:

Dr. Rafael Miguel*; states that about 60 percent of his nearly 1,000 patients are on long-term opioid painkillers."

Dr. Lynne Columbus; operates a Palm Harbor pain clinic that treats about 3,000 patients, … half of whom are on long-term painkillers.

*Dr. Miguel is also a Professor and Program Director of Pain Medicine Program at the University of South Florida as well as senior member of Sarasota Memorial Pain outpatient pain center.

Interventional Pain treatment limitations #4
In a recent press interview Dr. Gordan N. Kuhar, board certified anesthesiologist, with subspecialty certification in Pain Medicine and the medical director of Saratoga Hospital's Pain Management Center stated that in his 15 years of practicing medicine he can count on two hands the times he's actually made a patient's pain go away completely. Typical [interventional] treatment methods include epidural steroid injections, discography and joint injections to minimize people's pain.

Surgery Failures #1
Failed back syndrome (FBS) is a well-recognized complication of surgery of the lumbar spine. It can result in chronic pain and disability, often with disastrous emotional and financial consequences to the patient. Many patients have traditionally been classified as "spinal cripples" and are consigned to a life of long-term narcotic treatment with little chance of recovery. Despite extensive work in recent years, FBS remains a challenging and costly disorder.^ Onesti S. T. (2004). "Failed back syndrome.". Neurologist 10 (5): 259–64. doi:10.1097/01.nrl.0000138733.09406.39. PMID 15335443.

Surgery Failures #2
“According to the American Academy of Orthopedic Surgeons, there are approximately 200,000 laminectomies performed every year. An estimated 20% -30% are reported to be unsuccessful, with a reoperation rate of 10%-25%. Even though these statistics include surgeries for a wide variety of conditions in addition to stenosis, it is easy to see that the problems of “failed back surgery” are enormous”.
http://statisticsbehavioralsciences.bestbookusa.com/failed-open-back-surgery-for-spinal-stenosis-what-next/

•ALL PATIENTS AT FIRST CHOICE PAIN CARE WILL BE UNDER THE EXCLUSIVE CARE OF PHYSICIAN “PAIN SPECIALISTS” AS DEFINED BY THE FLORIDA BOARD OF MEDICINE’S STANDARDS OF PRACTICE IN PAIN CLINICS (RULE 64B8-9.0131). FIRST CHOICE PAIN CARE EMPLOYS NO PHYSICIANS ASSISTANTS (PA) OR NURSE PRACTITIONERS (ARNP) AS UNDER FLORIDA STATUTES THEY ARE NOT QUALIFIED TO PRESCRIBE CONTROLLED SUBSTANCES. 

 

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