News Article | May 8, 2017
Frank X. Pedlow, MD, Orthopedic Surgeon currently serving patients within his own private practice, and affiliated with Massachusetts General Hospital and St. Elizabeth’s Medical Center, has been named a 2017 Top Doctor in Boston, Massachusetts. Top Doctor Awards is dedicated to selecting and honoring those healthcare practitioners who have demonstrated clinical excellence while delivering the highest standards of patient care. Dr. Frank X. Pedlow is a very experienced orthopedic surgeon, and is one of the only spine surgeons in New England that has received training in both the Neurosurgical and Orthopaedic principles and techniques of spine surgery. His successful career in medicine began in 1986, when he graduated from New York Medical College. Upon receiving his Medical Degree, he completed his residency in Orthopaedic Surgery in the Harvard Combined Orthopaedic Residency Program, and served as Chief Resident at Massachusetts General Hospital. He then undertook his Spinal Surgery fellowship at Emory University Spine Center. Dr. Pedlow previously served as a Neurosurgery Fellow at LIJ Medical Center, and also spent time training internationally in Orthopedic Surgery at the University of Montreal in Canada, the Royal National Orthopedic Hospital in England, and the Robert Jones and Agnes Hunt Orthopedic Hospital in England. Dr. Pedlow is board certified by the American Board of Orthopaedic Surgery, and provides surgical and non-surgical solutions for a wide range of conditions and injuries. His practice specializes in the diagnosis and treatment of degenerative conditions of the neck and back, minimally invasive spine surgery, motion preservation surgery including cervical artificial disc replacement, athletic injuries to the spine, and spine care of the injured worker. He is particularly renowned as a specialist in the treatment of complex spinal disorders. For his excellence, Dr. Pedlow has been named a top doctor in Boston Magazine’s “Best Doctors” issue, and consistently has been named by Best Doctors, Inc. as one of the best orthopaedic spine surgeons in Boston, receiving this honor more than any other orthopaedic spine surgeon in Boston. Dr. Pedlow has also been named one of the region’s “Top Doctors” by Castle Connolly Medical, Ltd, has served as the spine consultant for the Boston Bruins, and has treated players from every major professional and many collegiate sports team in Boston. His dedication to his work and extensive expertise in his specialty makes Dr. Frank X. Pedlow a very worthy winner of a 2017 Top Doctor Award. Top Doctor Awards specializes in recognizing and commemorating the achievements of today’s most influential and respected doctors in medicine. Our selection process considers education, research contributions, patient reviews, and other quality measures to identify top doctors.
Lotzke H.,Gothenburg University |
Lotzke H.,Spine Center Gothenburg |
Lotzke H.,Spine Center |
Jakobsson M.,Gothenburg University |
And 12 more authors.
BMC Musculoskeletal Disorders | Year: 2016
Background: Following lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation. While rehabilitation is typically postoperative, the phase before surgery - termed prehabilitation - is reportedly an ideal time to prepare the patient. There are presently no guidelines for prehabilitation before lumbar fusion surgery. Physical activity has well-known health benefits, and staying physically active despite pain is a major principle in non-pharmacological chronic low back pain treatment. Psychological factors such as fear of movement, pain catastrophizing and low self-efficacy are known to be barriers to staying active. No studies have investigated prehabilitation protocols that promote physical activity and target psychological risk factors before lumbar fusion surgery. The aim of our proposed randomised controlled trial is to investigate whether patients who undergo lumbar fusion surgery for degenerative disc disease experience better functioning with a physiotherapeutic prehabilitation program (PREPARE) based on a cognitive behavioural approach compared to conventional care. Methods/Design: We will recruit 110 patients between 18-70 years of age with degenerative disc disease who are waiting for lumbar fusion surgery. These patients will be randomly assigned to receive either PREPARE or conventional care. PREPARE uses a person-centred perspective and focuses on promoting physical activity and targeting psychological risk factors before surgery. The primary outcome will be disability measured using the Oswestry Disability Index 2.0. Secondary outcomes will include functioning (patient-reported and performance-based), physical activity (accelerometer), health-related quality of life, back and leg pain intensity, pain catastrophizing, kinesiophobia, self-efficacy, depression, anxiety, satisfaction with treatment results and health economic factors. Data will be collected at baseline (preoperatively) after the intervention (preoperatively), 3 and 8 weeks, 3, 6, 12, 24 and 60 months postoperatively. Discussion: We hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery. We will use a combination of outcome measures both patient-reported and performance-based, as well as accelerometer data. This will provide a more comprehensive picture of the patient's functioning than just patient-reported outcomes alone. Trial registration: Current Controlled Trials ISCRTN17115599, Retrospectively Registered 18 May 2015. © 2016 The Author(s).
News Article | October 29, 2016
While narrow, pointed-toe heels, black strappy platforms and booties are ranked among the top hot shoe trends for this fall by InStyle fashion magazine, many women cringe at the thought of wearing them due to their problems with painful and crooked toes. As reported in the New York Times in-depth report on foot pain, about 75% of people in the United States (and not just women) will experience foot pain at some time in their lives, and most of it is caused by shoes that do not fit properly or that force the feet into unnatural shapes (such as pointed-toe, high-heeled shoes). Orthopedic foot and ankle surgeon Dr. Alexis E. Dixon of DISC Sports & Spine Center (“DISC”) has released a list of the top four medical diagnoses behind crooked toes and what people can do to remedy these problems. “The type and fit of shoes do play a major role in foot and toe health, but sometimes you don’t need to look far to find a family member with similar foot problems,” says Dr. Dixon, “The good news is that many sources of pain and deformity in the toes can be managed without ever going to the operating room.” Here are Dr. Dixon’s top four diagnoses behind crooked toes and her recommendations for treatment: 1. Bunions – A bunion is not a bump that grows, and it cannot be shaved off! It occurs when the great toe starts to angle towards the second toe, most commonly because of narrow shoe wear. This, in turn, causes the great toe’s bone in the foot (or metatarsal bone) to angle the opposite way, making it more prominent on the inner border of the foot. Once a bunion occurs, wearing wider shoes or open-toed shoes may make the discomfort more manageable, but surgery is the only way to correct the deformity. If you are having a significant amount of pain that is inhibiting your ability to do the things you love to do, or you have difficulty with all shoe wear, you should definitely get your feet checked out. Surgery is rarely urgent, but it is more complex than simply shaving off the bump, since—as noted above—bunions do not represent excessive growth of the bone. Adequate correction requires cutting and re-setting bones into a better position, so you have to plan for adequate recovery time. Many patients prefer to have the surgery done in the winter so that they can wear open-toed shoes by spring. 2. Bunionettes – Similar to bunions, bunionettes are a prominence of the fifth toe at the outer border of the foot. Treatment is very similar to that of a bunion, which begins with first wearing wider shoes until symptoms are no longer tolerable. Surgery rarely allows for simple shaving off of the bump because, again, this is an angular deformity of two bones, and the bones have to be straightened to correct the angle. 3. Hammertoes – A hammertoe is deformity of one or more of the smaller or lesser toes that happens most often due tight shoe wear, but is sometimes related muscle imbalance or inflammatory arthritis. First, the toe begins to stick up, then the toe begins to form a Z-shape at the next joint. This prominence can cause the skin on top of the toe to rub against the shoe, and can lead to painful calluses at the ball of the foot. The first step in treatment is avoiding shoes that bother the toes. There are shoe inserts that can cushion the ball of the foot if that’s where pain is, and there are toe spacers that can alleviate pressure. However, sometimes hammertoes can become so severe that even shoe wear modification is ineffective. In this case, outpatient surgery can be used to straighten the toes. Different implants may also be used but are usually either screws that are completely internal or pins that protrude through the skin and are removed in office, usually one visit after the stitches are removed. After hammertoe surgery, the toes are much straighter, and often even straighter than they were before the hammertoe developed. This is because one of the joints in the toe needs to be fused in order to correct the deformity and prevent recurrence. The goal of surgery is to alleviate the pain, but patients usually find improvement in appearance of their feet after surgery as well. 4. Hallux Rigidus – This is another term for arthritis in the joint at the base of the great toe. When a patient has hallux rigidus, the body responds by laying down new bone, or an osteophyte, at the top of the toe. The formation of new bone can lead to a bump that is painful when rubbed against the shoe. Some patients complain about stiffness and pain at the bump, while other patients experience pain from the arthritis itself. When the bump is painful due to pressure, outpatient surgery can be performed to remove it from the top of the foot. The surgeon will usually also look inside the joint and see if there is any debris that can be removed to alleviate the pain. A newly developed surgery actually places a cartilage graft within the joint—an exciting new way to resurface the damaged cartilage. Sometimes a patient’s arthritis is so severe that there is virtually no cartilage left, and any motion in the joint is painful. The first step in treating pain with any range of motion of the joint is to wear stiffer shoes so that the joint is protected from motion. This can be done by either purchasing shoes with stiff soles, or by placing carbon fiber inserts into the shoes, which can be prescribed by your surgeon. If the severe arthritis pain persists, the patient’s surgeon may perform a fusion of that joint, which allows the two bones to heal together as one and relieves the pain. This can be done as an outpatient surgery and is typically an excellent option for men, as well as women who do not wear very high heels. Wearing high heels after a surgery like this can be difficult, so Dr. Dixon typically doesn’t recommend this procedure for women who would like to continue to sport this particular fashion. Dr. Dixon also cautions patients that pain at the ball of the foot is often mistaken for a Morton’s neuroma, which is an irritation and scarring of the sensory nerve to the toes. While Morton’s neuromas do exist and can cause forefoot pain, there are other, more subtle, diagnoses that can also be the cause of pain in this area of the foot. She recommends against repeated injections for Morton’s neuroma, stating, “These can erode away at the fat pad that cushions the bottom of your foot, leading to chronic pain that is difficult to reverse.” About DISC Sports & Spine Center DISC Sports & Spine Center (DISC) is California’s premier medical group providing the full scope of sports medicine, spinal care, orthopedics, pain management and conservative treatments. DISC has set a new standard for high-acuity, minimally invasive spine surgery and arthroscopy in an outpatient setting, both safely and on a more cost-effective basis. In partnership with Surgical Care Affiliates (SCA), one of the nation’s leading surgical care companies, DISC operates state-of-the-art outpatient surgery centers in Marina Del Rey and Newport Beach. Both centers are accredited by the AAAHC, have a zero MRSA infection rate and are conveniently located next to major freeways and airports. DISC, which accepts most major insurance plans, is also the official medical services provider for Red Bull. For more information, contact 866-481-DISC, or visit http://discmdgroup.com.
News Article | November 30, 2016
Exercise is the first step in preventing sciatica. That’s the word from Dr. Hooman M. Melamed, a board certified Orthopaedic Spine Surgeon and Director of Scoliosis at DISC Sports and Spine Center in Marina Del Rey. “Back muscles and the spinal structure can become deconditioned from lack of exercise or movement, making them less able to support the back, which leads to back injury and causes back pain,” says Dr. Melamed. “Movement helps exchange nutrients and fluids within the discs, which keeps them healthy and prevents pressure on the sciatic nerve.” But Dr. Melamed cautions that doing the wrong type of exercise, however, can worsen existing sciatic pain, so it is important to get an accurate diagnosis prior to starting a program of sciatica exercises. Not all back pain emanates from injury. In fact, according to a New York Times article on sciatica, in the majority of back pain cases, the causes are unknown. But as more young adults are showing signs of disc deterioration (one third of adults over 20) and the aging population’s decreasing bone density, increasing weight and lack of exercise combine to increase their risk of sciatica, DISC Sports & Spine Center is recommending a holistic approach to preventing and treating back pain. Described as a possibly tingling, numbness or weakness that originates in the lower back and travels on one side of the body, through the buttock and down the large sciatic nerve in the back of each leg, sciatic pain can vary from infrequent and irritating to constant and incapacitating, with symptoms usually relating to the location of a pinched nerve. Pain in the lower back, buttock or leg is worse when sitting, can radiate to the hip, and can often be accompanied by shooting pain that makes it difficult to stand up. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes. Being overweight, not exercising, and even wearing high heels can also contribute to back pain. Dr. Melamed says gentle core muscle strengthening exercises – fortifying abdominal and back muscles – and stretching exercises not only alleviate sciatica pain, but they also help people to recover more quickly from a sciatica flare up and diminish the likelihood of future pain episode. Gentle yoga exercises, such as the ones featured on YogaJournal.com, may be beneficial in strengthening muscles and improving flexibility. The journal Spine published a study on chronic back pain sufferers who practiced lyengar yoga for 16 weeks, for example, and at the end of the study, 64 per cent reported a reduction in pain. “When back pain does occur, your first thought may be to seek bed rest, but it’s actually better to exercise to relieve sciatic pain,” says Dr. Melamed. “A day or two of rest is okay, but any longer and the pain usually intensifies.” Heat and/or ice packs are readily available and can help alleviate the leg pain, especially in the initial phase. Usually ice or heat is applied for approximately 20 minutes, and repeated every two hours. Most people use ice first, but some find more relief with heat. The two may be alternated. It is best to apply ice with a cloth or towel placed between the ice and skin to avoid an ice burn. Topical anti-inflammatories, such as St. John’s wort oil and/or cayenne pepper cream, applied to the external pain area two or three times a day can help alleviate pain. In severe pain cases, Qutenza, a low-dose prescription patch derived from chili peppers that’s used to treat shingles, can be applied to the pain area. Turmeric Ginger and Omega 3 supplements also have powerful anti-inflammatory effects. Certain forms of massage therapy may also provide pain relief while also increasing blood circulation, relaxes muscle spasms and releases endorphins, which are the body’s natural pain relievers. Acupuncture, once thought of as an alternative medicine, has been approved by the U.S. Food and Drug Administration (FDA) as a treatment for back pain, and the National Institutes of Health has recognized acupuncture as effective in relieving back pain, including sciatica. Dr. Melamed also recommends avoiding dairy, processed foods, and any processed or refined sugars and grains. Removing these foods from your diet is an effective way to help your body manage pain and more importantly, aid in recovery. For most people, sciatica typically improves on its own in a few days or weeks. Following initial pain relief, a program of physical therapy and exercise should usually be pursued to alleviate pain and prevent or minimize any ongoing sciatic pain. About DISC Sports & Spine Center DISC Sports & Spine Center (DISC) is California’s premier medical group providing the full scope of sports medicine, spinal care, orthopedics, pain management and conservative treatments. DISC has set a new standard for high-acuity, minimally invasive spine surgery and arthroscopy in an outpatient setting, both safely and on a more cost-effective basis. In partnership with Surgical Care Affiliates (SCA), one of the nation’s leading surgical care companies, DISC operates state-of-the-art outpatient surgery centers in Marina Del Rey and Newport Beach. Both centers are accredited by the AAAHC, have a zero MRSA infection rate and are conveniently located next to major freeways and airports. DISC, which accepts most major insurance plans, is also the official medical services provider for Red Bull and a proud partner of the LA Kings. For more information, contact 866-481-DISC, or visit http://discmdgroup.com.
News Article | October 28, 2016
One of the biggest hurdles for physical therapists is making certain that their patients continue to come back appointment after appointment. Non-compliance can be rampant in the industry due to several psychological and physical barriers. These commonly include those who are low functioning or non-weight bearing, have a low pain tolerance, have co-morbities or are obese. Aquatic therapy has proven to be an excellent way to break down the boundaries for patients who might otherwise stop attending their rehabilitation after one or two sessions. On Tuesday, October 11, 2016, HydroWorx will host a webinar on this topic. Led by presenters Keith Ori and Teresa Kropp, both of Orthopedic Rehab, Inc. in Kalispell, Montana, “Using Aquatic Therapy to Avoid the One-and-Done Patient” is scheduled for 1:00-2:00 p.m. E.D.T. During the hour-long live event, Ori and Kropp will share their successes in using water therapy as a means to reduce patient noncompliance and increase patient recovery, as well as revenue streams. Attendees of “Using Aquatic Therapy to Avoid the One-and-Done Patient” will be introduced to the subject through a series of discussions including: “Using Aquatic Therapy to Avoid the One-and-Done Patient” is free to the public, but pre-registration is required. Please visit http://ww2.hydroworx.com/webinar-fear-avoidance to reserve a spot for this online event. About the Speakers Keith Ori is the owner of Montana-based Orthopedic Rehab, Inc. He has practiced as a physical therapist for more than 30 years, and is also a clinical instructor with the University of Montana. He has opened seven physical therapist owned clinics specializing in post-op physical therapy, and works with orthopedic surgeons and his own staff to develop world-class pool therapy and client protocols. He has spoken extensively about his aquatic business model and has authored pieces on the value of aquatic therapy. Teresa Kropp specializes in aquatic therapy, orthopedics and sports medicine. Like Ori, she received her degree in the early 1980s. As the clinical manager of the Aquatic and Spine Center, Orthopedic Rehab, Inc., Montana, she brings her skills and experience to her rehabilitation work. About HydroWorx Since the late 1990s, HydroWorx has manufactured aquatic therapy pools with integrated underwater treadmills to enable rehabilitation professionals to more effectively offer their patients the opportunity to increase range of motion, decrease risk of falls and joint stress, and remain motivated through the rehab process. Products such as the HydroWorx 2000 and 500 Series therapy pools, along with the new HydroWorx 300 system have revolutionized the face of aquatic therapy; in fact, HydroWorx technology is used by world-class facilities such as OrthoCarolina, Cleveland Clinic, Kennedy Krieger Institute, Genesis Healthcare, Neuroworx, Clear Choice Healthcare, PruittHealth, Premier Rehab, Leg Up Farm and many other healthcare facilities across the country. HydroWorx offers a wide range of underwater treadmill pools and peripheral products and services. Every day, more than 29,000 athletes and patients use HydroWorx technology to recover from injuries and health conditions. More information about HydroWorx can be found at http://www.HydroWorx.com.
News Article | November 23, 2016
Palm Beach Gardens, FL, November 23, 2016 --( For self-funded employers seeking to offer employees access to better quality healthcare outcomes, reduced complications and excellent patient experience, direct contracting with healthcare providers accredited by the Global Healthcare Accreditation Program achieves just that. “This experience is invaluable to Mercy on our journey to expand our medical travel and medical tourism business. We are excited for the future and our continued relationship with the GHA Program,” stated Jen Albers, Director of Mercy Spine Center, Pain Management, Headache Management and Medical Destinations. Earning the distinguished accreditation for their Medical Destination program, Mercy Health received GHA status for their domestic work with large, self-insured U.S.-based companies, to provide better healthcare solutions. This direct contracting resulted in employers such as Walmart, Lowes, JetBlue and McKesson greatly improving employee healthcare while simultaneously lower costs. The Global Healthcare Accreditation (GHA) Program is a healthcare accreditation program designed for both healthcare organizations and self-funded employers alike in pursuit of the common goals of elevating patient care and experience, and excellence of care provided for medical travel. As part of the unique GHA program, healthcare organizations will be able to obtain not only knowledge on medical travel exemplar practices, but also unique business solutions that provide value for an organization in any stage of development. GHA aims to enable each accredited organization to achieve better process and better performance on a daily basis. Established in 2009, the GHA program focuses on an organization’s core competencies and compliance levels to ensure it is fully committed to providing safe and efficient patient care throughout the entire medical travel cycle. The program offers four distinguished areas of accreditation: Hospital (24-hour setting), Ambulatory (non-24-hour setting), Diagnostic, and Laboratory. “Mercy is a leader in precision, high quality healthcare. The organization has a systemic passion to always service excellence and the dignity of each individual patient as its highest priority – this character trait of Mercy co-workers will allow the Medical Destination program to expand its global footprint. GHA Leadership looks forward to Mercy’s future in the international medical travel industry,” stated Karen Timmons, Chief Executive Officer, Global Healthcare Accreditation. About Mercy: Mercy Springfield Communities is comprised of Mercy Hospital Springfield, an 866-bed referral center; an orthopedic hospital; a rehab hospital; a children’s hospital; five regional hospitals in Lebanon, Aurora, Cassville, Mountain View, Missouri and Berryville, Arkansas; and Mercy Clinic, a physician clinic with nearly 700 doctors and locations throughout the region. It is part of Mercy, named one of the top five large health systems in 2016 by Truven, which serves millions annually. Mercy includes 45 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, more than 700 physician practices and outpatient facilities, 40,000 co-workers and more than 2,000 Mercy Clinic physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has outreach ministries in Louisiana, Mississippi and Texas. Mercy’s Medical Destination Program manages the traveling patient program for all of its facilities. Organizations interested in The Global Healthcare Accreditation Program can make a request at firstname.lastname@example.org |Tel US 001.561.327.9557 |www.GlobalHealthcareAccreditation.com Palm Beach Gardens, FL, November 23, 2016 --( PR.com )-- Mercy Hospital Springfield, part of the fifth largest Catholic health systems in the nation, is awarded a three-year term of accreditation from the Global Healthcare Accreditation Program for its Medical Destination Program.For self-funded employers seeking to offer employees access to better quality healthcare outcomes, reduced complications and excellent patient experience, direct contracting with healthcare providers accredited by the Global Healthcare Accreditation Program achieves just that.“This experience is invaluable to Mercy on our journey to expand our medical travel and medical tourism business. We are excited for the future and our continued relationship with the GHA Program,” stated Jen Albers, Director of Mercy Spine Center, Pain Management, Headache Management and Medical Destinations.Earning the distinguished accreditation for their Medical Destination program, Mercy Health received GHA status for their domestic work with large, self-insured U.S.-based companies, to provide better healthcare solutions. This direct contracting resulted in employers such as Walmart, Lowes, JetBlue and McKesson greatly improving employee healthcare while simultaneously lower costs.The Global Healthcare Accreditation (GHA) Program is a healthcare accreditation program designed for both healthcare organizations and self-funded employers alike in pursuit of the common goals of elevating patient care and experience, and excellence of care provided for medical travel. As part of the unique GHA program, healthcare organizations will be able to obtain not only knowledge on medical travel exemplar practices, but also unique business solutions that provide value for an organization in any stage of development. GHA aims to enable each accredited organization to achieve better process and better performance on a daily basis.Established in 2009, the GHA program focuses on an organization’s core competencies and compliance levels to ensure it is fully committed to providing safe and efficient patient care throughout the entire medical travel cycle. The program offers four distinguished areas of accreditation: Hospital (24-hour setting), Ambulatory (non-24-hour setting), Diagnostic, and Laboratory.“Mercy is a leader in precision, high quality healthcare. The organization has a systemic passion to always service excellence and the dignity of each individual patient as its highest priority – this character trait of Mercy co-workers will allow the Medical Destination program to expand its global footprint. GHA Leadership looks forward to Mercy’s future in the international medical travel industry,” stated Karen Timmons, Chief Executive Officer, Global Healthcare Accreditation.About Mercy:Mercy Springfield Communities is comprised of Mercy Hospital Springfield, an 866-bed referral center; an orthopedic hospital; a rehab hospital; a children’s hospital; five regional hospitals in Lebanon, Aurora, Cassville, Mountain View, Missouri and Berryville, Arkansas; and Mercy Clinic, a physician clinic with nearly 700 doctors and locations throughout the region. It is part of Mercy, named one of the top five large health systems in 2016 by Truven, which serves millions annually. Mercy includes 45 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, more than 700 physician practices and outpatient facilities, 40,000 co-workers and more than 2,000 Mercy Clinic physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has outreach ministries in Louisiana, Mississippi and Texas. Mercy’s Medical Destination Program manages the traveling patient program for all of its facilities.Organizations interested in The Global Healthcare Accreditation Program can make a request at email@example.com |Tel US 001.561.327.9557 |www.GlobalHealthcareAccreditation.com Click here to view the list of recent Press Releases from Employer Healthcare & Benefits Congress
News Article | October 29, 2016
DISC Sports & Spine Center is celebrating World Spine Day (October 16) by spreading the word on the importance of physical activity and improving posture as part of a regular health regime aimed at preventing injury and maintaining good spinal health. Tapping the expertise of accomplished neurological spine surgeon Dr. Richard B. Kim, DISC Sports & Spine Center is recommending five areas of focus for ensuring a healthy, pain-free spine. “The theme for this year’s World Spine Day is straighten up and move, which, as simple as it sounds, is exactly what most people need to do,” explains Dr. Kim. “Most adults spend the better part of their day sitting at work, and struggle to get in even 30 minutes of exercise a day. Both of these issues are huge contributors to spine injuries and are fairly easy to avoid.” Good posture is the best way to ensure a healthy spine. If you have to stand for long periods of time, keep one foot forward of the other, with knees slightly bent, which takes the pressure off of your lower back. When sitting, make sure your knees are slightly higher than your hips for good lower-back support. And if you can’t get up and walk around at the office, at least try alternating between standing and sitting and reevaluate your posture throughout the day. Just simply being aware of your posture can help prevent slouching. Use a step or stool when reaching for things about your shoulder level and, when it comes to moving heavy items, remember pushing is easier on your back than pulling. If your posture is good, the bones of the spine will be correctly aligned. Exercise daily as your core muscles—your lower back and abdominal muscles—need to be strong and supple in order to support your spine and take pressure off of your lower back. Certain yoga poses can strengthen and stretch core muscle groups and may also be relaxing. In fact, check out the Mayo Clinic website’s 15-minute exercise routine developed specifically to improve spinal health. It incorporates yoga poses with simple stretches that people of all ages can master. Practice deep breathing, also known as belly breathing, as it encourages full oxygen exchange – incoming oxygen swapped for outgoing carbon dioxide – and can also slow your heartrate and stabilize blood pressure. Think about the slow, steady movements of a sea turtle while inhaling slowly through your nose, allowing your chest and lower belly to rise as you fill your lungs. Let your abdomen expand fully. Then breathe out slowly through your mouth (or your nose, if that feels more natural). Maintain a healthy weight as additional weight puts a strain on your back. Ideally, try to keep within 10 lbs. of your ideal weight for a healthier back. Get a good night's sleep and be sure that your mattress and pillows are working to support your spine. Did you know that if you sleep on your belly, your lower back is compressed all night long, and your head and neck are invariably twisting to one or the other side in a fairly extreme manner? Or that sleeping on your back typically puts an additional 55 lbs. of pressure on your back? Slide a couple of pillows under your knees and you cut that pressure in half. Better yet, try to learn to sleep lying on your side with a pillow between your knees to reduce pressure. If you do experience minor back pain, treat it with anti-inflammatories and gentle stretching, followed by an ice pack. But if pain persists, don’t try to tough it out, consult your physician or orthopedic surgeon immediately. About DISC Sports & Spine Center DISC Sports & Spine Center (DISC) is California’s premier medical group providing the full scope of sports medicine, spinal care, orthopedics, pain management and conservative treatments. DISC has set a new standard for high-acuity, minimally invasive spine surgery and arthroscopy in an outpatient setting, both safely and on a more cost-effective basis. In partnership with Surgical Care Affiliates (SCA), one of the nation’s leading surgical care companies, DISC operates state-of-the-art outpatient surgery centers in Marina Del Rey and Newport Beach. Both centers are accredited by the AAAHC, have a zero MRSA infection rate and are conveniently located next to major freeways and airports. DISC, which accepts most major insurance plans, is also the official medical services provider for Red Bull. For more information, contact 866-481-DISC, or visit http://discmdgroup.com.
News Article | November 2, 2016
In the mid-19th century, some European doctors became fascinated with a plant-derived drug recently imported from India. Cannabis had been used as medicine for millennia in Asia, and physicians were keen to try it with their patients. No less an authority than Sir John Russell Reynolds, the house physician to Queen Victoria and later president of the Royal College of Physicians in London, extolled the medical virtues of cannabis in The Lancet in 1890. “In almost all painful maladies I have found Indian hemp by far the most useful of drugs,” Reynolds wrote. Like other doctors of his day, Reynolds thought cannabis might help reduce the need for opium-based painkillers, with their potential for abuse and overdose. “The bane of many opiates and sedatives is this, that the relief of the moment, the hour, or the day, is purchased at the expense of to-morrow’s misery,” he wrote. “In no one case to which I have administered Indian hemp, have I witnessed any such results.” More than 125 years later, the misery caused by opioids is clearer than ever, and there are new hints that cannabis could be a viable alternative. Some clinical studies suggest that the plant may have medical value, especially for difficult-to-treat pain conditions. The liberalization of marijuana laws in the United States has also allowed researchers to compare overdoses from painkiller prescriptions and opioids in states that permit medical marijuana versus those that don’t. Yet following up on those hints isn’t easy. Clinical studies face additional hurdles because the plant is listed on Schedule I, the U.S. Drug Enforcement Administration’s (DEA’s) list of the most dangerous drugs. Some researchers worry that rigorous research is being outpaced by informal experimentation, as millions of people with access to medical marijuana treat themselves. “It’s clear that the policy has gone way out in front of the science in terms of allowing access to products that haven’t been through the standard clinical trials process,” says Mark Ware, a pain specialist at McGill University in Montreal, Canada. Nearly 2 million Americans were addicted to or abusing prescription opioid drugs in 2014, according to the Centers for Disease Control and Prevention, and the Kaiser Family Foundation estimates that more than 21,000 died from overdoses.That same year, a study published in JAMA Internal Medicine hinted that medical marijuana could make a dent in that alarming toll. The researchers, led by Marcus Bachhuber, then at the Philadelphia Veterans Affairs Medical Center in Pennsylvania, examined death certificates in all 50 states between 1999 and 2010. They found that the annual rate of deaths due to overdose on an opioid painkiller was nearly 25% lower in states that permitted medical marijuana. In 2010, that translated into 1729 fewer deaths in those states. The researchers also found that the effect grew stronger in the 5 to 6 years after the states approved medical marijuana. More recently, David Bradford, a health economist at the University of Georgia in Athens, and his daughter Ashley, a master’s student there, sought to investigate whether marijuana was supplanting conventional drugs in states where it’s legal. Analyzing Medicare drug prescription data from 2010 to 2013, they found a significant difference in the number of prescriptions for several conditions, including anxiety and nausea, in states with medical marijuana. But one condition stood out from the rest: “The effect for pain was three to four times larger than all of the others,” David Bradford says. In medical marijuana states, each physician prescribed an average of 1826 fewer doses of conventional pain medication each year, they reported in the July issue of Health Affairs. That translates into many millions of doses per year in those states. The Bradfords haven’t yet analyzed how many of those doses were opioid drugs versus other painkillers, but David Bradford suspects it’s a large chunk. “It’s suggestive evidence that medical marijuana might help divert people away from the path where they would start using [an opioid drug], and of course if they don’t start, they’re not on that path to misuse and abuse and potentially death.” In a follow-up study, the Bradfords analyzed prescription data from Medicaid recipients, a younger population than the Medicare enrollees in their previous study. So far, the reduction in pain prescriptions appears to be even more dramatic in this group, David Bradford says. Additional evidence about whether cannabis can reduce opioid use could come from Canada, which legalized medical marijuana in 2001 and might legalize recreational use as soon as next year. In Quebec, researchers established a patient registry in 2015 to collect demographic data on patients who use medical marijuana, the type and dose they take, and the conditions they’re seeking treatment for, along with self-reports on benefits and adverse outcomes. McGill’s Ware, who is leading the effort, says the registry is also collecting data on opioid use. “We’ll certainly be looking at whether patients who manage their pain with cannabis can reduce their opioid doses over time or even wean themselves off opioids entirely,” he says. Yet in the United States, where 25 states and Washington, D.C., have legalized medical marijuana, there are no state-wide efforts to collect data on how patients are using cannabis or on whether they have been affected for good or ill, in part because marijuana is still illegal at the federal level. That’s a huge missed opportunity, says Ryan Vandrey, a behavioral pharmacologist at Johns Hopkins University in Baltimore, Maryland. “It’s mind-boggling that we have millions of people in the U.S. using cannabis for medicine and we not only don’t have the proper data to help them take it appropriately, we’re not doing a good job of collecting it.” Researchers have good reason to think marijuana might relieve pain. Tetrahydrocannabinol, or THC, the plant’s main psychoactive ingredient, binds to a class of receptors on neurons that are involved in mediating pain, appetite, and mood, among other things. “It’s working directly on pain pathways in the brain, spinal cord, and periphery,” says Ethan Russo, a neurologist and medical director of Phytecs, a Los Angeles, California–based company developing therapies based on compounds isolated from marijuana. Previously, Russo oversaw international clinical trials for Sativex, an oral spray made by GW Pharmaceuticals in Salisbury, U.K., that has been approved in 27 countries for treating spasticity caused by multiple sclerosis and in Canada for certain types of pain. Sativex combines THC with cannabidiol, another compound in marijuana that may counteract the anxiety and cognitive side effects associated with THC and that appears to have antiinflammatory effects. But few marijuana-based therapies have gone through clinical trials. A metaanalysis published last year in the Journal of the American Medical Association found just 28 randomized clinical trials investigating cannabis for chronic pain. (Sativex accounted for nearly half of them.) The authors concluded there was “moderate quality evidence” to support its use. Part of the reason for the scarcity of cannabis trials is that whole plants and natural extracts aren’t patentable, giving pharmaceutical companies little incentive to pursue them. Recently, however, some states that have legalized medical marijuana have begun to fund clinical studies. California, which in 1996 became the first U.S. state to legalize medical marijuana, led the way with its Center for Medicinal Cannabis Research, which has done several placebo-controlled studies on pain. Barth Wilsey, a pain management physician at the University of California in San Diego, led two of them. The first, published in 2008, found that smoking marijuana reduced pain caused by nerve damage in 38 patients, with minimal side effects. The second, published in 2013, found that vaporized cannabis, even in low doses, relieved pain in a similar group of patients who hadn’t responded to traditional medications, including opioid analgesics. A trial just getting underway at the University of Colorado (CU) Anschutz Medical Campus in Aurora will be the first to directly compare cannabis and opioid painkillers in patients with back and neck pain. “There’s definitely emerging evidence in the literature for [using cannabis to treat] neuropathic pain, but there’s hardly anything for chronic back and neck pain, which is one of the most common reasons people go see their doctor,” says neurobiologist Emily Lindley, who will run the CU study. Hers is one of nine medical marijuana research grants funded so far by the state of Colorado with a total of $9 million from tax collected on marijuana sales. The impetus for the study was a survey done a few years ago at CU Hospital’s Spine Center. Nearly one-fifth of the 184 patients with chronic back and neck pain who responded to the survey reported using marijuana to treat their pain. Of those, 86% reported that it “moderately” or “very much” relieved their pain, and 77% said marijuana provided as much or more relief than their opioid prescription painkillers. “We expected to see some positive effects regarding pain control but not quite to that extent and not with that many patients,” says Vikas Patel, chief of orthopedic spine&surgery at CU. Now, Lindley’s study will enroll 50 patients with back and neck pain, who will visit the university three times and receive either vaporized cannabis, the opioid drug oxycodone, or a placebo. (In the case of cannabis, the placebo is marijuana with the THC chemically extracted; for oxycodone, the placebo is a pill.) At each visit, the patients will be given a battery of tests to assess their pain levels and look for side effects like impairments of memory, attention, and concentration. But such research faces regulatory obstacles, because DEA still classes marijuana as a Schedule I drug: the most dangerous drugs with no known medical benefits. It has taken Lindley nearly 2 years from the time she received her grant to start her study. Getting the required Schedule I license from DEA took about 6 months. Prior to that, the university spent tens of thousands of dollars to install secure narcotics cabinets to meet DEA’s requirements and a new ventilation system to comply with its own no smoking policy. In August, DEA rejected two petitions to remove marijuana from Schedule I. The decision was made after a scientific review by the Food and Drug Administration (FDA) concluded that the evidence for the medical benefits of marijuana did not meet their standards for new drug approval. FDA noted that most cannabis studies to date have been fairly small—with a few dozen participants, not hundreds—and they’ve followed patients for a few hours, not the 12 weeks or more that’s typical in the clinical trials pharmaceutical companies conduct. Another complication is the variation in how cannabis is delivered. Patients in many early studies smoked it, and people ingest varying amounts of THC per puff. Newer delivery systems, such as vaporizers and edible products, add still more uncertainty about the doses patients actually receive. Then there’s the natural variation in the concentration of THC and other cannabinoids in different strains of marijuana. Even scientists who are bullish on the potential for medical marijuana acknowledge that consistent dosing is an issue. Yet many researchers see the situation as a Catch-22: The Schedule I listing and other restrictions on marijuana research hinder the type of studies that are needed to convince regulators to loosen those restrictions. Two bills introduced in Congress this year aim to lower some of these hurdles. The bills would limit the time that DEA spends reviewing proposed research studies (just as FDA has 30 days to review drug studies). They would also restrict DEA’s role in making sure listed drugs are stored securely. Now, DEA also has to weigh in on changes of scientific protocol, and that can really slow things down, says Vandrey of Johns Hopkins, who is collaborating on a study there to compare the analgesic effects of cannabis and the opioid drug hydrocodone in healthy subjects. A third bill, introduced in July, aims to ease research with cannabidiol and other chemical components of marijuana. “The current interpretation [of the Controlled Substances Act] is that anything in the plant is Schedule I,” Vandrey says. Even though there is no evidence that cannabidiol is prone to abuse, researchers interested in studying it have to jump through the same hoops as if their study involved whole-leaf marijuana. “That, in my mind, is just silly,” Vandrey says. Research on terpenes, still another group of cannabis compounds that may have analgesic effects, faces the same hurdles. “With changing attitudes and changing policy, I’m hopeful that research can proceed with fewer barriers,” McGill’s Ware says. He and others hope they’ll soon be able to firm up the case for marijuana as an effective pain treatment. “I’d hate to think we’re still asking the same questions 10 years from now,” Ware says. Listen to our podcast interview with writer Greg Miller on the impact of legal pot on opioid abuse.
News Article | October 28, 2016
On an almost-daily basis, new headlines, documentaries and studies illuminate the dangers of the growing opioid addiction sweeping the nation. Yet, chronic pain sufferers continue to receive mixed messages, as opioid manufacturers put out the message that chronic pain can be treated easily and safely by opioids, despite such compelling evidence that long-term opioid use can lead to physical dependency. Responding to this troubling epidemic, Dr. Michael Port, a double-board certified pain management specialist at DISC Sports & Spine Center, has issued a statement, maintaining that it’s vital for patients to have a full understanding of the definition of chronic pain and all treatment options available to them, especially those with the ability to successfully relieve their symptoms without opioids. As Dr. Port explains, chronic pain is not neatly defined, but can be most simply understood by the presence of two components. To be diagnosed as chronic, a patient’s pain must typically last longer than three to six months or be non-physiologic, non-functional in nature. In the human body, pain serves a purpose, usually to let the body know something is wrong. For instance, if you break your arm, your body sends signals to the brain alerting it that damage has been done. Non-physiologic, non-functional pain is any pain that doesn’t serve a purpose or has outlasted the duration of the injury. In this scenario, the arm has healed, but the pain persists. “Opioids are effective, amazing medications when used for very specific purposes, such as short-term, acute, nociceptive, physiologic types of pain,” clarifies Dr. Port. “This means you broke your arm, you had surgery. You take it for a week, and when the pain goes away, you stop the narcotics. All is good. “On the flipside, opioids are NOT great for chronic pain because your body becomes accustomed and accommodates to the drugs very quickly. What was great on Week 1 becomes not so effective on Week 2 or Week 3 and actually starts to have a lot of bad side effects. So, when do you use narcotics for chronic pain? Hopefully sparingly, intermittently or not at all.” For Dr. Port, the first and most important step when treating someone suffering from chronic pain is to make the correct diagnosis, which also means checking for previously undiagnosed or misdiagnosed conditions. This includes ruling out any underlying conditions that may be treatable, such as infections, cancer or a degenerative arthritic issue. Defining the source of the chronic pain is a critical step in treating it, because this work may lead to an array of treatment options including rehabilitation, surgery, interventional therapy, psychological therapy, other pharmacologic options or complimentary medicine, such as acupuncture and soft tissue/chiropractic treatment. When a patient suffers from chronic pain and the source of the pain cannot be identified, Dr. Port emphasizes that there are several classes of medicine that aren’t opioids or habit forming drugs. Nonsteroidal anti-inflammatory drugs, steroids or epidurals can all be used to manage pain long term without exposing the patient to the risk of dependency. About DISC Sports & Spine Center DISC Sports & Spine Center (DISC) is California’s premier medical group providing the full scope of sports medicine, spinal care, orthopedics, pain management and conservative treatments. DISC has set a new standard for high-acuity, minimally invasive spine surgery and arthroscopy in an outpatient setting, both safely and on a more cost-effective basis. In partnership with Surgical Care Affiliates (SCA), one of the nation’s leading surgical care companies, DISC operates state-of-the-art outpatient surgery centers in Marina Del Rey and Newport Beach. Both centers are accredited by the AAAHC, have a zero MRSA infection rate and are conveniently located next to major freeways and airports. DISC, which accepts most major insurance plans, is also the official medical services provider for Red Bull. For more information, contact 866-481-DISC, or visit http://discmdgroup.com.
News Article | March 1, 2017
MORRISTOWN, NJ, March 01, 2017-- Dr. Jason E. Lowenstein, a Board Certified Morristown, NJ physician specializing in Orthopaedic Surgery, has been selected by Castle Connolly Medical Ltd. for inclusion in its authoritative guide to the top primary care and specialty care doctors in the tri-state metropolitan New York area.Morristown, NJ February 28, 2017-- Castle Connolly Medical Ltd., America's trusted source for identifying Top Doctors, has published the 15th edition of Top Doctors: New York Metro Area and has selected Jason E. Lowenstein, MD for this exclusive honor.The 15th edition of Top Doctors: New York Metro Area includes over 5,500 top primary care and specialty care physicians in a twenty-county area spanning three states: New York, New Jersey and Connecticut. Selected physicians, including Dr. Lowenstein, represent the top 10% of doctors in the area in 65 medical specialties and subspecialties for the care and treatment of more than 1,800 diseases and medical conditions.Castle Connolly Top Doctors are selected each year by Castle Connolly Medical Ltd. after being nominated by their peers in an online nomination process. Nominations are open to all board certified MDs and DOs and each year tens of thousands of physicians cast many tens of thousands of nominations. Nominated physicians are selected by the Castle Connolly physician-led research team based on criteria including medical education, training, hospital appointments, disciplinary histories and much more.About Jason E. Lowenstein:Dr. Jason E. Lowenstein is a board-certified, fellowship-trained, Adult and Pediatric Spine Surgeon. He is the Director of the Scoliosis and Spinal Deformity Center at Morristown Medical Center, and is a partner at The Advanced Spine Center in Morristown, NJ. ( www.theadvancedspinecenter.com ) Dr. Lowenstein specializes in the treatment of Spinal Deformity in children and adults, including Scoliosis, Kyphosis, and Spondylolisthesis, Disc Herniations and Stenosis of the Cervical, Thoracic, and Lumbar spine, Complex Revision Surgery for Failed Back Syndrome, and Minimally Invasive Spine Surgery.For more information on this Castle Connolly New York Metro Area Top Doctor , please visit Jason E. Lowenstein's profile on www.castleconnolly.com Castle Connolly Medical Ltd.'s President and CEO Dr. John Connolly has this to say about Dr. Lowenstein's recognition: "Roughly ten percent of area physicians were selected for our 15th edition of Top Doctors: New York Metro Area. Being nominated by Board Certified peers and then selected by our experts is an accomplishment worthy of recognition. The New York Metro area is home to a great number of very high quality medical professionals, yet some stand out. My congratulations to Dr. Lowenstein."To find out more or to contact Dr. Jason E. Lowenstein of Morristown, NJ, please call (973) 538-0900 or visit www.jasonlowensteinmd.com and/or www.theadvancedspinecenter.com This press release was written by American Registry, LLC and Castle Connolly Medical Ltd., with approval by and/or contributions from Jason E. Lowenstein.Castle Connolly Medical Ltd. identifies top doctors in America and provides consumers with detailed information about their education, training and special expertise in printed guides and online directories. It is important to note that doctors do not and cannot pay to be included in any Castle Connolly guide or online directory. Learn more at http://www.castleconnolly.com American Registry, LLC, recognizes excellence in top businesses and professionals. For more information, search The Registry at http://www.americanregistry.com