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• Monday, May 16, 2016

  NYT Editorial Includes Wider Use of Physical Therapy Among Strategies to Battle Opioid Epidemic

  
  The editorial board of The New York Times (NYT) says that Congress has "snapped to attention" and produced a "flurry of legislation" aimed at battling the opioid abuse epidemic, but warns that the efforts need to be backed up by appropriate funding for prevention and treatment—including the use of physical therapy as an alternative approach to addressing pain.
  "The House last week passed 18 bills related to opioids, and the Senate approved a comprehensive bill in March," the NYT states in a May 16 editorial. "The question now is whether Congress will appropriate enough money to address the scale of the problem."
  In addition to pressing for more federal funding for treatment programs, the editorial also calls for greater attention to prevention strategies related to pain treatment, specifically mentioning physical therapy as a nondrug treatment that should be easier for consumers to access and pay for through insurance.
  "States, which have more sway over doctors and hospitals, need to do more on the prevention side by placing limits on opioid prescriptions," according to the editorial. "States can encourage doctors to order alternative pain treatments, like physical therapy, and require insurers to cover those services."
  The editorial's position is consistent with recent guidelines from the US Centers for Disease Control and Prevention and the National Institutes of Health, which have both pressed for the use of nonopioid treatments, including physical therapy, as a first-line approach to chronic pain.
  "Congress may be late to wake up to the epidemic, but it does at last seem prepared to open more paths to treatment," the editorial concludes.

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    Thursday, May 05, 2016

  Court Dismisses Lawsuit Filed by NC Acupuncture Licensing Board

  
  Advocates for North Carolina physical therapists (PTs) have scored a victory by way of a superior court, which dismissed a lawsuit brought by the North Carolina Acupuncture Licensing Board (NCALB) against the North Carolina Board of Physical Therapy Examiners (NCBPTE), several PTs, and a physical therapy practice over the issue of dry needling by PTs.
  In September 2015, NCALB filed the lawsuit against NCBPTE, asking the Wake County Superior Court to declare that dry needling by PTs is the unlawful practice of acupuncture, and to require NCBPTE to advise its licensees that dry needling is outside the scope of physical therapist practice. The acupuncture board also asked the court authorize it to send cease and desist letters to PTs who practice dry needling and to sue the PTs who refuse to comply.
  On April 26, Judge Louis Bledsoe III dismissed the suit largely on jurisdictional grounds. "There is no reason to stop North Carolina patients from receiving dry-needling treatment," said North Carolina Physical Therapy Association (NCPTA) President C. David Edwards, PT, DPT, CCCE, in a statement posted to the NCPTA website. "This is especially true when the ones who are trying to eliminate dry needling are doing it to protect their power in the marketplace."
  The dismissal of NCALB’s case against the PT board is not the end of the fight over dry needling in the state. A second lawsuit filed in early October challenging NCALB’s efforts to prevent PTs from engaging in dry needling is still pending in US District Court. That lawsuit, supported by NCPTA, argues that NCALB is violating antitrust law and due process rights in its actions to prevent PTs from practicing the skilled intervention.
  The plaintiffs in the case, titled Henry v North Carolina Acupuncture Licensing Board, filed their lawsuit against NCALB after several years of efforts by the acupuncture board to shut down dry needling by physical therapists. NCALB engaged in various actions to prevent PTs from performing dry needling, including the issuing of "cease and desist" letters to PTs and clinics across the state claiming that the PTs practicing dry needling were illegally engaged in the practice of acupuncture, a Class 1 misdemeanor.
  The Henry lawsuit has legal support in a 2015 decision by the US Supreme Court holding that state licensing boards controlled by market participants, such as NCALB, are not exempt from antitrust claims unless their conduct is actively supervised by the state. The NCPTA lawsuit is the first in the country to bring this type of antitrust violation claim on behalf of PTs since the Supreme Court decision.
  NCPTA set up a "Go Fund Me" page to help fundraising efforts. APTA is working collaboratively with the chapter, and is providing support as NCPTA pursues the legal action.
  Dry needling has been discussed in several states, most of which have included the intervention as part of the PT scope of practice. APTA has created a webpage with resources on the topic, and the association's Learning Center offers courses on dry needling and clinical decision-making and background evidence for dry needling.

Thought this was great to pass along.  A bit on the dramatic side of Dry Needling... But it does work!!!!!

LOOK: James Harrison willingly stuck dozens of sharp needles in his leg

By John Breech | CBSSports.com

March 25, 2016 9:01 pm ET

Steelers linebacker James Harrison has spent most of his offseason trying to figure out if wants to play another year.

The problem for Harrison is that he's just not sure his 37-year-old body can make it through another punishing NFL season.

Harrison's still trying to recuperate from last season and apparently, part of that recuperation involves sticking dozens of needles in his legs, as you can see below.

(Via Harrison's Instagram)

Although that looks like acupuncture, it's not exactly acupuncture.

According to Harrison, it's "dry needling."

If you've never heard of dry needling, join the club. According to our friends at the American Physical Therapy association, dry needling "is a skilled intervention that uses a thin filiform needle to penetrate the skin and stimulate underlying myofascial trigger points, muscular, and connective tissues for the management of neuromusculoskeletal pain and movement impairments."

Sounds like fun. You probably shouldn't do that to yourself at home though.

Anyway, dry needling isn't the only thing Harrison does to prepare his body for possibly playing another season. He has does normal things, like lifting weights.

Harrison hasn't decided if he's going to play in 2016, and it doesn't sound like Steelers coach Mike Tomlin is going to ask him to rush his decision.

"James is not going to shortchange himself," Tomlin said at the NFL owners meetings this week, via ESPN.com. "James is not going to shortchange the game of football. I believe him when he says he's going through a process to see his overall readiness and potential effectiveness. He knows what he's doing. He;s been doing it a long time. He knows whether or not his body can do what he needs it to do. I respect that mentality."

After one or two or 100 more dry needling sessions, Harrison will probably make up his mind about 2016.

James Harrison loves his dry needling. (USATSI)

Topics: James Harrison, Pittsburgh Steelers, NFL

Sleep is so very important when dealing with pain management !

Fibromyalgia Sufferers Have Difficulty Maintaining Continuous Sleep, Study Says

Posted on March 25, 2016 in Fibromyalgia with 4 Comments

A new study published in the Clinical Journal of Pain concludes that people with fibromyalgia have difficulty maintaining continuous sleep as compared to patients with primary insomnia and patients who do not report disturbed sleep.
“This post hoc analysis demonstrates that the nature of sleep disturbance among patients with fibromyalgia reporting difficulty with sleep can be distinguished from patients with primary insomnia and from controls,” the study’s authors wrote.
“We demonstrate that despite comparable wake time during the night (WASO), fibromyalgia patients can be differentiated from patients with primary insomnia and from controls without sleep difficulties, on the basis of frequency and duration of wake or sleep bout episodes.”
The researchers studied 132 people with fibromyalgia (FM) who have difficulty sleeping, 109 people with primary insomnia (PI), and 52 people without sleep disturbance. FM and PI patients were preselected to meet the sleep disturbance criteria.
People with fibromyalgia and primary insomnia had decreased total sleep time and slow-wave sleep (SWS), and increased latency to persistent sleep (LPS) and wake time after sleep onset (WASO) versus controls (P<0.05 for each). People with fibromyalgia had shorter, but more frequent wake bouts versus people with primary insomnia.  Both groups had shorter sleep bout duration versus controls
“We feel these characteristics, in addition to broadening our understanding of the sleep disturbances in these populations, may have relevance in terms of the pathophysiology of the sleep disturbance as well as differential treatment practices for physicians evaluating and managing disrupted sleep in patients with fibromyalgia or those with primary insomnia,” the authors wrote.
The authors concluded, “That sleep in FM is characterized by an inability to maintain continuous sleep but a greater sleep drive compared with PI.”

New guidelines helping local doctors to avoid opioid over prescribing


By: Nicole Johnson - Email

Home   / Headlines List   / Article


FARGO, N.D. (Valley News Live) - New guidelines for doctors after the CDC reports too many people have become addicted to painkillers.
It's a problem we have seen in our area, and nationally. Opioid over prescribing is a key driver in drug overdose deaths, according to the CDC.
It released voluntary guidelines for primary care doctors, saying go slow, and use less. 40 people overdose on painkillers every day in the United States, and almost 2 million are addicted.
"I would like to say that physicians have had nothing to do with it, but I think we have,” says Sanford's Chief Medical Officer, Dr. Douglas Griffin.
He says the CDC's new recommendations will give more backbone to the fight they have already begun. "This is a difficult position for primary care physicians because people are in pain and they are hurting and you know they have issues these are very tough patients to take care of," says Dr. Griffin.
He says years ago they were encouraged to be liberal with pain medication, which has left patients in a vicious cycle. "They need to have those conversations with their doctor and then look for other alternatives, there are many other medications that can be used," says Dr. Griffin.
Other alternatives, like dry needling. It’s a fairly new practice that's gaining attention. "Basically we are finding an area that seems tight and we are looking for the muscle to twitch a little bit,” says Physical Therapist Drew Zimmerman.
He says people who suffer from chronic pain respond very well to dry needling, saying it could help break a cycle of dependency on medication. "Don't give up, there are lots of different methods out there, there are lots of different practitioners,” says Zimmerman. “Sometimes things get missed just because it doesn't work with one person or one treatment, don't give up."
While the CDC's new guidelines are simply suggestions to doctors, "I think it will make an impact," says Dr. Griffin. He hopes it will create change in this community.

I know sometimes this seems to foreign or hard to do but it just takes practice.!

Mindfulness Meditation Delivers Opioid-Free Pain Relief, Study Says

Posted on March 17, 2016 in Alternative Pain Therapy, Other with 8 Comments

Researchers at the Wake Forest Baptist Medical Center published a study that looked into whether meditation uses natural opioids to reduce pain.
The study, led by author, Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy found that mindfulness meditation does not employ the endogenous opioid system to reduce pain.
“Our finding was surprising and could be important for the millions of chronic pain sufferers who are seeking a fast-acting, non-opiate-based therapy to alleviate their pain,” said Dr. Zeidan.
The researchers injected study participants with either naloxone, which chemically blocks opioid receptors, or a saline placebo.

In this randomized, double-blinded study, 78 healthy, pain-free volunteers were divided into four groups for the four-day (20 minutes per day) trial.  The groups consisted of:

• meditation plus naloxone
• non-meditation control plus naloxone
• meditation plus saline placebo
• non-meditation control plus saline placebo.

A thermal probe was used to induce pain by heating a small area of the skin to 102.2 degrees, which is considered very painful by most people.  The participants then rated their pain using a sliding scale.
The authors concluded that pain ratings were reduced 24% from the baseline measurement for the group using meditation and naloxone.  They noted that this is important because the opioid receptors were chemically blocked, while significantly reducing pain.  Pain was also reduced by 21% in the meditation and saline placebo group.
The non-meditation control groups reported increases in pain regardless of whether they got the naloxone or placebo-saline injection.
“Our team has demonstrated across four separate studies that meditation, after a short training period, can reduce experimentally induced pain,” Zeidan said.  “And now this study shows that meditation doesn’t work through the body’s opioid system.”
“This study adds to the growing body of evidence that something unique is happening with how meditation reduces pain.  These findings are especially significant to those who have built up a tolerance to opiate-based drugs and are looking for a non-addictive way to reduce their pain.”
Zeidan’s team hopes to determine how mindfulness meditation can affect a wide range of chronic pain conditions.
“At the very least, we believe that meditation could be used in conjunction with other traditional drug therapies to enhance pain relief without it producing the addictive side effects and other consequences that may arise from opiate drugs,” he said"

Now is a good time to consider safer methods of pain management.  Physical Therapy is such a choice. Please read the following new guidelines coming out this week.

CDC Issues New Guidelines for Opioid Prescribing — Physician’s First Watch

MEDICAL NEWS | 

PHYSICIAN'S FIRST WATCH

March 16, 2016

CDC Issues New Guidelines for Opioid Prescribing

By Kelly Young

Edited by Lorenzo Di Francesco, MD, FACP, FHM

The CDC has issued 12 new recommendations for clinicians prescribing opioids for pain outside of cancer treatment or palliative care. The full guideline is published in MMWR.

Among the recommendations:

• For chronic pain, the first choices of treatment should be nonpharmacologic or nonopioid. Opioids should be an option only if the expected pain and function benefits outweigh the potential risks.
• Patients starting opioids should be prescribed immediate-release opioids at the lowest effective dose, not extended-release/long-acting opioids.
• Individual benefits and risks should be reassessed when increasing the dosage to 50 morphine milligram equivalents (MME) or more per day. Dosages of 90 MME or more should be avoided, or clinicians should "carefully justify a decision" to increase the dosage to that level.
• For acute pain, an opioid prescription for 3 days or fewer will often be enough. More than 1 week is rarely needed.
• Clinicians should regularly evaluate risk factors for opioid-related harms (e.g., history of overdose or substance use disorder) and consider offering naloxone to high-risk patients.
• Concurrent prescriptions of opioids and benzodiazepines should be avoided.

Interesting reading !