Legalized marijuana and pain management

March 7, 2018

Legalized marijuana and pain management. The State of California has legalized marijuana.  Some people think that because marijuana is legal, they can get opioids and smoke as much as they want.  This thought is not true. Firstly, marijuana has not yet been legalized by the Federal Government.  While Federalism, meaning that States can do what … Continue reading “Legalized marijuana and pain management”

My most recent trip to Egypt

March 7, 2018

Egypt January 2018 I am fortunate to return to Egypt for a fourth visit.  I am returning to al Maadi Hospital to work with Dr. Eziz in his excellent Physical Medicine and Rehabilitation Department.  Dr. Eziz has an very wide ranging physical space, with physical therapy, aqua therapy, exam rooms and a very high grade … Continue reading “My most recent trip to Egypt”

The Opioid Epidemic

February 10, 2018

We all know that too many people are dying from opioid overdoses.  These deaths usually occur in combination with other drugs, such as benzodiazepines (like Xanax) or alcohol.  Most of these death are accidental, but the accidental nature does not take away the risk associated with non-medical opioid use, nor the need to avoid it.  … Continue reading “The Opioid Epidemic”

Ketamine, Pain and Depression 1 26 18

February 10, 2018

Ketamine is a very interesting compound.  It acts at many different areas in the body.  Traditional antidepressants, such as the reuptake inhibitors like Prozac, Cymbalta or Effexor, act by preventing the reuptake of serotonin or norepinephrine.  These drugs work slowly.  They don’t always work, with a response rate of only 60%.  And they don’t continue … Continue reading “Ketamine, Pain and Depression 1 26 18”

IV Ketamine for Complex Regional Pain Syndrome and refractory Major Depressive Disorder

May 16, 2016

Complex regional pain syndrome (CRPS) and refractory major depressive disorder (MDD) pose terrible burdens on those who suffer from them. CRPS is a special form a neuropathic pain with special unique characteristics. CRPS is also known as Reflex Sympathetic Dystrophy (RSD). CRPS suffers can suffer from ongoing, intractable, pain in an extremity, from the arm … Continue reading “IV Ketamine for Complex Regional Pain Syndrome and refractory Major Depressive Disorder”

laser epiduroscopy for low back pain

May 16, 2016

I continue to be very interested in laser epiduroscopy. Epiduroscopy is a procedure in which we put a fiberoptic scope into the epidural space. It is approved for visualization of the epidural space and for putting medications into the epidural space. I believe that the greatest benefit of epiduroscopy, particularly laser epiduroscopy, is in the … Continue reading “laser epiduroscopy for low back pain”

Patient satisfaction and the opioid epidemic

January 23, 2016

Everyone wants to be well treated by their doctor. And doctors want to treat their patients well. With Obamacare, patient ratings of their encounters has become mandated. For many employed physicians, patient ratings are important both for their pay and their continued employment. This all sounds good except that we are now caught in the … Continue reading “Patient satisfaction and the opioid epidemic”

Epiduroscopy and low back pain

July 20, 2015

Interventional pain management has two frontiers to conquer, the treatment of low back pain and the treatment of spinal stenosis.  Today’s blog is about the treatment of low back pain.  Chronic low back pain, defined as pain in the back, with no involvement below the knees has many causes.  We have done a good job … Continue reading “Epiduroscopy and low back pain”

Urine drug testing

February 3, 2015

Safe opioid prescribing demands that we, the prescribing doctor, make sure that the patient getting the opioids is getting benefit from them.  Benefit means decreased pain, increased function and no side effects and no abuse.  Opioids are used for any type of pain, whether cancer pain, low back pain, pain from disc herniations, facet disease, … Continue reading “Urine drug testing”

Changes in opioid prescribing

February 3, 2015

Since late 2012, there has been an enormous sea change in how opioids are used.  From about 1986 to 2012, the prevailing thought was that pain was undertreated and that patients should be provided whatever opioids they needed.  This was for any type of pain, whether cancer pain, low back pain, pain from disc herniations, … Continue reading “Changes in opioid prescribing”