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July/August 2005
Volume 1, Issue 2
In this Issue:
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Pain Medicine Fellowship Begins July 1, 2005
An Original Contribution by Frank J. E. Falco, M.D.
The Temple University Hospital [Philadelphia, PA] Department of Physical Medicine & Rehabilitation (PM&R), in conjunction with Mid Atlantic Spine, was recently accredited by the ACGME (Accreditation Council for Graduate Medical Education) to provide a one-year Pain Medicine Fellowship starting on July 1, 2005. In March 1998, the ABMS (American Board of Medical Specialties) granted the ABPMR (American Board of Physical Medicine and Rehabilitation), the ABPN (American Board of Psychiatry and Neurology) and the ABA (American Board of Anesthesia) the authority to offer subspecialty certification in Pain Management (Pain Medicine) using a single standard of certification for all three specialties.
The Temple/Mid Atlantic Spine program is one of ten PM&R Pain Medicine Fellowships in the entire United States and will be training three PM&R Pain Medicine Fellows a year. The curriculum will cover acute, chronic, cancer, pediatric and geriatric pain, as well as, anatomy, physiology, epidemiology, pharmacology, interventional treatment, functional assessment, disability, hospice, and ethics.
Frank Falco, M.D. of Mid Atlantic Spine will be the Program Director of the Pain Medicine Fellowship where fellows will spend approximately one day/week at Temple and approximately four days/week at Mid Atlantic Spine.
Low Back Pain: Do's, Don'ts and Red Flags
An Original Contribution by Frank J. E. Falco, M.D.
Low back pain (LBP) is the second most common reason, other than having a cold, that we seek medical care. Approximately 90% of us will suffer a significant episode of LBP in our lifetime. LBP is the leading cause for disability under the age of 45 and second for those over 45.
The good news is that nine out of ten patients will recover from their back pain within four weeks with or without treatment. Tips (DO'S) to prevent back pain include:
- Lift with the legs not the back
- Do not lift heavy objects
- Wear low heeled shoes
- Get consistent sleep
- Shift heavy purses/briefcases
- Stop activity that hurts
- Do not stoop
- Exercise regularly.
Low back pain typically is due to injuries of the soft tissue structures, spinal joints, or discs. Risk factors (DON'TS) for developing low back pain include: poor posture, repetitive motion, prolonged sitting/standing, smoking, poor nutrition, and incorrect bending, lifting, and twisting.
Seek medical attention if your pain does not improve or if it increases over a period of two to three weeks. In addition, you should seek immediate medical care for any of the following RED FLAGS:
- Sudden pain onset if > age 50
O LBP related to a fall or trauma
- Sciatica (leg pain)
- Loss of bowel or bladder control
- Loss of groin or rectal sensation
- Leg weakness
- Falling when walking
- Fever or weight loss
- LBP worse at night.
Intrathecal Pump Drug Delivery:
Indication & Efficacy in Cancer Pain
An Original Contribution by Frank J. E. Falco, MD
Despite our best efforts, advances in treatment and new technology, pain and suffering continues to afflict those with cancer. Even in those who are cured of their cancer, many will experience devastating physical, psychological and financial devastation.
Although the use of opioids to treat cancer pain is more accepted today, there still are many physicians, patients and family members that are fearful of using opioids because of concerns for addiction, side effects, and religious implications
Pharmacological therapy continues to be the primary method for controlling cancer pain. In fact, the use of non-opioid and opioid analgesics along with adjuvant medications can adequately control the pain in 85% of cancer patients. The World Health Organization (WHO) developed a three-step approach in treating malignant and chronic benign pain. This approach, along with medications to treat the side effects from opioids (namely nausea, constipation, pruritis and sedation), has been effective in controlling cancer pain.
In cancer pain refractory to pharmacological management (15% of cancer patients have unrelieved pain or drug side effects), invasive methods of pain control, such as intrathecal pump drug delivery (IPDD), have been successful in reducing pain and drug toxicity.
Smith et al (Curr Oncol Rep 6:291-296,2004) evaluated 202 patients with a VAS =7.5 and taking = 200 mg morphine or opiod equivalent in a prospective, randomized study. The patients were divided into IPDD and medical management groups. The IPDD patients had better clinical success with lower pain (52% vs. 39%), lower drug toxicity (50% vs. 17%) and lived longer when compared to the medical group. IPDD also lower pain by 27% and lower drug toxicity by 50% in the most refractory of cancer patients who first failed to experience any improvement in the medical group. |
