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A veteran in the field of physical therapy, Howie Bartz owns numerous companies that deal with medical equipment used in physiotherapy. A graduate of Daemen College, he founded his first company, Bartz Physical Therapy, shortly after he received his...

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Pharmacogenetics and Pain Management – Clinical Use and Interpretation of the Common Pharmacogenetic

In recent years, pharmacogenetic testing has become more common in pain management. During this time, a few cytochrome P450 (CYP450) enzymes have been identified as being particularly important to the metabolism of certain pharmaceutical agents commonly used in pain treatment, such as opioids, antidepressants, and anti-inflammatory agents.

More recently, 2 non-cytochrome P450 “pharmacodynamic” genetic tests have been identified that help explain opioid dosage requirements in pain patients. The first measures, opioid mu receptor 1 (OPRM1), which determines the ability of opioids to bind to the mu opioid receptor site. The other measures catechol-o methyltransferase (COMT), the enzyme that degrades catecholamines in the central nervous system.

All pain practitioners who prescribe opioids should know that a patient with an OPRM1 with a low sensitivity rating and/or a COMT with a high activity rating likely will require a higher opioid dose than normal to obtain relief from a severe pain problem.

This article presents an up-to-date status and review of the pharmacogenetic markers that have relevance to pain practice. Read the full article here: http://www.practicalpainmanagement.com/resources/diagnostic-tests/pharmacogenetics-pain-management

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Exercise & Lifestyle Tips to Reduce Back Pain

Back pain is often a result of the aging process for many people, but there are steps you can take to keep your back strong and healthy.

“As you age, your back undergoes degenerative changes,” says Garrett Helber DO. Most people refer to these changes as arthritis, which include disk degeneration, spinal canal narrowing and enlargement of the joints of the spine. As a result, some people may experience pain, although there are many that do not,” he says.

How posture affects back health

“It can also contribute to issues with the muscles surrounding the spine, including the neck,” says Dr. Helber. “Good posture helps to minimize the stress on your spine and on the surrounding muscles, which helps to reduce pain in the long term.”

Some additional posture tips:

Sit up with your back straight and your shoulders back. Your buttocks should touch the back of your chair.

Distribute your body weight evenly on both hips.

Keep your knees even with or slightly higher than your hips (use a foot rest or stool if necessary).

Do not cross your legs; keep your feet flat on the floor.

Adjust your chair height and work station so you can sit up close to your work. Rest your elbows and arms on your chair or desk, keeping your shoulders relaxed.

Exercises to strengthen your back

Fortunately, there are also exercises you can do to stretch and strengthen your back and help avoid or reduce pain. “Using a core stability ball instead of a chair while sitting at your desk will activate and strengthen back muscles while working,” Dr. Helber says.

Outside of work, Dr. Helber recommends these exercises:

Superman: Lie on your stomach on a flat surface and raise both your arms and your legs at the same time as though you are flying. Hold the position for five seconds. Then repeat 10 times. This helps strengthen your lower back.

Pelvic tilt: Lie on your back with your knees bent. In this relaxed position, the small of your back will not touch the floor. Tighten your abdominal muscles so that the small of your back presses flat against the floor. Hold for five seconds, then relax. Repeat three times and gradually build to 10 repetitions.

Knees-to-chest: Lie on your back with both legs straight. Bring one knee up to your chest, pressing the small of your back into the floor (see pelvic tilt). Hold for five seconds and repeat five times. Repeat exercise with the other leg.

Back extension stretch: Lie on your stomach. Use your arms to push your upper body off the floor. Hold for five seconds. Let your back relax and sag. Repeat 10 times.

Lifestyle changes can decrease back pain

There are three main things you can do to strengthen your back and decrease pain, says Dr. Helber:

Avoid smoking or using nicotine products.

Maintain a healthy body weight.

Stay active and perform the exercises outlined above.

When it comes to keeping your back strong, good habits will serve you well, especially proper posture and exercise. Read the full article here: http://health.clevelandclinic.org/2015/09/got-back-pain-try-superman-3-exercises/

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Nonpharmacologic Treatment for Long-Term Neck Pain

A Swedish study is set to analyze the effect of massage and exercise therapy on subacute and long-lasting neck pain, which is a pesky, costly, and potentially debilitating condition. According to the researchers, between half and three quarters of people with current neck pain will report neck pain again one to five years later. In addition, half of all work-related injuries reported in Sweden involve disorders of the muscles and joints. This makes the socio-economic impact of neck pain extensive, and the overall costs in terms of lost productivity and quality of life very high. The upcoming study will be a randomized controlled trial in which at least 600 study participants with subacute or long-lasting nonspecific neck pain will be recruited and randomly allocated to one of four treatment arms: massage therapy; exercise therapy; exercise therapy combined with massage therapy; and simple advice to “stay active.” Study participants are being recruited through advertising with a mix of traditional and online marketing channels, and the research will use a combination of in-person and online interventions and measurements – including web-based self-report questionnaires at seven, 12, 26 and 52 weeks after inclusion. The primary outcomes are a clinically important improvement in pain intensity and pain-related disability at follow-up, measured with a modified version of the Chronic Pain Questionnaire (CPQ). The secondary outcomes are global improvement, health-related quality of life (EQ-5D), use of sick leave, use of pharmacologic therapy, and overall healthcare utilization. Adverse events will be measured by questionnaires at return visits to the clinic. Neck pain intensity and pain-related disability will be measured every week for one year. “We hypothesize that massage and physical exercise have beneficial effects on subacute and long-lasting neck pain because that is the case with chronic low back pain,” the study authors observed, citing earlier research. “There is scientific evidence for the effect of massage on nonspecific low back pain, especially when combined with exercises and education. Physical exercise has been shown to be efficient in reducing the pain and disability in long-lasting low back pain and to reduce work absenteeism.” Participants randomized to exercise therapy will receive instruction and support on physical exercises in 30-minute sessions (total visit time 45 minutes) at the study center. The primary focus is on strengthening of the deep neck muscles and shoulder muscles, as well as strengthening and passive stretching of breast muscles and jaw muscles. The delivery method is one-on-one, and the only exercise equipment used is a rubber band (for the shoulder muscle strengthening). Participants randomized to the “advice to stay active” arm will get guidance and support from a therapist on staying active and on pain-coping strategies, according to guidelines and evidence-based reviews. Read more: http://www.hcplive.com/medical-news/stay-tuned-nonpharmacologic-treatment-of-long-term-neck-pain#sthash.OMCixVwY.dpuf

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Runner’s Knee – Otherwise Known as Patellofemoral Pain Syndrome

In medical terminology, “runners knee” is called patellofemoral pain syndrome (PFPS). It is a problem that responds very well to physiotherapy treatment and there is a reasonable amount of research evidence behind what we do. The pain arises from around or under the patella (knee-cap) and can be as a result of it not tracking properly in its groove. There are some common risk factors that can affect how the patella tracks.

How to treat it?

There are a lot of treatment options for patellofemoral pain and it normally responds well to physiotherapy. The treatment is not prescriptive and will depend on where you are in your training and why you have developed symptoms. The main treatment options are as follows :

Education: understanding why you came to have this injury will help to avoid recurrence. This is a key part of the treatment. It is important to look back and see if you have made any training errors related to load or training surface.

Rest or reduction in activity: mostly there will need to be some alteration in your running activity. If you are lucky, it might just be cutting this back a little but if the pain is too severe, you will need to rest to allow the irritation to settle. If you are training for a particular event then it is important that you keep up cardiovascular training where possible but using an alternative method that does not aggravate the symptoms until you are back to running.

Taping: there is evidence to suggest that taping the knee can help in the short term to relieve pain and may allow you to continue running and start exercising the muscles in the thigh earlier. Some patients also find it helpful to use a knee brace.

Correcting any biomechanical issues: this will involve assessing how you move, and using mirrors and videos to help to teach you new movement patterns. It is likely to involve improving glutes and quads strength and activation, and sometimes muscle stimulators may also be used to make changes more quickly if you are very weak. There are a number of different exercises that target these muscles, including squats, single leg squats and lunges. However, pain is a big inhibitor to muscle function so it is important that the exercises are comfortable. It is worth understanding that doing these exercises without appropriate instruction and supervision may worsen the condition.

Soft-tissue release and stretching: each person will present differently. Some people have tightness in their calves, quads and hamstrings, and therefore soft-tissue release and stretching may be appropriate. Mobilisations to the ankle and around the kneecap may also be used. However, issues in flexibility as a primary factor are probably less common than strength and control issues with patellofemoral pain. This means that stretching/rollering alone is unlikely to resolve your symptoms.

Orthotics: if you do roll your feet in excessively then you may need an orthotic device – an insole you insert into your shoe to help support your arch. This can be bought off the shelf or custom-made by a podiatrist. If your feet only roll in a little then you may be able to improve the position of the foot enough with the correct pair of trainers.

Anti-inflammatories: if you are unable to carry out normal functional activities without significant pain, then a course of anti-inflammatories may be appropriate. If you are in training and have a race coming up, then – with the advice of a medical professional – it may be appropriate to run with some pain and use anti-inflammatories to reduce the symptoms. This course of action obviously risks masking the pain and should therefore be discussed with your doctor or therapist. If you choose to continue to train, despite pain, to compete in a race, it is important that you allow yourself time post-race to address thoroughly the issues surrounding why you developed the pain in the first place.

Read the full article here: http://www.theguardian.com/lifeandstyle/the-running-blog/2015/sep/30/running-into-problems-runners-knee-physiotherapist

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Back Pain Patients Seek Pain Relief First, Mobility Second

Pain relief is a greater concern than mobility for people with a common form of lower back pain known as lumbar spinal stenosis, a new study indicates.

When asked to choose between a treatment that would reduce discomfort and one that would help them stand and walk, the vast majority of patients wanted to ease their pain, the researchers found.

"There has long been a debate in the medical community over striking the right balance between pain relief and physical function," said the study's lead author, Dr. John Markman, director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery in Rochester, N.Y.

"While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief," Markman said in a university news release.

The researchers explained that lumbar spinal stenosis occurs when the vertebrae, discs, joints and ligaments of the spinal column break down, causing the spinal canal to narrow. This compresses nerve roots, which leads to pain, tingling and numbness in the lower back, buttocks and legs. Most patients with this condition are in pain when they stand or walk.

Surgery can help reduce pain and help people move around with greater ease, but not all patients are candidates for a surgical procedure. Steroids injected into the spinal column can bring pain relief, but only temporarily.

The study's authors focused on nearly 270 patients who had trouble standing and walking and suffered from chronic back pain associated with lumbar spinal stenosis. The participants were asked to choose between a therapy that reduced their pain and one that would enable them to stand and walk. Nearly 80 percent of the patients said they would rather have relief from their pain than greater mobility, the study published recently in Neurology found.

"Even the patients who could not stand long enough to pick up a letter from their mailbox or wash the dishes after dinner chose pain relief," said Markman.

The authors pointed out patients are playing a greater role in setting new standards for pain relief, demanding new medications that are both safe and effective. "This study convincingly demonstrates the need to prioritize pain relief because that is what patients want," Markman said. Read more here: http://consumer.healthday.com/bone-and-joint-information-4/backache-news-53/pain-relief-top-concern-for-those-with-lower-back-pain-703179.html

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NIH Panel: Opioid Use Calls for Individualized Treatment for Americans in Pain

Until more research is conducted on the safety and effectiveness of opioid painkillers, the health care community should focus on individualized care for the one-third of Americans who experience chronic pain, an independent panel of medical experts has concluded.

The panel, convened by the National Institutes of Health, released its findings in a report published Jan. 12.

Prescription painkillers have been linked to addiction and death. More than two-thirds of the 22,767 drug-related overdoses in 2013 involved opioids, according to the Centers for Disease Control and Prevention.

The panel found that some patients experiencing pain are often denied effective comprehensive treatments, while other patients are inappropriately prescribed medications. In addition to studying opioid effectiveness, more research is needed on management and risk mitigation strategies, the panel said.

In the meantime, the panel recommends health care providers follow guidelines issued by professional societies, and for those guidelines to be continually updated as new research is conducted. http://www.safetyandhealthmagazine.com/articles/11705-nih-panel-on-opioid-use-calls-for-individualized-treatment-for-americans-in-pain

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Treatment Options to Manage Pain from Compression Fractures

Have you ever bent over to grab something only to be paralyzed by sharp back pain? If you haven’t had a fall or experienced any other trauma and you’re beyond age 60, another possible reason is a compression fracture. It’s more common in postmenopausal women, but it can happen in men too. Another sign of a compression fracture is that your lower back pain gets worse with any type of movement of the back. If you are lying or sitting still, the pain is minimal, but once you begin to move, the pain worsens immediately.

Patients usually describe the pain as feeling like a series of muscle spasms, says Samuel Samuel, MD, Medical Director of Pain Management at Cleveland Clinic’s Marymount Hospital and Marymount South. “The primary cause of compression fractures is osteoporosis, which is especially common in post-menopausal women.” he says. “However, there are several other causes such as multiple myeloma, cancerous tumors or trauma.”

Treating Compression Fractures

A medical procedure known as a kyphoplasty or vertebral augmentation is very effective for patients with a spinal compression fracture, Dr. Samuel says. During this outpatient procedure, the physician injects a cement material into the spine to stabilize the fracture.

“It is usually highly effective immediately at controlling the pain,” he says. “The procedure has some risk to it because we’re working on the spine, but we do it using X-rays so that we make sure we have delivered the cement to the correct place.” Dr. Samuel says the procedure helps preserve the height of your vertebral body so it doesn’t collapse any further.

Patients usually wake up from the procedure with significantly less pain than they had before. However, there may still be some minor pain or discomfort, he says.

Physicians often prescribe a back brace for additional support.

You can purchase a brace at a medical supply store, but it requires a prescription for a proper lumbosacral orthosis device. “Usually the braces that are sold in the pharmacies are not sufficient to treat the compression,” Dr. Samuel says.

Best treatment is prevention

You’ve heard the old adage. But, especially for post-menopausal women, Dr. Samuel recommends helping prevent compression fractures by getting the proper amounts of vitamin D and calcium. For best results:

Incorporate salmon and other seafood into your diet.

Exercise and stay active.

Get routine bone density tests through your primary care physician.

Talk to your doctor about whether a class of medications called biphosphonates is right for you. They help prevent the loss of bone mass by strengthening your bones with calcium and vitamin D.

Read more here: http://health.clevelandclinic.org/2015/09/brittle-bones-can-lead-back-pain-especially-menopause/

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New Study: Does taking opioids for back pain delay return to work?

Being prescribed an opioid for low back pain may keep workers off the job longer, according to a new study from McMaster University. Researchers analyzed 1,442 claims from the Ontario Workplace Safety and Insurance Board and found that workers receiving disability benefits for low back pain were more likely to stay on claim if they received opioids.

The researchers did not establish causation between opioid prescription and a longer time to resolve claims – workers who received opioids may have been more injured and needed the additional time to recover. “On the other hand, adverse effects of opioids on mental and physical function could be the reason,” Jason Brusse, lead study author and assistant professor of anesthesia at McMaster, said in a university press release. Back pain is a common problem among working adults in North America, with a lifetime prevalence of 63% and a point prevalence of 21%. After the common cold, low back pain (LBP) is the most frequent cause of lost time from work. Globally, LBP is the primary cause of years lived with disability.

Brusse recommended additional research on the correlation. The study, which was published Aug. 26 in the journal BMJ Open, was funded by the Ontario Workplace Safety and Insurance Board Research Advisory Council and the Ontario Chiropractic Association. Access the full study here: http://bmjopen.bmj.com/content/5/8/e007836.full?sid=2934fde8-468c-493c-9b9c-06914e1f0003

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Effectiveness of Therapeutic Facet Joint Interventions in Managing Chronic Spinal Pain

The therapeutic spinal facet joint interventions generally used for the treatment of axial spinal pain of facet joint origin are intraarticular facet joint injections, facet joint nerve blocks, and radiofrequency neurotomy. Despite interventional procedures being common as treatment strategies for facet joint pathology, there is a paucity of literature investigating these therapeutic approaches. Systematic reviews assessing the effectiveness of various therapeutic facet joint interventions have shown there to be variable evidence based on the region and the modality of treatment utilized. Overall, the evidence ranges from limited to moderate. A total of 21 randomized controlled trials meeting appropriate inclusion criteria were assessed in this evaluation. A total of 5 observational studies were assessed. In the lumbar spine, for long-term effectiveness, there is Level II evidence for radiofrequency neurotomy and lumbar facet joint nerve blocks, whereas the evidence is Level III for lumbosacral intraarticular injections. In the cervical spine, for long-term improvement, there is Level II evidence for cervical radiofrequency neurotomy and cervical facet joint nerve blocks, and Level IV evidence for cervical intraarticular injections. In the thoracic spine there is Level II evidence for thoracic facet joint nerve blocks and Level IV evidence for radiofrequency neurotomy for long-term improvement.

The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake consumption. Based on the present assessment for the management of spinal facet joint pain, the evidence for long-term improvement is Level II for lumbar and cervical radiofrequency neurotomy, and therapeutic facet joint nerve blocks in the cervical, thoracic, and lumbar spine; Level III for lumbar intraarticular injections; and Level IV for cervical intraarticular injections and thoracic radiofrequency neurotomy. Read the full study here: http://painphysicianjournal.com/current/pdf?article=MjM2NA%3D%3D

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How Much Do Spinal Steroid Injections Ease Low Back Pain?

Spinal epidural injections of steroids may relieve low back pain from a ruptured disc, but only briefly, a new study shows and the injections offer no significant relief for pain related to narrowing of the spaces around the spinal cord, the researchers say.

Some earlier studies have reached similar conclusions, but others have shown some benefit. Meanwhile, the use of epidural steroid injections has been increasing in the face of contradictory guidelines for physicians.

To clarify this confusing situation, Dr. Roger Chou from Oregon Health & Science University in Portland and colleagues sorted through the evidence from 63 published reports about the use of epidural steroid injections for treating low back pain from ruptured discs or spinal narrowing.

“I think the important thing is for patients and clinicians to be able to make informed decisions,” Chou told Reuters Health by email. “Epidural corticosteroid injections are perceived as being more effective than they are.”

Spinal steroid injections brought immediate relief of pain and improvement in function in patients with ruptured discs, but not in patients with spinal narrowing, or stenosis, the researchers reported in Annals of Internal Medicine.

The new analysis seems unlikely to settle any controversies, however.

Dr. Zack McCormick, who specializes in physical medicine and rehabilitation at Northwestern University Feinberg School of Medicine in Chicago, told Reuters Health by email that because the studies available for analysis by Chou’s team were of low quality, the conclusions “cannot be applied to the realistic day-to-day practice of spine medicine.”

“The goal of epidural steroid injection is not for long term ‘cure,’ but rather to (improve) symptoms in order to allow restoration of sleep, quality of life, and tolerance of physical therapy,” McCormick said.

“Epidural steroid injections should not be used as an isolated therapy,” he added. “More studies are needed which show outcomes of epidural steroid injections in conjunction with a multi-modal approach that includes physical therapy, oral medications, and other adjunctive treatments, as this represents true clinical practice.” Read the full article here: http://www.reuters.com/article/2015/08/24/us-health-backache-steroids-idUSKCN0QT2CX20150824

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Steps to Take Prior to Considering Knee Surgery

Knee surgery

Arthroscopic surgery to trim or remove a torn meniscus — the cartilage that cushions your knees — is the most common orthopedic surgery in the United States. About 700,000 of the procedures are done each year, a 50 percent increase in the past 15 years.

But research shows that it’s often no better than physical therapy at easing symptoms. And in a New England Journal of Medicine study, patients who had sham surgery — in which surgeons made a small incision, then simulated the rest of the procedure — fared just as well as those who had the real deal. Other research shows that arthritis is more likely to develop in people who have the procedure than in those who don’t.

Bottom line: If you’re suffering age-related knee pain and an MRI scan reveals a tear, first try rest, ice, a knee brace, over-the-counter anti-inflammatory drugs and physical therapy.

http://www.washingtonpost.com/national/health-science/if-your-doctor-says-you-need-surgery-you-may-want-to-explore-other-options/2015/08/24/111c4120-09fe-11e5-a7ad-b430fc1d3f5c_story.html

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Growth Estimates for the Global Genetic Testing Market

The Global Genetic Testing Market accounted for $3.2 billion in 2014 and is expected to grow at a CAGR of 9.26% to reach $6.5 billion by 2022. The factors contributing to the market growth include aging population, growing awareness, availability of direct to consumer tests and increasing incidence of genetic disorders. However, factors such as high cost for testing and reimbursement issues are inhibiting the growth of the market. Genetic testing is the most profitable and rapidly expanding segment of molecular diagnostics. It is the array of techniques used for the analysis of DNA, RNA, and protein. It is used as a medical tool to determine the genetic defects associated with a particular disease. Genetic testing is also used in non-clinical applications such as paternity testing and forensics. In clinical applications, the primary focus of genetic testing is to identify the genetic reason for the cause of a disease, confirm a suspected diagnosis, prediction of future disease, to identify when an individual may pass his/her hereditary information to kids, and to predict treatment response in a patient. Genetic testing is also used to screen new-born babies, fetuses, or embryos used in-vitro fertilization for genetic defects. The genetic testing market is categorized based on its applications into pharmacogenomics testing, predictive testing, prenatal and neonatal testing. Genetic testing for cancer is likely to be the fastest growing segment during the forecast period. Increasing incidence of genetic diseases is providing more opportunities for genetic testing along with the rise in personalized medicine. The federal agencies who play a significant role in regulating genetic tests are Food and Drug Administration (FDA), Federal Trade Commission (FTC) and Center for Medicare and Medicaid services (CMS). Read more here: http://www.medgadget.com/2015/08/global-genetic-testing-market-2015-estimated-to-grow-at-a-compound-annual-growth-rate-9-26-by-2022.html

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Minimally Invasive vs. Traditional Total Knee Replacement Surgery

If you’ve decided to have a total knee replacement, you might be considering a minimally invasive procedure. This type of surgery uses smaller incisions and less cutting of the tissue surrounding the knee. The advantage of such a surgery is that it allows for faster recovery, a shorter hospital stay and less blood loss.But aside from these potential short-term advantages, there’s good reason to strongly consider a traditional surgery for a total knee replacement.

Be sure to talk it over with your doctor. While the minimally invasive approach is not for everyone, the risk of complications associated with a more complex operation may outweigh its benefits for you.Whatever surgery you choose, evidence suggests that minimally invasive surgery is no more beneficial than traditional total knee replacement in the long term. The first thing to do is get options from a surgeon who does minimally invasive total knee replacement and one who does only traditional surgery, and weigh the pros and cons of each. After your decision:

Choose a surgeon who is highly experienced and performs a large volume of the type of procedure you want.

Work with your doctor to lose weight to reduce the strain placed on your knees.

Stay as active as possible. Before your operation, have your physician recommend exercises that strengthen your quadriceps without causing pain. Good examples are riding a stationary bicycle and swimming or water therapy.

Exhaust all conservation treatments, such as medications, injections and physical therapy, before considering knee replacement.

Read the full article here: http://health.clevelandclinic.org/2015/08/why-minimally-invasive-knee-replacement-may-not-be-for-you/

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Estimates of Pain Prevalence and Severity in Adults

A new analysis of data from the 2012 National Health Interview Survey (NHIS) has found that most American adults have experienced some level of pain, from brief to more lasting pain, and from relatively minor to more severe pain. The analysis helps to unravel the complexities of a Nation in pain. It found that an estimated 25.3 million adults (11.2 percent) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain. Those with severe pain are also likely to have worse health status. The analysis was funded by the National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) and was published in The Journal of Pain.

“The number of people who suffer from severe and lasting pain is striking,” said Josephine P. Briggs, M.D., director of NCCIH. “This analysis adds valuable new scope to our understanding of pain and could inform the National Pain Strategy in the areas of population research and disparities. It may help shape future research, development, and targeting of effective pain interventions, including complementary health approaches.”

Pain is one of the leading reasons Americans turn to complementary health approaches such as yoga, massage, and meditation—which may help manage pain and other symptoms that are not consistently addressed by prescription drugs and other conventional treatments. For this reason, NCCIH research priorities include the study of complementary approaches to determine their effectiveness for treating symptoms such as pain. Read more here: http://www.nih.gov/news/health/aug2015/nccih-11.htm

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How to Successfully Implement a DME Program into Private Practice

We often hear from physicians that there are several challenges to implementing Durable Medical Equipment programs into their practices. In this post, we address four common areas of concern and show that when you work with the right supplier, it can be a win-win for both your office and your patients.

First and foremost, quality products are a must. The market is fraught with that products that are poorly designed and constructed. Patients will return cheap products if they’re not satisfied with the results or there are durability issues. Second, find a quality provider with a proven track record. Ask for referrals from their current clients and seek out providers that have commissioned outcome studies to measure the efficacy of their products. In our latest outcome study, Meditech had a product return rate of <1%.

It’s important to understand the payers, especially Medicare Local Coverage Determinations (LCD’s), which are decisions on whether a service is considered reasonable by a Medicare Administrative Contractor (MAC). These fiscal intermediaries often determine the national denial rate, which can vary across products and services, but in a recent jurisdictional review of claims for Lumbar-Sacral Orthoses (HCPCS L0631 and L0637) for claims processed from December 2014 through February 2015 there was a claim denial rate of 83% for the 899 claims reviewed. Based on review of the documentation, the following were the primary reasons for claim denials: claims had a missing or incomplete detailed written order, claims had medical record documentation issues, or claims had proof of delivery issues. Read the full article on meditech.us here: http://www.meditech.us/successfully-implement-dme-program-private-practice/

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Osteoarthritis Update: 2015

Osteoarthritis (OA) is one of most common causes of chronic pain and a major cause of reduced activity in middle aged and older patients. It is estimated to affect between 20 and 30 million Americans, but these numbers may be deceiving.

Up to 85% of people older than 65 years of age have radiographic evidence of OA, and autopsy studies indicate evidence of OA in weight-bearing joints in almost all persons by the age of 45 years. Based on these statistics, it is no wonder that it feels as if every patient being treated for chronic pain has OA as a primary or contributing factor. Osteoarthritis (OA) is a common cause of pain and disability in adults. Approximately 27 million Americans have clinical OA, which translates to nearly 14% of those over age 25 and 33% of those over 65 years of age. OA is a disease of the entire joint involving the cartilage, joint lining, ligaments, and underlying bone. The breakdown of these tissues eventually leads to pain and joint stiffness. The joints most commonly affected are the knees, hips, and those in the hands.

There is a highly heritable component associated with OA. In fact, there is a genetic contribution to OA for 60% of women. Among the genes that have been linked to OA are several that are involved in the development and maintenance of joint shape, including members of the Wingless and bone morphogenetic protein families. Important genetic markers for the development and progression of the disease are under research.

OA impacts quality of life and increases health-related expenditures. For example, OA of the knee is one of the 5 leading causes of disability among non-institutionalized adults. About 80% of patients with OA have some degree of movement limitation and 25% cannot perform major activities of daily living; 11% of adults with knee OA need help with personal care and 14% require help with routine needs. About 40% of adults with knee OA report their health as “poor” or “fair.”

According to the Centers for Disease Control and Prevention, OA costs $3.4 to $13 billion per year.9 The average direct cost of OA per patient is $2,600 per year, and the total annual cost is $5,700 per person. Treatment for OA focuses on relieving symptoms and improving function, and can include a combination of patient education, physical therapy, weight control, medications, and, perhaps eventually, total joint replacement. Hospital expenditures for total knee and hip joint replacements in 2009 were estimated to be $28.5 billion and $13.7 billion, respectively.

Read the full article here: http://www.practicalpainmanagement.com/pain/myofascial/osteoarthritis/practical-overview-osteoarthritis

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Genomics: The Future Gold Standard of Medicine?

Personalized medicine, with care tailored to the unique genetic blueprint of each patient — perhaps once thought of as science fiction — is becoming a strategic imperative across the entire health care field. At NorthShore University HealthSystem, in the north Chicago suburb of Evanston, Ill., integrating genetics into everyday care has become its driving force, says President and CEO Mark Neaman. Personalized medicine touches on so many of the     hot-button issues that keep hospital executives tossing and turning at night — meeting the demands of consumerism, treating the health of patient populations and preventing hospital readmissions, to name a few.

“It’s what’s next in the practice of medicine,” he says. “We’re positioned to make this next move, but you can’t just put up a sign and say, ‘We’re into personalized medicine.’ It takes so many other components, including the talent and the commitment, the technology, and the underlying electronic health record system. You’ve got to have all of these building blocks.” NorthShore patient Sivan Schondorf has a history of breast  cancer in her family, and initially had genetic counseling in 2000. With a simple blood test in 2005, she found she had a mutation of the BRCA1 gene, meaning an 87 percent chance of developing breast cancer, along with a higher risk for ovarian cancer. After years of genetic counseling and monitoring, she decided to have a double mastectomy in 2009. Since moving back to the Chicago area in 2011, Schondorf has worked with doctors at NorthShore to develop a genetic care plan and has visited every six months or so for screenings to ensure that she doesn’t develop ovarian cancer.

The idea of tailoring care to each individual based on his or her genetics isn’t new, but it’s picked up steam with several advancements in recent years, says Kathy Hudson, deputy director for science, outreach and policy at the National Institutes of Health, which is spearheading the president’s initiative. Those include improved cost-effectiveness of collecting genetic information from     patients, expanding knowledge on how to analyze data at a precise molecular level, and the ability to mine details from electronic health records and mobile devices to gain further insights into a patient’s health, she says.Already, NIH has convened a panel of experts to figure out the course to making precision medicine a reality. As part of the initiative, President Obama earmarked $130 million toward gathering genetic, environmental, lifestyle and behavioral data     from 1 million people across the country — which Hudson acknowledges is an “audacious endeavor.” The work group is slated to deliver a preliminary report to the president in September.

While the Center for Personalized Medicine isn’t yet a revenue generator, Khandekar believes it will have a direct impact on the bottom line in soon. “This is the investment that you make for the future,” he says. “I was speaking at one hospital recently and one of the first questions was, ‘So how much money do you make?’ I said, ‘I don’t think we make any direct money at this time,’ but in a very short time, if we don’t do this, we will lose a lot of money because patients will leave us.” Read the full article here: http://www.hhnmag.com/Magazine/2015/July/NorthShore-genomics-personalized-medicine