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Source: Phoenix Magazine’s “Top Docs” April 2017 issue

Arizona doctors say continuing education on drug addiction is welcome, but there’s a lot more to be done to combat opioids.

Growing Pains

Written by Lauren Loftus 
Alternatives to Opioids
• Dorsal root ganglion (DRG) stimulation: The Axium™ Neurostimulator System is a new FDA-approved device that stimulates the DRG (a spinal structure densely populated with sensory nerves), providing pain relief to targeted areas of the body.
• Endomorphins: Tulane University researchers are developing a new painkiller that targets the same pain-relieving opioid receptor as morphine but is not addictive.
• Marijuana: A Harvard-led review of studies on the use of cannabinoids by pain patients found significant improvement in symptoms.
• Psychotherapy: Therapies including Cognitive Behavior Therapy work to improve quality of life and build coping mechanisms so pain becomes more tolerable.

In his annual State of the State address in January, Governor Doug Ducey announced he had sent a letter to the Arizona Medical Board and Arizona Board of Osteopathic Examiners recommending that doctors complete Continuing Medical Education (CME) in drug addiction to combat rampant opioid abuse. Many Phoenix-area doctors say this one-hour course (as part of the 40 CME hours required every two years) will be a step in the right direction, albeit a small one, for physicians to better address addiction and the slippery slope of over-reliance on prescription pain pills. The bigger issue, some say, is how we address pain in the first place.

“We created a culture where people have the impression that they should have no pain, because that’s what we told people for a long time,” says Dr. Bentley Bobrow, a professor of emergency medicine at the University of Arizona College of Medicine – Phoenix and chief medical officer of
ThePainProject.com. Over the last decade or so, he says, “we tried to treat every single kind of pain, and we over-treated it. And we inadvertently helped people become dependent on medication and surgeries.”

According to the Arizona Department of Health Services, on average, one person dies every day in the state from an overdose of prescription pain relievers – opioids such as Oxycodone and Vicodin that, like heroin, work by attaching to receptors in the brain and blocking the experience of pain. These pills are prescribed for all types of ailments, Bobrow says, often appropriately for acute pain associated with surgical recovery, broken bones, etc., but also for chronic pain that may not have a direct diagnosis. “When you see a doctor and do the tests and they don’t find anything wrong with your back or knee… then they give you a prescription,” he says.

Despite their potency and potential for abuse, many doctors receive little to no formal training on how to properly prescribe these drugs. Dr. Frank LoVecchio, an emergency medicine specialist at Banner University Medical Center Phoenix, says he had “almost none” and points out that many medical schools have only started incorporating education on addiction and opioids into curriculums in the last year.

Another issue is over-prescribing. Dr. Eric Feldman, an interventional spine physician with The CORE Institute in Phoenix, says though the vast majority of doctors have good intentions, many prescribe way too many opioid pills to patients who have had routine procedures or surgeries: “Instead of giving them 14 Percocets, they give [patients] 50… you take five after [surgery] and now you have 45 [pills] in your medicine cabinet.”

Dr. Minesh Zaveri, medical director at St. Luke’s Medical Center, says Ducey’s executive action to get physicians trained is a good start, but “we still need to address underlying issues.” Pain – especially chronic pain – is not easily fixable, he says, so it follows that pain pills aren’t a magic fix. “Society wants relief right away, but what is the source of why you’re having a problem?” he asks.

Dr. Bobrow says medical training needs to shift from the biomedical model – “what you can see, what you can quantify” – to the biopsychosocial – biological factors in addition to psychological and social factors. “All of these things together are what form our experience of pain,” he says.

Addressing pain will require a better grasp on addiction, Bobrow says, but it will also require a deeper understanding of mental health and societal trends. That’s a tall order, and one that seems impossible to cover fully in Ducey’s order for a one-hour course. “We’re trying to fish people out of the river when they’re floating by when they’re addicted,” Bobrow says. “What we really need to do is go upstream and figure out why people are falling into the river in the first place.”

Click here to read print edition: PhoenixMagazine_April2017_Zaveri

Source: Good Morning Arizona
November 14, 2016

September 14, 2016

Media Contact: Angela Menninger, 602-373-8212 (cell), angela@dualitypr.com

Dr. Minesh Zaveri Only Doctor in Phoenix to Provide ‘Last-Chance’ Pain Management Therapy

PHOENIX (Sept. 9, 2016) – Patients suffering from lifelong chronic pain, especially those who have been told that no other pain management tools exist to provide relief, now have a new treatment option at St. Luke’s Medical Center and Sonoran Pain Management.

Newly approved by the U.S. Food and Drug Administration, a neurostimulation device for chronic pain therapy allows doctors to target their efforts using electricity to change the way the brain perceives pain. The device, known as the St. Jude Medical Axium™ Neurostimulator System for dorsal root ganglion (DRG) stimulation, was used by pain management specialist, Dr. Minesh Zaveri , medical director at St. Luke’s Medical Center and Sonoran Pain Management, to treat a 64-year-old patient of Phoenix, Ariz. suffering from Chronic Regional Pain Syndrome.

“For the first time, we have a device that gives physicians the ability to effectively provide pain relief to wide array of patients with neuropathic conditions that are otherwise underserved by traditional pain management options including  prescription medications i.e. opiods as well as surgery,” said Dr. Zaveri.

Chronic pain, moderate to severe pain that persists for one or more months longer than would generally be expected for recovery to a specific disease, injury or surgery, is a largely under-treated and misunderstood condition.

According to the Institute of Medicine, chronic pain affects more than 100 million Americans, an incidence rate which outpaces heart disease, cancer and diabetes combined. Research suggests that, in total, the condition costs the American population an estimated 515 million workdays annually and generates upwards of 40 million visits to physicians each year both at a combined a cost of approximately $100 billion per year, as estimated by The American Pain Foundation.

Unlike traditional neurostimulation devices, the St. Jude Medical Axium system targets the DRG, a spinal structure densely populated with sensory nerves that transmit information to the brain via the spinal cord.

This first-of-its-kind device delivers a form of spinal stimulation that can target specific areas of the body where pain occurs. In many cases, DRG provides significant pain relief to a target pain area, without causing a patient to feel a paresthesia/tingling sensation associated with traditional neurostimulation. If the patient does experience a light tingle, it is usually confined to the local area.

Previously, common treatments included prescription painkillers and traditional spinal cord stimulators, which are implanted devices that send electrical pulses to the spinal cord to interrupt the pain signals’ pathways by delivering low intensity electrical pulses to trigger selective nerve fibers along the spinal cord. Researchers theorize that stimulating these nerve fibers diminishes or blocks the intensity of the pain message being transmitted to the brain, replacing feelings of pain with a more pleasant tingling sensation called paresthesia.

“As the only hospital in Phoenix offering the St. Jude Medical Axium system, St. Luke’s Medical Center is offering thousands of Arizonans a game-changing treatment,” said Zaveri. “Vickie Dietz is a shining example of how well the DRG stimulation works to improve pain levels and increase function through patients’ daily lives and routines.”

For Dietz, living with chronic pain meant living a life of agony.   She was prescribed significant amounts of Percocet as well as other medications which only gave side effects without significant reduction in pain or increase in function.  She saw multiple providers prior who thought only medications were an option.  She and Dr. Zaveri saw the DRG implant as a last resort to manage her debilitating chronic pain. Despite a total knee replacement in 2014, Dietz’s pain has continued to get progressively worse. In fact, after the knee replacement and months of physical therapy, the pain and accompanying symptoms continued to worsen to the point where she developed intense tightening, muscle hardness and extreme heat in the area, which would become unbearable. Many days, Dietz’s resting pain on a scale of 0 to 10, sat at an 8 or 9.

“It’s hard to explain the level of pain I felt day-in, day-out. Even common things like walking through the grocery store or having a bed sheet brush up against my knee in bed would be excruciating,” said Dietz.

The turnaround came during her trial evaluation period, in which she was fitted with a temporary device that worked like an implanted system, but could be removed. She was able to determine the level of pain relief she would feel with a permanently implanted system. During the first three days of the evaluation, she noticed a 60-70 percent improvement in pain level. By the last four days, she reported 100 percent relief.

“The results were unbelievable,” said Dietz. “I couldn’t remember the last time I didn’t feel pain or have a “fever” in my knee. I finally felt normal and knew I needed to move forward with a permanent implant.”

After Dietz’s surgery to place a permanent implant on Aug. 25, her pain has not only significantly subsided, but her mobility has significantly improved, as has the heat and hardening she felt. In fact, the pain that was at an 8 or 9 is now at a pain level 2. Given that full surgical recovery takes approximately six weeks, Zaveri is optimistic that her prognosis will only improve as she continues her recovery and begins enjoying aspects of her daily life that she has had to put on hold due to chronic pain.

Long term data from the ACCURATE clinical trial have shown significantly more patients receiving DRG stimulation achieved meaningful pain relief and greater treatment success when compared to patients receiving traditional SCS (74.2 percent vs. 53 percent). Study findings also demonstrated patients receiving DRG stimulation reported no differences in paresthesia (tingling) intensity due to changes in body position (known as postural effects) when compared to traditional SCS. After 12-months, nearly all patients receiving DRG stimulation reported better stimulation targeting in their area of pain without extraneous paresthesia than patients receiving traditional SCS (94.5 percent vs. 61.2 percent).

For more information about Dr. Zaveri’s  use of the Axium Neurostimulator System for chronic pain management, patients can call 602-795-PAIN (7246) or visit sonoranpain.com.

About St. Luke’s Medical Center
Serving Metropolitan Phoenix for more than 100 years, St. Luke’s Medical Center is a 200-bed tertiary care hospital part of IASIS Healthcare offering a full range of medical services, including emergency care, orthopedics, cardiac care, bariatrics, physical rehabilitation, pain management and wound care. St. Luke’s has a long history of innovation as the first hospital in Arizona to open a cardiac catheterization lab, and the first in the Valley to perform open heart surgery. With a focus on serving the diverse health care needs of the community, experienced professionals provide high quality care with the latest technology, in a caring environment. St. Luke’s Medical Center is an Official Healthcare Partner of the Phoenix Suns and Phoenix Mercury. For more information, visit stlukesmedcenter.com or call 1-877-351-WELL (9355).Find St. Luke’s Medical Center on Facebook and follow the hospital on Twitter.


Source: KTAR.com
September 14, 2016

PHOENIX — A Phoenix hospital has become the first in the Valley to use a new device to offer relief for chronic pain sufferers.

The device is known as the St. Jude Medical Axium Neurostimulator System for dorsal root ganglion stimulation. It’s a neurostimulation device that allows doctors at St. Luke’s Medical Center to use electricity to change the way the brain perceives pain. Continue reading.

Watch a special feature on Dr. Zaveri and spinal cord stimulation that aired on NBC Channel 12 News:

“I’ve been able to do things that I never thought I’d be able to do again. It makes me feel like a person again – and a mom. I can be a mom again. That’s the big thing.”

– Sonoran Pain patient


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