Southeastern Integrated Medical, PL

In this second of a two-part series, John Bailey, MD explores how physicians can better assess back pain patients in an effort to diagnose and treat their conditions.

In 2007, the American College of Physicians and the American Pain Society developed the Joint Clinical Practice Guidelines, to simplify and standardize the assessment of back pain patients.

The guidelines divide patients into three groups. The first priority in evaluating low back pain patients is to identify the “do not miss” group. This group of patients will have signs and/or symptoms that will require rapid evaluation for certain emergent conditions. This group can include cancer and other conditions which may trigger immediate imaging of the low back with x-rays, CT scans or MRI’s. Consultation with a surgeon specializing in the spine will often occur. These emergencies may include cauda equina syndrome (which is often caused by a herniated disc which traps and can damage spinal nerves), epidural abscess and hematoma. Unless recognized and promptly treated permanent deficits such as paralysis, loss of sensation, or loss of bladder function may result.

The second group includes patients with pain being triggered by nerve or spine joint triggers. This group includes: radiculitis (radiating pain) / radiculopathy ( neurological deficit), spinal stenosis (narrowing), facet pain, discogenic pain, and sacroiliac pain. Many of these pain triggers respond very well to interventional pain therapies such a

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In this second of a two-part series, John Bailey, MD explores how physicians can better assess back pain patients in an effort to diagnose and treat their conditions.

In 2007, the American College of Physicians and the American Pain Society developed the Joint Clinical Practice Guidelines, to simplify and standardize the assessment of back pain patients.

The guidelines divide patients into three groups. The first priority in evaluating low back pain patients is to identify the “do not miss” group. This group of patients will have signs and/or symptoms that will require rapid evaluation for certain emergent conditions. This group can include cancer and other conditions which may trigger immediate imaging of the low back with x-rays, CT scans or MRI’s. Consultation with a surgeon specializing in the spine will often occur. These emergencies may include cauda equina syndrome (which is often caused by a herniated disc which traps and can damage spinal nerves), epidural abscess and hematoma. Unless recognized and promptly treated permanent deficits such as paralysis, loss of sensation, or loss of bladder function may result.

The second group includes patients with pain being triggered by nerve or spine joint triggers. This group includes: radiculitis (radiating pain) / radiculopathy ( neurological deficit), spinal stenosis (narrowing), facet pain, discogenic pain, and sacroiliac pain. Many of these pain triggers respond very well to interventional pain therapies such as epidural spinal injections, nerve root blocks, joint injections or radiofrequency treatments.

It is estimated that 85% of low back pain patients fall into the third group. This group is often initially treated by primary care physicians. This is a huge category that includes musculoskeletal sources of pain, as well as pain secondary or exacerbated by other illnesses such as depression, and other psychiatric disorders.

Pain can also be magnified by withdrawal syndromes. The withdrawals can result from not only opioids and benzodiazepines, but also abrupt cessation of other medications such as duloxetine (Cymbalta) and venlafaxine (Effexor), Paroxitine (Paxil) and muscle relaxants such as baclofen and tizanidine.

Pain conditions are best treated by an integrated approach involving physicians who are experienced in pain management. Often pain triggers respond to treatment by an interventional pain physician and this often allows the patient to avoid or minimize the dose of opioid pain medications. Although opiods can be very effective for acute pain they are often much less effective for most chronic pain conditions due to tolerance and opioid induced hyperalgesia.

It is important to take low back pain seriously and speak with your physician if your pain does not improve within 24 hours.

For more information on this topic or to schedule an appointment with a SIMED Interventional Pain Management physician call (352) 224-1813 or click here to request an appointment online.

This is Part 1 in a two part series addressing pain. In addition to his fellowship in interventional pain, Dr. Bailey completed a two year addiction medicine/pain fellowship in the UF Department of Psychiatry. He also served as Medical Director for “The Refuge”, a rehabilitation facility specializing in patients with PTSD and co-existing psychiatric disorders.

I have found my background in Post-Traumatic Stress Disorder (PTSD) to be especially important since it is a condition I recognize in patients every day. It is extremely common that patients with pain symptoms which are out of proportion to physical findings suffer from co-existing PTSD. Sometimes careful and sensitive questioning uncovers PTSD signs and indicates a patient who would benefit from appropriate therapy.

Criteria for Post-Traumatic Stress Disorder include:

re-experiencing the original trauma(s) through(flashbacks or nightmares)
avoidance of anything associated with the trauma
increased arousal(insomnia difficulty falling or staying asleep, anger, and hyper vigilance).
“disassociating”, staring off into space, and entering into a fugue state, “blank out”.

There is evidence that PTSD, especially complex PTSD produces permanent structural and physiologic changes in the brain that profoundly influence behavior, impulse control, relationships, and the interpretation of physical and emotional input. At the root is dysfunction of brain areas such as the prefrontal cortex that change incoming physic

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This is Part 1 in a two part series addressing pain. In addition to his fellowship in interventional pain, Dr. Bailey completed a two year addiction medicine/pain fellowship in the UF Department of Psychiatry. He also served as Medical Director for “The Refuge”, a rehabilitation facility specializing in patients with PTSD and co-existing psychiatric disorders.

I have found my background in Post-Traumatic Stress Disorder (PTSD) to be especially important since it is a condition I recognize in patients every day. It is extremely common that patients with pain symptoms which are out of proportion to physical findings suffer from co-existing PTSD. Sometimes careful and sensitive questioning uncovers PTSD signs and indicates a patient who would benefit from appropriate therapy.

Criteria for Post-Traumatic Stress Disorder include:

re-experiencing the original trauma(s) through(flashbacks or nightmares)
avoidance of anything associated with the trauma
increased arousal(insomnia difficulty falling or staying asleep, anger, and hyper vigilance).
“disassociating”, staring off into space, and entering into a fugue state, “blank out”.

There is evidence that PTSD, especially complex PTSD produces permanent structural and physiologic changes in the brain that profoundly influence behavior, impulse control, relationships, and the interpretation of physical and emotional input. At the root is dysfunction of brain areas such as the prefrontal cortex that change incoming physical and emotional sensations, causing misinterpretation, and amplification. Thus patients with a history of traumatic stress often have difficulty correctly interpreting physical sensations, and pain is often magnified out of proportion to the disease or injury.

Common diagnoses that often co-exist with PTSD include: fibromyalgia, chronic headaches, temporomandibular joint (TMJ) syndrome, back, neck, abdominal, and pelvic pain. These individuals often have decreased coping mechanisms and difficulty with trusting others. These issues may complicate care and reduce compliance.

Furthermore, psychological trauma markedly increases the risk for drug abuse and addiction. Patients who suffer from posttraumatic stress disorder (PTSD) may present as angry, argumentative, and emotionally unsteady. Uncomfortable emotional memories and out of proportion emotional reactions may be triggered by reminders of the trauma. This may significantly affect the patient-physician interaction, especially if there is some characteristic the physician shares with the PTSD patient, such as hair color, facial hair etc.

There is evidence that the combination of PTSD-related emotional triggers, drug triggers (people places and things), and stresses (pain) can activate or increase drug cravings. Opioids and other potentially addictive drugs may be used to self-medicate the uncomfortable sensations associated with PTSD since opioids may temporarily decrease depression and the anxiety associated with hypervigilance.

Physicians are encouraged to carefully explore the patients past to uncover a history of abuse or trauma. It should be kept in mind that patients are often reticent to discuss their history, due to trust issues, shame, or discomfort. It is amazing how often physicians are told they were the first that ever asked and it is rewarding to help patients evolve from victim to survivor. Discussing details of their trauma should be done when there is a strong patient-physician relationship built on trust. Skilled psychology therapists can assist in identifying and dealing with traumatic events as painful memories are often repressed and inaccessible without long term therapy.

If you feel that you may suffer from PTSD related pain conditions or would like more information on this subject you may contact SIMED Interventional Pain Management to schedule an appointment by calling (352) 224-1813 or click here to request an appointment online

If you prefer you may also contact SIMED Health Psychology (Gainesville, Ocala & Chiefland) (352) 332-9441 or SIMED Psychiatry (Villages & Lady Lake) at (352) 753-6886 to discuss how PTSD may be affecting you.

This past week Cynthia Harding, MD and Gloria Chin, MD of SIMED’s Hand Center addressed an audience of more than 80 participants in The Villages on the topic of Hand Center Seminar in The Villages

Dupuytren's Contracture. This is an affliction of the hands that results in bumps, pits and fingers that curl inward due to thickening of the fascia, or tissue layer directly under the skin. Sometimes patients mistake Dupuytren's Contracture for Trigger Finger.

Although a patient might have both conditions, they are unrelated. The thick cords that patients feel when they develop Dupuytren’s are not swollen tendons. Dupuytren’s does not normally cause much pain but can impair someone’s ability to use their hands effectively for work, sports, or other simple functions including hand washing.

Surgery was once the only effective treatment for Dupuytren’s. Dr. Harding spoke on the use of Xiaflex®, an injectible medication that helps release the contracture. She explained how the injection is applied to the affected site and how the patient follows up a few days later with her or Dr. Chin to physically treat the hand. There is no cure for Dupuytren's Contracture but this treatment helps many patients resume normal use of their hands. Following Dr. Harding’s talk, she and Dr. Chin answered questions and their staff distributed educational materials.

If you would like an appointment to evaluate any hand issue including Dupuytren’s, Trigger Finger or hand & wrist injuries, call SIMED’s Hand Center at 352-751-0981 or request an appointment online.

Nutrition Facts Label Proposed Format (350x660) The U.S. Food and Drug Administration today proposed to update the Nutrition Facts label for packaged foods to reflect the latest scientific information, including the link between diet and chronic diseases such as obesity and heart disease. The proposed label also would replace out-of-date serving sizes to better align with how much people really eat, and it would feature a fresh design to highlight key parts of the label such as calories and serving sizes.

The changes proposed affect all packaged foods except certain meat, poultry and processed egg products, which are regulated by the U.S. Department of Agriculture’s Food Safety and Inspection Service.

Some of the changes to the label the FDA proposed today would:

Require information about the amount of “added sugars” in a food product.
Update serving size requirements to reflect the amounts people currently eat.
Present “dual column” labels to indicate both “per serving” and “per package” calorie and nutrition information for larger packages that could be consumed in one sitting or multiple sittings.
Require the declaration of potassium and vitamin D, nutrients that some in the U.S. population are not getting enough of, which puts them at higher risk for chronic disease. Vitamin D is important for its role in bone health. Potassium is beneficial in lowering blood pressure. Vitamins A and C would no longer be required on the label, though manufacturers could declare them voluntarily.
Revise the Daily Values for a variety of nutrients such as sodium, dietary fiber and Vitamin D.
While continuing to require “Total Fat,” “Saturated Fat,” and “Trans Fat” on the label, “Calories from Fat” would be removed because research shows the type of fat is more important than the amount.
Refresh the format to emphasize certain elements, such as calories, serving sizes and Percent Daily Value, which are important in addressing current public health problems like obesity and heart disease.

For more information on the proposed guidelines click here. Speak with your SIMED physician to find out if you're eating properly and what you can do to improve your nutrition.

Nutrition Facts Label Proposed Format (350x660) The U.S. Food and Drug Administration today proposed to update the Nutrition Facts label for packaged foods to reflect the latest scientific information, including the link between diet and chronic diseases such as obesity and heart disease. The proposed label also would replace out-of-date serving sizes to better align with how much people really eat, and it would feature a fresh design to highlight key parts of the label such as calories and serving sizes.

The changes proposed affect all packaged foods except certain meat, poultry and processed egg products, which are regulated by the U.S. Department of Agriculture’s Food Safety and Inspection Service.

Some of the changes to the label the FDA proposed today would:

Require information about the amount of “added sugars” in a food product.
Update serving size requirements to reflect the amounts people currently eat.
Present “dual column” labels to indicate both “per serving” and “per package” calorie and nutrition information for larger packages that could be consumed in one sitting or multiple sittings.
Require the declaration of potassium and vitamin D, nutrients that some in the U.S. population are not getting enough of, which puts them at higher risk for chronic disease. Vitamin D is important for its role in bone health. Potassium is beneficial in lowering blood pressure. Vitamins A and C would no longer be required on the label, though manufacturers could declare them voluntarily.
Revise the Daily Values for a variety of nutrients such as sodium, dietary fiber and Vitamin D.
While continuing to require “Total Fat,” “Saturated Fat,” and “Trans Fat” on the label, “Calories from Fat” would be removed because research shows the type of fat is more important than the amount.
Refresh the format to emphasize certain elements, such as calories, serving sizes and Percent Daily Value, which are important in addressing current public health problems like obesity and heart disease.

For more information on the proposed guidelines click here. Speak with your SIMED physician to find out if you're eating properly and what you can do to improve your nutrition.

SIMED is pleased to announce the arrival of two new physicians.

Joseph Gentile, MD
Orthopedic Surgery

Dr. Gentile is accepting patients at SIMED’s Gainesville location:
4343 Newberry Road, Ste 2, Gainesville

To schedule an appointment with Dr. Gentile, please call (352) 332-7246 or you can click here to
request an appointment online.

Tenley Noon, MD Tenley Noone, MD
Family Medicine

Dr. Noone is accepting patients in Primary Care & Urgent Care at these SIMED locations:
20410 10th Street, McIntosh
4343 Newberry Road, Ste 10, Gainesville

To schedule an appointment with Dr. Noone, please call (352) 224-2225 or you can click here to
request an appointment online.

SIMED is proud to announce that we have been recognized as a Florida Fit Friendly Company! This award, presented by the state of Florida's Surgeon General John Armstrong, MD, FACS and on behalf of the Florida Department of Health, is presented to organizations whose Wellness programs educate and encourage individuals to make more meaningful choices towards a healthier lifestyle.

A special "Thank You" goes out to our employees and their families who are helping to make SIMED a top Wellness company in North Central Florida!

Florida Fit Friendly Worksite Wellness Award

SIMED believes in providing the best possible care to our patients. Your opinion matters to us so let us know how we're doing! By taking our brief patient survey you can help us not only improve our customer service, but acknowledge our SIMED employees who are doing an exceptional job for you already.

You can also help us recognize our outstanding SIMED employees by nominating them for our Starfish Employee Recognition Program if they've done something to Make Your Day while you were visiting a SIMED location.

It's easy! There are 3 ways to nominate any SIMED employee:

1. Through the Online Patient Survey
2. By Requesting a paper nomination form at any SIMED location
3. By telling any SIMED manager!

Let us know about the SIMED employees who have helped Make Your Day!