The US Centers for Medicare and Medicaid Services Promotes More Access to Nondrug Pain Management in Medicaid

The US Centers for Medicare and Medicaid Services believes that medicaid should be providing more access to non-drug pain management such as rehabilitative, physical therapy, and preventive services. This stems from the fight against opioid misuse that has been plaguing the country more and more recently.

Could states be doing more to increase access to nonopioid and nonpharmacological approaches to management of chronic pain under Medicaid? The US Centers for Medicare and Medicaid Services (CMS) thinks so, and has issued guidance that outlines options and shares examples of some states’ promising initiatives. The approaches are largely consistent with APTA’s #ChoosePT opioid awareness campaign, which emphasizes the importance of patient access and choice in the treatment of pain.

The CMS information bulletin released in late February is anchored in the US Centers for Disease Control and Prevention’s (CDC) guidelines for prescribing opioids for chronic pain, published in 2016. Those guidelines, which recommend nonopioid approaches including physical therapy as the preferred first-line treatment for noncancer chronic pain, have been increasingly acknowledged and adopted by state health care entities, and early reports are positive, according to CMS. The new CMS document is designed to help states understand possible avenues for incorporating programs that help support the CDC guidelines.

In outlining possibilities that could allow for the use of nonpharmacological approaches to chronic pain, CMS offers states a wide palette of mandatory and optional benefits, from more effective use of inpatient, outpatient, and health center services to expanded coverage for rehabilitative, physical therapy, and preventive services. The bulletin also offers home health benefits, special “demonstration” projects, and potential waivers as ways states could take creative steps to strengthen their nondrug offerings.

CMS also offers examples of states that have changed or extended their Medicaid coverage options, including Oregon, which expanded its list of Medicaid-covered services for uncomplicated back and neck pain to include physical therapy, cognitive behavioral therapy, and other services; and California, where a 14-county Medicaid program implemented an intensive prescriber education program on nonopioid options for pain management.

APTA has been engaged in the fight against opioid misuse in multiple ways. In addition to its flagship #ChoosePT opioid awareness campaign, the association has produced a white paper on reducing opioid use and contributed to the National Quality Partners Playbook on Opioid Stewardship. On the advocacy front, APTA continues to meet with legislators and agency representatives to address the opioid crisis, and comments on a range of topics, including a federal Pain Management Best Practices Inter-Agency Task Force draft report. Additionally, a recent formal partnership between APTA and the Department of Veterans Affairs includes collaboration to promote veterans’ access to nopharmacologic approaches to pain management.

“Providers and beneficiaries need access to effective therapy for chronic pain,” CMS writes. “A multidisciplinary approach…that incorporates nonopioid pharmacologic and nonpharmacologic therapies, well-communicated treatment goals and expectations, and a careful consideration of the benefits and risks of available treatment options is the most appropriate approach for most patients and has the potential to lead to more appropriate prescribing of opioids.”

Source: http://www.apta.org/PTinMotion/News/2019/03/05/CMSMedicaidPain/

Symptoms and Treatments for a Pulled Chest Muscle

“The terms pulled muscle and muscle strain refer to an injury that involves an overstretched or torn muscle. A person with a muscle strain in the chest may experience sudden, sharp pain in this area.”

Although uncomfortable, a strained chest muscle is usually a minor injury that tends to heal within days or weeks.

This article outlines the causes of a pulled chest muscle, and explains the possible treatments. You’ll also learn how to differentiate the symptoms from those of other causes of chest pain.

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Source: https://www.medicalnewstoday.com/articles/324534.php

Do You Experience Muscle Aches?

Muscle aches are a common, often times unexplained medical issue that individuals face. There are many factors that play into your muscles being sore. They extend through medical issues, trauma, over-use and more. This article breaks down the causes of muscle aches as well as information to speed up the healing process.

Please accept our privacy terms

We use cookies and similar technologies to improve your browsing experience, personalize content and offers, show targeted ads, analyze traffic, and better understand you. We may share your information with third-party partners for marketing purposes. To learn more and make choices about data use, visit our Advertising Policy and Privacy Policy. By clicking “Accept and Continue” below, (1) you consent to these activities unless and until you withdraw your consent using our rights request form, and (2) you consent to allow your data to be transferred, processed, and stored in the United States.

Source: https://www.medicalnewstoday.com/articles/322869.php

Alopecia PRP Treatment

European star Vicky Pattison recently spoke out about her struggle with alopecia. While being in the spot light, Vicky has overused extensions and other hair growth treatments. She has now turned to PRP therapy to help stimulate hair growth. Vicky has documented her treatments on her social media platforms.

Source: https://www.google.com/url?rct=j&sa=t&url=https%3a%2f%2fwww.ok.co.uk%2flifestyle%2fbeauty%2f1448552%2fvicky-pattison-hair-loss-treatment-traction-alopecia-prp-therapy-geordie-shore-john-noble-wedding&ct=ga&cd=CAIyGjc3ZTJhNmY5MDMyMTNlMzA6Y29tOmVuOlVT&usg=AFQjCNGU90zPeqzqu2oDj-S3i6KMT9Xs2A

What is causing your deltoid pain?

Not only are your deltoid muscles in charge of lifting your arms and giving your shoulders its range of motion, it’s one of the most common areas we experience pain post-workout or activity. Symptoms vary from person to person, and remedies depend on the type of injury or strain you are experiencing. If you are experiencing muscle pain, contact us today on how we can help you!

Source: https://www.medicalnewstoday.com/articles/322031.php

13 Causes of Middle Back Pain

The treatment plan for middle back pain ultimately relies on the underlying cause of the problem. Understanding what is causing your pain and discomfort is a huge step in finding a solution. With as many vertebrae, spinal disks, muscles and ligaments as there are in the back, there are many different reasons for pain and areas that need to be assessed.

Source: https://www.medicalnewstoday.com/articles/321195.php

Researchers Say Frequent TV-Watching Comes With VTE Risk That Can’t Be Eliminated Through Physical Activity

Everyone it seems needs to have a good binge watching TV session every once and a while. It helps us de-stress, unwind, relax, and clear our heads, as well as being a form of entertainment. This process though, may not be always good for us as researchers are finding out. Being a couch potato may come with risks that exercise can’t reverse:

Dedicated binge-watchers take note: a new study has found that in addition to its link to other well-established negative health effects, regular long periods of television viewing can also increase risk for venous thromboembolism (VTE)—and it’s a risk that isn’t dramatically offset by increased levels of physical activity (PA).

The study tracked the self-reported television viewing and PA habits of 15,792 participants aged 45-64 over a series of surveys that began in 1987-1989, with follow-ups every 3 years after that, through 2011. Participants were part of the Atherosclerosis Risk in Communities (ARIC) research initiative administered in Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and suburbs of Minneapolis. Researchers excluded participants who reported baseline VTE or anticoagulant use.

Participants were asked to rate their television viewing habits during leisure time as “never,” “seldom,” “sometimes,” “often,” or “very often” at baseline, visit 3 (1993-1995), and visit 5 (2009-2011). Researchers also tracked estimates of physical activity using the Baecke physical activity questionnaire, which asks respondents to estimate the duration and intensity of PA during the previous year. Demographic variables and body mass index (BMI) also were recorded. Results were published in The Journal of Thrombosis and Thrombolysis (abstract only available for free).

For purposes of the study, researchers divided PA responses into 3 levels based on American Heart Association recommendations: “recommended” (75 or more minutes per week of vigorous intensity PA or 150 or more minutes of a combination of moderate and vigorous intensity PA), “intermediate” (up to 74 minutes per week of vigorous intensity PA or up to 149 minutes per week of a combination of moderate and vigorous intensity PA), and “poor” (no reported vigorous or moderate PA). They also reduced television-viewing categories from 5 to 4 after finding that no participant reported “never” watching television. Here’s what they found:

  • Among all participants, 18.6% reported watching television “seldom,” 46.8% reported watching “sometimes,” 26.5% reported watching “often,” and 8.1% reported watching “very often.”
  • Age, sex, and race-adjusted models showed a positive dose-response correlation between frequency of television viewing and VTE incidence (a total of 691 events during the study period), with participants who watched television very often having a 1.71 times higher risk of VTE than those reporting “seldom” watching television.
  • The relationship of VTE risk to television viewing remained in place despite levels of PA. Participants who reported “recommended” levels of PA and watching television “very often” were found to have a 1.8 times greater risk of VTE than the seldom-watch group—a risk rating not much different from the 2.07 times increased risk associated with the group that reported watching television very often and having no PA.
  • BMI did play a role. Obese individuals who reported watching television “very often” were found to have a 3.7 times higher risk of VTE than normal-weight individuals who reported watching television “seldom.” However, authors note that higher BMI did not explain the associations observed between television viewing and PA.

The relationship between sedentary behavior and poorer health may be well-known, but authors of this study believe they’ve added a new dynamic—the inability of PA to counteract the risk for VTE caused by prolonged sitting.

“These results suggest that sedentary behavior is not just the opposite issue from [PA],” authors write. While they acknowledge that individuals who engaged in more PA did lower their risk of VTE independent of television viewing frequency, the researchers also point out that “even individuals who met the…recommended level of [PA], when they viewed TV very often, had an increased risk of VTE compared with those who met the recommended level and seldom watched TV.”

The results echo findings in a study from 2017 that concluded that risk of a mobility disability increased relative to television-viewing time, regardless of hours spent in PA.

[Editor’s note: for more information on the role of the physical therapist in the treatment of individuals diagnosed with VTE, check out this clinical practice guideline available at PTNow.]

Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association’s PTNow website.

Source: http://www.apta.org/PTinMotion/News/2018/04/03/VTERiskTV/

Middle back pain: Causes, treatment, and exercises

Back pain is not something anyone wants to deal with, or live with. You or someone you know may suffer from back pain daily, and many times people do not even know the causes, or that simple exercises or treatments can be done to improve the quality of life. Find out what is causing your middle back pain, and how to treat it!

Source: https://www.medicalnewstoday.com/articles/321195.php

Relieving Neck and Back Pain From Work

Do you have a job that requires you to sit at a desk for about 8 hours a day staring at a computer screen?  Do you find that your neck feels stiff at times for no reason?  We’re here to tell you that it could be related to sitting at your desk.  The good news is that there are ways to stretch and exercise your neck and back to relieve the pain.  The article below gives you a more thorough explanation as to why your neck is hurting and examples of exercises to try anywhere – even in your office.

Try these simple exercises to help stop neck pain giving you grief at work

Updated

As the Christmas-New Year break draws to a close, many of us will trudge back to office buildings and sit down in our cubicles to start the working year.

If the prospect of sitting in front of a computer for 40 hours (or more) a week for another 12 months triggers a sudden need to massage or stretch your neck, you’re not alone.

A 2010 study reviewing the global burden of diseases ranked neck pain as the fourth most common disability, and it’s a common problem affecting men and women in the so-called knowledge workforce.

Employers often rely on ergonomic adjustments to improve the health and comfort of their staff — lifting or lowering chair heights, repositioning computer screens or fiddling with the angle of keyboards.

However, a researcher from the University of Queensland has found regular exercise can do a better job of reducing neck and shoulder pain than ergonomic adjustments alone.

Dr Xiaoqi Chen, a physiotherapist and post-doctoral researcher, asked 760 Brisbane office workers to pair ergonomic adjustments with a set of regular strengthening exercises to study the effect on pain levels.

Those who performed the exercises regularly (at least two-thirds of the time) reported a reduction in neck pain at work.

“We found that general fitness exercises such as walking, running and cycling were useful, but neck and shoulder-specific strengthening exercises were more beneficial and there was a larger effect size with our meta-analysis,” she said.

Despite the high prevalence of neck and shoulder pain around the world, a lack of research means little is known about the numerous causes of neck pain and the best methods of prevention and treatment.

“Neck pain is a very complex phenomenon,” Dr Chen said.

“Some risk factors are modifiable, such as a lack of physical activity, a lack of physical capacity of the neck and shoulder muscles or a poor ergonomic set up.

“That’s good news because these are factors we can modify to improve neck pain.”

Two factors that can’t be controlled are age and gender.

Dr Chen said current research showed women were at a higher risk of developing neck pain, especially those with office jobs.

“We’re hoping that perhaps employers and industries would pay more attention to exercise because all this time people have been spending a lot of money and effort on ergonomic adjustments.

“It’s not to say that ergonomic adjustments are not useful, but perhaps we could start doing a combination of ergonomic adjustments as well as introducing exercises into the workplace which might benefit more people.”

Exercises to prevent neck, shoulder pain

Front raise

  • Hold a weight (or resistance band) in each hand in front of your thighs, palms facing down
  • Raise your arms in front of you, pausing when they reach shoulder height
  • Slowly lower your arms to the starting position

Side raise

  • Hold a weight (or resistance band) in each hand and rest your arms at your sides
  • Raise your arms until they’re parallel with the floor, pausing when they reach shoulder height
  • Slowly lower your arms to the starting position

Reverse fly

  • Hold a resistance band in front of you at shoulder height
  • Pull your arms, and the band, apart and pull your shoulders back
  • Hold the stretch while gently squeezing your shoulder blades together
  • Return to the starting position

These exercises strengthen your deltoid, trapezius and rhomboid muscles.

So why is it so hard to keep your back strong if you’re sitting at a desk all day?

“I reckon this is related to the computerisation of work in recent years,” Dr Chen said.

“And also these days people are using iPhones and iPads a lot more so they’re having to look down on their phones and also having to be in stationary postures for long periods of time.

“It’s definitely not a natural position to adopt and I reckon that might be related to why some of these people are getting neck pain.”

Strengthening your muscles takes time — up to 10 weeks if you’re making it a regular part of your routine.

Dr Chen said finding an exercise buddy and tracking your improvements was a good way to keep motivated and stay on track.

“We suggest people to start off with a weight that is about 50 per cent of their one repetition maximum to be safe and do about 10 to 15 repetitions of those, maybe about 20 minutes each time, three to five times a week for 10 weeks,” Dr Chen said.

“We would also strongly suggest to people, when they’re starting a new exercise, to consult their doctor and physiotherapist before doing so.”

Exercise at work

Associate physiotherapy professor Dr Venerina Johnston is collecting data from Dr Chen’s research to see how employee exercise at work affects productivity.

She said many workplace health initiatives required staff to participate after work or during their lunch hour, but in this case employees were allowed to exercise during work hours.

“One of the criteria was that the organisation had to give the staff time off to do the exercises, which is about an hour a week, so that’s why we looked at productivity as one of our outcomes,” Dr Johnston said.

“If you’re going to give people time off to exercise, then you want to know what the impact is, negative or positive.”

She and Dr Chen said employers looking to incorporate exercise into strategies to improve employee health could foster competition by setting up a leaderboard or offer incentives to groups that completed strengthening exercises regularly.

 

Source: http://www.abc.net.au/news/2018-01-02/simple-exercises-to-reduce-neck-pain-for-office-workers/9283044

Treating Sciatic Nerve Pain

Your sciatic nerve is a nerve that leads from your back down your leg and if it becomes inflamed or injured it can cause a lot of pain.  However, there are potential solutions for pain relief.  The article below gives a list of solutions to try.  Chiropractic care is listed at the top because it is a method you can frequently seek.  We often see patients with sciatica at Integrated Wellness in South Jordan, so if you suffer from sciatica schedule an appointment with us after continuing to read below.

11 Effective Solutions For Sciatica Pain

When it comes to sciatica, there’s no shortage of treatments.

December 18, 2017
What is sciatica?
Sciatica is leg pain caused by a pinched nerve in the lower back. Although the pangs begin in nerve roots located on either side of the lower spine, they then course through the sciatic nerve, which runs the length of each leg from the buttock down to the foot. The leg agony, called radiculopathy, “is often worse than the back pain,” says William A. Abdu, MD, medical director of the Spine Center at Dartmouth-Hitchcock Medical Center. Usually felt in one leg, the sensation “can be intolerable,” says Birgit Ruppert, a physical therapist at the Spine Center. “Some people liken it to the nerve pain you experience if you have a toothache.” 
Why it happens

The most common cause is a herniated disk: When a disk develops a tear or crack and bulges into the spinal canal, it can pinch the sciatic nerve. Usually, symptoms clear up within about six weeks, but for some people, the pain can last far longer.

Ready to start feeling better? Here are a few treatments worthy trying:

Chiropractic Care

Sixty percent of people with sciatica who didn’t get relief from other therapies and then tried spinal manipulation experienced the same degree of pain relief as patients who eventually had surgery, found a 2010 study in the Journal of Manipulative and Physiological Therapeutics. The 120 people in the study saw a chiropractor about 3 times a week for 4 weeks and then continued weekly visits, tapering off treatment as they felt better. In people who responded to chiropractic care, benefits lasted up to a year. “Spinal manipulation may create a response in the nervous system that relieves pain and restores normal mobility to the injured area,” says study researcher Gordon McMorland, DC, of National Spine Care in Calgary, Alberta. “It also reduces inflammation, creating an environment that promotes the body’s natural healing mechanisms.”

Acupuncture

“You can get relief as soon as the first session, though it takes about 12 sessions to see improvement,” says Jingduan Yang, MD, assistant professor at the Jefferson Myrna Brind Center of Integrative Medicine at Thomas Jefferson University. A small study in the Journal of Traditional Chinese Medicine found that of 30 people with sciatica, 17 got complete relief and 10 saw symptoms improve with warming acupuncture, in which the needles are heated.

Yoga

A study in the journal Pain reported that people with chronic back pain who practiced Iyengar yoga for 16 weeks saw pain reduced by 64% and disability by 77%. Although yoga’s effects on sciatica are less clear, gentle forms may be beneficial. By strengthening muscles and improving flexibility, a yoga practice can help sciatica sufferers “move and function better so they don’t fall into a posture that aggravates the sciatica,” says James W. Carson, PhD, a psychologist at the Comprehensive Pain Center at Oregon Health & Science University. For extra grip and stability, try these Natural Fitness Grip Socks ($13, bedbathandbeyond.com ).

Trigger Point Massage

Don’t expect a chilled-out spa massage if you have sciatica. In this instance, trigger-point therapy is best, says Jeff Smoot, vice president of the American Massage Therapy Association. The sciatic nerve sits underneath a muscle called the piriformis, which is located beneath the glutes. “When the piriformis muscle gets tight, it pinches the sciatic nerve, causing tingling and numbness down into the leg,” says Smoot. He applies pressure to irritated and inflamed areas, or trigger points, in the piriformis muscle, as well as in muscles in the lower back and glutes. Typically, Smoot schedules treatments 7 to 10 days apart. If patients don’t see progress by the fourth visit, “they need to try another form of therapy,” he says.

Topical Preparations

St. John’s wort oil ($10, amazon.com), a liniment, is “one of my favorites for nerve pain,” says Tieraona Low Dog, MD, director of the fellowship at the Arizona Center for Integrative Medicine. Apply the anti-inflammatory oil two or three times a day where there’s pain. Another option: an OTC cayenne pepper cream ($17, amazon.com); capsaicin, found in chiles, hinders the release of pain-causing compounds from nerves. For severe cases, Low Dog uses the prescription chile patch Qutenza, designed for shingles pain. “One application is effective for weeks,” says Low Dog.

Ice or Heat

Because the sciatic nerve is buried deep within the buttock and leg, ice or heat on the surface of the body won’t ease that inner inflammation. But the time-honored treatments can act as counterirritants—that is, “they give your body other input in the painful area, and that brings the pain down a notch,” says Ruppert. Apply an ice pack or a heating pad ($28, amazon.com) as needed for 15 minutes.

Devil’s Claw

The herbal medication devil’s claw is “quite a potent anti-inflammatory, working like ibuprofen and similar drugs to inhibit substances that drive inflammation,” says Low Dog. She generally starts patients on 1,500 to 2,000 mg twice a day. Look for a brand that has a standardized extract of roughly 50 mg of harpagoside, the active compound. Safety reviews show that the supplement is well tolerated by most people but should be avoided by patients with peptic ulcers or on blood-thinning medications. (Find supplements you can trust here.)

Pain Relievers and Muscle Relaxants

Taking a nonsteroidal anti-inflammatory drug, either OTC (like ibuprofen) or Rx, can ease the distress. Because painful muscle spasms may also accompany a disk herniation, doctors sometimes prescribe muscle relaxants or pain-reducing tricyclic antidepressants. (Just don’t make any of these 13 common mistakes you’re making with your pain meds!) A caveat: “These won’t help with the pain caused by pressure on the sciatic nerve,” says A. Nick Shamie, MD, a spokesperson for the American Academy of Orthopaedic Surgeons.

Epidural Steroid Injections

People whose pain doesn’t lessen within about a month and who aren’t helped by other therapies may find their pain remedied by an x-ray-guided injection of steroid into the lower back near the sciatic nerve, says Raj Rao, MD, a spokesperson for the AAOS. “The hope is to reduce inflammation within that nerve branch,” explains Rao. Because of concerns about side effects, such as loss of bone density, the epidural shots are limited to three a year.

Exercise and Physical Therapy

Moving is usually the last thing people dogged by sciatica want to do, but it’s important to be physically active. “Lying in bed makes it more likely that the pain will last longer,” says Ruppert. “Exercise increases blood flow to the disk and the nerve, helping to get rid of the chemicals causing the inflammation.” Take 15- to 20-minute walks. If that hurts too much, give swimming or water aerobics a try; there’s not as much pressure on the back when you’re in the water, says Ruppert. It may also be worth seeing a physical therapist, who can prescribe stretching exercises to restore flexibility to the back or moves that strengthen core muscles, helping to stabilize the spine and reduce the likelihood of a similar injury.

Surgery

After 4 to 6 weeks of unremitting symptoms, patients may qualify for surgery. The Spine Patient Outcomes Research Trial found that those who had surgery for a herniated disk had greater decreases in pain and disability 3 months afterward than patients who did not. The benefits lasted up to 4 years.

Source: https://www.prevention.com/health/health-concerns/best-treatments-sciatic-nerve-pain