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Tompkins Orthopedic Physical Therapy Services
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New CDC guidelines to help doctors prescribe opioids more safely: Prescription rates have been increasing recently Opioids are natural or synthetic chemicals that are used to reduce pain, and some of the most common opioids include hydrocodone (Vicodin), oxycodone (OxyContin), methadone and fentanyl. Today, they are commonly prescribed for many painful conditions, and the number of opioid prescriptions has been increasing to the point that rates have now quadrupled since 1999. Although opioids are supported by evidence to be effective for alleviating pain and improving function in the short term, it's not clear if they are also beneficial in the long term for pain lasting more than three months (chronic pain.) In addition, using opioids for any amount of time comes with serious risks, including addiction and overdose. In 2013, approximately 1.9 million people abused or were dependent on prescription opioid pain medication, and between 1999-2014, more than 165,000 people died from an overdose related to opioids. Many doctors find managing chronic pain to be challenging Many primary care doctors report that they face challenges when it comes to managing patients with chronic pain. Some doctors claim that managing these patients is stressful, and they are concerned with properly prescribing opioids, as well as the fear that patients may misuse these prescriptions or become addicted. In general, most doctors believe that opioid pain medication can be effective for controlling pain, but addiction is a common problem for patients that take them for too long. They also agree that opioids are generally over-prescribed and that more efforts are needed to regulate this. All of this information highlights the need for more guidance to help doctors manage these patients. With this in mind, The Centers for Disease Control and Prevention (CDC) created an updated set of guidelines for doctors prescribing opioids to treat patients with chronic pain. Older study is updated and supplemented with a newer study In order to create these guidelines, the CDC updated a 2014 study called a systematic review that investigated the effectiveness and risks of opioids. A systematic review is a powerful, high-quality study that collects and evaluates all available research on a topic - such as opioid prescriptions - to find common themes and hopefully reach a conclusion. Researchers also conducted another review on the benefits, harms, values, preferences and costs associated with opioids. They were interested in questions related to when opioids should be initially prescribed or continued for chronic pain, which opioids are the safest to prescribe, and how to monitor patients for potential harms. The findings from both of these reviews were combined, and a set of guidelines for prescribing opioids was established. Recommendations encourage prescribing other drugs first and starting with low dosages Based on the information reviewed, the researchers put forth a set of 12 recommendations for doctors prescribing opioids. The most important of these include the following: * Use non-opioid drugs and other treatments first before opioids; doctors should only consider prescribing opioids if the benefits outweigh the risks, and if prescribed, should be combined with other non-opioid and other treatments like physical therapy * Before starting opioids, doctors should establish treatment goals with their patients, discuss the risks and benefits, and consider how the use of opioids will stop if the benefits of using the drugs don't outweigh the risks * When opioids are used, doctors should prescribe the lowest effective dosage and only immediate-release opioids instead of extended-release or long-acting opioids * Doctors should evaluate the benefits and harms of continued opioid use with their patients every three months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages * For patients with opioid use disorder, doctors should offer or arrange assistance, such as medication-assisted treatment As a patient, it's important to be aware of these guidelines so that you know your condition is being properly managed. When making any treatment decision, your doctor should always discuss the available treatment options and carefully explain the risks and benefits associated with each one. This is necessary to make informed decisions and avoid any unnecessary treatments like opioid prescriptions that may be dangerous. Patients should also be aware that many chronic painful conditions can be effectively treated with physical therapy, which is capable of leading to significant improvements without the need for pain medications. -As reported in the February '16 issue of Recommendations and Reports http://dlvr.it/P2j8Jb
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Patients found to move better after performing certain exercises: Even though surgery is commonly used for injury, it often leads to poor results Hip fractures are one of the most common and severe types of injury in older people. In most cases, older individuals that fracture their hip are treated with surgery; however, the recovery after surgery is actually quite poor. In fact, only 30% of these patients regain the same level of physical function as before the fracture. Many of them also experience an impaired ability to stay mobile (impaired mobility) and lose their physical independence, which means they may require long-term personal care. After surgery, many patients follow a course of rehabilitation. This type of treatment aims to improve mobility, maximize physical function and prevent or reverse the loss of one's physical condition. One type of rehabilitation is structured exercise, which is designed to improve healing from the fracture and improve strength and coordination. Though supervised exercises are used to treat patients recovering from a fractured hip, it is not clearly known if they actually improve the overall mobility of these patients. Based on this, a powerful study called a systematic review was conducted, which was used to gather all the relevant studies on supervised exercise for hip fracture patients. It was followed by a meta-analysis, which analyzed each of the studies found in the systematic review and sought to make conclusions based on them. Four medical databases are searched to find appropriate studies To conduct the systematic review, four major medical databases were searched for studies on structured exercise for hip fractures. Only studies called randomized-controlled trials (RCTs) were accepted, which are considered the most powerful type of individual study. They involve randomly assigning a group of patients to smaller groups in order to determine which is more effective for treating a condition or injury. This search led to a total of 19 RCTs that were deemed acceptable and included in the systematic review. These 19 RCTs were further evaluated to determine if they could be closely compared, and 13 of them were accepted for the meta-analysis. Researchers of the meta-analysis were most interested in the primary outcome, which was overall mobility: the ability to walk, move around and change, or maintain, body position. They also looked into a number of secondary outcomes, which included measures like balance, physical performance and quality of life. All studies accepted to the meta-analysis were then analyzed in detail. Structured exercise leads to improvements in mobility after hip fracture Results from the meta-analysis showed that structured exercise does indeed lead to significant improvements in overall mobility after a hip fracture. In particular, programs that took place in settings other than hospitals were found to lead to even greater effects than those performed in hospitals. This was also found to be the case with programs that included what's called progressive resistance training. This form of training uses weights and other forms of resistance like elastic bands to build strength in the hip, and the load grows progressively heavier as the patient builds strength. These outcomes suggest that structured exercise - especially when it involves progressive resistance training and is performed outside of a hospital - can help patients with a hip fracture by improving their overall mobility. Based on this, carefully-guided exercise that fulfills these criteria may be very useful for these patients and get them back to their levels of physical functioning quicker after surgery, though more research is needed to confirm this. -As reported in the March '16 issue of the British Journal of Sports Medicine http://dlvr.it/P03bzH
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Meme Monday: Try encouraging your kids into sports like tennis and swimming or try them as a family! http://dlvr.it/Nz3KSQ
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We want you to know this...: We want you to know this... Here is our latest monthly video. http://dlvr.it/Ny2XZ7
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Booklets after surgery can help educate patients & reduce their fears: Many patients continue to have low back pain after surgery Low back pain is still one of the most common and expensive medical conditions in existence. The number of people affected by low back pain and the costs related to it is comparable to those for depression and cardiovascular disease. Some patients with low back pain also experience pain that radiates down to the leg, which is called sciatica. When these patients continue to experience pain after attempting various different types of non-surgical treatment, a type of surgery called lumbar discectomy many be recommended. This surgical procedure is generally effective for reducing leg pain, but many patients continue to experience low back pain after surgery. One reason for this lasting pain is that some patients have fears and beliefs that prevent them from moving about and staying active normally. In fact, these patients should be following a rehabilitation program and getting back into physical activities after some time, and this is found to be the best way for them to improve. This is why it's important to educate these patients after surgery and instruct them on how to get active. A booklet called "Your Back Operation" was therefore developed by a team of medical professionals to better educate these patients, and to evaluate how effective it is, a study was conducted. Two groups of patients given two different booklets Healthy patients who were scheduled to have lumbar discectomy for the first time were recruited for the study. All candidates were screened to determine if they could be included, and 102 patients were accepted and completed the entire study. These patients were evenly divided into either the control group or the intervention group. The control group received a booklet with general advice on how to recover from surgery, but it did not encourage positive beliefs or give any specific instructions on getting active and back to work. The intervention group was given the "Your Back Operation" booklet instead. This booklet encourages an active lifestyle after surgery and instructs patients to follow an early rehabilitation program led by a physical therapist to help them recover more quickly. It also tells them that returning to work earlier will lead to a faster recovery and better overall results. All patients were given questionnaires with questions about their pain, beliefs, and fears before surgery, immediately afterward and then again two months later. Both groups experience positive outcomes after reading booklets Two months after surgery, patients in both groups experienced positive outcomes from the surgery. Compared to their status before surgery, these patients reported less leg and low back pain, as well as less disability when getting around. The only major difference between the two groups was that the intervention group had fewer fears and negative beliefs about their condition after reading the "Your Back Operation" booklet. This shows that while both booklets were effective and well received by patients; the booklet that focused more on getting active was more effective for changing patients' beliefs. Since this is such an important part of the recovery process from surgery, these improved beliefs can make a big difference in helping patients improve more quickly. These booklets are also very inexpensive and can easily be distributed. From these findings, it seems that while any education may be helpful for patients after surgery, the "Your Back Operation" booklet can lead to a better overall mindset that will encourage them to get active and seek out rehabilitation from a physical therapist. -As reported in the January '16 issue of the Annals of Physical and Rehabilitation Medicine http://dlvr.it/NxpVxb
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Recipe Wednesday - Baja-Style Salmon Tacos: Yum! Click here for this tasty recipe! http://dlvr.it/NwtP8M
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Exercise & education reduces the risk for getting low back pain: It's important to figure out strategies to prevent this very common condition Low back pain (LBP) is one of the most common health conditions throughout the world. It's estimated that about 12% of the global population currently has LBP to some degree, and this makes it an extremely expensive problem as well due to the costs of treating it and time lost from work. In addition, about half of the patients who get LBP once will experience another episode within one year of recovering from it the first time. This shows how important it is to figure out ways to prevent LBP before it starts. There have been many studies that have investigated this topic, but it's still not clear what the most effective strategies are for preventing LBP. Therefore, a very powerful review of literature called a systematic review was conducted on high-quality studies that looked into treatments to prevent LBP. This was followed by a meta-analysis, which took all the data found and analyzed it in detail to help determine which methods were actually best for the prevention of LBP. A search of medical literature leads to 21 studies used in the review Researchers who were conducting this systematic review and meta-analysis searched through four major medical databases to identify studies that were relevant to the topic. They were looking for high-quality studies called randomized-controlled trials (RCTs) - the most powerful type of individual study - that investigated different strategies to prevent LBP. This search led to 21 RCTs being accepted for this current study. The 21 RCTs contained data on 30,850 different patients and investigated six different strategies for preventing LBP: exercise, education, exercise and education, back belts, shoe insoles, and other prevention strategies. These studies were then reviewed and analyzed in detail with the goal of identifying which of these strategies was the best overall. Exercise alone is effective, but adding education may be even more helpful When education is added to exercise, it appears that the combination is even more likely to reduce the risk for LBP. Unfortunately, this was not found to be the case with education alone, and it seems that it needs to be combined with exercise to have a significant effect. In addition, back belts, shoe insoles, and ergonomic adjustments were not found to prevent an episode of LBP or sick leave due to LBP. On the whole, this study further supports the combination of exercise and education as a strategy to prevent LBP. This adds to a group of research on this topic that continues to show the importance of these two components in the prevention of LBP. Patients concerned with their risk for LBP should, therefore, speak to their physical therapist for education advice and guidance on the best forms of exercise that will help prevent LBP. -As reported in the February '16 issue of JAMA Internal Medicine http://dlvr.it/NtLYNM
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Meme Monday: Pretty interesting, right?! Click here to see "9 Things You Should Know About Pain" http://dlvr.it/NrtzVS
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Recipe Wednesday - Thai-Style Chicken Curry: Sounds so yummy! Click here for this great recipe! http://dlvr.it/Npmt16
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Are you getting enough sleep? Exercise can help.: Are you getting enough sleep? Exercise can help. Here is our latest monthly video. http://dlvr.it/NpSRf9
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