Beyond Opioids: The Future of Pain Management

March 14, 2018 — Cindi Scheib wanted to die.

A three-day weekend spent jumping and dancing on Labor Day 2014 had left her with a neck injury – specifically the cervical spine – that was possibly an exacerbation of an unrecognized mountain biking injury earlier that year. To make matters worse, her doctor performed the surgery to fix the injury on the wrong part of her spine.

Now 54, Scheib has lived with constant neck pain and other unusual sensations throughout her body ever since. These sensations, including electrical shocks down her spine, buzzing, vibrating, burning sensations, ringing in her ears and sensitivity to normal noises, had gotten so bad, she said, that “I wanted to go to bed and not wake up tomorrow. This life was so bad, so horrible, that I couldn’t imagine how I was going to live the rest of whatever life I had,” says the Harrisburg, PA, nurse.

Full story at WedMD

Magnetic nano-sized disks could restore function for Lou Gehrig’s disease patients

For decades the renowned English physicist Stephen Hawking lived with a motor neuron disease until his death last year. People who suffer from this condition lose functionality of brain cells that control essential muscle activity, such as speaking, walking, breathing and swallowing.

To help individuals afflicted by MNDs, UTSA has embarked on revolutionary research that uses magnetic nano-sized disks and magnetic fields to individually modulate functionality to crucial neurons. This research could open the door to reversal of degenerative conditions like Hawking’s to restore the quality of life for about 1 million adults across the globe.

Full story at Medical-News

Standard methods not adequate to detect prosthetic joint infections in rheumatic disease patients

Standard diagnostic methods are not adequate to identify prosthetic joint infections (PJIs) in patients with rheumatic diseases, according to findings from a new study by researchers from Hospital for Special Surgery (HSS) in New York City. The study was presented at the American College of Rheumatology/Association of Rheumatology Professionals annual meeting in Atlanta on November 12.

Lead study author Susan M. Goodman, MD, a rheumatologist at HSS, said that while patients with rheumatic diseases are more prone to developing PJIs, it is also harder to make a PJI diagnosis in this population because many of the typical inflammation features of PJIs are similar to those seen in inflammatory arthritis flares. “If a patient with osteoarthritis comes in with a swollen and inflamed prosthetic joint, it is an infection until proven otherwise, but for patients with rheumatoid arthritis, it can be very hard to sort out whether this is part of an overall flare of disease or if it is a true infection,” she said. “None of the available tests are that helpful.”

Full story at News-Medical

On the PTA Payment Battleground, We Are All APTA

I was working as a physical therapy technician when Congress instituted the Medicare cap on therapy services on January 1, 1999. I was to graduate as a physical therapist assistant (PTA) in May of that year, and, at that time, I had no idea or even much concern about what the cap would mean for our profession or my career.

I heard horror stories about layoffs of physical therapists (PTs) and PTAs due to the payment changes, but as a new graduate I was focused solely on finding a job in my chosen profession. It was not until years later, when I began working in outpatient care and seeing problems with payment, that I realized the importance of getting involved with advocacy.

Since that time, I have been as engaged as possible at the local, state, and national levels to be part of the solution to problems that arise for our profession, including payment for the services that we provide to our patients on a daily basis.

Full story at APTA

New Research: Prescriptions for Narcotics Are Surging for Knee Pain

Although physical therapy and lifestyle changes have been shown to bring significant improvements to those with knee osteoarthritis, new research suggests U.S. physicians may be leaning toward pain medications instead.

Published in Arthritis Care & Research, the study looks at 2,297 physician visits for the condition, data that’s kept in a national database. Researchers found that PT and lifestyle suggestions—like losing weight, quitting smoking, eating healthier foods, and getting more exercise—declined from 2007 to 2015, while prescriptions for nonsteroidal anti-inflammatory drugs, narcotics, and opioids increased.

In fact, during study period, lifestyle recommendations and referrals for physical therapists were reduced nearly by half, while prescriptions for narcotic pain relievers nearly tripled.

Full story at Runner’s World

Does Everyone Have a Unique Muscle Activation ‘Fingerprint?’ Researchers Say Yes

The message
It’s no secret that people move differently, but researchers who carefully tracked muscle movements of study participants during exercise think the differences may go even deeper than variation in movement styles. Their conclusion: humans possess muscle activation “signatures” that are as unique to each individual as fingerprints or iris structure. Not only could these patterns be used to identify an individual, they write, but finding a person’s activation strategies could help to identify the potential for future musculoskeletal problems, and better tailor treatments to individual patient needs.

The study
Researchers analyzed movement patterns of 53 individuals using surface electromyography (EMG) on their legs as they pedaled on a stationary bicycle and walked on a treadmill. Using a machine learning protocol, authors of the study tracked activation patterns from 8 muscles of the right leg: the vastus lateralis (VL), rectus femoris (RF), vastus medialis (VM), gastrocnemius lateralis (GL), gastrocnemius medialis (GM), soleus (SOL), tibialis anterior (TA), and biceps femoris-long head (BF). They used the data to establish unique muscle activation signatures recorded during an initial session. Participants then returned for a second round of the same activities between 1 and 41 days after the first (average, 13 days), allowing researchers to evaluate the similarities between activation patterns observed at each session.

Full story at APTA

Study Finds Racial Variation in Post-Operative Care Following Knee Replacement Surgery

A large study analyzing 107,000 knee replacement surgeries found that African Americans were significantly more likely than white patients to be discharged to an inpatient rehabilitation or skilled nursing facility rather than home care after the procedure. Researchers also found that African American patients under 65 were more likely to be readmitted to the hospital within 90 days of a knee replacement.

The regional database analysis study was published in JAMA Network Open, an open access journal of the American Medical Association, on October 30. It was a collaborative effort among researchers from Hospital for Special Surgery (HSS) in New York City (Michael L. Parks, MD), the University of Alabama at Birmingham (Jasvinder Singh, MBBS, MPH), the University of Pennsylvania (Yong Chen, PhD) and Weill Cornell Medicine/New York Presbyterian Hospital (Said A. Ibrahim, MD, MPH). The study included patients who had elective knee replacement surgery in the state of Pennsylvania between 2012 and 2015.

Full story at Hospital for Special Surgery

APTA Cosponsored Study: Direct Access to Physical Therapy for LBP Saves Money, Lowers Utilization Better When It’s Unrestricted

Unrestricted Direct Access to Physical Therapist Services Is Associated With Lower Health Care Utilization and Costs in Patients With New-Onset Low Back Pain

The message
Does unrestricted direct access to a physical therapist (PT) make a difference compared with “provisional” direct access systems that include restrictions such as visit limits and referral requirements for specific interventions? A new analysis of insurance claims records from nearly 60,000 adults across the US says yes.

The study, cosponsored by APTA, reveals that for patients with new-onset low back pain (LBP), seeing a PT first in states with unrestricted direct access resulted in lower health care costs and use compared with patients seeking care in provisional access states. And the differences don’t end there: researchers found that patients in provisional access states who saw a PT first tended to incur higher costs than those who saw a primary care provider (PCP) first, while data from unrestricted direct access states showed relatively equal, if not slightly lower, costs for seeing a PT first compared with PCPs.

Full story at APTA

Final Home Health Rule Cements PDGM, Allows PTAs to Perform Maintenance Therapy

When it comes to its most talked-about provisions, the US Centers for Medicare and Medicaid Services’ (CMS) final rule for home health payment under Medicare isn’t much of a change from the proposed version released earlier this year, meaning that an entirely new payment system will indeed be rolled out beginning January 1. But other parts of the rule have been tweaked—and in several areas, those tweaks represent wins for the physical therapy profession and the patients it serves in home health settings.

It’s official: PDGM is on for 2020.
There wasn’t much debate about whether this would happen, but the final rule eliminates any doubt: the Patient-Driven Groupings Model (PDGM) will be the system under which CMS pays home health agencies (HHAs). It’s a big change, and APTA offers extensive information on the details of the model, but the bottom line is that the PDGM moves care from 60-day to 30-day episodes and eliminates therapy service-use thresholds from case-mix parameters. The system classifies episodes according to a set of 5 major buckets and subsets within those buckets. Patients are assigned a status within the 5 major areas, and within some of those areas they can be assigned to more detailed clinical categories—the combination of categories assigned to a patient generates a particular case-mix grouping. CMS says it will monitor how HHAs are operating under the PDGM, including the provision of therapy services.

Full story at APTA

Traumatic brain injury patient lives to tell the tale

John Kaczmarczyk’s wife, Noelle, and their son, Dylan, were at home when they heard a thud. They went to investigate the sound and found the alarming cause. John, 58, was unconscious on the floor at the bottom of a flight of stairs with shattered glass around him.

Rapid response

Noelle and Dylan quickly assessed the situation. They suspected John fell backwards while walking up the stairs to take out the recycling. He was breathing and they didn’t see blood at first. Noelle stayed with John and Dylan went to call 911.

Everything that happened next felt like rapid fire to Noelle. Emergency medical services quickly arrived at their home and transported John to the Norwalk Hospital Bauer Emergency Care Center, where the trauma team examined him immediately.

Full story at News-Medical.net