Category Archives: Pain clinics

India – Aligarh Muslim University

Aligarh Muslim University
Aligarh 202 002
India

The Department of Anaesthesiology, Jawaharlal Nehru Medical College, Aligarh Muslim University has started ‘Pain Management Services’. The patients of chronic pain like back ache, sciatica, trigeminal neuralgia, cancer pain and other myofascial pain syndrome will be greatly benefited from this clinic. JN Medical College Hospital is the second Medical College in UP to start Pain Clinic. The clinic will be supervised by Professor MMH Siddiqui and Dr Hammad Usmani.

On The Net
AMU

contact
Prof. M.M.H. Siddiqui – 2703817
Dr. Haammd Usmani – 9897114190

Prolotherapy In Denver

DR. JO ANN DOUGLAS is nationally Board Certified by the American Osteopathic Association in Neuromusculoskeletal Medicine. She graduated from University of New England College of Osteopathic Medicine (UNECOM) in Biddeford, Maine in 1998, completing her rotating internship at Saint Vincent Hospital in Worcester, MA and her neuromusculoskeletal residency at UNECOM in 2001. Dr. Douglas is one of the first osteopathic physicians to be trained in prolotherapy as part of the Post-Doctoral Residency Training Program for Board Certification in Musculoskeletal Medicine. Prior to osteopathic medical school, Dr. Douglas attained her M.S. Degree in Exercise Science from the University of Massachusetts, where she worked for several years as an athletic trainer and exercise physiologist for the womens athletic teams.
At her current facility, Colorado Osteopathic and Sports Medicine, which has two convenient locations in Lakewood, CO (minutes from Denver) and Breckenridge, CO, Dr. Douglas specializes in treatment of the musculoskeletal system with (OMT) Osteopathic Manipulative Treatment (for restrictions/hypomobility) and Prolotherapy (for instability/hypermobility). She treats both the spine and the extremities.
Many recurrent problems are often interrelated; yet physicians not specially trained in osteopathic medicine, prolotherapy and OMT often overlook the fact that physical symptoms can demonstrate a connection between various physical problems in the body. As a result of her training and experience with patients, Dr. Douglas has a high success rate in assessing the connection between the various parts of the body. Her extensive knowledge in musculoskeletal functioning and its interconnected relationship with the entire body allows Dr. Douglas to use prolotherapy to simultaneously treat back pain, shoulder pain, rotator cuff tears, chronic ankle sprains, tennis elbow, migraine headaches, scoliosis, degenerative disc disease, TMJ, arthritis, herniated disc, and tendonitis (a few of the many complications associated with musculoskeletal problems). For example, prolotherapy can be used to stabilize a chronic ankle problem that may be contributing to back pain because of the body’s tendency to compensate. Or even more dramatic, a persistent migraine headache can improve because of decreased muscle tension in the neck, shoulders and back resulting from the compensation for the same ankle instability!

www.mycodo.com

MD – Pain clinics in Maryland

AGS Foundation For Health in Aging
http://www.healthinaging.org/

Non-profit organization established by
the American Geriatrics Society to build a bridge between the
research and practice of Geriatrics and the Public, and to
advocate on behalf of older adults and their special health
care needs.

American Alliance of Cancer Pain Initiatives
http://www.aacpi.wisc.edu

National organization dedicated to promoting cancer
pain relief nationwide by supporting the efforts of state and
regional pain initiatives.

American Cancer Society
http://www.cancer.org/docroot/home/index.asp

Nationwide, community-based voluntary health
organization that is committed to fighting cancer through
research, education, patient service, advocacy, and
rehabilitation. It provides health information and support for
patients, families, friends and professionals.

American Chronic Pain Association
http://www.theacpa.org

Organization offers support and information for people
with chronic pain, with over 400 chapters and support groups
throughout the U.S., Canada, Mexico, Australia and Europe.

American Pain Foundation
http://www.painfoundation.org

Independent nonprofit organization serving people
with pain through information, advocacy and support. Its
mission is to improve the quality of life for people with pain
by raising public awareness, providing practical information,
promoting research, and advocating to remove barriers and
increase access to effective pain management.

American Society For Pain Management Nursing
http://www.aspmn.org/

An organization of professional nurses dedicated to
promoting and providing optimal care of individuals with pain
through education, standards, advocacy and research.

Beth Israel Medical Center Dept. of Pain Medicine & Palliative Care
http://www.stoppain.org

Resource and information center with support
and information for patients, caregivers and professionals.

JCAHO Standards For Pain Management Revisions 2001
http://www.jcrinc.com/subscribers/perspectives.asp?durki=3243&site=10&return=2897

Develops professionally based standards and evaluates
and accredits general and rehabilitation hospitals, long term
care and assisted living facilities, clinics, home care
agencies and other health care organizations and programs in
the United States.

Johns Hopkins Chronic Pain Treatment Program
http://www.hopkinsmedicine.org/jhhpsychiatry/pain.htm

Comprehensive, multidisciplinary pain center for
the reduction of intractable chronic pain and its accompanying
emotional and medical complications.

Maryland Cancer Plan
http://www.marylandcancerplan.org

A new comprehensive cancer control planning
initiative to update the Maryland State Cancer Plan. It is
housed under the office of the Maryland State Council on
Cancer Control and includes subcommittees on pain management
and end of life issues.

Maryland General Assembly
http://mlis.state.md.us/

Provides information about the Maryland State
Legislature, including names and contact information of
Maryland Senators and Delegates, who sponsored a bill, what
the bill is about and what actions were taken.

Maryland Health Care For All!
http://www.healthcareforall.com/

Grassroots coalition working to ensure that all
Marylanders have access to quality and affordable health care.

Maryland Quality Care End-of-Life Council
http://www.oag.state.md.us/Healthpol/SAC/

Created in December 2002, the
Council advises the Office of the Attorney General, the
Department of Aging, and the Department of Health and Mental
Hygiene. It also advises the General Assembly on changes in
laws related to the provision of care at the end of life.

Maryland State Advisory Council on Pain Management
http://www.dhmh.state.md.us/ohcq/council/home.htm

Established in November 2002 to provide advice and
recommendations regarding issues of acute and chronic pain
management by Maryland health care providers, as well as the
pain management needs of adults and children.

Medbank of Maryland
http://www.medbankmd.org/

Non-profit organization whose mission is to provide
access to prescription medications for chronically ill,
low-income, underinsured/uninsured Maryland residents. MEDBANK
assists healthcare providers and patients in completing the
paperwork required to enroll patients in Pharmaceutical
Company Patient Assistance Programs.

National Initiative for Rheumatoid Arthritis
http://www.rheumatologycme.org/

Independent multi-component education program
offering online CME course, case studies, slides and other
resources for healthcare professionals.

Pain and Addiction Medicine Information Site (ASAM)
http://www.asam.org/pain/pain_and_addiction_medicine.htm

Information and resources on addiction
medicine and pain management from the American Society of
Addiction Medicine.

Pain Connection
http://www.pain-connection.org/

Non-profit human service agency in
Maryland that provides monthly pain support groups, information,
referrals and community education.

Pain Law Initiative

Mary Baluss, an attorney from
Washington, DC, is the Director of the Pain Law Initiative and
specializes in pain management cases, hospice care and end of
life care issues. She has developed and litigated legal
concepts intended to improve access to pain relief. She
advocates for both patients and the physicians who prescribe
opioids for chronic pain. She is also the General Counsel for
The National Foundation for the Treatment of Pain
http://www.paincare.org/. Ms. Baluss can be contacted
at the following address, phone numbers and/or email:

Mary Baluss, Esq.
Pain Law Initiative

2850 Arizona Terrace NW
Washington, DC 20016
202/244-0710 (phone)
202/361-2775 (cell-preferred number)
202/318-3027 (fax)
[email protected]

Sickle Cell Information Center
http://www.scinfo.org

Sponsored by the Georgia Comprehensive
Sickle Cell Center at Grady Health System, the site o patient
and professional education, news, research updates and
worldwide sickle cell resources.

Stronger Bones
http://www.strongerbones.org/osteoporosis.html

Resource devoted to promoting bone
health and preventing osteoporosis, provided by the Maryland
Department of Health & Mental Hygieneís Office of Chronic
Disease Prevention.

University of Maryland Medicine Pain Center
htttp://www.umm.edu/pain/

Comprehensive, multidisciplinary pain center for
the assessment and treatment of chronic pain syndromes.

Sugar treatments for chronic musculoskeletal pain

News 10 has an article about Prolotherapy, which is use a dextrose (sugar water) solution, which is injected into the ligament or tendon where it attaches to the bone. This causes a localized inflammation in these weak areas which then increases the blood supply and flow of nutrients and stimulates the tissue to repair itself.

Part of the theory is the injections cause an inflammation that causes healing, and anti-inflammatory drugs stop healing process.

They also list this link to Magaziner Center in Cherry Hill, N.J. and a phone number at Information on Prolotherapy Injections for Chronic Pain: (856) 424-8222

History of Medicare’s Prolotherapy Coverage Policy

The Coverage Issues Manual (CIM) ’35-13, “Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents – Not Covered,” states that the medical effectiveness of these therapies has not been verified by scientifically controlled studies, and therefore, cannot be covered by the Social Security Act, ‘1862(a)(1), as a “reasonable and necessary” treatment. This policy of non-coverage along with an erroneous Administrative Law Judge (ALJ) opinion issued in favor of Irwin Abraham, MD, in December 1997, on behalf of a Medicare beneficiary, prompted Dr. Abraham to request a national coverage decision reversing the current policy of non-coverage.

Prolotherapy was last examined for coverage by the Health Care Financing Administration (HCFA) in September 1992. The request had been generated by a beneficiary claiming a benefit from the prolotherapy treatments she had been receiving. HCFA received a number of anecdotal accounts of significant benefit derived from prolotherapy treatments, but when a literature search was conducted it failed to produce any scientifically sound studies on which to base a coverage decision.

The ALJ decision in favor of Dr. Abraham was based on Dr. Abraham’s ability to successfully bill HCFA under the CPT code 20550, “Injection, tendon sheath, ligament, trigger points or ganglion cyst” in the past. However, after the carrier identified the treatment of Dr. Abraham’s patient as prolotherapy, the carrier denied further payment. The ALJ reasoned that because the treatment had been paid for in the past, the carrier was estopped from further payment for the same procedure on the same patient who claims a benefit from the treatment. The ALJ further reasoned that payment for this treatment in the past and the teaching of this method in some medical schools is sufficient evidence that HCFA had modified its policy regarding prolotherapy. Unfortunately, the ALJ did not address the possibility that the carrier had mistakenly paid for the treatment before recognizing it as the non-covered prolotherapy. Furthermore, because the carrier failed to submit evidence that prolotherapy was indeed experimental and investigational, the ALJ determined that without advance notice to the beneficiary that the procedure was non-covered, Medicare would cover the treatment as reasonable and necessary.



HCFA conducted a new electronic literature search using MEDLINE and Ovid. The results only provided editorial articles devoid of any new scientific research. Also, HCFA staff searched the internet and contacted the American Association of Osteopaths for a complete list of current scientific evidence on the efficacy of prolotherapy. None of these efforts produced significant evidence to support the coverage request.

Analysis of Scientific Evidence

In light of the aforementioned ALJ decision, Dr. Abraham’s confusion regarding the policy here is just; however, an ALJ decision is neither binding nor precedent setting on HCFA’s national coverage decisions. Dr. Abraham supplied HCFA with five articles, two of which are clinical trials that support his request for coverage of prolotherapy. Neither of these articles contain sufficient evidence to persuade HCFA to alter the policy now in place.



The Ongley et al. article: “A New approach to the Treatment of Chronic Low Back Pain,” published in The Lancet, July 1987, studied 81 patients with chronic low back pain with an average duration of ten years in a double-blinded study to compare prolotherapy injections with a non-proliferant injectable course of therapy. Forty of the 81 patients received a regimen of forceful spinal manipulation and injections of a dextrose-glycerine-phenol solution. The 41 patients in the placebo group received less extensive initial local anesthesia (<10 ml 0.5% lignocaine compared with infiltration of 60 ml 0.5% lignocaine in treatment group), a non-forceful manipulation and saline as a substitute for the proliferant used in the experimental group. Also, the experimental group on the first day received a regimen including infiltration of triamcinolone (an anti-inflammatory) into the gluteus medius origin, whereas the placebo group only received lignocaine into the gluteus medius origin. The program included exercises in both groups to encourage the synthesis of the new cells with existing connective tissue. While the authors concluded that "the experimental regimen is a safe and effective treatment for chronic low back pain that has not responded to other conservative forms of treatment," they write earlier in the body of the results section of the paper that "(i)ndependent evaluation of physical signs revealed no significant differences between the groups after treatment."


The Ongley study fails to support the coverage of prolotherapy for a number of reasons. The authors report a subjective improvement in pain amelioration, but they fail to supply any persuasive objective criteria on which to base a coverage decision that must be grounded in scientifically valid evidence. Even the authors acknowledge in their conclusion “(f)uture studies may be needed to analyse [sic] the relative import of each component of the overall procedure.” Since the authors chose to provide the participants with manipulation, exercises and anesthesia in addition to the proliferant and saline injections, it is difficult, if not impossible, to isolate the component of the treatment which gave the participants the reported relief.




Establishing a link between the subjective improvement in pain management and a particular regimen is problematical because the participants in the experimental group received a different preparation course with more anesthesia and a forceful manipulation as opposed to the placebo group’s faux manipulation. Since the study did not treat the proliferant injections as a single variable, there is no way to positively identify prolotherapy as the cause of the pain relief rather than the forceful manipulation. Also, because Medicare currently covers forceful manipulation and massage therapy by a qualified provider, HCFA would need evidence that the addition of another variable, such as prolotherapy, to a patient’s course of treatment would provide greater benefit than that which is currently covered. Furthermore, even if the results concluded that the benefit in pain reduction could be positively attributed to prolotherapy, the sample size of 81 patients is really an insufficient number on which to base a positive national coverage decision.




The more recent study submitted by Dr. Abraham also falls short of the requisite level of evidence needed for a national coverage decision. The Klein et al. study, “A Randomized Double-Blind Trial of Dextrose-Glycerine-Phenol Injections for Chronic, Low Back Pain” published in 1993, fails in much the same way as the Ongley study before it. Again, the number of participants is small; therefore it would be difficult to use the results in support of a newly crafted national coverage decision.

The Klein study was comprised of 79 patients, 39 of which were placed in the proliferant group. Thirty of 39 patients in the proliferant group achieved a 50% or greater diminution in subjective pain or disability. The control group was not a true placebo because “the patients received four of the five active interventions of the full treatment regimen and demonstrated statistically significant within-group improvements compared to baseline disability and pain scores.” Twenty-one of 40 patients in the placebo group reported a 50% or greater diminution in subjective pain and disability scores. A response of more than 50% of patients in the control group reporting improvement suggests that an actual treatment effect rather than a pure placebo response occurred. Even the authors note, “(t)he interventions shared by both treatment groups, including exercises, injection of local anesthetics, repeated needling, and manipulation may all enhance the success of the procedure, but the relative contribution of each intervention requires further study.”

The authors identify that further studies are needed to show greater improvement in treating pain with prolotherapy because “the statistical significance was only borderline” when the experimental group was compared to the control group. Also, “objective testing of range of motion, isometric strength, and velocity of movement showed significant improvements in both groups following treatment, but did not favor either” the proliferant or the control group. Further, “the MRI and CT scans showed significant abnormalities in both groups, but these did not correlate with subjective complaints and were not predictive of response to treatment.”

A total of 160 patients studied over the past twelve years, with only 79 of the patients receiving the proposed treatment, is not a large enough sample to support a change in the coverage policy. More studies with larger control and experimental groups must be evaluated using regimens designed to isolate variables and correlate them to positive results. Ideally, these studies would consist of improvements in both objective and subjective measurement tools. However, substantial and statistically significant improvements in subjective pain scores could be persuasive if HCFA could attribute the patient benefit to the prolotherapy regimen.

ClinicalTrials.gov shows an closed study “Joint Injections for Osteoarthritic Knee Pain” to determine whether prolotherapy can decrease pain and disability from knee osteoarthritis.

CT Pain Management Professionals

Pain Management Center of Farmington

270 Farmington Ave.
Farmington, CT 06032
Tel. (860) 677-6671
Fax. (860) 677-6736

Bruce S. Gottlieb, Ph.D.
Steven Beck, M.D.
Lucia O. Christie, OTR/L, M.S.

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Beth Sandy Aaronson, MD
PHYSICAL MEDICINE & REHAB
PAIN MANAGEMENT

17 Keeler Pl
Ridgefield, CT 06877

Ph: (203)797-7440
Fx: (203)730-1178

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Paul E Appleton, MD
GENERAL PRACTICE
PAIN MANAGEMENT

133 Brookmoor Rd
West Hartford, CT 06107

Ph: (203)723-4032

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Pamela Bennett
PAIN MANAGEMENT

30 Birchsid Dr
Norwalk, CT 06850
[email protected]

Ph: (203)588-8348
Fx: (203)588-6223

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John J Delfino, DMD
DENTISTRY
PAIN MANAGEMENT

15 Chieftans Rd
Greenwich, CT 06831
[email protected]

Ph: (212)998-9781
Fx: (203)532-4480

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Stephen G Ducey, MD
M.D.
PAIN MANAGEMENT

447 Montauk Ave
New London, CT 06320 Map

Ph: (860)447-1426

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Madeleine B Kitaj, MD
NEUROLOGY
PAIN MANAGEMENT

Kitaj Headache Ctr
30 Quaker Farms Rd
Couthbury, CT 06488
[email protected]

Ph: (203)732-1571
Fx: 203-262-8441

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Stephen Luk, MD
PAIN MANAGEMENT

Hartford Hosp Dept EMS-Trauma
80 Seymour St
Hartford, CT 06105
[email protected]

Ph: (860)545-3766

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Annette Karen MacAnnuco, MD
PAIN MANAGEMENT

CT Spine & Pain Ctr Bristol Hosp
PO Box 977 Brewster Rd
Bristol, CT 06010
[email protected]

Ph: (860)585-3040
Fx: (860)585-3060

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Jonathan T Orr, MD
ANESTHESIOLOGY
PAIN MANAGEMENT

9 Beaver St #2
Danbury, CT 06810
Ph: (212)423-6801

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Richard S Pope, PA-C
RHEUMATOLOGY
PAIN MANAGEMENT

1389 W Main St #120
Waterbury, CT 06708

Ph: (203)755-5555

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Paul Allen Pudimat, MD
ANESTHESIOLOGY
PAIN MANAGEMENT

Backus Pain Clinic
61 Emerald Glen Ln
Salem, CT 06420
[email protected]

Ph: (860)823-6395
Fx: (860)823-6563

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Patricia A Richard, MD DMD
ACUPUNCTURE
PAIN MANAGEMENT

1735 Post Rd
PO Box 702
Fairfield, CT 06824-0702
[email protected]
www.drpatrichard.com

Ph: (203)254-8080
Fx: (203)256-1330

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Louis D Sclafani, DC
CHIROPRACTIC
PAIN MANAGEMENT

132 Federal Rd #103
Danbury, CT 06811
[email protected]

Ph: (203)778-2225

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Raymond Tetsuo Sekiguchi, MD PhD
FAMILY PRACTICE
PAIN MANAGEMENT

49 Lake Ave
Greenwich, CT 06830
[email protected]

Ph: (203)552-9037
Fx: (203)552-9048

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Marsha R Stanton, RN MS
NURSING
PAIN MANAGEMENT

Purdue Pharma Medical Ed Dept
1 Stamford Forum
Stamford, CT 06901-3431
[email protected]
Ph: (203)588-8093
Fx: (203)588-6213

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Dr. C. Evers Whyte, MS, DC, DACBN
The Center for Health Renewal

30 Myano Lane, Suite 26
Stamford, CT 06902

Phone: 203.708.9299
Fax: 203.708.9269
Email: [email protected]

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James F Brodey, MD
Specialties- Pain Management

270 Farmington Ave
Farmington, CT 06032-1909
Phone: (860) 674-0084

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Jeffrey S Morrow, MD
Medical School: Boston University School of Medicine
Specialties: Anesthesiology, Pain Management

2 Batterson Park Rd
Farmington, CT 06032-2553
Phone: (860) 674-8453

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Amir Tulchinsky, MD
Graduation Year: 1984
Specialties: Anesthesiology, Pain Management

263 Farmington Ave
Farmington, CT 06030-0001
Phone: (860) 679-2759

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Robert James Krug, MD
Specialties: Physical Medicine & Rehabilitation, Pain Management

Appointment Phone: (860) 714-3500
490 Blue Hills Avenue
Hartford, CT 06112-1513
Phone: (860) 714-2647

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Evelyn C Abernathy, MD
Specialties: Pain Management, Hematology (Blood)

80 Seymour St
Hartford, CT 06115-2701
Phone: (860) 545-2008