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1300 Upper Hembree Rd Bldg 100, Suite B Roswell, GA 30076

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Roswell Pain Specialists specialize in the care of patients with acute and chronic pain. Approximately 80 million people in the United States suffer from some form of Chronic Pain, the main type being lower back pain which affects nearly 31 million Americans. Acute pains identifiable cause and purpose makes diagnosis and treatment easier. Chronic pain is defined by a persistent pain lasting 6 months or more. These types of pain range from medical problems including Cancer or Arthritis to an injury or the occurrence could appear for no concrete reason whatsoever. The most important step towards proper pain management care is finding a pain management specialist to assist with your treatment needs. Roswell Pain Specialists’ doctors will assist in the necessary variety of treatment options. These options can often times include simple changes to your existing lifestyle including diet, exercise, and stress reduction. Other times medication or therapy may be necessary. Roswell Pain Specialists are proud to announce we have added an ambulatory surgery center, Roswell Pain Surgical Center, for the convenience and treatment of our patients in need of outpatient interventional and surgical procedures. We feel this is a huge opportunity to better serve you and your family members.

At Roswell Pain Specialists, we provide our patients with a thorough consultation and formulation of treatment plans tailored to their individual needs. Education is incorporated in our treatment plans and we empower our patients to become involved in their own care. Our integrative pain management approach helps patients reduce pain and increase their function as well as activities of daily living.

No matter where it hurts, we can handle it. Our physicians are ready to help you get back into the swing of things.

a Keeping You Healthy Is Our Priority.

ROSWELL PAIN & WEIGHT LOSS SPECIALISTS 1300 Upper Hembree Rd Bldge 100 Suite B • Roswell, GA 30076 678-736-7680

www.thepainpros.com

The physicians and staff of Roswell Pain Specialists are committed to improving the health of the patients we serve with care and compassion. Our people, education, quality and integrity form the cornerstones of our practice. It is our pledge to uphold the duties of our profession as we dedicate ourselves to healing those we serve.

Damon Kimes, MD Dr. Kimes, our Chief Medical Officer founded Roswell Pain Specialists in 2011. He completed his undergraduate training with degrees in Chemistry and Psychology while attending Cleveland’s, Case Western Reserve University where he achieved both peer elected and academic honors. After receiving his medical degree at the historic Meharry Medical College, Dr. Kimes trained in Family Medicine at University of Tennessee-Memphis, where he was elected Chief Resident and Emergency Medicine at Emory University in Atlanta. Augustina Amune, DC Dr. Augustina Amune studied at Albany State University where she received her Bachelor’s degree in Biology. She then attended Palmer College of Chiropractic – Florida Campus, where she received her Doctorate in Chiropractic Medicine. Dr. Amune is a family oriented practitioner with a compassion for her patients. She combines this with her extensive knowledge of the musculoskeletal system to create an excellent and successful healing environment. From the gentle techniques necessary to adjust a baby, to specific techniques designed to rehabilitate herniated discs and other pain and neurological issues, be assured that Dr. Amune will treat you as an individual and determine the proper course of treatment specific to you as an individual. Deitrick Cox, MD Dr. Cox is board-certified in Physical Medicine and Rehabilitation /Psychiatry. After obtaining his medical degree from Morehouse School of Medicine, he completed his internship at Harvard School of Medicine’s Cambridge Health Alliance. He then completed his residency in PM&R at Emory University. Dr. Cox uses a multidisciplinary approach that includes physical therapy, patient education, and procedure-based therapies to improve and restore patients’ function and quality of life. Using procedures such as electromyography (nerve & muscle testing) and interventional spinal procedures, Dr. Cox is able to diagnose and treat pain conditions of neurological, musculoskeletal, and spinal origins.

GET BACK TO YOUR LIFE.

1300 Upper hembree rd bldg 100 suite b roswell, ga 30076 www.thepainpros.com 678.736.7680

Are you missing 18%* of your Patients’ Positive Opioid Test Results? You may be without High Sensitivity Definitive Testing.

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From back pain to arthritis, Roswell Pain Specialists are equipped to bring chronic pain relief.

1300 UPPER HEMBREE RD BLDG 100 SUITE B • ROSWELL, GA 30076 I PH: (678)736-7680

At Roswell Pain Specialists, we provide our patients with a thorough consultation and formulation of treatment plans tailored to their individual needs. Learn more at www.thepainpros.com

SAMHSA PUBLISHES BEST PRACTICES ON MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER Best Practices

Treatment Improvement Protocol 63, “Medications for Opioid Use Disorder,”

reviews the use of methadone, naltrexone, and

buprenorphine, the three FDA-approved medications to treat opioid use disorders.

Data indicate that OUD-treating medications are both cost effective and cost beneficial

The Substance Abuse and Mental Health Services Administration has published new guidance to help health care professionals better understand medications that can be used to treat Americans with opioid use disorder (OUD). Treatment Improvement Protocol (TIP) 63, “Medications for Opioid Use Disorder,” reviews the use of methadone, naltrexone, and buprenorphine, the three FDA-approved medications to treat opioid use disorders. TIP 63 provides guidance for health care professionals and addiction treatment providers on how to appropriately prescribe these medications and effectively support patients using these medications for OUD treatment. “We know that people can and do recover from opioid use disorders when they receive appropriate treatment, and medication-assisted treatment’s success in treating opioid use disorders is well documented,” said Dr. Elinore F. McCance-Katz, assistant secretary for Mental Health and Substance Use. “TIP 63 emphasizes that increasing access to medications to treat opioid use disorder will help more people recover, enabling them to improve their health, living full and productive lives.” TIP 63 is part of SAMHSA’s larger response to the opioid crisis. More access to treatment with OUD medications is critical to closing the gap between treatment need and treatment availability and an important public health strategy. Data indicate that OUD-treating medications are both cost effective and cost beneficial.

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Our Treatment:

• Arthritis • Back & Neck Pain • Bone & Joint Pain • Cancer Pain • Complex Regional Pain Syndrome (CRPS) • Reflex Sympathetic Dystrophy (RSD)

• Fibromyalgia •Geriatric Pain • Headache Pain • Lower Extremity Pain Much More...

1300 Upper Hembree Rd. Bldg 100 Suite B • Roswell, GA 30076 | PH: (678)736-7680

The highest level of Quality, Customer Service and continuous compliance are always met.

ROSWELL PAIN AND WEIGHT LOSS SPECIALISTS

“We were surprised that morphine was able to induce these really long-lasting changes,” says Dr. Peter Grace, the study’s lead author. Dr. Grace says the cause of the chronic pain increase has to do with cells that form part of the immune system. He says if those areas could be isolated or their eects reduced, the resulting pain may not be as great. “If it does turn out to be a relevant issue to patients, then what our study suggests is that targeting the immune system may be the key to avoiding these kinds of eects,” Dr. Grace says. “Opioids could essentially work better if we could shut down the immune system in the spinal cord.” e team’s research only looked at spinal cord injuries and morphine, and did not study other opioids that are commonly prescribed to patients experiencing pain. But he said it’s likely drugs like Vicodin or OxyContin could aect other parts of the body in a similar way. “While we haven't actually tested other opioids in this particular paradigm, we predict that we would see similar eects,” Dr. Grace says.

ain relievers are supposed to relieve pain. It sounds simple enough, but new research suggests a common pain medication may actually be prolonging chronic pain. Morphine is an opioid painkiller commonly prescribed in hospitals and clinics, and while it is eective in the short term, doctors don’t always consider the potential consequences for pain down the road.at’s why a team of researchers based out of the University of Colorado - Boulder set out to study how morphine treatment aects chronic pain, and found some troubling results. e team, which used mice with spinal cord injuries, found that in mice not given morphine, their pain thresholds went back to normal about four to ve weeks after the injury. But mice who were given morphine didn’t see their pain levels return to normal until around 10 to 11 weeks, meaning the use of morphine eectively doubled the length of their chronic pain. P

Chronic problem Chronic pain can be debilitating for many people facing serious health problems, and it can also be a key factor in substance abuse. Many people report developing a dependence on opioids after having them prescribed for an injury. But new research suggests the number of people who develop dependency issues because of chronic pain may be far higher than people realize. A study from researchers at Boston University looked at a group of nearly 600 people who had either used illicit substances or misused prescription drugs.

ey found that 87 percent reported suering from chronic

pain, with 50 percent of those people rating their pain as severe.ey also found that 51 percent of people who had used illicit drugs like marijuana, cocaine and heroin had done so to treat their pain. While many prevention eorts focus on recreational users, the numbers suggest that chronic pain plays just as prominent a role in substance abuse. “Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain,” the authors of the study wrote. “Pain needs to be addressed when patients are counseled about their substance use.”

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Talkin’ ‘Bout My Generation

NIDA Researchers Develop Screening Tool for Teen Substance Use This article is a condensed version of a piece that originally appeared on the National Institute on Drug Abuse (NIDA) website.

Teens’ use of addictive substances often goes undetected by health care providers. But NIDA-supported researchers have developed a Brief Screener for Tobacco, Alcohol and other Drugs (BSTAD), to help spot teens’ problematic habits. In a recent study, BSTAD developers Dr. Sharon Kelly and colleagues at the Friends Research Institute in Baltimore examined the frequencies of use likely to qualify a teen for a diagnosis of an alcohol use disorder (AUD), nicotine use disorder (NUD), or cannabis use disorder (CUD). The frequencies proved to be surprisingly low, according to the researchers.

Teen drug substance use revealed For the study, the BSTAD survey employed a few, simple questions about teens’ use of alcohol, tobacco or drugs within the past year.The teens’ BSTAD responses revealed that 22 percent had used alcohol in the past year, 16 percent had used marijuana, 10 percent had used tobacco, and 3 percent had used at least one illicit substance other

than marijuana. (Original article by Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer) 28

“ Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention. “

-Dr. Sharon Kelly, Friends Research Institute

Analysis of the data showed that almost all teens who reported on the BSTAD that they had consumed an alcoholic beverage on two or more days during the past year had an AUD. Conversely, teens who reported drinking on fewer than two days were unlikely to have this disorder.The corresponding BSTAD cut point for an NUD was nicotine use on two or more days during the past year and for a CUD was marijuana use on two or more days. BSTAD enables early detection Using these cut points, the researchers found that the BSTAD was highly sensitive. Ninety-six percent of teens with an AUD, 95 percent with an NUD, and 80 percent with a CUD would be flagged as likely in need of further assessment for a brief intervention or referral to treatment. BSTAD’s specificity was also high: 85 percent of teens without an AUD, 97 percent without an NUD, and 93 percent without a CUD reported use below the cut points, and so would be correctly classified. “Very low substance use frequencies were found to be optimal in identifying these disorders,” Dr. Kelly comments. The BSTAD does not distinguish

Researchers encourage regular screening Both the World Health Organization and the American Academy of Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Still, many providers do not regularly screen their patients for substance abuse. “Providers are extremely busy and need a quick and valid screening measure for identifying teens who use substances,” says Dr. Kelly. She and colleagues developed the BSTAD in response to a NIDA call for new tools to fill this need. To create the BSTAD, Dr. Kelly and colleagues added the questions about tobacco and marijuana to the widely disseminated National Institute on Alcohol Abuse and Alcoholism screen for youth alcohol use. In the validation study, the FRI research team administered the BSTAD in person to half of the participants, and the rest of the participants self-administered the instrument on an iPad. The teens reported a strong preference for the iPad. The iPad version offers the potential extra convenience that results can be automatically transferred into a teen’s electronic medical record. 

the severities of the disorders, she notes, so when it flags a teen, providers need to follow up with questions to determine appropriate interventions or referrals to treatment. Furthermore, Dr. Kelly says, “Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention.” Providers also should rescreen teens regularly, because onset of substance use can occur abruptly during adolescence. Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Both the World Health Organization and the American Academy of

COME GET HELP! 1300 UPPER HEMBREE RD. BLDG 100 SUITE B ROSWELL, GA 30076 678.736.7680 WWW.THEPAINPROS.COM

No matter where it hurts, we can handle it. Our physicians are ready to help you get back into the swing of things.

FOR MORE INFORMATION PLEASE CONTACT US ROSSWELL PAIN & WEIGHT LOSS SPECIALISTS

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Too Much? From the Office of Dr. Study cites concern over doctors' prescribing habits

Family physicians are the largest prescribers of opioid pain medications, even outpacing pain specialists, according to a recent study published in the journal JAMA Internal Medicine. The findings reinforce the need for prevention efforts that focus on prescribing behaviors of physicians as well as patients who are at risk of overdosing, the researchers say. “Overprescribing is a national concern, and mitigation efforts should not be oversimplified or targeted to a select few prescribers, or to regions of the country, or to patient populations or communities,” says Victoria Richards, associate professor of medical sciences at Quinnipiac University School of Medicine, in a HealthDay article on the study. According to the advocacy group Physicians for Responsible Opioid Prescribing, many prescribers underestimate the risks associated with opioids – especially the risk of addiction – and overestimate their effectiveness.

Prescription rates vary

painkiller prescriptions per person as those in the lowest prescribing state. Yet, health conditions that cause people pain do not vary much from place to place and do not explain this variability in prescriptions issued. These latest findings add fuel to those who advocate for stricter oversight of narcotic pain medication. Approximately

44 people die each day from prescription opioids, and opioid- related deaths have tripled since the 1990s. More than 80 percent of these deaths are accidental or unintentional, according to the CDC, which estimates that up to 60 percent of opioid overdose deaths occur in people without a prior history of substance abuse.

Another indicator of the need for more scrutiny of prescribing practices is that prescribing rates for opioids vary widely among states, says the Centers for Disease Control and Prevention (CDC). In 2012, health care providers in the highest-prescribing state wrote almost three times as many opioid

Who is prescribing painkillers? In 2013, 15.3 million family practice physicians and 12.8 million internal medicine physicians wrote prescriptions for narcotic pain medication, researchers found in studying Medicare Part D drug coverage claims.The study also found that nurse practitioners wrote 4.1 million prescriptions for narcotic painkillers while physician assistants ordered up 3.1 million.The research, led by Dr. Jonathan Chen of Stanford University, focused on prescriptions for narcotic painkillers containing hydrocodone (drugs such as Vicodin), oxycodone (Oxycontin and Percocet), codeine and others in the opioid class. In studying prescriptions written by 808,020 American doctors in 2013, the researchers found that pain management specialists and anesthesiologists wrote the most prescriptions for opioids. On average, individual pain doctors ordered 900 to 1,100 prescriptions for painkillers in 2013, and anesthesiologists wrote nearly 500. By comparison, each family physician wrote an average of about 160 prescriptions. Because there are many more family doctors than specialists, as a group, their number of painkiller prescriptions was higher than for any other provider category—more than 15 million prescriptions collectively, followed by internal medicine physicians at just under 13 million. In total, these two groups wrote more than half of all opioid prescriptions in the country. Pain specialists, including those involved in the more invasive sub-specialty of interventional pain management, accounted for about 3.3 million prescriptions.

CDC issues draft guidelines In the wake of growing concern over the excessive use of prescription opioids, the CDC recently issued a draft Guideline for Prescribing Opioids for Chronic Pain.The document provides recommendations regarding when and how these drugs are used for chronic pain: selection, dosage, duration, follow- up, and discontinuation; and assessment of risk and addressing harms of opioid use. However, the Guideline is not a federal regulation; adherence to it will be voluntary, the CDC notes. 

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Our integrative pain management approach helps patients reduce pain and increase their function as well as activities of daily living. ROSWELL PAIN & WEIGHT LOSS SPECIALISTS

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