Fellowship Trained & Board Certified in Pain Medicine

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Archive for July 2016

Birmingham pain clinic - Cahaba Pain HMP Sign

Opening September 14th!

Construction of our Birmingham pain clinic is coming along well.  We’ll be opening our doors on September 14th ready to offer comprehensive pain management services.  Our friends at Kassouf & Co are now taking applications for those interested in joining our team (see our Careers page).  We look forward to providing excellent patient care to those suffering from chronic pain.  Call us at 205-208-9001 to set up your appointment today!

 

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Obstructive Sleep Apnea- When the Snoring Stops

While snoring is hardly a medical problem itself, it may be one of several signs that a patient suffers from obstructive sleep apnea (OSA). OSA results when the upper airway relaxes during sleep and breathing is interrupted. Friends or family may observe the snoring progress to what sounds like choking and eventually apnea where breathing actually stops. During this time carbon dioxide (which is exhaled during normal breathing) starts to accumulate in the bloodstream. Simultaneously, oxygen levels fall. Eventually, the brainstem detects these changes and stimulates the patient to breathe. This may result a gasp or an awakening, the patient resumes breathing, and the cycle repeats itself.

This is important because decreased oxygen levels constrict the blood vessels in the lungs and force the right side of the heart to work harder to pump blood through them. Over time, OSA can lead to chronic hypertension, and in some cases, heart failure over time.

Patients with OSA often complain of sluggishness as they don’t enjoy normal, restorative sleep patterns. Patients may experience a sore throat, headaches, and may doze off repeatedly during the day even while at the wheel.

OSA is especially important to diagnose and treat in patients who are on or will be put on pain medications or anti-anxiety medications since these drugs may cause the soft tissues of the mouth and upper airway to relax, thus increasing the likelihood of apneic episodes. Additionally, opiate medications such as hydrocodone or morphine decrease the brain’s responsiveness to higher carbon dioxide levels. There are well documented cases where patients with untreated OSA have died after being put on opiates after surgery without proper monitoring of their oxygen levels.

Risk factors for OSA include: obesity, thick neck circumference, use of sedatives including alcohol, age (older), smoking, chronic throat problems, and male gender.

A diagnosis of obstructive sleep apnea is made with a sleep study during which the frequency and severity of the apnea are recorded.

Treatment usually involves having the patient sleep in a mask that delivers positive pressure to to the airway (e.g. CPAP mask). Sometimes surgery is offered if removing tissue can open up the throat passages.

In summary, if a patient complains of poor sleep and energy levels, has high blood pressure, is overweight, falls asleep easily during the day, and snores loudly or experiences episodes of apnea as witnessed by others, he/she probably needs a sleep study. In this case, a physician would be wise to order a sleep study before starting a narcotic medication (especially a long-acting drug). Patients with OSA or who are suspected of having sleep apnea should have their oxygen levels monitored when placed on pain medication in the hospital if they are not wearing a CPAP mask.

As hard as it for some patients to get used to wearing the CPAP mask, many experience an improvement in their blood pressure and feel a renewed sense of energy. Symptoms like headache may disappear, and the threat of right heart failure may be eliminated.

If you suspect that you or a loved one suffers with obstructive sleep apnea, consult your physician.

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The Risks of NSAIDS- It’s only ibuprofen…

Recent years have seen an increasing awareness of the risks associated with NSAIDS (non-steroidal anti-inflammatory drugs) which include a variety of medications from over the counter Ibuprofen (e.g. Advil®) and Naproxen (Aleve®) to the commonly prescribed Meloxicam (Mobic®) and Diclofenac (e.g. Arthrotec®).

These medications have been prescribed for years, and most of us take them without any problem.  Last year, however, the FDA strengthened its warning about the risk of heart attack and stroke with NSAID use.  Although Aspirin is an NSAID, it is does not increase one’s risk of heart attack or thrombotic stroke and is not covered by the latest warning.

What many are surprised to learn is that the risk of having a gastrointestinal or GI bleed may be as high as 2-4% with routine use of NSAIDS for prolonged periods of time.  Kidney disease is also a potential consequence of NSAID use.  Even without causing catastrophic complications, NSAIDs can interfere how well antihypertensives (medications that treat high blood pressure) work.

Certainly NSAIDS have a role in the treatment of inflammatory pain, but patients must be educated on the risks involved in taking them.  This would include providing them with signs and symptoms of a GI bleed for example.

Takeaway points

  • Patients (especially those with risk factors or history of heart disease, stroke, kidney problems, etc.) should talk with their physician before starting an NSAID, even one available over the counter.
  • Tylenol may be a safer analgesic (pain reliever) for patients who cannot take NSAIDs
  • Aspirin is cardio-protective. It inhibits platelet function, therefore offering some protection from heart attack.  It remains the best thing for patients having cardiac chest pain to take as they are headed to the ER.
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