Each year in the United States approximately 16 million patients visit their physician with a chief complaint of abdominal pain. Despite medications, physical therapy, nerve blocks and surgical interventions, two million patients develop chronic, persistent abdominal pain which can be debilitating and have a major impact on a patient’s socioeconomic status and spiritual health. Chronic abdominal pain (CAP) is most often described as burning, aching sensations followed less commonly by dull, throbbing, cramping, sharp & stabbing pain usually sensed around the umbilicus (belly button) or epigastrium (stomach area). Medical conditions causing CAP include chronic pancreatitis, intra-abdominal scar tissue formation after surgeries such as gallbladder, spleen & intestinal removal and gastric bypass, heartburn and endometriosis surgeries. Other disorders include irritable bowel syndrome, chronic esophageal dysmotility, gastroparesis, mesenteric ischemia and Familial Mediterranean Fever.Treatments available for CAP at the Ramos Center for Interventional & Functional Pain Medicine include a multidisciplinary approach including cognitive & behavioral therapies addressing mood & sleep disorders together with teaching of chronic pain coping skills, physical therapy, medications and nerve blocks.For patients who have failed to obtain adequate pain relief and/or improvements in functional capacity with these more conservative therapies, spinal cord stimulation (SCS) is available after a qualifying pain psychology evaluation, response to diagnostic & therapeutic nerve blocks and a successful 4-7 day SCS trial. Multi-center research studies have shown that 80-94% of CAP patients receiving

permanent SCS implants have experienced >50% pain relief (median decrease in average pain rating VAS: 8/10 => 2.5/10), 66-75% decrease in opioid dose requirement and >50% increase in functional capacity. Post-implant patient surveys revealed 89% of SCS implant patients were happy with this therapy with 50% being extremely satisfied.

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Physician’s CommuniqueChronic Abdominal PainJohn J. D’Auria, MDFIPP, DABA , DABIPP, DABPM

September is Pain Awareness MonthWHAT YOU NEED

TO KNOW:

Nearly 100 million Americans experience chronic pain —more than those who have diabetes, heart disease and cancer combined.Pain is a warning sign that indicates a problem that needs attention.Pain starts in receptor nerve cells located beneath the skin and in organs throughout the body.Living with pain can be debilitating and adversely affect everyday lifeArthritis refers to over 100 different conditions ranging from autoimmune disease to normal joint inflammation.According to the National Institutes of Health, eight out of ten people will have back pain at some time in their life.Millions of people get crippling headaches, and there are dozens of different headache types -- but receiving the right diagnosis is key to getting the right treatment. There are many different methods and techniques for treating pain, both chronic and acute.

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EMPLOYEE SPOTLIGHTBeverly G.

Triage Supervisor

Since 2009, Beverly has been answering patient phone calls regarding questions related to medications, insurance, pain, imaging and scheduling. Typically behind the scenes and a liaison between our patients and providers, we wanted to provide you with an opportunity to put the name and voice with the face! Third time is a charm for this lucky lady. Beverly became a new Mom again this year! Not only is she very well liked and respected by her peers, Beverly is an invaluable resource to the Ramos Center and an important contributor to its success. Should you have any questions about your care, feel free to reach Beverly at (941)708-9555 Ext. 109

Ramos Center

for Interventional & Functional Pain Medicine

The Ramos Report

Volume 2

Pain & Personal ity

Disorders

BRADENTON Riverwalk Professional Park 100 3rd Ave. West n Suite 110 Bradenton, FL 34205

SARASOTA Medical Office Building at Doctors Hospital 5741 Bee Ridge Rd. n Suite 550 Sarasota, FL 34233

phone (941) 708-9555 fax (941) 708-5465 email info@ramoscenter.com website RamosCenter.com

Marly Ayala-Ycaza, M/S Psy. L M H C Licensed Mental Health Counselor

(941 ) 708-9555 ext. 127 n mycaza@ramoscenter.com

Personality characteristics and disorders have long been noted in the chronic pain

population. Personality is a bunch of strategies that we use to manage our daily events. “Personality” is to the mind what the immune system is to the body. In other words, a healthy personality will be able to manage internal and external stressors while an individual with a personality disorder will not.

Chronic pain is an internal stressor that can be difficult to deal with if your personality is not a healthy one. The DSM-V (Diagnostic and Statistical Manual of mental Disorders) presents different types of personality disorders that explains why some people can learn to manage their pain, while others struggles with it.

The International Association for the Study of Pain defines it as an unpleasant sensory and emotional experience associated with tissue damage. The emotional part of this unpleasant experience is very attached to your personality. For example, histrionic personalities would unconsciously add drama to pain, compulsive personalities will struggle with lack of control over pain, and schizoids may curl inside of their fantasies to give sense to pain. Some personality disorders such as paranoids and borderlines will constantly blame others for their struggles such as their physicians, relatives, insurance provider, etc.

Many people with emotional and physical pain turn their lives around when they become able to accept their experience as it is, while simultaneously working to change what they can control. This seemingly simple notion is both complex and learnable. Healthy personalities are flexible and adaptable to new situations, regardless of pain, they will find ways to continue enjoying life and ways to continue working, being mentally active, trying other ways to maintain social and family networks, as well as living life with another perspective.

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About 1 in every 3 individuals who are over the age of 65 will experience a fall within one year. Every 20 minutes, an older adult dies from a fall, totaling 21,700 deaths per year. 2.5 million injuries treated in the ER every year. Falls are responsible for over 80% of hip fractures and 734,000 hospital admissions annually. The median admission charge for non-fatal fall injury hospitalizations were $46,067. The average length of hospital stay is four days, totaling hospital charges exceeding $3.64 billion each year. Additionally, these individuals often cannot regain their prior level of functional independence and are the most common reason for nursing home placement.

Given the problems associated with falls, the American Geriatrics Society recommends any individual age 65 or older be evaluated if he or she has a fall or complains of difficulty with balance. This evaluation is meant to prevent the next fall or a fall related to balance difficulty. Both of these problems typically have multiple contributing factors. Factors may include problems with vision (cataracts, macular degeneration, diabetic eye changes and glaucoma are the most commonly encountered problems in this population), uncontrolled pain (due to arthritis, particularly in the back, hips or knees), muscle weakness (often related to prolonged periods of inactivity), medications (risk of falls increases with the number of medications an individual takes; lightheadedness, particularly when getting up from laying down or seated, can be an indicator that blood pressure medications are too strong; psychotropic medications like antidepressants and antipsychotic medications all increase the danger of falls). By addressing these issues, the possibility of falls can be reduced.

Justin M. Kotlarczyk MSPT, CSCSPhys ical Therapistjkotlarczyk@ramoscenter.com Direct Line: (941) 357-4039

Falls Are the Leading Cause of Deaths of Adults 65 or Older!

The superior chronic pain therapy that leaves patients SPEECHLESS...

Kat i uska M . Ramos Cer t i f ied Cl in ical Hypnotherap ist

NLP PractitionerD i re c t L i n e : ( 9 4 1 ) 2 1 6 -002 1

( 94 1 ) 708 -9 5 5 5 E x t . 1 4 1k r amos@ramoscen t e r. com

Mind and SuccessKatiuska Ramos Clinical Hypnotherapy

Hypnotherapy and Smoking Cessation

What can you do yourself to reduce your falls risk?A physical therapy evaluation can identify specific problems with strength and balance that can be corrected with an individualized regimen of exercises. It’s important to do these exercises ever day, and continue the exercises even after formal therapy is completed; otherwise, all that’s gained from the therapy could be lost very quickly. Physical Therapy will decrease your risk of falls by assessing your range of motion, strength,visual system, vestibular (inner ear) system, proprioceptive system (joint and limb assessment), as well as functional tests. When you integrate a physical therapy program that incorporates all aspects of balance but will focus mainly on the system that customized to your deficiencies, it will allow you to coordinate and obtain better balance, ultimately decreasing your risk of falls.

Getting your medications reduced – particularly removing any psychotropic medications – is probably the most useful intervention.

Removal of cataracts, particularly in those individuals who have had a fall, is beneficial; it’s important to make sure both eyes are done in the shortest period of time possible, and your prescription for corrective lenses is adjusted after the cataracts are removed.

There are several exercises that research suggests help reduce the risk of falls. Exercises include tai chi and yoga. Falls risk reduction from tai chi can last for up to two years after a 12-week program is completed.

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When tight, stiff muscles make movements difficult, everyday activities can be difficult too. This condition is called severe spasticity. With severe spasticity, you can experience stiffening of the muscles that makes your muscles feel like they are locked, or even jerk uncontrollably when you try to use them. This condition can happen as a result from a stroke, MS, cerebral palsy, brain injury, or spinal cord injury. For you, the right treatment may be ITB Therapy™ (baclofen injection). A baclofen injection is a muscle relaxant and antispastic medication that is used for treatment of severe spasticity. ITB is a treatment using Intrathecal (baclofen) that is delivered into the fluid around your spinal cord to help manage severe spasticity. For long term treatment, a drug pump that is surgically placed under the skin of your abdomen which delivers pain medication directly to the fluid around the spinal cord, providing pain relief with a small fraction of the medication needed if taken orally. Your doctor can program the pump to deliver the appropriate daily dose for you. Before you can be considered for long term treatment, you must have a test dose to see how you respond to the drug when it is delivered in this way. After the test dose is done, your doctor will discuss the results with you and determine if you are an appropriate candidate for the therapy.

Ask your provider if a baclofen injection or pump may help you turn “I wish” into “I can.”

Pain & Spasticity PumpsTurning “I Wish” Into “I can”

Smoking is a dangerous and deadly habit that is also the leading cause of cancer. Your chances of a heart attack, stroke, lung disease or other health problems increases dramatically from smoking.

Remember, it is never too late to stop smoking and has immediate health benefits. Two weeks to 3 months after quitting your heart attack risk begins to decrease. As your circulation improves walking becomes easier because your lung function increases up to 40%. One to 9 months after quitting, your coughing and shortness of breath decreases. As the lungs become cleaner your cilia begins to regrow thus increasing their ability to handle mucus and reduce infections. If you stop smoking before the age of 50, your risk of dying in the next 15 years is cut in half compared to those that continue to light up.

Nationwide efforts to reduce reliance on opioid pain medications are bringing renewed interest to a range of non-medicinal pain-relief treatments that do not involve medications.. For people whose back or neck pain has not been relieved by back surgery or other treatments may have another option to consider...Spinal Cord Stimulation.

Spinal Cord Stimulation (SCS) was first used to treat pain in 1967 and was approved by the Food and Drug Administration (FDA) in 1989 to relieve pain from nerve damage. SCS is a well established pain treatment that is being recommended for an increasing number of conditions such as failed back surgery syndrome, cervical and lumbar radiculitis, neuropathy, and complex regional pain syndrome to name a few.

Around the world, some 14,000 patients undergo spinal cord stimulator implants each year. Smaller devices have made implantation less invasive. Stimulators deliver mild electrical pulses to the nerves along the spinal cord, modifying or blocking the transmission of abnormal pain signals to the brain. The pulses are sent to the nerve fibers of the spinal cord by small electrodes which placed near the spinal cord, and connect to a

compact battery-powered generator, which is surgically implanted under the skin.

Unlike most treatments requiring surgery, spinal cord stimulation can be tried for a short time before a person commits to having the implant or having any lasting negative effects. The trial period is part of a two-step screening process to select those most likely to benefit. Should a patient not want the trial anymore, the lead is pulled out in the office, and a small bandage is applied—a simple, painless process. Careful screening is needed because spinal cord stimulation does not work for everyone. Most people who are good candidates for the therapy, however, report at least a 80%

reduction in pain, as well as significant improvement in daily functioning. Some people are also able to take fewer opioid medications (painkillers) after they start spinal cord stimulation.

At the Ramos Center, we have pain specialists with experience in the SCS procedure and expertise on the latest techniques and devices on the market. If you or someone you know suffers from chronic neck and back pain or has had unsuccessful back surgery, spinal cord stimulation may be a viable option.

New Research Studies Now Open!

If you are a smoker, you know how permanent the habit can seem to be. Perhaps, you tried many different methods to stop smoking. All the medical data and scary tactics in the world can’t seem to influence you to quit. The reason for this is simple… the habit has not been established by the logical, intellectual part of your mind. Instead the habit’s cause is in your subconscious. Hypnotherapy works directly with your subconscious mind to help you reach your goals.

To change your behavior, we will first recognize the reason or reasons you smoke. For example, you smoke to nurture yourself, to relieve stress, to provide a break in your activity, control your weight, etc.. After that, during hypnosis, your subconscious will provide you with specific, constructive alternatives to smoking that will be genuinely desirable.

Quitting smoking can be a real challenge for most people. However, it is one of the best things you can do for your health.

Pain & Balance

Physical TherapyMarly Ayala-Ycaza M/S Psy. LMHC Licensed Mental Health Counselor

Qualified study participants may receive compensation for time and travel. All studies administered by

a board certified physician. No medical insurance is required.

Contact Marly Ayala-Ycaza today to find out if you qualify! (941)708-9555 Ext. 106

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