Medical Journal Houston Vol. 11, Issue 1, April 2014

Legal Affairs: Halifax Hospital Settlement: Scrutiny of relationships between hospitals and physicians, see page 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Leading Source for Healthcare Business News April 2014 • Volume 11, Issue 1 • $3.50 Special Feature: Addiction Good intentions; unintended consequences INSIDE ▼ NeuroPace® RNS® System for epilepsy treatment see page 10 INDEX ▼ Financial Perspectives.......3 Legal Affairs......................4 THA.................................6 Breaking Ground..............8 Integrative Medicine.........9 Technology......................10 Physicians Forum............11 by W. Clay Brown, M.D., Medical Director of Adolescent Services, Memorial Hermann Prevention and Recovery Center, and Mike Leath, R.Ph., M.D., Chief Physician, Memorial Hermann Prevention and Recovery Center In our culture of immediate gratification and quick fixes, the role a medical doctor unwittingly plays in substance abuse or addiction relapse sometimes boils down to simply prescribing a standard medication to resolve a temporary medical issue: Ambien for difficulty sleeping, Soma for a sprained back muscle, or Vicodin for a root canal. However, a short-term solution may inadvertently lead a patient into a lingering struggle with addiction or a slide back into substance abuse. Today, there are  approximately 750,000 physicians in active patient care in the United States. Unfortunately, a significant number have had less than half a day of training in prescription drug diversion. Thus, many doctors may be  unaware of mood/mind-altering properties of certain medications, especially with new medications coming onto  the market, or uninformed about the problem of crossaddiction, the swapping one substance for another. Please see ADDICTION page 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The Opioid Dilemma: A Catch-22 in Medical Practice? Digital dementia and internet addiction see page 9 . . . . . . . . . . . . J. Lance LaFleur, MD, MBA, Houston Pain Centers “If we know that severe pain and suffering can be alleviated and we do nothing about it, we, ourselves, are tormentors.” –Primo Levi It is difficult to overestimate the stakes of the accurate management of pain. Left undiagnosed and untreated, the headache after subarachnoid hemorrhage or the arm pain from myocardial infarction or chondrosarcoma could very well be lethal. When the pain is not only a symptom, but a disease state, the diagnostic and treatment quandaries remain. Unfortunately, the use of opioids, one of the historic mainstays of therapy for the chronic pain patient, is becoming increasingly complex. Approximately 8% of Americans with immense suffering, who are often confined to their homes because of severe, disabling pain, comprise part of the total 37% in our nation with chronic pain.1 The cost of medical treatment for patients with chronic pain in the U.S. is in excess of $100 billion annually.2 Current treatment paradigms employed by fellowship trained, board-certified interventional pain physicians are both comprehensive and multidisciplinary. They often include rehabilitation approaches (e.g., assistive devices and physical or aquatic therapy), lifestyle changes, adjuvant analgesics and opioids, psychological and psychiatric approaches (e.g., cognitive behavioral therapy and transcranial magnetic stimulation), spine and joint injections, and radiofrequency ablation of nerves. Some patients with severe, refractory Please see CATCH-22 page 16 PRSRT STD US POSTAGE PAID HOUSTON TX PERMIT NO 13187