Pain pill alternatives offered by Naples clinic to help uninsured

March 03--NAPLES -- For the first time in decades, Heidi Baver has hope for a normal life.

Pain from lupus is manageable after the diagnosis 28 years ago. Stress from lack of sleep has subsided.

The 48-year-old florist is getting acupuncture at the Neighborhood Health Clinic near downtown Naples. The clinic shuns narcotic pain drugs.

"It's not just the healing quality, it's the mental healing quality," Baver, 48, said of her twice-weekly acupuncture. "I can feel my body respond. I can feel it every day. There is less pain and the stress levels are controlled. For once, you don't have to worry anymore."

In addition to acupuncture, the clinic conducts physical therapy classes to give patients real-life tips for managing their chronic pain. Several volunteer physicians provide cortisone and epidural injections for pain relief.

Patients are seeing dramatic results, including some who went the pain-pill route previously with bad outcomes, said Dr. Robert Tober, medical director at the 121 S. Goodlette-Frank Road clinic that serves uninsured working people of Collier County.

"There are more people who will tell you they get more relief from non-addictive medications," Tober said.

Clinic directors realized in 2011 they needed to develop a structured pain management program because so many patients struggle with pain and their jobs involve physical labor, said Nancy Lascheid, clinic co-founder with her husband, retired dermatologist William Lascheid.

"It's effective," she said. "We are getting results."

Bypassing opiates and other controlled substances in light of the pill mill crisis is a commendable approach, said Dr. Sanford Silverman, president of the Florida Society of Interventional Pain Physicians.

"It's a great model to do other things besides opiates. It's good to get patients being held accountable," he said.

Because of the state's crackdown on pill mill activity since 2011, physicians have been writing fewer prescriptions for the addictive drugs, like Oxycodone, he said. Still, alternative therapies aren't going to be as effective for people with severe pain due to trauma injuries, cancer and other debilitating conditions, he said.

"There's definitely a move away from (the narcotics) but still a lot is being used for the right reasons," Silverman said.

The alternatives aren't an option for some because commercial insurance doesn't cover acupuncture, and neither does Medicare for the elderly, he said.

"Some people will pay for acupuncture and some won't," he said, referring to his experiences at his practice, Comprehensive Pain Medicine in Pompano Beach.

With the Affordable Care Act, known as Obamacare, the federal government last fall proposed payment cuts, effective Jan. 1, to physicians who provide interventional pain medicine, which focuses on diagnosing, treating and addressing the source of pain, Silverman said.

The cuts apply only when interventional pain services, such as epidermal injections, are done in physician office settings, he said. At the same time, the government increased reimbursement when the treatment is done in hospital outpatient programs.

The consequence will be fewer interventional pain services in doctors' offices and a shift toward more generalized pain pill therapy, he said.

Getting a normal life

Baver, the lupus patient, began acupuncture about a year ago.

"This should be mainstream and covered by insurance," Baver said.

Most of her lupus pain has been in her arms. In years past, she couldn't tolerate pain pills because of side effects. Topical medications caused a burning sensation. She was left with over-the-counter products containing ibuprofen.

After a month of acupuncture, she stopped taking ibuprofen at night to sleep.

"It literally has zero side-effects," Baver said of acupuncture. "I think the people who are around me see a difference. I am more easygoing because I am getting sleep. It just made my life normal and so much better because I see my body responding to the treatment in many, many ways."

Dr. Carol McDermott, the acupuncturist who volunteers at the clinic, said research shows acupuncture is effective for pain management therapy.

"It is not a substitute," McDermott said. "We use it as an adjunct to other therapies."

Acupuncture triggers release of endorphins and serotonin in the brain, providing relief from pain, she said. Besides the physical component, there is a psycho-social aspect -- acupuncture helps address anxiety, nervousness and depression, which many pain patients experience, she said

"I explain it is cumulative. It is not one treatment," McDermott said, adding that frequency of treatments will vary from patient to patient.

Getting clean and fighting pain

Tom Russo used to medicate his back pain with vodka and Oxycontin, a widely abused pain drug.

Now 50, his life began to spiral out of control after a freak accident in 2000 when a forklift driver ran over his feet and he injured his back at a fish market in lower Manhattan. Russo, 36 at the time, was immobilized for two months.

After moving to Fort Myers, his substance abuse caused him to lose his family and home. He ballooned to 450 pounds.

Last year, he got clean at the Collier County-based David Lawrence Center's substance recovery program and later he lived at St. Matthew's House homeless shelter. A month ago, he started attending the clinic's physical therapy classes conducted by volunteer Stephanie Riley. She teaches patients about pain and instructs them to keep a daily log of their pain level, which might reveal patterns for when it worsens and why.

Russo is learning proper sitting positions to minimize his back pain and how to use pillows. He is learning techniques to manage stress and much more.

"I've been here four times and it has helped me tremendously," Russo said. "I can get out of bed now without pain. I can walk and I'm not waddling."

Riley tells him she already has seen an improvement in him. Because of his good attendance to the classes, he will be eligible for physical therapy treatments.

"So this way, there is a commitment and responsibility that patients take," Riley said.

Russo understands where she's coming from. It was a long road getting to that point.

"I did the vodka and pain meds," he said. "It was not the way to go. It is not going to solve the problem."

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