New, Moving or Expanding: IPPMC Welcomes MRI Machine
Practice recently earned excellence award
SARTELL — A 5,000-square-foot expansion is nearing completion at the Interventional Pain & Physical Medicine Clinic (IPPMC). One of the latest pieces to fall in place was a new 12,000-pound MRI machine workers moved into place Monday with a forklift.
IPPMC started in 2003 in a small building on Stearns Way. Five years later, it moved to a 15,000-square-foot building at 2301 Connecticut Ave. The additional 5,000 feet was necessary to accommodate more patients and staff, according to Dr. Thomas Kowalkowski, who founded the practice.
For three years, the clinic had been using an MRI machine in a semi trailer parked outside the front door.
“This is a newer machine, and it’s going to be a permanent part of our facility, so we can continue to provide people the best care possible,” said Kowalkowski, who graduated from St. John’s University, the University of New England and completed a fellowship in anesthesiology and pain medicine at Oregon Health and Science University.
IPPMC has about 50 employees, and its building now features everything from an organic coffee and juice bar to a whirlpool, exercise pool and sauna, to a fully-stocked gym. The clinic also has openings for nine more full- and part-time positions.
“I wanted to come back here because this is home to me,” Kowalkowski said. “We’re the only multidisciplinary pain program of this level outside the Twin Cities, and people are responding to that.”
Earlier this month, IPPMC earned the Excellence in Pain Practice Award from the World Institute of Pain.
IPPMC is one of 17 pain centers in 11 countries to receive the honor.
WIP announces Excellence in Pain Practice Award recipient
WINSTON-SALEM, North Carolina, USA (March 11, 2013) – The World Institute of Pain (WIP) has conferred the Excellence in Pain Practice (EPP) Award for Multidisciplinary Clinical Pain Practice on the Interventional Pain and Physical Medicine Clinic (IPPMC) in Sartell, Minnesota, USA.
“IPPMC’s attributes include providing a multidisciplinary pain centered approach to the prevention, evaluation, treatment, and rehabilitation of painful disorders,” said Dr. Bruce Wymore, a family practitioner in Alexandria, Minnesota.
Dr. Jose Veliz, a pain medicine specialist in Escondido, California added that IPPMC Medical Director Dr. Thomas Kowalkowski has, “a true passion for pain medicine. “
In conveying the award, WIP’s EPP Award Committee Chairman, Dr. P. Prithvi Raj said, “The Committee found the Interventional Pain and Physical Medicine Clinic’s multidisciplinary approach to clinical pain practice to be exemplary. The impact of this pain center on the specialty of pain practice is evident through its individualized approach to improving the quality of life by reducing pain and suffering, through teamwork and a multi-disciplinary model of care.”
The EPP Award program, established in 2010 by the World Institute of Pain, recognizes pain centers that demonstrate the highest standards of pain practice around the world. Varying levels of recognition are attainable, including specialization in a particular area of clinical pain practice, multidisciplinary clinical pain practice, and comprehensive recognition that encompasses all dimensions of pain management including cutting-edge research. EPP Awards have been conferred on 17 pain centers in 11 countries.
To qualify for the award, a site visit is conducted by an FIPP (Fellow of Interventional Pain Practice) member of WIP’s inspector’s panel. The EPP Award Committee exercises its due diligence in the determination of each award given, in accordance with WIP’s guidelines for EPP Award recognition.
WIP is an international, nonprofit organization founded in 1993 that brings together the most recognized experts in the field of pain medicine for the advancement and standardization of interventional pain practice. WIP achieves its purposes and objectives through organizing physician-oriented educational symposia, practical workshops, and World Congresses; certifying as Fellows of Interventional Pain Practice (FIPP) physicians who pass a competency-based, multi-part examination; publishing the scholarly journal, Pain Practice; and establishing liaisons with physicians and industry worldwide to promote the specialty of pain medicine.
IPPMC Patients need NOT be concerned with the multi-state meningitis and septic arthritis outbreak.
IPPMC has not utilized these pharmaceutical products. All medications at IPPMC are FDA Approved. IPPMC is dedicated to offering the highest standard of care based on patient outcomes.
FDA released an updated statement on the fungal meningitis outbreak: http://www.fda.gov/Drugs/DrugSafety/ucm322734.ht
Ginkgo Biloba: No-Go for Alzheimer's Prevention
Another large trial shows no benefit from ginkgo biloba extract in preventing Alzheimer disease, researchers report in the Lancet Neurology.
Nearly 2900 older adults without dementia who spontaneously reported memory complaints to their physicians were randomized to consume standardized ginkgo biloba extract or placebo for 5 years. Overall, the rate of diagnosis with probable Alzheimer's did not differ significantly between the ginkgo and placebo groups (1.2 and 1.4 cases per 100 person-years).
The authors note that a lower-than-expected Alzheimer's rate in both groups reduced the study's power, while a Lancet Neurology editorialist concludes: "For adults aged 70 years or older with a memory complaint who might be mildly cognitively impaired, use of [ginkgo biloba extract] does not decrease the risk of Alzheimer's disease over 5 years."
New Way of Fighting High Cholesterol Upends Assumptions
Atherosclerosis – the hardening of arteries that is a primary cause of cardiovascular disease and death – has long been presumed to be the fateful consequence of complicated interactions between overabundant cholesterol and resulting inflammation in the heart and blood vessels.
However, researchers at the University of California, San Diego School of Medicine, with colleagues at institutions across the country, say the relationship is not exactly what it appears, and that a precursor to cholesterol actually suppresses inflammatory response genes. This precursor molecule could provide a new target for drugs designed to treat atherosclerosis, which kills tens of thousands of Americans annually.
The findings are published in the September 28, 2012 issue of Cell.
Lurking within our arterial walls are immune system cells called macrophages (Greek for “big eater”) whose essential function is to consume other cells or matter identified as foreign or dangerous. “When they do that, it means they consume the other cell’s store of cholesterol,” said Christopher Glass, MD, PhD, a professor in the Departments of Medicine and Cellular and Molecular Medicine and senior author of the Cell study. “As a result, they’ve developed very effective ways to metabolize the excess cholesterol and get rid of it.”
But some macrophages fail to properly dispose of the excess cholesterol, allowing it to instead accumulate inside them as foamy lipid (fat) droplets, which gives the cells their particular name: macrophage foam cells.
These foam macrophages produce molecules that summon other immune cells and release molecules, signaling certain genes to launch an inflammatory response. Glass said conventional wisdom has long assumed atherosclerotic lesions – clumps of fat-laden foam cells massed within arterial walls – were the unhealthy consequence of an escalating association between unregulated cholesterol accumulation and inflammation.
Glass and colleagues wanted to know exactly how cholesterol accumulation led to inflammation, and why the macrophages failed to do their job. Using specialized mouse models that produced abundant macrophage foam cells, they made two unexpected discoveries that upend previous assumptions about how lesions form and how atherosclerosis might be more effectively treated.
“The first is that foam cell formation suppressed activation of genes that promote inflammation. That’s exactly the opposite of what we thought happened,” said Glass. “Second, we identified a molecule that helps normal macrophages manage cholesterol balance. When it’s in abundance, it turns on cellular pathways to get rid of cholesterol and turns off pathways for producing more cholesterol.”
That molecule is desmosterol – the final precursor in the production of cholesterol, which cells make and use as a structural component of their membranes. In atherosclerotic lesions, Glass said the normal function of desmosterol appears to be “crippled.”
“That’s the next thing to study; why that happens,” Glass said, hypothesizing that the cause may be linked to overwhelming, pro-inflammatory signals coming from proteins called Toll-like receptors on macrophages and other cells that, like macrophages, are critical elements of the immune system.
The identification of desmosterol’s ability to reduce macrophage cholesterol presents researchers and drug developers with a potential new target for reducing the risk of atherosclerosis.
Glass noted that a synthetic molecule similar to desmosterol already exists, offering an immediate test-case for new studies. In addition, scientists in the 1950s developed a drug called triparanol that inhibited cholesterol production, effectively boosting desmosterol levels. The drug was sold as a heart disease medication, but later discovered to cause severe side effects, including blindness from an unusual form of cataracts. It was pulled from the market and abandoned.
“We’ve learned a lot in 50 years,” said Glass. “Maybe there’s a way now to create a new drug that mimics the cholesterol inhibition without the side effects.”
Co-authors are first author Nathanael J. Spann, Norihito Shibata, Donna Reichart, Jesse N. Fox and Daniel Heudobler, UCSD Department of Cellular and Molecular Medicine; Lana X. Garmire, UCSD Department of Bioengineering; Jeffrey G. McDonald and David W. Russell, Department of Molecular Genetics, UT Southwestern Medical Center; David S. Myers, Stephen B. Milne and Alex Brown, Department of Pharmacology, Vanderbilt Institute of Chemical Biology; Iftach Shaked and Klaus Ley, La Jolla Institute of Allergy and Immunology; Christian R.H. Raetz, Department of Biochemistry, Duke University School of Medicine; Elaine W. Wang, Samuel L. Kelly, M. Cameron Sullards and Alfred H. Merrill, Jr., Schools of Biology, Chemistry and Biochemistry and the Parker H. Petit Institute of Bioengineering and Bioscience, George Institute of Technology; Edward A. Dennis, UCSD Department of Chemistry and Biochemistry; Andrew C. Li, Sotirios Tsimikas and Oswald Quehenberger, UCSD Department of Medicine; Eoin Fahy, UCSD Department of Bioengineering; and Shankar Subramaniam, UCSD Departments of Cellular and Molecular Medicine, Bioengineering and Chemistry and Biochemistry.
Funding for this research came, in part, from National Institutes of Health grants GM U54069338 (to the LIPID MAPS Consortium), P01 HC088093 and P01 DK074868.
FDA Introduces New Safety Measures for Extended-Release & Long-acting Opioid Medications
The U.S. Food and Drug Administration today approved a risk evaluation and mitigation strategy (REMS) for extended-release (ER) and long-acting (LA) opioids, highly potent drugs approved for moderate to severe, persistent pain that requires treatment for an extended period.
The REMS is part of a federal initiative to address the prescription drug abuse, misuse, and overdose epidemic. The REMS introduces new safety measures designed to reduce risks and improve the safe use of ER/LA opioids, while ensuring access to needed medications for patients in pain.
"Misprescribing, misuse, and abuse of extended-release and long-acting opioids are a critical and growing public health challenge,” said FDA Commissioner Margaret A. Hamburg, M.D. "The FDA’s goal with this REMS approval is to ensure that health care professionals are educated on how to safely prescribe opioids and that patients know how to safely use these drugs.”
The new ER/LA opioid REMS will affect more than 20 companies that manufacture these opioid analgesics. Under the new REMS, companies will be required to make education programs available to prescribers based on an FDA Blueprint. It is expected that companies will meet this obligation by providing educational grants to continuing education (CE) providers, who will develop and deliver the training.
The REMS also will require companies to make available FDA-approved patient education materials on the safe use of these drugs. The companies will be required to perform periodic assessments of the implementation of the REMS and the success of the program in meeting its goals. The FDA will review these assessments and may require additional elements to achieve the goals of the program.
"We commend the FDA for taking action to save lives by increasing access to prescriber education,” said Gil Kerlikowske, director of the Office of National Drug Control Policy. "Since day one, the Obama Administration has been laser focused on addressing the prescription drug abuse epidemic and today’s action is an important contribution to this comprehensive effort.”
ER/LA opioid analgesics are widely prescribed medicines with an estimated 22.9 million prescriptions dispensed in 2011, according to IMS Health, which provides services and information to the health care and pharmaceutical industries. It is estimated that more than 320,000 prescribers registered with the Drug Enforcement Administration (DEA) wrote at least one prescription for these drugs in 2011.
ER/LA opioid analgesics are associated with serious risks of overuse, abuse, misuse and death and the numbers continue to rise. According to the Centers for Disease Control and Prevention, 14,800 Americans died from overdoses involving opioids in 2008. In 2009, there were 15,597 deaths involving these medications – nearly four times as many deaths compared to 1999.
"Misuse and abuse of prescription opioids is a complex problem and demands a holistic response,” said John Jenkins, M.D., director of CDER’s Office of New Drugs. "The new REMS program is one component of a multi-agency, national strategy to address this important public health issue.”
Key components of the ER/LA opioid analgesics REMS include:
Training for prescribers
Based on an FDA Blueprint, developed with input from stakeholders, educational programs for prescribers of ER/LA opioids will include information on weighing the risks and benefits of opioid therapy, choosing patients appropriately, managing and monitoring patients, and counseling patients on the safe use of these drugs. In addition, the education will include information on how to recognize evidence of, and the potential for, opioid misuse, abuse, and addiction, and general and specific drug information for ER/LA opioid analgesics.
Updated Medication Guide and patient counseling document
These materials contain consumer-friendly information on the safe use, storage and disposal of ER/ LA opioid analgesics. Included are instructions to consult one’s physician or other prescribing health care professional before changing doses; signs of potential overdose and emergency contact instructions; and specific advice on safe storage to prevent accidental exposure to family members and household visitors.
Companies will be expected to achieve certain FDA-established goals for the percentage of prescribers of ER/ LA opioids who complete the training, as well as assess prescribers’ understanding of important risk information over time. The assessments also cover whether the REMS is adversely affecting patient access to necessary pain medications, which manufacturers must report to FDA as part of periodic required assessments.
It is expected that the first continuing education activities under the REMS will be offered to prescribers by March 1, 2013.
There is no mandatory requirement that prescribers take the training and no precondition to prescribing ER/LA opioids to patients. However, the Obama Administration endorsed a mandatory training program on responsible opioid prescribing practices in April 2011 as part of its comprehensive plan to address the epidemic of prescription drug abuse. The program, which would be linked to DEA registration by providers, would require legislative changes that are being pursued by the Administration.
The FDA continues to support this approach, but absent the needed legislation, intends to exercise its authority to require mandatory elements for companies and voluntary elements for prescribers – all of which are important and necessary steps to help curb the misuse and abuse of ER/ LA opioid analgesics, without being overly burdensome.
New Back Pain Gene Identified
Researchers at King’s College London have for the first time identified a gene linked to age-related degeneration of the intervertebral discs in the spine, a common cause of lower back pain.
Costing the UK an estimated £7billion a year due to sickness leave and treatment costs, the causes of back pain are not yet fully understood. Until now, the genetic cause of lower back pain associated with lumbar disc degeneration (LDD) was unknown, but the largest study to date, published this week in the journal Annals of Rheumatic Diseases, has revealed an association with the PARK2 gene.
The researchers, funded by the Wellcome Trust and Arthritis Research UK, say more research into this surprising association needs to be carried out in order to fully understand how it is triggered, but this new finding could ultimately pave the way towards developing new treatments in the future.
LDD is a common age-related trait, with over a third of middle-aged women having at least one degenerate disc in the spine. Discs become dehydrated, lose height and the vertebrae next to the discs develop bony growths called osteophytes. These changes can cause or contribute to lower back pain. LDD is inherited in between 65 – 80 per cent of people with the condition, suggesting that genes play a key role.
Scientists compared MRI images of the spine in 4,600 individuals with genome-wide association data, which mapped the genes of all the volunteers. They identified that the gene PARK2 was implicated in people with degenerate discs and could affect the speed at which they deteriorate.
The researchers say the results show that the gene may be switched off in people with LDD. Although it is still unclear how this might happen, it is thought that environmental factors, such as lifestyle and diet, could trigger this switch by making changes known as epigenetic modifications to the gene.
Dr Frances Williams, Senior Lecturer from the Department of Twin Research and Genetic Epidemiology at King’s College London, said: 'Back pain can have a serious impact on people’s lives and is one of the most common causes of sickness leave, costing both the NHS and UK economy billions each year.
'We have performed, using data collected from around the world, the biggest genome-wide association analysis of lumbar disc degeneration (LDD). We know that people whose discs wear out are at increased risk of episodes of lower back pain, but normal human discs are hard to get hold of to study so until now our knowledge of normal human biology was incomplete.
'We have identified a gene called PARK2 as associated with LDD. We have shown that the gene may be switched off in people with the condition.
'Further work by disc researchers to define the role of this gene will, we hope, shed light on one of most important causes of lower back pain. It is feasible that if we can build on this finding and improve our knowledge of the condition, we may one day be able to develop new, more effective treatments for back pain caused by this common condition.'
IPPMC Earns ACR Accreditation
Interventional Pain & Physical Medicine Clinic has been awarded a three-year term of accreditation in magnetic resonance imaging (MRI) as the result of a recent review by the American College of Radiology (ACR). MRI is a noninvasive medical test that utilizes magnetic fields to produce anatomical images of internal body parts to help physicians diagnose and treat medical conditions.
The ACR gold seal of accreditation represents the highest level of image quality and patient safety. It is awarded only to facilities meeting ACR Practice Guidelines and Technical Standards after a peer-review evaluation by board-certified physicians and medical physicists who are experts in the field. Image quality, personnel qualifications, adequacy of facility equipment, quality control procedures, and quality assurance programs are assessed. The findings are reported to the ACR Committee on Accreditation, which subsequently provides the practice with a comprehensive report they can use for continuous practice improvement.
The ACR is a national professional organization serving more than 34,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services.
Fellow of ABPM&R, DO,FIPP Medical Director
American Board of Physical Medicine and Rehabilitation
Subspecialty of Pain Medicine
World Institute of Pain
Diplomate of the American Board of Interventional Pain Physicians
Physical Medicine & Rehabilitation, University of Minnesota
University of New England (COM)
Undergraduate: St. John's University, Collegeville, MN
Fellowship: ACGME Fellowship in Anesthesiology/Pain medicine, Oregon Health and Science University
Dr. Kowalkowski practices Interventional Pain and Sports medicine full time. He is a diplomate of the American Board of Physical Medicine and Rehabilitation from the University of Minnesota with a sub-specialty in pain medicine. He has completed an ACGME Fellowship in Anesthesiology/Pain Medicine from Oregon Health and Science University. Dr. Kowalkowski is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. He is a member of the American Society of Anesthesiologists, The World Institute of Pain, American Society of Interventional Pain Physicians, North American Spine Society, International Spinal Injection Society, and PASSOR (Physiatrist Association of Spine, Sport, and Occupational Rehabilitation).
Dr. Kowalkowski is one of less than 100 physicians across the country with his specific training and credentials in pain medicine. He is dedicated to the diagnosis of acute and chronic pain conditions of complex musculoskeletal, orthopedic, and neurological problems pertaining to pain medicine. Dr. Kowalkowski is committed to providing you with the best possible care using an individualized approach. The practice focuses on interventional pain medicine using state of the art technology in the treatment of pain.