Addiction, Opioid Conference at Rutgers New Jersey Medical School

Today I attended a terrific conference on Addiction and Opioids, at Rutgers New Jersey Medical School (NJMS).

Addiction, Opioid, Suboxone, Conference at Rutgers NJMS, 2017

Addiction, Opioid, Suboxone, Conference at Rutgers NJMS, 2017

Addiction, Opioid Conference, Rutgers NJMS, Patrick Foye, MD, 2017

Patrick Foye, MD, at an Addiction, Opioid Conference, Rutgers NJMS, 2017

Addiction, Opioid Conference, Rutgers NJMS, Petros Levounis, 2017

Addiction, Opioid Conference, Rutgers NJMS, Petros Levounis, MD, Lecturing, 2017

Classification of Opioids, Rutgers NJMS, Addiction Conference

Classification of Opioids, Rutgers NJMS, Addiction Conference

To see Dr. Foye for evaluation or treatment of coccyx pain (tailbone pain), please go to the website: www.TailboneDoctor.com/forms and complete the paperwork.

Pain Conference was Awesome, NJSIPP and NYSIPP

Dr. Foye recently attended the Pain Medicine Symposium 2017, which is a medical conference for pain management physicians.

The conference was run by the New York Society of Interventional Pain Physicians (NYSIPP) and the New Jersey Society of Interventional Pain Physicians (NJSIPP).

There were physician experts speaking and attending from around the world.  Modern treatments were covered, including regenerative medicine (Platelet Rich Plasma [PRP] injections, stem cell injections, etc.), neuromodulation procedures, nerve ablation, injections and other procedures done under fluoroscopic guidance, injections and other procedures done under ultrasound guidance, etc.

It was a terrific conference and a great chance to network and reconnect with other physicians who also specialize within the field of pain management.

NYSIPP NJSIPP Patrick Foye MD New Jersey Society of Interventional Pain Physicians

Conference, NJSIPP, NYSIPP, New York and New Jersey Society of Interventional Pain Physicians, 2017

Conference, NJSIPP, NYSIPP, New York Society of Interventional Pain Physicians and New Jersey Society of Interventional Pain Physicians, 2017

Patrick Foye MD at NYSIPP NJSIPP New Jersey Society of Interventional Pain Physicians, NYC skyline

Patrick Foye MD at NYSIPP NJSIPP New Jersey Society of Interventional Pain Physicians, NYC skyline

Patrick Foye MD,  Fluoroscopy Lab at NYSIPP NJSIPP New Jersey Society of Interventional Pain Physicians, Conference 2017

Patrick Foye MD, Fluoroscopy Lab at NYSIPP NJSIPP New Jersey Society of Interventional Pain Physicians, Conference 2017

 

Is the Spinal CORD Located at the Coccyx?

Patients sometimes ask me whether the “spinal cord” is located at their coccyx.

It’s a reasonable question, since the spinal cord does extend through most of the human spine.

What is the Spinal Cord?
  • The spinal cord is a dense, relatively tightly packed collection of nerves.
  • The spinal cord is almost like a big, thick electrical cable, with lots of electrical wires (nerves) going through it.
  • But it’s more complicated because there is also a complex system of connections that work like relay switches (synapses), where electrical signals get turned on and off.
Where is the Spinal Cord and the Spinal Canal?
  • In general, the “spinal cord” itself goes from the base of the brain down to the upper lumbar region.
  • Usually the lowest part of the spinal cord is at about the level of the 1st or 2nd lumbar vertebral bone, which, for reference, would be a few inches ABOVE your belt line or waistband.
  • So, the spinal cord is relatively far away from the tailbone in the vast majority of patients.
  • (A small percentage of patients may have a spinal cord that is “tethered” down, sometimes seen in people with spina bifida, for example, but even then it would not be so far down that it would be expected to be down at the level of the coccyx).
  • However, the spinal CANAL extends downward through the sacrum.
  • The coccyx does NOT have a spinal cord within it, and the coccyx does NOT have a spinal canal within it.
The “Meninges” are “Lining” for the Spinal Canal
  • The walls on the inside of the spinal canal  are mostly made of spinal bones.
  • But there is a lining inside the bones. It’s sort of like the way that there is a plastic lining inside of the walls of a swimming pool. This lining keeps the spinal fluid from leaking out.
  • The lining of the spinal canal is called the “Meninges” or meningeal lining or meningeal layers. It includes the  dura mater, arachnoid mater, and pia mater .
  • The  meningeal lining is almost like Saran wrap or whatever you call plastic wrap in your part of the world
  • Although the coccyx does not have any spinal canal within it (unlike the rest of the human spine)… BUT… some of the meningeal fibers that line the spinal canal do extend down through the sacrum and a few of those fibers attach at the top of the coccyx. This is probably not clinically significant in the vast majority of patients, but it rare cases patients may have tension or tugging or tightness of those fibers, where movements or tightness at other levels of the spine may cause tension/tugging on the coccyx, and vice versa. It’s uncommon, but possible.
OTHER Nerves at the Coccyx
  • Since there is no spinal cord at the coccyx, does that mean that there are no at the coccyx region????  …… No! Definitely not!
  • There are lots of other nerves at the coccyx.
  • Examples include normal somatic nerve fibers that carry pain and other sensation from the coccyx and surrounding tissues.
  • The skin over the coccyx is innervated by nerves.
  • Importantly, the ganglion Impar is located at the level of the upper coccyx.
In summary, the spinal cord itself is NOT located at the coccyx. But other nerves ARE located at the coccyx.

Why Doctors Specialize in Physical Medicine and Rehabilitation

There are many reasons why doctors choose to specialize in a given area of medicine.

The video below was done by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) regarding why doctors choose to specialize in Physical Medicine and Rehabilitation (PM&R).  It features Patrick Foye, M.D., and other PM&R physicians.

 

Social Media for Public Medical Education

To “Doctor” means “To Teach.”
  • The word “Doctor” comes from the Latin word  docēre [dɔˈkeːrɛ] ‘to teach‘.
  • So, a Doctor is a Teacher.
  • Doctors teach patients about the health and about their medical conditions and treatment options. A patient who is well-informed about their condition can make better decisions about their healthcare.
  • There are many ways to teach people about their health.
  • The most traditional approach is for a physician to spend time with each individual patient, informing one patient at a time regarding his or her specific diagnosis.
  • But physicians also have some responsibility to society overall, beyond just the individual patients who come for in-person medical care.
    • Public and private physician groups regularly issue public statements regarding matters of public health.
    • Examples include medical professional groups such as pediatricians recommending childhood immunization programs, or a national cancer society recommending certain protocols for cancer screening programs.
  • Modern methods of communication such as the Internet allow physicians to provide information online for free use by the public.
    • This can include blogging, YouTube videos, social media posts on Facebook, Twitter, etc.
    • Physicians are increasingly using the Internet to provide helpful information to society at large, providing benefit even to those who may never meet the physician in person.
    • In general, when people find medical information online, they should discuss this with their in-person treating physician, who can advise the person as to whether the information is correct and whether it is relevant to this individual person.

In the Link below, there is a video encouraging physicians to provide medical information online via Social Media.

Social Media for Physicians

4 Free Chapters from the book, Tailbone Pain Relief Now!

Now available: 4 Free Chapters, from Dr. Foye’s internationally acclaimed book, Tailbone Pain Relief Now!
Right now on Amazon you can get the first 4 chapters of this book for FREE.
  • Chapter 1: Introduction to Tailbone Pain
  • Chapter 2: Symptoms of Tailbone Pain
  • Chapter 3: Overcoming Stigma: Psychology of Tailbone Pain
  • Chapter 4: Anatomy of Tailbone Pain
  • The full book contains 31 chapters, 272 pages, providing crucial information for people suffering from tailbone pain (coccyx pain).
  • It is written in plain language, so it is easy to understand.
  • The book has an impressive 5-star rating by readers on Amazon.
Get your 4 free chapters now.
  • Then you can decide whether you also want a full copy of the book in the format of your choice: either as a printed paperback or as an e-book.
  • Available internationally.

Learn the tips, tricks, and secrets you need to get an accurate diagnosis and the best possible treatments. 

Look-Inside Tailbone Pain Book, Coccyx Pain Book

Look-Inside Tailbone Pain Book, Coccyx Pain Book

Second Dose, Repeat Coccyx Injection for Tailbone Pain

Tailbone Injections and Repeat Injections are Common and Reasonable for Coccyx Pain
REPEAT Tailbone Injections for Coccyx Pain
  • The best reason to repeat a tailbone injection is when the same injection has previously provided excellent relief for a substantial duration of time.
    • For example, if an specific injection gave 100% relief but then a year later the pain starts coming back, then repeating the injection often makes sense.
  • Second dose: In some patients, the initial injection may fail to give adequate relief, but it still may make sense to REPEAT the injection.
    • This is sometimes referred to as the “2nd dose” effect.
    • Headache comparison: Imagine that you have a headache, and you take 2 tablets of Tylenol. After 4 or 5 hours, if you do not have complete relief of your headache, then it may be reasonable to take a “second dose”. The same treatment is given, but this may be dramatically more effective than the initial treatment was.
    • At the coccyx, imagine that you had a coccyx injection, and received only partial relief, or perhaps even no relief at all. Then, depending on your specific details, it may make sense to REPEAT the same injection, in order to obtain the “Second dose” effect and thereby receive relief.  It is often very dramatic to see patients where a single injection has given little or no relief, and yet a repeat injection (second dose) has given complete relief and terrific improvement in quality of life.
  • The decision regarding whether to undergo or repeat a coccyx injection in any given patient should be a consideration and discussion between the individual patient and their in-person treating physician (ideally a physician with experience in evaluating and treating patients with coccydynia [coccyx pain, tailbone pain]).

 

For more information on tailbone pain, go to: http://www.TailboneDoctor.com

To obtain your copy of the book Tailbone Pain Relief Now! go to: http://www.TailbonePainBook.com  or get it on Amazon at: http://amzn.com/0996453504

Appreciation Award Given to Dr Patrick Foye, MD

2017 Appreciation Award Given to Dr. Patrick Foye, M.D.
  • At this year’s graduation ceremonies for graduating residents physicians and fellows, the Department of Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School presented the Department’s “Appreciation Award” to Dr. Foye, in honor of his almost-five-years serving as Interim Chair of the Department.
  • Dr Patrick Foye MD, PMR Appreciation Award 2017

Photos from 20 years ago

Photos from ~20 years ago
  • #FBF (Flash-back Friday)
  • with Dr. Denise Campagnolo (she was #NJMS/Kessler #PMandR Residency Director in that era).
  • I found these today.
  • But I’m not sure who that guy is with the thick, dark, hair.  :-) -Dr. Foye
  • Dr Patrick Foye MD, Denise Campagnolo_5 Dr Patrick Foye MD, Denise Campagnolo_1

Unboxing: Tailbone Pain as Published in PM&R Clinics of North America

Unboxing a New Publication on Tailbone Pain, Coccyx Pain, Pelvic Pain
  • Publishing is an important part of any career in Academic Medicine.
  • Publishing is how we share our research, our clinical pearls, our experience and expertise.
  • Publishing makes all of this available to other clinicians, physicians, researchers, and others who may be interested worldwide, for years to come.
  • The VIDEO below shows Patrick Foye, M.D., un-boxing a newly-received, freshly-minted copy of a new publication.
  • The journal is called, “Physical Medicine and Rehabilitation Clinics of North America”.
  • This entire hardcover edition was dedicated to “Pelvic Pain” and Dr. Foye wrote the chapter on “Coccydynia: Tailbone Pain” (Coccyx Pain).
  • To reveal the VIDEO, click on the images or click on the link below.
  • Unboxing Tailbone Pain PMR Clinics of NA, screenshot, closerUnboxing Tailbone Pain in PMR Clinics of NA
  • To reveal the VIDEO, CLICK this LINKhttps://youtu.be/mL0x2Ei4hx8
 Below is the TEXT transcribed from Dr. Foye’s Video:
  • I’m Dr.Patrick Foye, and I’m an M.D., or medical doctor, and I’m the Founder and Director of the Coccyx Pain Center or Tailbone Pain Center here in the United States, available online at www.TailboneDoctor.com.
  • And the reason that I’m holding this cardboard box that arrived in the mail today is sort of an unboxing of sorts Some of you may know that in addition to treating patients I am a full-time faculty member here at Rutgers New Jersey Medical School, where I’m a Professor within the Department of Physical Medicine and Rehabilitation and being a Professor, and an academic faculty member, part of what that means is that, in addition to being a physician and treating patients, that I’m also a medical educator, that I’m teaching medical students and residents physicians and fellows and colleagues and also doing research and publications.
  • And I probably have, I don’t know, easily over 100 publications (between research articles and book chapters and various publications over the years) which is not surprising given that I’ve been in academic medicine for more than twenty-one years.
  • But the part that’s neat for me is that it’s still exciting, and I still love what I do,  and I still love when I finally see something in print when I know that myself and my colleagues have been working on for a long time.
  • So, the unboxing, of sorts… This arrived here at the Tailbone Pain Center  here today and in opening it up it is basically the current addition of a journal called the Physical Medicine and Rehabilitation Clinics of North America.
  • And they did an entire hardcover issue on pelvic pain specifically.
  • And I was asked to write the section in here on coccyx pain or tailbone pain, since that’s my primary area.
  • So I can tell you that for myself and the other physicians across the country who have been involved in this particular publication this has been at least well over two years in the making.
  • Academic projects take a long time between the time you are invited to write an article or a paper or a manuscript or a book chapter and then doing the edits and going back and forth with the editors and sometimes with medical illustrators and then finally making it to publication and making it into print.
  • It’s always cool when it finally comes out and you actually have a tangible copy, and the idea that this tangible copy is also showing up in other places that physicians are getting their hands on this and hopefully learning, in this case, the proper way to evaluate and treat tailbone pain.
  • So within this, if I open it up here again: PM&R Clinics of North America, entire section on Pelvic Pain.
  • There are lots of different authors from around the country doing their own different sections.
  • There’s a section here on anatomy and physiology, office evaluation of  pelvic pain in general, myofascial pain  musculoskeletal pain and then the next chapter, which is mine, which is basically on coccyx pain.
  • So if I swing back to that, I’ll share just a little bit with you of what’s in here for physicians.
  • Now this is different than some of the things I’ve written and published more specifically for patients.
  • I still continue to do that as well and I’m a huge believer in empowering patients.
  • But this particular one is on is for is written for physicians.
  • So if you have a physician who perhaps is a Physical Medicine and Rehabilitation doctor, this might be something that’s on their shelf.
  • If you have tailbone pain you may want to ask them if they have received the pelvic pain edition of the PM&R clinics of North America journal, because there’ll be lots of information in there for them.
  • And, again, in this particular chapter on coccydynia or tailbone pain.
  • We talk in here about the terminology, how frequent this is, the anatomy, the different joints, ligaments, muscles, etc.
  • that that attach to the tailbone.
  • The different causes of tailbone pain.
  • So here we’re talking about coccyx fractures, dislocations, coccygeal dynamic instability (which means an unstable joint at the tailbone, which is one of the most common causes of tailbone pain, and something that you really need sitting versus standing x-rays in order to evaluate for and make that diagnosis).
  • Here I also talk about bone spurs at the lower tip of the tailbone (a common source of tailbone pain), abnormal positions of the coccyx, arthritis, sympathetic nervous system pain at the tailbone, pelvic floor dysfunction, cancer, bone infection,  and lots of other things that can cause pain.
  • It also educates doctors about the symptoms: pain with sitting being the most common and many patients will also have pain with sit-to-stand.
  • They may have other pains in other back low back and pelvis and buttock regions as well.
  • Here I mentioned about the physical exam findings to look for with tailbone pain, the diagnostic tests or imaging studies like x-rays and especially the sitting versus standing x-rays explaining to them what that is (because unfortunately many, many doctors around the country and around the world are not familiar with sitting versus standing x-rays for tailbone pain, which is really, really unfortunate because unstable joints are probably the most common cause of tailbone pain and they can only be diagnosed on imaging studies by doing the sitting versus standing images so those x-rays become really, really important).
  • But I also talked about MRI and CT scans and nuclear medicine bone scans and other things in this section, which is within that area about diagnostic tests.
  • I’ve also published… this is the first time I’ve published this particular algorithm, which is basically going from somebody that has pain and getting the x-rays (ideally the sitting versus standing x-rays) and then depending on what those show deciding whether the person needs to move forward with treatment versus whether they may need further imaging studies, such as MRI or CT scan or other things to look for malignancies and other conditions, depending on what your initial findings were on the initial X-rays.
  • And then depending on how they respond to treatment deciding whether to circle back and if you didn’t get the advanced imaging studies (like MRI or CT scans) to consider those in those patients if they’re not getting the kind of initial relief or response.
  • And then other things within treatment…
  • everything from cushions to medications to
  • Some of the interventional injections that can be done for tailbone pain are covered in here, from steroid injections to ganglion Impar sympathetic nerve blocks to nerve ablation.
  • All of that, physical therapy and in surgical cases…
  • coccygectomy, which is surgical removal of the tailbone.
  • Fortunately that’s not necessary the majority of the time and is sort of something that’s done only when people have exhausted other measures.
  • So, again, a lot of information packed in here for physicians.
  • And hopefully, the goal really is to educate physicians so that they can be as knowledgeable and experienced as possible in evaluating and treating patients with pelvic pain and in my section for tailbone pain (coccyx pain) in particular.
  • So hopefully that will be helpful for the physicians because then that will be helpful for their patients.
  • So again this one medical journal mainly for physicians.
  • I also have written an entire book much longer than what I have in here.
  • It’s an entire book about tailbone pain.
  • This one is written more for patients, or for people who are non-physicians, the people who are actually suffering with tailbone pain.
  • So this one is 272 pages, all about the coccyx, covering in much more detail a lot of these things and written in layperson language, so you don’t need a medical degree by any means to read this book.
  • You can find this on Amazon: you can get it as an ebook through Amazon, you can get the softcover copy through Amazon.
  • At the time that I’m making this video you can still get a free copy (just pay shipping and handling) you can get that through www.TailboneBook.com.
  • So lots of different ways to if you have tailbone pain and are looking for more information and looking to be empowered with knowledge, because then that helps you with knowing what makes sense in terms of evaluation or treatment.
  • So again lots of information for physicians and also for patients.
  • So hopefully spreading the word so that patients can get relief.
  • Because a lot of people unfortunately suffer unnecessarily for long periods of time with tailbone pain because not a lot of Doc’s are familiar with how to treat it.
  • If you’re looking for more information, certainly you can you can find me online at www.TailboneDoctor.com  And if you have questions or comments certainly post them down below beneath the video and I’ll look forward to hearing from you and may be meeting some of you someday.
  • All the best.
  • Bye-bye now.
Here is the published abstract:

PMR Clinics NA, Tailbone Pain Abstract

 

 

Book Now Available! Click on the book to get it now:


Get the Book at www.TailbonePainBook.com