Michigan Neurology Associates & PC was established in Macomb County, Michigan, in 1990 and has evolved from a small, strictly neurologic practice to include the multispecialty components of a comprehensive Neuroscience center, including general, subspecialty, and pediatric neurology; general physiatry including both medical and interventional pain management; and neuropsychometric testing and general psychologic counseling services to address the complex comorbid conditions often associated with patients who have sustained trauma, have neurologic diseases, or complex pain syndromes with three convenient locations in Clinton Township, and St. Clair Shores, Michigan.
We are aware that the practice of pain medicine requires an understanding of two competing public health problems: the high prevalence and burden of patients in chronic pain and the overdose and diversion risks associated with opioid analgesics and other controlled substances often used in treating chronic pain. As Monique Stanton, President and CEO of CARE of Southeastern Michigan, noted in a recent newspaper article, Macomb County sees “some of the highest numbers of opioid addiction, and deaths, nationwide,” and “We are in a life and death situation in this epidemic.” Ms. Stanton’s comments resound within our medical practice as we use urine drug testing along with a complement of other strategies (such as pill counts, Patient narcotic agreements, and reviewing the patient’s prescribing history in the Michigan Automated Prescription System(MAPS)) to ensure that our patients are using their medications appropriately and not diverting.
We offer a full complement of radiologic, electrophysiologic, and ultrasound-based diagnostic procedures on site. Our four offices within the greater Detroit metropolitan area facilitate geographic access for patients with these complicated medical issues. All of our 7 physicians are either board eligible or board-certified in their general specialty or in subspecialty areas of their respective disciplines. All patients have a bona fide physician/patient relationship with a unique “physician of record.” All patients are initially interviewed and examined by the physician of record. After a definitive diagnosis is made and a treatment plan is set in place, we have 6 physician assistants or nurse practitioners that assist and collaborate with the physician of record in ongoing care. If diagnostic testing or physical therapy is deemed medically necessary, patients have the ability to optimize the coordination of their care within one of our facilities if they so choose. Since a physical therapist is on site and the radiologists are handpicked, we can often discuss patient-specific care issues as a team to further optimize individual therapy.
All of our practitioners are committed to the philosophy of a multidisciplinary approach to this complex and challenging patient population. The majority of our patients are experiencing chronic pain, i.e. greater than 6 months in duration, before they come to our attention. The practice has over 200 referral sources including primary care physicians, orthopedic and neurosurgeons, ENT, OB/GYN specialists, oncologists, and ER physicians. The local medical community turns to our clinic for assistance in managing a group of patient they do not feel equipped to help because they understand that the goals of treatment should be meaningful to the patient and contain both attention to realistic pain relief and improving functional activities of daily living components, which are best accomplished via a multispecialty clinic approach.
We provide on-site minimally invasive fluoroscopic and ultrasound-guided injections and/or nerve blocks or ablations to reduce pain, improve function, and facilitate physical therapy treatment. Those patients who continue to have impaired function or suboptimal quality of life because of their chronic pain are assessed for possible spinal cord stimulator implantation after a successful trial, or an intrathecal pain pump trial after psychiatric clearance. We routinely integrate cognitive behavioral health, multiple physical therapy modalities, topical preparations, atypical analgesics to reduce opioid dosing in our treatment plans.
Our physicians prescribe and manage opioids for those patients for whom interventional procedures and physical therapy have not resulted in sufficient relief of their intractable pain to maintain normal life functions and activities of daily living. Our prescriptions of opioids are conservative, carefully monitored, and regularly assessed to ensure that the medications are effective, keeping in mind that patients with pain severe enough to be on opioid medications are never cured of their chronic pain, but the symptoms are realistically managed. As discussed above, we are committed to ensuring that the opioid medications we prescribe are responsibly used by the patient and not misused or diverted. To that end, we require strict adherence to our Controlled Substance Policies and Pain “contracts” including completion of appropriate diagnostic testing, psychologic assessment (both for assessing comorbidities and substance abuse potential), participation in physical therapy, pill counts, MAPs review, urine toxicology screening, and confirmatory testing.
Thomas Giancarlo, D.O.
President, Michigan Neurology Associates & PC