The Importance of Leadership

In the field of pain management, many components must come together to overcome chronic pain conditions that patients experience. These components include medication, surgical and non-surgical procedures, physical therapy, and education. One lesser-known component in the pain management process is that of leadership. Leadership is required for all of the diverse pieces of the treatment puzzle to address patient needs and to help ensure favorable treatment outcomes.

Since he first began practicing medicine, Dr. Narinder S. Grewal, MD, has embodied the leadership traits and abilities needed to give his patients the very best chance at recovery. Through his careful diagnosis, treatment, and patient advocacy, he has helped thousands of patients overcome debilitating spinal and musculoskeletal injuries. Here is a closer look at how his leadership has been instrumental in changing patients’ lives for the better.

Dr. Grewal’s Leadership Traits

There are several key traits that Dr. Narinder Grewal harnesses in his leadership role as the director of the Advanced Pain Management and Neurology Group in Valencia, California. Primarily, he is a transformational leader, able to identify a specific need and then to work with a team to develop a solution. As a leader, he has assembled a team of medical professionals, including pain management specialists and neurologists. Each member of the team is committed to transforming lives, and Dr. Grewal is instrumental in guiding this team and their care plans to success.

In his patient-oriented clinical practice, Dr. Grewal believes that a personalized approach is the ideal means of assisting patients. By carefully using diagnostic tools and procedures, he can more accurately pinpoint the underlying causes of chronic pain. He leads by example, learning new procedures and techniques as part of annual continuing education programs and conference attendances. Once he has mastered these new procedures, he then shares his findings with his staff at the clinic. In this way, he is not only transforming himself and his team but ultimately his patients who benefit from cutting-edge treatment plans.

Related: Is CBD an effective way to handle pain management?

Dr. Grewal also uses inspirational leadership techniques to achieve positive patient outcomes. His ability to provide his team with inspiration is well-known in the pain management field of medicine. He inspires his staff to learn more and to approach patient encounters with compassion and care. Dr. Grewal also inspires his patients. Early on in his medical career, he learned about the concept of patient advocacy and has used that as his guiding light throughout his career. In his role as a patient advocate, he helps patients become active participants in their treatment programs. By providing education and guidance – in effect, putting his patients in charge of their care plans — those patients are far more likely to adhere to the treatment plans, take their medications as directed, and engage in therapeutic efforts to recover more quickly. Dr. Grewal and his staff at Advanced Pain Management have achieved incredible results through this method. Dr. Grewal is an inspiration to his peers in the pain management field as well as to his clinical staff, his patients, and his family.



What is CBD Oil? Does it work for pain management?

white petaled flower on clear glass beside clear glass with liquid on it

In the wake of over 200,000 overdose deaths since 1999 related to the use or misuse of opioid-based drugs, the medical community has actively sought safer alternatives for treating their patients. Dr. Grewal is one of those

Chronic pain is a condition that affects millions of Americans. It can lead to lost mobility, the inability to work or to conduct normal lives, and in some cases can result in permanent disability. Traditionally, powerful pain-relieving medications were prescribed to alleviate the pain patients experienced. However, in light of the potential dangers and high potential for abuse of these drugs, the pain management field of medicine is ready to investigate new alternatives. CBD oil may be one of those alternatives.

What is CBD Oil and How Does it Work?

One of the emerging alternatives to dangerous opioid-based prescription medications is that of CBD oil, or an oil derived from cannabis. There are hundreds of active chemical compounds in cannabis – a class referred to as cannabinoids — but the two receiving the most attention are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive compound that creates feelings of euphoria, leading to the “high” desired by recreational marijuana users. CBD, on the other hand, is not psychoactive, and has been shown to reduce the severity and duration of pain in limited clinical trials. CBD does not appear to be beneficial in acute pain settings, but for chronic pain, it shows great promise as an alternative to opioid medications. Cannabis strains high in CBD content are being bred specifically for medical applications, and these strains have demonstrated their effectiveness both in the United States and abroad.

As patients experience chronic pain for successive months, physiological and chemical changes begin to take place in their bodies. Among these changes is the creation of specific chemical receptors. This has far-reaching implications for the pain management field. Receptors for cannabinoids increase, thereby improving the response to the analgesic effects of CBD. Pain which originates in the nervous system, called neuropathic pain, is especially responsive to CBD. Patients afflicted with neuralgia, strokes, multiple sclerosis, and a host of other pain conditions report a significant reduction in pain, both in the level of pain as well as its duration. Medical professionals, including those in the pain management and interventional pain treatment fields, believe that CBD-based pain medications may serve best as an alternative when conventional therapies have not produced the desired results, or in cases where the harmful effects of opioids outweigh their potential for mitigating pain.

Should I Try CBD Oil?

The answer to this question lies within each patient and his or her care plan developed with professional medical help. In general, however, it is useful to understand that the exact mechanisms of CBD and their effect on chronic pain are poorly understood by the medical community. Cannabis has been excluded from research for many years, and medical science is only now gaining the ability to investigate the chemical compounds in cannabis and their ultimate effects on conditions like chronic pain. As more science is conducted, a clearer understanding will be achieved.

It is also useful to know that CBD oil has been shown to be surprisingly safe. As an alternative to powerful drugs that have a high potential for abuse and for overdose complications, CBD oil may represent a safer path forward. Patients wishing to try CBD oil to overcome chronic pain should still seek the guidance and recommendation from their physician, but in general, CBD oil is safe and well-tolerated by most individuals.

Tennessee Pain Management Sheds Light on Crisis

In July 2018, the Tennessee-based Comprehensive Pain Specialists (CPS) practice announced that it would be shuttering its clinics. As one of the largest pain management groups in the Southeastern United States, CPS has treated thousands of patients and employed hundreds of personnel. At its peak, CPS operated over 50 clinics in Tennessee and other southern states like Arkansas, Kentucky, Mississippi, and North Carolina. Several Midwestern states were also served by CPS clinics; clinics were located in Ohio, Illinois, and Indiana.

A host of problems have influenced this surprise closure. Financial troubles at the sprawling Nashville-headquartered company were aggravated by a federal criminal investigation that put the company’s former chief executive in the crosshairs. A nationwide opioid shortage has also led to significant challenges for this and other pain management specialists like it.

Legal Challenges at Comprehensive Pain Specialists

In April 2018, a federal grand jury swore out an indictment against John Davis, the former CEO of Comprehensive Pain Specialists. The indictment centered on charges of criminal kickbacks; Davis has pleaded not guilty of the charges against him. Pain management clinics across the country have faced similar scrutiny; many so-called “pill mills” were based on a criminal practice of insurance fraud and monetary kickbacks, treating as many patients as they could to bolster revenue. CPS may not have partaken in such criminal misdeeds, but the charges against Davis certainly influenced public perception of the clinical practice.

Other legal issues have impacted the clinical practice since its founding in 2005. Over a dozen contractors of the company have filed civil lawsuits, alleging unpaid debts. Two of the suits filed against CPS were brought by former physicians of the company. According to federal regulatory officials at the Justice Department, the clinics closure was not related to the criminal proceedings or the lawsuits.

In November 2017, an investigation by Kaiser Health News uncovered unusual Medicare billing practices at the CPS clinics. Urine drug screening by the clinic system resulted in $11 million in payments by Medicare in the year 2014; one healthcare provider was responsible for $1.1 million in urine screening bills that year. In 2015, the CEO and medical director of the company billed Medicare for $1.8 million in urine screening. Faced with scrutiny over the allegations, the clinic stated that it utilized this screening method to prevent black-market sales of opioid drugs by its patients.

The Opioid Crisis and Nationwide Shortage of Opioid Drugs

In the United States, a sharp uptick in opioid-related overdose deaths has led the medical community and federal/state regulators to declare an “opioid crisis”. Some of the thousands of overdose deaths stem from over-prescription of powerful pain-relieving medications, while many others were caused by illicit drug use.

Economic analysts suggest that over $1 trillion has been spent on expenses related to the opioid crisis. These expenses include law enforcement and intervention, lawsuits, and medical costs in both treating overdoses and preventative solutions. Since 1999, the Centers for Disease Control have reported over 200,000 overdose deaths.

Despite the rise of overdose deaths in the U.S., there exists a shortage of opioid drugs in the medical community. One of the leading manufacturers of pain medications has had issues with laboratory accreditation and processes, sharply curtailing production of opioid-based drugs.

Ramifications of the Clinic Closures

Thousands of patients of the CPS practice have scrambled to find medical practitioners to continue treatment. Many physicians are wary of prescribing opioid drugs due to the crisis and increased scrutiny by federal and state pharmaceutical regulators. This has caused many former patients of CPS and similar pain management clinics to turn to black market sources for drugs. When opioid drugs cannot be obtained, either legally or illicitly, patients have resorted to illegal drugs like heroin to conquer chronic pain. This, of course, has led to many other cases of overdoses, including fatal overdoses.

Reputable pain management specialists know that interventional therapies must include options other than prescribing potentially dangerous opioid drugs. Innovative treatments like neurostimulation, nerve blocks, and physical therapy have shown great promise in treating chronic pain without the harmful side effects and risk of overdose. Pain management specialists continue to investigate safe, effective alternatives to powerful pain relieving medications.

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Exploring Cannabis Pain Management as a Substantiated Alternative

cannabis, a safe alternative?

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Chronic pain is a condition that affects millions of people around the world. A broad number of therapeutic solutions have been employed to treat chronic pain, including powerful prescription medications. Of these medications, opioid-based painkillers have been widely used. These medications are not without their hazards, however; with a high potential for abuse and a growing number of opioid-related overdose deaths, medical professionals around the world are now seeking safer alternatives for treating pain.

Medical cannabis has shown promise in limited trials, and in fact this alternative was discussed at the International Conference on Opioids, a three-day medical conference held in Boston, Massachusetts. The so-called “opioid epidemic” was discussed at length as physicians, pain management specialists, and caregivers alike seek to treat pain without the potential harmful effects of powerful opioid-based drugs.

Cannabis for Treating Pain?

There are hundreds of active chemical compounds in cannabis in a class referred to as cannabinoids, but the two receiving the most attention are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC is the psychoactive compound that creates feelings of euphoria, leading to the “high” desired by recreational marijuana users. CBD, on the other hand, is not psychoactive, and has been shown to reduce the severity and duration of pain in limited clinical trials. CBD does not appear to be beneficial in acute pain settings, but for chronic pain, it shows great promise as an alternative to opioid medications.

As patients experience chronic pain for successive months, physiological and chemical changes take place in their bodies. Receptors for cannabinoids increase, improving the response to the analgesic effects of CBD. Pain which originates in the nervous system, called neuropathic pain, is especially responsive to CBD. Patients afflicted with neuralgia, strokes, multiple sclerosis, and a host of other pain conditions report a significant reduction in pain, both in the level of pain as well as its duration. Medical professionals believe that CBD-based pain medications may serve best as an alternative when conventional therapies have not produced the desired results, or in cases where the harmful effects of opioids outweigh their potential for mitigating pain.

Delivery Systems for CBD and Quality Control

Traditionally, medical marijuana has been smoked by patients to provide relief for a number of health conditions. The medical profession, however, realizes that inhalation of smoke can create unpleasant side effects. Research has been conducted into other means of delivering the therapeutic benefits of cannabidiol (CBD). These other means include CBD-infused edible products and delivery systems that vaporize the active compounds without combustion. In clinical trials, CBD tinctures, edibles, and vaporization systems have all been shown to be as effective as inhalation in treating chronic pain.

One area the medical community wishes to see improvements in is the quality control and consistency of medical cannabis products on the market, asserts Dr. Grewal. Patients have been self-medicating for decades, and products on the market vary in quality. Standardization efforts, particularly in laboratory assays and product labeling initiatives, can work to help patients understand dosages and percentages of active chemical compounds, leading to improved patient outcomes. Further research is needed, of course, to gain understanding in dosages and dose response in patients afflicted with chronic pain conditions.

A Safer Alternative

Despite the limited clinical evidence showing medical cannabis as effective in treating chronic pain, patients around the world and a growing number of medical professionals believe that this naturally-derived substance represents a safe path forward. Opioid-related deaths have reached staggering levels, causing pain management specialists to seek safe, effective alternatives to traditional pharmacotherapies involving opioids. Medical cannabis will continue to be studied, and may one day serve as a replacement therapy for the potential harmful opioid-based medications.

Exploring Acupuncture Therapy as a Safe Alternative

acupuncture is an ancient Chinese medicine

Opioid-related overdose deaths have reached epidemic proportions in the United States over the past decade. Powerful opioid painkillers have been a traditional approach to treating both acute and chronic pain conditions, but the potentially dangerous side effects have led many healthcare professionals to seek safer alternatives.

One of those alternatives is grounded in Eastern medicine, and is based on centuries of positive patient outcomes. This alternative is known to the Western medical community as acupuncture, and pain management professionals have begun to incorporate this alternative therapy in their own clinical practices.

What is Acupuncture?

Acupuncture is a traditional form of Chinese medicine, and has been practiced since at least 100 BC. Over time, it has evolved and spread to other countries, finally arriving on U.S. shores in the early 20th century.

Acupuncture consists of inserting tiny sterilized needles into the skin, targeting nerve centers and/or pressure points in the human body. It is commonly used as a form of pain relief, especially for chronic pain conditions like musculoskeletal pain, spinal disorders, and joint pain. A typical acupuncture session consists of multiple needles being inserted, ranging from just a few to 20 or more, depending on the type and severity of pain. The needles are often left in place for ten to 30 minutes. The needles vary in thickness and in manipulation; needles are often rotated or moved up and down relative to the patients’ skin surfaces to create a localized aching sensation. A specialized form of acupuncture called auricular acupuncture uses tiny metal darts that penetrate the skin of the patient’s ears, leading to surprisingly effective pain relief in many patients.

Related: Mental Health & Pain Management

Acupuncture therapy may also incorporate the application of heat, laser light, pressure, or low-voltage electricity to enhance the effects of the therapy. There are both specialist acupuncturists and medical professionals that have received special training in the application and manipulation of the needles. A growing number of pain management clinics in the United States have added acupuncture to their rosters of treatment options for patients, believing that acupuncture is a safer alternative to painkillers while achieving much of the same effectiveness at treating chronic pain conditions.

Alternatives to Opioid Medications

In the pain management community, alternatives to potentially addictive or deadly opioid medications like Oxycontin, morphine, hydrocodone, and fentanyl, are a growing trend, according to Dr. Narinder S. Grewal of Advanced Pain Management. Medical cannabis-based treatment therapies are showing promise, and acupuncture has been received well by patients across the country.

Acupuncture has gained popularity based on its history and its reported benefits in mitigating pain. The benefits are free of the side effects of opioid painkillers, which include a high potential for abuse and the chance of overdose deaths. Acupuncture is also endorsed by the American Pain Society, one of the leading professional organizations for pain management specialists.

Much of the science behind how acupuncture works and why it produces beneficial effects remains unclear, and that has led to practitioners of acupuncture being the focus of skepticism. One of the remaining hurdles for incorporating acupuncture into pain management treatment protocols is that of medical insurance. Currently, only five states cover acupuncture when used in treating pain, while the remaining 45 states do not. Advocates of acupuncture, including professional medical organizations and healthcare providers, are working with insurance companies to improve patient access to this alternative therapy that has the potential to save lives.


A Look at Mental Health & Pain Management

The field of pain management has come a long way in recent years, thanks to dedicated researchers investigating alternative therapies beyond pain medication. One of the recent breakthroughs in this field has been that of mental health treatment adjunctive to medication. Recent studies have shown the effectiveness of incorporating mental health services into pain management protocols, demonstrating that these services can dramatically improve patient outcomes, according to Dr. Narinder Grewal

Mental Health Treatment in Pain Management

A study conducted by the University of Pittsburgh School of Medicine was the first of its kind to look at the role of psychological services as part of an overall pain management strategy. Until the study was conducted, the medical community was relatively unaware of the benefits of mental health in combatting chronic pain conditions. The study’s findings were presented to the American Academy of Pain Medicine annual meeting in 2018.

In the study, researchers used a wide variety of data collection techniques and analyzed data pools from electronic health records, patient surveys, and information from the Collaborative Health Outcomes Information Registry. Patients that had visited a pain psychologist on at least three occasions were compared to a large control group matched by pain duration and intensity along with demographic factors, but who didn’t access mental health professionals as part of their pain treatment. Data was collected over a 12-month study period.

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Findings of the University of Pittsburgh Study

In the study, patients that had utilized the services of a psychological counselor as part of pain management therapy reported significant improvements, not only in the shorter duration of pain symptoms but a decrease in intensity. Those patients also experienced substantial improvements in sleep quality, overall function, and mental health status. Psychologists working in the pain management field typically use one or more pain-focused treatment protocols, including:

  • Relaxation training and therapy
  • Cognitive-behavioral therapy
  • Coping skills training
  • Pain education
  • Acceptance and commitment training

The study pointed to several surprising factors. As compared to the control group of over 7600 patients, those patients utilizing psychological services in their pain treatments were more likely to be female, to have access to Medicaid insurance, and to be black or another minority. Those patients also had higher initial levels of pain, poor motor function, and higher levels of depression and/or anxiety. The study demonstrated that even these patients, facing significant struggles in their pain levels and related symptoms, could make substantial improvements in their outcomes with the intervention of mental health professionals.

Further study is warranted, but for now, the pain management community welcomes the findings of the University of Pittsburgh study. Many pain management clinics across the country have incorporated alternative treatment therapies such as flexibility training, yoga, and non-prescription pain relief protocols. Mental health treatment is a valuable and effective addition to the overall pain management strategy, helping to improve patients’ lives while reducing the dependence those patients may develop on potentially harmful opioid pain medications.

Contact Dr. Grewal 

Featured Story: Best Practices for Pain Management

As mentioned on Newswire, Narinder Grewal MD has emerged as a premier resource for the implementation of innovative pain management techniques. With extensive experience as a certified anesthesiologist, he is a legitimate source of reference for individuals seeking therapy. According to Narinder, patients can typically choose from several different methods of treatment including physical therapy, prescription medication, and noninvasive surgical procedures.

What are the benefits of each?

Dr. Grewal goes into further details about the many pros and cons of each technique. For the most part, his patients are diverse among their selection of pain treatment. Therapy has proven to be a prominent choice of individuals who suffer from physical ailments such as a nagging knee injury. Patients also often choose the rouse of surgical procedures which can sometimes be costly.

Looking for more?

To discover details about Dr. Grewal’s academic background and professional career, visit his website.

Narinder S. Grewal is a licensed medical practitioner who specializes in the field of anesthesiology. He currently operates his own practice out of Valencia, California. With a residency at Henry Mayo Newhall Memorial Hospital, he has become well-versed in the area of pain management. Dr. Grewal has over 40 years of first-hand experience in the medical sector. To learn more about his professional career, continue reading this blog.