Thursday, March 8, 2018

Pain Post By: Cesar A. Euribe, MD

Why do some people feel pain differently?


     Pain is an act of believe. No one will ever know the truth, all we can do is believe in you when you say I am in pain.  We cannot see pain, we cannot measure pain, we only know about pain itself because of our own experiences with it.  How we feel pain, how strong it is for us, how much we can take of it,  are all unique characteristics specific to each person.
     Pain perception is not just mediated by injury or potential damage. It is very influenced by genetics, social and emotional factors. The reason why we use a 0 to 10 scale to judge pain is because a pain level of a 5 for myself might only be a 2 for you, or a 9 for someone else.

What we would call protoplasm, some people appear to tolerate pain more than others and vice versa. Two siblings with same injury will feel different intensity of pain.

Some children raised in very protective environment versus very stoic will react and behave differently towards their pain.

We all experience headaches and we don’t make much of one, BUT a common headache becomes overbearing for a patient with a brain tumor because a simple headache will be linked to the tumor by the patient.

We are all so different.

Cesar A. Euribe, MD

Tuesday, January 23, 2018


 Where does my pain come from?

One of the many topics patients ask me about is Fibromyalgia.   I thought I would write this to help answer any questions our patients, or future patients may have.   Fibromyalgia affects at least 2% of the population in the United States and it continues to be poorly understood. It is characterized by widespread pain and a multitude of symptoms that include fatigue, irritable bowel syndrome, sleep disturbances and mood disorders among others. The theory behind this syndrome is that the nervous systems in unable to regulate the pain signals and that it’s highly sensitive to the painful stimuli vs. non-fibromyalgia patients.

Current treatments focus on multi-disciplinary care involving the use of aerobic exercise, nutrition, antiepileptic medication, antidepressants, non-steroidal anti-inflammatory medication, modalities such as a massage, heat, ice, acupuncture, biofeedback, cognitive behavioral therapy among others.  Low dose naltrexone has been used in research and in clinical practice to reduce inflammation in fibromyalgia patients. Intravenous micronutrient infusion has also been utilized in patients with fibromyalgia with promise in the management of fibromyalgia symptoms.

           In my experience, one of the frustrations of fibromyalgia patients is the feeling that others don’t understand the pain they experience daily. Hopefully, increasing awareness and with more public figures identifying themselves as suffering from fibromyalgia, this will further research efforts and bring forth more knowledge about this medical condition and treatments.

Melissa Alvarez Perez, MD

Friday, January 5, 2018

Mark your calendars for On Top of the World Communities’ 16th Annual Health and Wellness expo on Saturday, January 13, 2018 from 10 am to 2 pm at the Circle Square Cultural Center. 

Come find our booth. We will have a physician there to answer any question as well as a few treats for stopping by. 

Attend this FREE expo and see what CFPM has to offer for all patients in pain!

16th Annual Health & Wellness Expo

Wednesday, January 20, 2016

Serving you for the past 20 years

Proud to have been serving you for the past 20 years
Its a good feeling to say that I have been privileged to serve Marion County for the past 20 years.  Being able to serve and aide my own community is a true blessing and I honestly have enjoyed every moment. 
I looked forward to continuing to serve the community and expand my services I can provide for 2016.  Together with my staff my goal is to provide care for all your pain management needs through Injections, Stimulator Trials, Morphine Pump Trials, Medication Management, and Alternative Therapies. For 2016 I can only hope to continue to grow and provide even more care and options for treatment this year then the previous year.
In 2016 we remember to always uphold our core values and look forward to another year of serving our community.
Core Values:  

*We value our patients above all.
*We strive to make our care second to none and give to them our best knowledge of science and medicine.
*We have total dedication to their pain relief and long term results.
*We try to provide a plan of care that is comprehensive, multifactorial and safe.
*Above all complaint with the principles of "first do no harm", ethics, respect, honesty and compassion.
I wish everyone a safe and healthy new year.

Wednesday, January 6, 2016

Concept of Wellness

Concept of Wellness

           The emphasis in the new millennium is in the improvement of quality of life. Quality of life cannot be achieved unless it is developed within a concept of wellness. The answer to some patients does not come from traditional medications, surgeries, or procedures. Though it can be important and needed to have these interventions, it is not the only available solution at the exclusion of others.
          Combining the traditional approach with the concept of wellness eventually is the only way to improve quality of life. Part of the concept of wellness involves focusing on the good and enjoyable part of our lives more than focusing on the debilitating or negative aspects of our lives; focusing on what we can do instead of what we can't do.
         As we give our attention to enhancing personal relationships and enjoying the gift of life, the resulting happiness will serve to raise the level of serotonin in the blood and lesson the sensation of pain.

Tuesday, June 9, 2015

Updating Patient Insurance Information, Post By: Kay Ouellette, Billing Manager

Many people don’t realize how important giving the correct insurance information at the time of service is.  It can create great headaches for the Practice and the patient.  When the Office does not have the correct information and a claim is billed to the wrong insurance company it starts a chain reaction, which ultimately ends up to the patient’s responsibility.

Let’s start at the top:
-     Patient checks in at the window and does not update the sheet for any patient changes and marks same. 

-      Provider sees the patient and a claim is created. 

-      Billing looks over the claim to see whether the claim needs special attention according to the insurance company such as a needed authorization attached, medical notes, or accident date on the claim. (this really depends on each insurance company, example Medicare, Wcomp, auto, or commercial insurance all have different requirements.) The biller is assuming the claim is correct due to do patient update, so at this point the Provider has spent the time to see the patient, the biller has taken time to review the claim or charges and file the claim. 

-     The claim is sent to the insurance company. The insurance company can take anywhere from 30-45 days to process the claim and sometimes much longer, only to receive a denial for the claim stating it has rejected, because the patient does not have coverage at the time of service.

-     Now the provider has to work the denial and try to research if it denied in error or not.  Upon researching the claim the patient didn’t have this insurance at time of service and then the balance gets transferred to patient responsibility. 

-    The patient’s receives a bill and is not happy. 

Needless to say there is a lot of time, effort, and resources to bill an insurance company and if you have several patients a day that do not give the correct insurance update then there is a lot of time and money that is lost.
We at Central Florida Pain Management are very grateful for all who on conscious of their current insurance and make an effort to update it.   Thank you.

Post By:
Kay Ouellette, CPC
Billing Manager

Prior Authorization, Post By: Teresa McPherson, CEO

In today’s world of so many insurances to choose from and not really knowing which one is the right plan for your care can be confusing when it comes to choosing a plan.  Some insurances plans such as HMO’s may require a prior authorization for any services to be rendered.  I would like to take a few minutes and help our current and potential patients understand what a prior authorization is:

Pre-authorization is a term used for obtaining prior approval from your insurance before having a procedure or service done.  We here at Central Florida Pain Management try to make sure we obtain authorization that is needed prior to services being rendered so you can receive services that are needed for your care.

Insurance Denial and Appeals
Sometimes even with a prior authorization on file a provider can still receive a denial for services that have already been rendered to the patient.  A denial means that the insurance company has decided not to pay for the procedure or other service that your doctor recommended or preformed due to many reasons such as the insurances own medical necessity guidelines which may not be met (yes, that’s correct your insurance can decide what services are acceptable over your own doctors recommendations) based on the procedure to be performed, related diagnosis code and how many times the patients may have already received this type of service already .  There are even some still pre-existing policies out there as well.  We here at Central Florida Pain Management strive to try and make sure that any services that require a pre-authorization are obtained and meet your insurances guidelines.  However even the most diligent providers office can still be denied payment for some services.  Sometimes the provider can appeal with a letter and medical documentation to convince the insurance company to change their decision and provide coverage for the service.   However in some cases if the provider is participating with the insurance plan and the appeal is denied the provider does not receive any reimbursement for the services that were provided to the patient.  It is not only important for your doctor’s office to understand your insurance plan and what it will and will not cover but it’s also just as important that the patient understands what plans/polices they are choosing to sign up with.  Only with both parties informed can the doctor and patient make the right decisions together for any future care.

Post By:  Teresa McPherson, CEO

Friday, February 20, 2015

Pain Practioners

Pain practitioners are pulled in many directions.

-First our obligation  is to care for our patients TO THE BEST OF OUR ABLITY, give them a medically sound and scientific  treatment. Unfortunately pain is closely linked to emotions. Plus a significant amount of medications for pain relief also stimulate our pleasure, gratification and addictive centers. This generates a secondary effect on the patients using opioid pain medications. Their pleasure/addictive centers get stimulated by the opioids creating a craving for more. This makes the situation difficult because patients are blurred into using more and more opioids, in the name of  still having PAIN.  It has only been recently that we have been able to clearly understand this conflict unfortunately at the expense of having created many iatrogenic (medical) addicts.

-Then, we are monitored by the DEA (drug enforcement administration) with rules and regulations that we prescribers HAVE to follow.  An important group of our available pain medications (opioids) are not only very powerful in diminishing pain but also very addictive and craved by users, so needles to say very lucrative in the black market. This creates a tense environment between prescribers and their pain patients.

-Also insurance companies are directly targeting pain practices. They are cutting re-imbursement for needed procedures, visits, tests and refusing to pay for a lot of the safer medications that we consider more effective and appropriate.

 Multiple “masters” to try and please. No winners, just losers creating a lot of tension between us (doctors) and our patients. The gap between us has gotten wider, and full of roadblocks and  conflict generating demands.
Post By: Cesar A. Euribe, M.D.

Thursday, February 19, 2015

Pain Doctors Reputation, By Cesar A. Euribe, MD


In the practice of Pain Management we encounter multiple roadblocks.

Our patients come from a variety of backgrounds and most suffer with difficult situations and chronic pain.

Pain providers also come from many different backgrounds and styles of practice. Over the last few years there has been an influx of so called pain management specialists who joined the field with NO formal training, experience or understanding of the core of the pain management discipline.  Unfortunately some of the self proclaimed specialists were only equiped with their pens, prescription pads and a DEA license.

Pain practitioners are pulled in many directions.  I will talk more about this soon.

Cesar A. Euribe, MD