Wednesday, December 3, 2014

Truth about Addiction - By Cesar A. Euribe, M.D.

              The Truth about Addiction

The disease of addiction is a sad and difficult malady to treat. Ever since it was recognized we learned that the disease of addiction crosses all races, socioeconomic, cultural, educational and gender lines.

 Its diagnoses requires several conditions to be met:

1. - Genetic predisposition

2. - Dysfunctional upbringing

3. - Obsessive use in spite of negative consequences

4. - Mind altering pleasure generating serotonin and dopamine surges produced by drugs, food, sex , activities like gambling, exercise etc.

5. - A loop that goes from high to low and craving that requires more and more use.

Pain management is confronted all the time with doubts about is it pain or is it addiction. We are lucky we have Dr. Roger Spencer board certified in Addiction medicine. Also boarded in Anesthesiology and pain management.

We can help many patients with our expertise.

Cesar A. Euribe, M.D.

Monday, November 17, 2014

Medical Marijuana - Post By: Cesar A. Euribe, MD

“Medical?” Marijuana


I was all excited with the possibility of marijuana becoming legal for medical use here in Florida.

As a physician I would have hoped that the first thought that came to my mind was of joy for how many patients I was going to be able to help their medical conditions like …???___ By prescribing marijuana.  It was not, it was more of wonder as to what was my knowledge or education on the pharmacology and clinical indications for THC.

 I have a lot of anecdotal experience and being a baby boomer know many that during the Vietnam era, Peace and Love and Woodstock were, and some still are, great fans of the product.  My generation never claimed, even with “wide spread” experience that marijuana was medicinal. Then I wonder why was medical therapy and approval of drugs, being defined by “popular vote”.

Practicing pain medicine has been an eye opener for me. I have witnessed many unscrupulous physicians and a great number of patients that either claimed or have actually been hurt by the prescribing of mind altering (dopamine, serotonin, Mu and other mood and pleasure receptor modifiers). Marijuana IS a mood altering receptor modifying drug. Like alcohol I am concluding more and more that Marijuana should be controlled as recreational like alcohol. Lump it there with the ATF. I do not think that as a physician I should be asked to control the use of recreational drugs by VOTING them medical. I have a lot on my plate just trying to make sense of pain killers.

But truthfully my first thought was more like WOW I CAN GET RICH.

Post By: Cesar A. Euribe M.D.

Friday, October 24, 2014

Medical Terms, Post By: Cesar A. Euribe, M.D.

Medical Terminology
There are several terms that we use in medical practice that may not be very clear for everybody.  Here are some common terms that I have patients ask about frequently.  

-Palliative Care: refers to the type of interventions provided to patients in order to alleviate their symptoms. It usually does little to the disease process but it takes care of specific symptoms. This type of care applies well to patients with cancer. The disease process is managed by the oncologist but the side effects of medications, tumor invasions, radiation treatment, etc, produce many symptoms that require expert attention.

-Pain Management: is the most frequent palliative care intervention. It treats the pain that comes with many disease processes.

-Symptom management: is taking a cough suppressant to reduce coughing spells, it does not cure the cold but reduces the symptoms.

Pain management specialists treat the symptom of PAIN. We use medications, interventions and alternative therapies to achieve relief.

 So this terminology is frequently exchanged but as you can see it also has specific meanings.

Post By:  Cesar A. Euribe M.D.

Wednesday, August 13, 2014

Pain Management Insurance FAQ - Post by Teresa McPherson, CEO

In today’s world and the ever changing coverage and rules of health insurance it is sometimes difficult to know if you are choosing the right medical coverage for yourself.   Here are the most common questions patients ask me:

How can I find out if a doctor is in network with my Insurance plan?
This information can be found online these day’s via your insurance plan website.  If unsure about how to access and find this information as some sites may not seem user friendly you can also call your insurance carrier and inquire.  There is a member phone number on the back of your insurance card.  Once you confirm that your doctor or doctor you are being referred to is in network this means services provided to you will be processed at a contracted fee schedule.  Co-pays, Co-insurance and Deductibles will still apply to the patients responsibly per the plan you have chosen.
Is my doctor’s office responsible for checking my coverage and benefits?
No.  As with most insurance the patient’s benefits can be quite vast with all the different plans available to choose from.  Also some insurance plans require prior authorizations for certain or all services rendered depending on your chosen plan such as HMO’s and Managed Care and Replacement plans for Medicare.  However, here at Central Florida Pain Management we verify your coverage and any prior authorization as a courtesy to our patients to help ensure your services will be reimbursed by your plan and also to help eliminate any unexpected out of pocket cost to you.  Remember coverage can change between the time it is verified and services are rendered.  The benefits are the patient’s responsibility to know and understand.
 What if my policy changes?
Your insurance carrier must notify you of any changes to your policy or coverage cancellation.  However, keep in mind it is ultimately the patients responsibility to keep current on any and all changes.
How will I know if I need Prior Authorization?
Some insurance plans require prior authorization for certain or all services in order for the services to be paid. We here at Central Florida Pain Management will call to obtain authorization with the many plans we are participating with.  However, it is your responsibility as the patient to know if your insurance requires prior authorizations.

Remember all insurance plans should provide you with a policy and coverage handbook.  You can also contact your health plan via phone by calling the member phone number on the back of your insurance card and customer care will be able to answer any questions you have regarding your policy.
Blog by: Teresa McPherson, CEO

Monday, August 11, 2014

Bella's second PlayDate!

Bella's second play date. This time with Jazmine.  Ashley, our office mangers, Catahula Leopard Dog. 

Bella is loving her vacation!

Bella Pain Management Therapy Dog on a PlayDate!

Bella's Playdate video!

Bella and Emmy playing together during a sleepover. 

Emmy is Teresa, our CEO's, yellow Lab.

Spinal Cord Stimulator Central FL Pain Management - Blog by Cesar A. Euribe, M.D.

WILL a Spinal Cord Stimulator HELP MY PAIN??

Amongst the different modalities that help our patients in pain, there is one that stands ahead of the rest. IT CAN BE TRIED BEFORE IT IS ACUALLY IMPLANTED.  
A trial of spinal cord stimulation is always done on patients that we consider good candidates for neuromodulation.  The trial helps us determine the benefits our patient can get with SCS  therapy. 

The indications to consider the use of SCS for pain control have increased over the last 25 years. It is available to patients with CRPS,  post Herpetic Neuralgia, failed back surgery syndrome, phantom pain, lumbago, radicular pain (sciatica), claudication  secondary to poor perfusion.

Also the technology has exponentially gotten better in the last 10-15 years.  Making amazing progress in the quality, size, number of electrodes in a lead, paddle leads for implants, computer programs and algorithms, battery capacity and many other improvements. A comparison can be made to the improvements that cell phones have been through in the same period of time.

 If you suffer from chronic pain caused by one of the conditions described above, you are concerned about using powerful and dangerous drugs, the procedures no longer help you and pain is still limiting your life, CONSIDER A TRIAL OF SCS.

 NEUROMODULATION via spinal cord stimulation is one very important tool in the available therapies used by Pain management specialists.


Blog by: Cesar A. Euribe, M.D.

Friday, August 1, 2014

Plan of Care

Why a “plan of care”
FIRST DO NO HARM                                    

After an appropriate evaluation, diagnostic studies and assessment, providers present their patients with a plan of care. Plans of care should be based on the patient’s “needs” not “wants”. The current scientific knowledge, training and experience of the provider will govern the best plan for that particular patient. Some plans are very clear cut and based exclusively on science and findings such as surgically removing the appendix on a patient with appendicitis. Others are more complex and hard to be universally accepted and subject to many opinions by the patient, the provider, the family and even sometimes the insurance companies.

Unfortunately pain management plans of care are more like the latter. Subject to controversy and debate by many.

Those who are trained and boarded as subspecialists in pain management, try very hard to deliver a plan of care that is within the current science and acceptable pain practice. Experience and training play a very important role in the development of a scientific good treatment plan. However we constantly face challenges because of the different “opinions” that some patients and some providers have. They go from one extreme to another, nothing more controversial than pain drugs. 

A good, scientific plan of care must
a)     establish medical necessity.
b)     prescribe appropriate medications for the medical condition.
c)      obtain diagnostic tests that are needed
d)     prescribe any procedure or intervention needed
e)     refer in consultation for other services that might benefit the patient.
f)       provide follow up care and future support.


Most of all we must follow the accepted reasoning of FIRST DO NO HARM when we develop a scientific plan of care.

Cesar A. Euribe, M.D.

Monday, July 21, 2014

A doggie named Max - Post by Cesar A. Euribe, M.D.


About 12 years ago I made the decision to get a dog. I had been reading about how appropriately trained dogs were helping care for patients suffering chronic pain, cancer or other debilitating conditions. Doggies were able to provide calmness, comfort and emotional support to many of these patients.

So, a 2 ½ month old yellow lab became part of my life both at home and at the office. Any possible doubt about my decision, disappeared from my mind after my new friend “Max” met most of the expectations we had for a therapy dog.

As a young puppy Max underwent several months of crate training, obedience and therapy schools.  My wonderful co-workers helped me so much and delivered consistency. After all of that, out emerged a wonderful, comforting, well trained and liked dog.

Max served our patients for the rest of his privileged life, he provided comfort and attention to so many people, and yes he was privileged for having been well cared and actually have added purpose to his comfortable life. I am not a dog lover who fanatically considers dogs as almost human. Max did teach me a lesson of respect for animals and being responsible for another life.

Max passed from complications of diabetes and seizures. He was made comfortable and remained working during the 2 years he lived after his diagnosis.

We now welcome BELLA a sweet puppy who if lucky, will have the same wonderful life Max had, Her master is Mr. Dan McLaughlin, PA. She has been coming to the office for over a month now. Looks very promising.

 WELLCOME BELLA to the CFPM family.
Written by: Cesar A. Euribe, M.D.

Wednesday, July 16, 2014

Why can't you believe me? - By Cesar A. Euribe, M.D.

Todays Blog:
Why Can't you believe me?
Written by: Cesar A. Euribe M.D.

Pain has only been considered more then just a symptom for the past 30-40 years.  During this time we have been able to learn and discover many amazing things.  Scientists began to identify how many pain conditions were actually unrelated to the cause of pain initially.  They also have identified how our bodies neurological pain pathways are different than the sensory pathways physicians have always considered the same.  Pain was thought to be the over-stimulation of the sense of touch and traveled to our brain by using the same nerves as touch.  We recently discovered the multiple opioid receptors we have which when activated they produce profound pain relief.  Since they also induce the release of the most powerful "pleasure" producing substances in our brain, they can be highly addictive. "They are like the good, the bad, and the ugly".
The study of pain is still in its early phases. We have learned and understand a lot more, however, we are like the treatment of diabetes was at it’s early beginnings.  People have been aware of diabetes for thousands of years but it took ages to discover how to completely treat it as we do today. 

Unfortunately, scientists have not discovered tools to measure or document pain as of yet. Pain Management physician's have to simply accept the patient’s description of pain and believe it as true and accurate.  The patients explanation of how much pain they are in or if the patient is even in pain, becomes a pure act of faith.   Therefor, as any subjective situation in medicine it becomes complicated and for the “pure scientists” find this fact difficult to accept.  Because of the medications we use it also lends itself to manipulation and lies of the part of a few.
WE IN PAIN CARE WANT TO BELIEVE IN ALL OUR PATIENTS’ COMPLAINT OF PAIN, but because of the bad apples who complain mainly for secondary gain (like money, work, etc.) we are forced into questionable doubt.

Do you have questions?

Contact our doctors here at Central FL Pain Management here in the contact us section, or give our office a call.

Thursday, June 5, 2014

Have you Wondered? by Dr. Cesar A. Euribe

Why plants are green?
Why some people are mean?
Why dogs became pets?
Why do we have pain?
Why do people seem to feel more or less pain than others?

Well I can at least help with the pain questions.
       We feel pain pain as a signal to avoid injury or more harm. It, like fear  is a protective mechanism.  The differences in perception of pain are mainly related to genetics (protoplasm) and environment. Like everything else in our lives.  

When I used to circumcise newborn boys we (in a barbaric way) strapped them to a papoose and proceeded with the mutilation. No anesthetic. Some babies just laid and slept, others didn't stop crying and everything in-between. Obviously they felt different amount of pain. 

     PURE GENETICS (protoplasm) no socialization, secondary gain in other words no influence from their environment.  Family characteristics and up-bringing will start setting their influence almost immediately either emotionally and socially reinforcing or mitigating their personal level of pain perception. Family, social and other ENVIRONMENT issues will further influence the different perceptions of pain.

 Keep tuned, I will share some more in the future. 
Dr. Cesar A. Euribe


Thursday, May 22, 2014

Staff Appreciation - From Ashley, Lady Lady Office

As you may have noticed by now, we value our staff. They have high values that shine through in the work they perform, and all staff members have a caring heart which is always needed when helping patients in pain.
We are all a team, we are all one company who share one goal. To provide the best pain management patient care we possibly can. We strive daily to uphold an image of being friendly, caring, and, kind. 

We value each one of our employees and do our best to let them know we appreciate them.
This week we all met at Carrabba's restaurant and enjoyed a great meal with each other.

All the staff and providers came.
 We all share tips, websites, papers we've created and more to improve our patient care for each team member. We do not challenge each other, we challenge to better then our competition.


I am proud to call each person family. Thank you to everyone for your loyalty, patience, and daily efforts, without you we couldn't successfully help so many patients in pain every day.
Ashley O.
Office Manager
Lady Lake Office




Saturday, May 3, 2014


 "If I only got rid of my pain"
 "If I only lost 20 pounds"
 If I only ..." I would feel so much better, I would be so much happier ...

The feeling of wellbeing is a combo. It requires several components to be in harmony and balanced. Patients in pain will always make their pain  or any other problem they pick on that day as being the reason for them not feeling well.

the 4 mayor components of well being are

these 4 elements co-exist all at the time in us. They must be IN-Sync  and doing well for us to feel well.

Friday, May 2, 2014

Central Florida Pain Management video - Migraines

While they've been known to knock a person out, migraines weren't thought to permanently affect the brain - until now.

A new study published last month in the journal Neurology suggests migraines may leave a mark.


Thursday, May 1, 2014

Ride the Wave to Good Health - Expo

Our office recently attended a Health Expo at The Savannah Center here in The Villages.  The expo was put on by The Villages Human Resource Center for The Villages Employees. 
Not only did they offer free health care screenings for those who attended, but they also had raffle prizes, and trivia.  Not only was there a range of providers with informational booths, but also lots of entertainment.  With Hula dancer, music, and an ongoing movie it was fun for all the employees who came out, as well as ourselves!

Savannah Center

Tina, Mr. McLaughlin & Ashley

Savannah Center

Ashley, Office Manager, Lady Lake

Tina, office Manager, Ocala

Hula Dancers

This expo really made it easy for the become more aware of the health related programs offered locally, services, and multiple providers here in the area. 
Our number one goal is patient care, which includes providing patient education.  We loved being at this expo, and can't wait until our next one!

Wednesday, April 30, 2014

Beating Chronic Pain

Good news for chronic pain suffers... a recent USA Today article says exercise could help ease your pain.
Our patient Bette White, explains her journey through chronic pain treatment.

Monday, April 28, 2014

Central Florida Pain Management - Arthritis Pain

If you struggle with inflammatory arthritis or an age related arthritis; you know the joint pain is no joke.

The specialists here at Central Florida Pain Management explain the different treatment options they offer those suffering with arthritis pain.

Managing Pain April 2014 - Video

The specialists at Central Florida Pain Management explain how they weed out drug seekers, abusers, and help monitor and manage those afraid of addiction.