Rivernorthpmc.com

PRODUCT SERVICE NOT COVERED LMN
: River North Pain Management Consultants, S.C., (AVM00)
: Claimant:
Claim# :

Meloxicam Indications:
The indications of Mobic (Meloxicam) in this patient are specific for the treatment of the inflammatory signs and symptoms
of spinal stenosis and/or facet arthropathy of the cervical or lumbo-sacral spine as well as of the hip. Clinical studies
evaluated large group of patients in a 12-week, double-blind, controlled trial. Mobic was compared to placebo. The four
primary endpoints were investigator's global assessment; patient global assessment, patient pain assessment, and total
WOMAC score (a self-administered questionnaire addressing pain, function, and stiffness). Patients on Mobic showed
significant improvement in each of these endpoints compared with placebo. Similarly, the use of Mobic for the
management of signs and symptoms of spinal stenosis was evaluated in six double-blind, active-controlled trials outside
the U.S. ranging from 4 weeks' to 6 months' duration. In these trials, the efficacy of Mobic, in doses comparable to
Piroxicam and Diclophenac SR consistently correlated with the efficacy seen in the U.S. trial.
The mechanism of action of Meloxicam, like that of many other NSAIDs, may be related to prostaglandin synthetase
(Cyclooxygenase) inhibition which is involved in the initial steps of the arachidonic acid cascade, resulting in the reduced
formation of prostaglandins, thromboxanes and Prostacyclins, therefore reducing the inflammatory cascade and
consequently the patient’s overall pain symptoms .
Omeprazole Indications:
Non-steroidal anti-inflammatory drugs (NSAIDs) including Meloxicam are known to cause gastro-duodenal lesions and
dyspeptic symptoms in most patients receiving these drugs. In a large multicenter study P. Ekström et al. looked at a
large number of patients Receiving Continuous Non-Steroidal Anti-Inflammatory Drug Therapy; these were randomized to
receive either 20 mg omeprazole once daily or placebo. Gastro-duodenal ulcers, erosions, and dyspeptic symptoms were
evaluated after 1 and 3 months. During a 3-month study period 4.7% of omeprazole-treated patients developed peptic
ulcer, compared with 26.7% of patients treated with placebo. This prophylactic effect of omeprazole was sustained
independently of previous peptic ulcer history or Helicobacter pylori status. Their conclusion was that Omeprazole, 20 mg
once daily, provides effective prophylactic therapy in patients at risk of developing NSAID-associated peptic ulcers or
dyspeptic symptoms, and therefore this is sufficient indication for this patient to benefit from the intake of Omeprazole.
Tramadol Indications:
Tramadol is effective in the treatment of chronic pain syndromes, both those caused by malignancy and other chronic
inflammatory conditions. This includes upper and lower back pain syndromes, joint pain, neuropathic, osteoarthritis, etc. In
fact, Tramadol is a unique analgesic which offers moderate, dose-related pain relief through its action at multiple sites. In
contrast to pure opioid agonists, it has a low risk of respiratory depression, tolerance and dependence. Tramadol has
been established as an adjunct to non-steroidal anti-inflammatory drugs in the treatment of chronic pain syndromes. This
enough is an indication for this patient to benefit from the intake of this medication.
Carisoprodol Indications:
Carisoprodol is a mild analgesic and potent peripherally acting muscle relaxant with low toxicity. Is indicated as a co-
adjuvant in the relief of pain, refractory muscle spasms, and stiffness in various acute inflammatory, degenerative and
traumatic muscle and joint disorders. This enough is an indication for this patient to benefit from the intake of this
medication.
Gabapentin Indications:
Anticonvulsants are widely used in the treatment of neuropathic pain, and are assumed to act preferentially on lancinating,
shooting pain. In fact, studies have shown that Gabapentin induced a moderate and statistically significant relief of
ongoing spontaneous pain and is particularly effective in reducing paroxysmal pain. Side effects were generally minor and
did not interfere with everyday activities. The present study suggests that gabapentin has preferential anti-hyperalgesia
and/or anti-allodynia effects, and is equally effective in pain due to peripheral nerve injuries/inflammation and central
lesions. This enough is an indication for this patient to benefit from the intake of this medication.
Physician Name: Axel Vargas, M,D.,
Signature : ____________________________
(DEA#): BV4250546

Source: http://rivernorthpmc.com/files/Medication_Indications_Template.pdf