Dr. Robert Ben Mitchell, D.O.
16375 NE 18 Ave, Suite 310
North Miami Beach, FL 33162
786-262-5750
Publications: Medical Journal Articles
Sliding Scale Morphine for the Management of Severe Pain
(84 kilobyte PDF file - 20 pages)
by Dr. Robert Ben Mitchell, D.O.
published in The American Journal of Pain Management
(volume 11; number 4; October, 2001; pages 130-136)
Abstract: Due to its quick onset of action and short half-life, intravenous (IV) morphine is commonly used to treat patients with severe pain. While effective, current regimens that employ IV boluses for titration and fixed infusion rates for maintenance are not efficient, as they lack the flexibility to be adjusted rapidly to fluctuating pain levels. This limitation results in either the under or over-medication of patients and many phone calls to physicians regarding new orders for pain control. This paper outlines the procedural mechanics to effectively and efficiently use IV morphine by continuous infusion for titration and sliding scale maintenance of patients with severe pain.
The Importance of Follow-Up: A Case of A Twenty-Seven Year Old Fracture
(474 kilobyte PDF file - 10 pages)
by Dr. Robert Ben Mitchell, D.O.
published in The American Journal of Pain Management
(volume 13; number 2; April, 2003, pages 74-77)
Abstract: Follow-up is the art of effecting continuity between what you do for a patient today and what you will need to do for them tomorrow. It is the back-bone of integrated medical care for all patients and should be routinely performed in all health care situations and settings. Due to its routine nature, however, follow-up can often be taken for granted. This case study describes a patient who voluntarily delayed medical follow-up for twenty-seven years, only to discover he had been walking on an incompletely healed right leg fracture for all of those years. The reflections of the author may serve as an object lesson to remind clinicians and patients of the importance of prompt follow-up care.
Patient Compliance Coding: controlling patient access to narcotic medication
(112 kilobyte PDF file - 25 pages)
by Dr. Robert Ben Mitchell, D.O.
published in The American Journal of Pain Management
(volume 14; number 3; July, 2004; pages 97-106)
Abstract: Opium derivatives such as morphine and its analogs have been used for centuries to alleviate and control pain. These medications have proven to be safe and effective treatments when used appropriately and under the guidance of knowledgeable physicians. However, like any medication, adverse effects are possible when opiates are improperly prescribed by physicians or improperly used by patients. The goal of this article is to address one solution to these problems by outlining a technique called Patient Compliance Coding (PCC). PCC is a proprietary tool developed at the Chronic Pain Management Program (North Miami, Florida) to ensure patients follow instructions when using narcotic medications. During 2003, the PCC was employed with the program's
entire patient population to increase their compliance with medication regimens
and eliminate adverse outcomes such as overdose deaths. This system is being presented here for the first time in publication for other physicians to use and study, that we may better understand its function in and benefits for both the field of pain management and our patients.
Maximal stress values and the mind-body-medication limits of patients with chronic pain
(51 kilobyte PDF file - 10 pages)
by Dr. Robert Ben Mitchell, D.O.
published in The American Journal of Pain Management
(volume 15; number 3; July, 2005, pages 98-102)
Abstract: One of the key factors in treating chronic pain is to determine how much activity a given patient can endure within their physical restrictions, psychological barriers, and the limited pharmacological benefits their pain medications provide. If patients are well disciplined, acknowledge the boundaries or their minds and bodies, and understand the finite capacity of their prescribed medicines, then they may lead relatively active and rewarding lives. However, patients who do more than their bodies and minds can tolerate, or exceed the analgesic limits of their medication regimens, create acute flares of pain in excess of, and in addition to, their chronic symptoms. This, in turn, may interfere with their ability to be compliant, and it complicates physicians’ efforts to provide effective pain management. To prevent this from occurring, this paper discusses a proprietary system that compares the predictive stress value (PSV) of various activities with their actual stress value (ASV), to estimate patient response to these events. It then calculates their maximal stress value (MSV), so patients can modify their activities ahead of time, to not exceed their mind-body-medication limits (MBML).
Laser Pointer Therapy: an inexpensive, easy to use, adjunctive therapy
for patients with chronic pain
(453 kilobyte PDF file - 14 pages)
by Dr. Robert Ben Mitchell, D.O.
completed May 29, 2005
unpublished
Abstract: Most patients with chronic pain have a variety of factors which cause or contribute to their ongoing condition. For example, a herniated disk may lead to, or be further complicated by spasms of spinal muscles, postural misalignment, or nerve root compromise. This complex interplay where problems occur locally but interact globally makes it unlikely that a single treatment will remit or resolve all of a patient’s problems. Thus, it is essential to consider several therapeutic modalities when designing a treatment plan. In addition to mainstay options like medication, surgery, and physical rehabilitation, physicians should also consider adjunctive therapies which, though limited in application and effectiveness, can still make important contributions to a patient’s overall maintenance, management and recovery. This paper discusses one such adjunct - Laser Pointer Therapy (LPT) - a technique for applying deep stimulation into joints and muscles by means of laser pointers which are currently available without a prescription through a variety of retail sources. This treatment is inexpensive and easy for patients to use at, or away from home, and it may be beneficial when focal therapy is desired.