Dr. Michelle Weiner, DO, MPH

Dr. Michelle Weiner, DO, MPH

Dr. Michelle Weiner, is an Interventional Pain Management Physician board certified in Physical Medicine and Rehabilitation. She completed her residency and fellowship training at the University of Miami. Her specialty is focused on prevention, treatment, reversal of health deterioration, increasing function and managing pain. Dr. Weiner focuses on diagnosing and treating spine and musculoskeletal pain as well as chronic migraines at the Spine and Wellness Centers of America

Frequently Asked Questions About Ketamine

What is Ketamine?

Ketamine is a dissociative anesthetic agent that was originally used in the 1960s to treat war veteran’s acute pain. At subanesthetic doses (doses below the amount necessary for general anesthesia), it is useful for the treatment of major depression, chronic pain and other conditions.

Is Ketamine FDA approved?

The use of Ketamine for the treatment of major depression is considered investigational by the Food & Drug Administration, although it is FDA approved medication for anesthesia it is not FDA approved for other uses. If ketamine is a recommended part of your plan of care, it is completely voluntary.

How effective is Ketamine?

According to small clinical trials, low dose oral ketamine is efficient for over 70% of subjects. The effects of a single dose can las 1-7 days. Many patients are able to discontinue ketamine and maintain improvement of symptoms. Like all medical treatments, there is no guarantee that ketamine therapy or treatment will be successful. 

Do I have to do Ketamine treatment if the doctor ordered it?

Ketamine treatment is completely voluntary, discuss with Dr. Michelle Weiner if this plan of care is right for you. Ketamine infusions can stop at any time you wish.

What are potential side effects of Ketamine?

Side effects can include dizziness, blurry vision, nightmares, perceptual disturbances, confusion, elevated blood pressure, elevated heart rate, euphoria, fatigue and nausea. These side effects typically begin 30 minutes to 3 hours post administration no matter if given intramuscular, oral or intravenous.

What should I do prior to my Ketamine treatment?

Do not eat at least 3 hours prior to your Ketamine treatment, regardless if intramuscular, oral or intravenous. Practice your intent prior to the Ketamine session, ensure that your set and setting are comfortable for you. Bring eyeshades, headphones and a source of music.

What should I avoid after my Ketamine treatment?

Please avoid driving, participating in hazardous activities or making important decisions for 12-24 hours. The therapeutic benefit of Ketamine is best combined with mindfulness awareness practices such as meditation, journaling, yoga, coaching and therapy.

Are there any risks involved in Ketamine treatment?

There is a small risk of habituation and problematic use with ketamine. Addiction has been very rarely seen in investigational studies for use in depression, very rare issues have arisen in many decades that it has been used for anesthesia. As always, consult with your doctor to determine if this treatment is right for you.

What happens after my treatment?

You will be evaluated to determine what the next steps are in your plan of care with Dr. Michelle Weiner. If you are prescribed home lozenges, you must take the exact dose as schedule and keep a log of the date, time and dose.

What if I have any questions?

Feel free to ask any question, any time. We want to ensure you are comfortable with your experience.

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Virtual Reality Effects on Pain Perception: Implications for Pain Management

Current Status: Pending

Literature suggests that the use of virtual reality distraction for adjunctive pain control has been successful. In clinical settings and experimental studies, participants immersed in a virtual reality experienced reduced levels of pain, general distress/unpleasantness and reported a desire to use virtual reality again during painful medical procedures.

There has been research into the use of virtual reality distraction for adjunctive pain control with significant success. There has been growing evidence for the use of EEG for the measurement of pain. It has also been suggested that virtual reality could be used an alternative to marijuana and opioids for pain management. Further implications have been seen specifically among chronic pain sufferers. This is especially interesting since there is a reduced risk of addiction as is seen associated with marijuana and opioid use. This study aims to investigate the effect of virtual reality distraction on pain perception.

Additionally, we intend to create a body of open source content for potential use by other investigators utilizing similar tools. 

The intervention has the potential to relieve chronic pain sufferers of their pain with a non-invasive mechanism and minimal risk. The participants may experience a temporary decrease in the perception of pain during the course of the experiment or a distraction from said pain.

Pending IRB approval at UM

Seniors Over 60 With Chronic Pain Using Medical Marijuana

Current Status: Active

 

The purpose of this study is to identify what is effective and safe for older adults with chronic pain to develop an understanding of what educational materials are required for facilitate access to appropriate products at medical marijuana treatment centers (MMTC). 

Survey older adults (> 50 years) with chronic pain who have MM access cards and receive their product from state-approved dispensaries to document: demographic/health data; patterns of use; product specifics; pain effects on daily life; pain-related medical conditions; education prior to MM purchase; helpful and problematic effects of MM use. 

The proportion of Florida’s population that is 60 and older is growing more rapidly than other components of the population. Musculoskeletal disorders with associated chronic pain are a common problem in later life. Symptom management in older adults, including chronic pain management can be challenging (Briscoe, 2018). Medications, especially opioids, can increase the risk of confusion, constipation, falls and injury (Briscoe,2018). Medical marijuana (MM) is often recommended by doctors in the treatment of these medical conditions, guided by state law that defines qualifying conditions.

Medical marijuana use among older adults is growing at a rate more rapid than younger age groups (Lum, et al, 2019). The 2016 National Survey on Drug Use and Health estimated a 2.9% prevalence of marijuana use among this older population. However, the survey did not ascertain if use was for medical or recreational purposes (Han et al., 2016). Older adults may have important differences in pathophysiology, pharmacological interaction of medications, comorbid conditions, and toxicological responses to cannabis.

There is little evidence to evaluate the differences associated with medical marijuana use among older adults, such as individual reasons for use and problems arising with use (Haug et al., 2017).

Chronic pain is a major public health problem. Approximately 178 million (41%) adults in the U.S. age 18 and older suffer from at least one painful health condition (Nahin, et al, 2019).

In Florida, there are 327,492 medical marijuana card holders and chronic non-malignant pain was the No. 1 diagnosis for which patients are registered (The Florida Department of Health, Office of Medical Marijuana Use, 2020). Yet, it is not a qualifying condition, creating challenges for physicians wishing to support patient use of MM for chronic pain.

Chronic pain accounted for nearly 34 percent of diagnoses at certified dispensaries (The Florida Department of Health, Office of Medical Marijuana Use, 2019).