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

What to Expect Before, During, & After Treatment

Before

Prior to your first treatment, there is medical preparation. You must refrain from alcohol and any other substances. The night before the Ketamine session you should have a light meal. The day of the treatment, you should not eat anything within three hours of your appointment. Prior to your session you should review your intentions – what are you willing to release, believe and move forward with. Make sure to bring your phone for music, headphones, eyeshades and a comfortable blanket. The music should be chosen ahead of time to avoid any delay in your treatment. The chosen music should be abstract, without words and geared towards a relaxing mood. Playlist should be for 30 minutes to three hours. If you don’t have a playlist don’t fret, while this should be done prior to your session, we can still help you on the day of your treatment.

During

Right before the start of your Ketamine session, you should empty your bladder as you may feel the urge to urinate during the session. If you need to use the restroom during your session, you will be assisted to the restroom as your legs may be wobbly for a bit. Ensure that you will be interruption free for one to three hours. Once you begin your session you can finally let go of your intention, relax and observe. Remember, if you do not feel comfortable with what you are seeing and experiencing, breathe in and out, change your music and/or change your mindset so that you gain a different experience. You should be semi-upright or laying down in a comfortable position with your body in a completely relaxed state. For an oral medication, you will receive a lozenge. For an IM injection, you will get a light pinch into your muscle. For an intravenous treatment, an IV will be inserted in you and a saline bag mixed with Ketamine will be attached. The ambiance will be cozy, dark and comfortable.

After

You will be monitored for some time before given the all clear to stand up. The first time you stand up you will need to steady yourself as you will be a bit wobbly on your feet. Once your provider discharges you from the clinic, you are free to eat and drink as tolerated. For the next 24 hours it is very important: do not drive, do not make any important decisions, do not operate heavy machinery. This is the perfect time to journal the memories of your experiences, even if you cannot make sense of them. This is why it is so important to have a psychotherapist of integration coach involved, to be able to decipher the messages you are receiving and know what you should do with them next. 

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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).