Allevio is working hard on a pilot project for Canadian patients who are 55+ years of age, managing a pain condition, and who are going to be spending a portion of their winter in Florida this year.

Essentially, if you are going south this winter and choose to participate in the program, Allevio will work with you and an affiliated physician in Florida to help ensure you receive high-quality, continued and coordinated care.  We also want to make sure our patients aren’t taken advantage of and their Florida-based physicians are putting patient needs first.

If you are going south this season, please let us know: snowbirds (AT) or call us at extension 22 to let us know. If you want to learn more about the project or participate, we’d love to hear from you!


Stuck waiting on hold to speak with a member of our team for too long, or do you have a quick question you’d like answered without having to call or email?  Feel free to send us an instant message! The link is on the bottom of our webpage, and we are happy to help however we can.

Our IM application gives you instant access to our administrative team, where you can ask them a question, securely transfer documents, and even change appointments.

Best of all, the service is completely FREE to use for our patients and people looking for information about what we offer while we are ironing out the bugs… While we may charge for it in time, for now, please feel free to use it instead of picking up the phone.

We look forward to chatting with you!


While the majority of Allevio patients are not victims of a personal injury, many of them do suffer from chronic pain and appreciate the struggle of not being taken seriously.  When a patient is in chronic pain, injured from an accident or not, the challenges they feel and the resources they need can be substantial.

This recent decision by Ontario Arbitrator Jeffrey Shapiro and argued by counsel from this law firm is an important one, as it clearly states that if an accident victim can somehow validate their claim of having chronic pain, the patient can be removed from the most basic benefits program in Ontario insurance: the Minor Injury Guideline (the “MIG”).

Why is this important?

The MIG is a program that in theory offers relatively quick and efficient access to accident benefits for victims of an insured automobile accident. The program offers $3,500 in benefits to the patients who qualify and affords them the opportunity to seek help from registered allied health professionals for their minor injury.

Until now, a diagnosis of chronic pain was not considered enough to allow patients the opportunity to access more resources to support their rehabilitation or their adapting to a new permanent impairment.


One night of bad sleep can throw us off for days. It disrupts our energy levels, our ability to think clearly, and even our digestion. People that suffer from insomnia know that when caught in a spiral of poor sleep, stress and fatigue our ability to function the way we would like to is severely limited.

The relationship between pain and sleep is even more complex: pain can keep you up at night or make it very hard to fall as sleep, but at the same time poor sleep can raise the threshold for sensations making your experience of the pain worse than before.  A large scale Norwegian study  recently examined the connection between pain and sleep disturbance and found that patients reporting problems with both insomnia and chronic pain were more than twice as likely to have a lower tolerance to pain than other chronic pain patients. This study was the first general population study of its kind, calling for a more targeted effort towards sleep improvement in chronic pain patients.

So where do you start? There are a few habits that you can try out tonight to help you break the vicious cycle of pain and poor sleep; addressing both the chicken and the egg. Acknowledging the importance of good rest for your pain management and giving these tips a try are already proactive steps that will set you on a path to improvement.

Find your favorite routine

When you fear that you pain will disturb your sleep, it is common to have anxiety around going to bed. Developing a routine that you enjoy can be a nice distraction and something that you and your body can look forward to. Music, a warm bath, mindfulness techniques, breathing exercises,  and light reading all can relax you well before you are tucked in to bed.

Keep it cool

Even as the winter approaches, it is easier to fall asleep if your bedroom is cool. Check that your thermostat is at 65 degrees or lower before you get into bed.

Limit Screen-time

Looking directly into a bright light for most of the day ( computer, smartphone, tablet) disrupts our circadian rhythms making it more difficult to fall asleep at night. It is tough to break the habit of looking at our phones in bed, especially since it can serve as an alarm clock. Yet, avoiding screens for at least 45-60 minutes before closing your eyes can make a huge difference on the time it takes to fall asleep and the quality of the rest we are getting.  Is that last text message or email worth a whole night of restless sleep?

Get in a supported position

The Mayo Clinic has a series of photos of helpful positions for sleeping with back pain. These simple recommendations, easily achieved with just a well placed pillow, can protect your back from strain while you sleep.

Wind down naturally

If our system is stimulated it is very difficult for it to find a restful state. Avoid caffeine and alcohol in the later part of the day (after 2pm). This includes, coffee, tea, green tea and chocolate.

Check in with your physician or specialist

If you are not able to break the pain/insomnia cycle it is worth a visit to your doctor to make sure that the pain medications you are taking are not disrupting your sleep and to rule out any other underlying causes.


Exciting new research has recently emerged regarding the impact of mental imagery on reported pain levels, which could open new paths for research and treatment.

For patients living with chronic pain, it’s probably old news that pain can be different on different days, during different activities, or even when a patient is in different moods. This is because there are both physical and emotional components to pain, transforming a very intricate and precise firing of neurons into a varied and personal subjective experience. We know that these signals can be interrupted and diminished by drugs, physical therapies,  and new advances in technology

In a study conducted with 40 healthy volunteers, participants were stimulated on their arm with different temperatures and asked to rate their experience of pain on a scale of 1 to 100. For each temperature stimulus, a photo of a person’s face was shown to the participant on a screen. The research consisted of two parts: In the first part participants were shown the faces with the matching temperatures repeatedly, conditioning the group to associate the image with the level of pain reported. This part was essentially a classical test of the placebo effect, where the participants would expect and then report a level of pain that they associated with the image, even if the stimulus was changed. In the second part, the image was shown for 12 milliseconds and then masked, too fast to be perceived by the conscious mind. The researchers found similar results in the second experiment, indicating that the mechanisms in the brain responsible for the placebo effect can work without the person being consciously aware of the cues.

Mindfulness meditation is a process where calming the body, eliminating stress and recognizing pain signals as they occur allows patients to control how strong these impulses are interpreted by the brain. We mentioned use of mindfulness meditation techniques on the blog earlier this year.  This mental exercise technique uses guided visualization to bring awareness to all parts of the body. This is an active process, where the patient is imagining specific images that promote relaxation.

What sets this new research apart is that it questions whether or not the brain can respond to mental images without the person being conscious or aware of what they are seeing and ultimately determining if the unconscious mind can be trained to affect pain responses.

The conscious mind is sometimes described as the tip of an iceberg, with the larger unconscious mind lying beneath the surface of the water. What if treatments could target this submerged underworld?

If you are interested in reading more about the study the  full text  is available online.


Some recognizable examples of Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin), diclofenac, and  naproxen (Aleve).  They are frequently used as the first line of defence to reduce pain and inflammation.  Most NSAID medications are available without a prescription and are widely used to reduce fever and pain related to long- and short-term medical conditions such as headaches, arthritis, menstrual cramps, and flu symptoms. However, just because they are available without a prescription does not mean that they are 100% safe. New labeling requirements have raised awareness of potential risks for the estimated 30 million Americans taking nonsteroidal anti-inflammatory drugs each year.

The Food and Drug Administration has recently strengthened its warning on NSAIDs due to recent studies that shows even small amounts of NSAIDs present a risk of heart attack, heart failure, or stroke. The updated warning is a result of a growing body of research into these widely used over the counter (OTC) drugs. While it was always presented as a risk, the new strengthened warning clarifies that NSAIDs may increase the risk of heart attack or stroke in all patients, with or without heart disease or risk factors for heart disease as previously thought.  Those with risk factors of heart disease should be particularly cautious because they are already at a higher baseline for such complications. The FDA will require new labels to reflect this developing research.

Should you worry? Not if you are using these medications as directed. There seems to be a consensus from the medical community that more studies are needed before we empty out our medicine cabinets. Bruce Lambert, director of the Center for Communication and Health at Northwestern University, who specializes in drug safety communication shared his comments with the New York Times, “One of the underlying messages for this warning has to be there are no completely safe pain relievers, period.” Another article for NPR highlights the general rule of using caution with any medication.

Although the FDA’ s  new warnings need not cause alarm, the announcement is an important reminder to the millions of people that use NSAIDs on a daily basis that misuse or overuse of OTC drugs could result in severe health consequences. Patients that rely on these OTC painkillers long term should talk to their health care providers about reasonable alternatives.


There is a small percentage of patients who continue to have pain after having Total Knee Arthroplasty(TKA), i.e. a total knee replacement. While pre-operative screening is recommended to ensure the best outcomes for patients recovering from this procedure, between 8-23% will continue to have pain that lasts longer than the expected recovery period. This can be a result of chronic signaling or changes to the nerves which have been “rewired” to transmit pain messages more effectively. When this happens, the pain is considered chronic and requires that these messages be interrupted in order to provide patients with relief.

One option for Total Knee Pain is pulsed radiofrequency. How does PRF work? Electromagnetic waves are delivered to the nerve that change the pain signaling patterns to the brain (see this great video in a previous blog post about how neuropathic pain signals are transferred). Imagine it as a kind of reset button for the nerve that has been carrying too many pain messages. Once the targeted nerve has been stimulated with the electrode it is reconditioned to its pre-pain state. Because pulsed radiofrequency is applied in very short bursts, there is no long-term damage done to the nerve. The treatment takes minutes to perform and the patient is able to resume her normal activities in just a few hours.





We always imagine medicine racing forward, but what if a look back into our evolutionary biology could give us answers to some of the health problems we face today?

Lower back pain is one of the most frequent complaints worldwide, and the World Health Organization has recognized it as a leading cause of disability. Scientists in Scotland, Canada and Iceland have published a study which found that people with lower back pain and other problems are more likely to have a spine shaped similarly to our ape ancestors.

Prof Mark Collard, from the University of Aberdeen and Simon Fraser University in Canada noted in an article for the BBC:

“Our findings show that the vertebrae of humans with disc problems are closer in shape to those of our closest ape relatives, the chimpanzee, than are the vertebrae of humans without disc problems.”

This study compared human, chimpanzee, and orangutan vertebrae to examine links between shape, movement and disc herniation of the spine. Because humans have evolved into a bipedal species (i.e. walking on two legs) the shape of our spine has changed to adapt to our lifestyle as the demand on the vertebrae changed. Researchers noted that humans with lower back pathologies might have a spine that is “less adapted for walking upright.”

The researchers note that the findings of this study have diagnostic and preventative value as practitioners would able predict who is at risk for certain spine injuries or back pain.


The latest from the Apollo Blog outlines very interesting and encouraging interim research about chronic pain patients who are using opiates (pain killers) as their main way to manage their pain: a significant number of patients who are on addictive pain killers are reporting using less of those drugs while on the medical cannabis available through the Apollo program.

Also very interesting: a clinically significant number of their patients are offering lower numbers on pain scores, leading us to think that they are finding some relief for their pain when other types of treatments are failing.

According to a preliminary analysis of Apollo patient data, 27% lowered their use of opioid medications, which included Percocet, methadone and oxycodone. Across all patients, a significant average pain reduction score of 30% was reported.

Through the research, we are proud to present that 54% of patients showed a clinically significant reduction in pain score. Clinical significance is present when a pain score reduction of more than 30% is reached. Patients at or above this level saw an average reduction in pain score of 45%.

As a practice that is keen to see the world not just improve the way it manages pain, but better manage addictive medication, we see this as a major development for patients looking to manage pain without the challenges of high-dose narcotics.

Several Allevio physicians work closely with and are actively referring into the program.


Today we are happily sharing another whiteboard video by Dr. Mike Evans, Toronto based professor, doctor and health educator extraordinaire.

Dr. Evans outlines some very practical aspects of preparing for joint surgery which encourage the patient to be at the centre of the process. The key message: all of the surgeons, nurses and practitioners that participate in your care before and after your joint surgery will be doing everything they can to support you with their skill and expertise, but ultimately you will play the instrumental role in the healing and long term functionality of your new joint.

The video points out that, in Ontario, patients are generally in and out of hospital after 4 days… sometimes sooner. This gives us bit of perspective on this major procedure. The actual surgery is a the shortest event in the whole process. It is what you do before and after your time in the hospital that will influence your outcome dramatically.

Dr. Evans introduces the idea of the new normal: Your joint has been causing you pain and therefore limiting your activity. After surgery it might be difficult to imagine doing things you had avoided to prevent pain leading up to the replacement. However, it is important to develop the physical  and mental strength before  your procedure and keep up this momentum and attitude in the days and months after surgery. More specifically, simple tasks done in advance (organizing your home for your return and having a contact list of people to call on for help) can allow you to focus on your rehabilitation as soon as you leave the hospital.

We see a lot of people at Allevio who are considering joint replacement or are working with our specialists post-operatively.  We are in the process of developing a Total Knee Program and we currently offer several therapies that address pain following joint replacement surgery. If you are a patient considering or having a joint replacement, please take time to research the conditions and treatments below, or feel free to ask your clinical team about these options. It is always important to do homework and understand what treatments may be available, and what independent reserach has shown for any treatment you may consider.

Some potential treatments may include:

Pulse Radio Frequency

Platelet Rich Plasma (see previous post)

Osteopathy (see previous post)

Chiropractic strategies including various modalities

Custom designed support bracing and orthotics, available through certified and trained experts such as Chiropractors for bracing and Chiropractors or Chiropodists for orthotics.


More than managing headaches and chronic pain, Allevio is here to help you get your life back. Our services are completely geared to offering you the best relief available.

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240 Duncan Mill Road Main Floor Suite 101 Toronto, Ontario M3B3S6

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