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!


New research is taking a closer look at the drugs targeted at physical pain and how they might affect other aspects of behavior and emotional experience.

One study in 2010 found that acetaminophen,the active ingredient in Tylenol, reduces behavioral and neural responses associated with the pain of social rejection. The study feels that because the drug can help both types of pain, there is a large overlap between social and physical pain.

Dubbed the “pain related affect”, researchers are looking into “subjective feelings or impressions of anguish that accompany almost any harmful stimulus.” In other words, it is not only physical sensations that register as pain, but emotions and social distress that can hurt as well. In fact, “hurt feelings” result in the same firing of neural pathways.

Acetaminophen has always stood apart from other mind-altering pain killers such as opioids as it was not thought to influence a patients emotions or mental state. As this widely used over-the-counter drug is considered relatively benign (aside from conditions that result from over use) it has become one of the most commonly used drugs for pain on the market.

However, recent research shows that Tylenol does in fact alter moods and may moderate feelings of anxiety. The study above found that participants taking acetaminophen responded less to scenarios of social rejection than those taking the placebo. These studies garnered much attention and interpretation in the media and are an interesting contribution to the discussion of how the brain interprets pain. For more of this topic see the links below.


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.


Platelet Rich Plasma (PRP) injection is a therapeutic treatment using the patients’ own blood, put through a centrifuge to separate and concentrate the number of platelets, which is then re-injected to the injured site or pain area. Because platelets contain a variety of growth factors which are instrumental in the healing process of tissues, this concentrated dose is championed for its regenerative properties. Considered a conservative therapy (as opposed to surgery, for example), PRP injections are administered in an office setting and work fast to kickstart a number of biological processes.

Recently, Platelet Rich Plasma injection treatment has become popular among professional athletes as a solution to potentially career-slowing injuries. When Tiger Woods spoke to the media about his treatment in 2009, research on PRP was relatively new and considered more trend than science due to its high profile list of supporters.

However, the popularity of the treatment has pushed the scientific community to further examine the effects PRP. The evidence base continues to mount with exploration into how platelet-rich plasma may play a role in improving clinical outcomes in patients with early onset osteoarthritis. In a double-blind randomized trial published in 2013, patient groups who received PRP reported a relief in symptoms over the placebo group who received injections of saline.

Dennis Cardone, associate professor in the Department of Orthopedic Surgery at NYU’s Langone Medical Center explains in an interview with NPR, that although its effectiveness is still in the early stages of research, PRP is at least now something that he can safely offer to patients who might not have had conservative options before.


Since hosting a continuing medical education seminar, some of our physicians have started to work more closely with Apollo Applied Research, and have offered the service to patients. One of these patients was recently seen in a follow up encounter, and the physician forwarded us all a small note about their findings:

Dear Colleagues:

I wanted to share with you an amazing success story.

A patient presented with chronic and persistent upper right shoulder pain for the last 18 months. A number of pharmacological therapies were prescribed…

Pain persisted despite these attempts.

As a last resort, I prescribed the patient medical cannabis through Apollo Applied Research, and the patient has reported a considerable decrease in pain with no psychological impact. The patient has reported they have stopped using all other pain medications for this chronic ailment.

The patient has also reported a significant improvement in her quality of life, indicating that her sleep has improved, and she feels able to exercise for the first time in many years.

While of course this is NOT evidence, a case study or anything more than ONE instance of positive feedback about Apollo’s project yielding positive results for ONE patient, it is an encouraging experience for one patient in an area we are all learning more about… and it is another person no longer using painkillers and opioids… and that alone is worth sharing.


ECHO Ontario is a joint project between University Health Network and Queen’s University Continuing Professional Development Office to replicate the Project ECHO developed at the University of New Mexico. The goal is to empower primary care physicians to treat patients more effectively by granting better access to specialists.

The “Hub” practitioners of the program are reputed to be very strong and we know Dr.Andrea Furlan – she’s a highly respected member of the pain community.

Here are some videos on the project.


Apollo Applied Medical Marijuana Research is at Allevio Pain Management this evening discussing their Medical Cannabis research project for patients with Chronic Pain.
This is a small CME event that was geared to our specialists, but was also attended by some primary care practitioners and Anesthesiologists working with three UHN / University of Toronto affiliated hospitals.
There’s a ton of great and detailed information about this product and the best practices when it comes to finding the right strains for patients. For more information about this, and to find out if the Apollo study or clinic is right for you, please get in direct touch with your physician or with Apollo directly.


Marie J. Hayed, PhD, and Mark S. Brown, MD have published an article in JAMA Internal Medicine that notes as Medical Marijuana prescriptions increase in a given community, so too do opioid-related deaths decrease. (Opioids are pain killers such as Oxycodone, Oxycontin, Vicodin, Percocet and Dilauded).

From the UofC, Berkeley Wellness Letter, Feb 2015:

…the 13 states which medical marijuana laws between 2000 and 2010 had a 25% lower opioid-related death rate, on average, than states where marijuana was illegal. The longer the laws were in effect, the greater the reduction. The researchers estimated that in 2010 there were about 1,700 fewer opioid-related deaths than would be have been expected if medical marijuana had not been available.

An important statistic as so many physicians are nervous about choosing the proper medications for patients, and an important tool in the ongoing battle to combat pain killer abuse.

While Allevio does not prescribe medical marijuana (or manage pharmaceuticals for patients generally), the Apollo Applied Research program for Medical Marijuana is the program we tend to refer to. The program is ethics-approved and does not charge patients for prescriptions.


For our UK readers, this is a list of active and past clinical trials of Osteopathy for different health conditions, including but not limited to low back pain, back pain, shoulder pain, neck pain, TMJ and migraine headaches.  This list is powered by the NHS (National Health System) and WHO (World Health Organization) International Clinical Trials Registry.

Many of our Allevio patients turn to Osteopathy as part of their multi-disciplinary approach to their chronic pain, rehabilitation or re-conditioning with a sports injury.  For more information about Osteopathy, click here.


Over the past number of weeks, the Toronto Star has published a series of videos and articles about several patients who, under the care of the Rothbart Centre, have contracted bacterial meningitis and epidural abscess, among other complications. We join our patient community, the physician community and of course our entire community in extending our deepest sympathies to the patients and their caregivers for what has happened.

At Allevio, our main focus is to keep patient care and safety as our primary concern.  We are currently adding new physicians to our team to accommodate the increasing need for evidence-based interventional pain management in Toronto.  We adhere to all Public Health guidelines, and go beyond the standards wherever possible. You can find our (and other clinic’s) College of Physicians and Surgeons of Ontario (CPSO) Out of Hospital Premises inspection findings here. We were granted a “Pass” when inspected.

The result: Standards and procedures that are safer for patients and practitioners, an understanding of proper protocol that goes above and beyond, and a patient safety record that reflects our commitment to outstanding care.

For patients who have recently been treated at the Rothbart Centre who chose to receive care at Allevio Pain Management, we are of course happy to see you, but ask you to:

  1. Speak to your Family Doctor for medical clearance if you are concerned about infection
  2. Ask your Family Doctor to complete our Referral Form
  3. Complete our Pre-Consult Questionnaire
  4. Check with the CPSO (College of Physicians and Surgeons of Ontario) to see if they have additional recommendations for patients who have been treated at the Rothbart Centre.


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.

Our Flagship Location

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

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