Our Mission and Promise

Continuing our decade-long mission of making a positive difference in the lives of thousands of patients in the Triangle.

Wake Spine & Pain Specialists was founded in 2009 by Dr. Vijay Mandhare with a single mission to “Relieve Pain so that our patients can attain more mobility, better function and can Reclaim Life”.

We are grateful for the trust and loyalty of our referring providers and it is our promise to provide excellent, timely and compassionate care, keeping patient satisfaction and safety at the center of everything we do.

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Convenient Ways to Refer Patients

  1. Fax: 919-787-7247
  2. Referral Hotline: 919-322-1835
  3. Email: referrals@wakespine.com (from HIPAA compliant email only)
  4. P2P via EMR
  5. Web Form

North Carolina STOP Act

In July 2017, The North Carolina legislature passed the Strengthen Opioid Misuse Prevention (STOP) Act to counter the high rate of opiate overdoses.

The STOP act requires personal consultation between APPs and their supervising physicians in pain clinics upon initiating a patient on opiate therapy and every 90 days thereafter.

Starting Jan. 1, 2018, practitioners cannot prescribe more than a five-day supply of any Schedule II or Schedule III opioid or narcotic upon initial consultation of treatment for acute pain. For patients with acute pain following a surgical procedure the prescription cannot exceed seven days.

Closely on the horizon,  a mandatory review of the patient’s 12-month prescription history via the North Carolina Controlled Substance Reporting System (NCCSRS) will be required before a practitioner can prescribe a Schedule II or Schedule III opioid medication and every subsequent three month period thereafter if the treatment is continued.

In January 2020, all practitioners will be required to electronically prescribe all targeted controlled substances. In this same vein and closely on the horizon, a mandatory review of the patient’s 12-month prescription history via the North Carolina Controlled Substance Reporting System (NCCSRS) will be required before a practitioner can prescribe a Schedule II or Schedule III opioid or narcotic medication.

View the STOP Act FAQs by NC Medical Board

We are passionate about combating the opioid crisis in our state and ensuring our patients and community are safe. By adhering to our comprehensive opiate standard of care and developing treatment plans that integrate opiate therapy with other treatment modalities, we are proud to see that our patients consistently experience a significant reduction in pain, improvement in general activities, quality of life and sleep.

We also use a care team approach to deliver timely care. Our care team is comprised of an expert physician, highly trained advanced practice providers (APP) and caring and attentive medical assistants. Each care team conducts a daily review of the day’s schedule where our physicians collaborate with their APPs and discuss challenging cases and treatment plans, leveraging their multidisciplinary backgrounds.

CDC and the Opiate Crisis

In the past 18 months, numerous changes to laws and guidelines have been introduced to help mitigate the growing number of overdoses by patients prescribed opioid medications in the state and across the country.

CDC Guideline for Prescribing Opioids for Chronic Pain released March 2016 provides guidance to primary care clinicians regarding decreasing risks associated with opioid use. They are based on the following three principles:

  1. Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care;
  2. When opioids are used, the lowest possible effective dosage should be prescribed to reduce risks of opioid use disorder or overdose.
  3. Clinicians should always exercise caution when prescribing opioids and monitor all patients closely, particularly patients taking high-risk regimens like ≥50 MME/day.

Source: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

We are proud to say that since inception, Wake Spine & Pain Specialists has always followed a comprehensive opiate treatment protocol to protect our patients from the significant risks that are associated with opioid therapy. Opiate therapy is initiated only when patient satisfies specific criteria and has not responded to more conservative treatment options.

With pharmacovigilance and a trusted physician/patient relationship, Wake Spine & Pain offers responsible pain management, maximizing pain relief without compromising patient safety.

Opioid Dose (Morphine milligrams equivalent (MME)) Calculator

FDA and CDC Warning About Concurrent Benzodiazepine and Opioid Use

Both the FDA and CDC have recently released strong advisories against serious risks of concurrent benzodiazepine and opioid use.

Safety announcement from FDA released in August 2016 warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines; requires its strongest warning.

Sources: https://www.fda.gov/Drugs/DrugSafety/ucm518473.htmhttps://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

In the current opiate crisis environment, there is an urgent need for greater collaboration between pain management specialists and primary care clinicians.

For patients who are on concurrent Benzodiazepines and Opioids, our providers will work closely with referring providers to determine safer treatment alternatives. Physician collaboration is important to the success of a safe treatment plan that prevents patients from having to choose between pain relief and treatment for depression.