A radio-frequency neurotomy is a musculoskeletal medicine procedure that is done to cauterize or burn the small, short nerves that carry pain from the spinal facet joints to the spine, interrupting the pain pathway. Its purpose is to stop pain from the spinal joints (facets) for six months to one year.
X-ray equipment (fluoroscopy) is always used. The patient lies down and the to-be injected area is numbed with a local anesthetic (Novocain) and then two needles are directed to the target area. Electrodes are inserted into the needles and motor stimulation is done to ensure that the spinal nerve is not being stimulated. Radio waves are sent through the electrodes to create the heat in the needles.
Are There Side Effects?
You may experience a sensation similar to a sunburn following the procedure. This is normal and temporary. If severe, additional medications to treat this side effect are available. However, complications for this procedure are low.
How Will I Feel?
Although this is thought to be painful or uncomfortable, the painful part mainly resides in the positioning of the needles. Since the area is numbed, the actual burning itself is not painful. Post-procedure pain medication is usually provided to limit any discomfort.
Most people report feeling relief as soon as the post-procedure medication begins to wear off. So, the results of the procedure are quick.
This procedure doesn’t restrict you from your activities and daily life. However, if you choose to do sedation, we recommend not driving or operating machinery until 24 hours.
If you are interested in learning more of want to know if you are a candidate, we would love to see you for a consultation.
Contact PM&R at 315-565-2848.
Arthritis is the inflammation of one or more joints. This can cause pain, swelling and tenderness. About 350 million people worldwide suffer from arthritis. About 40 million of those people are Americans. Of those affected, over half are women.
Arthritis is commonly misconstrued as only affecting the aging or elderly. However, more than half of those with arthritis are under the age of 65. With these staggering numbers, you might be wondering how one can prevent this joint pain? Check out these helpful tips below.
As with prevention of any ailment, a healthy diet is always beneficial to your overall health and wellness. There are several foods you can add to your diet to help prevent joint pain. The foundation of any diet should consist of fruits and vegetables. Five servings a day is recommended. In addition, foods rich in omega-3 fatty acids help reduce swelling and inflammation. This healthy fat is found in salmon, sardines, mackerel, trout, flaxseeds and walnuts. Try eating 3 to 4 ounces of fish, twice a week. Foods rich in vitamin D promote healthy bones. In addition to your fish, try to add some more milk or cheese to your diet as well.
Excessive weight plays a large role in joint pain. When you lose weight through diet and exercise, you are able to not only relieve stress from your joints, but also increase muscle that supports your joints.
The more you are moving, the less stiff your joints will be. If you are looking to get your heart rate elevated but want a low impact exercise option, try swimming, bicycling, rowing, and elliptical or even walking. These are best options for protecting your joints. In addition to these low impact exercises, you might want to try practices like yoga and Pilates. These both help strengthen your ab and back muscles, which ultimately help maintain balance and lessens your likelihood of injury by falling.
Make Use of Your Stronger Joints
Do you typically carry a heavy purse or backpack? Consider how you are lifting and carrying heavy items. Allow for larger muscles and joints such as your arms to carry these kinds of items. Take the pressure off smaller joints like fingers and wrists.
Go Hands Free
As mentioned above, keeping joints locked in the same position for an extended period of time does not help with joint pain. A daily occurrence like talking on the phone can prove harmful over time. Try going hands free using the speaker or blue tooth features of your phone.
Do you suffer from arthritis pain? Let us help you return to an active and healthy lifestyle. Call PM&R Associates today to schedule an appointment at 317-565-2848.
The use of spinal cord stimulation (SCS) for pain has a long history. With time, the equipment has gotten better and the treatment has become more effective. Spinal cord stimulation is used extensively by the armed forces for war injuries. This is an effective method of pain control for both back and leg pain of any origin. It is used for back pain without leg pain, leg pain of any cause without back pain, or in patients with both. Any patient with back or leg pain of any cause is a candidate. It is used when other procedures have failed or medication is not effective in relieving pain.
What is a spinal cord stimulator?
A spinal cord stimulator is a device that has two parts. One part is the leads that are placed in the epidural space, which is the space where medication is placed with an epidural injection. The second part is the battery and waveform generator. The battery has to be replaced every seven to ten years. The leads stay in until removed.
How does it work for pain?
There are two phases in treating pain with spinal cord stimulation. The first is a trial period of one week where the leads are implanted on a temporary basis, but the battery is not. The patient has wires coming out of the skin that are attached to a trial simulator, which functions like the implanted battery. The patient can increase or decrease the stimulation, change programs, or even turn it off if it is bothersome for certain activities. After the one-week trial, the stimulator leads are removed. If the patient gets good results, a permanent stimulator is scheduled for implant.
The leads are placed using a needle under x-ray guidance, so you will be required to lie face down during the procedure.
After the procedure, you will be asked not to do excessive bending or twisting. The dressing during the trial must be kept dry. Most patients experience pain relief the same day or the next day after the procedure.
All insurance companies require a psychological evaluation before they will authorize the trial. This is to be sure there are no psychological problems that are severe enough to prevent the patient form getting relief from the stimulator.
Benefits of Spinal Cord Stimulation
- Limited to no side effects
- Minimally invasive
- Adjustable pain relief
- Targeted pain relief
Do you think you could benefit from spinal cord stimulation for pain? Give us a call today to schedule an appointment at 317-565-2848!
Here at PM&R Associates, we combine new and traditional medicines. We offer a variety of different injections for the treatment of joint pain. All joint injections are done with either X-ray or ultrasound guidance. We prefer ultrasound because it is safer for the patient, since there is none of the ionizing radiation associated with X-ray. We also use a specially formulated “no sting” local anesthetic to numb the skin before all injections. Below you will find different joint injection treatments and the pros and cons of each.
STEROID (CORTISONE) INJECTIONS
Pros: Steroid injections will reduce inflammation, if inflammation is present, and will reduce pain, swelling, and fluid in the joint.
Cons: Steroid injections have a limited use with osteoarthritis (OA) or degenerative joint disease as those are typically not associated with inflammation. It is a pharmaceutical treatment, which means it has a peak action and the effect tapers. Both local and systemic side effects increase with the dose injected and frequency of injections. Side effects of steroid injections may include weakening of the joint, increased blood pressure, elevation of blood sugar, and decreased ability to fight infection. Patients are usually limited to no more than 3 injections per year for any particular joint.
Pros: Non-steroid injections work best in degenerative joint disease or osteoarthritis (OA).It is a biologic treatment, which means it gets better with time and lasts longer than pharmaceutical treatments. Since no cortisone is used, this can be repeated as often as needed and is typically covered by insurance.
Cons: Non-steroid injections do not work for everyone. May be safely repeated more often than every three months.
ARTIFICIAL JOINT FLUID INJECTIONS (VISCO-SUPPLEMENTATION)
Pros: This injection s made of hyaluronic acid from rooster combs, which works like an artificial joint fluid given by injection. It is expensive, but it is usually covered for some joints by most insurances.
Cons: Usually requires multiple injections with limits on how many times it can be repeated. Not all joints are covered by all insurances and it required prior authorization. Given its cost, it’s worth noting that it may be no more effective than cortisone injections. Some experts feel risks are not worth the benefits and can have allergic reactions.
PRP INJECTION (PLATELET-RICH PLASMA)
Pros: PRP injection is a biologic treatment, which means the patient gets better with time and the effect lasts longer than pharmaceutical treatments. Taken from the patient’s own blood and given back the same day, PRP injections are now regularly performed across the country and can last 6 months to a year or longer. Sometimes it lasts longer, but not everyone gets better.
Cons: PRP injections are not covered by insurance, so there is a surcharge above what insurance pays. It may only prevent additional deterioration and even in those studies with symptomatic improvement, there were no MRI changes.
STEM CELL THERAPY
Pros: Stem cell therapy delivers decreased pain scores 75-78% at 6 months. It is able to treat avascular necrosis, which is a condition in which the bone of the joint actually dies. MRI will detect an increase in both cartilage and menisci. Stem cell therapy is not as painful as other options. It typically shows an increase in lifestyle scores by 75% at 6 months. This injection is dissolved in PRP, so the patient gets the benefits of both at one price.
Cons: Stem cell therapy is often expensive and is not yet covered by insurance.
To learn more about our injection treatment options, give us a call today.
The shoulder is a highly mobile joint composed of tendons, ligaments, cartilage, and bones, all of which are prone to injury with activity and sports. People experiencing shoulder pain may be suffering from a variety of conditions such as bursitis, tendinitis, osteoarthritis, or degenerative arthritis. Shoulder pain can also be caused by sports injuries or other accidents, and those over the age of 50 are especially susceptible to developing rotator cuff tendon tears.
Symptoms of shoulder pain can range from mild to severe and may disturb physical activity and sleep. Pain, weakness, and a loss of range of motion are all symptoms of a shoulder injury. Those who participate in high-risk sports, those whose jobs involve physical labor or older adults are all at a higher risk for a painful shoulder injury. For more details, check out the below list of common causes of shoulder injuries.
Sports that involve repetitive overhead motion can be detrimental to your shoulders. The tendons that connect muscles to bones can partially or completely overstretch. Overhead arm movements can cause tendons to rub or scrape against part of the shoulder blade. Examples of sports with repetitive overhead motion include swimming, tennis, pitching and weightlifting.
Similar to the above-mentioned sports injuries, repetitive lifting at work can also be a cause of shoulder injuries. Those who work in manual labor are susceptible to shoulder injuries. This includes painters and carpenters.
Suffering from a fall, car accident, or another sudden injury can result in a rotator cuff strain or tear. Typically, these injuries cause intense and immediate pain. Rotator cuff tears often occur with other shoulder injuries, such as a broken collarbone or a dislocated shoulder.
It’s important to consider your shoulder health, not only when at work or while paying sports, but also during your everyday activities. Overuse injuries can occur when too much stress is placed on a joint or other tissue, typically by overdoing an activity or through repetition of an activity. Hanging curtains, gardening and washing walls can also be causes of shoulder injuries. Performing these activities with poor posture or with insufficient joint mobility and strength may predispose you to shoulder pain.
If you are experiencing shoulder pain that won’t go away, give us a call at PM&R Associates.
Degenerative disc disease is a degenerative process affecting the intervertebral discs. Pain is experienced due to loss of cushioning, fragmentation and herniation related to aging. There are more than 3 million cases of regenerative disc disease in the US every year. At PM&R Associates, we offer stem cell injection treatments for disc pain.
What is a stem cell injection?
The injection of stem cells is a biologic treatment, which means the patient gets better with time and the effect lasts longer than pharmaceutical treatments. Stem cells are suspended in platelet-rich plasma (PRP), so the patient gets the benefits of both at one price: The patient gets stem cells, platelets, fibrin, and growth factors.
For disc pain, stem cells are first obtained, usually from fat, and then injected into one or more degenerated spinal discs. The injection is always done with x-ray guidance. This is a procedure to reduce pain and increase function in a patient with a degenerated painful spinal disc.
Am I a candidate?
Anyone with a painful spinal disc is a candidate for stem cell therapy. Usually, it is done in patients that have not gotten relief from less invasive procedures such as epidural steroid injections (ESI) or selective nerve injections or blocks, TENS units, physical therapy, facet joint injections and similar treatments. The only surgical procedure that treats the degenerated discs is a surgical fusion and it may be no more successful.
What should you expect from the treatment process?
In order to obtain the stem cells, fat must be taken from your abdomen by a needle and syringe aspiration. Fluid with numbing medication is injected before the fat is removed with a syringe. The fat is dissolved and the stem cells are obtained and then mixed with platelet rich plasma, which is obtained from you blood. After the stem cells have been processed and mixed, they are injected into the degenerated discs.
Discomfort at the site where the fat was obtained is mild and goes away in a few days. There is usually significant pain and pressure in the back or neck after the procedure, which goes away on its own after a few days, but in some individuals, the discomfort can last longer.
After the procedure, you will be asked not to take a bath or use a hot tub until all the injection sites have healed. You may take a shower the day of the procedure. We ask you not to increase your activity too quickly as you get better to avoid any setbacks.
Patients are seen back in the office two months after the procedure, and by then patients usually have started to get better. Patients can continue to see results for many months afterward.
What are the risks and side effects?
Infection is one of the more serious side effects. If an infection of the disc occurs, you will usually be very sick and require antibiotics. Hospitalization and I.V. antibiotics may be necessary. You will be given I.V. antibiotics before the procedure and the procedure is done under a full surgical scrub and drape to minimize the risk of infection.
The most serious side effects from intravenous sedation is sudden death, brain damage from low blood pressure, or allergy from the medication. These are extremely rare and have never happened in my practice. A nurse will be monitoring your blood pressure, blood oxygen level, and heart rate. If necessary, oxygen will be administered through a tube inserted in your nose. These risks can be avoided by not getting sedation.
You may have an allergic reaction to any of the medications used. If you have a known allergy to any medication, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place.
Are you suffering from degenerative disc disease? Stem cell injections may be a treatment option for you. Call PM&R Associates for more information today!