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!
Do you spend most of your working hours standing or walking? Maybe you enjoy going on daily jogs or participating in regular sports activities. Even if you don’t fall into either of these categories, it’s likely that your knees are put under stress day in and day out, as this happens to nearly everyone. You might not experience the aches or pain now, but at some point, your knees will tell you when they need a little more care and attention.
At PM&R Associates, we have helped many patients with their chronic and acute knee pain conditions. However, one approach we highly encourage is the prevention of knee pain. We’ve created a quick list of everyday tips to ensure your knees stay pain-free and functioning as they should.
Knee pain can strike in a couple of different ways. If you’re feeling an occasional spasm or twinge of pain, try these following tips:
- Water! Water! Water! Water can be the miracle solution to several different bodily ailments. Even if you don’t think you need water, there is a good chance you may be dehydrated. Water helps boost circulation, lubricates joints and removes wastes and toxins from your body. Adults should be drinking approximately eight 8-ounce glasses of water daily, and if you’re active, that amount should be increased.
- Active individuals should also be weary of doing deep-knee squats, lunges and intense running on hard surfaces, like a treadmill or concrete. Sports activities that require sudden stops and twists, like tennis or basketball, should be avoided as well. If you’re looking for alternative exercises, look towards bicycling, swimming or using an elliptical machine. Or at the very least, switch up your regular activity to give your knees a break.
- Runners know the importance of a good pair of running shoes. If you own a pair of old, ratty shoes, throw them out! Worn-out inner and outer soles are good indications that your shoes are at the end of their lifespan. Worn-out shoes lose their spring and cushion, which makes them inadequate for providing support for your feet and knees.
- If you can, avoid kneeling. Knee caps take the brunt of the damage when we kneel. If you’re in the garden or stocking low shelves at work and you must kneel, wear knee pads, sit on the floor or try using a low stool or bench. This will take the pressure and stress off your knees, saving you years of future pain.
If you have persistent knee pain, you might have to be extra-cautious when it comes to proper care. Have a look the following bonus tips:
- If you don’t have time to visit us for treatment right away, use cold therapy to relieve chronic knee pain. Use a frozen gel or ice pack, or even a bag of frozen peas wrapped in a towel and apply it to the achy or painful knee. Cold therapy helps with reducing inflammation and swelling.
- Are you carrying an extra few pounds around? Shedding extra weight (even if it’s just 5 pounds) can alleviate pressure and stress on the knees.
- Before you begin your fitness or exercise routine, don’t forget to stretch. Stretching keeps your joints, ligaments and muscles limber for mobility and movement. If stretching ever becomes painful, never push past the pain.
Knee pain may be the result of many factors, such as injury to the tendons, ligaments, and cartilage in and around the knee, or even a degenerative condition like osteoarthritis. If you are experiencing pain that won’t go away, give us a call at PM&R Associates.
If you’ve elected to receive a stem cell treatment, you’ve likely done your research. You know all about the condition you need to treat, and your doctor knows the appropriate treatment—in this case, stem cell therapy. There are many kinds of stem cell therapies, just as there are many kinds of stem cells. Regardless of what kind of stem cell treatment you are going to receive, there are a few preparation basics that apply to most procedures.
Take Your Supplements.
For some procedures, you may be given a supplement in the form of a pill or a sublingual fluid. Confirm the dosage of this supplement with your doctor, and make sure you are aware of any contraindications with any prescription drugs you take. Be sure to take the exact amount that you have been advised to take.
Eat Clean, Drink Clean.
One of the most important parts of preparing for your stem cell treatment is to have clean, healthy blood. This means you should avoid eating or drinking sugary foods or drinks, consuming alcohol, smoking or taking any kind of tobacco, and consuming caffeine in any form. Unless you are told otherwise, it is best to eat a light, protein-rich meal before your treatment so you are adequately nourished.
A good night’s sleep is important prior to your first stem cell treatment. Although most stem cell treatments are non-invasive or minimally invasive, it’s always a good idea to rest up. You should also avoid exercise prior to your appointment, and avoid strenuous activity for at least three days after your treatment.
Bring a Friend.
Even though stem cell therapy is not a surgical procedure, it is highly recommended that you have a friend or relative provide transportation to and from your appointment. This is a good idea not only for physical safety but also for the emotional support of having a loved one nearby.
Confirm and Prepare.
Finally, double check all of the preparation info your doctor gave you. If she or he has advised you to do something you are unsure about, it’s crucial that you confirm the steps you need to take prior to and after your treatment. Depending upon the stem cell procedure, some people feel tired after the initial extraction, injection, or infusion. That’s why it’s very important to give yourself as many days as possible to adjust to your new, healthy self. If you are a younger patient and in good health, you will likely have a quicker adjustment time, but you should still plan to stay home and rest for at least 24 hours.
At PM&R Associates, we offer stem cell injection treatments for both disc pain and joint pain. Call us today to see if you are a candidate. 317-316-0019