Spine and Nerve RSS Feed

Spinal Cord Stimulation (HF10 Neuromodulation)

Thu, 15 Oct 2026 17:43:09 GMT

Sacroiliac Joint Fusion (iFuse Implant System)

Thu, 15 Oct 2026 17:41:04 GMT

RFA Lumbar Facets

Thu, 15 Oct 2026 17:38:48 GMT

Radiofrequency Ablation (RFA) for Pain

Thu, 15 Oct 2026 17:37:40 GMT

PRP

Thu, 15 Oct 2026 17:36:14 GMT

Mild Procedure (Vertos Medical)

Thu, 15 Oct 2026 17:35:20 GMT

Kyphoplasty

Thu, 15 Oct 2026 17:34:00 GMT

Genicular Nerve Block

Thu, 15 Oct 2026 17:32:58 GMT

Genicular Nerve Radiofrequency Ablation

Thu, 15 Oct 2026 17:31:36 GMT

Herniated Discs (cervical)

Thu, 15 Oct 2026 16:59:46 GMT

Basivertebral Nerve Ablation (Intracept)

Thu, 07 Nov 2024 23:20:43 GMT

Sacroiliac Joint Injections

Wed, 04 Nov 2020 01:47:51 GMT

Whiplash

Wed, 04 Nov 2020 01:43:11 GMT

Rotator Cuff Syndrome

Wed, 04 Nov 2020 01:41:11 GMT

Overview

The rotator cuff of the shoulder is composed of four different muscles that support the shoulder

joint. This group of muscles keeps the head of the humerus (upper arm bone) secured within the shallow socket of the shoulder joint. When the rotator cuff tendons are injured they become

irritated or damaged, resulting in pain, weakness and reduced range of motion.

Rotator cuff injuries are common and increase with age, in people who have jobs with overhead

motions such as painters and carpenters. Many people can manage their symptoms and return to activities with physical therapy to improve strength and flexibility; however some patients also

require surgical interventions to help correct the injury.

Symptoms

Rotator cuff injuries can manifest as pain, weakness, and/or range of motion. Pain in rotator cuff

injuries can be described as a deep ache in the shoulder that can also disturb sleep. Rotator cuff injuries will make it difficult for the person to perform any over head motions such as brushing your hair, or reaching behind your back. Patients may also experience weakness when performing specific movements.

Diagnosis

Diagnosis of rotator cuff injuries is primarily through physical exam with your medical provider. X-rays, ultrasound, and MRI are also utilized to help diagnose the extent of rotator cuff injuries.

Treatment

Conservative treatments for rotator cuff injuries include rest, ice, and physical therapy. If these do not provide relief then cortisone or steroid injection can be helpful in reducing inflammation in the shoulder joint. As a last resort corrective surgery may be needed to repair the rotator cuff tendons, this is typically done arthroscopically.

Knee Osteoarthritis

Wed, 04 Nov 2020 01:36:40 GMT

Overview

Knee osteoarthritis is a degenerative disease involving the cartilage in the knee joint. Osteoarthritis occurs when the protective cartilage surrounding the end of your bone begins to wear down. It can most commonly affect the knees, hips, hands, and spine. Symptoms can usually be managed, but the damage to the joints can never be reversed.

Risk factors for developing osteoarthritis include age, gender, obesity, previous joint injuries, repetitive stress on a joint, genetics, bone deformities, and metabolic disorders.

Symptoms

Symptoms of osteoarthritis develop slowly over time and can vary from person to person. Most commonly, patients will experience joint pain, stiffness (especially in the morning), tenderness around the joint, loss of flexibility or range of motion, grinding sensation, and swelling.

Diagnosis

Diagnosis of osteoarthritis of a joint can be made by taking an x-ray of the joint to evaluate the bones in the knee joint. An MRI may also be useful in diagnosing osteoarthritis to help evaluate the soft tissue around the joint.

Treatment

Treatment of osteoarthritis first begins with lifestyle changes including consistent exercise and proper weight management.

Physical therapy, and pool therapy have also been shown to be effective in helping treat osteoarthritis pain. Additionally, alternative movement therapies such as tai-chi and yoga have been found to help reduce pain caused by osteoarthritis.

Traditional medication options include acetaminophen (Tylenol), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or Aleve.

Supplements such as glucosamine/chondroitin, capsaicin, and omega-3 fatty acids, while controversial in efficacy, have anecdotally reduced patient’s osteoarthritis pain.

Devices such as knee braces and a TENS unit can also provide relief.

Typically, if lifestyle changes, therapies, and medications fail to relieve pain, then cortisone or steroid injections can be performed to help reduce inflammation in the knee joint. Other available injections include hyaluronic acid, prolo injection therapy, and platelet-rich-plasma injections.

Finally, if all conservative measures fail, the patient can undergo surgery to change the structure of the knee. Two types of surgeries are available: partial knee replacement and total knee replacement.

Spondylosis

Wed, 04 Nov 2020 01:32:08 GMT

Facet Joint Injections

Wed, 04 Nov 2020 01:28:41 GMT

Hip Osteoarthritis

Wed, 04 Nov 2020 01:24:15 GMT

Overview

Hip osteoarthritis is a degenerative disease involving the cartilage in the hip joint. Osteoarthritis occurs when the protective cartilage surrounding the end of your bone begins to wear down over time. It can most commonly affect the knees, hips, hands, and spine. Symptoms can usually be managed but the damage to the joints can never be reversed.

Risk factors for developing osteoarthritis include age, gender, obesity, previous joint injuries, repetitive stress on a joint, genetics, bone deformities, and metabolic disorders.

Symptoms

Diagnosis

Diagnosis of osteoarthritis of a joint can be made with x-ray of the joint. MRI may also be useful in diagnosing osteoarthritis.

Treatment

Treatment of osteoarthritis first begins with lifestyle changes including consistent exercise and proper weight management.

Physical therapy and pool therapy have also been shown to be effective in helping treat

osteoarthritis pain. Additionally, alternative movement therapies such as tai-chi and yoga have been found to help reduce pain caused by osteoarthritis.

Traditional medication options include acetaminophen (tylenol), and non-steroidal anti-

inflammatory drugs (NSAIDs) such as ibuprofen, or aleve.

Supplements such as glucosamine/chondroitin, capsaicin, and omega-3 fatty acids, while controversial in efficacy, have anecdotally reduced patient’s osteoarthritis pain.

Typically, if lifestyle changes, therapies, and medications fail to relieve pain, then cortisone or steroid injections can be performed to help reduce inflammation in the hip joint.

Finally, if all conservative measures fail the patient can undergo surgery to replace the hip joint. This is typically done by an orthopedic surgeon.

Piriformis Syndrome

Wed, 04 Nov 2020 01:19:23 GMT

Medial Epicondylitis (Golfer's Elbow)

Wed, 04 Nov 2020 01:16:30 GMT

Medial Branch Block Injections

Wed, 28 Oct 2020 00:11:36 GMT

Lumbar Transforaminal Epidural Steroid Injection

Wed, 28 Oct 2020 00:04:59 GMT

Lumbar Radiculopathy (SCIATICA)

Tue, 27 Oct 2020 23:58:09 GMT

Lumbar Epidural Steroid Injections

Tue, 27 Oct 2020 23:54:51 GMT

Lateral Epicondylitis (Tennis Elbow)

Tue, 27 Oct 2020 23:47:12 GMT

Greater Trochanter Syndrome

Tue, 27 Oct 2020 23:41:51 GMT

What is greater trochanter pain syndrome?

Greater trochanter pain syndrome (GTPS) is a common cause of lateral hip pain. It is more common in females between the ages of 40 and 60. GTPS is the cause of hip pain in 10–20% of patients presenting with hip pain.

What causes GTPS?

Repetitive activity.
Mechanical overload.
Training errors: high-intensity training, high mileage, running on an asymmetrical surface, cambered road.
Sedentary lifestyle.
Scoliosis.
Obesity.
Uneven leg length.
It is believed that the tendinopathy is brought about by repetitive microtrauma, especially when an abnormal pelvic width is present.

Signs and Symptoms:

Lateral hip pain that may radiate to the lateral thigh and buttocks and occasionally to the lateral knee.
Pain may be worsened by certain hip movements (hip abduction and external rotation).
Tenderness on the greater trochanter/lateral hip.
Pain when lying on the side affected, prolonged sitting, sitting with legs crossed.
Pain with activities such as walking, climbing stairs, standing and running.

How is it diagnosed?

GTPS is a clinical diagnosis. This means that the diagnosis is based on the medical history as well as signs and symptoms. The clinician conducts a physical examination which includes some maneuvers or tests. Sometimes, the clinician may need to order other imaging studies such as MRI of the hip or lumbar spine, Ultrasound or x-rays if there is a need to rule out other medical condition/s.

How is it treated?

Anti-inflammatory medication, ice, rest.
Physical therapy.
Avoidance of certain activities that may be aggravating the condition.
Weight loss.
Load modification and optimization of biomechanics.
Shock wave therapy.
Therapeutic ultrasound.
Corticosteroid injection.

If conservative management fails, then surgery may be an option. Surgery may involve lengthening or release of the ITB and fascia lata, gluteal tendon tear repair, minimally invasive endoscopic bursectomy, or open reduction trochanteric osteotomy.

Facet Joint Syndrome

Tue, 27 Oct 2020 23:26:17 GMT

Cervical Disc Herniation

Tue, 27 Oct 2020 23:19:59 GMT

A herniated disc is a rupture in the fibrous outer wall of a vertebral disc. This can cause impingement of the nerve roots exiting the neural foramen or compressing of the spinal cord.

Myofascial Pain Syndrome

Tue, 27 Oct 2020 23:10:14 GMT

What is it?

Persistent muscle pain that is caused by fascial tightening around your muscles, limiting your mobility, causing painful “knots.” Fascia is thin connective tissue that is around every organ. It provides structure, but when stressed, it tightens up. This can lead to chronic pain. Fascia is designed to stretch as you move. If it tightens around the muscle, it limits mobility and becomes painful.

How does it occur?

A lifestyle of limited physical activity, such as prolonged computer use, repetitive movement that overworks on part of the body, such as checking groceries with the same arm daily, and trauma - surgery or injury.

How is it diagnosed:

Fascial pain is often determined by history and physical exam. MRIs and CAT scans can not image fascia. The fascia may be painful when touched, but improve with prolonged pressure (such as massage). Sometimes MRIs are used to rule out nerve injuries/disc problems or other sources of pain.

How is it treated:

Myofasical release or massage therapy is very helpful to help break up scar tissue within the fascia and help lay down new healthy tissue. Trigger point injections can help bring blood flow to the taught fascia. These are often done with lidocaine to anesthetize taught fascia and muscles. Physical therapy is helpful as well. Stretching regularly is important to maintain elasticity in the fascia. Posture is important as well. Slumping or walking in an altered way to compensate for an injury can cause fascia to tighten. It is often a combination of multiple modalities of treatment that help fascia pain.

Medications:

Antiinflammatories, lidocaine patches, topical medications such as FourPainRx, biofreeze or salonpas, muscle relaxants, anticonvulsants such as gabapentin or pregabalin, and tricyclic antidepressants can help pain as well.

Surgery:

Surgery is not indicated for myofasical pain syndrome.

Occipital Neuralgia

Mon, 26 Oct 2020 22:58:42 GMT

What is it?

A condition that causes headaches starting from the back of the scalp (occipital region) and can radiate to the sides (parietal region) of the skull. This is due to the occipital nerves becoming inflamed or injured. This can cause headaches that are severe, shocking, and piercing. The headaches can radiate to the back of the head or behind the ears.

How does it occur?

Occipital neuralgia is due to pinching of the occipital nerves. This can be due to muscle tightness in the neck, but can also be caused by a head or neck injury (e.g. whiplash).

What are the symptoms?

Headaches in the back of the head (occipital region) that are aching, burning, throbbing, with intermittent shocking or shooting pain that starts on one or both sides of the head. Headaches can be severe and be accompanied by nausea or light sensitivity.

How is it diagnosed?

It can be difficult to diagnose because there is not one specific test that will diagnose occipital neuralgia. Physical exam and neurologic exam will help rule out other abnormalities. An MRI can help rule out other causes of pain. Cervical facet joint pain can cause similar symptoms including headaches. An occipital nerve block can help diagnose it as well.

How is it treated?

Heat, stretching, physical therapy, massage therapy, antiinflammatories, muscles relaxants and anticonvulsants, such as gabapentin and pregabalin can help the symptoms. Occipital nerve blocks (with steroid) can help, as well as botulinum toxin (botox).

Surgery?

Occipital nerve stimulation- surgical treatment involving placement of stimulating electrodes at the base of the skull with leads connected to a pulse generator that sends electrical impulses to the occipital nerves. Most patients are able to treat occipital neuralgia without surgical measures.

Spinal Stenosis

Sat, 24 Oct 2020 01:44:51 GMT

Cervical Radiofrequency Ablation

Fri, 23 Oct 2020 20:58:06 GMT

Cervical Radiofrequency Ablation

is a method used to reduce pain coming from the facet joints in the neck. The facet joints are the lateral joints in the spine. These can be damaged causing headaches, localized neck pain even pain radiating to the shoulders. First a positive diagnostic block is done to determine that the facets are causing the pain. Radiofrequency ablation can provide 70-80% relief of this pain for those that have a positive diagnostic block.

How is it done?

Radiofrequency ablation can be done with either local or IV anesthetic. The nerves that branch from these joints, the medial branches, are heated causing a disruption in the pain signal and decreasing pain.

There may be temporary discomfort and numbness in the area after the procedure. It may take a few weeks to get the full benefit from the procedure but the relief can last 6 months to 2 years.

Cubital Tunnel Syndrome

Fri, 23 Oct 2020 20:44:14 GMT

Spondylolisthesis

Fri, 23 Oct 2020 20:38:25 GMT

Pain Management

Fri, 23 Oct 2020 20:30:11 GMT

Complex Regional Pain Syndrome (CRPS)

Fri, 23 Oct 2020 20:24:51 GMT

Cervical Radiculopathy

Fri, 23 Oct 2020 20:18:01 GMT

Coccydynia

Wed, 21 Oct 2020 17:29:43 GMT

Herniated Discs in Lower Back

Wed, 21 Oct 2020 17:24:02 GMT

Peripheral Nerve Stimulation

Wed, 21 Oct 2020 17:16:35 GMT

Peripheral Nerve Stimulation (PNS), is a minimally invasive image guided therapeutic procedure that is performed to relieve chronic pain disease processes. Through the available research and clinical experience, this minimally invasive treatment has been demonstrated to significantly improve function and pain, for multiple conditions including but not limited to chronic shoulder pain, chronic neuropathic disease processes, and chronic post operative pain.

How is PNS performed?

Patient Positioning

Patient positioning will be variable depending on the disease process being targeted, but ultimately the patient will be comfortable and relaxed during the procedure.

Anesthesia

Typically this procedure is done with use of IV anesthesia in addition to local anesthetic numbing. The patient will be very relaxed with significant control/blocking of procedural pain; but the patient will still be breathing on their own and therefore will not require a tube down the throat (no intubation).

Image Guidance

Using an Ultrasound machine and/or fluoroscope for guidance (live X-ray guidance), the physician carefully places the PNS device in the target location. Image guidance allows for precise placement of the PNS electrodes in the safest manner possible.

PNS procedure further details

Using a minimally invasive technique with image guidance, small therapeutic leads with electrodes are carefully guided to the target location (typically target nerves causing/contributing to chronic disease process). Once in position, the leads and associated electrodes utilize electricity to stimulate the target structures and have a positive impact on the pain signal and health / function of the nervous system.

End of Surgery

The therapeutic device is left in place, but all other tools are removed. The small incision at the procedure site is closed with suture, and a sterile bandage is applied.

How long does it take for PNS stimulation to work?

Some patients notice fairly immediate relief, but it may take several weeks for patients to notice the full therapeutic benefit.

Who performs the PNS procedure?

PNS is performed by one of the board certified Interventional Pain Physicians at Spine & Nerve Diagnostic Center (SNDC).

Where is the PNS procedure performed?

The PNS procedure is performed at one of the state of the art surgery centers that SNDC works with. Typically this is an outpatient procedure, and there is no overnight stay.

Anatomy of the Spine

Fri, 02 Oct 2020 23:02:19 GMT

Cervicogenic Headaches

Fri, 02 Oct 2020 23:02:08 GMT

Definition:

Headache caused by a disorder of the cervical spine and its components, such as bone, disc and/or soft tissue elements, usually, but not invariably, accompanied by neck pain and stiffness.

Causes:

Trauma such as fracture, dislocation, or whiplash injury
Osteoarthritis or rheumatoid arthritis
Nerve compression
Tumor
Infection
The most common cause of cervicogenic headaches is an injury to the cervical facet joints

Symptoms:

Pain almost always affects the same side of the neck and head
Headaches are triggered by neck movement
Reduced flexibility of the neck

Diagnosis:

Begins with a thorough clinical evaluation, including a complete medical history, analysis of symptoms, and physical examination.

Testing may include x-rays, MRI and/or CT scans, and electro-diagnosis (EMG).

The “Gold Standard” for diagnosing a cervicogenic headache is a diagnostic block using anesthetic. For example if an injection of anesthetic medication to the cervical facet joint improves or resolves the headache, it is proof that the facet joints in the neck are causing the

headache.

Treatment:

Avoiding postures or movements that provoke the pain

Maintaining a good posture while sitting or driving—by sitting tall with shoulders back and without protruding the head forward

Using a neck brace can be helpful while sitting upright or sleeping in a chair.

Other effective treatments are …

Physical therapy
Chiropractic treatment
Acupuncture
TENS/EPM units
Facet joint injections
Cervical medial branch blocks followed by radiofrequency ablation procedure
Platelet rich plasma injections to the facet joints

Dorsal Column Stimulation-Spinal Cord Stimulation

Fri, 02 Oct 2020 23:01:56 GMT

Overview

Spinal cord stimulation (SCS) employs the use of electrical impulses to relieve pain emanating from different parts of the body. The concept behind pain relief imparted by SCS is known as the “Gate Control Theory of Pain”. It is the theory that the electrical impulses disrupt the pain signals from reaching the brain and registering as pain.

Candidates

Traditionally SCS therapy has been reserved for conditions such as chronic neuropathic pain (radiculopathy), chronic regional pain syndrome (CRPS), peripheral neuropathy and phantom limb pain. Over the last few years, the therapy has been extended to help those individuals with

axial pain (neck/back pain).

Trial Period

One of the advantages of SCS therapy is that the patient is allowed a “trial” period which may last anywhere between 3 and 10 days. The leads are placed with the use of needles which may take place in office or outpatient surgery center. Typical procedure lengths are anywhere between 30 and 90 minutes. During the procedure, the patient is lightly sedated, but they are able to confirm the correct placement of the leads as the device is turned on intraoperatively to ensure the stimulation is felt in the patient’s typical pain areas.

Following the procedure, the external battery is taped down to the patient’s skin and the device is

worn externally for the length of the patient’s trial. During the trial period, the patient has access to a remote control which imparts several programs and settings which the patient may change to

obtain maximum benefit.

Permanent Implantation

At the conclusion of the trial period, the patient returns to have the leads removed in office. If the patient reports acceptable benefit, then the decision is made to proceed to permanent implantation of the device. For the permanent implant, the leads and Implantable Pulse Generator (IPG) are surgically placed underneath the skin under general anesthesia.

Post Implant

The post procedure period allows three months of limited activity to allow the leads to scar down

into a fixed position. Thereafter, restrictions are lifted, and the patient is able to control the device from a wireless control with multiple programs and settings to achieve maximum benefit.

Nerve Conduction Study (NCS)

Fri, 02 Oct 2020 23:01:44 GMT

Platelet Rich Plasma (PRP)

Fri, 02 Oct 2020 23:01:30 GMT

Posterior Image-Guided Lumbar Decompression (PILD)

Fri, 02 Oct 2020 23:01:18 GMT

PILD, short hand for Posterior Image-Guided Lumbar Decompression, is a minimally invasive

procedure designed to treat symptomatic lumbar spinal stenosis (LSS). More specifically, lumbar stenosis resulting in a condition known as neurogenic claudication is the classic diagnosis for which PILD is indicated.

Neurogenic claudication (NC) is described as a sensation of heaviness, numbness, pain, or cramping in the back and/or legs upon ambulation, standing, or lying down for a specific amount

of time or distance. The symptoms are relieved by a period of rest, but they return once the inciting activity is resumed. The reason that NC occurs is because of lumbar stenosis, which is

compression of nerves due to arthritic build up in the spine.

It used to be that spine surgery was the only way to remove this arthritic build, but PILD, performed under x-ray image guidance, provides a minimally invasive technique to provide the

same result. The procedure involves the use of needle instrumentation to remove small portions

of bone (lamina) and ligament to open up space around the nerves being compressed.

My MRI report reads that I have “stenosis” all over my spine. Does that make me a

candidate for PILD?

Everyone will attain some degree of stenosis in their lifetime, but only some individuals will attain a degree to be considered “severe” or symptomatic. Your practitioner is specifically trained to evaluate your MRI and listen to your symptoms to determine whether you are a good candidate for the procedure.

I’ve heard of minimally invasive lumbar decompression (MILD) for lumbar stenosis--is

that different from PILD?

No, MILD is a branding of the PILD technique.

I have pain as well as functional limitations--is PILD designed to help both?

Although it can help both pain and functional limitations, PILD is specifically designed to help with function. The objective is to improve walking/standing ability, and although pain is often improved also it is not a guarantee.

In addition to lumbar stenosis, I’m told I have disc/joint arthritis and foraminal stenosis--

am I still a candidate for PILD?

Yes, in fact, it has been demonstrated that most patients who display success with PILD have multiple conditions. Although PILD does not address all of these other issues it is still effective in relieving symptoms due to LSS resulting in NC.

Prolotherapy

Fri, 02 Oct 2020 23:01:06 GMT

Prolotherapy is a form of regenerative medicine that has been present for at least over a century.

The idea is to introduce a chemical irritant to an area of injured tissue that has not healed properly. The irritant, commonly either sugar water or saline water, is mixed with Lidocaine and

injected into injured tissue to create a chemical irritation. In addition to this chemical irritation,

providers may also create mechanical irritation with a technique called “dry needling” where the

practitioner uses the injection needle to repeatedly break up body tissue. The combination of this

mechanical and chemical irritation induces an inflammatory state which brings in cells and chemicals to heal the new and previously damaged tissue. The end result is a “do over” in which

the body heals the tissue properly in this second attempt at healing.

How many Prolotherapy injections do I need to have done to obtain the desired results?

Prolotherapy has traditionally been performed in a series of usually three injections. However,

everyone is different and some individuals may require less and some may require more treatments.

Which types of conditions can Prolotherapy be used for?

Fortunately, regenerative medicine can be used in some of the most common conditions known

to cause pain including osteoarthritis, tendonitis, repetitive strain trauma, and myofascial

(muscle/tendon/ligament) pain. These conditions affect common problem areas including the

neck, back, shoulder, hip, knee, ankle, and the wrist to result in conditions such as lateral and

medial epicondylitis, plantar fasciitis, carpal tunnel syndrome, spinal disc pain, rotator cuff pathology, whiplash injuries, and others. These maladies are all issues that could be treated with

regenerative medicine.

Can this be done in clinic or does this procedure need to be performed at an outpatient

surgery center?

In general Prolotherapy procedures can be performed in clinic, with only local anesthesia for pain control, and with or without image guidance.

If I require image guidance which modality will be used?

Image guidance can be done under either x-ray or ultrasound. The decision for either will be patient and condition dependent.

Regenerative Medicine

Fri, 02 Oct 2020 23:00:24 GMT

A common question that medical providers hear from their patients is, “are there any new treatments that have been developed which can help me?” Well, we at the Spine & Nerve

Diagnostic Center are very excited to present a treatment that may be the answer to your question.

Traditionally, the medical world has relied mainly on steroid injections which have been in use

for the last century. While steroid in the treatment of inflammatory pain has a proven 100 year

track record, what does one do when steroid injections aren’t enough? Fortunately, the new field

of Regenerative Medicine is now available to help in those very situations.

Regenerative medicine is the promising new field of medicine that focuses on repairing damaged

tissue to reduce pain and restore function. To understand how regenerative medicine works, one

must understand that injured tissue releases chemicals and chemical messengers to recruit cells

which repair the damage. However, this healing process is not always complete, which leaves

some unfortunate individuals with chronic pain and functional decline. This is a situation in which regenerative medicine such as prolotherapy, platelet rich plasma injections (“PRP”), or

stem cell therapy may be helpful.

Application

Fortunately, regenerative medicine can be used in some of the most common conditions known

to cause pain including osteoarthritis, tendonitis, repetitive strain trauma, and myofascial

(muscle/tendon/ligament) pain. These conditions affect common problem areas including the

neck, back, shoulder, hip, knee, ankle, and the wrist to result in conditions such as lateral and

medial epicondylitis, plantar fasciitis, carpal tunnel syndrome, spinal disc pain, rotator cuff

pathology, whiplash injuries, and others. These maladies are all issues that could be treated with

regenerative medicine.

Stem Cell Therapy

Fri, 02 Oct 2020 22:59:43 GMT

Stem cells take regenerative medicine a step further. These cells are considered precursor cells

meaning they have not yet fully differentiated. The intention is that once these cells are injected

into a certain body tissue, they have the ability to develop into that specific type of tissue.

Therefore, in addition to the same chemical messengers that are contained in platelet rich plasma, stem cells add the possibility of growing new tissue. Stem cells can be isolated from different sources. Those stem cells isolated from our body’s bone marrow are known as bone marrow aspirate cells (BMAC). Importantly, this mixture of cells contain mesenchymal cells which are important to orthopedic injuries because they have the ability to differentiate into ligaments,

tendons, cartilage, and bone--commonly damaged tissue in musculoskeletal injuries. Although

there are different areas to isolate adult stem cells, the pelvic bone is the most common area for

extraction. Once extracted, the stem cells are spun in a machine called a centrifuge. The centrifuge separates out the stem cells. These cells are then injected back into the damaged area.

Where do you acquire the BMAC?

BMAC may be acquired from multiple areas in the body, but we typically focus on the pelvis for

acquisition of BMAC.

Do I need to be sedated for the BMAC procedure?

This procedure can be done either with local anesthesia or with intravenous sedation. If the latter

option is used then the procedure is done at a surgery center.

Can BMAC and PRP be combined?

Yes, the two therapies may be combined and often are used in this manner.

Which types of conditions can stem cells be used for?

Fortunately, stem cell therapy can be used in some of the most common conditions known to

cause pain including osteoarthritis, tendonitis, repetitive strain trauma, and myofascial

(muscle/tendon/ligament) pain. These conditions affect common problem areas including the

neck, back, shoulder, hip, knee, ankle, and the wrist to result in conditions such as lateral and

medial epicondylitis, plantar fasciitis, carpal tunnel syndrome, spinal disc pain, rotator cuff

pathology, whiplash injuries, and others. These maladies are all issues that could be treated with

stem cell therapy.

Sacroiliac Joint Pain (SI joint pain)

Wed, 30 Sep 2020 01:30:34 GMT

An under diagnosed cause of low back pain could be due to the Sacroiliac joint (SI joint).

What is sacroiliac joint?
The SI joints are located between the iliac bones and the sacrum (in the pelvic region) and connects the spine to the hips. The SI joint functions as a shock absorber for the spine; it provides support and stability. It also transfers weight and forces between the upper body and legs. It is the largest joint in our body, and therefore at risk for injury.

What are the signs and symptoms of SI joint pain?

SI joint pain can present as low back pain and/or buttock pain. The pain can also be felt in the thighs, upper back and groin. The pain can involve one or both sides. It may be associated with numbness or tingling in the leg or a feeling of weakness in the leg. Symptoms may get worse with sitting, standing, sleeping, walking or climbing stairs. One can have pain when sitting or sleeping on the affected side. SI joint problem may make it difficult to ride in a car. Prolonged standing, sitting or walking can also be difficult. Transitional movements (going from sitting to standing), standing on one leg or climbing stairs may make the pain worse.

What causes SI joint pain?

There are various causes of SI joint pain:

Trauma - injury to the ligaments that support the SI joint may occur as a result of a fall, motor vehicle accident, repetitive trauma, weight lifting, sports or fracture related to osteoporosis (insufficiency fractures). Trauma from a motor vehicle collision is the most common cause of SI joint injury and pain.
Loosening of the ligaments that surround the joint - During pregnancy, the body releases hormones that may cause the joints to loosen up and move more, which leads to changes in the way the joints move. The pain may persist even after pregnancy if the ligaments do not return to the way it was prior to pregnancy and may be brought about by certain factors such as extended labor and delivery of large babies. Certain conditions such as Ehlers-Danlos syndrome can also cause SI joint problem.
Degeneration - the cartilage over the SI joint slowly wears away as a person ages.
Uneven motion - sacroiliac joint pain can occur when movement in the pelvis is not the same on both sides. Uneven movement can be caused by uneven leg length (one leg is longer than the other) or when one leg is weaker than the other. Altered patterns of walking, spinal deformities, unequal leg length can cause SI joint pain.
Biomechanical problems - conditions such as wearing a walking boot following foot/ankle surgery or non-supportive footwear, can lead to sacroiliac joint pain.

How is the condition diagnosed?

A medical evaluation is necessary to diagnose this condition. A complete history and physical examination will be conducted. Physical examination will include testing the joints by doing specific maneuvers/tests which will manipulate the joints and also feel for tenderness over the SI joint.

Imaging studies which may include X-ray, CT scan, or MRI, may be ordered to help in the diagnosis and to make sure that the pain is not caused by other spine or hip related problems.

A diagnostic SI joint injection may be performed to confirm the cause of pain. The SI joint is injected with a local anesthetic and corticosteroid medication. This is done with x-ray guidance to ensure accurate needle placement in the SI joint. Sacroiliac joint involvement is confirmed if the injection significantly decreases the pain. If the procedure does not change the pain level, it is unlikely that the SI joint is the cause of the low back pain.

How is this treated?
Nonsurgical treatments may include physical therapy, chiropractic manipulation, and stretching exercises, oral anti-inflammatory medications or topical patches, creams, or mechanical bracing (SI joint belt).

SI joint injection: A mixture of anesthetic and corticosteroid is injected into the SI joint. If the injections are helpful, they can be repeated up to three times a year. Corticosteroids are not only effective but are typically covered by insurance carriers and have over 100 years of proven success.

Platelet rich plasma (PRP) injections have been shown to be effective in treating SI joint pain. This is newer technology but has been shown to be very effective when patients have failed to improve with corticosteroids.

Nerve ablations: Injections into joints or nerves are sometimes called “blocks.” Successful SI joint injections may indicate that the patient may benefit from radiofrequency ablation – a procedure that uses an electrical current to destroy the nerve fibers carrying pain signals in the joint.

Surgery: If nonsurgical treatments and joint injections do not provide pain relief, minimally invasive SI joint fusion surgery may be recommended. Through a small incision, the surgeon places titanium (metal) implants and bone graft material to stabilize the joint and promote bone growth. The surgery takes about an hour. The patient may go home the same day or the following day. For several weeks after surgery, the patient cannot bear full weight on the operated side and must use crutches for support.

Cervical Epidural Steroid Injection

Thu, 24 Sep 2020 21:48:20 GMT

A cervical epidural steroid injection (CESI) is a minimally invasive image guided therapeutic injection that is

performed to relieve neck pain and radiating upper limb symptoms. Through the available research and clinical experience, this procedure has been demonstrated to: improve pain and function, break the pain cycle, and decrease inflammation of the target structures. Importantly, this image guided treatment allows the delivery of a concentrated volume of therapeutic medication directly to the site of injury/inflammation, which increases the probability of optimal effectiveness while minimizing the risk of systemic side effects (especially compared to oral medications).

How is a CESI performed?

Patient Positioning

The patient lies face down, with a pillow underneath the chest and the neck slightly flexed, and forehead resting on the procedure table.

Tissue Anesthetized

A local anesthetic is utilized to numb the skin, as well as to numb the tissue from the skin to the spine.

Fluoroscopic Guidance

Using a fluoroscope for guidance (live X-ray guidance), the physician carefully directs the therapeutic needle to the target epidural space. Once the needle tip is confirmed to be in the target epidural space using multiple techniques including the aforementioned image guidance, a contrast solution is injected to ensure that the therapeutic medication will ultimately flow in the desired path to treat the target tissue.

Medications injected

The therapeutic medication injected includes a steroid medication (typically Dexamethasone, which is one of the strongest anti-inflammatory pain medications available for safe treatment of spine conditions), which is injected into the target epidural space and bathes the target inflamed/injured tissue.

End of Procedure

The therapeutic needle is carefully removed, and a small sterile bandage is applied to cover the small needle surface wound.

How long does it take for the CESI to work?

Typically it takes about 3-7 days for the full therapeutic effect of the CESI.

Who performs a CESI?

CESIs are performed by one of the board certified Interventional Pain Physicians at Spine & Nerve Diagnostic Center (SNDC). Our interventional physicians have performed thousands of these procedures.

Where are CESIs performed?

CESIs are typically performed at one of our state of the art SNDC procedure suites.

Radiofrequency Ablation of the Medial Branches

Thu, 24 Sep 2020 17:49:17 GMT

Radiofrequency ablation of the medial branches is a minimally invasive image guided therapeutic procedure that is performed to relieve joint pain due to arthritis of the spine. Through the available research and clinical experience, this procedure has been demonstrated to: improve pain due to arthritis of the spine and ultimately improve function and health. Importantly, this image guided treatment allows the prolonged blocking of the pain signals from painful arthritic joints. Typically, the benefit of this procedure lasts around 12 months; if the symptoms recur the procedure can be repeated.

Importantly, prior to moving forward with the ablation procedure, it is critical to ensure that the correct joints (and nerves supplying those joints) are being targeted. Therefore, a test block is performed twice (two tests blocks are performed to minimize the risk of a false positive result with the test block) to confirm that treatment of the target joints will result in significant improvement for the patient. The tests blocks are performed on two separate appointment days prior to the radiofrequency ablation and these blocks are performed with local anesthetic only (therefore the pain relief lasts around 3 hours).

How is a radiofrequency ablation of the medial branches procedure performed?

Patient Positioning

The patient lies face down.

Tissue Anesthetized

A local anesthetic is utilized to numb the skin, as well as to numb the tissue from the skin to the spine.

Fluoroscopic Guidance

Using a fluoroscope for guidance (live X-ray guidance), the physician carefully directs the therapeutic radiofrequency ablation needle to the target joint area (and specifically the nerve sending the pain signal from the joint).

Radiofrequency ablation procedure

Once the needle tip is confirmed to be in the exact target location using multiple techniques including the fore-mentioned image guidance, the needle tip is then heated up to the target temperature for 90 seconds which ultimately results in therapeutic targeted ablation of the specific target nerve. As mentioned above, this ablation procedure typically results in about 12 months of sustained improvement in arthritic joint pain.

End of Procedure

The therapeutic needles are carefully removed, and a small sterile bandage is applied to cover the small needle surface wounds.

How long does it take for the radiofrequency ablation procedure to work?

It can take up to four weeks for the full therapeutic effect of the radiofrequency ablation.

Who performs a radiofrequency ablation procedure?

Radiofrequency ablation procedures are performed by one of the board certified Interventional Pain Physicians at Spine & Nerve Diagnostic Center (SNDC). Our interventional physicians have performed thousands of these procedures.

Where are radiofrequency ablation procedures performed?

Radiofrequency ablation procedures are typically performed at one of our state of the art SNDC procedure suites.

Interspinous Process Decompression for Lumbar Spinal Stenosis

Thu, 24 Sep 2020 17:35:56 GMT

Interspinous Process Decompression (IPD) for lumbar spinal stenosis is a minimally invasive image guided therapeutic surgery that is performed to relieve back and radiating lower limb pain caused by lumbar stenosis. Through the available research and clinical experience, this minimally invasive surgery has been demonstrated to:

Improve back and lower limb pain caused by lumbar stenosis, and ultimately improve function including but not limited to walking distance. Importantly, this minimally invasive surgery is a mechanical solution to a mechanical problem, specifically the treatment increases the amount of space around the nerves in the spinal canal which improves blood flow to these nerves and relieves the painful mechanical compression.

How is IPD for lumbar stenosis performed?

Patient Positioning

The patient lies face down. In order to access the target level of the spine in optimal fashion, the patient will have pillows and/or a device underneath the abdomen to arch the low back.

Anesthesia

Typically this procedure is done with the use of IV anesthesia in addition to local anesthetic numbing. The patient will be very relaxed with significant control/blocking of procedural pain, but the patient will still be breathing on their own and therefore will not require a tube down the throat (no intubation).

Fluoroscopic Guidance

Using a fluoroscope for guidance (live X-ray guidance), the physician carefully places the IPD device in the target location of the lumbar spine.

IPD minimally invasive surgery

Using a minimally invasive technique with image guidance, a small incision is made (about 1 cm in length) and multiple surgical tools are utilized to dissect down to the target location (which is in-between the spinous processes of the target lumbar levels). Once in the target location, the therapeutic device is deployed. The device itself ultimately opens up the space where the nerves need to travel at that target level, essentially improving the degree of stenosis at that level.

End of Surgery

The therapeutic device is left in place, but all other tools are removed. The small surgical wound is closed with suture, and a sterile bandage is applied.

How long does it take for IPD to work?

Some patients notice fairly immediate relief, but it can take up to six weeks for the full therapeutic effect.

Who performs IPD?

IPD is performed by one of the board certified Interventional Pain Physicians at Spine & Nerve Diagnostic Center (SNDC).

Where is the IPD surgery performed?

The IPD surgery is performed at one of the state of the art surgery centers that SNDC works with. Typically this is an outpatient procedure, and there is no overnight stay.

Dorsal Root Ganglion Stimulation

Thu, 24 Sep 2020 17:28:09 GMT

Dorsal Root Ganglion (DRG) stimulation, is a minimally invasive image guided therapeutic surgery that is performed to relieve chronic pain disease processes. Through the available research and clinical experience, this minimally invasive surgery has been demonstrated to significantly improve function and pain, for multiple conditions including but not limited to, complex regional pain syndrome, neuropathies, chronic post operative pain and post amputation pain. This minimally invasive surgery targets the DRG which is a critical structure in the pain pathway, and DRG stimulation is able to have a powerful positive effect on the patient's nervous system/pain pathways through modulation of the DRG.

How is DRG stimulation performed?

Patient Positioning

The patient lies face down. Pillows will be underneath the abdomen/pelvis region in order to flatten the back.

Anesthesia

Fluoroscopic Guidance

Using a fluoroscope for guidance (live X-ray guidance), the physician carefully places the DRG stimulation device in the target location of one or multiple of the foramen of the spinal canal (the foramen are the openings of the spinal canal where nerve roots exit the spine, and the foramen is where the DRG is located).

DRG stimulation minimally invasive surgery

Using a minimally invasive technique with image guidance, small therapeutic leads with electrodes are carefully guided to the aforementioned target location of the spinal foramen where the DRG resides. These electrodes utilize electricity to stimulate the DRG and have a positive impact on the pain signal and health/function of the nervous system. First a trial is performed where the leads are hooked up to an external power generator which is placed in a pocket that adheres to the patient, and a sterile bandage covers the surgical site for the duration of the trial. The trial lasts around 5-7 days. If the trial is successful, specifically if the patient notes a significant improvement in pain and function, then the permanent implant is performed. The permanent implant is very similar to the trial, except there is no external power generator; instead there will be two small incisions (one midline incision and one incision around the gluteal region) which allow for the entire device to be internalized. There is a remote that can talk to the power generator in order to change therapeutic programs as well as other functions.

End of Surgery

The therapeutic device is left in place, but all other tools are removed. The small surgical wound is closed with suture, and a sterile bandage is applied.

How long does it take for DRG stimulation to work?

Some patients notice fairly immediate relief, but it may take several days for patients to notice the full benefit during the trial period.

Who performs DRG stimulation?

DRG stimulation is performed by one of the board certified Interventional Pain Physicians at Spine & Nerve Diagnostic Center (SNDC).

Where is the DRG stimulation surgery performed?

The DRG stimulation surgery is performed at one of the state of the art surgery centers that SNDC works with. Typically this is an outpatient procedure, and there is no overnight stay.

Trigger Point Injection

Tue, 22 Sep 2020 22:00:13 GMT

What is Tarsal Tunnel Syndrome?

Thu, 10 Sep 2020 18:32:21 GMT

Many people come to our office with complaints of numbness and tingling or pain in their feet. Most people simply want to know what’s may be causing their symptoms. Some people have been told that it may be coming from their back. Others have been told that it may be a circulation problem or symptoms of diabetes.

While all these conditions are possible causes of numbness, tingling or pain, an often overlooked but common cause of these symptoms is Tarsal Tunnel Syndrome (TTS).

TTS is basically the equivalent of carpal tunnel syndrome of the foot and ankle.

TTS is a compression of the tibial nerve as travels through the tarsal tunnel. The tarsal tunnel is found behind the medial malleolus (the bony bump that we can feel on the inside of the ankle). The tibial nerve branches into 3 separate nerves while it is in the tarsal tunnel. One branch supplies the heel. The 2 remaining branches supply the bottom of the foot.

The tibial nerve shares the tarsal tunnel with the tendons of 3 muscles and with the posterior tibial artery. As you can imagine, the tunnel is a very crowded place. For this reason, it is not uncommon for the tibial nerve to get “pinched” within the tarsal tunnel.

When the nerve is compressed, it can create numbness, tingling and pain on the bottom of the foot and heel. The toes may also be affected. The symptoms are often made worse with walking. TTS is more common in athletes and active people.

The diagnosis of tarsal tunnel syndrome can be made by history and physical exam. It is often confirmed by nerve conduction studies. Nerve conduction studies often show slowing or dysfunction of the tibial nerve or its branches.

The treatment of TTS consists of a trial of physical therapy, medication management, injections, and surgery. Generally conservative treatment is tried first. If there is no improvement with conservative treatment, more interventional methods are considered.

Tarsal tunnel syndrome can affect quality of life. Early diagnosis can improve function and lead to more effective treatment.

-Dr. Reddy

What is a Physiatrist?

Thu, 10 Sep 2020 18:32:19 GMT

Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move and function.

Physiatrists are medical doctors who have completed training in the medical specialty of physical medicine and rehabilitation (PM&R). Specifically, rehabilitation physicians:

Diagnose and treat pain
Restore maximum function lost through injury, illness or disabling conditions
Treat the whole person, not just the problem area
Lead a team of medical professionals
Provide non-surgical treatments
Explain your medical problems and treatment/prevention plan

The job of a rehabilitation physician is to treat any disability resulting from disease or injury, from sore shoulders to spinal cord injuries. The focus is on the development of a comprehensive program for putting the pieces of a person’s life back together after injury or disease – without surgery.

Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.

Diagnosing Fibromyalgia

Thu, 10 Sep 2020 18:32:18 GMT

The Healing Art of Jin Shin Jyutsu

Thu, 10 Sep 2020 18:32:17 GMT

The Healing Art of Jin Shin Jyutsu

The body contains energy pathways that feed life into all of the cells. When one or more of these pathways become blocked, the effect can lead to discomfort, pain, illness and injury. Jin Shin Jyutsu (pronounced Gin Shin Jitsu) a Japanese form of acupressure, helps release the tensions that cause these various physical symptoms. By gently applying the hands to a clients’ fully clothed body, Jin Shin Jyutsu re-harmonizes and balances the energy flows. This aids in healing, promotes optimal health and helps the client to feel better. The practice of Jin Shin Jyutsu naturally addresses any latent emotions which could be hindering physical healing.

Self-care is a beautiful piece of Jin Shin Jyutsu. By developing an awareness of the life force within yourself, you can learn to harmonize your mind, body & spirit. Your hands are your jumper cables and by holding your fingers, toes or utilizing simple flows you can easily become more responsible and engaged in maintaining your own health, balance and happiness. For example, if you have a stomach-ache or are overcome by worry hold your thumb and breathe deeply. Both symptoms will melt away.

This article was written by Beth Lendrum, Holistic Health Counselor, Jin Shin Jyutsu Practitioner

916-467-6232

bethjsj@gmail.com

Beth Lendrum has studied many different healing modalities in her journey to help others. These modalities include Reiki I, Eastern nutrition, Chinese Medicine, Massage Therapy, essential oils and Jin Shin Jyutsu. Once she discovered Jin Shin Jyutsu in 2004, she knew that practicing this was her calling. She studied Eastern nutrition and Chinese Medicine in a Traditional Chinese Medicine Hospital in Beijing China. In 2007, she travelled to Japan to study with the last living Jin Shin Jyutsu master. Beth lives in El Dorado Hills with her husband, 2 children and her healing miniature poodle, Cisco. Beth has a practice in El Dorado Hills and Roseville.

Beth Lendrum is not affliated with the Spine & Nerve Diagnostic Center but has helped treat patients referred to her by the providers at Spine & Nerve Diagnostic Center.

Risk of Osteoarthritis Linked to Finger Length Ratio

Thu, 10 Sep 2020 18:32:15 GMT

The University of Nottingham located in the United Kingdom published a study in 2008 which looked at the role that the length of people’s fingers may play in predicting osteoarthritis. The researchers at the University of Nottingham studied more than 2,000 people. The conclusion of the study was that people who have an index finger shorter than the ring finger are up to twice as likely to suffer from osteoarthritis. Osteoarthritis is a general term, which refers to degeneration of joint cartilage or the bone. This is most commonly associated with age, but some people develop it at an earlier age than others. This study seems to conclude that people who have a longer ring finger than index finger have a higher rate of developing osteoarthritis earlier than one would expect.

A more recent study published in March 2014 reported in the Oxford University Press demonstrated the same thing. In the Oxford University study published in the Journal of Rheumatology, they specifically looked at osteoarthritis of the knee and found that the lower the ratio of the second digit length to the fourth digit length, the higher the incidence of osteoarthritis in the knee and higher the need for a total hip replacement. The second study looked at 580 people and followed them over a 10.5 year period.

Interestingly, the ratio of the second digit to the fourth digit has hormonal connections. The amount of prenatal testosterone levels seems to account for having a fourth digit that is taller than one would expect. Other prenatal factors that effect the digit ratio are lower estrogen concentrations. Men typically have shorter second than fourth digits, and in women, the fingers tend to be equal in length.

Based on these studies, we can draw the conclusion that men probably have a higher risk of osteoarthritis than women; and that among both men and women, the ratio of the fourth digit to the second digit can be one predictor of osteoarthritis. However, this is only one factor, and components such as other genetics, family history, injuries and type of work are also contributors to osteoarthritis.

Norco and Vicodin Can No Longer Be Called in or Faxed

Thu, 10 Sep 2020 18:32:13 GMT

DEA Reclassifies Hydrocodone Combination Products to Schedule II

On August 22, 2014, the U. S. Drug Enforcement Administration (DEA) published the Final Rule moving hydrocodone combination products (HCPs) from Schedule III to the more-restrictive Schedule II classification. The Final Rule in effective October 6, 2014.

The Controlled Substances Act (CSA) places substances with accepted medical uses into one of four schedules, with the substances with the highest potential for harm and abuse being placed in Schedule II, and substances with progressively less potential for harm and abuse being placed in Schedules III through V. Schedule I is reserved for those controlled substances with no currently accepted medical use and lack of accepted safety for use. Hydrocodone combination products (HCPs) are drugs that contain both hydrocodone, which by itself is a Schedule II drug, and specified amounts of other substances, such as acetaminophen or aspirin.

Hydrocodone combination products include Vicodin, Norco, Lortab, Lorcet, and Vicoprofen.

The Final Rule was made to address concerns about the abuse potential of HCPs. The Centers for Disease Control report that drug overdose is the leading cause of injury death. More than 16,000 people die each year from pharmaceutical related death in the U.S. Hydrocodone is the most prescribed drug in the U.S. Americans consume 80 percent of the world’s supply of narcotics but only account for 4.6% of the world’s population.

What does this mean to patients who are prescribed hydrocodone? Doctors can no longer call in or fax prescriptions for HCPs. Prescribers will need to prepare HCP prescriptions on hard-copy, tamper-resistant prescription forms, for patients to bring to their pharmacy. Only a 30 day supply can be written. Refills are not allowed unless the patient is evaluated by a health care provider and then written by the provider.

Smokers three times likelier to face chronic back pain

Thu, 10 Sep 2020 18:31:58 GMT

Eight out of ten Americans suffer from back pain at some point in their lives, according to the American Chiropractic Association, and back pain is the most common reason for missed days at work. A new study published in the journal Brain Mapping indicates that if you smoke, you’re more likely to experience chronic back pain.

Researchers at the Feinberg School of Medicine at Northwestern University found that smoking may strengthen some of the brain circuitry associated with chronic pain (defined as pain lasting five years or more). Among 160 participants studied over a one-year period, smokers had much stronger links between two areas of the brain — the nucleus accumbens and the medial prefrontal cortex – making smokers particularly vulnerable to chronic back pain.

The researchers already knew that the stronger the link between these two areas of the brain, the more likely a person is to developing chronic pain; their key discovery was in making the connection between smoking and increased activity between these two brain areas, showing that smokers are less resilient to chronic back pain. According to the team’s calculations, smokers are actually three times more likely to develop chronic back pain than nonsmokers.

The good news for smokers, however, is that quitting reverses this link. The study participants who quit smoking saw a dramatic change in their brain circuitry in subsequent MRIs. As the leader of the research team, Bogdan Petre, explained, “When they stopped smoking, their vulnerability to chronic pain also decreased.”

If you’re ready to explore the possibility of quitting smoking, there are countless free resources at your disposal. The National Cancer Institute has a free tobacco quit line: 1-877-44U-QUIT and a helpful website: http://smokefree.gov/free-resources . The American Cancer Society provides guidance: http://www.cancer.org/healthy/stayawayfromtobacco/quitting-smoking-help-for-cravings-and-tough-situations , as does the National Cancer Institute: http://www.cancer.gov/cancertopics/factsheet/tobacco/help-quitting . The Centers for Disease Control offer support at 1-800-QUIT-NOW and www.cdc.gov/tobacco/quit_smoking/index.htm . QuitNet provides 24/7 online support and a directory of local resources: www.quitnet.com , and Nicotine Anonymous offers face to face meetings and support groups: 1-877-TRY-NICA and www.nicotine-anonymous.org . If you’re having trouble quitting, speak with your healthcare professional.

Insomnia found to be a marker for back pain in adults

Thu, 10 Sep 2020 18:31:55 GMT

If you’re having prolonged sleep troubles, you may be 150% more likely to experience back pain. Among women, the correlation between insomnia and back pain is even higher.

We’ve long known that insomnia increases a person’s sensitivity to pain in general, but a new study from the University of Haifa in Israel was the first to discover such a strong correlation between insomnia and back pain specifically.

The study was well designed. Over 2,000 healthy, working adults came in for routine physical exams at the Sourasky Medical Center in Tel Aviv at three intervals over the course of eight years. On average, they were 46 years old and worked about 9½ hours a day. Insomnia was assessed using the first five questions of the Athens Insomnia Scale, which asks patients to respond on a scale of 1(never) to 7 (always) to questions including whether they are able to fall asleep or stay asleep, wake too early in the morning, have sufficient sleep time, and whether they feel they have good quality sleep overall. Insomnia was defined as sleep disturbances lasting longer than one month. Back pain was defined for the study as consistent back pain for over three months, as reported by the patient in a medical interview, and as confirmed by a medical record of a visit to a physician at least once in the last 12 months for this reason. The study controlled for variables including socioeconomic status and lifestyle behaviors (including self-reported hours of strenuous leisure time and physical activity per week, and whether or not they were smokers). Only those participants with no known health problems were included in the final result.

The study leaders noted that the connection is complex and merits further study: “One possible link is stress; people suffering from insomnia generally describe their lives as stressful, so it’s almost certain that they would suffer from chronic restlessness that will increase muscle tension and reduce the number of micro-pauses in muscle activity, which leads to back pain.”

How does this study affect Spine & Nerve Center patients?

If you are a patient of Spine & Nerve Diagnostic Center, it’s highly likely that you are, unfortunately, already acquainted with back pain. But it’s important to consider, too, that caregivers of those with serious medical conditions also experience poor sleep because they wake in the night due to their loved ones’ inability to sleep. Even if they sleep 7-8 hours per night, if they are routinely awakened, the quality of sleep is poor and can lead to serious health problems.

The National Institute of Health publishes a very informative brochure on sleep, which you can access here: http://www.nhlbi.nih.gov/files/docs/public/sleep/healthy_sleep.pdf . The brochure provides many helpful tips for better rest, and includes a sample sleep diary. If you are concerned about whether you or your loved ones are getting enough quality sleep, consider keeping a sleep diary for a couple of weeks and sharing it with your primary care physician to help improve your sleep and, by extension, your overall long-term health.

1 in 3 American Adults Experience Chronic Pain

Thu, 10 Sep 2020 18:31:54 GMT

An estimated 116 million adults experience chronic pain, according to a report published by the Institute of Medicine of the National Academies, and treatment is all too often “delayed, inaccessible, or inadequate…” according to committee chair Dr. Philip Pizzo of the Stanford University School of Medicine, who co-authored the report.

The Academies’ report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research acknowledges that pain is more than just a physical symptom, and is not always resolved by curing the underlying disease. Chronic pain –defined as pain lasting longer than 12 weeks—is individual and “a disease in its own right;” managing it successfully requires an individualized approach that addresses all the factors that influence pain.

A review published in the journal Anesthesiology found that people who try to ignore their long-term pain may ultimately hurt more. Dr. Teresa Long, Director of the Persistent Pain Management clinic at the University of Kansas Hospital explains: “Left untreated, chronic pain often gets worse over time; the nerve pathways become more sensitive and pain sensations escalate. After a while, the feeling can end up lingering even after the actual tissue or bone has healed.”

Such is the case with Reflex Sympathetic Dystrophy, or RSD, a neuropathic pain disorder in which pain from one area spreads to other parts of the body. One patient from the Spine & Nerve Center with RSD has trouble with his memory and sleeps only two to four hours each night. He had to retire early from his career because of the physical labor involved, and due to his need for pain medication, he can’t apply for even a very simple day job because he wouldn’t be able to pass the drug test. There is no cure at this point for RSD; one can only manage the pain. He reported feeling like his “life was over” and received little sympathy because, for several years leading up to the diagnosis, others could not be convinced that he was in pain.

Another Spine & Nerve patient, Venus Furtado, was diagnosed with Fibromyalgia – a nerve disorder characterized by widespread pain and fatigue— five years after she was involved in a serious car accident. She’s been living with chronic pain since 1990. When you have Fibromyalgia,” she said, “taking a shower can feel like being hit with ten thousand baseball bats.” Even wearing loose clothing can be painful some days. Ms. Furtado had to make wholesale life changes to accommodate her pain; she was unable to continue her career as an alcohol and drug counselor because of the mental fog that accompanies fibromyalgia (often called “Fibro-fog”). There is little relief from the pain. “Even when you’re asleep,” she said, “the body is always fighting the pain, and you wake up exhausted.”

Chronic pain’s lack of visibility often compounds the physical struggle. People suffering from chronic pain aren’t necessarily in a wheelchair or on crutches, so others don’t always sympathize or take their pain seriously. The US Pain Foundation created an organization to help counter this problem; the INvisible Project helps builds community among chronic pain sufferers and educates the public through stories and photography. It shows that the pain is real, even though you can’t see it. We at the Spine & Nerve Center invite you to participate, and more details are available here: www.invisibleproject.org .

For more information on chronic pain, please see the National Institute of Health’s fact sheet:

http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm and speak with your physician about effective pain management.

Exercise is Key to Preventing Back Pain Recurrence

Thu, 10 Sep 2020 18:31:53 GMT

Most people in the Western world will suffer from disruptive lower back pain at some point in their lives. And studies show that about 75% of people who’ve had one bout of debilitating back pain will have another within a year, which often leads to a downward spiral of pain and a weakening in the muscles of the lower back. But there’s good news: even if you have back pain now, a commitment to the right kind of exercise will help keep future back pain at bay, according to a broad new review published in the Journal of American Medicine Association, Internal Medicine .

This comprehensive, high-quality study involved more than 30,000 participants with back pain, and systematically evaluated a range of back pain prevention tactics to determine what really works and what doesn’t. Several key prevention methods were evaluated: shoe orthotics, back belts, a variety of different exercise programs, education about lifestyle changes, and exercise programs that also included some education about back-pain prevention.

The study defined a successful prevention program as “one that had kept someone from reporting another bout of back pain within a year or longer, or that had staved off lost work time due to back problems.”

The study’s conclusion was surprising: education, back belts, and orthotics were almost totally ineffective without exercise. Heat therapy, massage, and other passive treatments without exercise were equally inconclusive in their effectiveness. It was only the exercise programs – alone, or with education about lifestyle changes – that proved their mettle in this vast and rigorous study. Exercise with education reduced the incidence of another episode of back pain in the following year by 45 percent, or almost half.

Further, the type of exercise regimen didn’t much matter. Whether the program focused on strengthening the core and back muscles, or whether it combined aerobic conditioning with strength and balance training, as long as the person exercised regularly, —that is, two to three sessions per week, every week—their chance of low back pain recurrence was significantly reduced.

It’s possible that one type of exercise program is better than others, but this particular study didn’t focus on evaluating types of exercise regimens in great detail. The important takeaway from this groundbreaking study is that for most people, it is within your power to keep the low back strong.

The team that conducted this research intends to mount future studies that would compare different routines and follow participants for several years, to determine the long-term benefits of the various fitness programs.

Before you dive into a back-strengthening workout, your health professional should determine that you have no serious injuries and each of these movements is safe for you. Then try this menu of exercises, designed by a Certified Strength and Conditioning Specialist to prevent and treat lower-back pain: Eight Moves to Boost Back Resiliency

CDC Issues New Guidelines for Opioids

Thu, 10 Sep 2020 18:31:52 GMT

The Centers for Disease Control recently issued new recommendations for prescribing opioids for chronic pain, in order to address the opioid epidemic that our country is now facing. At Spine & Nerve, our approach is consistent with the CDC’s guidelines for opioids. The opiate epidemic is a very serious problem, and the care providers at Spine & Nerve Diagnostic Center continue to follow an ever-evolving “best practices” approach that incorporates an integrated, multi-disciplinary pain management plan. Our approach to the treatment of chronic pain includes cognitive behavioral therapy, physical therapy, biofeedback, exercise and other alternative, non-opioid methods of pain relief. The goal of this multi-disciplinary approach is a non-reliance on opioids for all patients.

Our clinicians assess each patient to ensure the efficacy of their therapy, including urine drug screenings, assessments of anxiety and other measures of overall well-being, and functional improvement tests. We avoid prescribing doses of more than 90 morphine milligram equivalents (MME) per day; on the occasions that our care providers do see a need to prescribe over 90 MMEs per day, the decision is carefully weighed, discussed among all the prescribing providers on staff, and is justifiable given the chronic pain patient’s physical need and proven track record of responsible opioid use. As a patient-centered pain practice, we take into account the needs of each individual in our care as a sample of one, and we have seen this prescribing practice proven out as a responsible approach.

For more information, please see the published guidelines from the Centers for Disease Control as well as the National Pain Strategy .

If You are on Opioids, You Should Know your Morphine Equivalent Dose, by Vinay M. Reddy, M.D.

Thu, 10 Sep 2020 18:31:09 GMT

Morphine Equivalent Dose (MED), also known as Morphine Milligram Equivalents (MME) is a numerical way to compare different opioids (narcotics). For example, if person A is on 4 tablets of Norco (hydrocodone/acetaminophen) 10/325 and person B is on 4 tablets of Percocet (oxycodone/acetaminophen) 10/325, how do we know who is on a higher dose? We can calculate the MEDs. 1mg of Hydrocodone has an MED of 1, whereas 1 mg of Oxycodone has an MED of 1.5. Therefore, person A is on 40 MEDs per day and person B is on 60 MEDs per day.

If person C is on 20 mg of oxycontin (oxycodone ER) twice a day and taking 4 Norco, then the total MED is 100.

Why is this important?

It is important because opioids are always associated with a risk of overdose and death. Higher doses of opioids are also associated with lower rates of return to work and higher rates of emergency room visits.

People with total MEDs greater than 50 (5 Norco per day) have a 2 fold increased risk of overdose compared to people with MEDs lower than 20 (2 norco a day). People with MEDs of 100 or higher have a 9 fold increased risk of overdose.

A 2016 study published in The Journal of Addictive Disorders (J Addict Dis. 2016 ; 35(1): 42–51. doi:10.1080/10550887.2016.1107264) found that most patients on opioids under-estimated their risk of overdose.

Knowing you MED will help you understand your risk and may save your life!

A chart to calculate MED is available from the Centers for Disease Control and Prevention at https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf

Opioids Dependence Rates Higher than Initially Thought

Thu, 10 Sep 2020 18:31:06 GMT

For years we have known that opioids (drugs such as Norco, percocet, oxycontin, morphine, fentanyl, etc.) are dangerous. They can lead to dependence and addiction. They can often also lead to overdose and death.

A new study suggests that the risk is higher than previously thought. A Centers for Disease Control and Prevention (CDC) study, released on March 17, 2017, (https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm) evaluated the likelihood of long term opioid use by studying opioid use patterns in the U.S. between 2006-2015. The study demonstrated that patients who had one day of opioid therapy had a 6% chance of long term dependence (still being on it one year later). People who took opioids for eight days or longer had a 13.5% chance of still being on them one year later. And people who used opioids for 31 days or longer had a 29.9% chance of being on them one year later. The CDC study’s conclusion was as follows: “When initiating opioids, caution should be exercised when prescribing >1 week of opioids or when authorizing a refill or a second opioid prescription because these actions approximately double the chances of use 1 year later.”

Because of these risks, we will try to prescribe the lowest dose of opioid (narcotic) that is helpful to reduce your pain. In some instances, we will decide against opioids to treat your pain as the risk outweighs the benefits.

Drug Overdose Deaths Plateau In California, Soar Nationally

Thu, 10 Sep 2020 18:31:05 GMT

Please click on this link for this article by Pauline Bartolone.

Drug Overdose Deaths Plateau In California, Soar Nationally

This story was produced by Kaiser Health News , which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Acupuncture For Chronic Pain

Thu, 10 Sep 2020 18:31:03 GMT

I recently reviewed a report on acupuncture for chronic pain. It reviewed 13 clinical randomized trials that occurred up until December 2015 and included over 20,000 patients. It compared the use of acupuncture to no acupuncture in patients or sham acupuncture, which was fake acupuncture and it found a significant difference in both pain relief and improved function in the patients using real acupuncture. It also found that the results can persist over many months.

Our clinic does feel that acupuncture can be a significant beneficial modality for treatment of many types of pain. Patients can sometimes lower their pain medication with the use of acupuncture. Some insurances do cover it. If you would like to discuss this with your provider let us know.

Sacramento Opioid Awareness Summit

Thu, 10 Sep 2020 18:31:02 GMT

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New California Law Requires Providers to Prescribe Overdose Reversing Drug Naloxone

Thu, 10 Sep 2020 18:31:02 GMT

California Assembly Bill 2760 went into effect on January 1, 2019. That bill requires providers to offer a prescription for the overdose reversing drug, naloxone, when the following conditions are present:

The prescription dosage for the patient is 90 or more ME per day; and/or
Opioid medication is prescribed concurrently with benzodiazepine; and/or
The patient presents with an increased risk for overdose, including a patient with a history of overdose, a patient with a history of substance use disorder, or a patient at risk for returning to a high dose of opioid medication to which the patient is no longer tolerant.

The new law also requires providers to educate patients receiving a prescription for naloxone regarding overdose prevention and how to use naloxone. Naloxone comes in several different brands and can be administered via a nasal spray, injection or auto-injector. Providers are also required to educate one or more persons that a patient designates regarding overdose and use of naloxone.

If you are a Spine & Nerve Diagnostic Center patient on opioids, you are already familiar with naloxone, as it has been prescribed by our providers for opioid users for over a year. We strongly believe in responsible pain management, which includes offering other types of treatment other than opioids. But for those patients on opioids, we offer naloxone for our patients’ safety. If you have any questions about naloxone, please ask your provider at your next appointment.

Are your joints aching more this winter? You’re not alone!

Thu, 10 Sep 2020 18:31:01 GMT

This cold weather that we’re experiencing here in the Sacramento Valley (which we know doesn’t compare to the cold around the country ) is bringing in more patients complaining of aching joints.

It’s well documented that as winter goes on, joint aches and pain rise. The exact science behind cold-related joint aches is still up for debate — but it appears that the cause is the rise in barometric pressure versus the actual cold that makes symptoms worse. Other aspects that contribute are decreasing physical activity and seasonal mood changes that interact with our body’s pain perception. Lower temperatures can cause joint fluids to thicken, making them more stiff and sensitive to pain. The cold can also stiffen the muscles and ligaments that support these structures.

Here are some tips to protect your joints and make them less painful this winter:

1. Stay active! It is very common that as the temperature drops, people become more sedentary. For better joint mobility and function, you have to keep using them! Aim for at least 30 minutes of physical activity daily

2. Start your day off with a hot shower. This is an easy way to warm the body up in the morning time, when the body is at its stiffest.

3. Dress warmly and in layers to help keep all that natural heat inside. Heating pads and heat packs can also help to increase your core temperature, or warm bottles of water to apply directly to those painful joints.

4. Stretch throughout the day to avoid increasing stiffness. This starts in the morning after your hot shower, but is also helpful mixed in to the rest of your daily activities

Hopefully these tips help make this winter more comfortable for you! If you feel that you need more advice or to discuss further treatment options, give our office a call to set up an evaluation.

Stay active and stay warm Sacramento!

Build Strength During the Coronavirus Outbreak With ‘Prehabilitation’

Thu, 10 Sep 2020 18:30:59 GMT

As the new coronavirus spreads throughout the U.S., federal officials are urging Americans to stay home as much as possible to reduce their chances of getting sick from COVID-19, the respiratory illness caused by the virus. In this article from AARP two physicians discuss a proactive approach to fight infections, and improve health.

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