Pain Management

By Reza Ghorbani, MD, FIPP

Advanced Pain Medicine Institute

. http://www.advancedpainmedicineinstitute.com/

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Pain Management

Recent surveys show that pain accounts for 80% of all physician visits. Unfortunately, only 48% of pain patients felt that they were getting enough information on the most effective ways to treat and/or manage their pain.
Interventional pain physicians are specialists in the field of treating back, neck and shoulder pain as well as chronic trunk and limb pain, repetitive motion pain, chronic headache and migraine, arthritis, fibromyalgia, complex regional pain syndrome (RSD) and cancer pain. Additionally, these specialists can treat post-herpatic neuralgia associated with shingles, diabetic neuropathy and all types of muscular-skeletal pain.
This article specifically addresses how interventional pain physicians are utilizing the latest and most advanced techniques for treating lower back and leg pain caused by herniated discs. Some of the causes of lower back pain and lumbar radiculopathy (sciatica) include lumbar strain, degenerative disc disease, facet joint disease, herniated discs, vertebral compression fracture, spinal stenosis, failed back surgery syndrome and sacroiliac joint disease.
With disc herniation, pain and weakness can limit patients daily activities. In these cases, the first line of treatment includes physical therapy along with analgesics and lifestyle limitations. If the problem persists more than a few weeks, the next line of treatment should include transforaminal epidural steroid injections under fluoroscopic guidance for accurate delivery of medication to the affected spinal nerves. The steroid will reduce the inflammation of the spinal nerves and allow the herniated disc to heal itself. If a series of these injections provide temporary relief for the patient, the next step should include percutaneous disc decompression using a small probe to aspirate the herniated portion of the disc in order to relieve the pressure on the spinal nerves.
Percutaneous disc decompression is a simple, innovative solution and an alternative to open back surgery for herniated discs (in selected cases), following failed conservative treatments. Compromised disc position can compress the spinal nerves that extend from the spine to the legs and cause pain and weakness in the back and legs. Percutaneous disc decompression is shown to be safe and effective in clinical studies and proven to considerably reduce the pain intensity and improve functional status. It is an outpatient procedure using local anesthesia and sedation and it is correlated with low complications.
Percutaneous disc decompression does not involve any cutting of the skin, causes minimal defect in the disc structure, has a very low incidence of scar tissue formation and only takes less than 10 minutes to perform. It typically has a rapid recovery time of only a few days.
Contraindications to percutaneous disc decompression include traumatic spinal fracture, infection, tumor and pregnancy, patients with extruded disc fragment within the spinal cord, severe spinal stenosis or severely degenerated disc disease and patients with severe and rapidly progressing neurological deficits.
It is important to note that when choosing a pain physician specialist, one needs to verify that the physician has a board certification in pain medicine, recognized by the American Board of Medical Specialties. Also, the physician should be board certified by the American Board of Interventional Pain Physicians (ABIPP) and a member of the Fellow of Interventional Pain Practice (FIPP), the only organization that certifies the ability of a pain physician specialist to perform procedures.