215.741.4410 Two Convenient Locations in: Langhorne, PA

Oxford Valley Pain & Spine Center's Blog

Surgical Pain Management

GUEST BLOG

By Dr. Nirav K. Shah (left) and

Dr. Nazer H. Qureshi (right)

Princeton Brain and Spine

www.princetonbrainandspine.com

Board Certified Neurosurgeons

215-741-3141    1-609-921-9001

Princeton, Langhorne, Freehold, Flemington, and New Brunswick

SURGICAL PAIN MANAGEMENT

Pain can be debilitating. Chronic pain can affect your ability to do the things you love most such as playing golf on a sunny day, travelling with your family, or even watching the next Phillies game.

Sometimes conventional surgery fails to completely relieve pain and a patient will continue to have pain related to the spine such as pain in one’s back/neck and/or extremities. This is known as failed back syndrome. Patients often ask, “I have had spine surgery or I have had spinal fusion and I am still having quite a bit of discomfort. What are my options?”

Options after Failed Spine Surgery

One option is surgical pain management such as spinal cord stimulation. This is an option for patients who have tried conservative care such as physical therapy and medications. The patients have also had multiple spine surgeries including spinal fusion without resolution of his/her symptoms. Symptoms could include pain as well as associated numbness and tingling in the extremities. After these failed surgeries, an orthopedic surgeon or spine surgeon may be reluctant to perform additional surgery due to scar tissue formation. Therefor there are no surgical cures at the site of the previous spine surgeries. This is when a patient can be considered for spinal cord stimulation. Spinal cord stimulation studies have proven to reduce pain levels by at least fifty percent or greater.

What Is Spinal Cord Stimulation?

Simply put, an electrode is placed on the spinal cord to block the pain. There are a few steps that must occur prior to taking the patient to the operating room.

Steps for Placement of Spinal Cord Stimulator

  1. A neuropsychological evaluation is performed to see if the patient understands what the procedure entails and whether he/she will be able to tolerate the operation.
  2. A pain management physician will perform a spinal cord stimulator trial. For this, the physician will place a percutaneous lead placement. In other words, a stimulator placed in the spinal canal. The wires are then attached to a battery (pulse generator) which is then taped to the patient’s body. For the next three to five days, the patient must keep an active diary of how the pain is controlled with the spinal cord stimulator.  After three to five days have passed, the patient will return to the pain management physician to discuss the next steps.
  3. If the trial is deemed successful by the pain management physician and patient, then the patient is referred to a neurosurgeon for further consultation regarding permanent implementation of the spinal cord stimulator. The neurosurgeon will make the final decision as to what the best course of action if for the patient.

The surgical procedure requires two incisions in the back. One is for the placement of the paddle lead and the other is on the patient’s side for placement of the implantable pulse generator. This procedure is done by a neurosurgeon and then the pain management physician will manage the device stimulation on a long-term basis.

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Spinal Cord Stimulation Implants

What is Electronic Spine Stimulation?

Electrical nerve stimulation uses electrical pulses that interfere with the nerve impulses. The nerve pulses create the sensation of pain. The electrical pulses help to ease the pain. There are two types of nerve stimulations: Peripheral Nerve Stimulation (PNS) and Spinal Cord Stimulation (SCS).

The procedure is a two step process.

1. The first step is a trial run. In this first step, the doctor will insert a temporary electrode through the skin. The patient will be able to control the electrode to see if the stimulation works to ease the pain to a manageable level.

2. If the trial run succeeds, then your doctor will do the second step which is to implant the a stimulator permanently under your skin. The second step procedure implants the thin electrical wires with electrical leads near the spinal column. No incision is needed to implant the leads. There is a small incision to implant a tiny generator that is inserted into the buttock or the abdomen. The generator is programmable which means the patient can mange the currents to the spinal column. This procedure is done with the help of a local anesthetic and a sedative.

Once the procedure is done, the doctor and you will determine the best pulse setting. At home, most patients use the stimulator several times a day for an hour or two.

Our office does the trial part. We refer patients to other professionals to implant the stimulator permanently. To learn more about the actual implant of the spinal cord stimulator, please see our next blog which will be a guest blog by doctors who do the permanent stimulation.

Why Electronic Stimulation May be an Option

This procedure may be an option for people with severe chronic pain. It is done to treat existing pain (including low back pain, leg pain, and complex regional pain syndrome ) and also a diagnostic tool to determine if other problems exist including paraplegia, multiple sclerosis and intractable angina. Treatment success varies from patient to patient.

What Are the Risks?

As with most procedures there are risks. The risks associated with this procedure include scar tissue (fibrosis) around the electrode, pain, hardware failure, infection, spinal fluid leakage, headaches, bladder issues, and getting used to the stimulator. If you have an implanted stimulator, you can not have an MRI (magnetic resonance imaging) test.

Please Contact Us

If you have questions about Spinal Cord Stimulation Implants or any pain issues, please contact us at 215.741.4410. Our office is located near the Oxford Valley Mall.

 

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Cupping – the “hot” Olympic treatment

ABC Olympic Photo

Anyone who has watched the Rio Olympics has noticed that a fair number of the athletes have red circles on their skin.  The red marks come from an ancient form of medicine known as cupping. The Egyptians used cupping as far back as 1,550 B.C.

In cupping, the doctor or health provider places unique cups on your skin for several minutes. The cups can be made out of glass, bamboo, silicone, or earthenware.

Cupping IS used for pain management, stress, better flow of blood, and for deep level massages. Cupping can be dry or moist.

The main steps of cupping are these:

  • The use of fire. The health provider uses alcohol, paper, herbs, or some flammable substance which is placed in the cup and seat afire. As the fire subsides, the therapist places the cup upside down on the patient’s skin.
  • When the air in the cup cools, a vacuum is created which causes the blood vessels to expand. The blood vessel expansion is what creates the red marks. The cup stays on your skin for about three minutes. Today, a rubber pump is sometimes used to create the vacuum instead of fire.

The vacuum is supposed to draw up non-circulating blood and sticky fluids so the healthier blood, cells, nutrient, and oxygen can circulation underneath. This shift in circulation helps people who have muscle pain and bruises.

In wet cupping, the doctor or therapist makes small cuts in the skin with a scalpel – after the cup is removed. A second cup is then used to draw out some of the blood.

Patients normally get 3-5 cup treatments per session. The treated areas are also treated with an antibiotic salve and/or a bandage to prevent infection.

For questions about cupping, please all our Oxford Valley Pain and Spine office in Langhorne, PA. We do cupping treatments. We can be reached at 215.741.4410.

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Lumbar Steroid Injections – Results and Side Effects

Lumbar Steroid Injections – Results

Injections can help relieve pain for a short period of time. They are not a long-term solution.

Considerations

As with all medical procedures, there can be side effects. Side effects can include infection, bleeding, nerve damage, and tearing of fluid that surrounds the spinal cord.

Because steroid injections can cause soft tissue damage, they are usually only given 3-4 times in the same spot in any given year.

The procedure is an out-patient procedure that takes about 30 minutes. You will be monitored for an additional 15-20 minutes after the procedure and then told to rest at home. We perform the procedure at our own ambulatory surgery center.

Women who are pregnant should be sure to inform their doctor before considering this procedure.

If your back is hurting, a lumbar steroid injection procedure may help manage the pain. Please call the Oxford Valley Pain and Spine Center at 215.741.4410 to schedule an appointment. We are located in Langhorne, PA. We treat patients from Levittown, Newtown, Doylestown, Norristown, Philadelphia, Trenton, and the surrounding regions.

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Lumbar Steroid Injections

Why is the procedure used?

An epidural steroid injection (ESI) is used to relieve the pain from lumbar spinal stenosis.

What is the procedure?

An ESI consists of two parts:

A corticosteroid. This is a strong anti-inflammatory medicine. It can help relieve swelling and reduce inflammation which, in turn, can reduce nerve and soft tissue pressures. Reducing these pressures reduces pain. It takes longer than the anesthetic to provide relief.

A local anesthetic pain relief medicine. This medicine is aimed to provide immediate pain relief.  It does not reduce the inflammation.

An ESI is injected into the space around the spinal cord (within the spinal canal) and nerve roots (epidural space).

Before the ESI is performed, MRI (magnetic resonance imaging) tests and CT (Computed Tomography) scans are often done to help determine the exact location where nerve roots are being squeezed. During the injection, an X-Ray machine (called a fluoroscope) is often used to guide placement of the needles so the injection can be properly targeted.

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Herniated Disc – Causes and Symptoms

What is a herniated disc. A herniated disc happens when the soft, spongy material that cushions (shock absorbs) the bones of the spine (vertebrae) slips out of place, breaks open, or becomes. damaged. Other names include slipped disc or ruptured disc. The most common place for a herniated disc is in the lower back.

When a herniated disc presses on a nerve, it can cause pain, numbness, and weakness.

What are the causes of herniated disc? The two main causes are aging and injury. As we age, the discs can become dry and less flexible. An injury causes the gel in the disc to escape through the tears and cracks caused by the injury.

What are the symptoms? If the herniated disc presses on a nerve; then the nerve contact can cause pain, weakness, and tingling in the nerve area. Some patients experience back ache. In severe cases, you may lose bladder or bowel control. Pain in the buttocks and legs is called sciatica.

How is a herniated disc diagnosed? Through the oral examination with your doctor and usually through an MRI or CT Scan.

What are the treatments? Treatments vary.

  • Sometimes rest and waiting until the injury heals can remedy the problem. Rest should be monitored since too much rest can weaken muscles.
  • Exercises and physical therapy can help.
  • Medications don’t cure the problem but they can help manage symptoms.
  • Heat in the form of heating pads, hot showers, heat-packs and sometimes ice-packs may help.
  • About 10 percent of people with a herniated disc need to have a surgery.
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3rd Set of Pain Management Definitions

Here is the 3rd set of pain management definitions. As with all definitions, and all our posts, the information provided is educational only. Patients should contact our office and make an appointment with our doctors. Postings do not create a doctor-patient relationship.

  • Magnetic Resonance Imaging (MRI): A diagnostic procedure that uses magnetic fields, radio waves, and a computer. It may be used to help determine the source of the pain.
  • Myelogram: X-Ray procedure where a dye is injected into the spinal canal to determine the nerve roots.
  • Nerve Block. The injection of a nerve-numbing substance into a group of nerves.
  • Neuropathic. A nerve-related condition
  • NSAIDs. Non-Steroidal Anti-Inflammatory Drugs. These help to reduce inflammation and manage pain. NSAIDs are available over the counter and through a prescription.
  • Opioids. Narcotic pain relievers.
  • Palliative Care. Palliative care (also known as comfort care) aims to offer relief to chronically ill or terminally ill people through pain management and symptom management.
  • Pharmacotherapy. Medication-based therapy.
  • Physical modalities. Physical methods, such as heat, cold, massage, or exercise, used to relieve pain.
  • Prosthesis. An artificial replacement of a body part. The goal of a prosthetic device is to mimic natural form and function.
  • Psychological Approaches. Techniques or therapies used of or in addition to medication to help you manage your pain. The focus is on the emotional triggers of pain. Examples of this approach include biofeedback, relaxation, stress management, and cognitive-behavior therapy.
  • Rehabilitation. Treatment plan used to help you regain function or relieve pain caused by an injury. Exercise is often a key component.
  • Tolerance. When the initial dose of a substance loses its effectiveness over time.
  • Yoga. Complementary medical technique. It exercises the mind and body with meditation, postures, and breathing techniques that help manage pain. Stretching is a key component.

 

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2nd Set of Pain Management Definitions

Here is the second of three sets of pain management definitions.

If you need help with any pain management problems, please do not hesitate to call Oxford Valley Pain and Spine in Langhorne, PA. We offer comprehensive medical care for back, neck and spine pain. Please call 215.741.4410

  • Complementary Medicine. Treatment that falls outside the standard medical approaches. Complementary medicine techniques for pain include acupuncture, chiropractic care, herbs, and yoga.
  • Computed Tomography (CT) Scan. Diagnostic procedure that uses computers and X-Ray technology.
  • Cryotherapy. Therapeutic use of cold to decrease discomfort, reduce swelling, or break a muscle spasm.
  • Conservative Management. An approach to treating pain that uses physical therapy, medications, and injections instead of surgery.
  • Fibromyalgia. Chronic disorder that causes pain and stiffness throughout the body including muscle pain, fatigue, and often depression.
  • Disc. The soft pad positioned inbetween each of the veterbrae of the spine. The vetebral disc acts as a shock absorber.
  • Hyperalgesia. Increased sensitivity to pain or enhanced intensity of pain sensation.
  • Inflammation. A reaction of tissues to injury or disease. Symptoms include swelling, redness, heat, and pain.
  • Joint. The junction of two or more bones. The joint allows for varying degrees of motion between the bones.
  • Ligament. Fibrous tissue that connects bone to bone at or near a joint. The ligaments provide joint stability. Torn or sprained ligaments can cause pain.
  • Lumbosacral. Relating to or near the small of the back part of the pelvis between the hips.
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Glossary of Pain Management Terms

Here are the definitions for a few common pain management terms. We will post more in subsequent blogs.

  • Acute.  Pain that can be intense but usually lasts for a short period of time, usually shorter than six (6) months. It usually relates to a bodily injury and ends when the injury heals.
  • Acupuncture. A medical technique that uses tiny needles inserted into the skin at certain points along the body to help manage pain, produce anesthesia or promote therapy.
  • Analgesic. A medication or treatment that manages or reduces pain.
  • Arthritis. A generic term that describes over 100 different conditions; a disorder  of a joint where two bones meet creating swelling, redness, warmth, or tenderness. It includes a loss of joint space and formation of spurs, erosions or cysts in the bone.
  • Cancer Pain. May be acute or intermittent pain. It is often related to tumor recurrence or treatment.
  • Central Nervous System. The brain and the spinal cord.
  • Chronic Pain. Pain that lasts months or years. It may get worse with time.

For questions about any pain issues, please contact our Langhorne pain management office by calling 215.741.4410. We treat Pennsylvania and New Jersey patients – mostly from Bucks County, Montgomery County, Philadelphia, and Mercer County.

 

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Chronic Pain. You are not alone.

Chronic pain is defined as pain that lasts more than three (3) months or past the time of normal healing of tissue. Chronic pain can be caused by a medical disease, an injury, inflammation, or unknown causes.

The numbers and percentages of people who experience chronic pain in the United States are staggering. There are a variety of statistics and data that confirm that large numbers of people suffer from chronic pain. Here are just a few of the statistics:

  • National Health and Nutrition Examination Survey (1999-2002). This survey estimated that 14.6% of the population had widespread or localized pain lasting 3 months or more.
  • Centers for Disease Control. According to a survey noted by the CDC for the years 2001-2003, close to 43% of adults suffer from some sort of musculoskeletal pain such as arthritis, rheumatism, chronic neck pain or chronic back pain.
  • National Health Interview Study (2012). This study showed that 11.2 % of people suffer from some sort of daily pain.
  • American Academy of Pain Medicine. According to this organization, 100 million people suffer from chronic pain (Source. Institute of Medicine of the National Academies)
  • National Institute of Health Statistics. Chronic pain sufferers said that back pain was the most common pain (27%). Migraine pain (15%), neck pain (15%) and  other types of pain were also common.Back pain was the leading cause of disability for people under 45.
  • American Pain Foundation. Over 1/2 (51%) of the people with chronic pain felt they had little control over their pain.

If you are experiencing chronic pain, please contact our office. Our doctors are ready to help you diagnose and treat your pain. Our office is in Langhorne, PA. We see patients from Bucks County, Montgomery County, Philadelphia, the Trenton area.

You can call 215.741.4410 to schedule an appointment.

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