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Oxford Valley Pain & Spine Center's Blog

What is a Fluoroscope?

The fluoroscope, discovered in 1985, was the first X-Ray machine. X-Ray  machines let physicians view the body’s interior greatly increasing the ability to diagnose and treat diseases. The fluoroscope has evolved into sophisticated technology that is now a cornerstone of interventional pain management.

Now, fluoroscopes give interventional pain medicine doctors practitioners the ability to use continuous, real-time x-ray imaging to guide interventional procedures. These procedures can target the sourceof physical pain with much more accuracy and safety.

In its simplest form, a fluoroscope consists of an X-ray source and a fluorescent screen, between which a patient is placed. However, since the 1950s most fluoroscopes have included X-ray image intensifiers and cameras as well, to improve the image’s visibility and make it available on a remote display screen. For many decades fluoroscopy tended to produce live pictures that were not recorded, but since the 1960s, as technology improved, recording and playback has become the norm.

Fluoroscopy is similar to radiography and X-ray computed tomography (X-ray CT) in that it generates images using X-rays. The original difference was that radiography fixed still images on film whereas fluoroscopy provided live moving pictures that were not stored. However, today radiography, CT, and fluoroscopy are all digital imaging modes with image analysis software and data storage and retrieval.

The use of X-rays, a form of ionizing radiation, requires that the potential risks from a procedure to be carefully balanced with the benefits of the procedure to the patient. Because the patient must be exposed to a continuous source of X-rays instead of a momentary pulse, a fluoroscopy procedure generally subjects a patient to a higher absorbed dose of radiation than an ordinary (still) radiograph. Only important applications such as health care, bodily safety, food safety, nondestructive testing, and scientific research meet the risk-benefit threshold for use.

For help with any pain issues, please call our Langhorne, Pennsylvania office at 215.741.7031. We help patients throughout Bucks County, Mercer, Philadelphia, and Montgomery Counties. We see many patients from Langhorne, Doylestown, Newtown, Fairless Hills, Levittown, Bristol, Richboro, and Bensalem

Sources. Wikipedia and https://accessanesthesiology.mhmedical.com/Content.aspx?bookId=1158&sectionId=64175538


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Upper Back Pain

Upper Back Pain

Most people who have pain related to the spine have the pain in the neck or lower back. The neck and lower back are designed for motion. The upper back is designed for stability and just limited movement.

The two main causes of upper back pain are:

1. Irritation of the muscles – called myofascial pain

2. Dysfunction of the joints

The upper back is known as the thoracic pain, the neck is known as the cervical spine, and the lower back is the lumbar spine.

Upper Back Anatomy

•The thoracic spine is made up of 12 vertebrae in the spine’s middle and the ribs that are attached to the vertebrae.

• Each vertebra is attached to a rib. The ribs are attached to the vertebra in the back and the breastbone, called the sternum, in the front. The combination of vertebra, ribs, and breastbone create the thoracic cage that protects the heart, lungs, and liver

• The top 9 ribs join at the front of the chest. The bottom 3 ribs do not join at the front. The bottom 3 ribs (and vertebra) allow for slightly more motion than the top 9.

• The joints in the thoracic cage also allow the body to twist from side to side.

Usually a diagnostic test; such as an MRI or CT scan will not suggest that surgery is needed for the upper back.

Some of the causes of upper back pain are:

• A sudden injury

• Strain over time such as working at a computer for long stretches of time.

Muscular Irritation

The upper body also has a number of large muscles that attach to the shoulder blade and the rib cage.

Common causes of muscular irritation in the upper back are a lack of strength, repetitive stress, auto accidents, sports injuries, and other causes.Treatments for muscular irritation of the upper back include:

  • Acupuncture
  • Massages
  • Chiropractic manipulation
  • Strengthening and stretching exercises
  • Physical therapy
  • Muscular pain can also respond to anti-inflammatory medications.

Joint Dysfunction Causing Upper Back Pain

The thoracic spine vertebra connect with the ribs by the joints. If the joints are damages, upper back pain can result

Treatments include:

  • Spinal manipulation – by a chiropractor, an osteopathic doctor
  • Treatment by a trained physical therapist
  • Home exercise to stretch and strengthen the back
  • Anti-inflammatory medicines can help
  • A local trigger point injection may help

For help with any pain issues, please call our Langhorne, Pennsylvania office at 215.741.7031. We help patients throughout Bucks County and neighboring counties.

We see many patients from Langhorne, Newtown, Doylestown,  Fairless Hills, Levittown, Bristol, Richboro, and Bensalem


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The opioid epidemic/crisis is the rapid rise in the use of prescription and non-prescription opioids in the United States and Canada in the 2010s. The crisis began with the over-prescription of these powerful pain relievers in the 1990s resulting in opioids being the most prescribed class of medications in the United States. In the 1990s, about 1/3 of the country or 100 million Americans were diagnosed with chronic pain. Opiate prescriptions were an all too common treatment.

Opioids are a class of strong painkillers drugs and include Percocet, Vicodin, OxyContin and Fentanyl which are synthetic to resemble opiate drugs such as opium derived morphine and heroin. According to the Drug Enforcement Agency, overdose deaths, particularly from prescription drugs and heroin, have reached epidemic levels. Nearly half of all opioid overdose deaths in 2016 involved prescriptions. As of 2016, 289   million opioid prescriptions are written yearly. In 2016, 62,000 Americans died from overdoses as compared to 16,000 in 1999.

Not only has the number of prescriptions dramatically increased, the potency of the opioids has also gotten worse. Many drug users are now being prescribed opioids that are more powerful than morphine.

When people continue to take opioids beyond what a doctor prescribes, whether to minimize pain or to enjoy the euphoric feelings, it can mark the beginning stages of an opiate addiction.

In the U.S., addiction and overdose victims are mostly white and working-class.   Geographically, those living in rural  areas of the country have been the hardest hit as a percentage of the national population.

Prescription drug abuse has been increasing in teenagers. 12- to 17-year-olds were one-third of all new abusers of  prescription drugs in 2006. Teens abuse prescription drugs more than any illicit drug except marijuana, more than cocaine, heroin and methamphetamine combined, according to the Office of National Drug Control Policy’s 2008 Report Prescription for Danger.

Pennsylvania ranks 21st for the number of opioid prescriptions per 100 people. There are wide variances in opioid prescriptions per state because of a lack of uniform standards and because of different medical opinions on how well opioids manage pain. Some doctors claim that there is little evidence that opioids help with anything other than cancer pain.

To help address, the lack of standards and the rising opioid epidemic, in 2016, the CDC published its “Guideline for Prescribing Opioids for Chronic Pain”, recommending opioids only be used when benefits for pain and function are expected to outweigh risks, and then used at the lowest effective dosage, with avoidance of concurrent opioid and benzodiazepine use whenever possible.


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What is Radiofrequency Ablation

What is Radiofrequency Ablation?

Radiofrequency ablation is a pain management procedure that is performed on an outpatient basis usually under a local anesthetic. The whole procedure takes between a half-hour and an hour and a half. The pain doctor typically uses an x-Ray fluoroscope to help guide the proper placement of any needles.

Radiofrequency Ablation Steps

  • Patients are usually given some sedation through an IV intravenous line.
  • The doctor, after cleaning the necessary areas, numbs a part of the skin with an anesthetic
  • A needle (one specifically used for radiofrequency is directed to the affected nerves with the use of the fluoroscope (shown above)
  • A small current of electricity passes through the needle to make sure the needle is in the correct spot. The correct spot means that the patient’s pain should be reproduced so the physician knows the right spot is being targeted.
  • The nerves are then numbed and radiofrequency waves are sent to the needle tip. The waves help create a lesion which thwarts the ability of the targeted nerves to send pain signals.
  • Other affected nerves will be targeted and the process repeated.

Generally, patients are told to avoid doing any strenuous tasks including doctor. Our pain management doctors tell you  which medications you can continue taking on the day of the procedure.

To discuss your pain management issues, whatever the cause and whatever the severity, please phone our Langhorne, Pennsylvania office at 215.741.7031. We see patients throughout the Delaware Valley region including patients in Bucks, Mercer, Philadelphia, and Montgomery counties including Doylestown, Richboro, Langhorne, Newtown, Bensalem, Levittown and Southampton.



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Anatomy of the spine

Anatomy of the Spine

Your spine is the main support system for your body. It allows you to walk, stand, sit, lie down, bend, and twist. The spine absorbs shock and provides for range of motion. A spine has 33 bones and many nerves, muscles, tendons, and ligaments. The 33 bones in your spine are the vertebrae. They are interconnected.

The three main parts of the spine are:

• The cervical spine: This part is the neck. There are 7 cervical vertebrae identified as C1-C7.

• The thoracic spine. This is the upper back. These 12 vertebrae are identified as T1-T12

• The lumbar spine. This is the lower back. The 5 vertebrae are called L1-L5

The 5 sacrum vertebrae connects the spine to the hip bones.There are also four coccyx bones.

A normal spine has an S shape to it.

Each vertebrae:

• Has a body, an arch, and processes for the muscles

• Is separated from the adjacent vertebrae by an intervertebral disc which ideally prevents the bones from rubbing against each other. The discs have an inner center gel called the nucleus and an outer ring called the annulus.

• Has four facet joints (one pair that connects to a vertebrae above and another pair which connects to a vertebrae below).

The ligaments hold the spine together and protect the discs.

The brain and the spinal cord together make up the central nervous system.

The spinal nerves send messages back and forth between the spinal cord and the brain.The two primary muscle groups in the spine are flexors and extensors.

For help with chronic pain or acute pain, please call our Langhorne, Pennsylvania office at 215.741.7031. We help patients throughout Bucks County and neighboring counties. We treat patients from Newtown, Langhorne, Levittown, Doylestown, Trenton, and other nearby locations. Our office is near the Oxford Valley Mall.


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Pain Management Myths

Common Pain Management Myths

It’s tempting to think with just a little persistence or just little home remedy, that you can cure or control your pain. The reality is that pain is not normal. Even as you age, acute or chronic pain should not normally prevent you from walking, sleeping, enjoying your family, and enjoying life. Many conditions that cause pain such as herniated discs, back pain, and neck pain can be diagnosed and treated.

It’s a myth to think you can just push through the pain. Just being tough and muscling through the pain may work for a day, even a week. But if there is some internal nerve damage, joint damage, spinal damage, or other physical problem – the best course of action is to see a pain management physician. Not treating the problem will not make your pain go away. Worse, not treating the underlying source of your pain could actually make it worse.

While rest can help with acute pain that is normally caused by an injury (such as a workplace injury), chronic pain requires medical treatment because the source of the pain needs to be diagnosed. Resting too much can actually make things worse because it can decrease the ability of the muscles and joints to work. Too much rest may even cause a blood clot or other problems such as problems digesting your food. The aim of an experienced pain management doctor is to get you as active as possible again so you can focus on life and not your pain.

Chronic pain is real. It is nothing something you imagine or make up – even though people tell you so. If you are experiencing daily pain, seeing a psychologist or psychiatrist may help you understand your pain is real and how you can relate to others while you’re finding solutions. Seeing an experienced pain management doctor can help you manage or control your physical pain.

For help with chronic pain or acute pain, please call our Langhorne, Pennsylvania office at 215.741.7031. We help patients throughout Bucks County and neighboring counties. We treat patients from Newtown, Langhorne, Levittown, Doylestown, Trenton, and other nearby locations. Our office is near the Oxford Valley Mall.

Oxford Valley Pain and Spine Center. Doctors Anju  and Sanjay Madnani

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More on Interventional Pain Management

Common interventional pain management techniques?

When bed rest, exercise, compresses and other remedies don’t work for acute or chronic pain, speaking with an interventional pain management physician is the logical next step.

Some of the procedures an interventional pain doctors may use, after taking your oral history, conducting a physical exam, and ordering imaging tests are:

• Epidural steroid injections. A local anesthetic is injected into the epidural area, the space outside the spinal cord and nerve membrane, along with a steroid, The aim is to identify the source of the pain and to reduce inflammation and pain in the spinal nerve roots. Typically, several injections may be required to really begin to manage the pain.

• Facet joint injections/medial branch blocks. These techniques help identify the pain. They ae mainly used to help manage the pain while the patient works through other stages of pain management such as physical therapy.

• Lumbar facet nerve blocks. These injections help to both diagnose the pain and block the pain. Usually, multiple procedures are required.

• Radiofrequency ablation. This technique uses radio waves to create an electrical current, which, in turn, directs heat to specific nerve tissues- by either impairing or destroying the pain producing nerves which go from the spinal column to the brain.

• Spinal cord stimulation. This new technique inserts a medical device near the spinal cord. The device transmits electrical impulses to the epidural region. They can typically be controlled by the patient on an as-need basis. Our office does the trial to see if the stimulator helps you. We then direct you to neurosurgeons who conduct the permanent implant.

Sacroiliac injections may also be administered.

Other possible interventional pain treatments include Botox injections, hardware blocks, and disc denervation among other procedures. Additionally, an interventional pain doctor may recommend:

• Chiropractic care

• Physical therapy

• Nutrition counseling

• Acupuncture

• Biofeedback

For help with any pain issues, please phone our Langhorne, Pennsylvania office at 215.741.7031. We help patients throughout Bucks County, Philadelphia, Montgomery, and Mercer Counties. We see many patients from Langhorne, Bensalem, Doylestown, Newtown, Levittown,, Fairless Hills, Richboro, and other nearby locations.


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What is Interventional Pain Management?

What Is Interventional Pain Management?

Intervention pain management helps people with acute or chronic pain manage and control their pain. Interventional pain management uses the latest medical procedures and treatments along with other therapies to treat the whole person in a comprehensive manner. This specialized approach focuses on therapies and medical techniques to diagnose and manage your pain – instead of relying on medications to provide a quick remedy. The aim of interventional pain management is to get you functioning again so you can enjoy your life.

Interventional pain management offices use work with different health care providers. For example, our office has two pain management doctors. We also regularly work with chiropractors and physical therapists. Our two doctors are trained in acupuncture. We also work with mediation health care providers and yoga teachers. When appropriate, we may refer a client to a neurologist, an orthopedist, or a psychologist.

Interventional pain management doctors first work to diagnose what is causing the pain by taking an oral history, conducting a physical examination, and often recommending certain diagnostic imaging tests. In some cases, a medical procedure may be used to identify the source of your pain and also to treat any identifiable pain.

Once the diagnosis of the pain has been made, the appropriate treatment (which may consist of a medical procedure) is explained to the patient.

We’ll have more on the different types of interventional pain procedures in our next blog.

For help with any pain issues, please call our Langhorne, Pennsylvania office at 215.741.7031. We help patients throughout Bucks County, Mercer, Philadelphia, and Montgomery Counties. We see many patients from Langhorne, Doylestown, Newtown, Fairless Hills, Levittown, Bristol, Richboro, and Bensalem


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Top Ten Workplace Injuries

Top 10 Most Common Workplace Injuries

  • Overexertion:  Many workers are    injured when they lift, push, carry, pull, hold or throw objects that are too heavy or bulky.
  • Slip and Falls: Falls can happen      because floors are wet, slippery, uneven, there are cracks, poor lighting or many other reasons. Fall to Lower Level – This type of fall happens from an elevated area such as roofs, ladders, and stairways.
  • Bodily Reaction: Injuries where a worker doesn’t fall but does slip, trip or have some movement reaction.
  • Struck by an Object: Objects can fall and strike someone  from shelves,     machines, or anywhere without warning.  This includes merchandise and       equipment.
  • Worker Strikes an Object: This occurs when a worker runs into or collides with someone else or with an object such as furniture, equipment or a part of the  building such as a wall or door.
  • Roadway Accident: Many workers are hurt while on assignment away from the office in a motor vehicle accident.
  • Machinery Accidents: If a machine isn’t used properly (and even when it is used properly), the machine can cause a worker to lose a finger or arm or suffer some other serious injury.
  • Repetitive Motion  Injury: Repeat    usage of any tool can cause injury to muscles and tendons, back pain, carpal tunnel syndrome and other injuries.
  • Assaults: Some workplace disputes can escalate into violence and cause a   worker to be harmed.
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What Is a Discogram


Discogram. L4 is OK. L5 is not.

How a Discogram Can Help Manage Pain?

A discogram is a diagnostic test that is done prior to any surgery to help determine the source of you back pain. A dye is injected into the disc and pressure is put on the disc by the pain management physician. The location of the dye helps the doctor determine which disc is causing your pain.

How the procedure works

The procedure is done at our ambulatory surgery center.

Patients must fast 6 hours before the test is done and arrive at the center about an hour and a half before the procedure. A nurse preps you and an IV will be used to sedate you (though you’ll be conscious). A fluoroscopy machine will be used. The pain management physician numbs the target area with a local anesthetic and then injects the dye into the disc by using a needle. The test takes about 20 minutes.

The doctor will use several needles and inject the dye into different discs. During the procedure, you will be asked questions about your pain level (this is why you have to be conscious).

Once the procedure is finished, the doctor’s team will monitor you for about ½ hours.

The test should not be given if you are pregnant, diabetic, or on blood thinners. Your doctor will explain your options if you are not ready for the test.

Steps to take after the discogram

Patients will need someone to drive them home after the test. They shouldn’t driver for 24 hours. You may feel some pain in the injected areas for several weeks.The doctor will then order a CT can where he/she can examine where the dye traveled to. If dye stays in the center of the disc, that indicates the disc is normal. If the dye spreads to the exterior of the disc, that indicates wear and tear and a probable source of your pain.

So there are two ways the doctor is evaluating the source of your pain – your responses to the injections and the location of the dyes.After the CT scan, the doctor will then let you know what the next steps are.

Contact us

For help with any pain issues, please call our Langhorne, Pennsylvania office at 215.741.7031. We help patients throughout Bucks County, Mercer, Philadelphia, and Montgomery Counties. We see many patients from Langhorne, Newtown, Fairless Hills, Levittown, Bristol, Richboro, and Doylestown.


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