Tag Archives: arizona pain clinic

Key Points on Facet Syndrome – from an AZ Pain Center

Posted on by
PinterestPrintShare

The lifetime prevalence of back pain is 84%, and for neck pain it is 67%. This means that most Americans will suffer from one or both during his or her lifetime.Arizona pain doctor

Low back pain is the number one reason that individuals seek medical treatment and is also the number one cause of disability. In 2006, procedures for facet syndrome represented 37% of all pain management interventional treatments according to Medicare. In the 10 years from 1997-2006, this represented a 624% increase in these procedures.

Interestingly, the true diagnosis of facet syndrome cannot be made by history, physical exam or radiology findings. The most reliable diagnostic method is with a medial branch block or a facet joint block.

Medial Branch Block

Medial Branch Block

One question that pops up a lot is what amount of pain relief is necessary for the patient to be a candidate for a subsequent radiofrequency ablation?

Multiple studies have actually looked at the difference in results between 50% versus 80% relief for the medial branch block as a prerequisite for an ablation. None of these have found any difference in results with a subsequent radiofrequency neurotomy.

In addition, some insurance companies require two successful medial branch block or facet joint procedures prior to a radiofrequency denervation. Interestingly, multiple studies looking at this also failed to find a difference in success rates between one versus two diagnostic procedures.

Arizona pain management doctors

Radiofrequency Ablation

When it comes to corticosteroid injections into the facet joint, there are multiple studies that have found intermediate length pain relief. However, there have not been any large studies showing the benefit to be better than medial branch blocks.

There is substantial evidence favoring the medial branch blocks for both diagnostic and therapeutic purposes. Medial branch blocks can provide up to three months on average of pain relief. So not only can the injections tell the Arizona pain doctor whether or not the facet joint is the cause of pain, but can also eliminate that pain for months.

If a subsequent radiofrequency ablation is performed, the pain relief from that can be anywhere from six months to 18 months, which is incredible. Studies have also looked at repeating the radiofrequency ablation if the pain relief wears off. Those have shown results just as good as the first time.

Arizona Pain SpecialistsIf you are suffering from chronic neck or back pain, Arizona Pain can help. They have 4 locations around the Valley, including a pain management Glendale AZ location along with one in Phoenix, Scottsdale, and Chandler in the east valley.

Over 50 insurance plans are accepted including BCBS, Aetna, Humana, United, Cigna, Banner, Medicare, Medicaid, Personal Injury, Worker’s Compensation and many more.

Treatments offered at the AZ pain clinics include pain management, stem cell injection treatments, chiropractic, acupuncture, physical rehabilitation, spinal decompression therapy and more. Call (602) 507-6550 for more information and scheduling.

An Overview of Trigeminal Neuralgia from a Phoenix pain clinic

Posted on by
PinterestPrintShare

Trigeminal neuralgia causes extreme facial pain that can be disabling. It is the most common form of facial pain in those over the age of 50. In nine out of 10 cases the symptoms of the problem began after the age of 40.

Interestingly, women are affected more often than men at a ratio of 1.5 to 1. It is unclear Trigeminal Neuralgia Treatmentwhat causes trigeminal neuralgia. Is thought that the nerve may be pinched near the origin of the brainstem.

The painful symptoms that go along with trigeminal neuralgia entail shooting pains on one side of the face. The pain is described as being sharp, shooting and almost like an electrical shock. Everyday normal activities can bring on the pain such as shaving, washing or eating.

Physical examination is not usually extremely helpful in most patients with trigeminal neuralgia. All the cranial nerves should be tested to make sure their function is intact, facial expressions are normal, the tongue works fine and things like that.

When trigeminal neuralgia is present, the patient should have an MRI scan to rule out tumors or multiple sclerosis. Also, the MRI can sometimes show compression of nerves by blood vessels. Having said that, there’s not enough evidence to support whether or not blood vessels actually cause symptomatic nerve compression.

Face pain treatmentThe International Headache Society has come up with multiple criteria to make the diagnosis of trigeminal neuralgia. The first is that the individual should have pain that lasts anywhere from a few seconds to a few minutes and occurs along the branches of the trigeminal nerve. The second is that the pain should be intense, sharp or static in nature. Another is that there should be no signs of other neurologic disorders.

When it comes to treatment for trigeminal neuralgia, the medication of choice is carbamazepine. Studies have shown this medication can reduce the symptoms in about 70% of patients. Additional medications that may have efficacy include Neurontin, baclofen, pregabalin and Lyrica.

When it comes to interventional treatments, there are a few options that pain management doctors in Arizona can choose from. Percutaneous balloon microcompression involves percutaneous introduction using a needle into what is called Meckel’s cavity. There is some data to back up this technique, with the advantage being that it treats the first branch of the trigeminal nerve selectively.

Trigeminal Neuralgia RadiofrequencyAnother injection that can be performed involves glycerol being introduced into the area around the trigeminal nerve. This can be performed, or the Phoenix pain doctor can do a radiofrequency treatment on the area and attempt to obtain longer pain relief. There are no large-scale studies showing the long-term outcomes of this procedure. For really difficult cases, a surgical microvascular decompression and be performed which separates blood vessels from the nerves.

One of  the problems seen with medication management for trigeminal meralgia is the side effects associated with chronic medication use. What comes to treatment recommendations looking at all the options available, multi-modality treatment is most likely best. This includes medication management along with potentially glycerol injections and then maybe radiofrequency ablation.

The risks of these treatments are very low. In older patients radiofrequency ablation is recommended, and that younger patients microvascular decompression is to provide the longest term relief.Pain Clinics in Phoenix

Arizona Pain Specialists has Award Winning pain doctors in Scottsdale, Phoenix, Chandler & Glendale who have extensive experience in effective facial pain treatment including TMJ and trigeminal neuralgia. Call (602) 507-6550 today for more information and scheduling.

How to Avoid Knee Replacement Surgery?

Posted on by
PinterestPrintShare

Tens of millions of Americans are afflicted with knee arthritis and live with daily pain. Knee replacement surgery has been shown as one of the top five quality-of-life procedures in Pain Clinic Glendale AZthe world. However, the procedure is not meant to last forever and should be looked at as a last resort, elective procedure.

Here are the ways to avoid total knee replacement procedure.

  • Activity Avoidance

The first method of treatment is known as activity avoidance. If you are an avid downhill ski year and the activity causes knee pain for three days afterwards, it’s probably best to avoid skiing. It would probably be a better idea to switch to an activity that is not so stressful. Also, if you are an avid runner, it would be best to switch to a lower impact activity such as swimming or cycling (cross-train).

  • Medications

First-line treatment should consist of over-the-counter pain medicines such as Tylenol and anti-inflammatories (Naproxen, Ibuprofen). These should be taken according to the manufacturers recommended dosing, and may be exceptionally helpful to relieve mild to moderate pain from the arthritis.

There are also various over-the-counter skin creams that can provide significant analgesia, such as capsaicin.Knee pain clinic Phoenix

For those times when the arthritis pain exacerbates, short term narcotics may be helpful. Taking them over the long-term is not a good idea as there can be significant risks with this approach.

  • Physical Therapy, TENS, Acupuncture, Cane

Physical therapy can help avoid or prolong the need for a knee replacement. Strengthening up the muscles around the knee can help take pressure off of the arthritic areas. This may also include ultrasound and electrical stimulation treatment. Using a TENS unit may also help with pain relief, which involves placing small foam pads over the knee and providing a small electrical stimulus. This can alter the way that the brain perceives pain signals.

Several studies have been done looking at acupuncture for arthritis pain. They show that the effectiveness of acupuncture is significant, and may provide lasting relief for the problem.

A cane may offset knee stresses by up to 50% and relieve pain considerably.Arthritis Clinic Phoenix

  • Bracing

Bracing for an arthritic knee can help as well. There is a type of knee brace called and off-loader that pushes on the less painful side to open up the arthritic area. These braces are slightly bulky and may be uncomfortable, but also may provide significant alleviation of the arthritis discomfort.

There are even studies showing that a knee sleeve may provide symptomatic relief for those suffering from knee arthritis (Segal, PM R. 2012 May;4(5 Suppl):S89-96).

  • Injections

One gold standard treatment for the arthritis pain are steroid injections. These are done as an outpatient in a physicians office, and involve placing numbing medicine and steroid into the joint for relief. Over 75% of patients achieve substantial pain relief that lasts for weeks to months (Cheng et al, Pain Med. 2012 Jun;13(6):740-53). Steroid injections may be repeated a few times a year.

Decades ago, studies of steroid injection into small animals showed cartilage degradation from the steroid injected. Subsequent studies and larger animals showed no such ill effect, so steroid injections remain very popular for arthritis to this day.

Hyaluronic acid injections have become very popular and are known as Synvisc and

Knee Doctor Phoenix

Synvisc contains hyaluronic acid.

Hyalgan. Hyaluronic acid is a natural component of the knee, and these injections are made from rooster combs. CHA injected helps provide the natural lubricant along with theoretically increasing the knees desire to produce cartilage.

The FDA has approved the use of these injections, and multiple studies have shown beneficial effects that may last for 6 to 12 months. The working theory is that if an individual has some cartilage remaining, these injections are indicated. However, if an individual is down to bone on bone arthritis, then it does not make a lot of sense to perform them.

The newest type of injections for knee arthritis are platelet rich plasma and stem cell PRP therapy Phoenixinjections. Platelet rich plasma involves taking a simple blood draw from a patient and spinning it down in a centrifuge machine to obtain platelets and growth factors. There are some small studies showing that injecting the substance into an arthritic knee can help repair some of the damage (AAOS). Pain relief may be substantial, and the substance has been shown to call in stem cells from a persons body.

The newest stem cell injections involve obtaining material from either a persons iliac crest, fat, or an external source such as donated amniotic fluid. It is unclear to what extent arthritic pain can be reduced with the substances. Current studies are ongoing.

There are quite a few treatment options for avoiding or delaying knee replacement surgery at modern pain management clinics such as Arizona Pain Specialists. If you or a loved one is suffering from knee pain in the greater Phoenix or Scottsdale areas, call today at (602) 507-6550.