Adam Sewell MD Blog

Medications that Cause Neuropathy

Post author By adamsewellmd
Post date April 30, 2020
No Comments on Medications that Cause Neuropathy

Patients are often unaware that many common medications can cause neuropathy. Medications known to cause neuropathy from “toxic effect”:

Most chemotherapeutic drugs

Antibiotics (eg, dapsone, fluoroquinolones, isoniazid, metronidazole, nitrofurantoin)

Antiretrovirals (eg, didanosine, stavudine)

Amiodarone

Colchicine

Disulfiram

Phenytoin

Pyridoxine

Tumor necrosis factor inhibitors (eg, infliximab)

There are many ways to treat the toxic buildup that occurs from such medications. The first step is to migrate to a different medication and discontinue the original medication. The next steps vary depending on the medication but typically can involve infusions medications that restore liver function. For heavy metal there are iv infusions that will bind to the heavy metals and help your body eliminate them.

Tags Neuropathy

Adam Sewell MD

How to Win Back Your Health

Post author By adamsewellmd
Post date April 29, 2020
No Comments on How to Win Back Your Health

I have been fortunate to have been able to treat thousands of patients in my career. Looking back at my experiences of having a front row seat to watch and help so many people overcome their health challenges has been a real blessing. I found three characteristics that are common among patients that have overcome health challenges.

Positive Attitude (Focusing on Positive)

Probably the first and most misunderstood characteristic: Positive attitude. This idea is commonly misunderstood to be unrealistic. This is not the case. This is the most common characteristic I have seen in patients who have overcome almost any illness. The patients will acknowledge negative issues and results but they never dwell on the negative. There is a large body of research from Carol Dweck, PhD on the importance of a “growth mindset” in the areas of education and learning. Ms. Dweck set out to find why some children were able to learn faster than their peers. What she found was that the children that were considered “gifted” and learned faster had one thing in common, they all had a certain set of beliefs. These beliefs she called the “growth mindset.” These beliefs were most evident when the children came across obstacles. For example, when the student failed to solve a problem correctly those students with the growth mindset would almost immediately attempt to solve the problem again. Often when faced with an incorrect answer they would say statements such as “it’s okay I will love to figure out this problem” and “I love challenges”. The growth mindset students would also be forward thinking and anticipate success with beliefs such as “ I am going to really love it when I get this problem correct” and “I can figure this out, I love challenges” This set of beliefs was the only thing that separated the “gifted” students from the average students. How can you apply the “growth mindset” to your life? How will looking at the world through the growth mindset lens change your thoughts and therefore your actions?

Taking Responsibility.

When we give away responsibility we give away our power. Nearly all patients that heal and recover completely have always taken their healthcare as their responsibility. While they consult physicians and other healthcare professionals they take responsibility for getting better. When recommended a treatment they read about it and prepared themselves. Often I could tell the success of a treatment prior to the treatment because the patients would often be so focused on getting better. The patients would often come to a new patient appointment with many informed questions and would take notes. If there was an obstacle to their care such as an insurance company they would work on their end to handle it. If there was a problem with scheduling they would figure it out. What was very interesting is that by taking responsibility it would empower the patient and in many cases this would correlate with a faster rate of recovery. How often do we accidentally give our power to someone else? How can we take our power back by taking responsibility?

Willing to Try

The final characteristic common to patients who were able to win back their health was a willingness to try. All too often, when we face a challenge we can default to blame or a “why me” attitude and give up. Those patients that overcome a health challenge have a willingness to try different treatments and therapies. Not all therapies worked and many did not work right away. It is the ability to persist and keep trying until the correct solution is discovered that makes the difference between failure and success. What I found most about patients who overcame illness was that by taking initiative and being willing to try new treatments this would produce results. When these results were analyzed it would provide information that would often lead to a solution. Without the initial attempt and failure, we would have never had the information to find the solution. The willingness to try was directly linked to the solution the patient was seeking. How willing are you to try new things? How willing are you to think “outside of the box”. I think this quote by Tobias Wolfe says it well — “We are made to persist .. That’s how we find out who we are”

Tags Neuropathy

Neuropathy

Patient’s Guide to Neuropathy

Post author By adamsewellmd
Post date April 28, 2020
No Comments on Patient’s Guide to Neuropathy

Pain in the foot of the elderly.Symptoms of peripheral neuropathy. Most symptoms are numbness in the fingertips and foot.

Neuropathy is probably one of the biggest misunderstood areas of medicine. Partially because neuropathy does not fall under one medical speciality and partially because the term neuropathy encompasses many different illnesses.

I find that the easiest way to explain the types of neuropathy is to group the neuropathies by what is happening to the nerve:

Axonal Nerve Damage (Damage to the wire)

If you have a problem with the long part of the nerve that sends the information, kind of like having a problem with the telephone line it is called axonal neuropathy. The reason it is called axonal is because the neuropathy is caused by the long part of the nerve known as an axon being damaged. The best way to think about this is to think of wire where parts of the wire has been damaged. Kind of like an old cellphone charger where you have to place the cord “just right” for it to charge your phone.

The following illnesses cause “axonal neuropathy” (wire damage neuropathy)

Diabetes
Critical illness
Longstanding HIV infection
End-stage kidney disease (aka “Uremic polyneuropathy”)
Amyloidosis
Hypothyroidism
Vitamin deficiencies
Lyme disease
Toxic — due to alcohol, chemotherapy exposure, and most heavy metals

Demyelinating Nerve Damage (Damage to the insulation around the wire)

Other illnesses cause “demyelination” the best way to think of this form of nerve damage is like a wire where the insulation surrounding the wire has been damaged:

This type of nerve damage is usually caused by:

Autoimmune illnesses (for example Guillain-Barré syndrome*)
n-hexane exposure

Environmental (physical damage to the wire due to the environment)

The third type of nerve damage is environmental meaning the nerves were damaged by something in the environment. Environmental factors can also impact nerve health in many ways.

Environmental nerve damage has been caused by:

Vibration-induced nerve damage
Prolonged cold exposure
Low oxygen supply

Each of these types of neuropathy can be determined with some testing. Once you determine what type of nerve injury you have there are many ways to go about fixing the problem.

First step is to control the pain — we will often use a small device that can generate an energy field around a nerve or a set of nerves while we treat the nerve. Chronic pain isn’t a joke as anyone who suffers from it will tell you and getting out of pain is the first step to healing. There are many reasons why but one of the most important is that if you are in chronic pain the pain causes release of flight or fight chemicals called catecholamines. These are the chemicals that get released if you are suddenly startled or are in physical danger like before a fight. These chemicals cause your heart to beat faster and shift blood flow away from organs that don’t need it and towards the muscle to get your body ready to either fight or take flight (run away). Being in this state will likely stop any healing process.

So what do you do to stop the pain and then heal the nerve?

There is now technology that can turn off pain from nerves. This technology is call a neural stimulator (not to be confused with tens units or shock like devices). The neural stimulator generates an energy field around the nerve or group of nerves and can interrupt painful patterns. It is kind of like a remote control for your pain. It essentially allows you to turn off your pain and replace it with a pleasant sensation. For most patients, once the pain is controlled then sleep cycles return to normal blood pressure often will level out and blood pressure medications are often decreased. Once the body is in the state there are several ways to heal the damaged nerves which we will cover in our next post.

Tags Neuropathy

Adam Sewell MD

VERTEBROPLASTY

Vertebroplasty, or vertebral augmentation, is a minimally invasive, out-patient procedure that alleviates chronic back pain caused by vertebral (spinal bones) compression fractures.

This treatment option is particularly helpful when conservative therapies have failed to relieve pain (De Negri 2007).

A vertebral compression fracture occurs when the vertebrae develop small cracks, break, or collapse/compress, compromising the spine and other nearby structures in the body.

Other Conditions commonly treated with Vertebroplasty include:

Osteoporosis
Bone cancer metastasis
Injury or Trauma

Procedure

Once the area is sterilized, a local anesthesia, and possibly a sedative, are administered, the physician makes a small incision in the patient’s back. A. narrow and hollow tube is inserted into the vertebra to withdraw any dead or damaged tissues.

Image devices, such as fluoroscopy or X-ray, are used to guide the physician, so that correct needle and bone cement placement are confirmed. Medical bone cement is injected from the needle through the hollow tube to sure up the fractures. They are inserted directly into the damaged vertebral body. The bone cement quickly dries, forming a support structure within the vertebra. This provides improved spinal stabilization and strength.

Benefits

Vertebroplasty is a widely-accepted procedure that has provided great pain relief for many patients. Additionally, it increases vertebral body height, and decreases wedge angle (improper shape) without worsening of the retropulsion (backward movement) of the vertebrae (Hiwatashi 2007).

Many Patients with compression fractures often have kyphosis, which is a pronounced, or moderate, curving of the upper back. There is more than one cause, but the most common is vertebral compression fractures, which often occur with osteoporosis. Severe kyphosis is a health concern. It can be debilitating and will create an obvious spinal curve.

Risks

Vertebroplasty is generally considered a safe and appropriate non-surgical minimally invasive procedure for most patients with chronic back pain, caused by vertebral compression fractures. However, as with any procedure there are potential risks.

Some of the risks common the leakage of bone cement outside the vertebral body. This is extremely rare, and so is, infection, bleeding, numbness, tingling, headache, and paralysis may result from misplacement of the needle or bone cement.

Bone cement misplacement is made far less common by the usage of fluoroscopy or x-ray, or other radiological imaging devices to ensure proper placement of the bone cement and needle.

Vertebroplasty as a safe treatment for painful vertebral compression fractures, and complications are rare with the procedure (DaFonseca 2006) (Hiwatashi 2007)

Outcomes

Fracture Prevention

Overall good health can prevent factures. This includes, eating balanced diet, regular exercise, weight lifting, calcium and vitamin D supplements are healing and preventive for the spine.

Bisphosphonates medications (Fosamax) may prevent additional compression fractures, due to osteoporosis, by strengthening bones and preventing further bone density losses.

Those suffering from painful compression fractures, that have not responded to the prevantatives listed above, may be good candidates for minimally invasive procedures like vertebroplasty and kyphoplasty (Old 2004).

For more information about Vertebroplasty or Kyphoplasty, or any other items mentioned, please see your pain physician.

Resources

Adam Sewell MD

SYMPATHETIC BLOCK

A sympathetic nerve block is the injection of a local anesthetic into a sympathetic ganglion to diagnose and/or treat pain disorders involving the sympathetic nervous system.

The sympathetic nervous system is a collection of nerves that spread tall areas of the body but that originate in the spinal cord. They branch out, influencing many bodily functions, such as blood pressure, urination, defecation, and sexual arousal.

A ganglion is a bundle of nerves that come together. The stellate ganglion (upper body) as well as the sympathetic chain (lower body) supply the entire body’s sympathetic nervous system. The blood supply to your hands, feet, or other areas may be affected and can produce pain or sensory changes when these nerves are irritated or injured. Headaches, neck pain, and facial pain can be a result of sympathetic nerve dysfunction.

Procedure

A sympathetic nerve block involves injecting a local numbing anesthetic (lidocaine, bupivacaine) and a corticosteroid into the space where the sympathetic nerve ganglion are located. A local skin anesthetic will numb the area, and then a needle is inserted near the ganglion. X-ray guidance will ensure proper needle placement, and your doctor may offer you IV sedation. The procedure takes less than 20 minutes to perform.

Benefits

Sympathetic nerve blockade is commonly used techniques for a variety of diagnostic and therapeutic purposes (Elias 2003). The block may offer complete pain relief, but if the pain does not go away, your physician may determine that your pain is not originating from the sympathetic nervous system and the block has had diagnostic value instead of therapeutic.

Regardless of the outcome, sympathetic nerve blockade is a minimally invasive treatment that has relieved pain for many people with chronic pain. One of the most successful aspects of the block is its ability to immediately relieve pain in some patients.

Risks

Sympathetic ganglion blocks are considered an appropriate and safe non-surgical treatment for many patients who suffer from pain. Complications of the ganglion block include infection, bleeding pneumothorax (collapsed lung), nerve damage, and pharmacological complications related to the drugs utilized (Elias 2000). Some temporary symptoms may include, drooping of the eyelid and stuffy nose, but these usually resolve within a matter of hours.

Outcome

Sympathetic nerve blocks are effective in relieving some chronic pain conditions, especially, where Complex Regional Pain Syndrome is concerned.

Pain that originates from the sympathetic nervous system, that is not easily treated by oral pain medications, may respond well to a sympathetic nerve block.

If you are suffering from chronic pain and are in need pain relief, call Arkansas Pain today to see what they can do for you.

Articles

Adam Sewell MD

SUPERIOR HYPOGASTRIC PLEXUS BLOCK

Post author By Jasmeet Singh
Post date April 13, 2020
No Comments on SUPERIOR HYPOGASTRIC PLEXUS BLOCK

A superior hypogastric plexus block is a type of injection that is used to control pelvic pain that has been resistant to oral medications. This block can also be indicated if the patient cannot endure the side effects of the same oral medications.

The superior hypogastric plexus controls pain to and from the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon, so this block can potentially alleviate pain originating from these regions. Recent literature shows that the superior hypogastric plexus block has been used successfully to treat both malignancy-associated anal-rectal pain and nonmalignant penile pain.

The Superior Hypogastric Plexus Block can Halt Pain originating from:

Bladder
Urethra
Uterus
Vagina
Vulva
Perineum
Prostate
Penis
Testes
Rectum
Descending colon

Pain secondary to:

Cancer that metastasized to the pelvis (cervical, prostate, testicular, colorectal etc.)
Endometriosis
Radiation Injury

Anatomy:

The superior hypogastric plexus is a collection of nerves situated on the vertebral bodies in front of the bifurcation of the abdominal aorta. Its location allows it to innervate the vast majority of the pelvic region (including the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon).

Procedure:

The superior hypogastric plexus block is usually performed with a posterior approach. If you can lie down on your abdomen, face down without significant distress your physician will most likely use the this approach. If you cannot lie down in this position, he or she may choose the anterior approach, or the transdiscal approach. The anterior approach can be done with fluoroscopy, computed tomography-guidance, or via ultrasound. The transdiscal approach uses fluoroscopy or ultrasound and allows you to lay down on your abdomen or your side. With this technique, your physician advances the needle through the skin and muscles of your back and the L5-S1 intervertebral disc to reach the superior hypogastric plexus.

The posterior approach remains the most common ways to perform this block and can be done under fluoroscopy or computed tomography-guidance. Fluoroscopy tends to be the preferred imaging method since there is less radiation exposure to the patient.

You will be asked to lay down on your abdomen, with a pillow under the pelvis to help flatten out the lower lumbar spines natural curvature. Your lower back will be prepped and draped in a sterile manner and anesthesia will be administered. When your skin is adequately anesthetized, two needles will be advanced under fluoroscopy guidance until correct needle placement is obtained. Their correct placement will also confirmed by administration of contrast dye, and once position is confirmed, either a diagnostic block or a therapeutic block will be performed.

A successful block is marked by profound pain relief.

Local anesthetic is usually administered for diagnostic superior hypogastric plexus block or for patients with noncancer-related pain. For patients who have a documented response to administration of local anesthetic onto the superior hypogastric plexus, a therapeutic block is preformed with administration of the neurolytic agent like phenol. Radioablation of the superior hypogastric plexus is also another treatment modality for longer-lasting pain relief.

The procedure is short, taking less than 30 minutes. Sometimes your physician will recommend intravenous sedation to make you more comfortable. Your vital signs will be monitored during, and after, the procedure.

Superior hypogastric plexus block is a short, minimally invasive procedure that is effective at treating some chronic pelvic pain, especially if it’s caused by cancer.

Risk:

This procedure has a low risk of complications. They include: Needle misplacement, bleeding, especially into your retroperitoneal space, nerve injury and/or paralysis, puncture of surrounding organs, puncture of adjacent vessels, and distal ischemia. Risks that can result from the anesthetic include: Drug allergy and seizure (if the medication is injected into a blood vessel), and the risk of infection always exists with insertion of any needle.

Outcomes:

Superior hypogastric plexus block is a well-established treatment modality for chronic pelvic pain, especially if it results from cancer. In several recent studies, it has proven more effective that continuous opioid usage (De Leon-Casasola et al). Most patients experience some paint with the initial block, but more can be performed if optimal pain relief has not been reached the first time.

If you are suffering with chronic pelvic pain or pain that you or physician believe is originating from the bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon, the superior hypogastric plexus may be of great benefit for you.

Contact Arkansas Pain today to see if you’re a good candidate for a superior hypogastric plexus block. We are happy to offer this exciting treatment option to patients in Melbourne and Merritt Island, FL. Call today for an appointment.

Journal Articles:

Adam Sewell MD

STELLATE GANGLION BLOCK

A stellate ganglion block has a wide array of therapeutic and diagnostic indications, including:

Pain Syndromes

Sympathetically-maintained pain syndromes
Complex Regional Pain Syndromes Type 1 and 2
Reflex sympathetic dystrophy
Shoulder/hand syndrome
Causalgia (nerve injury)
Phantom limb pain
Intractable angina
Herpetic neuralgia from herpes zoster (shingles)

Vascular Insufficiency in Upper Extremities

Arterial insufficiency
Raynaud’s phenomenon
Scleroderma

Miscellaneous

Hyperhidrosis (excessive perspiration) of the face and upper extremities
Hot flushes and sleep dysfunction related to hot flashes
Posttraumatic stress disorder (PTSD)

Anatomy:

The stellate ganglion is the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion where they meet over the vertebral body of C7 It is in close proximity to the carotid sheath, phrenic nerve, and recurrent laryngeal nerve.

Procedure:

A stellate ganglion block is an injection of local anesthetic into the sympathetic nerve tissue in the neck area. These nerves are part of the larger sympathetic nervous system and are located on both sides of the voice box. There are several methods by which the stellate ganglion block can be performed, and all of them take under one hour. Correct placement is also confirmed by administration of contrast dye. Once position is confirmed local anesthetic is administered. A successful block is marked by profound pain relief and improved vascular flow to ipsilateral upper extremity. A local anesthetic is usually injected to assist with the discomfort. For patients who have a documented response to administration of local anesthetic onto the stellate ganglion, a therapeutic block can be performed. Radioablation of the stellate ganglion is also another treatment for longer-lasting pain relief.

Some patients may experience symptoms from Horner’s Syndrome (drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block was preformed). This is normal and will usually subside when the anesthetic wears of (usually ~4-6 hours after the block is preformed).

Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs for a while after the procedure and place you in a sitting position to facilitate the spread of the anesthetic.

Benefit:

Stellate ganglion block is a short, minimally invasive procedure that can effectively treat a wide array of conditions that have not responded to other treatments. These include relief for sympathetic-related facial pain, chest and upper extremity pain, circulation improvement in upper extremities and face, decreasing perspiration in upper extremities and face, decreasing hot flashes and associated sleep disturbances, and it is even showing promise as a novel treatment for PTSD.

Risk:

The risks for the procedure are typically low. As with all medical procedures, there is some risk, however. These include – misplacement of the needle resulting in: bleeding, nerve injury, pneumothorax (collapsed lung), or esophageal perforation.

There are, also, risks that can occur because of the anesthetic. These include, drug allergy, seizure (if the medication is injected into a blood vessel), brachial plexus block (numb arm on side of block that lasts as long as the life of the anesthetic injected), spinal or epidural block (transient weakness and/or numbness from neck down as long as the life of the anesthetic injected), hoarseness (from anesthetizing recurrent laryngeal nerve), and shortness of breath (from anesthetizing phrenic nerve).

Lastly, as with all punctures of the skin, the risk of infection always exists. The most common side-effects related to the procedure are drooping of the upper eyelid, pupil constriction, and decreased sweating on the side that the block as well as voice becoming more hoarse. These side effects usually subside after the anesthetic wears off.

Outcomes:

After the block is preformed one of three things may occur:

Your pain is gone or greatly improved and stays that way for longer than the life of the anesthetic. This shows your physician that the block has therapeutic value for you and he or she can come up with a treatment plan that maximizes your pain control
Your pain is unchanged but, there is evidence of a sympathetic blockade. This is of diagnostic value to your physician and tells him or her that your pain is not responsive to a sympathetic block and he or she can try other treatment modalities to treat your pain.
Your pain is unchanged but there is no evidence of a sympathetic blockade. This indicates that the block was a technical failure.

Stellate ganglion blocks are a well-established treatment method for providing relief from sympathetically-maintained pain syndromes. However, their benefits do not end there. Listed above, are the many of the benefits. Additionally, some people tend to have relief for weeks, while others benefit from the block for years. Fortunately, the procedure is a low risk, nonsurgical treatment that if successful the first time, will most likely continue to provide pain relief with repeat treatments. If you are suffering with pain contact Arkansas Pain today to see if you can benefit from a stellate ganglion block. We are happy to offer this exciting treatment option to patients in the Merritt Island and Melbourne area. Call today.

Journal Articles:

Adam Sewell MD

SPINAL CORD STIMULATOR THERAPY

Post author By Jasmeet Singh
Post date April 13, 2020
No Comments on SPINAL CORD STIMULATOR THERAPY

Spinal Cord Stimulator therapy is a revolutionary treatment for patients suffering from chronic back pain. A small electronic device is surgically implanted close to the spinal cord in the epidural space. Low-level electrical impulses emitted from the device interfere with pain messages transmitted by nerves, blocking the sensation of pain. Implanting a spinal cord stimulator may be effective in helping patients return to a more active and healthy lifestyle.

Conditions that are treated with SCS include:

Spinal Stenosis
Nerve Root Compression
Failed Back Surgery Syndrome
Lumbar Radiculitis or Sciatica
Peripheral Neuropathy
Degenerative Disk Disease
Central Sensitization

Description

Also referred to as a Dorsal Column Stimulator, a Spinal Cord Stimulator system is composed of a pulse generator implanted under the skin of the abdomen or buttock and an extension wire that connects to a pulse generator to the lead implanted close to the spinal cord. The pulse generator is powered by a battery that must be surgically replaced every two to five years, unless it is rechargeable. The lead is a flexible, thin wire with anywhere from 4-16 electrodes. An extension wire attaches the lead to the pulse generator, and a hand-held remote control is used by the patient to program the pulse generator.

Procedure

The procedure is performed in two stages. First is the insertion of a temporary trial implant. You will be positioned lying on your side or stomach, and then given a local anesthetic and light sedation to prepare for the SCS implant insertion. The surgeon will make a small incision in the middle of your back. Using fluoroscopy guidance (X-Ray), the doctor will insert SCS leads into your epidural space. Sutures are used to keep the leads secure above the spinal cord. At this time, a trial stimulator, rather than a permanent implant, is worn for a week to assess effectiveness of spinal cord stimulation in treating your pain. The trial stimulator will be taped to your back. If the SCS is successful in relieving pain, a second surgery is performed. During this second surgery, the extension wire is tunneled under the skin from the epidural space to the location of the generator implant (either abdomen or buttock). The surgeon makes a four to six inch incision to place the generator between the skin and muscle, where it is sutured securely. After the procedure, you should be able to go home that day.

Benefits

The spinal cord stimulator produces a low voltage current which keeps the brain from being able to sense pain. Instead of pain, you will feel a tingling sensation. Using the remote, you will be able to control the intensity of the stimulator or turn the system on and off. The spinal cord stimulator has been proven to relieve lumbar back pain in patients with a variety of conditions, especially Failed Back Surgery Syndrome. Patients who receive a spinal cord stimulator implant rely less on pain medication.

Risks

Just as with any surgical procedure, possible risks include:

Infection at the surgical site
Bleeding
Scar tissue formation
Failure of electronic device to operate properly
Unpleasant sensations or motor disturbances, such as uncontrolled movement caused by the electrical stimulation of the device
Battery leakage or failure
Leaking of the cerebrospinal fluid from the epidural space
Migration of the leads, making the nerve stimulation ineffective
Skin breakdown at the site of the generator
Rarely, surgical intervention may be needed to fix problems with the device or leads.

Outcome

Once the SCS device is in place, your doctor will work with you to be able to find the best pulse strength to help you. You will be taught how to use the stimulator remote at home. Typically, patients use the spinal cord stimulation for one or two hours at a time, three to four times a day. The spinal cord stimulator should be turned off while driving and swimming. SCS pulse generators have three programmable settings.

You may find that the device feels differently depending on whether you are sitting down or standing up. This is because the electrical impulses spread differently depending on how the leads and wires move with your body.

According to the American Society of Interventional Pain Physicians, there is evidence that you will experience strong relief short-term, and moderate relief long-term with this surgery. The SCS implant may be effective in helping those who suffer from chronic back pain lead a more active lifestyle. However, there may be a gradual decline in effectiveness of SCS, as your body can develop tolerance to the treatment.

Resources

Adam Sewell MD

SPHENOPALATINE GANGLION BLOCK

Post author By Jasmeet Singh
Post date April 13, 2020
No Comments on SPHENOPALATINE GANGLION BLOCK

Sphenopalatine-Ganglion Pain, especially in the face and head, is a condition that may be secondary to these conditions.

Acute and cluster headaches
Trigeminal neuralgia. (3,7)
Temporomandibular joint (TMJ) pain.(7)
Herpes zoster. (12)
Sluder’s neuralgia. (6)
Paroxysmal hemicrania. (4)
Atypical facial pain. (14)
Head and neck cancers
Complex regional pain syndrome (CRPS) (9)
Reflex Sympathetic Dystrophy (RSD) (9)
Vasomotor rhinitis
Pre- and postoperative anesthesia in oral and maxillofacial surgery. (11)

Benefit:

Sphenopalatine Ganglion Block is a short, minimally invasive procedure that is effective at treating some acute and chronic facial and head pain.

Anatomy:

The Sphenopalatine Ganglion is a collection of nerves that is close to the surface. It is located in the depression of the skull behind the middle nasal bone, and in front of the nasal canal. The Sphenopalatine Ganglion is covered by a layer of connective tissue and mucous membrane which allows its block to be applied either topically or by injection (17,18,19).

Procedure:

There are many approaches your physician can use to perform the Sphenopalatine Ganglion Block, including the transnasal, transoral, and lateral approach. The transnasal approach is the simplest and most common technique among the three. You will be asked to lie down on your back and extend your neck into a sniffing position. Your physician will inspect your anterior nares (inside your nostrils) for any visible polyps, tumors, or significant septal deviation before beginning. A small amount of 2% viscous lidocaine is instilled into the nostrils being treated, after which you will be asked to briskly inhale. This draws the local anesthetic toward the back of your nose, lubricating it and anesthetizing it in the process, while making the procedure more comfortable for the patient. If your physician decides to perform the Sphenopalatine Ganglion Block topically, he or she will introduce a sterile 10-cm cotton tipped applicator dipped in anesthetic and slowly insert it in your nose. The applicator is usually left in place for approximately 20-30 minutes. If your physician decides to perform the Sphenopalatine Ganglion Block via injection, your physician will anesthetize part of your cheek. Next he or she will advance a small needle under X-Ray guidance through the anesthetized tissue. Your physician will carefully advance the needle to the correct location, after which he or she will confirm correct positioning under fluoroscopy before injecting the anesthetic. No matter whether placed topically or via injection, a successful block is marked by profound pain relief. For patients who have a documented response to administration of local anesthetic onto the Sphenopalatine Ganglion, you and your physician may decide upon performing a neurolysis or radioablation of the sphenopalatine ganglion for longer duration of pain and symptom relief. Depending on whether your physician performs this block topically or via injection, this procedure may take anywhere from 15 minutes to 30 minutes at most. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor your pain and vital signs (pulse, blood pressure) after the procedure.

Risk:

The risk for this procedure is very low. The most common side effects of this procedure include developing a bitter taste in your mouth from the local anesthetic potentially dripping down from the nasopharynx. You may develop a slight numbness in the back of the throat from the local anesthetic dripping down into your throat. You may develop a nose bleed from your physician accidentally abrading your internal nare from the placing of the block. Some patients may also experience slight lightheadedness that usually resolves after 20-30 minutes after the procedure. With any procedure that involves local anesthetic there is a slight risk of drug allergy and seizure. Lastly, as with any penetration of skin and soft tissues, the risk of infection always exists.

Outcomes:

Sphenopalatine Block is a well-established treatment for acute and chronic facial and head pain. Having a Sphenopalantine Radiofrequency Ablation is a proven and effective treatment for patients with chronic cluster headaches.

References:

Adam Sewell MD

SACROILIAC JOINT INJECTIONS

Post author By Jasmeet Singh
Post date April 13, 2020
No Comments on SACROILIAC JOINT INJECTIONS

Sacroiliac Joint (SIJ) Disease is one of the major causes of lower back pain. The sacroiliac joint is located at the junction between the spine and the pelvis. The sacroiliac joint is a weight-bearing joint as the weight from the upper body is transmitted down the spine, through the sacroiliac joint and into the pelvis, hips, and lower extremities. The sacroiliac joint is supported by many muscle groups and ligaments that are richly innervated by free nerve endings and spinal nerve roots. When there is inflammation to the sacroiliac joint, the abundance of nerves become irritated and patients experience intense lower back pain. Patients typically complain that pain associated with sacroiliac joint worsens when sitting for long periods of time or performing twisting motions and will usually resolve with exercise.

Treatments

Sacroiliac Joint Steroid Injections: involve injecting a steroid into the joint space of the SIJ, where the irritated nerve roots are located. This injection includes both a long-lasting steroid and a local anesthetic (lidocaine, bupivacaine). The steroid reduces the inflammation and irritation and the anesthetic works to numb nerves in the area. The combination medicine then spreads throughout the joint and surrounding areas, reducing inflammation and irritation. The entire procedure usually takes less than 15 minutes.

SIJ Traumeel Injections: Traumeel is a homeopathic natural anti-inflammatory medication that has very few side-effects and can be injected into the SIJ when steroid medications are not desired.

Medial and Lateral Branch Blocks: The medial and lateral branches innervate (supply with nerves) the sacroiliac joint. Blocking these nerves is diagnostic and therapeutic. If your pain is better after the injections, than you may be a candidate for radiofrequency procedure.

Radiofrequency Ablation: The medial and lateral branches innervate (supply with nerves) the sacroiliac joint and can be destroyed with radiofrequency. The nerves typically grow back, but people report pain relief from ranging from three months to three years.

Spinal Cord Stimulation: A small electrode is typically placed in the epidural space and electrical current is directed through the electrode. If pain relief is attained, a permanent system with battery and electrodes can be placed under the skin.

Chiropractic Manipulation: The sacroiliac joint can sometimes be manipulated into place if it is believed to be out of alignment.

TENS unit: Electrical current is directed over the skin to the most painful area. The brain cannot perceive the pain it previously felt, but now feels the “tingling or buzzing” sensation that is commonly used to describe TENS therapy. TENS therapy may also cause the brain to release endorphin (the body’s natural pain fighters).

Physical Therapy: Is extremely important to increase range of motion and continue to maintain strength in a painful shoulder.

Acupuncture: Acupuncture is an alternative treatment that was originally started in China over 2000 years ago and is quickly gaining acceptance and popularity in Western Medicine for the treatment of many conditions (Facco 2007). Research continues to explore the use of acupuncture in the treatment of many chronic pain conditions.

Benefits

Chronic lower back pain is one of the most difficult conditions for physicians to treat. Commonly seen, the pain may go into remission with periods of decreased or absent symptoms. However, the pain frequently returns and causes a chronic pain syndrome in most people. Sacroiliac Joint Injections are a minimally invasive, low risk procedure that can cause a significant decrease in symptoms without disrupting your daily activities. In patients suffering from chronic sacroiliac joint pain, Sacroiliac Joint Injections are preferred to the more conventional methods of treatment (Pereira 2000).

Risks

SIJ injections are considered an appropriate non-surgical treatment for many patients who suffer from lower back pain. The associated risks, although rare, include nerve damage, bleeding, and infection. Some of the potential side effects of the corticosteroid may include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in the immune system.

Outcome

Patients have reported that Sacroiliac Joint Pain began spontaneously or had an insidious (slow) onset. Others recognize a specific event that triggered the occurrence of the pain. Frequently, the pain can be due to a traumatic injury to the spine resulting in residual sacroiliac joint inflammation. While conservative treatment, such as NSAID’s and physical therapy may be effective, Murakami and Tanaka reported in 2007 that the effect of periarticular injection (injections occurring around a joint) into the SIJ was 96% effective in pain improvement in patients with sacroiliac joint complaints, with minimal complications (2007 Murakami).

How We Can Help You

Arizona Pain Specialists is a Pain Center of Excellence and we realize the burden Sacroiliac Joint Pain can have on your life. We believe a compassionate patient-centered program integrating allopathic (alternative) and complementary treatments is the most effective method to obtain long-term pain relief.

During an initial visit, a pain physician will evaluate and diagnose your painful condition and build a customized treatment program that is specific for you. If you or someone you know could benefit from treatments we offer please contact Arizona Pain Specialists today.