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Services At CC4PM we realize that your pain affects you emotionally as well as physically. Pain can cause stress and even depression due to its control over your quality of life. Because of the emotional toll pain can take, CC4PM provides through affiliation with Stress Care Behavioral health under the direction of Dr. Glenn Swimmer a complete range of psychological support services.
Common Treatments and Procedures CC4PM’s goal is to utilize the most minimally invasive pain management remedy necessary for each patient. Although we cannot guarantee that every patient will be rid of all pain after treatment, the vast majority improve significantly through our intervention. We offer a wide variety of treatment options, and sometimes a combination of these may be used to fit the patient’s requirements. Options are listed below. For more information click on the Patient Education & Media tab to the left:
v
Trigger Point Injection/ Nerve Blocks:
The cause of your muscle pain or spasms maybe one or more trigger
points. Trigger points are specific sites on the muscles that cause
pain (both locally and throughout the back) when pressure is applied
to them. Trigger points are believed to occur due to excessive
physical activity, fatigue or trauma. This injection is done in the
comfort of the physician’s office. The physician will feel and
stretch the muscle to find the trigger point. The physician will
then do a series of injections with various medications to best
relieve the pain. This type of injection may help you increase
movement and may help the muscle heal.
v
Sympathetic
Nerve Block: The
sympathetic nerves run on the front surface of the spinal column.
When regulation of the sympathetic nervous system is altered,
usually as a result of injury, pain can occur resulting in Complex
Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic
Dystrophy (RSD). A sympathetic nerve block involves injecting
numbing medicine around these nerves in the neck or the back,
reducing or eliminating the pain.
v
Facet Joint Injection:
If your doctor
suspects the source of your pain is in the facet joints, where the
vertebrae connect to one another, he may recommend a procedure
called a facet joint block. Under fluoroscopy (x-ray), a steroid
and/or anesthetic medication is injected directly into the joint
capsule or injected in such a manner to block the nerve(s) to the
facet joint to relieve pain.
v
Epidural
Injections/Blocks:
When inflammation within the spinal column causes nerve root
irritation and swelling, doctors sometimes administer a potent
anti-inflammatory medication to reduce inflammation and ease pain.
Steroids typically are injected directly into the epidural space –
the area between the dura mater (the outer membrane of the spinal
cord) and the vertebrae – to deliver medication directly to the site
of inflammation. These injections are given under fluoroscopy
(X-ray) and can be done in a series, if necessary, to provide pain
relief. At CC4PM we
perform many of these injections using
the
transforaminal technique
(see animation on PATIENT EDUCATION and MEDIA PAGE), which provides
in most cases a better response than traditional approaches.
v
Qutenza®
Patch treatment for Shingles:
Shingles (herpes zoster) is caused by the varicella-zoster virus (VZV)—the
same virus that causes chickenpox. After recovery from chickenpox,
the virus becomes dormant in some nerve cells. If the virus
reactivates and becomes active again in adults, it is called
shingles. When VZV surfaces again, it travels along the nerves in
the skin, causing a rash, blisters, and pain. In some people, the
pain continues after the shingles rash has healed. This is called
postherpetic neuralgia (PHN). PHN pain results from nerve damage
caused by the virus. Qutenza®, a unique, FDA-approved
patch that can provide 3 months of pain relief from a single,1-hour
application. Qutenza® targets the nerves in the skin, and
is a non-narcotic. It has no contraindications and can be used alone
or with other pain medications. For more information, see
www.qutenza.com.
v
Discogram:
This is a test in
which contrast fluid is injected into a disc in your spine. The test
helps pinpoint what is causing your back or leg pain. It is often
done when certain treatments for your pain are being considered. As
part of the test, an image of the disc is taken. This image shows
where and how the disc is damage.
v
Functional
Anesthetic Discogram (F.A.D.):This
is the most comprehensive test available for axial, or low, back
pain. F.A.D. is performed
by inserting a thin flexible catheter into the nucleus of each
suspected disc. The patient is able to stand with the catheters in
place and perform the activities that typically generate their axial
back pain. Your CCPM physician is then able to isolate the source of
your low back pain by selectively anesthetizing the discs in
sequence. Patients are monitored for improvements in pain score as
well as range and fluidity of motion. This permits an accurate
determination of whether the pain is discogenic vs. non-discogenic
as well as an evaluation of the pain contribution by each disc.
v
IDET(“Intradiscal Electrothermal Therapy”):
This is a significant medical advancement in the treatment of
contained herniated discs. Because of its new technology, IDET is a
minimally invasive procedure. It is a fast treatment that requires
only local anesthesia and a mild sedative. Recovery is rapid with no
bracing necessary. The procedure is much like having an epidural
steroid injection. First, you will be given a local anesthetic.
Then, your doctor will insert a needle into the center of the
herniated disc. The needle emits radio waves that dissolve excess
tissue, reducing the size of the bulge. This relieves the pressure
in the disc and also against the nerves. When the pressure is
relieved, the symptoms are minimized. Disc Nucleoplasty new
technology allows for a quick recovery. For more information see
www.smith-nephew.com.
v enSpire™
Interventional Discectomy System:
Another new
technique for the surgical removal of herniated disc material that
is pressing on the surrounding nerves or spinal cord is the enSpire™
Interventional Discectomy System. A small needle-based tool is used
to cut, grind and aspirate disc tissue for lumbar discectomy
procedures. A unique, expandable (up to 7 mm) spiral cutting wire is
deployed through the small needle to mechanically remove selected
disc tissue. The quantity of tissue can be easily confirmed visually
and may be sampled for pathologic study. With this needle-based
procedure, CCPM’s physicians may achieve results similar to those
achieved with surgical discectomy in contained herniated discs, but
with minimal tissue disruption or scarring. For more information see
www.spineview.com.
v
M.I.L.D.® (“Minimally Invasive Lumbar Decompression”):
Lumbar Spinal Stenosis (LSS) is a narrowing of the lower spinal canal
that causes pressure on the nerves and leads to pain and immobility.
M.I.L.D. is a groundbreaking new procedure for the treatment of LSS
that safely and therapeutically reduces pain and improves mobility
while maintaining the spine’s structural stability. During the
procedure, the physician uses M.I.L.D. devices to remove small
pieces of bone and tissue causing the pressure on the nerves.
Performed under image guidance through a 5.1 mm M.I.L.D. Portal
(about the diameter of a pencil), M.I.L.D. requires only an adhesive
bandage for closure. Many M.I.L.D. patients report immediate relief,
and most go home the same day. For more information see
www.vertosmed.com.
v
TruFUSE® Facet Fusion
Technique:
The wearing
down of the facet joints, which are the large joints that connect
each vertebrae to another, can be caused by degenerative joint
disease such as osteoarthritis as well as other causes of spinal
instability. An innovative spinal surgical solution for such
conditions is the TruFUSE® procedure.
Performed minimally invasively in
less than 30 minutes, the technique involves using fluoroscopy to
localize the affected facet joint. A self-centering spatula aligns a
drill guide into the plane of the joint, and a specialized reamer is
then used to create a taper-shaped tunnel at the midpoint of the
facet. An oversized TruFUSE®
dowel is impacted into the joint. The dowels perform several
functions: separate the arthritic joint surfaces to reduce
inflammation; stretch the anterior joint and create a fit to enhance
stability; and optimize the environment for facet fusion. TruFUSE
offers many potential benefits, including rapid recovery time,
minimal tissue and blood loss, and lower risk of infection.
Additional information can be found at
www.trufuse.com.
v
Vertebroplasty: This is a minimally invasive treatment for patient suffering from a weakness of the vertebral body. This procedure stabilizes the vertebral body by using medical grade cement that is injected into the vertebral space and hardens immediately to provide needed support and decrease the pain.
v
Balloon
Kyphoplasty: Balloon
kyphoplasty is a minimally invasive treatment that can repair
Vertebral Compression Fractures, which are primarily caused by
osteoporosis and certain types of cancer. Orthopaedic balloons are
used to lift the fractured bone and return it to the correct
position. The balloon is then deflated and removed, creating a
cavity within the vertebral body. The cavity is then filled with a
special cement to support the surrounding bone and prevent further
collapse. The cement forms an internal cast that holds the vertebra
in place. Generally, the procedure is done on both sides of the
vertebral body. The incision site is small, approximately 1 cm in
length. Performed under local or general anesthesia, this procedure
usually takes less than an hour and may require an overnight
hospital stay as determined by the physician after completion.
Balloon kyphoplasty can make it easier for patients to return to
everyday activities such as walking, bending or lifting with
significantly less pain than they had prior to the procedure. It has
been performed world-wide since 2000.
v Radio frequency (RF) Lesioning or Ablation (RFA): RF is used to interrupt pain signals by heating up and destroying specific nerve tissue. The RF energy is applied through a small needle the physician places in the area of your pain under the guidance of fluoroscopy (X-Ray). This procedure is done under a light sedation and using local anesthesia in a hospital setting. This technology can provide lasting pain relief and has a wide range of useful applications to control your pain.
v Spinal Cord Stimulation: This implantable medical device is very effective in treating chronic pain that is due to nerve damage or neuropathy. Before a stimulator is permanently implanted you must go through a trial period (Stage 1) with a temporary system. Depending on your pain pattern, the physician may insert one or two leads in to your epidural space. These leads conduct electrical current that masks or blocks the pain signals to your brain and replaces it with a tingling or massaging feeling called “parenthesis.” The trial period is usually 1-3 days. If you are pleased with the pain relief you will be scheduled for the permanent implant (Stage 2). Stage 2 involves the same lead placement as the trial but the leads are placed under your skin and connected to an IPG (Implantable Pulse Generator) or Radio Frequency system. For more details, see www.ans-medical.com.
v Intrathecal Drug Pump (implantable programmable pain pump): This implantable medical device can be effective at treating chronic nociceptive pain (i.e., neuronstimulation caused by injury, inflammation, or disease). Before a pump is permanently implanted you must go through a trial period (Stage 1) with a temporary system. A small catheter is placed in your intrathecal space of your spine where medication is released to reduce or control your pain. This trial is usually 1-3 days. If successful at providing relief, you will be scheduled for the permanent pump. Similar to your trial, a catheter is placed in your intrathecal space of your spine and then connected to a pump that has a reservoir that holds very concentrated medication. This pump comes in various sizes and dosing technologies. Discuss with your physician what technology would be best for your condition. See www.medtronic.com for more details.
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