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WOMEN'S HEALTH

 

Breast Cancer related pain

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BACK AND SPINE

 

Post laminectomy syndrome

Failed back syndrome

Neck pain

Chest thoracic spine pain

Low Back Pain
Sacral pain
Herniated Disc
Spinal Stenosis
Whiplash Syndrome
Arthritis
Scoliosis
Kyphosis
Spondylolisthesis
Spinal stenosis
Radiculopathy
Degenerative disk disease


CONDITIONS TREATED

 

Breast Cancer related pain

Cancer pain

Carpal Tunnel syndrome

Complicated pain patterns
Connective Tissue diseases (Crest Syndrome)
Depression and chronic pain
Facial pain
Failed back surgery syndrome
Feet pain
Fibromyalgia
Headaches - all types
Hypermobility
Joint pain - knee, hip, shoulder, ankle
Low back pain
Myofascial pain/soft tissue injury
Neuralgias/Neuropathies (Nerve Pain)
Pelvic pain
Motor Vehicle car accident - "whiplash" pain
Repetitive strain
Spinal pain/back/neck
Sports injuries
Sympathetic pain syndromes
TMJ Temporomandibular Joint Dysfunction


TREATMENT

 

Interventional Injections

Epidural steroid injections cervical thoracic lumbar

Facet block

Iliopsoas compartment block

Paravertebral-median branch nerve block

Peripheral nerve block

Plexus Anesthesia
Trigger point injections
Sacroiliac joint block SIJ
Selective nerve root block SNRB
Sympathetic ganglion nerve block
Nerve Modulating Procedures
Radiofrequency nerve ablation
Spinal cord stimulator


PHYSICAL THERAPY

 

 

 

 

Radiofrequency nerve ablation

Some patients experience pain from arthritic calcified facets or degenerated chronically inflamed sacroiliac joints. In these patients facet injection and sacroiliac joint injection may give only temporary pain relief. The condition of the spine may be such that the underlying problem cannot be completely fixed. Radiofrequency nerve ablation is a viable option. Radiofrequency nerve ablation is a technique used to heat the medial branch nerve, abnormal facet and sacroiliac joint. The heat actually causes thermal injury to the nerve. Again, one must remember that the cervical, thoracic and lumbar spinal levels have multiple neural innervations. For example, if a physician wants to perform a radiofrequency ablation for an L4 - L5 facet, the nerve from the level above, as well as the level below, must also be ablated. Pain relief from radiofrequency ablation can last anywhere from six months to two years. If performed correctly, radiofrequency ablation offers minimal risk. The thermal lesion is very controllable in size, and the procedure is performed with fluoroscopic guidance. Additionally, prior to thermal ablation, testing occurs to avoid inadvertent motor nerve damage.

 

Radiofrequency nerve ablation technique.
Graphic courtesy of Stryker                      

 

Case - Right Buttock Pain
An 81-year-old male with Parkinson’s disease presented with severe right buttock pain following a right total-hip arthroplasty. When initially evaluated, the patient’s buttock muscle was almost “rock hard” due to chronic contraction. Treatment began with sacroiliac joint injection and gluteal trigger point injections, and the patient slowly made some improvement. Weightbearing spine films revealed advanced degeneration of the lumbar facets, most likely irritated when the new artificial hip abruptly changed his body mechanics. The patient experienced significant pain relief with lumbar facet injections, as well as with sacroiliac injection; however, relief would only last a day or two. Eventually he underwent radiofrequency nerve ablation in the lower three lumbar facets on the right and in the right sacroiliac joint. The patient reported almost complete relief of his pain.

 

   
Sympathetic pain syndromes

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Sympathetic pain syndromes