Controlling Pain and Interventional Pain Management

Posted on May 16, 2012 by osc

Exercise Properly and Throw No Pain, No Gain Out the Window

by Orthopaedic & Spine Center Staff – Call (797) 596-1900 for consultation

We have all heard the phrase “No pain, no gain.” Often these words are grunted by gym rats in a workout facility (insert clip “I pick things up and put things down”). In fact, Jane Fonda is credited as popularizing the motto in the early 1980s, during her “aerobic video” phase. She encouraged us to keep pushing ourselves to feel the burn as we worked our muscles to exhaustion in our living rooms. The motto encourages us to keep trying, keep pushing, keep going, even if it hurts.

Apply these words to everyday life: Is this a healthy way to live? Is it in our best interest to keep tolerating the pain? Does it do any good to ignore our own suffering?

The answers to these questions are a resounding no, no and no!

Doctors generally class pain into 2 types, nociceptive and neuropathic. Nociceptive is a result of an injury to a part of the body, such as a muscle or bone. The pain is in one place and constant, and when the damage heals, the pain usually goes away. Examples are bumps, bruises, broken bones, and burns.

Neuropathic pain is more complicated. It is the result of an injury or problem with the nerves, and is often triggered by an injury or surgery. The injured nerve stops working properly and sends the wrong signals to the brain. Nerve pain is often difficult to diagnose because the pain results from an issue inside your body, not on the outside. It can be related to a number of medical conditions such as diabetes, shingles, cancer, carpal tunnel syndrome, a failed surgery or it can be from a totally unknown cause. Symptoms can include tingling, numbness, burning, or a “pins and needles” feeling.

When not properly managed, any type of pain can affect your quality of life. Simple acts can be agonizing. You may have difficulty sleeping at night or trouble concentrating, be unable to work or feel hopeless that no relief is in sight. There are options for you to effectively manage your pain and continue to live an enriched and productive life. Make an appointment with an Interventional Pain Management Specialist to hear about medicines and procedures that may help you feel better.

OSC's Interventional Pain Management Specialists

Dr Jenny Andrus and Dr Raj Sureja

Visit www.osc-ortho.com to learn more about Dr. Raj Sureja and Dr. Jenny Andrus, the OSC Interventional Pain Management Specialists, and the procedures they do to help patients improve their quality of life. Throw the motto “no pain, no gain” out the window and start living your life to its fullest again!

Contact Orthopaedic & Spine Center for a consultation on (797) 596-1900

Different Types of Epidurals

Posted on March 20, 2012 by osc

An Overview of the Different Types of Epidural Injection Used for Interventional Pain Management

Did you know that there are different types of epidural steroid injections? Everyone thinks of an epidural as the procedure you have to relieve pain and make you go numb before having a baby. But, this kind of epidural is different from the steroid epidural that is done, either within the cervical or the lumbar spine, and which provides long term pain relief.

First of all, you should only seek care from a skilled physician who has experience in providing epidural injections. At OSC, Dr. Mark McFarland, a fellowship-trained spine specialist does them in the lumbar spine, as do the two Interventional Pain Management Specialists (Dr Jenny Andrus & Dr Raj Sureja), who do cervical and lumbar. The facility where your epidural is being performed should use fluoroscopy (a special X-ray using dye) to make sure your epidural is being done in the right place and that it is not being done “blindly”. At OSC, we have two state-of-the-art “C ARM” fluoroscopy machines. They are called “C Arms” because they look like a great big letter “C”.

It should be noted that an epidural does not penetrate into the spinal cord, the vertebral bone or into the spinal nerves. The physician will look for the epidural space, near the nerve that is inflamed and will place the medication near the nerve itself. At no time should the needle ever enter the spinal cord. Sometimes patients believe this to be true and it frightens them away from having an epidural.

You can get an epidural in your cervical spine (neck) or in your lumbar spine (lower back). The cervical epidural is used for pain that is caused by some kind of problem in the cervical spine, like a disc herniation or spinal stenosis. However, the pain can be felt in the neck, head, shoulder, or arm. The lumbar epidural is for problems with the lumbar spine, characterized by pain in the lower back, buttock or leg. Cervical Epidurals usually provide pain relief for patients anywhere from a few months to several years. Lumbar epidurals typically do not last quite as long and can provide pain relief for up to a year in most cases.

Intralaminar Epidurals are most commonly performed and involve the injection happening in the middle or mid-line area of the spine. Sometimes this approach works well and provides pain relief. In cases where the nerves along the side of the spine are inflamed or where there are discs that are herniated to either side, a Transforaminal Epidural may be best. These Epidurals are done with a more diagonal or side approach so that the affected nerve(s) and or disc can be better treated.

Contact Orthopaedic & Spine Center today for a consultation.

Tel: (757) 596-1900

Email: info@osc-ortho.com

My Second Steroidal Epidural Procedure!

Posted on January 15, 2012 by osc

A Patient’s Journey to Pain Relief with OSC Orthopedic Associates

After my initial epidural procedure failed to give me as much pain relief as I was hoping for, Dr Mark McFarland recommended I try a second cortisone procedure before moving to the surgical option to remove the herniated disk.

I head into to see Dr. Raj Sureja for my second cervical epidural – cue dramatic drum rolll please

I found this great Youtube video by Dr Sureja explaining the process of injecting cortisone into the spine and why this helps relieve pain:

This time, I am much less anxious about what my experience will be. Knowledge is power, right? I know that I might get dizzy or feel faint, but I also know that the epidural really doesn’t hurt and that it will be over soon.

Dr. Sureja comes in and is his usual gentle and wonderful self. He decides to do my epidural at a level below the last one, to see if this time, I get some relief from the medication.

I lay down on my stomach on the table and again, during the procedure, I being to feel faint. I hate the fact that I just get so faint whenever I am scared or feel pain. Dr. Sureja says it is the Vagus Nerve Reflex that causes this and that it happens to other people as well. Luckily, this time, I recover from my faintness very quickly and my blood pressure does not drop as low. After a short waiting period after the procedure, I am released into the care of my long-suffering in-laws, who have again volunteered to pick me up and take me home.

Dr Raj Sureja with orthopedic colleague, Dr Jenny Andrus of OSC

When I arrive home, I quickly get my ice pack and head for the bed, to lay flat and to ice the injection site. I pray that I will not get the severe headache that I got last time, so I try to lie still, watch TV and nap. After a few hours, my husband comes home from work and fixes me dinner. I am just fine to get up and eat at the table. Later that evening, I do experience some leg jitters and insomnia. However, these side-effects are nothing compared to those that I experienced after the first epidural. Hallelujah, no headache, no flushing and no other problems! The whole experience seemed to go much more smoothly, in large part, because I wasn’t so afraid and I didn’t work myself up before I went to have the injection. Now, the fun part begins…waiting to see if I feel better.

Next time…..Second Time is a Charm!

After my Cervical Epidural Injection

Posted on December 12, 2011 by osc

What Happened After my Cervical Epidural Steroid Injection

I went home after my epidural and continued to experience light-headedness, so I went and got in bed, laid flat and watched TV. OSC’s Dr Sureja gave me an instruction sheet to help after the procedure, and I immediately followed the instruction to ice the injection site, so I did.

My instruction sheet also gave a list of potential side-effects and complications to watch for and what to do should those occur. Infection, nerve damage, bleeding, and a dural puncture were all discussed as rare, but possible complications. More commonly, the side-effects possible were dizziness, pain at the injection site, flushing, leg pain, headache, high blood pressure, elevated blood sugar, anxiety or irritability, weight gain.

Dr Jenny Andrus

Unfortunately, I experience several of the side-effects, starting with leg pain and heaviness. I also experienced a lot of flushing and feeling hot. However, armed with the knowledge that these side-effects were common and although uncomfortable, not life-threatening, I dealt with them. I took a long hot bath as I was having leg pain and I could not sleep. I continued to ice my neck throughout the night, on-and-off. I started getting a headache early in the morning and by 9:00 AM, it was very bad. I did not go in to work.

So I called the practice and Dr. Sureja’s partner, Dr. Jenny Andrus at OSC, phoned in a mild pain prescription for me. She said to let her know if I did not get relief in a few hours. I took the medication and quickly started to feel better. I felt pretty much back to normal in about 24 hours after the epidural. After that time, I did not experience any more or continued side-effects. Dr. Sureja told me that the epidural might work well within a few days, might take a while to feel better or might not work at all. I certainly wanted it to work and I was willing to wait a few days to see if I began to feel relief from my chronic neck and shoulder pain.

Next time….Pain Relief…YES or NO????

E (Epidural) Day – Interventional Pain Management

Posted on December 11, 2011 by osc

Pain Relief through an Epidural

Following from my last post, with much fear and trembling, I checked in to the OSC MRI and Fluoroscopy Waiting Room for my Cervical Epidural. I was taken into the Fluroscopy Suite by Mary, Dr. Sureja’s nurse and by one of our Radiology techs, Debbie. They gave me a gown to change into (although I could keep on my bra and everything from the waist down), put on a surgical cap (kind of like a shower cap) to hold my hair, and helped me to get situated on the procedure table.

The procedure table is very comfortable. I was told to lay on my stomach with my face in a round cushion, which was open so that I could breathe and see. Kind of like a massage or PT table. Dr. Raj Sureja came into the room and started talking to me and he was so kind and reassuring. He explained every step of the procedure and told me exactly what to expect. He told me that he would talk to me to keep my mind off of what was going on OR that he would be quiet, if that would help me get through my fear. I told him to talk to me, so he did.

First, he injected numbing medication into the area where he would do the epidural. My injection area was in the back of my neck, near the intersection of my neck and shoulders. This shot barely hurt at all and only for a moment, but I still started to feel hot and faint. Mary and Debbie turned on a fan and blew it on me to cool me off. Dr. Sureja took pictures of my spine and herniated disc with the fluoroscopy machine and then inserted the catheter into my neck, through which he would place the steriod medication. He continually took pictures of my spine to make sure he was placing the medication correctly. He was very gentle and I cannot say this enough, patient and kind. Although, at this point, the epidural did not hurt, I must say it felt weird.

It was over very quickly and unfortunately, I was very faint feeling, so it took me a while to sit up and feel better. They got me some water and let me sit awhile until I started to feel better. They were concerned because my blood pressure dropped and that was why I was feeling so light-headed. They put me in a room and continued checking on me and taking my blood pressure until I felt normal. Then they released me to go home, with an instruction sheet and into the custody of my in-laws, who drove me home. When you have an epidural, you have to have someone to drive you home, because you may experience dizziness or headache or just feeling funny. It was nice to have someone to worry about the driving. All I wanted to do was go home and rest. Even though I got faint and felt silly, I made it through the procedure! Hopefully, it will help!

Next time, the day after!

Preparing for my Cervical Epidural Steroid Injection

Posted on December 8, 2011 by osc

Interventional Pain Management with OSC’s Dr Raj Sureja

Okay, I think that I have told you in my previous blog posts that I am a BIG CHICKEN and TERRIFIED of needles. So, it should come as no surprise to you that I was facing the prospect of having an epidural injection into the space surrounding my spinal column with great fear and trepidation. I could lie to you and tell you I had no fear, because I work for OSC and have faith in the physicians here. But, no matter how much I trust them and their skill level, I was still scared to death.

A needle, not only in my back, but in my spinal canal???

Am I crazy???

: Schematic of Epidural Injection

When the pain becomes so bad, that your life is affected everyday by your plans to manage your pain and how many activities you can complete during the day before your pain gets too bad, and how much time do you have to spend in the tub or lying on the heating pad before your muscles relax enough so that you can get some sleep, you become willing to do things that you never thought you would or could do to get relief. Hence, I made an appointment with Dr. Raj Sureja, Interventional Pain Management Specialist at OSC, to perform my cervical epidural.

: Dr Raj Sureja with OSC’s Dr Jenny Andrus

In preparation for the epidural, you are given a sheet of instructions that are easy to read and follow. Mostly, you are warned against taking anti-inflammatory medications of any kind for several days before your procedure (this includes Advil and Aleve). They are concerned about the effect that the medications will have on bleeding and any complications that could arise from having the procedure done while on these drugs. The OSC personnel also asked if I had any known allergies to drugs or if I had ever had a reaction to dye during a radiologic procedure. They also checked to see if I could possibly be pregnant or have any other condition that might make having an epidural dangerous.

Given the go-ahead, I stopped taking my anti-inflammatory medications, switched to Tylenol and waited for my appointment! Next time….E-Day!

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