Tag Archives: Interventional Pain Management

Controlling Pain and Interventional Pain Management

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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.

Jane Fonda fitness video

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

Knee Pain Relief and the Confessions of a Big Baby

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Written by an Orthopaedic & Spine Center Staffer (who shall remain anonymous)

My knees ache! Carrying around this extra weight for all these years is not helping. “Lose weight”, says my doctor. How can I exercise to get the weight off when my knees are so painful? It is a vicious cycle: Lose weight with more exercise to stop aching; can’t exercise to lose weight because my knees ache from all the extra weight! My friend had a cortisone shot in her knee (done by her orthopedic specialist) and said it helped her pain for at least two months. Forget it! Just pass the potato chips and the foot stool! Steroid shot? No way, I hate needles!

Orthopedic specialist Dr Boyd Haynes III MDIf I can just talk myself into the shot, I could get relief from my pain and start exercising to lose the weight, I could then stop the pain for the long haul. That seems like a much better cycle to be in.

Perhaps there is some comfort in knowing that the stuff inside the needle is actually a synthetic version of a substance that is produced by our own bodies. When our bodies are under stress, the adrenal gland produces cortisone that is released into the blood stream. However, the cortisone produced by the body does not last long and it is definitely not going directly to my bad knees. When a patient is given an injection to the knee, the cortisone goes right to the area of the problem. Now, cortisone is not going to relieve the pain, but it relieves inflammation, which can cause pain. It may also take a few days to work, but lasts much longer than the steroids our bodies produce.

On the outside of the skin, an anesthetic will be used so the injection site shouldn’t hurt. Since the cortisone may take a few days to make a difference in my discomfort, an anesthetic like Lidocaine or Marcaine may be included in the injection to numb my pain, fortunately with the same needle!

OSC pain spoecialists Dr Jenny Andrus and Dr Raj Sureja

Dr Jenny Andrus & Dr Raj Sureja - Interventional Pain Management Specialists

There might also be some comfort in knowing that the orthopedic physician has very specially trained hands that will use ultrasound to guide the injection. The ultrasound wand is placed near the site of the injection and the computer screen shows the physician exactly where the needle should go for the synthetic cortisone to provide the most benefit. It would be amazing to see the inside of my knee on the computer! It is reassuring to know that it is not just a random, blind jab, but a carefully guided placement of medicine. Having this information really helps calm my nerves about this procedure.

So, now that I have gained power through knowledge, I will take a deep breath, cover my eyes and invest in my future health!

Different Types of Epidurals

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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

Once, Twice, Three Times an Epidural!

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A Real -Life OSC Patient Talks About Her Pain Management Experience and Use of Epidurals

Hello, it’s me! (that was also the title of a great Todd Rungren song in the 70s)

Yes, I am back again and this time, it is to talk about having epidurals, not once, not twice, but three or more times.

Back in 2011, during the early summer, I had an epidural injection (which didn’t work) quickly followed by another epidural injection (that did work). The second epidural injection was one or two discs lower that the first one, but it really did the trick! I lived almost totally pain-free for about 7 months. Yes, I might get a minor twinge here and there, if I slept wrong, but the relief from the epidural injection was palpable and wonderful! I had forgotten what it was like to have pain free nights, able to sleep restfully and days at work that were not marred with searing pain in my neck, trapezoids and shoulder region. It was sheer bliss, and for someone who hates needles and passes out very easily, I have become the world’s biggest advocate of epidurals,because they work!

Dr Jenny Andrus M.D.

Dr Jenny Andrus - Interventional Pain Management Specialist

So, now that I am starting to feel pain again, I ran, not walked, to schedule my next epidural, because I want the pain relief that it afforded me. I began to wonder, just how many epidurals can you have safely over a year or over a lifetime? To answer my question, I consulted Dr. Jenny Andrus, a Pain Management Specialist here at OSC. Dr. Andrus told me that you can safely have multiple epidurals in a year, but usually not more than 3 or 4. Too much steroid can be a bad thing, so a good physician makes sure to monitor how much steroid is administered to an individual over a certain period of time. A person who has a herniated disc or other spinal issue can safely have epidurals through-out their lifetime for pain management. This is wonderful news for persons who cannot have surgery for medical reasons or for those who just choose not to have spinal surgery. Sometimes, as in my case, better pain relief is afforded by having two injections, at different vertebral levels, done closely, within a few weeks. This gets a good amount of steroid near the inflamed nerve root, allowing it to heal, the inflammation to lessen and providing pain relief. It is amazing how much misinformation there is about epidurals, but if I can help to set the record straight, I am happy to do so!

Contact Dr Jenny Andrus for a consultation through Orthopaedic & Spine Center

Tel: (757) 596-1900

Email: info@osc-ortho.com

 

My Second Steroidal Epidural Procedure!

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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.

 Pain management specialists Dr Raj Sureja and Dr Jenny Andrus

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

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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

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????

 

Preparing for my Cervical Epidural Steroid Injection

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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???

pain relief with epidural
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
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!

Interventional Pain Management Providing Innovative Pain Relief

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More than 75 million Americans suffer from chronic, debilitating pain, according to the National Pain Foundation. In 2003, Research America released the results of a survey of 1,000 people in the United States that showed that 57% of all adults have had chronic or recurrent pain in the last year and that 75% of people currently in pain had to make adjustments to their lifestyle due to their pain. Chronic pain also accounts for more than 80% of all physician visits and leads to time off work and billions of dollars in lost productivity. With the prevalence and the exorbitant cost involved, it would seem only natural that health care workers would be clambering to find better ways to treat this epidemic problem. Unfortunately, this is not the case, and thus pain remains poorly understood and grossly under-treated. The complex mechanisms of pain transmission coupled with its inherent subjective nature creates an intimidating battle and requires physicians who are both comfortable with its diagnosis and more importantly who have an appreciation for the art of treating those in pain.

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