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How Can Radio Frequency Ablation Help Manage My Pain?

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Radio frequency ablation is a minimally invasive procedure that doctors typically use to relieve pain in your neck and back. It uses a device known as a radiofrequency lesion generator, which heats small nerves. This procedure severs the nerves that send pain impulses to joints or fractures in your spine.

What is this procedure?

The doctor initially uses nerve blocks to identify the specific nerves that are causing pain. In a second procedure, the surgeon places needles near the target nerves and uses the radiofrequency lesion generator to deliver a small amount of electrical current to the needles. The surgeon is able to control the level of current very precisely, ensuring that the nerves receive the correct amount of heat. The surgeon then withdraws the needles, ending the procedure.

Who is a candidate?

The best candidates for radio frequency ablation have pain in their back or neck due to facet-joint diseases like arthritis. Facet joints are known as true joints because they have a joint capsule, cartilage lining and synovial joint fluid. These joints are located along the entire length of the spine from your lower back to your neck.

What results can I expect?

A 2007 study on radio frequency ablation showed that this procedure provides effective long-term relief of pain in the back and neck. The results of this study included a long-term decrease in pain for 75 percent of these patients. Other major studies on this procedure show similar results. The most likely reason for radio frequency ablation being ineffective occurs when the specific nerve causing the pain can't be identified.

What are the risks?

Radio frequency ablation is generally safe. The most likely risks are common to all procedures that involve injection, which include pain and swelling at the injection site. Major complications of this procedure are very rare, and primarily consist of damage to major nerves.

To schedule an appointment with Dr. Vu please contact our Orange County Pain Management Center to see which location is best for you. 

What is Intradiscal Electrothermal Therapy?

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Our pain management clinc specializes in a variety of options for the management of chronic pain. One of the options is Intradiscal Electrothermal Therapy (IDET) is a minimally invasive procedure that involves threading a catheter into one of the vertebral discs that lie between the vertebrae in the spine. The catheter contains a thermal coil that heats the vertebral disc, which destroys the small spinal nerves for that disc. The most common use of IDET is the treatment of low back pain originating from the vertebral disc, known medically as discogenic low back pain.

Who is a candidate?

The best candidates for IDET have had discogenic low back pain for longer than six months that hasn't responded to convention treatments. The patient's primary complaint should be low back pain that originates from only one disc. Patients younger than 55 years will have better results due to faster healing.

What is the procedure?

The surgeon uses a local anesthetic to numb the skin, inserts a needle into the target intervertebral disc using a fluoroscope to guide the insertion. After the needle is properly positioned the surgeon inserts a catheter through the needle. The needle is rapidly heated from body temperature to 60 degrees Celsius, and then slowly heated to at least 80 degrees Celsius.

What can I expect afterwards?

The pain relief from IDET will be gradual and may even increase for the first week. Significant pain relief from this procedure often requires at least eight weeks and you will typically obtain the maximum relief from pain within four months. You will typically need to avoid heavy labor for the first four months after IDET.

What are the risks?

IDET has a low risk of side effects. A 2001 study of 35,000 IDET patients showed that six of these patients experienced nerve root injuries. Five of these cases completely resolved and the remaining case was still resolving at the conclusion of the study.

What is a Intrathecal Pump?

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An intrathecal pump is a device that delivers medication into your spinal cord through a catheter. It's most common use is to treat pain that originates from the spine with painkillers such as Dilaudid and morphine. An intrathecal morphine pump operates continuously, allowing patients to reduce the medication they must take orally.

Who is a candidate?

The best candidates for an intrathecal morphine pump have severe, chronic back pain that doesn't respond to other treatments. Common causes of this type of pain include cancer, failed back syndrome and reflex sympathetic dystrophy.

Who should not have this procedure?

All patients must pass a screening process before receiving an intrathecal morphine pump. This procedure is contraindicated in patients taking blood-thinning medication such as Coumadin. Patients with active infections should also avoid this procedure.

What is the procedure?

The procedure for implanting an intrathecal morphine pump consists of two stages. The first stage involves the doctor manually injecting the medication to assess its effectiveness and check for any side effects. The doctor will then implant the pump if this trial effectively relieves your pain.

You will typically lie on your side during the implantation procedure, although you may also sit up during this process. Your vital signs will also be monitored, including blood oxygen, blood pressure and heart beat. The doctor will clean your skin with an antiseptic solution and insert a needle into your lower back while using an X-ray machine to guide the correct placement of the needle. The doctor will then insert a catheter through the needle and connect the catheter to a pump. The pump will be attached to the side of your abdomen.

What should I expect?

You will receive a local anesthetic to numb your skin and deeper tissues, although you will still experience some discomfort. You will usually receive a sedative intravenously, making the procedure easier to tolerate.

If you'd like more information about how an intrathecal pump might benefit you for the management of pain. Please contact our Orange County Pain Management clinic

What is a Discography?

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A discography is a diagnostic procedure used on patients with back pain, typically for the purpose of planning surgery to the lower back. It involves the surgeon inserting a needle and obtaining the patient's response to determine the most effective approach to the surgery. Doctors most often use discography to plan a lumbar fusion.

Who should get a discography?

The best candidates for a discography have disabling low back pain that resists many forms of conservative treatment. Patients with pain in their groin, hips or legs may also be good candidates for this procedure. These patients typically require surgery to treat their pain.

What will the surgeon do?

The surgeon will start an intravenous line in case you require pain medication during the discography, although you need to be fully alert for the procedure to be completely effective. You'll also receive a local anesthetic to numb your tissue from your skin to the surface of the target spinal disc. The surgeon will insert a guide needle towards the disc until it reaches the disc's surface. The next step is to insert a disc needle through the guide needle and into the disc. The final step of this procedure is to pressurize the disc by injecting a sterile fluid into the disc.

What will I do?

You will provide the doctor with information during the procedure, primarily to report when you feel pain, pressure and nothing at all. You may also need to further classify the pain into familiar pain and unfamiliar pain.

What are the Risks?

The risks of a discography are very rare when an experienced surgeon performs this procedure. The most significant complication is an infection in the disc space, due to the difficulty of treating this type of infection. A discography also carries a remote risk of a spinal headache and an extremely unlikely chance of a nerve root injury.

To learn more about Discography and other pain management options, please contact us at any of our Orange County Pain Management locations.  

Using a Spinal Cord Stimulator to Treat Failed Back Surgery Syndrome

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A spinal cord stimulator transmits electrical signals directly to the spinal cord, primarily for the purpose of controlling chronic pain. The insertion of an spinal cord stimulator is a surgical procedure that requires a trial period to achieve satisfactory results. Physicians was often use this device to treat failed back surgery syndrome, although other conditions that cause back pain may also be suitable for treatment with SCS.

Procedure

An SCS primarily consists of a set of electrodes and a generator. The generator produces electrical pulses that are transmitted to the electrodes through conducting wires. The surgeon places the tips of the electrodes into the epidural space of the spinal canal and adjusts the electrical pulses with a set of controls. The trial period lasts for 5 to 7 days, after which the physician will secure the electrodes to interspinal ligaments.

Indications

Failed Back Surgery Syndrome (FBSS) is the most common use of SCS in the United States, primarily due to the persistent pain in the lower back and legs that is common in FBSS. Ischemic limb pain caused by an inoperable condition is also a popular use of SCS in Europe. Physicians may use SCS to relieve the pain caused by frequent migraines, and this procedure also stimulates the release of norepinephrine in cases of angina pectoris.

Benefits

The specific results of spinal cord stimulator depend on factors such as patient selection, surgical technique, postoperative testing and patient education. SCS shows good to excellent results in the long-term relief of chronic pain in 40 to 70 percent of patients. A study published in a 2005 issue of Clinical Neuroscience reported that 24 percent of patients were able to attain gainful employment or perform housework after treatment with SCS. Some of the patients in this study also received pain medication in addition to treatment with SCS.

Complications

SCS carries the risks that are common to all surgery such as adverse reactions to anesthesia, infections and bleeding. The complications that are specific to SCS primarily include unpleasant sensations from the SCS pulses. These sensations have a variety of causes such as loose connections, changes in an electrode's position and changes in the tissue surrounding the electrodes. A misplacement of the electrodes when they are inserted can cause more severe complications such as compression of the spinal cord and paralysis.

To learn more about pain management with a Spinal Cord Stimulator or the options availible to you please contact us to learn more.