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COMPRESSION FRACTURES: A guide to Alternative treatment options

chase@viralgrowth.marketing (Chase Jacobs) — Mon, 17 Apr 2023 05:47:53 GMT

A compression fracture is just what it sounds like: compression has led to a crushing or cracking of the spine.

This compression can be acute and caused by sudden trauma, or it can occur over time due to wear, tear, or a repetitive stress injury.

These fractures can be very painful and debilitating.

Unfortunately, a lot of clinics will tell patients that these fractures will heal on their own.

They may recommend rest, specific types of physical therapy, and pain medications. Some doctors will suggest a brace to help with support and to stop patients from bending over as they heal.

However, these treatments do little to promote healing to the compression fracture itself. Compression fractures occur in the vertebral bodies (back bones), and bones are notoriously slow healers since they don’t have a good blood supply.

To complicate the matter, pain medications such as opioids are often prescribed.

Opioids, and particularly fentanyl, are highly addictive and powerful synthetic drugs.

They might be a good choice for very short-term pain management, but a compression fracture may take several weeks, or even months to heal—if it heals at all.

However, there is an alternative option that provides almost instantaneous relief: Kyphoplasty !

Kyphoplasty is a procedure specifically designed for compression fractures.

The concept is simple: A special balloon in placed into the bone with the compression fracture and gently inflated.

This creates a cavity and essentially restores the height of the compressed vertebral body.

Next, “bone cement” is injected slowly into the cavity and used to reinforce the spine and offer immediate relief and mobility.

It does not get in the way of natural healing, but rather offers a type of reinforcement that’s unmatched in braces.

Plus, kyphoplasty can provide added strength to the spine to prevent future breaks or fractures.

Don’t let compression fractures prevent you from having a quality of life.

Kyphoplasty may be an option for your compression fracture and provide you with immediate relief without needing long term pain medications or a lengthy recovery.

Call or email Interventional Pain and Spine to schedule an appointment with Dr. Vyas and ask about kyphoplasty for your compression fracture.

What Are Epidural Injections?

chase@viralgrowth.marketing (Chase Jacobs) — Fri, 28 Oct 2022 06:32:06 GMT

Are you experiencing ongoing neck and/or back pain? Have oral medications, physical therapy, or other treatments failed to help? You may benefit from minimally invasive epidural injections.

Clinical research studies have indicated that Epidural Steroid Injections (ESI) relieved back pain more effectively than other conservative therapy.

Would you like to find out more about these treatments? The following guide will explain this procedure and some of it’s benefits.

How Do Epidural Steroid Injections Work?

Steroids are powerful anti-inflammatory medications. This means that they work to decrease swelling.

The epidural space describes the area outside the sac of fluid around the spinal cord. Providers inject steroids and anesthetics into this area.

The goal is to decrease swelling that’s pushing on the spinal cord and nerves. Compression in these areas creates pain, numbness, tingling, and weakness.

Reasons To Get An Epidural Injection?

Epidural Steroid Injections are used to safely treat many back, neck, and nerve pain conditions. This allows individuals to resume their normal activities. For some, this may be part of a combination of treatment, including physical therapy.

Some of the various reasons that providers choose ESI include:

Avoiding or delaying the need for surgery
Decreasing the amount of pain medication you’re taking
Decreasing the number of inflammatory markers that increase pain
Increasing your mobility and daily function
Relieving neck pain that spreads to your arms
Relieving back pain that spreads down your hips and legs

Pressure on your spinal cord and nerves can result from several conditions. These include bulging disks, slipped vertebrae, bone spurs, thick ligaments, and joint cysts. Arthritis in the spine can lead to a thickening of the spinal ligaments and compression.

Epidural Injection Tips For Before The Procedure

Make a list of questions to ask your provider so you don’t forget to ask anything in their office. Here are some ideas to get you started:

The name of the procedure?
How this procedure can help your condition?
Benefits and the risks?
Possible complications or side effects?
Who will perform the injection?
Where will the procedure take place?
Will you go home the same day?
How long will it take to see results?
What to do if you have questions or concerns when you get home?

During your visit, be sure to tell your provider if you’re pregnant or plan to become pregnant. Also, describe all your medical conditions such as diabetes or an allergy to contrast dye. Bring a complete list of all medications, supplements, or antibiotics you’re taking.

Be sure to tell them if you take medicines that thin your blood. Examples include aspirin, naproxen, heparin, ibuprofen, warfarin, and clopidogrel.

These could increase the risk of bleeding after the procedure. Your provider may have you stop taking these medicines for a few days before the injection.

The Experience of Epidural Injections Explained

Epidural injections often take place in doctors’ offices, surgical centers, or hospitals. Most patients go home on the same day.

Providers with specialized training administer these injections. Examples include anesthesiologists, neurologists, physiatrists, and spine surgeons. Pain and spine management experts also provide this treatment.

Before the procedure, your provider may give you medication to help you relax.

Your injection site determines how you’ll be positioned for the injection. Most commonly, patients lie face down with a pillow underneath your stomach. You may also lie on your side in a curled position or sit up.

The area is cleaned with special soap, called Betadine or Chloraprep, which feels cold on your skin. This decreases the risk of infections. They’ll often inject numbing agents into and just below the skin to reduce discomfort. This may sting at first before it makes the area numb.

Next, the doctor will insert the needle. Most commonly, they use real-time video X-rays to see exactly where the needle is going. Once the needle is in the epidural space, they’ll inject steroids and numbing medicine.

You may feel pressure, tingling, or burning during the medication injection. Most patients don’t feel pain. It’s important to stay still so that the needle stays in the right place.

After the injection, the provider removes the needle and applies a dressing.

Post-Procedure Expectations

The staff will watch your vital signs for 15 minutes to an hour after the procedure. Once you’re feeling awake, you’ll be sent home. You’ll need to avoid driving and air travel for the remainder of the day.

It’s not uncommon to feel some discomfort at the injection site for a few hours. Ice packs work well to improve your comfort. Your provider may ask you to rest and avoid strenuous activity for the rest of the day.

Some patients experience increased pain for two to three days after the procedure. This isn’t uncommon since it takes about that long for the steroid to take effect. Most people feel pain relief 48 hours to a week later.

Epidural injections can reduce pain for weeks, months, or a year. Unfortunately, some patients may not achieve pain relief and need to explore other treatments.

Possible Epidural Injection Side Effects

Side effects following epidural injects aren’t usually serious. Examples include dizziness, headache, and nausea. The steroid can cause the following symptoms:

Anxiety
Face and chest flushing
Increased temperature
Menstrual changes
Trouble sleeping
Water retention

Some people experience anxiety with the procedure, which can lead to fainting. These symptoms usually get better with rest.

If you develop more serious problems, it’s important to call your doctor at once. For example, look out for increased redness, swelling, heat, and pain at the injection site. Also, call for increased numbness or weakness in your arms or legs, or if having trouble breathing.

These signs may indicate a serious or rare complication such as medication reactions, infection, bleeding, or brain and nervous system issues.

What Is Lumbar Radicular Pain?

chase@viralgrowth.marketing (Chase Jacobs) — Sun, 31 Jul 2022 08:03:17 GMT

The American Society of Pain and Neuroscience (ASPN) issued a new set of recommendations to guide clinicians in the safe and appropriate use of steroid injections for pain management in patients who are receiving the COVID-19 vaccine (J Pain Res 2021;14:623-629).

“The central question that we wanted to deduce and answer is whether a local steroid injection might potentially reduce the efficacy of the COVID-19 vaccine, which relies upon a robust and potent immune response that primes the body to fight the virus,” lead author Krishnan Chakravarthy, MD, PhD, an assistant clinical professor of anesthesiology at the University of California, San Diego, told Pain Medicine News.

Lumbar radiculopathy is one of the most common patient complaints. In fact, three to five percent of the population complain of lumbar radicular pain, and even more people struggle with the pain in silence.

From spine surgeons to pain management physicians, these patients often become frustrated as they have no understanding of what’s happening. It is imperative for these patients to understand what lumbar radicular pain is and what the common treatments are.

What Is Lumbar Radicular Pain?

Lumbar radiculopathy is a kind of disease in the lower spine. More specifically, this condition involves the nerve roots in the lumbar spine. Those with it may experience pain, numbness, and/or weakness in the buttock and/or one of the legs. Often, people use the term sciatica to refer to lumbar radicular pain. If the spinal nerve root becomes compressed, this can lead to lumbar radicular pain. This is the most common cause of the condition.

Because of the compression of the nerve, the pain can refer to other areas. Most often, this pain refers to one of the legs. Delaying care by ignoring the pain can lead to further damage of these nerves and/or nerve roots. Because lumbar pain is so common, your physician is likely to have seen many cases before. They should be able to help you find the source of the problem and get your pain under control.

What Causes Lumbar Radiculopathy?

When the spinal nerve roots become irritated or compressed, lumbar radiculopathy may form. Irritation and/or compression can develop because of mechanical manipulation or result from another condition such as:

Lumbar disc herniation
Spinal stenosis
Osteophyte formation
Spondylolisthesis
Foraminal stenosis

In fact, many degenerative disorders could cause lumbar radiculopathy.

How Can I Get A Diagnosis For Lumbar Pain?

You can get a diagnosis from a spinal doctor, a chiropractor, an orthopedic physician, a primary care doctor, or similar specialist. Whoever you see will look over your medical history and give you a physical examination.

While they’re examining you, the physician will look at your spinal range of motion, movement limitations, balance issues, and sensory issues. These sensory issues may include loss of extremity reflexes, muscle weakness, or abnormal reflexes.

The physician may also decide to get an x-ray or MRI to view your spinal structure. However, if you have a contraindication like a pacemaker or a spinal cord stimulator, you may get a CT myelogram instead of an MRI.

What Are The Symptoms Of Lumbar Radicular Pain?

Not every patient’s lumbar pain is the same. But, here are some of the most common complaints associated with lumbar radiculopathy:

Pain
Tingling
Numbness
Weakness
Loss of reflexes

These kinds of symptoms typically happen in the lower back, buttocks, leg, and foot. The pain can radiate to either leg, but it usually only affects one leg.

If you’re having any of these symptoms, see a doctor as soon as possible. If you continue to use your spine as normal, you could cause more damage. It’s important to get to the root of the problem so that you know you aren’t hurting yourself.

What Are The Treatments For Lumbar Radiculopathy?

If you’re suffering from lumbar radicular pain, there are a few kinds of treatments that your doctor may mention. These fall into two categories: surgical and non-surgical.

Physicians start out by testing non-surgical techniques unless your results show a strong need for surgery.

Non-Surgical Treatments for Lumbar Radicular Pain

There are a couple of non-surgical options for correcting lumbar pain:

Physical therapy
Pain management
Injections

Your physician may decide that you need one, two, or all three. You could even do all of them at once or try two or three at a time. There is no right or wrong order because it depends on your particular case.

Physical therapy can go through a prescription process or involve you doing muscle exercises at home. Either way, the movements that the patient does are meant to stabilize the spine. This can help your body make more room for the spinal nerve roots so that they can decompress. Pain management involves administering medications to someone with lumbar radiculopathy. These can range from non-steroidal anti- inflammatory drugs (NSAIDs) to steroidal medications.

The kinds of medications that your physician recommends will depend on your level of pain and your use of medications in the past. These medications should help reduce swelling and pain.

The injections that you could get include an epidural steroid injection and/or a nerve root injection. These can help reduce swelling and pain that radiates into your hips. It should also be able to help with the pain that radiates down into the leg, no matter which leg the pain is affecting.

Surgical Treatments for Lumbar Radicular Pain

The kinds of surgical treatments that you can have depend on what is causing your lumbar pain. Most of these kinds of surgeries work to decompress the nerve or stabilize the spine.

There are various types of surgical treatments to help alleviate your lumbar radicular pain, including spinal fusion, laminotomy, laminectomy, and microdiscectomy.

These surgeries work to fix deformities in the spine and its nerves. By having the appropriate surgery done, you could find relief from your lumbar radicular pain.

Pain Management For Lumbar Radicular Pain

Pain management for lumbar radicular pain is important. Whether your physician opts for non-surgical or surgical techniques, you need to get the pain under control before additional problems arise.

If you’re looking for treatment options, our team at Interventional Pain and Spine is here for you. We will customize a treatment plan to get you through your lumbar pain.

Steroid Injection Therapy Does Not Compromise Covid-19 Vaccine Efficacy, New Guideline Suggests

chase@viralgrowth.marketing (Chase Jacobs) — Sun, 31 Jul 2022 07:56:03 GMT

“Our conclusion is that, overall, it doesn’t make sense to hold focal steroid therapy from patients in pain out of concern that vaccine efficacy may be compromised, although individual patients may have different needs,” Chakravarthy said.

He added that the committee’s recommendations are “fluid” and noted that they will continue to be updated as new data emerge.

Of note, there is no evidence that patients receiving epidural steroid therapy for the management of pain are at increased risk for adverse outcomes from COVID-19 vaccination.

Epidural steroid injections “represent an integral component of modern-day pain management for many patients,” but they carry a “theoretical risk of immunosuppression from neuraxial steroid administration,” the authors wrote.

A study of IV hydrocortisone administered to healthy adult volunteers resulted in reduced circulation of inflammatory T cells within 48 hours (J Clin Invest 1978;61[3]:703-707). Similarly, an analysis of close to 2,000 serious infection cases in 16,207 patients with rheumatoid arthritis receiving chronic oral glucocorticoids (5 mg) found a 30%, 46% and 100% increased risk for serious infection with continuous treatment for three months, six months or three years, respectively, compared with nonusers (Ann Rheum Dis 2012;71[7]:1128-1133).

Although steroids are systemically absorbed from the epidural space, specific data regarding the efficacy of vaccines in the setting of local steroid injection are “lacking.”

So, “while epidural steroids may be absorbed systemically, based on current dosing strategies and the pharmacodynamics of these injections, they are unlikely to demonstrate the immunosuppressive effects associated with chronic high-dose systemic steroid use,” the authors summarized.

There is no evidence that bolus steroids in the epidural space will affect vaccine responsiveness, according to the recommendations.

Short-term systemic bolus steroids have not been demonstrated to affect vaccine responsiveness in the tetanus or influenza vaccines. Moreover, inhaled steroids “do not appear to affect serologic responsiveness to Hepatitis B vaccination,” the authors stated.

Neuraxial steroid injections do not need to be deferred when indicated in the context of COVID-19 vaccination, according to the recommendations.

Patients with severe immunodeficiency risks (e.g., those undergoing chemotherapy or transplant or who have autoimmune disorders) face decisions regarding vaccine administration versus treatment delay. This dilemma is often determined based on the “perceived severity of the underlying condition for which the patient is receiving steroids.”

Although it may appear that pain treatment, which is elective, is less critical than other immunosuppressive therapies for conditions such as cancer and, therefore, should be delayed until after the pandemic, “this approach does not account for the unique experiences of individual patients and the sense of urgency they feel for achieving pain relief,” Chakravarthy said.

Thus, there is an “ethical component” of the decision: the right of patients to receive effective pain management. This consideration is a component of the “individual and societal trade-offs associated with delays in standard medical care,” which have characterized the COVID-19 pandemic, Chakravarthy noted. No specific guidance suggests withholding nonsteroidal anti-inflammatory drugs (NSAIDs) or other anti-inflammatories prior to vaccination.

The authors thoroughly reviewed research regarding the potential impact of NSAIDs and cyclooxygenase inhibitors on vaccine efficacy. Some research suggests that all of these agents might blunt antibody production, potentially affecting the immune response required for a successful vaccination. However, “overall, the data are inconclusive and insufficiently robust to draw meaningful conclusions and change potential practice algorithms,” they stated.

Placing the Recommendations In Context

Commenting on the study for Pain Medicine News, Giustino Varrassi, MD, PhD, the president of the Paolo Procacci Foundation, in Rome, and a former president of the World Institute of Pain, said he is “personally grateful to the prestigious authors of the publication.”

In fact, the authors “reconfirm what was already known, the clinical use of corticosteroids does not affect the efficacy of vaccines.” The paper’s contribution “makes clear and provides scientific support to these important concepts,” Varrassi said.

Also commenting on the study for Pain Medicine News, Steven P. Cohen, MD, the director of medical education in the Pain Medicine Division, and a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, in Baltimore, agreed with the conclusions of the guidelines and emphasized the importance of personalized medicine, “whereby the risks and likelihood of benefit are carefully weighed and discussed with the patient.”

Cohen noted that acute pain suppresses the immune system, as do opioids. “Steroids can perhaps prevent the initiation or escalation of opioids,” he said.

Chakravarthy agreed, emphasizing that guidelines are “meant to guide, but we are in an age where individual practice preferences are important, and we ultimately want physicians to use their own individual discretion.”

Each patient will have his or her “particular needs and specific risks and benefits, and these must be taken into account when choosing a treatment course,” Chakravarthy said.

Controlled Trial Shows Turmeric Effective In Alleviating Pain Of Knee Oa

chase@viralgrowth.marketing (Chase Jacobs) — Sun, 31 Jul 2022 07:48:47 GMT

From the treatment of digestive issues to reducing pain and inflammation in rheumatologic conditions, the root of the flowering plant turmeric (Curcuma longa extract) has long been a staple of traditional medicine. Now, a well- designed trial has shown that turmeric—best known in the United States as a ginger-like cooking spice—could potentially serve as a clinical alternative to existing pain treatments in conditions such as osteoarthritis (OA).

Curcumin, the active ingredient in turmeric, has been studied extensively for its analgesic and anti-inflammatory properties in both animal and human trials. Given the efficacy seen and a side effect profile that compares favorably to existing pain medications, the authors of a clinical review of the data stated that turmeric “could be a possible candidate for consideration for use as a stand- alone analgesic, or in analgesic combinations as part of opioid-, NSAID- [nonsteroidal anti-inflammatory drugs] or paracetamol (acetaminophen)-sparing strategies” ( J Clin Pharm Ther 2018;43[4]:460-466 ).

In the current double-blind, single-center study ( Ann Intern Med 2020 Sep 15. [Epub ahead of print]. doi: 10.7326/M20-0990 ), researchers at the University of Tasmania randomized patients with symptomatic knee OA and knee effusion–synovitis volume, as evidenced by ultrasound, to receive two capsules of turmeric (n=36) or matched placebo (n=34) per day for 12 weeks.

Primary outcomes were change in knee pain measured on a visual analog scale and evidence of effusion–synovitis volume as seen on MRI. The researchers also looked at pain score change on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and cartilage composition values.

Results showed turmeric was more effective in reducing pain compared with placebo, but did not change effusion–synovitis volume or cartilage composition. Turmeric also showed greater change in knee pain on the WOMAC than placebo. Adverse events occurred in 14 individuals in the turmeric group and 18 in the control group.

Limitations of the study include its small population and short study period, according to its authors, who called for larger multicenter trials to expand on the findings.

Interventional Pain Procedures Can Reduce Office Visits, May Increase Functionality

chase@viralgrowth.marketing (Chase Jacobs) — Sun, 31 Jul 2022 07:42:15 GMT

Patients who did not receive interventional pain procedures at an office clinic subsequently had 37% more office visits and 139% greater use of opioid prescription medications, according to a new retrospective study.

Fewer office visits could correlate with patients achieving greater functionality, as well as possibly reducing opioid prescriptions and other health care utilization, said lead researcher Ryan Jacobs, MD, a pain fellow at Advocate Illinois Masonic Medical Center, in Chicago.

“These are improvements we have anecdotally noticed in our clinic,” Jacobs said. “However, prior to our study, these improvements have not been actually quantified.

“As we all try to continually assess the efficacy of the clinical interventions we perform on our patients, I believe more clinicians are realizing that pain scores are not necessarily the best outcome measures to assess efficacy. Instead, we are starting to appreciate that improvements in functional measurements are more clinically significant.”

The study involved 1,423 patients treated from 2013 to 2019 at the clinic of Chicago Anesthesia Pain Specialists, which is part of Advocate Illinois Masonic Medical Center. Enrollment criteria included at least four office visits over a minimum of 12 months.

Patients were stratified into two groups: those who received an interventional pain procedure during one or more of their visits (n=835) and those who did not receive any interventional procedure (n=588). Among patients who received an interventional procedure, 63% had a lumbar injection, 10% had a cervical spine injection and 27% had multiple pain conditions treated.

a 14.2% (P<0.001) reduction in morphine milligram equivalents (MME) during their treatment course, from an initial 36.3 MME to 31.2 MME.

“Approximately 65% of these interventional patients received opioid prescriptions at some point over their treatment course,” Jacobs said. “But nearly 80% of the almost 24,000 office visits by all study patients were for patients on opioid therapy.”

Patients with existing opioid therapy who received interventional pain procedures had a 14.2% (P<0.001) reduction in morphine milligram equivalents (MME) during their treatment course, from an initial 36.3 MME to 31.2 MME.

“The study results were not necessarily surprising, as I believe this is something that we all noticed in the various patients coming through our clinic,” Jacobs said. “However, it was very encouraging to see that what we anecdotally thought to be the case was actually statistically accurate.” The results were presented virtually (abstract 1522) at the 2020 annual pain medicine meeting of the American Society of Regional Anesthesia and Pain Medicine.

Cost of Chronic Pain

Jacobs said the national burden of pain is projected to be more than $600 billion per year, representing both lost productivity and health care costs. “Chronic pain patients have more than a twofold increase in direct medical costs compared to nonpain patients,” he said.

It is also estimated that nearly 60% of the cost difference between the two patient groups is caused by the increased frequency of office visits alone among pain patients, with an additional 20% of the cost difference stemming from increased medication use by pain patients (Spine [Phila Pa 1976] 2013;38[1]:75-82).

Similarly, accidental drug overdose and opioid use disorder are associated with substantial increases in average annual excess health care costs and resource utilization. “The scheduling policy of the Drug Enforcement Administration, not to mention responsible and ethical practice, also mandates increased frequency of office visits for patients with opioid prescription, further contributing to the increased health care utilization among patients prescribed opioids,” Jacobs said.

Educating pain patients about their conditions and the anatomic basis of their pain is of primary importance when discussing treatment options, he said. “Rather than simply telling our patients that we can do X procedure, it is critical that we inform our patients about the type of procedure we believe will most improve their pain and why we believe that is the case,” Jacobs said. “In the process, we allow our patients to take control of their pain and the treatment they choose for it.”

Fda Approves Scs Device For Painful Diabetic Neuropathy

chase@viralgrowth.marketing (Chase Jacobs) — Sun, 31 Jul 2022 07:09:14 GMT

The FDA expanded its approval for a spinal cord stimulation (SCS) device to include an indication for painful diabetic neuropathy (PDN). The approval follows the high-frequency device’s (Senza, Nevro) positive clinical trial results, recently published in JAMA Neurology ( 2021;78[6]:687-698 ).

The trial found that at three months, 79% of participants (N=216) receiving SCS treatment alongside conventional medical management reported at least 50% improvement in visual analog scale (VAS) scores without worsening neurologic deficits, compared with 5% of participants receiving conventional management without SCS (P<0.001).

At six months, the mean VAS score for the SCS group dropped from 7.6 (95% CI, 7.3-7.9) to 1.7 (95% CI, 1.3-2.1), while the scores stayed the same for those treated without SCS, beginning at 7 (95% CI, 6.7-7.3) and finishing at 6.9 (95% CI, 6.5-7.3).

Along with the changes in pain scores, the researchers also noted neurologic exam improvements in 62% of the SCS participants at six months, compared with 3% of the patients receiving conventional management alone (P<0.001).

Primary investigator Erika Petersen, MD, FAANS, FACS, a professor of neurosurgery at the University of Arkansas for Medical Sciences College of Medicine, in Little Rock, reported that her team also witnessed improvements in ambulation, specifically in walking tests, where patients in the SCS arm made gains and walked further after treatment periods, while the conventional management arm did not.

“It’s one thing to say [a patient’s] pain level is lower, but if somebody [a patient] can actually do more because of the pain being better controlled than that, it really translates to improved overall function,” Petersen said in a previous conversation with Pain Medicine News.

“In Arkansas, where we have many patients with diabetes and PDN, we were determined to study a non-pharmacological treatment like SCS where few other options are effective,” she said in an email.

“These findings were tremendous steps forward for the field of neuromodulation,” Petersen said late last year. “The fact that 10-kHz SCS does not generate paresthesias is beneficial when considering SCS for diabetic neuropathy, as many of these patients experience tingling sensations at baseline and do not tolerate added paresthesias.”