Posted by admin on June 16, 2010 under Back Pain | 
Bradenton.com
New way to relieve back pain, Bradenton doctor’s innovation gives woman new sensation
By TIMOTHY R. WOLFRUM – twolfrum@bradenton.com
Tara Dudash remembers vividly the day the pain disappeared.
The 36-year-old Sarasota resident said she had suffered debilitating lower back pain for 12 years before she met Dr. Nilesh Patel of Bradenton’s Coastal Pain Management and Rehabilitation.
Dudash had been to countless physicians — “I have more doctors in my phone than I have friends on speed dial,” she said — and tried everything from medication to massage.
TIFFANY TOMPKINS-CONDIE / ttompkins@bradenton.com Tara Dudash, a 36-year-old Bradenton accountant was relieved of debilitating back pain by a procedure performed by Dr. Nilesh Patel called Cooled Radiofrequency Denervation.
She said she once attached four electrical nerve stimulators to her back simultaneously in an effort to relieve the pain that required her to change positions every 20 minutes and made deep sleep nearly impossible.
When Patel told her “I can fix you,” Dudash said she “almost laughed in his face.”
But in October 2008, two days after Patel performed a new procedure he helped innovate, a dubious Dudash said she felt a new sensation.
No sensation.
“I was driving home from work, and I felt really weird,” Dudash said. “I actually turned down the radio and thought, ‘Why do I feel so odd?’ I realized I didn’t have any pain.
“It was an unrecognizable feeling. … It was kind of like receiving a miracle.”
Dudash suffered from severe pain on the right side of her lower back in the sacroiliac joint, where two major bones of the pelvis, the ilium and sacrum, meet.
To relieve the pain, Patel performed a cooled radiofrequency denervation, an outpatient surgery that consists of placing a small electrode in the affected area and ablating, or destroying, the nerves.
The innovative aspect of the procedure is the cooling, done through water circulation that surrounds the electrode. Cooling the area around the electrode allows the heat to travel farther and affect more of the nerves without destroying nearby tissue.
Patel, a member of the American Society of Interventional Pain Physicians, was one of the pioneers of the procedure when he was a staff member at the Cleveland Clinic.
“When we saw this technology, it made sense,” said Patel, who said the weather drew him from Cleveland to Bradenton six years ago. “This is the same technology they use for ablation of large tumors because it allows you to create a lesion of precise size.”
Because the nerves regenerate, Dudash will return to Coastal every nine months to a year to repeat the procedure. The first surgery relieved her pain for seven months, but the most recent procedure was done in June 2009.
Patel and his partners at Coastal, Dr. Andrew Gross and Dr. Gennady Gekht, are conducting a clinical trial of the procedure. The doctors are still recruiting five patients for the 51-member trial, which is free. Patel said the ideal candidate is someone who suffers from isolated, lower back pain on one side of the body.
Patel hopes a successful trial will help popularize the innovation.
“That’s the time when the switch goes on,” Patel said. “People wait for high-quality research before they adopt new technology. … Physicians tend to gravitate toward things that work.”
The procedure has worked for Dudash, who tried everything to dull the pain she felt beginning as a business finance student at the University of South Florida in Tampa.
“I was 20-something. Nobody really pays attention to anything when they’re 20-something,” she said. “They think it’s going to go away. It didn’t. It just slowly, gradually got worse. Nobody could find anything wrong with me.”
Because of the pain, it took Dudash eight years to graduate from USF. When she met new people, she told them about her back troubles so they would know why she was sometimes short with them.“I just accepted this was how my life was going to be,” she said. “I was starting to crack. It was getting unbearable. If a pet was hurting that much, we would euthanize it.”
Now, Dudash is living an active life. She co-owns Water Designs of Sarasota, a swimming pool design company, with her husband, Joe, and is a part-time accountant. She wears high-heeled shoes and regularly exercises, running on the beach.
“I have no excuses when it comes to swimsuit season,” she said.
Posted by admin on June 13, 2010 under Back Pain, Pain Treatment |
Common, but Treatable
If the mere thought of running out of ibuprofen sends you into a panic, you’re far from alone. One in four Americans—the majority of them women—get sidelined by an achy back, neck, head or joints. In a 2006 government survey, more than half of them reported their agony lasted three months or longer.
Chronic pain can affect our relationships and our job performance. But experts say there is no reason to wince through your days needlessly. “There are options available,” says Scott Glaser, M.D. of the American Society of Interventional Pain Physicians. “We are now able to find the source of the pain, treat it and control it, and give individuals back their quality of life.” Find out how to treat the most common pain complaints.
Back Pain
There are two main causes. The sponge-like discs and joints between spinal vertebrae become injured or degenerated with daily wear and tear. Or the spinal nerves become compressed and inflamed from injury or conditions like arthritis. Dr. Glaser says “ice and heat applications are time-honored therapies” for chronic pain.
Other options include chiropractic treatments, physical therapy, massage and biofeedback. Jacob Teitelbaum, M.D., author of Pain Free 1-2-3, recommends boswellia, willow bark and curcumin-based supplements, which have anti-inflammatory properties. If those methods don’t work, a pain specialist may suggest patches that deliver painkillers directly to area or medication injected into the joints between the vertebrae or the nerves. Heat treatments or electrical stimulation can also help. Back surgery should be a last resort because of long-term risks and the possibility of creating more pain.
Chronic Headaches
Everyone gets a headache now and then, but 15 percent of Americans get severe headaches, and they occur twice as often in women than men. Migraine, cluster and tension headaches are the three most common types, and they can be triggered by anxiety, stress or hormonal changes.
If you suffer from migraines, over-the-counter remedies such as Excedrin Migraine can help, says Dr. Teitelbaum, and daily doses of magnesium and vitamins B6 and B2 may help prevent them. Stronger drugs to treat migraine pain and relieve tension and cluster headaches are available by prescription. Inhaling pure oxygen, available in small canisters by prescription, can also relieve cluster headaches. And antidepressants can help prevent tension headaches.
A Sore Neck
The same factors that cause back pain contribute to neck pain—bulging spinal discs touch nerve endings, and suddenly shaking your head is next to impossible. Worse, upper neck pain can also trigger headaches, Dr. Glaser says. “The spine is simply a series of bones sitting on top of each other protecting the spinal cord and nerves,” Dr. Glaser says, “Every joint where these bones touch is capable of being a source of pain.”
If neck pain is associated with headache, chiropractic care can help release the muscles that cause most tension headaches. Medications used to treat the headache can also offer relief. As with lower back pain, minimally invasive procedures to deaden nerve endings or deliver medications are an option.
Facial Pain
Facial pain has many causes, from a toothache to more serious conditions like trigeminal neuralgia, when inflamed nerves cause shooting, stabbing pain in the face.
For simple tooth pain, over-the-counter pain killers can help until you can see your dentist. If the problem is in your jaw’s temporomandibular joint (TMJ), you can use ice packs and a bite guard at night that helps position the jaw correctly, relieving chronic pain. For trigeminal neuralgia, anticonvulsants and muscle relaxants are typically prescribed. In extreme cases, surgery to damage the nerve so it stops delivering pain messages may help, but often results in some facial numbness.
Fibromyalgia
People with fibromyalgia (mostly women) suffer fatigue, stiffness, joint tenderness, muscle pain and so-called “fibro fog” or memory problems. No one knows for sure what causes fibromyalgia, but some theories include traumatic events and repetitive injuries, as well as genetic factors.
Over-the-counter painkillers can help, as can antidepressants and drugs used to treat restless legs syndrome. Dr. Teitelbaum, who had fibromyalgia himself, recommends getting at least eight hours of sleep nightly; hormonal support to regulate thyroid, adrenal and reproductive hormones; treating infections, including anti-fungal treatments for infections such as Candida; proper nutrition and exercise.
Arthritis
The cartilage between joints erodes over time, causing pain that is the hallmark symptom of arthritis. There are two main forms of arthritis: Osteoarthritis, caused by aging and repetitive injury, and rheumatoid arthritis, an autoimmune condition that causes the body to attack its own healthy joints.
There’s no cure for arthritis, but anti-inflammatory painkillers like ibuprofen can help. Rheumatoid arthritis responds to anti-rheumatic drugs and corticosteroids. Exercise can also ease arthritis pain as it strengthens the muscles surrounding the joints and keeps the joints limber. Steroid injections into the joint or replacing the normal joint fluid with injections of medication also provide relief. Joint replacement surgery is also a popular treatment for severe arthritis in the hip and knee.
Seeking Treatment for Pain
All too often, people grin and bear it when it comes to pain, says Dr. Glaser, which can make it worse. “We tend to see patients a year after they’ve injured their back,” he says. “That makes it much harder to treat. Patients that come to me a month after they start hurting have a much higher success rate.”
If you’re in pain, talk to your primary care doctor. If conservative treatments aren’t working, Dr. Teitelbaum recommends seeking a pain specialist through the American Academy of Pain Management. “Pain is like the flashing red oil light on your dashboard,” he says. “It’s your body’s way of saying something needs attention.”
