Pain Management

内蒙古快3Pain Management, Pain Relief, Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Pain Management at Sarasota Interventional Radiology (SIR-Florida)

Sarasota Interventional Radiology (SIR-Florida), is conveniently located to serve Sarasota and Manatee counties, including the cities of Sarasota, Lakewood Ranch, and Bradenton. Gerald E. Grubbs, MD, founder and medical director, plays a critical role in utilizing image-guided, minimally invasive, non-opioid techniques for the treatment of pain. These are known as interventional approaches, which may stand alone as the patient’s treatment plan or may fit into a multidisciplinary program. 

Because we understand how difficult living with pain can be, our philosophy is to treat the whole person, and we include family in every step of the process. Our protocol includes:

• Consulting with the patient to discuss symptoms and review medical history
• Educating the patient and family members about pain treatment options 
• Providing important information regarding pre-procedure preparation and post-procedure care
• Maximizing patient comfort and safety during and after the procedure
• Making every effort to accommodate special patient needs 
• Following up with the patient during the recovery period and beyond

内蒙古快3Pain Management, Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Types of Pain

Acute pain is defined as sudden onset of pain that persists for a limited amount of time, generally less than six months, and is usually associated with an injury, cuts or burns, a broken bone, dental work, or post-surgery time frame. Acute pain usually resolves when the underlying cause of the pain has healed. If not treated promptly, acute pain may develop into chronic pain.

Chronic pain is a common but complex medical condition in our era. Defined as pain lasting longer than 12 weeks, chronic pain is usually associated with a condition such as osteoarthritis. It affects about one of every three American adults, or an estimated 50 million people, not including cancer patients. For many who experience chronic pain, the pain is serious enough to affect their daily functioning and quality of life. As the population ages, the prevalence of chronic pain is expected to rise due to people living longer, many of whom will have some level of chronic arthritic and/or spinal back pain.

Back pain is one of the most common forms of chronic pain, and its primary causes are pinched nerves and degenerated discs. With a herniated, prolapsed or slipped disc, a nerve or nerves are irritated or “pinched.” The resulting pain, known as radiculopathy, radiates from the affected nerve to other parts of the body. Herniated discs are more common in the lower back but may also occur in the upper and mid-back. Pain from a pinched nerve in the lower back that radiates down the leg is called sciatica. 

Degenerative disc disease is a natural occurrence associated with aging. With this condition, one or more of the discs between the vertebrae of the spinal cord break down. No longer are they the rubbery discs that act as shock absorbers and facilitate flexing and bending of the back, but they wear out and allow for bone-on-bone friction that causes weakness, numbness, and pain.

Joint pain is another form of chronic pain, with pain coming from any part of the joint, such as cartilage, bone, ligaments, tendons, or muscles. Joint pain is frequently caused by osteoarthritis but also may be attributed to rheumatoid arthritis, psoriatic arthritis, bursitis, gout, and joint injuries. The joints most affected are the knees, hips, shoulders, and elbows.

"My experience at your facility left me very favorably inclined toward your operation. I would like to especially express appreciation for those who do the basic chores so essential to any complex process; their cheerful and vigilant contributions make it all a positive experience."

William G, Sarasota, Fl

内蒙古快3Pain Management, Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Nerve Pain and Pain Management at SIR-Florida

Epidural Steroid Injection
The epidural steroid injection (ESI) may bring relief to those who suffer from low back pain or sciatica. While it also may be used to treat neck and mid-back pain, ESI on the neck and cervical spine may be complicated, and Dr. Grubbs at SIR is one of the few physicians in the Sarasota-Bradenton area who performs ESI in those areas.

ESI is a 20- to 30-minute outpatient procedure that is performed with conscious sedation. While the patient is lying flat on the stomach, a local anesthetic is administered to numb the lower back. Then state-of-the-art CT imaging is used to safely guide the needle into the epidural space. Saline and contrast are injected first to ensure that the needle is accurately placed within the epidural space, and injection of the steroid follows. The patient may feel pressure as the steroid is injected, but this should not be painful. After the procedure, the patient spends 30 minutes to an hour in the post-op recovery area and then may go 内蒙古快3 with a driver.

Selective Nerve Root Block
A selective nerve root block may be beneficial when severe leg or arm pain impacts one’s quality of life. Like the epidural steroid injection, the procedure is performed with conscious sedation and a local anesthetic to numb the area. CT imaging is used to guide the needle to the nerve root where a contrast is injected to confirm the needle’s location, and the steroid is then injected.

The procedure takes about 20 to 30 minutes, followed by about 30 minutes in post-op recovery. Immediate pain relief should occur in the days following the procedure, but the nerve root block may need to be repeated in several months.

Trigger Point Injection
A trigger point is an area of spasm and inflammation in skeletal muscle. Common sites of trigger points include the upper and lower back, shoulders and, less commonly, the extremities. A palpable nodule may be present in the muscle where the trigger point is located. There is much tenderness in the area of the trigger point, and pain may radiate from the trigger point to an area around it. An injection that includes an anesthetic, corticosteroid, or mixture is administered directly into the trigger point site to relieve the pain.

Facet Joint Injection
The facet joints are small stabilizing joints located between and behind adjacent vertebrae. They can become painful due to arthritis, injury or stress, and also from being in almost constant motion. Facet joint disorders are among the most common problems of recurring neck and low back pain. The cervical, thoracic and lumbar facet joints can be injected with a small amount of local anesthetic and/or steroid to anesthetize them and block the pain. This procedure is known as a facet joint injection. The injection helps diagnose the cause and location of pain and provides longer term pain relief by reducing inflammation.

Sacroiliac (SI) Joint Injection
The sacroiliac (SI) joints are located next to the spine and connect the sacrum with the hip on both the left and right sides. Inflammation or dysfunction of these joints is responsible for an estimated 15-20% of chronic low back pain. SI joint pain has been one of the most challenging conditions to treat, but the SI joint injection has proven to be effective in reducing this type of pain.

The SI joint injection is performed for either diagnostic or therapeutic purposes. Using fluoroscopy for guidance, contrast is injected into the joint to ensure proper needle placement and insertion of a numbing medication. Following the injection, the patient is asked to perform some normal activities to determine if the pain persists. If the pain is significantly diminished, the diagnosis is confirmed that the SI joint is the source of the problem. The patient may undergo additional injections and/or be referred to physical therapy to promote further pain reduction.

Ketamine is a medicinal therapy, administered by infusion, that is used to manage chronic pain. It functions as a strong NMDA receptor antagonist that eliminates pain hypersensitivity in patients with neuropathic pain and several other types of chronic pain. Neuropathic pain is pain that results from damaged nerve fibers and presents as shooting and burning pain, with tingling and numbness. Ketamine works by blocking the nerve channels that cause intense pain, while allowing the nerves themselves to function normally.

In addition to neuropathic pain, ketamine treats other pain conditions:

• Centralized or intense widespread pain
• Complex regional pain syndrome, or CRPS—chronic or excessive pain that most frequently affects one of the limbs (arms, legs, hands, or feet) and usually occurs after an injury or trauma to that limb)
• Hypersensitivity or hyperalgesia—an extreme reaction to a stimulus that is normally only slightly painful, such as a pinch
• Allodynia—pain from a stimulus that normally does not cause pain, such as touch or temperature

Ketamine may be a viable option for pain management if conventional approaches such as medications, physical therapy, and standard clinical interventions are not successful in alleviating the pain.
内蒙古快3Pain Management, Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Pain Block as Part of Pain Management

Celiac Plexus Block
The celiac plexus is a bundle of nerves that surrounds the main artery in the abdomen, known as the aorta. While these nerves control basic nerve functions, they can carry pain information from the abdomen back to the spinal cord and brain. A celiac plexus block is an injection of medication that helps relieve this abdominal pain, which is often caused by cancer or chronic pancreatitis.

Stellate Ganglion Block
A stellate ganglion block is an injection of local anesthetic into the sympathetic nerve tissue of the neck, located on both sides of the voice box. This injection is performed to diagnose and manage pain in the face, head, arms and chest caused by nerve injuries, shingles or persistent angina. It also improves mobility and reduces swelling, color and sweating changes in the upper extremity. The stellate ganglion block can be used for both diagnostic and therapeutic purposes.
"Three and a half years ago, at the age of 36, I suffered a stroke behind my right eye. As a result, I developed Complex Migraine Syndrome. At the time, my wife was working for a local neurology group. She immediately got me in to be seen, and I was sent for an MRI. Over the next few years, we tried every medication (except the triptans due to my high risk for stroke), Botox, acupuncture and anything else the doctor suggested. Nothing relieved my migraine pain. I was suffering from 3-5 migraines a week, often accompanied by right sided weakness and facial droop. I was working nights and going to school full time at the onset, but after a year my doctor urged me to quit my night job and take a medical leave from school (neither were options my wife and I wanted to have happen), because he assured me these things were "triggering" my migraines. Needless to say, I did both and there was no change in my pain. Eventually I felt as though the doctor pretty much gave up on me. It was so depressing and debilitating to think I would have to spend the rest of my life living with constant migraine pain.

On Super Bowl Sunday, my family was relaxing at 内蒙古快3 watching the game when I noticed a friend of ours posted a video on Facebook of a Sphenopalatine Ganglion Block being done at a clinic in NY. I showed it to me wife and she went on the internet and found that your office was offering this procedure in nearby Sarasota. I called the next day and was able to get in to see Dr. Grubbs that same week. After the consultation and CT scan, he declared that I was a good candidate for the procedure. The next Wednesday, my wife and I drove to Sarasota Interventional Radiology. I had a migraine when I went back for the procedure. A short time later, my wife came back to the recovery area and said she was amazed at the transformation already--no more facial droop! And she could see that there was no pain in my face!

It has been 11 1/2 weeks so far, and I have been migraine free! I have my life back! I started a new job the week after my procedure and now I have the energy to do so many things I have been missing out on with my family. I am back in school and looking forward to continuing my academic career as well.

I am so appreciative to Dr. Grubbs and his staff-they were friendly, kind and accommodating. The procedure was quick and painless. I could not be more pleased with the results so far!

God bless you all!"

Paul H.
内蒙古快3Pain Management, Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Cold Laser Therapy 

The most technologically advanced and powerful Class IV cold laser therapy is available at SIR-Florida as a safe and effective option to treat pain and inflammation. This groundbreaking treatment uses a laser beam to activate certain areas of the body to generate very specific types of response. The type of response that can be obtained depends on the strength of the laser beam. 

Class IV cold laser therapy is a deep-tissue penetration that significantly increases the body’s cellular production of adenosine-triphosphate (ATP) to reduce inflammation and heal the affected area. This powerful deep-tissue penetration safely and effectively treats more conditions than traditional low-level laser therapy.

Numerous studies have shown that Class IV cold laser therapy can help with a variety of conditions including, but not limited to, the following conditions:
• Arthritis
• Back pain
• Bursitis
• Carpal tunnel syndrome
• Diabetic complications, e.g., neuropathy and foot ulcers
• Fibromyalgia
• Heel spurs
• Knee pain
• Migraines
• Neck pain/whiplash
• Nerve root pain
• Plantar fasciitis
• Postoperative pain
• Repetitive stress injuries
• Shingles
• Shoulder pain
• Strains and sprains
• Tendonitis
• Tennis elbow

Other conditions that may be helped by Class IV cold laser therapy include:
• Wounds that are slow to heal and have been resistant to treatment, including slow-healing fractures
• Multiple trigger points (sore spots in the muscles) that do not go away, including areas associated with fibromyalgia
• Soft tissue injuries
• Ulcers

At SIR-Florida, cold laser technology provides healing and immediate pain relief with no side effects, drug interaction effects, or invasive surgery. It treats acute and chronic conditions as well as post-surgical pain and requires only about ten minutes to administer.
内蒙古快3Pain Management, Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Back and Nerve Pain Treatments 

Radiofrequency Ablation
Radiofrequency ablation(RFA) is used for chronic pain located in the neck and low back, with increasing use for joint pain caused by degeneration of the joint from arthritis, such as knee, hip, and spinal osteoarthritis. RFA does not actually treat the cause of the pain, namely the arthritis, but instead reduces or eliminates the pain felt by the patient because of interruption of the pain signal to the brain.

RFA sends an electrical current that generates heat to the nerve tissue that is transmitting pain to ablate or damage the tissue. It is performed with small needles that are guided to the treatment area with the aid of fluoroscopy so that the needles are precisely placed in the proper location. RFA is safe, effective, and well tolerated. Relief from pain is felt about three weeks after the procedure and can generally last for up to six months because the nerves can regenerate or grow back. In some cases, however, relief has been reported to last for even a year or more.

RF Nerve Treatment (Sinergy™ Cooled RF)
Sinergy™ Cooled Radiofrequency (RF) is a minimally invasive treatment that uses cooled RF energy to target the nerves causing chronic pain. Circulation of water through the Sinergy ™ device while heating the nerve tissue enables the physician to create a large-volume treatment area. Patients may experience relief for up to 24 months with improved physical function and reduced use of medications.

Plasma Disc Decompression
The spine is made up of a series of bones known as vertebrae, which are connected by discs. These discs have a strong outer surface called the annulus and a soft, gel-like center called the pulposus. If the outer layer is damaged or weakened by age, the gel of the pulposus can leak. This is referred to as a slipped or herniated disc, which can press on nerves causing pain, numbness, tinkling or weakness in the in the leg and/or arm, as well as the neck and/or arm.

Patients with herniated discs may respond to conventional treatments such as medications, rest, injections and/or physical therapy. When such treatments are not effective but patients are not yet ready for surgery, plasma disc decompression (PDD) offers a safe and effective alternative. PDD is not appropriate for spinal fractures or degenerative disc disease.

During this procedure, a needle is placed into the disc using state-of-the-art CT imaging for guidance. A device is then inserted through the needle and into the center of the disc where excess tissue is removed. This reduces the pressure on the vertebrae which, in turn, eases pressure and reduces pain. PDD is extremely safe and has few risks or complications. To accelerate healing of the herniated or bulging disc, PDD can be combined with platelet-rich plasma (PRP) and stem cell procedures.

A discogram is a diagnostic test used to determine if the source of back pain is an intervertebral disc, a disc that acts as a cushion between the vertebrae and allows motion of the vertebrae. During a discogram, dye is injected into the soft center of the disc, sometimes reproducing the patient’s back pain. It may be necessary to inject several intervertebral discs to pinpoint the cause of the back pain.
内蒙古快3Pain Management, Cancer Treatment, Prostate and Lung Cancer, Sarasota Interventional Radiology (SIR-Florida) - Florida’s Premier Radiology Practice

Knee Pain Treatments 

Knee osteoarthritis is a common joint disorder that occurs when the cartilage in the knee deteriorates and the joint (synovial) fluid breaks down. When the natural cushioning wears away, the bones in the knee begin to rub against each other and result in pain, inflammation and stiffness. Knee osteoarthritis may be hereditary, or it may be caused as a result of an injury, infection or even obesity.

At SIR-Florida, Synvisc™ is used to treat knee osteoarthritis. (Synvisc™ has not been tested to show pain relief in joints other than the knee.) A gel-like fluid made of a natural substance in the body called hyaluronan is injected into the knee, which acts as a lubricant in the joint. Synvisc™ is an outpatient procedure performed under CT guidance and requires about 30 minutes to complete.
Zilretta™ is an extended-release injectable suspension used to treat pain caused by osteoarthritis of the knee. It is a non-opioid, corticosteroid that works by slowly releasing microspheres containing a medication called triamcinolone acetonide directly into the knee joint where the microspheres slowly and continually release the medication for about three months. Zilretta™ is the first FDA-approved treatment for osteoarthritic knee pain to use the extended-release microsphere technology. It has shown to relieve knee pain for 12 to 16 weeks.

Zilretta™ has been shown to be generally safe, with the most common side effects reported to be joint pain, headache, back pain, joint swelling, sore throat and runny nose, upper respiratory infection, and bruising. Type 2 diabetics may experience a slight elevation in blood sugar.

Commonly used for a joint, an arthrogram is a series of images that evaluate the condition of the joint after injection of a contrast agent. The arthrogram is frequently performed with the use a special type of x-ray called fluoroscopy to guide needle placement into the joint, inject the appropriate amount of contrast, and take pictures of the joint. The arthrogram shows the surfaces of soft tissues lining the joint as well as the joint bones, whereas a regular x-ray shows only the joint bones. It has diagnostic and therapeutic uses for other areas, such as hips, ankles, wrists, elbows and jaw and is also used to study the shoulders for rotator cuff tears.
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