Advanced Pain Management Doctor
Patient Education and Links
Dr. S. Chowdhury M.D. and Gina Pasore, A.R.N.P.
ADVANCED TREATMENT OPTIONS
You don't have to give up: Advanced treatment options are available.
If you have failed the typical pain management treatments, do not be in despair. There are still many options out there for you. Over seventy-five percent (75%) of the pain management doctors in practice are not able or trained in performing some of the more advanced and yet more conservative treatments.
For example, pain caused by herniated discs typically causes pain down one or both legs. The usual conservative treatments include physical therapy and chiropractic care. If not improved, treatment would quickly move to an epidural steroid injection. Personally, I would only perform one epidural (if no improvement after one injection) then move on. Some of the advanced techniques available at this point include transforaminal injections or epiduroscopy. The purpose of transforaminal injections or epiduroscopy is to get closer to the area of inflammation at the nerve affected by scar tissue, disc protrusion, or disc fragments.
Transforaminal injections are injections through the hole where the nerve comes out of the spinal column. The advantage of this technique would be to avoid the scar tissue in the epidural space caused by previous surgery or inflammation. This can be very successful despite standard epidural injections failing. Epiduroscopy is another option which has recently become available to pain physicians. This involves placing a scope this size of a pencil lead into the epidural space through the tailbone area. The scope is then used to open up some of the scar tissue when possible and proceed directly to the affected nerve and deposit steroid under direct visualization on top of the nerve. The procedure takes 10 to 30 minutes and is done as on outpatient with the patient awake but sedated. The results of this procedure have been near miraculous in many cases. Epiduroscopy has kept many patients who would have previously moved on to implantation of a DSC (dorsal column stimulator) or laminectomy/decompression (i.e. major back surgery.) This procedure has also been successful on patients with previous back surgery. The recovery from epiduroscopy is one to three days with many patients returning to there normal activities the next day. At this time, I would estimate that less than 1% of the pain management physicians are effectively performing this procedure.
DSC (dorsal column stimulators) and Intrathecal Pumps (Morphine Pumps) is a final option for pain caused by herniated or bulging discs. Usually surgery is considered before this step. DCS or MS pump is a very aggressive step to take and unfortunately tends to be used too early in the treatment scheme many due to lack of education. These, however, tend to be very useful and beneficial when used appropriately.
These are just examples of treatments available for radicular pain or pain down the legs caused by herniated disc. There are many other treatments available for other types of pain.