Dr. Shazia Can Answer Your Questions

 

General

What is pain management?

When should a person seek a pain management specialist?

What is the difference between acute and chronic pain?

What are the most common problems that cause chronic pain?

What are the major issues surrounding pain?

What medications are most commonly used to manage pain?

Is there a risk of becoming addicted to pain medications like opiates?

Is there a cure for pain?

Does health insurance cover pain management?

What is the economic impact of pain?

 

Facet and Medial Branch Blocks

What is a facet block or medial branch block?

What are the risks of the procedure?

What happens during the actual procedure?

How will I feel after the injection?

Will I have any restrictions on the day of the procedure?

For what reasons should I call the Pain Management Center after the injection?

 

Neurotomy

What is a Neurotomy?

How is the procedure performed?

How will I feel after the injection?

What are the risks associated with Neurotomy?

Are there any restrictions following the procedure?

For what reasons should I call the Pain Management Center after the injection?

 

Epidural Steroid Injection

What is the epidural space?

What is an epidural and why is it helpful?

What are the risks of the procedure?

What happens during the procedure?

What happens after the procedure?

How will I feel after the injection?

General Pre/Post Instructions

For what reasons should I call the Pain Management Center after the injection?

 

Spinal Cord Stimulation

What is a Spinal Cord Stimulator (SCS)?

How does it work?

How is the procedure performed?

What Does My Trial System Include?

Will I be able to control the spinal cord stimulator?

What are the benefits of SCS?


General


Q. What is pain management?

A. Acute and chronic pain can disrupt all aspects of a person’s life, making normal activities difficult or impossible. Pain is a complex medical problem and can require the care of a medical specialist with specific training in how to treat pain. The goal of pain management is to help patients decrease pain and suffering, to return to the maximum level of functioning and independence, and to help restore the patient’s quality of life.

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Q: When should a person seek a pain management specialist?

A: Many people live with pain and see pain management as a last resort, instead of a first stop on the road to wellness. You should seek the care of a pain management specialist when pain does not respond to the usual and customary treatments within a reasonable period of time. Be aware of your body and take note when you are in pain. If that pain persists — contact your doctor or a pain management specialist immediately.

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Q. What is the difference between acute and chronic pain?

A. Acute pain is of short duration, usually the result of an injury, surgery or illness.

Chronic pain is ongoing, often occurring in the back, neck, head. Chronic pain can also be related to nerve injury, the musculoskeletal system or illness. Your doctor may refer you to the Lafayette Pan Care because your pain condition has not responded to conventional therapies.

Treatments for acute and chronic pain are generally different. In some cases, acute and chronic pain can be stopped or alleviated by a single procedure or series of procedures. Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to pinpoint. Once we have identified what is causing your pain, we may be able to treat it so that the condition no longer occurs. In some patients, the specific factor causing the pain, cancer for example, can’t be changed, but we may be able to reduce the pain or help the patient to cope with the pain through a combination of medical, psychosocial and rehabilitation techniques.

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Q. What are the most common problems that cause chronic pain?

A. While there are a multitude of conditions that may lead to chronic pain, these are the most common causes:

  • Back pain
  • Neck pain
  • Muscle Pain (Myalgia)
  • Nerve Pain
  • Headaches
  • Post Herpetic Neuralgia (Shingles)
  • Fibromyalgia
  • Osteoarthritis
  • Carpal Tunnel Syndrome

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Q. What are the major issues surrounding pain?

A. Chronic pain can be so overwhelming that it affects all areas of life. It is not uncommon for the pain sufferer’s marriage and work lives to be damaged. Exercise and other recreational activities will be put by the wayside. Appetite and sleep often suffer, causing additional problems. Irritability, anxiety and depression are common. Lafayette Pain Care seeks to help patients overcome these issues and return to a healthier, happier life.

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Q. What medications are most commonly used to manage pain?

A. While drug therapies differ for each person, the most common are:

  • Adjuvant pain medications such as antidepressants, anticonvulsants and muscle relaxors.
  • Opiates or "pain killers" used to treat acute pain or cancer-related pain, and often prescribed for chronic pain.
  • Anti-inflammatory drugs to alleviate pain by reducing swelling and irritation.

There are alternative delivery methods for medications. Common methods used at the office are oral medications, topical creams, sublingual medicines, nasal sprays, injections and patches.

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Q. Is there a risk of becoming addicted to pain medications like opiates?

A. A common misconception about opiates is that they are addictive. However, when used properly for the treatment of pain, there is little risk of becoming addicted. Addiction is defined as continuing to use a substance when it has become detrimental to the person's life. Being dependant is not the same thing as being addicted.

Many people with health problems are dependant on medications, for instance people with high blood pressure are dependant on blood pressure medications. Diabetics are dependant on insulin. When opiates are taken as directed for legitimate pain, the person does not get "high" from taking them.

Opiates consist of the same chemical makeup as your body's natural painkiller, endorphins. People that have lived with pain over a long period of time sometimes have reduced levels of natural endorphins because the body has stopped producing them. Dr. Siddiqui is happy to discuss and questions or concerns with you.

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Q. Is there a cure for pain?

A. The causes of pain are complex and each patient is different. Fortunately, there are a growing number of ways to treat and alleviate pain based on the patient’s condition. Dr. Shazia Siddiqui and the care team at Lafayette Pain Care work closely with her patients and their family members to diagnose the cause of pain and determine the best course of treatment. We understand what you are going through and will do our best to help you return to a healthier, happier life.

Q. Does health insurance cover pain management?

A. Most policies cover pain management. Please call Lafayette Pain Care at 765-XXX-XXXX for more information.

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Q. Does health insurance cover pain management?

A. Most policies cover pain management. Please call Lafayette Pain Care at 765-XXX-XXXX for more information.

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Q. What is the economic impact of pain?

A. When you are living with pain, your ability to work is compromised. You may find you can’t fully perform your job or stop going to work altogether. Obviously, this is a problem! A recent report by the Institute of Medicine estimates the annual value of lost productivity in 2010 dollars ranged from $297.4 billion to $335.5 billion. The value of lost productivity is based on three estimates: days of work missed, hours of work lost and lower wages.

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Facet and Medial Branch Blocks


What is a facet block or medial branch block?

A. A facet block is an injection of local anesthetic and steroid into a joint in the spine. A medial branch block is similar but the medication is placed outside the joint space near the nerve that supplies the joint called the medial branch (steroid may or may not be used). You may require multiple injections depending upon how many joints are involved.

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What are the risks of the procedure?

A. As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.
Some short-term side effects may occur. If local anesthetic spreads to nearby nerves you may have weakness or numbness that can last for several hours. If this happens you may have to stay in the Pain Management Center until this resolves. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have short-term elevation of blood sugars.

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What happens during the actual procedure?

A. An oral Ativan for relaxation can be given. The procedure will be done in the fluoroscopy (x-ray) room with you lying on your stomach. The back is then cleansed with an antiseptic soap. Sterile drapes are placed. The skin is anesthetized (numbed) with a local anesthetic. This is felt as a stinging or burning sensation. Using x-ray guidance, needles are then advanced to the appropriate locations (the joints or the medial branch). Once the needles are in the proper location local anesthetic with or without steroid is injected through the needles and the needles are removed. You will then return to the recovery area where you will be monitored for approximately 5 minutes, then discharged to leave with your ride after M.D. authorizes discharge.

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How will I feel after the injection?

A. Your back pain may be improved immediately after the injection from the local anesthetic. It is important to keep track of how you feel for the remainder of the day. The steroid, when used, takes two or three days to have on effect in most people and peaks in about two weeks.
Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three or four times a day will help this. You may take your usual pain medications as well after the injection.

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Will I have any restrictions on the day of the procedure?

A. You may not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. The procedure will be cancelled if you don¹t have a responsible adult with you!! This is for your safety.
No heat is to be used in the injected areas for the remainder of the day.

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For what reasons should I call the Pain Management Center after the injection?

A. If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call the Pain Management Center right away at (870) 262-6155.

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Neurotomy


What is a Neurotomy?

A. Neurotomy is a long-term treatment used to reduce pain from facet joints. This is usually done after two successful medial branch blocks are preformed. The facet joints are thumbnail-sized joints that are located in pairs between each bone of your spine. A neurotomy can be preformed two ways: 1. by radiofrequency (heat) 2. by a chemical (Phenol). This procedure destroys the nerves going to the facet joints (called the medial branch nerves) to reduce the pain coming from these joints.

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How is the procedure performed?

A. An IV is started for medications and safety. A brief pre-procedure history will be taken and you will then be transported to the procedure room where you will be positioned on the X-ray table. Although you will be awake throughout the test you will be given medicine. After being positioned on the X-ray table, your skin will be cleaned with sterile soap. Anesthetic is injected to numb your skin and muscles over the spine. After this, fluoroscopy (X-ray) is used to guide a needle into the proper location. Additional anesthetic is injected to numb the nerve to be destroyed and the procedure is then performed. Afterward, you are taken to a recovery room where you'll need to rest before going home. During the injection, pain is sometimes increased temporarily.

The procedure is performed on ONE side of the spine at a time. You will come back to the clinic a few weeks later to have the other side completed.

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How will I feel after the injection?

A. Following the procedure you may experience some increased discomfort or soreness for several days (up to 14 days). Using an ice pack three to four times a day will help with this. You may take your usual pain medications as well after the injection.

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What are the risks associated with Neurotomy?

A. As with all medical procedures, there are certain risks and potential complications associate with a neurotomy. Complications are rare with this procedure, but can occur and include:

  • Pain or discomfort around the injection site
  • Numbness of skin covering the injection site
  • Permanent nerve pain
  • Allergies or reactions to medications used
  • Infection

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Are there any restrictions following the procedure?

A. You may not drive for the remainder of the day after the procedure. An adult must be present to drive you home or you must have public transportation. You may return to activity when you feel able to do so. Because of soreness, some patients may choose to wait a week or two before planning any major traveling or other strenuous activity.

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For what reasons should I call the Pain Management Center after the injection?

A. If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call the Pain Management Center right away at (870)262-6155.

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Epidural Steroid Injection


What is the epidural space?

A. The membrane that covers the spinal cord and nerve roots in the spine is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space to the back and into the legs. Inflammation of these nerve roots may cause pain in these regions due to irritation from a damaged disc or from contract in some way with the bony structure of the spine.

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What is an epidural and why is it helpful?

A. An epidural injection places anti-inflammatory medicine into the epidural space to decrease inflammation of the nerve roots, hopefully reducing the pain in the back or legs. The epidural injection may help the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of pain is healing.

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What are the risks of the procedure??

A. As with most procedures there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used.

Some short-term side effects may occur. If local anesthetic spreads to nearby nerves you may have weakness or numbness that can last for several hours. If this happens you may have to stay in the Pain Management Center until this resolves. You may have increased pain for a few days after the injection, including localized pain at the injection site. Diabetics may have short-term elevation of blood sugars.

If a patient is on Coumadin, Plavix, Aggrenox, or Lovenox (blood thinners) they must notify the office so the timing of these medications can be explained

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What happens during the procedure?

A. An oral Ativan for relaxation can be given. The patient is placed lying on their stomach on the x-ray table and positioned in such a way that the physician can best visualize the low back using x-ray guidance. The skin on the back is scrubbed using 2 types of sterile scrub (soap). Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a small needle, using x-ray guidance into the epidural space. A small amount of contrast (dye) is injected to insure the needle is properly positioned in the epidural space. A mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) is injected.

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What happens after the procedure?

A. Patients are then returned to the recovery area where they are monitored for 5 minutes. Patients are then asked to keep track of the amount of pain they received as well as how long the pain relief lasted.

A follow-up appointment will be made for a repeat block if indicated. These injections are usually done in a series of three (3), about two (2) weeks apart. The back or legs may feel weak or numb for a few hours. This is to be expected, however it does not always happen.

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How will I feel after the injection?

A. Your back pain may be improved immediately after the injection from the local anesthetic. It is important to keep track of how you feel for the remainder of the day. The steroid, when used, takes two or three days to have on effect in most people and peaks in about two weeks.

Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three or four times a day will help this. You may take your usual pain medications as well after the injection.

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General Pre/Post Instructions

A. Patients can eat a light meal within a few hours before the procedure. If a patient is an insulin dependent diabetic, they must not change their normal eating pattern prior to the procedure. Patients may take their routine medications. (i.e. high blood pressure and diabetic medications). A driver must accompany the patient and be responsible for getting them home. No driving is allowed the day of the procedure. Patients may return to their normal activities the day after the procedure, including returning to work.

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For what reasons should I call the Pain Management Center after the injection?

A. If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call the Pain Management Center right away at (870) 262-6155.

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Spinal Cord Stimulation


What is a Spinal Cord Stimulator (SCS)?

A. Spinal cord stimulator (SCS) is a device, which delivers low voltage electrical stimulation to the spinal cord. The electrical stimulation to the spinal cord is delivered through one or two wires, which are carefully placed in the epidural space. The epidural space is a space adjacent to the spinal cord.

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How does it work?

A. The electrical signals sent by spinal cord stimulator replace the sensation of pain with a tingling sensation.

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How is the procedure performed?

A. The spinal cord stimulator is implanted in TWO stages. The first stage is a trial, also known as a test drive. It is performed in the procedure room with local anesthetic and intravenous sedation. In this stage, we place the wires through the skin, into the epidural space, which is above the spinal cord. Once the stimulation is in the general areas of your pain, the procedure is complete. Bandages or dressing will be applied to keep your leads clean and protected. We leave the wires in place for a week. This is really a test to determine is a permanent stimulating generator should be used.

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What Does My Trial System Include?

A. Remote Control: An easy-to-use device you can use to adjust your therapy. Leads: Small, flexible, implantable wires that are designed to deliver pain-masking stimulation to the spinal cord. You may have one or two Leads. External Trial Stimulator: Placed outside the body, it generates pain-masking electrical impulses Cables: Connect the Leads to your Trial Device.

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Will I be able to control the spinal cord stimulator?

A. Yes. You can use your remote to turn your therapy on and off, increase or decrease the stimulation or change the programs to adjust the areas of stimulation when and where you want it.

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What are the benefits of SCS?

A. The goal of the implantation of spinal cord stimulator is to reduce rather than eliminate pain. It might reduce the pain by 50 percent or more it Gould increase the activity level and it might reduce the use of narcotic medications.

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