The Most Comprehensive Pain Center in the Valley

Your PAIN Stops Here!

Meet our TOP DOCS 2010

Newsletter Issue 5 Jan/Feb 2011

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Preferred Pain Center Contact Information and Locations. Patients Routinely Seen Within 24 hrs

Three Secrets of Pain Management These secrets may help patients achieve their best possible chance at a pain free existence.

Treating Sciatica from Disc Problem Achieving pain relief and avoiding surgery from a disc herniation is possible. Options are discussed.

Just the Facts: TENS Units The facts on TENS units and how they work.

The aim of the wise is not to secure pleasure, but to avoid

pain. -Aristotle

Comprehensive Pain Management

Preferred Pain Center offers a team

of medical professionals from

various backgrounds including

traditional, alternative, and holistic

training.

Ajay Narwani, MDPain Management

Double Board Certified Pain/AnesthesiaABMS Interventional Pain ManagementDiplomate American Board Anesthesia

Anesthesia Residency U. Texas-HoustonPain Fellowship U. Texas-Galveston

Sky Moore, DCRehab/Chiro

Rehabilitation and Chiropractic SpecialistDoctoral Degree National College in Chicago

Certified in NonSurgical Spinal Decompression TherapyCertified in Manipulation Under Anesthesia

T r e a t m e n t s o f f e r e d a t

P r e f e r r e d P a i n C e n t e r

• Interventional Pain Management • Medication Management • PT/Rehab • Acupuncture • Spinal Decompression Treatment • Chiropractic Treatment

Follow us on Twitter

twitter.com/preferredpain

Follow The Blog of Pain

preferredpaincenter.com/blog

Preferred Pain Center Phoenix, AZ

The Most Comprehensive Pain Center in the Valley

Page 2 www.preferredpaincenter.com (602) 507-6550

If you are diagnosed with sciatica from a lumbar herniated disc, you are not alone. At any one point in time, at least 1% of the population is having the same issue. What to do next?

Having burning pain along with pins and needles down your leg is unsettling, painful, and disruptive. The key is to achieve pain relief without undergoing surgery. Surgery has small but real risks for a disc herniation, one risk is that of recurrence at the same level (10%). You want to achieve pain relief while your body takes care of disintegrating the piece of disc that has ended up where it's not supposed to be.

The options of what to do once you are diagnosed with a herniated disc involves the following:

1. Initial Acute Pain relief. This may occur from medication. The medication may be in the form of a Medrol Dose Pak, which is a burst of Prednisone for a few days and then tapering off to prevent adrenal problems. The Prednisone acts as a hefty anti-inflammatory agent which often decreases the sciatica pain dramatically. Another medication that can be extremely helpful is Lyrica, which is a neuropathic pain

Treatment for Sciatica from a Disc Herniation By David L. Greene, MD, CEO

medication that can relieve the pain coming from the pinched nerve. Narcotic pain medications and muscle relaxers have their place in the management of pain from a herniated disc. These medications should only be received from one physician and care should be taken not to go over the prescribed dosage.

2. Mid-term Pain Relief. Physical therapy, Chiropractic Treatment, Acupuncture, Spinal Decompression, and Interventional Pain Treatments (epidural injections) have all been shown to help significantly for sciatica pain. This may occur singly or with combination treatments. These treatments may help immediately upon treatment commencing or after a week of trying the Medrol Dose Pak. The only one of these treatments that has shown any evidence of having the disc herniation shift back inside the confines of the disc space is Spinal Decompression. This may occur for a small herniation, but it will not happen for a substantial piece of disc.

3. Long Term Pain Relief. With a herniated disk, the treatments above may do the trick for pain relief with avoiding surgery. If the pain goes away for a while from epidural injections and spinal decompression for instance, then returns 3 months later, the treatments can be repeated. Having a series of injections every few months is a small price to pay to avoid surgery and the complication profile with injections is rare. The cost of spinal decompression is less than 5% of the cost of spinal surgery.

If you have a herniated disc, do not despair. Surgery can often be avoided and pain relief achieved with the above methods, either singly or in combination.

Within 3 months, ¾ of patients show reasonable to major

improvement without surgery for sciatica treatment.

The Most Comprehensive Pain Center in the Valley

Page 3 www.preferredpaincenter.com (602) 507-6550

The Blog of Pain www.preferredpaincenter.com/blog

Three Secrets of Pain Management By David Greene, MD, CEO

If a patient has failed 3 back surgeries, has significant scar tissue surrounding multiple nerve roots with persistent leg pain, and lives on chronic pain medication then the expectations will be very different from a patient with a moderately painful back strain for the first time.

So once the examination and work up are established and the treatment plan is being laid out, the medical provider should have a frank discussion with the patient about the chances for success.

Technology Is Great, And Sometimes Not

In some aspects technology has progressed the pain management treatment options dramatically. For instance radiofrequency ablation has been an excellent progression when facet blocks work and then wear off, as RFA can provide upwards of 2 years pain relief.

Also spinal cord stimulators have progressed nicely with technological improvements to provide more effective pain relief in last resort situations. One aspect where technology in my opinion is not so great is in PT machines. If patients do their treatments on high tech machines, how do they maintain a home program when treatment is over?

The best PT treatments in my opinion involve low tech rehab equipment, so that patients can learn their stretching and strengthening routines and then continue at home for best results.

These 3 secrets can help pain patients know what to look for and ask when seeking treatment. Keeping realistic expectations and having multiple treatment options with modern technology when appropriate provides the best chance for success.

When dealing with pain, it's not always easy or possible to hit a home run and achieve a pain free existence with treatment. It is possible though!

Here's 3 secrets to pain management treatment:

Comprehensive Pain Centers Are Better

Patients end up in pain from their own unique experiences. Whether it's from a car accident, sports injury, a moving incident, or simply a sneeze throwing out your back, a "one size fits all" mentality is not the best treatment approach.

Pain treatment is similar to a buffet ice cream sundae smorgasbord set up where having more ingredient options is better. People may not put all the ingredients on their sundaes because they have different tastes to suit their palate. Comprehensive pain centers include more ingredients so patients can receive individualized treatment.

The combination of traditional treatment options including Physical Therapy, Medication Management, and Interventional Pain treatments form the base of a comprehensive pain center, and adding complementary (alternative) treatments such as Chiropractic, Spinal Decompression Therapy, and Acupuncture round out a comprehensive multi-discipline pain center. The premise is for medical providers working collaboratively to help patients individually.

Patient Expectations Are Paramount

As with most treatments from medical providers, the best results are achieved if patient expectations are correctly handled from the beginning of treatment. If a doctor tells every patient the treatments will make him or her pain free, there will definitely be some unhappy customers.

Recent Testimonial

I had severe pain across my lower back and hips for 3 years. It was the first thing that crossed my mind when I would open my eyes every morning. I had pain all the time! I feel so blessed to have met Dr. Narwani and Preferred Pain Center. The clinic is clean, the staff is wonderful, and Dr. Narwani makes you feel so secure. I am pain free, I can breathe again, I can take the stairs at work, and I’ve lost 7 pounds. I went dancing last weekend, which is the first time I’ve done that in 2 ½ years. I became one with Lady Gaga! Thanks so much Dr. Narwani

and Preferred Pain Center!

Sharon Ebel, Executive Assistant

The Blog of Pain educates and discusses all subjects related to

pain.

• Obesity and Back Pain • The Basics of Medial Branch Blocks

for Facet Arthritis • How is a Lumbar Discogram

Performed?

Preferred Pain Center Phoenix, AZ

The Most Comprehensive Pain Center in the Valley

Page 4 www.preferredpaincenter.com (602) 507-6550

TENS Units provide non-pharmaceutical pain control which can reduce dependency on pain medications. They are easy for patients to manage and can be worn during everyday activities such as at work and during recreational activities. They are inexpensive and non-addictive.

They are safe and simple to use without the risks associated with surgery or heavy duty narcotic medications. Patients can think clearly without living in a "narcotic fog", thereby living more actively and productively.

The electrical stimulation from TENS machines are transmitted through the skin and relieve pain by stimulating peripheral nerves through what is termed the Gate Control mechanism. The Gate Control theory of pain suggests that in the spinal cord there is a control mechanism acting as a gate.

The Gate Control theory was first introduced in 1965 by Melzack and Wall in their Science article "Pain Mechanisms: A New Theory".

Just the Facts: TENS Units

Main Office Location

2813 E. Camelback Rd Suite 430

Phoenix, AZ 85016

Surgery Center Location

10255 N. 32nd Street Phoenix, AZ 85028

Phone (602) 507-6550 Fax (602) 759-1741

Follow us on Twitter!

twitter.com/PreferredPain

Preferred Pain Center Information – Call (602) 507-6550 for appts

Most Insurance Accepted including Worker’s Comp & Personal Injury

Patients Routinely Seen within 24 hours!

Offices A. Main Office B. Surgery

Center C. Laveen D. Mesa E. Chandler

The electrical impulses from TENS units, according to this theory, represent a non-noxious input. They suppress pain by closing the gate to incoming noxious input, such as pain from an arthritic back. If the gate is closed by non-noxious stimuli, such as that provided by TENS unit (transcutaneous electrical nerve stimuli), then the body will not be able to process the noxious stimuli and pain will be reduced.

There are two types of cells in the area of the spinal cord where signals travel. One is "inhibitory" and the other is "transmission". Transmission cells are activated by incoming signals and when a critical threshold level is reached, pain starts as the gate opens and the brain receives those signals and processes them as pain. The job of the inhibitory cells is to inhibit activation of the transmission cells, thereby closing the gate and keeping it closed. TENS units excite inhibitory cells and close the gate.

TENS machines produce two different current frequencies below the pain threshold that are tolerated by patients. This way, they close the gate rather than open it.

A

B

C

D

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