Holistiq Spine & Orthopedic Clinic

Products And Services

• Sympathetic-Nerve Blocks

  The sympathetic nervous system is responsible for regulating involuntary body functions, including blood flow, heart rate, digestion and perspiration. Sympathetic nerves spread outward from the spine, and, when compromised, can cause pain in various parts of the body. A sympathetic-nerve block is an injection of medication into whichever of these nerves is causing the pain. It works by numbing the nerve, which interrupts the pain signals the nerve is sending to the brain. It is used both to diagnose damage of and treat pain caused by the sympathetic nerves. Uses For Sympathetic-Nerve Blocks There are a number of uses for sympathetic nerve blocks; two of the most common are therapeutic and diagnostic. A therapeutic nerve block is used to treat pain; it typically contains a local anesthetic. Nerve blocks used to treat chronic pain can work for up to 6 to 12 months, and can be repeated as needed. A diagnostic nerve block is designed to determine the cause of pain; an anesthetic is injected only for the amount of time it takes to pinpoint the area causing the issue. Sympathetic-Nerve-Block Treatment Areas Injections of sympathetic nerve blocks are given near various areas of the spine. Types of blocks include stellate blocks, which target the upper spine‘s sympathetic nerves, including those that run to the chest, arms, neck and head; lumbar blocks, which target the lower spine‘s sympathetic nerves, including those that run to the legs and feet; and thoracic-region blocks, which target the mid-spine‘s sympathetic nerves, including those that run to the abdomen.

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• Cannabis For Pain Management

  It’s estimated that around 50 million Americans live with chronic or severe pain. Whether looking for a natural alternative to narcotics or simply seeking more effective relief, more and more of those people are using cannabis to manage their chronic pain. While research in the U.S. is limited due to the Federal Government continuing to classify marijuana as a Schedule 1 drug — equal in risk to heroin and cocaine — there is research from other countries and lots of anecdotal evidence pointing to marijuana being effective for managing some forms of chronic pain. How Does Marijuana Work In Reducing Pain? Of the 80 unique compounds in marijuana, the two that receive most of the attention for pain relief are cannabidiol (CBD) and tetrahydrocannabinol (THC), although other chemicals in marijuana could also prove effective with more research. THC resembles the cannabinoid chemicals that occur naturally in our bodies. In fact, we have built-in receptors for cannabinoids. When a person inhales or ingests marijuana, the THC stimulates those receptors in the brain. This activates the brain’s reward system and produces the euphoric sense that is colloquially known as the high. But at the same time it also reduces pain levels. CBD does not have the psychoactive component of THC, so it does not cause a high, but it also reacts with the brain’s pain receptors to cause anti-inflammatory and pain-relieving effects. Studies Point To Relief Marijuana seems to be very effective (and there is research to support it) for helping nerve pain (neuropathy) and cancer-related pain. Research on various types of chronic pain relief is ongoing, mostly outside of the U.S. These are some studies conducted in 2018: Israeli researchers found marijuana provided “substantial” pain relief for over half of 1,200 cancer patients using it for six months. A German review of 16 studies with 1,700 participants found that marijuana-based remedies increased the number of people who reported 50% or greater reduction in pain. Another study found marijuana effective for treating fibromyalgia, which causes widespread pain in the muscles and bones, and areas of tenderness. A European Academy of Neurology study found that cannabinoids resulted in migraine headache patients cutting pain by 40% or more. More research needs to be done, but these results are promising for chronic pain relief. Cannabis Versus Opioids For Pain Relief When considering that over 150 people die every day in the U.S. as a result of opioid-related drug overdoses, with another huge number being addicted to these narcotics, the option of addressing chronic pain with cannabis instead is promising. When compared with the side effects of opioids, the side effects with cannabis are minimal and non-life threatening. If you seek to treat chronic pain with cannabis, it’s best to start with low dosages and try different strains. Through this kind of trial and error, you may find the perfect treatment for your chronic pain.

  Link: Cannabis For Pain Management

• Chiropractic Care

  Chiropractic care is an alternative healthcare approach that focuses primarily on disorders of the musculoskeletal system. Chiropractors use a hands-on approach to diagnose and treat problems that affect the nerves, muscles, bones and joints by mechanically adjusting the spinal column. Although spinal manipulation is the foundation of chiropractic care, chiropractors, who take a holistic approach to treatment, use many other types of therapy to relieve pain and restore mobility. Chiropractors in North America can receive a Doctor of Chiropractic (D.C.) degree, which typically requires four years of premedical undergraduate work, 4 years of chiropractic college, and 1 year of internship. Reasons For Chiropractic Care The primary reason a patient seeks chiropractic care is to relieve pain in the back or neck. Such pain, which may not be responsive to typical medical treatment, may respond well to realigning the subluxations (dislocations) of the vertebrae. Many patients also consult with chiropractors for help with the following: Pain, tingling or numbness in the limbs Migraines and other headaches Discomforts of pregnancy Athletic injuries Menstrual problems Allergies Mobility or range-of-motion issues Underlying conditions, such as fibromyalgia For many patients, chiropractic care becomes an integral part of their lives; they report that it lessens stress, improves overall health and strengthens immune response. Chiropractic Assessment At a first visit, a chiropractor usually takes a medical history, noting past illnesses and injuries, medications taken, and lifestyle habits, including those related to diet, exercise, sleep patterns and use of tobacco, alcohol and drugs. A physical examination is then performed, and the chiropractor evaluates whether chiropractic treatment will be helpful, and whether the patient has any conditions, such as severe osteoporosis, bone fractures, joint diseases or damaged blood vessels in the neck, that may contraindicate chiropractic care. Other diagnostic tests, including checking blood pressure and taking X-rays, may be performed. Chiropractic Therapy While undergoing chiropractic treatment, which usually takes an hour or less, the patient lies on a table so the chiropractor can manipulate the spine. The chiropractor‘s movements can be gentle and feel like a massage, and/or be more abrupt as pressure is applied to correct spine misalignment. "Clicks" are occasionally heard, but this is normal and not dangerous. Prior to, during or after some sessions, the chiropractor may use other techniques, including ultrasound or heat therapy, on the patient. Although some patients experience muscle soreness in the hours or days after an adjustment, it is short-lived. Patients often report that their pain has been lessened or relieved, and their mobility increased, after receiving chiropractic care. Several treatment sessions are usually necessary to provide patients with long-term relief from symptoms. Most patients in acute pain visit the chiropractor 3 times a week for a few weeks, and then taper off to once a week, stopping only when their symptoms are gone. When pain is chronic, continued treatment, and periodic adjustments when acute episodes occur, may be required.

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• Epidural Steroid Injections

  By reducing inflammation, epidural steroid injections (ESIs) are used to temporarily relieve lumbar (lower back), cervical (neck), thoracic (mid-spine) and sciatic-nerve pain. ESIs contain cortisone and an anesthetic, and are delivered directly to the epidural space, which is the area between the spinal cord and the outer membrane that covers the brain and spinal cord (the dura). As a result, they provide more effective and faster pain relief than oral medications. Candidates For Epidural Steroid Injections Candidates for epidural steroid injections have back pain, and/or pain radiating down the arms and legs. Pain relieved by ESIs can be the result of many conditions, including the following: Lumbar-disc herniation Degenerative disc disease Lumbar spinal stenosis Vertebral compression fractures Cysts in a facet joint or nerve root Annular tears Epidural steroid injections can be used alone to provide pain relief, or given as part of a rehabilitation program to help a patient perform physical therapy exercises with less discomfort. Relief from a single injection can last from 1 week up to 1 year; a typical positive response lasts for 1 month. If helpful, injections can be repeated at 2-week intervals, but usually no more than 3 or 4 times per year. ESIs can also be of diagnostic value in pinpointing the source of the pain and determining its severity, which can assist a physician in developing an appropriate treatment plan. The Epidural-Steroid-Injection Procedure Epidural steroid injections are administered by many types of physicians, including anesthesiologists, orthopedists, physiatrists, pain-management specialists and neurologists. Typically, they are administered in an outpatient facility, under the guidance of fluoroscopy, to verify that the medication is reaching the inflamed nerve root. Because the injection contains a local anesthetic as well as a corticosteroid, the injection is not usually painful, although a patient may feel pressure at the injection site. The injection procedure takes only a few minutes. In most cases, the patient experiences immediate pain relief due to the anesthetic, but the relief is temporary and wears off in a few hours. During the next day or two, however, as the corticosteroid works to reduce inflammation, the patient should feel a significant, if not total, alleviation of pain. The patient can usually resume normal activities the day after the procedure. Risks Of Epidural Steroid Injections Epidural steroid injections are a safe form of treatment, although, in rare instances, they can cause headaches, bleeding, infections, nausea or vomiting, allergic reactions or nerve damage. Patients who are pregnant, have infections, or suffer from chronic bleeding disorders are not candidates for epidural steroid injections. ESIs can temporarily elevate blood pressure and blood sugar, and cause mood swings, so patients with hypertension, diabetes or mood disorders should be monitored before, during and after treatment.

  Link: Epidural Steroid Injections

• Nerve Conduction Study

  Nerve conduction study (NCS), also known as a nerve conduction velocity (NCV) test, enables the diagnosis of possible nerve damage by measuring the speed with which an electrical impulse travels through a nerve. This test, often performed in conjunction with electromyography (EMG), allows the doctor to differentiate nervous system issues from musculoskeletal ones, and is invaluable in helping to establish the source of nerve damage, information that can be vital to effective treatment. Nerve conduction studies may be used to diagnose specific causes of nerve damages, including: substance abuse, nerve compression or various types of neuropathy. Candidates For An NCS Nerve conduction studies may be administered to patients with symptoms such of chronic pain, numbness or tingling in various parts of the body. Physicians may recommend an NSC study to either rule out or confirm a diagnosis of one of the following conditions: Myasthenia gravis Amyotrophic lateral sclerosis (Lou Gehrig‘s disease) Alcoholic or diabetic neuropathy Traumatic nerve injury Guillain-Barre syndrome Certain hereditary diseases Spinal nerve compression It is important that the doctor administering the NCS be aware of any medications the patient is taking and of any underlying medical conditions. The patient‘s temperature needs to be taken because a low body temperature will result in slower nerve conduction. The NCS Study Procedure During the outpatient NCS study, the nerves presumed to be affected are targeted. Electrodes are placed at various points on the skin, their adherence aided by a sticky gel. Each electrode is placed at a precise distance from its partner, a recording electrode. As the nerve is stimulated by a mild, brief electrical charge, the exact time the impulse takes to reach the receptive device is recorded. This response time is displayed on a monitor for the doctor to observe and evaluate. Patients usually experience some discomfort from the mild shocks administered during the NCS study, but this is short-lived. After the procedure, patients may experience some muscle soreness. Risks Of An NCS The NCS is noninvasive and ordinarily results in no side effects. While patients experience various degrees of discomfort during the test itself, the electrical voltage employed during the test is very low and not damaging. Some patients with sensitive skin may have some irritation from the gel used to attach the electrodes. Typically, patients can resume normal, but not strenuous, activities immediately following the test. Some patients with sensitive skin may have some local irritation from the gel used to attach the electrodes. Individual patients with underlying medical conditions may be given specific recommendations after the examination.

  Link: Nerve Conduction Study

• Pain Medication

  A number of different types of medications may be used to reduce pain in various parts of the body. Any of the medications described below may be helpful in relieving pain, depending on the medical condition of the patient and the severity of the pain being experienced. Over-The-Counter Medications Over-the-counter medications are frequently helpful in relieving symptomatic pain that is mild to moderate. Such medications may include analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDS, such as ibuprofen and naproxen. It is important for patients to consult with their physicians regarding appropriate dosages and to avoid possible interactions with prescribed medications or over-the-counter preparations they may be already taking. Opioids For severe or post-operative pain, opioids, sometimes known as narcotics, may be necessary. These may include codeine, propoxyphene (Darvocet), hydrocodone (Vicodin) and oxycodone (Percocet, Oxycontin). While these drugs can be extremely effective against pain, they tend to be addictive. Ultram (Tramadol), a prescribed medication called an opioid analgesic, is somewhere between an over-the-counter medication and a narcotic and may be habit-forming. Muscle Relaxants Muscle relaxants can also help to relieve symptoms of pain, particularly when such symptoms are associated with muscle spasms. Examples of commonly used muscle relaxants are cyclobenzaprine (Flexeril), carisoprodol (Soma) and diazepam (Valium).

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• Platelet-Rich Plasma Injections

  Platelet-rich-plasma (PRP) injections use components of the body‘s own blood to stimulate healing. Platelets, which are usually associated with coagulation (clotting), are also, according to recent research, able to assist in mending and strengthening damaged tissue by increasing certain growth factors. During the normal healing process, the body uses platelets to promote new-tissue growth and repair injuries. By supplementing platelet content, the healing process is accelerated. There is ongoing research on the efficacy of PRP injections, and some medical professionals remain skeptical about their value. Conditions Treated With Platelet-Rich-Plasma Injections Platelet-rich-plasma injections can be used to treat a wide range of orthopedic conditions, including the following: Arthritis Tendonitis Bursitis Joint pain Ligament sprains or tears Nerve inflammation Postsurgical healing from tendon or ligament repair PRP therapy is also used to promote rapid healing after nonorthopedic surgeries, including cosmetic ones. Benefits Of Platelet-Rich-Plasma Injections There are several benefits to PRP therapy. They include the fact that the platelet-rich plasma being injected is autologous (comes from the patient), so there is no risk of cross-reactivity, immune reaction or disease transmission. It is also minimally invasive (unlike surgery), and facilitates healing (unlike corticosteroids). The Platelet-Rich-Plasma-Injection Procedure During the PRP-injection procedure, which usually incorporates ultrasound imaging, a small amount of blood is withdrawn from the patient. This blood is processed in a centrifuge to separate its various elements, and concentrate the platelets. The resulting plasma is up to five times more concentrated with platelets than "natural" blood. Once concentrated, the platelets are loaded, along with some of the patient‘s whole blood, into a sterile syringe, and injected into the patient. The procedure is usually performed under local anesthetic in a physician‘s office. A typical patient experiences little or no discomfort from the injection, but the injection site is usually inflamed and sore for about 48 hours. Taking pain medication and applying ice are recommended. Most patients require one to three PRP injections, about 4 to 6 weeks apart, in order to achieve optimal results. Occasionally, a fourth injection is necessary. Typically, by the fifth day after an injection, the patient has a significant reduction in pain, and can begin physical therapy. Risks Of Platelet-Rich-Plasma Injections Although PRP injections are generally safe and effective, sterilization is of great importance. There is a slight chance of infection or blood clots, and the remote possibility of allergic reaction.

  Link: Platelet-Rich Plasma Injections

• Radiofrequency Neurotomy

  Radiofrequency neurotomy is a treatment designed to provide relief from severe pain in the back or neck. It uses the heat generated by radiofrequency waves to interfere with the nerves‘ ability to send out pain signals. The heat generated by these waves is delivered to targeted nerve areas through special needles that are inserted, just above the spinal area, through the skin. Radiofrequency neurotomy does not usually provide permanent pain relief; its goal is to significantly decrease neck or back pain. Patients who have been previously unresponsive to more conservative methods of treatment, such as physical therapy or pain medication, are often candidates for this procedure. Candidates For Radiofrequency Neurotomy People experiencing chronic back or neck pain are considered good candidates for radiofrequency neurotomy. Patients who are taking blood-thinning medications are generally not good candidates because blood thinners can cause adverse reactions when mixed with the medication that is administered during radiofrequency neurotomy. A series of diagnostic tests are performed to determine whether radiofrequency neurotomy will be beneficial for the patient. The diagnostic testing process begins with the injection of a small amount of numbing medication into the area where the pain is located. The areas of the body that have been numbed by the medication are the locations where the radiofrequency needles are placed. Once the needles have been inserted, the patient‘s pain level is tested. If the pain gradually lessens, the patient is a good candidate for radiofrequency neurotomy. The Radiofrequency Neurotomy Procedure Radiofrequency neurotomy is performed as an outpatient procedure in a doctor‘s office, and is usually completed within an hour. The procedure begins with the placement of an intravenous (IV) line into the patient‘s arm or hand. The IV is used to administer medication that keeps the patient comfortable and relaxed during treatment. A specialized X-ray machine, known as a fluoroscope, provides information that allows for the most accurate positioning of the radiofrequency needles. This ensures that only the targeted nerve tissues are affected, and that the healthy surrounding nerve tissues remain undamaged. Risks Of Radiofrequency Neurotomy The risks of radiofrequency neurotomy vary. Some patients experience mild and temporary discomfort/reactions, while other patients experience serious and long-term pain or discomfort. Complications include the following: Temporary pain/numbness where the needles were placed Persistent numbness that cannot be resolved with medication Paralysis Another possible complication of radiofrequency neurotomy is bowel or bladder incontinence. Recovery From Radiofrequency Neurotomy Patients can return home immediately following radiofrequency neurotomy. The recovery process varies from patient to patient, though most patients need only a few days to recover. One of the most commonly reported side effects of the procedure is mild, temporary soreness throughout the body; it is typically treated with rest, or over-the-counter pain medication. Results Of Radiofrequency Neurotomy Radiofrequency neurotomy is more successful in some patients than others. The relief the procedure provides is only temporary, and lasts anywhere from just a few months to up to 2 years. Radiofrequency neurotomy can be repeated if pain recurs.

  Link: Radiofrequency Neurotomy

• Myofascial Release

  Myofascial release is a form of therapy designed to relieve chronic and acute pain through special, targeted massage that aims to reduce tightness within the fascia, a sheet of connective tissue below the surface of the skin. Tightness within the fascia can restrict a patient‘s range of motion or cause the patient to favor one side of the body. The goal of myofascial release is to relieve pain and allow the patient to regain range of motion. Candidates For Myofascial Release Myofascial release is often effective in treating chronic pain caused by conditions that include carpal tunnel syndrome, fibromyalgia and temporomandibular joint (TMJ) disorder; it is also effective in treating acute pain caused by trauma. Some patients experience myofascial pain in the form of headaches or lower back pain. Myofascial release may be recommended in combination with traditional pain-relief treatments, including anti-inflammatory medications, heat and ice application, and stretching exercises. The Myofascial Release Procedure Myofascial release is performed by chiropractors, sports medicine specialists, physical therapists and massage therapists trained in myofascial release. It typically takes place in a health center or outpatient clinic. After an initial consultation in which the location of the affected fascia is determined, the medical professional typically applies gentle pressure to the affected area or guides the patient through prolonged, low-load stretching. Sessions usually last 30 minutes to an hour, and are performed, depending on the severity of the patient‘s condition, every day or every few days.

  Link: Myofascial Release

• Trigger-Point Injections

  Trigger-point injections treat pain in areas that have developed trigger points, which are knots of muscle that form when muscles contract and but cannot relax. Trigger points are caused by injury to or overuse of the affected muscle; they can also be caused by stress and anxiety. They can irritate the nerves around them, which causes pain in other areas of the body. The chronic pain brought on by trigger points can also decrease the affected muscle‘s range of motion. Candidates For Trigger-Point Injections Trigger-point injections are typically used to treat pain in the neck, lower back, arms and legs. They can also be effective for tension headaches, temporomandibular joint (TMJ) pain or fibromyalgia, and for myofascial pain syndrome, a chronic pain condition in which trigger points develop in certain muscles, and cause pain when touched. Patients with this condition often experience deep, aching pain in the affected muscle that worsens over time, as well as muscle and joint stiffness, and difficulty sleeping. Symptoms can significantly affect a person‘s quality of life, and should be addressed if they do not subside. Over time, patients with untreated myofascial pain syndrome can develop muscle weakness or fibromyalgia. The Trigger-Point Injection Procedure A needle containing a local anesthetic, and, sometimes, a corticosteroid to reduce inflammation, is inserted into the trigger point to make it inactive and, therefore, alleviate the pain. The procedure typically takes between 15 and 20 minutes, and is done in a doctor‘s office. If necessary, multiple sites can receive trigger point injections in one appointment. Risks Of Trigger-Point Injections Trigger-point injections are considered safe, and have few side effects. The patient may feel sore around the injection site for up to 2 days, but applying ice usually helps. In most cases, normal activities can be resumed the next day. Trigger-point injections not only relieve pain, they loosen the muscles that are responsible for the pain, which facilitates the rehabilitation process.

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