|1
A Look Inside: Neurostimulation!
Medtronic’s high-tech approach to life with less pain.
New Locations!
Now seeing patients in both Palm Bay and Titusville.
New Procedures!
Read up on all the latest treatments and procedures.
Here’s What
You Will Find... Contents 7
10
16
4
High-Tech Pain Relief
7
From the Test Kitchen
8
Personalized Pain Relief
9
Titusville, We’ve Arrived
How neurostimulation works to stop the pain before it reaches the brain. A delectable poultry dish sure to make your taste buds do a happy dance. Individualized creams that provide an alternative pain treatment. Introducing our newest location coming to Titusville.
10
Palm Bay, We’re Here to Stay
12
Easy Peasy Procedure
14
New School Meets Old School
18
Food for Thought
Announcing our new permanent Palm Bay Location.
Doctors Gayles, Udeshi and Arcos present a minimally invasive procedure. Western medical treatments that complement conventional medicine.
Learn the pros and cons of some of your favorite foods.
Down: 1. TITUSVILLE, 2. DERMATRAN, 3. SPINALCORDSTIMULATION, 4. AURICULOTHERAPY, 5. DRGOLOVAC, 8. SIJOINT, 11. STEPS Across: 3. SPINALSTENOSIS, 6. RFA, 7. FOUR, 9. ADAPTIVESTIMULATION, 10. OSTEOARTHRITIS, 12. PALMBAY, 13. NEUROSTIMULATIONTHERAPY
2|
Medical Studies currently being conducted: Intrathecal Hydromorphone
Safety Study – Dilaudid Intrathecal Pain Pumps, Dr. Gayles, Dr. Udeshi For more information, please refer to Clinicaltrials.gov
P: 321-784-8211 F: 321-394-9425 Stanley Golovac, MD Richard Gayles, MD Ashish Udeshi, MD George Arcos, DO
MILD (Midas Encore Study)
Lumbar Spinal Stenosis, Dr. Golovac For more information, please refer to vertosmed.com and midasencore.com (This study is closing at the end of March)
PRIZM Registry
Prialt Pain Pump, Dr. Gayles For more information, please refer to clinicaltrials.gov
STEPS Trial
Lumbar Spinal Stenosis, Dr. Gayles, Dr. Udeshi For more information, please refer to stenosistrial.com
Spinal Stenosis Holding You Back?
leg when walking or standing? It may be Spinal Stenosis
For more study information, please email our Clinical Research Coordinator, Amanda Darling at: amandad@floridapaininstitute.net -orSusan Clark, ARNP-C at: susanclarkflp@gmail.com You may also call 321-784-8211 ext. 1115
Right now, doctors at you are 55 or older and think you may have Spinal Stenosis – but are not yet ready for major spine surgery – this study may be right for you. The study is for the Totalis™ System – a minimally-invasive
the same day.
To learn more, please contact us: Amanda Darling, Study Coordinator | 321-784-8211 ext. 1115 AmandaD@floridapaininstitute.net Dr. Richard Gayles, Florida Pain Institute 595 N Courtenay Pkwy, Merritt Island, FL 32953 321-784-8211 | www.floridapaininstitute.net
|3
Pain Relief Goes High Tech 4|
LEADING-EDGE TECHNOLOGY THAT CHANGES LIVE WAITING FOR A ROCK CONCERT TO BEGIN, 25-YEAR-OLD NICOLE ADDIS FELT FIT, HAPPY AND EXCITED TO BE OUT AFTER GIVING BIRTH TWO MONTHS PRIOR. AS THE BAND STARTED, A CROWD RUSHED IN BEHIND NICOLE, PUSHING HER TO THE FLOOR. “I heard a sickening pop sound,” recalls Addis. “Then my foot immediately started to throb and swell. I could only stay for two songs before the pain got so severe I had to leave.” X-rays in the ER showed no broken bones, but after a week on the couch, Addis was still in pain. She was anxious to resume training for a half-marathon –- half-way to her lifelong goal of completing a full marathon—but when the pain continued to be too agonizing for her to walk, Addis saw a podiatrist (foot doctor) who thought she might have extensive tendon damage. After steroid injections, physical therapy, pain medication, experimental treatments and two surgeries, Addis’s pain was worse than after the original injury. “I was so disheartened,” says Addis. “I had intense burning pain and extreme sensitivity to touch. Even exposure to air conditioning was excruciating.” It took a visit to a pain management specialist to diagnose the problem as complex regional pain syndrome (CRPS). The doctor suggested a screening trial for spinal cord stimulation, also known as neurostimulation therapy. Spinal cord stimulation is proven effective for managing certain types of chronic pain. It uses a surgically placed device to deliver mild electrical signals to the area near the spine. Spinal cord stimulation provides pain relief by disrupting the pain signals traveling between the spinal cord and the brain. Instead of pain, patients feel a tingling sensation where the pain used to be. Richard Gayles, MD, works in the areas of pain management. Although not Nicole’s physician, Dr. Richard Gayles has treated many patients with spinal cord stimulation, including patients with CRPS. “What we want to do with spinal cord stimulation,” explains
Dr. Gayles, “is not only control pain, but also help improve function, so patients can do the things they want to do, every day.” Unlike many other treatments, spinal cord stimulation doesn’t require medication. A person doesn’t have to wait for medications to take effect – the stimulation is instantaneous. And often, spinal cord stimulation therapy allows a person to decrease or eliminate medication use so there are fewer or no drug side effects like fatigue or nausea to manage. Dr. Gayles adds, “Spinal cord stimulation is one of the few therapies that a person can actually try before committing to the longterm therapy. You don’t have to guess if the treatment might work for you.” When Addis researched spinal cord stimulation, her heart sank. She knew her podiatrist wanted her to have an MRI to rule out tendon damage, but she had read that the therapy required an implantable device that wouldn’t be compatible with MRIs. The alternative was exploratory surgery, which Addis wanted to avoid. Now more than ever, MRI is the go-to scan for diagnosing problems with soft tissue, like muscles and nerves. MRI is one of the most commonly performed tests in the world, and has been referred to as the “gold standard” for pain diagnosis. Addis was desperate for pain relief. While waiting to see if her insurance would cover an MRI scan, Addis agreed to have the trial to see if spinal cord stimulation might work for her. “My hope was for the therapy to just take the edge off the pain,” remarks Addis. “Just enough so I could get to the back of the grocery store without resting. The trial lasted one week and it was the first time in four years that CRPS was not the focus of my thoughts! I knew I wanted spinal cord stimulation right away.”
*Under specific conditions and requires SureScan® implantable neurostimulator and Vectris® leads.
Managing Pain and Protecting Future MRI Options The morning Addis was scheduled for her implant, she was surprised to find out that she would be the first one in her state to receive a newly-released neurostimulation system that allows safe access* to an MRI scan on any part of her body. If a system doesn’t have the new MRI technology, it may have to be surgically removed before a person can be scanned safely. With this innovative technology, Addis could manage her pain and protect future MRI options. “Getting that hightech neurostimulator was a turn-around for me,” recalls Addis. “Besides a major reduction in pain, I was able to have an MRI which showed no tendon damage! I avoided an unnecessary surgery and got the okay to run again.” Everyone responds to pain and pain management differently. Not everyone will respond to spinal cord stimulation as Addis did. It’s important for people who are living with chronic pain to research their options and prepare themselves with information. Partnership between patients and physicians is the most effective way to make decisions about the pain therapy that will be right for them.
from standing to walking. For someone receiving spinal cord stimulation, a stimulation level that blocks pain when standing may be uncomfortable when lying down. As a result, without adaptive stimulation, frequent adjustments must be made with the hand-held programmer to keep things comfortable. “They didn’t turn on the adaptive stimulation feature for the first three weeks after surgery,” states Addis. “Whenever I stood up or sat down, I had to turn the stimulation up or down with my remote programmer. It was getting a little annoying.” Addis adds, “With this adaptive stimulation turned on, I hardly ever touched my remote. Now I don’t think about pain or adjusting the stimulation. I can just live my life.” Today, pain management options reach well beyond pills, injections and surgeries, which don’t always result in longterm pain relief. Better diagnosis and better understanding of what causes pain have led to advances in treatments, including spinal cord stimulation.
“Adaptive” Stimulation – Set It and Forget It Addis was surprised to find out that only one company, Medtronic, offers the new MRI technology and another unique feature called adaptive stimulation. Throughout each day, a person changes positions repeatedly—from sitting to lying down, from lying down to standing up, AFTER FINDING PAIN RELIEF WITH SCS, NICOLE ADDIS TRAINS FOR A MARATHON. ABOVE, ADDIS WITH HER FAMILY.
To achieve both sustained pain relief and improved function, Dr. Gayles looks to spinal cord stimulation therapy. “Fortunately for patients, recent advances in one stimulation device make the therapy even easier to manage their pain,” explains Dr. Gayles. “They have access to MRI advanced diagnostic care and they have adaptive stimulation, which means patients can make significantly fewer adjustments to their stimulation throughout the day.”
New Technologies, New Possibilities Today Addis is well into her marathon training, working full-time and enjoying activities with her two daughters. She has advice for anyone who is considering spinal cord stimulation. “Anyone dealing with chronic pain and feeling hopeless should at least do the trial,” suggests Addis. “It’ll give you a good indication of your chance for successful therapy. And I’d definitely get the most advanced device, one that wouldn’t limit my access to MRI scans and has adaptive stimulation.” This educational content was provided by Medtronic.
|5
Out of Pain. Into Relief. Ask your doctor if spinal cord stimulation is right for you.
Medtronic’s spinal cord stimulation, also called neurostimulation therapy, is a path you can take to move beyond the pain. To step back into the life you love. With the people who love you.
Visit tamethepain.com/future for more information. NEUROSTIMULATION SYSTEMS FOR PAIN THERAPY Brief Summary: Product Technical Manuals and Programming Guides must be reviewed prior to use for detailed disclosure. Indication for Use: Chronic, intractable pain of the trunk and/or limbs-including unilateral or bilateral pain. Contraindications: Diathermy. Warnings: Defibrillation, diathermy, electrocautery, MRI, RF ablation, and therapeutic ultrasound can result in unexpected changes in stimulation, serious patient injury or death. Rupture/piercing of neurostimulator can result in severe burns. Electrical pulses from the neurostimulator may result in an inappropriate response of the cardiac device. Precautions: The safety and effectiveness of this therapy has not been established for: pediatric use, pregnancy, unborn fetus, or delivery. Follow programming guidelines and precautions in product manuals. Avoid activities that stress the implanted neurostimulation system. EMI, postural changes, and other activities may cause shocking/jolting. Patients using a rechargeable neurostimulator should check for skin irritation or redness near the neurostimulator during or after recharging. Adverse Events: Undesirable change in stimulation; hematoma, epidural hemorrhage, paralysis, seroma, CSF leakage, infection, erosion, allergic response, hardware malfunction or migration, pain at implant site, loss of pain relief, chest wall stimulation, and surgical risks. For full prescribing information, please call Medtronic at 1-800-328-0810 and/or consult Medtronic’s website at www.medtronic.com. USA Rx Only Rev 0313
UC201505042 EN
66||
New Tastes! Whole Roasted Chicken
with Root Vegetables
by Alexandra Golovac, Fitness Nutritionist - Chef
Makes: 4-6 servings Serving size is 1 - 1½ chicken = 6 - 7 oz of chicken This makes for a great lunch or dinner.
Ingredients
Directions
Veggies:
1. Preheat the oven to 425 degrees.
• 1 onion, chopped • 5 carrots, chopped • 10 small baby dutch potatoes, quartered or red petite potatoes • 6 cloves of garlic • 1 tbs olive oil • Salt, pepper, granulated garlic/ garlic powder
Chicken:
• 1 whole chicken (between 3-5 lbs) • 2 tbs of softened butter • 1 clove or garlic, crushed • 1 tbs rosemary, freshly chopped • Juice of 1 Meyer lemon (save the juiced lemon halves to stuff inside of the chicken) • Salt, pepper, granulated garlic • 1 Meyer lemon sliced (to place on top of the chicken while roasting)
2. Chop up your veggies and toss them with the olive oil and a generous amount of salt, pepper and granulated garlic. Pour your veggies into the bottom of a large baking dish. 3. Rinse your chicken. Remember to look inside of your chicken and to remove any giblets. Usually these giblets are neatly packaged up and all you need to do is pull them out. Pat the chicken dry with paper towels and place it in your baking dish on top of the veggies. 4. In a small bowl combine the softened butter, garlic, rosemary and lemon juice. Whisk together well. Pour this mixture over your entire chicken. Use clean hands to massage it into the chicken (top and bottom). Make sure the entire chicken is coated. 5. Now, season your chicken with salt, pepper, and granulated garlic. I like to use these spices liberally. Don’t neglect the bottom of your chicken. Make sure to spice it everywhere. 6. Place the leftover-juiced lemon rinds inside the body cavity of the chicken. 7. Slice up another Meyer lemon and place these slices on top of the chicken. These slices might get rather crispy during the cook, but they impart flavor into the chicken. You can switch them out with fresh slices before serving, or forgo them entirely. 8. Roast your chicken for 1 1/2 hours or until the internal temperature is 160 degrees and the juices run clear. You need to take this temperature from the thickest part of the chicken thigh, and be careful not to hit the bone or that might skew the temperature reading. Once the chicken has reached the desired temperature, allow it to rest for fifteen to twenty minutes. Carve, remove skin, and serve!
|7
8|
New Titusville Facility! US 1 n cisiyo PreW a
• Doctor of Medicine Degree in 1991 from the University of Michigan School of Medicine and residency in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins in Baltimore. • Certified for three elite boards and ABA Special Qualifications in Pain Management
5
I-9 5
76
I-9
it 1
Ex
Pineda Location 5545 N Wickham Rd., Ste 104 Melbourne, FL 32940
Culver Dr NE
Outlook Dr
Exit 176
N Wickham Rd
Hoofprint Dr
South Titusville Medical Center 7455 South US Highway 1 Titusville, FL 32780
Palm Bay Rd NE
Cloudberry Pl
Outlook Dr
Merritt Island Location 595 N Courtenay Pkwy., Ste #101 Merritt Island, FL 32953
Co Rd 509
Hoofprint Dr
Dr
Needle Blvd
s ke La er De
High Pasture Way
Aster Ct
Hurtwood Ave
N Courtenay Pkwy
Kurek Ct
Minna Ln
404
Pineda Causeway
Titusville Location:
Pkwy rfolk No
404
1
Richard Gayles, MD
Kings Hwy
Centre Lake Dr NE
Palm Bay Location 490 Centre Lake Drive NE Palm Bay, FL 32907
Plus 3 Other Convenient Locations in: Merritt Island Melbourne Palm Bay
How to Arrange an Appointment: • Ask your Primary Care or Treating Physician to refer you to Florida Pain Institute. • Referrals can be faxed to 321-394-9425. * Include: referral, patient demographics, current insurance information, current office
|9
US
Dr. Richard Gayles, Your Titusville Physician.
St ood w l l Be ita St Bon ay ed WBlvd d u l Sec r Park ir Rive tthew C Ma
notes, and diagnostic testing reports that pertain to the area to be treated. • We accept the majority of area insurance plans. Please call to check coverage availability: 321-784-8211.
Call: 321-784-8211 or Visit: www.FloridaPainInstitute.net
10 |
New Palm Bay Facility! New Locations, Same Dedication to You!
Florida Pain Institute is pleased to announce 2 new locations. In the new year we will be providing pain relief at our new permanent office located in Palm Bay as well as a new location in Titusville. Physicians, Dr. Udeshi and Dr. Arcos will be practicing in the new Palm Bay location. Our new website provides you with easy access to beneficial information about conditions, treatments, and multiple clinical research studies.
When you visit us online you will soon discover how simple it is to schedule appointments within 72 hours, or to locate and contact us at either of our 4 locations, including our new Palm Bay and Titusville offices. Each location provides the same intimate care you’ve come to expect from the Florida Pain Institute over the past 22 years of service.
Specializing in Back, Neck & Cancer Pain | 11 Common Pain Conditions:
Common Pain Treatments:
• • • • • •
• • • • • •
Cancer Pain Back Pain Joint Pain Neck Pain Motor Vehicle Injuries Whiplash Pain
Radiofrequency Ablation Intrathecal Pump Therapy MILD Vertebroplasty Spinal Cord Stimulation X-Ray Guided Injections
For more information please visit:
FloridaPainInstitute.net
This is more than a website; it is an online library full of all the information you need related to chronic pain.
Call 321-784-8211 or Schedule an appointment within 72 hours at FloridaPainInstitute.net
Dr. George Arcos
Dr. Ashish Udeshi
See for yourself!
u
Visiting us online is now easier than ever with our mobile site. Simply visit www.FloridaPainInstitute.net or scan the QR code to the right with your mobile device. You will soon see how easy it is to navigate our site, contact us with questions, or schedule an appointment.
Using your smart phone, scan the QR code to access our new site today.
Disc-FX® 12 |
A Minimally Invasive Treatment Option for Back Pain. The Disc-FX® System is an innovative, minimal access spine system designed to efficiently access the damaged disc without injury to surrounding disc anatomy. Disc-FX® permits multiple treatment options compared to other single treatment services in the marketplace. In addition to manual decompression, Disc-FX® can help to clean the disc and seal tears in the annulus. In the past, patients with contained disc herniations have been treated with conservative care including rest, medication, injections and/or physical therapy. Unfortunately, this does not always provide relief. In the past people who did not respond to conservative care were forced to live with the symptoms or consider major spine surgery. If they underwent surgery, it could take weeks or months to recover, causing a major disruption in their daily lives. With Disc-FX®, this is not the case. Disc-FX® provides an option for those people who have failed conservative care, and are not yet ready for major surgery. It is a minimal access procedure performed on an out-patient basis whereby the patient will go home the same day as the procedure with only a small bandage on their back. Following manual removal of the offending herniation, the patented Disc-FX® device is activated to help clean the disc and seal tears in the annulus. As a result, pressure in the disc is reduced, which eases symptoms.
WHO IS A CANDIDATE FOR THE PROCEDURE? Patients with symptomatic, contained lumbar disc herniations that have not responded to conservative treatment, may experience relief from the use of Disc-FX®. Typical signs of a contained lumbar disc herniation is lower back pain or pain radiating down the leg accompanied by some lower back pain. DiscFX® may not be beneficial for advanced degenerative disc disease or spinal fractures. The doctor will evaluate and determine if you are a candidate for Disc-FX®
POTENTIAL BENEFITS OF THE PROCEDURE • Out-patient Procedure • Smaller skin incision than traditional surgery • Short procedure time • Multiple treatment options • Local anesthetic • Targeted access to damaged (diseased) area • Treat multiple disc levels • Quick relief of symptoms • Earlier return to normal activities • Minimal tissue damage • Preserves all additional surgical options, should they be needed.
ALL ABOUT THE Disc-FX® SYSTEM Prior to the Procedure:
Medical evaluation includes a physical exam. Diagnostic tests such as MRI (magnetic resonance imaging), steroid injection,
How It Can Help You or discography may be conducted to diagnose and locate the symptomatic herniation and determine if the procedure is appropriate.
During the Procedure: The Disc-FX® System requires the patient to lie on their stomach throughout the procedure. Minimal anesthesia requirements are typically necessary. A needle is inserted into the skin near the affected disc level, followed by an incision through which a working ‘tube’ is placed. Graspers are used to manually remove and decompress the offending herniation. The patented Trigger-Flex® can then be used to help clean the disc and seal tears in the annulus. At the conclusion of the procedure, the ‘tube’ is removed and a small bandage is applied over the sutures.
After the Procedure:
Patients are required to remain at the facility after the procedure for observation which is typically one or two hours. Upon release, patients are then informed to rest for one to three days with limited sitting or walking. In most cases, symptoms caused by the disc herniation are gone or diminished within two weeks. A patient may experience some discomfort or bruising where the incision was created. After about one week, patients participate in physical therapy which is important for a full recovery. They are typically allowed to engage in some physical activity and return to work. Your physician will provide a comprehensive recover schedule.
ARE THERE ANY COMPLICATIONS WITH THE PROCEDURE? As with any other minimally invasive disc treatments, side effects of Disc-FX® are relatively rare and should be discussed with your physician.
ABOUT DR. RICHARD GAYLES • Doctor of Medicine Degree in 1991 from the Michigan School of Medicine and residency in the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins in Baltimore. Fellowship completed at the Cleveland Clinic in Ohio. • Certified for three elite boards and ABA Special Qualifications in Pain Management
ABOUT DR. ASHISH UDESHI • B.S. degree in Biology with Honors in 2004 and a graduate of the University of Miami Miller School of Medicine in 2008. • Residency in Anesthesiology, Fellowship for Interventional Pain Medicine, and Board Certified in Anesthesiology. • Speaks fluent English and Spanish.
ABOUT DR. GEORGE ARCOS • B.S. degree from the University of Florida in 1979 and Doctor of Osteopathy from New York College of Osteopathic Medicine in 1983 • Residency in Anesthesiology and Board Certified in Anesthesiology and Pain Management.
| 13
Auriculotherapy 14 |
Considered A Form Of Alternative Medicine A new and novel way to treat acute and chronic conditions goes back to an old school philosophy known as auriculotherapy. Auriculotherapy is considered a form of alternative medicine, which also includes body acupuncture, chiropractic manipulation, homeopathy, and biofeedback.
noticed strange scars on the upper ears of some of his patients. He found that all of them had been treated for sciatic pain by a local lay practitioner who had cauterized a specific area of the external ear in order to relieve their low back pain. Dr. Nogier conducted a similar procedure on his own sciatica patients and found that their back pain was also reduced. He then tried other means of stimulating this “sciatica point,” including the use of acupuncture needles, and found that they too were effective in alleviating sciatica pain.
All of these techniques are also referred to as Complementary Medicine because they are not only alternatives to conventional Western medical Dr. Nogier brilliantly extended this one observation treatments, but can also serve as additional into a more comprehensive procedures that complement model. He theorized that if conventional medicine. WHILE EAR ACUPUNCTURE is often used an area of the upper external in conjunction with body acupuncture, Auriculotherapy is similar ear is effective in treating low auriculotherapy can also effectively to acupuncture, but pertains back pain, maybe other parts relieve pain, stress, and tension when to certain points on the ear. of the ear could treat other used alone. Ear acupuncture has a long By touching an electrical parts of the body. The ear is and diverse history, ranging from ancient stimulant to the ear, a variety said to represent the whole China, ancient Persia and ancient Egypt. of health-related conditions anatomical body, but in an may be alleviated. upside down orientation. Auriculotherapy can reduce the pain, stress, and tension not fully relieved by other medical procedures, but works best when implemented as part of a multidisciplinary complement of multiple treatment approaches. While ear acupuncture is often used in conjunction with body acupuncture, auriculotherapy can also effectively relieve pain, stress, and tension when used alone.
Ear’s Early Role In Pain Control While ear acupuncture has a long and diverse history, ranging from ancient China, ancient Persia, and ancient Egypt, modern applications of auriculotherapy are based on the work of Dr. Paul Nogier of Lyon, France. In the 1950s, Dr. Nogier
Proponents believe that auriculotherapy works because many of the nerve endings in the ear connect to hormonal parts of the brain and organs within the body.
Ways To Apply Ancient Treatment The use of this form of pain control has existed for centuries, but only now, after significant research, are we able to define with modern technology the way to best utilize auriculotherapy to manage various types of pain and help pain sufferers enjoy their lives. It is a treatment modality where the specific malfunctioning organ or a systemic illness can be treated by application of a transcutaneous electrical
nerve stimulation unit to a correlating part of the external ear. The conditions most likely to respond to auriculotherapy are: Arthralgia, Arthritis, Chemically induced peripheral neuralgia, Chronic fatigue, Craniofacial pain, Fibromyalgia, Headache, Hemarthrosis, synovitis, Insomnia, Muscular pain, Neck and back pain, Neuralgia, Neuritis, Temporomandibular disease, Tendonitis and Tinnitus.
How It’s Done With the use of a special wand and nerve detector, a trained specialist identifies the targeted nerve bundle’s location with a high-pitched sound. Once the area is found, the point is marked and then cleaned for electrode placement. The area behind the ear called the auricle is the site for the battery generator. Once in place the stimulator begins working and relieving pain immediately. The area needs to stay dry so bathing is allowed but direct water contact to the site of the stimulator should be avoided, or the battery will stop functioning and the treatment period will be shortened. Both the electrode and battery will stay in place for the next 96 hours, or four days. At that point the patient can simply remove the stimulator at home without having to come into the office. There are four weekly intervals of treatments. Approximately 10 minutes of detection and application time in the office are necessary. The second cycle usually starts on the following Monday and is repeated each Monday for the entire course of the four week therapy. A total of four cycles are needed to have a lasting effect of up to one year of relief. Pain relief will vary from patient to patient,
but for the most part being able to exist without the codependency of medicines is a much better way of life. Other areas can also be targeted once the pain is relieved at the most painful site. The use of a nerve stimulator, which is not considered an experimental device, is covered by insurance, and is not contraindicated in a person with a pacemaker, automated implantable cardioverter-defibrillator, spinal cord stimulator, intra-thecal pump delivery system or any other implanted medical device. Blood thinners do not have to be temporarily stopped for this non-invasive procedure and it has proven to be safe and painless. Florida Pain Institute is the only Florida-based Interventional Pain Clinic to offer such a revolutionary treatment. For more information about candidacy and treatment, call 321-784-8211.
ABOUT DR. STANLEY GOLOVAC • Medical degree from UTESA University in 1985 and residency in the Department of Anesthesiology at Jackson Memorial in Miami. • American Board Certified in Anesthesia with an emphasis in Pain Management. • Speaks fluent English, Spanish, and Portuguese.
| 15| 15
Sacroiliac Joint Sysfunction 16 |
Common Cause of Severe Low Back Pain – Dr. Udeshi The SI (sacroiliac) joint is the joint located between the pelvis and the tailbone, and can account for 1030 percent of low back or posterior pelvic pain. They are formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone in the lower portion of the spine, and the iliac bones are the two large bones that make up the pelvis. As a result, the SI joints connect the spine to the pelvis. These joints support the entire weight of the upper body when we stand, which places a large amount of stress across them. The SI joint can be injured and inflamed from multiple causes, both acute and chronic. The acute causes include, slip and fall accidents when people land on their tailbone or injuries from car accidents when one or both legs press firmly against the floor prior to impact. The chronic medical conditions can be related to osteoarthritis, rheumatoid conditions, or prior lumbar fusions that cause inflammation and irritation to the joint spaces. Additionally, in pregnant women, physiological changes during pregnancy cause excessive laxity and mobility in the joint area that can lead to irritation and discomfort. The majority of patients that present with SI joint pain complain of localized pain around the joints in the low back area either on one or both sides. The pain can also refer to the posterior buttocks, hips, and back of the legs. However, a key factor is that the pain does not go below the knees. The pain is worse with activities that include walking and standing and relieved with lying down.
Diagnosis &Treatments The diagnosis of SI join conditions can be challenging. However, various physical exam tests performed by the physician can manipulate the joint area and aid in the diagnosis (i.e. Patrick’s, Gaenslen’s test). Additional studies such as x-rays and MRI images of the lumbar spine can also be utilized. However, the best-known test to confirm the source of the pain is a diagnostic injection directly into the joint space with local anesthetic. Initial treatments include local application of heat and cold, pelvic stabilization with an SI joint belt brace, and physical
therapy modalities. These modalities focus on pelvic stretching, deep tissue massage, and ultrasound therapy. Medications such as topical ointments, nonsteriod anti-inflammatories or cycloxygenase-2 inhibitors can also be given to alleviate the inflammatory nature of the pain.
Interventional Techniques For patients who do not respond to the initial therapies, an intra-articular injection of local anesthetic with antiinflammatory medication can be given into the joint space. A physician places a needle into the joint under direct x-ray guidance and injects contrast dye to confirm proper needle placement within the joint space. This is followed by injection of a local anesthetic and steroid combination. Symptomatic relief from the injection provides both diagnostic and therapeutic information. Depending on the duration of pain relief after the treatment, the injections may be repeated intermittently to alleviate the pain (months-year), or alternative long-term treatments could be considered. One such long-term treatment to relieve discomfort is called radiofrequency ablation (RFA) of the nerves innervating the joint space. RFA utilizes electrical energy to stun the nerves that are responsible for SI pain. Routinely performed under x-ray guidance where needles are directed to the sacral and lumbar branches supplying the SI joint area, the procedure can safely be done under either local anesthesia or intravenous sedation for patient comfort. RFA typically lasts anywhere from 6 to 18 months, though some patients have relief for several years until the nerves grow back. In the rare circumstance in which pain may still persist, SI joint fusions have been performed. However, surgical procedures can be an aggressive approach requiring general anesthesia, longer recovery, and mixed outcomes, and should be considered only for the most extreme cases.
Chronic Knee Osteoarthritis Characterized By Articular Cartilage Deterioration – Dr. Arcos Chronic knee osteoarthritis (OA), characterized by deterioration of articular cartilage, is one of the most common diseases of aging. Chronic osteoarthritis (OA) pain of the knee is often not effectively managed with medications
or rehabilitation techniques. In the United States, the diagnosis of knee osteoarthritis affects millions of Americans. In addition to severe knee pain, OA leads to restricted movement, sleep disturbance and functional disability. Activities of daily living, such as housework, yard work, and gardening are severely diminished. While chronic narcotics are often of limited value, the use of anti-inflammatory drugs is associated with serious side-effects such as bleeding and stomach ulcers. Surgical approaches, such as Total Knee Replacement (Arthroplasty) can be effective for some patients, however serious complications may occur. Medical literature indicates that 25-40 percent of patients who have undergone TKA, experience severe pain, despite aggressive physical therapy and postoperative rehabilitation protocols. Non-surgical options for severe OA knee pain have included joint injection with steroids or hyaluronic acids, acupuncture, single or continuous femoral or sciatic nerve blocks, and lumbar plexus blocks. Each of these approaches has proven insufficient for control of severe OA knee pain. The physicians of the Florida Pain Institute are proud to offer a new novel therapy, based on a theory that by blocking the nerve supply to the knee, alleviation of pain and restoration of function would result. The genicular nerves are articular branches of various nerves surrounding the knee. These nerves can be easily targeted by a pain specialist utilizing fluoroscopic guidance. Two procedures are performed to provide relief of knee pain. First, a diagnostic genicular nerve block is done. If good pain relief and functional improvement is obtained, a second procedure can be performed. The radiofrequency ablation (RFA) of the genicular nerves can provide long-term relief of knee pain. The demand for genicular RFA is rising, given the incidence of knee osteoarthritis, and prevalence of knee surgeries. Several reports cite patients previously unable to walk due to severe knee pain, who reported excellent response to the procedure.
Results of genicular RFA are more favorable than cortisone injections or synovial lubricant injection.
Safe, Effective, Minimally Invasive All medical literature concludes that genicular RFA is a safe, effective, and minimally invasive therapeutic procedure for chronic knee osteoarthritis pain. A recent 2014 study reviewed the use of genicular RFA for pain after Total Knee Arthroplasty. The authors noted a significant reduction in pain, with marked restoration of function after genicular RFA. No complications were reported. Individuals with multiple medical conditions may not be appropriate candidates for surgical interventions, but genicular RFA is an excellent treatment option in this patient population. Recently, a double-blind randomized controlled trial of genicular RFA was published. The results showed that the RFA group had significant pain relief at 12 weeks post-procedure, maintaining restored function, without any adverse events. Candidates for this new approach to osteoarthritis knee pain include: • Patients with degenerative or osteoarthritis knee pain. • Patients with persistent knee pain following knee replacement surgery. • Patients who have exhausted conventional methods without relief of pain. • Patients who wish to avoid invasive surgery or chronic narcotics. • Patients who successfully obtained relief from diagnostic genicular nerve block. • Patients with significant medical co-morbidities that rule out surgical intervention. If you suffer from severe, debilitating osteoarthritis knee pain, the physicians at the Florida Pain Institute are available to discuss this exciting new therapeutic option with you.
Chronic Knee Osteoarthritis Erosion of Articular Cartilage Joint Space Narrowing Bone Spur
| 17
4-F’s for Life 18 |
Dr. Golovac’s “4-F’s” Way of Life FRESH Fruit - Not Canned FRESH Vegetables - Olive Oil is the best cooking oil. FISH
- Baked or Broiled - use fresh lemon juice for flavor. Avoid margarine.
FOWL - Skinned! - NOT Fried! Baked, roasted or grilled is the way to go. When you are in a hurry, try wrapping a boneless breast with vegetables (i.e. onions and bell peppers in aluminum foil and bake or grill. It is quick and easy.
Other Good Foods Include:
Apple Juice (natural, no sugar added), Whole Grain - Low Sugar Cereals, Honey, Lobster, Natural Orange Juice (fresh, unsweetened), Nuts (raw, unsalted), Oatmeal (plain, unflavored), Raisins, Sardines, Shrimp, Skimmed Cheese, Skimmed Milk, Tea, Veal
Avoid the Five “C’s” COOKIES CAKES CHOCOLATE COCKTAILS CANDY
Other Bad Foods Include:
Alcohol, All Fried Foods, Bacon and any Pork, Bologna, Butter, Margarine, Crystalline Sugar, Dips, Donuts, Enriched White Flour, Ice Cream, Hot Dogs, Mayonnaise, Crisco & Other Shortenings (use olive oil instead), Non-Dairy Substitutes, Pies, Potato Chips, Soft Drinks with Sugar, Sweet Rolls, White Bread
New Knowledge Test to see how much you’ve learned.
1
2
| 19
3
4
5
6
7 8
9
10
11
12
13
Across
Down
3. The narrowing of the spinal canal is referred to as?
1. Dr. Gayles will be practicing at which new location?
6. This can be used as a long term treatment for SI Joint Pain.
2. This is a national specialty pharmacy that compounds custom topical cream formulation.
7. How many locations does Florida Pain Institute currently have?
3. The physicians at Florida Pain Institute have treated many patients with _________ _______ ______________ to not only control pain but also to help improve function so patients can do the things they choose to do on a daily basis.
9. Medtronic offers the new MRI technology and another unique feature called? 10. What is one of the most common diseases of aging? 12. Dr. Udeshi and Dr. Arcos will be practicing at what new location? 13. This can be used to treat chronic, intractable pain of the trunk and or/limbs including unilateral or bilateral pain.
4. This is considered a form of Alternative Medicine and can reduce pain, stress and tension? 5. Which Physician recommends the “4-F’s” Way for Life? 8. What is the common cause of severe lower back pain? 11. What is the name of the trial that is used to help reduce pain and increase mobility for Lumbar Spinal Stenosis? See page 2 for answers.
FLORIDA’S PREMIER PAIN CLINIC | 20
Dr. Stanley Golovac
•
Dr. Ashish Udeshi
•
Dr. George Arcos
Dr. Richard Gayles
•
Specializing in Back, Neck & Cancer Pain FLORIDA PAIN INSTITUTE is a multi-service facility that offers extensive Pain Management consultation and management services for acute and chronic pain. Florida Pain Institute has offices in Merritt Island, Pineda, Palm Bay, and Titusville. Pineda Location 5545 N Wickham Rd., Ste 104 Melbourne, FL 32940
Merritt Island Location 595 N Courtenay Pkwy., Ste #101 Merritt Island, FL 32953 404
Outlook Dr
Dr
Cloudber ry Pl
N Wickham Rd
Hoofprint Dr
Co Rd 509
s ke La er De
High Pasture Way
Needle Blvd
Hoofprint Dr
Outlook Dr
US 1
Exit 176
Pkwy rfolk No
n cisiyo PreW a
5
I-9
Merritt Island Melbourne Palm Bay Titusville
Hurtwood Ave
Aster Ct
Serving all of Brevard with 4 Convenient Locations in:
N Courtenay Pkwy
Kurek Ct
Minna Ln
404
Pineda Causeway
Palm Bay Rd NE
d St woo Bell ita St Bon ay d W lvd lude Sec r Park B ir Rive tthew C Ma
76
it 1
Ex 5
I-9
1
Palm Bay Location 490 Centre Lake Drive NE Palm Bay, FL 32907
US
Culver Dr NE
Kings Hwy Centre Lake Dr NE
Titusville Location 7455 South US Highway 1 Titusville, FL 32780