Who schedules my procedure?
Your procedure will be scheduled by my office staff with the surgery center. Someone will confirm date and time prior to procedure.
What do I need to bring with me the day of my appointment?
If you are being referred by another doctor that office will forward all records, insurance information and MRI's to us. If you are not being referred please bring your insurance information and any MRI's- X-rays of the affected area. You should arrive 15 minutes before your appointment to complete paper work.
Do you have foreign language staff?
I ask that you bring an interpreter with you. If this is not possible, I have staff that speak Spanish, Russian, Korean, and Polish. If you inform us ahead of time, we will attempt to provide someone who speaks your language.
ABOUT BACK PAIN
What are the basic types of back pain and what are their causes?
There are many types of back pain and the causes of back pain can often be multi-factorial.There are simple types of back pain which are muscular causes, there are bony causes and disc causes. The muscular causes include muscle strain and sprain most commonly caused by an imbalance where one group of muscles is more developed than another group of muscles. The bony causes include slippage of one vertebral body, that is, the bones of the back slip upon another. This is called spondylolisthesis, a malady is when the bones are actually misaligned. Discogenic causes are usually referred to as "slipped disc." These discs are cushions between two vertebral bodies, which can rupture or slip. They are structured much like a jelly-filled donut, and are "the shock absorbers of the spine." If the "jelly" comes out, the donut goes flat and it can no longer act as a shock absorber. This may result in severe pain, or what is commonly known as sciatica or nerve impingement. This jelly that is inside the disc contains some extremely powerful enzymes that can cause terrible inflammation on the nerves if the nerves come in contact with this. These enzymes can also cause back pain as well as nerve pain. Because of this irritation or inflammation that the disc is causing, we use drugs to stop inflammation. Many times we use orally taken non-steroidal anti-inflammatory medications or steroid medications. These three types of back pain - muscular, bony and disc - comprise the vast majority of back pain.
What is the leading cause of chronic back pain?
Most frequently, it is muscular. This is why physical therapy is such an important adjunct to invasive pain management and oral medication. Physical therapy re-educates the patient and strengthens the muscles in the back so that the patient can be restored towards normalcy and at the very least minimize their pain.
How can a patient tell when the back pain is due to muscular pain or due to a much more serious condition like discogenic pain?
If the patient is lifting something too heavy and jerks and suddenly feels a "pop" in his back that is shooting down the leg, this is most likely due to a herniated disc, This patient should go immediately to a physician with some expertise in spinal treatment and the physician will most likely examine the patient, perform a straight leg test which will or will not cause pain, obtain a MRI or a CAT scan to actually visualize the discs radiographically, or the physician may perform a electromyogram. This is usually a test performed by a neurologist or a physiatrist that can delineate whether there is an electroconduction problem down the nerve. All of these things - the history, the physical, the MRI testing and the EMG testing - better enable the physician to tell what type of pain the patient is suffering from and what is the etiology of their pain. Once the etiology is accurately obtained, then and only then can the physician form a treatment plan which is proper for that patient.
What is the most common use and when are epidural steroid injections indicated for back pain?
Steroids are anti-inflammatory drugs, so they are only indicated where there are conditions of inflammation. The steroid medication is injected percutaneously into the epidural space in a wide variety of fashions under fluoroscopic guidance. This is a fancy X-ray machine in an operating room where the medication can be placed exactly where the inflammation is believed to be. This fluoroscope also minimizes any of the complications that can occur by placing the needle blindly into the spine. The advantage of delivering epidural steroids is that the physician can deliver a high enough concentration in and around the inflamed area much greater than we could have obtained if the medication was given orally. Epidural steroid injections have been in use since the early 1960"s and have been well studied and well published in the medical literature. They have been proven effective since that time.
Is there a limit to the number of injections you can have in a lifetime or in a year?
The number of injections is deliberately limited based on the experience of the medical profession since the 1960"s. Generally speaking, if we don"t get very good relief in two to three weeks with two to three injections, the patient will most likely not get substantial relief just from epidural injections. There are occasions however where we can vary the type of injection which is given and we will go to a fourth or fifth injection. Generally speaking it is the total dose of steroid a patient receives that actually limits the number of injections the patient can receive. When steroids are delivered to the body, we can develop some side effects from the steroids. This is a complex problem of endocrinology which can cause increased blood sugar or retention of fluids to name a few.
What are some things that can be done for the patient that fails injections?
The vast majority of patients that present to the Bergen Pain Management® center do respond to injection therapy alone. However there are patients who do not respond adequately to injection therapy. The treatment after injections is variable depending on the underlying disease. If a patient has discogenic pain with a herniated disc, this patient may very well be a candidate for a nucleoplasty, IDET procedure, a disc decompressor procedure, or a radio frequency lesioning. It is a rare event that the patient proceeds to a more invasive surgical procedure.