Health Chats
Minimally Invasive Options for Chronic Back Pain
Wednesday Apr 21, 2010, 12:00PM - 01:00PM (EST)
Chronic pain can rule your life, interfering with your ability to work, sleep and enjoy your family and friends. When chronic pain disrupts your quality of life and does not improve with standard treatments such as aspirin or ibuprofen, Cleveland Clinic Pain Management is here to help. There are many safe, proven effective treatments available that can eliminate or reduce chronic pain. The sooner you seek treatment, the sooner you can start enjoying life again.
On April 21, 2010 from Noon-1pm (EDT), please join Dr. George Girgis of the Cleveland Clinic Pain Management Department, who will answer your questions about minimally invasive options for chronic back pain, including new innovations in back pain treatment. He will also present options ranging from physical therapy, medications, kyphoplasty, neuromodulation and more.
Cleveland Clinic Pain Management specialists are among the most experienced in the world, treating more than 10,000 patients each year. Cleveland Clinic Board-certified physicians are dedicated to the goal of helping people with chronic pain return to a normal, productive lifestyle. Using the latest in diagnostic technology, paired with medical and interventional therapeutics, they will work with you to identify the source of your pain, eliminate or reduce the pain and teach you to manage it.
Dr. Girgis:
again, fibromyalgia is chronic disease and unfortunately unkbown etiology, more common in female.
Dr. Girgis:
FDA approved lyrica, cymbalta and most recently Savella as medical management for this condition. Lyrica and cymbalta can be used together, lyrica and savella also can be used together however cymbalta and savella can not be used together, thats for medical management.
Dr. Girgis:
More importanatly, is doing physical therapy, deep tissue massage and also life style changes. Narcotics generally not a good idea for treatment of fibromyalgia. For rheumatoid arthritis, NSAIDS, or even steroids and some other medications are good for that.
opus88:
I have neuropathic pain from DDD. I would like to hear of non evasive treatments for this. Also, under your credentials it states "increased risks in patients with neuropathic pain". Can you explain that statement please?
Dr. Girgis:
Generally speaking DDD do not lead to neuropathic pain!! you may mean radiculopathic pain which could be as a consequence of DDD, loss of disc heights which could lead to narrowing of the corresponding neuroforamina on the side of the vertbral column( halls which allows exiting of nerve roots to go to their distened areas) , in that case these neuroforaminae gets narrowed and may impinge on the nerve roots, a conditioned called NFS( neuroforaminal stenosis), treatment should consists of lumbar transforaminal epidural steroid injection, physical therapy and some medications like gabapentin.
Neurosynaptic:
I have had problems due to scoliosis as I am getting older (55). At this point I have pain every day in specific areas along the sides of my spine. I tried one year of alternative therapies (acupuncture, herbs, massage, heat, chiropractic treatments) but I was told any "realignments" don't hold since my joints "slip easily". My question is: Where do I start in changing from naturalpathic to other forms of therapy? What type of MD should I see first?
Dr. Girgis:
refering back to scolisis question, you may get a benefit from facet medial branch nerve block and for long term RFA( radiofrequency ablation).
BEC82V:
I have severe disc disease due to an accident and have been told surgery is not an option for me. I have stenosis at levels L2 & L3, L3&L4 and L4&L5. Could there possibly be any help[ for me?
Dr. Girgis:
certainly, minimally invasive procedures are available by pain management specialist like epidural steroid injection, facet blocks, trigger points, facet MBN RFA, treatment should be dictated by history, physical examinations and diagnostic data findings to support a diagnosis.
d44:
I have a small diffuse disc bulge which is flattening the anterior thecal sac there is bilateral facaet joint ,ligamentum flavum hypertrophy resulting in mild central canal narrowing, there is narrowing of the inferior aspects of the neural foramina bilaterally right greater then left--this is in L3-L4. A small dics diffuse dics bulge asymetric towards the left side causing obliteration of the left lateral recess and comprromise of the inferoir left neural foramen,there is bilateral facet joint ,ligamentum flavum hypertrophy causing moderate degree of central canal stenosis this is in L4-L5,There is minimal disc bulge mild right neural foraminal narrowing is noted the left neural foramen is patent there is bilateral facet joint and ligamentum flavum hypertrophy mild central canal narrowing is noted this is in L5-S1...what does all this mean and do I need surgery??? or what will happen if I do nothing ??when I wake up I feel numb and in alot of pain,I m on neurontin 300mg tid...
Dr. Girgis:
it seems that you just typed the MRI report!! which sometimes looks scary. as a physician I usually order MRI looking for something and tring to confirm my clinical findings, roughly if we scan 100 person randoly with MRI scan of his back, 50 % roughly will have MRI findings, whether this is relavent or not, IT IS THE SYMPTOMS AND CLINICAL EXAMINATION THAT DICATTES THE TREATMENT PLAN. In your case you have too many MRI findings, namely central spinal canal stenosis, DDD, facet arthropathy etc, now comes your symptoms to play a huge role in determining what treatment plan should be started.
Dr. Girgis:
there are many options for you , again we have to determine which one suits you.
MedHelp:
Dr. Girgis has time for one more questions.
Blessed1979:
I have severe degeneration and multi-level herniated/bulging discsm - I am in pain all day.I Have been advised that surgery - laminectomy is the only answer - have had 4 consultations with reputable neurosurgeons - What is your opinion of PNT (Neuromodulation therapy)
Dr. Girgis:
Neuromodulation is a great therapy for neuropathic pain as well as radicuolpathic pain( with no surgical option to correct that radiulopathy), first we have to determine if you are a surgical candidate or no, also we have to rule out any ominous signs like loss of bowel or bladder control, motor deficit or sensory deficit. tretment should be coordinated between pain specialist and your neurosurgeon.
MedHelp:
Thank you Dr. Girgis for answering our questions and all the members who participated today!
Dr. Girgis:
Thank you everyone for allowing me to participate in answering your questions, I hope I was helpful in guiding you.
Dr. Girgis:
It is always my pleasure to help patients, thanks for medhelp as well.
