IV Ketamine for Complex Regional Pain Syndrome and refractory Major Depressive Disorder

Complex regional pain syndrome (CRPS) and refractory major depressive disorder (MDD) pose terrible burdens on those who suffer from them. CRPS is a special form a neuropathic pain with special unique characteristics. CRPS is also known as Reflex Sympathetic Dystrophy (RSD). CRPS suffers can suffer from ongoing, intractable, pain in an extremity, from the arm … Continue reading “IV Ketamine for Complex Regional Pain Syndrome and refractory Major Depressive Disorder”

laser epiduroscopy for low back pain

I continue to be very interested in laser epiduroscopy. Epiduroscopy is a procedure in which we put a fiberoptic scope into the epidural space. It is approved for visualization of the epidural space and for putting medications into the epidural space. I believe that the greatest benefit of epiduroscopy, particularly laser epiduroscopy, is in the … Continue reading “laser epiduroscopy for low back pain”

Patient satisfaction and the opioid epidemic

Everyone wants to be well treated by their doctor. And doctors want to treat their patients well. With Obamacare, patient ratings of their encounters has become mandated. For many employed physicians, patient ratings are important both for their pay and their continued employment. This all sounds good except that we are now caught in the … Continue reading “Patient satisfaction and the opioid epidemic”

Epiduroscopy and low back pain

Interventional pain management has two frontiers to conquer, the treatment of low back pain and the treatment of spinal stenosis.  Today’s blog is about the treatment of low back pain.  Chronic low back pain, defined as pain in the back, with no involvement below the knees has many causes.  We have done a good job … Continue reading “Epiduroscopy and low back pain”

Urine drug testing

Safe opioid prescribing demands that we, the prescribing doctor, make sure that the patient getting the opioids is getting benefit from them.  Benefit means decreased pain, increased function and no side effects and no abuse.  Opioids are used for any type of pain, whether cancer pain, low back pain, pain from disc herniations, facet disease, … Continue reading “Urine drug testing”

Changes in opioid prescribing

Since late 2012, there has been an enormous sea change in how opioids are used.  From about 1986 to 2012, the prevailing thought was that pain was undertreated and that patients should be provided whatever opioids they needed.  This was for any type of pain, whether cancer pain, low back pain, pain from disc herniations, … Continue reading “Changes in opioid prescribing”

Epidural injections and particulate steroids

Epidural steroid injections are commonly used to treat low back pain, neck pain, radicular pain, and radiculopathy.  This pain can come from a variety of causes, including disc herniation, spinal stenosis, post lumbar surgery syndrome, lumbar degenerative disease or cervical degenerative disease, also known as spondylosis, and degeneration of the discs.  Recently, the FDA caused … Continue reading “Epidural injections and particulate steroids”

HIPPA and Opioid Management: Information Can Come In But It Cannot Go Out

Opioids are an important part of pain management.  We, as pain practitioners, provide opioids to allow you to be more active and function better.  Practically, being more active and functioning better means that either you have fewer work restrictions or, if you cannot or do not work, that you are better able to perform your … Continue reading “HIPPA and Opioid Management: Information Can Come In But It Cannot Go Out”

New Psychosocial services at the Helm Center

We are excited to announce that The Helm Center will offer enhanced psychological services. Interventional pain management has four components: Procedures, such as epidural injections; Medications Functional restoration, meaning exercise, and Cognitive behavioral therapy. Cognitive behavioral therapy, or the psychological management of pain, can be the most important as how respond to stress, pain and … Continue reading “New Psychosocial services at the Helm Center”

No on Prop 46

California has benefited from a cap on pain and suffering in law suits since the mid 1970s, when MICRA was implemented. MICRA put in place a $250,000 cap on pain and suffering. One thing that many people do not realize is that it does not limit the amount of payments necessary to provide medical care. … Continue reading “No on Prop 46”