Epidural injections and particulate steroids

January 19, 2015

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

October 20, 2014

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

July 8, 2014

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

July 2, 2014

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”

Cooled radiofrequency ablation to treat knee and hip pain

May 8, 2014

One of our goals in interventional pain medicine is to develop new ways of treating pain, particularly options other than taking medications.  The treatment of osteoarthritis of the knees and hips is one such therapy.  Many people have pain in the knees or hips.  This pain can come from osteoarthritis.  It can come from an … Continue reading “Cooled radiofrequency ablation to treat knee and hip pain”

Coverage for epidurals and facets

November 17, 2013

As Obamacare gets implemented, we are seeing a ramping up of efforts to decrease the type of care that can be provided. Obamacare has many components.  Individual insurance is regulated, by fiat, out of existence, forcing holders of those policies into the Exchange.  The Exchange will require patients to buy insurance they may not want, … Continue reading “Coverage for epidurals and facets”

How to manage a doc

November 17, 2013

I have a confession to make.  I have done a utilization review.  This means that requests for treatment, including medications and injections will be sent to me.  Most of these reviews are for Workers’ Compensation injuries, but the situation is analogous for Medicare and private insurers.  As the Exchanges get formed, they will be managed care … Continue reading “How to manage a doc”

Changes in opioid prescribing

October 27, 2013

How we use opioids has changed enormously over the last year.  We used to think, and be taught, that opioids had minimal risks and that patients should be given whatever they needed for pain relief..  This belief went so far that the Medical Board of California mandated that every physician get 12 hours of training … Continue reading “Changes in opioid prescribing”

Percutaneous Adhesiolysis

June 7, 2013

Low back pain and leg pain are common.  They often respond to simple actions, such as keeping up your normal activities, over-the-counter pain medications and exercise. Physical therapy and chiropractic therapy are very important for pain that does not respond to simpler measures.    Pain that does not go away often responds to simple interventional pain … Continue reading “Percutaneous Adhesiolysis”

Safety of epidural steroid injections and Dr. Oz

May 9, 2013

On about May 7, 2013, Dr. Oz ran an episode on lumbar epidural steroid injections.   Dr. Oz criticized lumbar epidural steroid injections.  Dr. Oz did a major disservice                to the 2.9 million who watch his show daily.  His viewers are primarily women aged 25-60.  It is women aged 25-60 who make decisions about getting healthcare, … Continue reading “Safety of epidural steroid injections and Dr. Oz”