Pain management is comprised of two large groups.  The first group is the acute pain patient seen in the hospital, who commonly will be the acute postoperative patient.  However there are other kinds of patients, such as the difficult cancer patient, sickle cell anemia, and trauma, who we will also see in the hospital. 

The second large group is the chronic pain population, who are commonly comprised of the migraine headache, sciatica, neck and arm pain, chest wall pain, and joint pain as examples.

We practice a multidisciplinary approach with the patient.  For example, a patient may not only see an anesthesiologist, but also a physiatrist, behavioral psychologist, as well as a head and neck expert.  As one compiles this information, this leads to a comprehensive evaluation that leads to improved patient outcome.

Be aware that many of our patients have seen multiple physicians in the past.  These patients may have a complicated history and may have failed previous treatments.  Therefore, and individualized approach is used.  For example, those patients who may present taking multiple narcotics are asked to choose a single narcotic as well as sign a narcotic agreement which allows us to be the sole provider of their pain medications.  This allows us to simplify the regimen and lessen the number of variables that can complicate treatment.

Physical therapy is an important integral part of what we do in that the goal of treatment includes improved activities of daily living and improved functioning so that they can sit at a restaurant or a theater and enjoy that experience.  Physical therapy becomes a vehicle for that patient to return back to work. 

With respect to injection therapy, clearly there will be those patients who benefit from highly selective precision-guided techniques.  We are able to target specific nerve roots under precision fluoroscopic guidance to have maximal benefit to not just reduction in pain, but also to enable a faster rehabilitation time.

Modalities which can provide benefit which are safe and effective, will be promoted.  As an example, acupuncture can improve local blood flow.  So for that patient who has a muscular tension headache which triggers a migraine headache, acupuncture can remove the muscular component, thereby simplifying treatment of the migraine component.

I am an anesthesiologist by trade.  My forte has been to provide diagnostic and therapeutic nerve blocks from stem to stern, whether it is a cervical, thoracic, or a lumbar problem.  This is my expertise.

My second goal is to provide a leadership role in the comprehensive management of that patient by coordinating the care from the physiatrist, psychologist, etc.  This serves to better integrate the treatment to that patient.

Spinal cord stimulation is the placement of a small wire into the epidural space, whether cervical, thoracic, or lumbar spine, to address unilateral extremity pain as the primary indication.  The wire allows delivery of a small electrical current to interrupt pain pathways.  It is used only after conservative treatment has failed.  As an example, the typical patient will have had one or two failed surgeries, may have scarring within the spinal canal, and have one leg with persistent pain.  This kind of patient will probably do the best.  Other benefits of spinal cord stimulation include improved blood flow to the extremity.  Therefore those patients who have blood flow deficiencies to the extremity, RSD, or refractory angina can all benefit from improved blood flow in addition to pain reduction.

A pain pump looks like a small hockey puck which is implanted and has a small flexible tube which is placed within the spinal canal.  The pain pump has the ability to continuously infuse narcotics and other medications directly to the spinal cord.  Cancer is the premier area where we are involved in the implantation, monitoring, and maintenance of this device.  The important benefits of the pain pump are that it can markedly reduce side effects of systemic narcotics, such as constipation and sedation.

There are two methods of referral.  The most common way is to be referred by the patient’s internist, spine surgeon, or family physician.  This allows us to communicate with the primary care physician and provide useful information that can be important for future care.

The second method is self referral.  The pain physicians then perform some of the initial work up so that we can compile a comprehensive profile of what will benefit that patient the most.

Clearly, stem cell research is a large focus, particularly with respect to disc regeneration and percutaneous spinal fusion.  Now in mice and soon in pigs, percutaneous spinal fusion is possible without any incision whatsoever.  Hypothetically, human applications would be available in 5 to 7 years.

Patients are invited to visit www.jointvitality.com or www.kneevitality.com.  Fluoroscopic precision-guided injections of hyaluronic acid can greatly reduce inflammation.  Note that many patients cannot tolerate oral non-steroidal anti-inflammatory medications, which can cause gastro-intestinal bleeding, and may be problematic with patients who have kidney abnormalities and cardiac abnormalities.  Precision guided intra-articular injections avoid these side-effects and offer new hope.  Currently, injections are offered for hip, knee, and shoulder joint conditions.  In the future, will offer injection therapy for small joints, such as the joints of the wrist, ankle, and TMJ.  We are working with a biotechnology firm in Utah to develop and injectable hydrogel, which will have enormous shock-absorbing benefits, in addition to the anti-inflammatory benefits.

Note that with fluoroscopy, the specific parts of that diseased joint can be targeted.  The fluoroscopy also enables appreciation of pathology that would be missed with blind injections.  Blind injections have also an increased risk to the patients, and with knee applications there may be a 30% incidence of the needle not being within the joint itself.  Therefore, with fluoroscopic guidance, we are able to not only improve efficacy, but also reduce risk over blind injections.

We are building relationships with physicians overseas.  In 2007, we will start to train Ukrainian medical students and residents as a beginning point to develop joint opportunities.  Clearly medical tourism is a growing trend, where patients may opt to travel to a foreign country for their surgery at a fraction of the cost in the U.S.  By establishing an infrastructural network with clearly delineated standards of care in other countries, we can make the experience a more comfortable one for the patient.  With satellite conferencing, an open collaboration for specific patient problems as well as continuing medical education is made possible.

My involvement with the California Association to Aid Ukraine has been in terms of providing wheel chairs to crippled children in the Ukraine.  This has been an important personal interest of mine from a humanitarian standpoint.  This involvement has been a platform for building relationships in the medical community of the Ukraine.

kneeVitality is an injection of a proprietary blend of medicines including hyluronan. Hyluronan was approved by the FDA in 1997 for viscosupplementation. The procedure, called viscosupplementation, injects a preparation of propritary medicine into the knee joint. kneeVitality is a naturally occurring substance found in the synovial (joint) fluid. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.

Visosupplementation is the injection of fluids into a joint to alleviate and repair damage done to the knee through wear and tear. An analogy can be made between greasing joints on a car or bike and visosupplementation of the knee. The main difference is that kneeVitality treatments help the knee repair itself.

After time the natural lubrication in the joint wears down. kneeVitality restores this lubrication creating a natural shock absorption which not only helps reduce pain but also repairs the knee.

Yes. kneeVitality treatments are safe.

Yes, many individuals who complain of knee problems are suffering from osteoarthritis. kneeVitality is designed to help reduce the symptoms and delay the onset of arthritis.

The benefits of the injection could last from 1 month to 1 year or longer. kneeVitality helps your knees repair themselves which extends the benefits of the treatment.

No. It feels about the same as a flu shot. Most patients do not report any pain after the procedure is complete.

No. Generally take it easy for about 24 hours then you can return to any normal activities including skiing, biking, running, etc.

Yes. kneeVitality is perfect for runners including marathon participants as well as anyone else who wants to repair and protect their knees.

The picture on the left is an actual x-ray of an injection on a patient. The picture on the right is a drawing to illustrate where the injection is placed. As you can see, placement of the medication is the key to a successful outcome. Using x-ray guidance, jointVitality's medical professionals are specifically trained and experienced to correctly place the medication in the knee joint to produce the greatest reduction in knee pain.

Absolutely. You will receive benefits from the kneeVitality treatment even if you have already had major knee surgery. Typically the only individuals that would not benefit are those that have had total knee replacements.

kneeVitality is available in Denver, Colorado and Los Angeles, California. The simple shot to administer the viscosupplementation is performed by a physican.

Please direct any further questions to jointvitality@yahoo.com