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Pain Management Procedures

Dmitri Petrychenko Pain Management Office offers following procedures (to view description of the procedure, click on the name below):

• Caudal steroid injection
• Celiac Plexus Block
• Cervical Epidural Steroid Injection
• Dekompressor Discectomy
• Discography
• Facet joint injection
• Femoral Nerve Block
• Intradiscal Elektrothermal Therapy
• Intrathecal Pump Implant
• Lumbar Epidural Steroid Injection
• Lumbar Radiofrequency Neurotomy
• Lumbar Sympathetic Block
• Lumbar Transforaminal Epidural Steroid Injection
• Percutaneous Disc Nucleoplasty
• Peripheral Nerve Block
• RACZ Caudal Neurolysis
• Sacroiliac Joint Steroid Injection
• Spinal Cord Stimulator (SCS)/Implant
• Stellate ganglion block
• Trigger Point Injection
• Vertebroplasty

The most abundant type of pain is lower back pain. This can be divided into a radiating pain down the legs and non-radiating. A first category pain is caused by strangulation of a nerve that controls lower extremities.
A second category pain is usually caused by arterial alterations, local neuralgias, vertebrae fractures or by damages in smaller nerves. Arthritis pains are most often encountered in people leading sedentary life-style: drivers, office workers. The cause can be an ordinary draft or the use of air conditioner. These pains intensify while extending the spine or turning the loin.
Sometimes it can be fairly simple to diagnose and eliminate such pain. For example we can make the blockade of the spine facet joint. Such procedure has minimal possible complications, its risk can be compared to risk of an ordinary intramuscular injection, even though the injection is made in the upper or lower back or in the neck.
In a more complicated case of diagnostics, for example, in the case of vertebra fracture, which can be hard to eliminate, for people in their elderly ages I would advise to make an MRI scan.
Even more complex can be the treatment of radiating pain down the legs. A nerve root may be compressed by an intervertebral disk protrusion (intervertebral hernia, which can occur quite often), by a narrowing bone ring in the place of nerve exiting from spinal cord, or by narrowing of the spinal cord channel. To determine the cause it is advisable to make an MRI scan.

Modern medicine can offer the following treatment methods:

• A patient has to try the simplest method – anti-inflammatory pills.
• If it was unsuccessful, or if a patient experiences heavy pain, which prevent him from leading normal lifestyle, modern medicine offers a simple treatment mode – an epidural injection. Till recently they were made in the middle of the back; however, now an epidural injection method has changed and they are directed to treatment of a specific nerve on either side of the back. According to recent medical statistics, this treatment method is the most efficient. The whole course consists of a series of injections with an interval of 1 or 2 weeks. The injection itself is virtually painless. For patients, who weakly withstand pain, during the procedure it is possible to use intravenous anesthetics. These procedures are carried out with the use of fluoroscopy and introduction of contrast substance. The side effects are infrequent, but sometimes may occur: diabetics may have their blood sugar level raised; sometimes the swelling of arms, legs or face occurs, in rare instances they may last up to several weeks. This treatment mode is 80% efficient – the relief from pain lasts for the period from 6 to 12 months, for young people – even for several years.
• If the above treatment modes do not have sufficient effect, for younger patients, whose intervertebral disk thickness has not diminished yet as a result of age-related changes, it may be recommended to try a discography – a diagnostic procedure, that helps to reveal the specific disk, make a more accurate diagnosis of diskogenic disease and decompress it with the help of minimally invasive nucleoplasty. For an elderly person a thermal effect (radio frequency) on the damaged nerve is used, which helps to preserve motor functions, but decreases its ability to conduct pain.
• If the above methods do not give any effect it is advised to make an electrostimulation of a spinal cord. This method helps to achieve anesthetization without the use of drugs and includes an approbation period, which if showed to be successful allows to make an implantation – a 20-minute procedure which does not have serious side effects.

I have to notify you, that if you are using any blood thinning medications, such as aspirin, coumadin and  plavix – you have to notify your doctor prior to making any invasive procedures, because the risk of internal bleedings in these cases is very high.

• The next step is intrathecal pump, which includes an approbation period and requires hospitalization for 2-3 days, and a period of implantation with a minimal operative intervention.

In the lower section of the back there can also be other sources of pain: such as pelvic bone joints, a coccyx (tailbone), pathologic processes of stomach and pelvic organs, postoperative seams, tumors, shringles, chronic inflammatory processes of internal organs.

The cooperation of patient and doctor is highly important in the process of fight for pain relieve. In individual cases to make a correct diagnosis (to reveal the true cause of disease) it is necessary to go through a series of blocks, which means to make several visits. Don’t try to find another doctor after the first procedure, if it did not give you an anticipated result. Choose the doctor you can trust and work with him. Often you can’t get rid of the pain right away, but this is what a lot of people usually think. And, unfortunately, the doctor can’t feel for you. That is why it is so important that patient can precisely describe the pain character and its nuances (smarting, aching, pricking), as well as how the organism reacts on a specific procedure. Only in a process of trusting cooperation of doctor and patient as a result of series of diagnostic and treatment procedures we can get a full and long lasting reveal.

Dr. Petrychenko’s pain management office performs all, but does not restrict itself only to these, described pain treatment methods as well as treatment of different head-aches, nape and face aches, treatment of trigeminal (trifacial) nerve, oral, oesophageal, and neck pains, pancreotic and reflexo-sympathetic dystrophy pains, and also hardly diagnosable thoracic pains (if cardiac pathology and aesophageal and lung diseases are eliminated but a pain syndrome remains).

A special attention in clinic is given to cancer patients and children.

Dr. Petrychenko in his practice also uses pharmacological treatment modes, carries out spasm treatment and removes postamputation pains.

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