At Polaris, we believe in providing integrated, holistic care for our patients.
We strive to be conservative in our approach, especially when it concerns treatment for spinal issues. Pain can be a complex issue and we are committed to providing individualized care to help our patients return to their normal lives.
Our pain management program, spearheaded by Drs. Shane Mangrum and David Tran, is tailored around non-surgical and non-narcotic treatments for patients. We don’t merely treat the pain on the surface, we want to get down to the root of the problem.
Polaris’s approach places great emphasis on strengthening the body. Dr. Mangrum and Dr. Tran are double-boarded in pain medicine & rehabilitation as well as sports medicine and instruct our patients on home exercises that will help their overall condition. We have also found that our therapies provide our patients with better outcomes when paired with a physical therapy regime.
Dr. Mangrum & Dr. Tran use injections such as epidural steroid injections and facet injections to calm nerves that can be irritated by bulging discs, or structural problems in the spine. These are outpatient procedures are done without anesthesia, so patients are usually on their way home within two hours.
Pain management therapies can be implemented as a “front line” treatment for patients with back or neck pain, or to help rehabilitate patients after surgery.
EPIDURAL STEROID INJECTIONS (ESI)
ESIs are injections of steroids in the spinal area that helps relieve pressure on the spinal nerves. These nerves may have become inflamed in their narrowing passages in the spinal column. ESIs are commonly used to treat low back, leg, neck, & arm pain. These injections can provide relief from herniated discs, pinched nerves, bone spurs, thickening of ligaments in the spine, joint cysts, slipped vertebrae, and many other pain generators. The majority of patients are not sedated for this procedure because ESIs are generally well-tolerated and not too painful. This injection is usually followed up with physical therapy with an emphasis on a home exercise program. If the ESI provides significant relief, it’s possible that our patients may receive multiple injections per year.
This type of treatment provides relief to pain originating from the facet joints, located outside of the spinal cord. These facet joints allow the various vertebrae of the spine to move against one another. With this injection, a pain relieving medication is delivered into the facet joint where there may be inflammation or arthritis.The effects of a facet injection can last several days to several months. Facet joint injections also act as a diagnostic test, by confirming the source of a patient’s pain.
MEDIAL BRANCH BLOCK (MBB)
Medial Branch Blocks can be used as both a pain relieving treatment and a diagnostic test. With this injection, medication is injected next to the nerves causing pain. In contrast with a facet injection, the medicine is injected near the nerves that serve the joints instead of in the joints themselves.MBBs can be both diagnostic and therapeutic. If the pain does not go away after the injection, then our doctor can determine that the pain is not coming from the facet joints that were injected. If the pain goes away for a few hours but comes back, this confirms that the facets are indeed causing the pain.
RADIOFREQUENCY ABLATION (RFA)
This treatment this preceded by a facet injection or a medial branch block. RFAs use radiofrequency energy to heat and destroy nerves that are sending pain signals to the facet joints. After a facet joint injection or an MBB is performed and the source of the pain in confirmed, an RFA procedure may be used to provide longer lasting relief. RFAs alleviate pain for 6 to 18 months before the nerve grows back. During this treatment, an insulated needle is injected into the space right next to the facet joint nerves. Once in place, the needle heats up and burns (or ablates) the nerves causing the pain.Our nursing staff routinely places an IV and provides light sedation through the IV during RFA procedures. Patients should plan a few days of rest following the treatment and start a physical therapy program with an emphasis on home exercise.
SACROILIAC (SI) JOINT INJECTION/BLOCK
SI joint problems are a common cause of low back pain. The sacroiliac joint connects the sacrum (the triangular shaped bone at the end of the spine) to the pelvis. It is not clear how pain in the SI joint is caused, but it is thought that alteration in the normal movement of the joint may be the culprit.A sacroiliac joint injection both diagnoses the source of low back pain and treats it. SI joint injections determine whether the patient’s source of pain is stemming from the SI joint, will also providing pain relief to the SI joint itself.
SPINAL CORD STIMULATORS
Spinal cord stimulators (SCS) are a treatment option for patients with pain that arises from nerves that have been damaged from conditions like arthritis, injuries, complications from surgery, or disease. SCS treatment works by delivering mild electrical currents to nerves in the spinal column. This electrical stimulation interrupts the pain signals that travel to the brain, thus minimizing pain.The stimulator leads are implanted surgically within the epidural space above the spinal cord. The device that delivers the current is implanted underneath the skin in the back or abdomen. Recent studies have shown that spinal cord stimulators can better treat neuropathic back and leg pain when compared to repeat surgery.Patients that are candidates for this type of device have generally had chronic pain for more than a year. Prior to implanting the device, our patients have a seven day trial period with leads connected to an external power source to determine how effective the SCS will be. If effective, the SCS can then be surgically implanted.
An EMG test may be ordered to assess the function of the body’s nerves and muscles. This test can help evaluate the origin of a patient’s numbness, weakness, and tingling symptoms.The nerve conduction study is administered by applying small electrical shocks to the nerve. During the needle portion of the test, a tiny needle is inserted into several muscles to see if there are any problems with the nerves. The doctor looks and listens to the electrical signals that travel from the need to the EMG machine.This test helps find the cause of a patient’s unexplained weakness, numbness, and/or tingling. It also aids in the evaluation of nerve function.