There’s a reason that “pain in the neck” is a common colloquial expression for a nuisance or irritation. Pain associated with the spine, back or neck is all-too common to most people.
In fact, according to the Centers for Disease Control and Prevention (CDC), low back pain causes more global disability than any other condition. In one study it was the most common type of pain reported by patients, impacting 25% of U.S. adults in a 3-month period.
So, we sat down for a talk with our own Dr. Ninad Sthalekar, who specializes in interventional spine procedures and pain management, to discuss non-operative options for back and neck pain. Here, Dr. Sthalekar discusses how injections and new supplements are dramatically reducing pain and restoring vitality for patients at BCOS.
What kind of injections can provide relief for back and neck pain?
There are two types: epidural steroid injections and facet joint injections. Both are minimally invasive, yet very effective. There are great options for patients who are looking for pain relief but hoping to avoid surgery.
What is an epidural steroid injection?
It is an injection of cortisone, a powerful anti-inflammatory medication, directly into the affected area of the back or neck to relieve the inflammation that is causing pain. Epidural steroid injections are used to treat many forms of back, neck, and extremity pain.
Can an epidural injection help with sciatica?
Definitely, we treat many patients suffering with sciatic pain with epidural steroid injections. The sciatic nerve starts in the low back and runs down the back of both legs, it is the largest nerve in the body. When it is compressed or inflamed, pain can radiate down one or both legs. The pain of sciatica is both very common and very intense for many people. But with an epidural steroid injection, we can reduce the pressure on the sciatic nerve and thereby reduce the associated pain.
What is a facet joint injection?
Facet joint injections are used to treat arthritic conditions of the spine. With a facet joint injection, we inject a small amount of anesthetic into the arthritic joint to anesthetize the specialized nerve fibers that innervate the arthritic joint and block the pain signal. If a patient finds relief from anesthetizing those nerve fibers, they are typically a good candidate for a more permanent procedure called a facet joint ablation.
What is a facet joint ablation and how long can the pain relief from it last?
With a facet joint ablation, the procedure itself is very similar to the injection. However, with the ablation, we are able to heat or cauterize the nerve fibers to those arthritic joints in the back or neck, which disrupts the pain signal for a longer period of time. With facet joint ablation, pain relief can last over a year.
What should a patient expect during an epidural or facet injection procedure?
Patients are checked in and brought back to the procedure room. There, they have the option for light sedation, though most patients opt for local anesthetic only. We make sure the patient is comfortable and perform the procedure under x-ray guidance to ensure safety and accuracy. In fact, we are now using GE’s state-of-the art 9800 fluoroscopic imaging system that provides low radiation, live, multiplanar imaging to navigate the pain management injection.
The epidural steroid injection and facet joint injections typically take less than 5 minutes, though a facet joint ablation may take a little longer. Most patients can walk out of the procedure, drive themselves home, and go about their daily life.
These procedures are minimally invasive, low risk, highly accurate methods to non-surgically mitigate back pain. Within a short office visit, we are able to reduce pain, increase mobility, and dramatically improve quality of life for our patients.
Many Americans are in the process of getting vaccinated for COVID-19. If a patient is getting the COVID-19 vaccine, does that impact the timing and administration of cortisone injections?
That’s a good question and one we are hearing a lot lately. The short answer is, yes, the COVID-19 vaccine does impact the timetable for administering cortisone injections. Most medical advisory boards, including The American Academy of Orthopedic Surgeons, are recommending that patients should avoid getting a cortisone injection 2 weeks before and 2 weeks after receiving the COVID-19 vaccine. While there is currently no direct evidence that a corticosteroid injection before or after the COVID-19 vaccine decreases the efficacy of the vaccine, the current consensus is that waiting is advisable. These recommendations are based on the best available clinical evidence at this time and may change as more evidence becomes available. But at this point, we are recommending that our patients do not schedule a cortisone injection for 2 weeks before or 2 weeks after receiving the COVID-19 vaccine.
Can you discuss other new developments in the non-operative treatment of back and neck pain?
You know, we take a holistic approach to pain management and we are always researching new modalities and options that can help use reduce pain for our patients. Recently, we are really excited about two new supplements, Synogesic and ReviveMD, that have proven to be very effective in treating both pain and inflammation. With many patients trying to avoid or reduce the use of opioid medications, we are finding that natural supplements can promote healthy inflammation responses and sustained relief without the risks of opioids or the downsides of long-term NSAID usage.
What is Synogesic?
It is a food-based dietary supplement that has natural anti-inflammatory properties and is taken in a capsule form. Its key components are a proprietary blend of turmeric, ginger, boswellia, rutin, vitamin C and vitamin D.
For what kind of conditions do you recommend Synogesic?
Synogesic can be used for any inflammatory condition such as arthritis, chronic tendonitis, chronic radiculitis, chronic arthritis. It can be helpful for arthritic pain of any joint including arthritis in the ankle, knee, hip, shoulder, and spine – really any joint where there is arthritic pain.
What kind of results are patients experiencing with Synogesic?
Synogesic was studied in a 90-day clinical trial at a major orthopedic institute and in an observational study at BCOS. In the clinical study, patients were found to have a 50% reduction in inflammatory markers in both their serum and joint fluid after taking Synogesic. At BCOS we had approximately 130 patients taking Synogesic and our results showed a 50% reduction in pain scores.
Can you share any Synogesic success stories?
I’ve been really excited by the results that we are seeing with our patients taking Synogesic. Last year, I had a patient who’d been receiving epidural injections for neck pain and I recommended she try Synogesic. Within two weeks her neck discomfort started to significantly decrease to the point that now she says it is so mild that she doesn’t even notice it most of the time. It’s really incredible.
Where can patients get Synogesic?
It is only available with a physician recommendation. You can’t buy it on Amazon or at a drug store. So, when we see patients, we review their symptoms, treatments, and medications and determine if they could benefit from Synogesic. If so, we can provide our recommendation and they can order it directly from the company, Certainty Health Solutions in Blue Bell, Pennsylvania.
Let’s talk about the ReviveMD Product. What is it and what is it used for?
ReviveMD is a physician-grade, pure CBD product from the hemp plant, which is legal in all 50 states. It is used to treat chronic pain conditions. We recommend it for three diagnoses: pain, insomnia, and anxiety.
Do you often see patients who have insomnia and anxiety?
Actually, we do. Chronic pain can have a spiral effect, where the pain interferes with sleep that causes insomnia that triggers anxiety. When you can ease the chronic pain, you can alleviate the insomnia and anxiety as well.
What kind of results are patients experiencing with the ReviveMD CBD product?
The feedback has been excellent. We have over 400 patients using it and it is helping to control their pain and improve their quality of life. It is non-addictive and non-abusive and does not carry the risks and side effects associated with narcotic pain medications. It has been very successful for our patients.
There are many CBD products out there, why are you recommending this one?
I did a great deal of research and investigated many different manufacturers. I chose this ReviveMD product and manufacturer for three specific reasons, First, they are based in the United States and they have their own hemp fields. They grow and manufacture their own products, so it’s not outsourced anywhere, and they have to abide by US farming laws. Secondly, all of their products are 3rd party tested. And finally, the product can only be obtained with a physician recommendation. So, it is physician grade. You can’t go online or to the store and get this, so it is well-regulated when it comes to dosing and usage recommendations.
How is ReviveMD administered?
It comes in liquid/tincture form and as a cream. The dosing schedule is individualized based on each patient’s medical condition and is discussed in detail with the recommending physician.
Can you share any ReviveMD CBD success stories?
Among many success stories, I am particularly happy with its effectiveness for patients who want to avoid or eliminate opioids for pain management. I have many patients who have been able to completely discontinue their use of narcotic pain medication and are exclusively using ReviveMD CBD now.
Recently, we had a patient who was undergoing a total knee replacement but was reluctant to use narcotic pain medication. We recommended the ReviveMD CBD products and devised a personalized dosing schedule. The patient ultimately used the tincture as well as the cream for post-surgical pain management without opioids.
Where can patients get ReviveMD?
Similar to Synogesic, patients can only get ReviveMD CBD from the manufacturer, with a physician recommendation. We can see a patient in the office and determine if they are a good candidate for it and also recommend an individualized dosing schedule
Can patients take both Synogesic and ReviveMD?
Yes, they do not interfere or compete with each other.
I am really pleased to be able to recommend natural, safe products like Synogesic and ReviveMD CBD to our patients. Chronic pain can have such a negative impact on a person’s physical and mental health. So, we are always researching new innovations to alleviate that anguish. These two products are making a difference for our patients.
For more information about non-operative options and supplements for back pain, contact Bucks County Orthopedic Specialists at 215-348-7000 to schedule an appointment at our Doylestown or Warrington offices.
