Advanced Solutions Pain Management Contact Doctor White Plains Ny

The vast majority of patients who seek pain relief at Advanced Solutions Pain Management find help with no more than simple trigger-point injections for muscle spasms; epidural steroid injections for herniated discs, sciatica or spinal stenosis; or a variety of nerve block injections — directed to the nerve responsible for generating the pain signal — that can help many patients suffering from acute and chronic pain.

In-office X-ray and ultrasound scanning capabilities prove a major advantage for accurate administration of these injections and also illustrate how far the discipline of pain management has evolved in the last few decades, according to Joseph Ho, MD, Co-Director and Co-Founder of Advanced Solutions Pain Management and Director of Pain Management at White Plains Hospital.

"There are so many patients suffering from pain, but there are a lot of treatment options we can provide. We want to spread the idea that pain management can provide excellent options beyond physical therapy, medication and surgery. Utilizing pain management services can make a positive difference between patients living in a lot of pain with poor quality of life and patients living an enjoyable life."
— Joseph Ho, MD, Co-Founder and Co-Director of Advanced Solutions Pain Management and Director of Pain Management at White Plains Hospital

"In the past, you flew blindly — by palpation or trial and error," Dr. Ho says. "Epidural and spinal procedures we provide have long been standard practice for patients in labor and delivery, and later their utility was recognized for treating spine pain. But even then they weren't being performed under X-ray guidance. About 20 years ago, X-ray guidance was a luxury, but in the last decade, it's become the standard of care."

Sabrina Shue, MD, assisted by medical assistant Sunita Roi, performs a fluoroscopy-guided procedure to relieve pain.

Having this capability within the suite allows physicians to advance care in a number of ways. Importantly for the patients, it provides accurate and timely treatment for those whose pain has already diminished their quality of life, and it enables physicians to perform both diagnostic and curative injections.

Diane Lam, MD, pain management physician at Advanced Solutions Pain Management, notes some patients arrive in her office after being referred by neurosurgeons or orthopedic spinal surgeons for a diagnostic or therapeutic nerve block or epidural steroid injection before surgery is required.

"Surgeons want to know which level of the spine the pain actually comes from before they operate, so they order diagnostic nerve blocks," Dr. Lam says. "We apply local anesthetic and inject the patient in the levels of the spine where we think the pain originates. If the patient experiences relief, we know we've found the source and can provide the surgeon precise information about where to operate."

In other cases — patients suffering from stiffness due to adhesive capsulitis, or frozen shoulder, for example — nerve blocks may be performed to facilitate the treatment process. Frozen shoulders are best treated in a seemingly counterintuitive manner: movement. To have patients successfully participate in physical therapy, physicians can administer nerve blocks that quiet the nerve in the shoulder for a few hours, allowing patients to follow the care plan prescribed by physicians and exercise with significantly reduced pain.

An Intermediate Option

Nerve blocks can last weeks or months, but some patients only achieve a few pain-free hours. While any suspension of symptoms indicates treatable pain, physicians may turn to another treatment modality for prolonged relief.

Kyphoplasty, a procedure in which cement is injected via cannulas into a fractured and compressed vertebral body, can effectively reduce the fracture, restore vertebral body height and reduce pain.

Radiofrequency ablation is a minimally invasive procedure that damages the nerve to the point where it no longer transmits pain signals. Because the procedure does not involve steroid use, radiofrequency ablation is a treatment option for patients who can't tolerate steroids, including those with uncontrolled diabetes and osteoporosis as well as those already on steroids for other reasons.

The process is straightforward and easy on patients and produces beneficial results.

"We place needles near nerves we suspect are responsible for sensing the pain," Dr. Ho explains. "Instead of injecting corticosteroids to reduce the inflammation, we heat the tip of the needle to cauterize and damage the nerves. If it works, the procedure can provide six months to one year of pain relief."

Dr. Shue discusses an individualized treatment plan with a patient during a consultation.

Radiofrequency ablation is particularly effective for patients suffering from various types of neuralgia. Postherpetic neuralgia accompanies shingles and can occur anywhere in the body, but is often found in the thoracic area, according to Sabrina Shue, MD, Co-Founder and Co-Director of Advanced Solutions Pain Management. Epidural steroid injections and nerve blocks can be used effectively, as can stellate ganglion blocks for facial postherpetic neuralgia, but radiofrequency ablation may achieve longer-lasting pain relief.

The same is true for patients with trigeminal neuralgia. However, because the trigeminal nerve is complex — its three branches traverse the face — large volume differential nerve blocks are generally tried first to assess which branch of the trigeminal nerve causes the pain. Radiofrequency ablation can be used following nerve blocks in the same manner as with postherpetic neuralgia.

Neuromodulation of Pain

A more advanced technique to treat nerve-related pain is a two-part procedure for patients whose pain stems from cervical and lumbar radiculopathy, complex regional pain syndrome, failed back surgery syndrome or sciatica.

"We see our fair share of patients who have not achieved relief from nerve blocks, epidural steroid injections and surgeries," Dr. Ho notes. "These patients are often told they will have to live with the pain, but we offer spinal cord stimulation that can make a dramatic difference and give them their lives back."

Joseph Ho, MD, performs a neurologic examination on a patient.

Spinal cord stimulation uses an electrical current to alter or block the transmission of pain impulses through the spine. This two-part procedure may not necessarily treat the source of the pain or completely resolve it, but it does offer significant pain reduction that can greatly improve quality of life.

One of the great features of the procedure is its conduciveness to adjustment for precision. During the initial phase of the procedure — called the trial — patients are anesthetized, and physicians insert subcutaneous leads into the spinal column according to where patients indicate their pain is. Physicians test the leads to ensure optimal coverage of the pain source, and if patients indicate that the pain is still severe, the leads can be adjusted.

Diane Lam, MD, performs a back examination on a patient.

"Basically, we're trying to match the leads' stimulation to the corresponding area where the patient normally feels pain," Dr. Ho explains. "We can test whether or not we're getting good pain coverage, adjust the leads accordingly, and test again. If the patient receives good coverage where the pain is, then we know the leads are in the right place."

Patient feedback is critical to the success of the procedure. Once the leads are in the optimal area of the spinal column, they are taped to the back, and patients return home equipped with an external battery and remote control for as much as a week's worth of testing the device's utility. If after they return, patients report pain relief of more than 50 percent and less need for pain medication, Dr. Ho continues with the second phase of the procedure, in which he implants the battery-powered generator subcutaneously in the patient's abdomen or buttocks. The spinal cord stimulator device is similar to a cardiac pacemaker, except it is used to treat pain rather than regulate heart rhythm.

Spinal cord stimulation, a procedure in which small electrodes are placed in the spine, can successfully treat pain arising from failed back surgery syndrome, cervical and lumbar radiculopathy, and other back and neuropathic pain conditions.

During the last 10 years, the generator technology has improved dramatically, according to Dr. Ho. For example, a decade ago, the battery life was only about five years, and patients had to return for another procedure at that time to replace the battery. Now, batteries are rechargeable and able to sustain beyond 10 years.

If patients report no change in pain, the trial leads are removed and other treatments can be discussed. This "try it before you buy it" aspect distinguishes spinal cord stimulation from other approaches.

"It's a phenomenal option for patients," Dr. Ho says. "With other available treatments such as surgery, once you've committed, that's it. You're committed to the results as well. But spinal cord stimulation allows physicians to perform a test run and see if it helps patients before they commit to implantation. There are few options like this out there."

"We're proud to practice good medicine. We don't do what we do for billing, and we don't treat patients like numbers. We always treat patients with respect and work hard to get them feeling better. That's our practice's common goal."
— Sabrina Shue, MD, Co-Founder and Co-Director of Advanced Solutions Pain Management

Vertebral Augmentation for the Spine

Some patients won't find relief through nerve blocks, epidurals or radiofrequency ablation because the cause of their pain has a different pathology than misfiring constellations of nerves. One of the more advanced treatment options available to Advanced Solutions Pain Management patients is a quick, successful procedure for vertebral compression fractures.

Most commonly, vertebral compression fractures are found in osteoporotic patients, whose weakened spines increase the risk of fracture from trauma or benign causes such as bending or sneezing. In addition, when cancers metastasize to the spine, the area where the metastasis is found can weaken and cause compression fractures.

Osteoporosis can weaken vertebrae to the point of giving out and collapsing, resulting in significant pain. Although the symptoms can improve over time, if left unchecked, these compression fractures can cause serious complications, Dr. Ho notes.

"The obvious problem with not treating compression fractures early is that they cause a lot of pain," Dr. Ho says. "This can limit patients' activity, especially if they're bedbound, which can lead to blood clots and embolism. Compression fractures also cause abnormal posture and can lead to kyphosis, further compromising many patients with poor cardiac and pulmonary function already."

The physicians at Advanced Solutions Pain Management treat these patients with kyphoplasty — a minimally invasive, outpatient procedure that relieves pain and restores compressed vertebrae close to their original height — using a technique reminiscent of balloon angioplasty. While patients lie prone on the procedure table, the physician uses fluoroscopic X-ray guidance to identify the fracture site and then inserts two needles into the collapsed vertebral body of the spine. Through the needles, the physician threads a balloon to the fracture site and into the compressed vertebral body, where the balloon inflates, restoring the body height. The physician then deflates the balloon and fills the void created by the fracture with cement.

Members of the Advanced Solutions Pain Management staff: Violet Berisha, office manager; Maria Loja, medical assistant; Jenny Roldan, medical assistant; Sunita Roi, medical assistant and human resource manager; and Miguel Espinal, medical assistant

Kyphoplasty reinforces the fractured bones and dramatically reduces patients' pain. It is much more effective than medication management and observation alone. It also serves as a prophylactic measure against further compression fractures in the future, as the weight of the spinal column continues to compress one weakened vertebra after another.

Patients of any age who suffer from compression fractures can gain relief from kyphoplasty. Dr. Ho says the results can be felt almost immediately.

"I've seen patients who were bedbound before kyphoplasty walk out of the office 30 minutes after the procedure," Dr. Ho says. "This technique typically could make a dramatic difference in about one or two hours."

Like all the interventions Dr. Ho and his partners provide, kyphoplasty is an effective option patients can try before undergoing major surgery to remove part of or fuse the spine. Referral to pain management specialists not only potentially spares patients from some surgeries, but also reduces costs, hassle and morbidity while improving patients' quality of life.

"Before kyphoplasty, patients had to choose between suffering through conservative medication management and observation or more invasive surgeries," Dr. Ho says. "Now, there's an intermediate option that can effectively relieve patients' pain — sometimes very quickly — and diminish the need for spine surgery."

Dr. Shue, Dr. Lam and Dr. Ho gather in their office-based certified fluoroscopy suite, where procedures are routinely performed.

Early Referral, Fast Treatment

No matter what kind of pain patients experience, physicians at Advanced Solutions Pain Management always provide timely treatment. When patients arrive at the door, they've often exhausted other avenues of treatment and are ready to live a pain-free life. With this consideration in mind, Dr. Shue explains that treatments can often be administered within a few days if not the same day as the initial visit.

"We work with patients to provide pain relief management or procedures as quickly as we can," Dr. Shue explains. "Since our office includes three pain management physicians and we have our own procedure room equipped with fluoroscopy and ultrasound, we can provide faster service than many other offices. Before coming to our office, many of my patients complain that they have to wait for weeks to see a physician to address their pain and then, once examined, have to wait another few weeks for treatment. That delay doesn't happen in our office."

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For more information about the full range of conditions treated and treatments offered by Advanced Solutions Pain Management physicians, visit www.aspainmanagement.com.

Advanced Solutions Pain Management Contact Doctor White Plains Ny

Source: https://lowerhudsonbronx.mdnews.com/more-ways-treat-pain-advanced-solutions-pain-management

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