Procedures

Chronic pain is defined as pain lasting more than 3 months. It can also be regarded as any pain that lasts beyond what is expected to be a reasonable healing period after injury, or surgery. When any ongoing issues prevent the return to the normal state of the body, we have a process that may snowball to create other problems, including a gradual spread of discomfort to neighboring regions, and the recruitment of other tissues (surrounding muscles, tendons, nerve fibers, etc). The progression of discomfort naturally triggers a sense of anxiety (Why is this happening? Why doesn’t it get better in a timely manner? Is there anything more serious going on that may have been missed? When is this going to end? Am I going to be normal again?). The inner turmoil may easily overwhelm us, creating a sense of insecurity and distrust in the future. Our preoccupation with this increasing problem absorbs all our thoughts and energies. We restrict our activity and try to minimize the damage. This leads to isolation and, not infrequently, a sense of desperation and hopelessness. There is also a gradual loss of fitness, strength, and mobility, as well as progressive worsening of symptoms. Therefore, most of the time, chronic pain is associated with severe deconditioning, depression, anxiety, a sense of loss and loneliness, withdrawal from social and professional activities, and familial strain. It is the typical presentation of our usual patients. You are not alone. And we are here to tell you that every day, somebody, maybe even worse off than you, turns things around, and together, we make a comeback.

Usually, the first visit takes place in the Pain Clinic. You will undergo a typical office visit, where you will be greeted by our staff and get acquainted with our protocols. Dr. Calin Savu, MD or Nurse Amber Sloan, APN will provide the first assessment, based on the information you will provide. Occasionally, if a need is identified, a procedure may be performed at the same time as the first visit. However, a lot of variables enter that decision, including your insurance carrier’s rules, or whether you are on blood thinners that you may need to stop prior to a treatment. While a number of interventions may be done with ultrasound guidance, which is available in the clinic, others require X-ray (fluoroscopic) guidance. That is available only in the Pain Center, a free standing ambulatory surgical facility, which is located 1 floor below, and for which you need to be scheduled. We continuously strive to minimize the waiting times between appointments and provide timely relief.

The procedures will be performed by Dr. Calin Savu, a pain medicine specialist trained in chronic pain therapy, with more than 20 years of experience in such treatments. His pledge is to offer the most up-to-date, proven, and effective forms of care, matching or surpassing the care available at the largest pain centers in the US. He is assisted by a team of thoroughly trained and vetted clinicians, who will provide you with the highest quality of care, with compassion and respect.

While it may take very little time for the actual procedure to be completed, there are a number of steps that add a fair amount of time as is the case the case with most medical and surgical interventions. It’s not unusual to occasionally spend a bit over a couple of hours in our facility. After registration, you will be going through an admission process that determines the present status of your general health, as well as the specific character, location, and intensity of your particular pain. While it may sound that you are going to be asked the same questions repeatedly, and by different staff members, you should consider this as a feature, not a bug. Many times, essential details provide us with information that continuously shapes our thought process, our diagnostic and therapeutic protocols, and our final decision-making. Be patient and help us understand your problem. After treatment, a thorough assessment is essential to determine your immediate response. When the nursing staff decide it is safe to release you, a hand-over to the person accompanying you may include important information about the next stages of monitoring and treatment (self-assessment of pain for diagnostic blocks, information regarding the next appointment, referral to other departments-PT, OT, Medicine).

After initial registration, you will be prepped and taken to a pre-procedure room. A nurse review of your general health status and specific pain details will follow. Once we decide to proceed with your treatment, a light anesthetic cream will be applied to the area to be targeted. you will be positioned lying on your stomach on your stretcher and get transferred to the procedure room. Once there, after another verification of your identity and pain problem, the target area will be cleansed with a sterile solution. We use extremely thin and flexible instruments to minimize discomfort. Many describe a burning or stinging sensation for a few seconds, followed by a growing pressure as we approach the intended structure, using continuous X-ray monitoring. The use of X-ray (fluoroscopy) guidance maximizes precision and minimizes the chances of mishaps, that are overwhelmingly reported when poor techniques and inappropriate/insufficient use of X-ray technology are used. When the desired area has been located and reached, a small amount of contrast dye will be injected to obtain further confirmation of ideal placement; the targeted structure will be then bathed in a combination of diagnostic or therapeutic substances, depending on your particular procedure. Upon completion, you will be rolled back to the pre-procedure area, where a brief period of observation will allow us to assess your immediate response, answer any questions from you or your company, and get a set of departing instructions.

Eating a light breakfast or lunch is usually permitted. However, our staff will instruct you regarding your specific procedure. It is essential for patients with metabolic conditions (diabetes) to continue their daily habits without any changes.

In the morning of the procedure, it is suggested to take a shower using an anti-microbial soap (Dial) and a washcloth or a sponge and gently rub the general area to be treated for a few minutes. ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; Notify the nurse if you are taking any blood thinner, or have an infection or are sick; Stop taking anti-inflammatories (Advil, Naprosyn, Mobic, etc) for 7 days; we will provide you a list for blood-thinner stoppage durations during your first visit. For patients receiving Coumadin, blood will need to be drawn prior to the procedure to make sure it is not too thin. IF YOU ARE SCHEDULED FOR A DIAGNOSTIC TEST, DO NOT TAKE ANY PAIN MEDICATION THE DAY OF THE PROCEDURE. You have to continue your routine medication on the day of the procedure (heart, diabetes, blood pressure) If these recommendations are not followed carefully, we may have to cancel the procedure, causing a delay in treating your pain. Expect to be at our facility for one to three hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.

If you experience severe back pain, new or progressive numbness or weakness of your legs, dizziness, nausea or vomiting, or if you or someone else notice signs of infection in the area of the injection, you should call The Pain Center immediately at (870) 972-0411 during office hours or go to the nearest emergency room. If these symptoms progress over more than a couple of hours, and are unable to travel safely to the closest ER facility, call 911 and request a team to come in and evaluate you; explain you had a recent procedure in your back/neck/extremity and it was upon our advice you are calling to request assistance. Our office hours are 7:45 a.m. to 4:45 p.m. Monday through Thursday and 7:45 a.m. to 12:00 p.m. on Friday, except holidays.

Pain Medicine is a branch of Medicine which is made of many disciplines. Pain doctors have to draw their knowledge from Internal Medicine, Orthopedic (bone and joint) medicine, Neurology (nervous system), Rehabilitation, Anesthesiology, Radiology, Pharmacology and Psychiatry. The Pain Medicine professionals have to make sense of your general medical, as well as the specific pain(s) history. A thorough exam is necessary to identify problems and hints that may help in identifying the problem. It also helps us understand the impact pain has on your present physical state and your ability to function, be productive, and enjoy life. Based on this information, we can then develop a plan to identify the elusive causes of your pain and suffering, however subtle or frequently overlooked they may be; we then can finally put together a plan towards recovery of function, abilities, and quality of life; in the process, a lot of time needs to be spent on gradually promoting good long term habits that would improve the odds of success. It is essential to understand that we don’t fix problems as if we replace a broken part and we’re back in business at 100%. We develop a collaborative plan between the pain specialists and the patients, where each party has to understand and accept their tasks and responsibilities. Frequently, chronic pain is the result of chronic conditions (diabetes, degenerative arthritis, neuropathies) which cannot be cured. But even then, we strive to find solutions, and tools that empower the pain patient to withstand some degree of discomfort and handle it in a confident and knowledgeable fashion, leading to a successful and enjoyable life.

While MRIs and CT scans may be helpful to identify potential sources of pain, they rarely determine a precise cause for chronic pain. Consider them a screening tool that may narrow the search for an answer. But they do not pinpoint the true pain source or generator. The reason is the large discrepancy between MRI findings and true painful structures. While some areas look “bad” on an MRI, they may be quiet and cause very little discomfort. Others may look fair on MRI but go through a powerful inflammatory process; this is actually a chemical reaction that can not be pictured on a screen, however advanced is the camera. A more effective and elegant way is to instill a potential antidote within the painful inflammatory “soup” developed at the suspected site. If our suspicion is correct, the antidote (in the form of local anesthetic) will provide dramatic relief, at least for the life duration of the anesthetic agent- usually a few hours. A dramatic improvement in the pain level and the ability to function following such a block is the hallmark for a “positive test” and gets us one critical step closer to providing the appropriate solution, i.e. the treatment.

Most will experience a sunburn-like feeling for about three weeks. Following the Radiofrequency Rhizotomy, there is a 60% chance of pain relief. This typically lasts for three months to one year. The nerve eventually grows back and the procedure may be repeated. While the patient experiences the pain relief. Vigorous physical therapy is necessary to try and strengthen the involved joints.

The procedure is performed by a pain medicine specialist trained in chronic pain therapy and assisted by a licensed radiological technologist and a licensed registered nurse.

It will take from one to two hours including recovery time.

You will be dressed in a gown and have an IV started. You will be then taken to the procedure room and positioned on your stomach with pillows underneath. You will be asked to lay very still and quiet during the placement of the needles. Once the needles are in place, we will start to inject the dye and antibiotic solution.

No, a discogram will not relieve your pain. This is a diagnostic, not a therapeutic procedure. Our goal is to locate the source of your pain by reproducing it entirely.

You may eat lightly before the procedure. ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory; or have an infection or are sick. You will have to get approval from the doctor who ordered the blood thinner to stop taking the medication three days in advance for Coumadin, seven days for Aspirin, and four days for anti-inflammatories or Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure). Expect to be at the office for one to three hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions. When you start to feel some discomfort, you will be asked to respond with only one of the following statements: The pain is identical to my usual pain; The pain is not identical to my usual pain; I feel pressure, not pain. Depending on your answer, we’ll decide if the procedure is over or we need to continue. Once the procedure ends you will be given a pain reliever through IV, then sent to the hospital for a CT scan. This will give us images of the dye distribution and show any tears, scarring, and degeneration of the disc.

The blocks are administered by a pain medicine specialist who is trained in chronic pain therapy. A local skin anesthetic is given. A very thin spinal needle is inserted with the guidance of an x-ray to the area desired. An x-ray dye is then injected to confirm correct placement, once the placement is achieved a mixture of numbing medication and steroids will be injected.

The procedure will take less than an hour including recovery time.

When steroids are taken by mouth most of the medication is absorbed in the stomach. Very little would reach the true source of pain. The same is also true for intramuscular injections.

The block takes place in a procedure room. You will be positioned lying on your stomach. The area will be cleansed with a sterile solution and numbed with an injection of Lidocaine. Many describe a burning or stinging sensation for a few seconds.

Most patients will experience immediate relief from pain due to the numbing medication that is mixed with the steroid. This will last from one to three hours after which the pain may return but to a lesser degree.

You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory. Approval will be needed from the doctor who ordered the blood thinner to stop taking the medication four days in advance for Coumadin, seven days for Aspirin and four days for anti-inflammatories and Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin; You may take your routine medication the day of the procedure (heart, diabetes, blood pressure); Expect to be at the office one to three hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.

The blocks are administered by a pain medicine specialist who is trained in chronic pain therapy. A local skin anesthetic is given. A very thin spinal needle is inserted in the base of the neck on the affected side, near the transverse process of the cervical spine. A small amount of x-ray dye is injected to confirm the position. Once the placement is achieved, a mixture of numbing medication and steroids will be injected.

It will take less than an hour, including recovery time.

The block takes place in a procedure room. You will be placed in a gown and positioned on your back. The area will be cleansed with a sterile solution and numbed with an injection of lidocaine. Many describe a burning or stinging sensation for a few seconds. You can expect hoarseness of your voice, redness of the eye, drooping of the eyelid, and papillary constriction for four to eight hours after the injection. The duration of relief is variable.

The patient may notice increased warmth and color in the affected arm and pain relief may be noted immediately.

You may eat lightly before the procedure. ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory; or have an infection or are sick. You will have to get approval from the doctor who ordered the blood thinner to stop taking the medication three days in advance for Coumadin, seven days for Aspirin, and four days for anti-inflammatories or Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure). Expect to be at the office for one to two hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions. NOTE: This procedure cannot be performed if you have an active infection, flu, cold, uncontrolled cough, fever or very high blood pressure. Please make your nurse or doctor aware of any of these conditions.

Epidurals are administered by a pain medicine specialist trained in chronic pain therapy. A local skin anesthetic is given. An epidural needle is then gently inserted into the epidural space of the cervical, thoracic, or lumbar area, depending on the area of your pain. A combination of local anesthetic (numbing medicine) and steroid (anti-inflammatory medicine) is injected into the epidural space.

It will take less than an hour for the actual procedure.

When steroids are taken by mouth most of the medication is absorbed in the stomach and distributed equally throughout the entire body. Very little reaches the true source of the pain. The steroids reduce swelling and irritation which will reduce the pain.

You will be taken to a procedure room and positioned lying on your stomach. The area will be cleansed with a sterile solution and numbed with an injection of Lidocaine. Many describe a burning or stinging sensation for a few seconds. After that, you should just feel pressure. The physician will continuously communicate with you what to expect during the process.

Most will experience some immediate relief from pain due to the numbing medication that is mixed with the steroid. This will last from one to three hours and the pain will return. It will take about three days for the steroids to start working on the nerve root.

You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, Aspirin or an anti-inflammatory. Approval will be needed from the doctor who ordered the blood thinner to stop taking the medication four days in advance for Coumadin, seven days for Aspirin and four days for anti-inflammatories and Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin; You may take your routine medication the day of the procedure (heart, diabetes, blood pressure); Expect to be at the office one to three hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.

If you experience severe back pain, new numbness or weakness of your legs, or signs of infection in the area of the injection, you should call The Pain Center immediately at (870) 972-0411 or go to the nearest emergency room. Our office hours are from 7:45 a.m. to 4:45 p.m. Monday through Thursday and 7:45 a.m. to 12:00 p.m. on Friday.

This simple and fast nerve block will be performed by a pain medicine specialist trained in chronic pain therapy and assisted by a trained clinician. With fluoroscopic guidance, an extremely thin needle is advanced to the target zone. The needle is placed in close proximity to the medial branch.

It will take less than 5 minutes for the actual procedure.

You will be prepped and taken to a procedure room. You will be positioned lying on your stomach and the area of focus will be cleansed with a sterile solution. The number of sticks depends on the span of the painful area. Many describe a momentary burning or stinging sensation followed by gradual pressure as the tip of the needle is advanced through the deeper tissues under continuous fluoroscopy (x-rays). Once the placement has been accomplished, you will only feel a slight tightness, pressure or tingle, as the anesthetic substance is placed around and onto the nerve.

Most will experience patient experiences pain relief. Vigorous physical therapy is necessary to try and strengthen the involved joints. Most will experience significant relief within the first half an hour. A flow-sheet will be given to the patient with the request to mark pain scores on a scale from 0 to 10 every hour on the hour starting 30 minutes from the completion of the procedure. While we encourage maintaining a typical rate of activity during this interval, if your pain has decreased, we recommend attempting some minor exertion or movements which would otherwise have been painful and noting if the procedure enabled a better tolerance to these activities.

You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; notify the nurse if you are taking a blood thinner, aspirin or an anti-inflammatory or have an infection or are sick; stop taking Plavix four days before the procedure. When taking Coumadin, blood will need to be drawn prior to the procedure to make sure it is not too thin; DO NOT TAKE ANY PAIN MEDICATION THE DAY OF THE PROCEDURE; we need you to have a baseline level of discomfort in order to appreciate the effectiveness of the block. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure); Expect to be at the office one to two hours. This includes registration, paperwork, review of consent, procedure, recovery, and review of discharge instructions.

The Radiofrequency Rhizotomy will be performed by a pain medicine specialist trained in chronic pain therapy and assisted by a trained clinician. A local skin anesthetic is given. With fluoroscopic guidance, a radiofrequency needle is advanced to the base of the transverse processes. The needle is placed along the course of the medial branch. The needle is heated to 80 degrees C for 90 seconds. At least two branches for each joint are treated in the same manner.

It will take less than an hour for the actual procedure.

You will be prepped and taken to a procedure room. You will be positioned lying on your stomach and the area of focus will be cleansed with a sterile solution. The area will be numbed with an injection of lidocaine. Many describe a burning or stinging sensation for a few seconds. The probe will be fluoroscopically guided and placed. A very small electrical current will be passed through the probe. This is not painful. You will only feel a slight tightness, pressure or tingle. When the desired area has been located, the nerve will be bathed in a numbing medication before the cauterization begins.

Most will experience a sunburn-like feeling for about three weeks. Following the Radiofrequency Rhizotomy, there is a 60% chance of pain relief. This typically lasts for three months to one year. The nerve eventually grows back and the procedure may be repeated. While the patient experiences the pain relief. Vigorous physical therapy is necessary to try and strengthen the involved joints.

You may eat lightly before the procedure; ARRANGE FOR A DRIVER TO TAKE YOU HOME. Your procedure will be rescheduled if you do not have a driver; Notify the nurse if you are taking blood thinner, Aspirin or an anti-inflammatory or have an infection or are sick; Stop taking Aspirin seven days in advance; and four days for anti-inflammatories, and Plavix. Blood will need to be drawn prior to the procedure to make sure it is not too thin. DO NOT TAKE ANY PAIN MEDICATION THE DAY OF THE PROCEDURE. You may take your routine medication the day of the procedure (heart, diabetes, blood pressure). Expect to be at the office one to three hours. This includes registration, paperwork, review of consent, procedure, recovery and review of discharge instructions.