INTERVENTIONAL PAIN MANAGEMENT

WHAT IS INTERVENTIONAL PAIN MANAGEMENT?

Interventional Pain Management is the discipline of medicine devoted to the diagnosis and treatment of pain-related disorders principallywith the application of interventional techniques in managing sub-acute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. (NUCC Definition)

WHY DO WE PRACTICE INTERVENTIONAL PAIN MANAGEMENT?

Is aching, throbbing, or shooting pain impeding your work, fun, and lifestyle? You’re not alone – 25.3 million American adults have struggled with chronic pain for the last three months. Unlike traditional medicine practitioners that douse or disrupt your pain with addictive pharmaceuticals or risky surgery, interventional practitioners strive to heal the root causes of your pain, then, after eradicating it, nurture your whole body toprevent it from returning.

Dr. Robles is one of the top interventional pain management practitioners in the country.

One of the few doctors on the planet to attain 14 certifications at the world’s most progressive institutions, Dr. Robles is boarded in: The American Boards of Pain Medicine (ABPM); The American Academy of Pain Management; The American Academy of Pain Medicine; The American Board of Anesthesiology with a Subspecialty Recertification in Pain Management; The American Association of Orthopedic Medicine with Certification in Prolotherapy / Regenerative Techniques; and the American Board of Medical Acupuncture. He has also earned IROM certification for Interventional Regenerative Orthopedic Medicine.

Dr. Robles is a Fellow of International Pain Practice (WIP), as well as a certified musculoskeletal ultrasound technician (MSKUS), and a musculoskeletal sonographer (RMSKS™) – which explains his precise diagnosis and pain management skills.

Even more than all of these achievements, hundreds of happy, pain-free patients are Dr. Robles’ pride and joy.

During his continued medical education he worked and collaborated with a team of imaging technicians, physical therapists, and nutritionists who are just as determined as he is to employ evidence based approaches to not only relieve your pain – but to change your life.

WHAT IS DR. ROBLES’ MEDICAL PHILOSOPHY?

Dr. Robles realizes that healing is both a science and an art. Why? Because pain is not a black and white condition. No two people experience it quite the same way, in quite the same place, and with quite the same severity.

Pain management requires patience for: repetitive observation, perpetual education, as well as the passionate, hands-on honing of subtle procedures and customized techniques. Pain management requires a compassionate practitioner with a sensitive touch that treats the whole patient – it requires an Advanced Pain Clinic practitioner.

WHAT CONDITIONS DO OUR SPECIALISTS TREAT?

Advanced Pain Clinic specialists treat patients with a vast spectrum of chronic pain symptoms and conditions, including:

• arthritis pain
• neck and shoulder pain/rotator cuff
• herniated disc/sciatica
• degenerative disc disease
• spinal stenosis
• hip pain
• pelvic pain
• knee pain
• foot pain
• bone spurs
• joint cysts
• burn pain
• vertebra misalignment
• sacroiliac dysfunction
• myofascial pain
• fibromyalgia and other chronic pain conditions
• strength, walking, and balance conditions
• osteoporosis
• nerve injury
• musculoskeletal disorders
• tendonitis/muscle pain
• back, neck, shoulder pain
• joint replacements
• post-surgery or trauma arthritis pain
• strokes and brain injuries
• amputations (phantom pain)
• PTSD- Post Traumatic Stress Disorder
• Temporal Mandibular Pain (TMJ)

WHAT TYPES OF MINIMALLY INVASIVE PROCEDURES DOES OUR TEAM PERFORM?

Dr. Robles’ team crafts custom plans to treat your unique pain with one or more of these minimally invasive, hands-on procedures: ultrasound-guided diagnostics and pain management, fluoroscopy guided epidural injections, radiofrequency ablation, sacroiliac injection, spinal cord stimulation, physical therapy, acupuncture and nutrition.

He examines and listens to his patients describe their pain, lifestyles, and expectations before creating a treatment plan. As with any medical procedure, results will vary depending on your age, genetics, lifestyle, environment, and other health conditions.

FLUOROSCOPY GUIDED SPINE INJECTION

Dr.Robles uses x-rays to create real-time images of your spine. Guided by these images, he pinpoints the precise areas that requires injection, minimizing risks while maximizing accuracy.

Depending on your particular case and pain type, you may receive one or more of the following fluoroscopy guided spine injections:

• Epidural Steroid Injection: steroid is injected into the space surrounding your spinal fluid and nerve root sac (epidural area) to decrease inflammation and relieve pain
• Nerve Root Block: small amount of steroid is injected as close as possible to the root of the pain-causing nerve; may not work for patients with multilevel spinal problems
• Lumbar Facet Injection: injecting anesthetic or steroid directly into your spine’s facet joints to numb pain or diagnose arthritic lower back pain; best for patients who may not benefit from epidural injection; not an option for patients taking blood thinning medication

Fluoroscopy guided spine injections may treat a wide variety of chronic pain conditions, including:

• sciatica
• arthritis
• mechanical back pain
• herniated disc
• spinal stenosis
• bone spurs
• joint cysts
• vertebra misalignment

The following chart outlines possible treatment results:

• Anxiety
• Benefits
• Insomnia
• Bleeding
• Headaches
• Infection
• Side Effects
• Skin flushing
• Facial flushing
• Short recovery time
• Rarer Complications
• Low risk of side effects
• Potential long-term results
• Numbness near the injection site
• Offers a high rate of pain relief
• Pain symptoms may temporarily return
• Minimally invasive with no hospital stay
• Elevated blood sugar in diabetic patients

RADIOFREQUENCY ABLATION

Radiofrequency ablation (RFA) is a pain relief method that disrupts nerve fibers that carry pain signals to the brain. It is most commonly used to treat chronic pain resulting from arthritis of the spine (spondylosis) and sacroiliitis. It may also be used to treat neck, back, knee, or pelvis pain, as well as peripheral nerve pain.

Prior to this procedure, Dr. Robles may recommend a diagnostic procedure called medial branch block. An anesthetic is injected near the small medial nerves which connect to a specific facet joint. If you experience immediate pain relief, you may be a good candidate for radiofrequency ablation.

Using ultrasound guidance, Dr. Robles will pass a radiofrequency current through electrodes into your tissue, destroying only the pain-causing nerve or tumor tissue, which is later absorbed into body waste.

SACROILIAC INJECTION

The sacroiliac joints are located next to your spine. Sacroiliac joint dysfunction occurs when these joints become inflamed or dysfunctional. Sacroiliac injection is used for two purposes: to diagnose sacroiliac dysfunction, and to relieve sacroiliac joint pain.

To diagnose dysfunction, our certified team of technicians uses an x-ray fluoroscope image to guide a needle into the area to inject a numbing agent. If you feel a certain level of pain relief, you have sacroiliac dysfunction.

Our team will use this same technique to treat pain resulting from the dysfunction. The pain reducing injection contains corticosteroid, an anti-inflammatory medication intended to soothe inflammation and pain. This treatment may be repeated up to three times per year, depending on your diagnosis and specific case history.

SPINAL CORD STIMULATION

Spinal cord stimulators are battery powered devices that deliver electric stimulation directly to your spinal nerves, disrupting their ability to transmit pain signals to your brain. This current replaces pain impulses with a pleasant buzzing or tingling sensation and increases mobility. This stimulation treats chronic, long-term pain that hasn’t responded to other pain management.

The procedure to install the device is minimally invasive and performed under light sedation. A brief trial period is usually required to minimize the risk of complications, then the permanent device will be installed.

PHYSICAL THERAPY

Physical therapy (PT) is a regimen of exercise and stretching that may help reduce pain and restore physical mobility without expensive or invasive surgery. Physical therapy is often used in conjunction with other pain management methods, like chiropractic adjustment or acupuncture. Our physical therapists treat patients on a case-by-case basis, customizing treatment to your condition and needs. Physical therapy plans may include:

• stationary bicycling, stretching, and bending
• massage therapy
• electrical muscle stimulation
• heat or ice packs
• nutritional or lifestyle guidance

Physical therapy may help relieve many conditions, including:

• lower back pain
• arthritis
• hip and joint pain
• neck and shoulder pain
• balance and dizziness conditions (vertigo)
• athletic injuries
• muscle sprains and strains

ACUPUNCTURE

Although this pain relief method is rooted in a 2,500-year-old successful Chinese medical tradition, Dr. Robles realizes that for many Americans trying acupuncture can seem like a leap of faith. They often exclaim: how can those little hair-like needles eliminate my chronic pain?

Before offering the biochemical explanation, Dr. Robles reminds his skeptics that in 1997, after reviewing thousands of clinical studies, the National Institutes of Health (NIH) recommended acupuncture for a variety of conditions in their Acupuncture Consensus Statement.

After applying modern research, the traditional medical establishment conceded that Chinese practitioners did indeed manage pain – they merely developed and worded their ideas differently two thousand years ago. As Dr. Robles puts it, your pain favors neither the term “chi”, nor the term “endorphins” – it just wants relief.

WHAT CONDITIONS DOES ACUPUNCTURE TREAT?

The World Health Organization has published a list of 40 conditions that scientific clinical studies have shown are effectively treated with acupuncture. Here are a few that Dr. Robles has patiently and compassionately treated for over two decades:

• head, back, and neck aches
• fibromyalgia
• lower back pain
• rheumatoid arthritis
• osteoarthritis
• tennis elbow
• carpal tunnel syndrome
• tendonitis
• sciatica
• scoliosis
• numbness
• tremors
• neuralgia
• Bell’s Palsy
• Parkinson’s disease

HOW DOES ACUPUNCTURE WORK?

Each acupuncture point, which shows up in different colors from surrounding tissue on infrared imaging photos, has a function. For example, MRIs have demonstrated that stimulating LI 4 (large intestine 4) releases endorphins (natural pain killers). Some points stimulate the immune system, while others treat conditions. Dr. Robles and his team of acupuncturists choose points by both function and location near your head, shoulder, back, ankle, or wrist pain.

These acupuncture points have high concentrations of nerve endings and bundles, mast cells (used for immune function) lymphatics and capillaries. They also have a lower electrical resistance than surrounding skin. These nerve fiber bundles travel:

• from acupuncture points in the extremities to the spinal cord
• through the spinal nerve column
• on to stimulate the brainstem and hypothalamus-pituitary gland
• causing release of neurotransmitters like endorphins, norepinephrine, and encephalin
• inhibiting nerve pain fibers and blocking transmission of pain sensations

When your practitioner inserts needles into the correct point, you may begin producing B-endorphin, a natural opiate 10-100 times more potent than morphine, which, once released, circulates for several hours in your body. Dynorphins, 200 times stronger than morphine, are released in the spinal cord when electro-stimulation (e-stim) is applied to acupuncture points.

BOOK YOUR APPOINTMENT TODAY

Chronic and debilitating pain caused by spinal injury, arthritis, sacroiliac dysfunction, osteoarthritis, and other conditions can negatively affect your health and quality of life. Our Advanced Pain Clinic offers high-tech Interventional Pain Management treatments to specifically target your sore areas.