The Secret to a Healthy Life

The best advice is usually information that has been touted for centuries. It seems as if every month new medical recommendations are broadcasted regarding what supplements to take, which antioxidant foods to eat, and which vaccinations to have or not have.

Throughout history, health issues have been of foremost concern and thoughts on best practices have been shared by physicians and other intelligentsia. Benjamin Franklin is a good example of an impactful non-physician health advocate. Everyone knows his quotes: “An apple a day keeps the doctor away” and “An ounce of prevention is worth more than a pound of cure” and “Early to bed and early to rise, makes a man healthy, wealthy and wise.” Mr. Franklin was a great supporter of the individual taking an active role in maintaining their own health.

The key to having a healthy, long life is relatively straight forward—take care of yourself. Eat healthy foods, get good sleep and exercise. The most important of all three is exercise. In fact, if one focuses only on exercise, the other two will be incorporated into one’s lifestyle automatically. Studies have shown that regular exercise improves sleep habits and motivates people to make smarter diet choices.

The average life expectancy of Americans is increasing; however, a lower quality of life is prevalent due to chronic illnesses. It’s not hard to find 85 year olds in the community. Some octogenarians are living very active lives, while others are quite sedentary with debilitating, chronic pain.

The common denominator amongst the healthy people is almost universally that their activity level has remained significantly elevated throughout their lives, compared to their age-range peers. Many chronic pain problems can be prevented or minimized by making lifestyle changes earlier in life.

We should all plan for good physical health in the same way that we plan for our financial health. We put money aside for financial security in the form of retirement plans, investments, savings accounts, etc. The same planning and discipline should be applied to our physical health by maintaining a regular exercise program. The best example is people who are in their 60s, 70s, and 80s and above remaining active—swimming, running, biking and walking. Most of them aren’t athletes who have been exercising for years; it is something that they now choose to do in order to improve their chances of a healthy and active older age. They are making it a priority to fund their “health bank.”

It’s never too late to start investing in your physical health and strengthening your body. The really good news is that even small bursts of exercise can improve your health. Studies have shown that people who live in two story homes have better cardiovascular health and live longer than those who don’t. The energy it takes to climb a flight of stairs exercises the heart enough to keep it fit, if done on a regular basis.

A good fitness plan doesn’t have to be a burden and should be something that you actually look forward to. Start with small goals and build on them. If you don’t currently have an exercise routine, start with 15-20 minutes a day, twice a week, doing something you enjoy. It can be as simple as taking a walk, but be sure to quicken the pace or include hills. Maximum benefit occurs when you increase your heart rate or your breathing rate. Work towards a long term goal of exercise 30 minutes a day, five days a week. If you can find a friend to exercise with or share your milestones with, you’ll be even more motivated to succeed.

Dr. DeLaney is the founder and medical director of Balanced Pain Management, located at 114 La Casa Via, Suite 210, in Walnut Creek, California 94598. She is board certified in both Chronic Pain Management and Anesthesiology and has published multiple papers on chronic pain management. She continues to give lectures at local and national medical meetings on Pain Management. She is a member of the California Society of Anesthesiologists, the American Pain Association, the American Academy of Pain Management, the American Society of Anesthesiologists and the American Society of Regional Anesthesia and Pain. For more information, visit her website at or call 925-988-9333.

Make America Great!

My hope for a great America can truly be realized during our current presidency.  America is now in many ways a much better nation of individuals acting as a whole than it was in 1776. When the Declaration of Independence was signed, the actions of Americans did not follow the words and ideals that were written as guidelines for conduct and behavior. Despite the phrase “all men are created equal” that was penned to illustrate the fact that all people deserve the same regard, there are many examples of total disregard for this sentiment. Millions of people in this country were denied, and many are still being denied the right to the pursuit of life, liberty and happiness.

In 1539, the killing of Florida Native Americans occurred by Europeans in the Napituca Massacre. Since then, hundreds of thousands of Native Americans have been subjected to genocide. Today, many indigenous Americans who have largely been relegated to reservations, are fighting yet another greedy indiscretion regarding construction of the Dakota Access Pipeline. When completed, a section of the pipeline will be under Lake Oahe; a lake considered a sacred water source by the Native Americans living there. This is just one more example of how Native Americans have yet to recover anything remotely close to what was taken from them centuries ago.

In 1826, slavery of Africans in America was accepted as a commonplace necessity and the torture and dehumanization of men, women and children took place for over 300 years in order to provide the manual labor needed to create this great country.The socioeconomic and emotional repercussions of that atrocity are still reverberating through generations of families.

In the 1950s, McCarthyism targeted innocent people, who lost their jobs and were jailed, under the “threat of communism and homosexuality.”

Today, the President of the United States is trying to pass a travel ban against innocent people of Muslim heritage under the “threat of terrorism.” Also, Mexican immigrants who have lived and worked in this country for decades or more are literally being hunted and deported from their homes and families without regard to their contributions to their communities and America.

Unfortunately, the list of American atrocities against its own citizens is long throughout history and continues today. The difference between American then and now is that we have evolved into a beautifully diverse country of citizens and hopeful citizens who have the advantage of 20:20 hindsight. The United States is home to people who represent every race, nationality, color and creed from all over the world. The ultimate benefit of this is that we can come to understand, have empathy for, and be familiar with people and cultures outside of our own immediate circle.

Now is the time for us to act and react to political issues based on our own ethical compasses. The importance is not in whether we’re going to support or follow the lead of a Republican or Democrat. Americans need to decide if the people we elect to serve and lead the country are doing so for the benefit of the people of the country and to more closely uphold the original ideals as set forth by our founding fathers. If they are not, we need to acknowledge that fact, be vocal and dissent. This is a government of the people, for the people, and by the people. Let us not forget that idea and let us not repeat the mistakes of the past that violated the rights of the people.


Regenerative Medicine

Regenerative medicine is a new medical buzz term and is a very useful and exciting option in pain management therapy. Two of the most common regenerative treatments are Platelet Rich Plasma (PRP) injections and Stem Cell (SC) injections. Essentially, these injections harness the body’s ability to heal itself, in a very condensed form, by directing the blood’s healing factors towards injured and arthritic tissues. The procedures involve drawing a patient’s blood (or bone marrow) and then using a centrifuge machine to isolate and concentrate the healing elements (PRP and SC) that can be then reinjected into the target areas of the body that are painful.

Regenerative medicine therapy is successful for many types of pain including muscle tears and strains, partial ligament and tendon tears (shoulder rotator cuff injuries especially), osteoarthritis of the knees and hips, sacroiliac and spinal facet arthritis, as well as most other joints. Oftentimes, chronic pain is the result of reduced blood flow to the area of injury such that the crucial elements in the blood for healing are not able to access the area to repair the injury.

The Platelet Rich Plasma or Stem cell product that is re-injected has both an anti-inflammatory effect and a healing and tissue renewal effect. Whole blood, or blood with all of its components, contains plasma (55%), red blood cells (45%) and white blood cells and platelets (1%). Plasma contains clotting factors, antibodies, protein, glucose and vitamins and minerals and is the main fluid that the other components are suspended in. Red blood cells carry oxygen and carbon dioxide to and from the tissues and organs. White blood cells destroy bacteria and produce antibodies against viruses and bacteria. Platelets are responsible for blood clotting by sticking together along with the clotting factors in the plasma to form a “patch” along the blood vessel. When injury and bleeding occur, platelets also release growth factors into the injured areas to help facilitate the repair process and tissue regeneration.

There are over 40 kinds of growth factors that are released by the platelets, activated depending on what type of tissue needs to be healed. Growth factors can stimulate injured tissues in the body to grow and repair themselves, including bone, cartilage, connective tissue, muscle, and blood vessels.
Stem cells can grow and mature into any type of tissue that the body might need to repair an injury. When platelets release their growth factors, the stem cells are “called” in from the bone marrow like a rescue brigade to start regenerating and replacing the damaged bone, muscle, cartilage, etc. Stem cells are located in the bone marrow and are readily accessible. They can be harvested from large bones, such as the iliac crest (hip bone), with a minimally invasive procedure. When concentrated stem cells are injected into an area of damage, the effect is similar to having a transplant because they grow into new tissue altogether.

The effects of both PRP and SC injections on pain relief and tissue regeneration take about three to four weeks to complete. Generally, people see a gradual improvement in pain and function starting at one week that progresses over a month. The injections can be repeated for maximum effect at 4 or 5 week intervals for persistent pain. A maximum of three injections is used as the endpoint of therapy after which further improvement is not likely.

Prior to the having the injections, all medications that block platelet activity need to be discontinued for one to two weeks. These include aspirin and aspirin-containing products, and anti-inflammatories such as prednisone, ibuprofen, naproxen and the like. There are other medications that can be substituted for those if needed for pain relief in the interim that will not interfere with the platelet activity. Platelets and stem cells will remain viable and active for up to four weeks after injected so it is important not to take medication that will block their activity during the healing phase as well.

Regenerative medicine is quickly gaining acceptance as a valuable and highly effective treatment in Pain Management. I have been performing PRP and SC injections in my office for the past two years and the success rates have been exceptional. The risk of the treatment itself is minimal and because PRP and SC are autologous products (from your own body) they are completely safe and free from potential drug reaction side effects unlike other kinds of injections.

Challenge Yourself


Challenges in general keep us alive. Without them, there is little to look forward to. This, I believe, is the same for everyone, regardless of age. When we are younger, we eagerly anticipate challenges and accept them as part of life because we are told that it’s part of growing up.  Most children are eager to grown up, therefore they look upon challenges as milestones on the way to adulthood. For example, learning to drive, graduating from high school and college, getting the first job, and buying a first home are all challenges that most young adults eagerly accept and accomplish.

As we get older, we tend to eschew change and even new challenges. Our perception may be that “change” and “challenge” are synonymous with “failure” and “work.” The fact is, however, that even failure and work will lead us to a better future if we have persistence. More importantly though, is the idea that we either forget or don’t realize that challenges keep us happy and motivated for the future.

Physical challenges are important for many reasons. Pushing your body to perform at a higher level than the usual function increases endorphin levels, libido, mental clarity, emotional well-being, heart health and metabolism. These benefits lead to longer and more productive lifestyles.

Regardless of one’s age, one of the best ways to ensure that life remains vital and fulfilling is to embrace challenges.

Chronic Pain: It’s Not in Your Head, It’s in Your Brain!

The formal definition of pain as coined by the International Association for the Study of Pain (IASP) is “A noxious sensory and emotional experience.” This means that something not only hurts because your body feels it, but also hurts because it is a negative experience as perceived by your brain. Chronic pain is defined as pain that lasts longer than three months or pain that does not dissipate in an acceptable amount of time for a particular healing process to occur.

Chronic pain specialists work to minimize the severity of pain and its interference on activities of daily living, regardless of whether the pain is due to normal aging and degenerative processes or an injury, such as a surgical procedure or trauma. My approach is to identify, as specifically as possible, the “pain generator.” This is the area of the body—be it muscle, bone, nerve, fat, ligament, etc.—that is causing the pain. Unfortunately, this is usually not a very straight forward process because there may be multiple pain generators and external factors influencing pain and the perception of pain.

In order for a person to experience pain, a succession of events occur. Initially there is “Nociception,” or the injury itself, then there is “Transmission,” which is the pain signal carried by the nerves. Lastly, there is “Processing,” which occurs in the brain.  The brain is the ultimate judge of whether the offending injury hurts or not. Over many years, the study of pain has revealed that these events are not straight forward either. At each level of the pain pathway, there are different factors that can change the overall cycle or procession of the pain signal. As a pain specialist, I try to block the pain at as many points as possible. For example, most medications are used to try to block pain at the level of the injury or nociception. The most common medication that I use for this is the anti-inflammatory type of medication such as Ibuprofen or Naproxen. If medications fail or a patient isn’t a good candidate for a medication regimen, then I try to intercept the pain at the transmission level. I use nerve blocks and steroid injections and other techniques to “calm” the nerve and slow down the pain signal.

The most important aspect of the pain pathway is the processing of pain or what the brain thinks about the information that it is receiving. Studies have shown that not everyone experiences pain the same way; even movies, books and anecdotes will tell you that one person’s pain may be another person’s pleasure. The good news is that despite what doctors and medical therapies may not be able to do to alleviate pain, the brain can.

Research studies done on the psychology of pain have proven that the brain changes in response to pain and that pain can be alleviated by the brain changing in response to specific treatment “exercises.” We now realize that patients have much more control over a very real phenomenon that occurs in the brain to cause chronic pain. For example, it is well known that depression and anxiety reduce the pain threshold and those individuals who suffer from those disturbances are at greater risk of any type of pain becoming chronic. We have also identified that patients who tend to “catastrophize” medical issues and ruminate on the potential negatives of situations are highly likely to develop chronic pain and disability. These emotional states actually make the body and the nervous system more susceptible to pain. On the contrary, similar studies have shown that patients who are in love or who have positive thoughts and hopeful outlooks on their medical conditions are much less likely to suffer with chronic pain.

Cognitive and behavioral therapy is a type of psychology treatment that helps the brain learn to modify and change the pain signal that is coming in from the body. It is real medical therapy and we are just beginning to understand how truly powerful a tool it is in chronic pain management.

It’s Winter; Be Careful to Prevent Falls

Slips and falls in the rain and snow are a major cause of painful traumas, especially in older people this time of year. The worse type of injury is the vertebral fracture. This occurs when a hard fall onto the back or buttock causes one or more of the bones of the spine to fracture and collapse. The fracture is extremely painful because unlike other fractures, it’s position deep in the body prevents it from being immobilized to allow healing and even everyday activities such as sitting up to eat a meal causes movement of the fractured bone.

If you experience a fall and have severe pain that doesn’t improve within one to two weeks and have severe back pain with any position or activity except lying down, more than likely, you have a spinal fracture. It is very important to have a physician evaluate you and order a diagnostic x-ray so that you can receive appropriate treatment in a timely manner.

The treatment for a spinal fracture depends on the severity of pain and on how much the pain limits your everyday activities. Younger adults may have a fracture, but because of good muscle tone and strength surrounding the spine, they might not have such severe pain that prevents their usual activites such as work, dressing, bathing, eating, etc. Older adults however, tend to have less muscle mass and support of the spine so that even sitting at the dinner table to eat a meal is a chore because of severe pain. In less painful fractures, wearing a tight, elastic, low back support belt can be very helpful, along with taking anti-inflammatory medications such as Advil or Aleve. These fractures may take up to six months to a year to heal naturally.

For older adults who have severe pain that prevents them from participating in their usual activities of daily living, we recommend a curative procedure called a Percutaneous Balloon Kyphoplasty. The procedure fixes the fracture by injecting cement into the bone through a thin, hollow needle. The cement is the same that is used in knee and hip replacement surgeries. It hardens immediately and the severe pain is gone immediately as well. The procedure is safe, done in the office under conscious sedation and takes one to two hours. There are no physical restrictions after the procedure and since the fracture is then fixed, there is no need for any strong pain medications.

I recommend that the procedure be done as soon as the fracture is identified if there is severe pain. If the fracture is allowed to heal on its own, it will likely heal with a deformity of the bone that causes the spine to bend forward, called kyphosis. Kyphosis can lead to long term health problems including respiratory diseases and chronic back pain. An MRI of the spine is usually ordered by the doctor to ensure that the fracture is still new enough to be fixed. Usually the MRI will show inflammation of the bone due to the fracture even six months after the fall has occurred. Once the bone heals, usually six months to a year after the fall, nothing can be done to reverse the deformity.

The best option of course is to avoid falls and injuries. “An ounce of prevention is worth a pound of cure,” as our friend, Benjamin Franklin, says. Wear shoes with good treading and if you need a cane or a walker, use it! Do as much safe exercise as you can to keep your back and spine strong and healthy.


Get Motivated!

Here we are again—a New Year and a new start for goals, aspirations and dreams. Actually, every day of our lives is an opportunity for a fresh start, but most of us tend to use January as the starting line for change. The New Year is a time to start a weight loss plan or fitness/work out plan to get healthier and look better.

As I get older I find that it’s becoming harder and harder to motivate myself to do the same things that I used to even though I know what is good for me to do. For example, I’ve always been athletic and not only interested in exercise, but I use it as a mental escape and a way to relieve stress, and last but not least, to look good in my clothes and feel attractive.

I frequently counsel patients on the importance of staying active despite growing older, but I realize from personal experience that this is much easier said than done. One important realization that I’ve made, however, is that it’s not easy for anyone. Some people are just more motivated than others or they work harder to find their motivation to exercise and stay as healthy as possible. I heard a quote from a professional body builder who said that it’s never convenient for him to work out, but he made a commitment to himself to do it in order to reach his goals and be successful. One can extrapolate this mantra to any goal in life and it was somehow particularly soothing to hear someone else verbalize that it’s not easy for them to work out—even when that’s what they do for a living.

I remember my sister saying years ago, “Leslie, you take good care of yourself”. Ironically, my motivation for exercising and staying in shape had never included being healthier or taking care of myself, but as she recognized, that’s exactly what I was doing. I believe we should look at exercise in this way first and foremost because that’s what it does for us. Exercise keeps the heart healthy, lowers blood pressure, prevents and reduces depression, lowers stress and keeps us looking and feeling younger, to name a few benefits.

Another reason to exercise and get fit is to save money. It’s expensive to be unhealthy. Many people who don’t exercise or eat right have hypertension, diabetes, joint disease, chronic pain, insomnia and anxiety. I’ve heard too many patients worry about how they’re going to pay for their medications and because of the expense they don’t have money for enjoyable activities. Taking care of yourself is another way to gain control of your finances, health and your life. Let’s not be so complacent that we’d rather spend money on a pill for a preventable malady than work to keep ourselves healthy. We are responsible for our own health just as we are responsible for paying taxes and taking out the trash.

For many, getting healthier is a major change in a way of life. Therefore, it’s best to have patience and take it one step and one day at a time. The most important part of being and staying healthy is about what you eat. Start with a good meal plan and lose weight the healthy way. Losing weight has a positive feedback effect of losing more weight because of having increased energy and that subsequently encourages increasing activity. Most fitness professionals will tell you that your diet is 75% of the work of being in shape. This January, make the first step to eat right and the rest will follow.


Who will the Future Doctors Be?

I worry about the future of medicine, of doctors in particular, as the healthcare laws, mandates and reforms continue to change and evolve. It seems to me that outside of clinical and bench research and resultant treatment advances, few of the healthcare changes are occurring for patient benefit and certainly none are for the benefit of the doctor.

The outcry for “Healthcare Initiatives” by government and lawmakers because of the continued escalation of dollars spent on individuals’ use of medications, hospital services and insurance coverage, is never ending. Unfortunately, government’s answer to the problem never focuses on the root issue and therefore their proposals for fixing the situation will never be successful. A patient recently asked me, “How will Trump’s election and health care changes affect you?” My answer is that regardless of what Trump does or doesn’t do, most assuredly the changes won’t benefit me or other doctors in any way. We doctors can only brace ourselves for the impact and hope it doesn’t hurt too much.

For decades, the answer to rising healthcare costs has been to reduce doctors’ reimbursement rates. Doctors who have had a large percentage of their patients come from poor communities or who depend largely on government subsidized reimbursement (Medicare/Medical/etc.) have had to close their practices or work for someone else, such as Kaiser Health System, in order to have a guaranteed income. Not only are reimbursement rates reduced yearly, which is analogous to being demoted or taking a pay cut every year, doctors are actually being PENALIZED for not participating in more paperwork that does not improve patients’ health and adds even more uncompensated time to our days and increases our overhead. For example, Medicare devised the PQRS initiative, which stands for “Physician’s Quality Reporting System” that supposedly improves patient care by having doctors fill out various questionnaires regarding aspects of patients’ care and medical screening whether they are related to an individual doctors’ treatment of the patient or not. Doctors are being penalized by an additional 6% or more back to 2013 if they have not submitted the required paperwork. Unless something changes, future penalties are already scheduled up to 2018 for paperwork not submitted this year. The PQRS does not improve patient health outcomes; it gives the government a reason to do more of what they’re going to do anyway—make doctors pay.

It is ironic to me that the Medical Doctor, as a career, could be careening down such a treacherous road. I was eleven when I decided to become a doctor. I was told that it was a very noble profession but that I would have to sacrifice much in order to accomplish that goal. I would have to study hard, spend many years in school, and delay gratification for at least twelve years longer than most anyone else who wasn’t trying to do the same. I was warned that I would have to work very hard once I became a doctor and that my nights and weekends would not be my own. I was assured, however, that the reward would be worth it. The reward would be prestige, respect, financial comfort and independence, to name a few. Disappointingly, the promised reward is becoming ever more elusive.

I enjoy being a doctor, despite the undercut reward because I am gratified by working hard, taking care of people and “doing good.”  Doctors are smart, kind people, who make decisions every day about how to best care for someone else. However, every person deserves to make decisions for their best benefit, especially if it concerns survival. I worry about what kind of people will become doctors in the future.The carrot should always be bigger than the stick and right now the carrot is shrinking at an alarming rate. The way it stands now, physicians are often the scapegoats and worker bees that businessmen and corporations oftentimes profit from unfairly. Government decisions are squeezing the very people who have sacrificed years of blood, sweat, and tears for their careers. Although I won’t quit, I for one would not make the same choice knowing what a doctor’s work and life would be like at this time. I am fearful about whether there will be any kind, compassionate, capable physicians when I need one in my old age. Despite all, I will remain hopeful that someday, smarter, wiser and gutsier politicians will step up and start looking out for the future of this country and its people.


Coming of Age

As we live our lives we are apt to experience a multitude of “coming of age” moments. One of those moments is when we realize that an elder in our family circle, who was previously known as the “care giver,” now needs us to care for them in a way that we are unaccustomed. Some people seem to grow old and infirm inordinately quickly; perhaps from too many heartaches and disappointments. Life isn’t easy but I believe that we are here to help each other ease the path. There oftentimes is no “START” sign that alerts us to the fact that a family member or friend now needs our help navigating their health issues.

When I moved to California my mom would visit from the East coast with her oversized luggage in tow. Seriously, the airlines marked it with a “HEAVY” sticker every time because she would also pack her favorite snacks. On one occasion while I was picking her up at Oakland airport, I was unable to lift her big red bag into my Jeep Wrangler. I left her at the curb to get the car but I had to come back for her help. In retrospect she was having trouble walking due to leg pain but she never said a word about that. She told me to just go ahead and put the bag in the Jeep myself and I started laughing because it was HUGE. Normally, I can handle most physical tasks, but I was literally afraid of busting a gut or something. Eventually, we hoisted the bag into the car together and laughed all the way home. My mother never told me when she was hurting or that she needed help and I therefore assumed she was doing just fine. I had no reason to suspect that she wasn’t the same strong woman that I had known all my life.  When she went to the hospital in Pittsburgh for unclear reasons, but related to abdominal pain, I assumed she would tolerate the event with minimal difficulty. Devastatingly, my mom died unexpectedly during that hospitalization. My biggest regret is that I wasn’t there to support her when she needed me.

Older patients may get better medical care when they have family with them at their doctor visits or when they are in the hospital. Understandably, this isn’t always possible due to social, economic and logistic reasons; however, the reason they do get better care when accompanied by someone who knows and cares for them is multifactorial. The art of medicine and the medical practice model have changed vastly over the last fifty years. As a result, the amount of time that a doctor has to spend with her patients and conceptualize an idea of the problem and issues to focus on is reduced to a fraction of what it should be. If a patient comes to the office alone, we have only the information that they can give us to help formulate a diagnosis and treatment plan. Not infrequently, patients can’t remember specific facts or incidents surrounding the issues for which they are seeking help. They may be overwhelmed by the medical experience or may have impairments with memory or thought processes.  Patients may even be too embarrassed to mention issues that are significant and crucial for the doctor to know. Also, due to time restrictions with each patient, we physicians are losing the ability to develop trusting relationships with the people for whom we are assuming responsibility. Patients are reticent to heed the advice of a doctor they don’t know well or if they don’t understand the information that is being given to them.

In my experience, if a close relative or friend accompanies a patient, I have an opportunity to see a more three dimensional view of that person’s medical issues and how they are affecting her life and to what degree. Even if that support person is only present for the initial office visit, it is helpful to have a familiar point person who can be contacted if I have future questions or concerns.  Also, my treatment of a particular pain issue may involve medications or therapies that an older patient is unacquainted with. I do my best to teach and explain the rationale behind all of my decisions and treatment plans, but it is frequently much easier if I can simultaneously relay the information to the support person who may have a better understanding of my thoughts as well as the ability to reiterate the recommendations after the office visit to the patient.

All of the aspects of the complex medical system we have today along with the numerous health issues that people are dealing with make it more important than ever that we take the time, whenever possible, to be there for our friends and family. Sometimes we might just have to insist to be an “extra ear” to accompany our family member but most likely the offer will come as a relief in knowing that they are not alone.

Nerve Blocks and Steroid Injections

Anesthesiologists have been performing nerve blocks for surgical anesthesia for centuries to allow a patient to undergo an operative procedure more comfortably with less general anesthetic and therefore fewer side effects. Modern anesthesiologists prefer to administer more regional anesthetics (i.e., anesthetizing only a specific region of the body) over a general anesthetic whenever possible because we find that patients have less pain, nausea and delirium postoperatively, as well as shorter, if not outpatient, hospital stays. Typical types of surgery that would fall into this category are surgeries on extremities including total hip and knee replacements; leg, foot, arm, shoulder and hand surgeries.

The pain management specialty was borne from the desire to help more patients who are not having surgery, but who are in pain nonetheless, with the same techniques. By offering interventional techniques such as nerve blocks and steroid injections, we can treat outpatient pain problems without having to rely on or use high dose oral pain medications. The most commonly performed procedures are epidural steroid injections for neck, mid-back and low back pain. Herniated discs and stenosis (spinal arthritis) can cause inflammation and swelling of spinal nerves to create severe pain in the neck, arms, low back and/or legs. The injection of steroid medication into the epidural space, which surrounds the nerves, helps reduce the swelling and inflammation and pain. We often inject a local anesthetic, aka “numbing medication,” with the steroid for some immediate pain relief, which is what makes the injection a “block.” Oftentimes the anti-inflammatory effect of the steroid provides long lasting pain relief for months or years; however, occasionally the pain relief effect may only last days or weeks. The difference in the result from person to person depends on multiple factors including: severity of the disc herniation or arthritis, weight burden on the spine, muscle tone surrounding the spine, and amount of inflammation, to name a few. Unfortunately, these steroids don’t cure the ultimate cause of the pain, but they can and do, for most people, improve function and reliance on pain medications. The injections can safely be repeated if the pain returns, however, the best way to avoid future pain exacerbations is to optimize spine health with weight reduction, core strength training and stress reduction/management.

As with any medical technique or recommendation, the benefit of the treatment should far exceed the risk. Cervical and thoracic epidural injections inherently carry more risk to perform because the spinal cord can be injured if they are not performed correctly. The spinal cord terminates at L2 and exists as long spaghetti-like nerve endings below this level, so lumbar epidural injections carry less risk of spinal injury, however all injections should only be performed by specialty trained doctors. Patients who are at higher risk for complications from injections include those with diabetes or bleeding disorders or those who are taking blood thinners. If steroid injections are done too frequently, side effects can occur including adrenal suppression (the body doesn’t make its own steroid hormones), early cataracts and hormonal imbalances.

My pain management philosophy is to use a balance of treatment options so the patient isn’t at higher risk from any one particular type of treatment. Also, the complexities of chronic pain are better addressed by using a treatment plan that is directed at alleviating more than one aspect of the pain. Oftentimes pain, anxiety, depression, insomnia, isolationism, anger and embarrassment are intertwined and there just isn’t one type of medication or injection or treatment that will make all of those symptoms resolve simultaneously. The best treatment plan is one that will reduce pain and increase quality of life and function for the short term and the long term with the least side effects.