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New Back Cure? (A reproduced news article)[This information was true at the time of publication. - Management]
Dr. Ronit Adler, anesthesiologist and chief of the Good Samaritan Hospital Chronic Pain Management Center and her husband, neurosurgeon Dr. Jeffrey Epstein, are two of the few physicians licensed for a new procedure for those who suffer from sciatica, pinched nerves and often undefined chronic back pain.
Adler and Epstein are the only such physicians in the state of New York who are able to perform this non-surgical procedure approved on a trial basis by the Federal Drug Administration.
This procedure, called myeloscopy, utilizes a super thin tube and needle inserted through a small needle into the epidural space to visualize the spinal canal. Because of its flexibility, the tube is able to offer a view of this densely complicated area not previously envisioned through traditional imaging tools. In addition, because many back pain patients undergo surgery in their quest to escape their pain, they subsequently suffer from adhesions or surgical scars, which often mimic the original discomfort. Such adhesions have been difficult to differentiate from recurrent or residual disk herniations.
Once the affected area is clearly seen, the tube facilitates the direct and precise injection of a relatively small dose of steroids. In addition, the pressurized volume of fluid and steroid applied at the precise problem site is able to open the adhesions caused by previous surgeries and can offer immediate relief from pain in many patients, said a hospital spokesperson.
Adler and Epstein, who have performed four such procedures to date on mail and female patients ranging from 32 to 55 years of age, believe that of the tools used to manage pain, the myeloscopy procedure is the most dramatic. "Previously, pain management physicians were able to mask chronic back pain with medication or implants, but the myeloscopy has the potential to permanently remove the pain. For patients who have had to cease even the most basic activities and have been literally driven to contemplate suicide because of their physical agony, this may be a revolution in the treatment of the chronic back patient," the doctors stated.
Ronit Adler, M.D. Managing the Myths and Milestones of Pain by Melissa Sands (reprint of a news article - November 1997)
The fear of pain-enduring acute and long suffering pain, according to experts, eclipse our fear of dying itself. Yet as a society, oddly enough, we have a love/hate relationship with pain. "One of the biggest myths is our no-pain-no-gain mentality which gives affirmation to suffering," according to Ronit Adler, M.D. , an anesthesiologist and pain management specialist at Good Samaritan Hospital Medical Center, West Islip.
"Our [culture's] belief that pain is necessary and that it qualifies us for some positive result is pure fallacy." Dr. Adler insists, "Pain relief is an important part of health care." Here's why:
Chronic pain - defined as pain lasting longer than three months and continuing long after the original injury occurs despite the healing process and only exacerbates patient's illness or injury. It induces feelings of anger, hopelessness, sadness, and despair altering one's personality. Sleep is interrupted. Everyday stress becomes magnified.
The emotional toll of pain is well known. Less widely known or acknowledged are the actual physical ramifications. Failure to relieve pain adequately has been shown to interfere with the effectiveness of treatment, for example, in cancer patients. When the ability to eat and sleep is interrupted with, because of persistent pain, treatment is under minded by the will to live, an elusive and powerful factor to surviving and healing.
Adler is dedicated to educating patients, their families, and the medical community as well about the myths and the medical milestones in treating pain.
Ronit Adler's medical vocation surfaced at an early age. "As a child I knew I wanted to go into medicine," she recalls. "When I saw suffering I wanted to help, call it a rescue complex if you will. Even back then I felt had I been a doctor I could've possibly changed the outcomes for sick people."
Ronit came to the United States at age six and grew up in Queens. She began her medical education in Mexico and spent her third and fourth years of study at Yale-affiliated hospitals. After completing her residency in anaesthesiology at Downstate Medical Center, Adler was chosen for a specialty training fellowship year in the emerging science of pain management.
In 1991 Adler became director of Pain Management at the Brooklyn Veteran's Administration Hospital and also Consulting Physician-Director at St. Albans Extended Care Center in Queens. Shortly thereafter she took up her present post at Good Samaritan Hospital in West Islip.
It was during her residency years, working at Kings Country Hospital in Brooklyn from 1987 to 1991 that Dr. Adler found her niche. As she explains,
"The problem I had with anesthesia was that it lacked the human touch. I was dealing with a patient only during a set surgical procedure; then the patient was out of my care. The lack of continuity was distressing to me. I never received a sense of satisfaction from seeing a patient improve.
Treating pain was altogether a different experience. For example, doing an epidermal for a woman during labor enabled me to see the results of my actions. to see the woman alert and aware to experience giving birth was very appealing to me. And the gratification was immediate which is rare in a physician's world of delayed ratification."
Pain management is relevant in birth, death, and all the debilitating crises in between. A relatively new science, Dr. Adler notes,
"People have been dabbling in pain treatment for some twenty years. The increasing numbers of physicians has certainly influenced the revolutionary sensitivity to patient's suffering. Gone are the days when we have to grin-and-bear-it."
Dr. Adler is on the cutting edge of diagnosing pain, on the forefront in fighting old myths. For example, she explains,
"Another huge myth - this one ascribed to by countless physicians themselves - is that patients lie about their pain. If a patient is smiling and has stable vital signs and reports an excruciating degree of discomfort, in the past doctors would dismiss the patient's complaints.
Now we use a scale of 1 to 10 and believe that no one is better able to make the pain assessment than the one feeling the pain. We make a thorough pain history, documenting from the patient's own words the location, duration, and impact of the pain on his or her mood and how daily life is affected."
According to Director Adler, ignorance remains the biggest obstacle in recognizing and alleviating chronic pain.
"The fear of addiction to narcotics prevents many cancer patients, injury victims of back and neck pain and their families from opting for relief," Dr. Adler admits. "Addiction is a myth. There are many stages of medication which can successfully mitigate pain. Narcotics can be administered and tapered without addictive repercussions."
Dr. Adler went on to inform us about the latest treatments:
"The narcotic infusion system is a motorized pump which is inserted to deliver medication to the proper place. It enables treatment with 300 times less medication than what would be needed to be taken by mouth."
"Another remedy to intractable pain is the spinal cord stimulator. Useful in multiple surgery and failed back syndrome patients. This device, an electrical stimulator, counters the sensation of pain with a pleasant pulsation."
There are some times when pain is misdiagnosed, Dr. Adler points out an example. Migraine often a throwaway term afflicting huge numbers. It can be from a whiplash or long term typing on computers. Since the cause of the migraine doesn't show up on X-rays, it's difficult to diagnose. the mega-headache can be due to increased calcium which produce nodules - like the pearl and oyster story. A muscular skeleton exam in which the problem is felt by the physician is often the beginning to identifying and treating headache pain.
Pain management requires working together. Specially trained surgeons and nurses and the expertise of professionals in physical therapy, occupational therapy, home health care services and social workers - all contribute to the mix. At the heart of this new science is the patient and their family, equal partners in the process."
Ronit Adler currently lives in West Islip with her husband, a neurosurgeon of, 7 years, and their two children, an eighteen month old daughter and a four year old son.
She is one physician making a difference because of her passion for pain.
RSD Syndrome (reprint of a news article - Suffolk Life - March 1997)
Reflex Sympathetic Dystrophy Syndrome is not a rare disorder and may affect millions of people in this country. The diagnosis is often not made early and some of the very mild cases may resolve with no treatment and others may progress through the stages and become chronic and often, debilitating. The disease, often follows a fall or sprain and is marked by a swelling and "hot" feeling in a hand, foot, arm or leg. RSDS does spread in 70% of patients. The usual pattern of spread is up the same extremity and then may continue to spread on the same side of the body or to the opposite extremity. In stage 3 some patients may have RSDS spread throughout the whole body. Many patients who are not treated early will experience spread of the disease and this may become a lifelong problem. Even with early treatment this may become a chronic condition, according to Dr. Ronit Adler MD and partner Jeffrey Epstein MD.
Casting and immobilization can cause a worsening of RSDS symptoms. In some cases it may be necessary, but great care should be taken. There are many other forms of treatment for RSDS, Adler stated. Treatment may include medication, blocks, physical therapy, psychological support and possibly, sympathectomy dorsal column stimulator or morphine pump. The physician directing the care of the patient should have a treatment plan. In severe or long term cases a pain clinic with a coordinated plan may be helpful. RSDS is a complex condition with varying degrees of severity and disability. Patients should be cared for by a physician who knows how to treat RSDS. Often, a team approach (physician, physical therapist, anaesthesiologist, psychologist and social worker) is most helpful.
The future of RSDS is very hopeful. There is research going on in a number of institutions in this country and around the world. Research involving the basic processes that cause RSDS as well as finding effective treatment are ongoing. Groups of physicians and scientists are meeting to reach an understanding of what RSDS is and what causes it. It is hoped that all physicians will recognize and diagnose RSDS in the early stages so that the patient will be treated promptly and appropriately. If the physician is not familiar with the treatment of RSDS , he or she should refer the patient to a physician or center that treats RSDS as quickly as possible.
Cancer
One ofthe most common complaints of cancer patients is pain from the disease. Pain can be caused by the disease itself, chemotherapy, or radiation therapy, or from the spread of the disease to other tissues such as bone, nerves, or internal organs.
The core of cancer pain management consists primarily of the use of narcotics. Antidepressants, sedatives, anti-inflammatory drugs, and patches which deliver pain medicine continuously are also available to help the narcotic work better. Nerve block procedures can be performed which can often permanently relieve the pain caused by cancer.
Newer pain management techniques are also available through the center. Especially useful are narcotics used around the spinal cord. The use of these peri-spinal narcotics helps control the pain with minimal side effects.
Post Radiofrequency Instructions
Today you had a Radiofrequency (RF) treatment to the nerves that supply the painful facet joints in your lower back. This RF treatment is also called a "neurotomy." Local heat was used to destroy specific (medical branch) nerves that allow you to feel or sense pain coming from these injured or diseased spinal joints. We hope that the neurotomy, by damaging these nerves, will prevent the pain signal from traveling to your spinal cord and subsequently to your brain.
On the day of the injection, you will go home 30-60 minutes after the procedure. You should not drive and should limit your activity for the next 2 days which includes not working. Your back may be very sore during the next 2 to 4 days, usually from muscle spasms and irritability while the medical branch nerves are dying from the heat lesion over the next 3 - 10 days. Take the medication that your physician has recommended. Pain relief can often be experienced around 2 to 3 weeks after the procedures when the nerves have completely died. When your pain imporves, start your regular exercise/activities in moderation. Your back may feel weak or tired for several weeks after the procedure and this is normal.
You may resume your regular medications after the procedure, including aspirin, Motrin, Naprosyn, Feldene, Indocin, Advil, Clinoril, DayPro, Relafin or other non-steroidal anti-inflammatory drugs (NSAIDS) that your doctor may have had you taking. You can take extra strength Tylenol every 4 - 6 hours as needed, and if something stronger is needed, your physician will prescribe a medicine for you.
Your doctor may ask you to come to the office 2 - 3 weeks following the procedure for a 5 minute test (electromyogram or EMG) which checks the technical success of the procedure by looking for nerve damage in specific muscles in your back.
Over the next 9 - 12 months, the nerves will grow back (regenerate). The pain may or may not recur in this time period. If the pain does recur, your physician will discuss with you whether a repeat procedure would lead to equal or more prolonged relief.
Clinical Services
Comprehensive Pain Care of Long Island treats all types of acute and chronic pain syndromes. Some common pain syndromes include back and neck pain, headache, shingles, leg and arm pain, pain related to cancer, work related injuries, arthritis, and reflex sympathetic dystrophy.
Psychological, biofeedback, and other non-invasive techniques are readily available to help provide comprehensive pain diagnosis and treatment. All medical and surgical specialities are available on a consultation basis.
Comprehensive Pain Care of Long Island is located in West Islip and utilizes its offices for in-patient treatments. Services are covered by most insurances and insurance pre-certification is obtained as needed.
If you have any pain disorder or have any pain related questions, please call us at (631) 661-0400. Physician referral information may also be obtained.
Back and Neck
Back and neck pain are tow of the nation's leading debilitating conditions. It will affect 80% of the population within their lifetime.
What are Some Treatments?
There are many ways to treat back and neck pain, some of which include bed rest, oral medication, trigger point injections, epidural injections, spinal cord stimulation, physical therapy, and surgery. The treatment prescribed however, is based on the cause of the pain.
In 60 - 80% of cases of acute disc herniation, epidural steroid injections have been shown to be as effective as 30 days of bed rest but can get the patient active in 10 - 15 minutes.
What is Spinal Cord Stimulation?
Spinal cord stimulation (SCS) is a new and sophisticated treatment. SCS is the application of low voltage electrical stimulation to the nerve fibers in the spinal cord. This stimulation interferes with the transmission of a pain signal to the brain. After an initial period of adjustment to the stimulation, the patient may be able to have a more active lifestyle because pain and the need for pain medicine are reduced or eliminated.
Shingles
Shingles, known by physicians as herpes zoster, is an extremely painful condition affecting mainly middle aged and elderly people or people who have problems with their immune systems. It is caused by a reactivation of the chicken pox virus which lives in the nerves along the spinal cord.
What are the Symptoms?
Shingles usually start with itching, tingling, or severe burning pain along the course of a nerve in the body. Several days to a week later, blisters or scabs appear along the course of that nerve. Shingles most commonly occurs on the face, chest or abdomen.
What Can Be Done for the Pain?
Treatment works best within one month of the outbreak. Sympathetic nerve blocks are the best way to control the pain while decreasing the chance of continuing pain after the sores heal.
Oral antiviral medications also may speed the healing process but, unfortunately, are not effective for acute shingle pain. Both treatments are most effective when used in combination.