Premier Pain Talk

Neuromodulation and Advanced Pain Procedures

In this episode of Premier Pain Talk, we dive into the world of neuromodulation and advanced pain procedures that are changing the game in pain management. Dr. Danko breaks down spinal cord stimulators, peripheral nerve stimulators, and intrathecal pain pumps—explaining how these cutting-edge therapies help patients regain control over their pain. We also explore minimally invasive procedures like the MILD procedure and the Vertaflex procedure, along with other innovative techniques designed to provide long-term relief.
Whether you're a patient seeking options or a provider looking to stay informed, this episode is packed with valuable insights on the latest advancements in pain treatment. Tune in to learn how these technologies are transforming lives!

Pain Management 101 - The Most Common Pain Procedures

In this episode of Premier Pain Talk, Dr. Michael Danko breaks down the seven most common pain management procedures, including epidural steroid injections, medial branch blocks, radiofrequency ablations, SI joint injections, small and large joint injections, and trigger point injections.
Whether you're a new or experienced provider looking to refine your knowledge or a pain patient wanting to better understand your treatment options, this episode offers valuable insights into how these procedures work and who they can help. Tune in for a clear and practical guide to the most frequently performed interventions in pain management!
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Behind the White Coat: Insights from a New Provider in Pain Management

In this episode of Premier Pain Talk, host Dr. Michael Danko is joined by April Egbert, DNP, APRN, and special guest Lindsay Link, PA-C, a newer provider in the field of pain management. Together, they pull back the curtain on what it’s really like stepping into this specialty — from the challenges of treating complex pain conditions to the rewarding moments of helping patients regain their quality of life. Whether you're a healthcare professional or someone curious about the behind-the-scenes of pain care, this episode offers a candid look at the journey of a new provider and the dedication it takes to make a difference.
 
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Misperceptions of Pain Management

In this eye-opening episode of Premier Pain Talk, Dr. Michael Danko sits down with special guests April Egbert, DNP, APRN, and Lindsay Link, PA-C, to tackle the many misperceptions surrounding pain management. They dive into the myths patients often believe, the realities of modern pain care, and even share what surprised them about the specialty before becoming providers in the field themselves. If you’ve ever wondered what pain management truly involves — and what it doesn’t — this candid conversation is a must-listen. Tune in for expert insights, thoughtful discussions, and a fresh perspective on an often-misunderstood field.
 
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Intrathecal Pain Pumps with Dr. Michael Danko and April Egbert, DNP, APRN

It's the return of Premier Pain Talk!
Dr. Michael Danko is joined by April Egbert, DNP, APRN to discuss how patients are selected who may be good candidates for Intrathecal Pain Pumps, how patients are prepared for their pain pump trial period, expectations of insurance companies, and what to expect in the months that follow a patient's pump implant.
Premier Pain Treatment Institute is a pain management clinic with locations in Hillsboro, Loveland, Middletown, and Mount Orab, Ohio. Visit us online for more information! 
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Treatment For Sacroiliac (SI) Joint Pain- EP 26

Treatment For Sacroiliac (SI) Joint Pain
Today on the podcast, host, Dr. Michael Danko talks about one of the most common causes of low back pain. Tune in to learn about the characteristics of sacroiliac (SI) joint pain and the different treatments that are available.
Episode Highlights:
The sacroiliac (SI) joint is a common contributor to low back pain. 
The SI joint is primarily designed for stability; It is a shock absorber for the forces that are transmitted from the spine into the extremities. It has a joint capsule and ligament structure around it.The joint is pretty complex where it is part of the kinetic chain that connects the spine with lower extremities.
Dr. Danko explains what primary and secondary pain generator means.
How do you experience problems with the SI joint? What are the main causes?
Dr. Danko talks about the mechanics of the joint and how arthritis, trauma, and pregnancy are a few contributors.
What other things can lead to SI pain?
How does SI joint present?
If you have a burning quality sensation or numbness and tingling that is most often a sign of nerve root compression or pinched nerve.
There are different diagnostic maneuvers they can do in the eam room to determine if the SI joint is the cause of the pain.
What medications are used to treat SI joint pain?
Physical therapy can be helpful for the condition but if medication and physical therapy do not work, they can do injections to the joint.
How do you know if you need to move on to longer term solutions?
Dr. Danko explains what a posterior SI joint fusion is and how it works.
What about radio frequency ablation?
 
Resources:
https://premierpaintreatment.com/
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https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246

Restorative Treatment For Mechanical Low Back Pain- EP 25

Restorative Treatment For Mechanical Low Back Pain
Dr. Danko and his partner at the practice, Dr. Tim Feldheim hosted a webinar about an exciting new therapy called, ‘restorative neurostimulation’. Many people experience low back pain at some point throughout their life and for varying reasons and this therapy is  targeted at low back pain.Tune in to learn more.
Episode Highlights:
There is an exciting new therapy called restorative neurostimulation; The implantable device that provides the therapy is called reactivate.
Dr. Feldheim talks about how this therapy is targeted at low back pain and overviews back pain in general. 
Why might you have a need for low back surgery?
What is stenosis and what does it cause?
Mechanical low back pain constitutes ⅔ of patients with low back pain; Dr. Feldheim explains what processes occur to create pain.
Overload leads to pain and then our body responds with inhibition which happens when our muscles want to fire but they cannot. There is a continued and repetitive worsening cycle of overload, pain, inhibition.
The saying, “If you don’t use it, you lose it, is true of the multifidus muscle as well”, says Dr. Feldheim.
Can fat integrate into muscle?
Dr. Feldheim talks about the current treatments for multifidus dysfunction. 
Have you heard of dry needling?
What is restorative neurostimulation?
With this new treatment, the focus is actually on the source of the pain and reversing that for people with mechanical low back pain. It is FDA approved. 
There are many things that set this therapy a part especially in its ability to reactivate muscle control, restore thfunction spine stability that a lot of the other therapies are not targeted at, and overall reduce pain.
Dr. Danko talks about how this is a novel therapy and how it differs from other kinds of stimulation devices.
This is a great long term therapy; There is already three year data out to show its effectiveness.
Dr. Danko says they have been  doing this implant for about 9 months at Premier Pain Institute. He gives the details about the device itself and how it works.
A significant reduction in pain medication was reflected with the research studies done on the longevity of this treatment.
What does the continued improvement look like over the long term?
This is a reversible therapy that can be removed. 
If you can reverse the cascade from the initial injury and restore your core stability and strength, and you don’t have an active energy, you could restore and heal yourself with the device and not have to use it long term.
What about routine use?
Dr. Danko talks about the indexes they use to gauge function and pain levels.
The data supports this to be a safe device with a low risk of complications.
What is the typical schedule with the reactive device with utilization of it?
What is the difference between this and a TENS unit and why is this a better therapy?
It is a minimally invasive surgery. Dr Danko talks about what to expect and the steady improvement.
Representatives help you get set up and continue to maintain and adjust the device.
There is broad established insurance coverage for this treatment as well.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246

Dr. Matt Wiederholz Explains The Difference Between Peripheral Nerve Stimulation And Spinal Stimulation- EP 24

On today’s episode, Dr. Danko talks with Dr. Matthias Wiederholz; He is the founder and visionary behind Performance Pain & Sports Medicine, also known as Performance. Performance is a boutique medical practice with a focus on the treatment of acute and chronic pain. Dr. Danko and Dr. Wiederholz have worked together on targeted drug delivery and today they are going to discuss a new therapy called peripheral nerve stimulation of which Dr. Wiederholz is one of the leading experts in the country. 
Episode Highlights:
Dr. Wiederholz shares how he started medical school in New Jersey and then did his residency training in physical medicine rehabilitation in Houston, TX where he met his wife.
What is peripheral nerve stimulation?
This podcast raises awareness about therapy so that patients can understand the options and not lump them all together. 
Dr. Danko explains how he doesn’t want a patient to disregard a peripheral nerve stimulator because they think it is a spinal cord stimulator or stay stuck with opinions that they may have acquired due to a relatives experience years ago because much has changed.
Dr. Wiederholz explains peripheral nerve stimulation, the core principles, and how it differs from spinal cord stimulation.
There is a lot of emphasis on targeting nerves but it is also a therapy that can be used not just for neuropathic but also mechanical pain with joints and other varieties.
Dr. Danko asks Dr. Wiederholz to share some of the most common sources of pain that he treats with peripheral nerve stimulation.
What about comorbidities or delaying joint replacement?
Dr. Wiederholz shares a story about a patient of his and how the gel injections and steroid injections were not lasting; They targeted the nerves around her knee and had great success.
Where does peripheral nerve stimulation fit in the progression of therapy?
What about the trial phase for trying it out first?
Can it help arthritis?
What will patients feel and not feel when their nerves are being stimulated?
If someone does some online searching of peripheral nerve stimulation they may see reference to it being a wearable technology. Dr. Danko asks Dr. Wiederholz to talk about it and what it looks like for the daily life of a patient. 
What is it like to have practices in two different states? For Dr. Wiederholz, he is in Houston, TX and Lawrenceville, NJ. 
Dr. Wiederholz shares some personal life details about living in two different states and how he balances it.
3 Key Points:
When you think of the nervous system there are two main parts: 1) The Central Nervous System which is your brain and spinal cord and then 2) The Peripheral Nervous System which is all the other nerves in your body. There are a huge number of targets for peripheral nerve stimulation.
Peripheral nerve stimulation uses electrical impulses to stimulate nerves and block pain signals. The technology does have similarity to spinal cord stimulation however, there are important differences and with peripheral nerve stimulation it is a very targeted approach.
Peripheral nerve stimulation has a wide variety of applications for patients not just neuropathic but also including mechanical pain in the joints. 
 
Resources Mentioned:
https://premierpaintreatment.com/
https://www.facebook.com/PremierPainTreatment/
https://www.performancepain.com/provider/matthias-wiederholz-md

What Are The Minimally Invasive Spinal Fusion Treatments? -EP 23

This week's episode is brought to you by a webinar that Dr. Michael Danko hosted with his practice, Premier Pain Institute. Two treatments are discussed are the zip procedure, also called posterior spine fusion and  Silo, a sacroiliac joint fusion. Dr. Danko explains how both of the treatments are used in his practice and have great outcomes. Tune in for all of the details. 
 
Episode Highlights:
Dr. Danko discusses the minimally invasive spine technology from Aurora Spine and Pain, specifically the zip and silo products. 
Dr. Danko and Dr. Feldheim are with Premier Pain Institute located in Cincinnati, Ohio. They have offices in Loveland, Ohio, Mt. Orb, Ohio and Hillsboro, Ohio.
When are you a candidate for posterior spine fusion?
Spinal stenosis is a reduced space around the nerves in the spinal canal; With this condition, patients typically have difficulty with standing and walking that amplifies their back and leg pain. Patients may also experience weakness and numbness.
Degenerative disc disease is the condition where the discs in the vertebrae start to lose their cushioning over time and those discs can become painful. 
During the process of degenerative disc disease, a condition called spondylolisthesis can occur where the bony structure starts to slip and is not aligned properly.
Nearly all humans will experience degenerative discs at some point in their lives; 90% of people are affected by age 50. Dr. Danko reviews the symptoms you may experience with it.
What is the treatment for degenerative disc disease? The first step is usually physical therapy and the modalities they have to offer. Dr. Danko explains the indication to progress to imaging, injections, and beyond.
What is the zip procedure? It is the alternative to the pedicle screw fixation procedure. Dr. Danko explains the implant and how it works.
What is the recovery process for the zip procedure?
What is Silo? When do patients need it?
Fusion sounds like a scary procedure but Dr. Danko explains how it is a safe, straightforward, outpatient procedure.
If you believe that you are a candidate for any of these procedures, your first step is to discuss your situation with a provider at the office. 
3 Key Points:
Many patients that have ongoing back pain are sent for imaging to help detect what exactly is the problem. At Premier Pain they are often having  imaging performed to detect conditions like spinal stenosis, disc herniation, degeneration of the disc or vertebrae, and spondylolisthesis. The doctors use the images to piece together along with the patient symptoms to know where the target of exactly what they need to treat.
Dr. Danko explains the process of outpatient zip procedure and how it works as well as what the recovery process looks like.
The sacroiliac joint fusion performed with SILO is a safe and effective treatment. Dr. Danko explains how patients may end up being in need for the procedure. There is a progression in the conservative treatment plan including external supportive devices, anti-inflammatory medications, and injections before moving on to more durable solutions or permanent fixes.
Resources Mentioned:
https://premierpaintreatment.com/
https://www.facebook.com/PremierPainTreatment/
Premier Pain Institute Phone #: 513-454-7246

Targeted Drug Delivery For Chronic Pain- EP 21

Targeted Drug Delivery For Chronic Pain
On today’s episode of Premier Pain Talk, is a topic near and dear to Dr. Danko’s heart- targeted drug delivery also called a pain pump. It is an underutilized therapy but can be done very well and be very effective. This is an option that offers hope when other treatment options are not working or will not work. Dr. Feldheim, Dr. Danko’s partner at Premier Pain Institute joins the podcast as well today.  Tune in for the details.
 
Episode Highlights:
Dr. Danko talks about how he was lucky to incorporate targeted drug delivery early on in his career and how it has become a staple therapy option that he offers; He has a lot of great patient success stories with it.
The therapy is delivering medication directly to the spinal fluid and targeting the pain receptors far more effectively than oral medication or transdermal patch.
When basic procedures are not successfully relieving the pain, when there isn't a surgery that is going to fully correct the pain, looking at therapies like targeted drug delivery and spinal cord stimulation offers hope without just continuing on an oral medication regimen.
Dr. Feldheim defines chronic pain.
Dr. Danko and Dr. Feldheim discuss some of the painful conditions that may qualify you for treatment with a pain pump.
Chronic back and leg pain is one of the most common that they treat.
What is complex regional pain syndrome (CRPS) ?
There is a wide range of treatment options for chronic pain; Dr. Feldheim reviews them.
What is neuromodulation?
What happens when you take an oral medication? How does it differ with targeted drug delivery?
How does the pump work? Dr. Feldheim explains. The right amount of medication goes to that precise spot and helps treat the pain. People experience fewer side effects and more success in getting to where the pain is being transmitted.
Dr. Danko talks about the trial you can do prior to see if your body will be responsive to this treatment type.
A psychological evaluation is required to go through with the trial.
In regards to the trial, Dr. Danko talks about how it is a much more patient friendly way to determine what is best for you. 
What does recovery and follow up look like?
What is the goal long term?
There are multiple ways to manage the pump once it has been implanted. 
It is important to remember that this therapy is meant to treat chronic pain. This can include cancer pain. 
Oral pain medication is something your body becomes dependent upon. Dr. Danko explains why it needs to be out of your system when you get a pain pump.
How do you break free of dependence on medication?
There are ways that you can activate doses of medication from your phone that are set by the provider.
Dr. Danko reviews the risks.
The change of quality of life can be profound through this therapy. Patients in the practice are willing to share their story and can connect to new clients who may be considering going through with it.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246