Premier Pain Talk

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/
https://premierpaintreatment.com/locations/
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

Treatment for a Herniated Disc -EP 20

Treatment for a Herniated Disc
In the spirit of the football season kicking off, today on the episode Dr. Danko discusses one of the most common injuries to the low back, which is a lumbar disc herniation. What exactly is it? How does it happen? What are the treatment options? Tune in for all of the details.
 
Episode Highlights:
What is a lumbar disc? Dr. Danko explains what they are and their structure.
With a herniated disc, it will bulge and the gelatinous material will push on the outer wall and cause pain, numbness, tingling, weakness, bowel and bladder problems.
Dr. Danko talks about the scenarios and which symptoms are an emergency to make sure there isn't going to be permanent nerve damage.
What is an extrusion?
Most commonly the pain in the back is going to go away through rest, ice or heat, and anti-inflammatory medications unless it is a more significant herniation.
What about physical therapy?
One of the earlier episodes on the podcast, Dr. Danlo talks with his physical therapist friend, Dr. Burchett, check out Episode 6, “How Physical Therapy Can Help With Chronic Pain, With Dr. Drew Burchett”
If physical therapy is not effective, the next step is generally an MRI scan.
What is an MRI? How does it work and what does it tell your healthcare provider?
Dr. Danko explains when a CAT scan may be used and the difference between a CAT scan and an MRI.
If you’re continuing to have pain you may be referred to a pain management specialist for an epidural steroid injection. 
An epidural steroid injection is much different than an epidural a female may have when having a baby. Dr. Danko explains what it is and how it works.
An epidural injection for low back pain is done in an outpatient facility.
What if you don’t get relief from an epidural steroid injection? What is a good response to it?
Dr. Danko explains an alternative that is a more durable solution if the other injections do not work.
When would you be referred to a neurosurgeon for a more in depth procedure?
What about spinal cord stimulation? It has a trial procedure as well that does not require surgery.
There are several steps starting with the more  conservative options and working towards more definitive solutions like the surgical options. If a surgery can’t fix the problem permanently,  there is a great option called a spinal cord stimulator.
Visit  https://premierpaintreatment.com/ for more information.
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246

Are You A Candidate For A Pain Pump? With Dr. Chris Beuer- EP 19

On this episode,  we re-visit Dr. Danko's discussion with his friend Dr. Chris Beuer from St. Louis, Missouri.
He feels fortunate to have found the feel of pain management and have the ability to actually make a difference in people’s lives. They discuss Pain Pump Therapy, what it is, and why it is used. These two doctors are passionate about improving quality of life for their patients. Tune in!
 
Episode Highlights:
Dr. Beuer introduces himself, shares about his practice in St. Louis, and what brought him to his current job position. 
What is pain pump therapy and why is it used?
Pain pumps have a reputation of being hard to manage but a lot has changed over the years. Dr. Beuer explains.
Dr. Danko has found that the earlier you can offer the Pain Pump Implant Therapy, the better in the chronic pain world. It doesn’t mean it is the first thing you jump to but it is also not something you need to wait to use as a ‘salvage therapy’.
What conditions are best for the pump? What are the steps to determine if it's right for the situation? Dr. Danko asks Dr. Beuer to talk about when it is indicated for patients.
There is an ability to test the pain pump as well to see if it is worth it to the patient to try.
How do pain pumps help people come off other pain medications?
There is concern that a pump is limiting. Life using it is very simple. The medicine is refilled about every three months or so which takes a couple minutes to do. It is also important to note that it is on very low doses because it is very effective when
Dr. Danko brings up that they both have been involved in a lot of Clinical Research and there is also a lot of great data already out on pump therapy.
What about cancer pain? What are typical situations that are seen in pain management practice?
Pain pumps can also be used for spasticity issues. Cerebral palsy, spinal cord injuries, or strokes are common scenarios with these spasticity issues. 
Dr. Beuer shares how he got into triathlons and Iron Man competitions. Originally people told him there was no way he could do it in six months and he took it as a challenge. He has completed 16 Iron Mans and shares experience about brutal weather.
Patient education on the body’s ability to adapt is important too for understanding a plan of building strength. 
Dr. Danko asks Dr. Beuer to share about his experience being involved with Team USA in triathlons.
3 Key Points:
Premier Pain Talk is shedding light on the misconceptions about pain management. The field is not correctly portrayed in the media. It is not just about handing out pills. There are many interventional procedures, including pain pumps.
How do pain pumps help people who have been on long term pain medications to no success?
The body has an incredible ability to adapt. Patient education around the topic is so important in showing them that they can overcome limitations, too.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://www.facebook.com/PremierPainTreatment/
https://www.christianhospital.org/painfree

What To Expect As A New Patient At Premier Pain Treatment Institute- EP 18

What To Expect As A New Patient At Premier Pain Treatment Institute
This is a special bonus episode with Dr. Michael Danko; He shares what to expect when you come to the Pain Management Clinic when you come in for your new patient appointment. Tune in now.
Episode Highlights:
The first thing is getting a referral from your referring provider. The new patient scheduler calls to get you scheduled once that is received.
Insurance verification happens prior to the first appointment and verify benefits.
There are three office locations: Loveland, OH, Mt. Orb, Ohio, and Hillsboro, OH.
Your first time in the clinic you are asked to come 30 minutes earlier to get everything ready, complete a new patient packet and turn in any imaging or previous records. 
If you are intending to have medication management, you will have to do a urine drug screening; If not, that may be bypassed.
Vital signs will be recorded and then the pain management provider will come in to discuss your concerns with you.
Your pain management provider will narrow down your symptoms and correlate with the physical exam findings.
Reviewing the images will help narrow down further where the pain is coming from.
If physical therapy is needed, they will get that initiated.
If you are at the point of surgery, they will recommend and refer that as well.
Most often there are a variety of options; The pain care providers are very thoughtful in constructing a full care plan.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246

Relieve Chronic Back Pain with Spinal Cord Stimulation- EP 17

On this episode of Premier Pain Talk, host Dr. Michael Danko talks with Dr. Michael Fishman. He is a fantastic pain physician out of the Greater Philadelphia area. They are discussing spinal cord stimulation and some of the new horizons coming with it as well as digital health and data capturing and potentially new options for pain therapy down the road. Tune in!
 
Episode Highlights:
Dr. Fishman went to medical school at Jefferson Medical College, and he developed an interest in anesthesia, ENT, and neck surgery. And at the end of the day, he ended up as a surgery resident at a program outside of Philadelphia.
During his time working with the anesthesiologist at the hospital, Dr. Fishman ultimately found that perhaps there is a better use of his interests to look after patients after surgery and around their surgeries. 
Dr. Fishman’s clinic is like a lab where we get the opportunity to think of new ways to help people and ways to get patients the right treatment at the right time.
One of the therapies that gets Dr. Danko super excited and makes it not feel like work sometimes, is something called a spinal cord stimulator. It is an implantable device and has been around for many years.
Spinal stimulation in Dr. Danko’s mind has gone through now maybe even more advancements than cell phone technology or other technology of any type.
What is ‘The Gate Control Theory On Chronic Pain’?
Tonic stimulation is something that people should be familiar with, and it's a buzzing electrical sensation or maybe tapping and pulsing. They talk about how it had previously been practiced.
Over the last few years, there has been a  fine tuning of  the electrical signals that are being passed in the spinal cord. 
If you talk to a bunch of different pain doctors or different people from industry, you are going to get a bunch of different answers for advancements with changes in the way the electricity is being delivered through devices.
There is a psychological and social component that is also important to understand when you think about why pain doctors do what they are doing; That is why when they do apply therapies like simulation, it's important to understand biologically why also.
For humans, isolation, depression, anxiety, status, etc all go in the same path with pain; But we can change the pain experience for the better or for the worse. 
 
3 Key Points:
One thing about Yale Haven hospital that everybody should know is it is smack dab in the middle at the junction of I-95 I-91, which means that it is a super busy hospital and gets most of the trauma in the state.
DTM therapy is fantastic and the science behind how to fine-tune that therapy is very durable. 
Getting patients the right treatment is the job of a pain doctor, but it’s also about the right timing being understood and the circumstances/ context for each person to make the best version of themselves that they can be, says Fishman.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://www.facebook.com/PremierPainTreatment/
https://www.christianhospital.org/painfree
https://celerihealth.com/

Premier Pain Talk-Facet Joint Fusion - Minimally Invasive Treatment After Failed Radiofrequency Ablation- EP 16

Facet Joint Fusion - Minimally Invasive Treatment After Failed Radiofrequency Ablation
Today on the podcast, Dr. Danko brings you the webinar talk from his practice of the July edition of PPTI Care Series. He is providing information on a posterolateral spine fusion or a facet joint fusion, which is a minimally invasive treatment option for low back pain. Tune in and get all the details.
 
Episode Highlights:
A posterolateral spine fusion is also called a facet joint fusion. It is a minimally invasive treatment for low back pain. 
Why is it called a fusion? That word is often tagged to a much more scary, arduous procedure. Dr. Danko discusses the hesitancies patients may have and the impact of preconceived notions.
When is this procedure appropriate for patients?
Who is a candidate for this procedure?
What options are available if you’re not a candidate for this procedure?
Dr. Danko explains the procedure and the technology that is used.
In treating low back pain, there are a variety of conditions that could benefit from the procedure; Dr. Danko lists and explains them.
What is adjacent segment disease?
Lumbar facet joints are small joints at each segment in the spine that progress all the way up to the thoracic and cervical spine as well. They are what allow you to bend and twist. 
Dr. Danko talks about the progression of treatment when you are experiencing pain in the joints.
How does radiofrequency ablation work and what if they are unsuccessful?
As you get older almost everyone has degenerative disc disease. What are the categories of symptoms and conservative treatments?
What do the doctors look for when they evaluate imaging?
Dr. Danko explains how patients can go home the same day that the procedure occurs.
Bone graft material bridges from the transverse process of the segment retreeding to the segment above.
Contrast dye is also used in the bone graft. 
How does this procedure compare to a 360 fusion?
Dr. Danko explains how they work with adjacent segment issues.
The procedure can be done at more than one level. Depending on the setting, both levels may be addressed at the same time. 
 Talk with your provider about your tailored needs, what you may be a candidate for, and what referrals you may need.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246