Premier Pain Talk

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

Advancements in Digital Health For Neuromodulation With Dr. Allen Burton- EP 15

Advancements in Digital Health For Neuromodulation With Dr. Allen Burton
On today’s episode, Dr. Danko has a special guest that he really admires, Dr. Allen Burton; He is the chief medical officer with Abbott. Dr. Danko and Dr. Burton have a discussion to share about some of the digital advances that are coming along in therapy called spinal cord stimulation and dorsal root ganglion stimulation.
 
Episode Highlights:
Dr. Burton started his career as an anesthesiologist and specialized in pain management and was certified in Interventional Pain Management. He practiced for 20 years in an academic and private setting. He also shares how he has been a part of clinical research.
Dr. Burton shares what it meant to him to be a part of clinical trials at MD Anderson.
For both the clinical trials of DRG (dorsal root ganglion) stimulation and burst DR stimulation, Dr. Burton was one of the clinical investigative sites in their approval for the FDA.
What is spinal cord stimulation?
What is dorsal root ganglion stimulation?
A unique attribute of this therapy is that the patient gets to try it with the trial period; It is unique among medical therapies.
How do patients navigate with their physician whether or not to go through with it?
Dr. Danko talks about how he evaluates the results of the trial period with the patient.
Many patients in the clinic are scared and sometimes have had surgeries and repeated surgeries. Dr. Burton talks about the intricacies and how he helps them see the difference of this procedure.
What is Abbott’s neuromodulation business about? Dr. Burton explains the neurosphere program and how it moves them forward.
It is important for the patient to understand the benefits as well as their family and insurance company understand the benefits. Dr. Burton explains the app, My Path that they created that includes educational modules as well as a recording log.
Dr. Burton reviews the questionnaires that the patient will be walked through in the different time frames along the way so that a comprehensive understanding of how the trial is going can be achieved by all parties.
How is the insurance company convinced of the necessity of the procedure from the data on the trial?
What is ahead for research and the automated features of the My Path app? Dr. Burton explains the generation it is on now and what it looks like going forward as well as the benefits. 
Dr. Danko loves the multiple metrics that are provided in the snapshot report for doctors at the end of the trials. 
Dr. Danko and Dr. Burton talk about tracking patients long term and how it helps them fine tune their treatment and maintain their care.
What about virtual clinic? Dr. Danko talks about the struggle it was to transition to it during COVID. Dr. Burton discusses how they use it and the opportunities that it opens up.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246
https://www.abbott.com/

Non-Surgical Treatment For Discogenic Low Back Pain - EP 14

Non-Surgical Treatment For Discogenic Low Back Pain
On today’s episode of Premier Pain Talk, Dr. Danko presents a webinar on the novel treatment called intervertebral allograft injection for degenerative disk disease. Tune in for all of the information.
Episode Highlights:
Have you heard of VIA disc? It is a nonsurgical treatment for degenerative disc disease. It is fairly new to pain management. Dr. Danko has been able to provide this to his patients for over a year now. 
Dr. Danko explains his experience with the procedure. 
Low back pain is a very common issue, the single greatest cause of disability over the course of our lives.
Over the last 25 years, the prevalence of back pain has increased. Dr. Danko explains why and common factors.
Vertebral compression fractures can occur and cause really severe back pain and they get worse with forward flexion.
Where does disc herniation pain come from?
What are the degenerative changes?
What is degenerative disc disease and how does it occur? How is it accelerated?
Dr. Danko explains what a provider looks at and what kind of exams are done when identifying discogenic back pain.
Discogenic back pain is a constant central back pain that can occur in the legs as well and worse with leaning forward.
What is an MRI scan and what does it help identify?
Degeneration of the discs go from grade 1 (normal healthy disc to grade 8 (most deteriorated)
What treatments were determined to not be effective?
VIA disc has been a game changer. Why?
VIA disc NP is the first and only nucleus pulposus allograft to replace a patient’s tissue loss due to disc degeneration.
What is the VIA disc procedure like? Dr. Danko explains.
Muscle relaxants and back braces are common after the procedure.
Healing takes time. Dr. Danko has advice for not becoming discouraged but rather being patient waiting on the regeneration process.
 
 
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246

Basics of Epidural Steroid Injections - EP 13

Basics of Epidural Steroid Injections
Today on the podcast, Dr. Danko explains one of the most basic injections in pain management, the epidural steroid injection. What is it and what does it entail? What are the common conditions that are treated by epidural steroid injection? Tune in for all of the details.  
 
Episode Highlights:
An epidural steroid injection is an injection of steroid into a space in the spine called the epidural space. 
The spinal cord travels from the base of the skull into the low back and there are big nerves called nerve roots coming out of the spine and into the extremities which help control the major functions in your body.
A condition such as a herniated disc or spinal stenosis will cause compression of the nerves and create symptoms of pain, numbness, tingling, burning, etc.
What is a steroid and how is it helpful?
These injections can be done in an office setting, ambulatory surgery center, or a hospital setting depending on where the procedure is done and typically involves X-Ray guidance to help target the exact location.
Contrast dye is used to show the appropriate spread of the area where the doctors are wanting to inject the medication which is the epidural space.
Dr. Danko explains the several types of approaches to target the spine from different angles.
Common conditions that are treated with these injections are lumbar disc herniations and lumbar radiculopathy, and spinal stenosis.
Dr. Danko explains what typically happens prior to an injection.
How is it determined whether or not the injection was successful?
These injections can be repeated 3-4 times per year.
How does insurance work for these injections?
Are there reasons not to get these injections? Dr. Danko explains the contraindications.
There are other options if you are not a candidate for these injections. Dr. Danko explains the options that you may explore with the doctor.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246

Premier Pain Talk-Minimally Invasive Treatment For Spinal Stenosis - EP 12

Minimally Invasive Treatment For Spinal Stenosis
On today’s episode, Dr. Danko has a special guest, a friend of his, Dr. Anjum Bux from Kentucky. They are discussing the minimally invasive lumbar decompression treatment and pain pump therapy. Dr. Bux is one of the international experts on pain pumps and has been involved in a lot of the guidelines that have been developed with it. Tune in now.
Episode Highlights:
Dr. Anjum Bux introduces himself. He grew up in Kentucky south of Lexington and trained at the University of Kentucky where he did his anesthesia residency. 
Dr. Bux joined his father’s practice who is an anesthesiologist, pain physician. In the last 4 years, he moved to 100% pain management. They cover all of central Kentucky.
One of the most common conditions that both Dr. Danko and Dr. Bux treat is called spinal stenosis. A lot of people are familiar with herniated discs, pinched nerves or some of the more acute issues but spinal stenosis is a chronic condition and is something that develops more slowly over time.
Dr. Danko asks Dr. Bux to give an overview of spinal stenosis and what the symptoms are.
What is the shopping cart sign? 
If you have back pain while walking, talk to your doctor and get an MRI. Dr. Bux explains what they look for and how it helps them determine what is causing the pain.
What are some of the initial or basic treatments to treat stenosis? 
Dr. Bux talks about an example of one of his patients who did not get relief with injections.
Epidural injections for stenosis patients? What is the duration of relief like?
What does the MILD procedure stand for? 
Lumbar decompression clears out what is causing the stenosis, opening the space to relieve pressure on the nerves.
What if you’re not a candidate for surgery because of anesthesia? Dr. Bux explains how they go about it.
Dr. Danko and Dr. Bux discuss the safety of the procedure and how the risk for infection is very low.
What is the durability of the treatment? Dr. Bux talks about the research studies around it.
What are the restrictions after lumbar decompression treatment?
Dr. Bux talks about the benefits of a back brace.
What is the importance of physical therapy and what is its role for patients especially in these circumstances? 
Dr. Danko talks about the significance of a pain pump.
Dr. Bux is one of the international experts on pain pumps and has been involved in a lot of the guidelines that have been developed with it. He talks about what a pain pump is.
How does a pain pump actually cut down on the tolerance and physical dependence of medicine? They discuss the sustained durability.
Dr. Bux explains how he helps patients to wean off their pills and greatly improve quality of life.
 
 
3 Key Points:
Dr. Danko and Dr. Bux discusses the condition of spinal stenosis, how it develops and  how it presents with symptoms.
Lumbar decompression clears out what is causing the stenosis, opening the space to relieve pressure on the nerves.
The MILD procedure is backed by research that shows continued improvement for patients and can treat more than one level with the same procedure. 
 
Resources Mentioned:
https://www.buxpainmanagement.com/provider/anjum-bux-md
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246

Why Would You Need To See A Pain Management Specialist?- EP 11

Why Would You Need To See A Pain Management Specialist?
When might your surgeon or primary care doctor recommend a referral to pain management? What does it mean and how do you know if you’re ready? If you’re sent to pain management, it can be for a variety of reasons. Tune in to hear Dr. Danko break down an overall review for understanding treatment in pain management. 
 
Episode Highlights:
If your primary care doctor is referring you to pain management does that mean that they have run out of options in your care plan? Dr. Danko explains.
Opioids and injections are not all of what pain management does and those two treatments are not tied together.
Medication management is most commonly for continuation of a controlled substance or to consider starting a controlled substance, with the most common being an opioid.
Opioids in the right situations can be beneficial and help patients function better but also come with the need for closer monitoring.
Some Pain Management Practices are interventional procedures only and some practices are medication management only which is why it is important that you understand what kind of practice you are being referred to.
What about injections? 
Implantable devices are used to treat chronic pain, too. When are they used?
Dorsal ganglion stimulation is a specialized stimulation that is specific to individual nerves and focal areas in the body.
Have you heard of the new type of stimulation called restorative neurostimulation?  Dr. Danko explains how it can strengthen muscles and the trial options available.
There are several minimally invasive surgical procedures that Interventional Pain Management specialists can be qualified to perform; For example: minimally invasive lumbar decompression, indirect lumbar decompression, posterior SI joint fusion, posterior spine fusion, and facet joint fusion. These are all outpatient procedures that are shorter in duration and generally don’t need general anesthesia. They are done through small incisions not open joint procedures.
What does it mean that Pain Management is a subspecialty? How does board certification affect what may be offered? 
It is important to do your homework when you’re going to see a new provider to thoroughly understand their training and options they provide.
Interventional Pain Management is not a scary thing like you may read about in books or see in movies. They are medical specialists just like other doctors who are working to help patients improve quality of life.
3 Key Points:
When a patient gets referred to pain management there can be a lot of unknowns. Dr. Danko sheds light on why a patient may be referred and a better understanding of what treatment in pain management looks like.
Not all Pain Management Specialists are the same; Some Pain Management Practices are interventional procedures only and some practices are medication management only which is why it is important that you understand what kind of practice you are being referred to.
There are several minimally invasive surgical procedures that Interventional Pain Management specialists can be qualified to perform. Having discussions with providers will help you realize that nothing is going to be forced and they are there to help you sort through the options available to improve your quality of life.
 
 
 
Resources:
https://premierpaintreatment.com/
https://premierpaintreatment.com/locations/
https://www.facebook.com/PremierPainTreatment/
Call the office at 513-454-7246