Premier Pain Talk

What Is The Difference Between Peripheral Nerve Stimulation And Spinal Stimulation, With Dr. Matt Wiederholz?- Ep 5

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
 

How Peripheral Nerve Stimulation Controls Chronic Pain, With Dr Tim Feldheim- Ep 4

How Peripheral Nerve Stimulation Controls Chronic Pain, With Dr Tim Feldheim
On today’s episode, Dr. Danko and Dr. Feldheim discuss the rapidly growing and emerging therapy in chronic pain, peripheral nerve stimulation. Dr. Felheim completed his training at The University of Florida and a fellowship at Case Western University. At The Premier Pain Institute they have had positive experiences with peripheral nerve stimulation that they are sharing with the listeners. Tune in for the details!
 
Episode Highlights:
Dr. Feldheim explains who peripheral nerve stimulation is good for. They most commonly see peripheral neuropathy characterized by inflammation of the nerves in the lower extremities but can affect the upper; it is usually accompanied by intense burning, numbness, tingling like feeling.
What is Reflex Sympathetic Dystrophy (RSD)?
Lumbar radiculitis is an extremely common cause of a diseased nerve pain state, a lot of people know this as sciatica.
Dr. Feldheim reviews the list of other conditions that cause peripheral nerve pain and damage.
Neuropathic pain can be caused by crushing of nerves, lacerations due to trauma or injury, surgical insults, stress injury, small fiber neuropathy and phantom limb pain post  amputation.
What are the current treatments for peripheral nerve stimulation? Dr. Feldheim reviews the medications that are commonly prescribed as well as topical treatments and therapeutic modalities that may help.
What is peripheral nerve stimulation? It does not include FieldSTEM.
At PPT, one of their most common is the shoulder, they target the suprascapular nerve. 
Peripheral nerve stimulation is a very safe and effective option. If you are very active,  need routine MRI, or for those who have not had success with spinal cord stimulation, this can have great benefits.
Dr. Danko explains how there is a trial with peripheral nerve stimulation and why that is both exciting and important.
Multiple imaging modalities can be used to target the nerves.
Dr. Danko explains the setup of the devices and how they work. 
A team of specialists work with the STIMwave technologies on insurance and things of that nature.
Dr. Danko asks Dr. Feldheim to share other conditions that he has seen in regards to peripheral nerve stimulation.
Are these procedures done in the office or the operating room?
How long does the trial last? 
Dr. Feldheim explains which patients would be best served with spinal cord stimulation and peripheral nerve stimulation.
What about knee replacement issues? 
Needing a battery versus not needing a battery: what are the pros and cons? Dr. Danko explains.
How does stimulation compare to the TENS unit? 
How long does the procedure take and what is the recovery period?
 
3 Key Points:
There are many conditions that can cause issues in peripheral nerves. Dr. Danko and Dr. Feldheim are explaining the common causes and current treatments for this type of pain.
The wearable device used for peripheral nerve stimulation is very durable and effective offering freedom to do daily activities and have better quality of life.
What is the difference between spinal cord stimulation and peripheral nerve stimulation and what are indicators for one treatment over the other? 
 
Resources Mentioned:
https://premierpaintreatment.com/
https://www.facebook.com/PremierPainTreatment/
513-454-7246 

How Can Spinal Cord Stimulation Relieve Your Pain? With Dr. Michael Fishman- EP 3

On this episode of Premier Pain Talk, host Dr. Michael Danko talks with Dr. Michael Fishman. He is a fantastic pain physician 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.
 
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/

The Benefits Of Pain Pump Implant Therapy For Chronic Pain, With Dr. Chris Beuer- Ep 2

The Benefits Of Pain Pump Implant Therapy For Chronic Pain, With Dr. Chris Beuer
On this episode, Dr. Danko introduces 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 now.
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

Premier Pain Talk with Dr. Michael Danko- Ep 1

Premier Pain Talk, Answers Your Questions About Chronic Pain Relief!
This a new podcast about pain management, healthcare, and what the journey is like for many. Dr. Michael Danko and Kyle Ingebritson introduce themselves and discuss their goal and mission of the podcast. They desire to shed light on the knowledge gap of what pain management is, dispel misconceptions, and have fun while educating listeners. 
 
Episode Highlights:
Dr. Michael Danko and Kyle Ingebritson introduce themselves and the mission of the podcast. 
There is a knowledge gap of what pain management is and many patients are scared away. Dr. Danko talks about how patients and providers alike have misconceptions about the field of care.
How does the field of pain management gain understanding for new interventions?
How many years does it take to function as an independent pain management doctor?
Pain management had potentially been forgotten about and it is back now. Kyle asks Dr. Danko to share his viewpoint on how therapies are related and where it fits.
Dr. Danko shares his journey in life and career formation to where he is now. 
What is chronic pain management? 
Premier Pain Treatment Institute was opened by Dr. Danko in 2016. They now have 3 locations and 8 providers. It started as a sub lease and a rental in another office. 
A staff of 40 people with different personalities and different needs as well as changes in the business overtime takes intentionality to be a good manager of people and lead everyone well.
Kyle asks Dr. Danko to share about his life and hobbies. 
3 Key Points:
There are many misconceptions around pain management and what it actually is; Patients and providers alike have all sorts of formulated thoughts from culture and media. 
Connecting how therapies are related is important in considering where pain management overlaps. It is helpful to create an understanding and benefit of care.
Premier Pain Treatment Institute is a leading provider of Pain Management Services in Greater Cincinnati and Northern Kentucky.
 
Resources Mentioned:
https://premierpaintreatment.com/
https://www.facebook.com/PremierPainTreatment/