Sep 22, 2022
In the second podcast of season 5, Dr. Nima Adimi, a pain and spine specialist at Ridgeview discusses many areas around pain management, including how we evaluate, manage and treat pain and spine patients, the multidisciplinary teamwork involved, current guidelines, new and contemporary management strategies, and what is in the pipeline for the future of pain medicine.
Enjoy the podcast.
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About 80% of patients referred to Ridgeview's pain center are LBP patients. The first conversation is the usual Goals of Care which are highly important in setting the expectations for the patient, including what type of testing or imaging the patient has received, what treatment modalities have they tried.
Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscules and other parts of the body. The pain is usually described as a burning sensation and affected areas often sensitive to the touch.
Nociplastic pain (a type of pain caused by damage to body tissue. A pain that feels sharp, aching or throbbing) or a type of pain which is mechanically different from the normal nociceptive pain caused by inflammation and tissue damage or the neuropathic pain which results from nerve injury. It may occur in combination with the other types of pain or in isolation. Its location may be generalized or multifocal and it can be more intense than would be expected from associated physical causes. Its causes are not fully understood, but is thought to be a dysfunction of the central nervous system whose processing of pain signals may have become distorted or sensitised. This type of pain typically arises in some chronic pain conditions, with the archetypal condition being fibromyalgia.
Which is a common diagnosis for Dr. Adimi. During this podcast, listeners learn the limitations for further interventions due to hyperalgesia. These interventions will often require opioid titration prior to implementing therapy.
Include non-addictive strategies, such as physical therapy, chropractic, fucntional/personal trainer, behavioral health. Discussions continue regarding medications such as gabapentinoids and their side effects, NSAIDs, muscle relaxers, medical cannabis, low dose naltrexone, etc.
Least invasive strategies are discussed, including: trigger point injectsions, epidural, radiofrequency ablation medial branch blocks, facet joint injections, occipital and trigeminal nerve blocks, spinal cord stimulators, peripheral nerve stimulators.
During this section of the podcast, Dr. Adimi discusses how spinal cord stimulators are impacting pain with new and exciting modalities, intrathecal pain pumps and their limitations an dhow the use of narcotics, anesthetics and snal poison (ziconotide) are implemented. Dr. Adimi notes that SCS are not effective for mechanical back pain/arthritis patients.
Vertiuflex for spinal stenosis patients is discussed, along with the "mild" procedure and minimally invasive lumbar decompression.
In wrapping up the podcast, Dr. Adimi discusses the future of pain and the new arena or space the pain specialist will be occupying. New research on SCS for Prakinson, movement disorders, dystonia as well as how it impacts select patient populations like Peripheral Diabetic Neuropathy Study.
Please check out the additonal show notes for additional resources.