The City of Mission Viejo has recently started hosting lectures for the community featuring different doctors from the area. One of the most recent lectures was led by Dr. Andres Betts, MD, DABPM on New Frontiers in Interventional Pain Therapy. He discussed what pain specialists are able to do for their patients and some of the latest treatment options available.
Everyone experiences pain at some point in their life. The degree of pain, however, is different for every individual. Dr. Betts focused mainly on pain stemming from the lumbar, thoracic, and cervical spine.
What are Spinal Nerve Dermatomes?
Within each section of the spine, there are different nerves that relay sensations to different areas of the body. There are 8 cervical, 12 thoracic, and 5 lumbar & sacral nerves. The dermatome is the area of skin associated with each nerve. If a patient is experiencing pain & tingling down the leg, Dr. Betts and other pain specialists are able to identify what area of the spine is injured, based on the dermatome. Once the area of the spine is identified, the doctor is able to develop a treatment plan – oftentimes starting with an injection.
What are the different injections doctors use to treat pain?
The first type of injection that Dr. Betts discussed is called a Fluoroscopic Spine Injection. In this procedure, the radiologist and his assistants use x-rays to see real-time images of the spine. These images help the doctor and his team to identify the source of your pain. Once they identify the area they want to treat, the x-rays are used to guide the needle to the appropriate area. This type of procedure allows the physician to give a more accurate injection.
There are several types of fluoroscopy guided spinal injections including: epidurals, nerve root block, and facet injections.
Epidural – Medication, commonly a steroid, is placed into the specific section of the spine that is inflamed, more specifically around the dura (the tough outer membrane of the spinal cord). This is used for patients suffering from a disc herniation, degenerative disc disease, or stenosis of the spine.
Nerve root block – A steroid is injected into a specific level of the spine that the doctor believes is the root of the problem. The injection is placed in the hole between the vertebrae. If the patient’s pain decreases or goes away completely after the injection, the doctor and his team can essentially confirm that the specific nerve root that was injected was causing the pain.
Facet joint injections – Similar to a nerve root block, the facet joint injections are used to help diagnose, locate, and confirm the specific source that is causing pain. The facet joints of the spine enable you to bend and twist. If you experience grinding, the typical cartilage of the facet joint may be damaged. The facet joint injection works to give the patient pain relief and reduce inflammation.
Dr. Betts explained that for each patient, there is a maximum amount of injections allowed per year. Consult with your pain specialists, radiologist, or orthopedic doctor to learn if you are a candidate for an injection, and about how often you can receive them. Nervous about receiving an injection? Don't worry! Injections are not uncommon-- 7,000,000 are performed annually.
Other topics discussed by Dr. Betts
Dr. Betts and other pain specialists do more than just injections. For example, Dr. Betts discussed kyphoplasty; a procedure done to treat a spinal compression fracture. He discussed a treatment method that they refer to as Balloon Kyphoplasty Vertebral Augmentation. In this procedure, a small balloon is used to create a void between the vertebrae. Cement is then used to fill the void and correct kyphosis (hunching of the back).
Perhaps the most recent development in the pain medicine field is the use of stem cells. Dr. Betts referred to stem cell therapy as regenerative medicine. Stem cells from your own body are taken and then reinserted into the injured area. The cells are typically taken from your bone marrow or adipose tissue and reinserted using IV or injection to the affected site. The stem cells can become bone, ligament, or tissue depending on what is damaged in the body. The stem cells "know" based on your injury, what is needed to help you recover. For example, a patient with a torn ligament in their knee may have stem cells inserted into their knee. The stem cells will "know" that they need to help regenerate the ligament.
Interested in attending future events at the City of Mission Viejo? They host a variety of health lectures on a monthly basis at the Norman P. Murray Center. You can reserve your spot by visiting their website at http://cityofmissionviejo.org/events. We look forward to seeing you all there!