Pain Management

Services

Trained at some of the top teaching hospitals in the county, our Pain Management Team utilizes a comprehensive approach to diagnosing and treating the cause of your pain by tailoring an individual plan made specifically for you. We incorporate all aspects of your medical background and history with the latest in diagnostic testing to determine what the primary and possible secondary causes of your pain may be. Throughout the diagnosis, treatment, and recovery, our goal is getting you back to what you love with the belief that our therapies are being done with you, not to you.

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Meet Our

Pain Management Team

Richard Dentico, M.D.

PAIN MANAGEMENT / REGENERATIVE MEDICINE / HAIR RESTORATION / VEIN DISEASE

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Vishal P. Rekhala, D.O.

SPECIALIZING IN PAIN MANAGEMENT / VEIN DISEASE / REGENERATIVE MEDICINE

Dalia Gearhart FNP-C

Stephen Lebitsch, FNP-BC

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Treatments

MLS Laser Therapy

MLS Laser Therapy is an FDA-cleared treatment for pain that uses concentrated light energy to stimulate the body’s own healing process. Laser therapy minimizes pain and inflammation as an alternative to prescriptions and surgery. It reduces recovery times, which is especially important post-surgery, so patients can quickly return to a higher quality of life. MLS (multi-wave locked system) technology in specific delivers two therapeutic wavelengths – the 808nm (anti-edemic and anti-inflammatory) and the 905nm (analgesic). The combination of these wavelengths produces greater pain-relieving effects than either can produce on their own, while also minimizing the risk of thermal damage. It is this unique combination and synchronization of continuous and pulsed emissions that characterizes MLS and distinguishes it from other Class IV lasers.

Closurefast Procedure

The ClosureFast™ procedure is a minimally invasive treatment that uses radiofrequency (RF) energy to effectively treat patients with varicose veins or chronic venous insufficiency (CVI). Because the valves in the legs cannot be repaired, the only alternative is to re-route the blood flow from the diseased veins to the healthy veins.

To do this, a vein specialist inserts a catheter into the diseased vein through a tiny incision below the knee. Guided by ultrasound imaging, a vein specialist will treat the vein in 7 cm segments for 20 seconds each. The catheter delivers consistent and uniform heat to contract the collagen in the vein walls, causing them to collapse and close. After the vein is sealed shut, blood is then naturally redirected to healthy veins. The treated vein then becomes fibrous tissue and will gradually be absorbed into surrounding tissue.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) is a non-operative solution in treating musculoskeletal, sports, and orthopedics injuries. PRP is concentrated from your own blood to trigger healing/repair process in the area of injury.

In PRP, the platelet is used as the initiator of repair. Platelets can release a multitude of signaling proteins, growth factors, chemotactic factors which stimulate tissue repair and vascular remodeling. This cascade of events allows the tissue to return to normal structure improving function and pain.

What are the benefits of PRP Treatment?
PRP therapy shows great promise in restoration of normal soft tissue architecture and regeneration of tissue such as tendons and ligaments. Patients can expect to see significant improvement in symptoms and eliminate the need for other treatments such as cortisone injections, medications or surgery.

Little to no Risk Factors
PRP is from your own blood, so there little to no risk factors with this treatment. Side effects or complications with PRP are very rare.

PRP may be effectively used in the treatment of:

Spinal Injections

Chronic pain can affect all parts of the body, but is especially prominent in the lumbar or cervical regions of the back. Pain management injections involve the direct delivery of steroids and anesthetic to nerve, joint or epidural space. Injections are typically prescribed after a course of medications and/or therapy is completed, but before surgery is considered. Also referred to as blocks, injections are useful for providing pain relief and as a diagnostic tool for identifying the source of back pain. These treatments are based around the idea that giving a focused amount of medication directly to the site where the pain may be coming from can help alleviate the pain an individual experiences. There are a variety of such treatments based on the different sources of pain in the body; procedures are all performed with image guidance (X-ray) to ensure medication is delivered to a precise location.

Conditions

Degenerative Disc Disease (DDD)

“Degenerative disc disease” is a misnomer as a degenerated spinal disc is not a disease, but rather part of the normal aging process of the spine. When a disc degenerates, it loses the ability to function efficiently as a part of the spinal joint. This, in turn, may lead to pain in the neck or back, sometimes with radiating pain and weakness in the extremities.

DDD is the most common cause of Lower back pain and neck pain from ages 10 -50. DDD is a primarily genetic condition caused by defective collagen cross linking which results in faster wear and tear on the spinal discs. The discs act like shock absorbers to support the spine yet allow motion. Many patients with DDD have a close relative(s) with the condition. The other 30 % of DDD is felt to be due to environmental factors such as normal aging, injuries, poor body mechanics such as improper bending and twisting, obesity ( only a minor risk factor ) and nicotine use /smoking. Nicotine and smoking are the number one reversible cause of DDD progression. Nicotine and cigarettes damage the capillary blood vessels which supply the vertebral endplates.

The Discs in the spine get their nutrition and oxygen from diffusion through the endplates because the discs do not have their own direct blood supply. Over time, if the blood supply to the vertebral endplates is damaged, then the discs are starved of oxygen and nutrients and cannot repair and maintain the strength of the disc. Stopping smoking and nicotine use is the best way to protect the healing power of the discs and slow progression of DDD.

Herniated Disc

As a disc degenerates, the soft inner gel of the disc can leak back into the spinal canal. This is known as a disc herniation. Once inside the spinal canal, the herniated disc material puts pressure on the nerve, causing pain to radiate down the nerve. This may lead to sciatica or leg pain the case of a herniated lumbar disc, or arm pain in the case of a herniated cervical disc.

Varicose Veins/Venous Reflux Disease

Varicose veins are enlarged, swollen, and twisting veins, often appearing blue or dark purple. They happen when faulty valves in the veins allow blood to flow in the wrong direction or to pool. Symptoms can include aching legs, swollen ankles, and spider veins.

If you have varicose veins or experience leg pain and fatigue you may have venous reflux disease. Venous reflux disease develops when the vein valves that keep blood flowing from your legs to your heart become damaged or diseased. This can cause blood to pool in your legs and result in dilated or varicose veins.

Venous reflux disease is a progressive medical condition and if left untreated, may worsen over time and
develop into a more serious form of venous disease called chronic venous insufficiency.

Osteoporosis

Osteoporosis is a condition which causes thinning of the bones. This may result in vertebral compression fractures, deformity (kyphosis), or even death. Osteoporosis and related spinal fractures are largely preventable or treatable with medications, calcium intake, and kyphoplasty or vertebroplasty surgery.

Osteoarthritis

Osteoarthritis is the most common cause of back and neck pain after age 50. Osteoarthritis is caused by the progression of DDD and involves the formation of bone spurs at the edges of the disc space from loss of disc fluid. The disc space and motion segment become unstable and shift suddenly, causing the back or neck to “go out.” From this repetitive abnormal shifting of the vertebrae, the body responds by forming bone spurs to try to re-stabilize the spine and protect the nerves. When the disc wears out, stress is also transferred to the paired “facet” joints in the back of the spine, causing them to wear out their articular cartilage (same type of cartilage as in the knee and hip joint). The facet joints then also form bone spurs as the body tries to re-stabilize the spine. The friction caused by the loss of the smooth gliding surface in the facet joints also causes back and neck pain.

If the Bone spurs and ligaments enlarge from the chronic instability or “shifting” caused by DDD, the nerves can eventually become pinched by the bone spurs both from the discs in front and the facets in back. The bone spurs and ligaments which buckle in and thicken due to loss in disc height and instability both narrow the spinal canal and can use pain, numbness, tingling or weakness radiating down into the arms or legs. When this happens, the condition is called Spinal Stenosis. Spinal Stenosis is a complication of Osteoarthritis of the Spine.

Sacroiliac Joint Dysfunction

The sacroiliac joint connects the triangular bone at the bottom of the spine (the sacrum) with the pelvis. If its normal motion is disturbed, it may be a source of low back or leg pain. More specifically, sacroiliac joint pain may be caused by too much or too little movement.

SIJ pain is often seen in patients with previous lumbar spine fusion because of stress transfer to the SI joints. It is also seen in patients with trauma to the SI joints from car accidents or falls onto the buttock region which can cause a shear stress across the joint and damaging the cartilage inside the joint.

Scoliosis

Scoliosis means that there is an abnormal curvature, or bend in the spine. This would be a curvature in the spine when viewed from the front or back. The human spine normally is curved as viewed from the side.

There are many types of scoliosis. Sometimes young people develop it in preteen or teenage years. Much more commonly it occurs over time due to aging and arthritis.

Scoliosis can cause pain and dysfunction but not always. There are many treatments for scoliosis.

Spondylolisthesis

Spondylolisthesis is a condition in which a defect in part of the spine causes vertebra to slip to one side of the body. Typical symptoms include back and/or leg pain.

Spondylolisthesis – is a Latin term which means a “slipped spine.” The most common type of Spondylolisthesis can be associated with DDD in adults in the 30-60 year age range when the spine becomes unstable because of disc height loss . This is called a Degenerative Spondylolisthesis . Another common cause of Spondylolisthesis is a stress fracture in the part of the bone between the facet joints ( the pars interarticularis ) which tends to occur in teenagers . This type of Spondylolisthesis is called a Lytic Spondylolisthesis . Lytic Spondylolisthesis or Spondylolysis associated with a genetic condition in which a thin pars region is fractured due to repetitive stress. It is commonly seen in gymnastics who tend to be hyper flexible , football and soccer players which often involve sudden or violent twisting and bending of the spine.