Dr. Abraham Rivera Discusses Spinal Stenosis

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Spinal stenosis, the narrowing of the bony canal that cradles the spinal cord, is most common in people over age 50. Their search for relief from back pain often follows a predictable path, from NSAIDS and opioids to chiropractic and alternative medicine. Sometimes, this trial-and-error process can take years and many thousands of dollars. Too often, the sufferer is forced to cut back on work or pain management specialistdrops out of the workforce completely long before he or she is ready to retire. The real tragedy? Most of these patients would find relief early on if they knew where to turn: an interventional pain management specialist.

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Pain Free Living September 2017 Article by Dr Rivera

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Dr. Jorge Leal Talks About the Effects of Mental Pain on Our Bodies

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Interviewer: I’m sure a lot of you out there know it well. You’re in mental pain, which causes physical pain which, in turn, causes more mental distress. It’s a vicious cycle. When does it end? Dr. Jorge Leal from Florida Pain Relief Group joins us now to talk more about this. Dr. Leal, great to have you here.

Dr. Leal: Thank you.

Interviewer: Oftentimes, when you have people come in that are just mentally and physical exhausted because of their pain, is it sometimes because of something that’s happening inside their minds?

Dr. Leal: It is very common that you see a lot of mental abnormalities in people who suffer with chronic pain. It is sometimes difficult to tell which one was first, but you have to definitely emphasize both aspects. The physical and emotional aspect of pain and suffering are intertwined. Not infrequently, people that suffer from chronic pain also suffer from sleeplessness. And if you don’t sleep well, your day does not go well and your pain can be intensified by the lack of sleep, lack of concentration, anxiety, causing a release of catecholamines which basically are adrenaline. Response to chronic stress can also make you more sensitive to pain, more susceptible to pain and it just, indeed, becomes a vicious cycle.

 

 

Interviewer: Can depression cause pain too?

Dr. Leal: It can intensify pain and sometimes it is associated with chronic pain, very commonly.

Interviewer: So what’s more important? Treating the mental side first or treating the physical side first?

Dr. Leal: Well, you have to treat both. One without the other will not be effective so you have to emphasize in treating both aspects of the pain experience, the psychological aspect and the physical aspects as well.

Interviewer: I’m curious to know how you go about that.

Dr. Leal: In our center, we have a comprehensive approach to the treatment of pain and we identify, by certain psychometric tools that we have available, to gauge when is someone susceptible to psychological problems. We identify if they have any kind of depression or any other psychological condition that might interfere in the management of pain. And we identify it, and then we seek appropriate treatment in terms of referral to the appropriate mental health specialist, counseling and so forth.

Interviewer: I think it’s important that you mention a lack of sleep can cause all of these problems. That it’s not necessarily something wrong with your brain, it’s something physically that’s happening to you and then it’s affecting your whole body.

Dr. Leal: Absolutely. And as you will know, this is very common in our day of life. Lack of sleep is extremely common and has tremendous negative consequences in our health. It’s now becoming more and more talked about, and we have to deal with that. That being said, pharmacological treatments for insomnia are fraught with their own problems, including addiction to sleep aids. So a very good sleep hygiene is extremely important and we do emphasize that in our practice.

Interviewer: And you can help people get off the pills and figure out a great way to just remedy their sleep.

Dr. Leal: Indeed.

Interviewer: Okay. Good stuff. Dr. Leal, thank you very much. You can visit their website,  or give them a call at 844-KICK-PAIN to schedule your same-day appointment. We’ll be right back with more Daytime, so don’t go away.

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Dr. Abraham Rivera Talks Pain From Weekend Activities and Best Ways To Treat It

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Interviewer: Well, when the weekend finally rolls around, besides everybody saying, “Woo-hoo,” we all want to do activities we usually enjoy before heading back to work on Monday, but some of those activities, as you might experience, golfing, tennis, even gardening, can cause you pain. Dr. Abraham Rivera from Florida Pain Relief Group joins us now with a solution for all you weekend warriors out there. Now, Dr. Rivera, welcome.

Dr. Rivera: Thank you.

Interviewer: Let’s talk about what kind of pain that we’re zeroing in on here: bursitis, tendinitis, arthritis, all of the itises.

Dr. Rivera: Correct, correct. I mean, this is like you say, the weekend warriors. They go out there. They have very sedentary occupations. Now, it’s the weekend. They want to go out and play 18 holes of golf.

Interviewer: Right.

Dr. Rivera: Or they want to play a couple tennis matches. Of course, they come and see me Monday or Tuesday because they are sore, you know, to be expected. Now, many times when I talk to these patients, I find out that there is a problem with their technique. They have the wrong grip on the tennis racket or they have the wrong clubs. Often, they have shoulder disease, and they’re trying to hit that ball like when they were 22, and they’re 50 now. You can no longer hit that ball that way. So just believe it or not, by going over their technique, many times you solve the problem right there.

 

 

Interviewer: So I assume you’re a good golfer?

Dr. Rivera: Heavens no, but I do play with quite a few, and I see when they pay the price the next day.

Interviewer: So how do you fix, say, for instance, shoulder pain because a lot of people do like to get out there and hit the tennis ball around or play a round of golf. How do you treat them so they can go back to work without the pain?

Dr. Rivera: Yeah, many times, it’s just a case of acute tendinitis. They’re rubbing the tendon that goes over the shoulder joint against a spur that they have in their shoulder, and we typically diagnose that. We can prescribe some topical medication. We can give them some anti-inflammatory. Sometimes we have no resort but to inject the joint with cortisone. It’s something we can do in the office very quickly.

Interviewer: Now that’s something because I’ve had… I have rheumatoid arthritis in my knee, and I’ve had cortisone shots in my knee, but I was told you have to stop them after a while. Is this correct?

Dr. Rivera: Yeah, cortisone is a very seductive drug because it works.

Interviewer: Yes.

Dr. Rivera: You can only get so many of these so many times a year.

Interviewer: Right.

Dr. Rivera: It can have side effects. It can weaken the tendons. It can cause osteoporosis.

Interviewer: So what’s the next level then after that? I’m asking for myself.

Dr. Rivera: Yeah, I hear you. I hear you. You know when patients have disease in their joints, the thing I try to tell them, make them clear they understand, is they cannot travel that joint. By traveling that joint to the full range of motion, they’re wearing it out more. So try not to move it.

Interviewer: Yeah, hard to do. I’m a very active individual, but I was told that stem cell therapy might actually help.

Dr. Rivera: Well that certainly holds a promise. It is… the data is very promising, very tantalizing. It is an alternative. Unfortunately, it’s not covered by most insurances, but it’s certainly an alternative.

Interviewer: And real quickly for the gardeners out there, what can you do about their sore, stiff hands after they’re out there on a Saturday or Sunday?

Dr. Rivera: Preventive. I tell those patients to, number one, take an anti-inflammatory up front, a simple aspirin, Glucosamine, something over the counter. There is a lotion they can put on that contains some anti-inflammatories, and finally, I tell them to avoid impact. Okay, hammers, things that wack.

Interviewer: Right.

Dr. Rivera: Don’t want vibration.

Interviewer: Yeah, don’t hammer your flowers into the ground. Only if they’re dead. Okay, Dr. Rivera thank you so much. If you need to see Dr. Rivera or any of the other great doctors at the Florida Pain Relief group, just hit up their website  or give them a call, 844-KICK-PAIN to schedule your very same day appointment, which is very, very good to be able to get in there right away, right, when you have the pain? All right, Dr. Rivera, thanks again. We’ll be right back.

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Dr. Jorge Leal Talks Chronic Pain: What Is It And Do You Suffer From It?

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Interviewer: When you’re in pain and you head to the doctor, you already know what’s coming. Rate your pain on a scale of one to ten. But is that really the best way to gauge it, and if so, then what? Dr. Jorge Leal from Florida Pain Relief joins us now to talk more about this. Okay, Dr. Leal, what exactly is pain management?

Dr. Leal: Pain management, it’s a relatively new specialty that is basically charged with trying to diagnose and then manage the chronic pain.

Interviewer: Now, we hear about doctors all the time saying, “Rate your pain from one to ten.” Is that really an accurate benchmark, and does that really help you when I say, “I’m at a seven”?

Dr. Leal: Well, it’s the best that we have. As you well know, pain is subjective, meaning that only the individual that is experiencing the sensation is capable of rating it, so we try to keep it simple. So just a numeric rating system has been effective and has been validated statistically that it is as good as we can achieve, given the circumstances that it is a purely subjective experience.

 

 

Interviewer: Is medication usually the best way to treat pain, or are there better alternatives out there?

Dr. Leal: Well as you well know in our society, pills seem to be the first thing that we reach for, but perhaps that may not be the correct one. Due to the fact that pain has been relatively under-treated in the past, we became to rely heavily on pills to try to keep the pain under control. And then eventually we started to realize that indeed may be doing some harm and there may not be any benefit in the long run in trying to control some person…individual’s pain.

Interviewer: So what is the best way then to treat pain? Because there are a lot of people that are taking pills as we speak right not to try to just get through the day. So, from the Florida Pain Relief Group, how do you approach somebody who’s got pain?

Dr. Leal: Well, the most important thing is to try to find out what is causing the pain. And for that, we need to approach the problem in a comprehensive fashion to find out what caused the pain, what has been done in the past, what worked, what hasn’t worked, have there been any side effects? So all those things get taken care of…into consideration, and then we formulate a plan of therapy. And that could be from medications to interventional techniques to sometimes surgical approaches, and some rehabilitative techniques are available.

Interviewer: What are some non-invasive options that you have for people who are dealing with pain?

Dr. Leal: Well, the most important thing is to treat any underlying psychological difficulties or problems that the individual may be having. Not uncommon, it’s almost akin to the chicken and egg. Which comes first, the pain causing anxiety or anxiety aggravating the pain? So they are intricately related, so they must be addressed. So psychological counseling, psychological therapies, including also pharmacological therapies, are very important in the management of pain.

Interviewer: But the bottom line is you want your patients to be free of this pain. They don’t want them to live with it.

Dr. Leal: That is correct. The idea is to manage it and allow them a better quality of life.

Interviewer: All right, a lot of people will be happy to hear that. Dr. Leal, thank you very much. You can visit their website. It is floridapainpeliefgroup.com, or you can give them a call, 844-KICK-PAIN to schedule your same-day appointment. There is relief out there. We’ll be right back with more Daytime, so don’t go away.

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Dr. Rodolfo Gari of Florida Pain Relief Group Talks Causalgia and CRPS: What They Are and Who Gets It

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Host: Sometimes when your pain is caused by a rare syndrome, it can be hard to get a correct diagnosis. But when it’s connected to the central nervous system that is linked to your brain and spinal cord, it’s important to get that diagnosis as quickly as possible.

Dr. Rudy Gari from the Florida Pain Relief Group joins us now to talk about one of these rare syndromes. Dr Gari, good to have you back.

Dr. Gari: Thank you.

Host: There’s something called causalgia?

Dr. Gari: Yes.

Host: What in the world is that?

Dr. Gari: So causalgia is another name for the same syndrome. It’s also called reflex sympathetic dystrophy. It’s also called complex regional pain syndrome.

 

 

Host: All right.

Dr. Gari: And we’ve actually talked about complex regional complex pain syndrome before, and this is along the same lines. And it basically has to do with the fact that you have a short circuit of your nervous system where the pain doesn’t go away. So the way that I explain this to my patients is just imagine if you touch your finger on a stove, you get the little shock that goes from your finger to your brain, and then it stops. It just tells you, “It hurts, you’re about to burn your finger, you know, take it away.”

What happens with causalgia or complex regional pain syndrome, RSD, reflex sympathetic dystrophy, the same thing, is that it goes to your brain, but instead of stopping there, it actually turns into a loop. So it goes from your finger to your spinal cord, back to your finger, back to your spinal cord and it doesn’t end. So it’s like constant, constant…the pain doesn’t go away.

A lot of these patients, what happens is, even if you were to like breathe or just a slight touch to the skin, it’s extremely painful. It’s called hyperalgesia, which means just an extreme painful syndrome just by touching skin.

Host: Who is a typical patient that would suffer from causalgia?

Dr. Gari: Typical patient could be either a male or female. I’ve seen that also happen as young as 12 years old.

Host: Really?

Dr. Gari: And it’s just basically…the analogy is like a little bit like a seizure that goes from the spinal cord to your fingers or your feet or so forth and it doesn’t go away. The treatment for that is to stop that cycle.

Host: Well, yeah, obviously we wanna stop that cycle as quickly as possible, because what a horrible way to live. What kind of treatments are available for something like that?

Dr. Gari: Sure. So what happens with causalgia is that the pain travels via these nerves called sympathetic nerves. They’re tiny little nerves. And the pain just keeps going over and over again. So the way you stop it is to do something that’s called a sympathetic block.

Host: Okay.

Dr. Gari: So if it’s in your legs, we do what’s called a lumbar sympathetic block. If it’s in your arm we do something called a stellate ganglion block. And it blocks those fibers and it causes it to stop. So you kind of like stop the seizure.

Host: How do you do that? Do you go in and inject something into the nerve?

Dr. Gari: It’s an injection. Yes, it’s an injection. So these nerves travel down your spinal cord. So if it’s the arm, the bundle of nerves for that is right here in your neck. It’s a tiny, little needle that we go on and put an injection there, we put the local anesthetic to stop that. If it’s in your legs, it goes from your back on the side of the spinal cord, we put in a spinal [inaudible 00:03:12] local anesthetic that gets it to stop. A simple procedure to us because we’ve done so many of them. It’s done using fluoroscopy x-ray to make sure we have the needle in the right place. Patient goes in and goes out the same day.

Host: Oh my gosh, it must be so life-changing for people who are suffering.

Dr. Gari: It’s actually one of the syndromes that is curable.

Host: Oh, isn’t that great?

Dr. Gari: So our specialty is often called pain management because unfortunately, a lot of pain that we have is not curable. But causalgia, when it’s treated early, you can cure that.

Host: Good news for a lot of people. Dr. Gari, thank you very much. You can visit their website. It is floridapainreliefgroup.com, and schedule your same-day appointment. Or give them a call, 844-KICK-PAIN. You don’t have to live with pain. We’ll be right back so don’t go away.

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Dr. Rodolfo Gari Talks Pain Experienced By Cancer Victims and Successful Ways To Treat It

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Interviewer: Sadly, getting cancer at some point in your life is all too common in this country, but the pain from cancer doesn’t have to be. Dr. Rudy Gari is here from Florida Pain Relief Group to talk about this, as well as pain that can persist even after cancer is gone. Dr. Gari, great to have you back.

Dr. Gari: My pleasure, Thank you.

Interviewer: Let’s talk about this. How many patients who have gone through cancer, have been treated, still have pain afterward?

Dr. Gari: Well, unfortunately…fortunately, if they’ve been treated and cured, that’s a great thing, but a lot of times that cancer can spread to different nerves and can cause damage to some of those nerves, so it can leave a long-lasting painful injury even after you’ve been very blessed by having the cancer cure.

Interviewer: Okay, so what are some kinds of different cancer pain that people experience?

Dr. Gari: So, basically, cancer pain is associated with any type of cancer that ends up affecting the organs, your nerves, anything like that. In fact, my first patient that I had after I finished my training out of medical school in residency was a patient that was dying of cancer, and I remember her vividly because she came to me and she said, “Doctor,” say says, “I’m going to die, but my mother died of the same thing. She had breast cancer. All that I want to do is, I don’t want to die in pain.” So I said, “You are not going to.” She was referred to me by an oncologist. Most oncologists, if not all of them, they do a great job of taking care of that pain, but there are some patients that, after medications, you’re still going to, you might have some pain, and she said, “I just want to be able to spend my last days without pain.” We ended up putting in something called a morphine pump implant that allowed medications with a very small amount of morphine to go into the spinal cord that actually gave her pain relief.

 

 

Interviewer: So, apart from this morphine implant pump, and which helped her immensely, what else do you have out there to treat this pain?

Dr. Gari: Well, we have everything. So, we have every possible tool that’s available in the field today, including allografts, stem cells, nerve blocks, medications, physical therapy, things called radio-frequency. We can do what’s called cryotherapy. We can burn the little nerves out that are causing pain. We can put in something called smogra stimulators, morphine pumps. There is an incredible amount of tools available to physicians like myself that specialize in pain management to be able to treat cancer pain other than just giving medications.

Interviewer: Why are they experiencing this pain?

Dr. Gari: Well they experience this pain because of the fact that, just think about it, if you hit your nerves, it’s painful. So that cancer can spread, and it can spread and it can cause a distension of different organs. It can cause…it can impinge on the nerves. It can cause significant pain.

Interviewer: Okay, so for anybody out there’s who’s watching right now, who’s going through this, there’s definitely relief.

Dr. Gari: We can help you, yes, absolutely.

Interviewer: Okay, Dr. Gari, thank you very much. The Florida Pain Relief Group even offers same-day appointments. You can visit their website, or give them a call, 844-KICK-PAIN. Dr. Rudy Gari, great to have you back.

Dr. Gari: Thank you.

Interviewer: We’ll be right back.

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Dr. Rodolfo Gari Talks Shoulder Pain: What Causes It and Ways to Relieve It

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Cindy: Nobody wants their everyday activities to be limited because of pain, but shoulder pain can do just that if it goes untreated. Dr. Rudy Gari from Florida Pain Relief Group joins us now to talk more about shoulder pain and, my gosh, this is my life right here, shoulder pain, constant. What causes this, and is it degenerative?

Dr. Rudy Gari: Well, that’s one of the types of shoulder pain, is degenerative. Other types are traumatic. Example, my son, he thinks he’s Superman, and he was working out at the gym, and he hyper-extended his arms, and he dislocated his shoulder. We actually took him to one of the best surgeons in the country, who said, “Well, maybe he needs surgery.” He had a little bit of a tear there. Instead of having surgery, we actually brought him back to our facility and put in some stem cells into his shoulder, and he’s young enough, it actually allows it to regenerate that tear.

Cindy: So, even a tear can be fixed without surgery. That’s the first I’ve heard of that.

Dr. Rudy Gari: We’ve actually seen MRI evidence, before and after. And because stem cells regenerate tissue, we’ve seen the little mice with an ear growing out of his back, okay? That’s regenerated tissue. That’s the future of medicine, and so we’re doing a lot of treatments for joint pains through stem cells, allografts, what’s called now, regenerative medicine.

Cindy: That’s great because I know somebody who recently had shoulder surgery, and the recovery is worse than what he was going through before the shoulder surgery. It’s a long time.

Dr. Rudy Gari: It’s a big operation. Some patients need it, but it really is a big operation. It’s a very long…months, it can be, through recovery period.

Cindy: Definitely. Now let’s talk about arthritis. We think of it as being in our knees, and maybe in our hands, but can we get it in our shoulders?

Dr. Rudy Gari: We get arthritis in every joint, not only in our knees, and shoulders. We actually see a lot of arthritis in your back. Your back has 31 different bones. Each one of those bones is mounted together through these little joints, and they’re called facet joints. You get inflammation in any of the joints, shoulders, neck, anywhere, and that can cause pain, but the good thing is that it can be treated. We have to go after the source. It’s usually some sort of inflammatory process, like in the back, for example. You have pain in the back from inflammation, and once we make that diagnosis, there’s a procedure that’s called radio frequency, actually burns these tiny little nerves that cause pain from those joints. We can do it down the back, in the hip joints, knee joints, just different places.

Cindy: So, for people who are living with chronic arthritis, this could be the relief that they’re looking for?

Dr. Rudy Gari: Absolutely, and we help a lot of people with that.

Cindy: Okay, so should anybody come that’s got shoulder pain, and they think that it’s going to take more than just…like, they’ve gone for the massage and it’s not working, so they come to you? So what do you do then?

Dr. Rudy Gari: The first thing that we’re going to do, Cindy, is make a diagnosis. So, we’re going to take a good history, examination, probably send this patient for an MRI, find out whether it is a tear, arthritis, something else going on, because you have to make a diagnosis first, before you can actually go with a treatment.

Cindy: Right, and your goal is to try to find a way to treat that without having to go through the surgery?

Dr. Rudy Gari: Surgery should be the last option on everybody. Sometimes, you need it.

Cindy: Right.

Dr. Rudy Gari: But, you know, once you get it, it’s a long recovery process, so we want to do everything possible to avoid that.

Cindy: Good stuff. All right, Dr. Gari, thank you very much. You can visit their website, to schedule your same-day appointment, or give them a call right now, 844-KICK-PAIN. Dr. Rudy Gari, great to see you.

Dr. Rudy Gari: My pleasure.

Cindy: We’ll be right back.

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Dr. Rodolfo Gari Talks Pelvic Pain, Its Causes and Successful Treatments

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Interviewer: Pain, anywhere on your body can really put a damper on your life and your activities. But when it’s somewhere that’s constantly in use, like your pelvis, it can truly be debilitating. Dr. Rudy Gari from Florida Pain Relief Group joins us now with more about this. Dr. Gari, good to have you back.

Dr. Gari: My pleasure.

Interviewer: So many women that I know have pelvic pain. And it really is awful for them and they do not know where to turn. How many times do you have somebody come through your office door and they say, “The pelvic pain is driving me crazy”?

Dr. Gari: Just about every day.

Interviewer: And what in the world can be causing this?

Dr. Gari: Well, pelvic pain can be caused by a host or a variety of different factors. Sometimes these women may have some sort of endometriosis. They may have adhesions, they may have a different…some sort of a strain. So there’s all kinds of different disorders that can be causing this and unfortunately, most of the treatments that out there are just not very good. A proven example is the adhesions. If you have adhesions,..

Interviewer: What is that?

Dr. Gari: So adhesions are kinda like a… almost like a spider web if you will, but it’s your own body spider web.

Interviewer: Okay.

Dr. Gari: So like a little scaring sometimes inside, but it’s inside your abdomen, your pelvis. So, it can be pulling on a nerve or pulling on one of the organs there and can be causing pain. So what a surgeon can do is go in there and actually through what’s called a laparoscopy, go in there with a scope and remove those adhesions, and you feel much better. Here’s the problem, most of the times it comes right back.

Interviewer: Okay.

Dr. Gari: So it becomes a futile event to continue doing that. So, we have make sure that, “Hey, you know, has everything been done that can be done?” And then let’s look for some alternatives to doing the same thing that hasn’t been working. And some of the things, for example, that we’ve done, there’s nerve block called a superior hypogastric plexus block.

Interviewer: That sounds very scientific.

Dr. Gari: Yeah. So basically your pelvis has a bundle of nerves called the superior hypogastric plexus and that’s where you get the pain sensation. So some things very simple that we can do is go in there and actually put… place a long acting local anesthetic and a little bit of steroid into the ganglion to help calm it down. And there’s a whole bunch of techniques like that that we can do. There are other things that we can do for patients that are their wits end, there’s nothing that can be done, We’ve actually performed spinal cord stimulation at the… that stimulates the pelvic area.

Interviewer: Really?

Dr. Gari: So instead of pelvic pain, you have a much more comfortable sensation.where it doesn’t bother you anymore.

Interviewer: I’m thinking there are women out there right…listening that are thinking, “Well, what kind of a time commitment is that for me? Do I have to come back every week to get this stimulation so that I feel better?”

Dr. Gari: No, this actually…for the first week of the trial, see if it’s gonna work for you. So you’ll have the little trial for about a week, make sure that it’s some you’re comfortable with, that it helps you. And if it does help you, we can get that implanted. It’s a tiny little electrode, maybe the size of a string. It goes in, into the back of your spine, it stimulates those nerves, and then there’s a little generator that gets implanted under the skin about the size of a half dollar…

Interviewer: Wow.

Dr. Gari: And that battery lasts several years. You can program that in different ways and you have a lot of control over yourself.

Interviewer: So, lots of options out there?

Dr. Gari: Absolutely.

Interviewer: Okay, Dr. Gari. Thank you very much. You can contact Florida Pain Relief Group to schedule your same-day appointment. Stop living with pain, you don’t have to. You can visit their website. It is floridapainreliefgroup.com or give them a call, 844 KICK PAIN. We’ll be right back with more Day Time, so don’t go away.

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Dr. Rodolfo Gari Talks Best Posture and How It Helps To Avoid Back Pain

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Interviewer: We’ve heard it since we were kids, sit up straight. We all know slouching is bad for the back, but sitting up straight can also cause strain. Dr. Rudy Gari from Florida Pain Relief Group is here to help us find the happy medium. Hi Dr. Gari.

Dr. Gari: Hello.

Interviewer: So I think I’m sitting properly right now.

Dr. Gari: Yes, you are. Yes, you are.

Interviewer: Okay. But is there some ways that we can sit that we think we’re doing the right thing but we’re not?

 

 

Dr. Gari: Well, there is something that’s called the loss of lordosis. So people that have for example back pain. So your back should be curved. That’s called the lordosis. It means the curvature of the back that’s natural. And so, that actually allows us to have less back pain when we have that lordosis. Patients that have back pain for example can get muscle spasms and they lose that typical lordosis and now their back is flat. That flatness actually increases the pressure in nerve because our bodies were not designed to sit that way.

So while posture is very important, but often with the terms posture is also your core muscles. So strengthening your core muscles in many ways helps your posture, helps your pain and there is a lot of things that are done with physical therapy.

Interviewer: Yes, indeed. So bad posture can cause not only back pain but what else can that do?

Dr. Gari: Well, it can cause back pain and it can also cause you to pivot the wrong way. It can cause you to have a bad gait and it can lead to a lot of other problems in your back, in your neck, and other places.

Interviewer: I’m thinking neck and headaches from bad posture.

Dr. Gari: Absolutely. Absolutely.

Interviewer: Definitely. Okay. Should we get things for our chairs and…

Dr. Gari: Well, if you think about it, sitting in chairs is not natural.

Interviewer: Okay. So stop sitting?

Dr. Gari: So our bodies weren’t designed to sit but we do. So one of the things that people do is some very simple things. For example, sitting at that big medicine ball. That’s going to correct your posture because your body is gonna normally adjust, your core muscles are going to pick it up to make sure that you don’t fall, that you sit correctly.

Interviewer: So throw out that office chair and get the medicine ball?

Dr. Gari: Throw out the office chair and get that big medicine ball, sit on the medicine ball, stand up. Standing is much better for you than sitting.

Interviewer: All right.

Dr. Gari: And especially when it comes to that pressure on your lower back.

Interviewer: They do have those stand up desks now.

Dr. Gari: Those are pretty good.

Interviewer: Do you recommend that?

Dr. Gari: I absolutely do. High heels can cause some bad posture. I know that you know that though. Everybody likes high heels, we feel good about it but if you have back pain, that’s not…

Interviewer: Put those away.

Dr. Gari: You might wanna put those away for a while.

Interviewer: Too much strain. Let’s talk about picking things up wrong. What are we doing?

Dr. Gari: Well, the worst thing that you can do is to bend forward and pick something up.

Interviewer: Okay. Don’t do that.

Dr. Gari: If you must pick up, don’t use your back muscles to lift that object. You wanna make sure you maintain that lordosis, that curvature. Squat down and use your legs to lift up that object. Sometimes we have those back braces so you can put those on if you have to lift something because that’s gonna help your back. What you don’t wanna do though, you don’t wanna wear those on a regular basis because that will actually weaken your core muscles. We want our core muscles to be the ones doing the work of keeping posture and not get used to those back braces.

Interviewer: So the key to keeping that healthy is keeping this habit?

Dr. Gari: It’s all about the core muscles absolutely, Pilates.

Interviewer: Right, yeah, very well.

Dr. Gari: You know Pilates, right?

Interviewer: Mm-mmh.

Dr. Gari: Pilates was a physician who started that because he had back problems and he did all those exercises for himself.

Interviewer: All right. It might be time to try some of those. Dr. Gari, thank you very much. Florida Pain Relief Group even schedules same-day appointments. You can visit their website,  or give them a call. It is 844 (KICK-PAIN). We’ll be right back with more Daytime so don’t go away.

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Dr. Rodolfo Gari Talks About Pain After Surgery And The Best Treatments

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Interviewer: If we’re in pain and we get surgery, we expect that to fix the problem, right? Well, sometimes it doesn’t. Dr. Rudy Gari from Florida Pain Relief Group is here to help us figure out what to do next. Welcome back, Dr. Gari.

Dr. Gari: My pleasure.

Interviewer: How often do you have people come through your door and say I’ve had back surgery?

Dr. Gari: Everyday.

Interviewer: Everyday, and some people say they’ve had more than one?

Dr. Gari: I’ve had patients have one, two, three…I’ve had one patient that’s had five back operations.

Interviewer: And are they just at their wit’s end because it’s not helping?

Dr. Gari: Unfortunately. But we actually take a lot of pride in the fact that our specialty pain management, it’s the end of the road, but it’s a nice road to be in because there’s a lot of things that we can do for you. There’s a large majority of the back operations that do very, very well for patients, and the majority of patients do well from back surgery. But there is that select few that it doesn’t do well. And so for example the chances of a successful operation after the first back surgery is somewhere between 70% and 80 plus %.

Interviewer: You’re odds are pretty good.

Dr. Gari: Very good. Second one, maybe 40% to 50%. And the third one you’re dropping down to 15% to 20%.

Interviewer: So more surgery is not an option at this point.

Dr. Gari: It’s not an option because a lot of times by the time you’ve had three back operations, in the majority of situations you should be talking to a physician like myself that specializes in pain management because by that point, unfortunately your pain has pretty much become your illness. So we can find lots of ways to help you without another back operation.

Interviewer: What do you do when somebody comes to you and says I’ve had four operations? Do you get an X-ray to see what’s been done or how do you assess the damage?

Dr. Gari: The first thing I do is to listen very carefully, so we’re gonna get a thorough history. I want to know everything that’s happened. Why did you get the first back operation? Second, third, etc. Second thing I’m gonna do is I’m going to examine that patient. Find out where the pain is and where it’s coming from. A lot of times you can pick up a lot on the examination. For example, I had a patient just a couple of days ago who came in and said he had pain in his elbow. They told him he had tennis elbow. What he really had was a pinched nerve in his neck causing that. So you have to do an examination. I picked it up because he had weakness, loss of sensation, there’s a lot of things you can pick up in the examination. The third thing that I’m gonna do is maybe an X-ray, maybe an MRI, maybe a cat scan, different studies. I want to know exactly where you are after your operations. Once we’ve come across all that we’ll establish a diagnosis and establish a treatment plan, what to do. And over 90% does not involve another back operation.

Interviewer: Isn’t that great? And what percentage involves pills? There are different ways to treat it.

Dr. Gari: Well some patients are gonna need pills, and that could be an anti-inflammatory, it could be a muscle relaxer, it could be an opioid, it could be an anti-depressant, just different things. But we want to minimize your pills. Nerve blocks or sometimes things that are called [inaudible 00:03:09] re-stimulators, which are just little tiny electrodes that we can place in your back to actually take away that pain sensation in your back and your legs and replace it with a much more gentle and much more comfortable sensation.

Interviewer: So basically you give them their freedom back?

Dr. Gari: That’s what we try to do with every patient.

Interviewer: So instead of going for the operation first and foremost, go see Dr. Gari first to see if you even need it in the first place.

Dr. Gari: Absolutely. And we will gladly refer you to a neurosurgeon or a surgeon if we need that or if you want a second opinion.

Interviewer: Okay. Dr. Gari, thank you very much. You can visit their website, floridapainreliefgroup.com to schedule your same-day appointment. Give them a call at 844-KICK-PAIN. We’ll be right back with more Daytime so don’t go away.

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