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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Dr. Rodolfo Gari of Florida Pain Relief Group Talks Treatments for Weather-Related Joint Pain

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Cyndi: I’m sure many of you out there feel pain every single day, but just because you do, it doesn’t mean you can’t have it fixed. Even when it comes to a joint that often hurts, your knees, your hips, you name it. Dr. Rudy Gari from Florida Pain Relief Group joins us now to tell us what can be done about it. Dr. Gari, I think a lot of people at home are going, “That’s me, I’m half pain. When I bend down and do a knee bend, I can hear my knees. Is that normal?

Dr. Gari: No, it’s not normal. It’s something that’s called crepitus.

Cyndi: Crepitus?

Dr. Gari: Crepitus. And crepitus means that you have an inflammatory process, some sort of inflammation going on in those joints. It’s not a normal process. We have to examine and see what’s going on with it.

Cyndi: Can you help?

Dr. Gari: Yeah, absolutely.

Cyndi: Okay, good.

Dr. Gari: Yes, we can.

Cyndi: What about people who get symptoms of aches in their joints when there’s a weather system happening? What is happening there?

Dr. Gari: Well, what’s going on is that, I like to say that my patients are the best weather forecasters because they will tell me when it’s about to rain. Because they can actually sense, their pain increases, because the change in the atmospheric pressure affects the joint pressure that you have. We can sense that. So you know, normally we don’t, but if you have an inflammatory process in your joints anywhere, that becomes magnified significantly when the atmospheric pressure changes. So, humidity and a lot of that really tends to affect people that are in chronic pain a lot.

Cyndi: And you have some really innovative ways to help people with this inflammation, right?

Dr. Gari: Absolutely. What we do is, we first determine what’s going on, what’s causing that inflammation. We wanna get to the root of the problem. You know, what can we do? Sometimes it’s just arthritis, sometimes there may be some sort of a mass that can be removed, sometimes it’s trauma. But most of the times, almost always, it’s some sort of inflammatory process that’s causing that. And we get to that whether it’s through medication, through a pill, through an ointment, through a cream. Sometimes just a simple injection into the joint gets rid of it. Sometimes the joint in and of itself is so arthritic that we have to try to redevelop that joint. And one of the things that we perform as well is called regenerative medicine, where we can actually put stem cells, allografts, very innovative things, that can actually redevelop some of those tissues that you have in your joints.

Cyndi: That’s great. So it’s not necessarily a life sentence, it’s something that can be treated.

Dr. Gari: There’s a lot of exciting things that’s going on in medicine today, and it’s very exciting, what we can do.

Cyndi: What about for people who wake up in the morning with pain and stiffness in their joints, is there anything you can do for that or is it just a matter of getting up and stretching? Or is there more to it than that?

Dr. Gari: Well, the reason why you have joint pains in the morning is because your temperature drops. So when your temperature drops during sleep, and that also causes your joints and so forth to become a lot more stiff. So, when you get up, take a hot shower and so forth, that really increases, and you get less stiff and you have a lot less pain.

Cyndi: What about for people who have nagging, reoccurring pain? Is surgery ever the answer, or not?

Dr. Gari: Well, usually, the answer is no, but sometimes there might be something going on where you need an operation. But most of the times, you don’t need an operation. Most of the times, it could be something like physical therapy, a pill or medication, sometimes a little simple injection. Sometimes, there’s something that’s called the hydraulic membrane which, it’s like a lubrication into your knees that we can inject into your joints that can last several months. Sometimes there’s stem cells, there’s all kinds of different options.

Cyndi: Well, that’s good to hear because I know a lot of people would rather try every option before they have to go under the knife. Dr. Gari, thank you very much. You can contact the Florida Pain Relief Group to schedule your same-day appointment. We’ll be back with more “Daytime,” so don’t go away.

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Dr. Rodolfo Gari Talks Taking Pain Medication: How Much Is Too Much?

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Cyndi: Many of have been there. We go to a doctor for whatever may be ailing us and we walk out with a prescription. Some of you may be taking a long list of medications right now, but how much is too much? Dr. Rudy Gari from Florida Pain Relief Group joins us now to help answer that question. Dr. Gari, great to have you back.

Dr. Gari: My pleasure.

Cyndi: So there are a lot of people right now who are on medications their doctor has prescribed, and they are taking some over-the-counter medications as well. How do they know what’s working?

Dr. Gari: Well, there are many times where they don’t know. And so, for example, there is something in medicine called hyperalgesia, and we see that a lot in pain management. And what that means is that sometimes pain medications in and of itself causes pain, because you’re taking way too much of a medication, your body gets used to it. There are different receptors, and once you have saturated those receptors so much, it becomes counterproductive. So that’s one of the things. We often have to do what’s called an opioid rotation, where we switch the medication from a certain type to a different medication, and a lot of times we can lower it in half and get better pain relief.

Cyndi: Well, is there a test that can be taken to see how effective medicines are for certain people, for certain ailments?

Dr. Gari: Absolutely, and it’s a test that we provide to all of our patients because we believe in that. And it’s called pharmacogenomics. Pharmacogenomics is a very exciting test. I believe that it’s the way of the future and I believe every physician’s office will be offering this. And what it does is that it looks at your unique genetic makeup and how your own body metabolizes those medications. And we’re all different. So that’s the first thing that we do is, you know, you might be taking medications that you had to take 10 times more than you will. And sometimes it’s the reverse. Your body can be very susceptible to medications. For example, codine. We know that the FDA issued a box label warning against hypermetabolizers of codine, because codine gets converted to morphine, and there were actually, like, five kids that died from tonsillectomies.

Cyndi: Taking codine?

Dr. Gari: Just regular codine, normal doses, but they overdosed because their genetic makeup was such that they ended up producing a lot more morphine from the codine than normally would happen.

Cyndi: Do some pills cancel each other out?

Dr. Gari: Yes, yes, absolutely. They do. So we have to look not only at your genetic makeup and how it metabolizes, we have to look at how the medications work on your body and how they interact with each other.

Cyndi: Is there a type of miracle pill out there that can help all pain?

Dr. Gari: I think in the future we’ll have one. Not today, though. No.

Cyndi: So for people who are taking a lot of different medications right now, first of all it’s not healthy, is it, to be mixing all different pills?

Dr. Gari: Well, it’s not good at all, Cyndi. I mean, there are side effects with each medication, and those side effects become exponential, so that if you’re taking three of those pills, the side effects may be like fivefold instead of threefold because they interact with each other, and they counteract each other and they make things worse. So one of the things a doctor has to do, especially if they’re coming in for whatever it may be, we have to look at all of the medications that you’re on and determine which ones you may no longer need, or substitute a different medication for one that you’re taking that works better for you.

Cyndi: So the goal of the Florida Pain Relief Group is to get you off as many of those medications as possible, right?

Dr. Gari: We want to get you to what you were before you started taking the pills, as much as possible.

Cyndi: That is music to a lot of people’s ears. Dr. Gari, thank you very much. You can visit their website,  to schedule your same-day appointment.  Give them a call today. We’ll be right back.

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Dr. Rodolfo Gari Talks Effects of Pain Medications On Your Organs

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Interviewer: There are so many different types of pills out there. Pain pills, vitamins, blood pressure medicine, depression medication, the list goes on and on. There’s a good chance that you probably take a few of those. But have you thought about what they could possibly be doing to your organs? Dr. Rudy Gari from Florida Pain Relief Group is back to shed some light on this. Dr. Gari, great to have you here, and this is a really important topic.

Dr. Gari: Yeah, absolutely it is. And so one of the problems with pain pills is that, if you think about it, when you take a pill through your mouth, it has to travel first to your stomach. It gets absorbed. From there it goes to your liver…90% plus gets broken down, and then it gets spread from head to toe.

Interviewer: Okay, so what if you are taking multiple medications and they’re all going into your liver? What’s that doing to your organs?

Dr. Gari: Well, that can have a significant effect in your organs, especially those… So let’s talk about some of the pain pills. A lot of the pain pills have acetaminophen. Acetaminophen is a very good analgesic, but it wasn’t meant to be taken in very high dosages. So it’s metabolized by the liver, and we know that taking too much acetaminophen can affect your liver. So that’s a big problem with taking pills. We see a lot of that when patients come in. One of the things that we do is we want to give them their medications, but we want the medications to be absorbed right directly to where the problem is.

Interviewer: Yeah.

Dr. Gari: So we like to use some different ointments and creams. For example, if you have low back pain, we might apply some of that right exactly into the back or to the joints to get absorbed through the skin. You don’t have to take this pill that gets to your stomach, liver, and then goes head to toe and only a small fraction gets to the problem area.

Interviewer: Yeah, if you can bypass those organs and keep them as clean as possible, then…

Dr. Gari: Absolutely. So like a perfect example, let’s just take morphine, which is a medication. I can inject a tiny fraction of morphine, let’s say, into your back…maybe one-tenth of a milligram. A half a milligram. That’s actually a lot more powerful than if you take a hundred milligrams of morphine by mouth.

Interviewer: Wow. I don’t know why everyone wouldn’t say, “That’s the better method.”

Dr. Gari: Well, and what happens is when you take a very small portion and you put it to the area that’s painful, that’s the only place that it goes. When you have to take, for a hundred milligrams to get to equal one, you have to take a lot of it and it goes from head to toe. Liver, all your organs get affected that don’t really need to be affected by that medication.

Interviewer: When we see ads on TV, we see pills being advertised, and they are a cure-all for everything. It’s not, right?

Dr. Gari: Well, unfortunately, no it’s not. You know, you all want to take a pill and have it go away. But a lot of times, and what’s exciting now is that we target exactly where that problem area is and go right to it and use the smallest amount of medication necessary to get that taken care of.

Interviewer: How can medication affect you mentally as well as physically?

Dr. Gari: Well, what happens, if you think about it, our bodies and our selves can become dependent. So if you have to take a pill, it almost becomes a reflex.

Interviewer: Right.

Dr. Gari: We don’t want you getting into that habit of having to take pills all the time. So let’s say, like a patch. We can place a patch on you that’s good for seven days. We can do some ointments and creams that you don’t have to worry about taking a pill four times a day. So people get very dependent on that.

Interviewer: And we’ve all heard of people dying because of it too, because of overdosing.

Dr. Gari: And the problem is when you take it, sometimes you become…and we don’t know exactly how it’s going to work. We do a lot of different things like pharmacogenomics to determine your metabolism of that, but still, even with that, there’s side effects.

Interviewer: Okay, Dr. Gari, important stuff here. Thank you very much. Visit their website, to schedule your same-day appointment or you can give them a call.  We’ll be right back with more Daytime, so don’t go away.

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