Dr. Rodolfo Gari Talks What a Rhizotomy Is and How It Can Relieve Joint Pain

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Interviewer: People who are in pain oftentimes don’t go to the doctor because they fear the worst. We all sometimes feel like that, right? But some pain can actually be treated without surgery. Dr. Rudy Gari from Florida Pain Relief Group is back to tell us more. And good to see you, doctor.

Dr. Gari: Good seeing you.

Interviewer: And specifically, we’re talking about something called a rhizotomy. Now, what is a rhizotomy and what does it do?

Dr. Gari: Certainly. So a rhizotomy, basically, what we’re doing is we’re finding ways to deaden the nerves in a permanent way. There are tiny little nerves that give sensation to your joints, and they’re just purely sensory nerve. They don’t do anything else other than just cause you to have pain if you have some sort of inflammatory process, which can happen a lot. So, people, if they have some sort of a chronic inflammatory process through the joints, those nerves are constantly reminding them. What we do is we first make sure that that’s the cause of the pain, and once we’ve diagnosed that, we do something that’s called rhizotomy. And what that does is, we place these needles right into those tiny little nerves. The needle tip heats up and it burns those little nerves off, and that relief can last several months, sometimes up to a year.

Interviewer: So it’s not a permanent relief but it is something that will give you relief for, like you said, a certain amount of time.

Dr. Gari: Yes. Unfortunately, a lot of those tiny little nerves tend to grow back, but I’ve had people who’ve had relief for over a year. And if you have pain on a daily basis, that’s a lifetime.

Interviewer: Yeah, no kidding. And it’s not too much trouble, then, to just come back when the pain flares up again, too?

Dr. Gari: Absolutely. We can repeat this. And the nice thing about it is that this is done through a needle, so we’re not cutting skin, it’s not a permanent operation and it’s a relatively benign procedure. We have a lot of safety measures in check.

Interviewer: So does it hurt at all? You mentioned needle. That’s the first thing I think of, “How much pain is involved to get pain relief?”

Dr. Gari: Yes. No, it’s actually fairly painless. We give a local anesthetic at the skin. We then go ahead and use some intravenous sedatives. And, in fact, just this morning I had four patients that had the rhizotomy done and they went home already.

Interviewer: So what areas does this benefit, primarily? Is it the knee? Is it the shoulder? Can it be any joint?

Dr. Gari: Well, the rhizotomy can occur in just about anywhere. The most common places happens to be at the neck and the lower back. The reason for that, most of the bending takes place at your neck and lower back, so that’s where a lot of the trauma and a lot of the pain comes from.

Interviewer: Now, what makes this kind of a good idea to do as a procedure to relieve the pain, as opposed to other treatments?

Dr. Gari: Well, what happens is, there’s not a whole lot of treatments that are available when you have chronic pain of your joints, for example. It’s usually medications, and those medications have significant side effects. Anti-inflammatories can cause an ulcer, can cause bleeding. You have opioids. We all know about the problems with opiate addiction. So this is an alternative to you having to take medications. Medications are not benign. They’re not mean to be taken on a long-term basis, but people have to take them that way. This is an option so that you don’t have to take these medications long-term.

Interviewer: You know, it’s funny you mentioned that because I know so many people who have their elderly parents actually hooked on opiates, and they don’t even know it. Because that’s what they’re prescribed, that’s what they take. So this is something that’s so much healthier and so much better for you.

Dr. Gari: Absolutely. I had an 81-year-old female today, a very nice lady, that was taking a lot of medications. And the problem with that, if they get a little bit groggy, and they fall and they break a hip, that can be lethal.

Interviewer: Absolutely. All right, Dr. Gari, great information. Now, Florida Pain Relief Group even schedules same-day appointments. Be sure to visit their website, floridapainreliefgroup.com, or give them a call, 844-KICK-PAIN. Simple as that. We’ll be right back.

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Dr. Rodolfo Gari Talks Fibromyalgia: Who Gets It and Treatments

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Interviewer: In some cases, widespread muscle and joint pain can point to fibromyalgia. It will not only affect physical pain, but it can involve mental pain as well. Dr. Rudy Gari from Florida Pain Relief Group joins us now, with some help. Dr. Gari, great to have you here.

Dr. Gari: Thanks a lot.

Interviewer: Let’s talk about what causes fibromyalgia in the first place.

Dr. Gari: Sure. So fibromyalgia, we’re not really sure the exact causes of it, but here’s what we do know. So if you break down the word fibromyalgia, fibro means fibrous, and myalgia means muscle, inflammation of the muscles. What we know is that it tends to affect predominantly women, we’re not really sure why it does, but it does. And it involves a process whereby your fibrous tissues and your muscles combine to cause inflammation, and it can be very debilitating in a lot of people. There’s different things that could be done, we know what can help. For example, we know what makes it worse is usually stress, tension, so the treatment for that is relaxation and techniques to lower that threshold.

Interviewer: Is this really common, among a lot of women in particular, that you see?

Dr. Gari: Yes, it’s very common. We have a lot of patients with fibromyalgia, and the way that we treat them is comprehensively, and that involves relaxation techniques, physical therapy. Sometimes we do these things called trigger point injections, and trigger points are actually like little muscle spasms that can develop in patients with fibromyalgia, throughout your body. It’s a pretty simple technique, we just go in there with a very small needle and break up these little trigger points. We also give them medications to help them relax, and we find that with that comprehensive approach, we can give them their life back.

Interviewer: Yeah, I was going to ask you, what kind of reactions are you getting from patients who you’re helping? Because I’m sure a lot of them, for a long time, they weren’t being diagnosed. And they kept saying, or people might have been saying, “Well, are you depressed?”, and they weren’t getting to the heart of what was wrong with them. So we mentioned physical, how it hurts, but how mentally it can be so hurtful, for so many people. So what are you finding from the people that you’re treating with this?

Dr. Gari: Sure, well one of the things that would happen the last…many years ago, the first thing that we tell them is that this pain is real.

Interviewer: And that’s half the battle for so many people, right?

Dr. Gari: Yes, this pain is real, and sometimes I tell patients that, and they begin to cry.

Interviewer: Yeah, because nobody has listened to them.

Dr. Gari: No, this pain is real, this is real pain. You’re having this pain, it’s not just in your head. You’re feeling this, but the good thing is we can help you with this. And that you’d be…it’s almost as if it’s like tons of weight off their shoulders, that somebody understands what they have and that we can do something about it.

Interviewer: Do you see gentlemen at all with fibromyalgia?

Dr. Gari: We do see men with fibromyalgia, not as common as women, but we treat them the same way. This happens in both, it’s not just unique to women, it also affects men.

Interviewer: So apart from finally having somebody listen to them, and saying “Yes, I’m validating that you’re feeling what you’re feeling,” how quickly can people start to feel some kind of relief?

Dr. Gari: I’ve had patients come into the office with significant pain, mostly from trigger points. We do the trigger point injections right in the office, and they come out a different person. You can just look at their face. I wish I could take a picture of their face before and after. So it can be immediate, but that’s just the immediate treatment of the trigger points. We then go more comprehensive with everything else and make it more long-term.

Interviewer: Well, I know this is really encouraging news for a lot of people that are watching right now because fibromyalgia does affect a lot of people, and they’re looking for help. Dr. Gari, thank you very much for joining us today. Florida Pain Relief Group even schedules same day appointments. Be sure to visit their website, floridapainreliefgroup.com, or give them a call right now 844-KICK-PAIN. Doctor, thank you again. We’ll be right back.

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Dr. Rodolfo Gari Discusses What Regenerative Medicine Is and How It Can Relieve Your Pain

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Jerry: Those of you who suffer from pain know that it can be extraordinarily debilitating, but imagine if you’re able to beat that through a minimally invasive procedure and still remain active. Dr. Rudy Gari from Florida Pain Relief Group joins us now to tell us how. Okay, this is gonna be music to so many people’s ears who are out there. And by the way, including mine, because I suffer from terrible arthritic pain in both my knee and my foot. And we’re not gonna make this all about me, we want it to be all about what this almost miracle treatment is that you’re offering. How are you, first of all?

Dr. Rudy Gari: Doing great, Jerry.

Jerry: How about that lead in, huh? That was quite a build-up.

Dr. Gari: That was great, Thank you very much.

Jerry: Of course. Let’s talk about what you do. I mean, we’re talking about regenerative medicine. Tell us exactly what that is.

Dr. Gari: Well, Jerry, regenerative medicine is actually one of the most exciting fields in medicine today. And so people talk about minimally invasive procedures. Pain management physicians, like myself, anesthesiologists, have been doing minimally invasive procedures before those words became common. And what that is, essentially is, what can we do short of surgery? In fact, 99% of what we do there is actually no cutting of the skin. It’s just an injection.

Jerry: Okay, injection of?

Dr. Gari: Injection of something that is gonna help you, and that kind of leads into regenerative medicine. So regenerative medicine is actually using your own body’s stem cells to regenerate your own tissues. So we’ve seen lots of stuff, for example, we can regenerate organs or we can also regenerate a lot of our own tissues. And some people hear stem cells, we still have stem cells. We just don’t have the same amount of stem cells that we had when we were babies. So as we get older, we have less stem cells. So regenerative medicine is, for example, through some things called allographs. And they are actually amniotic membrane that has been reconstituted, and it has these factors called stem cell retruding factors. What that does is we apply that with a needle, with an injection, into your joint, your back, or wherever it might be. It actually tells your body, “Hey, I need to have this fixed.”

Jerry: That’s great. So we’re talking about how many injections before you start feeling much better?

Dr. Gari: Well, it actually takes a while because remember your body is going to have to heal. So it’s anywhere from two to three different injections.

Jerry: Over a period of time?

Dr. Gari: Over a period of time, because this is not like anything foreign implanted. This is your body regenerating itself.

Jerry: What are we talking about in terms of down time?

Dr. Gari: There’s not a whole lot of down time. There might be like a little burning, something like that, because there’s a little inflammatory process that takes place while your body’s trying to heal. But in fact, one of the people that work with us actually had regenerative medicine in his knee and climbed Mt. Kilimanjaro a week later.

Jerry: A week later? Sign me up for this stuff. Okay, any pain at the site of the injection when it happens?

Dr. Gari: There’s a little burning, a little uncomfortable, for like a day or two, but that goes away. It’s an inflammatory process because your body is busy trying to heal itself.

Jerry: Okay. So why isn’t everybody doing this, and should they be?

Dr. Gari: Well, a lot of people are doing this. It’s a new science, we’re very excited at Florida Pain Relief Group because we have experts in that field, and it’s becoming more and more and more. This is the wave of the future.

Jerry: Excellent. Dr. Rudy Gari, thank you so much. Florida Pain Relief Group even schedules same day appointments. Be sure to visit their website floridapainreliefgroup.com, or call 844-KICK-PAIN. That’s easy enough. Thanks so much, doctor.

Dr. Gari: Jerry, it’s my pleasure.

Jerry: Nice to see you. We’ll be back with more Daytime right after this.

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Dr. Rodolfo Gari Discusses Prescription Drug Alternatives

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Host: As many of you know, prescription drugs can help mask pain and it’s just for the now, but they are never the answer for fixing the problem long term. Dr. Rudy Gari from Florida Pain Relief Group wants to help us with an alternative. Welcome back Dr. Gari, nice to see you.

Dr. Gari: Nice seeing you.

Host: Now, when you work in the field of pain relief you must see a lot of people on an everyday basis coming in who have been on many, many prescription drugs for a very long time, because they’re in such pain. What do you say to these people when they come into your office?

Dr. Gari: Well, the first thing we tell them is this is not the only option. There’s a lot of things that we can do for you, and medications, especially prescription medications that can have some significant side effects, we have to make sure, number one, is it the right medication that you’re taking? So one of the first things that we do is we perform a test called pharmacogenomics. Pharmacogenomics is using your own genetic makeup to make sure that that medication that you have is the right medication for you. So we may adjust it, and what we’re looking for is something that’s going to reduce the side effects, but give you better pain relief. Now, it’s a several step process. The other thing we’re going to do is we’re going to diagnose you. We’re going to figure out exactly what’s wrong with you, because the medications are often treating the symptoms. So we want to get right to the source, you know, what is it that’s causing that pain? And there’s a lot of things that we can do for that.

Host: Okay, so you’re looking at, in terms of side effects, I mean, addiction is one of the most obvious side effects. So, what kind of pain relief management can you offer people who are in so much pain and on drugs?

Dr. Gari: Okay, so the first thing that we need to differentiate is drug addiction and drug dependence. Okay, so let me give an example. Drug addiction, when a patient is addicted to drugs like opioids, or narcotics as they call them, when we give them medication like an opioid, the level of function decreases. When a patient is dependent on their medication and we give an opioid, the level of function increases. So here’s an analogy. Let’s just say they have high blood pressure. You are dependent on your high blood pressure medication. So what we know for a fact is that if you are in serious pain, and you’re taking medication for that pain, the risk of addiction is actually quite minimal. So we have to separate those, so that sometimes we have patients that have both. They have problems with pain, and they also may have a problem with addiction, and we treat both of them.

Host: What other potential harmful effects are there for people on certain prescription drugs, and how do you help them?

Dr. Gari: Okay, certainly for…well the main thing is a lot of patients unfortunately have a lot of psychosocial problems because…

Host: Psychosocial?

Dr. Gari: Psychosocial, meaning that, you know, it’s not just them, it’s the entire family that’s involved. So I talk to the family.

Host: So co-dependence, etc.

Dr. Gari: Yes, and sometimes the family doesn’t understand what’s going on. So we go over what’s causing the pain, what medication are we taking? Can we change some of the medication, something that might work better for you? Can we perform certain procedures that’s going to lower your dependence on these medications?

Host: And perhaps save their lives?

Dr. Gari: Yes, yes, absolutely, and some of the biggest gratification is we have these patients that come in, they’re depressed. Their families don’t understand. We talk to the family, tell them what’s going on, we help them out, and we like to give them their life back.

Host: Boy, that’s…and you know, giving somebody their life back after they’ve been on so many mind-altering drugs for so long must be the greatest gift in the world.

Dr. Gari: There’s nothing more gratifying to me than doing just that.

Host: Well, keep up the good work Dr. Gari, and Florida Pain Relief Group even schedules same day appointments, so be sure to visit their website, floridapainreliefgroup.com, or give a call 844-KICK-PAIN, and we’ll be right back with more Daytime right after this.

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Dr. Rodolfo Gari Talks About Pinched Nerves, Back Pain and Exercises to Help

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Cindy: Everyone experiences back pain at some point in their life, whether it be strained muscles, a pinched nerve, or something much more serious. Dr. Rudy Gari from Florida Pain Relief joins us now to talk about why it happens and what we can do to stop it. Hi, Dr. Gari.

Dr. Gari: Hi Cindy, how are you?

Cindy: I’m well and thankfully pain-free right now, but I’ve had back pain and I think everybody that’s watching right now at some point in their lives has had it if they’re not having it right now. What can we do, first of all, to prevent this back pain?

Dr. Gari: Well the first thing that you can do is to make sure that your core muscles are intact. One of the biggest reasons for problems with back pain is that as we get older, our muscles and our core tends to loosen up, and those are really the protectors, and when they loosen up, it gets everything else loose and allows you to maybe twist the wrong way for you to get hurt.

Cindy: Yeah, I’ve done that.

Dr. Gari: Yeah.

Cindy: What about pinched nerves? We hear about that a lot. What can your organization do to help people who have pinched a nerve in their back?

Dr. Gari: A pinched nerve is actually a nerve that’s inflamed. What we can do is first identify exactly which nerve it is. Then if it doesn’t go away with typical physical therapy, medication, and so forth, very mild, we can go ahead and put some medication right exactly into that nerve with a very local anesthetic and something to take away the inflammation. If we take the inflammation, that pain goes away.

Cindy: Because a lot of times when people have back pain, it prevents them from doing any kind of activity, and then that’s a ripple effect for their whole health, isn’t it?

Dr. Gari: Absolutely, because if you think about it, your back is the core of your locomotion. You can’t walk, you can’t do anything, you can’t bend. It’s debilitating.

Cindy: Yeah, it can affect every aspect of your life.

Dr. Gari: Absolutely.

Cindy: What’s the most common back pain people come in complaining of?

Dr. Gari: The most common that we see is either some sort of a strain, or it’s some sort of a herniated disk, which is actually where your spine consists of the 31 different vertebrae, like bones, that hold us up, and there are these little shock absorbers in between. That little shock absorber gel, if it protrudes out it can hit a nerve, cause inflammation, and that can be very debilitating.

Cindy: What’s the option for somebody with a herniated disk? My mom had that.

Dr. Gari: Yeah, the option is to see if it goes away with physical therapy and just rest. If it doesn’t, then before you go and get operated, we can go in right like we talked about earlier, go in and take care of that inflamed nerve. It’s an outpatient procedure.

Cindy: Great.

Dr. Gari: Take away and reduce the inflammation, allow you to get back on your feet again, and eventually that inflammation goes away so that we can try to avoid you from getting surgery.

Cindy: Isn’t that nice? A lot of people will be happy to hear about that. What can people do at home and how can exercise play a role in really protecting our backs and preventing damage?

Dr. Gari: The exercise that you can do is, again, core exercises, especially your abdominal area. Want to make sure that you find ways not to have more extra pounds than you need to. You have to be careful with your exercises because you don’t want to hurt yourself either.

Cindy: Right.

Dr. Gari: But anything that strengthens your abdominal area and your back muscles, that’s the first line of defense before it ends up hitting your spine, which is where some of the problems tend to occur.

Cindy: What about yoga and Pilates? Do you think those are good?

Dr. Gari: Those are very good, absolutely. Stretching, and that all causes a lot of core exercises, yoga and Pilates. They’re very good. In fact, Pilates was actually started by a doctor, Dr. Pilate.

Cindy: Yes, of course.

Dr. Gari: Yes, and Dr. Pilate started this Pilates exercises because he suffers from back pain.

Cindy: See?

Dr. Gari: And he wanted to actually find some exercises where he could actually treat himself, and he treated himself with Pilate exercises.

Cindy: All right, well Dr. Gari, thank you very much. For relief of any kind of pain, you can make the same day appointment today at Florida Pain Relief. Be sure to visit their website, FloridaPainRelief.com, or give them a call. 844-KICK-PAIN. We’ll be right back.

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Dr. Rodolfo Gari of Florida Pain Relief Group Talks Hip and Knee Pain in Women

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Cyndi Edwards: Hip and knee pain are feelings that many people know all too well. Dr. Rudy Gari from Florida Pain Relief Group, joins us today to talk about what could be causing this and how you can treat it. Dr. Gari, welcome back to Daytime.

Dr. Gari: Thank you. Thank you.

Cyndi Edwards: Let’s talk about hip pain in women in particular. What are the main causes of that?

Dr. Gari: Okay, well hip pain results from pain in your joints. So our bodies consist of joints everywhere. Now what’s unique about the hip and the knees, is they tend to be much larger joints. And if you can think about that, your hips is where most of your weight is carried. So in women or men, what causes that is basically inflammation.

Cyndi Edwards: Okay.

Dr. Gari: So you can get inflammation at the joint. Sometimes the inflammation could be caused by injuries, whether it’s the tendon or the capsule around there. But basically, it’s some sort of inflammatory process that causes that. It could be arthritis. It could be just all kinds of causes.

Cyndi Edwards: Okay. So there’s a correlation right, between weight gain and hip pain?

Dr. Gari: Absolutely. So like what we discussed earlier, was the fact that the weight is carried there. So the more weight that you have, the more in pain you’re gonna be. Just try to imagine trying to carry a 30-pound dumbbell.

Cyndi Edwards: Yeah, no thanks. Can you relieve that pain? How can you do that?

Dr. Gari: Absolutely.

Cyndi Edwards: Without getting a hip replacement?

Dr. Gari: Sure. So a lot of people have heard of, you know, Motrin, Advil. Those are all what’s called NSAIDs, they’re non-steroid anti-inflammatory drugs.

Cyndi Edwards. Yeah.

Dr. Gari: So basically it’s to reduce inflammation, so you take a pill for that. The problem with that pill is that all it has to go into your stomach, right?

Cyndi Edwards: Mm-hmm.

Dr. Gari: And then a very small percentage travels into the blood, and then an even smaller percentage of that goes to the actual joint.

Cyndi Edwards: Right. So how do we get to the joint without actually cutting you open and going to the joint?

Dr. Gari: So what we do at Florida Pain Relief Group, is we can actually go ahead and visualize that joint. We give you a sedative and a local anesthetic. And using image guidance, we can place a needle right into that joint and place the medication there to reduce the inflammation. There’s also other types of treatments. So for example, we have this treatment that’s kind of like a lubricant that can last months.

Cyndi Edwards: Oh, great.

Dr. Gari: That can lubricate your joint. We even have regenerative medicine, that’s been fantastic. So what that does is, there are these things called allografts for example. And the allografts are this material that we use that helps your own body’s stem cells…

Cyndi Edwards: Regenerate?

Dr. Gari: …concentrate…

Cyndi Edwards: Oh.

Dr. Gari: …and regenerate your own damage that you have in those joints. So that it’s your own body healing itself.

Cyndi Edwards: Oh, love the sound of that. And so I suppose, just like the hip you can do the same for the knee. I have to ask about shingles, because we’re hearing a lot about that lately. A very painful affliction. How can you help people that come in with shingles?

Dr. Gari: Sure. So shingles is a very common occurrence, especially as we get older. And what shingles is, it’s actually a recurrence of the chickenpox.

Cyndi Edwards: Right.

Dr. Gari: So the chicken pox virus never goes away, it lives in us in a dormant state. And then something happens that triggers that to express again.

Cyndi Edwards: Right.

Dr. Gari: What happens is that the virus, when it expresses, it travels through your nerves. And that’s why you see it in like a certain distribution.

Cyndi Edwards: Yeah.

Dr. Gari: And as it travels, it just causes major havoc…

Cyndi Edwards: Can you do something for that…

Dr. Gari: ….in your nerves.

Cyndi Edwards: pain really quickly?

Dr. Gari: Yes we can.

Cyndi Edwards: Thank you, very good. But get the vaccine too, if you can.

Dr. Gari: Yes.

Cyndi Edwards: Dr. Gari, appreciate you coming in. If you want relief from any kind of pain, you can make a same-day appointment at Florida Pain Relief Group. Be sure to visit their website floridapainreliefgroup.com or give them a call: 844-KICK-PAIN. We’ll be right back.

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Dr. Rodolfo Gari Talks Neck & Shoulder Pain And Its Causes

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Interviewer: We all know that stress can wreak havoc on our bodies, with the problem area often being the neck and shoulders. Dr. Rudy Gari from Florida Pain Relief is back now to tell us how we can treat it. And you know doctor, I’ll tell you what, I know so many people that complain about these very same issues, the neck and the shoulder. A lot of people have this, don’t they?

Dr. Gari: Absolutely.

Interviewer: Yeah. So let’s talk about specifically neck pain. What causes it primarily?

Dr. Gari: Okay. Well, neck pain is caused by many different factors. It could be something as really benign as just tension, which you get tension, you get spasms around your shoulders. Yeah. It causes a lot of stress, a lot of tension in your neck, headaches. It could be something a lot more involved, like it could be a herniated disc and your cervical spine.

Interviewer: So now, is stress primarily associated with the neck and the shoulder pain that a lot of us experience?

Dr. Gari: Well, the shoulder and neck pain that you get from stress is a symptom of stress. So what happens when you get stressed is your body gets really tense. What it does is your muscles in your neck area contract. It goes into spasms. There are these things called trigger points that are almost like very many, little, tiny like very painful areas. And we can treat that. We can treat that very simply with just different medications. Sometimes just injecting a very small injection right into the muscle can just take it away. I’ve seen people come in, in tears, literally tears, because…

Interviewer: Oh wow, because they have such relief.

Dr. Gari: Well, because they’re miserable and… They’re miserable and then…

Interviewer: Oh coming in but then they’re crying tears of joy.

Dr. Gari: That’s right, and then it’s almost like tears of joy because, “Oh my God, I don’t have any pain anymore,” and it was just something very basic.

Interviewer: Absolutely. You know, so I’m coming to you, let’s say, and I’m coming to you with neck and with shoulder pain and maybe some pain in my upper thoracic and my back. What do you do? What’s the process? Explain.

Dr. Gari: Okay. So the first I’m gonna do is take a thorough history.

Interviewer: Okay.

Dr. Gari: I’m gonna take a history and find out what led to that. The next thing that I’m gonna do is perform a very thorough physical examination. After that, based on those findings, I might send you for some diagnostic studies. And it could be something like nerve conduction studies, EMG, basically just to find out if you have a pinched nerve.

Interviewer: Okay.

Dr. Gari: I may send you for some x-rays, MRI to see if you have a herniated disc. Just want to make sure that you don’t have anything a lot more involved that we should be treating other than just typical tension and neck pain.

Interviewer: Sure. So it really varies depending on, yeah, each person.

Dr. Gari: It varies and each person is different. The way that we like to treat you is to treat you as a person. We’re gonna take care of you as a person. Find out what you have and then tailor that treatment plan according, exactly, to your needs and to your situation.

Interviewer: So you have a specific plan for each person depending on the pain that they’re having?

Dr. Gari: Absolutely, yeah. It has to be tailored uniquely to the patient’s symptoms, history, examination findings.

Interviewer: Sure. Let’s talk about some exercises people can do to alleviate the pain we’re talking about, the neck and the shoulders specifically.

Dr. Gari: Okay. Well, some of the exercises are very basic. Sometimes if you just kind of touch your neck area, you feel like a lump there. That lump is actually your muscles completely contracted. And sometimes even just like massage therapy…

Interviewer: Yeah.

Dr. Gari: …you know how it feels so good because you relax that and that muscle, it’s no longer tense and the relief goes away. The problem is it doesn’t always go away from them. And that’s where we can get a little more involved.

Interviewer: Yeah.

Dr. Gari: But something very basic like that can just help out, just the massaging of that little knot that you have does a lot.

Interviewer: Fantastic, Dr. Gari, appreciate it. Now you can make same-day appointments with this guy and so be sure to visit their website, floridapainrelief.com or give a call 844-KICK-PAIN. That’s what he does. We’ll be right back. Thanks so much, Dr. Gari.

Dr. Gari: Thank you.

Interviewer: Thank you.

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Dr. Rodolfo Gari of Florida Pain Relief Group Talks Chronic Pain and How It Can Be Treated

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Interviewer: We hear the term chronic pain all too often. It’s a common problem, but what exactly is it? Dr. Rudy Gari from Florida Pain Relief Group joins us now to help. Dr. Gari, good to have you here.

Dr. Gari: My pleasure.

Interviewer: And unfortunately, over a billion people worldwide have chronic pain. So what exactly does that mean?

Dr. Gari: So chronic pain refers to pain that continues when it should have been gone. So for example, you sustain an injury and we know typically, the pain from that injury should be gone in about two weeks or more or less, whatever that might be. Well, maybe it’s three weeks, four weeks, and it lasts longer. That pain now becomes chronic and there are actually some patients that they’ve had pains for so long, so many months, so many years, where the pain, in and of itself, now becomes a disease. So now, you have an illness which is pain. Pain should be a symptom not an illness.

Interviewer: And that becomes their norm. That’s their everyday life.

Dr. Gari: That becomes their norm. It becomes…

Interviewer: They forget what feeling good feels like.

Dr. Gari: Sometimes you have patients that, you know, that are in chronic pain for years and it no different than if you have diabetes of high blood pressure.

Interviewer: Okay. So you see people like these I’m sure every day.

Dr. Gari: Every single day.

Interviewer: So what can you do for somebody who comes in and says, “Like I’ve had this pain for a lot longer than two weeks.”

Dr. Gari: So the first thing that we wanna do is we wanna cure that. So you know the field that I’m in is called Pain Management. I’d love it if it could be called Pain Curer. There are many things we can cure pain but unfortunately a lot of times, we have to find ways to get patients to live their life again through different means. So the first thing we wanna do is we wanna make sure, is this something that we can cure? So we have to make a diagnosis. We have to be physicians, we have to listen to that patient, look at all the medical records, perform an examination in the laboratory, whatever it takes. And there are actually some chronic pain that we have been able to successfully treat where it goes away.

Interviewer: I know a lot of people are on some kind of pain pill, opiates and I’m sure there are some doctors out there who say, “This is the only thing that’s going to help you cut through this pain.” You don’t believe that, right?

Dr. Gari: No. I don’t believe that. There are patients that are gonna need opioids, there’s no question about it. But if we can take that patient and instead of that patient taking 100 milligrams of morphine or, you know, per day, if we can reduce that to 30 milligrams a day, a two-thirds reduction in the amount of medication that you need to function, that is a significant and major improvement and we do that through different ways.

Interviewer: Well, we hear people overdosing on pain pills every single day. So obviously cutting back as much as possible is what you’re trying to aim for here. So let’s talk about different ways to manage pain. If it’s not popping a pill, what other things can you do?

Dr. Gari: So we have a tremendous toolbox for taking care of someone’s pain other than pain pills. A lot things that we do… So if you think about pain, pain is mediated by nerves. So there’s a thing called nerve blocks. We do a lot of those and because we wanna stop the pain transmission before you can feel that pain. So different types of nerve blocks, they are just typical injections done outpatient procedures. We give sedatives to relax you. Do those nerve blocks and we’ve had much success. I’ve been doing this for over 25 years, and we can help those patients by those types of nerve blocks where their pain drops from a very high level to a very low level and take a lot less pain medication than they were taking before.

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Dr. Rodolfo Gari of Florida Pain Relief Group Talks How Failed Back Surgery Syndrome Works

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Cyndi: Anyone who suffers from chronic back pain knows they’ll try anything to get relief. Well, sometimes that means undergoing surgery. But what if that doesn’t actually work? Failed back surgery syndrome can sometimes be a result, and avoiding surgery is an important measure to stamping out FBSS. Dr. Rudy Gari is here from Florida Pain Relief Group to talk more about this, FBSS, Failed Back Surgery Syndrome.

Dr. Gari: Yes.

Cyndi: Okay. How common is it to see this?

Dr. Gari: It’s very common. So we have great neurosurgeons, they do fantastic work, but unfortunately, you know, it’s not 100%. And so we have some patients that, despite a great surgical procedure, the patient continues to have back pain afterwards. So we actually get a lot of referrals from our surgeons when they’ve done everything possible that they can and they still have that back pain.

Cyndi: Are there certain people, in particular, that are more prone to this?

Dr. Gari: That can really happen to just about anybody. The more surgeries that you have, it makes more sense, the more likely that you are… Because the first surgery has a high success rate, the second one is less, and the third one’s even less. So yes, our surgeons do everything that they can, but unfortunately there are some patients that, despite that, they still continue with pain. And that’s where we come in and we can help out.

Cyndi: I imagine, after going through all that, these patients that are coming to you are at their wit’s end because they’ve tried. They’ve gone through major surgery, and they still have pain. So what can you do for them?

Dr. Gari: Sure. So we can do a lot of things for ’em. The first thing we do is perform a thorough history and physical examination and see what’s going on, make sure there’s nothing else that we can do from a surgical point of view. After that, that’s medications. We can do nerve blocks, physical therapy, spinal cord stimulation, stem cell therapy. There’s a lot of different tools that we can have, and we learn more and more every day. It can be pretty debilitating. I’ve had some patients say, “Doc, I just wanna be able to go to the mall and go shopping. I mean, things that we take for granted, they can’t do that. But we can help them, and sometimes that’s a success, is different treatments to allow you to go shopping, to go do grocery shopping, you know, those kind of things.

Cyndi: Does it require a lot of visits to you to get this relief, or is it something that takes time because everyone wants it fixed, you know, yesterday? But obviously you have to assess what the matter is first and then start with the treatment. But is it ongoing treatment usually, or is it a treatment that’s one time and then you’re good?

Dr. Gari: It’s both. So we have some patients that all that they need is, perhaps, you know, two or three nerve blocks and physical therapy and then they’re good. And then, if they aggravate their back again, they come see us. We have other patients where, you know, they just have a lot of damage. They have a lot of scar tissue and different things where they do require more visits from us.

Cyndi: I hear a lot about people who have pain due to scar tissue. Why does that cause so much pain?

Dr. Gari: So what happens is that a scar can form around the nerve, so that nerve is constantly being squeezed. We actually have a procedure that’s called epidurolysis, and what that does is, is that we can actually go in and try to remove, if not loosen up, that scar tissue. And we do that without surgery. We do it through a needle and then a little bit of a catheter. We can go in there and try to loosen that scar tissue.

Cyndi: And that relieves that nerve.

Dr. Gari: Yes.

Cyndi: Ah, and stops the pinching.

Dr. Gari: It’s that squeezing on the nerves by the scar tissue that is formed around it.

Cyndi: Oh, sounds like some really good advice and good news for a lot of people that are out there right now that are going through this because they may think there’s nowhere else to turn. But there is, definitely.

Dr. Gari: Yes, there is.

Cyndi: Thank you, Dr. Gari. Florida Pain Relief Group even offers a same day appointment, so you can visit their website. It is floridapainreliefgroup.com, or give them a call right now, 844-KICK-PAIN. Dr. Rudy Gari, thanks again.

Dr. Gari: My pleasure.

Cyndi: We’ll be right back.

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Dr. Abraham Rivera of Florida Pain Relief Group Talks Best Ways to Handle Foot Pain

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Interviewer: Not many body parts get beat up as much as our feet. Bone spurs, bunions, gout, none of this sounds pleasant. Dr. Abraham Rivera from Florida Pain Relief Group joins us now with ways we can fix these problems, and more. Dr. Rivera, good to have you back on Daytime.

Dr. Rivera: Thank you.

Interviewer: I’m happy to say I’ve never had a bone spur, but I’ve heard they’re horrible. Tell us what exactly is a bone spur and how can you help somebody fix that.

Dr. Rivera: The foot is a very complicated structure. It works, at the end of the day, like a bow and arrow. You have a surface that is made out of a tendon, which would be tantamount to the string on the bow and arrow. And you have bones that are bent, and the string keeps them bent. The places where the string attaches to the bones can grow bone spurs, and those can be very painful, especially when you put traction on that string, on that plantar fascia, which is the bottom of the foot.

Interviewer: What happened? Did the string let go or something? Is that why the bone spurs?

Dr. Rivera: The string is awfully hard so it doesn’t let go, but the string is constantly pulling on those bones. It’s kind of like you have a rope glued to a piece of drywall and you keep pulling on it. Eventually, the drywall kind of sticks out and protrudes out. That’s what happened. The bone spur grows out of the bone, literally. It causes pain every time you press on it and so forth.

Interviewer: What can you do to help somebody that has that?

Dr. Rivera: The first step, as I always tell my patients, is prevention. How’d you get here in the first place? Shoe wear.

Interviewer: Shoes, yeah. Bad shoes?

Dr. Rivera: I hate to tell you.

Interviewer: You’re looking down at my feet right now.

Dr. Rivera: You know, those things were not meant for walking around.

Interviewer: They’re not meant for human beings at all. They really aren’t.

Dr. Rivera: Correct, correct. They’re meant for TV anchors.

Interviewer: Exactly. And since you’re sitting, you’re fine.

Dr. Rivera: Adequate shoe wear. You have to have adequate arch support. And there’s a whole industry built around these things, from arch supports to orthopedic shoes. Truthfully, at the end of the day, go see your cobbler. It’ll cost you very little, and he will make you an arch support that really works in just about all the shoe wear you have, and get you the comfortable shoes that you really should be wearing.

Interviewer: Should be, definitely. Put vanity aside. Let’s talk about bunions.

Dr. Rivera: That is [inaudible 00:02:14].

Interviewer: Is that just because of shoes, or are some people predisposed to have bunions?

Dr. Rivera: Both of them are true. The first thing is ,yes, some people are more predisposed than others. But if you want to get one, buy pointy shoes. Absolutely, guarantee that will get you there.

Interviewer: So, you keep crunching those toes together, it causes the bone to stick out.

Dr. Rivera: Correct. It will. There’s only one way that can possibly happen, it’s pointy shoes.

Interviewer: Is there a topical cream that can help that, or do you need to have surgery to get that shaved down?

Dr. Rivera: Actually, you’d be surprised. Many times, again, by changing the shoe wear, taking the proper care of your feet, many of these things do not need surgery. Topical creams can be part of it, anti-inflammatory medication can be part of it, or we sometimes can inject the joints themselves.

Interviewer: What about gout? Because that’s really painful.

Dr. Rivera: Whole different monster. Now you’re dealing with a metabolic disease in which a patient doesn’t process well a substance called uric acid. This substance dissolves very poorly in the liquid of the joints. And for some reason, it prefers that big toe joint. When it does that, it becomes exquisitely painful. Patients describe to me that the sheets on their bed touching their feet drives them crazy.

Interviewer: Can you give people relief from that?

Dr. Rivera: Yes. We give them medications that decreases the amount of uric acid. Also, we can inject the joints to alleviate the acute pain. But finally, at the end of the day, we need to address the metabolic issue, the, “Why is it that this person is making so much uric acid?” Believe it or not, staying away from the food that contains that is cardinal on it. These people have to be on a diet.

Interviewer: There is relief out there. Dr. Rivera, thank you very much. You can even schedule a same-day appointment. Visit their website. It is floridapainreliefgroup.com. Or give them a call at (844) KICK-PAIN. Get relief today. Thank you again, doc.

Dr. Rivera: You’re welcome.

Interviewer: We’ll be right back.

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