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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.

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, 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.