Make Pain a Thing of the Past – management – Physician Partners of America

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Facet Joint Arthritis – A Common Cause of Low Back and Neck Pain

What is Facet Joint Arthritis?

Facet joint arthritis is a very common cause of low back and neck pain in adults.  It is a condition in which the small joints, called facets, in the back of the spine become arthritic and painful, similar to the way arthritis in the knee or hip is painful. Facet joint arthritis is also known as facet arthropathy or spondylosis.

What are Facet Joints?

Facet joints connect the vertebral bodies, or bones, in the spine to one another and help keep the spine stable with normal movement. Facet joints are lined with cartilage, contain a small amount of joint fluid, and are encased in a joint capsule. There is a pair of facet joints at each level, and they are named for the vertebral bodies they connect. For example, the L4/5 facet joints connect the lumbar 4 and lumbar 5 vertebral bodies.

How does Facet Joint Arthritis develop?

Each facet joint is lined with cartilage, and over time the cartilage may thin and wear out. As a result, the joint will become inflamed and develop bone spurs, enlarging the joint.  This is also called facet joint hypertrophy. These changes can be due to a variety of factors, but typically anything that puts greater strain on the facet joint over time, such as manual labor, obesity, lack of exercise and deconditioning, will lead to degenerative changes in the joint. Genetic factors may also play a role even in the absence of these factors.

Where does Facet Joint Arthritis occur?

Facet joint arthritis commonly occurs in the low back or lumbar spine. It also occurs in the neck, or cervical spine, and to a lesser extent in the upper back, or thoracic spine. The lower lumbar facet joints, such as L3/4, L4/5, and L5/S1, are the most common location of facet arthritis because they carry the greatest weight compared to other areas of the spine.

What are the symptoms of Facet Joint Arthritis?

In the lumbar spine, the symptoms are typically lower back pain, which may be accompanied by radiation of the pain to the buttocks or the back of the thighs. In the cervical spine, the symptoms are typically neck pain, which may be accompanied by radiation to the shoulders, upper back or to the back of the head. Leaning back and rotating the spine typically worsens the pain. Decreased spinal flexibility and muscle spasm frequently accompany the pain.

How do you diagnose Facet Joint Arthritis?

A proper history and physical exam may suggest facet arthritis. X-ray, CT scan or MRI may confirm the presence of arthritis; however, facet joint arthritis is just one potential cause of low back or neck pain. If interventional treatments are planned, diagnostic injections with local anesthetic are required to confirm that the source of the pain is the facets.

What are the initial treatment options for Facet Joint Arthritis pain?

Anti-inflammatory pain medications, muscle relaxers or other pain medications, activity modification, weight loss, physical therapy, and regular exercise all may be helpful at reducing pain.

What are the options if conservative treatments fail?

Because back and neck pain may have multiple causes, first one must confirm that the facet joints are the source of pain. To determine if the facet joints are causing pain, a diagnostic injection of local anesthetic can be performed, either into the facet joint, or around the nerves that sense pain in the facet joint. These nerves are called the medial branch nerves. If pain is reduced by this diagnostic injection, then a procedure called a rhizotomy is performed. A rhizotomy uses radiofrequency energy to heat the facet joint nerves so that they can no longer sense pain. In cases where an enlarged arthritic facet joint is causing nerve compression or spinal stenosis, referral to a spine surgeon may be indicated.

How do you keep Facet Joint Arthritis pain from returning?

Intermittent flare-ups are common with chronic back and neck pain. The best long-term pain management strategy consists of regularly participating in exercises that restore spine health and stability. With the assistance of a Physical Therapist, participating in a home exercise program that focuses on increasing strength, endurance and flexibility will be the best defense against chronic pain.

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Dr. Abraham Rivera Discusses Spinal Stenosis

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

Download article here or pick up on newsstands now!

Pain Free Living September 2017 Article by Dr Rivera

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Gari: Thank you.

Host: There’s something called causalgia?

Dr. Gari: Yes.

Host: What in the world is that?

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

 

 

Host: All right.

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

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

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

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

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

Host: Really?

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

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

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

Host: Okay.

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

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

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

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

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

Host: Oh, isn’t that great?

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

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

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Dr. Rodolfo Gari Talks 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 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 Pain Relief Myths: Pills, Patches & What Works

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Interviewer: We see ads all the time for magic creams and patches for pain relief. There are so many ways that claim to treat pain, between pills, patches, injections, lotions. So how do we know what actually works? Dr. Rudy Gary from Florida Pain Relief Group joins us now to help us figure it all out. Dr. Gary, welcome back.

Dr. Gary: Thank you.

Interviewer: Now, how do we know if these things really work?

Dr. Gary: Well, the best answer to that is to find out exactly what that is. You know, you hear it on the radio, you know, these cure-alls.

Interviewer: Yeah, call now.

Dr. Gary: Yeah, unfortunately, sometimes some of those are just kind of like a placebo effect. You know, it may be just aspirin could be in there. Is it gonna help? Yeah, it’s going to help you. We can probably just give you just about any patch, and one-third of the patients are going to react positively. The problem is it doesn’t last long.

Interviewer: Right.

Dr. Gary: What we have to do is you have to go see a real physician, somebody what went to medical school, studied anatomy and physiology, pharmacology, and is going to establish a diagnosis on you, is going to treat you as a patient, is going to listen to what is wrong with you, actually perform a physical examination, laboratory examinations, radiology, find out what the problem is, make a determination of how that affects you, and then get a plan in place, whether it’s a pill, a patch, an injection, whatever it may be, and target that area.

Interviewer: Well, let’s talk about some of those options out there, because what would be the best way to alleviate pain? Would it be a pill, would it be a patch, an injection, a cream? I mean, there are so many choices?

Dr. Gary: So the answer is it depends.

Interviewer: Yeah.

Dr. Gary: Right? So it depends on number one, who the patient is. It depends on what the problem is. Sometimes, we can eliminate the pain with a simple injection, that’s what we take and your pain is gone. Other times, that’s not the best way and we’re going to try out some very low-level analgesics. Maybe like a muscle-relaxant, you know you might be having spasms. We’re going to determine the type of pain. So there are actually different types of pain. There is what’s called neuropathic pain which is a nerve pain, and there is something else that’s called nociceptive pain, which is more like a dull achy pain. And the medication and the treatment depends on the type of pain that it is. It’s coming from your nerves, your joints, some of the organs, and we have to target, and the physician that’s very keen to that type is going to give you much better results.

Interviewer: We’ve heard of those icy patches that you can buy at the pharmacy, and I’m wondering, do they work? There’s hot patches, cold patches.

Dr. Gary: Well, they work to the extent that… There was actually someone that won the Nobel prize for that, it’s called the gate theory. And what that does is that works about as good as… So if you’re…you may recall when you were little and you put your finger on the stove and boy that really hurts. So what does mom do? Mom comes by and she rubs your finger, and the pain is better. Well, the reason why the pain is better is because what you feel is the rubbing sensation and that blocks the pain sensation. So whether the ice packs, heat packs, you’re going to feel the heat or the cold instead of the pain.

Interviewer: Right.

Dr. Gary: It does work, so does massage and a lot of different things.

Interviewer: It’s a distraction more than anything.

Dr. Gary: Yeah, because again, it’s called the gate theory of pain.

Interviewer: Right.

Dr. Gary: So only a certain type of fiber can go to your brain for you to understand that, and then it will block the other sensation.

Interviewer: Okay.

Dr. Gary: We actually have a procedure called [inaudible 00:03:26] stimulation. And what that does is that people that are having severe low back pain, pain shooting down the legs, have had three or four back operations, we can put these tiny little electrodes so you feel a tingling sensation instead of this pain that you have. And you can control that in programming.

Interviewer: Oh, I’m sure a lot of people are happy to hear about that. Dr. Gary, thank you very much. Florida Pain Relief Group even schedules same day appointments. We’ll be back with more daytime, so don’t go away.

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Dr. Rodolfo Gari Talks Kyphoplasty: Pain Management Without Surgery

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Interviewer: Our next guest has been here before, of course, talking about the innovative ways that he treats pain without surgery. We love the sound of that. We welcome back Dr. Rudy Gari from Florida Pain Relief Group who is here with another method and that is called – it’s got a funny name but I’ll try it right here – kyphoplasty.

Dr. Gari: Yes, yes.

Interviewer: Okay, so what is a kyphoplasty?

Dr. Gari: So, a kyphoplasty, basically, it is a way…we’re actually putting like a cement into your vertebral bodies. So, your spinal column consists of 31 different bones called vertebral bodies. Sometimes, usually as we get older or we fall and so-forth, that body can become fractured. It can have what’s called a compression fracture where the body actually shrinks. And we didn’t have a whole lot of methods before except to go on and put all kinds of fuses and rods in there to straighten it up. Now, what we can do, we can actually put medication, like a cement, into that vertebral body to make it stronger to try to really strengthen that bone, and the relief can be sometimes instantly.

Interviewer: That’s fantastic. Now, we’re talking about…you’re mentioning these vertebral bodies, it’s basically the vertebrae, right?

Dr. Gari: It’s the vertebrae, correct.

Interviewer: Okay, and so we’re talking about back and any part of the back that this kyphoplasty helps?

Dr. Gari: Well, this help patients that have had a fracture.

Interviewer: Okay. Specifically?

Dr. Gari: Specifically.

Interviewer: Okay.

Dr. Gari: They’ve broken their backbone, if you will, somehow and it’s a way to be able to give them strength of that vertebrae again, so that they can get back on their feet and be able to get things done.

Interviewer: And a lot of times people who have had these fractures, they start to shrink, don’t they? So does this prevent that from happening?

Dr. Gari: Well, what actually happens when we shrink it…well, first of all, it does align you a little bit more, but the reason why we shrink when we get older is not so much the bone, but there is actually this gelatinous tissue in between the bones…

Interviewer: That disappears.

Dr. Gari: …and that tends to get lower and lower. So, we can lose 1, 2, or 3 inches as we get older because it tends to dry out.

Interviewer: Yeah, I’ve lost an inch already. I used to be 6’3″, I’m 6’2″ now and I hate that. All right, so are we talking about permanent or temporary relief with this kyphoplasty?

Dr. Gari: Well, the kyphoplasty, you know, it’s a permanent thing. I mean, we put that in there and that vertebra is a lot stronger that what it’s been before.

Interviewer: That’s great.

Gari: And that stays in there.

Interviewer: Sure. Now, how does one know if they’re a candidate for this type of treatment?

Dr. Gari: Well, usually your…you know, most physicians know about this procedure. So, if you go to your primary care doctor or your orthopedic or whoever it may be, you know, they’ll diagnose that fracture and find a physician that is competent and skilled at performing these procedures.

Interviewer: Yeah. And you know, Doctor, a lot of people out there who are in pain, no matter what kind of pain it is, the first thing they reach for in the medicine cabinet is an anti-inflammatory or, worse yet, even an opiate. Why is that not a good idea?

Dr. Gari: They have side effects. Those anti-inflammatories…I’ve actually done a year of internal medicine and I’ve seen patients, actually, beat up and die from anti-inflammatories. You cannot be taking this and you should not be taking these on a daily basis. There’s a lot a lot of, I mean, a more mild and gentle anti-inflammatory drugs, but even they have side effects as well. They can affect your kidneys. There’s all kinds of different side effects from long-term medications and, of course, the opioid. We all know about the opioid addiction, the epidemic that goes on. They’re not meant to be taken in the long term. Some patients need long-term opioids. However, there’s a lot of things that can be done so that you don’t have to take all these medications with significant side effects.

Interviewer: Okay, and this being one of them and you have so many other treatments available.

Dr. Gari: Yes we do.

Interviewer: Dr. Gari, thank you so much. Now, Florida Pain Relief Group even schedules same-day appointments for you.

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Dr. Rodolfo Gari Talks Why Arthritis Doesn’t Have To Rule Your Life and Treatment Therapies For It

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Cyndi: Everyone’s familiar with arthritis, but do you know that it does not have to be a life sentence? Arthritis is a life-altering form of pain for so many people, but Dr. Rudy Gari from Florida Pain Relief Group is here to help. Welcome back, Dr. Gari.

Dr. Gari: Thank you.

Cyndi: So we all hear about arthritis, we talk about arthritis, but really what is arthritis?

Dr. Gari: So arthritis, if you break down the word, so itis means inflammation, and arthro means joints. So arthritis is basically an inflammation of your joints. And of course, your joints are what keeps the bones together. So you have joints throughout the entire body. That’s what allows us to bend and do things. So that can cause a lot of wear and tear. That wear and tear leads to inflammation. There are nerve endings in those joints, and it can get pretty painful.

Cyndi: We’ve heard of different types of arthritis. What’s the most common?

Dr. Gari: The most common type of arthritis is osteoarthritis.

Cyndi: Osteo?

Dr. Gari: Yes. In fact, most of us get some sort of arthritis. Even our late 20s it begins, 30s and 40s.

Cyndi: Is it pretty much inevitable that we’re all going to get some form of arthritis?

Dr. Gari: Unfortunately, most of us as we get older, we are gonna get arthritis. It doesn’t mean that you have to know that you have it. You kinda get these aches and so forth throughout the day. But most of us go about our daily lives just, you know, living as if nothing’s going on.

Cyndi: But there are some people their arthritis affects their everyday life and it can really be hard for them to function. So what can you do for people who have arthritis, either in the early stage or quite gradual?

Dr. Gari: The first thing that we do is to determine the type of arthritis, and that helps us to determine what the outcome might be. So let’s just say osteoarthritis, for example, because that’s really common. A lot of times, osteoarthritis causes joint pain everywhere. Most of the pain tends to be low back, cervical region. Our necks hold the head up. Our lower backs help us bend back-and-forth. Those are the daily activities. So we tend to focus on those joints because that’s what’s gonna improve your daily living as much as possible. Things that we can do, we mentioned that’s inflammation of the joints, so what we do is go in there to reduce the inflammation. Some sort of injections goes into those joints, there’s no surgery that’s involved. Two or three of these, if it relieves inflammation, there’s even other things such as radiofrequency, rhizotomies that I’ve mentioned before, that can help burn the little nerve endings that only cause pain.

Cyndi: Wow. We’ve heard about taking turmeric and things like that, and adding more things to our diet to help with inflammation, but that’s not necessarily going to be enough, is it?

Dr. Gari: What happens when you eat something, whether it’s a pill or whatever, it goes in your mouth and through your stomach, and then from there it gets absorbed, goes through your liver, and 95% gets broken down. So a very tiny, tiny fraction of what you’re taking is actually going to those joints. By us delivering the medication straight to those joints, we bypass all that.

Cyndi: Is it always a type of medication that you recommend, or do you have different therapies for arthritis?

Dr. Gari: Different therapies. Sometimes, actually, just moving around. Physical therapy, moving. I ask them to go in the pool, just move your joints more. Sleep. If you can get better sleep, your joints are gonna absorb some more fluid. That’s going to help out as well.

Cyndi: Right, but if you’re finding that it’s really hard to function, you can help.

Dr. Gari: Yes, we can.

Cyndi: You can get right in there and take care of it.

Dr. Gari: Absolutely.

Cyndi: Good stuff. Dr. Gari, thank you very much. Contact Florida Pain Relief Group to schedule your same-day appointment. You can visit their website, it is floridapainreliefgroup.com. Or you can give them a call right now, 844-KICK-PAIN, and you too can be pain-free. Thank you, again.

Dr. Gari: My pleasure.

Cyndi: 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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