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

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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.

During the course of a patient’s treatment for chronic pain, their physician may suggest the need for additional testing.

The reasoning for needing more testing is to get a better handle on a patient’s specific pain management needs. Among the testing that a physician may recommend is a study of how a patient’s nerves and muscles are working.

Dr. Prasad, a pain specialist in Dallas-Fort Worth, performs this test on his patients during the course of treating their chronic pain. Below he answers a few basic questions about what an EMG and NCS test means.


Question: What is an EMG/NCS test?

Dr. Prasad: “EMG stands for Electromyogram and NCS stands for Nerve Conduction Study. These are diagnostic tests to check on how a patient’s muscles and nerves are functioning. The results from this test will help a pain specialist to diagnose the severity of a patient’s condition and accurately map put appropriate treatment options.”

Question: Why am I being referred by my doctor to get an EMG/NCS test done?

Dr. Prasad“You may be referred for this test if you experience numbness, tingling or a burning sensation; muscle weakness such as foot drop, wrist drop, difficulty opening jars; back pain shooting down your leg, or neck pain shooting down the arm.

Q: What will happen during the test?

Dr. Prasad:  “During nerve testing, small electrode patches are applied to the skin over certain muscles and/or nerves. Then the overlying skin is gently electrically stimulated to see the nerve response. During EMG testing a small, thin needle is used very briefly to test how well the nerve and muscle are working together. There is no electric stimulation involved during EMG testing.”

Q: Is there anything that I should do before having the test?

Dr. Prasad: “Avoid wearing skin lotions, oils or creams on the day of the test. Wear comfortable, loose-fitting clothing that allows access to muscles and nerves to be tested. Generally speaking, patients can take their usual medications for blood pressure, diabetes, thyroid, and others as prescribed by their physician. However, if you are taking a blood thinner, please notify the doctor in advance.”

Q: Are there any restrictions before or after completing the EMG/NCS test?

Dr. Prasad: “There are no restrictions on activity before or after the test, and there are no lasting after-effects.”

Q: When can I expect the results of this test?

Dr. Prasad: “After completing the EMG/NCS test, the doctor has to look at all the findings before making the interpretation. The test results will be sent to your doctor that referred you for the test. They will discuss the results during your follow up visit.”