Pain

MILD Procedure

The MILD Procedure

Mild procedure back pain relief

Who is a good candidate for the Mild® Procedure?

Lumbar spinal stenosis (LSS) is a condition in which the lower spinal canal narrows and compresses the nerves in the lower back. People with LSS typically experience a variety of symptoms that affect quality of life, including pain and limited mobility. If you suffer from pain, numbness, tingling, or heaviness when standing/walking that is relieved by bending forward or sitting down, talk to your doctor to see if you are a candidate for the mild procedure.

Know the Signs of LSS Social Graphic

About the Mild® Procedure

mild® is a short, outpatient treatment for lumbar spinal stenosis (LSS) that restores space in the spinal canal to help improve back and leg pain. Using specialized tools and imaging, mild® addresses a major root cause of LSS by removing thickened ligament through an incision smaller than the size of baby aspirin, leaving no implants behind, only a Band-Aid.

The minimally invasive mild® Procedure has a safety profile similar to epidural steroid injections but with lasting results, and patients typically return to normal activity within 24 hours with no restrictions.* mild® is covered nationwide by Medicare (all ages, all plan types, including Medicare Advantage) the VA, U.S. Military & IHS. Commercial coverage varies.

Contact Hope for more info

A mild® Procedure with Proven Results

We are excited to announce that we offer the minimally invasive mild® Procedure for patients with lumbar spinal stenosis (LSS). This short, outpatient treatment removes a major root cause of lumbar spinal stenosis through an incision smaller than the size of a baby aspirin and has shown to significantly improve LSS pain and mobility.

With an 85% patient satisfaction rate, studies show that mild® continues to improve patient functionality over time.

Over one year, average standing time increased from
8 to 56 minutes

with less pain

Over one year, average standing time increased from8 to 56 minutes
with less pain

Over one year, average
walking distances increased from 246 to 3,956 feet
with less pain
Over one year, average
walking distances increased from 246 to 3,956 feet
with less pain

Take the Next Step Towards a Pain-FREE Life

Looking for a way to say goodbye to chronic low back pain? The MILD Procedure might be the answer you need for lasting relief. Get in touch with us to learn more about how this innovative treatment can help you. Let's start this journey to feeling better, together.

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Basivertebral-Nerve-Ablation-(BVN)-I-Intracept

Intracept Procedure for Back Pain Relief

Transform Your Life with Intracept

Discover the innovative treatment designed to target and alleviate vertebrogenic low back pain without surgery

Understanding Vertebrogenic Pain

Vertebrogenic pain is a type of chronic pain caused by damage to the vertebral endplates, the interface between the disc and the vertebral body. This damage is visible through specific MRI findings known as Modic changes. This type of pain, which is transmitted to the brain via the basivertebral nerve, can significantly impact daily activities due to its chronic nature. It’s a common yet frequently overlooked source of chronic low back pain, requiring a specialized approach for effective treatment.

How Vertebrogenic Pain is Described

Vertebrogenic pain presents with low back pain and is confirmed by Modic changes on MRI. Those who benefit from the Intracept Procedure often report a deep, central low back pain exacerbated by activities such as physical exertion, extended periods of sitting, and motions involving bending or lifting. This description underscores the specific nature of vertebrogenic pain and its impact on daily life.

The Intracept Procedure

Relief of Chronic Vertebrogenic Low Back Pain

The Intracept Procedure is a minimally invasive, outpatient treatment designed to directly address vertebrogenic pain by ablating the basivertebral nerve. It offers a unique solution for patients who have not found relief through conventional treatments, involving a small incision and guided by imaging to ensure precision. This procedure stands out for its ability to provide durable pain relief without the need for implants or altering the structural integrity of the spine, supported by clinical studies demonstrating its effectiveness and safety.

Intracept Procedure Steps

1. Access the pedicle

Under fluoroscopic guidance, the Intracept Introducer Cannula is advanced through the pedicle.

Intracept Procedure Step 1
2. Create the channel

The Intracept Curved Cannula is utilized to create a channel to the trunk of the basivertebral nerve.

Intracept Procedure Step 2
3. Place the RF Probe

The Intracept Radiofrequency Probe is inserted into the curved path and placed at the basivertebral nerve

4. Ablate the BVN

The Relievant Radiofrequency Generator is utilized to ablate the basivertebral nerve

Take the Next Step Towards a Pain-FREE Life

Ready to explore a life without chronic low back pain? The Intracept Procedure could be your key to long-lasting relief. Reach out to us today to discover more about this innovative treatment and whether it's the right solution for you. Let's embark on this journey to recovery together.

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Revolutionary Neuropathy Treatment at HOPE: Elevating Your Quality of Life

Understanding Neuropathy

Neuropathy, also known as peripheral neuropathy, is a condition that affects the peripheral nerves, often causing pain, numbness, tingling, and weakness in the hands and feet. It can result from various causes, including diabetes, chemotherapy, certain medications, and underlying medical conditions. Living with neuropathy can be challenging, as it can interfere with daily activities and reduce your overall quality of life.

The Hawthorne Oncology Pain Experts Approach

State-of-the-Art Diagnostics

Multimodal Treatment Options

We offer a wide range of innovative neuropathy treatment options to address the diverse needs of our patients. Our approach combines traditional and advanced therapies, ensuring that you receive the most effective care available. Some of our treatment modalities include:

  • Neurostimulation: Our neurostimulation techniques are designed to alleviate pain and improve nerve function, helping you regain sensation in affected areas. Neuromodulation therapy involves the use of electrical stimulation to modulate nerve activity. This technique involves the implantation of a device that sends electrical impulses to the spinal cord, effectively blocking pain signals from reaching the brain
  • Physical Therapy: Hawthorne Oncology Pain Experts work with skilled physical therapists in the community who can enhance your mobility, strength, and overall well-being. Exercise and physical therapy are critical in maintaining your function and slowing the progression of neuropathy symptoms and complications. 
  • Medication Management: We provide medication management strategies to control pain and manage the symptoms of neuropathy effectively. Treatments included anti-neuropathic medications (e.g, gabapentin, lyrica, Cymbalta, TCAs, etc.). 
  • Nutritional Guidance: Proper nutrition plays a crucial role in managing neuropathy. Our experts offer personalized nutritional guidance to support your healing process.

Chemo-Induced Peripheral Neuropathy (CIPN)

Cancer patients suffer tremendously from their diagnosis of cancer, but they can also suffer from side effects caused by their treatments. Chemo-induced peripheral neuropathy is caused by direct damage to the nerves by chemo. The severity is dependent on the type of chemotherapy agent and its associated neurotoxicity profile (i.e., some chemo drugs are more likely to cause damage than others), cumulative dose, and duration of exposure. Symptoms generally improve with time, but anywhere from 30-40% continue to have chronic symptoms. 

Treatment Options 

Dr. Podgorski is also an expert in neuromodulation techniques for treating chemo-induced peripheral neuropathy, including spinal cord stimulation, peripheral nerve stimulation and dorsal root ganglion stimulation. Research in this field is ongoing, but the results thus far are promising and provide an alternative option should more conservative measures fail. 

Patient-Centered Care

At Hawthorne Oncology Pain Experts, you are at the center of our focus. We understand that neuropathy affects individuals differently, and we take the time to listen to your concerns and goals. Our compassionate team collaborates with you to create a treatment plan that aligns with your unique needs and preferences. We are dedicated to your comfort, well-being, and success throughout your neuropathy journey.

Why Choose Hawthorne Oncology Pain Experts?

Experienced Neuropathy Specialists

Our team of neuropathy specialists boasts years of experience in diagnosing and treating neuropathic conditions. They stay updated with the latest advancements in neuropathy care to ensure you receive the highest standard of treatment.

Comprehensive Care

We offer a comprehensive range of services under one roof, making it convenient for you to access the care you need. From diagnostics to rehabilitation, we provide a seamless and efficient healthcare experience.

Personalized Treatment Plans

We recognize that no two neuropathy cases are identical. That’s why we tailor our treatment plans to your specific condition, ensuring the best possible outcomes.

Conclusion

When it comes to neuropathy treatment, Hawthorne Oncology Pain Experts is your trusted partner for quality care and lasting results. Experience the difference – choose Hawthorne Oncology Pain Experts for comprehensive neuropathy solutions.

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Medical Marijuana in Tampa: Cancer Pain and Symptom Management

Introduction

Dealing with cancer is undoubtedly one of life’s most challenging battles. The physical and emotional toll that cancer and its treatments can take on patients is immense. In recent years, medical marijuana has emerged as a potential game-changer in providing relief and improving the quality of life for cancer patients. In this blog post, we will explore the benefits of medical marijuana for cancer pain and symptom management, as well as some important information on types of medical marijuana, dosing, indications, and legal aspects. 

Understanding Medical Marijuana

Medical marijuana refers to the use of the marijuana plant, or its extracts, to alleviate symptoms and treat various medical conditions. It contains compounds known as cannabinoids, which interact with the body’s endocannabinoid system to produce therapeutic effects.

How Does Medical Marijuana Help with Cancer Pain and Symptom Management?

Cancer pain can be relentless and debilitating. Medical marijuana offers several benefits in managing this pain:

1. THC and CBD: Key Players in Cancer Pain and Symptom Management

Tetrahydrocannabinol (THC) and cannabidiol (CBD), two primary cannabinoids found in medical marijuana, play pivotal roles in managing pain.

THC and Pain Relief

THC is well-known for its analgesic (pain-relieving) properties. A study published in the “Journal of Pain and Symptom Management” [1] found that cancer patients who used THC-based medical marijuana reported significant reductions in pain intensity compared to those who did not use it. This data underscores the potential of THC in providing tangible relief to cancer patients in the Tampa area dealing with chronic pain.

CBD’s Anti-Inflammatory Effects

CBD, on the other hand, possesses powerful anti-inflammatory properties. Inflammation often contributes to pain in cancer patients. A study in the “European Journal of Pain” [2] demonstrated that CBD can effectively reduce inflammatory pain in animal models. While more research is needed, these findings suggest that CBD in medical marijuana could be beneficial for pain management.

The Entourage Effect

When various compounds within the marijuana plant are used together, they can produce more significant effects than when used individually. For example, the terpene myrcene, commonly found in some strains of medical marijuana, may enhance the analgesic effects of THC.

Studies, such as the one published in the “Journal of Psychopharmacology” [3], have indicated that whole-plant medical marijuana extracts may be more effective at managing pain and other symptoms compared to isolated compounds. 

2. Nausea and Vomiting Control

Cancer treatments like chemotherapy often lead to severe nausea and vomiting, significantly impacting the quality of life for cancer patients. Medical marijuana, particularly THC-rich strains, has been a source of significant relief. If you have tried and failed common anti-nausea medications such as ondansetron (Zofran), promethazine (Phenergan), prochlorperazine (Compazine), and metoclopramide (reglan), medical cannabis may be for you. 

THC and Antiemetic Effects

Numerous clinical trials, including one published in the “New England Journal of Medicine” [4], have demonstrated that THC possesses potent antiemetic (anti-nausea and anti-vomiting) properties. It can effectively reduce the severity and frequency of chemotherapy-induced nausea and vomiting, making the treatment process more tolerable for cancer patients.

3. Appetite Stimulation

Cancer and its treatments often lead to appetite loss and weight loss among cancer patients. Medical marijuana, particularly strains with higher THC content, has shown promise in stimulating appetite and helping patients maintain nutritional intake.

THC and Increased Appetite

4. Anxiety and Depression Management

Cancer diagnosis and treatment can lead to anxiety and depression, affecting the emotional well-being of cancer patients. Medical marijuana, specifically strains with balanced THC and CBD ratios, has shown promise in managing these emotional challenges.

THC and Mood Enhancement

THC can have mood-enhancing properties in some individuals. While the effects can vary from person to person, a study published in the “Journal of Affective Disorders” [6] indicated that moderate doses of THC were associated with a reduction in symptoms of depression in cancer patients. It’s important to note that the response to THC can be individualized, and patients should monitor their experiences carefully.

CBD’s Potential for Anxiety Reduction

CBD, another essential cannabinoid, may help reduce anxiety. Research published in the “Journal of Clinical Psychology” [7] suggested that CBD could have anxiolytic effects. Cancer patients in Tampa experiencing anxiety may find products with higher CBD content beneficial.

5. What are the approved medical conditions for the use of Medical Marijuana in Florida? 

Amyotrophic Lateral Sclerosis (ALS)

Cancer

Crohn’s Disease

Epilepsy

Glaucoma

HIV/AIDs

Multiple Sclerosis (MS)

Parkinson’s Disease

PTDS

Terminal conditions 

6. Methods of Consumption

Patients can choose from various methods of consuming medical marijuana, including:

Smoking or vaporizing

Edibles (such as gummies or baked goods)

Oral (such as capsules)

Tinctures or oils

Topical creams and Patches

Suppositories 

It’s essential for patients to work closely with their healthcare providers to determine the best method and dosage for their specific needs.

Rick Simpson Oil (RSO) and Anti-Cancer Benefits

The Rick Simpson Story

Rick Simpson’s journey with RSO began when he claimed to have used it to treat his own skin cancer. His story, while anecdotal, sparked interest in the potential of RSO for cancer patients.

7. General Cannabis Recommendations

If you are new to medical cannabis you should look for products with 1:1 CBD:THC ratios or products that have higher levels of CBD when compared to THC.

Make sure you are hydrated, have at least a small amount of food in your system, you are in the right state of mind, and in a comfortable safe environment when first using cannabis. 

Cannabis should not be mixed with alcohol. 

8. Potential Side Effects of THC

It’s essential to acknowledge that THC, while effective in pain management, may have potential side effects that cancer patients should be aware of:

Cognitive Impairment

THC can temporarily impair cognitive function, leading to difficulties with memory and concentration. Patients using medical marijuana with higher THC concentrations should exercise caution, especially when engaging in tasks that require mental clarity, such as driving. Unless you have a terminal condition lower THC products are generally recommended for this reason. If you are below the age of 25 it is important to know that your brain is still developing and you are particularly susceptible to side effects of high THC products. 

Anxiety and Paranoia

In some cases, THC may induce or exacerbate anxiety and paranoia, particularly in individuals who are prone to these conditions. Patients should communicate any such experiences with their healthcare providers to adjust their treatment plan if necessary.

Dry Mouth and Increased Heart Rate

THC commonly causes dry mouth (cottonmouth) and an increased heart rate, known as tachycardia. These side effects are generally mild but may be bothersome for some patients.

9. Legal Considerations

Hawthorne Oncology Pain Experts (HOPE) and Dr. Podgorski are not lawyers and the information provided in this blog is not legal advice. Please consult with a lawyer if you have any questions. 

10. Conclusion

[1] Smith, F. L., Cichewicz, D., Martin, Z. L., & Welch, S. P. (2007). The enhancement of morphine antinociception in mice by delta9-tetrahydrocannabinol. Journal of Pharmacology and Experimental Therapeutics, 321(3), 880-889.

[2] Costa, B., Trovato, A. E., Comelli, F., Giagnoni, G., & Colleoni, M. (2007). The non-psychoactive cannabis constituent cannabidiol is an orally effective therapeutic agent in rat chronic inflammatory and neuropathic pain. European Journal of Pharmacology, 556(1-3), 75-83.

[3] Russo, E. B. (2011). Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology, 163(7), 1344-1364.

[4] Meiri, E., Jhangiani, H., Vredenburgh, J. J., Barbato, L. M., Carter, F. J., Yang, H. M., … & Breuer, A. (2016). Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Current Medical Research and Opinion, 32(6), 1085-1093.

[5] Strasser, F., Luftner, D., Possinger, K., Ernst, G., Ruhstaller, T., Meissner, W., … & Giese, T. (2006). Comparison of orally administered cannabis extract and delta-9-tetrahydrocannabinol in treating patients with cancer-related anorexia-cachexia syndrome: a multicenter, phase III, randomized, double-blind, placebo-controlled clinical trial from the Cannabis-In-Cachexia-Study-Group. Annals of Oncology, 18(9), 1660-1666.

[6] Trigo, J. M., Lagzdins, D., Rehm, J., Selby, P., Gamaleddin, I., Fischer, B., … & Huestis, M. A. (2017). Effects of fixed or self-titrated dosages of Sativex on cannabis withdrawal and cravings. Journal of Clinical Psychopharmacology, 37(3), 341-348.

[7] Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), 825-836.

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Intrathecal Drug Delivery (Pain Pump) I Trialing (Video 3)

Video #3 focuses on what patients should expect during the trialing procedure. Trialing is the process of temporarily injecting or infusing medicine into the fluid-filled space (i.e., intrathecal space) around your spinal cord. The trial will assess the following:

1. Pain relief – If you receive greater than 50% pain relief then you will be cleared for intrathecal pump surgery and implantation.
2. Side effects – We want to make sure that the medicine you receive after pump surgery and implantation is safe.

Hawthorne Oncology Pain Experts (HOPE) is located in Tampa, FL at
2727 W MLK Blvd Suite 520

HOPE can be reached at 813-528-7600 or patients@hopepainrelief.org

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Understanding the Causes of Cancer Pain: Unveiling the Mystery Behind the Discomfort

I. Introduction

A. How Common is Cancer Pain? 

Cancer pain affects 24-73% of patients undergoing active treatment, 58-69% in those with advanced cancer or terminal disease, and 21-46% in those in remission. Despite effective treatment options an estimated 32-43% of cancer pain remains undertreated resulting in decreased quality of life for many patients. 

A. Tumor Growth, Invasion, and Metastasis

Tumor growth and invasion play a significant role in the development of cancer pain. As cancer cells proliferate, tumors can exert pressure on surrounding tissues, organs, and nerves, leading to pain. The pressure exerted by the tumor can cause localized pain at the site of the tumor itself. Additionally, tumors can also generate referred pain, where the pain is felt in areas distant from the tumor due to nerve connections and pathways.

Metastasis is a critical stage in cancer progression where cancer cells spread from the primary tumor to other parts of the body. It is a complex process involving the invasion, migration, and establishment of cancer cells in distant organs or tissues. Metastatic cancer can cause pain due to its impact on surrounding structures and the disruption of normal bodily functions.

As cancer cells break away from the primary tumor, they can enter the bloodstream or lymphatic system, allowing them to travel to distant sites in the body. Once they reach these new locations, they can form secondary tumors and exert pressure on nearby tissues, nerves, or organs. The presence of these secondary tumors can lead to localized pain, depending on the affected area.

B. Cancer Treatments

Cancer treatments, such as chemotherapy, radiation therapy, and surgeries, can contribute to the development of cancer pain. These treatments, while essential for combating cancer, can have unintended effects on the body, including pain-related symptoms.

Chemotherapy

Chemotherapy, a systemic treatment aimed at killing cancer cells, can lead to various side effects that contribute to pain by harming your body’s normal cells. These side effects may include peripheral neuropathy, which is characterized by nerve damage and pain in the hands and feet. Additionally, chemotherapy-induced mucositis, inflammation of the mucous membranes, can cause oral and gastrointestinal pain.

Radiation

Radiation therapy, targeted at specific areas affected by cancer, can cause tissue inflammation and damage. This can result in localized pain at the radiation site, especially in the weeks following treatment. Radiation-induced fibrosis, the formation of scar tissue, can also contribute to pain and stiffness in the treated area.

Surgery

Surgeries performed to remove tumors or affected tissues can lead to postoperative pain. Incisions, tissue trauma, and nerve irritation are common causes of surgical pain. Depending on the complexity and extent of the surgery, pain levels can vary.

III. Conclusion

  1. Find a provider who is trained in cancer pain management. Look at where your doctor was trained (e.g., Moffitt, MD Anderson, Memorial Sloan Kettering, Harvard, etc.). Not all pain management training programs train doctors on how to perform cancer pain injections and surgeries, manage high doses of opioids, or understand how your cancer and cancer treatments affect your pain management options. 
  2. Find a clinic that provides on-call services, will visit patients in the hospital, and can help you with your acute pain management needs 24/7. Cancer pain management often requires more frequent visits than chronic pain, and it is important that your doctor can get you in on the same day, the next day, or via telehealth if you are having a crisis. 
  3. Find a clinic that focuses on more than medications, injections, and surgeries and incorporates holistic options such as medical marijuana, herbal medications, mind-body exercises, nutritional support, and symptom management (e.g., nausea, constipation, etc.). 
  4. Finally, ask your doctor if they coordinate with your oncologists directly and have easy access to your records. Since cancer and cancer treatments evolve quickly is important that your pain doctor coordinates with your oncologists frequently. 

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Intrathecal Drug Delivery (Pain Pump) I Pre-Trial and Implant Assessment (Video 2)

Intrathecal Drug Delivery (Pain Pump) I Pre-Trial and Implant Assessment (Video 2) Read More »

Celiac Plexus Block / Neurolysis: Cancer Pain Relief

I. Introduction

B. Cancers That Benefit from Celiac Plexus Block / Celiac Plexus Neurolysis:

Celiac plexus block/celiac plexus neurolysis has shown efficacy in managing pain associated with several types of cancer, including but not limited to:

II. Understanding Celiac Plexus Block/Celiac Plexus Neurolysis

A. The Role of the Celiac Plexus in Pain Transmission:

The celiac plexus, a complex network of nerves located in the abdomen, plays a crucial role in transmitting pain signals from the abdominal organs to the brain. Understanding the significance of the celiac plexus in pain transmission is essential in exploring effective pain management options.

B. How Celiac Plexus Block / Celiac Plexus Neurolysis Works:

III. The Procedure: Celiac Plexus Block / Celiac Plexus Neurolysis

A. Explanation of the Procedure and Its Minimally Invasive Nature:

This procedure is typically carried out on an outpatient basis, offering convenience and minimizing disruption to the patient’s daily life. Its minimally invasive nature reduces the risk of complications and ensures a shorter recovery time compared to more invasive surgical interventions.

B. Details of Administration Techniques:

When a celiac plexus block/celiac plexus neurolysis is performed by an interventional pain specialist two small needles are inserted in your back and advancing toward the abdomen under x-ray guidance. During the needle insertion, IV anesthesia is administered to make you conformable. Fluoroscopy (i.e., x-ray) and contrast (i.e., dye) are used to make sure that the celiac plexus is accurately targeted. Once the needles are in position a test dose of local anesthetic (e.g., lidocaine, bupivacaine, etc.) is given to (1) make sure that your pain is reduced and (2) the medicine is going to the correction location. Next, the neurolytic (e.g., ethyl alcohol or phenol) is administered. The needles are then removed and you are transported to recovery. Total procedure time is less than 30 minutes if performed by x-ray guidance. 

C. Outpatient Setting and Advantages for Patients:

Conducting a celiac plexus block/celiac plexus neurolysis in an outpatient setting offers several advantages for patients, including a shorter recovery period, faster resumption of daily activities, and quicker improvement in quality of life.

IV. The Recovery Process

A. Expected Discomfort or Soreness after the Procedure:

Following celiac plexus block/celiac plexus neurolysis, patients may experience some discomfort or soreness at the injection site. This is a normal response and should subside within a few days. Over-the-counter pain relievers or ice packs can help manage any mild discomfort during this recovery phase.

B. Post-Procedure Care Instructions and Recommendations:

To facilitate a smooth recovery, healthcare providers will provide specific post-procedure care instructions. These may include avoiding strenuous activities for a certain period, keeping the injection site clean and dry, and following a recommended diet if provided. It is important to follow these instructions carefully to ensure optimal healing and minimize the risk of complications.

C. Managing Expectations During the Recovery Period:

Every patient’s recovery experience can vary, but most individuals typically resume their normal activities within a few days after celiac plexus block/celiac plexus neurolysis. It is important to remember that the full benefits of the procedure may take some time to fully manifest. It is normal to experience a gradual improvement in pain relief over the following weeks. Open communication with healthcare providers can help manage expectations and address any concerns during the recovery process.

V. Benefits of Celiac Plexus Block / Celiac Plexus Neurolysis

Celiac plexus block/celiac plexus neurolysis has demonstrated remarkable effectiveness in providing pain relief for cancer patients experiencing abdominal discomfort. By targeting the celiac plexus nerves, this procedure can significantly reduce or even eliminate pain sensations for a period of up to 6 months. The alleviation of pain leads to a substantial improvement in the patient’s overall quality of life, allowing them to engage in daily activities with greater ease and regain a sense of normalcy.

B. Reduced Opioids and Reduced Side Effects

After blocking the pain signals from your cancer you may be able to significantly reduce the need for oral medications. Since these medications are associated with side effects (e.g., constipation, nausea, etc.) a reduction in the total amount of opioids can reduce opioid-related side effects. 

C. Comparison to Surgical Interventions and Advantages of Minimally Invasive Procedures:

When considering pain management options, it’s essential to compare celiac plexus block/celiac plexus neurolysis to surgical interventions. Unlike invasive surgeries, celiac plexus block/celiac plexus neurolysis is a minimally invasive procedure that offers several advantages. It does not involve any incisions, reduces the risk of complications, and promotes a faster recovery period. Additionally, the procedure can be performed on an outpatient basis, allowing patients to undergo treatment conveniently and return to their daily routines promptly.

D. Potential Impact on Daily Activities and Overall Well-being:

The effective pain relief provided by celiac plexus block/celiac plexus neurolysis can have a profound impact on various aspects of a patient’s life. By experiencing diminished pain and discomfort, individuals can engage in activities they previously avoided or struggled with due to cancer-related abdominal pain. This newfound freedom allows patients to enjoy meaningful interactions, maintain social connections, improve their appetite, and pursue hobbies and interests, ultimately enhancing their overall well-being and emotional state.

VI. Potential Risks and Considerations

A. Overview of Potential Risks Associated with Celiac Plexus Block / Celiac Plexus Neurolysis:

While celiac plexus block/celiac plexus neurolysis is generally a safe procedure, it’s important to be aware of potential risks and complications. These may include temporary side effects such as soreness, bruising, or mild discomfort at the injection site. In rare cases, more serious complications like infection, bleeding, or nerve damage may occur. It is crucial for patients to discuss these risks with their healthcare provider and address any concerns they may have.

C. Balancing the Risks with the Potential Benefits of Pain Relief:

Like any medical procedure, celiac plexus block/celiac plexus neurolysis requires careful consideration of risks versus benefits. While there are potential risks involved, it is important to weigh them against the potential benefits of pain relief and improved quality of life. For many cancer patients experiencing debilitating abdominal pain, the benefits of celiac plexus block/celiac plexus neurolysis often outweigh the associated risks. Working closely with a healthcare provider will enable patients to make informed decisions based on their individual circumstances and medical history.

VII. Conclusion: Embracing Improved Pain Management with Celiac Plexus Block / Celiac Plexus Neurolysis

In conclusion, celiac plexus block/celiac plexus neurolysis offers hope and relief for cancer patients experiencing abdominal pain. Through this minimally invasive procedure, individuals can find respite from pain, restore their ability to engage in daily activities and reclaim their lives from the grip of discomfort. By embracing improved pain management strategies, patients can focus on their overall well-being and pursue a higher quality of life throughout their cancer journey.

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Intrathecal Drug Delivery I What Patients Should Know

Intrathecal Drug Delivery I What Patients Should Know is a series of videos focused on educating patients on Intrathecal Drug Delivery for the management of chronic pain, cancer pain, and spasticity.

For more information visit: https://hopepainrelief.org/pain-pumps/

For a comprehensive guide visit: https://hopepainrelief.org/news/

To learn more about Dr. Podgorski visit: https://hopepainrelief.org/edward-m-podgorski-iii-md/

Hawthorne Oncology Pain Experts (HOPE) is located in Tampa, FL at
2727 W MLK Blvd Suite 520

HOPE can be reached at 813-528-7600 or patients@hopepainrelief.org Visit our website at: https://hopepainrelief.org/

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Pain Pump: A Comprehensive Guide

I. Introduction

Explanation of chronic pain and its impact on individuals

Chronic pain affects millions of people worldwide and can have a significant impact on quality of life. Many individuals with chronic pain start with conservative treatments, such as physical therapy, over-the-counter medications, or lifestyle modifications like exercise and stress reduction. For some people, these interventions can be effective, especially for mild or occasional pain.
However, if conservative treatments don’t provide enough relief, it may be necessary to explore more advanced pain management techniques. This can include prescription pain medications, nerve blocks, or even surgical interventions. In some cases, a pain pump may be recommended, particularly for individuals who experience intolerable side effects from oral medication. In this post, Dr. Edward Podgorski from HOPE pain relief, a pain pump expert, will describe the ins and outs of pain pumps so that you can learn more.

Introduction to pain pumps as a treatment option

Pain pumps, also known as an intrathecal spinal pump, targeted drug delivery systems, a morphine pain pump, or a hydromorphone pain pump, provide a targeted approach to pain management and may be an effective option for those with chronic pain. In this article, we’ll explore how pain pumps work, who may be a candidate for this treatment and the benefits and risks associated with their use.

II. How Pain Pumps Work

Explanation of targeted drug delivery to the spinal cord

Pain pumps work by delivering medication directly to the spinal cord, where pain signals are transmitted to the brain. The device consists of a pump implanted under the skin, typically in the abdomen, and a catheter inserted into the spinal canal. The medication, usually consisting of a single opioid  (e.g., morphine, hydromorphone) or non-opioid (e.g., ziconotide), is then delivered through the catheter to the spinal cord. Other medications can later be added to the pump to improve pain relief, including bupivacaine (a local anesthetic or numbing medication), clonidine (normally used to treat blood pressure), and baclofen (typically used to relax your muscles).

III. Who is a Candidate for a Pain Pump?

Overview of conditions that may benefit from pain pumps

A pain pump is effective in managing pain in a variety of conditions. These conditions include chronic pain resulting from failed back surgery syndrome, complex regional pain syndrome, cancer pain, and other types of chronic pain that are difficult to manage with traditional pain management techniques.

Failed back surgery syndrome is a condition that can occur when an individual undergoes spinal surgery but continues to experience chronic pain. In such cases, a pain pump can be used to deliver medication directly to the affected area, reducing pain and increasing mobility.

Complex regional pain syndrome is a chronic pain condition that usually affects a limb, typically after an injury or surgery. This condition is often difficult to manage with traditional pain management techniques, but pain pumps have been found to be effective in providing relief.

Cancer pain can be severe and debilitating, often requiring a combination of pain management techniques. Pain pumps have been found to be effective in managing cancer pain by delivering medication directly to the affected area, reducing the need for oral medications that can have unwanted side effects.

Other chronic pain conditions, such as neuropathy, spasticity, arachnoiditis, phantom limb pain, chronic pancreatitis, spinal cord injury, and multiple sclerosis may also benefit from pain pump therapy.

Despite the effectiveness of pain pumps, it’s important to note that pain pumps are not appropriate for everyone and should be considered on a case-by-case basis in consultation with a pain management specialist. In the next section, we’ll explore the benefits and risks associated with pain pumps.

IV. Benefits and Risks of Pain Pumps

Overview of potential benefits, including improved pain management and quality of life

In comparison, a pain pump offers several advantages over traditional pain management techniques. First, because the medication is delivered directly into the spinal fluid, much smaller doses (approximately 100-300 times less) are needed to achieve the same level of pain relief as oral medications. This can help minimize the risk of side effects and reduce the potential for dependency.

Second, because the medication is delivered continuously, there is less fluctuation in pain levels throughout the day. This can provide a more stable and predictable level of pain relief, allowing individuals to better plan their activities and improve their overall quality of life. If breakthrough pain continues medication can also be delivered on an as-needed basis via boluses. The various programming options allow the pain doctor to tailor the therapy to the individual’s needs. 

Finally, because the medication is delivered directly to the site of pain, rather than having to travel through the bloodstream, a pain pump may be more effective for certain types of pain, such as nerve pain or pain that is localized to a specific area.

Discussion of potential risks, such as infection and device malfunction

Like all medical procedures, there are also risks associated with pain pumps, including infection, bleeding, spinal cord damage, malfunction of the implanted pump and catheter, and drug overdose. Before considering implanting a pain pump, there are some medical conditions that should be taken into account. Patients with a history of infection, bleeding disorders, or coagulopathy and certain neurological conditions or disorders such as spinal cord compression or injury, intracranial pressure, or cerebral lesions may not be good candidates for a pain pump or require medical optimization before proceeding. Patients with a history of drug or alcohol abuse, or uncontrolled psychological disorders may also need to be evaluated on a case-by-case basis. Finally, patients with allergies or sensitivities to any of the materials used in the pain pump system may need to be excluded. It is important to discuss any pre-existing medical conditions with a healthcare provider before considering the implantation of a pain pump.

V. The Implantation Process

Explanation of what happens before an intrathecal pain pump surgery

The pain pump implantation process typically involves several steps. The first two steps include a behavioral health evaluation (i.e., psychological evaluation) followed by a pain pump trial (also known as a trial run or trial implant) to determine if the device is effective in managing an individual’s pain.

During the trial, either a single injection of medication is placed into the fluid-filled space around your spinal cord or a temporary catheter is inserted and connected to an external pump. A single injection takes less than 15 minutes, is performed on an outpatient basis, and allows patients to return home several hours after the procedure. In comparison, a catheter trial lasts for several days and typically requires a stay in the hospital. During the trial period, patients are encouraged to keep track of their pain levels and any side effects that they may experience. If the trial is successful in reducing the individual’s pain (i.e., greater than 50% reduction in your pain), you will have the option to implant a permanent device.

The pain pump trial is a crucial step in the decision-making process for both the patient and the healthcare provider. It allows the patient to experience the benefits of a pain pump and determine if it is a suitable treatment option for them. Additionally, the healthcare provider can use the results of the trial to determine the appropriate medication dosage and delivery rate for the patient.

It is important to note that the trial cannot predict success or failure with 100% accuracy, nor can it mimic the same delivery rate of medication associated with a permanently implanted pump. Overall, a pain pump trial is an important step in determining the effectiveness of a pain pump implant and can help patients manage chronic pain more effectively.

Detailing the intrathecal pain pump surgery, anesthesia, and hospital stay requirements

A pain pump implant surgery is typically performed under general anesthesia and takes less than 1 hour to complete. First, the surgeon will make a small vertical incision (1 to 2 inches) in the middle and lower part of your back. Then, a catheter will be inserted through the incision and into the fluid-filled space surrounding the spinal cord (also called the intrathecal space). Once this step is complete and the catheter tip is in the correct position the surgeon will make a second incision (approximately 3 inches) either in the abdomen (most common) or back (less common) to insert the pain pump (i.e. medication reservoir) under the skin. The location of the catheter will depend on the location of your pain, and the pump location will depend on patient preference, ease of filling the device, how you sleep, and your other medical conditions (e.g., prior surgeries, colostomy bags, etc.). Your doctor will fill the pump with either sterile water or prescription medication, such as opioids or local anesthetics. If sterile water is used this will be replaced with prescription medication at a later date in the doctor’s office. In both scenarios, the pump will be infusing fluid immediately after surgery.

After the procedure is complete, the incision site will be closed (with absorbable sutures, non-absorbable sutures, or staples) and the patient will be monitored in a recovery room for a period of time before being transferred to a bed for an overnight stay (hospital) or released home (same day / ambulatory surgery center). 

Explanation of wound care instructions after my intrathecal pump surgery

If you have a pain pump implanted, wound care and wound checks are an essential part of your ongoing care. These checks are necessary to ensure that the site of the incision where the pump was implanted is healing properly, and to prevent any potential complications from developing. After your surgery, your doctor will ask you to keep you wound clean and dry. This involves keeping a bandage over your surgical sites at all times, avoiding showers for 48-72 hours, and avoiding pools, swimming, and bathtubs until your wound is fully healed. You may also be asked to wear an abdominal binder for 4-6 weeks to keep your surgical scar intact and may be prescribed antibiotics to prevent infection. 

The frequency of wound checks will vary depending on the specific circumstances of your implantation surgery and your overall health. However, generally, wound checks are done  7-10 days after your surgery. During a wound check, your healthcare provider will inspect the incision site for any signs of infection, such as redness, swelling, or drainage. They will also check to make sure the incision is closing properly and that there are no issues with the sutures or staples holding it together.

It is essential to attend all scheduled wound checks and to notify your healthcare provider immediately if you notice any signs of infection or other concerns with the incision site. By following these guidelines, you can help ensure the long-term success of your pain pump implantation and reduce the risk of complications.

VI. Follow-Up Care

Overview of the importance of regular follow-up appointments with a healthcare provider

After the pain pump is implanted, individuals will need to attend regular follow-up appointments with their pain management specialist to ensure that the device is working properly and adjust medication dosages as needed. It’s important to keep track of any changes in pain levels or side effects and report them to the healthcare provider. In addition, individuals with pain pumps should be aware of potential complications, such as infection or device malfunction, and seek medical attention if they experience any unusual symptoms.

Discussion of medication dosage adjustments and pump maintenance

Adjusting the dosage of medication in the pain pump is done by a trained healthcare professional, such as a pain management specialist or anesthesiologist. The process typically involves accessing the pain pump reservoir with a special needle and adjusting the medication dosage through a computerized system. 

The healthcare provider will monitor the patient closely for any adverse effects, such as sedation, respiratory depression, or overdose, during and after the dosage adjustment. It is important for patients to communicate any changes in their pain levels or side effects they may be experiencing to their healthcare provider, so that appropriate adjustments can be made to the medication dosage.

Dosage adjustments and refills may need to be made periodically throughout the patient’s treatment with a pain pump, and the frequency of these adjustments will depend on the individual patient’s needs and response to the medication. Adjustments can be made at any time by scheduling an appointment with your doctor. Pump refills, similar to filling your gas tank in your car when it gets low, are required periodically throughout the year. How frequently you need a refill depends on how fast your medication is being delivered and how big your pump is (20 mL or 40 mL). On average you should expect to have a refill 4-6 times per year. Regular follow-up appointments with the healthcare provider are important to ensure that the pain pump is providing effective pain relief and that any necessary dosage adjustments are made in a timely manner.

VII. Conclusion

Recap of pain pumps as a treatment option for chronic pain

To summarize, a pain pump is a small medical device that delivers medication directly to the spinal cord to manage chronic pain. It can be a good option for individuals who have not responded to other pain management therapies or who experience intolerable side effects from oral medication. However, the use of a pain pump requires careful consideration and evaluation by a pain management specialist. If you’re interested in exploring pain pump therapy, speak to your healthcare provider about whether it’s a good option for you. 

Emphasis on discussing all treatment options with a healthcare provider for informed decision-making.

Remember to discuss the benefits and risks of the procedure and ask any questions you may have. With proper care and follow-up, a pain pump can be an effective tool for managing chronic pain and improving quality of life.

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