Spinal shots for pain

Narrator: Our next guest is Doctor Pearl Ren, an American board of Physical Medicine and Rehab, subspecialty of American Academy of Pain Medicine, from the Polyclinic. Intervention, pain management. What are we talking about here?

Shannon O’Kelley: These are new techniques used to use injections and different medications and different biologics to inject into the area of pain to decrease the pain and enhance healing, and decrease inflammation. All this new stuff that we’re seeing. Interventional medicine.

Narrator: Very interesting. I’m anxious to hear more about this. Here is Dr. Pearl Ren with Shannon O’Kelley.

Shannon O’Kelley: Dr. Ren, welcome. How are you doing?

Dr. Pearl Ren: I’m pretty good. How are you?

Shannon O’Kelley: I’m doing great. Welcome to Health Talks. Excited to have you here. You’re a physiatrist, physical medicine rehab physician, but our listeners need to know about your practice. I always like to get our listeners to be able to understand what you’re doing in your daily life at your office as a physician. So maybe you can tell us about your practice.

Dr. Pearl Ren: Sure, so physiatry means physical medicine and rehabilitation so we’re a little bit newer specialty in medicine, like around fifty years. So we’re basically treating musculoskeletal disease. So it does not belong to neurologists, not belong to orthopedics, so between nerve and bones is us.

Shannon O’Kelley: You guys are the specialists in the musculoskeletal realm. You deal with a lot of people, a lot of patients that have problems. And you guys are really kind of, I call the detectives of the musculoskeletal system. So you do a lot of workups and histories and physicals, a lot of diagnostics - 

Dr. Pearl Ren: That’s right.

Shannon O’Kelley: - and testing to find out what’s going on.

Dr. Pearl Ren: That’s correct.

Shannon O’Kelley: In your practice, you also specialize, do you have some kind of specialty in pain management? Did you not go to some extra training in the Academy of Pain Management?

Dr. Pearl Ren: It is true. So I’m in the specialty for pain management, special for interventional pain management, meaning we’re not only using the medications, we do a little bit of procedures, injections that help you deeply, down to the direct injured area to help your pain quicker, and easier not taking medicine every day, that type of treatment for pain management.

Shannon O’Kelley: And you mentioned interventional pain management. Maybe you could tell our listeners. That’s a fairly newer term we’re hearing a lot in medicine now, this interventional pain management. Maybe you can define that for us.

Dr. Pearl Ren: Sure. So pain management, including like medications, where most time people know to take meds, and other things, physical therapy, in conjunction with interventional pain management means we use injections, burning nerve, nerve ablations, and we’re kind of a little bit aggressive, we’re a little bit interventional, so, but it’s not surgery. We use a little small probe and then needles to do the pain management, so we call it interventional pain.

Shannon O’Kelley: Right, give us some examples of some diagnoses that you may see in your office, or maybe you frequently see in your office.

Dr. Pearl Ren: Yeah, we normally get people, neck pain, back pain, the most commonly kind of instance here. Like, one out of ten people can get neck pain, back pain, so because your nerves get compressed with herniated disk, so we call radiculopathy, which is your nerve compressed, it causes you leg and arm pain. That pain we treat it in the office, using interventional, like epidurals, nerve blocks, and also the facet joint pain can be arthritic pain from your spine, just the aging process where everybody going to get it from the joint pain, so the nerve blocking, called medial branch nerve block. Also, we can burn a nerve, called nerve ablation, neurotomy, can help longer for reduced chronic pain, like a couple years, even. So it’s a great procedure for that. 

Shannon O’Kelley: Good procedure, and again they are conservative procedures in your office. And let’s just touch base on this because I know a lot of patients, being a physical therapist, patients experience a lot of neck and low back pain, and you described it as either a compression to a nerve, or it’s an impingement or irritation to a nerve, or degeneration of the facet joints. Maybe you can describe the facet joints for our listeners, because we hear that sometimes. But what are they?

Dr. Pearl Ren: That’s right between the two bones with your vertebra, which is your spinal bones, so between the two bones with the disk in the middle, which are like cushions, and both side, left and right, with the facet joint, which you can bend and turn and twist which is all that motion created by the joint. So what the study shows, disks generating pain caused from herniated disks, bulging disks, 58%, 42% from facet joint mediated pain, so huge impact for the pain management. 

Narrator: We’ll be back with the conversation with Dr. Pearl Ren and Shannon O’Kelley as IRD physical and hand therapies health doc continues after this timeout.

Shannon O’Kelley: Dr. Ren, thank you again for taking time out to come down and talk to us about your practice, and more importantly, talk about some conservative treatment that you can provide your patients for, you know, neck and back pain, which is huge. You just said 58% of pain is from nerve compression, and 43% I think you said is from a facet irritation. Tell us about these injections you’re doing, because our patients always ask, you know, “What are they using? What kind of steroids? How many can I have?” And then, you know, you do the injections, a guided process, so you can get right there, very specific, when you inject that medication.

Dr. Pearl Ren: That’s correct. We use called fluoro-guided injections, spinal injections, which is mobile X-ray. We see every movement, we move the needles, and then we’re clear, knowing where we go. So epidurals, most people heard about, and you can see that on the YouTube.

Shannon O’Kelley: [laughs]

Dr. Pearl Ren: Most of my patients come in and say, “I just saw last night, kind of, you know, interesting. I don’t know how, you know, how much pain I’m going to experience.” So epidural injection is basically for disk or spinal canal narrowing, causing your nerve pinching, that gave you the pain in the leg and the arm, and also your neck and back pain. So that injection, it’s a steroid involved, so we use a steroid in the lidocaine, which is just a numbing agent, we direct, put the medicine right next to your nerve, so we call it sometimes nerve block, to really help the inflamed nerve, which is compressed by, you know, disks but sometimes bone spurs or arthritic ligaments, so that can give you really, on the roots, to direct the inflammatory treatment. So really fast with the guidance, so we put medicine right next to it, and the steroid, it’s one that’s high potent, anti-inflammatory medicine. That’s why they really help you in the localized areas. It’s not going to be, explore the whole system, like your knee and then the hip you don’t need it - 

Shannon O’Kelley: Right, right.

Dr. Pearl Ren: - you don’t need to take the medicine, so it’s just right next to the spine in the injured area. 

Shannon O’Kelley: Tell us about the results that you see with epidural steroid injection, otherwise known as an ESI. I mean, a lot of patients will say, well, you know, “Is it gonna hurt? I mean, what are the outcomes? Am I gonna see results after the first one? Do I have to have two? Do I have to have three?” So maybe give our patients some understanding, because sometimes those injections are perfect, sometimes there’s a little pain after them. So there’s different outcomes, right?

Dr. Pearl Ren: That is correct, yeah. Individuals are different, take the pain, the injection a different way. Lots of time, anxiety, depression, and stress all impact how you take the pain, but in general when we do injection, we do give you a numbing medicine. Plenty numbing medicine -

Shannon O’Kelley: [laughs] Yeah, yeah, yeah, thank you.