Contact Information Denis G. Patterson, DO Nevada Advanced Pain Specialists

Education and Training DO –Michigan State University College of Osteopathic Medicine (1998 – 2002) Pain Fellowship –Emory University (2006 – 2007) Residency –Mayo Clinic (2003 – 2006)

Certifications Board Certified, Pain Medicine (2007) Board Certified, Physical Medicine and Rehabilitation (2007)

Mechanical Low Back Pain Denis G. Patterson, DO Echo Project 11/18/2015

Introduction

Life expectancy continues to increase in the US > 65 year old age group grew by 30% between 1994 – 1999

Introduction Fear of the aging population is “having pain” Chances of having pain increase with each decade of life Pain leads to negative consequences for health, decreased function, and quality of life

Introduction Pain is one of the most common complaints for the > 65 year old age group when they visit the doctor The lumbar spine (low back) is a common area for pain

Basic Lumbar Spine Anatomy

Lumbar Arthritis AKA “Facet Joint Syndrome”

Facet Joint Syndrome It is a general term for age-related wear and tear affecting the facet joints Also known as lumbar osteoarthritis

Facet Joint Syndrome The condition usually appears in men and women older than 40 and progresses with age

Facet Joint Syndrome Causes: - Drying and loss of elasticity in the lumbar disks - Stiffening of the ligaments connecting bones and muscles

Facet Joint Syndrome Symptoms: - Low back, hip or buttock pain - Cramping lower extremity pain (usually not past the knee)

Facet Joint Syndrome Symptoms - Low back stiffness, especially in the morning - Pain with prolonged sitting or standing

Conservative Treatment Measures

Modalities Medications Physical Therapy Injections

Modalities Ice Heat TENS Massage Traction

Medications Tylenol NSAIDS Ultram Nerve pain medications Narcotics

Physical Therapy Goals: - Pain relief - Improve posture/biomechanics - Improve motion - Improve strength - Improve function - Resume regular activities

Facet Injections Gold standard for diagnosis of facet mediated spine pain Radiographic findings - joint space narrowing, hypertrophy, sclerosis, tropism Pain is not always related to radiographic findings

Facet Injections Two types of injections – Intra-articular joint injections –Medial branch blocks and radiofrequency ablation

How Do We Do These Procedures? Contrast-enhanced with fluoroscopic guidance. –May pre-medicate with prednisone and Benadryl if allergic. Used to ensure needle placement and proper medication flow. Safety. Question non-response in blind injections.

Facet Intra-Articular Injections Fluoroscopic localization. Use of contrast confirms intraarticular needle placement. Most common levels L4-L5, L5-S1. Inject anesthetic and steroid.

Medial Branch Block Similar results to intra-articular facet injection without entering the joint. Targets the medial branch of the dorsal primary ramus. Diagnoses pain originating from facet joint. Identifies patients who will benefit from radiofrequency ablation.

Medial Branch Block Performed as a series of 2 blocks. 1 st set of blocks are performed with 1 ml 1% preservative free lidocaine injected at each medial branch. –Provides 2-3 hours of relief 2 nd set of blocks performed with 1 ml 0.5% preservative free bupivacaine at each medial branch. –Relief lasts 4-6 hours. Positive response defined as 50% pain reduction.

Medial Branch Block

Radiofrequency Ablation (RF) Electrical current produced by a radio wave is used to to heat tip of needle and destroy medial branch and eliminate painful signal from facet joint. Procedure is similar to medial branch block except wire is placed through needle at target point instead of anesthetic. Medial branch is then lesioned for 120 seconds at 80 degrees. Provides 9-12 months of relief. –Nerve grows back with time.

Questions

Discussion