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Frequently Treated Conditions


Joint Pain

Also known as degenerative arthritis, osteoarthritis is caused by the breakdown and eventual loss of cartilage. Cartilage is the soft tissue that acts as a cushion in joints. When cartilage wears away, the joint is often left with bone rubbing directly on bone. Osteoarthritis is the most common of all the types of arthritis— affecting millions of Americans. It is most commonly caused by the natural aging process.

Using state-of-the-art treatments, our physicians are able to help many patients find relief from the pain associated with osteoarthritis.


Shingles

Shingles is a sudden outbreak of a painful rash caused by the re-activation of the chickenpox virus. Most people are exposed to chicken pox during childhood. Unfortunately, the virus that causes chicken pox (herpes zoster virus) can stay in the body in a dormant state, waiting for any weakening of the immune system to become active again. This can occur after any physical or emotional stress. When the virus comes out of dormancy, it causes an outbreak that is different than chickenpox. The reactivated virus travels through a nerve to cause a burning, painful skin rash. The symptoms of shingles are more severe than those of chickenpox. Prior to the development of the rash, the patient notices an itching, burning sensation in the skin of the affected area. A red, irritated rash follows this—usually only on one side of the body. Seventy-five percent of shingles cases affect the chest, head, or neck.

The rash usually resolves within two to four weeks, but the pain can continue to occur for the remainder of the victim’s life. If the pain continues once the rash has resolved the person is suffering from post herpetic neuralgia. It is said to be the second most painful condition known to man, second only to tic douloureux (trigeminal neuralgia). Few people under the age of fifty will develop this devastating complication, however, the incidence increases with each decade of life over the age of fifty.

The usual treatment for post herpetic neuralgia involves medication to kill the virus and treat the pain. A recent study1 (*Prevention of Post herpetic Neuralgia, 2000), however, looked at the results of medication treatment and compared them to treating the patient with local anesthetics (numbing medicine) administered right onto the painful nerve.

Specifically, the study observed six hundred adults over the age of fifty-five who had experienced a rash for less than seven days in duration. Half of the group received intravenous anti-viral medication and oral steroids. The other half received administration of local anesthetics directly onto the painful nerve. The results at one year showed that only 1.6% of the patients in the group receiving treatment with local anesthetics had continued pain. 22.2% of the group treated with IV anti-viral medication and steroids were still in pain at one year.

This dramatic difference in results suggests that every patient with the painful shingles disease should be treated with the local anesthetic option. However, there are only a few physicians in the state of Utah with the proper training to administer this treatment. They are usually listed in the telephone book under pain management physicians. Nexus Paincare is one of the few offices with physicians capable of providing this service. It is recommend that treatment for shingles be implemented as early as possible in patients at risk for developing post herpetic neuralgia.

The physicians at Nexus Paincare can help those suffering from shingles. Our specialized professional team is committed to finding the source of pain, providing effective treatment and helping patients on the road to recovery.

1. A. Pasqualucci et al, “Prevention of post-herpetic neuralgia: acyclovir and prednisolone versus epidural local anesthetic and methylprednisolone”, Acta Anesthesiologica Scandinavica 2000, 44: 910-198


RSD

RSD (or reflex sympathetic dystrophy), often called Complex Regional Pain Syndrome, is a painful, chronic condition that can affect skin, muscles, joints, and bones. This syndrome is usually on-set after a traumatic physiological incident, such as a broken bone, a sprain, or surgery. Sometimes the initial cause of RSD is unknown.

RSD will often go away on its own. But after 1-3 months of RSD pain, patients should seek the advice of a pain management specialist. There are many treatments and procedures that can effectively reduce or eliminate the affects of RSD.


Foot Pain / Neuropathy

A disease of the nerves, peripheral neuropathy mainly affect s the feet and legs. Patients often describe neuropathy pain as tingling, burning, or electric shock-type pain. While many physicians simply treat neuropathy with opiate medications, our physicians try to find the source of the pain—and are often able to effectively stop the pain at its source.

Neuropathic pain is caused for a number of reasons—a result of cancer pain, a lingering effect of shingles, diabetes, traumatic injuries, etc.


Back Pain

Despite months of therapy, do you still hurt? If you’re reading this, it is likely that the cause of your pain has not yet been discovered. You may have had months of physical therapy, massage and treatment with pain medications with only partial relief. If you would like to get rid of your pain, you have come to the right place. Often we can find a solution when others have failed. Using the latest advanced technology, we can pinpoint the exact cause of pain and tailor a treatment to relieve it.

Dr. Richard Rosenthal explains, “Our goal is to find the source of the pain and get rid it. We won’t give up until we have found a solution.” The following story will illustrate the type of case we see every day in our clinic

A patient came in with constant, severe back pain which began after a car accident. Her doctor informed her that she would have to have surgery to repair the damage. She was reluctant to go through with it. She worried about the long recovery, post-surgery pain and months of physical therapy.

She didn’t know what to do—she tried pain medications, physical therapy, and massage without any real relief. She was frustrated with the medical system and didn’t know why they couldn’t get to the bottom of the problem and fix it. For years she just lived with the pain. A friend told her about Nexus Pain Specialists. She decided she had nothing to lose by scheduling an appointment.

After a thorough evaluation, a diagnostic procedure was performed confirming that the pain was due to an arthritic joint. Once the cause of the problem was known, a simple 20-minute procedure was performed. She has now been pain free for over a year. No long-term recovery was required and the patient went back to work the next day.

“My pain is now manageable,” said the patient. “I am able to accomplish things much more comfortably because of the persistence and dedication of the doctors at Nexus.”

In addition to procedures, we offer a multi-specialty approach to help manage pain in even the most difficult cases. We utilize all types of prescription medications, including opiates, for the treatment of pain in selected cases. In addition, we provide physical therapy, guided imagery, behavioral management, medications, chiropractic and massage.

Let us get to the bottom of your pain and get you back to a more productive life.


Neck Pain

Chronic neck pain, or cervical pain, can occur for a number of reasons—whiplash after an auto accident, arthritis, degeneration as people age, traumatic injuries, etc. Severe neck pain can be disabling and can affect daily routines.

The specialists at Nexus Paincare help our patients to understand exactly what type of pain they’re dealing with. We create individual treatment plans for each patient that may include any of the following: diagnostic testing, treatment procedures, chiropractics, physical therapy, massage therapy, etc.

We believe that a multi-disciplinary approach is the most effective method of helping our patients recover from neck pain.


Migraines / Headaches

Most people will suffer from headache pain at some time in their lives. Headaches can vary in severity and consistency. Most commonly, people have random, occasional headaches that are helped by over-the-counter medications. Tension headaches and migraines involve more severe pain.

A tension headache is often associated with stress-induced muscle tightness that can cause mild to moderate pain, most commonly in the forehead and back of the head.

Migraines often generate a pulsating or pounding pain on one side of the head. Migraine pain often results in nausea and sensitivity to light and sound.

If a person experiences headache pain 15 or more days a month, they are considered to have chronic daily headaches. An estimated four to five percent of the adult population in the U.S. suffers from chronic daily headaches.

Most people take over-the-counter or prescription medications to mask the pain associated with chronic daily headaches. These medications only temporarily help the pain. There are other options that provide more lasting relief.

Minimally invasive treatments can help patients find relief from chronic daily headaches, for example, Botox® injections. Botox® is most commonly recognized as a cosmetic agent to help reduce wrinkles. But recent studies indicate that Botox® is also helpful in alleviating headache pain.

A 2003 study presented at the American Headache Society 45th Annual Scientific Meeting produced results indicating that 80 percent of patients treated with Botox® for headache pain claimed to have less frequent pain, less intense pain or both after the injections. Of the 271 patients who received Botox® injections for the study, 60 percent reported good to excellent pain relief, 20 percent reported some pain relief and 20 percent reported no relief.

Three-quarters of the 271 patients had tried other therapies in seeking pain relief. Half of them had been over-using medication in an effort to find relief.

Specialists in Utah are also using Botox® injections to help patients find lasting relief from chronic daily headaches.

At Nexus Paincare, we treated a series of 50 patients suffering from tension headaches with Botox® injections. There was only one patient who wasn’t completely satisfied.

Many patients who receive relief from Botox® injections are able to reduce their medication dosages or stop taking pain medications all together.

For millions of Americans, chronic daily headaches have become a way of life. People who live with daily headache pain may find the key to lasting relief through Botox®. There are also several other treatments that successfully provide headache pain relief.

There is no reason to suffer from chronic daily headache pain. People who experience this type of pain should consult with a pain management specialist and stop living in pain.


PTSD / Anxiety

PTSD, Generalized Anxiety and Nexus Pain Specialists

PTSD and Generalized Anxiety can be debilitating, preventing the individual from living the life they desire. What’s more, the emotional toll is passed onto their families and communities. Anyone who has lived with someone who has an anxiety disorder knows that it can become a constant struggle to help them maintain control of their emotions.  Here at Nexus Pain Care, we are familiar with recent studies that indicate a simple procedure can alleviate the symptoms of PTSD and Generalized Anxiety.

We can perform a simple, ten minute procedure that can potentially relieve a lifetime of Post-Traumatic Stress Disorder (PTSD).  This procedure is called a Stellate Ganglion Block.

 

What is a Stellate Ganglion Block?

Within our autonomic nervous system (the division of our nervous system that regulates bodily function without conscious effort), there are two divisions that serve to counterbalance our internal state: the sympathetic nervous system and the parasympathetic nervous system. The parasympathetic nervous system is activated when our body needs to “rest-and-digest”, whereas the sympathetic nervous system is activated when our body needs a “fight-or-flight” response.  This response to external stressors is healthy and normal, but when the stressor is extreme or present for long periods of time, the “fight-or-flight” response becomes constant and exaggerated. Such is the case when someone has post-traumatic stress disorder (PTSD).  

In addition, conventional treatments for PTSD include cognitive behavioral therapy and the use of antidepressant/antipsychotic drugs.  While improvements have been observed, many patients do not achieve complete remission.  Individuals may become dependent on their daily regimen of medication.

The cost and duration of these treatments is something else to consider.  According to the Veteran’s Health Administration1, the average cost of care for someone diagnosed with PTSD during their first year of treatment was $8,300.  Considering that many patients with this disorder require years of treatment, the charges become substantial.

Recently, studies have shown that a single stellate ganglion block, a procedure which temporarily shuts off a portion of the sympathetic nervous system, can provide long term relief for those suffering from PTSD.  In a study conducted by Alkire et al,2 twelve patients underwent the procedure and nine reported positive results that occurred almost immediately.  Importantly, “…anxiety, depression and psychological pain scores… were significantly reduced by the block.” The long term benefit of this procedure was reported in a similar study conducted by Mulvaney et al,3 where “one patient requested repeat treatment after 3 months, and the post-treatment score remained below the PTSD cutoff after 7 additional months of follow-up. Both patients [in this study] discontinued all antidepressant and antipsychotic medications while maintaining [improvements].” Similar results have been seen in other studies.4,5

1. The Veterans Health Administration's Treatment of PTSD and Traumatic Brain Injury Among Recent Combat Veterans. (2015). Retrieved September 28, 2016, from https://www.cbo.gov/publication/42969

2. Alkire MT, Hollifield M, Khoshsar R, et al. Prolonged Relief of Chronic Extreme PTSD and Depression Symptoms in Veterans Following a Stellate Ganglion Block. Presented at American society for Anesthesiology. 11 Oct 2014

3. Mulvaney SW, McLean B, de Leeuw J: The use of stellate ganglion block in the treatment of panic/anxiety symptoms with combat-related post-traumatic stress disorder: preliminary results of long-term follow-up: a case series. Pain Pract 2010; 10(4): 359–65.

4. Hicky A, et al.: Stellate ganglion block for PTSD. Am J Psychiatry. 2012 Jul 1;169(7):760.

5. Alino J, Kostka D, McLean B, et al. 5. Efficacy of Stellate Ganglion Block in the Treatment of Anxiety Symptoms From Combat-Related Post-Traumatic Stress Disorder: A Case Series. Mil Med, 2013; 178:473-7.

 

Medical Costs Associated with This Treatment

Using a Stellate Ganglion block to treat PTSD is a relatively new form of treatment.  Only within the last few years has it been studied. Medical insurance companies are slow in their evaluation process to provide coverage for new and emerging treatments.  Most likely, it will be years before insurance companies will approve this as a covered procedure.  However, when we consider the financial and emotional costs of PTSD, and witness the efficacy of Stellate ganglion blocks in treating the condition, we feel that waiting for insurance companies to approve this method of treatment is unjustified. Rather, we would like to move forward immediately and begin to treat people suffering from PTSD.  We provide these services at an affordable self-pay prices.

 

 

 

Nexus Pain Specialists


3585 N University Ave,  Suite 150, Provo, UT 84604 • Phone: 801-356-6100 • Fax: 801-356-2113
1575 West 7000 South, West Jordan, UT 84084 • Phone: 801-833-6569