Low back pain (LBP) is a highly prevalent condition and one of the leading causes of lost productivity and health-care costs. Interventional pain procedures are used extensively in diagnosis and treatment of chronic pain.
Pain makes it harder for you to enjoy your hobbies, relationships and daily activities. But you don’t have to live with discomfort. Caring pain management specialists at Tidelands NextStep Pain Management Services can offer relief and give you hope.
Listen in as Dr. Channing Willoughby discusses Interventional therapies for chronic back pain.
Interventional Therapies For Chronic Back Pain
From the Show: Tidelands Health - Better Health Radio
Summary:
Air Date: 9/19/16
Duration: 10 Minutes
Transcription:
Bill Klaproth (Host): Chronic back pain has negatively affected millions of Americans and for many of those traditional methods of physical therapy and medication has failed. So, what can be done? Here to talk with us about interventional therapies for chronic back pain is Dr. Channing Willoughby of Tidelands Health. Dr. Willoughby, thanks for being on with us. So, what constitutes chronic back pain?
Dr. Channing Willoughby (Guest): Yes, that’s a good question. Chronic back pain is mostly defined as any sort of pain that has persisted for more than three months.
Bill : So, for someone who’s three months in the traditional methods, maybe they’re taking some aspirin, maybe they’ve seen a chiropractor, it’s just not going away. So, that’s the time to see a doctor?
Dr. Willoughby: That’s right. If pain is severe, I would always recommend the patient to come in and be evaluated sooner, but at a three months point if your pain is still persisting and it’s keeping you from what you want to do on a day to day basis, I think that’s a very good time point where you want to go and see a physician and see what options would be available for you.
Bill: So, each case is evaluated at an individual basis but, generally, can you take us through it? Generally, physical therapy is first and medication as well. Are those the traditional methods of treatment out of the box?
Dr. Willoughby: Yes, that’s a pretty common approach. For most pain issues, we are very happy to say that medications of different types, mostly anti-inflammatories for degenerative issues, and a physical therapy program will get people back functional and overall decrease their levels of pain. Beyond that, some other treatment options may need to be instituted but for most people, that’s where we start unless there are some physical exam findings that may indicate otherwise.
Bill: So, for people that have come in, they’ve seen you, they’ve gone through physical therapy, maybe they’re on some medication, and those treatments just haven’t worked. Can you talk to us about interventional therapies? What are those?
Dr. Willoughby: Well, there is a whole host. Mostly here in our practice within the Tidelands Health Organization, we focus on interventional spine treatments, but there are certainly others for peripheral joint pains as well as some other lesser common pain syndromes but, for the most part, we are trying to evaluate degenerative issues of the spine. We work that up pretty thoroughly and once we kind of hone in what the primary diagnosis would be, we develop a procedural plan to try to help decrease pain and hopefully improve function for the patient.
Bill: And, what are those different therapies that you may use?
Dr. Willoughby: I would say the two most common types of treatment, although there is several that we could probably go on and on about, would be epidural steroid injections which are simply procedures for medicine placed into the spinal area, around areas where there may be issues of degenerated disk, possibly spinal stenosis, or inflammation of nerves. Our other more common types of procedure would be related to degenerated joints of the spine and those procedures are called “facet joints”. Without getting into too much detail, there are other procedures that follow-up beyond that. But, facet joints are basic steroid injections into degenerated joints of the spine itself.
Bill: So, for the epidural steroid injection, how long does that hold generally?
Dr. Willoughby: Most patients see several months of good relief. Ultimately, depending on what the underlying cause of the person’s pain is can sometimes determine how long they can expect benefits. I would say most people see several months. At the same time, I have people that get a couple of years of good relief before I ever see them back. So, I’m very happy for those folks.
Bill: So, it really depends on the patient, then. But, somebody that’s on that course of the epidural steroid injection, I know you said you have some patients that it’s lasted for a couple of years, but they’re pretty much on that course. They would have to continue to do that then, for the rest of their life?
Dr. Willoughby: Well, we recommend that as long as symptoms dictate such. Some people, if they have a, let’s say, a very specific degenerative disk issue that has been bothering them for a few weeks, epidural steroid injection can certainly improve their pain. That’s a person we are not surprised at all if we never see again. Someone that has a more degenerated spine with what we would call “spinal stenosis”, that is probably going to be a patient that we would expect to be treating more on an extended and regular basis, if you will.
Bill: How long does this treatment take? Is that in outpatient? Are you able to give this injection through an outpatient care facility?
Dr. Willoughby: That’s correct. Everything we do here as outpatient is a very streamlined process. We have a clinic just next to Waccamaw Hospital here. I tell people expect your visit to be about an hour when you have a procedure. The procedure itself, however, from start to finish, is probably no more than three to four minutes. It’s a very quick procedure.
Bill: Absolutely. And, the patient is able to get up and walk out? Is what happens?
Dr. Willoughby: That’s right. You know, depending on procedure. Every situation is different but I would say the vast majority of patients that we have are fine to drive themselves home.
Bill: How soon can a patient expect relief?
Dr. Willoughby: Again, somewhat depending on the patient’s diagnosis, but most people will report very good benefits about 48-72 hours after procedure has been completed.
Bill: Are there any risks with the epidural steroid injection?
Dr. Willoughby: Well, any procedure always holds a risk and we always go through a risk versus benefit analysis with the patient before we decide to move forward with the procedure. I would say the most common risk of any sort of injection are going to be bleeding and infection. I would also stress, however, those are the exact same risks that are incurred when you have an IV placed for any procedure. Certainly, in the magnitude of well left of 1%, I’ve been very fortunate, through my career. I have not seen any long term complications from these procedures.
Bill: Dr. Willoughby, does the patient traditionally continue on with physical therapy after the injection or is that it?
Dr. Willoughby: They can. Sometimes we run our treatment sessions concurrent with therapy. Sometimes therapy has been completely finished before we start our injection process. I stress that people with physical therapy, even after formal physical therapy is completed, they should take the exercises they’ve been taught and bring that into a daily regiment from that point forward in their life. I think that’s a good way to maintain good spinal health and ultimately keep pain symptoms at a minimum.
Bill: Right. So, speaking of pain symptoms, I know it’s based on the individual, but can people expect the pain to be gone? On a scale of one to ten, where it was maybe at an eight all the time, it’s at a two? What do you generally see happen?
Dr. Willoughby: In the realm of chronic pain, we like to say successes are measured when patients display greater than a 50% improvement. Anyone that’s been living a life on an eight or a nine out of ten if you’re able to get that pain down to, let’s say, three or four, while that’s still relevant pain for most, that person is going to be able to report to you they’re able to do things with their families like go to church without pain that would otherwise keep them from sitting still for an hour; going out to dinner with friends. A lot of activities that we, most of the time, take for granted, these people are not able to participate in. So, if we can get their pain over 50% improvement, we’re going to say that we’ve definitely, definitely had success.
Bill: And, how do you choose or how do you recommend this interventional therapy? Who is a good candidate for the epidural steroid injection?
Dr. Willoughby: There is a very broad list. I would say anyone that has chronic back pain and, again, we’ve mentioned that’s typically pain that’s lasted more than three months. Anyone of that description is certainly eligible to be evaluated to see if they are a candidate. Certainly, epidurals are not right for everyone and that’s why it’s important to seek out a physician to find out what treatment is right for you. Some of these people have already had back surgery. Some people are facing a potential back surgery and are interested in more conservative measures. That’s where we step in and try to help in any way we can.
Bill: And, does insurance usually pay for this?
Dr. Willoughby: These are insurance approved procedures. We have a great team here at our office that works with approvals with insurances that require such. Our ultimate goal, and what we stress to the patient is, we are going to make sure your insurance is covering this procedure before we schedule anything with you.
Bill: Sounds good. And, Dr. Willoughby, why should someone choose Tidelands Health for their back care needs?
Dr. Willoughby: I think Tidelands is unique, especially in the region where we live, in that we have a very comprehensive program. Right here at Tidelands Health, we have the ability to offer sponsored re-consultations, comprehensive pain management, physical therapy programs and a wide array of diagnostic utilities, all in one setting. I think the convenience it offer s for the patient is tough to beat.
Bill: Dr. Willoughby, thank you so much for your time today. Great information. I know chronic back pain can be debilitating. So, good to know that there are therapies out there that can help manage that pain. For more information about Tidelands Health physicians, services and facilities, visit www.tidelandshealth.org. That’s www.tidelandshealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Chronic back pain has negatively affected millions of Americans and for many of those traditional methods of physical therapy and medication has failed. So, what can be done? Here to talk with us about interventional therapies for chronic back pain is Dr. Channing Willoughby of Tidelands Health. Dr. Willoughby, thanks for being on with us. So, what constitutes chronic back pain?
Dr. Channing Willoughby (Guest): Yes, that’s a good question. Chronic back pain is mostly defined as any sort of pain that has persisted for more than three months.
Bill : So, for someone who’s three months in the traditional methods, maybe they’re taking some aspirin, maybe they’ve seen a chiropractor, it’s just not going away. So, that’s the time to see a doctor?
Dr. Willoughby: That’s right. If pain is severe, I would always recommend the patient to come in and be evaluated sooner, but at a three months point if your pain is still persisting and it’s keeping you from what you want to do on a day to day basis, I think that’s a very good time point where you want to go and see a physician and see what options would be available for you.
Bill: So, each case is evaluated at an individual basis but, generally, can you take us through it? Generally, physical therapy is first and medication as well. Are those the traditional methods of treatment out of the box?
Dr. Willoughby: Yes, that’s a pretty common approach. For most pain issues, we are very happy to say that medications of different types, mostly anti-inflammatories for degenerative issues, and a physical therapy program will get people back functional and overall decrease their levels of pain. Beyond that, some other treatment options may need to be instituted but for most people, that’s where we start unless there are some physical exam findings that may indicate otherwise.
Bill: So, for people that have come in, they’ve seen you, they’ve gone through physical therapy, maybe they’re on some medication, and those treatments just haven’t worked. Can you talk to us about interventional therapies? What are those?
Dr. Willoughby: Well, there is a whole host. Mostly here in our practice within the Tidelands Health Organization, we focus on interventional spine treatments, but there are certainly others for peripheral joint pains as well as some other lesser common pain syndromes but, for the most part, we are trying to evaluate degenerative issues of the spine. We work that up pretty thoroughly and once we kind of hone in what the primary diagnosis would be, we develop a procedural plan to try to help decrease pain and hopefully improve function for the patient.
Bill: And, what are those different therapies that you may use?
Dr. Willoughby: I would say the two most common types of treatment, although there is several that we could probably go on and on about, would be epidural steroid injections which are simply procedures for medicine placed into the spinal area, around areas where there may be issues of degenerated disk, possibly spinal stenosis, or inflammation of nerves. Our other more common types of procedure would be related to degenerated joints of the spine and those procedures are called “facet joints”. Without getting into too much detail, there are other procedures that follow-up beyond that. But, facet joints are basic steroid injections into degenerated joints of the spine itself.
Bill: So, for the epidural steroid injection, how long does that hold generally?
Dr. Willoughby: Most patients see several months of good relief. Ultimately, depending on what the underlying cause of the person’s pain is can sometimes determine how long they can expect benefits. I would say most people see several months. At the same time, I have people that get a couple of years of good relief before I ever see them back. So, I’m very happy for those folks.
Bill: So, it really depends on the patient, then. But, somebody that’s on that course of the epidural steroid injection, I know you said you have some patients that it’s lasted for a couple of years, but they’re pretty much on that course. They would have to continue to do that then, for the rest of their life?
Dr. Willoughby: Well, we recommend that as long as symptoms dictate such. Some people, if they have a, let’s say, a very specific degenerative disk issue that has been bothering them for a few weeks, epidural steroid injection can certainly improve their pain. That’s a person we are not surprised at all if we never see again. Someone that has a more degenerated spine with what we would call “spinal stenosis”, that is probably going to be a patient that we would expect to be treating more on an extended and regular basis, if you will.
Bill: How long does this treatment take? Is that in outpatient? Are you able to give this injection through an outpatient care facility?
Dr. Willoughby: That’s correct. Everything we do here as outpatient is a very streamlined process. We have a clinic just next to Waccamaw Hospital here. I tell people expect your visit to be about an hour when you have a procedure. The procedure itself, however, from start to finish, is probably no more than three to four minutes. It’s a very quick procedure.
Bill: Absolutely. And, the patient is able to get up and walk out? Is what happens?
Dr. Willoughby: That’s right. You know, depending on procedure. Every situation is different but I would say the vast majority of patients that we have are fine to drive themselves home.
Bill: How soon can a patient expect relief?
Dr. Willoughby: Again, somewhat depending on the patient’s diagnosis, but most people will report very good benefits about 48-72 hours after procedure has been completed.
Bill: Are there any risks with the epidural steroid injection?
Dr. Willoughby: Well, any procedure always holds a risk and we always go through a risk versus benefit analysis with the patient before we decide to move forward with the procedure. I would say the most common risk of any sort of injection are going to be bleeding and infection. I would also stress, however, those are the exact same risks that are incurred when you have an IV placed for any procedure. Certainly, in the magnitude of well left of 1%, I’ve been very fortunate, through my career. I have not seen any long term complications from these procedures.
Bill: Dr. Willoughby, does the patient traditionally continue on with physical therapy after the injection or is that it?
Dr. Willoughby: They can. Sometimes we run our treatment sessions concurrent with therapy. Sometimes therapy has been completely finished before we start our injection process. I stress that people with physical therapy, even after formal physical therapy is completed, they should take the exercises they’ve been taught and bring that into a daily regiment from that point forward in their life. I think that’s a good way to maintain good spinal health and ultimately keep pain symptoms at a minimum.
Bill: Right. So, speaking of pain symptoms, I know it’s based on the individual, but can people expect the pain to be gone? On a scale of one to ten, where it was maybe at an eight all the time, it’s at a two? What do you generally see happen?
Dr. Willoughby: In the realm of chronic pain, we like to say successes are measured when patients display greater than a 50% improvement. Anyone that’s been living a life on an eight or a nine out of ten if you’re able to get that pain down to, let’s say, three or four, while that’s still relevant pain for most, that person is going to be able to report to you they’re able to do things with their families like go to church without pain that would otherwise keep them from sitting still for an hour; going out to dinner with friends. A lot of activities that we, most of the time, take for granted, these people are not able to participate in. So, if we can get their pain over 50% improvement, we’re going to say that we’ve definitely, definitely had success.
Bill: And, how do you choose or how do you recommend this interventional therapy? Who is a good candidate for the epidural steroid injection?
Dr. Willoughby: There is a very broad list. I would say anyone that has chronic back pain and, again, we’ve mentioned that’s typically pain that’s lasted more than three months. Anyone of that description is certainly eligible to be evaluated to see if they are a candidate. Certainly, epidurals are not right for everyone and that’s why it’s important to seek out a physician to find out what treatment is right for you. Some of these people have already had back surgery. Some people are facing a potential back surgery and are interested in more conservative measures. That’s where we step in and try to help in any way we can.
Bill: And, does insurance usually pay for this?
Dr. Willoughby: These are insurance approved procedures. We have a great team here at our office that works with approvals with insurances that require such. Our ultimate goal, and what we stress to the patient is, we are going to make sure your insurance is covering this procedure before we schedule anything with you.
Bill: Sounds good. And, Dr. Willoughby, why should someone choose Tidelands Health for their back care needs?
Dr. Willoughby: I think Tidelands is unique, especially in the region where we live, in that we have a very comprehensive program. Right here at Tidelands Health, we have the ability to offer sponsored re-consultations, comprehensive pain management, physical therapy programs and a wide array of diagnostic utilities, all in one setting. I think the convenience it offer s for the patient is tough to beat.
Bill: Dr. Willoughby, thank you so much for your time today. Great information. I know chronic back pain can be debilitating. So, good to know that there are therapies out there that can help manage that pain. For more information about Tidelands Health physicians, services and facilities, visit www.tidelandshealth.org. That’s www.tidelandshealth.org. This is Better Health Radio. I’m Bill Klaproth. Thanks for listening.
