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What is Interventional Pain Medicine: Is This an Option For You
Dr. Erosa discusses Interventional pain medicine as a treatment option.
Featured Speaker:
Stephen Erosa, DO
Dr. Stephen Erosa is a Dual Board Certified Physician who offers a variety of interventional options for the treatment of chronic musculoskeletal, neuropathic, and post-surgical pain. Dr. Erosa earned his medical degree from the Philadelphia College of Osteopathic Medicine and completed his Residency and Fellowship training at Albert Einstein College of Medicine/Montefiore Medical Center in New York City. Dr. Erosa’s mission is to identify the source of your pain and provide a comprehensive and personalized treatment plan that has the potential to provide the longest-lasting pain relief without the need for long term oral medications. Dr. Erosa is able to provide a holistic approach to his patients due to his osteopathic, physiatric (physical medicine), and interventional spine/pain management training. Transcription:
What is Interventional Pain Medicine: Is This an Option For You
Prakash Chandran: Oftentimes, we find that mainstream forms of medications, such as opioids and rehabilitation are more effective than alternative options. However, there are many ways interventional pain medicine can be a better treatment method for you and your loved ones. We're going to talk about it today with Dr. Stephen, Erosa, Dual Board-Certified Physician at St. John's Riverside Hospital. This is Riverside Radio Healthcast, the podcast from St. John's Riverside Hospital. I'm Prakash Chandran. So first of all, Dr. Erosa, let's start with the basics. What exactly is interventional pain medicine?
Dr. Erosa: Interventional pain management, or interventional spine and interventional pain medicine is a subspecialty of medicine that focuses on targeting the specific cause of your pain using small minimally invasive procedures to diagnose, as well as treat chronic painful conditions without the need for long-term medication use.
Host: I see. And when you say minimally invasive, what exactly does that mean?
Dr. Erosa: So interventional procedures are not surgeries. Okay. They are small through the skin or percutaneous as we call it, though through the skin injections and procedures to provide medications, around effective nerves, joints and areas in and around the spine to help control chronic pain.
Host: I see. And so you mentioned the spine there, is the field of interventional pain management, does that mostly focus on the spine or does it also focus on other areas of the body?
Dr. Erosa: There are many procedures that work at the level of the spine because the spine can be a very strong pain generator for multiple areas of the body, from the neck to the shoulders, to the arms. However, it's not just specific to that. Many of our procedures focus on spine, but we do have several procedures for joint pains, knee, foot, hip upper extremities, wrist, elbow, shoulders, that are specific to those areas as well. So, no, it's not just the spine, but there are many procedures that involve the spine.
Host: That's good to know. So you mentioned that it was used for both diagnosis and treatment. Talk to us a little bit about how people use it as a treatment option?
Dr. Erosa: As far as looking at a chronic pain, once we are able to diagnose like where your pain is coming from. So that's let's take, for example, let's say neck pain, right? If you have neck pain, it's coming from the joints, there are treatments where we can block those joints. And then for long-term management do something called a radio frequency ablation where we place a special needle right next to those nerves, use radio waves to shut down those nerves for nine months to a year, providing sustained pain relief for that period of time.
Host: Wow. That sounds incredible. And like something from the future I'm curious to know how long pain management has been around for,
Dr. Erosa: So as a specialty actually doctors providing this this treatment it's been around for, well over 30 years as an accepted specialty by the American board of medical specialties, something that you could get specific training and a certification in, which is what I'm board certified in. It's been around since 2005. And so it is relatively new for as far as mainstream. However, these procedures were done very commonly for a long time. Now it's starting to become more popular and more readily used, especially during the opiate epidemic that we're in.
Host: Yeah. So let's chat about that a little bit. What are some of the long-term benefits of interventional pain medicine over the use of opioids and rehabilitation services?
Dr. Erosa: As far as opioids are concerned, we've learned or over the past 10, 15 years that long-term use has many negative side effects especially for non-cancer meaning musculoskeletal pain. So, if you have back pain, joint pain, hip pain, neck pain, and you're on long-term opioids, there are many negative side effects that can occur such as opioid induced hyperalgesia, meaning you're on these medications for so long and they actually make your pain worse. That's a whole talk for another time, but essentially if you keep blocking the pain from that method using opiates, your body wants to feel the pain. So it makes more receptors. And so utilizing interventional treatments, we can control the pain without the use of those medications. And once that therapy, whether it be radiofrequency ablation, epidural, injections, something we'd have not mentioned, but spinal cord stimulation or peripheral nerve stimulation, once those therapies are affecting you and providing you with relief, then you can either come off of those medications and you won't need to use as much opioid medications. In my practice, if somebody is at the point where they, they are having such pain for so long and physical therapy, rehabilitation, chiropractic care exercise, non-opioid medications are not helping. Then we need to look at what the cause is and start utilizing some of these advanced procedures to help block the pain before they even get started on an opiate.
Host: Yeah, I really like that philosophy there. And I was just going to ask you about who interventional pain management benefits the most. So you mentioned if basically people have tried everything before actually taking an opiate that's the time that they should actually come to you and get diagnosed, is that correct?
Dr. Erosa: That is correct. However many patients do come a little earlier on in that treatment modality because as a physical medicine and rehabilitation specialist, which is my first board certification, and an interventional pain specialist, I utilize all of those treatments in my algorithm to help patients. So if somebody comes sooner and they say, yeah, I've done XYZ, but I've not tried this, well, then we try it to see if we can get them better from a conservative perspective. And then if they feel, if they continue to have pain, then we move towards these more interventional treatments. So the short answer is some people come earlier, but interventional pain specialists have the training to provide the conservative care as well. So you can have a continuum or a holistic comprehensive treatment plan from your interventional pain specialist.
Host: One of the things that I'm curious about is you said one of the procedures might last eight to nine months, and then it's something that you could potentially repeat. Maybe talk a little bit about why that is. I'm assuming it's because the body changes over time and things need to be reset, but just talk about that whole procedure and why things need to be reset.
Dr. Erosa: So, when we do a procedure like radiofrequency ablation, what we're using is radio waves to shut down that nerve. Now that nerve over time will regenerate, will heal and wake back up again. And you may feel your pain again, the beauty of this is unlike a surgery that's permanent. This is something that can be repeated with sustained results and repeatable results. Now, the interesting thing is, like I said earlier, you know, physical medicine and rehabilitation is also a component of a comprehensive program. Now let's say we do this procedure, and then you feel much better. While you're feeling better, if you lose weight, exercise, strengthen your muscles. When those nerves wake back up, they may wake back up to a healthier environment and you may not need to have this procedure repeated again, but in the event that they wake back up and you still have some pain, well, don't worry. The procedure is safe and repeatable, and you can get that sustained pain relief again. And many of my patients do this once a year, once every year and a couple of months. And it's perfectly safe and a very valid pain management tool, like many of the other procedures that we perform as well have similar effects and similar treatment protocols.
Host: I'd love to learn a little bit more about who interventional pain medicine or management benefits the most, you know, or maybe asked another way. What is the makeup of your patient population? Are we talking about athletes? Are we talking about the elderly talk a little bit about that?
Dr. Erosa: The benefit of interventional treatment actually it depends on the diagnosis. So you have somebody with back and leg pain that's an athlete, who's a professional or a professional or amateur player, or just a weekend warrior, that gets a disc herniation. Well, they can benefit from an interventional treatment for disc herniation pain. Elderly people when they have degenerate will be called degenerative spondylosis and degenerative arthritic spine disease, arthritic joints. Well, those patients can benefit from interventional treatment. And the beauty of it is interventional treatment can happen before or after someone has surgery. So interventional options can provide patients pain relief, whether they need it for knee osteoarthritis pain, and they are not yet ready to have a knee replacement done. We could do a wide range of procedures to help with that. And then even afterwards, a very substantial portion of my patient population are chronic postsurgical pain patients. And those are the ones that use some of the most advanced interventions that we provide. So if you had a joint replacement, if you had a back surgery, whether it's neck mid back or low back, and you continue to have pain, this is where some of our will be called neuromodulation or spinal cord and peripheral nerve stimulators come into play to block the pain electrically for many years. So it really runs the full gamut and the full spectrum of orthopedic and nerve pain care.
Host: Yeah, that truly sounds incredible. So, you know, just as we close here, there's going to be people listening to this that are hearing about this term for the first time. I wonder if you could share just one important thing that you would like them to know when they're considering using interventional pain management as a treatment option?
Dr. Erosa: The one thing I could leave everybody with is if you know somebody or you are somebody that is having daily pain that is affecting your quality of life, your overall function, and you have already had surgery are not a candidate for surgery and have tried multiple other medications and therapies strongly consider seeing an interventional pain specialist because the interventional approach to chronic pain care, which includes nerve pain, postsurgical pain, orthopedic pain, can provide a specific diagnosis for your problem. And with very minimally invasive procedures from simple injections to small percutaneous through the skin procedures to help with chronic pain could provide you with months to years of sustained pain relief without the need for medications, or to help lessen your medication burden. So that you can live a more healthy, active, and productive life.
Host: Well, Dr. Erosa, I think that is the perfect place to end. I know for me personally, I'm going to share this with my father who's going through some of these pain symptoms and I think this can really help. So thank you so much for the information today. That's Dr. Stephen Erosa, dual board certified physician at St. John's Riverside Hospital. Thanks for checking out this episode of Riverside Radio HealthCast, for more information on providers, visit Riversidehealth.org or call (914) 207-1161 to make an appointment with Dr. Erosa. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Riverside Radio Healthcast the Podcast from St. John's Riverside Hospital. Thanks, and we'll see you next time.
What is Interventional Pain Medicine: Is This an Option For You
Prakash Chandran: Oftentimes, we find that mainstream forms of medications, such as opioids and rehabilitation are more effective than alternative options. However, there are many ways interventional pain medicine can be a better treatment method for you and your loved ones. We're going to talk about it today with Dr. Stephen, Erosa, Dual Board-Certified Physician at St. John's Riverside Hospital. This is Riverside Radio Healthcast, the podcast from St. John's Riverside Hospital. I'm Prakash Chandran. So first of all, Dr. Erosa, let's start with the basics. What exactly is interventional pain medicine?
Dr. Erosa: Interventional pain management, or interventional spine and interventional pain medicine is a subspecialty of medicine that focuses on targeting the specific cause of your pain using small minimally invasive procedures to diagnose, as well as treat chronic painful conditions without the need for long-term medication use.
Host: I see. And when you say minimally invasive, what exactly does that mean?
Dr. Erosa: So interventional procedures are not surgeries. Okay. They are small through the skin or percutaneous as we call it, though through the skin injections and procedures to provide medications, around effective nerves, joints and areas in and around the spine to help control chronic pain.
Host: I see. And so you mentioned the spine there, is the field of interventional pain management, does that mostly focus on the spine or does it also focus on other areas of the body?
Dr. Erosa: There are many procedures that work at the level of the spine because the spine can be a very strong pain generator for multiple areas of the body, from the neck to the shoulders, to the arms. However, it's not just specific to that. Many of our procedures focus on spine, but we do have several procedures for joint pains, knee, foot, hip upper extremities, wrist, elbow, shoulders, that are specific to those areas as well. So, no, it's not just the spine, but there are many procedures that involve the spine.
Host: That's good to know. So you mentioned that it was used for both diagnosis and treatment. Talk to us a little bit about how people use it as a treatment option?
Dr. Erosa: As far as looking at a chronic pain, once we are able to diagnose like where your pain is coming from. So that's let's take, for example, let's say neck pain, right? If you have neck pain, it's coming from the joints, there are treatments where we can block those joints. And then for long-term management do something called a radio frequency ablation where we place a special needle right next to those nerves, use radio waves to shut down those nerves for nine months to a year, providing sustained pain relief for that period of time.
Host: Wow. That sounds incredible. And like something from the future I'm curious to know how long pain management has been around for,
Dr. Erosa: So as a specialty actually doctors providing this this treatment it's been around for, well over 30 years as an accepted specialty by the American board of medical specialties, something that you could get specific training and a certification in, which is what I'm board certified in. It's been around since 2005. And so it is relatively new for as far as mainstream. However, these procedures were done very commonly for a long time. Now it's starting to become more popular and more readily used, especially during the opiate epidemic that we're in.
Host: Yeah. So let's chat about that a little bit. What are some of the long-term benefits of interventional pain medicine over the use of opioids and rehabilitation services?
Dr. Erosa: As far as opioids are concerned, we've learned or over the past 10, 15 years that long-term use has many negative side effects especially for non-cancer meaning musculoskeletal pain. So, if you have back pain, joint pain, hip pain, neck pain, and you're on long-term opioids, there are many negative side effects that can occur such as opioid induced hyperalgesia, meaning you're on these medications for so long and they actually make your pain worse. That's a whole talk for another time, but essentially if you keep blocking the pain from that method using opiates, your body wants to feel the pain. So it makes more receptors. And so utilizing interventional treatments, we can control the pain without the use of those medications. And once that therapy, whether it be radiofrequency ablation, epidural, injections, something we'd have not mentioned, but spinal cord stimulation or peripheral nerve stimulation, once those therapies are affecting you and providing you with relief, then you can either come off of those medications and you won't need to use as much opioid medications. In my practice, if somebody is at the point where they, they are having such pain for so long and physical therapy, rehabilitation, chiropractic care exercise, non-opioid medications are not helping. Then we need to look at what the cause is and start utilizing some of these advanced procedures to help block the pain before they even get started on an opiate.
Host: Yeah, I really like that philosophy there. And I was just going to ask you about who interventional pain management benefits the most. So you mentioned if basically people have tried everything before actually taking an opiate that's the time that they should actually come to you and get diagnosed, is that correct?
Dr. Erosa: That is correct. However many patients do come a little earlier on in that treatment modality because as a physical medicine and rehabilitation specialist, which is my first board certification, and an interventional pain specialist, I utilize all of those treatments in my algorithm to help patients. So if somebody comes sooner and they say, yeah, I've done XYZ, but I've not tried this, well, then we try it to see if we can get them better from a conservative perspective. And then if they feel, if they continue to have pain, then we move towards these more interventional treatments. So the short answer is some people come earlier, but interventional pain specialists have the training to provide the conservative care as well. So you can have a continuum or a holistic comprehensive treatment plan from your interventional pain specialist.
Host: One of the things that I'm curious about is you said one of the procedures might last eight to nine months, and then it's something that you could potentially repeat. Maybe talk a little bit about why that is. I'm assuming it's because the body changes over time and things need to be reset, but just talk about that whole procedure and why things need to be reset.
Dr. Erosa: So, when we do a procedure like radiofrequency ablation, what we're using is radio waves to shut down that nerve. Now that nerve over time will regenerate, will heal and wake back up again. And you may feel your pain again, the beauty of this is unlike a surgery that's permanent. This is something that can be repeated with sustained results and repeatable results. Now, the interesting thing is, like I said earlier, you know, physical medicine and rehabilitation is also a component of a comprehensive program. Now let's say we do this procedure, and then you feel much better. While you're feeling better, if you lose weight, exercise, strengthen your muscles. When those nerves wake back up, they may wake back up to a healthier environment and you may not need to have this procedure repeated again, but in the event that they wake back up and you still have some pain, well, don't worry. The procedure is safe and repeatable, and you can get that sustained pain relief again. And many of my patients do this once a year, once every year and a couple of months. And it's perfectly safe and a very valid pain management tool, like many of the other procedures that we perform as well have similar effects and similar treatment protocols.
Host: I'd love to learn a little bit more about who interventional pain medicine or management benefits the most, you know, or maybe asked another way. What is the makeup of your patient population? Are we talking about athletes? Are we talking about the elderly talk a little bit about that?
Dr. Erosa: The benefit of interventional treatment actually it depends on the diagnosis. So you have somebody with back and leg pain that's an athlete, who's a professional or a professional or amateur player, or just a weekend warrior, that gets a disc herniation. Well, they can benefit from an interventional treatment for disc herniation pain. Elderly people when they have degenerate will be called degenerative spondylosis and degenerative arthritic spine disease, arthritic joints. Well, those patients can benefit from interventional treatment. And the beauty of it is interventional treatment can happen before or after someone has surgery. So interventional options can provide patients pain relief, whether they need it for knee osteoarthritis pain, and they are not yet ready to have a knee replacement done. We could do a wide range of procedures to help with that. And then even afterwards, a very substantial portion of my patient population are chronic postsurgical pain patients. And those are the ones that use some of the most advanced interventions that we provide. So if you had a joint replacement, if you had a back surgery, whether it's neck mid back or low back, and you continue to have pain, this is where some of our will be called neuromodulation or spinal cord and peripheral nerve stimulators come into play to block the pain electrically for many years. So it really runs the full gamut and the full spectrum of orthopedic and nerve pain care.
Host: Yeah, that truly sounds incredible. So, you know, just as we close here, there's going to be people listening to this that are hearing about this term for the first time. I wonder if you could share just one important thing that you would like them to know when they're considering using interventional pain management as a treatment option?
Dr. Erosa: The one thing I could leave everybody with is if you know somebody or you are somebody that is having daily pain that is affecting your quality of life, your overall function, and you have already had surgery are not a candidate for surgery and have tried multiple other medications and therapies strongly consider seeing an interventional pain specialist because the interventional approach to chronic pain care, which includes nerve pain, postsurgical pain, orthopedic pain, can provide a specific diagnosis for your problem. And with very minimally invasive procedures from simple injections to small percutaneous through the skin procedures to help with chronic pain could provide you with months to years of sustained pain relief without the need for medications, or to help lessen your medication burden. So that you can live a more healthy, active, and productive life.
Host: Well, Dr. Erosa, I think that is the perfect place to end. I know for me personally, I'm going to share this with my father who's going through some of these pain symptoms and I think this can really help. So thank you so much for the information today. That's Dr. Stephen Erosa, dual board certified physician at St. John's Riverside Hospital. Thanks for checking out this episode of Riverside Radio HealthCast, for more information on providers, visit Riversidehealth.org or call (914) 207-1161 to make an appointment with Dr. Erosa. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Riverside Radio Healthcast the Podcast from St. John's Riverside Hospital. Thanks, and we'll see you next time.