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Spinal Cord Stimulation Can Improve Emotional Aspect of Chronic Pain

Spinal cord stimulation is changing lives in more ways than just the physical pain and discomfort that the procedure has been proven to ease.

While many patients who undergo the procedure report anywhere from a 50 to 70 percent reduction in physical pain, a new study suggests that spinal cord stimulation may also reduce the brain’s emotional response to pain as well.

First, let’s quickly break down the What, How, Who, and Why of spinal cord stimulation.

Spinal Cord Stimulation

What: What is Spinal Cord Stimulation?

Are you curious about what this so called “life changer” for chronic pain is? While it sounds intense and maybe even scary, it’s quite the opposite.

This effective, minimally invasive treatment is a two-step procedure.

Since pain is transmitted through the spinal cord to the brain, spinal cord stimulators work to block the transmission of pain through the spinal cord.

What is a “Spinal Cord Stimulator”?

Made up of electrical wires and a small pacemaker-like battery, a spinal cord stimulator sends electrical impulses.

These electrical impulses stimulate the spinal cord, blocking the transmission of pain from different areas of the body, such as the legs, back, arms or neck.

How: How Does Spinal Cord Stimulation Work?

The two-stage procedure consists of the spinal cord stimulator trial and the permanent placement of a spinal cord stimulator.

Step 1:

First, step one is the trial. Patients who are candidates for the procedure will initially undergo a temporary trial of spinal cord stimulation.

For the trial period, the wires are implanted into the spinal canal and come out of the skin connecting to an external computer battery.

Step 2:

Following the trial, step two involves placing the spinal cord stimulator permanently.

The spinal cord wires and “pacemaker” computer and battery are implanted usually a few weeks to a month after the trial.

Who: Who is Spinal Cord Stimulation For?

Stimulators are usually given to people who continue to have pain after spine surgery (failed back syndrome) or have nerve disease like diabetic neuropathy or chronic pain syndromes such as reflex sympathetic dystrophy.

Why: Advantages of Spinal Cord Stimulation

Some advantages of spinal cord stimulation include:

The procedure itself is minimally invasive.
There is short recovery time.
High success rates have been shown.
There is minimal to no blood loss.
It is a same-day, out-patient procedure.

Altering Pain Perception: Spinal Cord Stimulation for the Emotional Aspect of Chronic Pain

Plenty of studies show that spinal cord stimulation helps reduce chronic pain. But now, it has been shown to ease the emotional aspect of chronic pain as well.

A New Study Says it All

Researchers at The Ohio State University Wexner Medical Center have proven that patients who have chronic pain can reduce their emotional response to pain through the procedure known as spinal cord stimulation.

The researchers at Ohio State’s Neurological Institute studied 10 patients who were implanted with a spinal cord stimulator to reduce their chronic leg pain. From this, they were able to support previous suggestions that emotional, sensory, and cognitive factors also influence how pain is felt.

According to the study results that were published in the journal, Neuromodulation: Technology at the Neural Interface, the initial study provides insights into the role of the brain’s emotional networks in relieving chronic pain.

“We are the first to show that therapeutic spinal cord stimulation can reduce the emotional connectivity and processing in certain areas of the brain in those with chronic pain,” said principal investigator Dr. Ali Rezai, director of the Center for Neuromodulation.

The research builds off previous findings that proposed the concept of the neuromatrix theory of pain. The theory states that pain perception varies according to cognitive, emotional and sensory influences.

“Being able to modulate the connections between the brain areas involved in emotions and those linked to sensations may be an important mechanism involved in pain relief linked to spinal cord stimulation,” Dr. Rezai said.

More than 500,000 patients have had spinal cord stimulator implants for chronic pain, according to Dr. Rezai.

“Spinal cord stimulation is safe and effective for pain control for severe chronic pain of the extremities and other conditions. However, the mechanisms of action of spinal cord stimulation are still not well understood and this is an area of active investigation,” Dr. Rezai explained to Orthopedics This Week.

“Our team’s goal was to utilize functional MRI with spinal cord stimulation to evaluate changes in the brain networks and circuitry involved in pain perception including sensory, emotional, behavioral and cognitive regions.”

How it Works for Emotional Aspects of Chronic Pain

Spinal cord stimulation may affect how pain is perceived in certain areas of the brain for people with chronic pain.

Researchers mapped the areas of the brain involved in pain perception and modulation by using functional magnetic resonance imaging (fMRI).

Focusing on the highly interactive region of the brain—known as the default mode network, which is associated with the emotional and cognitive aspects of pain—researchers found that there is a noticeable difference in activity level for patients with chronic pain.

The difference in activity level in the DMN suggests it’s somehow impacted by persistent pain.

The Future for Spinal Cord Stimulation in the Improvement of Emotional Aspects of Chronic Pain

Using MRI scans, scientists were successful in mapping areas of the brain that seem to be affected by impulses released by the implanted device used in the procedure.

Researchers now hope that understanding how the DMN region of the brain reacts to pain can lead to advances in pain control.

“If we can understand neural networks implicated in the pathophysiology of pain, then we can develop new therapies to manage chronic persistent pain,” said Dr. Milind Deogaonkar, an Ohio State neurosurgeon who specializes in neuromodulation.

How Will You Know if Spinal Cord Stimulation Right for You?

If determined an ideal candidate for the procedure, a patient will then go through the trial period, which usually lasts for about a week.

If you experience at least a 50 percent reduction in your pain following the trial, the device will be used long term.

Although the level and frequency of the electrical impulses delivered from the device are pre-set initially, the patient later controls it himself or herself.

Spinal cord stimulation helps lead to more active, fulfilling lives for many patients.

Does the procedure seem like something you would like to try yourself?

Anterior and Posterior Spinal Fusion: What to Expect for Your Surgery

When your doctor recommends a surgery called anterior and posterior spinal fusion, you have a right to be a little nervous. Those are a bunch of scary sounding words that only a fool would take casually.

By this point, you have already tried a spinal nerve block injection. But the pain is persistent.

Naturally, you have questions if you or someone you love is up for that particular procedure. Of course, you have asked your doctor all the questions that came to mind at the time. But that is never enough. The really good questions don’t occur to you until much later.

This article is no substitute for a conversation with your surgeon. But, having already had that conversation, this should help fill in some of the gaps.

What you really want to know is that at the end of the process, everything is going to be all right. There is good news. For this procedure, the fusion rate is greater than 95%. You are most likely going to be just fine.

But to get from where you are to being just fine, there is a road on which you must travel. That’s the scary part. The truth is always less frightening than the nightmare conjured by your worst fears. Knowing exactly what to expect is a great way to tame the beast. Here is what you can expect from your surgery:

Anterior and Posterior Spinal Fusion (Timetable)

Anterior and posterior spinal fusion is major surgery. Here are some numbers associated with the surgery:

8 – 12 hours: The amount of time the surgery takes
7 days: The expected hospital stay after surgery
4 days: The amount of time the chest tube is in
20 minutes: The maximum time you can sit up per session shortly after surgery
14 days: The minimum time before the staples are removed
6 months: The amount of time for the fusion to become solid

There are other numbers that fall into the category of “to be determined (TBD).” Those numbers include the time elapsed before you can return to work. All of these numbers make a lot more sense once you realize what the surgery involves.

Anterior and Posterior Spinal Fusion (Procedure)

As with most surgeries, you are not to eat or drink anything after midnight prior to surgery. It is a very long procedure done in two parts. Studies show it is better to have these parts done as a continuous procedure than staged over time.

There will first be some bone removed from your hip to be used in the fusion. From there, the anterior portion of the procedure will begin.

The Anterior Lumbar Interbody Fusion consists of an abdominal incision, and repositioning of major blood vessels to expose the damaged disk.

That disk is removed and replaced by the bone material. If normal spinal compression is not enough to hold the bone in place, a screw may be used.

Once this portion of the surgery is completed, you are turned over for the remainder of the procedure.

More disk material is removed, and more bone grafts are performed. More hardware such as rods and plates are applied as determined by the doctor.

It is normal for an NG tube to be inserted to prevent you from being sick afterward. Also, expect a chest tube to be inserted. This will aid in diagnostics for the first few days you are in the hospital.

It is not important that you have an encyclopedic knowledge of the surgical details. The takeaway is that these procedures are not new. They are tried and true. You should take comfort from the fact that these details are common knowledge. It has been successfully done countless times before you experience it.

Recovery

Anterior and posterior spinal fusion is major surgery. Expect recovery to be a process commensurate with the procedure.

You will have been on an operating table for several hours, and opened in the front and back with internal plumbing temporarily pushed aside for access. Expect a bit of discomfort while you heal.

There will be some period when you are forbidden to lift anything heavier than a gallon of milk. Expect some inconvenience.

There will be a period of time when you are forbidden to take more than a flight of stairs in a single day. Return to work will be at the doctor’s discretion. And you will need to wear a brace for a while. Expect some limited mobility.

In this way, all major surgery is the same: The initial recovery period is the darkest, scariest, most frustrating, and most depressing time of the procedure.

While managing pain that seems like it will never end, you are relearning how to walk, eat, and perform functions you once took for granted.

This is the period when the doctor is telling you that everything looks great. But you feel like everything is broken, and will never get better. This is normal. Everyone goes through it to some degree.

It takes a while, but it does get better. Eventually, you will have a quality of life you didn’t dream possible. The details of recovery are much like the details of surgery. There is a time-honored process that will lead to a better life.

Other Considerations

It is important for your loved ones to know as much about what to expect from the procedure as you do. That is because they will be taking care of you while you recover.

Some relationships can be severely challenged due to the added stress of convalescence. Some of those stresses are financial. Even if insurance covers every penny of the surgery, you have to be prepared to be without your income until you can return to work.

If your line of work is what caused your issues leading up to surgery in the first place, you might have to consider a new line of work (if not early retirement).

This stress can be relieved by having some type of financial plan in place to deal with the possibility of lost income.

It might also be prudent to arrange some counseling during recovery, It is not unusual for patients recovering from major surgery to go through some situational depression due to lost mobility, income, and body image.

The best defense against these types of post-op stresses is knowledge. Consult your surgeon. Dr. Carl Spivak is a board-certified Neurosurgeon and President of Executive Spine Surgery P.P.C. He’s here to help you.

Get a realistic handle on the timetable. Learn about the procedure. Set yourself up for recovery success. And don’t try to go it alone. Involve family and friends, because love is always the best medicine.

Slipped Disc Treatment and Exercise Tips

Slipped Disc Treatment and Exercise Tips

If you’re suffering from a slipped disc, you’re not alone. Read about treatments and exercises to relieve slipped discs here.

Are you experiencing back pain while moving? How about tingling sensations in your limbs?

A slipped disc may be to blame. In fact, the condition is quite common. About 60% to 80% of people will experience lower back pain, and for a large percentage of these people, a herniated disc is the culprit.

If you suspect such is your case, you’ll want to read on. In this article, we’ll look at the potential causes and risk factors for a slipped disc, its numerous stages, most common treatments, and some essential exercise tips for faster recovery.

Slipped (Herniated) Disc: Risk Factors, Symptoms, And Treatment

A slipped disc results from the breakdown of the connective tissue around the disc. Following the breakdown, the gel-like part of the disc swells.

This condition doesn’t occur overnight. It goes through four stages: disc degeneration, prolapse, extrusion, and sequestration.

The causes of connective tissue breakdown are not always clear. However, aging is closely linked to slipped discs. Spinal discs lose water content through the years, making discs more fragile and less flexible.

The list of symptoms that follow disc herniation can vary from one patient to another. That said, they often include:

Pain and numbness on one side of the body
Abnormal muscle weakness
Tingling and pins-and-needles sensations
Pain extending to arms and limbs

Even younger people can fall victim to slipped discs, and the usual risk factors include:

Smoking (reduces the body’s oxygen supply)
Obesity
Improper and heavy lifting
Frequent driving
Accidents (such as falling)

Fortunately, a herniated disc will slowly but surely improve. But many patients experience episodes of pain on the way to recovery. To help them cope, doctors recommend non-surgical aids such as:

NSAIDs or analgesics
Codeine and corticosteroids
Muscle relaxants to relieve back and leg muscle tension

Note: Only a small number of patients need surgical treatment for a slipped disc. Surgery is a last resort and is recommended only when non-surgical treatments don’t work.

Keep in mind, however, that pain-killing drugs are not prescribed to cure the condition. They are prescribed to relieve the pain.

Back Pain Keeps You From Moving? Exercise Is Your Best Friend!

Resting for a day or two after a slipped disc is often necessary, especially if you are in severe pain. Once the backaches subside, however, you must resist the temptation to lie down for prolonged periods of time.

A sedentary lifestyle can further weaken the lower back muscles that lend support to the spine, worsening the injury. Moreover, your body may not respond to medical treatment if you cut out exercise from your daily activities.

Counter-intuitive as it sounds, an active lifestyle is one of your best allies in the fight against slipped disc and back pain.

“Don’t let anyone tell you a disc injury is for life,” says Andrew Lock.

As a physiotherapist, rehabilitation specialist, and bodybuilder, Andrew has taken numerous patients saddled with disc injury back to 100% pre-injury function through exercise.

One of his patients with a major disc injury took only three months to fully recover. And six months after the injury, the patient was back at the gym, doing 1,000-lb calf raises.

Now, lifting 1,000 lbs of iron or enduring an intense cardio session may sound intimidating. Don’t worry: simple aerobic exercises and stretching can go a long way in relieving back pain caused by a herniated disc.

Here are some handy tips and reminders to keep in mind while exercising:

Start slow. Treating a slipped disc is similar to losing excess weight. It’s a marathon, not a sprint. About 10 minutes of aerobic exercise during your first day is enough. However, you’ll want to gradually increase the time you spend on exercise to 30 minutes, 5 days a week.
Steer clear of physical activities that can aggravate disc injury. This includes reaching, heavy lifting, and prolonged sitting. Abdominal exercises like sit-ups and crunches can also strain the back, doing more harm than good.

Skip the back brace. Back braces are often recommended after a spine surgery to help the bones heal and provide more stability. For treating injuries like a slipped disc, however, wearing a back brace can weaken the muscles and intensify the pain.

Don’t worry if the pain increases when you start exercising. It’s normal, and the presence of pain doesn’t mean your condition is worsening. As long as the exercises are gentle and don’t strain the back, the pain will soon settle.

When seeking an exercise program, keep in mind that a cookie-cutter approach doesn’t exist.

Different patients require different exercises to treat herniated discs. A patient’s treatment program may recommend consulting with a physiotherapist for a tailored exercise plan to reduce pain and prevent the spine from sustaining further damage.

However, core strengthening exercises (like planks and side planks) are often an excellent recommendation. Most patients don’t realize the importance of front and back support in maintaining a healthy spine. If the back muscles are too weak (usually the case with slipped discs), stronger abdominal muscles can give the spine much-needed stability and relieve back pain.

You Don’t Have To Live With Back Pain

The effects of a slipped disc clearly go beyond pain.

Oftentimes, it’s the condition’s negative lifestyle impacts that can bog down a patient. Nighttime turns to nightmare as the pain worsens. Weak muscles make lifting impossible. Even standing, sitting, and walking for a few minutes can be difficult as the pain extends to arms and limbs.

The Bureau of Labor Statistics even pointed to back pain and injuries as the number one safety problem in the workplace – plaguing over one million workers annually and responsible for 60% of cases of people missing work.

But a slipped disc doesn’t have to be a back-breaker.

We’ve looked at the most common and effective treatments for a herniated disc: from pain killers of varying strength, physiotherapy, and exercise, to surgery as a last resort.

With proper guidance from a medical professional and a commitment to staying fit, you can return to your normal lifestyle, free from chronic back pain.

Are you ready to slip away from slipped discs?

Spinal Decompression For Lumbar Spinal Stenosis. #SpinalDecompression #LSS

Spinal decompression is a surgical treatment for lumbar spinal stenosis (LSS). LSS is a degenerative condition of the vertebrae, muscles, discs and ligaments that make up the spine.

What Causes Lumbar Spinal Stenosis?

LSS usually occurs as a natural result of aging, wear and tear on the body, bone degeneration or conditions like osteoarthritis and degenerative spondylolisthesis. It involves a narrowing of the spinal canal which causes pressure in the lower back. Most patients with LSS are 50 years of age or older.

What Are The Symptoms Of Lumbar Spinal Stenosis?

The pressure can cause severe pain, weakness and numbness in the back and legs. There can be leg pain that worsens with standing or walking and is only relieved by sitting down. There may be tingling that radiates from the lower back into the legs and buttocks. The symptoms of LSS are not necessarily progressive over time, but they can be. Symptoms can fluctuate between severe discomfort and no discomfort at all.

What Is The Prognosis For Lumbar Spinal Stenosis?

Over time, the space in the spinal canal that houses the nerves becomes increasingly narrow. This puts more and more pressure on the lumbar spinal nerves and reduces their ability to connect with the lower extremities. The symptoms can be debilitating as they worsen.

Nonsurgical Treatments For Lumbar Spinal Stenosis

The first line of defense for treating LSS is nonsurgical and/or alternative therapies such as chiropractic treatments, pain medications, steroidal injections, physical therapy, exercise, acupuncture, massage and a lumbar brace. Nonsurgical treatments often prove ineffective. In such cases, Dr. Spivak will suggest that surgical options be considered.

Surgical Decompression For Lumbar Spinal Stenosis

Dr. Spivak may recommend a surgical decompression (or laminectory) procedure. Surgical decompression can be performed via a large or small incision through which Dr. Spivak can extract any soft tissue, bone spurs, ligaments or bone that are pressuring the nerves and causing pain and discomfort. After the procedure is completed, the pressure will be removed, and the nerves can once again function normally. The only consideration is that surgical decompression can sometimes cause the spine to become unstable.

Surgical Decompression With Spinal Fusion

After performing surgical decompression for LSS, Dr. Spivak will attach metal rods and screws to keep bones in the proper position until the vertebrae fuse together. Decompression with spinal fusion is an effective treatment for pain and discomfort caused by LSS. It also provides good stability, but it can interfere with range of motion in the part of the spine where the procedure was performed.

Coflex® Interlaminar Stabilization™ Device

Another surgical option offered by Dr. Spivak for LSS is the Coflex® Interlaminar Stabilization™ device. This innovative device provides excellent spinal stability, greater mobility, relief from pain and discomfort and a speedier recovery than spinal fusion surgery.

As a board-certified neurosurgeon and president of Executive Spine Surgery, Dr. Carl Spivak is well known for his minimally invasive approach to spine surgery. Dr. Spivak specializes in state-of-the-art spinal procedures that allow for faster recovery, less pain, and less down time than traditional surgical procedures.

 

Laser Spine Surgery Now Available for Atlantic Health Employees

Executive Spine Surgery, in Hackettstown, New Jersey is pleased to announce that due to popular demand for minimally invasive, endoscopic spine surgeries in the Morris County, Sussex County and Warren County areas of New Jersey, renowned spine surgeon, Carl Spivak, MD will begin seeing Atlantic Health System Employees and families with Qualcare Medical Insurance.

“I have been doing minimally invasive endoscopic spine surgery for many years and had a lot of interest from Atlantic Health Employees, but was not part of their network,” said Dr. Spivak. “However, that all changed when Hackettstown Regional Medical Center was acquired by the Atlantic Health System. I am now proud to offer these new, state-of-the-art surgeries to all Atlantic Health employees and families.”

Atlantic Health System is one of the largest non-profit health systems in New Jersey. Atlantic Health System includes Morristown Medical Center in Morristown, NJ; Overlook Medical Center in Summit, NJ; Newton Medical Center in Newton, NJ; Chilton Medical Center in Pompton Plains, NJ; Hackettstown Medical Center in Hackettstown, NJ; and Goryeb Children’s Hospital in Morristown, NJ, as well as Atlantic Rehabilitation, and Atlantic Home Care and Hospice.

Dr. Spivak, a board-certified neurosurgeon, will now provide Atlantic Health System with state-of-the-art, minimally invasive endoscopic laser spine surgery. Endoscopic spine surgery is fusion-sparing and motion-sparing treatment of low back pain, leg pain, numbness and weakness, bone spurs, bulging discs, stenosis, herniated discs, facet joint arthritis, sciatica, scoliosis, spondylolisthesis, and more.

For more info click here

Lumbar Disc Herniation Treatment

A lumbar ruptured disc, also known as a herniated disc or a slipped disc, can cause hip, lower back, leg and foot pain. The pain can develop gradually or suddenly. It can be sharp or dull, mild or severe, and it may or may not be accompanied by sciatica. Bending over, coughing, even sneezing can make the pain worse.

What Is Lumbar Disc Herniation?

A herniated disc occurs when a disc breaks down and starts to degenerate. As the deterioration continues, tears and rips can develop on the outer surface of the disc, allowing the inner core of the disc to leak out through the opening. The damaged part of the disc then puts pressure on the surrounding nerves. Even the slightest pressure on these nerves can bring about severe pain.

What Is Sciatica?

Sciatica is the most common symptom of a herniated lumbar disc. If the herniated disc is situated in the lumbar (or lower) region of the back, it can put direct pressure on the sciatic nerve and cause sciatica. The sciatic nerve consists of several spinal nerve branches that extend from the lower spine to the bottom of the feet. When a damaged disc is pressuring the sciatic nerve, a patient can experience weakness, numbness, tingling, burning and pain down the entire length of the leg. Leg pain can occur with or without lower back pain; but if lower back pain is present, the leg pain will almost always be worse. In rare cases, sciatica can bring about a lack of function in a leg. It can also cause a lack of function in the bladder or bowel. Symptoms of sciatica usually occur in one leg only, but sometimes both legs are affected.

How Is Lumbar Disc Herniation Treated?

At Executive Spine Surgery, Dr. Spivak believes in minimally invasive treatments for spinal conditions like a lumbar herniated disc. Ninety-percent of herniated discs can be effectively healed with treatments such as exercise, application of ice, physical therapy, spinal injections and pain medication. Dr. Spivak believes that surgery should be reserved as a treatment of last resort for those whose pain has not improved or has gotten worse after six months of noninvasive and nonsurgical treatments.

When Is Surgery The Best Treatment For Lumbar Disc Herniation?

If you think you have a herniated disc, consult with a board certified neurosurgeon like Dr. Spivak as soon as possible, preferably within six weeks after the onset of your symptoms. The sooner you start treatment, the more effective that treatment will be. During your consultation, Dr. Spivak will perform a thorough examination of your back and consult with you about the most effective noninvasive treatment options. In most cases, nonsurgical treatments will be sufficient to bring about a healing. If nonsurgical treatments don’t solve the problem after six weeks, Dr. Spivak may suggest endoscopic spine surgery. This is a minimally invasive surgical procedure where tiny skin incisions are used to repair a herniated disc.

Dr. Spivak is the president of Executive Spine Surgery in Hackettstown, NJ, and a board-certified neurosurgeon. He is recognized worldwide for his expertise in innovative, noninvasive and state-of-the-art endoscopic spinal surgery