Nikesh Seth MD Hi, I am Nikesh Seth, MD – CEO of Integrated Pain Consultants. I will be posting weekly about new topics ranging from managing pain to the current Opioid epidemic. I am double board certified Anesthesiologist that is consistently awarded “Top Doc” in the field of pain management by Phoenix Magazine.
Radiofrequency ablation, also known as rhizotomy, has become an important way to manage and treat pain. These procedures are quick and simple and are generally well-tolerated by the patient. They can provide relief lasting anywhere from 6 to 12 months, and in some cases will provide pain relief for years. Dr. Nikesh Seth, an anesthesiologist and pain management physician, explains the process of radiofrequency ablation and explores the different conditions that can be helped with the procedure.
What is Radiofrequency Ablation?
In radiofrequency ablation, a small electrical current which is produced by radio waves heats a small area of the nervous system. Heating the nerves destroys them, which provides relief from pain in that area.
This procedure can be very helpful for arthritis and other kinds of joint pain. It is especially effective for axial spine pain, including low back pain and neck pain.
To prepare for the procedure, patients should stop taking aspirin or blood thinner medications a few days beforehand. This should be discussed with the doctor who wrote the prescription and the doctor who is treating you for your ablation.
The patient is placed on an X-ray table. X-rays give the doctor a precise view of the nerves which will be affected by the procedure. The doctor will administer a local anesthetic to the area. The patient may also receive a low dose sedative like Versed or Valium to increase their comfort level with the procedure. The patient does not need to stay awake during the procedure as the doctor’s use fluoroscopic guidance and motor simulation to ensure proper safety and placement of the needles before doing an ablation.
A hollow, thin needle is threaded into an incision near the patient’s pain site. This hollow needle can be guided by the X-ray image. When the needle is in place, a radiofrequency current is put through the needle and into the affected nerves. This procedure makes a small burn or a lesion on the nerve. However, this should not be painful. Most patients experience only a feeling of pressure thanks to the local anesthetic.
After the procedure, patients can move to a recovery room. They will be back to their normal activities within 24 to 72 hours after radiofrequency ablation. Most patients tolerate this treatment very well, and pain relief tends to come into effect within 10 days.
This treatment works best on patients who have already responded well to local anesthesia nerve blocks. If the nerve blocks did not work, it is possible that radiofrequency ablation will not help the patient.
Conditions Where Radiofrequency Ablation is Helpful
Radiofrequency ablation is beneficial for patients with arthritis. The wearing down of joints puts pressure on the nerves, causing a great deal of pain and discomfort. Ablation can help to reduce these nerves’ sensitivity and provide pain relief.
Axial spine pain is also a good candidate for radiofrequency ablation. Axial spine pain is not necessarily caused by an underlying condition like a herniated disc. It happens when a patient is active or sits in a sedentary position for too long, and it is relieved by a position change or rest. Axial lower back and neck pain is particularly bothersome for many patients. Frequently, these are the conditions which cause people to look into radiofrequency ablation.
Other types of conditions which can be relieved by radiofrequency ablation include pain from whiplash, previous spine surgeries, and spinal arthritis or spondylosis.
Advanced Techniques to Relieve Pain
Dr. Nikesh Seth recommends radiofrequency ablation as an advanced treatment to relieve pain from arthritis and other sources. Patients who need radiofrequency ablation have often tried other forms of pain relief without results. They are often frustrated by the process of relieving chronic pain. With radiofrequency ablation, patients can enjoy a safe, non-surgical pain relief method. Working with a pain management physician like Dr. Nikesh Seth, patients can create a treatment plan that works for them.
As the CBD bubble continues to inflate, Dr.Nikesh Seth, a pain management physician and anesthesiologist, is getting more questions in his practice about how CBD works, what conditions it works for, and whether it is safe. Dr. Seth explains that they do use it in the practice in places where it seems appropriate and it does appear to work. After all, the intention is to relieve pain, with as few negative side effects as possible. But Dr.Nikesh Seth needs to begin by saying that because the cannabis plant has been a Schedule 1 drug since 1937, doctors haven’t had access to conduct the research many would like to do in order to recommend this plant to patients with complete confidence. There are now many studies underway, and there are even many from before 1937 (when cannabis was made illegal) upon which we depend.
Mechanisms of CBD Oil
As far as it is known, CBD works because the cannabis plant contains many active ingredients known as cannabinoids. The one we all know about is THC, which gets users high. But there’s another major ingredient in the plant –CBD. CBD is not psychoactive (doesn’t get you high) but has been proven extremely useful for chronic pain, seizures, and inflammation. The FDA has even green-lighted a CBD-based drug for intractable seizures.
CBD occurs not only in the typical marijuana plant, but also in the hemp plant. Hemp is part of the same cannabis family of plants but has historically been used for many things like fabric, rope, and protein powder in addition to its use as a supplement or pain reliever.
Benefits of CBD Oil
About twenty years ago, it was discovered that the body has a system to process and use cannabinoids called the endocannabinoid system. Not only does the body produce some cannabinoids on its own, but it can also receive external cannabinoids and put them to work. Different cannabinoids affect different endocannabinoid receptors.
In fact, there’s a theory being researched now that the explosion of autoimmune disorders over the past fifty years is at least partly due to endocannabinoid deficiency after people no longer encountered CBD in their everyday diets.
When a person takes CBD, it has a complex effect on the body as it hits the different receptors. One compound affected by CBD is anandamide, which regulates pain. Current thinking and anecdotal evidence say that because CBD keeps the body from absorbing anandamide, it might help to reduce the patient’s pain sensitivity.
The chemicals known as cannabidiols also affect levels of inflammation in the nervous system and in the brain. This reduction in inflammation is beneficial for people with chronic pain, immune system problems, and insomnia.
Although you can get CBD in many formats, like pain rubs and lotions, the CBD that’s legally available all comes from industrial hemp. Because farmers in the US were forbidden to grow hemp until January when the new Farm Bill became law, there’s actually a shortage of hemp worldwide right now as CBD begins to be used by the general public and shows up at Walgreen’s and CVS among the other over the counter pain relievers.
Industrial hemp contains more CBD than the actual marijuana plant, and the CBD that’s legal in the US cannot contain more than .3% THC. The CBD oil that’s extracted from the plant is mixed with a carrier oil before it is used, because the carrier oils help CBD reach the appropriate receptors without being “cleared” (discarded) by the liver.
People take their CBD in a variety of forms, as oil, lotion, “medible” products. One of the most promising characteristics of CBD is that it seems to have very few discernible side effects. This could make it a better choice for some types of pain than traditional painkillers, or it can be used to complement these medications without interactions.
In the European Journal of Pain, scientists published an animal study on the uses of CBD oil for arthritis. A topical gel with CBD was applied to rats suffering from arthritis, and the rats had lower levels of pain and inflammation. While this study has not been done in humans, there is anecdotal evidence that CBD applied topically offers some relief from arthritis.
Other studies have looked at the effects of CBD for chronic pain, where it has been found to reduce inflammation and pain in chronic pain patients who have a difficult time getting relief from other methods of pain control.
One exciting aspect of this study is that patients do not develop a tolerance to CBD, meaning that they do not have to increase their dose over time.
CBD has a wide variety of potential uses in the medical community. It has been shown to be useful for drug withdrawal and to help people quit smoking. It may be effective against epilepsy and seizures. It may help to relieve symptoms of anxiety. It may also be useful for patients with Alzheimer’s. The compound may also have benefits for patients experiencing schizophrenia.
Compared to other drugs for the same conditions, CBD has fewer side effects. Most people do not have any problems when they take CBD oil, but the most common side effects include diarrhea, fatigue, and appetite changes
Dr. Nikesh Seth emphasizes using the word “may.” This isn’t a weasel word, but he explains that the type of double blind published studies that physicians in the medical community are accustomed to thinking of as the gold standard have not been done yet. Patients should be aware that CBD oil has not been tested long-term, particularly in subjects who are taking other medications.
As a complementary treatment for chronic pain, arthritis, and multiple sclerosis, CBD oil shows great promise. More studies are in the works to determine whether this compound can be useful for a broader range of medical conditions. If you are getting your CBD through Dr.Nikesh Seth’s office, they can at least tell you the supply chain is safe. If you are getting it elsewhere, you’d best know your supplier.
Epidural steroid injections offer immediate, long-lasting pain relief with few risks
Epidural steroid injections are one of the most common procedures I perform at Integrated Pain Consultants, but they are probably one of the most misunderstood treatments available on the market today.
Because of the name, patients frequently confuse epidural steroid injections with epidurals, pain blocks frequently given to women in labor.
The two are not the same, and it’s essential for patients with chronic pain to know the difference so they can have a better understanding of their treatment options.
Epidurals are anesthetics that are injected directly into the epidural space of the spinal cord, causing an instant loss of sensation and a stoppage of pain. Single-shot epidurals have been in use for almost 100 years.
Epidural steroid injections, on the other hand, involve a dual injection of a corticosteroid and a local anesthetic. The anesthetic provides immediate pain relief, flushing out inflammatory proteins that exacerbate pain, while the corticosteroid reduces inflammation and swelling in the epidural space. This reduction takes pressure off the nerves and soft tissues, providing pain relief over time.
Epidural steroid injections are a safe, minimally invasive and effective way to treat a variety of back pain, neck pain, and nerve pain conditions.
At Integrated Pain Consultants, we perform injections of dexamethasone — the safest and most effective corticosteroid on the market — in the neck, thorax, and lower back.
During the procedure, we use X-ray guidance to position the needle. We only perform the injection once we have confirmed the proper placement of the needle.
Epidural steroid injections can provide patients with chronic pain with some much-needed relief. Many of my patients have said that these injections alone reduced pain enough to allow them to return to their normal activities. Others have said they found these injections are more effective in combination with physical therapy.
Pain relief from epidural steroid injections can last up to a year or more. These injections can also help improve function and mobility and can result in a delay or avoidance of surgery.
The risks are few thanks to our safety measures, such as our use of X-ray guidance and our careful selection of corticosteroids, so all patients interested in safe, effective and long-lasting pain relief should consider epidural steroid injections as part of their treatment plan today.
Integrated Pain Consultants has three offices in Scottsdale, Mesa, and Phoenix, Arizona. New patients can schedule an evaluation by calling (480) 626-2552 or book an appointment online at: http://www.azipc.com.
A July study published in the medical journal JAMA Neurology finds that learning about neuroscience may provide pain relief when combined with a closely integrated exercise program
In the study, researchers from Belgium divided 120 patients with chronic back or neck pain into two groups for different treatments.
In the control group, patients received a general education on back and neck pain as well a commonly recommended program of physical therapy and general exercises.
In the experimental group, the remaining patients completed a program of “pain neuroscience education,” learning about the functions of neurons and synapses, the ways in which pain signals are transmitted to the brain and the effects pain can have on the central nervous system.
They also underwent an exercise program that complemented the education program, gradually increased in difficulty and focused on maintaining motor functionality rather than providing pain relief.
Treatment lasted three months in both groups, and patients received follow-up examinations six and 12 months afterward.
The results of this study greatly interested me, and they may surprise many readers.
Patients in the experimental group experienced less pain, higher pain thresholds, improved function and a significant reduction in disability, compared to those in the control group. By their own self-reporting, they also enjoyed better physical and mental health.
From this study, the researchers concluded that “pain neuroscience education,” when combined with “cognition-targeted motor control training,” seems to be more effective than current best-evidence physical therapy at treating pain, reducing disability, and improving functionality.
The reason this study caught my eye is because it confirms many of my intuitions as a pain specialist over the years.
Over my many years of experience, I have found that successful pain management requires two key factors: a patient’s awareness of their condition; and a creative, individually designed plan of care.
There are dozens of pain conditions that can affect a patient’s body — anywhere from the neck and back to the nerves and joints. And there are just as many treatments that can help provide relief and restore functionality.
In order for pain management to be successful, patients must know the cause of their conditions and the ways in which they operate to cause pain. In addition, they must receive a custom-made treatment plan, because there is no one-size-fits-all approach to pain management.
It is because of these two reasons that I take special care in my practice to inform my patients of all the relevant details regarding their conditions. This information not only provides them with mental comfort — as they have an identifiable problem rather than the frightening unknown — but it also allows us to craft a strategy together.
Armed with this knowledge and this strategy, we can tackle almost any pain condition with the right treatment.
As the researchers in Belgium found, knowledge and strategy are always more effective than ignorance and lack of planning. I see that point be proven true every day in my practice.
Dr. Nikesh Seth is the founder and CEO of Integrated Pain Consultants in Scottsdale, Ariz. He is a double board-certified anesthesiologist and interventional pain management expert and has been voted Top Doc by PHOENIX magazine for four years in a row.
Integrated Pain Consultants offers a wide range of minimally invasive techniques to treat pain so patients can return to their normal lives. IPC has three offices — in Scottsdale, North Phoenix and Mesa.
To set up an appointment or learn more about treatments offered, please call (480) 626-2552 or visit www.azipc.com/contact.
With football season less than two months away, excitement is building across the Valley for America’s favorite sport
Arizona high school teams have spent the summer beating the heat and training at camp, as The Arizona Republic recently captured in a photo album.
Since January, the Arizona Wildcats have had a new head coach — Kevin Sumlin, formerly at Houston and Texas A&M — to guide them through training. And Wildcats football ads have been spotted near Sun Devil Stadium and on the light rail.
Arizona State has a new head coach too: Herm Edwards, an eight-season NFL coach at the New York Jets and the Kansas City Chiefs. Edwards has spent the summer toughening up the Sun Devils and floating cuts if performance is lacking.
At the pro level, the Arizona Cardinals have Sam Bradford as their new quarterback. For them, the big question is whether Bradford can stay healthy enough to be successful in the 2018 NFL season, as he played only two games for the Minnesota Vikings last season because of lingering problems in his left knee.
With new changes come new opportunities. There have been changes for Arizona football teams this preseason, and this season there will be equally many opportunities for Arizona football players — at the high school, college and pro level — to excel on the field.
But as always, there will be many risks at play this season.
One of the main risks we are becoming increasingly aware of in the NFL, besides concussions, is drug abuse.
Last year, 1,800 former NFL players filed a lawsuit against the league, alleging that NFL teams routinely violated federal laws governing prescription drugs, disregarded guidelines from the Drug Enforcement Administration on controlled substances and plied their players with pain medications, The Washington Post reported in March 2017.
While the bulk of the charges were dismissed by a judge in May last year, the lawsuit exposed several dangerous practices that have taken place within the NFL.
Unlawful handling of medications is one such abuse.
In a deposition, Anthony Yates, the Pittsburgh Steelers’ team doctor and former president of the NFL Physicians Society, testified that “a majority of clubs as of 2010 had trainers controlling and handling prescription medications and controlled substances when they should not have.” Federal law prohibits unlicensed team personnel, including athletic trainers, from dispensing medication.
Turning a blind eye to off-label drug use is another abuse.
The lawsuit highlighted Toradol as a particularly common offender for off-label use. Toradol is a nonsteroidal anti-inflammatory drug (NSAID) available only with a prescription. While it is not addictive, it is powerful enough that many countries only administer it to patients after surgery.
The players’ court filing cited a 2014 survey that included responses from 27 NFL teams. On average, 26.7 players took at least one dose of Toradol on game day.
Yates also testified in his deposition that “even last season, he witnessed players lining up for the ‘T Train’ — Toradol injections before a game.”
But the greatest abuse of all that has taken place in the NFL is of opioids.
A 2011 study led by Dr. Linda Cottler of the University of Florida surveyed 644 retired NFL players, making it the most comprehensive study on painkiller use in the NFL to date.
It reported that more than half of respondents said they used opioids during their NFL careers and that 71 percent said they misused the drugs. It also found that 7 percent of respondents were still using opioids during retirement — three times the rate of opioid use in the general population at the time.
Football players at all levels should not be discouraged or stopped from pursuing their dreams on the field because of these abuses in the NFL. But they should be aware of the risks associated with football, especially in regard to drug abuse and the team cultures that foster it. If they see these cultures develop in the locker room, they must speak out against them.
If possible, doctors should promote alternative pain treatments for football players. There are many nonpharmacologic, minimally invasive treatments available to quickly reduce pain and get players back on the field, including platelet-rich plasma injections and ketamine infusions.
When a team doctor must prescribe opioids, they should be at the lowest possible effective dose for the shortest possible amount of time, as recent guidelines from the Centers for Disease Control and Prevention recommend.
And the NFL must do a better job at ensuring teams’ compliance with federal laws and DEA recommendations so as to prevent abuse.
As a pain specialist, I feel it is my responsibility to speak out on this important issue when football season is approaching. Concussions and injuries are only one part of a larger problem faced by the NFL and football leagues generally. While they have rightly received much media attention over the past few years, they have overshadowed the two dangers they can spawn — drugs and drug abuses.
For a consultation, please contact Integrated Pain Consultants at (480) 626-2552 or visit www.azipc.com.
Today, platelet-rich plasma injections are one of the most popular pain-management treatments I offer at Integrated Pain Consultants. But they were not well-known outside the world of sports until a few years ago.
PRP injections use a patient’s own platelets, drawn from their blood, to treat pain in an afflicted area and stimulate healing. Platelets, also known as thrombocytes, are cells within the bloodstream that form clots when a blood vessel is damaged.
For NBA fans, PRP injections made their first big appearance in 2011 when Los Angeles Lakers superstar Kobe Bryant flew to Germany for treatment on his right knee, ESPN reported. Other athletes, including golfer Tiger Woods, have also undergone the treatment.
More recently, Yahoo Sports reported that Stephen Curry of the Golden State Warriors got a PRP injection in his right knee after spraining it in the first round of the 2016 NBA finals.
Despite the increasing prevalence of PRP injections among athletes, sports journalists typically label the treatment “experimental.”
While the treatment is relatively new, recent medical research is increasingly supporting its benefits in pain management.
A 2013 study by the American Journal of Sports Medicine found that PRP injections provided greater pain relief than saline injections (a placebo). The study had a sample size of 78 patients with early osteoarthritis of the knee.
As researchers have discovered in recent years, platelets can do a lot more than stopping bleeding. A concentrated dose of platelets injected at the injury site can offer fast pain relief and can accelerate healing.
I am proud that Integrated Pain Consultants has offered PRP injections to patients. PRP injections aren’t just for athletes like Kobe. They can be for anyone who suffers back pain, neck pain, joint pain, or nerve pain.
Rheumatoid arthritis affecting more young people than once thought, says Mayo doctor
Doctors have largely thought of rheumatoid arthritis as a disease suffered by older patients, with symptoms typically appearing between the ages of 40 and 60. But Cynthia Crawson, a researcher and statistician at the Mayo Clinic, found that the probability of a young person being diagnosed with RA is much higher than experts previously thought.
In a recent research paper on RA in young people, Crowson says that there is a one-in-714 chance of someone in their 20s being diagnosed with RA.
RA is an autoimmune disease that causes inflammation in the joints and nearby tissues. It commonly appears in the wrists, knees, ankles, feet, and fingers, but it can also impact the skin, eyes, and lungs.
The most common symptom of RA is joint pain, but stiffness and severe fatigue are often present too. In some extreme cases, the joints grow so swollen by disease they become virtually useless.
About 1.5 million Americans suffer from RA, according to data from the Arthritis Foundation, and the disease is three times more common in women than in men.
While there is no cure for RA, there are many safe treatment plans available than do not require prescription medications. They can involve steroid injections, epidural joint injections, and simple lifestyle changes.
With RA affecting more young people than doctors once expected, it is crucial for younger patients with RA to find a doctor who is aware of the challenges they face.
I know the difficulties posed by RA can seem daunting, but the right treatment plan can put you on the path to pain relief and restored function.
Nerve pain comes in various forms, from many causes
Nerve pain, or neuropathy, evokes a wide variety of feelings within my patients. During my __ years as a doctor, I’ve heard it described as feeling like jolts of electricity zapping, fires burning, and pinpricks stinging.
Nerve pain also varies greatly in intensity and frequency. Patients have called it mild or severe, chronic or intermittent.The causes of nerve pain are nearly as diverse as the feelings it evokes.
Common causes include cancer, HIV, diabetes, shingles, and physical injuries where nerves are cut, compressed, or crushed. Another cause is complex regional pain syndrome, a chronic pain condition that usually affects a single limb after an injury. CRPS is caused by damage to the central nervous system, the peripheral nervous system, or both. It can be accompanied by swelling and a change in skin temperature or color.
Not all nerve pain is curable, but all of it is treatable. And it should be treated — immediately.
Pain-management treatment can help address the symptoms of nerve pain, leading the patient to achieve a better quality of life.
Neuropathy can be a lifelong and debilitating condition, depending on the case. Therefore, it’s crucial to work with a pain specialist to develop a pain-management plan that’s safe, effective, and sustainable.
There are dozens of treatment options available, including epidural injections, radiofrequency ablation, spinal cord stimulation, or joint injections, sympathetic blocks, ketamine infusions, stem cell therapy, spinal cord stimulation, and platelet-rich plasma injections.
And I am happy to say that Integrated Pain Consultants offers all of them.
SCOTTSDALE, Ariz., June 6, 2018 /PRNewswire-PRWeb/ — Scottsdale, AZ pain management expert, Nikesh Seth MD, has been named one of PHOENIX Magazine’s Top Doctors for the fourth straight year and with this latest award, positive feedback from patients continues to pour in.
Patients have submitted over 250 five star reviews in less than a year on Dr. Seth’s Integrated Pain Consultants’ Facebook, Google, and Yelp review sites.
Dr. Seth personally sees and evaluates each patient at Integrated Pain Consultants, and over 95% of them report achieving excellent pain relief within the first two visits. Dr. Seth is well known among patients and peers for his personalized, state of the art treatment options including spinal cord stimulator implants, radiofrequency ablation, and occipital blocks.
SCOTTSDALE, Ariz., June 20, 2018 /PRNewswire-PRWeb/ — Arizona pain management doctor Nikesh Seth of Integrated Pain Consultants was named one of PHOENIX Magazine’s Top Doctors for the fourth straight year. Top Doctors is a peer-selected list of the Phoenix Metropolitan area’s best physicians. It is compiled using an annual survey of local health care professionals.
Dr. Seth is a standout in his field. He is Double Board Certified in Anesthesiology and Interventional spine and pain management and offers over 30 state of the art treatment options including radiofrequency ablation, spinal cord stimulator implants, and several new types of epidural steroid injections.
Dr. Seth has participated in studies of pain management treatments and currently serves as a member of the faculty for the University of Arizona College of Medicine and Scottsdale Healthcare Residency Program.