Fellowship Trained & Board Certified in Pain Medicine

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All posts by Laura Concannon

Medial Branch Blocks to Treat Lower Back pain

   Medial branch blocks may be another alternate to epidural steroid injections. Epidural steroid injections are not always helpful for the treatment of low back pain.  Patients may describe transient or minimal relief with a block or block series.  Many times epidurals do not improve back pain because they do not target the true source of a patient’s pain, such as inflammation or degeneration within the facet joints of the spine.  This condition is called Facet Disease, Facet Syndrome, or lumbar spondylosis. Patients will typically complain of pain at or above their waist that does not radiate into their legs (or that radiates above the knee). Facet Disease can often be seen on imaging such as MRI, CT scans, or X-rays and can also be suspected after a physical exam done by your provider.  However, the diagnosis of facet disease is confirmed by facet blocks or medial branch blocks.

Medial Branch Blocks

    Medial branch blocks are a series of three procedures administered to diagnose and treat Facet Disease. The first two procedures involve injections using a medication, such as lidocaine, to numb the nerve that supplies the painful joint. Relief is usually short lived, but if pain is diminished this is a diagnostic indicator of Facet Disease. The third procedure in the series is called a radio frequency ablation, or medial branch radio frequency ablation.  With this procedure, instead of only numbing the nerves to provide temporary relief, we will heat them so the nerve cannot properly signal to the brain that there is pain. This should provide more long-term pain relief and patients can expect results to last anywhere from 6 months to a year.

Talk with your provider to see if medial branch blocks could be beneficial in treating your lower back pain.

At Cahaba Pain our team of providers are highly trained regarding this procedure and would love to discuss the benefits of this treatment with you.  

For more details on this procedure, please click here.

Natalie Chism, CRNP & T. Wade Martin, MD

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New Patient Consultation-What to Expect

At new patient consultations patients find it difficult to discuss their chronic pain due to the perceived stigma associated with this common diagnosis.   Therefore, they are understandably reluctant to seek treatment. At Cahaba Pain & Spine Care, we strive to make patients feel comfortable when discussing their pain at their new patient consultation. We look at each patient individually and work through their history to determine the source of their pain and develop a proper diagnosis. It is important for patients to give details regarding past medical and surgical history, as well as all known information about current medical problems and areas of pain. A full history can help us capture a better picture of each patient and formulate a specific plan tailored to their needs.

A Full Health History

During a new patient consultation, a full history will be taken by medical assistants and the provider. The provider will meet with the patient to go over the history, perform a physical assessment, review prior treatment records and results, and then with the patient’s participation, a detailed treatment plan is formulated for each pain complaint.  It is very important to us that the patient understands the plan and agrees with it. We will then implement this individualized plan of care.

CT Scans, X-rays, MRI’s

During a consultation, outside records, labs, test results, surgeries, prior treatments, and imaging such as CT Scans, X-rays, MRI’s, and myelograms will be reviewed.  It is very helpful for the patient to bring these results to their consultation appointment or to have them sent to our office.  If these are not available at the time of the appointment they will be requested. Depending on the plan, a urine sample may be required on the day of the appointment. If opiates are a part of the plan, a controlled substance agreement will be given to the patient to read and sign before leaving the office. We are happy to discuss any questions regarding this agreement and we expect that every patient reads it thoroughly before signing.

The Registration Process for New Patients

You can start the registration process before your consultation by visiting our website and searching under the Patient tab.  Click on Patient Forms and a PDF document will open to be printed and filled out.

We look forward to your visit at Cahaba Pain and Spine. Please call us with any questions you may have.

Ashley Vaughn, CRNP & T. Wade Martin, MD

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Constipation in Pain Management

Constipation is a very common side effect of opioids—and a topic that most patients are reluctant to discuss with their physician.  The term opioids refers to commonly prescribed pain medications such as Norco, Percocet, Tramadol and Morphine. While this is an embarrassing topic for some, the issue commonly occurs in chronic pain patients and is quite treatable. It is estimated that 1 in every 3 pain patients will experience OIC at some point during their journey.

First Line of Treatment

The obvious first line of treatment is to eliminate or decrease the opiate medication. This is something we would discuss in clinic and is always a goal as you begin to experience relief with your regimen. However, this is not an option for some and other modifications are needed.

Lifestyle and dietary changes such as increasing water intake, increasing daily fiber, and regular aerobic exercise can help alleviate symptoms. These should be trialed first as conservative therapy may be beneficial for some. However, if changes are not noted, medications are the next line of treatment.

Until recently, medication aimed at treating opiate induced constipation were limited. If dietary and lifestyles changes were not beneficial, we resorted to OTC formulations such as laxatives, enemas, and stool softeners. These were not always beneficial and left many patients feeling helpless and experiencing a decreased quality of life.

Medications to Treat Opioid Induced Constipation

Thankfully, there are now medications that specifically treat opioid induced constipation. They work by acting differently on the receptors in your body leading to improved bowel patterns with less side effects. As of now, there are 4 medications FDA approved to treat OIC.  Some of these medications include lubiprostone, naloxegol, methylnatrexone, naldemedine, which are known by the trade names amitiza, movantik, relistor and symproic.

Talk to your provider today if opiate induced constipation is something you are experiencing. We can discuss a treatment plan to optimize your quality of life and decrease this common side effect.

Natalie Chism, CRNP

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Mid-level Providers In Pain Management

With recent changes in healthcare, you have may noticed the expanding role of mid-level providers on your Pain Management team.  Nurse Practitioners and Physician Assistants are specialized mid-level providers with multiple years of experience and training combined with an undergraduate and master’s degree.  At Cahaba Pain and Spine Care, we currently employ 3 Nurse Practitioners and 1 Physician Assistant. 

Mid-level providers play an important continuing role in your pain management journey.  Nurse practitioners may be involved in new patient visits, follow up visits, telephone encounters, and other routine visits.  When seeing a mid-level provider, be assured we have reviewed your medical record and discussed your health information with the physician. We will go over your diagnoses and past treatment successes and failures in conjunction with the physician to determine the best course of treatment for your pain.

Pain Management Goals

Our team of providers will be there executing and adapting your treatment plan as needed.  Your treatment plan may include Physical Therapy, Medication therapy, appropriate consultations such as surgical referrals. We also perform procedures such as medial branch radiofrequency ablation, epidural steroid injections, lumbar medial branch blocks, sympathetic blocks, botox treatment, spinal cord stimulation, dorsal root ganglion spinal cord stimulation, and kyphoplasty.  Our goal is to use a multi-modal plan to improve your pain, function, and quality of life.

Compassionate Care

We strive to form relationships with our patients and treat them as we would our own family. We believe in a collaborative, compassionate, and holistic approach to pain management.

At Cahaba Pain and Spine, our team of mid-level providers have treated thousands of patients yearly. We are committed to being there for you as a patient and providing quality care. Pain management is a journey and our team would love to help guide you through it.

– Natalie Chism, CRNP with T. Wade Martin, MD

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