Fellowship Trained & Board Certified in Pain Medicine

Hours : Mon to Fri - 7:30am to 4:30pm
  Contact : 205-208-9001
 Schedule Appointment Patient Portal

All Posts in Category: General Health

Can Turmeric Help Arthritic Pain?

In the pain world today, we are always trying to find new ways to treat pain with fewer side effects and risks. One of the natural remedies known to help tame arthritic pain is Turmeric. Turmeric is a spice that is available in supplement form, but is also the main ingredient in widely used curry powder.

Turmeric has proven to reduce inflammation.

     The term arthritis means there is inflammation in a joint. Turmeric has properties that can reduce this inflammation, subsequently alleviating pain. It has been commonly used in Chinese and Indian medicine for years. New research reveals it is nearly compatible to Ibuprofen, without the increased side effects.


Talk with your provider if you are considering use this supplement.

    Although Turmeric is considered generally safe, it can pose a risk of GI side effects. Some nausea, vomiting, and diarrhea have been reported in individuals. In addition, it can act as a blood thinner. Therefore, it is important to talk with your provider if you are considering trialing this supplement to ensure it is appropriate.

In summary, Turmeric is in no way a “cure it all” method of pain relief. However, it could aid in providing better pain control for individuals who suffer from arthritic discomfort. Talk with your provider today if Turmeric is something you feel you could benefit from.

Read More

Adding Aqua Therapy Can Help Improve Your Pain.

Here at Cahaba Pain, we try several types of interventions to help our patient that are experiencing pain. We use these methods in addition to medications, if applicable. One option that has shown benefit is hydrotherapy.


What is hydrotherapy?

Excellent question. Many people might know this better as aqua therapy. Basically, this is physical therapy but, in a heated pool and under the instruction of a physical therapist. Studies have shown an improvement in quality of life and decreasing pain in patients that have tried hydrotherapy for low back pain, knee pain, etc. (Yücesoy et al, 2019). The water helps lighten the strain on the joints and the back allowing the patient relief while exercising. Aqua therapy has also been shown to help patients lose weight, as well.

Making exercise a part of your everyday life improves your overall health.

Staying active in the setting of chronic pain is a challenge, to say the least. However, it is important to physical and mental health to exercise. It seems to be a cycle. Patients will hurt after activity, so they will not move to avoid this pain. A lifestyle of little to no movement or physical activity can lead to a life of more pain and depression. Aqua therapy can help with this struggle and break the cycle. Ask your provider about aqua therapy.

Emily Walker, CRNP

Yücesoy, H., Geçmen, I, Adigüzel, T, Karagülle, M, & Karagülle, K. M. (2019). International Journal of Biometeorology. Efficacy of balneological outpatient treatment (hydrotherapy and peloidotherapy) for the management of chronic low back pain: a retrospective study. Advanced online publication. doi: 10.1007/s00484-018-01668-9

Read More

How smoking affects more than just your lungs.

There are some lifestyle choices that can increase pain in patients. Smoking, for instance, can intensify pain. Smokers tend to report higher pain scores and more impairments to daily functions than nonsmokers.
Smoking can also delay healing, worsen bone health, and weaken discs in the back. https://www.ncbi.nlm.nih.gov/pubmed/30192304 Along with these reasons, we also know that smoking causes significant harm to the lungs and increases the risk of various cancers.

How can I quit?

We all know smoking is bad for your body and those around you. How can I quit? We can work with you in this journey. The quitting process truly is a journey. It is a marathon and not a sprint. There are several tools to help. Medication, like nicotine patches and Chantix, are very helpful. Also, there are free apps available for download on your phone. We recommend counseling along with medication therapy. An accountability partner for encouragement, is always helpful.

Have you made the decision to quit?

Stopping smoking is a hard decision to make, but a step in the right direction for health and decreasing pain. If you are ready to quit smoking, please let us support you in taking that first step in this marathon.

Emily Walker, CRNP

Read More

NSAID use in Chronic Pain Management

Non-steroidal anti-inflammatory drugs (NSAIDS) are a common class of medications used to treat pain and fever. The most widely prescribed and over the counter formulations are Ibuprofen, Naproxen, Mobic, Diclofenac and Celebrex. These have been utilized for pain control for many years. Their role in decreasing inflammation has been proven to be beneficial in the management of acute pain, but also intermittently with chronic pain.

Risks of taking NSAIDs

     Although these medications serve as good alternative to opioid medications, they do pose a risk to your overall health. In 2005, the Food and Drug Administration released a black box warning on the risk of experiencing a stroke or heart attack with NSAID use. In 2015, they strengthened their stance on this risk due to evidence revealing a stronger correlation between the two. In addition, NSAIDs have also been known to increase an individual’s risk of bleeding.

Talk with your provider before starting a new medication

    Before starting you on an NSAID your provider will likely inquire about your previous medical history. Any individual with a history of a bleeding disorder, GI ulcer, previous heart attack/heart problems, or previous stroke will likely need to refrain from using these medications. If you are currently taking an NSAID and you answered yes to any of the above medications, it is important you discuss this with your provider.

Are NSAIDS the appropriate medication to help treat your pain?

     In summary, while NSAIDS are very useful for pain control they are not always appropriate for every patient. They are preferably utilized short term for acute pain flares and discontinued after this time. However, they are always outlier situations in which they may be used for a longer periods of time. If you are concerned about your current NSAID use and how you can decrease your risk of side effects talk with your provider today.

Natalie Chism, CRNP

Read More

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

Read More

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

Read More

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

Read More

Is Smoking Hurting Your Pain Recovery?

There are some lifestyle choices that can increase pain in patients. Smoking, for instance, can intensify pain. Smokers tend to report higher pain scores and more impairments to daily functions than nonsmokers (Mekhail et al., 2018). Smoking can also delay healing, worsen bone health, and weaken discs in the back (Mekhail et al., 2018). Along with these reasons, we also know that smoking causes significant harm to the lungs and increases the risk of various cancers.

We all know smoking is bad for your body and those around you. How can I quit? We can work with you in this journey. The quitting process truly is a journey. It is a marathon and not a sprint. There are several tools to help. Medication, like nicotine patches and Chantix, are very helpful. Also, there are free apps available for download on your phone. We recommend counseling along with medication therapy. An accountability partner for encouragement, is always helpful.

Stopping smoking is a hard decision to make, but a step in the right direction for health and decreasing pain. If you are ready to quit smoking, please let us support you in taking that first step in this marathon.

Emily Walker, CRNP

 

Mekhail, N., Azer, G., Saweris, Y., Mehanny, D. S., Costandi, S., & Mao, G. (2018). The impact

of tobacco cigarettes smoking on spinal cord stimulation effectiveness in chronic spine-

related pain patients. Reg Anesth Pain Med, 43(7), 768-775. doi:

10.1097/AAP.0000000000000870

Read More

Headache Management

Headache is a common problem

Nearly everyone knows someone who suffers with the chronic pain of headaches.  This may include tension headaches that arise during stress, migraines, or cluster  headaches. Tension headaches tend to follow a band-like distribution, and they are primarily frontal in location.  Migraine headaches are usually one-sided, and may respond to vasoconstricting drugs that make blood vessels tighten.  Cluster headaches are somewhat unique in that they can cause tearing in the eye on the side of the head affected as well as isolated congestion in that half of the nose.  There are also headaches related to excessive use of medication.  Medication overuse headache is thought to be the result of some repeated exposure to a rescue medication.

It is tempting to reach for a pharmacologic solution, but many headache syndromes can at least improve with lifestyle modification.  Among known headache triggers are alcohol,  a lack of sleep, stress, and certain foods.  For the clinician, good headache management starts with taking  a comprehensive history.  Identifiable risk factors should be modified when possible.   Patients who ingest excessive amounts of caffeine should scale back.  The same goes with alcohol, especially for those who may drink red wine (which for many is a  particularly strong headache trigger).  The importance of sleep cannot be overstated either.  While many of us can push through a hard day  on little sleep, it certainly appears that sleep quality and duration make a difference in headache frequency.

Pharmacologic management of headache

Depending on the type of headache and numbness or other associated symptoms,  more workup may be necessary.   The patient who has significant neurologic symptoms in the setting of headache may need  brain imaging to rule out  an intracranial mass or process.  Additionally the patient who suffers with frequent frontal headaches and has sinus complaints may need an evaluation by otolaryngology.  Only after these anatomic causes of headache are ruled out, should a pharmacologic strategy be considered.

The pharmacologic management of headache involves 2 major classes of drugs: Prophylactic medications that prevent headaches from starting, and abortive medications that rescue the patient after the headache has begun.  Common prophylactic medications include  beta blockers,  topiramate, and amitriptyline.  While these may be very helpful for many patients, they also have significant side effect potential.  Physicians will typically discuss these potential side effects with their patients, and this is important because the side effects can certainly influence functionality and quality of life by themselves.

Abortive medications, on the other hand,  are medications only taken after the patient feels the headache coming on.  These medications are designed to work quickly to relieve the pain from the headache.  Other than anti-inflammatories,  the most common medication in this class is the ergot derivatives.  These medications cause vasoconstriction in the head  which often relieves headaches especially those that are migraine.  This counteracts what has been observed in the study of patients with migraine which is a local dilation of the blood vessels in the head.   Of note is the risk that taking these rescue medications may increase blood pressure, and they are not recommended for patients who have suffered a previous stroke. Frequent reliance on rescue medications may in fact  lead to further headache issues.

Additional management options

There are other alternative therapies some patients report to be helpful.  Many patients have gotten good relief with acupuncture.  Routine exercise has also been shown to be beneficial in decreasing headaches.  There are other nonprescription substances that can be taken as well.  Supplemental magnesium has been shown to be helpful as well as riboflavin (vitamin B2).  These supplements should be tried by anybody who has frequent headaches after discussion with his or her physician.  Because many of these alternative therapies  have relatively benign side effects, they’re often under utilized.

Take-home points

If headaches are a common problem for you, take inventory of the things in your life that might be risk factors.   If you seek medical advice, be sure to give your health care provider a thorough history.  Often lifestyle changes will be enough to improve your headaches.   If you and your physician are discussing medications to treat headache, be sure to ask about side effects and ask about non-prescription options.

 

 

Read More

Obstructive Sleep Apnea- When the Snoring Stops

While snoring is hardly a medical problem itself, it may be one of several signs that a patient suffers from obstructive sleep apnea (OSA). OSA results when the upper airway relaxes during sleep and breathing is interrupted. Friends or family may observe the snoring progress to what sounds like choking and eventually apnea where breathing actually stops. During this time carbon dioxide (which is exhaled during normal breathing) starts to accumulate in the bloodstream. Simultaneously, oxygen levels fall. Eventually, the brainstem detects these changes and stimulates the patient to breathe. This may result a gasp or an awakening, the patient resumes breathing, and the cycle repeats itself.

This is important because decreased oxygen levels constrict the blood vessels in the lungs and force the right side of the heart to work harder to pump blood through them. Over time, OSA can lead to chronic hypertension, and in some cases, heart failure over time.

Patients with OSA often complain of sluggishness as they don’t enjoy normal, restorative sleep patterns. Patients may experience a sore throat, headaches, and may doze off repeatedly during the day even while at the wheel.

OSA is especially important to diagnose and treat in patients who are on or will be put on pain medications or anti-anxiety medications since these drugs may cause the soft tissues of the mouth and upper airway to relax, thus increasing the likelihood of apneic episodes. Additionally, opiate medications such as hydrocodone or morphine decrease the brain’s responsiveness to higher carbon dioxide levels. There are well documented cases where patients with untreated OSA have died after being put on opiates after surgery without proper monitoring of their oxygen levels.

Risk factors for OSA include: obesity, thick neck circumference, use of sedatives including alcohol, age (older), smoking, chronic throat problems, and male gender.

A diagnosis of obstructive sleep apnea is made with a sleep study during which the frequency and severity of the apnea are recorded.

Treatment usually involves having the patient sleep in a mask that delivers positive pressure to to the airway (e.g. CPAP mask). Sometimes surgery is offered if removing tissue can open up the throat passages.

In summary, if a patient complains of poor sleep and energy levels, has high blood pressure, is overweight, falls asleep easily during the day, and snores loudly or experiences episodes of apnea as witnessed by others, he/she probably needs a sleep study. In this case, a physician would be wise to order a sleep study before starting a narcotic medication (especially a long-acting drug). Patients with OSA or who are suspected of having sleep apnea should have their oxygen levels monitored when placed on pain medication in the hospital if they are not wearing a CPAP mask.

As hard as it for some patients to get used to wearing the CPAP mask, many experience an improvement in their blood pressure and feel a renewed sense of energy. Symptoms like headache may disappear, and the threat of right heart failure may be eliminated.

If you suspect that you or a loved one suffers with obstructive sleep apnea, consult your physician.

Read More