7901 SW 34th Ave

Amarillo, TX 79121

Victor M. Taylor, MD, DABA

Board Certfied Pain Management

Ph: 806-352-7431

Fax: 806-352-2374

Physical Rehabilitation in Chronic Pain | Opioids and Chronic Pain | Approach to Treatment

Frequently Asked Questions

 

Q: What do I need to do to prepare for an injection?

 

You will need a driver to go with you to the injection appointment. Depending on the facility, the driver may be required to stay throughout the duration of the appointment, and you will NOT be allowed to ride on a bus or in a taxi from the appointment.

 

You cannot eat or drink anything at least 8 hours prior to your injection time. This includes sucking on hard candy or chewing gum. If you need to take medications the morning of the procedure, you may do so with a small sip of water.

 

You must stop any blood-thinning medications such as the following:

 

  • Aspirin, any non-prescription pain medication except Tylenol, any     prescription NSAID (see partial list)
  • Non-steroidal anti-inflammatory drugs (NSAIDs) - including but not limited to: Motrin/Advil (Ibuprofen), Anaprox/Aleve/Naprosyn (Naproxen), Celebrex (Celecoxib), Voltaren/Zipsor/ Arthrotec/Cambia (Diclofenac), Daypro (Oxaprozin), Relafen (Nabumetone), Mobic (Meloxicam), Clinoril (Sulindac), Indocin (Indomethacin), Lodine (etodolac) , Vimovo (esomeprazole and naproxen), Duexis (ibuprofen and famotidine) and Salonpas patches.
  • Certain vitamins and supplements: Lovaza (Fish Oil/Omega-3), Flax Seed, Echinacea, Ephedra, Garlic, GinkoBiloba, Kava, St. John’s Wart, Curamin/Curcumin, Vitamin E and Valerian Root.
  • If you have a stent, A-fib, history of stroke or peripheral vascular disease or history of blood clots you may be on one of the following medications.  These must be stopped for 5 days prior to your treatment.  YOU are responsible for asking your prescribing doctor if it is safe for you to stop the medication for 5 days.
  • Coumadin, Plavix, Eliquis, Lovenox, Pradaxa, Effient, Heparin, Persantine, Aggrenox, Brilinta (Ticagrelor), Xarelto (Ribaroxaban)

 

Q: Do the injections work?

 

80% of patients will get significant and worthwhile relief from our treatments.  That means that 20% of patients who undergo treatment do not get long-term relief.  Remember that the only people who are undergoing interventional treatments are patients who have failed to improve with more conservative measures.

 

Patients who are able to actively engage in the prescribed home rehabilitation program do significantly better long-term than patients who are not able to do their exercises.

 

 

Q: Will the injections just mask the underlying problem?

 

Most of the injections that we perform have a therapeutic component and do not simply mask pain.

 

Epidural steroid injections can actually break up adhesions within the epidural space and allow for healing of the inflammation around the nerve.

Trigger point injections can break up areas of muscle spasm and lead to long-term relief.

 

Joint injections can decrease inflammation and break the cycle of inflammatory damage leading to long-term relief.

The following blocks by themselves only mask pain.  When used in conjunction with proper rehabilitation these blocks are an important part of long-term improvement.

 

Medial branch radiofrequency ablation/rhizotomy blocks the pain signal sent from the joint to the brain and simply masks the pain.  During this time we encourage patients to undergo rehabilitation and conditioning, which can lead to more permanent relief.

 

Sympathetic nerve blocks can interrupt a poorly understood feedback mechanism, and when combined with desensitization exercises, can lead to prolonged relief and improvement in the overall syndrome.

 

Q: How long will the procedure take?

 

You will likely be at the facility for about an hour to an hour and a half.  The actual procedure usually takes 10-30 minutes. Certain procedures may take longer.  When he arrived at the facility you’ll be checked in, paperwork including consents filled out and preparation for sedation initiated, if desired.  After the procedure, we will observe you for 20 minutes to an hour in the recovery area to make sure you’re doing well and that you don’t require any further medical attention.

 

Q: What is the cost of these injections?

 

The cost of the injection has two parts: a facility portion and a professional portion. At the current time we do our procedures in an outpatient surgical hospital.  There will be two separate bills.  You’ll receive a bill from my office for the procedure itself.  You’ll receive a separate bill from the hospital for the use of their facility.  My office will be happy to give you an estimate of what our cost will be.  The hospital billing office will be able to give you an estimate of their fees.

In 2017, we plan to offer the injections within an office-based setting with a set cash price without insurance involvement.  We will be able to tell you the exact cost of treatment in that setting.

Q: Will I be asleep for the procedure?

These procedures are not performed under general anesthesia, so you will not be completely asleep. There are three options for sedation: Valium by mouth, IV sedation with Versed and Demerol, or no sedation at all. Even with sedation, you will likely still be awake, as it is important for you to be able to interact with the staff throughout the procedure and to verbalize if you begin to experience anything that you are concerned about.

Regardless of sedation, Dr. Taylor will numb the area of injection with local anesthetic prior to proceeding with the main therapeutic part of the procedure. Discomfort during the procedures is mild, and most patients tolerate the procedures well, even those choosing to proceed without any sedation whatsoever.

 

Q: Will this cure my pain?

 

No.  The injections are part of an overall treatment plan established to help manage chronic pain.  The goal of treatment is to improve your ability to function and minimize her pain.

 

It is true that many patients are in fact cured of their pain, but a more realistic expectation is that you will receive meaningful and worthwhile relief that can help you heal and rehabilitate body.  Depending on your underlying physical condition, the length of time you have had pain and the degree of structural damage, you can continue to make improvement over time

Outcomes for individual patients varies quite a lot.  Many patients still require medication after treatment.  We encourage all patients to continue with home rehabilitation and work to improve her physical condition.

 

The vast majority of patients are happy with the results of their treatment.  Most patients who undergo treatment either are able to cut back on their use of medications or find that their pain is better controlled while using the medications than before treatment.

 

Some patients do get 100% relief of their pain and able to stop all medications

 

Q: Do you offering money back guarantee.

 

No.  When you pay for the purchase professional services, you are paying for the time, effort, skill and expertise required to provide the service.  Actual outcomes/results depending on multiple factors are outside of Dr. Taylor’s control.

 

We will guarantee to do my very best for you.  If you have questions or concerns about anything related to your treatment, I am happy to talk to you about that.  We really do care about and appreciate our patients, and I want you to feel that we are resources for you.  Chronic pains a terrible problem.  It is difficult to treat.  It is very difficult to live with.

 

Sometimes it is necessary to try different techniques in the treatment of chronic pain syndrome.  Our goal is to have a good outcome from the beginning with your pain.  Unfortunately more than 1 interventional technique is often necessary to treat patient’s pain.

 

Q: I am active during the day working or walking for exercise. Why do I need to do the specific exercises provided by Dr. Taylor?

 

The exercises we prescribe are specifically tailored to work with the medications and interventional techniques we’re using in the treatment of your pain.

 

The neural flossing exercises are crucial in the treatment of many spinal conditions, as the simple movements involved in these stretches keep the nerves in the area mobile and from becoming re-adhered after treatment. When the nerves are limited in their movement by adhesions or scar tissue, inflammation develops and causes the pain you were likely experiencing prior to treatment.

 

The other stretches, such as the stick figure stretches, work on specific muscles to prevent them from adding additional strain on the area of pain or other joints. Normal daily activities and/or walking cannot accomplish these goals.

 

Inversion therapy is performed traction that can gradually help improve the biomechanics of the spine leading to better function and less pain.

 

If simply doing the activities that we do in daily life such as walking or chasing after our children or grandchildren was sufficient, then no one would need treatment for musculoskeletal problems and chronic pain

 

Q: I have paperwork for FMLA, disability, or handicapped certification. Will you fill that out?

 

No, unfortunately medicine today is I highly specialized endeavor.  Determining work limitations degree of disability etc. require specific testing and specific expertise in guidelines related to work hardening and disability.

We will not provide any restrictions for occupational duties or make specifications as to what activities are safe for you to do. If you require something of this sort, we can provide a general letter explaining our philosophy on this and recommendations for the employer to make reasonable accommodations for your condition.

 

There is also an option to refer you to a physical therapy facility to have a Functional Capacity Exam performed, and the report can be filed with the requesting entity.

 

Q: Why am I having an injection in my back if my pain is in my legs OR in my neck if my pain is in my arms?

 

The nerves to the legs originate in the lower back.  The nerves to the arms originate in the lower neck and upper thoracic area.

 

If your pain appears to be caused by radiculitis (inflammation of a nerve that causes radiating pain to other areas) rather causes in the area itself (like a fracture, strain/sprain, muscle spasm, etc.), the treatment of choice would be targeting the pain at the source-where the nerve is irritated.

 

Q: Why is it a series of three epidural steroid injections?

 

When performing an epidural steroid there are 2 main goals and treatment.  1-to place a steroid in close proximity to an inflamed nerve root.  2-to use the volume injected to physically disrupt adhesions around the nerve so that the nerve root becomes free and mobile and is allowed to heal.

 

There is a tendency for inflammation to recur in for the nerve to become re-adhered and so we repeat the procedure.

 

3 injections as an average.  Patients, who have not had pain for a long or have an overall well-maintained spine, may only need one treatment.  Patients with severe spinal problems, who might normally require surgery but are not candidates, may end up receiving 3 or 4 injections a year to manage her pain effectively.

 

The actual stopping point for the number of injections is adequate pain control whether that takes one injection or four injections.

 

The other stopping point would be if the patient is not making meaningful progress after 2 injections we would not continue.

 

Most people require 3 injections over the course of 3-4 months.

 

After the first injection, you will be started on specific neural flossing exercises, which will help your progression and chance of success with the injections. Because the procedure is performed under fluoroscopic (x-ray) guidance with the use of contrast (injected fluid that shows up on x-ray imaging), we can actually see improvement in the spread of the medication with each injection of the series in most patients.

 

Q: What do you inject in an epidural steroid?

 

We anesthetize the skin using a very small 27-gauge needle in the local anesthetic lidocaine.  Once the skin was numb we used a 16-gauge needle to approach the epidural space.  Once we are in the epidural space we inject another local anesthetic called ropivacaine as well as dexamethasone.  A radiocontrast agent such as Isovue or Omnipaque is injected as well

 

Q: My doctor said I should see Dr. Taylor even though I already tried another pain doctor.  Why bother?

 

Our approach is different than some other pain doctors.

 

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