Radiofrequency Ablation: Say Goodbye to Chronic Pain

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Chronic pain is not an easy issue to live with. With today’s advanced technology, Radiofrequency Ablation (RFA) has made it possible to eliminate this debilitating ailment.

RFA is a procedure used to reduce pain by utilizing electrical currents produced by radio waves that heat up a small area of nerve tissue and decrease pain signals from the pungent area.

More than 70 percent of patients treated with RFA experience relief. The alleviation can last six to 12 months, sometimes even years.

People who are treated using RFA are often long-time chronic low-back and neck pain sufferers due to the deterioration of joints from arthritis.

During the RFA procedure, an IV is placed into a sufferer’s arm vein along with anesthesia, to ease discomfort. The person will be awake while the doctor inserts a small needle into the chronic area. The doctor then uses an X-ray machine to guide the needle in to the specific region.

A microelectrode (a small electrode with a tip that can be inserted into the wall of a single cell) is then inserted through the needle to begin the stimulation process. A small radiofrequency current is then sent through the electrode into the nearby tissue, heating it.

The side effects of RFA may include:

  • Leg numbness: This may occur because of the anesthesia given during the procedure and should only last a few hours.
  • Mild back discomfort: Patient can develop this when the anesthesia wears off and usually lasts two or three days. Applying ice to the area the day of the procedure and moist heat the day after can help decrease the ache.
  • Discomfort: This can include swelling and bruising at the site of treatment

This procedure has been proven to be a safe and successful way to treat some forms of pain. RFA is not recommended for people who have active infections or the ability to form blood clots.


About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

Homework, Sports, and Back Pain? What Parents Need to Know

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It’s officially back to school and you know what that means – homework, sports… and back pain?  The new school year brings a whole new slew of problems facing students.  Before you just jump to the medicine cabinet, it is important to understand the possible different sources of pain and what they might mean.


Heavy backpacks on young, growing bodies can cause poor posture, muscle spasms, as well as shoulder, neck, and back pain.  Besides buying backpacks that are properly sized and feature padded shoulder straps, it is important to make sure children carry no more then three normal sized books in their backpacks.  If your child is still feeling pain after reducing the strain on their bodies, you should seek medical attention.


Regardless of whether it’s a high impact or low impact sport, all athletes are still subject to pain and injuries.  While athletes may take precautions warming up, stretching, and staying hydrated, problems may still be inevitable.  Different pains can arise throughout the body causing discomfort but it is important to know what kinds of pains will work themselves out and what signal medical help.

Usually, pains in the back, shoulders, and knees and cramps in the muscles will ease or be gone within a day and leave little to worry about.  What can be a cause for concern are pains that don’t diminish and start to inhibit normal daily routines or worsen with training.  This lingering pain can’t be cured with over the counter pain relievers and can signal more serious problems.  It is important not to ignore these signs and to have them assessed by a medical professional who can help formulate the best form of treatment to get you back in the game in no time.


About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

Fibromyalgia 101:

Fibromyalgia 101: Listen to an interview with Dr. Gottlieb (starts at minute 51) at Blog Talk Radio

Surprising Things Surgeons Don’t Tell You

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Yahoo Health


By Lisa Collier Cool

There are many mysteries about surgery, including why it’s usually scheduled in the morning, the best ways to avoid errors and infections, and why it’s safer to avoid having an operation in July.

Another scary question: “Patients always wonder, ‘Will I wake up during surgery,’” says Marc Gillinov, MD, author of Heart 411 and a heart surgeon at Cleveland Clinic. Fortunately, he adds, “The answer is no: We monitor the depth of your sleep with an EEG-like device.”

More than 15 million Americans have surgery annually, and in some cases, what they don’t know could hurt them. But there are steps you can take to reduce your risk of a bad outcome, including getting a second or third opinion and exploring nonsurgical options. Here’s an insider guide to what every patient should know before going under the knife.

Location Could Play a Role

People who live in an area with a lot of surgeons are more than ten times more likely to be advised to have certain operations than are people in areas with fewer surgeons, according to a shocking Dartmouth report.

If that’s not enough to raise your hackles, consider this: one hospital chain was shown to perform unnecessary heart surgery on patients, some of whom didn’t even have heart disease, the New York Times recently reported.

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Surgery is Safer in the Morning

Many surgeries take place in the morning because an operation may be lengthy and patients aren’t supposed to eat beforehand. Hunger, thirst, and often nervousness can wear on the patient as the day goes on.

Although surgeries can take place any time of day, patients have fewer problems with anesthesia in the morning compared to the afternoon, according to a study published in Quality and Safety in Health Care.

Researchers looked at data from over 90,000 operations and found that nausea and vomiting after surgery, pain management problems, and other post-operative complications were four times as likely in operations which started at 4 p.m. compared to those which began at 9 a.m.

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Watch Out for the “July Effect”

Experts also caution patients to watch out for the “July Effect.” That’s because July is the worst month for fatal hospital errors, making it the most dangerous time to have surgery. The main reason is that July is when inexperienced, often sleep-deprived medical school graduates start residencies at teaching hospitals.

Researchers from University of California at San Diego reviewed more than 62 U.S. million death certificates issued between 1979 and 2006, including those of 244,388 people who were killed by medical mistakes and found that the rate of errors was similar in most months but peaked in July at teaching hospitals.

Surgical Errors Happen

Dr. Ken Waxman, MD FACS, Director of Quality at Ventura County Healthcare Agency recommends that facilities use surgical checklists, such as the list published by the World Health Organization. “The operating team must be mandated to perform all of the safety measures on this check list before and after every procedure. If not, don’t have your operation at that hospital,” he advises.

Surgical sponges and other tools (including scalpels and clamps) have been left inside of patients, causing infections and other complications. To address the issue, some hospitals have begun using radio frequency tags to alert surgeons if sponges are left inside the patients.

Other hospitals use bar codes and scan sponges before they are used and after they are removed. Dr. Gibbs of NoThing Left Behind, a national project to prevent retained surgical items, told the New York Times that technology should be used in addition to counting sponges manually.

Another concern is that surgeons will operate on the wrong limb. To prevent this, says Dr. Gillinov, “Restate the operation. Say something like “Thank you for fixing my left knee.” Some patients even write “wrong leg” in magic marker on the limb that doesn’t need surgery.

Don’t Have Surgery if You’re Sick

This may seem contradictory, but Dr. Scott Gottlieb, New York Eye and Ear Infirmary Director of Pain Management, emphasizes the importance of coming into surgery in good health. “Don’t rely on the surgery to ‘fix’ all your problems. Maintain a healthy diet and active lifestyle prior to the day you are scheduled to go. Recovery is always better with patients in optimal health,” he says.

Orthopaedic surgeon Dr. Elton Strauss, who is affiliated with Mt. Sinai School of Medicine, echoes the sentiment. “If you’re a smoker, you should stop smoking. If you’re a drinker, you should stop drinking prior to the surgery” for at least two weeks. He also recommends increasing water intake for two weeks.

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OTC Supplements Can Cause Problems

“I think it’s important to make sure you are honest with your physician prior to the surgery about the medications you take,” says Dr. Strauss.

“Today many patients take over-the-counter drugs and supplements that can complicate surgery. Patients don’t think about these drugs as being a problem, but they are. Vitamin E, fish oil and St. Johns Wort, to name just a few, cause a lot of bleeding issues,” he said.

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Take a Shower

Neurosurgeon Alain C.J. de Lotbinière recommends washing up before checking in–and has another surprising suggestion. “A very simple thing to prepare for surgery is to shower the day of the procedure with an anti-bacterial soap. You would not believe how many patients present for surgery in a filthy condition and then wonder why they experience post-op infections!” he groused.

In addition, make sure that staff members wash their hands and don fresh gloves in your presence before touching you.

Tarrytown, N.Y.-based book author Caitlin Kelly, who recently had hip replacement surgery, recommends taking hygiene precautions after surgery as well to guard against infection. “We bought a bottle of hexachloride solution (the same stuff surgeons use to wash their hands before surgery).”

“The visiting nurse was very impressed with our thoroughness (in home wound care), and my recovery was excellent,” she reports.

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Debunking Myths About Epidural Injections

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Although the term “epidural” is commonly associated with an injection given to women during labor, an ESI (epidural steroid injection) can be used as a relief for many different circumstances of pain in both men and women. An epidural injection is a procedure that is typically used to help alleviate neck and back pain (in addition to arm and leg pain) caused by inflamed nerves.

How it works:

An epidural steroid injection essentially involves bathing an inflamed nerve root in order to decrease the irritation of the nerve root that is causing pain. Despite the simplicity of this common practice, there are many myths and concerns associated with the beneficial procedure.

During the steroid injection, a needle (the size of a thick strand of hair) and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. The simple method is performed through fluoroscopic guidance; the viewing instrument is used to visualize the local anatomy during the injection. Afterward, the needle is placed into the epidural space, targeting the inflamed area with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.

What to expect:

Although many myths have projected the idea that ESIs are an instant cure for pain, the injections are not an overnight fix to the enduring discomfort of a patient. The epidural, however, generally helps the patient resume his or her normal activities by alleviating the pain so that the patient can proceed to seek physical therapy to slowly strengthen and heal the area that has caused them discomfort.

The effects of ESIs are different with every patient as some injections provide long-term relief of up to a year and others experience short-term relief consisting of a few weeks to a small number of months. It is usually suggested that no more than three ESIs are administered within a 6 month time frame.

Those receiving an ESI for back and nerve pain will have their vital signs examined and pain relief will be assessed frequently throughout the procedure. If there are any possible side effects from the medicine, the anesthesiologist on duty will be involved. Similarly to the symptoms experienced by women during an epidural for labor pain, some possible side effects include drops in blood pressure, itching, and nausea/vomiting depending on the amount of dosage received by the patient.

Keep in mind:

While ESIs are a useful non-surgical treatment for many patients, they are not right for everyone. Those suffering from infection, bleeding problems, or spinal tumors are not recommended candidates. It’s important to note that as with any type of injection, there are some risks associated with ESIs.  Some major risks include bowel and bladder incontinence, infections, headaches caused by epidural punctures, nerve damage, and bleeding.

An anesthesiologist will be involved in the management of this procedure to ensure the best possible outcome in providing pain relief, minimizing side effects, and ensuring your overall safety. However, it is important to assess the risks and benefits of an epidural steroid injection with your doctor to help determine if this treatment plan will be right for you. This form of pain management may also not work for everyone. If the injection does not provide relief, a new treatment may be better suited for you.


About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

Small Gestures: Simple techniques to manage tension and minor pains on the road

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By Phyllis Hanlon

Some days you feel as if you are stuck in a pressure cooker. Traffic, deadlines, issues at home that you can’t deal with because you’re on the road. It happens to everyone at some point.

So how do you ease the stress and bring on the calm?

A simple technique known as mudras might help. An ancient practice dating back to ninth century India, mudras integrates hand movements with self-awareness and conscious breathing to reframe thinking, according to Emily Fuller Williams, LMT and author of Mudras: Ancient Gestures to Ease Modern Stress.

To release anxiety, Williams recommends the “calmness” mudra. It can be done in your truck, as long as you aren’t moving. Sit straight and bend the elbows so the forearms are upright, hands at ear level. Rotate the hands back and forth at the wrist (like screwing in a light bulb), keeping your fingers extended. While performing this gesture for three minutes is ideal, some people notice a difference in mood within seconds, she says.

When both hands need to be on the steering wheel, mudras can be challenging to perform. But Williams notes that pulling gently on one earlobe can lower stress levels while driving. “When there are too many ideas in your head, this helps to drain some of them out,” she says. “You don’t get the full effect, but it’s better to do with one hand than not at all.”

Williams also suggests a “balance” mudra to re-center the body. With the hands resting on the belly, thumbs touching, place the back of the left hand in the palm of the right and breathe deeply. “This helps send lots of extra energy to the head through the fingers, helping to balance the brain,” she says,

Push and pull

Traffic congestion or other frustrations may lead some drivers to clench their jaw, which can lead to other problems. Donald R. Tanenbaum, DDS, MPH, co-author of Doctor, Why Does My Face Still Ache?, says, “Fatigued jaw muscles will likely lead to headaches in the temples, tightness or pain in the jaw muscles, limited jaw motion, ear pain and pain in the joints of the jaw itself.”

When that happens he advises truckers to place the tongue on the roof of the mouth, position a thumb or fist under the jaw and attempt to open your mouth. The resistance helps ease jaw tension and temple headaches. For neck tightness, he suggests pushing the forehead against the palm and holding. Repeating these exercises several times a day should help reduce accumulated pressure in the neck and head.

Stretches may also help untie knotted muscles. Scott Gottlieb, MD, director of pain management at New York Eye and Ear Infirmary in Manhattan, says, “Flexing your neck slowly side to side, and backwards and forwards, will relieve neck tension.” Do not roll your neck in one continuous circle — that can lead to injury.

For leg and back tightness, he proposes straight-legged ankle rolls to get the blood flowing again.

In the air

Stopping to smell the roses may induce appreciation for life, says Kelly Holland Azzaro, RA, CCAP, LMT, president of the National Association for Holistic Aromatherapy, but citrus scents are particularly helpful in dispelling stress. “Lemons, sweet orange and grapefruit help elevate your mood and relieve stress,” she says. She suggests putting a drop of diluted essential oil on a tissue and inhaling the aroma. “Or you could use a plug-in diffuser. The warmth sends the scent into the cab.”

While there’s no escaping stress, some simple remedies may keep you on course and in good health.

When Exercise Can Be Bad For You

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With obesity being one of the top health risks facing Americans today, the campaign for staying fit has never been more important.  Getting active and exercising has a myriad of benefits but there are times when it can be overwhelming for your body.  An important aspect of staying healthy is being able to understand the positives and negatives of exercise and becoming aware of your limits.

Sprains, strains, or stress fractures are the most common form of injury and will typically heal with rest.  Continuing to exercise may exacerbate the problem, prolonging the injury.  Try looking for a different exercise activity that avoids the injured part and allows it to rest and heal.  Be aware of any signs of more serious injury that may require medical attention.  Experiencing any problems moving a body part the way you usually do, trouble bearing weight on muscles or limbs, or tingling and numbness may signal a larger problem.

Exercise can also be too much of a good thing.  People who exercise too much might not only be suffering from emotional difficulties, such as with compulsive or purge-related exercising, but can cause overuse damage to the joints, muscles, and organs.  There is the saying “pain is weakness leaving the body” but there is a difference between making your muscles work harder than usual and experiencing potentially dangerous muscle spasms, weakness and dizziness.

Additionally, exercise can have negative consequences if you are sick.  Doctors often recommend that you may exercise if your symptoms are above the neck (i.e., a head cold) but that you rest if the symptoms are in your chest or stomach.  Exercising with a fever can increase your body temperature further. Overall, it is a good idea to listen to your body.  If you are experiencing pain or illness that makes exercise uncomfortable, take a break and seek a medical opinion.  Generally, it is suggested to wait 1-2 weeks after sickness to get back to your workout regime.


About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

6 Questions Diabetics Should Ask Their Pain Management Doctor

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According to the American Diabetes Association, 8.3 percent of the United Statespopulation is living with diabetes. Dr. Scott Gottlieb of Gramercy Pain Management inNew York City offers his insight as to what diabetic patients should ask their doctor.

1.  How does diabetes cause pain?

The reason patients feel pain is because the diabetes attacks the small blood vessels which ultimately damage the nervous system. The pain that patients are feeling comes from the damaged nerves.

2. What are the symptoms of diabetes?

The symptoms of Type 1 diabetes include but are not limited to: increased thirst and hunger, dry mouth, nausea, abdominal pain, frequent urination, fatigue, heavy breathing and frequent infections of the skin and urinary tract. The symptoms of Type 2 diabetes a patient can experience are similar to Type 1 diabetes with the addition of possible blurred vision, numbness or tingling of the hands and feet and sores that are slow to heal.

3.  What kind of treatment is available to help with diabetic pain?

There is a wide array of medications available to try to help with diabetic pain such as Non-Steroidal Anti-Inflammatory (NSAIDS) pills like Aspirin and Advil. Anti-seizure drugs such as Lyrica or Nerontin are also available to help with pain because it can calm sensitive nerves. Along with NSAIDS and anti-seizure drugs, antidepressant medications can alleviate the pain as well. For patients who do not wish to take pills orally, there are also topical creams available.

4.  If I do not want to take pain medications, what other types of ways can pain doctors alleviate diabetic pain?

If the patient does not wish to take pain medications, the pain management doctor can work with the patient to come up with a diet/exercise regimen and a possible regimen of massage, acupressure, or biofeedback to help with the pain.

5. What non-traditional methods could help with diabetic pain? 

The non-traditional methods to help with diabetic pain include regimens of diet/exercise, massage, acupressure or biofeedback (a technique that trains people to improve their health by controlling certain bodily processes that normally happen involuntarily).

6. How can diet/exercise help with diabetes and diabetic pain?

It is important for a diabetic to always eat a balanced diet. Instead of choosing carbohydrates that consist of only white flour, eat whole-wheat, which are considered “slow-release” and “high-fiber” foods that benefit a diabetics health more than white flour. Also, patients think that when they have diabetes they have to avoid sugar at all cost. Wrong. Diabetic patients can eat sugar, but in moderation and not everyday. Exercise is just as important as maintaining a balanced diet. Any type of physical activity such as hiking, walking, biking and swimming can control diabetes.

About Dr. Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, New York in Rockland County.

Avoid the Emotional Pitfalls of Pain

By Wyatt Myers
Medically reviewed by Lindsey Marcellin, MD, MPH
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Coping with chronic pain is never easy. But for some, the day-in, day-out impact of living with pain can lead to a second assault — emotional issues like frustration, anxiety, and eventually depression. And poor emotional health can further exacerbate physical pain, leading to a worsening of physical symptoms.

“What happens in the mind and emotions affects the physical body and vice versa,” says Katherine Puckett, PhD, LCSW, the national director of mind-body medicine for the Cancer Treatment Centers of America.

“Feelings of anger, depression, and anxiety contribute to stress, which in turn has physical effects such as increased muscle tension, increased heart rate, reduced functioning of the digestive system, increased inflammation in the body, and increased activity in the sympathetic nervous system that results in release of stress hormones,” say Puckett. Any or all of these physical effects of stress may in turn increase pain. And increased pain may make a person feel more depressed. It can be a vicious cycle if you don’t interrupt it.

How Pain Impacts Emotional Health

Chronic pain doesn’t necessarily doom you to depression or other emotional problems, but pain does lead to some situations that can make emotional issues more likely, says Scott Gottlieb, MD, of Gramercy Pain Management in New York. “Someone who is in pain stays home, feels frustrated, and can’t do what they used to do,” he says. “This impact of pain on activities of daily living can cycle some patients into a depressive state.”

Anxiety in particular often occurs when there’s uncertainty about what’s causing the chronic pain, adds Dr. Gottlieb. “For example, if someone is having headaches and nothing shows up in any tests or studies, it’s often hard for a patient to accept it’s just nerve pain as a diagnosis,” he says. “They feel pain in their head all day and are anxious that it is something more serious even though other serious causes have been ruled out.”

Managing Chronic Pain Emotions

These strategies can help you break free from the spiral of emotional problems leading to even more pain:

  • Try counseling. Even if you don’t feel like you have full-blown depression or anxiety, a visit with a counselor can help stem the tide of pain-related emotions before they get worse. “A good therapist will listen, get to know the person, gain an understanding of what he or she is going through, and offer helpful reflections and suggestions,” says Puckett.
  • Exercise more. Puckett says regular exercise is one of the best antidotes to both emotional problems and pain. And it doesn’t have to be an intense exercise that might exacerbate your pain either. If your doctor approves, “taking walks, enjoying nature, or playing with pets are all good choices,” Puckett says.
  • Try deep breathing. Philip Wazny, NMD, a naturopathic medical doctor and pain specialist at Integrative Health Care in Scottsdale, Ariz., recommends a simple stress- and anxiety-reducing technique. “For beginners, taking as little as 10 minutes a day to focus on your breathing can be a game changer,” he says. “I recommend that people sit in a quiet space and focus on their breath. It sometimes helps to count to seven while inhaling, hold the breath for two seconds and then exhale for eight seconds. By exhaling for a little longer, patients are forced to use accessory muscles that cause a reflexive inhalation of healing oxygen.”
  • Write it down. “Patients may benefit from keeping a pain log to chart their symptoms,” says Anand Gandhi, MD, a physician at the Laser Spine Institute. “This allows you to monitor pain over time and objectively compare from one day to the next.”

Above all, keep a positive attitude. It may be difficult at times, but Dr. Gandhi says this is critically important to not falling into the depths of anger, depression, or emotional distress. “Chronic pain causes both emotional and physical changes in many patients,” he says. “It is important that patients maintain a positive attitude and avoid allowing the pain to consume their lives.”