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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.

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.”

Don’t Let Holiday Travel Be a Pain in Your Neck

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The holidays are around the corner and many of us will be travelling far distances to spend time with friends and family.  It is a joyous time of year but it is not without its stresses.  Whether driving or flying, travel pains and stresses can hinder holiday spirit.

Here are some tips to help reduce these troubles and make traveling more tolerable.


Driving for long periods of time in the same position can strain the back, legs, and neck.  There are several simple stretches that can relieve the stress on the body and can be done while driving or during a brief stop.  Flex the neck slowly side to side and backwards and forwards to help relieve neck tension.  When stopped and your hands do not have to be on the wheel, raise one arm over your head, bend it, and grab the elbow with your other hand.  Pull the bent arm gently over your head to the side.  Alternate and repeat several times.  Also, when stopped and your foot can take a break from the pedals, stretch your leg straight and roll the ankle for several rotations.  Taking frequent short breaks and staying hydrated while driving will help relieve the physical stress of long-term sitting as well.


Adding to the stress of travel may be the fear of flying.  It is possible for emotional pain to exacerbate any physical pain you may be feeling so it is important to address both. The stretches outlined for driving can also be effective in relieving muscle tension stemming from anxiety but paying attention to your breathing can relieve stress also.  Breathe deeply, inhaling through the nose and exhaling through the mouth.  With or without fear of flying, long flights can be restless and uncomfortable so be conscious to sit straight up with your shoulders back to prevent unwanted back aches.

Post-holiday pains?  Be sure to see a medical professional for any lingering pain to determine if this indicates a more serious issue.

About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is 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. He has recently been featured on Yahoo! Health and Everyday Health.