Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Chronic Pain
Chronic pain is a complex condition driven by a number of biological, behavioural, psychological, and social factors. At NeuPath, we aim to acknowledge the multifaceted experience of living with Chronic pain by developing patient centered tailored treatment plans. A common first visit will include a thorough assessment which includes reviewing your pain history, previous treatments, and current medications. The initial appointment is extremely helpful in developing a customized treatment plan.
I’ve been treating Chronic Pain for many years and some of the most common interventions that I recommend are:
Address pain tolerance and coping mechanisms, explore maladaptive behavioural patterns
Discuss the difference between hurt vs harm
Focus treatment on anatomic areas of pain, using different modalities: medications and injections where appropriate
Work to ensure improvement and/or stability in symptom management and functional goals
We understand that chronic pain is a complex medical problem that can have a significant effect on your physical, emotional and spiritual well- being. The main goal of a successful pain management is reduced pain but, most importantly, a return to better function and quality of life.
Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Chronic Shoulder Pain
At NeuPath, our goal is to provide a comprehensive Chronic Pain assessment and a whole-patient focused treatment plan. I’ve treated Chronic Shoulder Pain for many years at NeuPath and many of my patients benefit from a treatment plan that includes the following interventions depending on the type of disorder:
General discussions on maintaining mobility and function
Medications focussed on reducing pain, inflammation and spasms
Injection-based treatments that utilize local anesthetics,, steroids and viscosupplementation by targeting the rotator cuff and the shoulder joint.
Progress amongst patients will greatly vary but after a few treatments, I hope to see a wider range of motion in the shoulder which can look very different from patient to patient. Again, patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity. At NeuPath, we work closely with our allied health partners to help our patients in their physical treatment plan.
Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Osteoarthritis
At NeuPath, our goal is to provide a comprehensive Chronic Pain assessment and a whole-patient focused treatment plan. I’ve treated Osteoarthritis for many years at NeuPath and most of my patients benefit from a treatment plan that includes the following interventions:
• Promotion of weight loss treatments to reduce the impact of gravity on weight-bearing function
• Medications, both systemic and topical
• Local injection-based treatment that targets both peri-articular structures, superficial nerves and the intra-articular joint space, using a variety of injectables including local anesthetic, steroids, and hyaluronic acid.
Patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity. At NeuPath, we work closely with our allied health partners to help our patients in their physical treatment plan.
Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Chronic Back Pain
Chronic Back pain can range from a muscle aching to a shooting, burning or stabbing sensation. Back pain is extremely common and the difference between regular back pain and chronic back pain is the frequency of occurrence. At NeuPath, our goal is to provide a comprehensive Chronic Back Pain assessment and a whole-patient focused treatment plan. I’ve treated Chronic Back Pain for many years at NeuPath and many of my patients benefit from a treatment plan that includes the following interventions:
Stress the role of exercise, focussing on mobility and core strengthening and correcting maladaptive posture
Use of anti-inflammatory, anti-spasmodic and analgesic medications for overall pain control and functional improvement
Injection-based treatments with local anesthetics targeting nerves, muscular structures and joints
Epidural injections to alleviate sciatica associated with back pain
Patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity. At NeuPath, we work closely with our allied health partners to help our patients in their physical treatment plan.
Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Chronic Migraines
A Chronic Migraine is defined as having at least 15 headache days a month of which at least 8 episodes present with migrainous symptoms lasting 4 or more hours per day. At NeuPath, our goal is to provide a comprehensive Chronic migraine assessment and develop an individualized patient focused treatment plan. I’ve treated Chronic migraines for many years at NeuPath and most of my patients benefit from a treatment plan that includes the following interventions:
Address avoidance of triggering factors for migraines and discuss about overuse of medications for acute relief
Focus attention on preventive, prophylactic treatment with a number of different classes of medications
Local injection-based therapy using local anesthetics targeting nerves and pain generating structures in the face, head and neck
Therapeutic Botox for sustained duration of improvement from symptoms
New generation of CGRP receptor antagonists that are given as injectables or oral preparations
Patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity.
Dr. Kim, NeuPath Centre for Pain & Spine Medical Director, on Neuropathic Pain
Some of the most common causes of neuropathic pain are diabetes, facial nerve problems, and central nervous system disorders. You can feel pain from any of the various levels of the nervous system like the peripheral nerves, the spinal cord and the brain. It is often not easy to tell the source of neuropathic pain but the pain presentation is typically one of burning or sharp, knife-like pain or electrical shocks.
At NeuPath, our goal is to provide a comprehensive Chronic Pain assessment and develop an individualized patient focused treatment plan. I’ve treated neuropathic pain for several years at NeuPath and most of my patients benefit from a treatment plan that includes the following interventions:
Use drugs targeting nerve excitability, these include topical creams and oral medications
Injections with local anesthetics to numb the areas of neuropathic pain
Intravenous infusion of lidocaine or ketamine in a controlled setting to reset the “nerve pain thermostat”
Patient outcomes will vary based on the individual but the best outcomes happen when the individual also addresses psychological factors, diet, and activity.
This outpatient procedure is used to help with treating lower back, hip and groin pain
What are Facet Joints
Facet joints are found on either side of the spine. Each of these joints is about the size of a thumbnail. In the lumbar spine there are 5 vertebrae that are connected by facet joints.
Facet joints connect vertebrae to one another along with guiding the spine when moving.
Medial branch nerves are located near facet joints. They communicate pain from facet joints. Therefore these nerves tell the brain when the facet joint has been injured or hurt.
Injury to a facet joint typically involves damage to cartilage inside the joint and connecting ligaments surrounding the joint.
Pain from an injured lumbar joint may range from muscle tension to more severe pain. This pain can radiate into different areas, depending on which facet joint is injured/affected.
RFA Procedure
A thin needle is inserted near the facet joint under fluoroscopy (a type of x-ray). Fluoroscopy is used to position the needle. The nerve will be stimulated by the Physician to assess if the needle is in the proper position. This can cause some of your symptoms to be reproduced and/or your leg or foot twitch.
With the correct needle position the area will be numbed with anesthetic medication. The Physician will use radiofrequency energy to disrupt the medial branch nerve signal.
Do I have Lumbar Facet Joint Pain?
If you have pain for greater than 2 months in the lower back, hip and/or groin area you may have lumbar facet joint pain.
Tests such as X-rays or MRIs do not always show if the facet is the reason for your pain. The best way to test if you have this pain is to block the pain signal from the medial branch nerve.
A Lumbar RFA disrupts the function of the lumbar medial branch nerve. The medial branch nerve is then no longer able to transmit pain signals from the affected facet joint.
After your Lumbar RFA procedure you will be monitored for approximately 30 minutes. The clinic will give you appropriate instructions to follow for care following the procedure.
We caution against driving after an RFA procedure.
Post procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation and can last 2 – 4 weeks. The full benefits for pain relief take usually 6-12 weeks.
Nerves will regenerate after the RFA procedure. However the time it takes for them to regenerate varies from 8 – 24 months. Your typical pain may or may not return after this nerve regeneration. If your pain does return another RFA can be done.
This outpatient procedure is used to help with diagnosing lower back, hip and groin pain.
What are Facet Joints?
Facet joints are found on either side of the spine. Each of these joints is about the size of a thumbnail. In the lumbar spine, there are 5 vertebrae that are connected by facet joints.
Facet joints connect vertebrae to one another along with guiding the spine when moving.
Medial branch nerves are located near facet joints. They communicate pain from facet joints. Therefore these nerves tell the brain when the facet joint has been irritated or hurt.
Injury to a facet joint typically involves damage to cartilage inside the joint and connecting ligaments surrounding the joint.
Pain from an injured lumbar joint may range from mild muscle tension to more severe pain. This pain can radiate into different areas, depending on which facet joint is irritated.
How Long Should the Pain Relief Last?
After your Lumbar Medial Branch Block procedure you will be monitored for approximately 15 – 30 minutes. The clinic will give you appropriate directions to follow as well as complete a pain diary. This pain diary is very important as it will guide the Physician’s treatment plan for you.
Pain relief will last for approximately 4-6 hours until the anesthetic wears off.
Short-term pain relief is considered a positive test. The Physician will then determine the next step in your treatment plan.
Post-procedure soreness may be experienced. Typically this soreness is caused by muscle and nerve irritation.
Medial Branch Block Procedure
A thin needle is inserted near the facet joint under fluoroscopy (a type of x-ray). Fluoroscopy is used to position the needle accurately and safely. A small amount of dye is used by the Physician to assess if the needle is in the proper position. This injected dye can cause some discomfort.
With the correct needle position, the area will be numbed with an anesthetic medication.
Do I have Lumbar Facet Joint Pain?
If you have pain for greater than 2 months in the lower back, hip, or groin area you may have facet joint pain
Tests such as X-rays or MRIs do not always show if the facet is the reason for your pain. The best way to test if you have this pain is to block the pain signal from the medial branch nerve.
A Lumbar Medial Branch Block disrupts the function of the lumbar medial branch nerve temporarily. The medial branch nerve is then no longer able to transmit pain signals from the affected facet joint to the brain.
Important Notes
Do not stop any anti-platelet/anti-coagulant medications (eg. Aspirin, Plavix, Coumadin, etc.) unless instructed to do so by a physician.
Please arrive with your pain level 5/10 or greater to ensure that you will be able to notice the effects of the injection. If your pain level is less than 5/10, your injection may be rebooked. You may want to avoid taking pain medications on the day of the procedure.