The way the Military treats PTSD

PTSD or post traumatic stress disorder is a anxiety disorder associated with some type of stressor. The stressor can be anything from abuse to near murder situations. Obviously, the military deals with PTSD in its soldiers on a regular basis. I often work on military individuals and they have been using a old technique in a new way. They have been utilizing a procedure called a stellate ganglion block for the disorder. This is also known as a SGB for short. SGBs are used in pain management for unusal autonomic problems such as complex regional pain syndrome (CRPS). CRPS is a poorly understood disorder that causes severe burning pain usually in the extremities. The SGB blocks nerves that are called autonomic nerves which control the functions that we don’t usually think about such as anything from heart rate and digestion to sweating. In CRPS, it is thought that these nerves may be damaged or dysfunctional. The important issue here is that these are very primate nerves that come out of the brain but also probably have branches that and information into the brain as well. That is where the SGB for PTSD is supposed to work. This block temporary stops the information through these nerves and thus since they are primitative nerves they go to the deepest darkest regions of the primitive brain and by blocking them it is hoped that the primative regions that control anxiety will be blocked as well and relaxed. At this time, no long term studies have been done but from my experience, the military men feel some degree of improvement. The big issue is that in some of the patients the results are short lasting and have to be repeated. Nonetheless, this is a fascinating approach to people who otherwise have poor results with oral antidepressant medications. So if you suffer from PTSD consider asking your doctor about the SGB. Most will never have heard of it but you can tell them that the military uses it with decent results


Spinal Stenosis and pain

One of the most common issues that people have to deal with is what is termed spinal stenosis. The term stenosis generally refers to “a narrowing” and can be applied to numerous locations of the body. In the issue of spinal stenosis, there is a narrowing of the spinal canal. The spinal canal extends from […]


Medical Advertising

I often recall PT Barnum’s famous saying about a sucker being born every minute or about the refrigerator salesman who could sell ice to Eskimos. The really is that a lot of people are quite gullible when it comes to advertising. If they weren’t thin advertising wouldn’t exist. I bring this up because of a […]


Vagueness in current diagnoses

First, I apologize for not writing a new blog for quite some time. I have been extremely busy lately. Secondly, I wish to bring up the simplification of medicine that is occurring with the dumbing down of education. It appears that schools are trying to compartmentalize medical problems into simple algorithms. This simplification extends to […]


The realities of opiate pain killers

This article was written by author Laura Tedesco on December 3, 2014 Prescription Painkillers Have Tripled CDC Report: Fatal Overdoses From Prescription Painkillers Have Tripled Has our nation’s reliance on prescription painkillers gotten out of hand? The epidemic of opioid overdoses is continuing to take its deadly toll on Americans: The rate of deaths involving […]


Drug addiction and psychology

Recently, I have been involved in addiction medicine. I initially got into that field due to having patients who were being discharged due to signs of addiction. Lately, I’ve been seeing people who never were my pain management patients and I have learned a lot from them. First, I realize that the majority of them […]


Catch 22

Recently, A New York Physician by the name of Dr. Stan Li was convicted of two counts of manslauter for prescribing painkillers to patients in New York. The article can be read here – http://www.huffingtonpost.com/2012/12/06/stan-li-new-york-city-doctor-overdose-manslaughter-deaths-charged_n_2251075.html. The Doctor was accused of prescribing to addicts and one of the addicts murdered four people in a hold up […]


My Opinion On THC

What’s THC? Well that’s the ingredient in Marijuana. A lot has occurred in the past 10 years with the rise of the baby boomer population coming to terms with there age. They represent a group that doesn’t like that they are aging and want to bring their “hippy” values to the mainstream. The question is […]


The pains of pain management

Had a pleasant female patient today that was referred to me by her son. The interesting thing was that I had discharged her son from my practice a month ago for getting prescriptions from another physician. For those who are unaware, in pain medicine, we have contracts with patients that they can only get their […]


An Enlightened Moment

I really try to pride myself on being a caring and compationate guy. Thus, I was very susprised the other day when a patient told me that I treated him poorly. I appologized for anything that I might had done but he felt that I didn’t take his pain seriously enough. Those who know me […]


Pain Medicine and the Modern Society

Recently, in the state of Florida, the laws changed as to the usage of pain medication. These changes greatly altered how most legitimate pain physicians operate. Prior to 2010, we generally only were involved in difficult medication management cases and most of our time was involved in procedures. With the law changes, the state has […]


Pain Masking Devices

When dealing with chronic pain situations, we as pain medicine physicians often get to a point where nothing appears to be working to resolve their pain. The patient either has escalated upwards on their oral pain medicine or the oral pain medications haven’t worked. Obviously, devices like spinal cord stimulation would also be considered a […]


Upcoming issues in healthcare

A lot has been discussed in the media recently about the upcoming changes to the healthcare system. Obviously, none of know for sure what to expect but we in the healthcare field have been told to expect some changes. One of the changes to expect is the exchange system. It is a rumor that most […]


Misunderstood Pain

Pain is a subjective experience. Those without pain cannot understand what it is like to live in constant pain and suffering. We live in a society that values youth and vitality but when people are suffering, it seems that the system wants to turn their back on them. I regularly see patients that have surgery […]


Addiction versus tolerance

I am often asked by patients whether or not they are addicted to their pain medications. I guess a good place to start is to define addiction. Addiction is a compulsive and repetitive action that is harmful to the individual. This implies that you repetitively repeat an action even though you realize it affects are […]


The End Of Private Practice

Times are a changing. With the increasing government control of healthcare and the increasing power of lobbies change is already underway. This involves not just obamacare, this has been going on for the past five years or so. Currently, about half of all healthcare insurance is via the government and their programs, Medicare, Medicaid, and […]


Chronic pain and chronic pain medications

Pain is a very subjective thing. What one person feels is a 10 over 10 another person might rate as a 1 over 10. For example, a navy seal might consider a broken bone not too bad while many people might rate it as severe. There is no quantitative test to determine pain and for […]


Migraine’s – Often Misdiagnosed

I am not sure but I think 80% of everyone out there has migraine’s. Often, they are told this by their primary doctor and the patient takes this diagnosis to heart. As a pain management doctor I get very annoyed when people are given a diagnosis without a proper work up. It would be as […]


Fibromyalgia – Does everyone have it?

There are several diagnoses that are troubling to me as a pain medicine physician. These are RLS, Migraines, Chronic Fatique Syndrome and Fibromyalgia. I find these troubling because many doctors rapidily diagnose people with these issues and then the patient takes that diagnosis to heart. Also troubling is that these issues are what I call […]


February Newsletter

This month’s topic is Sciatica.   What is Sciatica? We as physicians generally don’t use this term since it is vague. People generally don’t have complete damage or compression of the entire sciatic nerve. Generally people have compression of one of the many nerves that comprise the sciatica nerve. The sciatic nerve has branches form […]


December Newsletter – Sacroplasty

A fairly common problem, especially for women, is sacroilitis or sacroiliac joint syndrome. This is pain that arises from the sacroiliac joint (SIJ). The SIJ is the joint between the pelvis and the sacrum. It is commonly those little dimple area that people see on their backside. These joints generally fuse early in life and […]


October Newsletter

October Newsletter A recent study by the Chinese reveals that the usage of Methylene Blue, which is a common dye, when injected into the intervertebral discs may result in significant and permanent reduction of low back pain. The exact method of how this interaction occurs is unknown but the results reveal a 50% reduction in […]


The Artificial Disc

It wasn’t long ago when the artificial disc was considered the cure-all to back problems. The studies that were done in Europe showed success rates that were very impressive. 90% cure rates or so they say. It has been over five years since the artificial disc was approved for usage in the U.S.A. and the […]


Intradiscal Injections

Discogenic low back pain is a major concern for most people. It is the most common cause of low back pain (LBP). Amazingly, until the late 1980’s the discs were thought to not have sensation and thus could not cause pain. We learned that the outer surface is very well innervated and yes definitely can […]


Sacroiliac Joint Pain

Sacroiliac joint pain or SIJ pain is a common disorder that is seen in females much more than males. The SIJ is comprised of the surface between the sacrum and the iliac bones. The two iliac bones comprise the pelvis. The joint is essentially non-mobile in the vast majority of patients and although some believe […]


Discogenic Low Back Pain

Believe it or not, up until the late 1980’s, it was thought that the discs themselves didn’t cause pain. It was known that a herniated disc could press on a nerve and cause pain but it was assumed that the disc didn’t have any innervation and thus couldn’t cause pain in and of itself. Studies […]


Spine Surgery Success Rates

Many spinal surgeries offer some kind of success rate but do you the patient really understand what is meant by “success”? Obviously success means that you had a positive outcome, but to what degree. Usually conventional spinal surgeries offer a good to excellent outcome in 50 to70% of patients. Usually, but not always, good to […]


Low Back Pain

Low Back Pain or LBP is probably the most common complaint in our society. Some say that over 50% of all people will have some degree of severe LBP at some point in their lives. Most of these cases resolve on their own but a small group of around 5 to 10% develop chronic pain […]


Welcome To Emerald Coast Pain Blog

Welcome to the emerald coast pain blog. We’re just starting this up but let’s see what happens.