arizona pain monthly september

Dr. Tory McJunkin & Dr. Paul Lynch

Arizona Pain Monthly | September, 2010

Welcome to the September is-sue of Arizona Pain Monthly! We hope you and your fami-lies are doing well.

September is Pain Aware-ness Month, and at Arizona Pain Specialists, we believe in consistently educating our patients on their pain and the available treatment options for them. At our office, we practice interventional pain management, which is based on the use of minimally-inva-sive treatments that diagnose and treat pain. Rather than simply treat your pain, we work to find the source and causation of your pain and work from there. If a physi-cian is not treating the source of your pain, your pain may persist undiagnosed and worsen with time.

We focus on an interdisciplin-ary approach to pain man-agement, bringing you many levels of care. Available to you are minimally-invasive procedures, biofeedback, disc decompression, chiropractic care, acupuncture, and other treatments to aid in reliev-

ing your pain. You may be apprehensive about your treatments, but rest assured that, should you have any questions, the medical staff at Arizona Pain Specialists is ready and willing to answer them.

In a focus on patient edu-cation, we provide our patients with literature in the office on procedures, chiropractic care, and other forms of interdisciplinary care. In addition, should you have questions when you are at home, you can go to: www.ArizonaPain.com to view the “Pain Knowl-edge Center,” which is host to many articles and videos that are available to educate and inform you.

Do you suffer from chronic migraines once the mon-soon season begins in the desert? In this month’s Ask The Expert column, Dr. Patrick Hogan gives an expert look on methods to alleviate these painful headaches.

The month of September is also National More Matters Month with a focus on fruits and vegetables. The aver-age American gets nowhere near the amount of fruits and vegetables that are recom-mended daily. Featured this month are recipes that re-volve around the avocado, which is not only one of the most versatile vegetables, but is also a great anti-in-flammatory food.

We hope that this issue is educational and informative. Please contact us at [email protected] if you have questions or comments.

We thank you for your con-tinued loyalty if you are a long-standing patient, and we welcome you to the Arizona Pain Specialists family if you are a new patient.

Until next time, remember at Arizona Pain Specialists, we believe you can be pain free.

Taking Responsibility for Your Pain Those who suffer from chronic

pain often begin to lose hope and feel as though they will never be “normal” again. They often feel as though no physician can help their pain, and might feel like “giving-up.” It may take multiple office visits and multiple physicians for a chronic pain patient to receive a diagnosis, and this can feel dis-couraging.

Patients are seeking 100% pain relief – and while some find it – many only experience partial pain relief. It can be disheartening to think that while you may have reduced pain, you won’t have com-plete pain relief. Setting realistic goals about pain relief and daily functioning are important for most patients. A reasonable goal that many patients set for them-selves is to have enough pain relief to be able to carry out their lives and regain a sense of normalcy.

Chronic pain patient Jennifer Laman puts it well, “Pain is some-thing I will probably always deal with on some level. But, after treat-ment at an interventional pain management clinic, it is way better than it was before, and the best part is that I can live my life again.”

Arizona Pain Specialists offers a wide array of treatment mo-dalities available to help patients with any chronic pain condition. While we are on the cutting edge of medicine and technology, we

have seen even more dramatic success with patients who keep a positive outlook and take an active role in their pain man-agement.

When a patient takes responsibil-ity for their healing, success is often seen. By understanding your con-dition and the factors that trigger it, you can become empowered to take the steps necessary to find pain relief.

Biofeedback is a method by which a patient learns how to con-trol involuntary responses such as heartbeat, respiration rate, body temperature and other factors. By learning to control these respons-es, you can learn to correct the negative responses your body pro-duces when confronted by pain.

Yoga, aqua therapy, and targeted exercises are proven to help clear the mind, relax the body, and relieve tension. Even those with severe pain conditions often find their mood elevated – and their pain reduced – by taking a simple daily walk.

Meditation and prayer are pow-erful tools for many who suffer. Some find that these modalities help to take the focus off “their condition” and allow them to fo-cus on blessings that they do have.

Keeping a pain journal is another tool that empowers you to be able

to work that much more efficiently with your pain physicians. You will be able to identify factors such as foods, stressors, activities, and/or body positions that worsen or improve your pain. These findings can then be reported to your pain physician, and you will be able to take a more active role in monitor-ing your painful condition.

One of the most important fac-tors for a chronic pain patient is to try to keep a positive at-titude, and try to go about your planned activities for the day. Many people in pain find if they “continue-on” despite the pain, and complete necessary tasks for the day, they end up feeling better and experience less pain than they would have expected.

We hope these ideas inspire you and give you hope. Be encour-aged. Pain is difficult, but you must live your life to the fullest. Please email us and let us know what activities help you to manage your pain: [email protected]

“When pain is to be borne, a little courage helps more than much knowledge, a little hu-man sympathy more than much courage, and the least tincture of the love of God more than all.” -C. S. Lewis

This summer, we are challenging you to take Arizona Pain Monthly with you where ever you go! Submit a picture of you with a copy of Arizona Pain Monthly and you can win an ap-pearance in the magazine! We will consistently post photos that are sent to us on Facebook, but the WINNER will be fea-tured in an autumn issue of Arizona Pain Monthly!

The three categories are: most famous person, most exotic location, and farthest point away from Scottsdale, Arizona. The winners will be determined by committee at Arizona Pain Spe-cialists. The contest will end midnight, September 15th, 2010.

Please include with your photo:

Your NameNames of other people in the photoThe city and state where you liveThe location where the photo was taken

Send your submissions to: [email protected]

If you have any questions, you can also contact Arizona Pain Specialists via that email address.

We hope to see you and Arizona Pain Monthly traveling the globe soon!

Taking Arizona Pain Monthly Around the Globe!


Lynda E. took Arizona Pain Monthly to 10,000 feet. The Haleakala Crater, Hawaii

Molly H. took Arizona Pain Monthly to the Vatican, Italy

Scott G. took Arizona Pain Monthly to the Sydney Opera House, Australia

Arizona Pain Monthly in the hand of King Kamehameha, Hawaii

Dave O. with Arizona Pain Monthly at Havasu Falls, Arizona

Suzie S. took Arizona Pain Monthly to swim with Koi, Hawaii

Molly H. took Arizona Pain Monthly to the Colosseum, Italy

Alma S. with Arizona Pain Monthly in Vancouver, British Columbia


Life After Chronic PainJennifer Spencer is a friendly,

happy woman who speaks en-ergetically and enthusiastically about her weight-loss efforts, SCUBA diving, and her family. A consistent Facebook poster, Spen-cer encourages others and gives well-earned advice.

This vibrant, outgoing woman was not always as she is today. Just four years ago, she was in debilitating, life-altering pain.

“My pain was always at an eight out of ten. I was constantly in pain, there was no release. The only time I had any pain relief at all is if I was medicated and in bed,” Spencer explains. “I couldn’t live my life. Walking up and down the stairs was nearly impossible; once I was upstairs, that was it for the day. I stayed there.”

In 2006, Spencer began trying different methodologies to find any relief from the chronic neck and back pain that she was suf-fering from. “I tried injections, massage and acupuncture. While it helped, I still was in a lot of pain. Last year was an especially tough year,” Spencer explains. “My neck and back pain were at an all time high.”

Spencer began seeing the interventional pain physicians at Arizona Pain Specialists, who specialize in interdisciplinary medicine, and began finally seeing some alleviation to her chronic, daily pain. Since pain is difficult to treat, a patient is sometimes required to undergo multiple procedures to fully eradi-cate the pain generators.

“I had radio frequency ablation and it worked,” Spencer says. “But I did have other procedures that I would say have helped with my

pain. I have had epidural steroid injections plus the rounds of radio frequency ablation.”

Radio frequency ablation (RFA) is a minimally invasive procedure that interrupts the sensation of pain that would be sent to the brain. By use of this interruption, many patients who experience constant pain find that they are pain-free shortly after the proce-dure. The procedure is performed on an outpatient basis at Arizona Pain Specialists in the onsite state-of-the-art procedure center.

Epidural steroid injections are also used for chronic back and neck pain. Often, when it is deter-mined that a patient is a candidate for an epidural steroid injection, they all have one common factor, and that is what is called radicular pain. Radicular pain is that which can be described as pain associ-ated with an irritated nerve root. When radicular pain travels down the spine and irritates nerves in the low back, it is referred to as lumbar radiculopathy, which causes pain that will often travel down the leg. When it is the nerve roots in the neck that are irritated, this causes a condition known as cervical radic-ulopathy, causing pain to travel down an arm. Epidural steroid injec-tions can also be used to treat painful compres-sion of the nerves in the neck and back.

While minimally in-vasive treatments have been extremely effec-tive for Spencer, that doesn’t trivialize other alternative therapies. “Acupuncture is great,” Spencer says. “I’d rec-ommend acupuncture

to other people with chronic pain. It does help, I was amazed by it.”

Not only is Spencer now able to go about her daily life, she has been able to begin and maintain a weight-loss program. “Because I am able to exercise with no pain, I have lost 47 pounds since Janu-ary,” Spencer says. “I am not only able to use a treadmill, but I have been able to hike in the areas around my house. My favorite activity is exercising in the pool – and all of this is possible because I am no longer in excruciating pain.”

Because of her pain relief, Spen-cer has also been able to begin a new, exciting hobby. “My son and my husband became SCUBA certified and I was actually able to become certified myself. I love SCUBA diving, and am really ex-cited about our upcoming SCUBA diving trips.”

“Coming to a pain physician has changed my life,” Spencer contin-ues. “I would tell anyone else in chronic pain to know that there are doctors out there who can help you and to seek them out.”

Jennifer Spencer continues to visit the pain experts at Arizona Pain Specialists for ongoing care.


-Dr. Chance Moore

This is an introduction to some unique, but effective treatments for patients who are interested in alternative therapies they may have not tried before. There are a group of tool-assisted soft tissue techniques which address pain originating from muscle, tendon, ligaments, and/or fascia. Fascia is the connective tis-sue that surrounds every individual muscle in our bodies. Think of fascia like the casing of sausage. Muscles, tendons, ligaments and fascia consist of living connective tissue formed primarily of collagen fibers. The collagen fibers within these soft tis-sues are prone to painful fibrosis and adhesions. Adhesions and inappro-priate fibrosis within soft tissue can result from trauma, surgery, immo-bilization or repetitive strain. These tool-assisted treatments are able to help separate the layers of fascia and break up adhesions and fibrosis.

What is it?

Gua sha is the traditional Chinese term for a method of increasing microcirculation and releasing tissue adhesions through applying friction across the skin. The word ‘gua’ can be translated as ‘to scrape’ and ‘sha’ refers to the acute rash, specifically a ‘reddish, elevated, millet-like skin rash.’ Scraping the skin, or applica-tion of surface friction (gua), brings this rash to the surface, which in traditional Chinese medicine is said to be releasing stagnation of qi and blockages of meridians, which cause pain. The skin always remains intact and there are no abrasions. Gua sha moves blood within the tissue and is not let from the skin. The sha rash represents the transient therapeutic petechiae. Petechiae (pronounced puh-TEE-kee-ee) are round dots that appear on the skin as a result of blood underneath the skin. The skin will appear red, brown or purple. The scraping reveals blood pooling and is used to remove blood stagna-tion that is considered pathogenic. This increase in blood circulation is believed to promote normal circula-tion and metabolic processes. This

method originated in Asia and is used world-wide by doctors who practice acupuncture and Oriental medicine.

There are similar treatments for tissue fibrosis or chronic inflamma-tion, such as the Graston Technique or augmented soft tissue mobiliza-tion (ASTYM) which focuses on fascial restrictions and scar tis-sue. These techniques are used by athletic trainers, physical therapists, chiropractors, and occupational therapists as a treatment method for acute and chronic soft tissue pathol-ogy. Studies suggest that these types of treatments may promote healing at the cellular level by increased fibroblast recruitment and activa-tion. Although these techniques are currently utilized in many state of the art treatment facilities and by professional athletes, research still needs to be done in regards to tool assisted soft-tissue methods.

Who does it help?

Gua sha is most often used to allevi-ate chronic pain derived from mus-cular origin, and has also been used to help alleviate pain from acute or chronic injuries. The areas it is most commonly applied to are the upper neck, upper back, shoulders, elbows and knees. The modality can also be used to treat post-surgical pain in joints (e.g. knee, elbow, hip), sciatica, lower back, and has been effective in helping to treat headaches. Due to the nature of these treat-

ments, there are some contraindi-cations such as: abrasions, bruis-ing, sunburn, rash, break in the skin, pimples, moles, abdomen of pregnant women, and over skin previously gua sha’d with petechi-ae still visible. Although the treat-ments often look abusive, most patients feel relief immediately after completion of the treatment. Patients with extreme sensitivity to touch generally do not tolerate the intense nature of these treat-ments.

How does it work?

These types of treatment work by increasing the microcirculation of the area. This may stimulate plate-lets which release growth factors re-lated to the healing of tissue. While all of the methods can create pete-chiae, the stroking is not performed in the same manner. A variety of instrument angulations and pres-sures may be used depending upon the area of the body treated.

Researchers have begun to explore the physiology behind Gua Sha. In 2007, researchers from the Beth Israel Medical Center in New York took measurements of the microcir-culation of surface tissue before and after gua sha treatment in order to relieve pain. The result was a four-fold increase in microcirculation for the first 7.5 minutes following treat-ment and a significant increase in surface microcirculation during the entire 25 minutes of the study pe-riod following treatment. There was a decrease in muscle pain not only at the site treated but also in sites surrounding and around the treated areas. The authors stated that the distal area of relief was not due to a distal increase in microcirculation and asserted, “There is an unidenti-fied pain-relieving biomechanism associated with gua sha.”

Graston and ASTYM are designed to stimulate the breakdown of fibrosis and adhesions within the soft tissue and allow functional restoration to occur. This controlled micro-trauma physically breaks up the adhesions and initiates a local inflammatory response that leads to the re-absorption of inappropriate fibrosis or excessive scar tissue. In chronic tendonopathies, doses of controlled micro-trauma stimulate regeneration of the affected tendons. Following these techniques, existing collagen is further remodeled and new collagen can be created by an exercise and rehab program.


My migraines are awful when the monsoon comes, what can I do to keep from having one every day? -Christina F.

Many migraine sufferers com-plain that their headaches are more severe and more frequent during the summer months and monsoon season. A study of 7,000 patients conducted by Harvard researcher Dr. Kenneth Mukamal, published in the jour-nal Neurology in 2009, concluded that “higher ambient tempera-ture and, to a lesser degree, lower barometric pressure led to a transient increase in risk of headache requiring emergency department evaluation.”

Unfortunately, there is not much that we can do to control the weather. Probably the best strat-egy is to stay well-hydrated and to avoid strenuous outdoor activi-ties or exercise during times of the day when it’s excessively warm or humid. Many patients prepare for this difficult time of the year by scheduling appointments with their headache and pain special-ists so that they have adequate preventive and abortive medica-tions on hand.

It is probably also prudent to avoid known migraine triggers such as certain foods, changes in sleep habits, bright lights, loud noises, smells or fumes, medi-cation overuse, and emotional stress.

Finally, there are many patients with chronic headaches who benefit from interventional pain management procedures and chiropractic care, in addition to their current medications. Of-ten, these patients consult with their interventional pain special-ists and chiropractors prior to the summer heat and humidity to determine whether they are

candidates for new procedures or repeating their previous treat-ments. I recently got diagnosed with

scoliosis and have been on multiple medications taken twice daily. I use ice gels and heat, but am looking for long term pain relief. Any sugges-tions? -Jason V.

Scoliosis is an abnormal cur-vature of the spine. In scoliosis, the spine curves to one side or the other, usually best seen when looking at someone from front or back. Essentially the vertebra twist/rotate on each other rather than being in a straight line. Sco-liosis is usually diagnosed during childhood and roughly 85% of the time it is “idiopathic” (this a term that we doctors use when we don’t know what actually causes some-thing).

In adults who present with sco-liosis, we approach the situation first by determining whether the patient is a candidate for surgi-cal correction of the curvature, or whether we can manage their pain with more conservative treatments. Depending on the severity of the curvature, we may recommend a consultation with a spine surgeon to help us make this determination. If surgical correc-tion is not advisable, the patient is a candidate for a wide variety of treatment options.

First, patients are given a com-prehensive physical examination and imaging studies are typically ordered of the spine (x-rays, MRIs, CT scans). If basic life functions like breathing are affected, surgery may need to be considered.

Next, patients are advised to become active in low-impact muscle-strengthening endurance programs. The goal is to strength-en the muscles in order to better

support the spinal column. Also, the pain specialist may prescribe medications which might include non-steroidal anti-inflammatory drugs (NSAIDs such as ibuprofen or naproxen) or muscle relaxants.

Fortunately, there are several interventional pain management procedures that can help control pain that is associated with adult scoliosis. At Arizona Pain Special-ists we try to diagnose exactly where the pain is coming from (muscles, ligaments, discs, facet-joint nerves, etc.), as many sources of pain can exist with scoliosis. Then we target treatment towards those pain generators.

One of the most common sources of pain for scoliosis patients is the facet-joint. The facet joints are found in our spine and they give us the ability to bend forwards, back-wards, and to rotate. In the lum-bar spine, most of our flexion/extension movements occur at the L4/5 and L5/S1 joint levels. Facet-joint pain is often dull and achy, but at times can be sharp. Facet joint pain is often worsened with backwards bending and ro-tational movements. Patients can have difficulty with prolonged sitting and particularly with rid-ing in a car. A targeted treatment towards this type of pain is to block the nerves (called “medial branches”) that supply these joints and stop transmission of the pain signals to the brain. If the pain comes quickly back, we can conduct radiofrequency abla-tion (RFA) of those nerves for a longer-lasting (6-15 months) period of pain relief. These RFA procedures are typically repeated every 6-15 months because the nerves do grow back over time.

Patients may also benefit from chiropractic care, physical thera-py, acupuncture, TENS units and other modalities.

-Dr. Patrick Hogan

The solutions to this puzzle can be found horizontally, vertically, diagonally,forward and backward.

Meet Dr. Tiffany Moat, Chiropractor!

If you meet someone who you would consider to be a Star of Arizona Pain Specialists, we want to hear about it! Contact us at [email protected].

Carol Anne is the office manager at the Chandler location and is definitely a patient favorite. She greets every patient with a smile and helps to put everyone at ease. Carol Anne has been with Arizona Pain Specialists for a year, and works diligently to make sure the Chandler office is as patient-friendly and efficient as possible.

“I love to hear when patients are feeling better!” Carol Anne says of her favorite part of the job. “They come in for a post-op follow-up appointment smiling and happy, telling everyone how wonderful they feel. That makes me smile! I love building relationships with our patients.”

Carol Anne offers this advice to those in pain: “Don’t give up on your pain. There are so many options when it comes to managing your pain, and the staff at Arizona Pain Specialists is here to help!”

Chiropractors are an integral part of an interventional pain man-agement team. A chiropractor will work closely with your treating pain physician to give you the best care possible. Many chiropractic treatments complement other pain management techniques.

See how much you have in common with Dr. Moat!

--Favorite activities: Hiking, working out, snorkeling.--Favorite television shows: True Blood, Two and Half Men.--Favorite sports team: Arizona Cardinals.--Favorite food: Mexican food.--Favorite movie: Top Gun.--Favorite location in the world: Santa Barbara, CA--Favorite thing about Arizona: Spring time in Arizona, it’s beautiful!--Favorite bands: Jay-Z, U2 and Pearl Jam--Favorite book: Along Came a Spider, by James Patterson--Famous person you’d like to meet, dead or alive, and why: Martin Luther King Jr. because he stood up for what he believed in and impoved the lives of many Americans. --Crazy fact about you: I loved sports cars so much that I used to valet cars when I was in school and subscribe to car magazines. My girl friends thought it was strange. --Unknown talent: I’m a good cook.--What celebrity do people say you look like: I’ve been told Marisa Tomei.--Where are you originally from: Globe, Arizona--As a child, what did you want to be when you grew up: A chiropractor! I injured my back when I was young, and my mom took me to a chiropractor and it really helped.


arizona pain monthly september

Documents

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