ARK Spine Care & Pain Management offers the most comprehensive non-operative pain management care available. Dr. Jha is dedicated to upholding the highest professional standards and providing the highest quality of healthcare while striving to deliver pain relief for her patients.
Chronic pain is a complex condition with multiple layers of challenges, many which unfortunately are invisible to others except for the person suffering. It often has multiple facets to its presentation ranging from physical and emotional to social factors. Unfortunately, very commonly, chronic pain goes untreated or undertreated in our society.
At ARK Spine Care & Pain Management, we believe that best care starts from a thorough history taking and examination, followed by diagnostics, if indicated (x-ray, MRI, EMG/NCS). Thereafter, a management plan is formulated with the patient and tailored to their medical needs. Patients are involved in every step of their care.
Given the complexity, the essence of comprehensive pain management at ARK Spine Care & Pain Management includes a multimodal approach, which includes different modalities spanning from physical therapy, medications, psychological treatments if indicated, and injections. Reliance on only one modality may result in minimal or partial improvements. Our ultimate goal is to improve our patient’s level of functioning and pain scores in the most compassionate and safe way.
• Arthritis Pain / Arthralgia
• Back Pain, Acute Chronic
• Atypical Facial Pain/Trigeminal
• Cancer Pain
• Carpal Tunnel Syndrome
• Chronic Foot / Leg Pain
• Chronic Groin Pain
• Chronic Neuropathic Pain
• Complex Regional Pain Syndrome / CRPS
• Coccyx Pain
• Degeneration Disc Disease / Disc Bulge
• Degenerative Spine Disorders
• DeQuervain's Tenosynovitis
• Diabetic and Systemic Neuropathy
• Facet Joint Arthropathy Pain; Acute/Chronic
• Facial Pain (Trigeminal Neuralgia)
• Headaches, Migraines Headaches, Tension Headaches
• Herniated Disc Pain In Neck/Mid Back/Low Back
• Hip Pain
• Intercostal Neuralgia Pain (shingles)
• Joint Pain
• Knee Pain
• Leg Pain
• Low Back Pain
• Motor Vehicle Related Injury
• Muscle Pain (Myalgia)
• Myofascial Pain Syndromes
• Neck Pain; Acute/Chronic
• Nerve Pain
• Occipital Neuralgia
• Pain Associated with Surgical Incisions
• Pelvic Pain
• Peripheral Vascular Disease Pain
• Phantom Limb Pain / Stump Pain
• Piriformis Syndrome
• Post- Herpetic Neuropathy
• Post Laminectomy Syndrome
• Post-Stroke and Central Pain Syndromes
• Post Mastectomy Syndrome
• Post Thoracotomy Syndrome
• Radiculopathy; Cervical/Thoracic/Lumbar
• Reflex Sympathetic Dystrophy (RSD)
• Rib Fractures
• Rotator Cuff Syndrome
• Sacroiliac Joint Pain
• Sciatic Pain
• Shoulder Pain
• Spinal Stenosis
• Sympathetically Mediated Pain
• Thoracic Injury
• Testicular/Groin Pain
• Whiplash pain
• Work Related Injury
Treatments and Medications at ARK Spine Care & Pain Management
Safety is the most prominent driving force at ARK Spine Care & Pain Management, whether it’s pertaining to drug choice or types of injections.
Multi-disciplinary pain management approach is a term commonly used at ARK Spine Care & Pain Management, which is the essence of modern pain management practice, approved and supported at national and international levels by every medical society associated with pain management.
Patients are educated at every stage of their care throughout their journey towards wellness at ARK Spine Care & Pain Management and are expected to hold equal partnership in their care with their caring physician, Dr. Bhawna Jha.
This approach includes the following modalities:
- Physical Therapy / Aqua therapy / Acupuncture
- Psychological Therapy
- Interventional (injection) Therapy
- Epidural steroid injections: cervical, thoracic, lumbar, caudal.
- Facet joint injections / Nerve blocks: cervical, thoracic, lumbar.
- Transforaminal epidural steroid injections: thoracic, lumbar.
- Peripheral nerve blocks: occipital, ilioinguinal, genitofemoral, pudendal, lateral femoral nerve blocks, intercostal nerves, suprascapular, infrapatellar branch of saphenous nerve.
- Joint/Bursa/ligament injections: SI joint, hip, knee, shoulder, AC joint, wrist, trochanteric and ischial tuberosity, iliolumbar ligament, biceps tendon, pyriformis muscle injection.
- Radiofrequency ablation: conventional, cooled, pulsed of facet joint nerves, SI joint. Joint/Bursa/ligament injections: SI joint, hip, knee, shoulder, AC joint, wrist, trochanteric and ischial tuberosity, iliolumbar ligament, biceps tendon, pyriformis muscle injection.
- Sphenopalatine ganglion block.
- Cryoablation of peripheral nerves.
- Stellate ganglion block, Lumbar sympathetic plexus block, celiac plexus block, hypogastric plexus, ganglion impar.
- Spinal cord stimulator trials.
- Ultrasound guided procedures: TAP block, peripheral nerve blocks, joint injections, occipital nerve blocks etc.
- C2 ganglion block, Atlanto Axial joint injection.
- Medications: Several classes of medications have been used over the years including
NSAID’s, Antidepressants, Anti-Seizure, Skeletal Muscle Relaxants, and in very selected patients Opioids (narcotics).
Each medication has its own set of desirable and not so desirable effects (or called side effects). Side effects range from minor or "tolerable" to dangerous (addiction, withdrawal, breathing depression, accidental death).
Choice of medication is heavily dependent on case by case presentation.
At ARK Spine Care & Pain Management, some of the commonly used medications are:
1. NSAID’s: Ibuprofen, Naproxen, Ketoprofen, Indomethacin, Sulindac, Etodolac, Diclofenac, Meloxicam, celecoxib etc. All NSAID's carry kidney, stomach ulcer, and liver risks. More serious risks include increased risk of heart attack and stroke.
2. Antidepressant medications have been used for years to treat a variety of conditions like depression, chronic neuropathic pain, anxiety, and sleep disturbance. Some examples include: Amitriptyline, Savella, Venlafaxine, Trazodone, Doxepin, and Cymbalta.
3. Anti-seizure drugs include Lyrica, Neurontin, Keppra, Topomax, and others.
4. Muscle relaxants are useful for mild to moderate pain originating from muscle and bony structures. Mechanism of action is mainly through brain and has more of a calming, sedating effect rather than acting directly on the muscle tissue which seems to be the most common perception. These medications are typically used in the early course of pain and for a brief period of time. Unfortunately some of the muscle relaxants including benzodiazepenes, soma and others have addictive potential.
Different types of muscle relaxants include:
- Ativan and others.
ARK Spine Care & Pain Management does not prescribe benzodiazepines like:
- Ativan or other drugs in this class
These medications are mainly prescribed for anxiety, which is a very common condition associated with chronic pain. If you have been on these medications, we will request they be prescribed and monitored by your Primary Care Physician or Psychiatrist.
5. Opioids: Following information on opioid therapy has been taken from Pennsylvania Medical Society website:
"Chronic opioid therapy is a common treatment option for chronic pain, and its use has increased substantially over the last 15 years, in spite of limited evidence of safety and long-term efficacy in the general patient population. Prescription drug abuse has increased significantly over the last 15 years, and this increase has been attributed in part to the increased use of opioids to treat chronic noncancer pain. Drug poisoning deaths, the vast majority of which involve prescription drugs, surpassed traffic-related accidents as the leading cause of injury-related deaths in the United States in 2009. Opioid analgesics may be necessary for the relief of pain, but improper use of opioids poses a threat to the individual and to society.”
For further information on opioids, please read our Informed Consent and Agreement for Treatment document in our ARK Patient Information link.
Combination therapies of opioids and muscle relaxants, in particular benzodiazepines, pose increased risk of breathing difficulty, respiratory failure and even accidental overdose/death. This warrants extreme caution. Good communication between you and your physicians and amongst all physicians involved in your care is paramount.
ARK Spine Care & Pain Management’s Practice Codes
- New patients are not prescribed opioids at their first visit. We will make every effort to obtain records from your prior physicians, other health care providers and imaging centers as soon as possible, preferably prior to your first visit. For this we will need your assistance. Urine drug screening may be performed at the initial visit and can take one week to return for review.
- If Dr. Jha determines that opioid pain medication may be helpful, she will prescribe it only after all information is reviewed and the risks and benefits of these medications are weighed. Prior to writing a first prescription, an Opioid Contract is established between you and ARK Spine Care and Pain Management. A copy of the contract will be given to you.
- Pain medications can not be called to the pharmacy and no early refills are offered irrespective of the cause with the exception of dose changes that were authorized by Dr. Jha.
- We will contact your other providers, your family, pharmacy, and in some instances your employer to ensure safety and appropriateness of medication use.
- Any issues arising during the assessment period should be handled by your Primary Care Physician or the Emergency Department.