What is Dry Needling?

IS DRY NEEDLING THE NEW WEAPON AGAINST CHRONIC PAIN? 

The ancient art of acupuncture and the modern treatment called dry needling have one thing in common. They both use tiny filament needles to promote healing. shoulder pain

Acupuncture aims to restore a person’s well-being and balance by placing the needles into specific points in the body to open up the body’s Chi, or energy flow.

With dry needling, on the other hand, the target is pain caused by severe muscle spasm, inflammation or injury.  It is a medicine-based treatment that uses needles to stimulate blood flow and promote natural healing to an area of the body that is affected by pain.  The needling therapy leads to a series of intricate chemical reactions in the brain, such as the release of a neurotransmitter called adenosine, which blocks pain. In addition, the chemical response increases natural opiates that leads to an overall decrease in inflammation.

According to Tanya Kalyuzhny, DPT, director of physical therapy at the Greenwich, CT office of ONS, dry needling can be an effective treatment to disrupt neuro-musculoskeletal pain patterns, release muscular limitations and provide relief from other painful orthopedic and spine conditions.

“Dry needling is a useful technique to remedy a range of painful conditions from stubborn muscle tightness to back pain, temporomandibular joint dysfunction (TMJ) and tendinitis,” Kalyuzhny said. Dry needling has been shown to be one of the most effective procedures to release trigger points. For this reason, therapists also use dry needling with patients suffering from fibromyalgia, a condition that can be difficult to treat manually because the points of pain are deep into the muscle.

During the treatment, a physical therapist who is trained and licensed to perform the procedure will insert a needle directly into a point of spasm in the muscle band, known as a trigger point, or around the region of pain or injury. The therapist will gently maneuver the needle until the targeted muscle twitches in response.  The needle is then wound inside the tissue by turning it in a clockwise or counter-clockwise direction. Turning the tissue allows the collagen fibers to wrap around the needle and release toxins from within the muscle. The needle remains inserted into the trigger point for 10 to 30 minutes, during which time patients may experience momentary muscle cramping or a dull ache at the site. The needle is then unwound back to its starting position, which leaves the wrapped fibers in a relaxed state.

“The release of toxins can result in soreness and bruising for a day or two following the treatment,” said Kalyuzhny. Some people experience pain relief shortly after the procedure. However, additional treatments may be required depending on the nature of the chronic pain and other factors.  It can take as many as three treatments to start noticing a change.

While the treatment is relatively new to the general public, dry needling in use with high performance athletes who need to get back into the game as soon as possible.  “Professional athletes often rely on dry needling to loosen tight muscles and relieve pain caused by tendinitis and other sports injuries,” Kalyuzhny said

In most cases, dry needling is part of a larger therapeutic program that includes retraining and strengthening exercises to restore normal function and control of the affected musculature.  ONS has a number of physical therapists who are trained and licensed in dry needling. You can schedule a consultation to find out if dry needling is a pain management option for you.

Why ONS Patients Need Fewer Opioids

As soon as it became apparent that common surgical procedures could become inadvertent pathways to opioid dependence, surgeon Paul Sethi, M.D., and a team of colleagues at Orthopaedic & Neurosurgery Specialists (ONS) began looking into ways to reduce that risk for patients.

With Dr. Sethi as lead researcher, the group of orthopedic surgeons conducted years-long research into opiate-sparing, post-surgical options through the non-profit, ONS Foundation for Education and Clinical Research (ONSF).  Dr. Sethi is president of ONSF.

As a result of their study, the majority of ONS patients now are better able to tolerate pain following certain surgical procedures than in the past. ONS surgeons are writing far fewer opioid prescriptions, and, in many cases, no prescriptions for opiates at all.

“We know patients are concerned about post-surgical pain and there is also real apprehension about opioid use,” Dr. Sethi said. “We have been able to address their concerns by incorporating the newest and most comprehensive pain management techniques and non-opiate alternatives.”

FINDING SOLUTIONS FOR PAIN MANAGEMENT 

Dr. Sethi and his associates tested a pain-reducing intra-operative protocol that keeps the surgical area numb for the first few days following a procedure.  They found that patients who received the new treatment reported lower pain scores, took fewer, if any, opioids to control pain and rarely asked for refills.

While this new mode of pain management is currently used in a number of ONS surgeries, Dr. Sethi’s initial study focused primarily on decreasing opioid consumption following arthroscopic rotator cuff repair, a procedure with a particularly painful period of recovery.  He recently presented the research findings at the prestigious 2018 American Shoulder and Elbow Surgeons (ASES) meeting in Chicago, IL.

During the period of the study, he reported, patients who were administered a long lasting analgesic, liposomal buipivacaine, in addition to an interscalene block with bupivacaine (ISB), reported statistically and clinically lower pain scores than the control group who received the ISB alone. Patients who were given both compounds consumed 64 percent fewer opioids than the control group and 58 percent of the patients receiving the protocol had stopped taking opioids by post-surgical day 4, compared to on 15 percent of patients in the control group.

Moreover, none of the patients with the protocol requested a prescription refill during the five-day post-op period; 28 percent of the control group requested refills during the five-day span.  This is particularly significant in limiting the risk of addiction.  According to the Centers for Disease Control and Prevention (CDC), opiate use beyond five days, and prescription refills, directly increases the risk of developing an opiate dependence.

“We have found that we can keep our patients safe from the dangers of opioid addiction by using this new multimodal, opioid-minimizing pain management strategy,” Dr. Sethi noted.

PAIN RELIEF THAT’S SAFER FOR PATIENTS AND OTHERS

While there isn’t any other data to indicate how many opioid pills patients should be given after rotator cuff surgery, the ONS research team determined that 25 oxycodone 5mg pills, at most, should be sufficient to manage the pain during surgical recovery. This is in sharp contrast to the current average amounts prescribed, which a recent report, Exposing a Silent Gateway to Persistent Opioid Use, found to be 93 pills.

Fewer opioids is not only good for the patient, it reduces the risk that unused pills, which are often improperly stored or disposed of, can fall into the hands of opioid abusers.

“Now that we are able to perform many opiate-free surgeries, our patients are much happier,” Dr. Sethi said.

The Low Down on Low Back Pain

MOST LOW BACK PAIN CAN BE TREATED NON-OPERATIVELY, SAYS ONS NEUROSURGEON SCOTT SIMON, MD. 

Did you know that 80 percent of Americans experience low back pain at some point in their lifetime? According to neurosurgeon Dr. Scott Simon of Orthopedic and Neurosurgery Specialists in Blog sizeGreenwich and Stamford, the majority of low back pain is due to a lower back muscle and ligament strain or sprain.

“This type of low back pain usually occurs as muscles tighten after exercise or other exertions,” he said, adding that stress has also been shown to make people more susceptible to episodic low back pain. Avoiding sudden lifting away from your body and stretching before or after exercise can often help prevent pain.

In most cases, back pain from strains or sprains lasts two to five days. It is best treated with heat and anti-inflammatory medication such as Naprosyn or ibuprofen. In the vast majority of cases, the pain subsides on its own without the need for additional treatment. Even as the pain dissipates, however, Dr. Simon recommends easing back into exercise. “Re-injury can occur if the muscles and ligaments are still healing,” he said.

Despite the claims of manufacturers, there is no conrete evidence supporting the use of a product to prevent or treat back pain.  “The best mattresses, pillows or chairs are the ones that are most comfortable according to the needs and prefences of the individual,” Dr. Simon explained.

Those who experience back pain that lasts longer than a week or produces leg pain, weakness, numbness or tingling sensations may have a more serious problem and should seek medical attention. Pain that radiates down one or both legs may be due to nerve irritation or pinching from either a disc herniation or arthritis. In the majority of these conditions, patients can be treated with physical therapy

Anyone should see a doctor immediately if the low back pain is a result of trauma or if the pain is accompanied by any of the following symptoms:

  • Fever and chills

  • Significant leg weakness

  • Sudden bowel and/or bladder incontinence

  • Difficulty passing urine

  • Severe continuous abdominal pain

Is Your Back and Leg Pain from Sciatica?

PAIN FROM SCIATICA CAN RADIATE FROM THE SPINE TO THE TOES, SAYS NEUROSURGEON MARK CAMEL, MD.

While most back pain is confined to a specific region of the spine, those suffering from sciatica can experience pain from their back down to their toes.Herniated Disk According to neurosurgeon Dr. Mark Camel of Orthopaedic and Neurosurgery Specialists, “There are many causes of back pain. Making a correct diagnosis is the important first step before prescribing treatment.“

Sciatica is a condition in which pain travels along the sciatic nerve. It runs from the lower back through the hips and buttocks and down each leg. The pain from sciatica is usually limited to one side of the body. It also tends to affect people between the ages of 30 to 50.

The most common causes of sciatica is a herniated disk, spinal bone spur or a narrowing of the spine called spinal stenosis. These injuries put pressure on the nerve roots in the lower back and cause inflammation and pain. Sudden pressure on the the lower spine vertebrae from an acute injury can also trigger the condition creating a sharp, leg cramp that can last for weeks.

In most cases, sciatica can be resolved with such non-surgical treatments as rest, anti-inflammatory medications, heat and cold application as well as physical therapy. However, if the pain persists or worsens, doctors may administer a cortisone injection into the spine. If those measures fail to relieve the pain, surgery may be recommended. “Sciatica is a manageable condition with the appropriate treatment,” said Dr. Camel.

Patients experiencing lower back, hip, and leg pain or develop numbness, burning, and weakening in the leg or foot should consult with a physician.

Make an appointment with an ONS spine specialist to learn if sciatica is the root of your back and leg pain.

ONS MDs to Discuss Chronic Pain

DEMETRIS DELOS, MD AND CHRISTOPHER SAHLER, MD OF ONS TO DISCUSS EFFECTIVE TREATMENTS FOR CHRONIC PAIN. 

Maintaining quality of life while living with chronic pain is no easy feat. Two orthopedic specialists from ONS will discuss effective new treatments to help people with relentless pain return to the WavenyPain Flyer (2)activities they enjoy.  Join Demetris Delos, MD, an orthopedic surgeon who specializes in sports medicine an comprehensive knee and shoulder, and interventional pain management physiatrist, Christopher Sahler, MD for this informative talk on Wednesday, May 11 at The Inn at Waveny, 73 Oenoke Ridge in New Canaan.  Doors open at 4:00 pm for refreshments. Presentation begins at 4:30. RSVP at 203-594-5310 or mntiri@waveny.org.

 

Regenerative Medicine and Chronic Pain

IS REGENERATIVE MEDICINE THE ANSWER TO YOUR CHRONIC PAIN? 

In the past, most cases of damaged tissue within the body were considered irreversible, but developments in regenerative medicine hold the potential to change all that, writes Christopher Sahler, PRPMD, an interventional pain management specialist at ONS, in this week’s edition of the Greenwich Sentinel.  Although research into harnessing the body’s own healing process using amniotic fluids, blood, tissues, growth factors and stem cells is ongoing, certain biomedical therapies are in use today to help ordinary people suffering from orthopedic conditions and chronic pain.  The most common treatment, using platelet rich plasma collected from a patient’s own blood, is administered in a physician’s office using ultrasound guided injections directly into the diseased or damaged tissue to restart and increase the healing process.  Read the full article in the April 1 edition of Greenwich Sentinel.

Regenerative Medicine Benefits

Dr. Christopher Sahler
                Dr. Christopher Sahler

ONS PAIN MANAGEMENT SPECIALIST, CHRISTOPHER SAHLER, MD, WILL DISCUSS THE BENEFITS OF REGENERATIVE MEDICINE AT GREENWICH HOSPITAL TALK.

Does your own blood hold the key to healing your medical condition? The evolving field of regenerative medicine uses biomedical materials, often from your own body, to regenerate cells and rebuild diseased and damaged tissues. Join Dr. Christopher Sahler to learn about this exciting new medical field that uses therapies from blood, platelets and stem cells to treat pain and cure complex, often chronic conditions of the musculoskeletal system.  Healing Yourself: The Promise of Regenerative Medicine for Chronic Pain and Orthopaedic Care will take place on Thursday, March 10 at Greenwich Hospital’s Noble Auditorium.  6 – 7:30 pm. Free.  To register, call 203-863-4277 or go to greenwichhospital.org.

ONS’s Christopher Sahler, MD, Offers Tips for Combating Chronic Pain

Sahler - icontactExercise can help people with chronic pain return to daily activities with ease and comfort, writes Dr. Christopher Sahler, interventional pain management specialist at ONS in this week’s issue of the Greenwich Sentinel.  Slowing down is wise advice if pain is caused by an injury, he said, but a growing body of research suggests people suffering from chronic pain may feel better if they keep moving.

Not only does inactivity lead to a myriad of problems from weight gain to depression, it can actually exacerbate a person’s perception of pain.  Moderate, adaptive exercise, he explains, helps alleviate unrelenting pain because it releases endorphins, brain chemicals that improve mood and act as natural painkillers. Exercise provides the additional benefits of increasing a person’s agility and range of motion and it can stregnthen muscles to prevent injury.  Read the entire article which includes tips for gradually returning to normal, daily activities with greater ease and comfort.

 

Tips to Prevent Back Injury from Shoveling Snow

If the local forecasts are to be believed, many of us will be doing a fair amount of snow shoveling this weekend. Before you bundle up and head out, though, Dr. Jeffery Heftler, an interventional pain Blog-shoveling show 300 pxspecialist at Orthopedic and Neurosurgery Specialists (ONS) in Greenwich and Stamford, has a few words of advice to protect your back from strain and injury.

“The most important thing is to stay ahead of the accumulation of snow. It’s much easier on your back to shovel after every few inches has fallen than to wait and lift heavier loads of snow for a longer period of time,” he advises. Waiting can make the task even harder if the snow melts and then freezes over. Dr. Heftler also recommends investing in so called “push shovels” that are specially designed for pushing the snow aside while shovels with bent handles can help ease the tension on back and shoulders.

Without a doubt, Dr. Heftler sees more patients with back pain following a large snow storm. One reason, he suggests, is that people tend to think of shoveling snow as a nuisance and chore, when in fact it is an intense and strenuous exercise. “All too often, people who are generally inactive underestimate the physical challenge involved in clearing snow. Even someone in good shape can strain their back from the rotation of lifting the snow and throwing it over their shoulder,”   he says.

To protect your back, it’s best to take a few moments to warm up your muscles before going out in the cold. When shoveling, maintain the correct posture and technique to minimize the pressure on your weaker back muscles. Avoid rounding your lower back, for instance. Instead, go through the motions with a straight back leaning forward and your knees slightly bent. Use your core, hips and hamstrings to provide strength and stability instead of relying on your back and shoulder muscles to do the heavy lifting.

People with pre-existing back conditions are most vulnerable to shoveling related injuries and should avoid the activity altogether. “Even if you have to hire someone to clear the snow for you, it will pay for itself in terms of avoiding pain and days lost from work and winter sports,” Heftler says.

If you do experience pain while shoveling, Dr. Heftler says to stop, go inside and rest in a comfortable position until the discomfort passes. He recommends anti-inflammatory medications such as Advil or Aleve, and using ice or heat directly on the area where the pain is most acute. If the pain is severe and persists through the next day, consult with a physician.