Iowa City Ambulatory Surgical Center is leading the way with helping patients manage their chronic and long-lasting pain. Our surgeons and other team members have made it their mission to find solutions for their patients who suffer with chronic pain.
Dr. Dery, in particular, collaborates with patients and investigates the best possible pain management alternatives available which include these following options:
Radio Frequency Ablation
Radio frequency ablation, also known as RFA, is an outpatient procedure that Dr. Dery and his team perform on patients who experience chronic or long-term pain and are good candidates for the procedure.
Radio frequency ablation is a procedure that involves altering nerve tissue with a high frequency alternating current, and local anesthetic is used to the numb the affected area.
Dr. Dery explains, “The RFA procedure typically will destroy the nerves that innervate the arthritic joints, causing them to die away over the course of 4-6 weeks, after which the patient will notice pain relief for usually 5-6 months at least, although there are cases where some patients get years of benefit."
While this option helps patients find relief, it is temporary.
Typically, the nerves will grow back and re-innervate the joint within 5-6 months.
At this point, pain will return to the affected joint, though the return of pain will be slow and gradual. Most people schedule a repeat radio frequency ablation procedure once they feel the regular pain starting to come back.
The procedure is performed under image guidance, using these medical technologies:
- CT scan
Documented benefits from RFA have resulted in radio frequency ablation becoming widely used over the last 15 years.
Radio frequency ablation (RFA) has been a proven and effective way to treat some forms of chronic and long-lasting pain. It is also generally well tolerated with very few associated complications.
According to Dr. Dery, “It takes about 4-6 week to get the maximum benefit from the procedure. It is likely that the patient will experience a period of time (about a week) where the pain will be worse after the initial ablation, but it will subside on its own. No specific treatment will be required. There will be gradual reduction of pain and improvement over the following few weeks.”
We consult our patients on the entire process.
In many cases, when our patients come to us, they don’t understand what is causing the pain, or where the pain is coming from.
They are concerned that there isn’t a way to address the pain.
We work very hard to find solutions for the pain they are experiencing and ensure that our patients are well taken care of.
Cervical Steroid Injections
Cervical Epidural Steroid Injections are performed in order to relieve pain related to inflammation in the nerves around the neck.
The purpose of cervical epidural steroid injections is to temporarily relieve nerve pain in order for a patient to complete rehabilitation treatment.
The procedure is performed with the patient lying face down.
A local anesthetic is used to numb the region of the procedure. Then a larger needle is then inserted using x-ray (known as fluoroscopy) to guide the physician to properly navigate the needle to the affected area.
Contrast dye is used to ensure that the needle is positioned in the affected area. A steroid solution of anti-inflammatory medication is then injected into the affected nerve area.
The goal of the cervical steroid injection is to relieve the inflammation in the nerve area that is causing pain.
Many patients have voiced concerns about the safety of cervical steroid injections.
Dr. Dery explains how he addresses those concerns: “I explain in detail the theoretical risks of the procedure prior to scheduling the patient, and then again at the time of the procedure. I further explain that it is extremely unlikely for there to be a catastrophic outcome from doing a fairly safe injection such as an epidural. Finally, I explain that most people tolerate the procedure with minimal discomfort.”
Patients often want to know what they can expect after the procedure.
According to Dr. Dery, “It may take 10-14 days for the patient to get maximum benefits from the steroid injection. During the immediate period after the injection, they may experience a short-term worsening of their pain or no change in their symptoms.”
Patients will find a reduction of pain as a result of the injection.
It has been found that patients tend to have better outcomes when the cervical steroid injection is combined with a therapeutic exercise program.
Spinal Cord Stimulator
Our third most common pain management procedure we perform at Iowa City ASC is a spinal cord stimulator.
According to Dr. Dery, “Spinal cord stimulation is most effective for patient’s that have neuropathic pain and/or vascular disease.”
Before the trial for the procedure is scheduled, Dr. Dery has an in depth discussion with the patient.
“I explain what they can expect in great detail with the patient in their one hour educational session prior to scheduling the stimulator trial, since each case is unique and needs to be covered in details specific to the patient’s particular pain issues.”
During the stimulator trial, a temporary electrode is placed under the skin and attached to a stimulator to determine if the procedure will be effective for the patient.
If it is successful, a permanent stimulator may be placed beneath the skin. The procedure is typically performed using local anesthetic and a sedative.
The wires that will lead up along the spine will be connected to a stimulator that will be placed under the skin.
“During the trial period, there is no real recovery time since that is done through 1 or 2 needles. For the permanent stimulator, the patient will typically stay overnight and be discharged to go home the next morning, with 2 to 3 weeks of recovery during which their incisions will need to heal. We typically have patients do minimal physical activity for 8-10 weeks to give the stimulator an opportunity to heal into position. This minimizes a risk of wires being pulled out of positions,” explains Dr. Dery.
At Iowa City Ambulatory Surgical Center, it is our mission to ensure that our patients receive the best quality of care and solutions that are tailored for each individual patient’s needs.