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Welcome to the September issue of Arizona Pain Monthly! We hope you and your families are doing well. September is Pain Awareness 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-invasive 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 physician is not treating the source of your pain, your pain may persist undiagnosed and worsen with time. We focus on an interdisciplinary approach to pain management, 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 relievArizona Pain Monthly | September, 2010

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 education, 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: to view the “Pain Knowledge 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 monsoon 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 average American gets nowhere near the amount of fruits and vegetables that are recommended daily. Featured this month are recipes that revolve around the avocado, which is not only one of the most versatile vegetables, but is also a great anti-inflammatory food. We hope that this issue is educational and informative. Please contact us at Newsletter@ArizonaPain. com if you have questions or comments. We thank you for your continued 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. Dr. Tory McJunkin & Dr. Paul Lynch Page 2

Arizona Pain Monthly | September, 2010

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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 “givingup.” It may take multiple office visits and multiple physicians for a chronic pain patient to receive a diagnosis, and this can feel discouraging. 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 complete pain relief. Setting realistic goals about pain relief and daily functioning are important for most patients. A reasonable goal that many patients set for themselves 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 something I will probably always deal with on some level. But, after treatment 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 modalities 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 management. When a patient takes responsibility for their healing, success is often seen. By understanding your condition 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 control involuntary responses such as heartbeat, respiration rate, body temperature and other factors. By learning to control these responses, you can learn to correct the negative responses your body produces 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 powerful tools for many who suffer. Some find that these modalities help to take the focus off “their condition” and allow them to focus 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 monitoring your painful condition. One of the most important factors for a chronic pain patient is to try to keep a positive attitude, 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 encouraged. 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: “When pain is to be borne, a little courage helps more than much knowledge, a little human sympathy more than much courage, and the least tincture of the love of God more than all.” -C. S. Lewis

Taking Arizona Pain Monthly Around the Globe! 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 appearance in the magazine! We will consistently post photos that are sent to us on Facebook, but the WINNER will be featured in an autumn issue of Arizona Pain Monthly!

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

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 Specialists. The contest will end midnight, September 15th, 2010. Please include with your photo: Your Name Names of other people in the photo The city and state where you live The location where the photo was taken Send your submissions to: rachelm@ If you have any questions, you can also contact Arizona Pain Specialists via that email address.

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

We hope to see you and Arizona Pain Monthly traveling the globe soon! Suzie S. took Arizona Pain Monthly to swim with Koi, Hawaii

Dave O. with Arizona Pain Monthly at Havasu Falls, Arizona Arizona Pain Monthly in the hand of King Kamehameha, Hawaii

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

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

Arizona Pain Monthly | September, 2010

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

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Life After Chronic Pain to other people with chronic pain. pain. I have had epidural steroid injections plus the rounds of radio It does help, I was amazed by it.” frequency ablation.” Not only is Spencer now able to go about her daily life, she has Radio frequency ablation (RFA) is a minimally invasive procedure been able to begin and maintain a weight-loss program. “Because I that interrupts the sensation of am able to exercise with no pain, pain that would be sent to the brain. By use of this interruption, I have lost 47 pounds since January,” Spencer says. “I am not only many patients who experience This vibrant, outgoing woman able to use a treadmill, but I have constant pain find that they are was not always as she is today. been able to hike in the areas pain-free shortly after the proceJust four years ago, she was in dure. The procedure is performed around my house. My favorite debilitating, life-altering pain. activity is exercising in the pool – on an outpatient basis at Arizona “My pain was always at an eight Pain Specialists in the onsite state- and all of this is possible because I out of ten. I was constantly in pain, of-the-art procedure center. am no longer in excruciating pain.” there was no release. The only Because of her pain relief, SpenEpidural steroid injections are time I had any pain relief at all is cer has also been able to begin also used for chronic back and if I was medicated and in bed,” neck pain. Often, when it is deter- a new, exciting hobby. “My son Spencer explains. “I couldn’t live my life. Walking up and down the mined that a patient is a candidate and my husband became SCUBA certified and I was actually able stairs was nearly impossible; once for an epidural steroid injection, to become certified myself. I love they all have one common factor, I was upstairs, that was it for the and that is what is called radicular SCUBA diving, and am really exday. I stayed there.” pain. Radicular pain is that which cited about our upcoming SCUBA In 2006, Spencer began trying diving trips.” can be described as pain associdifferent methodologies to find ated with an irritated nerve root. “Coming to a pain physician has any relief from the chronic neck When radicular pain travels down changed my life,” Spencer continand back pain that she was sufthe spine and irritates nerves ues. “I would tell anyone else in fering from. “I tried injections, in the low back, it is referred to chronic pain to know that there massage and acupuncture. While as lumbar radiculopathy, which are doctors out there who can it helped, I still was in a lot of causes pain that will often travel pain. Last year was an especially down the leg. When it is the nerve help you and to seek them out.” tough year,” Spencer explains. roots in the neck that are irritated, “My neck and back pain were at this causes a condition an all time high.” known as cervical radiculopathy, causing pain Spencer began seeing the to travel down an arm. interventional pain physicians Epidural steroid injecat Arizona Pain Specialists, who tions can also be used to specialize in interdisciplinary treat painful compresmedicine, and began finally sion of the nerves in the seeing some alleviation to her neck and back. chronic, daily pain. Since pain is difficult to treat, a patient is While minimally insometimes required to undergo vasive treatments have multiple procedures to fully eradi- been extremely effeccate the pain generators. tive for Spencer, that doesn’t trivialize other “I had radio frequency ablation alternative therapies. and it worked,” Spencer says. “But “Acupuncture is great,” I did have other procedures that Spencer says. “I’d recI would say have helped with my ommend acupuncture Jennifer Spencer continues to visit the pain experts Jennifer Spencer is a friendly, happy woman who speaks energetically and enthusiastically about her weight-loss efforts, SCUBA diving, and her family. A consistent Facebook poster, Spencer encourages others and gives well-earned advice.

at Arizona Pain Specialists for ongoing care.

Arizona Pain Monthly | September, 2010

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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 tissue 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 tissues are prone to painful fibrosis and adhesions. Adhesions and inappropriate fibrosis within soft tissue can result from trauma, surgery, immobilization 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 application 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 stagnation that is considered pathogenic. This increase in blood circulation is believed to promote normal circulation and metabolic processes. This Arizona Pain Monthly | September, 2010

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

How does it work?

These types of treatment work by increasing the microcirculation of the area. This may stimulate platelets which release growth factors reThere are similar treatments for tissue fibrosis or chronic inflamma- lated to the healing of tissue. While tion, such as the Graston Technique all of the methods can create peteor augmented soft tissue mobiliza- chiae, the stroking is not performed in the same manner. A variety of tion (ASTYM) which focuses on instrument angulations and presfascial restrictions and scar tissue. These techniques are used by sures may be used depending upon athletic trainers, physical therapists, the area of the body treated. chiropractors, and occupational Researchers have begun to explore therapists as a treatment method for the physiology behind Gua Sha. In acute and chronic soft tissue pathol- 2007, researchers from the Beth ogy. Studies suggest that these types Israel Medical Center in New York of treatments may promote healing took measurements of the microcirat the cellular level by increased culation of surface tissue before and fibroblast recruitment and activaafter gua sha treatment in order to tion. Although these techniques are relieve pain. The result was a fourcurrently utilized in many state of fold increase in microcirculation for the art treatment facilities and by the first 7.5 minutes following treatprofessional athletes, research still ment and a significant increase in needs to be done in regards to tool surface microcirculation during the assisted soft-tissue methods. entire 25 minutes of the study period following treatment. There was Who does it help? a decrease in muscle pain not only at the site treated but also in sites Gua sha is most often used to allevi- surrounding and around the treated ate chronic pain derived from mus- areas. The authors stated that the cular origin, and has also been used distal area of relief was not due to a to help alleviate pain from acute or distal increase in microcirculation chronic injuries. The areas it is most and asserted, “There is an unidenticommonly applied to are the upper fied pain-relieving biomechanism neck, upper back, shoulders, elbows associated with gua sha.” and knees. The modality can also be used to treat post-surgical pain in Graston and ASTYM are designed joints (e.g. knee, elbow, hip), sciatica, to stimulate the breakdown of lower back, and has been effective in fibrosis and adhesions within the helping to treat headaches. soft tissue and allow functional Due to the nature of these treat- restoration to occur. This controlled ments, there are some contraindi- micro-trauma physically breaks up cations such as: abrasions, bruis- the adhesions and initiates a local inflammatory response that leads to ing, sunburn, rash, break in the skin, pimples, moles, abdomen of the re-absorption of inappropriate fibrosis or excessive scar tissue. In pregnant women, and over skin previously gua sha’d with petechi- chronic tendonopathies, doses of ae still visible. Although the treat- controlled micro-trauma stimulate regeneration of the affected tendons. ments often look abusive, most Following these techniques, existing patients feel relief immediately after completion of the treatment. collagen is further remodeled and Patients with extreme sensitivity new collagen can be created by an to touch generally do not tolerate exercise and rehab program. the intense nature of these treat-Dr. Chance Moore ments. Page 10

My migraines are awful when the monsoon comes, what can I do to keep from having one every day? -Christina F. Many migraine sufferers complain 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 journal Neurology in 2009, concluded that “higher ambient temperature 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 strategy is to stay well-hydrated and to avoid strenuous outdoor activities 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 specialists so that they have adequate preventive and abortive medications 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, medication 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. Often, these patients consult with their interventional pain specialists and chiropractors prior to the summer heat and humidity to determine whether they are Arizona Pain Monthly | September, 2010

candidates for new procedures or repeating their previous treatments. 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 suggestions? -Jason V. Scoliosis is an abnormal curvature 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. Scoliosis 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 something). In adults who present with scoliosis, we approach the situation first by determining whether the patient is a candidate for surgical 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 correction is not advisable, the patient is a candidate for a wide variety of treatment options. First, patients are given a comprehensive 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 strengthen 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 Specialists we try to diagnose exactly where the pain is coming from (muscles, ligaments, discs, facetjoint 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, backwards, and to rotate. In the lumbar 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 rotational movements. Patients can have difficulty with prolonged sitting and particularly with riding 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 ablation (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 therapy, acupuncture, TENS units and other modalities. -Dr. Patrick Hogan

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

Meet Dr. Tiffany Moat, Chiropractor! Chiropractors are an integral part of an interventional pain management 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. 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 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 patientfriendly 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!”

Arizona Pain Monthly | September, 2010

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Arizona Pain Monthly September  

Welcome to September’s issue of Arizona Pain Monthly! In this issue, you will learn about National Pain Month, a month that is dedicated to...

Arizona Pain Monthly September  

Welcome to September’s issue of Arizona Pain Monthly! In this issue, you will learn about National Pain Month, a month that is dedicated to...