Treatment For Sacroiliac (SI) Joint Pain Today on the podcast, host, Dr. Michael Danko talks about one of the most common causes of low back pain. Tune in to learn about the characteristics of sacroiliac (SI) joint pain and the different treatments that are available. Episode Highlights: The sacroiliac (SI) joint is a common contributor to low back pain. The SI joint is primarily designed for stability; It is a shock absorber for the forces that are transmitted from the spine into the extremities. It has a joint capsule and ligament structure around it.The joint is pretty complex where it is part of the kinetic chain that connects the spine with lower extremities.Dr. Danko explains what primary and secondary pain generator means.How do you experience problems with the SI joint? What are the main causes?Dr. Danko talks about the mechanics of the joint and how arthritis, trauma, and pregnancy are a few contributors.What other things can lead to SI pain?How does SI joint present?If you have a burning quality sensation or numbness and tingling that is most often a sign of nerve root compression or pinched nerve.There are different diagnostic maneuvers they can do in the eam room to determine if the SI joint is the cause of the pain.What medications are used to treat SI joint pain?Physical therapy can be helpful for the condition but if medication and physical therapy do not work, they can do injections to the joint.How do you know if you need to move on to longer term solutions?Dr. Danko explains what a posterior SI joint fusion is and how it works.What about radio frequency ablation?   Resources: https://premierpaintreatment.com/https://premierpaintreatment.com/locations/https://www.facebook.com/PremierPainTreatment/Call the office at 513-454-7246

Restorative Treatment For Mechanical Low Back Pain Dr. Danko and his partner at the practice, Dr. Tim Feldheim hosted a webinar about an exciting new therapy called, ‘restorative neurostimulation’. Many people experience low back pain at some point throughout their life and for varying reasons and this therapy is  targeted at low back pain.Tune in to learn more. Episode Highlights: There is an exciting new therapy called restorative neurostimulation; The implantable device that provides the therapy is called reactivate.Dr. Feldheim talks about how this therapy is targeted at low back pain and overviews back pain in general. Why might you have a need for low back surgery?What is stenosis and what does it cause?Mechanical low back pain constitutes ⅔ of patients with low back pain; Dr. Feldheim explains what processes occur to create pain.Overload leads to pain and then our body responds with inhibition which happens when our muscles want to fire but they cannot. There is a continued and repetitive worsening cycle of overload, pain, inhibition.The saying, “If you don’t use it, you lose it, is true of the multifidus muscle as well”, says Dr. Feldheim.Can fat integrate into muscle?Dr. Feldheim talks about the current treatments for multifidus dysfunction. Have you heard of dry needling?What is restorative neurostimulation?With this new treatment, the focus is actually on the source of the pain and reversing that for people with mechanical low back pain. It is FDA approved. There are many things that set this therapy a part especially in its ability to reactivate muscle control, restore thfunction spine stability that a lot of the other therapies are not targeted at, and overall reduce pain.Dr. Danko talks about how this is a novel therapy and how it differs from other kinds of stimulation devices.This is a great long term therapy; There is already three year data out to show its effectiveness.Dr. Danko says they have been  doing this implant for about 9 months at Premier Pain Institute. He gives the details about the device itself and how it works.A significant reduction in pain medication was reflected with the research studies done on the longevity of this treatment.What does the continued improvement look like over the long term?This is a reversible therapy that can be removed. If you can reverse the cascade from the initial injury and restore your core stability and strength, and you don’t have an active energy, you could restore and heal yourself with the device and not have to use it long term.What about routine use?Dr. Danko talks about the indexes they use to gauge function and pain levels.The data supports this to be a safe device with a low risk of complications.What is the typical schedule with the reactive device with utilization of it?What is the difference between this and a TENS unit and why is this a better therapy?It is a minimally invasive surgery. Dr Danko talks about what to expect and the steady improvement.Representatives help you get set up and continue to maintain and adjust the device.There is broad established insurance coverage for this treatment as well.   Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

On today’s episode, Dr. Danko talks with Dr. Matthias Wiederholz; He is the founder and visionary behind Performance Pain & Sports Medicine, also known as Performance. Performance is a boutique medical practice with a focus on the treatment of acute and chronic pain. Dr. Danko and Dr. Wiederholz have worked together on targeted drug delivery and today they are going to discuss a new therapy called peripheral nerve stimulation of which Dr. Wiederholz is one of the leading experts in the country.  Episode Highlights: Dr. Wiederholz shares how he started medical school in New Jersey and then did his residency training in physical medicine rehabilitation in Houston, TX where he met his wife.What is peripheral nerve stimulation?This podcast raises awareness about therapy so that patients can understand the options and not lump them all together. Dr. Danko explains how he doesn’t want a patient to disregard a peripheral nerve stimulator because they think it is a spinal cord stimulator or stay stuck with opinions that they may have acquired due to a relatives experience years ago because much has changed.Dr. Wiederholz explains peripheral nerve stimulation, the core principles, and how it differs from spinal cord stimulation.There is a lot of emphasis on targeting nerves but it is also a therapy that can be used not just for neuropathic but also mechanical pain with joints and other varieties.Dr. Danko asks Dr. Wiederholz to share some of the most common sources of pain that he treats with peripheral nerve stimulation.What about comorbidities or delaying joint replacement?Dr. Wiederholz shares a story about a patient of his and how the gel injections and steroid injections were not lasting; They targeted the nerves around her knee and had great success.Where does peripheral nerve stimulation fit in the progression of therapy?What about the trial phase for trying it out first?Can it help arthritis?What will patients feel and not feel when their nerves are being stimulated?If someone does some online searching of peripheral nerve stimulation they may see reference to it being a wearable technology. Dr. Danko asks Dr. Wiederholz to talk about it and what it looks like for the daily life of a patient. What is it like to have practices in two different states? For Dr. Wiederholz, he is in Houston, TX and Lawrenceville, NJ. Dr. Wiederholz shares some personal life details about living in two different states and how he balances it. 3 Key Points: When you think of the nervous system there are two main parts: 1) The Central Nervous System which is your brain and spinal cord and then 2) The Peripheral Nervous System which is all the other nerves in your body. There are a huge number of targets for peripheral nerve stimulation.Peripheral nerve stimulation uses electrical impulses to stimulate nerves and block pain signals. The technology does have similarity to spinal cord stimulation however, there are important differences and with peripheral nerve stimulation it is a very targeted approach.Peripheral nerve stimulation has a wide variety of applications for patients not just neuropathic but also including mechanical pain in the joints.   Resources Mentioned: https://premierpaintreatment.com/ https://www.facebook.com/PremierPainTreatment/ https://www.performancepain.com/provider/matthias-wiederholz-md

This week's episode is brought to you by a webinar that Dr. Michael Danko hosted with his practice, Premier Pain Institute. Two treatments are discussed are the zip procedure, also called posterior spine fusion and  Silo, a sacroiliac joint fusion. Dr. Danko explains how both of the treatments are used in his practice and have great outcomes. Tune in for all of the details.    Episode Highlights: Dr. Danko discusses the minimally invasive spine technology from Aurora Spine and Pain, specifically the zip and silo products. Dr. Danko and Dr. Feldheim are with Premier Pain Institute located in Cincinnati, Ohio. They have offices in Loveland, Ohio, Mt. Orb, Ohio and Hillsboro, Ohio.When are you a candidate for posterior spine fusion?Spinal stenosis is a reduced space around the nerves in the spinal canal; With this condition, patients typically have difficulty with standing and walking that amplifies their back and leg pain. Patients may also experience weakness and numbness.Degenerative disc disease is the condition where the discs in the vertebrae start to lose their cushioning over time and those discs can become painful. During the process of degenerative disc disease, a condition called spondylolisthesis can occur where the bony structure starts to slip and is not aligned properly.Nearly all humans will experience degenerative discs at some point in their lives; 90% of people are affected by age 50. Dr. Danko reviews the symptoms you may experience with it.What is the treatment for degenerative disc disease? The first step is usually physical therapy and the modalities they have to offer. Dr. Danko explains the indication to progress to imaging, injections, and beyond.What is the zip procedure? It is the alternative to the pedicle screw fixation procedure. Dr. Danko explains the implant and how it works.What is the recovery process for the zip procedure?What is Silo? When do patients need it?Fusion sounds like a scary procedure but Dr. Danko explains how it is a safe, straightforward, outpatient procedure.If you believe that you are a candidate for any of these procedures, your first step is to discuss your situation with a provider at the office.  3 Key Points: Many patients that have ongoing back pain are sent for imaging to help detect what exactly is the problem. At Premier Pain they are often having  imaging performed to detect conditions like spinal stenosis, disc herniation, degeneration of the disc or vertebrae, and spondylolisthesis. The doctors use the images to piece together along with the patient symptoms to know where the target of exactly what they need to treat.Dr. Danko explains the process of outpatient zip procedure and how it works as well as what the recovery process looks like.The sacroiliac joint fusion performed with SILO is a safe and effective treatment. Dr. Danko explains how patients may end up being in need for the procedure. There is a progression in the conservative treatment plan including external supportive devices, anti-inflammatory medications, and injections before moving on to more durable solutions or permanent fixes.Resources Mentioned: https://premierpaintreatment.com/https://www.facebook.com/PremierPainTreatment/Premier Pain Institute Phone #: 513-454-7246

Targeted Drug Delivery For Chronic Pain On today’s episode of Premier Pain Talk, is a topic near and dear to Dr. Danko’s heart- targeted drug delivery also called a pain pump. It is an underutilized therapy but can be done very well and be very effective. This is an option that offers hope when other treatment options are not working or will not work. Dr. Feldheim, Dr. Danko’s partner at Premier Pain Institute joins the podcast as well today.  Tune in for the details.   Episode Highlights: Dr. Danko talks about how he was lucky to incorporate targeted drug delivery early on in his career and how it has become a staple therapy option that he offers; He has a lot of great patient success stories with it.The therapy is delivering medication directly to the spinal fluid and targeting the pain receptors far more effectively than oral medication or transdermal patch.When basic procedures are not successfully relieving the pain, when there isn't a surgery that is going to fully correct the pain, looking at therapies like targeted drug delivery and spinal cord stimulation offers hope without just continuing on an oral medication regimen.Dr. Feldheim defines chronic pain.Dr. Danko and Dr. Feldheim discuss some of the painful conditions that may qualify you for treatment with a pain pump.Chronic back and leg pain is one of the most common that they treat.What is complex regional pain syndrome (CRPS) ?There is a wide range of treatment options for chronic pain; Dr. Feldheim reviews them.What is neuromodulation?What happens when you take an oral medication? How does it differ with targeted drug delivery?How does the pump work? Dr. Feldheim explains. The right amount of medication goes to that precise spot and helps treat the pain. People experience fewer side effects and more success in getting to where the pain is being transmitted.Dr. Danko talks about the trial you can do prior to see if your body will be responsive to this treatment type.A psychological evaluation is required to go through with the trial.In regards to the trial, Dr. Danko talks about how it is a much more patient friendly way to determine what is best for you. What does recovery and follow up look like?What is the goal long term?There are multiple ways to manage the pump once it has been implanted. It is important to remember that this therapy is meant to treat chronic pain. This can include cancer pain. Oral pain medication is something your body becomes dependent upon. Dr. Danko explains why it needs to be out of your system when you get a pain pump.How do you break free of dependence on medication?There are ways that you can activate doses of medication from your phone that are set by the provider.Dr. Danko reviews the risks.The change of quality of life can be profound through this therapy. Patients in the practice are willing to share their story and can connect to new clients who may be considering going through with it.   Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

Treatment for a Herniated Disc In the spirit of the football season kicking off, today on the episode Dr. Danko discusses one of the most common injuries to the low back, which is a lumbar disc herniation. What exactly is it? How does it happen? What are the treatment options? Tune in for all of the details.   Episode Highlights: What is a lumbar disc? Dr. Danko explains what they are and their structure.With a herniated disc, it will bulge and the gelatinous material will push on the outer wall and cause pain, numbness, tingling, weakness, bowel and bladder problems.Dr. Danko talks about the scenarios and which symptoms are an emergency to make sure there isn't going to be permanent nerve damage.What is an extrusion?Most commonly the pain in the back is going to go away through rest, ice or heat, and anti-inflammatory medications unless it is a more significant herniation.What about physical therapy?One of the earlier episodes on the podcast, Dr. Danlo talks with his physical therapist friend, Dr. Burchett, check out Episode 6, “How Physical Therapy Can Help With Chronic Pain, With Dr. Drew Burchett”If physical therapy is not effective, the next step is generally an MRI scan.What is an MRI? How does it work and what does it tell your healthcare provider?Dr. Danko explains when a CAT scan may be used and the difference between a CAT scan and an MRI.If you’re continuing to have pain you may be referred to a pain management specialist for an epidural steroid injection. An epidural steroid injection is much different than an epidural a female may have when having a baby. Dr. Danko explains what it is and how it works.An epidural injection for low back pain is done in an outpatient facility.What if you don’t get relief from an epidural steroid injection? What is a good response to it?Dr. Danko explains an alternative that is a more durable solution if the other injections do not work.When would you be referred to a neurosurgeon for a more in depth procedure?What about spinal cord stimulation? It has a trial procedure as well that does not require surgery.There are several steps starting with the more  conservative options and working towards more definitive solutions like the surgical options. If a surgery can’t fix the problem permanently,  there is a great option called a spinal cord stimulator.Visit  https://premierpaintreatment.com/ for more information. Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

On this episode,  we re-visit Dr. Danko's discussion with his friend Dr. Chris Beuer from St. Louis, Missouri. He feels fortunate to have found the feel of pain management and have the ability to actually make a difference in people’s lives. They discuss Pain Pump Therapy, what it is, and why it is used. These two doctors are passionate about improving quality of life for their patients. Tune in!   Episode Highlights: Dr. Beuer introduces himself, shares about his practice in St. Louis, and what brought him to his current job position. What is pain pump therapy and why is it used?Pain pumps have a reputation of being hard to manage but a lot has changed over the years. Dr. Beuer explains.Dr. Danko has found that the earlier you can offer the Pain Pump Implant Therapy, the better in the chronic pain world. It doesn’t mean it is the first thing you jump to but it is also not something you need to wait to use as a ‘salvage therapy’.What conditions are best for the pump? What are the steps to determine if it's right for the situation? Dr. Danko asks Dr. Beuer to talk about when it is indicated for patients.There is an ability to test the pain pump as well to see if it is worth it to the patient to try.How do pain pumps help people come off other pain medications?There is concern that a pump is limiting. Life using it is very simple. The medicine is refilled about every three months or so which takes a couple minutes to do. It is also important to note that it is on very low doses because it is very effective whenDr. Danko brings up that they both have been involved in a lot of Clinical Research and there is also a lot of great data already out on pump therapy.What about cancer pain? What are typical situations that are seen in pain management practice?Pain pumps can also be used for spasticity issues. Cerebral palsy, spinal cord injuries, or strokes are common scenarios with these spasticity issues. Dr. Beuer shares how he got into triathlons and Iron Man competitions. Originally people told him there was no way he could do it in six months and he took it as a challenge. He has completed 16 Iron Mans and shares experience about brutal weather.Patient education on the body’s ability to adapt is important too for understanding a plan of building strength. Dr. Danko asks Dr. Beuer to share about his experience being involved with Team USA in triathlons. 3 Key Points: Premier Pain Talk is shedding light on the misconceptions about pain management. The field is not correctly portrayed in the media. It is not just about handing out pills. There are many interventional procedures, including pain pumps.How do pain pumps help people who have been on long term pain medications to no success?The body has an incredible ability to adapt. Patient education around the topic is so important in showing them that they can overcome limitations, too.  Resources Mentioned: https://premierpaintreatment.com/ https://www.facebook.com/PremierPainTreatment/ https://www.christianhospital.org/painfree

What To Expect As A New Patient At Premier Pain Treatment Institute This is a special bonus episode with Dr. Michael Danko; He shares what to expect when you come to the Pain Management Clinic when you come in for your new patient appointment. Tune in now. Episode Highlights: The first thing is getting a referral from your referring provider. The new patient scheduler calls to get you scheduled once that is received.Insurance verification happens prior to the first appointment and verify benefits.There are three office locations: Loveland, OH, Mt. Orb, Ohio, and Hillsboro, OH.Your first time in the clinic you are asked to come 30 minutes earlier to get everything ready, complete a new patient packet and turn in any imaging or previous records. If you are intending to have medication management, you will have to do a urine drug screening; If not, that may be bypassed.Vital signs will be recorded and then the pain management provider will come in to discuss your concerns with you.Your pain management provider will narrow down your symptoms and correlate with the physical exam findings.Reviewing the images will help narrow down further where the pain is coming from.If physical therapy is needed, they will get that initiated.If you are at the point of surgery, they will recommend and refer that as well.Most often there are a variety of options; The pain care providers are very thoughtful in constructing a full care plan.   Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

On this episode of Premier Pain Talk, host Dr. Michael Danko talks with Dr. Michael Fishman. He is a fantastic pain physician out of the Greater Philadelphia area. They are discussing spinal cord stimulation and some of the new horizons coming with it as well as digital health and data capturing and potentially new options for pain therapy down the road. Tune in!   Episode Highlights: Dr. Fishman went to medical school at Jefferson Medical College, and he developed an interest in anesthesia, ENT, and neck surgery. And at the end of the day, he ended up as a surgery resident at a program outside of Philadelphia.During his time working with the anesthesiologist at the hospital, Dr. Fishman ultimately found that perhaps there is a better use of his interests to look after patients after surgery and around their surgeries. Dr. Fishman’s clinic is like a lab where we get the opportunity to think of new ways to help people and ways to get patients the right treatment at the right time.One of the therapies that gets Dr. Danko super excited and makes it not feel like work sometimes, is something called a spinal cord stimulator. It is an implantable device and has been around for many years.Spinal stimulation in Dr. Danko’s mind has gone through now maybe even more advancements than cell phone technology or other technology of any type.What is ‘The Gate Control Theory On Chronic Pain’?Tonic stimulation is something that people should be familiar with, and it's a buzzing electrical sensation or maybe tapping and pulsing. They talk about how it had previously been practiced.Over the last few years, there has been a  fine tuning of  the electrical signals that are being passed in the spinal cord. If you talk to a bunch of different pain doctors or different people from industry, you are going to get a bunch of different answers for advancements with changes in the way the electricity is being delivered through devices.There is a psychological and social component that is also important to understand when you think about why pain doctors do what they are doing; That is why when they do apply therapies like simulation, it's important to understand biologically why also.For humans, isolation, depression, anxiety, status, etc all go in the same path with pain; But we can change the pain experience for the better or for the worse.    3 Key Points: One thing about Yale Haven hospital that everybody should know is it is smack dab in the middle at the junction of I-95 I-91, which means that it is a super busy hospital and gets most of the trauma in the state.DTM therapy is fantastic and the science behind how to fine-tune that therapy is very durable. Getting patients the right treatment is the job of a pain doctor, but it’s also about the right timing being understood and the circumstances/ context for each person to make the best version of themselves that they can be, says Fishman.  Resources Mentioned: https://premierpaintreatment.com/ https://www.facebook.com/PremierPainTreatment/ https://www.christianhospital.org/painfree https://celerihealth.com/

Facet Joint Fusion - Minimally Invasive Treatment After Failed Radiofrequency Ablation Today on the podcast, Dr. Danko brings you the webinar talk from his practice of the July edition of PPTI Care Series. He is providing information on a posterolateral spine fusion or a facet joint fusion, which is a minimally invasive treatment option for low back pain. Tune in and get all the details.   Episode Highlights: A posterolateral spine fusion is also called a facet joint fusion. It is a minimally invasive treatment for low back pain. Why is it called a fusion? That word is often tagged to a much more scary, arduous procedure. Dr. Danko discusses the hesitancies patients may have and the impact of preconceived notions.When is this procedure appropriate for patients?Who is a candidate for this procedure?What options are available if you’re not a candidate for this procedure?Dr. Danko explains the procedure and the technology that is used.In treating low back pain, there are a variety of conditions that could benefit from the procedure; Dr. Danko lists and explains them.What is adjacent segment disease?Lumbar facet joints are small joints at each segment in the spine that progress all the way up to the thoracic and cervical spine as well. They are what allow you to bend and twist. Dr. Danko talks about the progression of treatment when you are experiencing pain in the joints.How does radiofrequency ablation work and what if they are unsuccessful?As you get older almost everyone has degenerative disc disease. What are the categories of symptoms and conservative treatments?What do the doctors look for when they evaluate imaging?Dr. Danko explains how patients can go home the same day that the procedure occurs.Bone graft material bridges from the transverse process of the segment retreeding to the segment above.Contrast dye is also used in the bone graft. How does this procedure compare to a 360 fusion?Dr. Danko explains how they work with adjacent segment issues.The procedure can be done at more than one level. Depending on the setting, both levels may be addressed at the same time.  Talk with your provider about your tailored needs, what you may be a candidate for, and what referrals you may need.   Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

Advancements in Digital Health For Neuromodulation With Dr. Allen Burton On today’s episode, Dr. Danko has a special guest that he really admires, Dr. Allen Burton; He is the chief medical officer with Abbott. Dr. Danko and Dr. Burton have a discussion to share about some of the digital advances that are coming along in therapy called spinal cord stimulation and dorsal root ganglion stimulation.   Episode Highlights: Dr. Burton started his career as an anesthesiologist and specialized in pain management and was certified in Interventional Pain Management. He practiced for 20 years in an academic and private setting. He also shares how he has been a part of clinical research.Dr. Burton shares what it meant to him to be a part of clinical trials at MD Anderson.For both the clinical trials of DRG (dorsal root ganglion) stimulation and burst DR stimulation, Dr. Burton was one of the clinical investigative sites in their approval for the FDA.What is spinal cord stimulation?What is dorsal root ganglion stimulation?A unique attribute of this therapy is that the patient gets to try it with the trial period; It is unique among medical therapies.How do patients navigate with their physician whether or not to go through with it?Dr. Danko talks about how he evaluates the results of the trial period with the patient.Many patients in the clinic are scared and sometimes have had surgeries and repeated surgeries. Dr. Burton talks about the intricacies and how he helps them see the difference of this procedure.What is Abbott’s neuromodulation business about? Dr. Burton explains the neurosphere program and how it moves them forward.It is important for the patient to understand the benefits as well as their family and insurance company understand the benefits. Dr. Burton explains the app, My Path that they created that includes educational modules as well as a recording log.Dr. Burton reviews the questionnaires that the patient will be walked through in the different time frames along the way so that a comprehensive understanding of how the trial is going can be achieved by all parties.How is the insurance company convinced of the necessity of the procedure from the data on the trial?What is ahead for research and the automated features of the My Path app? Dr. Burton explains the generation it is on now and what it looks like going forward as well as the benefits. Dr. Danko loves the multiple metrics that are provided in the snapshot report for doctors at the end of the trials. Dr. Danko and Dr. Burton talk about tracking patients long term and how it helps them fine tune their treatment and maintain their care.What about virtual clinic? Dr. Danko talks about the struggle it was to transition to it during COVID. Dr. Burton discusses how they use it and the opportunities that it opens up.   Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246 https://www.abbott.com/

Non-Surgical Treatment For Discogenic Low Back Pain On today’s episode of Premier Pain Talk, Dr. Danko presents a webinar on the novel treatment called intervertebral allograft injection for degenerative disk disease. Tune in for all of the information. Episode Highlights: Have you heard of VIA disc? It is a nonsurgical treatment for degenerative disc disease. It is fairly new to pain management. Dr. Danko has been able to provide this to his patients for over a year now. Dr. Danko explains his experience with the procedure. Low back pain is a very common issue, the single greatest cause of disability over the course of our lives.Over the last 25 years, the prevalence of back pain has increased. Dr. Danko explains why and common factors.Vertebral compression fractures can occur and cause really severe back pain and they get worse with forward flexion.Where does disc herniation pain come from?What are the degenerative changes?What is degenerative disc disease and how does it occur? How is it accelerated?Dr. Danko explains what a provider looks at and what kind of exams are done when identifying discogenic back pain.Discogenic back pain is a constant central back pain that can occur in the legs as well and worse with leaning forward.What is an MRI scan and what does it help identify?Degeneration of the discs go from grade 1 (normal healthy disc to grade 8 (most deteriorated)What treatments were determined to not be effective?VIA disc has been a game changer. Why?VIA disc NP is the first and only nucleus pulposus allograft to replace a patient’s tissue loss due to disc degeneration.What is the VIA disc procedure like? Dr. Danko explains.Muscle relaxants and back braces are common after the procedure.Healing takes time. Dr. Danko has advice for not becoming discouraged but rather being patient waiting on the regeneration process.     Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

Basics of Epidural Steroid Injections Today on the podcast, Dr. Danko explains one of the most basic injections in pain management, the epidural steroid injection. What is it and what does it entail? What are the common conditions that are treated by epidural steroid injection? Tune in for all of the details.     Episode Highlights: An epidural steroid injection is an injection of steroid into a space in the spine called the epidural space. The spinal cord travels from the base of the skull into the low back and there are big nerves called nerve roots coming out of the spine and into the extremities which help control the major functions in your body.A condition such as a herniated disc or spinal stenosis will cause compression of the nerves and create symptoms of pain, numbness, tingling, burning, etc.What is a steroid and how is it helpful?These injections can be done in an office setting, ambulatory surgery center, or a hospital setting depending on where the procedure is done and typically involves X-Ray guidance to help target the exact location.Contrast dye is used to show the appropriate spread of the area where the doctors are wanting to inject the medication which is the epidural space.Dr. Danko explains the several types of approaches to target the spine from different angles.Common conditions that are treated with these injections are lumbar disc herniations and lumbar radiculopathy, and spinal stenosis.Dr. Danko explains what typically happens prior to an injection.How is it determined whether or not the injection was successful?These injections can be repeated 3-4 times per year.How does insurance work for these injections?Are there reasons not to get these injections? Dr. Danko explains the contraindications.There are other options if you are not a candidate for these injections. Dr. Danko explains the options that you may explore with the doctor.   Resources Mentioned: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

Minimally Invasive Treatment For Spinal Stenosis On today’s episode, Dr. Danko has a special guest, a friend of his, Dr. Anjum Bux from Kentucky. They are discussing the minimally invasive lumbar decompression treatment and pain pump therapy. Dr. Bux is one of the international experts on pain pumps and has been involved in a lot of the guidelines that have been developed with it. Tune in now. Episode Highlights: Dr. Anjum Bux introduces himself. He grew up in Kentucky south of Lexington and trained at the University of Kentucky where he did his anesthesia residency. Dr. Bux joined his father’s practice who is an anesthesiologist, pain physician. In the last 4 years, he moved to 100% pain management. They cover all of central Kentucky.One of the most common conditions that both Dr. Danko and Dr. Bux treat is called spinal stenosis. A lot of people are familiar with herniated discs, pinched nerves or some of the more acute issues but spinal stenosis is a chronic condition and is something that develops more slowly over time.Dr. Danko asks Dr. Bux to give an overview of spinal stenosis and what the symptoms are.What is the shopping cart sign? If you have back pain while walking, talk to your doctor and get an MRI. Dr. Bux explains what they look for and how it helps them determine what is causing the pain.What are some of the initial or basic treatments to treat stenosis? Dr. Bux talks about an example of one of his patients who did not get relief with injections.Epidural injections for stenosis patients? What is the duration of relief like?What does the MILD procedure stand for? Lumbar decompression clears out what is causing the stenosis, opening the space to relieve pressure on the nerves.What if you’re not a candidate for surgery because of anesthesia? Dr. Bux explains how they go about it.Dr. Danko and Dr. Bux discuss the safety of the procedure and how the risk for infection is very low.What is the durability of the treatment? Dr. Bux talks about the research studies around it.What are the restrictions after lumbar decompression treatment?Dr. Bux talks about the benefits of a back brace.What is the importance of physical therapy and what is its role for patients especially in these circumstances? Dr. Danko talks about the significance of a pain pump.Dr. Bux is one of the international experts on pain pumps and has been involved in a lot of the guidelines that have been developed with it. He talks about what a pain pump is.How does a pain pump actually cut down on the tolerance and physical dependence of medicine? They discuss the sustained durability.Dr. Bux explains how he helps patients to wean off their pills and greatly improve quality of life.     3 Key Points: Dr. Danko and Dr. Bux discusses the condition of spinal stenosis, how it develops and  how it presents with symptoms.Lumbar decompression clears out what is causing the stenosis, opening the space to relieve pressure on the nerves.The MILD procedure is backed by research that shows continued improvement for patients and can treat more than one level with the same procedure.    Resources Mentioned: https://www.buxpainmanagement.com/provider/anjum-bux-md https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

Why Would You Need To See A Pain Management Specialist? When might your surgeon or primary care doctor recommend a referral to pain management? What does it mean and how do you know if you’re ready? If you’re sent to pain management, it can be for a variety of reasons. Tune in to hear Dr. Danko break down an overall review for understanding treatment in pain management.    Episode Highlights: If your primary care doctor is referring you to pain management does that mean that they have run out of options in your care plan? Dr. Danko explains.Opioids and injections are not all of what pain management does and those two treatments are not tied together.Medication management is most commonly for continuation of a controlled substance or to consider starting a controlled substance, with the most common being an opioid.Opioids in the right situations can be beneficial and help patients function better but also come with the need for closer monitoring.Some Pain Management Practices are interventional procedures only and some practices are medication management only which is why it is important that you understand what kind of practice you are being referred to.What about injections? Implantable devices are used to treat chronic pain, too. When are they used?Dorsal ganglion stimulation is a specialized stimulation that is specific to individual nerves and focal areas in the body.Have you heard of the new type of stimulation called restorative neurostimulation?  Dr. Danko explains how it can strengthen muscles and the trial options available.There are several minimally invasive surgical procedures that Interventional Pain Management specialists can be qualified to perform; For example: minimally invasive lumbar decompression, indirect lumbar decompression, posterior SI joint fusion, posterior spine fusion, and facet joint fusion. These are all outpatient procedures that are shorter in duration and generally don’t need general anesthesia. They are done through small incisions not open joint procedures.What does it mean that Pain Management is a subspecialty? How does board certification affect what may be offered? It is important to do your homework when you’re going to see a new provider to thoroughly understand their training and options they provide.Interventional Pain Management is not a scary thing like you may read about in books or see in movies. They are medical specialists just like other doctors who are working to help patients improve quality of life. 3 Key Points: When a patient gets referred to pain management there can be a lot of unknowns. Dr. Danko sheds light on why a patient may be referred and a better understanding of what treatment in pain management looks like.Not all Pain Management Specialists are the same; Some Pain Management Practices are interventional procedures only and some practices are medication management only which is why it is important that you understand what kind of practice you are being referred to.There are several minimally invasive surgical procedures that Interventional Pain Management specialists can be qualified to perform. Having discussions with providers will help you realize that nothing is going to be forced and they are there to help you sort through the options available to improve your quality of life.      Resources: https://premierpaintreatment.com/ https://premierpaintreatment.com/locations/ https://www.facebook.com/PremierPainTreatment/ Call the office at 513-454-7246

High-Frequency Stimulation For Treatment Of Diabetic Peripheral Neuropathy This week’s episode brings new exciting information about how high frequency stimulation and spinal cord stimulation has FDA approval for diabetic peripheral neuropathy and how that is expanding therapy options for patients. Tune in for all of the details.   Episode Highlights: Spinal cord stimulation is not new to diabetic neuropathy treatment but up until recently it was not approved by the FDA.How does the FDA approval affect this treatment?Dr. Danko explains an example of a patient situation that could  have a different treatment approach with this approval for high frequency stimulation.Diabetes is a significant problem in the United States; 34.2 million people have it, which is about 1 in every 10.Of those diagnosed with diabetes, 20% of them have the complication of diabetic peripheral neuropathy.Diabetes can cause a lot of different problems throughout the body; One problem it can cause is nerve damage in the small fiber nerves. Dr. Danko explains the symptoms and progression.What are some conventional treatment options? 45% of people don’t respond to them.Dr. Danko reviews the types of therapies and medications used to treat diabetic neuropathy.A qutenza patch is an exciting new treatment for neuropathy.There are limitations with a TENS unit. Dr. Danko explains the difference between it and high frequency stimulation.Spinal cord stimulation is a well established therapy that has been around for decades.What does the data show about spinal cord stimulation technology?If you have tried stimulation in the past and it hasn’t worked or you have heard about it not working for someone else, it is worth reconsidering now because the technology has gotten so much better.How does high frequency stimulation work?85% of patients have pain relief at 6 months (50% pain relief) and 86% at 12 months (75% pain relief) which gives durability to the therapy and is far beyond conventional therapies.Improvement of sleep, strength, reflexes, and sensory function have been shown with the high frequency stimulation treatment and 92% of patients are  satisfied with the treatment.  What is the trial period for the implant?What does the process look like?What is recovery like?Over 2 million people have not been able to get relief from conventional therapy for diabetic neuropathy that may qualify for high frequency stimulation.Dr. Danko answers some questions from webinar participants.Visit https://www.hfxforpdn.com/ for more information from the company.  3 Key Points: Though it was used under standard of care, spinal cord stimulation is not new to diabetic neuropathy treatment but up until recently it was not approved by the FDA. FDA approval brings broader insurance coverage and the ability to offer to more people.Diabetes is a significant problem in the United States; 34.2 million people have it, which is about 1 in every 10. Of those diagnosed with diabetes, 20% of them have the complication of diabetic neuropathy.Spinal cord stimulation is a treatment that delivers small electrical impulses to the spinal cord to block pain signals sent to the brain. It is a well established therapy that has been around for decades. There are a wide range of frequencies that have been used. High frequency stimulation is a minimum invasive procedure that is a reversible therapy as well.  Resources Mentioned: https://premierpaintreatment.com/https://www.facebook.com/PremierPainTreatment/Premier Pain Institute Phone #: 513-454-7246

Physician And Industry Relationship Can Make A Huge Difference In Your Care On this episode of Premier Pain Talk, Dr. Danko has a special guest, Laura Vroon, who has been working in the healthcare industry for over 21 years. They are discussing the Industry relation side and how it is beneficial in positive patient care. Many people are not aware of how much goes on behind the scenes to bring forth meaningful products and innovative therapies. Tune in now.   Episode Highlights: Today’s guest, Laura Vroon, introduces herself. She is very passionate about helping chronic pain patients. She is from Charleston, SC; She is married with two kids who are 16 and 13.Dr. Danko asks about Laura’s background as she has a unique perspective from multiple angles regarding the chronic pain space.Laura shares about how she started at the clinical level and how she learned so much about activities of daily living and how to restore function and good quality of life for patients. Dr. Danko asks Laura to share about her transition from working only with physicians to direct patient care and what was surprising to her.There is a lot of information out there and it is hard to decipher when patients are already going through so much.Support is a huge factor and understanding how much help individuals have or do not have.Laura shares how having her mom diagnosed with Alzheimer’s gave her a different perspective on the other side of being a caregiver.Laura shares about her transition from a clinical to executive role and how her desire to help patients more led her to moving into the people leader role. With so much field experience, it built her understanding of marketing and how to speak with and reach patients.How is the shape of Industry changing? How does it work with advocating for the patient?Dr. Danko shares about the fear around Industry.What are things in the industry that the general patient may not be aware of?No one is winning if patients aren’t getting better; So much time and energy is spent on bringing forth meaningful products and innovative therapies.Laura shares inside the corporate window of how they educate the clinical staff representatives.Finding the way to quality of life is the common goal around the whole Industry.Dr. Danko and Laura discuss the challenges they experienced around COVID, how they worked through it, and how it was so rewarding too.How has patient education changed?With many misconceptions around pain management and knowledge, Dr. Danko asks Laura to explain the outreach to colleagues, too, who may not be educated or familiar enough with what pain physicians do. Dr. Danko and Laura discuss awareness and how physician’s thinking and strategies are changing to give patients more access.What does the future look like for the Industry? How will it continue to improve? 3 Key Points: There is so much information out there for chronic pain patients. It is hard to sift and discern through it all especially when they are already going through so much which is why it is so important for everyone to be invested and involved in fighting for the individual’s solutions. It is a big opportunity for companies to have a better outreach to people and their families.Dr. Danko and Laura discuss how Industry is changing the way that they interact with patients in more of an outreach scenario.Partnerships with physicians and hospitals is where you reach the common goal of giving patients exactly what they need. All the online content and Social Media plays an important role in education and bridging the gap in that outreach. Resources Mentioned: https://premierpaintreatment.com/https://www.facebook.com/PremierPainTreatment/Premier Pain Institute Phone #: 513-454-7246

Radio Ablation For Chronic Pain Today on Premier Pain Talk , Dr. Danko is talking about a very common procedure in interventional pain management called radio frequency ablation. There are many conditions that can be effectively treated with it including arthritic joints and nerve pain from various sources. Tune in to hear how it works and the purpose it serves for many!   Episode Highlights: Radiofrequency ablation in layman’s terms is sometimes referred to as ‘burning the nerves’; other terms it goes by are rhizotomy and radiofrequency neurotomy. Dr. Danko explains how a radiofrequency ablation uses the word radio in it because it uses radio waves to create a current that heats a small area of nerve tissue.There are a wide range of conditions that can be treated with radiofrequency ablation and is a pretty common procedure; It can be used outside of interventional pain management in oncology, vascular treatments, and others.In terms of pain management, the spine is the most common area treated but it can also be used for joints or other nerves that are causing pain. Arthritic facet joints at the base of the back and facet joints in the neck and thoracic spine are common ailment points in need of treatment. Dr. Danko explains what symptoms may occur. Sacroiliac joints have high innervation, meaning there is a high supply of nerve to them   and pain may be experienced trying to get in or out of a car or chair, laying on the affected side.What about arthritic joints? When may you need radiofrequency treatment?There are other conditions that cause nerve pain that can be treated with radiofrequency treatments. Not all conditions qualify but it is important to talk with you pain physician to decide whether it could be effective for your situation.How do you determine if you are an appropriate candidate for radiofrequency treatment?What are the precursors to radiofrequency treatments?For those who don’t respond to these treatments there are other treatment options that can be considered based on further evaluation.This is a safe procedure to do in an outpatient facility and often without any sedation or light sedation.The procedure from start to finish is around 30 minutes give or take depending on the area with the ablation itself only taking 90 seconds or two 90 second intervals.The Premier Pain Institute has offices in Mt. Orb, Ohio, Loveland, Ohio, and Hillsboro, Ohio. You can find more information on this procedure at https://premierpaintreatment.com/ 3 Key Points: Radiofrequency ablation or RFA is a common procedure in interventional pain management that uses radio waves to create a current that heats a small area of nerve tissue.If you’re trying to delay a total joint replacement, radiofrequency treatments may be a viable option; It is not commonly known that if you continue to have pain after a joint replacement, this can be effective as well.How do you know if you are a good candidate for radiofrequency treatments for your pain? Dr. Danko explains the conditions and indicating factors. Resources Mentioned: https://premierpaintreatment.com/https://www.facebook.com/PremierPainTreatment/Premier Pain Institute Phone #: 513-454-7246

Aurora Zip And Silo Minimally Invasive Spinal Fusion Treatments This week's episode is brought to you by a webinar that Dr. Michael Danko hosted with his practice, Premier Pain Institute. Two treatments are discussed are the zip procedure, also called posterior spine fusion and  Silo, a sacroiliac joint fusion. Dr. Danko explains how both of the treatments are used in his practice and have great outcomes. Tune in for all of the details.  Episode Highlights: Dr. Danko discusses the minimally invasive spine technology from Aurora Spine and Pain, specifically the zip and silo products. Dr. Danko and Dr. Feldheim are with Premier Pain Institute located in Cincinnati, Ohio. They have offices in Loveland, Ohio, Mt. Orb, Ohio and Hillsboro, Ohio.When are you a candidate for posterior spine fusion?Spinal stenosis is a reduced space around the nerves in the spinal canal; With this condition, patients typically have difficulty with standing and walking that amplifies their back and leg pain. Patients may also experience weakness and numbness.Degenerative disc disease is the condition where the discs in the vertebrae start to lose their cushioning over time and those discs can become painful. During the process of degenerative disc disease, a condition called spondylolisthesis can occur where the bony structure starts to slip and is not aligned properly.Nearly all humans will experience degenerative discs at some point in their lives; 90% of people are affected by age 50. Dr. Danko reviews the symptoms you may experience with it.What is the treatment for degenerative disc disease? The first step is usually physical therapy and the modalities they have to offer. Dr. Danko explains the indication to progress to imaging, injections, and beyond.What is the zip procedure? It is the alternative to the pedicle screw fixation procedure. Dr. Danko explains the implant and how it works.What is the recovery process for the zip procedure?What is Silo? When do patients need it?Fusion sounds like a scary procedure but Dr. Danko explains how it is a safe, straightforward, outpatient procedure.If you believe that you are a candidate for any of these procedures, your first step is to discuss your situation with a provider at the office.  3 Key Points: Many patients that have ongoing back pain are sent for imaging to help detect what exactly is the problem. At Premier Pain they are often having  imaging performed to detect conditions like spinal stenosis, disc herniation, degeneration of the disc or vertebrae, and spondylolisthesis. The doctors use the images to piece together along with the patient symptoms to know where the target of exactly what they need to treat.Dr. Danko explains the process of outpatient zip procedure and how it works as well as what the recovery process looks like.The sacroiliac joint fusion performed with SILO is a safe and effective treatment. Dr. Danko explains how patients may end up being in need for the procedure. There is a progression in the conservative treatment plan including external supportive devices, anti-inflammatory medications, and injections before moving on to more durable solutions or permanent fixes. Resources Mentioned: https://premierpaintreatment.com/https://www.facebook.com/PremierPainTreatment/Premier Pain Institute Phone #: 513-454-7246

How Physical Therapy Can Help With Chronic Pain, With Dr. Drew Burchett? On this episode of Premier Pain Talk, Dr. Danko is talking to a friend, physical therapist, Dr. Drew Burchett. Dr. Burchett is the Director of Physical Therapy at The Therapy & Balance Centers in Delhi, Ohio. They will be discussing the importance of physical therapy for chronic pain. Tune in now. Episode Highlights: Dr. Burchett introduces himself  and talks about his approach to treating chronic pain and how it differs from brand new or acute injury.Patients with chronic pain who have been in physical therapy before have a story and they may be concerned that they already tried it  and it made their pain worse or it didn’t work. Dr. Danko and Dr. Burchett discuss the challenges and reasons why the patient should come back to try again.How often does the issue with chronic pain for a patient actually stem from a deconditioning or weakness that they may have? How much is it about establishing good habits and targeting those points?Dr. Burchett explains the progression from making a positive difference in pain to strengthening and posture and gait issues.80% of people will have low back pain at some point in their life. It is really important to have options for patients. Dr. Danko asks Dr. Burchett to share specific interventions regarding low back pain.Trigger point dry needling is extremely effective at relaxing specific muscles in the lumbar spine. Dr. Burchett explains what it is and what the patient experience is like.What about aquatic therapy? When is a patient best suited for it? There has to be a continuation of therapy beyond the formal physical therapy sessions. Physical therapists often talk about core stabilization and the importance of tailoring continuing home exercise programs specific to the patient.Dr. Burchett is not only an expert physical therapist, he is also a certified IronMan U Coach. He has a strong athletic background. He shares about that journey and what kind of athletes he coaches.Dr. Danko asks how Dr. Burchett decides if someone will be a good fit for their type of coaching or if a general coaching model would be better for that individual.Good quality nutrients are of high value in all aspects of life whether it is training for athletic events, managing chronic pain, or just staying healthy.They discuss different metrics to monitor change and progress along the way.What is heart rate variability? The trends of shifts and movements are key to watch for.Dr. Danko asks Dr. Burchett to explain how heart rate variability fluctuates and why.Dr. Burchett shares a story about a high level runner who had recurring anterior shin pain. He explains how people like her often are doing micro traumas to their bones and the importance of changing running form.As we age, we slow down and that is the fact of life but there are ways to improve quality of life through physical therapy interventions and other practices like these discussed today.     3 Key Points: Acute injuries differ from chronic pain issues. Physical therapy interventions are used to treat both with different approaches. Dr. Burchett explains how they focus away from a pain number and more on the progress of feeling better.There are physical therapists for a wide variety of injuries and conditions. Oftentimes when patients with chronic pain have already been in physical therapy and felt like it didn’t work they are reluctant to return or just do so out of obligations by insurance. Dr. Burchett shares about providing a new perspective for those types of patients.Dr. Burchett saw the need for medical knowledge in triathlon coaching which was the start of the inspiration for starting the business, Performance and Science with a friend of his. They take a different approach by looking at the athlete as a whole person and using scientific data to guide their plans. Tweetable Quotes: “Most of the patients that have chronic pain have been dealing with it for a long time and they may have done physical therapy early on when the issue was new or acute but then often for one reason or another they may get sent back to physical therapy for an ongoing condition that is considered more of a chronic condition.” -Dr. Michael Danko“When it is an acute injury patient, we really try to get them out of pain as quickly as possible and that is typically successful with physical therapy interventions.” - Dr. Drew Burchett“When you have a patient with chronic pain a lot of times since they have done therapy before, they have a story, and they may have a concern that they have already tried it and it made their pain worse or it didn’t work.” - Dr. Micheal Danko “Tell me what you have done before and tell me what was not successful, because if I know what was not successful then I am going to do a completely different route and try different interventions, techniques, and treatments so that we can find something that will work.” -Dr. Burchett“My main focus in the first couple of sessions is to try to make a positive difference in your pain.” -Dr. Burchett“We do nutritional logs, we monitor heart rate variability to make sure that they aren’t overtrained and they aren’t sick. We can see sickness coming from a mile away..there is a lot of data that we comb through everyday to make sure that we can make that person successful.” -Dr. Burchett Resources Mentioned: https://premierpaintreatment.com/ https://www.facebook.com/PremierPainTreatment/ Dr. Burchett: https://www.facebook.com/PremierPainTreatment/https://www.fyzical.com/delhi-oh/About/Staff