Arizona Pain Monthly August

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Dr. Tory McJunkin & Dr. Paul Lynch

Welcome to the August issue of Arizona Pain Monthly! We hope you have been able to enjoy time with family and friends over the summer.

The face of medicine is drasti-cally and rapidly changing, and we want to be sure that physi-cians and patients have a voice; we feel that it is imperative. With that goal in mind, many of the physicians at Arizona Pain Specialists have taken the initiative to pursue leader-ship roles within the Arizona medical organizations that work toward governmental medical reform. The Arizona Society of Interventional Pain Physicians is the local chapter of the American Society of Pain Physicians (ASIPP), a group that is dedicated to the develop-ment and practice of safe pain medicine. Within the Arizona chapter, Dr. Patrick Hogan is the Vice-President, Dr. Jonathan Carlson is the Secretary and Drs. Lynch and McJunkin are both Members-At-Large. During the 12th Annual ASIPP meeting

in Washington D.C. this past month, Dr. Hogan and Dr. Carl-son were able to meet with staff members for Senators McCain and Kyl as well as Congressional House Representatives. They were able to discuss important issues regarding healthcare, and are excited to continue working toward success in the future. Please see the article on page 12 for more information regarding the meetings on Capitol Hill.

Did you know that lightning will strike approximately half a million times during the Arizona monsoon season? With those lightning storms also comes humidity – and humidity can cause those with painful joint conditions like arthritis to expe-rience greater pain than usual. We would recommend keeping joints mobile as much as pos-sible. If your joints are allowed to remain immobile, they will stiffen even more so than if you are actively moving, and will end up causing you more pain.

Laughter has often been called

the best medicine, and as it releases endorphins, the body’s natural painkiller, we’ll leave you with a funny fact about Arizona storm systems. Did you know that the wall of dust often seen during monsoon season is called a haboob? The name comes from an Arabic word used to describe the phenom-enon often seen in hot, dry climates like Arizona and the Sahara desert.

We hope that this issue is edu-cational and informative. Please contact us at [email protected] if you have any questions or com-ments.

We thank you for your contin-ued loyalty if you are a long-standing patient, and we wel-come you to the Arizona Pain Specialists family if you are a new patient.

Until next time, remember at Arizona Pain Specialists, we be-lieve you can be pain-free.

Arizona Pain Monthly | August, 2010 Page 2

Page 3Arizona Pain Monthly | August, 2010

Expert Guest Dr. Anikar Chhabra

Our Guest Columnist this month is Dr. Anikar Chhabra, an ortho-pedic surgeon currently prac-ticing at The Orthopedic Clinic Association (TOCA).

Chronic knee pain is one of the most common orthopedic prob-lems that presents to our clinic. There are several different fac-tors that go into determining how these patients are treated. The first and possibly the most important is a thorough history of the problem. This gives the orthopedic surgeon the ability to determine how debilitat-ing the pain is, how long the symptoms have been occurring, how severe the symptoms are, what type of activities aggra-vate or alleviate the pain, and what treatments have been used. With this information the

physician can develop a working diagnosis.

A complete orthope-dic exam of the knees is then performed. Important informa-tion such as range of motion, knee stability, swelling, and muscle strength are obtained. Certain special tests are performed to try to reproduce symptoms to better determine the source of the pain.

The third step is to obtain dianostic test-ing. X-rays, MRIs or CT scans may be utilized depending on your initial diagnosis.

With all this informa-tion in hand, a work-ing diagnosis can be

developed. Based on the x-rays and exam, the knee pain can be characterized as degenerative (or arthritic) or not degen-erative. The treatment of an arthritic knee is very different from one that is not.

If the knee does not show signs of arthritis, some type of damage to the structures of the knee may be suspected. This can include meniscus tears, cartilage defects, or loose foreign bodies in the knee. The pain may also be coming from the muscles, tendons and liga-ments surrounding the knee, and not necessarily from inside the knee. This can often be dif-ferentiated by swelling inside the knee. MRI is often indicat-

ed to determine intra-articular pathology in these cases.

Chronic knee pain due to arthritis is a progressive pro-cess. Arthritis, or wearing away the cartilage at the ends of the bone, cannot be reversed. Without this cushion, the knee doesn’t glide smoothly and can cause significant pain. Treat-ment for this pain is based on the severity of the symptoms and how advanced the arthritis is.

The first step in treating an arthritic knee is beginning a home exercise program and physical therapy to strengthen the supporting structures around the knee. This can help relieve symptoms by causing less stress across the knee joint. Also, if the patient is overweight, weight loss is strongly encouraged to de-crease stress on the knees. Appropriate footwear can de-crease pain, especially in cases of patellofemoral arthritis. Often, an anti-inflammatory medication is prescribed as well. It is important for these patients to stay as active as possible and maintain good motion in the knee, as this has proven to decrease symptoms of arthritis. Often patients can get several years worth of re-lief from their symptoms with these non-invasive treatment modalities.

The next step, after the above treatments have become less effective, is to try to supple-ment the treatment with in-jections. Cortisone injections

Chronic Knee Pain: An Orthopedic Surgeon’s Approach


into the knee give a concentrated dose of anti-inflammatory medica-tion into the knee. These shots can be given up to every three months if needed, but can cause both local and systemic side effects. As the ar-thritis progresses the effectiveness of the steroid injections decreases.

Recently, a new type of injection has been used for knee pain, called viscosupplementation. These “gel shots” are given in a series of injec-tions, and have been shown to be effective in approximately 75% of patients. The series can be given every six months. Patients should continue to do home exercises and stay as active as possible during these treatments.

The final step when all of the above treatments have failed is to perform a total knee replace-ment. The time to do this is up to the patient, when they have “had it” with the pain and failed con-servative treatment. It is a major surgery, however, and the results are life changing. Over 400,000 knee replacements are performed in the US every year. There are risks involved with the surgery that need to be discussed between the patient and the physician. Some patients are not candidates for joint replacement due to medical problems that put them at risk for surgery. These patients are treated with continued conservative treat-ment and other methods such as selective nerve blocks and pain

management modalities.

Knee pain is a real issue, but with the right approach and treatment, many patients can get back to the active and healthy lifestyle they desire.

Dr. Chhabra is a national expert in the field of orthopedic surgery, knee surgery, and sports medicine. He is Board Certified in Orthopedic Surgery with Subspecialty Certifica-tion in Orthopedic Sports Medi-cine.

Dr. Chhabra specializes in arthroscopy of the knee and shoulder, minimally invasive surgery and sports-related injuries. He also treats complex disorders of the knee such as multiple ligament injuries, articular cartilage procedures, oste-otomies, unicom-partmental knee replacements, total knee replacments, and meniscal trans-plants. For an appoint-ment with Dr. Chhabra, please call the Ortho-pedic Clinic Association (TOCA) at 602-277-6211.

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 consist-ently post photos that are sent to us on Face-book, but the WINNER will be featured in an autumn issue of Arizona Pain Monthly!

The three categories are: most famous per-son, 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 NameNames of other people in the photoThe city and state where you liveThe location where the photo was taken

Send your submissions to: [email protected]

If you have any questions, you can also contact Arizona Pain Specialists via that email ad-dress.

We hope to see you and Arizo-na Pain Monthly traveling the globe soon!

Joe in the Wasatch Mountains Eden,UT

Kim in Sacred Rim Wind River Mountains, WY

Taking Arizona Pain Monthly Around the Globe!

Suzie in Maui, HI

Ashley with Darth Vader in Las Vegas, NV

Dungeness crab in

Sedro-Woolley, WA

Taylor proves it’s never too early to be pain-free!

Kristen in Washington, D.C.

Page 6

Page 8Arizona Pain Monthly | August, 2010

Jamie Varner will continue to receive treatment as he heals and prepares for his next fi ght.

Naming pain physicians as “the only ones tough enough to treat MMA fighters,” Jamie Varner is as tough as they come. Often training and fighting through multiple injuries, Mixed Mar-tial Arts (MMA) fighters suffer from debilitating pain that is most often treated with at-home remedies such as heat, ice, and over-the-counter pain killers. Varner, however, has discovered that pain physicians have been able to help keep him in fight-ing form. “The procedures and chiropractic care I get keep me healthy,” Varner says of his treat-ment programs. “I see them as preventative and on-going mea-sures; they keep me training and that’s the most important thing.”

On June 20th, Varner fought against wrestler Kamal Shalorus which ended as what many fans are seeing as a stolen victory. Varner came out fight ready, and fought well with impressive hand and foot speed despite Sha-lorus delivering multiple illegal kicks and maneuvers. However, due to controversial scoring, Var-ner came away without a victory and the match ended in a split draw. In addition to the disap-pointing scoring, Varner suffered multiple injuries including a fractured hand and foot.

An MMA fighter, by trade, has to be tough and has to sustain painful injuries. While they may be able to stay tough during the fight as the adrenaline is flow-ing, once they’ve come off their “fighter’s high,” reality – and often searing, debilitating pain – sets in.

A medial branch block is a pro-cedure many pain physicians use to treat neck and back pain. A minimally-invasive procedure, a medial branch block reduces the

irritation and inflammation that cause pain in the spine and often relieve pain quickly, allowing a patient to get back to their daily activities. Varner was deemed a candidate and was quickly scheduled for a medial branch block, which relieved his hor-rible back pain and allowed him to return to his rigorous training schedule.

“Before my last round of treat-ment, I had the worst back pain,” Varner says. “The pain was in my lower back, and was a spasming pain. Sometimes, it would spasm so badly, I wouldn’t be able to throw a punch, grapple or do any lifting. It got so bad at times that I literally could not move, I couldn’t do anything. The pain was absolutely debilitating.”

For anyone, this kind of pain would be severely limiting, but for someone who devotes their entire life to being a top athlete, it is especially devastating. “Training is my entire life,” Varner says. “I eat, sleep and train. To not be able to do that – I’m not living my life. The fight is important, of course, but that only lasts minutes. I train daily for months up until those fights. I devote most of my time to train-ing in preparation for my fights.”

In the few hours that Varner is not training, he is involved in helping others. As a youth, Varner suffered from spinal meningitis and now is devoted to help-ing young people who are challenged, but in differ-ent ways. Varner regu-larly works with at-risk and homeless kids and encour-ages them to find some-

thing they are excited about, using himself and fighting as an example. “I like being an MMA fighter, it’s what I do and what I live for,” Varner says. “I can’t even imagine not training and working toward my fights every day.”

Varner continues to receive on-going chiropractic care in the form of disc decompression, acupuncture and a TENS unit, and says that if the back pain were to return, he would undergo a me-dial branch block again because of the complete pain relief he has gained.

“I would recommend seeing a pain physician to anyone, not just fighters and other athletes,” Varner suggests. “I’d say anyone who is having back or neck pain should see a pain physician. It has completely fixed that prob-lem for me.

Varner continues to receive regular chiropractic care.


Fighting To Be Pain Free

Non-Surgical Spinal Decom-pression is a treatment that gradually lengthens and decom-presses the spine. The traction generated by the spinal decom-pression creates a negative pres-sure within the discs and helps restore normal spinal movement and function. Although the idea of spinal decompression has been around since Greek antiq-uity, Former Deputy Minister of Health in Ontario, Canada, Allan Dyer, MD, PhD is credited with the development of the heart de-fibrillator as well as non-surgical spinal decompression. Inspired by his own back pain, he pio-neered the modern computerized spinal decompression. In 1991, Dr. Dyer introduced the VAX-D; this equipment was effective, but expensive, only treated the low back, and forced the patient to lay face down. In the late 1990’s other manufacturers began producing their own versions of non-surgical spinal decom-pression machines, and each of these manufacturers claim their equipment is better than that of the competition. You can think of these different types of decom-pression tables as automobiles. Yes, there are differences in how they look, but they all work the same way. Some have more stain-less steel, some have DVD play-ers, but to date there aren’t any published findings showing one is better than the other.

How does it work?The discs of the spine are un-

der constant pressure, which greatly slows the rate of healing. This pressure is measured in mmHG, just like a weather ba-rometer. While you are standing, the gravitational load from your upper body plus the muscular

tension within your spine creates 100mmHg of pressure within your lumbar spine. There is enough muscular tension keeping your spine together that, when you are lying down, the pressure still measures 75mmHg. Inver-sion tables use gravity to help reduce this pressure and stretch the tight ligaments and muscles of the lumbar spine only. Inver-sion therapy has been shown to reduce this pressure in the lumbar disc by over half (40mmHg) when compared to lying down, but has some significant drawbacks with treatment as discussed in the July issue of Pain Monthly magazine.

The decompression machine has a specific cycle that is determined by the doctor. The machine can be set up to focus the tension in the lumbar region or the cervical spine (neck). It begins with a slow loga-rithmic increase in tension, which allows a negative pressure to occur within the disc. Then, after a holding period, the machine will slowly release the tension. This is critical to avoid muscle guarding and spasm and achieve a therapeu-tic effect. A negative pressure of approximately -160mmHg is cre-ated by this sequence of motions. This negative pressure creates a vacuum-like effect within the discs. Repositioning and drawing in of the jelly-like fluid within the discs called the nucleus pulposus occurs due to the vacuum. The discs in your body are living tissues, but lack a direct blood supply. Like the other cartilage of your body, the discs of your spine get oxygen and nutrients through movement by a process called imbibition. The intradiscal vacuum created by the decompression treatment is thought to draw moisture, nutri-ents, and oxygen back into the

discs from the vertebral bones above and below.

Although pain might start to sub-side within a few NSSD treatments, it is crucial to continue a treatment regimen. Spinal decompression treatment consists of about 12-25 sessions spanning a four to six week period and can be utilized in conjunction with other interven-tional procedures when trying to avoid surgery. The number and the length of time the treatment sessions span are dependent on the patient’s condition. The lack of pain does not indicate a full recov-ery, as any trauma to the disc wall takes time to heal properly. Given the chance, non-surgical spinal de-compression can help ameliorate chronic neck and low back pain.

Who is a candidate for spinal decompression?There are numerous structures

in the spine that can cause spinal pain. The first and most impor-tant step in treating pain is to find out what is causing your pain and get an accurate diagnosis. It is important to note that patients may have similar symptoms, but different diagnoses and therefore should be treated differently. People suffering from bulging or herniated discs, degenerative disc disease, stenosis, facet syndrome, or those that have had a failed back surgery without hardware are all eligible candidates for non-surgical spinal decompres-sion therapy. Patients are not candidates for spinal decompres-sion if they have surgical hard-ware, metatastic cancer, severe osteoporosis, recent vertebral fracture, are pregnant, or suffer from unstable spondylolisthesis.

-Dr. Chance Moore, Chiropractor


Q: Healthcare in the country is changing. What are physicians doing to make sure that patients will still receive the best care possible?

As the Vice-President and Sec-retary of the Arizona Society of Interventional Pain Physicians, a local chapter of the American Society of Interventional Pain Physicians (ASIPP), we take our titles and the responsibilities that come with them seriously. Healthcare is changing, and we felt we needed to step up and use our knowledge and perse-verance by running for these offices.

We both are very honored by the election outcome and we will collectively strive to pre-serve our patients’ access to much needed pain management care. We hope to become more active in the state of Arizona by raising more awareness on a legislative level. As a first step in becoming involved, we at-tended the American Society of Interventional Pain Physicians’ Annual Meeting in Washington, DC. The conference focused on the challenges ahead for health-care as well as how we can best prepare for our specialty’s future in light of the recent healthcare reform. At the con-clusion of the ASIPP conference, we met with the staff members for Senators McCain and Kyl, and Representatives Shadegg, Mitchell, and Franks. We dis-cussed a couple of issues that are very important to us:

- We lobbied on behalf of the National Pain Care Policy Act, which identifies several goals to increase awareness and educa-tion for both healthcare provid-

ers and the general public re-garding pain management. The bill also encourages increased research efforts into the causes of pain and potential treatments through the National Institutes of Health. Lastly, the bill would require the convening of an Institute of Medicine conference on pain care which would then report its findings to Congress. We stressed to the lawmakers that unfortunately, accord-ing to the Centers for Disease Control, approximately one out of five people suffer from chronic pain. In fact, pain in the lower back area is the primary reason that patients visit their primary care doctors. Portions of the National Pain Care Policy Act were authorized under the healthcare reform legislation, and they are currently awaiting funding through the appropria-tions process in Congress. We will keep everyone posted on the outcome.

- We discussed the reautho-rization of the NASPER (National All Schedules Electronic Reporting) program. The NASPER bill provides the reau-thorization of funding to states that develop and maintain databases to help prevent misuse of prescription narcotic pain medications. Pre-scription narcotic pain medications are now only second to mari-juana as the top drugs of abuse in the United States. Dr. Carlson is particularly concerned that “the number of teenagers who have sought rehabilitation treatment for addiction

to prescription medications has increased 300% in the past 10 years.” Prescription drug abuse is responsible for more deaths than motor vehicle accidents in 16 states. The preservation of these databases, and bet-ter coordination between the states that have them, will serve to preserve the availability of these medications for patients who truly need them.

Overall, we felt our mission on Capitol Hill was a success. We were able to interact with nu-merous Members of Congress, as well as their health policy advisors to educate them on these important issues facing those who suffer from pain. We hope this trip is the beginning of a long and successful process of improving patient care.

Dr. Patrick Hogan, DO, Vice-President of the Arizona Chapter of ASIPP &Dr. Jonathan Carlson, MD, Secretary of the Arizona Chapter of ASIPP



Meet Robin Ervin, Nurse Practitioner!

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 [email protected].

Dayna is never seen without her great smile, and many patients find her cheerful presence to be a calming factor.

Dayna works in patient services as a “check-in girl,” as-sisting patients with the check-in process when they first arrive at the clinic. She has been at Arizona Pain Special-ists for nine months, says she has always wanted to work in the medical field.

Dayna truly enjoys her job and says, “patients who come into Arizona Pain Specialists are in a lot of pain. I believe a smiling face can help them feel more at ease here.”

A nurse practitioner in the Scottsdale Arizona Pain Special-ists office, Robin Ervin likes to travel and spend her free time with her family.

See how much you have in common with Robin!

Favorite activities: Snorkeling, traveling, rockwall climbing.

Favorite TV shows: House Hunters and any show on HGTV!

Favorite food: Seafood paella.

Favorite location in the world: The British Virgin Islands.

Favorite things about Arizona: I love the heat!

Favorite bands: Pink and Prince.

Favorite book: Anything by James Patterson.

Crazy fact about you: My godfather was a patholo-gist and my father was a laboratory manager, so I saw my first autopsy at 10 years old.

Unknown Talent: I can play the piano.

What celebrity do people say you look like? Holly Robinson Peete.


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Arizona Pain Monthly August