Acupuncture is best known for pain control but can be used to treat a wide variety of health conditions. The treatment involves the stimulation of various acupoints on the body. There are hundreds of these points on the body and each acupoint has a unique effect. The points used during a treatment are selected by the acupuncturist based on the patient’s symptoms and overall health condition. The goal of acupuncture treatment is to relieve symptoms, prevent their recurrence and to help improve the patient’s overall health condition.

• Asthma
• Carpal Tunnel Syndrome
• Dysmenorrheal
• Fibromyalgia
• Headache
• Low Back Pain
• Myofascial Pain
• Nausea & Vomiting
• Osteoarthritis
• Postoperative Pain
• Tennis Elbow

• Lumbar Epidural (Translaminar)
• Thoracic Epidural (Translaminar)
• Caudal Epidural (Translaminar)
• Cervical Epidural (Translaminar)
• Lumbar Transforaminal ESI
• Thoracic Transforaminal ESI
• Cervical Transforaminal ESI
• Stellate Ganglion Block
• Hip/Bursa Injection
• Lumbar Sympathetic Block
• Sacroiliac joint Injection
• Trigger Point Injection
• Facet Joint Injection
• Piriformis Injection
• Ilioinguinal Block
• Medial Branch Block
• Shoulder Injection
• Bier Block
• Botox

A lumbar epidural injection is an outpatient procedure.It's often done in a hospital or an outpatient surgery center. Before your injection, your doctor will ask you questions about your health. He or she also will discuss how you need to prepare.

A BLOCK is a special test. It helps your doctor find the cause of your symptoms. During the test, medications is injected near your spine. This "blocks" the sympathetic nerves in that region. If these nerves are causingyour problem, the injection will relieve your symptoms for a while.

Continue Blocks/Injections Next Page >>

To help relieve your pain, mediation is injected into the epidural space. This space surrounds the dura within the spinal canal. Your doctor may also do a nerve block. During the procedure, medication is injected near aspecific nerve root (the part of the nerve that leaves the spinal canal). For certiain types of neck pain, your doctor may suggest CERVICAL EPIDURAL INJECTION. with the treatment, medications its injection help the doctor find the sorceof the pain. Its can help relieve your pain and soreness.

Your doctor may have suggested you have a LUMBAR EPIDURAL INJECTION. This procedure can help relieve low back and leg pain by reducing INFLAMMATION (swelling and irritation). Also, an injection can help your doctor diagnose the source of your pain by numbering certain areas of your back. Where you are injected depends on the goal of the injection.

General Information: These are injections of steroids (cortisone medicines) into the space just outside the covering (the dura) of the spinal cord. Because the injection is outside (epi) the dura, it is called an epidural injection. This procedure has nothing to do with spinal anestesia used for operations.

The spinal cord travels from the brain to the waist in a tunnal in the back pary of the spine. About everyinch along the way,the spinal cord gives off branches to the right and left. These branches carry sensations from the brain to various part of the body to make move. Also these branches send back varity of sensations(e.g., pain) through the cord and then to the brain.

These injecctions are performed when it is thought that inflammations is part of the process that causes the pain. A steroid medicine, which is a very potent antiinflammatory drugs, works best when it is injected into the area where the inflammation is occurring. Because the nerves of the spinal cord pass through the epidural space, the medicine comes in contact with them.

Receiving medical treatment for cancer can be a physically, emotionally and spiritually daunting task for patients and family members. The pain associated with a malignancy, as well as to some of the treatments, is often one of the more under-treated and poorly recognized problems.

The Bay Area Pain & Wellness Center is committed to providing the very best services for treating cancer pain. This may include offering our expertise in managing different types of pain medications, as well as coordinating ancillary services with home health nurses, hospitals and hospice organizations.

In some difficult cases, special interventional treatments are required due to a lack of efficacy or untoward side effects from traditional pain medicines. This may include the use of implantable spinal catheters and infusion pumps.

Whether such technologically advanced therapies are needed or not, Bay Area Pain & Wellness Center physicians, nurses and staff will remain attentive and available to the needs of the patients and loved ones. We will coordinate with your oncologists, surgeons, and nurses to provide complementary care with the rest of your team.

The Bay Area Pain & Wellness Center is committed to the comprehensive and integrated treatment of complex pain problems. Our evaluation process involves a consultation with one of our pain specialists as well as a consultation with a psychologist and physical therapist. Our goal is to treat the whole person. This pathway involves a program of education, rehabilitation, behavioral management and medication management. Your treatment will be under the leadership and supervision of your pain specialist. He or she will work closely with all of your providers in an interdisciplinary approach.

There is no cure for chronic pain, but with the proper treatment, a person can reach higher functional levels and reduce medication intake. It is estimated that just 25% of people who suffer from pain receive proper treatment.

We have developed a comprehensive, interdisciplinary approach to treating pain. A large part of our treatment plan is the Functional Restoration Program (FRP). The FRP is an intensive group process of education, cognitive behavioral therapy, and physical reconditioning through exercises and functional activities and medication optimization. Through this approach, all the pieces come to place. Patients with chronic pain regain control and take charge of their lives.

This pathway involves a program of education, rehabilitation, behavioral management and medication management.

Our physicians and nurse practitioners also use conventional methods in treating people who don't qualify for the FRP. However, no individual is treated without the education and strategies practiced in the FRP. Each person plays a key role in his/her own treatment plan. Thus the same philosophy in the FRP is carried throughout the practice, treat the pain, teach the person.

The CRPS and RSI pathways address neurological, musculoskeletal and emotional factors to promote overall function and well being.

For acute CRPS cases (also called Reflex Sympathetic Dystrophy or Causalgia), we provide a combination of physical rehabilitation, medication management, psychological treatments and special nerve blocks to promote the recovery of extremity range of motion, strength and function. We employ varying techniques to improve pain control.

Patients with chronic CRPS and RSI receive comprehensive interdisciplinary care that addresses the full impact of the problem on their lives.

Behavioral health specialists provide care in treating depression, anxiety, anger or other troubling mood states.

The area in your brain where you perceive pain is closely connected to the emotional centers of the brain, at least partially explaining why most people with pain have isturbance in their mood. Our behavioral specialists will teach you tools to better manage depression, anxiety, anger and other troubling feelings that keep you from living more fully.

Adjusting to changes in life due to pain: Chronic pain tends to bring about significant changes in your life, such as limiting your activity level or ability to fulfill life roles, such as mom, breadwinner or spouse, or maintaining the responsibilities you had before the pain. Our behavioral specialists help people to find meaning and fulfillment in their lives despite the pain

Using power of the mind to better manage pain: Ever notice that the pain you feel with a stubbed toe is different when it happens in front of a room full of strangers than when you are home alone after a particularly bad day? This has to do with things like attitude towards the pain, your belief in your ability to manage the pain, your ability to distract from the pain and what you are telling yourself when you have pain. Behavioral specialists help people build confidence in themselves and to promote independence and lessen anxiety about the pain and the future.

Teaching stress management and relaxation techniques: Most people in pain tend to live in a state of chronic stress. Inevitably, your body is exhausted from living in pain and your mind is taxed from living with worry. Behavioral specialists help you to relax your mind and body by teaching you how to manage the stressors in your life that may maintain or intensify your pain. Specific stress management methods include relaxation techniques such as abdominal breathing, progressive muscle releasing, and guided imagery, which have been proven to be effective for people in chronic pain.

Electromyography:
The electromyography (EMG) examination is a test of nerve and muscle function. The EMG exam may include nerve conduction studies and the EMG needle exam.

Nerve conduction studies are performed by placing disks on the skin over nerves and muscles and recording responses to electrical stimulation of the nerves. The nerves are stimulated with mild electrical impulses that are felt as slight shocks, much like the sensation experienced when you touch a door knob after walking across a wool rug in cold weather.

The EMG needle exam involves direct recording of muscle activity at rest and during movement, and is done by inserting a small needle into various muscles. A pinprick sensation is experienced when the needle is inserted and sometimes a mild, dull ache is noted while the needle is in place. The EMG exam is safe, well-tolerated, and involves only minor discomfort.

Life coaching is taking someone from where they are to where they want to be. Using a variety of techniques from yogic philosophy, NLP, and basic psychology to discover what is stopping them, change deep seated patterns, and heal the nervous system. Creating more freedom, spiritual growth, and new beginnings.

Food, diets, and eating get more attention in popular culture today than any topic imaginable. Bookstores and magazine racks are crowded with publications hawking magical” foods that can make us look and feel better. Proper nutrition is one of the most important building blocks of good health. If your nutritional habits are not rock solid, you cannot be 100 percent healthy.

The foods we eat directly impact the weight we place on our joints and spines, the strength of our muscles, the amount of inflammation in our bodies, and the health of the blood that travels through the vital organs like our hearts, brains, and livers. Food should never be an afterthought! Instead it should be an ongoing opportunity to cleanse your systems of harmful toxins and inflammation, while taking in plenty of the right nutrients.

Don’t eat more calories a day than you burn in a day. You can use the Mayo Clinic’s Calorie Calculator to get a rough idea of the number of calories you need to burn daily. It’s on their Web site at www.mayoclinic.com

These simple steps create an anti-inflammatory diet:

• Eliminate the white menace: sugar and foods made ofreal flour that is quickly converted into sugar. Read labels and watch out for high fructose corn syrup.

• Avoid excessive salt. Premade meals and fast foods are usually pretty salty, so if you avoid them, your salt intake will automatically subside.

• Throw out processed foods. This will help you stay away from Tran’s fats, high fructose corn syrup, and other sources of empty calories.

• Reduce your dependence on caffeine for optimum mental and physical performance.
• Drink clean water.

• Never skip breakfast, and eat about six small meals per day.
• Have some protein with each meal.

• Make foods rich in omega-3 fatty acids in place of foods high in saturated fats.

Work is one of the major activities of life. The loss one experiences from a major or chronic injury/ illness can be devastating. Not only does this sense of loss come from the physical loss of function, it is also accompanied by social loss (i.e.: loss of lifestyle, social isolation), mental loss (i.e.: depression, anxiety, loss of self esteem) and financial loss (i.e.: lost wages, loss of livelihood). That is why a multiphasic approach is so essential to the healing and recovery process.

Work affects every one of these areas from lifestyle, livelihood and social connections to self-esteem and financial independence. That is why, we offer Return to Work services. Through our Functional Restoration Program, patients often have a renewed belief that they can return to work for the first time in a long time. Once patients come to this realization, they often feel at a loss as to how to accomplish this. Some need to consider new careers for the first time in their lives. We provide return to work services to help guide patients through this process while they are in the Functional Restoration Program.

Services are customized to the individual patient which may include:
Assistance with returning to work at the patient’s place of employment through consideration of ergonomic adjustments/ tools, assistive devices, or suggestions for restructuring job tasks or modified duties. We can facilitate these discussions if all interested parties are willing.

If return to work at the patient’s place of employment is not possible or practical, we can assist the patient with job searches for similar employment elsewhere or considerations for a new career.
These services may include:
• Skill evaluations
• Interest testing
• Caree searches
• Goal setting
• Resume building
• Interview skills • Enhancement tools
• Job search resources
• Identifying job opportunities
• Identifying potential training
• Providing additional resources

Symptoms:
Symptoms include pain in and around the ear, the jaw joint, temples, often accompanied by muscle pain, headaches, limited jaw opening and chewing difficulties.
• Temporomandibular discorders (TMJ)
• Myofascial Pain
• Headaches
• Orofacial Neuropathies
• Dental Sleep Medicine

Evidence based research indicates that conservative, reversible treatment is the treatment of choice. Examples are: physical therapy, behavior modification and if needed, night time wear of orthotic appliance. More invasive treatments for those patients who do not respond to conservative therapy include muscle and joint injection and arthrocentesis.

"I'm in pain, why do you want me to see a psychologist?"

If you have been referred to one of our psychologists or staff psychotherapists at the Bay Area Pain and Wellness Center, it is not because your doctor thinks you are crazy or the pain is in your head. Rather, you have been referred because our experience, and the scientific data, has shown us that working with the whole person to manage their pain is much more effective than medical treatment alone. Our behavioral health team is uniquely trained to work with you in developing a total lifestyle plan for managing your pain.

What Do Health Psychologists do?

Generally, treatment with a health psychologist is time limited (6-12 sessions on average) focusing on ways for you to manage your pain and live a fulfilling life despite the pain. You are not going to be lying on a couch revisiting your childhood in depth. Issues from the past are discussed only as they relate to your pain management.

Before beginning treatment with our behavioral staff, your first visit will usually be an evaluation with one of our psychologists, either Dr. Kimeron Hardin or Dr. Greg Garavanian. The entire evaluation typically consists of an interview about your pain, its effect on your life and what your life was like before you had pain. It usually takes about one hour. In some cases, the psychologist will also request that you complete paperwork that can help determine whether or not you are depressed, excessively anxious or having difficulty adapting to living with pain. After the evaluation follow up appointments are scheduled with Dr. Hardin, Dr. Garavanian, or Christine Endo, MFTI.

Continue to Pain Psychology 2

Treating depression/anxiety/anger or other troubling mood states. The area in your brain where you perceive pain is closely connected to the emotional centers of the brain, at least partially explaining why most people with pain have disturbance in their mood. Health psychologists will teach you tools to better manage depression, anxiety, anger and other troubling feelings.

Adjusting to changes in your life due to pain. Chronic pain tends to bring about significant changes in your life, such as limiting your activity level or ability to fulfill life roles, such as mom, breadwinner or spouse, or maintaining the responsibilities you had before the pain. Health psychologists help people to find meaning and fulfillment in their lives despite the pain.

Using the power of your mind to manage the pain better. Ever notice that the pain you feel with a stubbed toe is different when it happens in front of a room full of strangers than when you are home alone after a particularly bad day? This has to do with things like attitude towards the pain, your belief in your ability to manage the pain, your ability to distract from the pain and what you are telling yourself when you have pain. Health psychologists help people build confidence in themselves and to promote independence and lessen anxiety about the pain and the future.

Teaching stress management and relaxation techniques. Most people in pain tend to live in a state of chronic stress. Inevitably, your body is exhausted from living in pain and your mind is taxed from living with worry. Health psychologists help you to relax your mind and body by teaching you how to manage the stressors in your life that may maintain or intensify your pain. Specific stress management methods include relaxation techniques such as abdominal breathing, progressive muscle releasing, and guided imagery, which have been proven to be effective for people in chronic pain.

Health psychologists are specialized in treating people with chronic pain and aware of the issues they commonly face, such as depression, anxiety, worries about the future, finances, and making decisions around medical treatments. They are often very helpful to people who have pain.

If you have more questions about what health psychologists do and how they help people in pain, please ask your provider or ask to speak directly with one of the health psychologists or staff psychotherapists.

Sex is an important aspect of living that can be greatly affected by chronic pain. If you have questions or concerns about how to improve your sexual functioning while living with chronic pain, please do not hesitate to ask someone on the rehab team for help. We’ve helped many patients to improve their sex life and we are happy to share our knowledge with you. We understand that sex can be a difficult topic for some people to talk about and we will treat your questions and concerns with the utmost respect.

As a patient in our clinic you are probably well aware that we emphasize the mind-body connection to obtain optimal health. Sex always involves our mind and body at the same time. Therefore, an approach that combines physical and mental strategies is most likely to help you reach your goal. Here are some different strategies to consider as you make steps to improve your sex life while living with pain

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Managing a chronic pain condition successfully means having the most "normal" lifestyle as possible - including a happy sex life. Your sex life maybe a bit different because of your chronic pain condition, but it doesn't have to be a thing of the past. At the clinic your providers understand that while sex may be a difficult thing for you to talk about it is also important. We respect your privacy and we are also available to discuss your specific concerns and share with you the knowledge we have about improving your sex life if it has been impaired by your chronic pain.

The Bay Area Pain & Wellness Center is committed to the comprehensive and integrated treatment of complex pain problems.

In order to do this effectively and efficiently, we have developed several different clinical pathways to assess and treat most of the patients we see in our practice.

This process allows us to better understand each and every one of you as individuals and treat you as a whole person.

During your initial consultation with your pain specialist, he or she will likely guide you into one of our specific clinical treatment pathways based on your needs.

This is a new and unusual concept in pain management that we hope will make your experience at the Bay Area Pain & Wellness Center the best possible.

Learn more about our Clinical Pathways:
• CPRS/RSD/RSI
• Spine Care
• Cancer Pain Management
• Chronic Pain Management

Complex Regional Pain Syndrome (CRPS) /
Repetitive Strain Injuries (RSI)

The CRPS and RSI pathways address neurological, musculoskeletal and emotional factors to promote overall function and well being.

For acute CRPS cases (also called Reflex Sympathetic Dystrophy or Causalgia), we provide a combination of physical rehabilitation, medication management, psychological treatments and special nerve blocks to promote the recovery of extremity range of motion, strength and function. We employ varying techniques to improve pain control.

Patients with chronic CRPS and RSI receive comprehensive interdisciplinary care that addresses the full impact of the problem on their lives.

Spinal reconstructive surgery can often prove to be a daunting task for patients. Such surgeries are labeled "fusions" and require an extensive amount of work around delicate nerves, joints, and bones in the spinal column. They often require the use of some type of hardware. The immediate perioperative period, as well as lengthy recovery phase, can pose many challenges for patients and their loved ones. These challenges may include a long and arduous process of physical rehabilitation, emotional stress and anxiety related not only to the recovery, but to the associated period of disability and complicated pain control.

Due to the complex nature and substantial cost of many spinal reconstructive surgeries, patients, family members, surgeons and third-party payers should carefully weigh the risks and benefits of pursing this form of treatment. We believe this process requires a global assessment of the patient, and it should not be limited to purely a structural or radiographic assessment.

A more comprehensive assessment must start with defining the goals of the surgery and making sure both the patient and the spine surgeon view these goals as realistic. Other factors that must be given careful consideration include the patient's level of fitness, the patient's emotional and psychosocial condition, the financial impact of surgery on the patient, and the patient's insight into the whole process. In some cases, providing the

appropriate care in areas identified as potential barriers to success can significantly improve the outcomes. In other cases, more conservative alternative treatments may prove to be more beneficial.

We can assist in pre-surgical screening for patients contemplating spinal reconstructive surgery in a number of ways. Our pain specialists can provide advice on surgical and postoperative pain medication issues to optimize the patient's ability to participate in physical rehabilitation. They can also provide a second opinion about medical factors associated with success as well as poor outcomes in such surgeries based on a global assessment of the patient.

Our psychologists can provide comprehensive consultations with testing to shed light on factors that often get overlooked in the surgical work-up of the patient. They may be able to assist in identifying and treating factors that may otherwise slow recovery. They may also be able to identify other factors that suggest a less than desired outcome, which can help surgeons, patients and third-party payers in the decision-making process.

The Center is sympathetic to the intricacies required for success in spinal reconstructive surgeries, and it is committed to providing the necessary expertise to help create the most positive experience possible for everyone involved.

• Functional Restoration Program
• Medication Detoxification Program
• Personal Training
• Introduction to Wellness
• Wellness-Advanced Practice
• Flare up management Lectures
• Healthy Bodies Class
• Individual Physical Therapy

In any traditional setting, physical therapy is directed towards rehabilitation of acute related injuries, or prevention of recreational/sport/work related injuries. Its role in the management of chronic pain is unique and often makes one wonder “What does PT have to do with pain?” Well, the answer is “Quite a bit!” A physical therapist specializing in chronic pain management can assist an individual in many aspects of rehabilitation. This ranges from global strengthening and developing a safe exercise program, to specific flare up management skills and application of specific cognitive strategies to shift an individual’s relationship with their pain. These factors make physical therapy an essential ancillary service in the successful management of chronic pain.

Patients that suffer from chronic pain have typically drifted into inactivity, muscle atrophy, weight gain and decreased endurance. These changes can lead to decreased ability to work, perform household activities and engage in social and recreational activities. Many people attempt to change this cycle, but find difficulty due to increases in pain and then further inactivity.

For some, rest and inactivity may feel like the best treatment for your pain due to a reduction of pain when at rest, but actually, this causes increased pain levels overall. When the body becomes inactive, your muscles become weak and tight, your joints become stiff and you have low energy levels. This leads to higher pain levels and more stress on the affected areas. For others, they attempt to continue their busy lifestyle, but end up burnt out by the end of the day. This lack of pacing also causes increased pain and often frustration.

How is physical therapy at BAPWC different than the physical therapy at other clinics?

A typical chronic pain therapist has minimal to no training in treating chronic pain. In school, therapists are taught how to treat acute pain, not chronic pain. The treatment is vastly different and therefore when a person with chronic pain visits a typical PT clinic, they receive acute pain treatment. Unfortunately, this is largely unsuccessful. Acute pain treatment focuses on passive treatments

including modalities (ultrasound, electrical stimulation), ice/heat, massage and some exercise. This treatment typically is not successful or provides only a temporary benefit for chronic pain. Chronic pain treatment focuses on managing your pain using skills such as pacing, flare-up management, slow and safe exercise development and progression and relaxation techniques. Treatment also focuses on assisting patients to overcome their fear of re-injury or fear of movement.

Acute care clinics often focus on one body part at a time. At BAPWC, you are treated like a whole, as we understand that your entire body works together to perform all daily activities. A low back injury can affect your neck or knees. Many people suffer from chronic pain in multiple areas and these need to be treated as a whole instead of piece by piece.

What are the services provided in the physical therapy department?

Individual physical therapy: One on one evaluation and treatment of musculoskeletal dysfunction. Specialty areas include treatment of spine dysfunction (both non-surgical and post-operative), shoulder, knee and ankle dysfunction, chronic pain, CRPS I (RSD), Thoracic Outlet Syndrome and Fibromyalgia.

What are the services provided in the physical therapy department?

Individual physical therapy: One on one evaluation and treatment of musculoskeletal dysfunction. Specialty areas include treatment of spine dysfunction (both non-surgical and post-operative), shoulder, knee and ankle dysfunction, chronic pain, CRPS I (RSD), Thoracic Outlet Syndrome and Fibromyalgia.

Work Conditioning: A program designed to increase the injured worker's endurance and lifting capacity, restore musculoskeletal functioning and to increase the worker's tolerance for job-related activities. This program is for the injured worker who may or may not have a specific job to return to, or is not ready to begin work hardening due to low functional level. The program is tailored for each individual client.

Functional capacity evaluation (FCE): An evaluation when in-depth information regarding the patient's physical or functional level is needed. The evaluation is a systematic approach to monitoring and reporting performance. This evaluation contains a battery of tests that focuses on selected work tolerances and/or physical capacities. Observation and objective measurements are used as well as the therapist's reasoning and judgment. Maximum voluntary effort is also measured through a variety of tests. An FCE is typically a 6-hour evaluation over 2 consecutive days, 3 hours per day.

A functional restoration approach focuses on increasing the patient's ability to complete their daily tasks, instead of focusing of eliminating pain. With pain that is chronic, the patient begins to deal with the fact that the pain will be a part of their life in the long term. Therefore, treatment must focus on management of the pain as well as increasing the patient's ability to perform their daily tasks. A functional restoration program focuses on posture, body mechanics, strength, flexibility, endurance and tolerance to allow the patient to return to their functional activities. Here's one way of looking at it: If you suffer from a pain level that is at a 6 out of 10 and your pain limits you to minimal activity, this program helps you to be more active, even if your pain is still at a 6 out of 10. Most people choose to be more, instead of less, active if the must be at that pain level!

The Primus BTE is a state of the art computerized evaluation and treatment tool. This machine has the ability to replicate almost any functional activity. The computerized evaluation and treatment tool combines isometric, isotonic, and isokinetic resistance with functional activities. It includes customized treatment templates for each patient, advanced training capabilities for neuromuscular re-education, stabilization and plyometrics and interactive functional anatomy software.

At the Bay Area Pain and Wellness Center (BAPWC) we understand treating chronic pain is a complex and ongoing process for our patients and for this we proactively strive for the best treatment solutions.

A common form of treatment for chronic pain is prescription medications, specifically opioid therapy. Over the past 10 years, the California Workers Compensation Institute (CWCI) reports opioid usage has increased 380%.

Along with the CWCI, the American Pain Society support Pain Medication Monitoring. With their support, we have integrated a Pain Medication Monitoring program here at BAPWC.

Program:
This program is a process that measures the presence and amounts of medications in your urine and other substances that could interfere with your own care plan. It also enables us to identify risks with your medications to reduce possible side effects and provides critical information needed to adjust your pain medication dosages.

Process:

You will be asked either on a random basis (or at certain appointments, determined by our staff) to provide a sample of your urine using a designated bathroom at our center. Our staff will interpret the results and may send the sample to an outside laboratory.

Results:

All results are confidential and remain protected as part of your patient record.

As always, we believe each person plays a key role in his / her own treatment plan. If you have any questions, please speak with one of our clinical staff at anytime