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Health Matters: Providence Holy Cross Medical Center | 5 Medications Therapies Surgery Interventional Procedures F or years, Richard Post had a nagging pain beneath his right shoulder blade, a "constant, daily, hour-by-hour pain" that began in 2009 and never left. A retired corporate credit manager, Post is an avid fisherman and likes to work in his Santa Clarita garage. But the discomfort got in the way of his mobility. He tried acupuncture and physical therapy. He had CT scans and MRIs and injections and even several surgeries, including a shoulder replacement. "Every time I saw a doctor," says Post, "I was explicit about where my problem was located, going so far as to put a dot of ink on my skin. It was in a very specific location and did not radiate through the shoulder and down my arm. But the first doctor I saw focused on my shoulder arthritis, and every doctor just read his report. When you've had a couple of surgeries and you still have the problem, to me that's a big issue." Then he saw Nikhraj Brar, MD, an accomplished interventional spine and musculoskeletal physician at Providence Holy Cross Medical Center. Dr. Brar uses minimally invasive spinal procedures like injections and nerve stimulators to relieve pain from nerve injury, back pain, osteoarthritis, tendon strains and joint injury or degeneration. "When I see patients, they are in subacute chronic or intractable pain," says Dr. Brar. "It's a stressful time for them. My approach is to not just look at them as a number on a pain scale but to understand them as a whole person. I look at their physical limitations and how I can assist to restore their function, mobility and movement." In Post's case, Dr. Brar did something radical: He listened. "He had my whole file," says Post, "and he put it off to the side and said, 'Tell me specifically about your issue; now show me where it is.' I know I've got arthritis—it comes with age. But I told Dr. Brar that what I have is not arthritis. And he agreed. He said, 'Here is where your pain is.' And he put his finger right on it." "Everybody but my wife will tell you I'm a great listener," Dr. Brar says with a laugh. "And Mr. Post wanted someone to listen to him. He had a legitimate pain complaint, and the location wasn't typical of shoulder arthritis. Because of what he was describing, I had a suspicion it was coming from a nerve." Dr. Brar was able to trace the pain to a muscle affected by the dorsal scapular nerve. First he tried a nerve block, an injection of anesthetic to the targeted area. When that did not give sustained relief, he decided to implant a peripheral nerve stimulator to interrupt the pain signal. "You could think of it like an on-and-off switch," he says. "If the nerve is always on and constantly causing pain, a stimulator can send an electrical impulse to turn the nerve off." The stimulator "is very small, with leads about the size of a hair follicle," the doctor explains. "You don't even need to make an incision—you can just thread it in using image guidance, like a live X-ray." In January 2021, Post had an outpatient procedure to implant the stimulator. And as soon as Dr. Brar got near the nerve and turned the stimulator on, the pain disappeared. "I started getting relief almost immediately," says Post. "On a scale of zero to 10, it dropped from a constant 7 to maybe a 2." The stimulator is designed to stay in place for two months, though pain relief can last longer. Post wound up having a second stimulator implanted later that year, in December. And even once it was removed, he remained pain-free. "Dr. Brar told me that he hoped I would get 50% to 60% relief," he says, "and I'm getting 100%. It's unbelievable." Post emphasizes that he appreciates how "Dr. Brar makes it personal. And it's not just him. I've had it arranged now where all my doctors are at Providence Holy Cross. The care is just phenomenal. You don't get that kind of medicine anymore, with all the ins and outs of different medical plans. Dr. Brar is the exception. And I'm finding that with all the doctors I've had with Providence Holy Cross— it's truly a hand-in-hand relationship." To learn more about treating your back pain or to schedule an appointment with a physician, call 844-510-4325. Dr. Nikhraj Brar A SPECTRUM OF TREATMENT The many options for relieving chronic pain More than 51 million Americans suffer from chronic pain, according to the Centers for Disease Control and Prevention—20% of the U.S. adult population. Pain costs Americans $560–$650 billion a year in health care costs and lost productivity, notes Dr. Nikhraj Brar. "People will tolerate a lot of pain for a long time," he says. "But the earlier you have treatment, the better you can prevent that pain from getting worse. There are multiple things you can do prior to having a big surgery." Dr. Brar advises those suffering from chronic pain to choose a doctor who is fellowship-trained and board- certified by the Accreditation Council for Graduate Medical Education (ACGME). "They're going to be trained to treat you conservatively, along a continuum of care," he says. "It could be as simple as physical therapy or a prescription for nonaddictive medication. But rather than doing those things on your own, let us follow up and be your champion." These include over-the-counter anti-inflammatory drugs as well as topical medications. More stubborn pain may respond to joint or muscle injections; nerve ablations, in which nerve tissue is destroyed; or the implantation of small nerve- stimulating devices. Patients may benefit from physical therapy, chiropractic visits, acupuncture, yoga or exercise. "Most people will get better with these first two categories," says Dr. Brar. Major advances in minimally invasive and robotic surgery mean faster recovery times for patients. For more information, read our interview with neurosurgeon Justin Spooler, MD, on page 6.

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