Relief Without Side Effects

Interventional injection offers alternative to prescription medications.

Soledad Teves experienced every caregiver’s nightmare after her 103-year-old father, Fernando Teves, went into the bathroom by himself – and then hollered for help.
“When he called out my name, I realized that something was wrong. I ran to him, and he was on the floor,” remembers Soledad, who shares a home with him. “He was trying to get up, and he couldn’t, and I couldn’t lift him up. I asked my brother to come over and help him, but after that, my father was in such pain. I was trying to make him comfortable, but he still was in pain.”

Fernando Teves with his dog, Dandy.

Fernando is back to enjoying walks with his dog, Dandy.

Over-the-counter medication didn’t alleviate Fernando’s intense lower back and leg pain, and Soledad knew she needed to help her father find relief.
Fortunately, Fernando had an appointment the next day with his primary care provider. That led to an imaging test, which resulted in a referral to Florida Pain Medicine and an appointment with Stephanie Epting, DO.
Fernando didn’t suffer any specific injury from the fall, but an MRI did reveal that he suffers from arthritis.
Soledad says her father has spinal stenosis, or narrowing of the spinal canal, and that in addition to the contusion he suffered from the fall caused him unrelenting pain.
Relieving Fernando’s pain without relying on prescription narcotics was important to avoid possible interactions with the numerous other medications he was already taking.
“Sometimes, it may be a situation of polypharmacy, meaning that the patient is on several medications for other conditions they have,” explains Dr. Epting. “Whether they are taking medication for blood pressure, diabetes or colon issues, for example, we have to really think about risks of interaction with the medication that we’re prescribing.
“Opiates can cause sedation and confusion,” she notes. “It was important to minimize opiates due to his fall risk.”
Based on Fernando’s symptoms and the imaging results, Dr. Epting came up with a plan that took into account the treatment goals that Fernando and his daughter sought to achieve.
“One of those goals was to treat him without medication as much as possible,” says Dr. Epting, “so we scheduled him for a caudal epidural steroid injection.”
The minimally invasive procedure involves injecting a steroid into the space where the irritated nerve roots are located. It can be effective in alleviating inflammation caused by such conditions as arthritis, pinched nerves, herniated discs and bone spurs.
A successful outcome depends on the precise placement of the injection. Dr. Epting uses x-ray technology, called fluoroscopy, to guide the needle.
“Before we actually inject the medication, we use contrast to show us where the needle is placed and where the injection will end up,” she informs.
The discomfort from the procedure depends on the patient’s tolerance,
Dr. Epting notes. Knowing what to expect can help minimize anxiety.
“We talk to patients through each step so there’s no element of surprise,” she adds. “They know exactly what’s going on. It allows the patient to have control. I tell them, If it becomes too much and you can’t take it, let me know, and we can stop the procedure. I don’t want patients to ever feel that they don’t have a choice, and I think that helps.”
Such injections may also be effective in helping patients tolerate physical therapy, which is “the first line of treatment for back pain,” Dr. Epting says. Physical therapy strengthens a patient’s core muscles to help prevent them from having a relapse of the discomfort.
The doctor supplemented Fernando’s injection with physical therapy and a home exercise program. She also prescribed a walker with a seat so he could rest when necessary.
While injections can be an effective interventional pain strategy, they’re not always the first course of treatment,
Dr. Epting stresses.
“We’ll definitely start with a more conservative approach, and we’ll take it to the next level if needed,” she explains.
Sometimes, a patient who takes a fall or endures another type of trauma may aggravate an existing condition, such as arthritis, leaving them with new or increased pain. Dr. Epting says that injections will not cure the underlying problem but can help with the patient’s symptoms.

Restore Function, Relive Life

At Florida Pain Medicine, their approach is complete, compassionate and comprehensive care based on the most up-to-date knowledge of pain and how to alleviate it. Doctors there treat soreness in the abdomen, arms, back, chest, feet, hands, head, hips, knees, legs, neck and shoulders.
Although injections, such as the one Fernando received, are effective for many patients, Florida Pain Medicine’s doctors go beyond relying on one or two methods to treat patients. Instead, they’re able to administer a large spectrum of treatments, singularly or in combination, including multiple medications that don’t have to be habit forming or narcotics based, as well as physical therapy, TENS units and braces. Other available treatments include techniques for blocking nerves that are causing pain and ablations to actually turn off the nerve.
Along with reducing the severity and duration of pain, such techniques allow the patient to resume or increase activities at home and work, overcome isolation, learn new skills to cope with pain, overcome problems sleeping, rehabilitate a condition or injury, and improve their quality of life.
Performing procedures in-office helps Florida Pain Medicine’s patients reduce the financial cost of their medical care, as opposed to procedures done in hospitals or ambulatory surgery centers.

Rapid, Lasting Relief

Fernando’s advanced age didn’t present any special challenges to his treatment, Dr. Epting notes.
“The way that I treated Mr. Teves is the same way that I treat a twenty-two-year-old or a thirty-year-old.”
“When it was finished, my father was soon able to walk little by little,” Soledad recalls. “He had relief almost the same day. By the third day, he said he didn’t feel anything.”
Fernando, who worked for a toolmaker in New York after emigrating from Peru, has been able to resume his everyday activities, such as reading, and strolling around his Temple Terrace neighborhood with the aid of a walker.
For the Teveses and Dr. Epting, that outcome represents the best-case scenario.
“It’s a great situation where he’s able to get back to his life and not have to repeatedly come back for follow-ups, or to rely on prescription medications that can lead to unwanted side effects,” the doctor summarizes. “We truly achieved our motto of restoring function so that Fernando could relive his life.”
Soledad says her father has confidence in Dr. Epting and won’t hesitate to return to her for more injections if he needs them.
“He was very happy after the treatment,” Soledad concludes, “so he did the best thing.”

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    • Florida Pain Medicine

      At Florida Pain Medicine, your interventional pain and diagnoses experts, their mission is to help you “RESTORE FUNCTION & RELIVE LIFE.” Florida Pain Medicine offers complete, compassionate, and comprehensive pain care. They provide the la... Read More

    • Stephanie Epting, DO

      Stephanie Epting, DO, graduated from the University of Miami with a Bachelor’s degree in Microbiology and completed her medical degree at the Philadelphia College of Osteopathic Medicine. She completed her residency at the New York Univ... Read More