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Denervation procedure alleviates chronic shoulder, arm pain.

Patrice*, 61, relocated to Florida from her native Philadelphia, Pennsylvania seven years ago when her husband, a physician, accepted a new directorship at a large medical practice in Tampa. The couple considered the area’s warm, sunny climate a bonus.

“Getting out of the cold winter weather was something my husband and I thought about,” Patrice admits. “He looked for positions in places that were nice and warm, so when this offer in Tampa came along, the weather was icing on the cake.”

In Philadelphia, Patrice worked full-time for a group of colorectal surgeons. She was responsible for billing, appointment scheduling and coordinating patients with the operating rooms. But when she and her husband headed south, Patrice opted to remain unemployed.

“I didn’t look for a job when we got down here,” Patrice confirms. “My husband’s work schedule is very erratic. Some days, he comes home early, and other days, he’s really late. And we just became grandparents for the first time, so I need to be free to travel up north to see the baby.

“We also have two dogs that take up a lot of my time, and I do volunteer work in the community, which keeps me busy. My days are filled with activity.”

About a year ago, Patrice’s days became filled with discomfort as well. Her issue began with tingling in the fingers of her right hand, but it didn’t stop there.

“I felt pain from my elbow to my shoulder on my right side,” she describes. “I don’t go to doctors very often, so I just let it go. But whenever I worked on the computer, there was terrible pain in my right arm.

“It was a continual, achy, annoying pain, and it became a nuisance. My husband said, You’ve got to see somebody about that. He knew Dr. Panchal through his practice and recommended him. I was hesitant at first, but then the pain got so bad, I couldn’t take it anymore, so I agreed to visit Dr. Panchal.”

Sunil J. Panchal, MD, a board-certified interventional pain specialist, is the president and medical director of National Institute of Pain, which has centers in Lutz and Tampa.

“Patrice reported having pain that radiated from her neck into her right shoulder and upper right arm,” Dr. Panchal notes. “The pain pattern she described was classic for a chronic condition of the facet joints of the cervical spine, specifically the lower facet joints in the neck.

“When a patient with this condition bends their head backward or tries to rotate their head, the movement puts pressure on the nerves running through those joints and causes the radiating pain. This condition is often misdiagnosed as disc degeneration, but then patients’ symptoms do not improve following disc surgery because it was not the correct diagnosis.

“Patrice and I talked about options for pain relief. The short-term options included steroid injections, but a long-term option that I recommended is radiofrequency denervation. That’s a procedure to deactivate the nerve roots in the facet joints, which relieves the pain.”

“Dr. Panchal told me that some people get minor pain relief from this procedure, but most people get significant relief,” Patrice says. “He’s had patients experience pain relief for six, even seven years with this procedure. I thought about it for a day and decided I had nothing to lose and should give it a try.”

Practice Run

Dr. Panchal began his treatment of Patrice by performing a diagnostic test of her lower cervical facet joints. Under x-ray guidance, he injected a local anesthetic into the nerves of the suspected joints to numb them. Patrice experienced complete relief while those nerves were numbed.

“Dr. Panchal referred to this injection as a practice run,” Patrice remembers. “After injecting the medicine into the nerves in my neck, he sent me home with a worksheet, which I filled out every half hour.

“After about four and a half hours, my pain was back to where it was before the injection, so I thought, This isn’t going to work. But when I went back to Dr. Panchal the next day and told him that my pain returned after four and a half hours, he said, Perfect. I gave you enough medicine to last four hours. That showed that the treatment would work, so I said, Let’s go ahead with the procedure because the relief was great!”

During radiofrequency denervation, Dr. Panchal places a thin, insulated needle under x-ray guidance into the level of the joint where the nerve root is located.

“We place the needle at the desired location on the side of the spine,” the doctor informs. “We do not go through the spine, which is often a concern of patients. We assure them that throughout the procedure, we remain outside of the spine.

“First, I use an electric current to confirm that I am targeting the correct nerves, then I proceed with the actual denervation. For that, I use radiofrequency energy to heat the tip of the needle. This affects an area of the nerve only a couple of millimeters wide. The heat deactivates the nerve and its ability to send pain signals to the brain, resulting in pain relief.

“The nerves are expected to grow back eventually, but most patients achieve relief for at least one year, and many experience relief for much longer. And it is safe to repeat the treatment annually if necessary.”

“A Win-Win”

Dr. Panchal performed the radiofrequency denervation on Patrice’s affected facet joints in mid November 2019. By January 2020, she had achieved substantial relief from her aggravating arm pain.

“The pain is ninety-nine percent better,” Patrice raves. “And on top of that, my finger tingling, which the procedure wasn’t necessarily supposed to help, has dissipated significantly. It rated a seven on a scale of one to ten before the procedure, and now, it’s only a three. It’s a win-win for me.”

Patrice considers herself a tough patient and a harsh critic of medicine, but says her experience at National Institute of Pain was exceptional. She credits Dr. Panchal and his staff for the excellent encounter, as well as her recovery.

“Dr. Panchal is personable and very knowledgeable,” Patrice describes. “That was important to me because I didn’t know much about facet joint dysfunction or radiofrequency denervation going in. His staff is friendly and compassionate. They made me feel comfortable during my appointments.

“And radiofrequency denervation worked for me! Now, I can sit at the computer for longer than fifteen minutes without having to hold up my right arm. If it ever becomes necessary, I’ll have the procedure again in a heartbeat. I definitely recommend Dr. Panchal to anybody in pain. He’s an excellent physician.”

*Patient’s name withheld at her request.
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    • National Institute of Pain

      We treat each patient individually, using the latest equipment and various innovative procedures to diagnose pain and determine your care needs. We then assemble the appropriate interdisciplinary team of health care professionals who can best... Read More

    • Sunil J. Panchal, MD

      Sunil J. Panchal, MD, is board certified by the American Board of Anesthesiology in interventional pain medicine. He earned his Bachelor’s degree in Biology from Rensselaer Polytechnic Institute in Troy, NY, and earned his medical degree from... Read More