Ormond Beach Gains Pain Relief Experts

Welcome an affiliate of a leading provider of progressive interventional treatments.

Kassia Silva, MD meeting with a patient

Kassia Silva, MD

A recent study from the Mayo Clinic revealed that, after skin disorders, doctor visits are most often prompted by joint pain, back pain and pain associated with osteoarthritis. Many of these patients complain of chronic pain, described as lasting three or more months.

Now open in Ormond Beach, Centurion Spine & Pain Centers specializes in the use of progressive interventional treatment options to address chronic joint, neck and back pain.

“We don’t stop at treating the pain that brings someone to us in the first place,” says Kassia Silva, MD, the lead physician at Centurion Spine & Pain Centers. “Our goal is to find the cause of that person’s pain and to treat the cause.

“We’re specialists and when someone is in pain, the best thing they can do is see a specialist because we can find the root cause of their pain and treat the cause instead of just putting a band-aid on it or treating it with pain medications.”

Centurion Spine & Pain Centers is an affiliate of Jax Spine & Pain Centers, which has six other locations in Northeast Florida.

“Our expectation is to serve the entire community with the best care possible, and by expanding to Ormond Beach, we’re hoping we can help more people in pain,” Dr. Silva says.

From weekend warriors nursing minor muscle strains to senior citizens crippled by spinal compression fractures, the staff of Centurion Spine & Pain Centers is highly trained and experienced in the diagnosis and treatment of all causes of pain.

Those causes can include degenerative disc disease, arthritis, sciatica, sports-related injuries, or injuries suffered at work, home or while participating in a favorite activity. No matter the trigger, Centurion Spine & Pain Centers has a solution.

“We usually begin conservatively when treating our patients, but the pathology ultimately dictates the direction we take,” Dr. Silva adds. “If someone comes to us who has already tried a slew of conservative treatments, we can move on to advanced procedures.”

Conservative treatments offered by Centurion Spine & Pain Centers include epidural steroid injections, which are used largely to alleviate debilitating back, leg or neck pain, and cortisone injections, which can alleviate joint pain.

The practice also performs medial branch nerve blocks, which are injections of anesthetic into a targeted nerve that is often used as a precursor to a more advanced treatment called radiofrequency ablation.

During radiofrequency ablation, radio waves produce heat that is delivered through a probe to the targeted nerves. The heat creates a spot on the nerve that impedes the transmission of pain signals to the brain.

As with steroid injections, cortisone injections and nerve blocks, radiofrequency ablation can alleviate pain for as much as six months or more, and these conservative treatments can be repeated.

But for patients seeking more permanent fixes or those whose pain returns or becomes so prolonged and agonizing that it adversely affects their lifestyles, the providers at Centurion Spine & Pain Centers turn to advanced treatment options.

Spinal Cord Stimulation

One such option is neurostimulation. Jax Spine & Pain Centers has been deemed a Center of Excellence for neurostimulation, which includes spinal cord stimulation, dorsal root ganglion (DRG) stimulation and peripheral nerve stimulation.

These therapies have proven effective with a variety of ailments, including sciatica, neuropathy, complex regional pain syndrome, failed back surgery syndrome and other neuropathic pain syndromes.
These therapies use a small device that alters pain signals running to the brain. The device is powered by a small battery that is typically implanted under the skin.

While these are considered advanced treatments, the technology is not new.

The first spinal cord stimulator, for example, was developed about 30 years ago. That device replaced pain signals with a tingling sensation called a paresthesia. The latest models are similar but advanced technology allows the pain to be replaced with no sensation at all.

“We used to think that the pain signals were blocked by distracting the brain,” says Justin Mann, MD, of Jax Spine & Pain Centers. “We now know that we actually affect pain on a cellular level, and that is what is decreasing the patient’s sensation of pain.”

Stimulation therapy typically begins with a three- to seven-day trial period during which the stimulator’s effectiveness is gauged. If the patient experiences a significant reduction in pain during the trial, the stimulator is implanted permanently.

“With spinal cord stimulation, the trial is similar to receiving an epidural steroid injection,” Dr. Mann adds. “We do it right in our office, and the only difference is that instead of injecting medication we thread leads or electrodes through the epidural needle.

“The top end of the electrode is fed into the epidural space of the spine, which is on the inside of the spinal canal but outside of the spinal cord. It’s a unique place anatomically that is especially receptive to this type of therapy.

“The bottom of the electrode is attached to a battery that sits on top of the skin during the trial. The battery, about the size of a half-dollar, creates electrical impulses that block the pain signals.”

About 90 percent of patients going through a spinal cord stimulation trial receive enough pain relief to have the stimulator implanted permanently. That procedure is similar to the one performed for the trial, except that it is done at a hospital or surgery center.

“During the permanent implant procedure, the patient lies stomach down, is given intravenous sedation, and the process done for the trial is recreated in terms of putting the leads into the spine,” Dr. Mann explains.

“During the procedure, we actually wake the patient at one point and ask if they’re feeling the delivery of energy through the device. We do that to make sure we’re covering the areas with the most pain.
“If the patient indicates that we’re successful in capturing these painful areas with the electrical signals, we complete the procedure, during which no bone or muscle is cut even while we’re placing the battery under the skin.”

The battery is charged wirelessly with an external generator that’s attached to a small belt. A nonrechargeable battery is also available, but most patients choose the rechargeable battery that can be recharged in an hour every two days.

DRG Stimulation

DRG stimulation is an advanced form of spinal cord stimulation that affects dorsal root ganglion, which is a body of sensory neurons at the side of the spine where the spinal nerve root exits to become a peripheral nerve.

This therapy treats specific areas such as the hips, knees, ankles and feet.

It is also used to treat causalgia, which is chronic pain that develops following an injury or event such as a stroke or heart attack. Often referred to as complex regional pain syndrome, or CRPS, causalgia is characterized by inflammation or nerve dysfunction and pain greater than experienced during the suffering of the injury that caused it.

That is especially true with amputations and paralysis, but doctors have found that people with severe diabetes as well as women who gave birth through cesarean section experience nerve pain for months or years.

This pain is sometimes a result of scar tissue that compresses a nerve in a way that limits the nerve’s ability to be fed the natural elements needed to remain healthy.

In addition to pain, damaged nerves can cause numbness, tingling, burning, muscle weakness and atrophy. When those symptoms last longer than a few months, they are considered permanent and in need of treatment.

As with spinal cord stimulation, DRG stimulation starts with a short trial that begins with the doctor threading two catheters the width of spaghetti.

“We perform this in our office, and it’s done while the patient is under light sedation,” states Michael Hanes, MD, of Jax Spine & Pain Centers. “Sometimes we can even get away with just having the patient take a Valium®.”

The catheters contain leads or electrodes that are placed on the dorsal root ganglion. The spinal column contains several ganglia, each of which is associated with a different area of the body. Physicians know which DRG to stimulate based on the location of the pain.

“These areas are pretty well mapped out, although there can be some variation from person to person,” Dr. Hanes educates. “That’s why we perform a trial of the system first, without incisions, just using needles to place the leads.”

As with spinal cord stimulation, the other end of the electrodes are connected to an external device that creates electrical impulses to block the body’s pain pathways. The pain can be replaced with a gentle tingling or no sensation.

Patients can control the amount of stimulation they receive by using a remote. The remote also allows the patient to turn the device on or off.

At various points during a trial, the patient is contacted by the doctor or a representative of the device’s manufacturer for updates. At the end of the trial, the patient and doctor meet again to discuss the patient’s experience.

With peripheral nerve stimulation, the leads are typically placed over the painful area of the body instead of near the spine, where the pain signals are generated.

“If the patient fails to experience significant pain relief, then we simply remove the leads knowing that we did as much as we could in that regard,” says Nicholas Bremer, MD, of Jax Spine & Pain Centers. “In those cases, we explore other options.

“But for those who do experience relief, and that is the case with a majority of the patients who complete the trials, we move on to get insurance approval for placement of the permanent device.”

To gain approval, a patient must experience a reduction in pain and increase in function of between 50 and 80 percent, measured using a visual log or numerical scale.


Another advanced treatment offered at Centurion Spine & Pain Centers is kyphoplasty (pronounced ki-fo-plas-tee), a painless, injection-like procedure that relieves pain associated with a spinal compression fracture.

A spinal compression fracture occurs when a vertebra weakens and either breaks or collapses, affecting nerves of the back. If left untreated, the fractures can cause severe pain, deformity and often a stooped posture.

These fractures most often affect the lower portion of the thoracic, or middle, area of the spine. Kyphoplasty, performed in an outpatient setting, can repair that damage.

“Prior to the development of this procedure, patients with a spinal compression fracture would usually be placed in a brace before being sent home in the hope that the fracture would heal on its own,” Dr. Silva reports.

“The brace was very uncomfortable, and the patients sometimes had a hard time breathing and ambulating. As a result, it wasn’t unusual for some patients to wind up in the hospital with pneumonia or blood clots that could go to their lungs.

“That’s why kyphoplasty is considered by many to be a lifesaver. It repairs the fracture and prevents patients from suffering some of these other issues. It actually reduces the risk of mortality.”

One study of more than 2 million compression fracture patients showed that those undergoing kyphoplasty were 22 percent less likely to die from complications associated with the fracture than those who did not go through the procedure.

Kyphoplasty is performed through a small incision in the back. The physician uses a needle and x-ray guidance to insert a balloon into the fractured vertebra. By inflating the balloon, the compressed vertebra returns to its original height.

The cavity created by the expansion of the balloon is filled with a fast-drying cement that immediately stabilizes the fracture, alleviating pressure on the nerves and eliminating the pain. The minimally invasive procedure takes about 30 minutes.

At Centurion Spine & Pain Centers, a kyphoplasty can be done within 24 hours of the diagnosis. And the results are immediate because the cement is dry before the patient leaves the office.

“The only reason we don’t say, Go home, and do everything you normally would is because they received sedation,” Dr. Silva notes. “We tell our patients, Go home and be careful for 24 hours. After that, they are usually good to go. Even if the patient is in their 80s who walks two miles a day, they can resume those walks within 24 hours.

“The ability to treat more patients with these advanced options is why I’m so excited to be opening this new sister practice to Jax Spine & Pain Centers. We strongly believe Centurion Spine & Pain Centers will be a welcomed addition to the community.”

An additional benefit of having the treatment done at Centurion Spine & Pain Centers is that it is less costly, says Mike Bergantino, chief operating officer of Jax Spine & Pain Centers.

“If you go to a hospital or surgery center, you’ll pay significantly more because you also need to pay professional and facility fees,” Bergantino points out. “At our office, your regular office copay covers the cost.”

© FHCN article by Roy Cummings. Photo by Thom Giordano. mkb
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