1. Chiropractic & Pain Case Studies
Advances In Interventional Pain Management Omid Ghalambor, MD, DABA, FIPP, DABIPP, DABPM
Chiropractic & Pain Case Studies
2/16/17
Brett Stephens, DC
Omid Ghalambor, MD

2. Case 1

3. Case 1 28 year Supervisor Auto body repair shop
Initial consultation 10/27/16
Found us by “Google search”
Chief Complaint “Low Back Pain”

4. Case 1 Reported pain being there on and off for about a year
Started without any known trigger event
Worsened since 3-4 months prior
Saw Dr. K in Allen for three months to get Airrosti treatments

5. Case 1
Pain was reported as Sharp in the low back, constant, occasionally radiating to both legs
Worse with sitting, driving, standing up holding his daughter.
Had tried Ibuprofen and Massage in addition to Airrosti treatments.

6. Case 1 Upon Exam he was unable to sit comfortably.
Rated the pain as 9/10.
Pain upon percussion of the low lumbar region.
Normal neurological exam.

7. Case 1

8. Case 1

9. Case 1

10. Case 1

11. Case 1

12. Case 1
Prescribed muscle relaxant (Flexeril) 10 mg po qhs and hydrocodone mg po tid prn.

13. Interlaminar Epidural Steroid Injection

14. Transforaminal Epidural Steroid Injection

15. Case 1
First Lumbar Bilateral L5-S1 Transforaminal Epidural Steroid Injection 11/01/2016 > 30% Relief
Second Lumbar Bilateral L5-S1 Transforaminal Epidural Steroid Injection 11/29/2016 > 50% Relief
Third Lumbar Bilateral L5-S1 Transforaminal Epidural Steroid Injection 12/27/2016 > 70% Relief

16. Case 1 Pain is now “Tolerable”
Patient referred to Dr. Mills Chiropractor to start chiropractic therapy with adjustments and physical therapy.

17. Case 1
Emphasized importance of ongoing adjustments and physical therapy
No follow up with Pain needed

18. Case 1
Happy camper 
No PCP > Spine Surgeon > Surgery > More problems down the road
No High Dose Narcotics > Dependence > Addiction > Impact of life/ Job

19. Case 1
What if Patient’s symptoms continue?

20. Case 1

21. Case 1
Lumbar Facet blocks (Diagnostic)

22. Facet Joint Injection

23. Case 1
Discography

24. Case 1
Discography

25. Case 1
Discography

26. Case 1
Discography

27. Surgical Options

28. Adjacent level disease

29. Down the Road…

30. Case 1
What are the options for Disc related (Discogenic) pain other than fusion surgery?

31. Case 1

32. Thermal Annuloplasty Endoscopic

33. Case 1
Intradiscal Plasma Rich Protein (PRP) Injection

34. Case 1

35. Case 1

36. Case 1

37. Case 1
Annular injection of Fibrin Sealant

38. Case 1
Evidence?

39. Case 2

40. Case 2
65 year old female
Referred by Dr. Morgan Spine Surgeon for a “Cortisone Injection”
Complaining of severe Neck Pain on the left
Max 8/10 VAS

41. Case 2
Past Medical History positive for low back pain under care of local Chiropractor in McKinney with great response.
Depression, GERD, Migraines, High Cholesterol

42. Case 2
After patient’s back pain responded well to chiropractic care, she started getting adjustments on her neck.
After two sessions of adjustments, patient’s neck pain worsened to the point that she needed to go to the ED.

43. Case 2
At the ED, X-ray of the cervical spine was performed and was negative for any “Red Flags”
Patient was discharged with NSAIDs, flexeril and hydrocodone.
She was then referred to Dr. Morgan spine surgeon and MRI of the Cervical Spine was ordered.

44. Case 2

45. Case 2
No indication for surgery based on imaging and normal neurological exam
Surgeon suggested a Cervical epidural steroid injection

46. Case 2
Upon exam, cervical facet loading on the left was extremely painful.
Palpation of the cervical facet joints was also uncomfortable.

47. Case 2
Patient was scheduled for fluoroscopic guided cervical facet joint injection both for diagnostic and therapeutic purposes

48. Case 1

49. Case 2
Patient was recommended to return back to her chiropractor for continued adjustments, keep working on her alignment as well as therapy for best long term outcome.

50. Case 2
What if patient’s “Migraine” headaches go away after cervical facet injections?

51. Cervicogenic headaches
Case 2
Cervicogenic headaches

52. Cervicogenic headaches C2-3 Update
Case 2
Cervicogenic headaches C2-3 Update

53. Cervicogenic headaches
Case 2
Cervicogenic headaches

54. Case 2
What if the patient continues to have pain from the facet joints despite series of injections and chiropractic care?

55. Cervical Facet Radiofrequency Neurotomy

56. Thank you!
Questions?