Pros, Cons And Alternative Pain Management

Knowing the basics of interventional pain management

When should a primary care physician refer a patient?

That really depends on the comfort level of the primary care provider and the complexity of the patient. At times, we receive referrals to endorse an ongoing treatment strategy created by another physician, while at other times we evaluate a patient for a new or refractory diagnosis.

How do you evaluate a patient?

Almost universally, patients will tell us, “pain is pain,” but in fact, it is much more complex. We work through the pain complaint often using a physician-directed history to understand the nuances and reach a diagnosis. Once we have a diagnosis, we discuss treatment options, some of which can continue back in the primary care provider’s office.

What types of interventional treatments are available?

While epidural steroid injections are well known, there are a much broader range of spinal and non-spinal injections, as well as minimally invasive surgical procedures and a growing number of implantable devices now available. Pain physicians select from a variety of approaches or techniques and tailor treatment based on each patient’s unique pain condition.

Should every patient receive an injection?

In general, interventional pain procedures are reserved for relatively focal pain areas like a particular joint rather than diffuse polyarthralgias. Studies have largely disproven the effectiveness of interventional treatments (such as trigger point injections) for widespread pain conditions like fibromyalgia. Treatment should always be tailored to a diagnosis, and some pain conditions are better treated with noninterventional approaches.

Acute, Chronic, or Acute-on-Chronic Pain: No One Size Fits All

A variety of acute pain conditions are amenable to treatment by the interventional pain physician. Epidural steroid injections administered for acute disc herniations provide superior efficacy when compared to treating these same radiculopathies if present for decades. Conversely, implanted pain therapies, such as spinal cord stimulation, are reserved for chronic or subacute pain pathologies that have proven refractory to more conservative interventional approaches.  When obtaining a history and conducting a physical examination of a patient with pain, assessment of chronicity of symptoms enables the pain physician to identify a treatment course.

Sorting through acute-on-chronic pain can be particularly challenging since some patients are unable to differentiate new-onset pain from their chronic pain condition.  To a patient, “pain is pain,” and sorting through a complex pain history often requires a physician-directed history to define these nuances.

Bleeding Risk During Interventional Pain Procedures

Though bleeding complications rarely occur following interventional pain procedures, pain physicians are paying closer attention to an expanding list of anticoagulants in contemporary use. Pain physicians are tasked with considering newer anticoagulant agents with heterogeneous half-lives and diverse mechanisms of action. Of late, barely a year elapses without the introduction of one or more anticoagulant agents that each warrant specific consideration prior to spinal injections.

Though established guidelines exist indicating the duration and settings for discontinuation of anticoagulant therapy, these general statements often neglect patient-specific variables: most notably the indication for therapy and the potential risks posed with interrupting therapy. As a result, interventionalists collaborate with PCPs to weigh the risk-benefit ratio of moving forward or abstaining from select pain procedures that require a period of abstinence from anticoagulants prior to neuraxial injections.

What is interventional pain management?

Interventional pain management is a discipline in pain management that is rooted in the goal to help patients relieve their pain. These specialized pain doctors look beyond medication to help someone deal with pain. They rely instead on a vast array of therapies to help diagnose, reduce, and if possible, completely relieve a person’s pain. The ultimate goal is to help a patient get back to their best life. Often, doctors do this by helping patients return to their normal activities as quickly as possible.

Interventional pain management clinics often have multiple types of practitioners on hand. They all tackle various portions of the patient’s problem. For example:

  • A chiropractor for spine issues
  • An acupuncturist for alternative measures
  • Pain doctors who perform minimally-invasive procedures or injections
  • Chiropractors or physical therapists to resolve muscular issues
  • Mental health therapists to treat often comorbid symptoms of depression and anxiety

By having multiple specialists on the staff, a patient has the best possible chance of getting the treatment they need. It also encourages collaboration between these different specialists to find all of the options a patient may have for reducing pain.

When someone is in pain, they’ll look for any possible method to get relief. A pain specialist who practices these techniques has the ability to first diagnose the problem to determine what the issue is, then treat the pain accordingly. In an interventional pain management practice, the issue causing the pain is taken care of via a procedure or treatment, and if it cannot be handled in just one session, then that’s where the management side of things comes into play. By working with a dedicated pain management team, a patient can receive an overall treatment regimen that will make sure that their pain levels are as tolerable as possible.

Below are some of the most commonly used interventional pain management techniques.

Radiofrequency Rhizotomy

Using x-ray guidance and a needle with an electrode at the tip that gets heated, radiofrequency rhizotomy temporarily turns off a nerve’s ability to send pain messages to your brain.

Other names for radiofrequency rhizotomy are radiofrequency ablation and neuroablation.

For many patients, this procedure can provide pain relief for 6 to 12 months. During these pain-free months, however, your doctor will most likely recommend physical therapy. A physical therapist can help you address underlying physical problems that are causing pain.

Intrathecal Pump Implants

Intrathecal pump implants, also known as pain pumps, provide potent medications straight to the source of your pain. They’re a type of neuromodulation—a treatment that interrupts pain signals to your brain.

Pain pumps are commonly used for cancer pain and failed back or neck surgery. With this procedure, a small device—called a pump—gets implanted under your skin. Your doctor programs the pump to deliver a specific amount of medication, and he or she will need to refill the pump every few months. The main benefits of pain pumps are that they provide consistent pain relief, and if you’re taking oral medications, you don’t have to rely on them as much. Because this is a more invasive procedure than an injection, a pain pump is typically used only if other treatments have been unsuccessful.

Electrical Stimulation

Electrical stimulation is another type of neuromodulation. Similar to a pain pump, something gets implanted in your body with electrical stimulation. But with this procedure, a stimulator is implanted along with an electrical lead to send electrical pulses directly to the area that’s causing pain—the spinal cord, nerves, or brain, for instance.

Electrical stimulation can be used for certain spine conditions as well as conditions that affect your brain or nerves, such as Parkinson’s disease, epilepsy, and diabetic peripheral neuropathy. You can have spinal cord stimulation or deep brain stimulation, for example. Instead of pain, some people feel a tingling sensation with this treatment.

Import Auto Repair

How do I manage a small auto repair shop?

Automotive repair works is a highly competitive field and if you want success in it, you need to make sure your shop is managed well and attracts a good number of customers. The right planning and execution can help you stay ahead of the game and establish a good reputation in your local area and provide you with a consistent customer base. Here are some tips that will help you run a successful automotive repair shop.

Customer service matters

Modern customers place a lot of importance on customer experience and will shun businesses that don’t provide good quality customer service. That’s why it’s essential to focus on customer service in all aspects of your interactions with vehicle owners. Your customers should have a good experience from the moment they walk into your shop till the time they walk out of your shop. Train your repair technicians to communicate with clients in a friendly and professional manner. You should also have a dedicated customer service phone line so clients can contact you in case of emergencies.

Offline marketing

The auto repair industry still relies on word of mouth so it’s a good idea to spend some time on offline marketing. Distribute pamphlets, place ads on your local publications, send newsletters to your existing clients and include promotional offers in them. All these small marketing strategies will help you establish a local reputation and presence. Without offline marketing, you’ll be a relatively unknown entity in your local area and won’t get as many customers as you otherwise could.

Focus on quality

Modern customers don’t hesitate to criticize businesses if they don’t live up to expectations; and they have a big platform that allows them to publish their opinion. They can post reviews on websites like Google, Yelp, Yellow Pages, etc. They can also comment on social media platforms like Twitter and Facebook. This criticism can have an impact on your reputation, which is why it’s important to focus on the quality of service. Make sure you have a well-trained staff and use good quality spare parts in your service.

Relationship with your customer

Most auto repair businesses will have regular customers that seek out their services every time there’s car trouble. It’s a good idea to develop a good relationship with these customers and keep them engaged. You can send them emails, engage them on social media, and provide them special offers on different occasions. These strategies will help you develop a steady customer base that can help keep your business afloat even during slow periods.

Online marketing

While offline word-of-mouth is a powerful tool, you need to market your business online as well. Online marketing will help prospective customers find you and learn more about your business. You can use strategies like paid ads, SEO, and social media marketing in order to establish an online presence and gain more visibility.

Start a Subscription Plan

Regular maintenance and occasional repairs are inevitable expenses that need to be factored into the total cost of vehicle ownership. A growing number of auto repair shops are now offering subscription plans for service and maintenance for their customers to keep these costs consistent throughout the year.

Offer a Seasonal Promotion

There is a cyclical nature to many repairs. Customers want tune-ups before taking summer road trips and windshield wiper blades replaced before the rainy season sets in. Creating regular promotions around these seasonal repairs can generate new customers and more sales from existing customers.


You might be surprised by how many of your customers don’t know how to do simple maintenance tasks like checking their car engine’s oil level or the air pressure in their tires. A value-added service that you can offer that can get customers in your shop and scheduling appointments is to offer an informational seminar where you share your expertise and knowledge.

Increase Mechanic Productivity

Sometimes even the most hardworking technicians and service advisors can find it difficult to stay productive.

Keep cool or warm – If at all possible, try to sustain a comfortable ambient temperature in the shop and in the bays. It is a good idea to bring in fans or heaters to circulate air and/or heat the air if it is necessary.

Stay hydrated – Some days fans just aren’t enough. Employees appreciate if you offer cold bottles of water or sports drinks. Not only does it boost employee moral and appreciation, but it prevents dehydration and decreases chances of workers becoming dehydrated.

Say “Thank You” -Acknowledge your team for a job well done. When your staff feel appreciated, they are more likely to stay motivated and productive. By making it a habit to notice the good and then saying something in gratitude, this will do wonderful things for your culture.

Technology changes – If you want your business to remain competitive in today’s world, you must embrace technology. With the right systems and processes, you are able to enhance reporting, accountability, customer service, and much more! Technicians’ ability and willingness to be productive is majorly enhanced if you (as the employer or manager) are clearly always striving to make their work life easier. They may take a little bit of time to get used to technology, but once they are adjusted, they usually appreciate the fact that you are an industry leader and looking out for the future of the company.

Increase productivity of your mechanic’s helps you to better manage your mechanic shop.

Use Automotive Management Software

Change is happening at a rapid rate through the uptake and use of digital technology so it is essential for you to keep up with the digital change and start to use an automotive software platform that puts you on par and better yet ahead of your competitors. Owning a vehicle has become one of the necessities these days, the responsibility of running and maintaining it has become more challenging and therefore the need for better communication through a range of channels including live in-app booking, inspection approvals and payment will reduce some of those challenges through a platform

With these features as standard it will reduce missed appointments and overbooking therefore saving yourself time. It also takes care of other simple incidents like digital inspection with videos and photos with instant approvals in real time. It helps in creating a consistent and reliable service.

The effective use of automotive management software will lead you to remove the question “how to manage an auto repair shop?”.

Give Discounts And Introduce Sales Offers

No matter which business one is in, the practise of offering discounts to lure customers in certainly has it appeal and success, and the automotive industry isn’t an exception. There are so many workshops that use this marketing strategy to provide special offers or discount to obtain more customers and sales.

You too can create a marketing plan or simply create a monthly special by offering either a percentage or dollar value discount to attract more customers. These marketing campaigns will help in marketing your store to attract new customers and increase brand awareness, and you will potentially earn some loyal customers in the process.

Considerations With Natural Indoor Mosquitoes Control

Plants & Herbs That Naturally Repel Mosquitoes


Chances are, you’ve heard of this one before- it’s one of the most common ingredients in most mosquito repellents. Strange enough though, many people don’t even know that citronella is actually a plant! Citronella is a beautiful perennial clumping grass that emits a strong aroma. That aroma masks other scents, and keeps mosquitoes from being attracted to things located around it.

Lemon Balm

A member of the mint family, the plant also known as horsemint and beebalm is a very easy plant for beginning gardeners to grow- even if you don’t have a green thumb! Lemon Balm is a very hardy plant, it resists drought, and it grows well even in shade.


Your feline friends will be happy to know that catnip is a great mosquito deterrent!In fact, in a 2010 study, researchers found that catnip is 10 times more effective than DEET, the ingredient commonly found in bug repellents.


A bright, hardy annual plant, marigolds are a great choice for repelling mosquitoes. Marigolds contain Pyrethrum, an ingredient found in many insect repellents, and they have a unique aroma which bugs find repulsive.


Calling all cooks! Want a double whammy when it comes to mosquito protection? Plant some basil. Not only will you have a quick and easy mosquito repellent, you will also have a delicious fresh herb on hand to add to all of your favorite recipes. (try my Perfect Pesto Recipe!)

Do citronella candles really work? The answer might surprise you

Naturally, many people strive to repel mosquitoes as effectively as possible. And, often, they turn to citronella candles (like the Cutter Citro Guard). But, does citronella really work, or is it just hype? TODAY Home asked experts about how to repel mosquitoes to get to the bottom of it.

Do citronella candles work?

Citronella is naturally occurring oil that repels insects. It is distilled from two types of grass, according to the National Pesticide Information Center. While it is currently approved as safe for humans and the environment by the U.S. Environmental Protection Agency, that doesn’t mean that it’s effective. And, because it is a “minimum risk pesticide” in terms of its effect on human health, it is exempt from EPA evaluation

The article explains that products with a citronella base are only effective as a mosquito repellent for about two hours, because the oils rapidly evaporate. It also says that products like candles help by continuously evaporating the oil, but the authors note that field studies show using candles only reduces mosquito bites by about half and concludes “…for the time-being, travelers to disease endemic areas should not be recommended citronella-based repellents.”

Natural mosquito repellent alternatives

Products that contain oil of lemon eucalyptus, which comes from the gum eucalyptus tree, are a lot more effective than citronella, Hoffer said. “People who use botanical repellents should be aware that they’re less effective and will need to be reapplied often, but 30% oil of lemon eucalyptus is usually a sufficient concentration to keep mosquitoes away for a few hours at a time,” he added. And, the CDC includes it on their list of recommended mosquito repellents

spray for skin and clothing is 30% lemon and eucalyptus oil. It’s supposed to repel mosquitoes for up to six hours, but it says you should only apply it up to twice a day

How to Get Rid of Gnats, Flies, Ticks, Mosquitoes, and All Other Pesky Insects

Now that summer is here, homeowners have to reconcile with the fact that with warmer weather comes more bugs. Nobody wants an infestation of any kind — whether it be mosquitoes that suck your blood while you’re sleeping or little fungus gnats that wreak havoc on your kitchen. So, what can you do to get rid of all these pesky pests?

Sure, there are plenty of insect repellents out there, but they might not be the best for the environment or for your health. Skip the insecticides and harmful chemicals and opt for a more non-toxic, sustainable route to getting rid of gnats, flies, ticks, and mosquitoes.

A gnat is a small, double-winged type of fly that usually descends in swarms, making them especially difficult to get rid of. Gnats look like mosquitoes in that they are black, have long legs, and two small wings.

These yucky pests make their way inside from either outdoors or — it pains us to even say it — your fruits and vegetables. Say what? Well, adult gnats lay their eggs on unripe fruits and vegetables. If the produce over-matures — say, it becomes overripe and you keep it too long — the gnat larvae either inside or on the produce’s surface feed off of the rotting organic material; soon, they’ll be mature enough to leave the fruit and terrorize your kitchen.

Vinegar won’t kill off a swarm of gnats on its own, but it can aid in the process of trapping them. To use an apple cider vinegar trap to get rid of gnats, mix a half cup of warm water with two tablespoons of ACV, a tablespoon of sugar, and a few drops of liquid soap. Put the bowl in the area you see gnats the most. Both the sugar and vinegar will lure in the gnats; then they’ll get stuck in the soap’s bubbles and won’t be able to fly back out.

Frequently Asked Questions

How fast can mosquitoes fly?

Depending upon the species, mosquitoes can fly at about 1 to 1.5 miles per hour.

How far can mosquitoes fly?

Mosquito species preferring to breed around the house, like the Asian Tiger Mosquito, have limited flight ranges of about 300 feet. Most species have flight ranges of 1-3 miles. Certain large pool breeders in the Midwest are often found up to 7 miles from known breeding spots. The undisputed champions, though, are the saltmarsh breeders – having been known to migrate up to 100 miles in exceptional circumstances, although 20 to 40 miles are much more common when hosts are scarce. When caught up in updrafts that direct them into winds high above the ground, mosquitoes can be carried great distances.

How much do they weigh?

Smaller species found around houses commonly weigh about 2.5 milligrams. Our largest species weigh in at a whopping 10 milligrams.

How much blood does a mosquito take in a meal?

When feeding to repletion, mosquitoes imbibe anywhere from 0.001 to 0.01 milliliter.

Why do mosquitoes feed on blood?

Female mosquitoes imbibe blood so that their eggs can mature prior to laying. It serves no nourishment function. Males do not take blood meals at all. In order to obtain energy, both male and female mosquitoes feed upon plant nectars – much in the same manner as honeybees

How to get rid of mosquitoes: Nine ways to keep mozzies at bay this summer

They are also drawn to the scent of the carbon dioxide we exhale, fragrances and sweat. Enjoy that bottle of beer, but alcohol consumption increases your body temperature, which is another factor which attracts mozzies.

Tidy up the yard

Mosquitos lay their eggs in stagnant water, so empty any extra water around your property such as full saucers under flowerpots, stagnant ponds, or puddles.

If you have a pond, mosquitos may lay their larvae there, but ponds attract dragonflies, which love to eat mosquitos. To keep pond water from being stagnant, you can install a pump or fountain to keep the water moving. You can also stock your pond with goldfish or koi which will eat the larvae.

Blow them away

Mosquitos are weak flyers and cannot withstand strong breezes, so an outdoor fan can be an effective deterrent. They are also deterred by smoke, giving you another reason to relax around the fire pit. Just be aware that it’s bushfire season, so don’t light fires in dry or windy conditions, always keep a fire extinguisher or hose nearby when using a fire pit, and pay attention to local or statewide fire bans.

Repel mosquitoes naturally

There are many scented plants said to deter these pesky insects. Plant them around your outdoor seating areas and reap their benefits. Basil, lemon balm, peppermint, lavender, marigold, rosemary and eucalyptus are some of the best choices to discourage mozzies.