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Good PMR/Pain doc in Colorado

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bedrock

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Can you all please recommend 1-2 good PMR/Pain docs in the Denver or Boulder area?

Have friend of the family with significant headaches since their Humvee was blown up by an IED in Iraq. Failed many medication trials as well as botox via neurology, failed lots of PT, massage etc. Doesn't want to take opioids.

From my phone conversation, I think a TON, C3, C4 MBB/RF is indicated, but in case they fail the MBB, I'd like for them to see a Pain physician with a PMR background who also understands TBI and might have other treatment options beyond the MBB/RF
 

cbest

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Venu Akuthota or Scott Laker at University of Colorado


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101N

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Why do they have to be PM&R?
 

Timeoutofmind

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Clinical question:

How do you guys know A/O and A/A joints not involved in a case like this? Based on imaging? Do u usually start with TON, C3, C4 MBB, and if no response, try O/A and A/A?

Also, I know you can inject intra-articularly for O/A and A/A, but is there anyway to deinervate these (for RF purposes) analogus to the other cervical facets?
 

bedrock

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Clinical question:

How do you guys know A/O and A/A joints not involved in a case like this? Based on imaging? Do u usually start with TON, C3, C4 MBB, and if no response, try O/A and A/A?

Also, I know you can inject intra-articularly for O/A and A/A, but is there anyway to deinervate these (for RF purposes) analogus to the other cervical facets?

You should always consider A/O and A/A joint in such cases. However, unless the pathology level is quite clear, like elderly with significant C1-C2 joint pathology on CT scan, you should always start with TON, C3, C4 MBB/RF because those are safer procedures with long lasting relief and because statistically C2-C3 and C3-C4 pathology is more common.

There is no safe commonly accepted way to completely ablate A/O or AA joints.
 

lonelobo

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Think he is asking for PMR for the Brain injury aspect, Neurology not trained to deal with that....diagnosis maybe
 

bedrock

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Should you ask for a pain doctor with neurology background?


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Would be fine. Both PMR and neurology residents are trained to treat TBI, but PMR residencies generally have more TBI exposure . A pain doc with either residency background would be fine, however about 30% of pain physicians came through PMR, compared to about 1% of that came through neurology, so finding PMR/Pain close to someone is much easier that finding neurology/Pain.

Thanks everyone. I sent them to Brian Fuller.
 
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Timeoutofmind

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You should always consider A/O and A/A joint in such cases. However, unless the pathology level is quite clear, like elderly with significant C1-C2 joint pathology on CT scan, you should always start with TON, C3, C4 MBB/RF because those are safer procedures with long lasting relief and because statistically C2-C3 and C3-C4 pathology is more common.

There is no safe commonly accepted way to completely ablate A/O or AA joints.

Thank you for taking the time to awnser my question. Much appreciated
 

Ligament

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    Would be fine. Both PMR and neurology residents are trained to treat TBI, but PMR residencies generally have more TBI exposure . A pain doc with either residency background would be fine, however about 30% of pain physicians came through PMR, compared to about 1% of that came through neurology, so finding PMR/Pain close to someone is much easier that finding neurology/Pain.

    Thanks everyone. I sent them to Brian Fuller.

    Good choice on Fuller!
     

    Timeoutofmind

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    You should always consider A/O and A/A joint in such cases. However, unless the pathology level is quite clear, like elderly with significant C1-C2 joint pathology on CT scan, you should always start with TON, C3, C4 MBB/RF because those are safer procedures with long lasting relief and because statistically C2-C3 and C3-C4 pathology is more common.

    There is no safe commonly accepted way to completely ablate A/O or AA joints.

    Sorry to bump an old thread...follow up clinical question:

    Say you rule out C2/3 and C3/4 pathology as per our discussion above, and you are considering A/A or A/O pathology...how do you know which of the two joints to start with? Just imaging? Anything else that helps guide the decision for you?

    Thanks in advance.
     

    Ligament

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    Sorry to bump an old thread...follow up clinical question:

    Say you rule out C2/3 and C3/4 pathology as per our discussion above, and you are considering A/A or A/O pathology...how do you know which of the two joints to start with? Just imaging? Anything else that helps guide the decision for you?

    Thanks in advance.

    If there is obvious pathology with imaging at either one of these joints, target that one first. Usually, there is little imaging abnormality. In that case, start with the AA joint, as it is less risky than the OA joint. I very rarely make it up to the OA joint.
     

    Timeoutofmind

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    If there is obvious pathology with imaging at either one of these joints, target that one first. Usually, there is little imaging abnormality. In that case, start with the AA joint, as it is less risky than the OA joint. I very rarely make it up to the OA joint.
    Makes much sense. Thank you again!
     
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