Introducing Dorota Zolotenko, RN. Our new Cosmetic Injector!

Dorota is a Registered Nurse with an honours graduate degree from Centennial College. Since her graduation, she practiced 7 years in long term care and occupational health, but her passion in cosmetic nursing never ceased. In 2007, she finally began to pursue her dream and began training for Botox and filler injections. She successfully honed her skills in different clinical settings and is now excited to join our team here at Wilderman Medical Cosmetic Clinic! Her friendly and kind demeanor cannot be missed.

We look forward to our journey together Dorota!!

Cingal®

Cingal

What is Cingal®?

Cingal® is a new medication being introduced to the Wilderman Medical Clinic. It has been proven to provide short and long term relief of pain associated with osteoarthritis (OA).

 

Why is Cingal® so effective?

The medication has two parts: Hyaluronic acid (HA) and a fast acting steroid, triamcinolone hexacetonide. Hyaluronic acid provides long lasting pain relief, while the steroid gives fast and short-term relief of pain.

 

What is Hyaluronic Acid?

Hyaluronic Acid (HA) is an organic molecule that makes up a large portion of the synovial fluid. Synovial fluid acts as a lubricant between two joints, reducing the friction between articular cartilages. Thus, injection of HA can provide lubrication and mechanical support of joints by bulking up the synovial fluid.

 

Why choose Cingal®?

The medication was developed by Anika Therapeutics, a company that already has a strong line of products that treats pain associated with OA. The hyaluronic acid used is a cross-linked formulation, unique to Anika Therapeutics. It is even sold separately by the company and has been proven to provide relief from symptoms of OA for 6 months. It is a highly concentrated, non-animal based HA. Combined with an FDA-approved steroid for treating inflammation, the unique Cingal® formulation can provide rapid and long term pain relief.

The procedure is done in a single-injection. It has shown to be effective in initial injection and repeat injections. Therefore, if you have found other methods of treating OA pain ineffective or unsatisfactory, Cingal® can be a great option to add to become an effective part of your treatment plan.

Cognitive Behavioral Therapy (CBT) as a Potential Treatment for Managing Chronic Pain

As the popularity of mindfulness practices increases among the general public, it is not unusual for scientists and health professionals to begin to consider the potential benefits of various psychotherapeutic approaches in managing health conditions. Some have put forward the idea that Cognitive Behavioral Therapy (CBT), one of the more popular psychotherapeutic approaches, can be used as a way to manage chronic pain.

At its most essential, CBT is a family of skills-based training exercises. It is largely founded on the premise that an individual, not their external conditions, create their own experiences. This understanding lends itself to the idea that pain is perceptual, rather than being a sensory phenomenon. As a perceptual phenomenon, pain takes into account the varied responses different individuals have to similar kinds of pain. As a sensory phenomenon, the pain would largely be described as a response to tissue damage. Under this perceptual phenomenon framework, additional factors such as cognitive, social and attentional are used to describe pain which then expands the pool of potential treatment options.

While CBT as a form of chronic pain management seems to provide some benefits, there is still much research to be done on measuring its efficacy. However, numerous studies, including a Cochrane review, have concluded that when compared with treatment-as-usual or wait-list control conditions, CBT had a statistically significant albeit small effect on pain and disability and it proved to be superior to other psychological treatments for chronic pain.

Future research should focus on what specific aspects of CBT work and for which kinds of patients the treatment works on.

Please visit cbt.drwilderman.com for more information.

Written by Eleanor Ndaiga

References:

Hofman S G et al. The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-Analyses. Cognit Ther Res [Internet]. 2012 Oct [cited 2017 Nov 17]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/

Williams A C de C, Eccleston C, Morley S. Psychological Therapy for Adults with Longstanding Distressing Pain and Disability. Cochrane Database Syst Rev [Internet]. 2012 Nov [cited 2017 Nov 17]. Available from: http://www.cochrane.org/CD007407/SYMPT_psychological-therapy-adults-longstanding-distressing-pain-and-disability

Ehde D M, Dillworth T M, Turner J A. Cognitive-Behavioral Therapy for Individuals with Chronic Pain. Am Psychol [Internet]. 2014 Feb-Mar [cited 2017 Nov 23]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24547801

Songer D. Psychiatry [Internet]. 2005 May [cited Nov 24]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000182/

Managing Lower Back Pain: 3 Types of Pain Management

Lower-back-pain

Lower back pain is one of the most common symptoms that patients are diagnosed with. Over 80% of the population will experience lower back pain at least once in their lifetime. The most common culprits are: muscle strains, injuries, or overuse. Back pain could also be a symptom of more serious conditions such as a herniated disc, osteoarthritis, spinal stenosis, etc. Pain management is usually assigned to patients with chronic back pain, which is defined as a pain that lasts for over three months, and/or pain that is caused by tissue unable to be healed.

Back pain management could be a very effective alternative to surgery. But in order to reach full potential, it requires the patient to be determined, committed, as well as knowledgeable about their situation. There are three types of pain management that are used to treat lower back pain: non-invasive non-drug pain managements, non-invasive pharmacologic pain managements and invasive pain management.

 

Non-invasive non-drug pain management techniques include exercises, manual techniques, behavioural modification, superficial heating/cooling of skin, and electrotherapy.

  • While exercises to treat back pain may seem counterintuitive, they are instead very beneficial. Although strenuous activity should cease as soon as a patient experiences back pain, this should only be a temporary action. Over time, resting after experiencing lower back pain can impede healing. Therefore, after a certain amount of time, active back exercises are essential for mending the spine and lower back region.
  • Manual techniques such as manual physical therapy differ from conventional treatment methods due to the treatment’s use of hands as opposed to devices or machinery. In this specific therapy, practitioners use their hands to put pressure on muscle tissue and manipulate joints, in an attempt to decrease back pain caused by muscle spasm, muscle tension, and joint dysfunction (Robert Daul). More information on these techniques can be read in the article, “Pain Relief through Manual Physical Therapy and its Various Techniques”.
  • Behavioural methods such as cognitive therapy aim to ease patients’ pain by relaxation techniques, coping techniques as well as many other methods. It involves learning to control muscle tension, blood pressure and heart rate for symptomatic improvement.
  • Superficial heating/cooling of skin involve the use of cold packs, hot packs, ultrasound, and diathermy (the use of high-frequency electromagnetic currents to produce heat and apply it to affected lesions). This kind of therapy should be used along with exercises.
  • The most widely used type of applied electrotherapy used is transcutaneous electrical nerve stimulation (TENS). TENS therapy reduces back pain by stimulating the sensory nervous system via electrodes with low voltage currents in the affected area. A patient can select the amount of frequency current, as well as several different stimulation patterns from a variety of options provided by a hand held controller. The effectiveness of this therapy is varied for each individual; to some, the results were beneficial and positive and to others, the results were neutral and provided no effect.

 

Non-invasive pharmacologic pain managements use pain relievers and other related drugs to alleviate chronic back pain. They may be used during any stage of back treatment, starting from initial diagnosis and continuing on during rehabilitation or in cases of a failed back surgery. These pain managements include a variety of common treatments such as:

  • Analgesics, pain relieving medication, which can include acetaminophen.
  • Nonsteroidal anti-inflammatory agents (NSAIDs) including aspirin, ibuprofen, naproxen, and COX-2 inhibitors.
  • Muscle relaxants, which are used to treat muscle spasms as a result of back pain.
  • Narcotic medications, which serve as an anaesthetic and are not used for chronic conditions but more so for acute or post-operative pain.
  • Neuromodulating medications, which are used to treat neuropathic and muscular pain.
  • Antidepressants and anticonvulsants, which are also applied to treat neuropathic pain.

Note: extended or long-term use of most medications mentioned above may increase health risks.

 

Invasive pain managements include injections and/or insertion of devices into the body. There are various different invasive therapies used to treat back pain, some of which are:

  • Injections are often temporary pain relief methods resulting from a direct administration of steroids or anaesthetics into joints, ligaments, muscles or around nerves. This method’s results could also be used to identify or confirm a diagnosis of a suspected region of pain.
  • Prolotherapy involves injecting an irritant solution in order to cause an inflammatory response. This event stimulates blood circulation and ligament restoration, thus encouraging natural healing to occur.
  • Radiofrequency radio ablation essentially involves administering heat to specific nerves in attempt to disrupt pain signalling to the brain,  therefore eliminating or greatly diminishing the pain.
  • Surgically implanted electrotherapy devices include implantable spinal cord stimulators (SCS) and peripheral nerve stimulators. This method is generally used when a patient’s back pain was not relieved via These SCS implants send mild electrical currents along the spinal cord in order to disrupt signalling to the brain, thus minimizing the feeling of pain.
  • Implantable opioid infusion pumps are responsible for transporting opioid substances (or narcotics) directly to the spinal cord and therefore relieving the pain.

 

Written By: Natalia Pan

 

References

Daul, R. (2006, January 13). Manual Physical Therapy for Pain Relief. Retrieved June 28, 2017, from https://www.spine-health.com/treatment/physical-therapy/manual-physical-therapy-pain-relief

Revord, J. P. (2012, October 12). Invasive Pain Management Techniques. Retrieved June 28, 2017, from https://www.spine-health.com/treatment/pain-management/invasive-pain-management-techniques

Revord, J. P. (2012, October 12). Noninvasive Pain Management Techniques. Retrieved June 28, 2017, from https://www.spine-health.com/treatment/pain-management/noninvasive-pain-management-techniques

Revord, J. P. (2017, April 21). Transcutaneous Electrical Nerve Stimulators (TENS). Retrieved June 28, 2017, from https://www.spine-health.com/treatment/pain-management/transcutaneous-electrical-nerve-stimulators-tens

Ullrich, P. F. (2009, June 15). Exercise and Back Pain. Retrieved June 28, 2017, from https://www.spine-health.com/wellness/exercise/exercise-and-back-pain

Pain Relief through Manual Physical Therapy and its Various Techniques

complementary-therapyManual physical therapy is a unique form of therapy due to the use of hands instead of devices or machines. Practitioners use their hands to apply pressure on the affected muscle area and manipulate joints. By doing so, they decrease the back pain caused by spasms, muscle tensions or joint dysfunctions. Unlike exercising, manual physical therapists strive to understand why a muscle is not functioning. They attempt to restore a function of the affected muscle by manipulating the joints associated with it as opposed to simply engaging the muscle like in exercise. This kind of therapy is considered uncommon and unconventional; therefore physicians seldom apply its prescription.

Despite its infrequent use, manual therapy can be very beneficial for stiff joints and muscle tension. Due to the therapy’s ability to restore a patient’s painless body movement in a natural way, it can serve as pain relief for both chronic and acute back pains. It focuses on relaxing stiff back muscles and restricted joints in attempt to restore movement, flexibility and relieve back pain. Manual therapy concentrates on two different types of movement:

  • Soft tissue work (massages), which focuses mainly on the soft tissues of the body, such as muscles. Soft tissue work results in muscle relaxation, increased blood circulation and relief of overall muscle pain.
  • Mobilization/manipulation is a technique that applies a variety of different motions such as: varying speed (slow to fast), force (gentle to rough), and distances to twist, pull, or push bones into place. This technique promotes muscle flexibility by loosening tight muscles as well as reducing pain in a joint.

There are five different techniques that manual therapy applies in order to relieve back pain. However, before proceeding, a full body assessment is required. The practitioner will perform a full assessment to determine whether the patient’s body is capable of enduring these techniques. Depending on the results of the assessment, the practitioner then decides on the appropriate amount and/or combination of techniques for the patient.

  • Soft tissue mobilization’s (STM) main goal is to break up myofascial adhesion (inelastic muscle tissue like scar tissue), move tissue fluids and relax muscle tension. It is most commonly applied to the muscle area near the spine using deep pressured, rhythmic stretching.
  • Strain-counterstrain technique mainly corrects a patient’s posture and structure caused by abnormal neuromuscular reflexes. It is mainly used for patients with acute back pain due to its gradual, gentle approach. The procedure starts with the patient’s most comfortable position and then incrementally transitions the said posture into a proper, corrected one. The slow, incremental changes in the positions lead to muscles mildly stretching. Those stretches gradually cause the muscles to reset themselves into a normalized tension.
  • Joint mobilization involves the practitioner applying a varied range of motion including slow velocity and an increasing amplitude movement directly on the affected joint. By doing so, the practitioner is able to move the patient’s bone surfaces in ways which the patient was not able to previously do. As a result, this technique loosens up the restricted joint and significantly increases its range of motion.
  • Muscle energy techniques (METs) are performed when the patient is asked to contract a muscle for several seconds while the therapist is applying an anti-force on it. This procedure is repeated a few times in order to stretch shortened muscles and mobilize restricted joints. METs are considered an active procedure due to the patient’s required participation, which differs from the static joint mobilization technique.
  • High velocity, low amplitude thrusting is a more aggressive technique compared to joint mobilization and METs. This is due to the technique forcing the joint to its restrictive barrier by thrusting it within the restrictive barrier. If done correctly, the patient’s joint will acquire an increased mobility and restore the gliding motions of joints.

Despite all the potential positive results experienced from the techniques mentioned above, it is of outmost importance that the patient engages in an exercise program in order to progress the healing process as well as prevent the back pain from recurring in the future.

 

Written By: Natalia Pan

 

References

Daul, R. (2006, January 13). Manual Physical Therapy for Pain Relief. Retrieved June 28, 2017, from https://www.spine-health.com/treatment/physical-therapy/manual-physical-therapy-pain-relief

Daul, R. (2006, January 13). Specific Manual Physical Therapy Techniques. Retrieved June 28, 2017, from https://www.spine-health.com/treatment/physical-therapy/specific-manual-physical-therapy-techniques

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