In Search of the Best Pain Clinic in LA: Common Procedures

By | August 31, 2011

Even the relatively mild scoliosis shown here can make an injection more difficult. Notice that the needle follows a curvilinear path as it approaches the epidural space. This makes the injection much less painful.

When looking for the best pain clinic in Los Angeles many people ask, “What is the success record of Dr. Jones at the Acme Pain Clinic in performing Interlaminar Lumbar Epidural Steroid Injections, LESI’s for chronic low back pain?” This is actually one of the worst, but unfortunately most common criteria used in selecting a pain practitioner either by patients or by other physicians looking to refer patients for treatment.

Firstly it ignores completely the question of diagnosis in the management of chronic pain, which we will deal with in an upcoming blog. Suffice it to say, I have seen many patients who have endured countless LESI’s that were never indicated. Conversely, I have seen many other patients who have undergone complex injections when this simple procedure would likely have sufficed.

Secondly it ignores the question of patient difficulty. The same injection done on two different patients is really two different injections. I have been in practice for a long time and have practiced in a number of different facilities. As such I have been asked on numerous occasions to proctor younger practitioners to determine whether or not they possess the requisite skills to be granted full anesthesia and pain management privileges. These younger physicians will either want to do the simplest injections on the healthiest patients to optimize their chances of appearing smooth and skillful or they will attempt something more difficult, but again on the “perfect patient” with the hope of impressing me. Both of these miss the mark.  At the best pain clinic in LA both the simple and complex patients as well as the common and more exotic injections are treated as routine.

I have often said that the best test of skill in interventional pain management, is to do a simple IL LESI on a patient with severe arthritis or scoliosis. The way that the practitioner makes adjustments for the anatomical abnormalities will tell me much more about his ability to think three dimensionally and control the fluoroscope and his needle than a more uncommon procedure on a more straight forward patient. But the important point here is that it is not so much the result, whether or not the needle ends up in the correct place that defines the skill of the practitioner, but the way in which he gets it there. Does he appear clumsy and gauche? Did he become flustered when he first encountered difficulty? Did he hurt the patient when a more skillful physician would likely have placed the needle painlessly?

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