Dr. Belmonte has a special interest in treating both Acute and Chronic Pain. His main area of focus is outpatient pain management as well as per-operative pain consultations. Dr. Belmonte is looking forward to helping PAA provide excellent pain management services.
COOLIEF is a non-invasive, out-patient treatment that uses cooled radiofrequency technology to safely treat chronic pain
This is also known as “cooled radiofrequency therapy"
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Our goal is to provide you with superior pain management in an effective, safe, and timely manner. Through the use of medications, physical therapy, alternative medicine, and interventional therapy, we will reduce your suffering as safely and quickly as possible.
We understand that both acute and chronic pain is a substantial medical problem in our community. Over 9% of adults in the USA experience chronic, mild to moderate, non-cancer related pain. Nationally, this translates into over 40 million physicians visits each year for pain management. This is over 515 million days of lost work. You are not alone and we at PAA are here for you.
While our goal is to alleviate your pain in a timely and effective manner, it is crucial that therapy is achieved in the safest way possible. Narcotic pain medication and non-narcotic medication therapy are employed in our practice. Our goal is to minimize medication use and provide alternative forms of therapy that include physical/occupational therapy and interventional procedures.
Radiofrequency lesioning is a minimally invasive procedure used in the treatment of chronic pain. RF lesioning uses radiofrequency energy to disable the sensory nerves that cause the pain. Deactivating the pain causing nerves may provide lasting relief from chronic pain. Unlike surgery, there is no incision. During treatment, an RF generator transmits a small radiofrequency current through the insulated needle, to disrupt the specific nerve that is sending pain signals to your brain. Pain relief usually lasts for 3-24 months.
Epidural spinal injections are advocated for spinal degenerative disorders with radiculopathy, spinal stenosis, discogenic pain or spondylosis, failed surgery disorders, refractory cervicogenic headaches and spinal fractures. The most common indication for epidural injections is to place corticosteroid adjacent to an inflamed nerve root that is causing radicular symptoms. Nerve root inflammation may stem from an acutely herniated intervertebral disc causing nerve root irritation or other causes of nerve root impingement such as isolated foraminal stenosis.
An epidural steroid injection includes both a long-lasting corticosteroid (e.g., triamcinolone, betamethasone) and an anesthetic numbing agent (e.g., lidocaine, bupivacaine). The drugs are delivered into the epidural space of the spine, which is the area between the protective covering (dura) of the spinal cord and the bony vertebrae.
Celiac plexus blocks are used to control pain arising from intra-abdominal structures. These structures include the pancreas, liver, gall bladder and abdomen. The most common application of the block is to treat pain associated with intra-abdominal malignancy, particularly pain associated with pancreatic cancer. Local anesthetic under xray guidance is injected at the celiac plexus, a diffuse network of nerve fibers that lie over the surface of the aorta at the T12/L1 verterbral level.
The pain caused by facet arthropathy is most pronounced over the axis of the spine and is exacerbated by movement, particularly extension of the spine, which forces the inflamed articular surfaces of the facet joints together. Axial spinal pain at rest or worsening with forward flexion or rotation of the spine is also a common feature.
A facet injection includes both a long-lasting corticosteroid (e.g., triamcinolone or methylprednisolone) and an anesthetic numbing agent (e.g., lidocaine or bupivacaine). The drugs are delivered to the painful facet joint, either inside the joint capsule or in the tissue surrounding the joint capsule using xray guidance. Each vertebra has four facet joints, one pair that connects to the vertebra above (superior facets) and one pair that connects to the vertebra below (inferior facets)
Facet injections also provide diagnostic information for your physician. Successful facet injections may indicate that you could benefit from a facet radiofrequency procedure.
A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck for pain located in the head, neck, chest or arm caused by sympathetically maintained pain (reflex sympathetic dystrophy), causalgia (nerve injury), herpes zoster (shingles), or intractable angina. Stellate ganglion blocks are also used to see if blood flow can be improved in circulation problems typically from Raynaud's or CREST.
A stellate ganglion block is an injection of local anesthetic (bupivicaine) around the stellate group of nerves in the neck under ultrasound guidance. The pain relief will affect one side of the head and neck, the upper arm and the upper part of the chest on the same side of the body. A stellate ganglion block may be performed to decrease pain and increase the circulation and blood supply to the affected arm.
A bursa injection is carried out by delivering local anesthetic and steroid medications into specific synovial fluid filled fibrous sacs which are adjacent to joints in the body often under ultrasound guidance.
The Sacroiliac joints are paired structures formed by the sacrum medially and the ilium of the pelvis laterally. The sacroiliac joints are the principal load-bearing structures that connect the vertebral elements of the spine with the pelvis and lower extremities. Once the sacroiliac joints become painful, they may cause pain in the low back, buttocks, groin or legs. The local anesthetic and steroid is injected under xray guidance into the sacroiliac joint. The procedure may be both therapeutic and diagnostic and may be followed with radiofrequency of the sacroiliac joint for longer lasting relief.
The lumbar sympathetic blockade has been used extensively to the treatment of sympathetically maintained pain syndromes involving the lower extremities including complex regional pain syndrome and peripheral vascular insufficiency due to small vessel occlusion. A local anesthetic is injected under xray guidance over the lumbar sympathetic chain which consists of four to five paired ganglia that lie over the anterolateral region of the spinal cord from T11 to L2.
The Superior hypogastric plexus block is used in the treatment of pain arising from the pelvic viscera. Patients suffering from endometriosis or locally invasive cancer involving the vagina, uterus, ovaries, prostate and rectum often gain significant pain relief. A local anesthetic under xray guidance is injected at the superior hypogastric plexus which is located over the anterior surface of the fourth and fifth lumbar vertebrae and first sacral vertebrae.
An intercostal nerve block reduces the inflammation of tissues by injecting local anesthetic around the intercostal nerves that are located under each rib. This is most useful for herpes zoster, shingles pain in the chest, chest scar after chest surgery or trauma.
An occipital nerve block is an injection of a steroid and local anesthetic around the greater and lesser occipital nerves that are located on the back of the head just above the neck. The block is usually done under ultrasound guidance and reduces the swelling of tissue around occipital nerves to treat migraine headaches.
The supraorbital nerve is a small nerve that provides sensation to the scalp, forehead, and upper eyelid. When these nerves are irritated the patient may experience muscle spasms and frontal headaches. Injection with local anesthetic and steroid may offer relief from these headaches.
We use botox for the prophylaxis of headaches with chronic migraines (>15 days per month with headaches lasting 4 hours a day or longer.
Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. Spinal cord stimulation is most often used for patients with chronic and severe neuropathic pain, who have not responded to conservative treatments. Patients with the following conditions may benefit from SCS: post-laminectomy pain syndrome, radiculopathy, diabetic neuropathy and complex regional pain syndrome
Implanting the stimulator is typically done using a local anesthetic and a sedative. We will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. If the trial is successful, a more permanent stimulator may be implanted.
A transforaminal injection is an injection of long acting steroid into the opening at the side of the spine where a nerve roots exits. This opening is known as a foramen. There is a small sleeve of the epidural space that extends out over the nerve root for a short distance. This epidural root sleeve is just outside the spinal canal. The long acting steroid that is injected reduces the inflammation and swelling of spinal nerve roots and other tissues surrounding the spinal nerve root. This may in turn reduce pain, tingling and numbness and other symptoms caused by such inflammation, irritation or swelling. Also, the transforaminal injections can be used to identify a specific spinal nerve root level or levels that are the source of pain.
A caudal epidural steroid injection is a specific type of epidural steroid injection. It is typically done to treat lower back, rectal or groin pain or patients who have had previous back surgery. It is performed at the base of the spine just above the tail bone or coccyx. A small needle is inserted at this location and advanced through the sacrococcygeal ligament into the caudal epidural space.
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