When it comes to pain management, Dr. Barkow takes an innovative and customized approach to patient care. At Orange County Pain Management, we believe in taking a look at the body as a whole unit and drawing from a variety of disciplines and alternative medicine options. We take an integrative approach towards not only managing effective, long-lasting pain relief, but improving quality of life as well.
“While I’m deeply rooted in Western medicine, I also take a holistic look at the human body and often ask my patients to look at their daily habits, movements and nutrition patterns to see if we can target their pain in a comprehensive manner.”
Dr. Stephen Barkow
The initial consultation includes a complete health history and physical examination to pinpoint the source of the pain. Dr. Barkow is then able to create an individualized pain treatment plan. This may include:

Regenerative Medicine

Regenerative Injection Therapies (RIT) are a spectrum of cutting edge therapeutic techniques used to naturally treat and heal the cause of a painful condition rather than masking the symptom. RIT stimulates and accelerates your own body’s natural ability to heal itself. Two of the most effective RIT include stem cell therapy and platelet rich plasma injections. Click here to learn more.

Minimally-Invasive Procedures

We offer a variety of interventional treatments, including, but not limited to:

 

Trigger Point Injections comprise of injections of local anesthetic and/or an anti-inflammatory corticosteroid into the affected muscle that contributes to pain. These injections help relax the muscle both with the injected solution and physical injection of the needle into the muscle. It can help temporarily numb and relax the muscle sites involved. It also can promote further stretching of the muscles more effectively and can increase blood flow to the muscle. These set of injections can be done in our office with the use of ultrasound guidance. You may be seated or lying down, depending on where the injection sites are. The area will then be cleansed with an antiseptic solution. The provider will use the ultrasound guidance to identify target muscle locations and then will injection a solution of local anesthetic and/or steroid. A band-aid may be applied after to the injection sites. There should be some immediate relief with the local anesthetic and even longer lasting relief with the steroid. Trigger Point Injections offer good pain relief from muscle spasm and localized muscle pain.
Cervical, Thoracic, or Lumbar Epidurals:

Epidural Injections are first line treatment for back pain that radiates into the arms or legs. Upon initial examination, our providers will assess you for back pain and analyze imaging such as X-Rays or MRIs to decide if an epidural is indicated for you. Typically, these injections treat back pain that starts in the spine but can radiate through the extremities. Radiation can include anything from pain, numbness, weakness, or tingling. The anti-inflammatory steroid works to calm down inflammation within the spine that can be irritating to the nerve roots. These can be done in a series of 3 separate injections, but you will be evaluated after each injection for progress and assessed if repeating is beneficial. This can provide relief from the inflammatory component of back pain. These injections pose little risk, but as with any procedure there is slight risk of infection. Patients can usually see pain relief and results within 1-2 weeks of the injection. Patients gain better range of motion, less symptoms into the extremities, ability to perform more activities, and overall pain reduction.

For this procedure you have to option to do this with anesthesia or without. For anesthesia procedures, you will be referred to a surgical center where Dr. Barkow performs injections. You would be put under twilight sedation for the procedure and he will inject steroid into the epidural space. If you choose to do this without anesthesia, you will come to a surgical suite outfitted with fluoroscopic (X-ray) guidance. You are able to drive yourself to and from this procedure as you will not have anesthesia. Dr. Barkow will first injection local anesthetic to numb the location of the injection and then, as he talks you through the procedure, he will inject steroid into the epidural space.

Facet Injections:

Facet Injections are steroid injections used to treat back pain and pain in the joints of the spine. Patients with facet pain usually have pain localized to the neck or low back that does not radiate. Facets are the paired joints within the spine, one pair at each vertebral level. Just as other joints in the body, these can develop arthritis over time and cause pain. Patients can experience pain with sitting, bending, twisting, standing, or walking. As our patient, you will be assessed for facet pain through a history, examination, and XRay/MRI. If the pain is coming from the facets of the spine, steroid injections can help calm down the inflammation in the affected facets. Patients can usually experience relief 1-2 weeks after the procedure.

For this procedure you have to option to do this with anesthesia or without. For anesthesia procedures, you will be referred to a surgical center where Dr. Barkow performs injections. You would be put under twilight sedation for the procedure and he will inject steroid into the affected facet joints. If you choose to do this without anesthesia, you will come to a surgical suite outfitted with fluoroscopic (X-ray) guidance. You are able to drive yourself to and from this procedure as you will not have anesthesia. Dr. Barkow will first inject local anesthetic to numb the location of the injection and then, as he talks you through the procedure, he will inject steroid into the facet joints.

Hyaluronic Acid Knee Joint Injections (Synvisc, Orthovisc, Hyalgan):

If you are experiencing arthritic knee pain, there is a special injection to alleviate this pain. Patients with arthritis in the knee describe aching pain, difficulty moving the knee, cracking, popping, and difficulty walking or climbing stairs. Upon our assessment we will gather a history of the pain, do a physical exam, and review X-Rays or MRIs. If arthritis is present, we can recommend Hyaluronic Acid injections into the knee. This solution is naturally present in the human body, specifically in the bone and cartilage structures. Our joints, particularly the knees, are surrounded by a membrane called the synovial membrane that provides a capsule around the two connecting bones. The fluid inside this membrane is viscous and thick and provides the elastic shock absorbing properties of the joint. In arthritis, this membrane can erode and cause more irritation to the joint and provide less padding. The Hyaluronic Acid solution can replace this void and provide lubrication and support for the joint.

These injections are FDA approved for osteoarthritis of the knee and done in a series of 3 injections- 1 week apart. The injections will be done in our office with the use of ultrasound guidance and local anesthetic. There are very minimal risks associated with the procedure and the injections can provide more support for the knee and decrease pain from arthritis.

Radiofrequency Thermocoagulation is a method of using heat and radiowaves to interrupt pain signals primarily in the spine. Radiofrequency needles generate local heat at the tip when an electrical current is applied. This treatment can be used for neck pain, mid-back pain, and lower back pain and can provide long term relief. For this procedure, our providers will assess and recommend first doing a diagnostic block to determine the levels of nerve irritation. For the block, you will go to a surgical suite and using X-Ray guidance, Dr. Barkow will inject local anesthetic into the target nerve roots. You will then assess if you have pain relief over the next 2-3 days. If this diagnostic block provides relief, it is indicated to proceed with the Radiofrequency Thermocoagulation where the nerves are actually burned. Typical nerves grow back in 12-18 months and this procedure can provide relief for that amount of time or more. It also gives the nerves an opportunity to grow back better and cause less pain. There are very little risks associated with this procedure.

Medication Management

When it comes to pain medication, Dr. Barkow is very considerate of all available options. Due to potential adverse effects of opiate medication, we typically require monthly appointments in order for Dr. Barkow to closely monitor its use. Ultimately, medication is used for the purpose of improving the patient’s overall function and decreasing pain. We will work with you to get you on the best pain-fighting regimen.

Nutritional Guidance

Dr. Barkow believes that “the body has the potential to heal itself, if we give it the support it needs.” We look at nutrition patterns to target pain in a comprehensive manner. We have a nutritionist on staff and a complete line of natural pain supplements to assist our patients living with pain.