Dr. Fakhry is interested in treating a wide range of acute and chronic pain disorders including neck and low back pain, facet pain, herniated discs, spinal stenosis, sacroiliac (SI) joint pain, joint related pain (knees, shoulders, hips, ankles, elbows), complex regional pain syndrome, and post-laminectomy pain syndrome. He will listen to each patient and develop an individualized diagnosis and treatment plan based on the patient’s history, physical examination and diagnostic studies. Dr. Fakhry has numerous research publications and has presented at national and international conferences, including his presentation on Platelet Rich Plasma and Stem Cells at the Academic Medical Center in Amsterdam as well as Epidural Steroid Injection Techniques at the SIMPAR Conference in Rome, Italy. In his free time, he enjoys traveling, exercising, sports, and charity work as he recently traveled to Windhoek, Namibia to volunteer his anesthesia and pain management services to the underserved. Dr. Fakhry’s well rounded training background, participation in research, and dedication to treating each patient as a family member has been instrumental in helping his patients decrease pain, improve mobility, and increase their overall quality of life.
Pain Management Doctors are board-certified in a specialty such as sport injuries, anesthesia, diabetes or cancer. They undergo an additional one-year fellowship in pain management, and are eligible for subspecialty board certification in pain management by the American Board of Anesthesiology.
First find the Pain Management Doctor that best fits your needs, review their experience, and determine that the location is convenient for you. Then, from that page, upload your insurance information. The Doctor’s office will contact you to verify whether your plan is accepted.
Many plans allow for access to out of network providers for the same out of pocket cost as in network providers.
Conservative treatment in back pain is gaining more and more acceptance as an effective approach to managing chronic back pain. They include a wide spectrum of options ranging from common medications to acupuncture, physical therapy, spinal injections, regenerative medicine injections, nerve blocks, massage or even biofeedback. Some studies suggest that, in the long-term, surgical procedures for chronic low back pain do not result in outcomes that are clearly better than conservative treatment.
Interventional pain management utilizes pain blocking techniques such as infusions, injections, RF ablation, spinal cord stimulation, electrostimulation, nerve blocks, peripheral nerve field stimulation or implantable drug delivery systems as modalities for treatment.
Epidural injections deliver steroids, anesthetics and/or regenerative medicine, like stem cells or PRP, into the epidural space around spinal nerve roots. These pain management injections can help reduce inflammation and pain, and also promote healing.
Pain relief may be experienced within 30 minutes after the injection due to the anesthetic effect. Longer-term relief from steroids usually begins in two to three days. Stem cells and PRP can take up to 4 to 6 weeks. On average, pain relief from the shots lasts about 3 months.
Fluoroscopy is an imaging technique that is vital for precisely locating the internal injection site for injection therapies such as pain medication, steroids, regenerative medicine and contrast dye material. During epidural injection procedures, fluoroscopic x-ray images accurately guide the doctor to position the needle so that medication is correctly administered.
Radiofrequency neurotomy (RF) uses heat generated by radio waves to target specific nerves and create an induced injury of the nerve, which temporarily turns off its ability to send pain signals. The procedure is also known as radiofrequency ablation. It can provide lasting relief for people with chronic pain, especially in the lower back, neck and arthritic joints. Patients who have had good results with nerve block injection may be good candidates for a radiofrequency ablation.
Regenerative medicine seeks to harness the body's own healing power rather than relying on a strategy that focuses primarily on treating pain symptoms. It focuses on ways to, repair, replace, or regenerate damaged tissues. Studies have illustrated that if adult stem cells are harvested and then injected at the site of diseased or damaged tissue, they can stimulate repair and reduce or eliminate pain.
Platelet-rich plasma (PRP) is a form of regenerative medicine that harnesses the body's ability to heal itself. Platelets are blood cells that cause blood clots and other healing functions. They are separated from the liquid portion of the blood by a centrifuge. The concentrated and activated platelets are injected directly into the injured or diseased body tissue, releasing growth factors that stimulate and increase the number of reparative cells the body produces.
Stem cells from fat tissue are an excellent source for the repair of cartilage degeneration. Fat tissue provides the largest volume of adult stem cells, while bone marrow provides far fewer stem cells, but yields additional growth factors to aid with the repair process. Combining them can amplify the healing power of the cartilage regeneration stem cell procedure. However, stem cells from fat tissue have been shown to provide better cell content and superior ability to differentiate into cartilage than those from bone marrow.
Traditional Eastern practitioners believe acupuncture unblocks and balances the energy which flows through the body along pathways called meridians. Western practitioners think that acupuncture minimizes pain through biological mechanisms, such as stimulating the hypothalamus and pituitary gland or causing change in neurotransmitters, hormones and immune function.
Migraine headaches are a neurological disorder that is characterized by over excitability of specific areas of the brain. Pain Management Doctors are using Botox injections into key muscle areas of the head and neck .This blocks the release of chemicals involved in pain transmission and prevents activation of pain networks in the brain.
Spinal cord stimulation therapy masks pain signals before they reach the brain. A small device, similar to a pacemaker, is implanted into the epidural space and delivers electrical pulses to the spinal cord. The electric pulses modify pain signals so they are either not perceived or are experienced as a tingling feeling. If unsuccessful, the implant can be removed and does not damage the spinal cord or nerves.
Interlaminar Epidural Steroid Injections (ILESI) are generally used in patients with posterior diffuse disc herniation. Transforaminal Epidural Steroid Injection (TFESI) is used in patients with neural foraminal disc herniation, lateral recesses or neural foraminal stenosis, neural root indentation. Your doctor will review your symptom profile, correlated with the imaging studies to determine the most effective approach.
Ketamine infusions are typically recommended when other treatment modalities for chronic pain have not been effective. Ketamine can deliver relief for some types of chronic pain. Ketamine works by blocking certain pain receptors in the brain and resetting the signaling of some nerve cells in your spine and brain. In sub-anesthetic doses, ketamine acts as an NMDA receptor block, which is significant in the treatment of chronic pain. By blocking the NMDA receptor in the spine’s dorsal horn, pain signal transmission is interrupted, giving central pain centers a chance to “reboot.”
"Medical necessity" is defined by insurance carriers as medical services or items that are reasonable and necessary for the diagnosis or treatment of illness or injury. Your provider should discuss with you whether your desired procedure qualifies as medically necessary. If a procedure can be proven to be a medical necessity, it may be covered by insurance.
Physical Medicine and Rehabilitation (PM&R) physicians are also known as physiatrists. PM&R physicians manage injuries and disorders with non-surgical modalities, focusing primarily on rehabilitation techniques and exercise. They treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons.
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Most insurers provide coverage for video visits at the same rate as in-person visits. You can search on PreferredMD specifically for Pain Management Doctors who accept your insurance for video visits. Select your carrier and plan from the drop-down menu at the top of the page to verify. If that information is not available, we recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.
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There are several effective non-medication alternatives for chronic pain; mind-body techniques, biofeedback and ancient Chinese therapies. For pain that has become more difficult to manage, injection therapy may also be a conservative modality to consider. Pain management injections can include nerve blocks, steroids, and/or regenerative/healing substances. Most pain management injections can be performed in less than an hour, with little or no downtime and can be used as a stand-alone treatment or in conjunction with other treatments.
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