By Dan Murphy
Pain management can be challenging for people with chronic pain conditions, but Steven Erosa, DO, at St. John’s Riverside Hospital and St. John’s Medical Group, is using interventional pain management to help patients.
“What we’re trying to do at St. John’s is to provide advanced interventional pain care and rehabilitation without the need for opioid or long-term medications,” says Dr. Erosa. “Pain management has a reputation or a history. It’s all over the news. It’s all over Netflix, Hulu, and TV shows—which are great, by the way. But they talk about a time when pain management was just Oxycodone and OxyContin. Now there is a replacement for these medications. There are patients who need these medications, but their overutilization led to a national crisis.”
Over 20 percent of Americans experience chronic pain, and many struggle to find relief. Opioid pain medications come with a risk of dependence, and may cause side effects like drowsiness that make driving or working unsafe. Often, patients search for other solutions to their pain.
Dr. Erosa explains that interventional pain care offers options for many people dealing with chronic pain.
“Interventional pain medicine is a specialty where we focus on diagnosing and treating complex pain problems from head to toe, all throughout the body,” he says. “We utilize diagnostic testing and imaging to identify the actual source of the pain, what we call a pain generator, and then apply an intervention—a procedure, a nerve block, maybe an ablation or some other minimally invasive treatment for that problem.”
Dr. Erosa attended osteopathic medical school and became a D.O. (Doctor of Osteopathic Medicine), which led him to explore the many options for helping people with chronic pain.
“As a D.O., I was trained in using my hands to treat conditions of the spine, joints, nerves, and bones,” he says. “I do utilize it in my practice when appropriate for patients, and that led me down the path of wanting to do something in the musculoskeletal medicine orthopedic realm. As I rotated through sports medicine, orthopedic surgery, and other fields, I found myself in physical medicine and rehabilitation, and it gave me everything I wanted out of medicine. I wanted continuity of care with my patients. I wanted to see them through the long-term problems they were having and help them find solutions to very complicated conditions. That led me to pain practice because I like doing procedures, I like hands-on work, and I like seeing patients get better.”
After completing a residency and fellowship in Physical Medicine and Rehabilitation and Interventional Pain Medicine at Albert Einstein College of Medicine, Dr. Erosa began treating patients with a wide range of conditions.
Common issues that bring patients into the clinic include arthritis, spinal stenosis, and spondylosis. As opioid use has declined in the treatment of chronic pain in recent years, Dr. Erosa has witnessed the arrival of new techniques for treating pain.
“Now what we’re seeing is an evolution of the practice into the interventional space, where we can actually do things for these chronic pain patients to alleviate the pain and let them live their lives more functionally,” he says. “At St. John’s, we perform all the regular traditional interventional treatments—from epidurals to nerve blocks to ablations and joint injections. We use both ultrasound-guided procedures in the office setting and in the hospital, and X-ray-guided procedures in the hospital proper. One of the new or novel procedures that I’m very proud of is neuromodulation, which is a fancy term for nerve stimulators. We are changing the way the nerves are processing pain and stimulating these nerves in a way to calm down focal pain in the joints, in the back, and in the upper and lower extremities.”
Dr. Erosa adds that not all implants are permanent. “We have temporary treatments that you use for a short period of time, but could give you up to a year or longer of relief. It really is amazing, because up until maybe 6 to 7 years ago, when it actually came out, there was no temporary implant that provided durable relief.”
At St. John’s Riverside Hospital, Dr. Erosa and his team work to find the right treatment for each patient. They begin with less invasive procedures, such as injections or nerve blocks, then move on to minimally invasive procedures if necessary.
“We’re now on the cutting edge of interventional spine therapies,” says Dr. Erosa. “We can implant very small devices, whether it’s a tiny screw or a tiny spacer, right next to certain areas of the back or spine. This is all done through a small incision and under local and twilight sedation. That way, you are able to get up and leave the hospital and go back to your normal activities the following day.”
He recalls one patient who suffered from Complex Regional Pain Syndrome (CRPS) following a foot operation.“It’s very debilitating,” Dr. Erosa explains. “The typical treatment is medication and physical therapy. She saw me maybe eight months into her treatment course and was not seeing any improvement. We decided to do some shots and nerve blocks first, and they provided only minimal relief. But then we discussed a temporary stimulator option that doesn’t require permanent implantation and doesn’t require any cutting. It’s all done through the skin, through a needle. So it was very minimally invasive, and she wanted this option because of her history. So we did it, and after 60 days, we removed that wire. She was 90% pain relieved. And now the best part is that to this day, five years later, she still has 90% pain relief.”
In addition to procedures and other treatments, Dr. Erosa often recommends physical therapy.
“At the end of the day, the one thing you’re always going to do is physical therapy, regardless of what you try,” he says. “If you need a shot first to get your pain down, great. Your pain is better. Now we need to start moving because sometimes part of the reason why you experienced pain is that you weren’t moving enough. I’ll summarize with this: There are diseases of activity and diseases of inactivity. And whether you’re pitching a baseball at 90 miles an hour and have shoulder pain, or you just don’t move your arm all day and have shoulder pain, you can have rotator cuff disease in both situations. It’s that Goldilocks zone. The right amount of physical activity is going to keep your body maintained.”
For more information about Dr. Erosa and interventional pain management, please visit St. John’s Riverside Hospital’s pain management page.
