Paul Davies, MD, KURE Medical Director says “Dr. Vidyarthi brings a wealth of knowledge and compassion in the area of neck and back pain.  He is extremely dedicated and I am very excited to welcome him to Southern MD.”

Dr. Vidyarthi earned his medical degree from The Pennsylvania State College of Medicine. He went on to complete his residency and fellowship training in Interventional Pain Management at the Milton S. Hersey Medical Center in Hersey, PA. Dr. Vidyarthi is the recipient of a number of honors and awards including The Dr. Marc B. Hahn Pain Medicine Fellowship Award which recognizes excellence in patient care, academic performance and mentoring skills for residents and medical students.

At KURE Pain Management, Dr. Vidyarthi’s focus will be devoted to treating patients with acute or chronic pain. Dr. Vidyarthi’s experience in interventional pain management will further promote KURE Pain Management as the region’s most comprehensive pain management facility. Providing excellence in patient care is one of the pillars of KURE Pain Management. This is achieved through its highly qualified staff, advanced interdisciplinary pain management treatment options, and compassionate care.

Dr. Vidyarthi joins a team of nationally recognized pain specialists including Dr. Doris Cope (former Vice Chairman of Pain Medicine, UPMC), and KURE founder and CEO, Dr. Paul Davies. KURE Pain Management is consistently recognized by patients as being one of the most well qualified pain management centers in the Mid-Atlantic region.

For more information about KURE Pain Management, visit www.KUREpain.com

Dr. Vidyarthi is a Diplomat in Pain Medicine, Psychiatry and Neurology.  He is a member
of the International Spine Intervention Society and the American Academy of Pain Medicine.

Dr. Vidyarthi obtained his Medical Degree from The Pennsylvania State College of
Medicine.  He went on to complete his Fellowship in Interventional Pain Management at The Milton S. Hershey Medical Center in PA.

Dr Vidyarthi is the recipient of multiple awards in the areas of patient care, academics and humanitarian service.   He enjoys charity fundraising for the YMCA, diabetes, cancer, cystic fibrosis and AIDS.  He also enjoys photography.

Interventional Techniques

Pain signals are transmitted from a peripheral site, or site of injury, to the cortex in a complex manner involving several orders of neuronal connectivity and several pain modulating pathways. Trigger point injections, nerve blocks, sympathetic blocks, epidural steroid injections, spinal cord stimulators, and intrathecal therapies target different steps of the pain pathways. Trigger point injections: A myofascial trigger point is “a cluster of electrically active loci, each of which is associated with a contraction knot and a dysfunctional motor endplate in skeletal muscle” (Simons, Travell, and Simons 1999). Trigger points usually affect postural and masticatory muscles and present as poorly-localized muscular pain or headache. They can be active or latent. Latent trigger points affect almost half of the population by adulthood. These are activated by sudden overloading contraction, viral infection, cold, fatigue, or increased emotional stress. Local anesthetic injection into these trigger points has been shown to decrease pain in clinical conditions like chronic headaches, myofascial pain syndrome, and fibromyalgia (Hong and Hsueh 1996). The possible complications from these injections are local site infection, hematoma formation or sometimes increase in pain.

Somatic nerve blocks:

Somatic nerve blocks are used in managing pain for both acute and chronic painful conditions. The somatic nerve to be blocked depends on the site involved and the type of chronic pain syndrome. Specific complications related to these blocks are permanent peripheral nerve damage and inadvertent intravascular injection of the local anesthetics.

Sympathetic nerve blocks:

Sympathetic nervous system hyperactivity can cause painful syndrome (CRPS). Some pain fibers also traverse the sympathetic tract to the spinal cord.

Epidural steroid injections:

Epidural steroid injections have modest benefit in neck, low back pain, and radicular pain (Benoist, Boulu, and Hayem 2011). Epidural steroids decrease nerve root inflammation and irritation caused by herniated disc or inflamed synovial facet joint. Most studies suggest modest benefits for variable periods of two weeks to perhaps three months. The short-term benefit from epidural steroid injections and the natural history of radicular pain may complement each other in regard to patient clinical improvement.

Radio-frequency ablation (RFA) or neurolytic nerve blocks:

Neurolytic blockade and RFA are valuable tools designed to produce prolonged interruption of neural transmission. The common rationale for neurolytic block,
prolonged relief of intractable pain, is used most often in patients with malignancy. Its role in non-malignant conditions is not clear and is individualized on case-to-case basis. RFA uses high frequency current (pulsed or ablative) to modulate the neural transmission. Clinically, it is most commonly used for cervical or lumbar facet pain (Dreyfuss et al. 2000) and trigeminal neuralgia (Taha and Tew Jr. 1996) but can also be used for sympathetic block, occipital neuralgia, and other chronic painful conditions.

Spinal cord stimulators (SCS) and peripheral nerve stimulators:

Spinal cord stimulators are effective in radicular and neuropathic pain,
e.g., CRPS in extremities. SCS and physical therapy used together improve quality of life and reduce pain in 50% of properly selected patients (North et al. 2005). Similarly, peripheral nerve stimulators are effective in patients with neuralgias, e.g., greater occipital or ilio-inguina / iliohypogastric neuralgia (Mobbs, Nair and Blum 2007; Schwedt et al. 2007). Complications specifically related to permanent implants include the risk for infection, epidural hematoma, lead migration and dural puncture.

Epidural and intrathecal drug delivery systems:

Delivering medications directly adjacent or into the spinal canal decreases the amount needed to produce analgesia and decreases the systemic side effects of high doses of narcotics. There are several newer medications, e.g., zicotinide (Prialt, an NSAID), that are effective for epidural and intrathecal use in conditions resistant to all other pain medications. Possible complications with intrathecal drug delivery system include local infection, meningitis, CSF seroma, catheter granuloma, catheter migration, respiratory depression, post-dural puncture headache, and epidural hematoma.

Summary

Pain procedures are quite safe; large numbers are performed in everyday clinical practice. Catastrophic events such as permanent nerve damage, epidural hematoma, epidural abscess, and paraplegia, occur only infrequently. However, even in the era of evidence-based practice, it is difficult to develop consistent criteria for pain intervention effectiveness, as evidence for many commonly-performed procedures is not available in the literature. In practice, pain reduction does not necessarily translate into improved function, although we often observe a broad spectrum of response to an intervention. It is imperative to consider risk and benefit of each intervention for each patient, individualizing the plan of care based on the individual’s comorbidity, motivation, and psychology.
The authors are past or present members of the UPMC St. Margaret Pain Medicine Center, University of Pittsburgh, 200 Delafield Road Suite 2070, Pittsburgh PA 15215. Dr. Cope has been the Director of the Pain Medicine Fellowship at the University of Pittsburgh Medical Center since the fall of 1997. Dr. Zhao leads the interventional pain management clinic at the VA Medical Center in Washington DC. Dr. Toshiwal is currently a Pain Medicine Fellow at the University of Pittsburgh Medical Center and may be contacted at grtosh@gmail.com

Providers serving southern Maryland:

Paul W. Davies, m.d., is board certified in pain management. He is one of the first fellowship trained pain specialists in the country. Dr. Davies was a post-doctoral fellow in pain management at Johns Hopkins School of Medicine. He earned his medical degree from the University of Manchester, England and has done residencies at the University of Pittsburgh, Baylor College of Medicine in Houston, and Albert Einstein Medical Center in Philadelphia.

Frank Bender, m.d, is board certified by the American Board of Physical Medicine & Rehabilitation with a subspecialty in Pain Medicine. Dr. Bender’s primary focus is on the diagnosis and treatment of patients who have spine, nerve, joint or muscle pain as a result of sports or occupational injury, or other medical conditions. His goal is to provide patients with a personalized treatment plan that will provide maximum, long term relief from pain with improved quality of life.

Janak Vidyarthi, m.d., obtained his medical degree from The Pennsylvania State College of Medicine. He went onto residency at The Milton S. Hershey Medical Center where he completed his Fellowship in Interventional Pain Management. Most recently, he was an Attending Pain Management Physician in Hanover, PA. Dr Vidyarthi has participates in multiple cycling fundraisers benefitting pediatric diseases, diabetes, AIDS and cancer research.

-Dianne Foster Armstrong

I agree, I saw “Big Tea” (Earle Grey) for a while. I was so sad when he moved away from the Stevensville office. He is a great guy! I now see Amit Patel, and he is amazing as well. I cannot say enough great things about the Dr’s and Staff of Kure Pain Mgmt!

-Jennifer Berry-Pike

“Dr. Bender is a welcome addition to the KURE team, bringing decades of experience with him to the Mid-Atlantic region,” says Margaret Rose Evans, Director of Sales and Marketing for KURE Pain Management, “We are excited to offer his services in pain medicine and spine intervention to our patients.”

Dr. Bender is board certified by the American Board of Physical Medicine & Rehabilitation with a subspecialty in Pain Medicine. Dr. Bender’s primary focus is on the diagnosis and treatment of patients who have spine, nerve, joint or muscle pain as a result of sports or occupational injury, or other medical conditions. His goal is to provide patients with a personalized treatment plan that will provide maximum, long term relief from pain with improved quality of life.

Dr. Bender’s expertise in interventional spine medicine and pain management helps to further promote KURE Pain Management as the most comprehensive pain management practice in the Mid-Atlantic region. Dr. Bender will work along side other nationally recognized pain specialists including Dr. Doris Cope and KURE founder, Dr. Paul Davies. He will see patients at KURE’s locations in Southern Maryland and on the Eastern Shore of Maryland.

Dr. Bender earned his medical degree at the Medical College of Wisconsin in Milwaukee. He completed his residency and internship at Mercy Hospital in Pittsburgh, PA, followed by a fellowship in Physical Medicine & Rehabilitation and Pain Intervention at the University of Pennsylvania Affiliated Hospitals in Philadelphia, PA.

Dr. Bender proudly served the United States Military as a member of both the Air and Army National Guards.

For more information about KURE Pain Management, visit www.KUREpain.com.

A recent testimonial from our patient satisfaction survey. At Kure Pain, our patients always come first.