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Pain Specialist

Dr. Mike Shah: What Does a Pain Specialist Do?

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By: Dr. Mike Shah, Interventional Pain Specialist, Board Certified in Physical Medicine & Rehabilitation, Minimally Invasive Spine Institute in Dallas

Approximately 100 million Americans suffer from some sort of chronic pain, according to data from the American Academy of Pain Medicine. That’s more than the number of people who suffer from cancer, heart disease and diabetes combined. Neck or back pain along with headaches are among the most common types of chronic pain, affecting millions of people and taking a significant toll on their quality of life.

Fortunately, a physician’s understanding of pain – what causes it and how it can be effectively treated – has grown dramatically during the past 20-30 years, and today there are more options than ever for safe, effective pain management. The first step in relieving painful symptoms is scheduling an evaluation with a pain specialist, a doctor who’s trained specifically in the diagnosis and ongoing treatment of pain.

What does a pain specialist do?

Pain specialists have in-depth, advanced knowledge of the physiology of pain – that is, the causes, the effects and the symptoms of pain, as well as the often-complex mechanisms that cause pain to persist. This training and knowledge allows pain specialists to become skilled in evaluating pain, diagnosing the underlying causes and treating the root cause. Interventional pain specialists are also skilled in treating pain using state-of-the-art out patient procedures. From neck or back pain to related issues such as headaches and shoulder or arm pain, a pain management doctor begins treatment with a thorough evaluation of the patient’s condition and symptoms as well as overall health. Utilizing this information, your pain management specialist can develop a comprehensive treatment plan that’s designed specifically for the individual patient. There is no “one-size-fits-all” solution when it comes to treating pain. The key to a successful outcome lies in ensuring each plan of care is tailored specifically for the patient’s unique needs as well as developing a clear path for communication between the patient and the physician regarding pain relief and progress. 

Can a pain management doctor help me feel better?

While most people think of chronic pain in terms of the physical symptoms it causes, the fact is many people with chronic pain issues also suffer from anxiety, depression, sleep problems and other physical and emotional side effects. The sooner pain is appropriately managed, the sooner these problems can be resolved as well. If you suffer from chronic pain, there’s a good chance a pain management specialist can help you feel better too. To learn more about pain medicine and whether it’s a good choice for your needs, call the Minimally Invasive Spine Institute at 877-504-9759 and schedule your personal consultation and evaluation appointment today.

At the Minimally Invasive Spine Institute, our team is dedicated to identifying the specific causes of pain using state-of-the-art pain mapping and other advanced techniques so your treatment can be tailored you. Our custom approach to care means you can expect optimal results for long-lasting relief, helping you get back to the activities you love. If you suffer from chronic pain, visit https://mipainrelief.com/ or call the Minimally Invasive Spine Institute at 877-504-9759 and schedule a consultation to learn how we can help you feel better.


Mike Shah

Interventional Pain Specialist, Board Certified Physical Medicine & Rehabilitation, Minimally Invasive Spine Institute

Dr. Shah is a Harvard-trained physician in Physical Medicine and Rehabilitation who is dedicated to providing pain relief to residents of the Dallas area since 2003. He received a Bachelor of Science in Biology from Duke University and his medical degree from Tulane University School of Medicine in New Orleans, Louisiana. Dr. Shah also received a master’s in Pharmacology from Tulane and a Master of Public Health from Tulane University School of Public Health. Following this, he completed his Physical Medicine and Rehabilitation residency at Harvard’s Spaulding Rehabilitation Hospital in Boston, Massachusetts, consistently recognized as one of the Top 5 Pain Management Hospitals in the country by U.S. News and World Report.

Pain Mapping

Dr. Michael Rimlawi Discusses: Pain Mapping Offers Optimal Pain Management

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By: Dr. Michael Rimlawi, Board-Certified, Fellowship-Trained spine surgeon and founder of the Minimally Invasive Spine Institute in Dallas

Some types of pain are easy to diagnose: You stub your toe or you get a paper cut on your fingertip, and you know exactly what’s causing the pain and how to treat it. But sometimes the source of pain is less obvious, especially if an injury causes what’s known as referred pain – pain that’s felt in an area away from the injury site. Referred pain typically is associated with nerve impingements like slipped or herniated discs in the neck or back. These injuries can press on nerves as they exit the spine, causing pain anywhere along the nerve pathway and making it more difficult to determine the exact source of pain. For instance, chronic arm pain may actually emanate from an injury in the neck; leg pain might be caused by a disc herniation or nerve impingement in the lower back.

Other times, referred pain symptoms can be associated with trigger points, local areas of tenderness that often form in the upper back, neck or shoulders. These areas of “knotted” muscle fibers can cause chronic headaches along with persistent pain in the arms, back or neck.

Pain Mapping: The Key to Accurate Diagnosis

Obviously, treating pain effectively depends on knowing the source of the pain. But with referred pain, identifying the source can be problematic, even with the use of diagnostic imaging like X-rays or CT scans. The good news: Pain mapping can be extremely effective in pinpointing discrete causes of pain that otherwise may be missed during a traditional diagnosis.

The Minimally Invasive Spine Institute’s pain mapping uses a series of special techniques to “zero in” on the sources of pain so treatment can be optimized for the patient’s specific needs. During the mapping process, the doctor injects pain-relieving medications at different locations depending on the patient’s symptoms and their medical history. Based on the effects of each injection – specifically, whether or not the injection provides a temporary relief of pain – the doctor will be able to identify the original source of painful symptoms so a treatment plan can be “mapped out.” Before the procedure, the injection sites are numbed with local anesthetics and light sedation is administered to ensure the patient remains relaxed and comfortable.

Pain Mapping for Optimal Pain Management

Because it’s a highly specialized technique, pain mapping should only be performed by a trained pain specialist. At the Minimally Invasive Spine Institute, we rely on the most advanced pain mapping techniques using state-of-the-art tools for accurate diagnoses of most types of chronic pain, including pain emanating from the spinal nerves. If you have chronic pain, pain mapping can provide critical insight into the underlying cause so you can enjoy more targeted therapy and faster, more meaningful relief of your symptoms.

To learn more about pain mapping or to have your chronic pain issues evaluated, visit https://www.mispinerelief.com/ or call the Minimally Invasive Spine Institute at 855-466-6741 and schedule a consultation today.


Michael Rimlawi

Minimally Invasive Spine Surgeon, Board Certified, Fellowship-Trained

Spine Surgeon Dr. Michael Rimlawi is director and founder of the Minimally Invasive Spine Institute’s team. Dr. Rimlawi is a board-certified, fellowship-trained spine surgeon who completed unique training in both orthopedic-spine and neurosurgery-spine at the renowned University of California San Diego. Dr. Michael Rimlawi treats all aspects of spinal disease including degenerative and traumatic conditions of the cervical, thoracic and lumbar spine. More than just a back doctor, he is a leader in the field of minimally invasive spine surgery and a pioneer in endoscopic laser spine surgery.

Best Sleeping Positions for People with Back Pain

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By: Dr. Michael Rimlawi, Board-Certified, Fellowship-Trained spine surgeon and founder of the Minimally Invasive Spine Institute in Dallas

Sleep is meant to be peaceful and rejuvenating, but what happens when back pain prevents this? According to the American Academy of Sleep Medicine, “Adults should sleep seven or more hours per night on a regular basis to promote optimal health. Getting less than seven hours of nightly sleep increases your risk of several adverse health outcomes.”

The addition of an extra pillow paired with various doctor-recommended sleep positions can help alleviate lower back pain. To help those suffering from back pain, we have mapped out a few tips to obtain a restful night’s sleep.

  1. Sleep on your side with a pillow between your knees

    Side sleepers

    Photo Credit: Can Stock Photo

    This position isn’t the key to relief, but the added pillow is. By tucking a pillow between your legs, the spine, hips and pelvis are in better alignment.

  1. Sleep on your stomach with a pillow under your lower stomach

    Adding a pillow under the stomach can take pressure off the space between your discs.

  1. Invest in a good memory foam pillow

    Many people research and research their bed but pay little attention to their pillow. Memory foam pillows molds itself around the curve of your head keeping every small bone carefully aligned.

  1. Sleep flat on your back with a pillow under your knees

    According to Health.com, this position takes stress off your pressure points and allows for better alignment of your spine and internal organs.

  1. When traveling, use a seat sleeper pillow

    Sleeping with a neck pillow

    Photo Credit: Can Stock Photo

    Travel pillows come in all shapes and sizes. Supporting your head and neck while seat sleeping is important. Check out Travel +Leisure’s 14 Best Travel Pillows for Every Type of Seat Sleeper to help find a pillow that will  keep the head from being pushed forward when you are sitting.

While sleep positions alone won’t solve back pain, making small adjustments to your sleeping style can make a big difference.

Healthy Sleep Duration

Source: American Academy of Sleep Medicine


Dr. Michael RimlawiMichael Rimlawi

Minimally Invasive Spine Surgeon, Board Certified, Fellowship-Trained

Spine Surgeon Dr. Michael Rimlawi is director and founder of the Minimally Invasive Spine Institute’s team. Dr. Rimlawi is a board-certified, fellowship-trained spine surgeon who completed unique training in both orthopedic-spine and neurosurgery-spine at the renowned University of California San Diego. Dr. Michael Rimlawi treats all aspects of spinal disease including degenerative and traumatic conditions of the cervical, thoracic and lumbar spine. More than just a back doctor, he is a leader in the field of minimally invasive spine surgery and a pioneer in endoscopic laser spine surgery.

Yoga Stretching

Best Yoga Stretches for Lower Back Pain

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By: Dr. Mike Shah. Interventional Pain Specialist & Pain Management Board Certified Physical Medicine & Rehabilitation, The Minimally Invasive Spine Institute in Dallas

One of yoga’s most attractive qualities is that it’s good for the mind, body and soul. This holds true for people with back pain. There are a variety of yoga poses that you can do that are very beneficial when it comes to relieving back pain. Next time your back is acting up, try these yoga poses.

DOWNWARD DOG

Downward dog yoga pose

Photo Credit: Can Stock Photo

This stretch reaches the entire body and stretches the large muscles that form the lower back.

CHILD’S POSE

Childrens Yoga

Photo Credit: Can Stock Photo

Child’s pose provides the back with a deep stretch.

TRIANGLE POSE

Triangle Pose

Photo Credit: Can Stock Photo

Great for strengthening the back, triangle pose helps lengthen muscles and stretch muscle fibers.

CAT AND COW POSE

Cat Pose

Photo Credit: Can Stock Photo

Not only does this pose do wonders for an aching back, it also loosens back muscles and can be used as a warmup in any workout.

When first starting yoga, be prepared for your body to be a little sore. For a person with weight issues, a lack of exercise can greatly increase the risk of back pain. Inactivity combined with extra weight puts pressure and strain on your joints and spine, putting you at a greater risk for sciatica, herniated disks and pinched nerves.

Many people suffering from chronic back pain, for whatever reason, are under the impression they will be less likely to hurt their back if they limit the amount of activity or exercise they participate in. However, regular activity helps with lower and upper back pain relief as well as other types of chronic pain. Physical activity activates the exchange of nutrients between spinal disks, keeping the spine healthy.

Because yoga uses a variety of postures and techniques, it is important that you stretch properly before and after each yoga program. Stretches where your body doesn’t leave the floor and stretch the lower back are helpful. However, it’s important to communicate your pain with your doctor before starting any new exercise routine. It is also important that you learn how to properly perform yoga’s postures and techniques to avoid potential injury.

The American College of Sports Medicine recommends that you see your doctor before engaging in vigorous exercise if two or more of the following apply:

  • You’re older than 35 years.
  • You have a family history of heart disease before age 60.
  • You smoke or you quit smoking in the past six months.
  • You don’t normally exercise for at least 30 minutes, most days of the week.
  • You’re significantly overweight.
  • You have high blood pressure or high cholesterol.

You have type 1 or type 2 diabetes, or you have impaired glucose tolerance (also called prediabetes).


Dr. Mike ShawMike Shah

Interventional Pain Specialist & Pain Management Board Certified Physical Medicine & Rehabilitation, Minimally Invasive Spine Institute

Dr. Shah is a Harvard-trained physician in Physical Medicine and Rehabilitation who has been dedicated to the eradication of pain in the Dallas area since 2003. He received a Bachelor of Science in Biology from Duke University and his medical degree from Tulane University School of Medicine in New Orleans, Louisiana. Dr. Shah also received a master’s in Pharmacology from Tulane and a Master of Public Health from Tulane University School of Public Health. Following this, he completed his Physical Medicine and Rehabilitation residency at Harvard’s Spaulding Rehabilitation Hospital in Boston, Massachusetts, consistently recognized as one of the Top 5 Pain Management Hospitals in the country by U.S. News and World Report.

Everyday things that cause Back Pain

Everyday Things that Cause Back Pain

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By: Dr. Mike Shah. Interventional Pain Specialist & Pain Management Board Certified Physical Medicine & Rehabilitation, The Minimally Invasive Spine Institute in Dallas

According to the American Chiropractic Association, In the United States, more than three million people experience back pain each year. Lower back pain can be described as a problem in any part of the spine and can range from annoying to excruciating. As the single leading cause of disability worldwide, back pain is one of the most common ailments adults face.

Understanding your back pain:

For many, back pain can be as simple as a muscle strain or sprain. This is the most common form of back pain, and the most treatable. This kind of back pain is referred to as “self-healing”, which means it does not require treatment. Other kinds of back pain can be symptoms of a more severe condition, for which it is often necessary to seek out the advice of a back doctor.

Causes of back pain:

There are many different causes of back pain. Most commonly, back pain is caused by overuse or wear and tear as opposed to one isolated event. While overuse is not always preventable, there are several ways to change your daily routine that can significantly decrease the risk of back pain.

  1. Back Pain for Chairs

    Photo Credit: Can Stock Photo

    Take a break.

    For a lot of people, working includes sitting at a desk or in an office for up to eight hours a day. A the most common contributors to back pain is remaining sedentary for long periods of time. In fact, sitting can put up to 40 percent more pressure on your spine than standing. Taking breaks and going for short walks or doing stretches every hour or so can alleviate pressure on your spine. If taking breaks and stretching possible during a busy day at work, try investing in a chair that supports your back and does not cause you to hunch over your desk.

  2. Stop smoking.

    It’s no secret that smoking is bad for you. Everyone is aware of the effects smoking has on the lungs and heart, but not everyone realizes the damage it can cause to other parts of the body, specifically the back. Smoking has been linked to lower back pain and lumbar spondylosis, a disease in which the cartilage of the disks and joints degenerate. Quitting smoking is an effective way to improve your overall health and decrease the risk of lower back pain.

  3. Switch out your mattress.

    If you can’t remember the last time you switched out your mattress, it’s probably time to invest in a new one. For those who already have back pain, the right mattress can make a difference. Professionals recommend finding a mattress that has a medium firmness, or placing a pillow between the knees or under the stomach to relieve pressure. Not only can it decrease back pain, but it may also improve the quality of sleep.

  4. Eating healthy

    Photo Credit: Can Stock Photo / Choreograph

    Eat healthy.

    Following a healthy diet is an effective preventative measure to easing back pain. The key to creating a “back-healthy” diet is eliminating foods that cause inflammation. Avoiding added sugar, processed foods, caffeine, red meat and alcohol and introducing more grains, lean proteins, vegetables and fruit can decrease inflammation and improve circulation throughout the body.

  5. Stretch.

    One of the effective forms of alleviating pre-existing back pain is doing preventative and therapeutic stretches. Other methods, such as low-impact exercises and yoga can prevent back pain from occurring by keeping off excess weight and keeping the joints limber. Yoga not only promotes physical strength and muscle relaxation, but also promotes deep breathing and mindfulness. Try asking an instructor to adjust specific poses to target the lower back.

  6. Back pain from Heels

    Photo Credit: Can Stock Photo / YuriV

    Take off the heels.

    No one will ever say that walking in heels is easy or comfortable. High heels force the back to arch and the spinal muscles to work in overdrive. Try trading in high heels for shorter ones or even sneakers occasionally, and even consider investing in gel inserts for shoes to provide more stability and relief.

  7. Walk when you can.

    Much like sitting at a desk, sitting in a car for long periods of time can negatively affect your spine. Hunching over the steering wheel or slumping in the seat causes unnecessary pressure on the back. Simple steps such as sitting upright and purchasing a supportive lumbar pillow can ease pain, but the most effective method is simply stopping often to walk and give your spine a break.

The American Association of Neurological Surgeons state, “An estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime. Although low back pain can be quite debilitating and painful, in about 90 percent of all cases, pain improves without surgery. However, 50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year.” Because back pain is so common and can have significant negative effects on daily life, it’s worth taking the time to consider the changes you can make to take care of your spine.

For more information on back pain, common conditions and treatments, please visit www.mispinerelief.com. If you are suffering from chronic or severe back pain, contact the Minimally Invasive Spine Institute at 855-297-7242 to schedule a consultation with one of our specialists.


Dr. Mike ShawMike Shah

Interventional Pain Specialist & Pain Management Board Certified Physical Medicine & Rehabilitation, Minimally Invasive Spine Institute

Dr. Shah is a Harvard-trained physician in Physical Medicine and Rehabilitation who has been dedicated to the eradication of pain in the Dallas area since 2003. He received a Bachelor of Science in Biology from Duke University and his medical degree from Tulane University School of Medicine in New Orleans, Louisiana. Dr. Shah also received a master’s in Pharmacology from Tulane and a Master of Public Health from Tulane University School of Public Health. Following this, he completed his Physical Medicine and Rehabilitation residency at Harvard’s Spaulding Rehabilitation Hospital in Boston, Massachusetts, consistently recognized as one of the Top 5 Pain Management Hospitals in the country by U.S. News and World Report.

Man using phone

Back pain? There’s an app for that.

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By: Dr. Michael Rimlawi, Board-Certified, Fellowship-Trained spine surgeon and founder of the Minimally Invasive Spine Institute in Dallas

According to one of the leading statistics companies, Statista, as of March 2017, there were 2.8 million apps to choose from on Android and 2.2 million apps on the Apple App Store. There is pretty much an app for almost everything, including apps that help you manage back pain.

  1. My Pain Diary offers users a chronic pain and symptom tracker so they can better understand their pain and its patterns. With the app you can do the following:
  • Keep an accurate record of your condition for your doctor.
  • Learn how much you are affected by humidity, barometric pressure, temperature, precipitation and more.
  • Identify triggers, remedies, patterns and trends.
  • Email or print a report for you and your doctors.
  • Track your complex medical condition multiple times a day.
  • Track your simple pain condition as it occurs.Created by a chronic patient after being diagnosed with RSD/CRPS, My Pain Diary strikes the perfect balance between utility and ease-of-use. It is available for purchase in the App Store and Google Play for $4.99.
  1. The #1 Rated Yoga AppDown Dog: Great Yoga Anywhere brings yoga to you! Rated the number one yoga app by The Wall Street Journal, this is a fantastic tool to have in your possession in the fight against chronic lower back pain. With the app you can do the following:
  • Provides a home yoga workout to help relieve back pain.
  • Provides the closest thing to the actual experience of taking a yoga class in a studio.
  • New vinyasa flow sequences every time you log in. You’ll never see the same one twice.
  • 3 sequence types to choose from (full practice, on your feet, and restorative).
  • 4 levels (beginner 1, beginner 2, intermediate, and advanced).
  • Set practice time for between 15-80 minutes.
  • Clear demonstrations of all the poses with easy to follow instructions.
  • This music is tailored to your workout and constantly updated. You’ll never hear the same order twice.
    The app is free to use (with an optional upgrade to a membership of $3.99 per month) and is available for download in the App Store.
  1. The Backache app reminds users to get up and walk around to relieve the back after sitting for long periods of time. With the app you can do the following:
  • Backache app will send you regular notifications when to take a micro break throughout the day.
  • Simply follow the physiotherapist as he shows you which of the 31 exercises to perform.
  • The micro breaks can be performed anywhere as no special equipment is needed.
  • Set up your own schedule to suit your requirements.
  • Backache app includes 31 exercises that target all areas of the body including back, neck, legs, chest, feet, arms and hands.

With so many options, there’s an app for everyone. Some may help you identify issues to discuss with your doctor since back pain can result from a variety of things. However, if you are experiencing severe back pain, consult a doctor immediately.

The most important word of advice I have is don’t try and play Dr. Google and don’t rely on apps or the internet to self-diagnose your pain. If you are experiencing back pain, see a Board-Certified, Fellowship-Trained spine specialist. These apps are not in any way an endorsement or recommendation.


Michael Rimlawi

Minimally Invasive Spine Surgeon, Board Certified, Fellowship-Trained

Spine Surgeon Dr. Michael Rimlawi is director and founder of the Minimally Invasive Spine Institute’s team. Dr. Rimlawi is a board-certified, fellowship-trained spine surgeon who completed unique training in both orthopedic-spine and neurosurgery-spine at the renowned University of California San Diego. Dr. Michael Rimlawi treats all aspects of spinal disease including degenerative and traumatic conditions of the cervical, thoracic and lumbar spine. More than just a back doctor, he is a leader in the field of minimally invasive spine surgery and a pioneer in endoscopic laser spine surgery.

Ryan Shazier Injury

Spinal Injuries in Football

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A Closer Look at Ryan Shazier’s Injury

By: Dr. Michael Rimlawi, Board-Certified, Fellowship-Trained spine surgeon and founder of Minimally Invasive Spine Institute in Dallas

Concussions and football are (and will continue to be) hot topics – especially in youth football. However, it’s important to note the other risks associated with the sport. Take for example the Pittsburgh’s linebacker Ryan Shazier who made a head-first tackle in Monday’s game against Cincinnati. Shazier was taken off the field, seemingly unable to move his legs at the time.

On Dec. 7, a press announcement was issued, “Last night, UPMC neurosurgeons and Pittsburgh Steelers team physicians Drs. David Okonkwo and Joseph Maroon performed spinal stabilization surgery on Ryan Shazier to address his spinal injury.”

While the exact type and extent of the injury and subsequent procedure has not been made public, from the video it appears as if Shazier hyper-extended his back. As noted by the grabbing motion to his back immediately after the hit, he may have also fractured, broken or possibly dislocated one or more bones in his lumbar spine. The injury likely centered in his lumbar spine region because he was seen moving his upper extremities immediately after the injury. If the injury extended to his cervical (neck) region, he likely wouldn’t be able to move either his arms or his legs.

When this type of injury occurs, the key concern is the stabilization of the patient’s spine. In cases where the spine is broken and unstable, even the slightest movement can cause the spine to shift, putting pressure on the spinal cord. Pressure on the spinal cord increases the risk of permanent paralysis.

One way to stabilize a spinal break is to fuse the spine together using instrumentation (also known as spinal screws and titanium rods). In laymen’s terms, let’s assume L2 is the injured area, the surgeon will fuse L1 to L3 with screws and rods to hold it in place, creating spinal stabilization. Prior to the fusion, the surgeon will examine the spinal cord for loose bone fragments that could be pressing on spinal cord nerves and remove them. This procedure is called decompression.

Will Shazier recover fully? No one can know the answer right now. His recovery is dependent upon the size and severity of the bone or tissue damage that may have impacted his spinal cord.

It is important to note that not all spinal fractures require spinal stabilization surgery. Various non-surgical treatments are available, depending on the type of spinal fracture. For less serious spinal fractures, non-surgical treatments can include bracing, pain management, physical therapy, medication therapy, activity modification and rest.

If you would like to learn more about minimally invasive spinal procedures to treat spinal fractures, contact us today.


Michael Rimlawi

Minimally Invasive Spine Surgeon, Board Certified, Fellowship-Trained

Spine Surgeon Dr. Michael Rimlawi is director and founder of the Minimally Invasive Spine Institute’s team. Dr. Rimlawi is a board-certified, fellowship-trained spine surgeon who completed unique training in both orthopedic-spine and neurosurgery-spine at the renowned University of California San Diego. Dr. Michael Rimlawi treats all aspects of spinal disease including degenerative and traumatic conditions of the cervical, thoracic and lumbar spine. More than just a back doctor, he is a leader in the field of minimally invasive spine surgery and a pioneer in endoscopic laser spine surgery.

Pain medication dependence avoidance

Tips for Avoiding Pain Medication Dependence

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By: Dr. Mike Shah, Interventional Pain Specialist & Pain Management Board Certified Physical Medicine & Rehabilitation, Minimally Invasive Spine Institute in Dallas

At the Minimally Invasive Spine Institute, the majority of our patients come to us because they are in pain. And contrary to popular belief, many of those patients don’t need surgery to relieve their pain. Through innovative interventional pain management procedures, nonsurgical therapy and rehabilitation, pain relief is possible with no incisions at all. However, sometimes medication is also needed.

Addiction and substance abuse in America have increased significantly and pain medication misuse has become a dangerous problem. It is safe to say the United States is in the midst of an opioid addiction epidemic. Often times medicine that is intended to help becomes a source of pain for many because of its misuse.

How can patients take steps to heal without the fear of misuse? We have developed four tips to help ease the fear of misuse when a pain medication is prescribed for proper pain management.

1. Follow doctor’s orders

Pain Medication Dependence DoctorsClosely following dosage and the doctor’s orders can help ensure patients are taking the proper amounts to aid with pain relief but not more than is prescribed. 

2. Know the signs of substance misuse

The National Institute on Drug Abuse describes a person who misuses drugs as someone who takes drugs at a higher dosage than prescribed, combines drugs with alcohol or other drugs, and someone who takes drugs through different forms of administration such as snorting pills. Being aware of these signs can be vital to understanding substance misuse. Noticing a personal change in the frequency or dosage of medication you’re taking can be a red flag.

3. Stay alert for early signs of trouble

If you notice you’re not taking the drug as prescribed, or if you begin missing school, work, etc., see your doctor immediately and inform him that you are concerned you may be developing a dependency on your pain medication. 

4. Upon doctor’s orders, stop taking pain medication once the pain has stopped

Stopping pain medicationOnce the injury has healed and the pain has subsided or decreased to a tolerable level, it is important not to lean on pain medication as a crutch. If you experience withdrawal symptoms after ending medication, seek medical attention immediately.  It is important not to leave pain medication unattended where it can be used by anyone else.  You can return unused medication to your pharmacy to keep your family members safe and avoid misuse.

Not everyone who misuses prescription medication becomes dependent. But any misuse must be addressed so it doesn’t develop further.

Substance misuse affects many people and families every single day. Knowing how and what to watch out for and how to handle any issues that may arise can make all the difference.


Dr. Mike ShahMike Shah

Interventional Pain Specialist & Pain Management Board Certified Physical Medicine & Rehabilitation, Minimally Invasive Spine Institute

Dr. Shah is a Harvard-trained physician in Physical Medicine and Rehabilitation who has been dedicated to the eradication of pain in the Dallas area since 2003. He received a Bachelor of Science in Biology from Duke University and his medical degree from Tulane University School of Medicine in New Orleans, Louisiana. Dr. Shah also received a master’s in Pharmacology from Tulane and a Master of Public Health from Tulane University School of Public Health. Following this, he completed his Physical Medicine and Rehabilitation residency at Harvard’s Spaulding Rehabilitation Hospital in Boston, Massachusetts, consistently recognized as one of the Top 5 Pain Management Hospitals in the country by U.S. News and World Report.

Back Pain Myth Busters

Back Pain Myths

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Common Myths About Back Pain

By: Dr. Michael Rimlawi, Board-Certified, Fellowship-Trained spine surgeon and founder of Minimally Invasive Spine Institute in Dallas

Back pain is bad enough, and myths about the issue can make it worse. Roughly 8 out of 10 people in America will experience back pain at some point in their life, and being able to separate fact from fiction can be important in dealing with it and knowing when to take it easy for a while or when to get help from a spine specialist.

Back Pain MythsMyth 1 – Rest heals back pain

While rest is important and recommended for back pain, it is not always the key to a healthy recovery. Some instances require more extensive recovery methods, and rest can actually be harmful to recovery. When experiencing severe or prolonged back pain, you should always consult a doctor.

Myth 2 – Sitting up straight can prevent back pain

Back Pain and PostureWhile slouching is bad for the back, sitting up straight for too long can strain the back. Lean back in your chair occasionally to create a curve in your back, and walk around during the day as much as possible. If you sit at a desk for long periods of time, chairs that allow you to place your weight on you legs and knees can help remove pressure from your spine. Below is a video of a few key preventative stretches from the Minimally Invasive Spine Institute that you can easily do at the office to help avoid back or neck strain.

Back StretchesMyth 3 – I’m active, so I won’t have back pain when I’m older

Active Back PainAnyone can experience back pain, regardless of their lifestyle. Being active can decrease the likelihood of back pain, but no one is immune from pain regardless of their lifestyle. Excessive weight gain can increase or lead to back pain so maintaining a healthy weight through regular exercise will help ensure a healthier spine.  However, excessive or improper exercise can put extra stress on our spine.  Using proper form and techniques when exercising can help protect you from injury.

Myth 4 – My spine is fragile, so I need to take it easy to avoid hurting my back

The spine is surrounded by muscles and tendons, which give it strength and flexibility. A spine without fractures is strong, and activities like walking or aerobics can strengthen it even more.  If your doctors instructs you to avoid specific activities, it is important to follow his or her instructions.

Myth 5 – Since I have back pain, I must have torn something

Back Pain from TearPain does not always equate to damage. Sensitivity from overuse can often cause pain in the back area. However, if you are experiencing intense or chronic pain, contact a spine specialist immediately.

Myth 6 – The only way I can fix my back pain is with surgery

Many of our patients at The Minimally Invasive Spine Institute don’t need surgery to relieve their pain. Through innovative pain procedures, non-surgical therapy, and rehabilitation — pain relief is possible with no incision at all.

At the Minimally Invasive Spine Institute our goal is helping patients find relief. In many cases, that means assisting them in determining the exact cause of their pain through testing and diagnostic imaging so we can accurately treat the source of their pain.  Pinpointing the cause of their pain can often allow us to avoid unnecessary procedures or large surgeries.

When I opened the Minimally Invasive Spine Institute, my goal was to build a patient centric center that incorporates a team of patient care advocates, therapists, chiropractors, pain management specialists, radiologists and fellowship-trained spine specialists to work as a team to help care for our patients. No patient is ever treated the same because each patient has their own specific conditions and symptoms. Each patient’s pain is unique to them. Each one of our patients has had a customized treatment plan specific to their condition, symptoms and needs.

If you are suffering through pain and chronic symptoms contact us today to speak with one of our compassionate patient care coordinators and learn more about our effective treatment process.


Dr. Michael RimlawiMichael Rimlawi

Minimally Invasive Spine Surgeon, Board Certified, Fellowship-Trained

Spine Surgeon Dr. Michael Rimlawi is director and founder of the Minimally Invasive Spine Institute’s team. Dr. Rimlawi is a board-certified, fellowship-trained spine surgeon who completed unique training in both orthopedic-spine and neurosurgery-spine at the renowned University of California San Diego. Dr. Michael Rimlawi treats all aspects of spinal disease including degenerative and traumatic conditions of the cervical, thoracic and lumbar spine. More than just a back doctor, he is a leader in the field of minimally invasive spine surgery and a pioneer in endoscopic laser spine surgery.

Severe Headaches: Migraines and How to Treat Them

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severe-headaches-also-known-as-migraines

Migraines are severe headaches that affect over 30 million Americans per year. Marked by nausea, vomiting and sensitivity to light and sound, migraines are debilitating and disruptive, sometimes with little or no relief for days at a time. Understanding their progression, potential triggers and effective treatments can greatly help those suffering to combat migraines and regain control of their lives.

Characteristics of Migraines

As far as severe headaches go, migraines are in a category of their own. Generally manifesting in childhood, what starts as a localized headache in one area of the head turns into throbbing, pulsating pain that causes nausea, vomiting, sensitivity to light and sound, mood swings, fatigue and even sinus pain and congestion. They are exhausting and debilitating and, for many who suffer, can last anywhere from two to four days.

Migraines follow a four-stage pattern:

  1. The first stage is known as the prodromal stage, and it starts one to two days before the migraine comes on. The individual may notice being thirstier than usual, craving specific foods, yawning more often than usual and going to the bathroom more. He or she may also become irritable and tired.
  2. In the second stage, the aura stage, the visual disturbances that accompany migraines begin to pop up. The individual may experience flickering of lights, areas where he or she appears to lose vision, and has difficulty focusing. He or she may also notice difficulty concentrating or speaking and may feel some numbness or tingling throughout the body.
  3. The third stage, the actual attack, is when the headache begins. Usually starting above the eyes and moving to one side of the head (although sometimes it can cover the entire head), the headache becomes more intense, often throbbing and pulsating. During this stage, nausea, vomiting, lightheadedness and worsening of symptoms during physical activity may also occur.
  4. The last stage is the postdrome stage, the period after the headache when the individual is exhausted, fatigued, lacking in energy and sluggish.

Migraine Headache Relief

Being aware of migraine triggers may go a long way in helping patients prevent migraine attacks. Some common triggers for these severe headaches include:

  • Specific types of foods, especially those containing MSG, caffeine, nitrates or alcohol
  • Missing meals
  • Stress
  • Environmental factors
  • Lack of or too much sleep

Migraine headaches are treated in several ways, depending on history of migraines, severity of symptoms and efficacy of previous treatment. Medication is one of the go-to primary treatments for migraines –from over-the-counter migraine formulas of acetaminophen, aspirin and caffeine, to prescription medications that work to constrict blood vessels and block pain pathways in the brain. In some cases, anti-depressants, opioids and even beta blockers are used to treat migraine headaches. There are also alternative treatment therapies that have proven effective in easing migraine symptoms. These include acupuncture, massage therapy and biofeedback.

If you are suffering from migraines or persistent headaches, contact MISI today at 877-504-9759 to schedule a consultation with one of our migraine specialists.