Arizona Pain Monthly Janauary 2011

Arizona Pain Monthly | January 2011 Bloom With Us

Welcome to the January issue of Arizona Pain Monthly. We hope the New Year finds you and your families well.

The year 2011 brings changes to Arizona Pain Monthly magazine. We are introducing new regular columns and features that we feel will be extremely beneficial to you and your families. We are also introducing a word to focus the monthly theme of the issue. For January’s Health and Well-ness theme, the focus word is Bloom.

For those that suffer from chronic pain, it can be extremely difficult to move past the burden chronic pain places upon you and your families. Chronic pain stops you from enjoying the activities you used to do, and can keep you from your families and friends. At Arizona Pain Specialists, it is our goal to help lift the burden of pain and help you bloom into a new person who is not limited by the effects of pain. We want to help you get back into your life, and help you to make new memo-

ries. We have seen patients take up hobbies that they have always wanted to try but have been held back from by their pain – like scuba diving, painting, and skiing.

The knowledge of your pain-ful condition and steps you can take at home to alleviate pain can be empowering. The physicians at Arizona Pain Specialists want nothing more than to educate you on your painful condition and the right treatments for you. We encourage you to research your condition and ask questions – we have many tools available to edu-cate you as well.

A new feature column that partners with patient education will be our book section. We will review books that are relevant to pain patients and their fam-ily members. Even with new columns and changes in Arizona Pain Monthly, we will continue to bring patient favorites like the recipe section, Ask the Expert, and Chiro Corner to you each month. As always, we welcome patient suggestions and insights

to features and stories that you would like to see featured in Ari-zona Pain Monthly.

2011 is an exciting year for our practice as we are taking many of your suggestions to heart and are launching a “Quality Revolu-tion” with the theme Changing Lives Daily. Our goal is to make your experience here much more pleasant and rewarding. Stay tuned as we roll out more improvements!

We hope that this issue is edu-cational and informative. We thank you for your continued loyalty if you are a long-standing patient, and we welcome you to the Arizona Pain Specialists fam-ily if you are a new patient.

Until next time, remember at Arizona Pain Specialists, we be-lieve you can be pain free.

Dr. Tory McJunkin & Dr. Paul Lynch

Please contact us at [email protected] if you have any comments or questions. We appreciate your feedback!


Asparagus Risotto

• 1 pound fresh asparagus• 6 cups low-sodium chicken broth• 2 shallots, diced• 4 tablespoons butter• 1 1/2 cup medium grain white rice• 1 1/2 cup dry white wine• 1/2 cup freshly grated Parmesan cheese

Trim ends off asparagus spears, then cut into bite-sized pieces. In a pot large enough for the chicken broth, bring all broth to a boil. Reduce heat to medium, and then add asparagus. Cook two minutes, and then remove to a bowl with ice water (this will preserve the green color and crisp-ness of the asparagus). Keep the chicken broth at a low, continuous simmer.

In a different large sauce pan, melt two tablespoons of butter, add the shallot and cook until translucent and tender, approximately 3-4 min-utes. Add the rice and stir to coat, and then toast the rice for 3 minutes, stirring constantly. Add the wine to the rice and simmer until the liquid has evaporated nearly completely. Stirring constantly, add the broth 1/2 cup at a time, each time cooking until the broth has nearly evaporat-ed. Entire process will be about 20 minutes, until the mixture is creamy and rice is cooked through. Remove from heat and add remaining butter, asparagus and cheese. Serve imme-diately.

Poached Pears with Raspberry Sauce

• 1/4 cup white wine or white grape juice• 1 cup water• 1/2 cup sugar• 2 pears, peeled and cut in half• 3 tablespoons seedless raspberry jam• 1/2 teaspoon vanilla extract

In a saucepan large enough to fit the pears, bring the wine or juice, sugar and water to a boil. Reduce the heat, carefully add the pears, and cover. Simmer for approxi-mately 10 minutes, or until pears are fork-tender. Remove the pears from the pan, keeping the cooking liquid. Place pears in an airtight container and chill.

In a bowl, combine the jam and vanilla extract. Slowly add small amounts of cooking liquid until the mixture has reached desired sauce-like consistency. Pour sauce into separate airtight container and chill.

Fifteen minutes prior to serving, remove the sauce from the re-frigerator. Place pear halves on a plate, drizzle sauce over each half. Garnish with mint leaves or fresh raspberries if desired.

Balsamic Chicken

• 4 boneless, skinless chicken breasts• 2 teaspoons extra virgin olive oil• 1/3 cup balsamic vinegar• 1/4 cup low-sodium chicken broth• 3 garlic cloves, peeled and minced• 4 tablespoons butter

Place chicken in a large, zip-top bag. Lightly pound the chicken with a meat mallet, until chicken is approximately 1/2 inch thick. In a large, deep frying pan, heat oil over medium heat, add the chicken and cook, being sure to turn chicken at least once. Cook until chicken has reached 170 degrees or is no longer pink in the middle. Remove chicken.

In the same pan, mix garlic, chicken broth and balsamic vinegar. Cook over medium heat, approximately five minutes until the mixture has reduced and has become syrup-y in consistency. Add the butter, stir until the butter is melted.

Spoon sauce over chicken and serve.


Expert Guest Dr. Richard Jacoby

Dr. Jacoby has served the Phoenix community for the last 35 years, and brings his expertise to those with lower extremity conditions. Dr. Jacoby is one of 350 physicians worldwide to have trained at The Dellon Institute with Dr. A. Lee Dellon.

Appointments can be made by calling 480-994-5977

Diabetic neuropathy (nerve dam-age) is a common complication of diabetes. About 60 to 70 percent of people with diabetes have some form of neuropathy. Some people have no symptoms, but others may experience pain, tingling, burn-ing, or numbness (loss of feeling) in the hands, arms, feet, and legs. Neuropathy can also slow the heal-ing process and stop patients from feeling the warning signs caused by foot injuries. Diabetic patients should check their feet daily for cuts, sores, swelling, and infection that could lead to amputation if left untreated.

We have found that neuroma pain (tumors of the nerve tissue) can be one of the first indicators that a patient is becoming diabetic. If this can be detected early in the pre-di-abetic state, we can take measures to prevent diabetes. We work to identify the warning signs of diabe-tes early, and advise our patients in how to maintain proper foot care, decrease the effects of diabetic neuropathy, and avoid unnecessary limb amputation.

Our consultations begin with a thorough physical exam and medi-cal history. We get to know our patients and their problems, and specific medical history knowl-edge helps us narrow the source

of their suffering and relate it to other medical issues. Diagnostic techniques include the Pressure Specified Sensory Device (PSSD), an effective, pain-free method of test-ing the lower extremity for sensory deficits.

Compression in and around the nerves doesn’t have to hinder the lives of diabetic patients. We focus our treatments on regaining health in the entire body. We start conservatively with improved diet and exercise plans to control blood sugar, taking steps to reduce stress and ensuring patients are getting enough sleep. Medications, regional nerve blocks, and laser therapy can be helpful measures for controlling pain.

If conservative treatment methods are not effective, the highly special-ized Dellon Decompression tech-nique is a preferred surgical option. In the past, neuropathy was ap-proached as a painful disease state for which symptoms could only be masked, but could rarely be cured. Some doctors subscribe to the the-ory that the nerve dies from the effects of neuropathy, and that the only treatment is to mask the pain and live with the disease.

We now know that the nerve is not dead, but has poor conducting abilities, similar to that of a short in electrical wiring. This is caused by compression around and within the nerves. This compression is much like that seen in carpal tunnel syn-drome where the hands experience numbness, tingling and burning due to compress of the wrist nerve. In fact, if the compression continues long enough within the carpal tun-nel, loss of muscular strength will also occur.

Dr. Lee A. Dellon, Professor of Neu-rosurgery & Plastic Surgery at Johns Hopkins, discovered that nerves in anatomically tight areas are subject to compression and swelling, caus-ing neuropathy. The surgery decom-

presses the tunnels by making them bigger, restoring nerve function and decreasing the risk for ulceration and amputation. This surgical pro-cedure can alleviate neuropathic pain, numbness, and muscular dis-orders in 80 percent of patients—both diabetic and non-diabetic.

For patients who don’t respond to conservative treatments and want to avoid surgical options, la-ser therapy is emerging as a conve-nient, pain-free choice. Deep tissue laser treatments can dramatically reduce neuropathy pain with no hassle, no drugs, and no side ef-fects. Laser light therapy offers the most technologically advanced la-sers currently available. These la-sers penetrate deep into the tissue, stimulating cellular activity and in-creasing blood flow to “wake up” the affected nerves. They flood the tis-sues with photons, energizing dam-aged cells and increasing circulation to the painful area. This increases production of ATP (adenosine-tri-phosphate), producing a cascade of healing responses in the body to relieve pain, reduce inflammation, and accelerate tissue healing time. The laser relieves pain associated with joint, muscle, circulatory and inflammatory conditions, from ev-eryday soreness to serious injuries.

There is no discomfort during treatment. Patients feel a deep, soothing warmth as the laser reach-es the tissues that are causing pain. This pleasant, reassuring sensation means the laser is stimulating cellu-lar activity. Patient treatments take 10–12 minutes, there are no known side effects, and results can be im-mediate.


I have been diagnosed with a herni-ated disc. What is that, and can you treat it?

A herniated disc is a very common con-dition of the spine that can cause severe pain. Our spinal columns are composed of many bones, called vertebral bodies, that are stacked on top of one another and which bear the weight of our body. In between each of these vertebral bod-ies is a disc which gives our spine flex-ibility. These discs are made up of a strong fibrous ring which surrounds a jelly-like substance in the center called the nucleus pulposus. The fibrous ring holds the inner jelly substance back like a dam holds back water. If this ring be-comes degenerated, weak, or torn, the substance can push through the ring. When the disc bulges backwards towards the spinal cord or nerves it is considered herniated, this is typically seen on an MRI or CT scan and a “herniated disc” is diag-nosed.

The area where you experience pain depends on where the disc herniation occurs. If the disc herniation occurs in the neck, you may have pain in one or both of your hands and arms. It is pos-sible that you will also have neck pain with the arm pain. If the herniation oc-curs in your low back, you could have pain in one or both feet or legs with or without back pain. The pain is often de-scribed as a burning, tingling, stabbing, or electrical pain that shoots down the arm or leg. Conversely, you may only feel an achiness or soreness in the neck or back without pain in your arms or legs. Since everyone experiences pain in a unique fashion, do not be surprised if your symptoms are not the “textbook” symptoms.

A couple of symptoms that are very concerning are new weakness and loss of control of bowel or bladder. If you de-velop new weakness or loss of control of your bowel or bladder, you should see your doctor immediately or be seen in an emergency room.

The treatment of a herniated disc de-pends on the severity of the symptoms. At times all that is required are some

oral anti-inflammatory or anti-nerve pain medicines. In addition to these treatments, physical therapy or chiro-practic care can also be helpful by re-ducing the pressure on the herniated disc. Narcotic pain medications are not usually the best choice for this type of pain and are also associated with severe side effects such as nausea, vomiting, constipation, dizziness and confusion.

If you have failed to get better with con-servative care (rest, anti-inflammato-ries, PT/Chiropractic care), an epidural steroid injection in the spine may be the best course of treatment. This medicine helps to reduce any inflammation as a result of the herniated disc. It also helps to turn down the pain signals in the nerve itself. One of the most important benefits of an epidural injection is that the doctors at Arizona Pain Specialists can target the specific area where the pain is generated. This allows for a sig-nificant reduction of pain in most cases. In some cases the herniation can be se-vere enough that surgery is required to reduce the pain and/or weakness.

-Tristan Pico, M.D.

I have heard that Tylenol can be a dangerous medicine if used improp-erly. Can you tell me more about this?

First it is important to know that Tyle-nol is often called by two other names: acetaminophen and APAP (a name usu-ally used on prescription bottles). All three refer to the exact same medicine. Acetaminophen is used for one of two reasons: to reduce fever and to treat pain. By itself it is not the strongest of pain relievers, but when it is used in combination with other pain medicines such as opiates (like codeine, hydroco-done, oxycodone, etc) it improves the ef-fectiveness of the opiate medicine. This is the reason why so many commonly prescribed opiate pain medicines also contain acetaminophen.

When used as directed, acetaminophen is a fairly safe medication. However, like any medicine, it can be dangerous if not taken as directed. If too much acetamin-ophen is taken there is a risk of severe

liver damage. In fact, according to the FDA, the most common cause of acute liver failure in the United States is likely acetaminophen (from either intentional or unintentional) overdose.

How much acetaminophen is too much? The most commonly described maxi-mum dose of acetaminophen is 4 grams (or 4000mg) in any 24 hour period in a healthy adult who does not have liver disease. The maximum amount for pa-tients with liver disease or for patients who are heavy users of alcohol will be even lower. Tell your Pain Physician about all of the medications that you take, and let them know if you have liver disease or if you regularly consume al-cohol. With this information, it can be determined what the safest total dose of acetaminophen is for you, but re-member that it will never be higher than 4000mg in a 24hr period.

The big issue arises from the fact that ac-etaminophen is very regularly found in combination with other medicines and the only way to know for sure whether or not a combination medication con-tains acetaminophen is to actually READ THE LABEL. Take a look at some of the bottles in your medicine cabinet, in particular cold and flu medications and headache medicines, and you will surely find that a lot of them contain acetamin-ophen as an ingredient. Also take a close look at your pain medication bottles, as many commonly prescribed pain medi-cines contain very high amounts of acet-aminophen: Vicodin ES for example con-tains 750mg of acetaminophen per pill.

If you are prescribed or are taking any medications that have acetaminophen, I recommend that you carefully read the label and write out the amount of acet-aminophen in each pill. Also do this with all of your other medication bottles. Then keep a daily tally of the amount of acetaminophen you are taking.

It’s important that you never exceed the daily recommended amount of ac-etaminophen, as this can cause severe liver problems.

-William Thompson, M.D.


Patients often complain of pain and stiffness upon waking that gets better as the day progresses. This is medi-cally known as the “gel phenomenon”. Arthritic joints feel and perform better when they are being used, but not over used. This is one of the reasons why a good home exercise program is so im-portant for people with arthritis. While sleeping is critical for your health, the simple act of not moving overnight can increase your symptoms. When symp-toms are worse in the morning, one aspect that you should address is your sleeping situation.

Do you need a new mattress?

If you are wondering if your mattress may be contributing to your pain, the Better Sleep Council suggests you ask these questions:

• Do you wake up with stiffness, numbness, aches and pains?

• Have you had a better night’s sleep on a different bed such as a hotel or a guest room?

• Does your mattress look abused or overused? (eg. it sags, has lumps, the springs are poking out…)

When your mattress is rated for 10 to 20 years with a warranty, remember this is pro-rated and typically even the best mattresses break down over time.

A scientific study from Oklahoma State University* found that partici-pants with mattresses five years old or older reported significant improve-ments in sleep quality and comfort when sleeping on a new mattress, re-gardless of the sleeper’s age or weight.

Do you need a new pillow?

A good pillow will help keep the spine in proper alignment and help you sleep without putting addi-tional stress on you neck or upper

back. There should be a straight line between the ear, the shoulders, and hips while lying on your back. When lying on your side, your head and neck should remain level with your mid and lower spine. In other words, your pillow should not be so thick that it causes your head and neck to be propped up or angled sharply away from your body.

If you find yourself sleeping on your side with one hand propped under your pillow, that’s a clue that your pillow is not thick enough. Pillows come in a wide variety of thicknesses and densities. I suggest buying a wide variety at a big box store like Target and seeing what works best for you.

What mattress is the best?

This is a question we get asked frequently. A mattress should sup-port the body’s weight evenly and allow the spine to stay in its natural alignment. Choosing the right one is a confusing task with a lot of prod-ucts to choose from. Regardless of whether you like your mattress firm or soft, the most important aspect is that it feels good to you. People who sleep on their sides tend to like a softer mattress and a thicker pillow and people who sleep on their backs tend to do well with a firmer mat-tress and a thinner pillow.

The right mattress for a great night’s sleep is the one that meets your personal needs for comfort and support. But before you start shop-ping for a new mattress, you will need to know some basics. A good mattress and foundation will gently support your body at all points and keep your spine in the same shape as a person with good standing posture. As an extreme example, when lying on the floor most people will have good posture but the air space under the low back and knees should be

supported. When lying on a mat-tress that is too soft, like a water bed, those spaces are supported, but your body is in a position that can be aggravating. When lying on the mat-tress, pay special attention to your shoulders, hips and lower back.Innerspring mattresses are the

standard type of mattress. They use steel coils in a variety of configu-rations. Varying types and layers of upholstery provide cushioning between your body and the spring unit, resulting in a range of comfort choices.

Solid foam mattresses also offer a wide choice of sleeping sensations or “feels.” They can be made of a solid core or of several layers of different types of foam laminated together. Polyurethane foams, traditional latex and visco-elastic “memory” foam mattresses have a high buyer satis-faction. People who are greater than 300lbs can find these mattresses too soft and hot while people less than 100lbs tend to find them too hard.

Airbeds are now designed to look like the tradition mattress, with an air-filled core providing the sup-port instead of an innerspring unit or foam core. This designs offer the ability to change the firmness on each side of the bed to suit each person’s needs.

For many patients, waking with pain and stiffness can be significantly improved with the right mattress. Most people spend about a third of their life on their mattress.

Sweet dreams from all of us here to you.

-Chance Moore, D.C.

* Subjective Rating of Perceived Back Pain, Stiff-ness and Sleep Quality Following Introduction of Medium-Firm Bedding Systems


Arizona Pain Foundation Update

Arizona Pain Specialists together with the Arizona Pain Foundation once again saw great success at the 3rd annual Christmas party for refu-gees primarily from the country of Burma (Myanmar). We were able to provide nearly 1,000 people with a hot meal and distributed staff donations of hygiene items includ-ing soap, toothbrushes, and laundry detergent to the families.

There were over 600 children in attendance that enjoyed the party immensely. Volunteers constructed balloon animals and balloon hats for the children, and there were arts and crafts stations set up where the children were able to

color Christ-mas pictures, and make ornaments and other crafts. The face-painting station was extremely popular, with an almost con-stant line the entire evening where volunteers painted Christ-mas trees, hearts and clown faces onto the excited and enthusiastic children.

For the volunteers, the best part of the event was seeing the joy

and gratitude of the par-ticipants, many of which have never celebrated an American Christmas before. “We were excited to be able to provide games, activities and gifts for the children and a hot meal for everyone,” Dr. Paul Lynch says. “For many of these people, this is the first time that they have experienced generosity and human warmth since leaving their war-torn homelands. We feel so blessed and so hum-bled to be able to provide this to so many people.”

For the children, it was obvi-ous that the best part of the evening was a visit from Santa, who brought a special toy for every child there. “Many of the children have never received even a simple Christmas gift before,” Dr. Tory McJunkin says. “It was such an amazing

experience to see the joy on their faces as so many have left ravaged, impoverished, and devastating en-vironments to come to America.”

Thanks to a generous donation from the Phoenix Dream Center, the older children in attendance were also the happy recipients of a new bicycle. Arizona Pain Spe-cialists CEO Joe Carlon says, “The excitement of the children was pal-pable – all of our volunteers were swept up in the joy of the children and had a great time as well. This event was truly a success, and we hope to continue this tradition for many years to come.”

The Arizona Pain Foundation is funded solely by 5% of all proceeds from the three Arizona Pain Spe-cialists clinics. Founded by Dr. Paul Lynch and Dr. Tory McJunkin, the non-profit Arizona Pain Foundation exists to bring aid to those most in need, both locally and abroad. In addition to the annual Christmas Party for Children from Around the World, the Foundation spon-sors missionaries in Central Asia, Mexico and Central America, and facilitates one outreach event each quarter.

Arizona Pain Foundation

experience to see the joy on their

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and gratitude of the par-ticipants, many of which have never celebrated an American Christmas before. “We were excited to be able to provide games, activities and gifts for the children and a hot meal for everyone,” Dr. Paul Lynch says. “For many of these people, this is the first time that they have experienced generosity and human warmth since leaving their war-torn homelands. We feel so blessed and so hum-bled to be able to provide this to so many people.”

ous that the best part of the evening was a visit from Santa, who brought a special toy for every child there. “Many of the children have never received even a simple Christmas gift before,” Dr. Tory McJunkin says. “It was such an amazing


Arizona Pain Foundation Update

For chronic pain patients, the title “The Gift of Pain” may be off-putting. If you suffer daily from pain, how can that be a gift? In an educated, highly conversational tone, Dr. Paul Brand explains that pain is indeed a gift, one that no one should wish to be without. This book reads as a personal journey tied in with the history of medicine in the 1900’s. Brand received his medical training in London during World War Two, training that would eventually be priceless during his work with lep-ers in India.

Raised by missionary parents in India, Brand saw primitive medical procedures performed daily by his parents – people coming to them in the extreme pain of a toothache or a parasite infestation. While his par-ents undoubtedly helped hundreds of people who would have other-wise suffered, the crudeness of ex-tracting a tooth with forceps with no anesthesia or numbing agents at all stayed with Brand. Despite this, he enjoyed growing up in India and writes fondly of his youth. A lesson

considered a medical pioneer for creating the tendon transfer tech-nique used to regain the use of the hands in leprosy patients.

Throughout the book, Brand re-iterates that because these people cannot feel pain, they are without the body’s most basic protective mechanism. Imagine for a moment that you cannot feel pain – would you pull your hand away from a hot stove? Would you feel that you had stepped on a nail and stop to re-move it? It goes beyond that, how-ever, as an improperly protected burn will result in an infection and continue to get worse. If you do not remove the nail from your foot and continue to walk on it, the foot will get infected. Without a proper pain mechanism, you are at a severe dis-advantage.

Dr. Brand’s aptly named “The Gift of Pain” explains in fantastic detail that pain is a gift, one that protects our bodies and helps us heal.

The Gift of Painhe learned and was eventually able to use is how, even as a child, pain taught lessons. An avid tree climber, he quickly learned not to climb the trees that were inhabited by hun-dreds of tiny scorpions.

Brand left the mission for formal education, eventually realizing that his calling was as a physician.

Brand’s focus on pain came early – his natural curiosity toward it led him to sign up for clinical research studies with early thought-leaders in modern medicine. It was through this training that he began to un-cover how pain signals travel to the brain, and how the body is one functioning unit, rather than a col-lection of independent parts. This work led him to working with a lep-rosy colony in India, where rarely any good physician had traveled. Leprosy was still considered an af-fliction caused by a curse from the gods, rather than a medical issue. Brand was horrified to discover that the disease had not been studied; a disease of such obvious and permanent deformities.

His research and treat-ment of this disease uncov-ered that leprosy itself did not cause fingers and toes to fall off, rather, it caused a complete paralysis of the nerves. Because leprosy suf-ferers could not feel dam-age done to their skin by a burn or stepping on a nail, the skin would become in-fected, decay, and eventually cause bone damage, which would lead to subsequent loss of appendage. Through-out study, it became appar-ent that leprosy was not as contagious as once thought, and Brand began dedicating his life to helping leprosy pa-tients regain the use of their hands and feet. Brand is now

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Welcome, Dr. Bonilla!Arizona Pain Specialists is pleased

and excited to welcome our newest physician to the team, Dr. Gabriel Bonilla. A Physical Medicine and Rehabilitation (PM&R) physician, Dr. Bonilla fits perfectly into the comprehensive Arizona Pain Spe-cialists model.

Physical Medicine and Rehabilita-tion is a specialty that fits together cohesively with the practice of pain management. PM&R physi-cians focus not only on curing the pain of their patients, but they are dedicated to the rehabilitation of their patients, that is, getting them back to living their lives the way they want to. Dr. Bonilla sums it up, “PM&R physicians specifically help patients who have suffered from strokes, spinal cord injuries, ampu-tations, deconditioning, musculo-skeltal injuries, nerve injuries, and many other debilitating problems.

The physical medicine part of prac-ticing focuses on solving the issue, and helping get rid of the patient’s pain. Then there is the rehabilita-tion part, which is reconditioning the body to recover from injuries, stroke or spinal cord damage.”

Another facet of PM&R practice is the use of Electromyography and Nerve Conduction tests, or EMGs. This test is done to see how well the nerves are conducting, basically how fast and how smoothly they send electrical signals. If the nerves are conducting slower than the standard time, it can be concluded that there is nerve damage.

“For example, if a patient has pain that is shooting down their leg, we can perform an EMG,” Dr. Bonilla says. “The patient may have weak-ness, reflex change or some kind of deficit, but we may not be absolute-

ly sure what part of the back is involved, or how bad the damage is. In con-ducting an EMG, hard evi-dence can be gained that there is an impingement or damage to a nerve. This will tell a physician where exactly the treating injection will need to go to have the most benefit to the patient.”

Dr. Bonilla brings quite a bit to the Arizona Pain Specialists team. A second-career physician, Dr. Bonilla originally was an engineer for the DuPont company. After completing his education and spend-ing a number of years as an engineer, Dr. Bonilla felt compelled to return to school and dedicate his life to becoming a physi-cian and helping as many patients as possible. He decided to focus on physi-cal medicine and reha-

bilitation as a specialty, receiving that education at the University of Virginia’s PM&R program. Spurred by his wife’s love of Arizona, Dr. Bonilla applied for jobs in the state and eventually moved his family to Flagstaff, and worked in interventional pain management, musculoskeletal injuries and EMGs. After coming to Phoenix in 2006, Dr. Bonilla began working one-on-one with another PM&R physician who specialized in interventional procedures. Through this training and education, Dr. Bonilla was able to sit for the pain medicine board exam, and is now double-board certified in Physical Medicine and Rehabilitation and Pain Medicine.

Dr. Bonilla has a long history of being a skateboarder and loving the sport. He speaks fondly of his days as a young engineer with a skateboarding ramp in his back-yard that he built. Now married with two children, Dr. Bonilla is an avid mountain biker, and one of his favorite things about Arizona is the ability to mountain bike in Sedona.

Dr. Bonilla is excited to begin working at Arizona Pain Special-ists and helping patients. “PM&R focuses on getting someone back on their feet, getting them back in action and back to their activities as much as possible,” Dr. Bonilla says. “If you are experiencing pain, and have tried treatments managed by a primary care physician or who-ever sees you first and you’re still having problems, always consider interventional pain management. The minimally invasive procedures are very safe and are performed by experts at Arizona Pain Special-ists – they have a lot of experience. Sometimes, you only get temporary relief, but if you have patience and keep trying, the solution will hap-pen. Believing that your doctor has your best interests in mind and not giving up – it’s a winning formula.”

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back is involved, or how bad the damage is. In con-ducting an EMG, hard evi-dence can be gained that there is an impingement or damage to a nerve. This will tell a physician where exactly the treating injection will need to go to have the most benefit to the patient.”

a bit to the Specialistscareer physician, Dr. Bonilla originally was an engineer for the DuPont company. After completing his education and spend-ing a number of years as an engineer, Dr. Bonilla felt compelled to return to school and dedicate his life to becoming a physi-cian and helping as many patients as possible. He decided to focus on physi-cal medicine and reha-


Making All the Difference

Magnetic resonance imaging, most frequently known as MRI, is the most common diagnos-tic test in pain management. Offering physicians the most in-depth look at the body with-out cutting it open, MRI scans can help diagnose a variety of problems, from torn ligaments to tumors.

MRI scans are not only able to show the tendons, ligaments, muscles, fat tissue and bones, but show them extremely accu-rately, depicted in great detail. For pain management, this level of detail is often ideal and pre-ferred over X-Ray or CT Scan, as these diagnostic tests are not capable of displaying the same level of detail. Additionally, disc bulges are not as accurately de-picted on any other diagnostic test, making the MRI preferable for identifying that particular condition.

MRI scans can be performed in either a traditional closed machine or in an open machine. For those who experience claus-trophobia or tend to become anxious when in tight spaces, a traditional MRI machine can be intimidating. The machine is tight and confined, and is basi-cally a long tube that the patient is contained in. Even those who do not generally experience claustrophobic tendencies can begin to feel distressed in a tra-ditional machine. Open MRI ma-

chines are far less constricting, as they are open on the sides, and the patient’s entire body is not enclosed by the machine.

At Arizona Pain Specialists, only the open MRI is offered, and many patients find this to be the lower stress option. While some physicians feel that the images from an open MRI are not as good as the ones from a traditional MRI, the images are comparable when produced

by an experienced technician.

“Patients overwhelmingly pre-fer the open MRI to the tradi-tional machine,” Arizona Pain Specialists MRI Technologist Kristen Miller says. “They con-sistently tell me they feel much more comfortable and at ease in our open machine. I’m happy we can offer that to our patients – it makes their experience just that much better.”

Open MRI


Arizona Pain Specialists also prides themselves on making the entire patient experience easy from start to finish. Offer-ing same day appointments and flexible office hours from 7:30 a.m. to 5:45 p.m., we are able to accommodate nearly any patient for any scan done in our office. “We can perform MRIs on any body part,” Miller says. “You don’t necessarily have to be a patient from here, you just have to have an MRI order. We can al-

ways get you in for an appoint-ment the same day, and with our flexible hours, we can perform your scan before or after work or on your lunch hour.”

Special consideration patients are also welcomed, such as those on oxygen. If a patient is still nervous about the experi-ence, oral medication can be made available upon request. However, many patients who have had traditional MRI scans

performed will notice that the open machine is quieter and much roomier. The MRI room at Arizona Pain Specialists was de-signed with patient comfort in mind as well; there are windows that let in natural light, soft music to listen to and blankets to ward off any possible chill. Every accommodation will be made to ensure that every pa-tient has the most comfortable experience possible.


Pam works in the clinic at the Scottsdale location. As a medical assistant, or M.A., Pam assists the doctors, nurse practitioners and physician’s assistant by taking a patient’s vital information, medical history, and other pertinent information. Pam is also the Lead Medi-cal Assistant in the clinic, and works tirelessly to keep everything running smoothly in the clinic - and she does a great job!

See what you have in common with Pam!

Favorite activities: Riding my motorcycle and spending time with my husband and two dogs. Favorite TV shows: NCIS and Burn Notice. Favorite sports team: The Denver Broncos. Favorite food: It’s a tie between Mexican and Italian food. Favorite movie: Door to Door. Favorite location in the world: Jamaica. Favorite location in Arizona: Crown King. Favorite thing about Arizona: The cultural activities.Favorite bands: Jerry Riopelle.Favorite book: Anything by James Patterson.Famous person you would like to meet, dead or alive, and why? Rosa Parks. She held on to her beliefs, despite difficulties and contro-versy, and her strength is inspiring even today. Unknown talent: I’m a seamstress!What celebrity do people say you look like: Actually none, I’ve never heard that. As a child, what did you want to be when you grew up? I wanted to be a veterinarian.Where are you from originally: Denver, Colorado.

Brooke currently works as an assistant in the Scottsdale location and has been at Arizona Pain Specialists for over a year. Brooke was originally a referral coordinator for the Scottsdale and Glen-dale clinics, but recently moved to her current position.

Brooke is responsible for making sure operations at the clinic run smoothly on a day to day basis, and does such tasks as ensur-ing that the medical and administrative departments have the supplies they need to complete their jobs.

Brooke’s supervisor says, “Brooke is an impeccable example of excellence in the workplace. She is efficient and hardworking and does it all with a great big smile that lights up the room. She is a blessing to have on our team and her peers would agree, she is top-notch!”

Brooke’s favorite part of her job is that there is never a dull mo-ment! She says that she loves learning and accomplishing goals on a daily basis.

Her advice for patients is: “Knowing you’re in good hands can give hope and a boost of confidence. There can be times of want-ing to give up, but if you stick with it, the results can be amazing!”

Employee of the Month at APS

Meet Pam M., Medical Assistant

Arizona Pain Monthly Janauary 2011

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Transcript of Arizona Pain Monthly Janauary 2011