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Neck Arthritis is literally a ‘Pain in the Neck’

Listen to Dr. Ronald Kloc, an interventional pain medicine specialist at the Mason City Clinic, talk about how he can help alleviate chronic and bothersome pain or arthritis in your neck with a new innovative procedure called radio frequency ablation.

Neck Arthritis – Dr. Kloc – Pain

 

(transcript below)

Carol Gifford:
Welcome to Mason City Docs On Call, a podcast series with North Iowa specialists who educate us about how to stay healthy. I’m your host, Carol Gifford. So, today’s subject is neck arthritis. So for anyone who has ever experienced neck pain or neck arthritis, you can understand how the
colloquialism of pain in the neck got its popularity. Unfortunately, neck pain is a common part of the natural aging process. Like the rest of our body, bones in the neck can change as we grow older. The surfaces where bones come together become rougher. The discs that cushion the
bones of the spine get drier, and the ligaments that hold bones in place become stiffer. Here today with us is Dr. Ron Kloc, an interventional pain medicine physician at the Mason City Clinic who’s going to help us understand more about neck arthritis and how we can best
manage it to enjoy life to its fullest. Welcome, Dr. Kloc.

Dr. Kloc:
Thank you.

Carol Gifford:
So neck arthritis seems like it’s a natural part of the aging process, and that’s what we hear. Is that your opinion?

Dr. Kloc:
Well, in a way we could have an aging of the joint itself, which happens to all of us. You have a joint space there with the cartilage and it holds up in most patients. However, in a large number of the population, maybe 10 or 15%, it starts to collapse a little bit more. It dries out a little bit more than their neighbors let’s say. And all of a sudden you have a rubbing of that joint. And the loss of the water content, the collapse of some of the water content in the ligaments and tendons causes these giants to collapse. And these are the patients who will start to have pain.

Carol Gifford:
And so who are these people? Are these people that do manual labor, or are these people that sit at their desk too much? I mean, is there a typical person that’s coming into your office that’s getting a lot of neck pain?

Dr. Kloc:
Well, there could be a correlation with how physical your job was over your life. But we see this in all people. And we see it in people who have had desk jobs all their lives. And I would say, yes, if you’ve put a lot of stress on your neck over your life, if you’ve lifted a lot of heavy things, farming and such over your life, that’s going to put a little extra stress, but we see it in
everybody.

Carol Gifford:
And is there any way to sort of lessen the onslaught? I mean, doing exercises or stretches, or is this just going to happen over time do you think?

Dr. Kloc:
There’s really no good preventative measure. The idea that we could stretch our necks, do a little of our own physical is, is a nice idea. It probably keeps us to some degree limber, but arthritis is the thing that basically attacks our tissues. And it’s not very reversible.

Carol Gifford:
So when people are coming into your office and they have neck arthritis, but they don’t know yet, what is their common complaint?

Dr. Kloc:
Well, a lot of patients will complain of neck stiffness and pain. And what they tell me is it hurts in the morning and they try to stretch it out. And sometimes it’s not very successful or maybe minimally successful. And so if they’d come here with that kind of a stiffness, we’ll want to find out what else is happening. Do they have any pain down their arms? How bad is it? Is it something that can be relieved by over the counter pain medicines let’s say?

Carol Gifford:
And so then how do you properly diagnose it as arthritis? What kind of exam do you go through to diagnose it?

Dr. Kloc:
Well, you want to take a look at their neck. You want to see what happens. You want to put your hands on their neck and see what hurts. You want to ask them to do their arms hurt. Do they ever get stinging sensations down their arms? You want to see their range of motion. But the real diagnosis is with imaging studies. So you don’t want to forget about doing a physical exam. It is important. But our imaging studies are so much better than, let’s say, even when I was in medical school. That was a few years ago now. But in those days we really didn’t have… Or we had the emergence of cat scans and MRIs right there when I was in school. But right now it’s not such an obscure test to get. So we’ll want to get an X-ray to start, because that shows the structure of the joint very well. I think it shows it better than let’s say an MRI. A CAT scan could be almost overkill. You see every little thing on a CAT scan, but X-ray gives you a good overview image of what the joints look like.

But then you want to get an MRI too, because the other clinical condition that can mimic this back pain, I guess its evil twin if you want to call it, is spinal stenosis, because that’s a little more difficult problem. That’s where the spinal canal in the neck starts to narrow and starts to put pressure on the spinal cord. Now, if it’s bad enough, people will get that stinging sensation down one or both arms. But in its early stages, you could just get neck pain. So we don’t want to misdiagnose that. We want to find out what it is. I don’t want this to be a mystery for people.

Carol Gifford:
So once you diagnose and you see it’s neck arthritis, what are some of the treatment modalities that you recommend to a patient?

Dr. Kloc:
Well, at first, you could ask them how much they’ve been doing, because they may have not been doing any physical therapy. It’s not a bad idea to try physical therapy, then try some anti-inflammatory medicines and sometimes even Tylenol. Even though that’s probably considered the mildest pain drug, it actually works. So we want to see if that’s going to be enough because the treatment modalities after that would be types of injection techniques, which I do a lot of, but we want to see if the simple stuff works first.

Carol Gifford:
And then will it progress and get worse over time?

Dr. Kloc:
Well, as far as the length of time it would take for the joints to collapse and become drier let’s say, yeah, it would become worse. So, I guess it depends on how long the patient’s going to live if they have a long, long life. I’ve seen people into their mid 90s and sometimes you look at their necks and they have quite a bit of arthritis there. So you knew probably, if you could extrapolate backwards a little bit, that when they were 65, it probably wasn’t so bad, but over the next 30 years, it did worsen and become and become a more of a problem. But it really depends on how proactive they are as far as getting treated because a lot of people kind of suffer in silence.

Carol Gifford:
Yes. But it sounds like you can manage. When you work with a patient, you can really help manage their pain.

Dr. Kloc:
Yes. The other thing that we want to look at after doing the simple things, and when a patient comes to me last time and they’ve done that already, or their family doctor and nurse practitioners had them do that already. So I want to know where they’ve been with this problem. But if we’re talking about a definitive cure of the problem, we want to look at first of all, what it is, right? It’s arthritis, it’s pain in the joint. So we want to do something to get rid of that joint pain. Now, these are pretty small joints when we talk about joints in the body. It’s certainly not the knee or the hip, right? These are things that are less than a centimeter large. So we can’t do a lot of injections inside the joint although some people do that. I don’t find those are very long lasting because they’re very, very small. It’s a pretty painful procedure.

So what I do is something, its kinder and gentler cousin. You can do these steroid injections in the joint, which I don’t like. But you could look at the little nerves that go to the joints. So these little nerves are our branch of the nerves that go down our arms and feel for things, right? So we find those little nerves right on top of the bone. The bone portion is called the lamina of the vertebrae. And it’s a small thing, but if you look at it under a fluoroscopic X-ray, you can see it pretty well. Those little nerves live in the middle of that lamina.

And what I do is I do a test first to numb up those little nerves. So first we’re just doing a test to see if we can get rid of your pain, and I’m going to do this at five different levels. And because you look at these X-rays and it’s hard to determine exactly which joints hurt. And I’ve been doing this for quite a while, and I still don’t know with certitude, which ones hurt. I think they probably all hurt to be honest with you. Or you don’t really have to go and test two joints, one time, three joints another time, four joints, or get the ones on the top, get the ones on the bottom. I just go ahead and do basically all five joints in the neck. The reason I say five, we have seven vertebraes because the top two really don’t have the classic joints. It’s made for more of a turning mechanism. So those have a different kind of structure to them. But if we’re talking about the ones where you go from a C3-4, C4-5, C5-6, C6-7, those kinds of joints, those are the ones that are going to hurt.
So basically to make a long story short here, we’re numbing up those little nerves that go to the joint. And the interesting thing about those nerves is those nerves are just sensory nerves. Okay? And a lot of nerves in the body, we have both kinds of nerves, which is motor nerves, which move our appendages or our body in some way, and sensory nerves. So you don’t want to do anything bad to motor nerves. Even if it hurts, you don’t want to take out that ability to move.

So we’re kind of lucky in the neck and in the lumbar spine where those nerves that go to the joints are just a sensory nerve. So all we’re doing is knocking out the pain. That’s it. That’s all you’re doing. So we’re going to see, does the pain get marvelously better after I knock out the nerves? Now, when you do that, it’s only going to last a certain amount of time. It’s going to last six to eight hours and it’s going to wear off. That’s where people look a little unhappy in the office. That’s going to wear off. But it’s just a test. It’s just a test. So, if it works, we can come back and do something more permanent. And that’s where the cure, or let’s call it a cure, happens.

Carol Gifford:
Oh, that sounds terrific.

Dr. Kloc:
Yeah.

Carol Gifford:
Very innovative.

Dr. Kloc:
Yeah. So you want to come back and you want to do something more permanent, right? So actually you’re going to burn the nerves, which sounds a little, I always say it in the office, it sounds a little crude that we’re going to go into your neck and we’re just going to start burning things.

Carol Gifford:
Right.

Dr. Kloc:
A lot of people will say, “You’re going to put a hot poker in my neck,” and that’s certainly not what we were going to do.

Carol Gifford:
Yeah.

Dr. Kloc:
We’re going to put a special needle in your neck, which is a radio frequency needle. Basically, it looks like any other needle.

Carol Gifford:
That’s the nerve that’s leading to the joints.

Dr. Kloc:
Yeah. Correctly. So-

Carol Gifford:
And the joints are just so small in the neck. You can’t go right into those.

Dr. Kloc:
Well, like I say, you can, but it’s…

Carol Gifford:
Tricky.

Dr. Kloc:
It’s tricky. It’s painful. There’s always a chance that you didn’t go through the other side. And I just don’t-

Carol Gifford:
I’m sorry, but when you burn these nerves, this is a permanent treatment and this will really take away a lot of the pain, not all of the pain, but a lot of the pain.

Dr. Kloc:
A lot of the pain?

Carol Gifford:
And what is this called again?

Dr. Kloc:
So it’d be called radiofrequency ablation. They call it other names. Some people call it a rhizotomy.

Carol Gifford:
Okay. But you’ve gotten really good results with this for patients.

Dr. Kloc:
Oh, yes. Yes.

Carol Gifford:
Oh, that’s wonderful. Okay. Well, this is wonderful. And so if you, the listening audience, has pain in your neck and think you have some sort of arthritis, you too can get an appointment with Dr. Kloc and talk to him about all these wonderful treatments that he has. So if you’d like to make an appointment with Dr. Kloc, you can call him at (641) 494-5475. Thanks for being on the program. Dr. Kloc.

Dr. Kloc:
Thank you.

Carol Gifford:
Thank you for listening to Mason City Docs On Call. For more episodes, go to mcclinic.com/radio-podcasts.

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