WEBVTT 1 00:00:00.411 --> 00:00:02.994 (upbeat music) 2 00:00:16.080 --> 00:00:17.480 - My name is Gary Schwartz. 3 00:00:17.480 --> 00:00:18.960 I'm the Co-Director of pain management 4 00:00:18.960 --> 00:00:22.163 and the Director of acute pain management for AABP 5 00:00:22.163 --> 00:00:23.483 at Maimonides Medical Center. 6 00:00:23.483 --> 00:00:26.230 I've been doing this for over 10 years. 7 00:00:26.230 --> 00:00:27.470 And my background is 8 00:00:27.470 --> 00:00:30.730 in regional anesthesia and interventional pain management. 9 00:00:30.730 --> 00:00:33.260 My goal is just helping patients restore function 10 00:00:33.260 --> 00:00:34.600 and getting back to their life. 11 00:00:34.600 --> 00:00:37.150 What do you do for these chronic knee patients 12 00:00:37.150 --> 00:00:40.501 or these knee patients that had knee arthroplasties 13 00:00:40.501 --> 00:00:41.640 and they still have pain. 14 00:00:41.640 --> 00:00:43.390 That was one subset of the population. 15 00:00:43.390 --> 00:00:46.560 Two, we've moved into a same day joint protocols 16 00:00:46.560 --> 00:00:48.220 at two of my institutions. 17 00:00:48.220 --> 00:00:50.100 And what could we offer to get people 18 00:00:50.100 --> 00:00:51.530 to do same day surgery? 19 00:00:51.530 --> 00:00:53.840 So for the chronic knee pain, they had knee surgery 20 00:00:53.840 --> 00:00:55.920 or they're too sick for knee surgery 21 00:00:55.920 --> 00:00:58.080 or they still have pain after a knee arthroplasty. 22 00:00:58.080 --> 00:00:58.913 What do you do? 23 00:00:58.913 --> 00:01:01.900 My options were thermal radiofrequency ablation 24 00:01:01.900 --> 00:01:03.320 or peripheral nerve stimulator. 25 00:01:03.320 --> 00:01:05.520 Which I still both use in my practice, 26 00:01:05.520 --> 00:01:07.210 but the thermal radiofrequency ablation 27 00:01:07.210 --> 00:01:09.990 sometimes it needs necessitated anesthesia 28 00:01:09.990 --> 00:01:11.410 to tolerate the procedure 29 00:01:11.410 --> 00:01:13.480 because the needle tip gets up to 80 degrees centigrade 30 00:01:13.480 --> 00:01:15.130 which could be a little bit painful. 31 00:01:15.130 --> 00:01:17.170 You could obviously fry an egg on that. 32 00:01:17.170 --> 00:01:19.048 And two, a couple of my patients 33 00:01:19.048 --> 00:01:21.920 had post-op neuritis where it did not kick in. 34 00:01:21.920 --> 00:01:23.360 They inflammation of these nerves 35 00:01:23.360 --> 00:01:25.200 they were in worse pain when they came in. 36 00:01:25.200 --> 00:01:28.220 And as a physician or anyone in general 37 00:01:28.220 --> 00:01:29.560 you don't wanna see someone worse off 38 00:01:29.560 --> 00:01:31.190 than they came to the office. 39 00:01:31.190 --> 00:01:33.960 The other procedure that I had to offer patients before 40 00:01:33.960 --> 00:01:36.860 was I could put wires in people called stimulation, 41 00:01:36.860 --> 00:01:39.690 either neuromodulation or peripheral nerve stimulation 42 00:01:39.690 --> 00:01:42.070 to send signals to stop the pain. 43 00:01:42.070 --> 00:01:43.930 The issues with that is they had wires with them. 44 00:01:43.930 --> 00:01:45.810 They had to charge a battery 45 00:01:45.810 --> 00:01:47.400 and it might not have been the best situation 46 00:01:47.400 --> 00:01:48.880 for some patients. 47 00:01:48.880 --> 00:01:50.870 And I really had very limited options 48 00:01:50.870 --> 00:01:53.140 for pre knee arthroplasty patient. 49 00:01:53.140 --> 00:01:55.200 I first learned about iovera 50 00:01:55.200 --> 00:01:56.270 through the team at Pacira. 51 00:01:56.270 --> 00:01:58.930 The team introduced me to iovera 52 00:01:58.930 --> 00:02:01.700 which was like a mind blowing experience to me. 53 00:02:01.700 --> 00:02:04.560 'Cause I was doing interventional pain me for 10 years. 54 00:02:04.560 --> 00:02:07.300 I was doing thermal radio frequency ablation. 55 00:02:07.300 --> 00:02:10.080 But for some of those procedures, patients needed sedation. 56 00:02:10.080 --> 00:02:12.790 They had some post-operative neuritis where they had pain. 57 00:02:12.790 --> 00:02:15.580 So three years ago we introduced into our practice 58 00:02:15.580 --> 00:02:17.150 after working with procedure team, 59 00:02:17.150 --> 00:02:19.220 seeing the device in action. 60 00:02:19.220 --> 00:02:21.950 And then I had a novel device that I was able to use 61 00:02:21.950 --> 00:02:23.480 under ultrasound guidance to treat 62 00:02:23.480 --> 00:02:25.620 my patients in the office. 63 00:02:25.620 --> 00:02:26.710 The device is lightweight, 64 00:02:26.710 --> 00:02:28.440 it's portable, it's easy to use. 65 00:02:28.440 --> 00:02:30.930 And most importantly, safe for my patients. 66 00:02:30.930 --> 00:02:32.500 My first expectations anything 67 00:02:32.500 --> 00:02:34.590 I'm always cautious with any new device. 68 00:02:34.590 --> 00:02:37.370 I was pretty amazed when I first saw the device in action 69 00:02:37.370 --> 00:02:38.970 where they took the needle into the water 70 00:02:38.970 --> 00:02:41.710 and you could actually see the size of the ice ball formed 71 00:02:41.710 --> 00:02:43.980 which was amazing to me in a handheld device. 72 00:02:43.980 --> 00:02:47.940 You could of a sudden get a pain management treatment 73 00:02:47.940 --> 00:02:49.480 that could be immediate to the patients 74 00:02:49.480 --> 00:02:50.660 but I'm skeptical as always. 75 00:02:50.660 --> 00:02:53.100 I'm from New York, I don't believe everything you hear. 76 00:02:53.100 --> 00:02:54.750 So the first time I told my patient about it 77 00:02:54.750 --> 00:02:56.630 I'm like, look, it might take some time. 78 00:02:56.630 --> 00:02:58.920 They say the device works pretty quickly 79 00:02:58.920 --> 00:03:01.470 but I was kind of wowed when the patients got right 80 00:03:01.470 --> 00:03:03.690 off the table and they're like, my pain is better. 81 00:03:03.690 --> 00:03:05.060 Which we normally don't see 82 00:03:05.060 --> 00:03:07.210 especially in the chronic pain management world. 83 00:03:07.210 --> 00:03:08.430 I always normally tell my patients, 84 00:03:08.430 --> 00:03:10.530 oh, it'll take about a week, 10 days to work 85 00:03:10.530 --> 00:03:12.990 come back in two weeks and let's see how you do. 86 00:03:12.990 --> 00:03:14.410 To the point where I was like, they're like, 87 00:03:14.410 --> 00:03:15.870 oh can I exercise later today? 88 00:03:15.870 --> 00:03:18.900 And I'm like, only activity as you were doing beforehand. 89 00:03:18.900 --> 00:03:22.340 I wouldn't do anything more because your mechanical issues, 90 00:03:22.340 --> 00:03:23.420 your anatomy is still there. 91 00:03:23.420 --> 00:03:24.780 If your knee looks like this, 92 00:03:24.780 --> 00:03:26.050 the iovera doesn't treat that 93 00:03:26.050 --> 00:03:28.230 your knee still looks like that. 94 00:03:28.230 --> 00:03:29.980 So activity is tolerated. 95 00:03:29.980 --> 00:03:32.080 Don't do more than you were doing before at first. 96 00:03:32.080 --> 00:03:33.650 (upbeat music) 97 00:03:33.650 --> 00:03:34.870 - [Gary] You're getting a little deeper. 98 00:03:34.870 --> 00:03:36.120 How do you feel now, sir? 99 00:03:37.570 --> 00:03:38.403 - Fantastic. 100 00:03:38.403 --> 00:03:40.293 - [Gary] So what's your pain for zero to 10? 101 00:03:41.250 --> 00:03:44.440 - 10 being the highest, maybe a two. 102 00:03:44.440 --> 00:03:46.020 - That's great, you were eight? 103 00:03:46.020 --> 00:03:47.070 And this is a pretty immediate relief 104 00:03:47.070 --> 00:03:50.520 we finished about 38 seconds ago. 105 00:03:50.520 --> 00:03:54.300 It makes me so proud and just happy for the future 106 00:03:54.300 --> 00:03:57.420 of interventional pain management and regional anesthesia 107 00:03:57.420 --> 00:03:58.480 of what we could do next, 108 00:03:58.480 --> 00:04:00.610 what we could target to help help our patients 109 00:04:00.610 --> 00:04:01.730 and just improve outcomes. 110 00:04:01.730 --> 00:04:02.830 'Cause that's what we're looking for. 111 00:04:02.830 --> 00:04:05.523 Unfortunately, I'm gonna be a patient at 1.2. 112 00:04:05.523 --> 00:04:07.860 So I'm looking forward to what comes next. 113 00:04:07.860 --> 00:04:08.960 I always look at three things 114 00:04:08.960 --> 00:04:11.200 when any treatment I do with my patients. 115 00:04:11.200 --> 00:04:15.310 I look for safety, one, efficacy two, speed three. 116 00:04:15.310 --> 00:04:19.050 And iovera incorporates all of that into my practice. 117 00:04:19.050 --> 00:04:21.300 And now I have a handheld device 118 00:04:21.300 --> 00:04:23.600 where I could actually freeze a nerve 119 00:04:23.600 --> 00:04:25.370 to give them immediate pain relief, 120 00:04:25.370 --> 00:04:26.910 send them out of the office happy 121 00:04:26.910 --> 00:04:28.131 and improve their function. 122 00:04:28.131 --> 00:04:30.714 (upbeat music) 123 00:04:31.960 --> 00:04:33.440 - [Narrator] Indication. 124 00:04:33.440 --> 00:04:36.520 The iovera system is used to destroy tissue 125 00:04:36.520 --> 00:04:40.600 during surgical procedures, by applying freezing cold. 126 00:04:40.600 --> 00:04:43.220 It can also be used to produce lesions 127 00:04:43.220 --> 00:04:46.940 in peripheral nervous tissue by the application of cold 128 00:04:46.940 --> 00:04:50.420 to the selected site for the blocking of pain. 129 00:04:50.420 --> 00:04:53.170 It is also indicated for the relief of pain 130 00:04:53.170 --> 00:04:56.650 and symptoms associated with osteoarthritis of the knee 131 00:04:56.650 --> 00:04:58.720 for up to 90 days. 132 00:04:58.720 --> 00:05:01.030 The iovera system is not indicated 133 00:05:01.030 --> 00:05:04.270 for treatment of central nervous system tissue. 134 00:05:04.270 --> 00:05:08.250 The iovera systems, one by 90 Smart Tip Configuration 135 00:05:08.250 --> 00:05:11.480 indicating one needle which is 90 millimeters long 136 00:05:11.480 --> 00:05:14.370 can also facilitate target nerve location 137 00:05:14.370 --> 00:05:16.900 by conducting electrical nerve stimulation 138 00:05:16.900 --> 00:05:18.903 from a separate nerve stimulator. 139 00:05:19.970 --> 00:05:21.923 Important safety information. 140 00:05:22.930 --> 00:05:25.160 The iovera system should not be used 141 00:05:25.160 --> 00:05:27.900 in people with the following conditions. 142 00:05:27.900 --> 00:05:29.570 Blood that thickens when patient 143 00:05:29.570 --> 00:05:33.230 is exposed to cold or cryoglobulinemia. 144 00:05:33.230 --> 00:05:34.600 Blood appearing in the urine 145 00:05:34.600 --> 00:05:37.170 when patient is exposed to the cold 146 00:05:37.170 --> 00:05:40.230 or paroxysmal cold hemoglobinuria. 147 00:05:40.230 --> 00:05:42.220 Skin rash that appears when patient 148 00:05:42.220 --> 00:05:46.160 is exposed to the cold or cold urticaria. 149 00:05:46.160 --> 00:05:49.150 Narrowing of the blood vessels in the hands and feet 150 00:05:49.150 --> 00:05:51.580 when patient is exposed to the cold 151 00:05:51.580 --> 00:05:53.360 or Raynud's disease. 152 00:05:53.360 --> 00:05:56.030 And open and or infected wounds 153 00:05:56.030 --> 00:05:58.063 at or near the treatment site. 154 00:05:58.960 --> 00:06:01.780 Patients being treated with the iovera system, 155 00:06:01.780 --> 00:06:03.370 a needle-based therapy 156 00:06:03.370 --> 00:06:07.160 may experience certain reactions, including, but not limited 157 00:06:07.160 --> 00:06:12.160 to bruising, swelling, inflammation, and or redness, 158 00:06:12.350 --> 00:06:15.040 local pain and or tenderness, 159 00:06:15.040 --> 00:06:18.880 and altered feeling at the site of application. 160 00:06:18.880 --> 00:06:20.400 Proper use of the device 161 00:06:20.400 --> 00:06:23.460 as described in the User Guide can help reduce 162 00:06:23.460 --> 00:06:26.240 or prevent the following reactions. 163 00:06:26.240 --> 00:06:28.780 In the areas where you are treated 164 00:06:28.780 --> 00:06:33.180 damage to the skin from being exposed to cold or heat, 165 00:06:33.180 --> 00:06:35.870 darkening or lightening of the skin 166 00:06:35.870 --> 00:06:38.150 and dimples in the skin. 167 00:06:38.150 --> 00:06:40.520 Outside the areas where you were treated 168 00:06:40.520 --> 00:06:43.523 muscles may not work or move normally. 169 00:06:44.410 --> 00:06:49.410 For more information, visit www.iovera.com.