Q&A With Dr. Aguila

Dr. Aguila specializes in treating patients with chronic pain due to various types of injuries to peripheral nerves. If your pain is due to injury or entrapment of one or more peripheral nerves, then there is a very high chance that Dr. Aguila can help.

Nerve pain can take many forms. There are a handful of common characteristics, however, that identify your pain as most likely coming from peripheral nerve damage: Sensory changes – symptoms like numbness, tingling, pins and needles, or decreased sensation/dullness. Character of pain – nerve pain often presents as a burning sensation but may also feel electrical in nature (i.e. a shocking or buzzing sensation). Nerve pain can “shoot” or radiate from one place to another and can mimic just about any sensation. The sensations that nerve damage produces are often so strange that patients frequently say that they have a hard time describing what they are feeling in words. Severity of pain – one of the hallmarks of nerve pain how excruciating it is. Patients with nerve damage usually appear to be in much more pain than the situation seems to justify. In addition, pain medication is often very ineffective at treating pain of nerve origin. Patients often remark that they would gladly cut off the offending arm or leg, etc., if they could just get rid of the pain.

When the impact on a person’s quality of life outweighs the risks associated with the surgery itself. Generally speaking, if a patient is otherwise healthy enough to tolerate a general anesthetic, the risks of peripheral nerve surgery are very low. If your problem is still very manageable with acceptable lifestyle modifications and reasonable levels of pain medication, then continuing along that course is probably a better option than surgery. On the other hand, for patients whose quality of life is significantly compromised, or in many cases, nonexistent, the already low risks of surgery fade to insignificance. Only you as a patient knows when the level of pain, numbness, etc., tips the scales in the favor of undergoing surgery to relieve pain and restore function. For most patients with a serious peripheral nerve problem, this is not a difficult issue to decide.

That often depends on the type of nerve problem the patient has. For example, patients with peripheral neuropathy who qualify for nerve decompression surgery will experience very good or complete relief from their symptoms about 80% of the time. When the pain is coming from a single damaged nerve where disconnecting the nerve is the best course of action, relief is usually achieved greater than 99% of the time. For most peripheral nerve problems, a good rule of thumb is that the success rate is 80% or better.

The short answer is yes! Dr. Aguila’s goal is always to relieve the patient’s pain completely and most of the time he is able to do that. Once the nerve pain is gone, and if that’s the only reason you were taking pain medication, then you’re pain management doctor will be able to wean you off your pain medication.

That depends on how the nerve has been injured. If the nerve is compressed or “pinched,” the solution typically involves cutting or removing tissue (not the nerve itself) to open the space up around the nerve so the nerve is no longer under pressure. If the nerve has been physically cut, it may be sewn back together directly or repaired via the use of a nerve graft. If a nerve is stuck in scar tissue, it may need to be freed up so it can glide through the tissue again. If the nerve has been damaged beyond repair or if it’s not an important nerve, sometimes the best course of action is to disconnect the nerve so that it can no longer send a pain signal to the brain.

EMG (Electromyelogram) and Nerve Conduction Velocity (NCV) studies are rarely useful in diagnosing or pinpointing the source of a peripheral nerve problem. Particularly in complex cases, the EMG/NCV studies will usually be either completely normal or identify only a small portion of the problem. By far, the best way to diagnose a peripheral nerve problem is by taking a careful history combined with a comprehensive peripheral nerve examination.

The pain from peripheral nerve damage will often persist long after the trauma from the original injury or surgery has healed. The difficulty for patients with peripheral nerve pain is that they often appear “normal” to the rest of the medical world. Most doctors were not trained in how to recognize or evaluate peripheral nerve injuries. This problem is compounded by the fact that peripheral nerve injuries typically don’t show up on imaging studies (X-ray, CT scans, MRIs) or Electromyogram/Nerve Conduction Velocity (EMG/NCV) studies. As a result, many medical professionals are at a loss to explain the source of the pain and frequently start to question the patient’s true motives (i.e. drug seeking) or even their sanity.

The first challenge is that the vast majority of physicians have not received any formal training beyond the basics with regards to the anatomy and physiology of the peripheral nervous system. Without this training, most doctors, haven’t been properly equipped with the necessary experience and background to identify a peripheral nerve injury/problem when it presents itself. The second challenge is that when they do suspect peripheral nerve damage, most doctors aren’t aware that surgery is an option for management of these problems, and so they’re left to either prescribe pain medication or send them to a pain management doctor. Dr. Aguila’s application of peripheral nerve surgery to treat pain is relatively new and most doctors are not even aware that it exists.

Actually, peripheral nerve surgery has been around for a long time. Carpal tunnel surgery and cubital tunnel surgery are examples of widely-known applications of surgery to treat peripheral nerve problems. In addition, the traditional approach to peripheral nerve surgery has historically focused on serious nerve injuries that affect the ability to move muscles. Until very recently, a comprehensive approach to the peripheral nervous system with the primary goal of solving chronic pain problems was almost unheard of. As a result, there are very few doctors who have the training and expertise necessary to tackle complex peripheral nerve problems where the primary symptom is chronic pain.

There are very few things that are absolute in medicine. Peripheral nerve surgery is not the answer to all types of chronic pain. As a general rule, the more complex the problem the higher the chance the patient may not obtain complete relief from their pain. While Dr. Aguila can usually relieve the pain completely, some patients only experience partial relief. Even partial relief with pain levels reduced to a manageable level, however, can improve the patient’s quality of life.

For patients paying cash, cash rates for Dr. Aguila’s surgeries can be provided once he determines the scope of the problem and maps out what he will need to do surgically. For patients who have insurance that Dr. Aguila does not accept, cash payment will be required up front and then our office will work with the patient to help them get reimbursed.

Dr. Aguila accepts many insurance options. Calling the office is the best way to find out if your specific insurance plan is accepted or not. Dr. Aguila’s surgical procedures are covered by most insurance carriers. We do not guarantee any specific results or outcomes for surgery, should our practice work on your behalf. Information on this website may be used as a reference for successes we’ve achieved for our patients, and not as an assurance or guarantee for similar results in all instances.