# PHI - Pain and Healing Institute > The Pain and Healing Institute (PHI) is a concierge, cash-pay practice in Beverly Hills uniting interventional pain management, regenerative medicine, and wellness and longevity care. Led by double board-certified physicians Dr. Faisal Lalani and Dr. Nadiv Samimi, PHI treats back, neck, joint, and nerve pain with image-guided procedures, PRP and stem cell therapy, ketamine infusion, peptides, IV therapy, and longevity-focused care. - **Website:** https://painandhealing.com/ - **Last updated:** 2026-09-11 - **Publisher:** PHI - Pain and Healing Institute - **Sitemap:** https://painandhealing.com/wp-sitemap.xml - **Index version:** https://painandhealing.com/llms.txt ## Key Information ### About ## A New Standard for Pain, Regeneration, and Longevity. At PHI, healing is not a single procedure. It is a relationship. The Pain and Healing Institute was built for patients who expect more than a prescription and a follow-up. In the heart of Beverly Hills, we combine advanced, evidence-based medicine with a concierge experience designed around your time, your privacy, and your goals. Whether you are managing chronic pain, recovering from an injury, or building a plan to feel stronger ten years from now, the first step is the same: a physician who listens, investigates, and stays with you through the entire process. ## Three Disciplines, One Practice Most pain practices treat symptoms. PHI treats the whole arc of how you move, recover, and age. Our care is organized around three connected pillars: **Interventional Pain Management.** Image-guided injections, nerve blocks, radiofrequency ablation, and advanced procedures performed by board-certified pain physicians, for patients living with back, neck, joint, and chronic nerve pain. **Regenerative Medicine.** Advanced biologic therapies that work with the body's own healing systems, including PRP, A2M, stem cell therapy, and exosomes for joint, tendon, and spine recovery. **Wellness & Longevity.** A concierge program designed around how you want to feel five, ten, and twenty years from now, including IV therapy, NAD+, peptides, ketamine infusion therapy, EMSCULPT NEO, and red light therapy. These are not separate menus. They are one continuum of care, and most patients move between them over time. ## Meet the Physicians PHI is led by two double board-certified physicians who trained together and practice together. **[Dr. Faisal Lalani](https://painandhealing.com/providers/faisal-lalani/)** is double board-certified in Anesthesiology and Pain Medicine and completed his fellowship in interventional pain management at Cedars-Sinai Medical Center, where he has also served as faculty. His background spans internal medicine, anesthesiology, regenerative medicine, and precision-guided procedures. **[Dr. Nadiv Samimi](https://painandhealing.com/providers/nadiv-y-samimi/)** is board-certified in Anesthesiology and Pain Medicine and completed his fellowship in pain medicine at Cedars-Sinai Medical Center, after serving as Chief Resident in Anesthesiology at USC. He focuses on interventional pain, regenerative treatments, and the practice's wellness and longevity care. Together, Dr. Lalani and Dr. Samimi bring a shared philosophy: pain should never be dismissed, and every patient deserves a physician who keeps searching for the answer. ## The Concierge Standard PHI is a concierge practice, and that is a deliberate choice. Our physicians answer to one party: you. Appointments are unhurried. Treatment plans are built around your goals rather than a billing code. And when a procedure calls for an advanced setting, it happens at a surgical suite in the same building, so your care never leaves the address you already trust. From the first call to long-term follow-up, the experience is designed to feel less like a clinic and more like a partnership. ## Designed Around You Every detail at PHI, from the calm of the space to the precision of the medicine, is built to support one outcome: helping you move freely, live fully, and feel like yourself again. The science is advanced. The setting is private. The relationship is the point. ## Begin Your Visit Schedule a consultation at PHI in Beverly Hills. 455 N Roxbury Drive Beverly Hills, CA 90210 (310) 856-9488 ### Articles ### Concierge Experience ### Concierge Is a Standard, Not a Price Point Concierge medicine is often reduced to a membership fee. At PHI it means something more specific: a standard for how every interaction should feel, from the first phone call to the last follow-up. Operating outside insurance networks is a deliberate choice, and it is what makes that standard possible. When clinical decisions answer to the patient rather than to a billing code, the entire experience changes. Here is what that standard looks like in practice. ### A Live Person, Every Time The team answers the phone Monday through Friday, 8:30am to 4:30pm. No phone trees. No voicemail purgatory. When a patient calls, a person picks up. It is a small thing that turns out not to be small at all, because the difference between reaching someone and navigating a menu is often the difference between getting care and giving up. ### Same-Day and Next-Day Scheduling Concierge care means a patient's time is respected. Most consultations and follow-ups are scheduled within 24 to 48 hours, and urgent cases are seen faster. Appointments themselves run as long as they need to, because the schedule is built around clinical need rather than volume. For conditions where earlier treatment genuinely changes outcomes, that speed is not a luxury, it is part of the medicine. ### Out-of-Network, Transparent Pricing PHI works outside insurance networks so that physician time, treatment selection, and care timelines are determined by what is right for the patient, not by what a plan will reimburse. Pricing is transparent: patients know what their care costs before it begins. There is no insurance pre-authorization, no surprise billing, and no treatment plan quietly shaped by coverage rules. For appropriate services, the practice can provide documentation patients may submit to their own insurer for potential out-of-network reimbursement. ### Care That Never Leaves the Building When a procedure calls for an advanced surgical setting, it takes place at an affiliated surgical suite in the same building. Most concierge pain practices send patients elsewhere for advanced procedures. PHI keeps them in-house, so a patient's care never has to leave the address they already trust. The result is a single continuous experience rather than a referral hand-off at the moment things get serious. ### Built for Patients Who Travel Patients come to PHI from across the country and around the world, from Las Vegas and Palm Springs to London and beyond. For those traveling in, the team coordinates scheduling, accommodations, transport, and consolidated treatment timelines so a visit is seamless rather than logistically exhausting. Care is sequenced to fit a travel window without compromising the medicine. ### The Relationship Is the Point Every detail, from the calm of the space to the precision of the medicine, supports one outcome: care that feels like a partnership rather than a transaction. The science is advanced. The setting is private. The relationship is the point, from the first call through long-term follow-up. ### Begin Your Visit Schedule a consultation using the form below at the Pain and Healing Institute in Beverly Hills. 455 N Roxbury Drive Beverly Hills, CA 90210 (310) 856-9488 ### Contact Us ### International & Out-of-Area Patients ## Why Patients Travel to PHI Patients fly in for a simple reason: the specific combination of care PHI offers is not available in every city. Board-certified interventional pain physicians, an on-site Surgical Suite, and a full range of regenerative options under one roof, delivered in a concierge model where your physician stays the same from consultation through recovery. For someone managing a complex or stubborn problem, that continuity is worth traveling for. You are not handed between providers or fitted into a rushed clinic schedule. You meet your physician, and that same physician plans and performs your care. We regularly treat patients arriving from elsewhere in California, from cities like Las Vegas and Palm Springs, and from international destinations. Traveling for care is normal here, and the visit is built around the fact that you are not local. ## How Your Visit Works When You're Traveling In The goal is to make one trip do the work of several. Here is the general shape, adjusted to your specific care: **Before you arrive.** Much of the early work can happen remotely. We can review your imaging and history and discuss your situation before you book travel, so you arrive with a plan rather than starting from zero. This also means we can tell you honestly, before you fly, whether PHI is the right fit for your problem. **While you're here.** We sequence consultation, any diagnostic steps, and treatment as efficiently as your care allows, rather than spreading them across separate trips. Because the Surgical Suite is on-site at the same address, procedures that would otherwise require coordinating an outside facility happen in the same building. **After you fly home.** Follow-up doesn't require living nearby. We handle recovery check-ins and progress monitoring remotely where appropriate, coordinating with your physicians at home when that's part of the plan. How much beyond the medical coordination our team assists with, things like pointing you toward lodging or local transport, is best confirmed directly with our concierge team, who tailor the level of support to each patient. ## Getting to PHI PHI is at **455 N Roxbury Drive, Beverly Hills, CA 90210**, in the heart of the city's medical district, walkable to hotels, restaurants, and shopping. **From LAX (Los Angeles International).** The closest major airport, about 12 miles south. Drive time is roughly 20 to 40 minutes depending on traffic. LAX has the most flight options, including the widest range of international arrivals. **From Hollywood Burbank Airport (BUR).** A smaller, calmer alternative roughly 12 miles away, often around a 20-minute drive. Many travelers find Burbank faster to move through than LAX, even when the driving distance is similar. Worth considering if your route offers a Burbank option. **Other airports.** Long Beach (LGB) and John Wayne / Orange County (SNA) are additional options, generally a longer drive but sometimes better for specific routes or fares. **Getting around once you're here.** Rideshare, taxis, and private car services all serve Beverly Hills, and most patients find a car unnecessary for short stays given how close lodging, dining, and the practice are to one another. ## Where to Stay Beverly Hills offers lodging for every preference, much of it within a short distance of the practice. **Walkable luxury.** Several of the city's well-known hotels sit within blocks of 455 N Roxbury, putting you minutes from your appointment on foot. **Comfortable and convenient.** A short drive out toward the Beverly Hills flats and the surrounding area opens up more moderate options without adding meaningful travel time. **Extended stays.** For patients whose care involves a longer visit or staged treatment, longer-stay and residential-style accommodations are available nearby. Rather than publish a fixed list that goes out of date, our team can point you toward options that fit your budget, timing, and how close you'd like to be, matched to your specific visit. Ask the concierge team when you schedule. ## Cost & Planning For traveling patients: pricing is disclosed clearly at consultation, with no pre-authorization delays and no surprise billing. You know the cost before you commit to the trip. Because much of the consultation work can happen before you arrive, you can make travel decisions with the full picture in hand rather than discovering scope or cost after you've landed. ## Frequently Asked Questions **Q: Can I do my consultation before I travel?** Often, yes. We can review imaging and history and discuss your situation remotely before you book travel, so you arrive with a plan and a clear sense of whether PHI is the right fit. Some care still requires an in-person exam, which we sequence into your visit. **Q: How long should I plan to stay?** It depends entirely on your care. Some visits are a single day; others involve a few days for sequenced treatment and a short recovery window before flying home. We give you a specific expected timeline before you travel so you can book accordingly. **Q: Do you treat international patients?** Yes. PHI regularly treats patients arriving from outside the United States, and the visit is structured around the realities of long-distance travel, including compressed scheduling and remote follow-up after you return home. **Q: Will my follow-up care require me to come back?** Not always. Many patients complete follow-up remotely, with check-ins and progress monitoring handled at a distance and coordination with your home physicians where appropriate. If an in-person follow-up is genuinely needed, we tell you that up front. **Q: Which airport should I fly into?** LAX offers the most flights and is about 12 miles away. Hollywood Burbank (BUR) is a smaller, often easier airport a similar distance out. Either works well; the right choice usually comes down to your departure city and schedule. **Q: Can your team help with travel and lodging?** Our team coordinates the medical side of your visit and can point you toward the right kind of lodging and local logistics for your situation. The exact level of support is best confirmed with the concierge team when you schedule. ### Our Story ### The Idea Behind the Practice Most medicine is built around isolation. A pain specialist for the back. A wellness clinic for the IV drip. A longevity doctor for the peptides. Three waiting rooms, three intakes, three plans that rarely speak to each other. For the patient, it means repeating your story over and over to providers who each see one piece of you. Dr. Faisal Lalani and Dr. Nadiv Samimi saw that fragmentation up close. Both trained in anesthesiology and pain medicine, both completed fellowships at Cedars-Sinai Medical Center, and both kept arriving at the same observation: the patient who comes in for a knee injection is often the same patient who wants to feel sharper at 60 than they did at 40. The pain, the recovery, and the long view are not separate problems. They are one continuum. PHI was built on that conviction. ![Dr. Lalani and Dr. Samimi](https://painandhealing.com/wp-content/uploads/2026/09/drlalani-drsamimi.webp) ### Two Physicians, One Standard PHI is not a practice where care is handed off between rotating providers. It was designed and built by two physicians who trained together and practice together, and that continuity is the point. Whether you arrive for an interventional procedure, a regenerative therapy, or a longevity consultation, you are cared for inside a single practice with the same protocols, the same staff, and the same standard from the first phone call to long-term follow-up. Dr. Lalani is double board-certified in Anesthesiology and Pain Medicine, completed his interventional pain fellowship at Cedars-Sinai, trained in residency at USC, and has taught interventional pain medicine to fellows and residents as faculty. Dr. Samimi is board-certified in Anesthesiology and Pain Medicine, completed his pain medicine fellowship at Cedars-Sinai, and leads the practice's wellness and longevity program. Together they bring one shared philosophy: pain should never be dismissed, and every patient deserves a physician who keeps searching for the answer. ### Care Designed Around the Patient From the start, PHI was designed to offer a more personalized approach to pain care. Appointments are unhurried, treatment plans are guided by each patient’s clinical needs, and care moves at a pace aligned with the patient's goals. When a procedure requires an advanced surgical setting, it can be performed at an affiliated outpatient surgery suite in the same building. This continuity allows patients to receive advanced procedures without leaving the location or care environment they already know and trust. While many concierge pain practices refer these procedures elsewhere, PHI keeps care conveniently coordinated in-house. ### A Practice Patients Travel For What began as two physicians with a shared idea has become a destination. Patients travel to PHI from across the country and from around the world, from Las Vegas and Palm Springs to London and beyond, for one reason: the medicine is integrated, the plan is built around them, and the standard is concierge from start to finish. The science is advanced. The setting is private. The relationship is the point. That is the practice Dr. Lalani and Dr. Samimi set out to build, and it is the one patients find when they walk through the doors at 455 N Roxbury Drive. ### Begin Your Visit Schedule a consultation using the form below at the Pain and Healing Institute in Beverly Hills. 455 N Roxbury Drive Beverly Hills, CA 90210 (310) 856-9488 ### Physicians ### Practice ### A Practice Built Around the Patient, Not the Billing Code At most practices, your time is measured against a schedule and your treatment against a billing code. PHI was built to remove both constraints. As a concierge practice in the heart of Beverly Hills, the Pain and Healing Institute answers to one party: the patient in the room. Appointments are unhurried, treatment plans are built around your goals, and the same two physicians stay with you from the first consultation through long-term follow-up. Healing here is not a single procedure. It is a relationship that often spans years, as patients move from resolving pain to rebuilding function to planning how they want to feel a decade from now. ### Three Disciplines, One Continuum of Care Most pain practices treat the symptom in front of them and refer everything else out. PHI is organized differently, around three connected pillars that cover the full arc of how you move, recover, and age. These are not separate menus. Most patients move between them over time. **Interventional Pain Management.** Image-guided injections, nerve blocks, radiofrequency ablation, and advanced procedures performed by board-certified pain physicians, for patients living with back, neck, joint, and chronic nerve pain. Every spinal and image-guided procedure is performed under fluoroscopy or ultrasound for precision. **Regenerative Medicine.** Advanced biologic therapies that work with the body's own healing systems, including PRP, A2M, stem cell therapy, and exosomes, for joint, tendon, and spine recovery. PHI is honest about what regenerative medicine can and cannot do, and matches the therapy to the evidence. **Wellness and Longevity.** A concierge program designed around how you want to feel five, ten, and twenty years from now, including IV therapy, NAD+, peptide therapy, ketamine infusion therapy, EMSCULPT NEO, and red light therapy. The focus is healthspan, the years lived in full function, not simply lifespan. ### Led by Two Double Board-Certified Physicians PHI is led by Dr. Faisal Lalani and Dr. Nadiv Samimi, who trained together and practice together. Dr. Lalani is double board-certified in Anesthesiology and Pain Medicine and completed his interventional pain fellowship at Cedars-Sinai Medical Center, where he has also served as faculty. Dr. Samimi is board-certified in Anesthesiology and Pain Medicine, completed his pain medicine fellowship at Cedars-Sinai, and served as Chief Resident in Anesthesiology at USC. They share one philosophy: pain should never be dismissed, and every patient deserves a physician who keeps searching for the answer. You can read more about each physician on their individual pages. ### The Concierge Standard Operating outside insurance networks is a deliberate choice. It means clinical decisions are guided by what is right for the patient rather than what a plan will reimburse. Appointments run as long as they need to. Treatment plans are built around your goals, your privacy, and your time. When a procedure calls for an advanced surgical setting, it takes place at an affiliated outpatient surgical suite in the same building, so your care never has to leave the address you already trust. From the first call through long-term follow-up, the experience is designed to feel less like a clinic and more like a partnership. ### Designed Around You Every detail at PHI, from the calm of the space to the precision of the medicine, supports one outcome: helping you move freely, live fully, and feel like yourself again. The science is advanced. The setting is private. The relationship is the point. ### Begin Your Visit Schedule a consultation at the Pain and Healing Institute in Beverly Hills. 455 N Roxbury Drive Beverly Hills, CA 90210 (310) 856-9488 ### Resources ### The Three Pillars ### Three Medicines, One Continuum Most medicine treats problems in isolation. A pain specialist for the back. A wellness clinic for the IV drip. A longevity doctor for the peptides. Three waiting rooms, three intakes, three plans that rarely speak to each other. PHI was built on a different idea. Pain, regeneration, and longevity are not three separate problems. They are one continuum, and most patients move between them over time. The question underneath all three is the same: how do I live better, for longer. The three pillars are how PHI answers it. ![Dr. Lalani and Dr. Samimi](https://painandhealing.com/wp-content/uploads/2026/09/drlalani-drsamimi-2.webp) ### Pillar One: Interventional Pain Management Interventional pain management is the foundation. Image-guided injections, nerve blocks, ablations, and advanced procedures performed by board-certified pain physicians, for patients living with back, neck, joint, and chronic nerve pain. This is precision medicine. Every spinal and image-guided procedure is performed under fluoroscopy or ultrasound, so treatment reaches the exact structure generating the pain rather than the general area. For many patients, the goal is not lifelong management but identifying the true source and addressing it directly. Featured procedures include epidural steroid injections, radiofrequency ablation, the Intracept procedure for vertebrogenic low back pain, and peripheral nerve stimulation for chronic nerve pain that has not responded to other treatments. ### Pillar Two: Regenerative Medicine Regenerative medicine works with the body's own healing systems rather than around them. Advanced biologic therapies including PRP, A2M, stem cell therapy, and exosomes, used for joint, tendon, and spine recovery. PHI is honest about what regenerative medicine can and cannot do. It can support remaining cartilage, calm the inflammation that accelerates tissue loss, and address pain at the tissue level. It does not reliably regrow significant cartilage that has already been lost, regardless of what the broader market sometimes claims. The physicians match the therapy to the evidence and tell patients what to realistically expect. Featured therapies include PRP therapy, A2M therapy for early-to-moderate osteoarthritis, stem cell therapy, and exosome therapy within comprehensive regenerative protocols. ### Pillar Three: Wellness and Longevity The third pillar is built around the long view: how you want to feel five, ten, and twenty years from now. A concierge program spanning IV therapy, NAD+, peptide therapy, ketamine infusion therapy, EMSCULPT NEO, and red light therapy. The focus here is healthspan, the years lived in full function and mental sharpness, not simply lifespan. PHI is one component of comprehensive longevity care, providing the physician-administered medical layer that works alongside the lifestyle foundations (sleep, nutrition, movement, stress) that matter most. The physicians are honest that longevity medicine still has more mechanistic rationale than long-term outcome data, and they pursue what the evidence supports rather than what is trendy. Featured protocols include NAD+ therapy, peptide therapy, IV therapy, and ketamine infusion therapy. ### Why One Roof Matters The pillars are not separate menus. They are one practice. The patient who arrives for a herniated disc may later explore regenerative options for a worn knee, then build a longevity plan for the decade ahead. Because all three disciplines live under one roof at 455 N Roxbury Drive, that journey happens inside a single relationship with the same two physicians, the same protocols, and the same standard. That continuity is the point. The medicine is integrated. The plan is built around the patient. The standard is concierge from the first call through long-term follow-up. ### Begin Your Visit Schedule a consultation using the form below at the Pain and Healing Institute in Beverly Hills. 455 N Roxbury Drive Beverly Hills, CA 90210 (310) 856-9488 ## Locations ### Beverly Hills ### Surgery Center ![surgery center](https://painandhealing.com/wp-content/uploads/2026/09/surgery-center.webp) ## Concerns ### Anxiety ## Where this page fits in anxiety care. Most anxiety is well-treated by standard care: therapy (particularly cognitive behavioral therapy and other evidence-based approaches), medications including SSRIs and SNRIs, lifestyle interventions, and time. For most patients with anxiety disorders, this approach produces meaningful improvement. This page isn't for patients newly diagnosed with anxiety or whose anxiety has not yet been thoroughly treated through standard means. If you're early in your anxiety journey, your most useful next step is connecting with a psychiatrist or therapist who specializes in anxiety, not an interventional pain practice. This page is for patients whose anxiety meets specific criteria: - An established anxiety diagnosis (generalized anxiety disorder, social anxiety disorder, panic disorder, or other specific condition) - Ongoing care with a mental health professional - Multiple attempts at standard treatment without adequate response - Severity that significantly affects quality of life despite ongoing care For this specific group of patients, ketamine infusion therapy may be a meaningful adjunct treatment alongside the broader mental health care you're already receiving. ## What this page is — and isn't PHI is not a psychiatry practice. We don't manage ongoing anxiety care, prescribe psychiatric medications for anxiety, or provide psychotherapy. What we offer is one specific physician-administered medical intervention with accumulating evidence for severe anxiety conditions that haven't responded to standard treatment. ## How ketamine may help treatment-resistant anxiety Ketamine works through a different mechanism than standard anxiety medications. While most anxiety medications act on serotonin or related neurotransmitter systems, ketamine acts on the NMDA receptor and glutamate signaling. This different mechanism may help patients whose anxiety has not adequately responded to standard medications. The clinical evidence for ketamine specifically in anxiety is less robust than for depression or PTSD, but is accumulating. Studies have shown meaningful symptom reduction in patients with generalized anxiety disorder, social anxiety disorder, and certain other anxiety conditions when ketamine is used in defined treatment protocols. We are honest with patients: ketamine is not a first-line anxiety treatment, and the evidence base is still developing. For appropriate patients whose anxiety has not responded to multiple standard treatments, ketamine may be a worthwhile addition to their care. For patients earlier in their anxiety journey, focusing on standard evidence-based treatment is typically more appropriate. ## When to consider ketamine for anxiety You may be a candidate for ketamine infusion therapy if specific clinical criteria are met. Candidacy depends on diagnosis, treatment history, medical status, and ongoing mental health care. The candidacy assessment happens during an in-person consultation with [Dr. Lalani](https://painandhealing.com/wp-content/uploads/2026/05/dr-lalani-headshot-scaled.jpg) or [Dr. Samimi](https://painandhealing.com/wp-content/uploads/2026/05/dr-samimi-scaled.jpg). We coordinate directly with your psychiatrist or therapist as part of that evaluation. A candidacy decision is collaborative, not unilateral. ## How PHI approaches ketamine for anxiety The first step is comprehensive evaluation. For appropriate candidates, treatment involves physician-administered IV infusions in a clinic setting. Each infusion typically takes 40 to 60 minutes. You're awake throughout, in a private setting, with continuous monitoring of vital signs. We deliver a defined treatment series rather than open-ended dosing. The number of infusions and their spacing vary patient to patient. Some patients receive maintenance infusions periodically afterward. Throughout your treatment series, we coordinate with your mental health team. We communicate with your psychiatrist or therapist as appropriate and integrate ketamine with your broader anxiety care. For more detail on the procedure itself, see our Ketamine Infusion Therapy treatment page. ## Why PHI for treatment-resistant anxiety PHI's approach to ketamine for anxiety reflects our broader commitment to physician-administered care, clinical coordination, and the safety infrastructure of a real medical practice. ## Frequently asked questions **Q: How is the evidence for ketamine in anxiety different from depression?** Stronger for depression, less mature for anxiety. Ketamine has multiple high-quality randomized trials specifically for treatment-resistant depression. Evidence for anxiety conditions is accumulating but not yet at the same level. For patients whose anxiety has resisted standard treatment, the available evidence is encouraging; for patients earlier in their treatment journey, standard approaches are typically more appropriate. **Q: Will ketamine cure my anxiety?** "Cure" is rarely the right word for chronic anxiety conditions. For appropriate candidates, ketamine may produce meaningful symptom reduction that combines with your other treatments to improve overall quality of life. For some patients, the response is dramatic. For others, the response is more modest. We're honest about realistic expectations. **Q: Is ketamine addictive?** Recreational ketamine carries addiction risk. Medical ketamine in defined treatment series with subanesthetic dosing has not been associated with significant addiction risk in clinical use. The setting matters: a defined medical protocol is meaningfully different from unsupervised use. **Q: How long do effects last?** This varies. A series of infusions is used because effects from a single infusion are typically temporary, but cumulative effect builds across the series. After the initial series, some patients experience sustained benefit for months. Some receive periodic maintenance infusions. **Q: What does the infusion feel like?** Most patients describe feeling relaxed and somewhat detached from worries during the infusion. Some experience visual phenomena or altered perception. Most find the experience tolerable; some find it uncomfortable, in which case dosing can be adjusted. **Q: Can I drive home after my infusion?** No. Ketamine's effects typically resolve within 1 to 2 hours after the infusion, but you'll need transportation home. Don't plan to drive that day. **Q: How does PHI screen for whether ketamine is appropriate?** We require established anxiety diagnosis, ongoing mental health care, history of multiple standard treatment attempts, and absence of medical contraindications. We don't accept patients seeking ketamine without these elements in place. This screening is part of our commitment to using ketamine appropriately rather than offering it broadly. **Q: What if I'm in crisis right now?** If you're experiencing acute crisis, contact your psychiatrist, mental health team, or call the 988 Suicide and Crisis Lifeline (available 24/7). PHI is not equipped for acute crisis intervention and is not the right resource in those moments. **Q: Do you take insurance?** PHI is a cash-pay practice. Ketamine infusion is typically not covered by insurance. All pricing is disclosed at consultation. **Q: How quickly can I be seen?** Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Ketamine treatment series can be coordinated to fit travel schedules. We see international patients from across the world: Asia, Dubai, London, Paris, Italy, Saudi Arabia, to name a few. ## Treatments we offer for anxiety PHI offers physician-administered ketamine infusion therapy for severe, treatment-resistant anxiety conditions, alongside complementary wellness protocols where appropriate. We work alongside your mental health team rather than replacing the broader care you need. > Ketamine's dose-related effects on anxiety symptoms in patients with treatment refractory anxiety disorders. Peer-reviewed via PubMed. — [Glue P, et al. ](https://pubmed.ncbi.nlm.nih.gov/28196579/) > Effects of ketamine in patients with treatment-refractory generalized anxiety and social anxiety disorders: Exploratory double-blind psychoactive-controlled replication study. Peer-reviewed via PubMed. — [Glue P, et al.](https://pubmed.ncbi.nlm.nih.gov/32441196/) > Practice Guideline for the Treatment of Patients with Anxiety Disorders. — [American Psychiatric Association](https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890423974) ## Schedule your anxiety consultation A 60-minute consultation will evaluate whether ketamine infusion therapy is appropriate for your specific anxiety situation, walk through the protocol, and coordinate with your mental health team. Call (310) 856-9488 or book online now. ### Athletic Performance & Recovery ## When You Want to Train Like You Mean It There is a particular kind of patient who arrives at this page. Someone serious about their training, even if not competing professionally. Someone who has been at it long enough to know their body well. Someone who notices that recovery takes a little longer than it used to, that consistency is harder to maintain, that the next decade of training will require a different approach than the last. The conversation is not about getting back to baseline after an injury. It is about staying ahead of the curve, recovering faster between sessions, supporting the systems that affect how your body responds to training, and maintaining athletic capacity into your 50s, 60s, and beyond rather than accepting decline as inevitable. This page sits at the intersection of athletic performance and longevity care. ## What Long-Term Athletic Optimization Looks Like Sustained performance over years depends on a different skill set than peak performance for a single event. The systems that matter include recovery capacity (how well you bounce back from training stress), tissue resilience (the capacity of tendons, joints, and connective tissue to handle ongoing loads), hormonal balance, mitochondrial function, inflammation regulation, sleep quality (possibly the most underrated performance factor, since sleep is when most recovery happens), and cognitive sharpness. PHI's offerings address several of these systems. None substitute for the foundational work of training programming, sleep, nutrition, and recovery practices. The fundamentals matter more than any treatment. ## How PHI Approaches Athletic Performance and Recovery The first step is a comprehensive evaluation of your training, sport or activity, performance goals, where recovery or capacity feels limited, and how your patterns are changing with age or load, followed by an honest discussion of which treatments fit your situation. IV therapy delivers hydration, electrolytes, and specific nutrients directly into circulation, particularly useful around demanding training periods or for patients with documented deficits. Peptide therapy uses specific compounds that may support tissue recovery, sleep quality, and growth hormone signaling; it is one of the most rapidly evolving areas in performance medicine, and we discuss options individually without listing specific peptides publicly. EMSCULPT NEO is FDA-cleared for muscle building and fat reduction and may complement training for specific muscle groups. Red light therapy delivers wavelengths that may support muscle recovery and tissue health, with evidence most established for muscle recovery. These treatments are delivered in our clinic setting under physician supervision, alongside coordination with your primary care, sports medicine, and other providers. For competition-specific context, see our Sports Recovery and Performance page. ## When This Page Applies to You You may benefit from PHI's offerings if you train consistently and want medical support for sustained performance, if recovery is taking longer than it used to, if you are approaching or in your 40s to 60s and want to maintain athletic capacity through aging, or if you want to integrate medical optimization with your existing training and lifestyle work. You are typically better served elsewhere first if you have an active injury that should be evaluated and treated before pursuing optimization, if you are new to training and have not established consistent foundational practices, or if you are hoping for transformation without the foundational training, sleep, and nutrition work. ## Why PHI for Athletic Performance and Recovery ## Frequently Asked Questions **Q: How is this different from the Sports Recovery and Performance page?** That page focuses more specifically on competitive sport contexts and event-related performance. This page frames athletic performance within broader longevity care for serious recreational athletes and active adults. The treatments overlap; the framing differs based on patient priorities. **Q: At what age does recovery start to decline?** Recovery capacity begins gradually declining in the 30s, with more noticeable changes typically in the 40s and 50s. The decline is not fixed and is significantly modifiable through training adaptation, sleep prioritization, and supportive medical interventions. **Q: Can these treatments slow athletic decline with aging?** Not entirely. Some age-related changes in athletic capacity are inevitable. What appropriate care can do is significantly slow the decline, support maintenance of higher capacity longer, and ensure that whatever capacity you have is fully realized rather than limited by addressable factors. **Q: What's most important for sustained athletic performance through aging?** Sleep, training programming with appropriate periodization, nutrition, recovery practices, and managing inflammation. Medical interventions support these foundations but do not replace them. The fundamentals matter more than any treatment. **Q: Will these affect drug testing for sport?** Some treatments are universally permitted by WADA and most sports organizations; others have considerations for elite athletes. We discuss specifics during consultation if you compete at a level where this applies. **Q: How frequently do active patients use these services?** This varies. Some patients use IV therapy occasionally around training peaks or events; others have regular protocols. EMSCULPT NEO typically involves a defined treatment series, red light therapy can be used regularly, and peptide therapy varies by specific application. **Q: Do you take insurance?** PHI is out-of-network with all insurance plans, which lets our concierge practice deliver focused, personalized care. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Athletic Performance and Recovery PHI offers evidence-based and supportive treatments for athletic performance and recovery within broader longevity care. Your physician will recommend the right combination based on your training, goals, and current situation. - IV Therapy, hydration and targeted nutrients around training - Peptide Therapy, for tissue recovery and growth hormone signaling - EMSCULPT NEO, FDA-cleared muscle building and fat reduction - Red Light Therapy, most established for muscle recovery > The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials. Peer-reviewed via PMC, 2021. — [Tripodi N, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8364035/) > High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Peer-reviewed via PMC, 2019. — [Kinney BM, Lozanova P](https://pmc.ncbi.nlm.nih.gov/articles/PMC6585690/) > WADA Prohibited List. World Anti-Doping Agency. — [World Anti-Doping Agency](https://www.wada-ama.org/en/prohibited-list) ## Schedule Your Athletic Performance Consultation A 60-minute consultation will evaluate your specific situation, walk through which optimization options match your training and goals, and integrate medical care with your existing performance practices. Call (310) 856-9488 or book online now. ### Brain Fog & Mental Clarity ## When Your Mind Doesn't Feel Like Yours Brain fog has a particular quality that is hard to describe to people who have not experienced it. The sense that your thinking is slower than it used to be. Words that do not come as easily. Trouble holding a complex idea in your head while you work on it. Reading the same paragraph three times. Walking into a room and forgetting why. Most people experience occasional cognitive fuzziness. Persistent brain fog, the kind that affects work performance, daily life, and your sense of yourself, is something different. It is often dismissed as stress, age, or just life. Sometimes that is accurate; often there is something more identifiable contributing. What we offer is the supportive optimization side of cognitive care, and we are honest that the most important first step is identifying contributors. For some patients, addressing specific causes resolves the brain fog without direct cognitive interventions. ## What Brain Fog Actually Is and Isn't Brain fog is a symptom, not a diagnosis. It describes impaired mental clarity, slowed thinking, difficulty concentrating, or memory problems, and it can come from many sources. Common causes that often resolve with appropriate intervention include chronic stress, poor sleep quality, nutritional deficits (B12, vitamin D, iron and others), hormonal changes (perimenopause, menopause, andropause, thyroid dysfunction), medication effects, post-viral syndromes including long COVID, depression and anxiety, dehydration, and excessive alcohol use. Causes requiring specific medical evaluation include significant new cognitive decline (particularly in older adults), cognitive changes alongside other neurological symptoms, changes following head injury, and sudden severe cognitive changes; these warrant primary care or neurological evaluation rather than wellness intervention. The first step is identifying which category your situation fits. ## What This Page Is and Isn't PHI is an interventional pain and regenerative medicine practice. We are not neurologists, primary care physicians, or specialists in cognitive disorders. For patients with brain fog, comprehensive care typically involves primary care evaluation (to assess for thyroid dysfunction, vitamin deficiencies, sleep disorders, hormonal issues, and other contributors) and specialist evaluation when specific concerns warrant. PHI's role is supportive optimization through specific medical interventions that may complement broader care. We do not replace your primary care for cognitive concerns; we add specific options that may help alongside addressing underlying contributors. ## How PHI Approaches Brain Fog The first step is a comprehensive evaluation: a detailed history of your cognitive symptoms and how they have changed, discussion of potential contributors (sleep, stress, hormones, nutrition, medications, recent illness), review of any prior workup, and an honest assessment of whether wellness optimization fits your situation or whether primary care evaluation should come first. For patients where wellness optimization is appropriate, options include NAD+ therapy, a coenzyme involved in cellular energy production that declines with age, with evidence for cognition we describe as emerging rather than established; peptide therapy, where specific peptides may support cognitive function and sleep, with bloodwork performed at consultation before any peptide is prescribed and without listing specific compounds publicly; and IV therapy, particularly useful for patients with documented nutrient deficits such as B12. These treatments are delivered in a clinic setting under physician supervision, not in the Surgical Suite, and we coordinate with your primary care physician for evaluation of underlying contributors. ## Why PHI for Brain Fog Optimization ## Frequently Asked Questions **Q: Will NAD+ therapy improve my cognitive function?** For some patients, yes. The mechanistic rationale is sound. NAD+ is involved in cellular energy production and declines with age, and some patients report meaningful improvement in mental clarity and energy. Others do not experience significant change. We are honest that the clinical evidence for NAD+ specifically in cognitive function is emerging rather than established. **Q: Should I get worked up before pursuing wellness treatments for brain fog?** Generally yes. Most patients with persistent brain fog benefit from primary care evaluation including thyroid assessment, B12 and other vitamin levels, hormonal evaluation when appropriate, sleep assessment, and review of medications. Identifying and addressing underlying contributors often produces more improvement than wellness interventions alone. **Q: Can IV therapy help my brain fog?** For patients with documented vitamin deficiencies, particularly B12, IV nutrient therapy can produce meaningful improvement. For patients without specific deficits, the cognitive benefit is more variable. We evaluate whether IV therapy fits your specific situation rather than offering it as a default. **Q: How long until I notice a difference?** This varies by treatment and underlying contributors. NAD+ may produce noticeable effects within days to weeks for responders. IV nutrient therapy may produce effects within hours to days when addressing specific deficits. Peptide therapy varies by the specific peptide. Sleep and stress optimization may take weeks to months for cognitive improvement. **Q: What about long COVID brain fog?** Post-viral cognitive symptoms are real and increasingly recognized. Some patients experience improvement with supportive interventions. Long COVID care typically involves coordination with primary care or specialty providers familiar with the condition, and PHI's offerings may complement this broader care for selected patients. **Q: Could my brain fog be perimenopause or menopause?** Yes, often. Hormonal changes around perimenopause and menopause commonly include cognitive symptoms. For women in this transition, hormonal evaluation and management, often through your primary care or gynecologist, typically addresses cognitive symptoms more effectively than wellness interventions alone. **Q: What if I'm worried about early dementia?** This warrants primary care or neurology evaluation rather than wellness intervention. If you have concerning cognitive changes, particularly with patterns suggesting early decline, please pursue appropriate medical evaluation. PHI is not the right starting point for these concerns. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Brain Fog and Mental Clarity PHI offers supportive optimization treatments for cognitive function. Your physician will recommend the right options based on your specific situation, suspected contributors, and goals. - NAD+ Therapy - Peptide Therapy, bloodwork at consultation before prescribing - IV Therapy, most useful when a nutrient deficit is contributing > NAD+ metabolism and the control of energy homeostasis: a balancing act between mitochondria and the nucleus. Cell Metabolism. — [Cantó C, et al.](https://pubmed.ncbi.nlm.nih.gov/26118927/) > Memory, forgetfulness, and aging: what's normal and what's not. NIH National Institute on Aging. — [NIH National Institute on Aging](https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-forgetfulness-and-aging-whats-normal-and-whats-not) > Long COVID basics. Centers for Disease Control and Prevention. — [Centers for Disease Control and Prevention](https://www.cdc.gov/covid/long-term-effects/index.html) ## Schedule Your Brain Fog Consultation A 60-minute consultation will evaluate your specific cognitive symptoms, walk through whether wellness optimization fits your situation or whether primary care evaluation should come first, and recommend treatments that match your situation. Call (310) 856-9488 or book online now. ### Cartilage Damage ## When Your Joint Surface Is Damaged Cartilage damage is one of the most challenging musculoskeletal problems because cartilage does not heal the way other tissues do. Bone heals. Tendons heal. Skin heals. Cartilage, with its limited blood supply, does not have the same natural healing capacity, so damage tends to persist or progress rather than resolve. This is part of why cartilage damage matters so much for active patients. A cartilage defect from a sports injury at 35 may contribute to early arthritis at 45. A small area of thinning at 50 may progress to severe arthritis at 60. The trajectory is not fixed, but it tends to move in one direction without active intervention. What we offer at PHI is the regenerative side of cartilage care, and we are honest about what it can and cannot do: it can support remaining cartilage, reduce inflammation that accelerates loss, address pain through tissue-level mechanisms, and sometimes support partial repair, but it typically cannot grow back significant cartilage that has already been lost. ## What Cartilage Actually Is Articular cartilage is the smooth, white tissue covering the ends of bones in your joints. It allows nearly frictionless movement and absorbs the loads placed on your joints during activity. Several characteristics make it different from other tissues: it has no blood vessels of its own and receives nutrients through joint fluid, its cells reproduce slowly, the cells needed for repair often cannot migrate effectively through the dense matrix, and it has a complex layered architecture that is difficult to recreate even with surgical repair. These factors combine to create the central challenge: damaged cartilage does not reliably restore itself, and replacing it with tissue that has all the original properties is technically difficult even with sophisticated interventions. ## Common Patterns of Cartilage Damage Several patterns may bring patients to consultation. Acute chondral injury from sports, trauma, or impact damages a specific area while surrounding cartilage may be largely normal, often in younger or middle-aged patients with otherwise healthy joints. Osteoarthritis-related cartilage loss thins the cartilage gradually across larger areas (see our Hip Arthritis, Knee Arthritis, and Shoulder Arthritis pages). Post-injury degeneration develops years after a significant joint injury. Osteochondral defects involve both cartilage and underlying bone. And cartilage damage from inflammatory arthritis, where ongoing inflammation accelerates breakdown, is treated in coordination with rheumatology. The pattern affects what treatment is most appropriate. ## How PHI Approaches Cartilage Damage Treatment begins with a comprehensive evaluation: how the damage developed, examination of the affected joint, review of imaging (MRI is typically required to evaluate cartilage), a discussion of where you are in the trajectory, and an honest assessment of whether regenerative medicine fits your situation. Options include PRP therapy, which has the strongest evidence base for joint cartilage among regenerative options; A2M therapy, which specifically neutralizes cartilage-destroying enzymes and is particularly relevant for early-to-moderate damage where slowing further loss is part of the goal; stem cell therapy for moderate damage or after PRP and A2M, with honest framing that "stem cells regenerate cartilage" is more often a marketing claim than a clinical reality; and exosome therapy within comprehensive protocols. Some patients benefit from combinations or staged approaches over time. For patients whose specific damage may benefit from surgical repair, procedures like microfracture, autologous chondrocyte implantation, and osteochondral grafts are surgical options we coordinate with specialists, and for severe end-stage arthritis joint replacement is often the eventual answer. ## When to See Someone Consider professional evaluation when you have been told you have cartilage damage on imaging, when a joint injury has produced persistent symptoms, when you have early-to-moderate arthritis and want to slow progression, when standard treatments are not producing lasting relief, or when you are trying to delay joint replacement and want to maximize your non-surgical options. Seek prompt evaluation if you experience an acute joint injury with significant pain, swelling, or inability to bear weight, joint locking or catching that limits motion, sudden severe pain in a previously stable joint, or signs of infection such as warmth, redness, or fever. ## Why PHI for Cartilage Damage ## Frequently Asked Questions **Q: Can regenerative medicine actually grow back cartilage?** Generally no, despite some marketing claims to the contrary. Regenerative medicine does not reliably regrow significant amounts of cartilage. What it can do is support remaining cartilage, reduce inflammation that accelerates loss, and address pain through tissue-level mechanisms. For appropriate patients this is meaningful even though it is not the same as restoring lost cartilage. **Q: What about stem cells for cartilage?** Stem cell therapy has accumulating evidence for joint cartilage applications, and many patients experience meaningful symptomatic improvement and possibly some cartilage support. The claim that stem cells reliably regenerate cartilage is more of a marketing position than a current clinical reality. We are honest about realistic expectations. **Q: Is PRP or A2M better for cartilage?** Neither is universally better. PRP delivers a broad mix of growth factors that support tissue health generally. A2M specifically targets cartilage-destroying enzymes. For some patients one fits better than the other; for others both may be appropriate at different times. Your physician will discuss which approach makes sense for your situation. **Q: How effective are these treatments compared to cortisone?** Cortisone is fastest and provides reliable short-term relief but does not address tissue-level health and may have cumulative effects on cartilage with repeated use. Regenerative treatments work over a longer time horizon, do not have the same cumulative concerns, and may support tissue health rather than only managing inflammation. Different patients fit different approaches. **Q: Will I need joint replacement eventually?** This depends on the severity and progression of your cartilage damage. Many patients with mild-to-moderate damage can avoid or significantly delay replacement through appropriate regenerative care, lifestyle modifications, and other treatments. Patients with severe damage often eventually benefit from replacement, and we are honest about which category fits you. **Q: What about microfracture or ACI surgery?** These are surgical cartilage repair procedures performed by orthopedic specialists, appropriate for specific defect patterns, typically focal damage in younger active patients. PHI does not perform them but coordinates with surgical specialists when this evaluation is appropriate. **Q: Can I exercise with cartilage damage?** Yes, with appropriate adjustments. Heavy-impact activities may need modification, while low-impact activities like cycling, swimming, and walking are typically beneficial. Continued appropriate movement is one of the most important factors for cartilage health. **Q: How long does it take to see if regenerative treatment is working?** Regenerative treatments do not produce immediate effects. Most patients begin to notice improvement at 4 to 8 weeks, with maximum benefit typically at 3 months, and some continue to improve over 6 months or longer. This is different from cortisone, which produces fast relief that fades. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Cartilage Damage PHI offers the full range of regenerative treatments for cartilage damage. Your physician will recommend the right option, or combination, based on your specific cartilage situation and treatment history. - PRP Therapy, strongest evidence base among regenerative options for joint cartilage - A2M Therapy, neutralizes cartilage-destroying enzymes - Stem Cell Therapy - Exosome Therapy > The effectiveness of alpha-2-macroglobulin injections for osteoarthritis of the knee: a randomized controlled trial. Peer-reviewed via PubMed, 2024. — [Thompson K, et al.](https://pubmed.ncbi.nlm.nih.gov/39259950/) > The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Peer-reviewed via PubMed. — [Wernecke C, et al.](https://pubmed.ncbi.nlm.nih.gov/26674652/) > Clinical practice guideline: management of osteoarthritis of the knee. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-knee/) ## Schedule Your Cartilage Damage Consultation A 60-minute consultation will identify your specific cartilage situation, walk through the regenerative options that match it, and give you a clear plan with realistic expectations. Call (310) 856-9488 or book online now. ### Cervical Facet Syndrome ## When Your Neck Pain Has a Specific Source Cervical facet syndrome is a recognized cause of chronic neck pain that often gets lost in the broader neck-pain diagnosis. If you have been treated for general neck pain for months or years without lasting relief, your pain may actually be coming from the small joints in your cervical spine called facet joints. The good news: cervical facet syndrome has one of the clearest diagnostic and treatment pathways in interventional pain medicine. A targeted diagnostic injection confirms the source. If the injection helps but does not last as long as you would like, radiofrequency ablation can extend relief to 6 to 18 months from a single procedure. For patients who fit this diagnosis, treatment outcomes are often more predictable than for many other chronic pain conditions. ## What Cervical Facet Joints Are Your cervical spine has seven vertebrae stacked on top of each other. Between each pair are two small joints at the back called facet joints, which allow your neck to bend, twist, and tilt while providing stability. Like any other joint, they can develop arthritis, become inflamed after injury, or be irritated by ongoing stress, and when this happens they generate the characteristic neck pain pattern of cervical facet syndrome. The pain often refers to the back of the head, the upper shoulders, or between the shoulder blades, depending on which level is involved. This referred pattern is part of why cervical facet syndrome can be confusing to diagnose. Many patients are surprised to learn that pain at the base of the skull or between the shoulder blades is actually coming from a joint in the middle of their neck. ## What Cervical Facet Syndrome Feels Like Common features include: - Chronic neck pain that has lasted weeks, months, or years - Pain that worsens with extension (looking up) or twisting the neck - Pain that may be one-sided more than the other - Morning stiffness that improves somewhat with movement - Pain that refers to the back of the head, upper shoulders, or upper back - Limited neck range of motion, particularly in extension and rotation - Pain that does not typically radiate down the arm, which would suggest a pinched nerve instead - Pain that often develops after whiplash or another neck injury, sometimes years later If several of these patterns describe your experience, cervical facet involvement is worth evaluating. ## How PHI Diagnoses and Treats Cervical Facet Syndrome The most reliable diagnostic test is a cervical medial branch block, a small injection of local anesthetic near the nerves that supply each facet joint. If your typical neck pain significantly improves in the hours immediately after, the facet joints are confirmed as a primary source. This dual diagnostic-and-therapeutic approach is part of why diagnostic injections are often the first interventional step. For confirmed cervical facet syndrome, treatment follows a clear sequence. Cervical facet injections are usually first, delivering local anesthetic and corticosteroid into or near the facet joints, with relief lasting weeks to several months. Cervical radiofrequency ablation is the natural next step for patients whose injections confirm the diagnosis but produce shorter-than-desired relief; it uses targeted heat energy to disrupt the small nerves carrying pain signals from the facet joints, providing relief that typically lasts 6 to 18 months and can be repeated when the nerves regenerate. PHI performs every cervical procedure in our surgical suite under image guidance. Whether one or two diagnostic blocks are needed before ablation is decided patient by patient, based on the degree of relief from the first block. ## Why PHI for Cervical Facet Syndrome ## Frequently Asked Questions **Q: How do I know if my neck pain is from facet syndrome versus a herniated disc?** The patterns are different. Cervical facet syndrome typically produces neck pain that worsens with extension and twisting, with referred pain to the head, shoulders, or upper back. A herniated disc more commonly produces radiating pain down the arm, often with numbness or tingling. Many patients have both, and physical examination plus diagnostic injections often clarify which is dominant. **Q: Why do I need a diagnostic injection if my MRI shows facet arthritis?** MRI findings do not always correlate with the actual source of pain. Many patients have facet arthritis on imaging that is not the primary cause of their symptoms. A diagnostic injection directly tests whether your specific facet joints are generating your pain, which confirms the diagnosis and changes treatment recommendations for some patients. **Q: How effective is cervical radiofrequency ablation?** For appropriate candidates with positive diagnostic blocks, cervical ablation produces meaningful pain relief lasting 6 to 18 months in most patients. The procedure can be repeated when relief diminishes. **Q: Will the procedure hurt?** Most patients describe the procedures as briefly uncomfortable rather than painful. Local anesthesia numbs the skin and tissue, and a range of sedation options is available depending on your comfort and the procedure. **Q: How long does recovery take?** Most patients return to most normal activities within 1 to 2 days after a facet injection. Ablation typically requires a few days to a week of restricted activity, with full benefit developing over 2 to 6 weeks as the targeted nerves stop transmitting pain signals. This varies patient to patient and is discussed with your physician. **Q: How is this different from a chiropractic adjustment?** Chiropractic adjustments work by manually moving joints to address mechanical restrictions. Interventional pain treatments target the specific nerves or joints generating pain through medical procedures. The two approaches address different things and can sometimes complement each other. **Q: Will I need surgery?** Most patients with cervical facet syndrome do not need surgery. The vast majority find meaningful relief through targeted injections and radiofrequency ablation. Surgery is reserved for specific situations. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Cervical Facet Syndrome PHI offers the established evidence-based treatment pathway for cervical facet syndrome. - Cervical Facet Injections, diagnostic and therapeutic - Radiofrequency Ablation, 6 to 18 months of relief from a single procedure > Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020. — [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/) > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PMC, 2022. — [American Academy of Neurology Guidelines Subcommittee](https://pmc.ncbi.nlm.nih.gov/articles/PMC12289388/) ## Schedule Your Cervical Facet Consultation A 60-minute consultation will evaluate whether your neck pain is consistent with cervical facet syndrome, walk through the diagnostic and treatment pathway, and give you a clear plan. Call (310) 856-9488 or book online now. ### Cervicogenic Headaches ## Your Headaches May Actually Be Coming From Your Neck Cervicogenic headache is one of the most commonly misdiagnosed headache conditions. Patients often arrive having been treated as migraine patients for years, having tried multiple migraine medications without adequate response, before anyone evaluates whether their headaches are actually originating from their cervical spine. The clue is in the name. Cervicogenic means originating from the cervical (neck) region. These headaches start from structures in your neck, particularly the upper cervical facet joints and surrounding nerves, and refer pain forward into the head. The result is a headache that feels like it is in your forehead or temples but is actually being generated several inches lower. This is meaningfully different from migraine, which involves specific brain pathways and responds to migraine-specific medications. Cervicogenic headaches do not respond well to triptans because the source is not being addressed, but they do respond well to treatments that target the cervical source directly. ## What Cervicogenic Headache Feels Like The pattern is often distinctive once you recognize it: - Pain that starts in the back of the head or upper neck and travels forward into the temple, forehead, or behind one eye - Pain that is typically one-sided and stays on the same side - Pain triggered or worsened by neck movement, sustained postures, or pressure on specific points in the upper neck - Pain that may worsen with prolonged screen time, driving, or other sustained neck positions - Restricted neck range of motion, particularly when turning the head - Tenderness in specific points in the upper neck or at the base of the skull - Pain that has not responded well to standard migraine medications including triptans Many patients have both cervicogenic headache and migraine. Sorting out which is which is part of comprehensive evaluation, and treating the cervical source can significantly reduce overall headache burden even in patients who also have migraine. ## What Causes Cervicogenic Headaches The cervicogenic pain pathway typically involves the upper cervical spine (C1 to C3). Common contributors include cervical facet arthritis in the upper cervical joints, whiplash injuries (sometimes with symptoms developing months or years after the original event), persistent forward head posture from screen work, occipital neuralgia (irritation of the occipital nerves at the base of the skull), atlanto-axial joint dysfunction, and combined sources involving multiple cervical structures. Identifying which specific structures are involved guides treatment selection. ## How PHI Treats Cervicogenic Headaches The first step is comprehensive evaluation: a detailed history of your headache pattern and prior treatment response, an examination of cervical range of motion and tender points, review of imaging, and sometimes a diagnostic injection to confirm the specific cervical source. Treatment options include cervical facet injections, which target the upper cervical facet joints and both diagnose and treat facet-mediated headache pain; occipital nerve blocks, which target the greater and lesser occipital nerves at the base of the skull, where both of our physicians have specific expertise; and cervical radiofrequency ablation for patients whose facet injections confirm the source but produce shorter-than-desired relief, providing relief that typically lasts 6 to 18 months. Therapeutic neurotoxin may be used in selected patients when significant muscle hyperactivity in the cervical and shoulder muscles contributes to the pattern; the brand is not specified, and the neurotoxin may be Botox or Xeomin depending on the case. PHI performs every cervical procedure in our affiliated surgical suite under image guidance, and coordinates with neurologists for patients whose headaches involve both cervical and migraine components. ## Why PHI for Cervicogenic Headaches ## Frequently Asked Questions **Q: How do I know if my headaches are cervicogenic versus migraine?** The patterns differ. Cervicogenic headaches typically start from the neck and refer forward, are triggered by neck movements or positions, are usually one-sided, and do not respond well to migraine medications. Migraines typically involve throbbing pain, light and sound sensitivity, nausea, and respond to triptans. Some patients have both, and a diagnostic injection can clarify which is dominant. **Q: Why didn't my migraine medications work?** Migraine medications target specific brain pathways involved in migraine. They do not address pain originating from cervical structures. If your headaches are actually cervicogenic, the medications would not be expected to work because they are addressing the wrong source. **Q: Can a diagnostic injection confirm cervicogenic headache?** Yes. A targeted injection that significantly reduces your typical headache pattern in the hours following the procedure provides strong confirmation that the targeted structure is contributing to your headaches. This is one of the most reliable ways to confirm cervicogenic involvement when imaging alone is inconclusive. **Q: What if I have both cervicogenic headache and migraine?** Many patients do. Treating each component appropriately can produce significant overall improvement. The cervical source typically responds to interventional treatments at PHI; the migraine component may benefit from coordinated care with a neurologist or from therapeutic neurotoxin for chronic migraine, which PHI also offers. **Q: How long does treatment take to work?** Many patients experience relief within hours of a successful diagnostic injection due to the local anesthetic effect. Sustained relief from cortisone develops over days to weeks. Radiofrequency ablation produces gradual improvement over several weeks as the targeted nerves stop transmitting pain signals. **Q: Will the relief last?** Duration varies. Some patients experience months of relief from a single facet injection. Others benefit more from radiofrequency ablation, which typically provides 6 to 18 months of relief and can be repeated when relief diminishes. **Q: Can I exercise with cervicogenic headaches?** In most cases yes, often with modifications. Specific exercises that strengthen the neck and improve posture often help. Activities involving sustained neck extension or rapid head movement may temporarily aggravate symptoms. A physical therapist familiar with cervicogenic headaches can help. **Q: Will I need surgery?** Most patients with cervicogenic headaches do not need surgery. The vast majority find meaningful relief through targeted injections and radiofrequency ablation. Surgery is reserved for specific situations. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Cervicogenic Headaches PHI offers the full range of evidence-based treatments for cervicogenic headache. Your physician will recommend the right option based on the specific cervical structures involved in your case. - Cervical Facet Injections, target the upper cervical facet joints - Occipital Nerve Blocks, target the occipital nerves at the base of the skull - Radiofrequency Ablation, 6 to 18 months of relief > International Classification of Headache Disorders, 3rd edition: cervicogenic headache. International Headache Society. — [International Headache Society](https://ichd-3.org/secondary-headaches/headache-attributed-to-disorder-of-the-cranium-neck-eyes-ears-nose-sinuses-teeth-mouth-or-other-facial-or-cervical-structure/) > Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020. — [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/) ## Schedule Your Cervicogenic Headache Consultation A 60-minute consultation will evaluate whether your headaches are originating from cervical structures, walk through the treatment options that match your specific source, and give you a clear plan. Call (310) 856-9488 or book online now. ### Chronic Headaches ## When Headaches Become a Way of Life Chronic headaches are exhausting in a way that is hard to convey unless you live with them: the constant calculation of whether today is going to be a headache day, medications that work sometimes and not others, cancelled plans, disrupted sleep, and the cumulative effect on work, relationships, and basic quality of life. Most chronic headache patients we see have already tried a lot: multiple over-the-counter and prescription medications, sometimes injections from other providers, lifestyle modifications, supplements, maybe physical therapy. Some have found partial relief; many have not found enough. What we offer is comprehensive evaluation to identify what is actually contributing to your headaches and the targeted treatments that match those specific contributors. The goal is to move from managing chronic headaches to addressing the specific underlying factors driving them. ## Why Chronic Headaches Is Often a Misnomer The term chronic headaches describes the pattern, frequent or persistent headaches over months or years, but not the cause. Treating them well requires identifying which specific headache type or types you actually have. Common patterns we see: chronic migraine, a specific diagnosis (15 or more headache days per month with at least 8 migraine days) with FDA-approved treatments including therapeutic neurotoxin (see our Migraines page); cervicogenic headache, which originates from cervical structures and often gets misdiagnosed as migraine (see our Cervicogenic Headaches page); tension-type headache, a band-like pressure often related to muscle tension; medication overuse headache, which develops from frequent acute medication use and can transform episodic headaches into chronic ones; and mixed headache patterns, which are common and require addressing each contributor. Identifying which pattern or combination applies to you is the most important step. ## What PHI Offers for Chronic Headaches Once your specific headache pattern is identified, PHI offers several treatments that may help. Therapeutic neurotoxin is FDA-approved for chronic migraine prevention and may also benefit selected patients with cervicogenic headache or significant muscle-driven factors; for chronic migraine specifically, this is one of the most evidence-supported treatments available. Nerve blocks, including occipital nerve blocks for headaches with a significant occipital component, can both treat and help identify which structures are contributing. IV therapy, delivered in a clinic setting, provides supportive care for some patients dealing with frequent severe headaches, and we are honest that this is supportive rather than primary treatment. We coordinate with neurologists for patients whose chronic headaches require neurology input alongside our interventional treatments, particularly chronic migraine patients who benefit from neurology-managed preventive medications, and with physical therapy for patients with significant muscle-driven or postural contributors. We do not promise quick fixes; we promise honest evaluation, clear identification of what is likely contributing, and a plan matched to those factors. ## When to See Someone Consider professional evaluation when you have headaches more than several days per month, when they interfere with sleep, work, or daily activities, when standard medications have not provided adequate relief, when you are using acute headache medications frequently (which can contribute to medication overuse headache), or when you have not had a comprehensive evaluation addressing multiple potential contributors. Seek prompt evaluation for a sudden severe headache (the worst of your life), headache with fever, stiff neck, confusion, or loss of consciousness, headache with new neurological symptoms, a headache pattern that has dramatically changed, or headache after head injury. ## Why PHI for Chronic Headaches ## Frequently Asked Questions **Q: What's the difference between chronic headaches and migraines?** Chronic migraine is a specific diagnosis (15 or more headache days per month with at least 8 migraine days). Other chronic headache patterns include cervicogenic headache, tension-type headache, and medication overuse headache. Many patients have multiple types simultaneously, and sorting out which you have is part of evaluation. **Q: Can therapeutic neurotoxin help my chronic headaches?** For appropriate candidates with chronic migraine specifically, therapeutic neurotoxin has strong FDA-approved evidence for headache prevention. For other patterns, evidence varies. Patients with significant cervicogenic or muscle-driven contributors may benefit even outside the chronic migraine indication, though the evidence base for those uses is less robust. **Q: I'm taking pain medication every day. Is that a problem?** Frequent use of acute headache medications can contribute to medication overuse headache, which can transform episodic headaches into chronic ones. If you are using acute medications more than several days per week, addressing this may be an important part of your plan, and it typically requires careful management to avoid worsening symptoms during the transition. **Q: How long does it take to see if treatment is working?** This varies by treatment. Therapeutic neurotoxin for chronic migraine takes 1 to 2 weeks per cycle to develop effect, with most physicians recommending two to three full cycles (6 to 9 months) before fully evaluating response. Nerve blocks often produce effects within hours. IV therapy may produce effects within hours to days. **Q: Will I need to be on prescription medications forever?** This depends on your situation. Many patients on chronic preventive medications can reduce or eliminate them when interventional treatments adequately address the underlying contributors. Others continue medications as one component of their plan. The goal is the right level of medication for your specific situation. **Q: What about lifestyle factors like sleep, stress, and hydration?** These can be significant contributors. Comprehensive treatment usually involves addressing them alongside medical interventions, and we often recommend coordination with nutrition, sleep medicine, or behavioral specialists for patients whose lifestyle contributors are significant. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: How quickly can I be seen?** Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Chronic Headaches PHI offers evidence-based treatments for chronic headache conditions. Your physician will recommend the right option, or combination, based on the specific headache types involved in your case. - Neurotoxins for Pain, FDA-approved therapeutic neurotoxin for chronic migraine prevention - Nerve Blocks, including occipital nerve blocks - IV Therapy, supportive care > International Classification of Headache Disorders, 3rd edition. International Headache Society. — [International Headache Society](https://ichd-3.org/) > Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Peer-reviewed via PMC. — [Escher CM, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5367647/) > Practice guidelines: treatment of migraine. American Academy of Neurology. — [American Academy of Neurology](https://www.aan.com/practice/clinical-practice-guidelines/) ## Schedule Your Chronic Headache Consultation A 60-minute consultation will identify the specific headache types contributing to your pattern, walk through the treatment options that match them, and give you a clear plan. Call (310) 856-9488 or book online now. ### Chronic Pain Syndrome ## What Chronic Pain Syndrome Actually Means If you have been diagnosed with chronic pain syndrome, you may already know that the term does not tell you much. It describes a pattern, pain that has persisted longer than expected, often with multiple contributing factors, but it does not identify what is actually causing your pain or what to do about it. In some cases, chronic pain syndrome is a legitimate diagnosis describing real changes in how your nervous system processes pain: signals that originally indicated tissue damage continue to fire after the original cause has resolved, the nervous system becomes increasingly sensitized, and sleep, mood, and quality of life are affected. In other cases, it is essentially a placeholder diagnosis used when previous evaluation has not identified a clearer source. The first step in our approach is figuring out which one applies to you, because for some patients a more focused evaluation reveals a specific treatable source, and for others the diagnosis is accurate and the focus shifts to treatments that address nervous system sensitization directly. ## When Chronic Pain Syndrome Has a Specific Source For some patients labeled with chronic pain syndrome, focused evaluation reveals a more specific underlying condition that responds well to targeted treatment. Examples include facet-mediated spinal pain that has not been correctly identified, sacroiliac joint dysfunction treated as general back pain, specific nerve entrapments or peripheral neuropathies, vertebrogenic pain patterns, and joint or tendon issues that fit regenerative treatment. When this is the case, the right treatment is usually the one specific to the underlying condition rather than a generic chronic pain approach. We route patients to the appropriate evaluation and discuss this on the related condition pages. ## When Chronic Pain Syndrome Is the Accurate Diagnosis For other patients, the diagnosis is accurate, and the focus shifts to treatments that address chronic nervous system sensitization directly, working through different mechanisms than standard injections or medications. Nerve blocks can interrupt specific pain pathways and sometimes produce sustained relief that outlasts the local anesthetic, and successful blocks can also be diagnostic. Radiofrequency ablation disrupts the nerves carrying pain signals from specific structures, providing longer-lasting relief for selected patients. Peripheral nerve stimulation uses small electrical signals to interrupt chronic pain signaling along specific nerves; for patients whose pain has a focal nerve distribution, the 60-day temporary system can produce meaningful relief without the systemic effects of long-term medications. Ketamine infusion therapy acts on a different pathway than most pain medications, with accumulating evidence for chronic pain involving central sensitization, particularly when pain coexists with mood overlap or sleep disruption; PHI administers physician-monitored ketamine in a clinic setting. ## When to See Someone Consider professional evaluation when you have been managing chronic pain for months or years without lasting relief, when standard treatments have not produced adequate response, when you are tired of the trial-and-error approach with medications, when you want a thorough re-evaluation to see whether a more specific source can be identified, when you are interested in treatments like ketamine infusion or peripheral nerve stimulation that are not widely available, or when you want a clear plan rather than continued symptom management without direction. ## Why PHI for Chronic Pain Syndrome ## Frequently Asked Questions **Q: Is chronic pain syndrome a real diagnosis?** Yes, when used appropriately. It describes real biological changes in how the nervous system processes pain, often after months or years of ongoing pain signals. The challenge is that the term is sometimes used as a placeholder when more specific evaluation has not been done, which is why thorough re-evaluation often matters. **Q: Will I need to take medication forever?** This depends entirely on your situation. Many patients can reduce or eliminate the need for chronic pain medications when interventional treatments, ketamine infusion, peripheral nerve stimulation, or other targeted approaches address the underlying contributors. Others use medication as one component of a broader plan. The goal is the right level of medication for your situation. PHI does not provide ongoing medication management. **Q: Is ketamine actually safe for chronic pain?** Physician-administered ketamine for pain has accumulating evidence and an established safety profile when delivered appropriately. PHI uses subanesthetic doses well below surgical anesthesia, administers infusions in a clinic setting under continuous monitoring, and structures treatment as a defined series rather than open-ended dosing. This is meaningfully different from recreational ketamine use. **Q: How is peripheral nerve stimulation different from spinal cord stimulation?** Spinal cord stimulation places leads near the spinal cord to treat broader pain patterns. Peripheral nerve stimulation places leads directly near a specific peripheral nerve to treat pain in that nerve's distribution. PNS is generally appropriate for more focal pain; spinal cord stimulation for more diffuse pain. **Q: Will I need to repeat treatments?** This depends on the specific treatment. Radiofrequency ablation provides relief for 6 to 18 months and may be repeated. Ketamine infusions sometimes work as a discrete series, with maintenance sessions for some patients. Your physician will set realistic expectations based on the specific recommendation. **Q: Should I try interventional treatment if previous injections didn't help?** Possibly, depending on what was tried and how. Many patients have had injections that were not precisely targeted to the source of their pain, or that were the wrong type for their actual condition. Diagnostic and targeted re-evaluation often identifies whether interventional treatment makes sense and which specific procedure to consider. **Q: How is PHI different from other pain practices?** Many pain practices offer one or two treatment types and refer everything else out. PHI offers the full range of interventional, regenerative, and infusion-based treatments under one roof, and we take time for thorough re-evaluation rather than running patients through standardized treatment algorithms. **Q: Do you take insurance?** PHI is a concierge practice and is out-of-network with all insurance plans. All pricing is transparently disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Chronic Pain Syndrome PHI offers evidence-based treatments for chronic pain syndromes. Your physician will recommend the right option, or combination, based on your specific situation, what you have tried, and your goals. - Nerve Blocks, diagnostic and therapeutic - Radiofrequency Ablation, 6 to 18 months of relief for selected patients - Peripheral Nerve Stimulation, the 60-day temporary system - Ketamine Infusion Therapy, for central sensitization > Chronic pain: an update on burden, best practices, and new advances. The Lancet. — [Cohen SP, et al.](https://pubmed.ncbi.nlm.nih.gov/34062143/) > Ketamine for Complex Regional Pain Syndrome and chronic pain: a narrative review highlighting dosing practices and treatment response. Peer-reviewed via PMC. — [Lii TR, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC10688501/) > Consensus guidelines for the use of peripheral nerve stimulation in the treatment of chronic pain: a Neuron Project from the American Society of Pain and Neuroscience. Peer-reviewed via PMC. — [Latif U, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12614495/) ## Schedule Your Chronic Pain Syndrome Consultation A 60-minute consultation will thoroughly re-evaluate your situation, identify whether more specific diagnostic options exist, and walk through the treatment options that match your specific condition. Call (310) 856-9488 or book online now. ### Chronic Pain with Mood Overlap ## When Pain and Mood Feed Each Other Living with chronic pain changes everything. Sleep gets worse. Energy disappears. Activities you used to enjoy become difficult. Relationships strain. Hope feels harder to come by. Then the mood symptoms arrive: depression from the cumulative weight of being in pain, anxiety about whether you will ever feel better, frustration that wears down to despair. The mood symptoms then make the pain feel worse, which makes the mood symptoms worse. This bidirectional cycle is real, biologically grounded, and extensively documented. Chronic pain and mood disorders share overlapping nervous system pathways, and treating one without addressing the other often produces incomplete results. What we offer at PHI is treatment that addresses both sides at once. ## Why Most Care Misses This Most chronic pain patients with significant mood symptoms have experienced a particular kind of medical fragmentation. Their pain doctor focuses on pain. Their psychiatrist focuses on mood. Each provider acknowledges the other domain matters but operates within their own lane. The result is two parallel tracks of treatment that rarely integrate: pain medications that do not help mood, antidepressants that take weeks and do not address pain, procedures that reduce pain temporarily but leave the depression unaddressed. For some patients this fragmented approach is enough. For many, it is not. PHI offers a different model, treating both sides through a single intervention, ketamine infusion therapy, that has established evidence for both chronic pain and mood symptoms. ## Why Ketamine Fits This Profile Particularly Well Ketamine has accumulating evidence for both chronic pain and mood disorders independently. Multiple high-quality studies have shown rapid antidepressant effects in treatment-resistant depression, and multiple studies have shown analgesic effects in chronic pain conditions, particularly those involving central sensitization, the nervous system changes that develop with persistent pain. For patients dealing with both, ketamine addresses both pathways through the same intervention. Many patients in this combined presentation report reduced pain intensity and frequency, improved mood, energy, and outlook, better sleep, reduced anxiety about pain, and a restored capacity for activities they had given up. This dual benefit is part of why combined chronic pain and mood overlap is one of the strongest indications for ketamine therapy in clinical practice. ## What This Page Is and Isn't PHI is an interventional pain and regenerative medicine practice with ketamine capability. We are not a psychiatry practice, and we do not manage ongoing antidepressant medications, provide psychotherapy, or replace psychiatric care. For patients with combined chronic pain and mood symptoms, the right relationship is collaborative: PHI handles the interventional and ketamine treatment side, your psychiatrist or therapist handles the mental health management side, and we communicate to coordinate. You may benefit from this approach if you have chronic pain lasting more than three to six months, also experience significant depression or anxiety, feel stuck in a cycle where each worsens the other, have not had adequate response to standard treatments for either condition, and want an approach that addresses both pathways at once. PHI is positioned for patients who already have established pain and mental health diagnoses; we are not a primary diagnostic resource for either condition alone. ## How PHI Approaches Combined Treatment The first step is a comprehensive evaluation: a detailed history of both your chronic pain and mood symptoms, confirmation of your established diagnoses and treatment history, review of your current providers, assessment of how your pain and mood interact, and an honest discussion of whether ketamine is likely to help your specific combined presentation. For appropriate candidates, ketamine infusion therapy is the primary intervention, administered in a clinic setting under continuous physician monitoring. There is no standard protocol: the treatment and its series are individualized and discussed during consultation rather than following a set number of sessions. We coordinate with your existing pain and mental health providers throughout. For patients with specific identifiable pain sources, targeted interventional procedures may continue alongside ketamine, since the two work through different mechanisms and can be complementary. ## Why PHI for Combined Chronic Pain and Mood ## Frequently Asked Questions **Q: How is the evidence for ketamine in combined pain and mood different from either alone?** Strong for both. The combined presentation is in some ways the most evidence-supported indication for ketamine, because the underlying mechanism (NMDA receptor modulation and central sensitization reduction) addresses both pain and mood pathways. Patients with both conditions often respond particularly well because both are being treated simultaneously. **Q: Will I need to stop my antidepressant or pain medications?** Generally no. Most patients continue their current medications during ketamine treatment. The goal is typically improved response on the combination rather than replacement. Some specific interactions require coordination, and your physician will review your regimen and coordinate with your other providers. **Q: How fast will I see improvement?** This varies. Some patients experience meaningful improvement in both pain and mood within hours of an early session. Others see gradual improvement over the course of treatment. Some improve in one domain earlier than the other, with both eventually responding. Your physician will discuss what is likely for your situation. **Q: Will the improvement last?** Effects from a single session are typically temporary, which is why treatment is delivered as an individualized course. After an initial course, some patients experience sustained benefit for months; others receive periodic maintenance. Your trajectory depends on your individual response. **Q: Can ketamine replace my antidepressant?** Generally no, not initially. The standard approach is ketamine alongside your existing medications. Some patients eventually reduce other medications under their psychiatrist's guidance after sustained response, but this is a careful, gradual process managed by your mental health team. **Q: Should I stop the pain procedures I've been doing?** Generally no. For patients with specific pain sources that respond to targeted procedures such as epidural injections, facet injections, nerve blocks, or radiofrequency ablation, continuing those alongside ketamine often makes sense. Ketamine addresses central sensitization and mood pathways; targeted procedures address specific peripheral pain sources, and the two can be complementary. **Q: What if my pain and mood both started after a traumatic event?** This is a profile we see often. Trauma can produce both chronic pain and PTSD or depression, and the two can be deeply intertwined. Ketamine has growing evidence for trauma-related conditions specifically. See our PTSD page for more. **Q: How does this compare to a ketamine clinic?** PHI is a physician-led medical practice, not a standalone wellness clinic. Ketamine is administered by our board-certified physicians under continuous monitoring, integrated with your existing care rather than in isolation, with individualized evidence-based treatment rather than open-ended dosing. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Ketamine treatment can be coordinated to fit travel schedules. ## Treatments We Offer for Chronic Pain with Mood Overlap PHI offers physician-administered ketamine infusion therapy as the primary intervention for combined chronic pain and mood symptoms. We work alongside your pain management and mental health teams. - Ketamine Infusion Therapy, addresses both pain and mood pathways > A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry. — [Sanacora G, et al.](https://pubmed.ncbi.nlm.nih.gov/28249076/) > Depression and pain comorbidity: a literature review. Archives of Internal Medicine. — [Bair MJ, et al.](https://pubmed.ncbi.nlm.nih.gov/14609780/) > Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion. American Journal of Psychiatry. — [McIntyre RS, et al.](https://pubmed.ncbi.nlm.nih.gov/33726522/) ## Schedule Your Combined Treatment Consultation A 60-minute consultation will evaluate your specific combined presentation, walk through whether ketamine is likely to help both your pain and mood, and coordinate with your existing providers. Call (310) 856-9488 or book online now. ### Complex Regional Pain Syndrome ## When the Pain Doesn't Match the Injury You probably remember the original event. A fall. A sprain. A fracture. A surgery. Maybe even something minor. The injury was supposed to heal in weeks, but something went wrong. Instead of resolving, the pain became worse. It stopped fitting the injury. It spread beyond what made anatomical sense. The skin around the affected area changed, becoming more sensitive, sometimes changing color or temperature, sometimes swelling. If this describes your experience, you may have Complex Regional Pain Syndrome, often called CRPS or RSD (the older name, Reflex Sympathetic Dystrophy). It is one of the most severe pain conditions known to medicine, and one of the most under-recognized. Many patients spend years being told their pain is exaggerated or unexplainable before someone correctly identifies CRPS. We take it seriously. The pain is real, the underlying mechanism is real, and there are specific evidence-based treatments that often produce meaningful relief, particularly when started earlier. ## What CRPS Actually Is CRPS is a chronic pain condition that typically develops after an injury, surgery, or other trigger, with pain disproportionate to the original injury that persists or worsens after the injury should have healed. The mechanism is not fully understood but appears to involve sympathetic nervous system overactivation, central nervous system sensitization, inflammatory and autoimmune components, and microvascular dysfunction. The result is severe pain combined with characteristic changes: pain disproportionate to the original injury; burning, electric, or stabbing pain; allodynia (pain from light touch); hyperalgesia; skin color changes; temperature differences between the affected and unaffected side; swelling; changes in sweating, hair, or nail growth; joint stiffness; and sometimes tremor or weakness. It typically affects an extremity and is classified as Type 1 (without confirmed nerve injury, the most common) or Type 2 (with confirmed nerve injury). CRPS is a clinical diagnosis, and imaging often looks normal, which is part of why it is so often missed. ## Why Earlier Treatment Matters CRPS responds better to earlier intervention. Patients who receive specific CRPS treatment within the first months of symptom onset generally have better outcomes than those who go years without it, because as CRPS persists the central nervous system changes can become more entrenched. This is why we emphasize prompt evaluation; both physicians specialize in CRPS and can usually see suspected cases within the week. That said, we do not want to discourage patients with longer-standing CRPS from pursuing treatment. Even patients with CRPS for years can experience meaningful improvement with appropriate intervention. We see all types of CRPS cases and help treat them. The treatments work; they just often work better with earlier application. ## How PHI Treats CRPS The first step is comprehensive evaluation: a detailed history of your original injury and how symptoms developed, an examination assessing the characteristic features of CRPS, review of imaging and prior workup, and a discussion of what you have already tried and your goals. Stellate ganglion block, for upper extremity CRPS, temporarily interrupts the sympathetic overactivation that maintains many CRPS symptoms; for appropriate responders the effect can outlast the local anesthetic, sometimes for weeks or months, and many patients receive a series of blocks for cumulative benefit. Lumbar sympathetic block applies the same mechanism for lower extremity CRPS. Both are performed under image guidance in our affiliated surgical center. Ketamine infusion therapy has substantial evidence specifically for CRPS, acting on the NMDA receptor to help reset the central nervous system sensitization; PHI administers physician-monitored ketamine in a clinic setting as an individualized course rather than a fixed protocol. Combined approaches are common, and we coordinate with pain-focused physical therapy and psychology, which play important roles in comprehensive CRPS care. ## When to See Someone Consider professional evaluation when you have severe regional pain that has persisted beyond expected healing time, when the pain is disproportionate to your original injury, when you have skin color changes, temperature changes, or swelling in the affected area, when light touch produces pain, or when standard pain treatments have not helped. CRPS is one of the conditions where earlier evaluation matters; if you have symptoms suggesting CRPS, please call (310) 856-9488 to discuss an expedited consultation. ## Why PHI for CRPS Treatment ## Frequently Asked Questions **Q: How is CRPS diagnosed?** CRPS is a clinical diagnosis based on established criteria that require specific combinations of sensory, vasomotor, sudomotor, and motor or trophic findings. Imaging is typically used to rule out other conditions rather than to confirm CRPS itself. Many CRPS patients have normal-appearing imaging, which is part of why the condition is often missed. **Q: Will I get better?** Outcomes vary. Some patients experience dramatic improvement with appropriate treatment, particularly when treatment starts earlier. Others have more challenging cases. Even patients with longer-standing CRPS often experience meaningful improvement. The treatments work; they may produce different degrees of benefit for different patients. **Q: How effective is stellate ganglion block for CRPS?** For appropriate responders with upper extremity CRPS, stellate ganglion block often produces meaningful symptom reduction. The effect may outlast the local anesthetic itself, sometimes for weeks or months, and many patients receive a series of blocks for cumulative benefit. **Q: How effective is ketamine for CRPS?** Ketamine has substantial evidence specifically for CRPS, including studies showing meaningful pain reduction and functional improvement. For patients with severe or refractory CRPS, it is often a particularly important option. PHI administers physician-monitored ketamine in a clinic setting. **Q: Can CRPS spread to other limbs?** Yes, in some patients. CRPS that started in one extremity can sometimes develop in other limbs over time, which makes appropriate treatment of the original CRPS particularly important. **Q: Is CRPS curable?** Cure is not always the right word. Many patients experience significant symptom reduction with appropriate treatment, sometimes to the point of remission. Others experience meaningful improvement that significantly reduces but does not eliminate symptoms. We are honest about realistic expectations based on your specific situation. **Q: What about physical therapy for CRPS?** PT plays an important role, but it must be CRPS-specific PT delivered by therapists experienced with the condition, because standard PT approaches can sometimes worsen CRPS symptoms. We coordinate with appropriate PT providers when this is part of your plan. **Q: Should I see a neurologist or a pain specialist?** Both can play roles. Neurologists often help with diagnosis and medication management. Interventional pain specialists provide the specific procedural treatments, such as sympathetic blocks and ketamine, that have strong evidence for CRPS. Many patients benefit from coordinated care across both specialties. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for CRPS PHI offers evidence-based treatments specifically for Complex Regional Pain Syndrome, matched to whether your CRPS affects the upper or lower extremity and your treatment history. - Stellate Ganglion Block, for upper extremity CRPS - Lumbar Sympathetic Block, for lower extremity CRPS - Ketamine Infusion Therapy, substantial evidence for CRPS > Validation of proposed diagnostic criteria (the Budapest Criteria) for Complex Regional Pain Syndrome. Peer-reviewed via PubMed. — [Harden NR, et al.](https://pubmed.ncbi.nlm.nih.gov/20493633/) > Ketamine for Complex Regional Pain Syndrome: a narrative review highlighting dosing practices and treatment response. Peer-reviewed via PMC. — [Lii TR, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC10688501/) ## Schedule Your CRPS Consultation A 60-minute consultation will evaluate your specific situation, apply established CRPS diagnostic criteria, and walk through the treatment options that match your particular case. Call (310) 856-9488 or book online now. ### Degenerative Disc Disease ## First, the Name Is Misleading If you have recently been told you have degenerative disc disease, you probably left that appointment more worried than informed. The name sounds catastrophic. It suggests something is breaking down inside your spine and the situation is only going to get worse. Here is what the name actually means: the discs between the bones of your spine show normal age-related changes. Almost everyone develops some degree of this by their 30s or 40s, and many people have it on imaging without ever feeling a thing. It is not technically a disease. The word "disease" in the name is unfortunate medical history, not an accurate description of what is happening in your back. That said, your pain is real. Some patients with disc changes never have symptoms; others have significant pain. The question is not whether your imaging looks abnormal, because it almost certainly does at any age past 30. The question is whether the changes on your imaging match the pain you are experiencing, and what to do about it. ## What's Actually Happening in Your Spine Your spinal discs sit between each pair of vertebrae and act as cushions, with a tough outer layer and a softer, gel-like center. Over time, the discs lose water content and become less flexible. The outer layer can develop small tears, and the disc may flatten, narrow the space between vertebrae, or shift slightly. These changes are part of normal aging, and most people with disc changes have no pain at all. But for some patients, these changes contribute to inflammation, instability, or nerve irritation that produces real symptoms. The pattern depends on which discs are affected: lower back pain that worsens with sitting and improves when you stand or walk is common, as is pain that increases with bending forward and lifting. Some patients also experience radiating pain or numbness when disc changes irritate nearby nerves. ## When Disc Changes Actually Need Treatment Not every disc change requires treatment. The decision depends on whether your symptoms are interfering with your life, not what your MRI looks like. Consider professional evaluation when your back pain has lasted more than six weeks without improvement, when the pain interferes with sleep, work, or daily activities, when you experience radiating pain, numbness, or tingling into a leg or arm, when conservative treatments have not provided lasting relief, or when you want to address the underlying issue rather than continuing to manage symptoms with medication. ## How PHI Approaches Degenerative Disc Disease The most important step is identifying which symptoms are actually coming from your disc changes and which might be coming from something else. Many patients with disc changes on imaging actually have pain coming from facet joints, sacroiliac joints, or muscle tension that imaging does not capture clearly. Your physician evaluates your specific pain pattern, reviews your imaging, and sometimes uses diagnostic injections to confirm the actual source. For pain driven by inflammation around the disc and surrounding nerves, anti-inflammatory injections often produce significant relief. For vertebrogenic pain, a specific source where pain travels through the basivertebral nerve from changes in the vertebral endplate, the Intracept Procedure is a single-treatment option with multi-year results. For patients seeking to address the underlying disc tissue, regenerative options including PRP, A2M, and stem cell therapy may be appropriate. There is rarely a single correct answer, and we walk through the options at consultation rather than pushing every patient toward the same treatment. ## Why PHI for Degenerative Disc Disease ## Frequently Asked Questions **Q: Is degenerative disc disease really a disease?** Not in the way most diseases work. The name comes from medical convention, not from the actual nature of the changes. Disc changes are extremely common, develop in most people with age, and often produce no symptoms at all. When they do cause symptoms, the symptoms are real, but the underlying changes are not progressive in the way a true disease would be. **Q: Will my disc changes get worse?** Disc changes generally progress slowly over years and decades. Some patients experience worsening symptoms over time; many remain stable for years. Your physician can give you a more specific assessment based on your imaging and current symptoms. **Q: Do I need surgery?** Most patients with disc changes do not need surgery. The vast majority find meaningful relief through non-surgical approaches including injections, the Intracept Procedure, regenerative medicine, and physical therapy. Surgery is reserved for specific situations and considered after non-surgical options have been thoroughly tried. **Q: My MRI looks bad. Does that mean my pain is severe?** Not necessarily. Imaging findings do not always correlate with symptoms. Many people have significant disc changes on imaging without any pain; others have severe pain with relatively mild findings. Your physician evaluates the relationship between your imaging and your actual symptoms, which is often more useful than the imaging report alone. **Q: Will my disc heal on its own?** Acute disc inflammation often improves over weeks to months. The underlying disc changes generally do not reverse, but the symptoms they produce can resolve significantly. The goal of most treatments is to reduce inflammation, address pain, and support the surrounding tissues so the disc can stabilize at a comfortable level. **Q: Can I keep exercising with degenerative disc disease?** In most cases yes, often with some modifications. Physical activity is one of the most consistent positive factors for disc-related back pain. The specific activities and intensities depend on your situation, and your physician can guide you on what to continue, modify, and add. **Q: How long does treatment take to work?** This varies by treatment. Injections often produce relief within days to a few weeks. The Intracept Procedure produces gradual improvement over several weeks. Regenerative options work over several months. Your physician will set specific expectations based on the treatment recommended. **Q: Will I need to repeat treatment?** This depends on the treatment. Injections sometimes need repeating every several months. The Intracept Procedure is typically a single treatment with multi-year benefit. Regenerative protocols sometimes involve a series followed by maintenance. Your physician will discuss the typical course for your recommendation. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Degenerative Disc Disease PHI offers the full range of evidence-based treatments for degenerative disc disease. Your physician will recommend the right option, or combination, based on your imaging, the source of your pain, and your treatment history. - Intracept Procedure, a single-treatment option for vertebrogenic disc pain - Epidural Steroid Injections, for inflammation-driven and radiating pain - PRP Therapy - Stem Cell Therapy - A2M Therapy - Exosome Therapy > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PMC, 2022. — [American Academy of Neurology Guidelines Subcommittee](https://pmc.ncbi.nlm.nih.gov/articles/PMC12289388/) > A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. The Spine Journal. — [Khalil JG, et al.](https://pubmed.ncbi.nlm.nih.gov/31229663/) ## Schedule Your Degenerative Disc Disease Consultation A 60-minute consultation will identify whether your disc changes are actually causing your symptoms, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now. ### Fatigue & Low Energy ## When You're Tired in a Way That Doesn't Resolve Most people experience occasional tiredness. Persistent fatigue is something different: the kind that does not improve with a weekend off, that makes basic tasks feel harder than they should, where coffee does not really help anymore but just temporarily masks how exhausted you actually feel. Most patients we see for fatigue have been managing this for months or years, often having been told it is stress, age, or just how things are now. Sometimes that is accurate; often there is something more identifiable contributing. What we offer is the supportive optimization side of fatigue care, and we are honest that the most important first step is identifying what is actually contributing. For many patients, comprehensive primary care evaluation reveals specific factors, such as thyroid dysfunction, vitamin deficiencies, sleep apnea, or hormonal changes, that can be directly addressed. Our offerings work best alongside that evaluation rather than as a substitute for it. ## Fatigue Has Many Causes Persistent fatigue is a symptom, not a diagnosis. Causes that often have specific treatments include anemia, thyroid dysfunction, sleep apnea (often undiagnosed and a major contributor), vitamin D deficiency, hormonal imbalances, depression and anxiety, diabetes and prediabetes, chronic infections, autoimmune conditions, medication effects, and post-viral syndromes including long COVID. Lifestyle and environmental factors include chronic insufficient sleep (the most common modifiable contributor), poor sleep quality, chronic stress, inadequate nutrition, a sedentary lifestyle, and alcohol or substance use. Some conditions, such as ME/CFS and fibromyalgia, have specific clinical considerations. The first step is identifying which categories may be contributing. For patients without prior workup, primary care evaluation typically comes first. ## How PHI Approaches Fatigue and Low Energy The first step is comprehensive evaluation: a detailed history of your fatigue and how it has progressed, discussion of potential contributors, review of any prior workup, and an honest assessment of whether wellness optimization fits your situation or whether primary care evaluation should come first. IV therapy delivers nutrients directly into circulation, particularly useful for patients with documented vitamin or nutrient deficits; IV B-complex, B12, and other formulations may produce meaningful improvement when deficits contribute to fatigue. NAD+ therapy delivers a coenzyme involved in cellular energy production that declines with age, with evidence for fatigue we describe as emerging rather than established. Peptide therapy uses specific compounds that may support energy, mitochondrial function, and sleep, discussed individually without listing specific peptides publicly. These are delivered in our clinic setting, and we coordinate with your primary care physician for evaluation and management of underlying contributors. ## When This Page Applies to You You may benefit from PHI's offerings if you have had primary care evaluation that identified specific contributors being managed but you still have residual fatigue, if your fatigue appears related to high stress or post-illness recovery, if you are in perimenopause, menopause, or andropause with appropriate hormone evaluation underway, or if you want supportive optimization alongside addressing underlying factors. You are typically better served elsewhere first if you have not had primary care evaluation for persistent fatigue, if you have significant new or progressive fatigue without identified cause, or if you are hoping wellness intervention will substitute for evaluating treatable medical causes. ## Why PHI for Fatigue Optimization ## Frequently Asked Questions **Q: Should I get a workup before pursuing wellness treatments for fatigue?** For most patients with persistent fatigue, yes. Primary care evaluation typically includes basic blood work (CBC, comprehensive metabolic panel, thyroid function, B12, vitamin D, ferritin) and discussion of sleep, mood, and lifestyle. Many fatigue cases have specific identifiable causes that respond well to direct treatment. Wellness optimization works better as an addition to addressing underlying factors than as a substitute. **Q: Will IV therapy fix my fatigue?** For patients with documented vitamin or nutrient deficits, IV nutrient therapy can produce meaningful improvement. For patients without specific deficits, it may provide more variable benefit. We evaluate whether IV therapy fits your situation rather than offering it as a universal energy boost. **Q: How effective is NAD+ for energy?** The mechanistic rationale is sound, since NAD+ is involved in cellular energy production and declines with age. Some patients report meaningful improvement; others experience more limited benefit. We are honest that the clinical evidence is emerging rather than established. **Q: Could my fatigue be from sleep apnea?** Possibly. Sleep apnea is one of the most common and under-diagnosed causes of fatigue. If you have loud snoring, witnessed pauses in breathing, morning headaches, or fatigue that does not improve with adequate sleep, sleep apnea evaluation is worth pursuing, and treating it typically resolves fatigue more effectively than wellness interventions can. **Q: What about long COVID fatigue?** Post-viral fatigue including long COVID is real and increasingly recognized. Some patients experience improvement with supportive interventions. Long COVID care typically involves coordination with primary care or specialty providers, and PHI's offerings may complement that broader care for selected patients. **Q: Could my fatigue be related to perimenopause or menopause?** Yes, often. Hormonal changes commonly include fatigue as a prominent symptom. Hormonal evaluation through your primary care or gynecologist is typically the right first step, and PHI's offerings may complement hormonal management once that is underway. **Q: What if I have ME/CFS or chronic fatigue syndrome?** ME/CFS has specific clinical features including post-exertional malaise. Care typically involves specialty providers familiar with the condition. PHI's offerings may complement specialty care for selected patients but are not substitutes for ME/CFS-specific evaluation and management. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Fatigue and Low Energy PHI offers supportive optimization treatments for fatigue and energy. Your physician will recommend the right options based on your specific situation, prior workup, and suspected contributors. - IV Therapy, most useful when a nutrient deficit is contributing - NAD+ Therapy - Peptide Therapy > NAD+ metabolism and the control of energy homeostasis. Cell Metabolism. — [Cantó C, et al.](https://pubmed.ncbi.nlm.nih.gov/26118927/) > Myalgic encephalomyelitis/chronic fatigue syndrome. Centers for Disease Control and Prevention. — [Centers for Disease Control and Prevention](https://www.cdc.gov/me-cfs/index.html) > Anemia of inflammation and chronic disease. NIH National Institute of Diabetes and Digestive and Kidney Diseases. — [NIH National Institute of Diabetes and Digestive and Kidney Diseases](https://www.niddk.nih.gov/health-information/blood-diseases/anemia-inflammation-chronic-disease) ## Schedule Your Fatigue Consultation A 60-minute consultation will evaluate your specific fatigue, walk through whether wellness optimization fits your situation or whether primary care evaluation should come first, and recommend treatments that match your situation. Call (310) 856-9488 or book online now. ### Healthy Aging & Longevity ## Aging Well Is a Different Goal Than Living Longer There are two ways to think about longevity. The first is lifespan, the total years lived. The second is healthspan, the years lived in good health, with full function, mental sharpness, and the capacity to do what you want. The two are not the same. For most thoughtful patients pursuing longevity care, healthspan is the actual goal. Living to 95 with the function of a 75-year-old is what the conversation is really about. What we offer is the medical layer of healthspan-oriented care: physician-evaluated, physician-administered protocols that work alongside the foundational lifestyle factors that matter most, with honest framing about which treatments have established evidence and which are still emerging, and coordination with your primary care, specialists, and lifestyle providers. ## What Actually Drives Healthy Aging The science of aging has advanced significantly in the past decade, identifying specific biological processes that contribute to age-related decline: mitochondrial dysfunction, cellular senescence, chronic low-grade inflammation (sometimes called inflammaging), hormonal changes, oxidative stress, telomere shortening, loss of proteostasis, and stem cell exhaustion. Each of these is partially modifiable through some combination of lifestyle factors and selected medical interventions. The most evidence-supported levers are lifestyle: sleep, nutrition, exercise, stress management, and social connection. Medical interventions add value on top of those foundations. We are honest that longevity medicine still has more mechanistic rationale than long-term human outcome data, and we pursue what evidence supports rather than what is trendy. ## Where PHI Fits in Longevity Care PHI is one component of comprehensive longevity care, not a complete longevity practice. We provide the medical interventional and regenerative side, particularly physician-administered peptide therapy, NAD+ therapy, IV therapy, red light therapy, and body composition support, coordinated with your other longevity-focused providers. We do not provide comprehensive primary care, mental health care, nutrition counseling, personal training, or long-term metabolic management. For patients building comprehensive longevity programs, PHI is one piece that works alongside your other providers rather than trying to be everything. ## How PHI Approaches Longevity Care The first step is a comprehensive consultation: a detailed history of your health, family history, and goals, a discussion of your current lifestyle and foundational practices, review of any prior workup, an assessment of which medical interventions fit your situation, and an honest discussion of expectations and evidence. We do not sell broad packages; each program is built around your specific goals and baseline. Peptide therapy uses specific compounds that target different systems (sleep, growth hormone signaling, tissue repair, mitochondrial function, inflammation); we discuss options individually without listing specific peptides publicly. NAD+ therapy delivers a coenzyme involved in cellular energy production and DNA repair that declines with age, with strong mechanistic rationale and accumulating clinical evidence. IV therapy delivers nutrients directly into circulation for documented deficits and cellular support. Red light therapy may support cellular function, mitochondrial health, and skin condition. These treatments are delivered in our clinic setting, and we coordinate with your broader longevity team. ## Why PHI for Longevity Care ## Frequently Asked Questions **Q: What's the most important thing for healthy aging?** Sleep, nutrition, exercise, stress management, and meaningful social connection. The lifestyle foundations matter more than any medical intervention. Patients who optimize these often need less medical optimization than they expect; patients who skip them and rely on treatments alone consistently underperform their potential. **Q: Will these treatments actually make me live longer?** Honestly, we do not know definitively. Mechanistic rationale supports several treatments for the systems that affect aging. Whether this translates to longer life or simply healthier aging within whatever years you have is an open question. We pursue evidence-supported interventions while being honest about the limits of what is known. **Q: How is this different from a wellness clinic?** PHI is a physician-led medical practice with board-certified pain and regenerative medicine physicians and surgical-quality infrastructure. The medical rigor and integration with broader interventional medicine differentiate it from many wellness offerings. We do not sell hope; we offer evidence-based and emerging interventions within a comprehensive framework. **Q: How long does a longevity program last?** There is no fixed timeline. Some patients work with us episodically around specific goals or life transitions; others maintain ongoing relationships with periodic optimization. The relationship is on your terms. We offer packages, but care is individualized and discussed after a treatment plan. **Q: How is peptide therapy regulated?** Peptide regulation has evolved over time and varies by specific peptide. Some have clear regulatory paths and clinical evidence; others are in more uncertain territory. We discuss specific peptides honestly during consultation, including evidence base and regulatory considerations. **Q: Should I get biological age or genetic testing?** These tests can provide useful baseline information, and we are beginning to introduce them. Various tests measure different things with varying clinical actionability. We discuss whether specific testing is likely to inform treatment decisions for your situation rather than recommending it as a default. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Longevity programs can be coordinated to fit travel schedules. ## Treatments We Offer for Healthy Aging and Longevity PHI offers physician-administered evidence-based and emerging treatments for longevity-oriented care. Your physician will recommend the right combination based on your specific goals, baseline, and existing care. - Peptide Therapy - NAD+ Therapy - IV Therapy - Red Light Therapy > The hallmarks of aging. Cell. — [López-Otín C, et al.](https://pubmed.ncbi.nlm.nih.gov/23746838/) > Hallmarks of aging: an expanding universe. Cell, 2023. — [López-Otín C, et al.](https://pubmed.ncbi.nlm.nih.gov/36599349/) > NAD+ metabolism and the control of energy homeostasis. Cell Metabolism. — [Cantó C, et al.](https://pubmed.ncbi.nlm.nih.gov/26118927/) ## Schedule Your Longevity Consultation A 60-minute consultation will identify your specific longevity goals, walk through which evidence-based treatments fit your situation, and integrate medical care with your existing health and lifestyle practices. Call (310) 856-9488 or book online now. ### Herniated Disc ## You May Not Need Surgery If you have been diagnosed with a herniated disc, there is a good chance someone has already raised the possibility of surgery. Sometimes that recommendation is appropriate. Often it is not, at least not as a first step. The reality is that most herniated discs can be treated successfully without surgery. Many resolve significantly on their own over weeks to months. Many others respond well to targeted non-surgical treatments that address the inflammation and nerve irritation causing your symptoms. This is not the same as saying surgery is never the right answer. For specific situations, including significant weakness, loss of bladder or bowel control, or pain that has not responded to thorough non-surgical treatment, surgery is a real and appropriate option. For the majority of patients, non-surgical treatment is the right starting point, and we help you understand which category you fall into. ## What a Herniated Disc Actually Is Your spinal discs sit between each pair of vertebrae and act as cushions. Each disc has a tough outer layer and a softer, gel-like center. A herniated disc happens when the soft center pushes through a weak spot in the outer layer. When this happens, the displaced disc material can press on nearby spinal nerves or release inflammatory chemicals that irritate them. The result is the symptoms most patients experience: back or neck pain combined with pain, numbness, tingling, or weakness traveling down an arm or leg. The location of your symptoms tells your physician where the herniation is. Pain into the leg suggests a lumbar herniation in your lower back; pain into the arm suggests a cervical herniation in your neck. ## What Your Symptoms Mean The patterns below are how patients usually describe herniated disc symptoms. The specific pattern affects both the diagnosis and the treatment recommendation. #### Sharp, electric pain that travels down your leg This is the most common presentation of a lumbar herniated disc. The pain often starts in the lower back or buttock and shoots down the back of the thigh, sometimes all the way to the foot. It may feel sharp, burning, or electric, and coughing, sneezing, prolonged sitting, or bending forward often makes it worse. This pattern usually responds well to targeted lumbar epidural steroid injections, which deliver anti-inflammatory medication directly to the irritated nerve. #### Pain that travels down your arm A herniated disc in your neck typically produces pain that travels down one arm into the hand, often with numbness, tingling, or weakness in specific muscles. Cervical epidural steroid injections target this pattern specifically, delivering anti-inflammatory medication near the irritated nerve in the neck. #### Significant weakness or bladder and bowel changes Substantial muscle weakness, difficulty walking, or any change in bladder or bowel control can indicate more significant nerve compression that requires prompt evaluation. If you experience these, please call us or go to an emergency department promptly. ## How Your Pain Will Likely Progress Without treatment, many herniated discs improve significantly over six to twelve weeks. The displaced disc material often shrinks over time, and the body's own anti-inflammatory response reduces nerve irritation. This natural improvement is real, but it does not mean you should suffer through it. Targeted treatment can significantly reduce pain during the healing process, allow you to maintain function and normal activities, prevent secondary issues from chronic pain, and identify whether your case is one that will not improve without intervention. Most patients want both pain relief now and a clear understanding of where their case is heading. We provide both. ## How PHI Treats Herniated Discs The most important first step is identifying which nerve is irritated and confirming the diagnosis. Imaging shows the herniation, the physical exam confirms which nerve is affected, and diagnostic injections sometimes confirm the relationship between the imaging finding and your actual symptoms. Once the diagnosis is clear, epidural steroid injections are usually the first interventional treatment, delivering anti-inflammatory medication directly to the irritated nerve. Selective nerve root blocks can both diagnose and treat pain from a specific nerve, which is particularly useful when imaging shows multiple potential sources. Regenerative options including PRP, A2M, and exosome therapy may be appropriate for patients seeking to address the underlying disc tissue rather than only the inflammation. Continued conservative care plays a role alongside interventional treatment, and PHI coordinates surgical referral for the specific situations where surgery is the right answer. ## Why PHI for Herniated Disc ## Frequently Asked Questions **Q: Do I need surgery for a herniated disc?** Most patients with herniated discs do not need surgery. The majority improve significantly with non-surgical treatment. Surgery is appropriate for specific situations including significant weakness, loss of bladder or bowel control, or pain that has not responded to thorough non-surgical treatment over an appropriate period. **Q: How long until my herniated disc improves?** Without treatment, many herniated discs show significant improvement over six to twelve weeks. With targeted treatment, pain relief is often faster, and some patients experience substantial improvement within days of their first epidural injection. Full resolution of symptoms typically takes longer, even with treatment. **Q: Will the disc heal back to normal?** The disc itself usually does not return to its pre-herniation state, but the displaced material often shrinks over time and the inflammation around the nerve resolves. Most patients become symptom-free even though the disc still looks somewhat abnormal on follow-up imaging. **Q: Can a herniated disc come back?** The same disc can re-herniate, particularly if you return to the activity or movement pattern that caused the original herniation. Recurrence rates are higher with surgery than without surgery, which is one of several reasons to consider non-surgical treatment first when appropriate. **Q: Should I rest or stay active?** Generally, gentle continued activity is better than strict rest. Brief rest during severe acute pain makes sense, but extended bed rest typically slows recovery. Your physician will give you specific guidance based on your situation. **Q: Will an epidural steroid injection cure my herniated disc?** The injection does not heal the disc itself. It reduces inflammation around the irritated nerve, which often reduces or eliminates symptoms while your body's natural healing continues. Many patients experience significant lasting relief from a single injection because the inflammation cycle is interrupted. **Q: Can I exercise during recovery?** In most cases yes, often with modifications. Physical activity is one of the best long-term protective factors against future disc problems. Your physician will guide you on what to continue, what to modify, and what to avoid during the acute recovery period. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Herniated Disc PHI offers the full range of evidence-based treatments for herniated disc. Your physician will recommend the right option, or combination, based on the location of your herniation, the severity of your symptoms, and your treatment history. - Epidural Steroid Injections, the usual first interventional step for radiating nerve pain - Nerve Blocks, selective nerve root blocks that confirm and treat the source nerve - Radiofrequency Ablation, for selected chronic or recurrent cases - PRP Therapy - A2M Therapy - Exosome Therapy > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PMC, 2022. — [American Academy of Neurology Guidelines Subcommittee](https://pmc.ncbi.nlm.nih.gov/articles/PMC12289388/) > Epidural injections for lumbar radiculopathy or sciatica: a comparative systematic review and meta-analysis. Peer-reviewed via PubMed, 2021. — [Manchikanti L, et al.](https://pubmed.ncbi.nlm.nih.gov/34323441/) > Epidural Steroid Injections. StatPearls, peer-reviewed via NIH/NCBI. — [StatPearls (NIH/NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK470189/) ## Schedule Your Herniated Disc Consultation A 60-minute consultation will confirm the diagnosis, walk through your treatment options, and tell you straightforwardly whether non-surgical treatment is likely to work for you. Call (310) 856-9488 or book online now. ### Hip Arthritis ## When Your Hip Starts Setting Boundaries Hip arthritis usually announces itself slowly. Stiffness in the morning. A little pain in your groin or buttock when you have been walking for a while. The realization that your range of motion is not what it was. You might notice it putting on shoes, getting in and out of a car, or rolling over in bed. Eventually, the joint starts setting boundaries you did not agree to. The hike you used to do becomes the one you skip. Tennis or golf gets shorter. Sleep gets worse because finding a comfortable position takes effort. Most hip arthritis patients we see have already been told something like "your hip is wearing out, we will replace it when it is bad enough." That advice is sometimes right eventually, but it skips over the years between early symptoms and ready-for-replacement, which is where most patients actually live. That period is what we focus on. ## What Hip Arthritis Actually Is Your hip is a ball-and-socket joint, with the head of your femur sitting in a cup-shaped socket in your pelvis. Cartilage covers the surfaces where these bones meet, allowing smooth, low-friction movement. Hip arthritis develops when that cartilage wears down. Without the cushion, bone-on-bone contact develops gradually, producing pain, stiffness, and limited movement, and the body responds with inflammation and sometimes bone spurs. The most common form is osteoarthritis, related to age and wear. Inflammatory arthritis such as rheumatoid or psoriatic arthritis affects the hip differently and is coordinated with rheumatology. Post-injury arthritis can develop years after a significant hip injury, and structural conditions like hip dysplasia can lead to earlier arthritis. ## What Hip Arthritis Feels Like The pattern is often distinctive once you recognize it: - Pain in the groin is the most classic location, which surprises patients who expected to feel it in the side or back of the hip - Pain that may also be felt in the buttock, side of the hip, or front of the thigh - Pain that worsens with weight-bearing activity like walking, standing, or stair climbing - Morning stiffness that improves with movement, typically lasting less than 30 minutes - Limited range of motion noticed when putting on shoes, crossing legs, or reaching for the foot - Pain at night that disrupts sleep, particularly when lying on the affected side Some patients also notice catching, grinding, or clicking with movement, which can suggest additional involvement such as a labral tear alongside the arthritis. ## What Stage Is Your Hip Arthritis? Hip arthritis exists on a spectrum, and where you sit on it strongly influences treatment. Early-stage arthritis typically involves intermittent pain mostly with activity, with imaging showing some cartilage loss but joint space largely preserved; patients at this stage have the most options, and regenerative medicine is often particularly worth discussing. Moderate arthritis involves more consistent pain including some at rest, with moderate joint space narrowing; options remain meaningful and may include longer-lasting interventional approaches alongside regenerative options. Advanced arthritis involves significant daily pain, substantial movement limitation, and severe narrowing or bone-on-bone contact; non-surgical options are still possible but more limited, and joint replacement is often the appropriate next step for patients who want their function back. Identifying where you actually fall is part of what we do at consultation. ## How PHI Treats Hip Arthritis The first step is comprehensive evaluation: a detailed history, examination of hip range of motion and movement, review of imaging, an assessment of where you are on the arthritis spectrum, and a discussion of your goals. Image-guided hip injections are typically the first interventional treatment for moderate arthritis; cortisone reduces inflammation and often provides relief lasting weeks to several months. The hip is one of the hardest joints to inject accurately without imaging because the capsule sits deep beneath several layers of tissue, so PHI performs all hip injections under image guidance. We are honest about cortisone: repeated injections have been associated with potential acceleration of cartilage loss in some studies, so for patients needing frequent injections, regenerative options often make more sense. Those regenerative options include PRP, A2M (which neutralizes cartilage-destroying enzymes), stem cell therapy, and exosome therapy. When total hip replacement is the right next step, we coordinate with orthopedic specialists rather than talking patients out of it. ## Why PHI for Hip Arthritis ## Frequently Asked Questions **Q: How is hip arthritis different from other causes of hip pain?** Hip arthritis specifically involves cartilage breakdown in the joint. Other causes include labral tears, bursitis, tendinopathy, and back-related pain that radiates to the hip. The treatment approach varies significantly, so the first step is identifying which cause is actually involved. **Q: Will I need a hip replacement?** This depends on the stage of your arthritis, how it is affecting your life, and your response to non-surgical treatment. Many patients with mild to moderate arthritis can delay or avoid replacement through injections, regenerative treatments, and lifestyle modifications. Patients with severe end-stage arthritis often eventually benefit from replacement, and we are honest about which category fits you. **Q: Are repeated cortisone injections safe for the hip?** Cortisone injections are well-established and effective. Some studies suggest potential acceleration of cartilage loss with frequent repeat injections, though the evidence is mixed. For most patients occasional cortisone is appropriate. For patients who need frequent repeat injections, regenerative options or eventual surgical consultation often make more sense. **Q: Can regenerative medicine reverse hip arthritis?** Reverse is rarely the right word. Regenerative treatments do not typically grow back lost cartilage. They can support remaining cartilage, reduce inflammation, slow further loss, and address pain through tissue-level mechanisms. For appropriate patients this can produce meaningful, lasting improvement. **Q: Should I exercise with hip arthritis?** Yes, with appropriate adjustments. Continued movement is one of the most important factors for management. Heavy-impact activities may need modification, while low-impact activities like cycling, swimming, and walking are typically beneficial. A physical therapist who understands hip arthritis can help. **Q: How fast does hip arthritis progress?** Progression varies significantly. Some patients are stable for years with minimal change; others progress more quickly. Factors include genetics, activity patterns, and body weight. Your physician can give a more specific assessment based on your imaging and current rate of change. **Q: What about hip resurfacing or partial replacement?** These are surgical options handled by orthopedic specialists. PHI does not perform them but can coordinate referral when surgical consultation is appropriate. Total hip replacement is appropriate for most patients with end-stage hip arthritis. **Q: Are these treatments covered by insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Hip Arthritis PHI offers the full range of evidence-based treatments for hip arthritis. Your physician will recommend the right option, or combination, based on the stage of your arthritis, your imaging, your goals, and your treatment history. - Hip Injections, image-guided cortisone for inflammation - PRP Therapy - Stem Cell Therapy - A2M Therapy, neutralizes cartilage-destroying enzymes - Exosome Therapy > The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Peer-reviewed via PubMed. — [Wernecke C, et al.](https://pubmed.ncbi.nlm.nih.gov/26674652/) > Clinical practice guideline: management of osteoarthritis of the hip. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-hip/) ## Schedule Your Hip Arthritis Consultation A 60-minute consultation will identify what stage of hip arthritis you are dealing with, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Hip Pain ## Hip Pain Has More Sources Than You Might Think Hip pain is one of the most commonly misdiagnosed types of pain we see. Patients often arrive having been told they have hip arthritis when they actually have gluteal tendinopathy. Or they have been treated for back pain when their issue is in the hip. Or they have been told to wait for hip replacement when they have a labral tear that responds well to other treatments. The hip is a complex region with multiple structures that can generate pain. Where you feel the pain, what makes it worse, and what makes it better all give important clues about what is actually happening. The right treatment depends entirely on the right diagnosis. This page walks through the most common patterns and what each typically means. ## Where the Pain Is Tells Us a Lot The location of hip pain often points to the source. #### Pain in the groin or front of the hip Pain felt deep in the groin or front of the hip usually points to the hip joint itself: hip arthritis, labral tears, hip flexor tendinopathy, or femoroacetabular impingement. Groin pain that worsens with weight-bearing often suggests joint involvement, while sharp pain with deep squatting or twisting may point to a labral tear. See our Hip Arthritis page for more on joint conditions. #### Pain on the outside of the hip Pain on the side of the hip, particularly when lying on that side or standing up after sitting, usually points to greater trochanteric bursitis, gluteal tendinopathy, or iliotibial band syndrome. This is one of the most commonly misdiagnosed patterns; many patients are treated for arthritis when the actual problem is in the surrounding tendons and bursa, which respond to different treatments. #### Pain in the buttock or back of the hip Pain in the buttock or back of the hip is often from outside the hip joint: sacroiliac joint dysfunction, piriformis syndrome, referred lower back pain, or hamstring tendinopathy. See our Sacroiliac Joint and Lower Back Pain pages for related information. #### Pain that radiates down the leg, or catching and clicking Pain radiating down the leg often points to nerve involvement from the lumbar spine (see our Sciatica page). Sharp catching, locking, or clicking can suggest labral tears, loose bodies, or impingement, which often benefit from imaging-confirmed diagnosis. ## When to See Someone Consider professional evaluation when your hip pain has lasted more than four to six weeks without improvement, when it is interfering with activities you want to do, when you are avoiding exercise because of it, when conservative treatments have not helped, or when you have been treated for one diagnosis without success and want a fresh evaluation. Seek prompt evaluation if you experience sudden severe hip pain following an injury or fall, inability to bear weight on the leg, hip pain with fever or feeling unwell, or significant joint swelling, warmth, or redness. These can indicate fracture, infection, or other conditions requiring urgent evaluation. ## How PHI Approaches Hip Pain The first step is comprehensive evaluation to identify what is actually causing your pain: a detailed history of exactly where the pain is and what changes it, a physical examination with specific tests for joint, tendon, and referred pain, review of imaging, and sometimes a diagnostic injection to confirm the source when more than one diagnosis is possible. Once the source is clear, treatment options include image-guided hip injections for joint-related pain (the hip capsule is deep, so PHI uses image guidance on every hip injection), PRP therapy for tendon-related pain such as gluteal, hip flexor, or hamstring tendinopathy and for early joint conditions, stem cell therapy for moderate to severe joint conditions, A2M therapy for cartilage involvement, and exosome therapy within comprehensive regenerative protocols. When advanced labral tears, severe arthritis, or specific structural issues call for surgery, we coordinate with surgical specialists. We do not apply the same protocol to every patient regardless of diagnosis. ## Why PHI for Hip Pain ## Frequently Asked Questions **Q: How do I know if my hip pain is from arthritis or something else?** The location and pattern often give strong clues. Groin pain with weight-bearing typically suggests joint involvement. Pain on the side of the hip typically suggests bursitis or gluteal tendinopathy. Pain in the buttock often involves the SI joint or back. A thorough examination plus imaging usually identifies the source, and many patients are surprised their hip pain is not actually arthritis. **Q: Why do hip injections need image guidance?** The hip joint capsule is deep beneath multiple layers of muscle and tissue. Without imaging guidance, injections often miss the joint capsule entirely, so the medication does not reach the intended target. Image guidance significantly improves accuracy and is considered standard for hip injections. **Q: My imaging shows hip arthritis but my pain isn't where I'd expect. Is it really arthritis?** Maybe, maybe not. Many patients have arthritis on imaging that is not the primary source of their pain. You might have mild hip arthritis and significant gluteal tendinopathy that is the actual cause. Both can coexist, and a diagnostic injection can sometimes clarify which is contributing more. **Q: How do you tell hip pain from back pain?** A combination of where the pain is, what makes it worse, and physical examination tests. Hip joint pain is typically felt in the groin and worsens with weight-bearing; back-related hip pain often involves the buttock or extends down the leg. Sometimes the answer is both, and a comprehensive evaluation sorts this out. **Q: Do you treat athletic hip injuries?** Yes. Many hip pain patients are active people who developed pain from sport rather than age-related arthritis. PRP, A2M, and other regenerative options are particularly relevant for athletic hip injuries including tendinopathy, labral irritation, and post-injury pain. **Q: Will I need a hip replacement?** Most hip pain does not require replacement. Replacement is appropriate for severe end-stage arthritis where non-surgical options have been adequately tried. For other sources of hip pain, replacement is typically not the answer. The first step is identifying what is actually wrong. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: How quickly can I be seen?** Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Hip Pain PHI offers the full range of evidence-based treatments for hip pain. Your physician will recommend the right option, or combination, based on the actual source of your pain, your imaging, and your treatment history. - Hip Injections, image-guided - PRP Therapy, strong evidence for tendon problems - Stem Cell Therapy - A2M Therapy - Exosome Therapy > Clinical practice guideline: management of osteoarthritis of the hip. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-hip/) > The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Peer-reviewed via PubMed. — [Wernecke C, et al.](https://pubmed.ncbi.nlm.nih.gov/26674652/) ## Schedule Your Hip Pain Consultation A 60-minute consultation will identify the actual source of your hip pain, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Immune Support ## When Immune Support Actually Makes Sense The wellness industry has heavily marketed immune support, often with claims that exceed evidence. Before getting into specifics, we want to be honest about when immune support actually adds value and when it does not. Immune support is most useful in specific contexts: around travel, particularly international travel or travel during illness peaks; during recovery from illness, when immune function may be temporarily depleted; for documented vitamin or mineral deficiencies; and during periods of high stress or sleep disruption. It is less useful when used as a substitute for sleep, nutrition, exercise, and stress management, or marketed for general boosting without a specific reason. The immune system is complex, and what matters is appropriate immune function for your situation, not maximum immune activity. ## What This Page Is and Isn't PHI is an interventional pain and regenerative medicine practice. We are not immunologists, infectious disease specialists, or primary care providers. For patients with frequent illness, suspected immune dysfunction, or autoimmune concerns, the appropriate first step is primary care evaluation, sometimes with specialist referral. PHI's offerings are supportive optimization that may complement broader care, not primary immune evaluation. ## When Immune Support May Help Common scenarios where IV therapy or peptide therapy may be useful include pre-travel preparation in the days before international travel; post-illness recovery, when IV nutrient therapy may address depletion of vitamins, minerals, and hydration; during seasonal illness peaks; for patients with documented vitamin deficiencies such as vitamin D or zinc, where IV repletion may produce higher tissue levels than oral supplementation; for high-stress or sleep-disrupted periods; and for longevity-focused patients addressing immune system aging as part of overall aging. ## How PHI Approaches Immune Support The first step is comprehensive evaluation: a detailed history of why you are considering immune support, discussion of any underlying patterns such as frequent illness or planned travel, an assessment of whether primary care evaluation should come first, and a recommendation matched to your context. IV therapy delivers immune-relevant nutrients directly into circulation; common immune-focused protocols include high-dose vitamin C, glutathione, zinc, and B-complex vitamins, with IV delivery producing higher tissue levels than oral supplementation when rapid repletion is desired. Peptide therapy uses specific compounds, some of which may support immune function; we discuss specific peptides individually without listing them publicly, including evidence base and regulatory considerations. These are delivered in our clinic setting, and we coordinate with primary care for evaluation of underlying causes when something more than supportive optimization is warranted. ## When to See Someone, and Where You may benefit from PHI's offerings if you have specific contexts where immune support adds value (travel, post-illness, documented deficits, high-stress periods), if you are pursuing comprehensive longevity care that includes immune support, or if you have established primary care for any underlying concerns. You should pursue primary care evaluation first if you are getting sick more frequently than expected, have recurrent or severe infections, have suspected autoimmune symptoms, or have unexplained fatigue alongside illness susceptibility. These warrant proper medical evaluation rather than wellness intervention. ## Why PHI for Immune Support ## Frequently Asked Questions **Q: Will IV therapy prevent me from getting sick?** Not reliably. IV therapy may support immune function during high-risk periods such as travel or illness exposure, and may speed recovery if you do get sick, but it does not reliably prevent illness. Patients who use IV therapy for travel often appreciate it; whether it actually prevents illness is hard to demonstrate. **Q: How does IV vitamin C work for immunity?** Vitamin C has established roles in immune function, and IV delivery achieves higher blood levels than oral supplementation. Whether this translates to meaningful clinical benefit depends on baseline status and context. For patients with documented deficiency or specific clinical situations, IV vitamin C has clearer rationale than for general wellness use. **Q: Should I take vitamin C supplements every day instead?** For most patients, oral vitamin C is the most practical approach for routine intake. IV vitamin C is most useful for specific contexts where higher tissue levels matter or oral absorption is impaired. The two are not equivalent and serve different purposes. **Q: I get sick more often than other people. Will this help?** Frequent illness warrants primary care evaluation rather than wellness intervention. Possible underlying causes include sleep disorders, autoimmune conditions, vitamin deficiencies, and immune deficiency conditions. Identifying and addressing the underlying cause typically helps more than wellness immune support. **Q: Is this safe with autoimmune conditions?** Patients with autoimmune conditions should approach immune-related interventions carefully, since some interventions that boost immune function could theoretically worsen autoimmune activity. We discuss this honestly during consultation and coordinate with your rheumatologist or other specialists when relevant. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. **Q: How quickly can I be seen?** Contact our concierge team and we'll coordinate your consultation and plan of care. For pre-travel timing, we work to schedule appropriately around your needs. Call (310) 856-9488 to discuss. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Immune Support PHI offers supportive optimization treatments for immune function in specific contexts. Your physician will recommend the right options based on your specific situation. - IV Therapy, vitamin C - Peptide Therapy > Vitamin C and immune function. Nutrients. — [Carr AC, Maggini S](https://pmc.ncbi.nlm.nih.gov/articles/PMC5707683/) > Glutamine: metabolism and immune function, supplementation and clinical translation. Nutrients. — [Cruzat V, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC6266414/) > Vitamin C fact sheet for health professionals. NIH Office of Dietary Supplements. — [NIH Office of Dietary Supplements](https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/) ## Schedule Your Immune Support Consultation A 60-minute consultation will evaluate your specific situation, walk through whether immune support adds value in your context, and recommend interventions that match your needs. Call (310) 856-9488 or book online now. ### Knee Arthritis ## More Options Than Cortisone or Surgery Knee arthritis is one of those diagnoses where most patients have been told there are essentially two paths: cortisone shots until you cannot get any more, then knee replacement when you cannot take it anymore. That is a frustrating roadmap, particularly if you hike, play tennis, golf, dance, run, or just want to move freely without your knee dictating the terms. The reality is that knee arthritis has more treatment options than any other joint arthritis. Hyaluronic acid injections FDA-approved specifically for the knee. Multiple regenerative approaches with robust evidence. Nerve-targeted procedures that can provide pain relief lasting up to two years from a single treatment. Combinations that work better than any single approach alone. The right path depends on your stage of arthritis, what you have already tried, and what you actually want to do with your knee. Most patients have more options than they have been told. ## What Knee Arthritis Actually Is Your knee is a hinge joint where the femur, tibia, and patella meet, with cartilage covering the ends of the bones and the meniscus providing additional cushioning. Knee arthritis develops when this cartilage wears down. The most common form is osteoarthritis, related to age, wear, prior injury, or genetics. Inflammatory arthritis affects the knee differently and is coordinated with rheumatology, and post-traumatic arthritis develops years after a significant injury. As cartilage wears, bone-on-bone contact develops gradually, inflammation increases, bone spurs form, and the joint's natural lubricating fluid often becomes less effective. The result is the symptoms most patients experience: pain, stiffness, swelling, limited motion, and difficulty with specific activities. ## What Stage Is Your Knee Arthritis? Knee arthritis exists on a spectrum, and treatment recommendations vary significantly by stage. Early-stage arthritis involves intermittent pain mostly with activity and imaging showing some cartilage thinning but joint space largely preserved; regenerative medicine is often particularly worth exploring at this stage. Moderate arthritis involves more consistent pain, more noticeable stiffness, occasional swelling, and moderate joint space narrowing, with hyaluronic acid often becoming relevant alongside regenerative options. Advanced arthritis involves significant daily pain, substantial movement limitation, frequent swelling, and severe narrowing or bone-on-bone contact; non-surgical options including genicular nerve procedures are still possible, but knee replacement often becomes appropriate for patients seeking to recover their function. Many patients are surprised by the range of options that fit their specific stage. ## How PHI Treats Knee Arthritis Treatment begins with a comprehensive evaluation of your symptoms, activity goals, alignment, imaging, and where you fall on the arthritis spectrum. Based on that, options at PHI include: Image-guided knee injections with cortisone for fast relief from inflammation, with the cumulative effects of repeated cortisone discussed honestly. Hyaluronic acid (Orthovisc), FDA-approved specifically for knee osteoarthritis, which replenishes the joint's natural lubricating fluid with relief that develops gradually but typically lasts longer than cortisone. PRP therapy, which has a strong evidence base for knee osteoarthritis with significant pain relief and functional improvement at 6 and 12 months. A2M therapy, which neutralizes cartilage-destroying enzymes and is particularly relevant for early-to-moderate arthritis. Stem cell therapy for moderate to severe arthritis or after PRP. Exosome therapy within comprehensive protocols. Genicular nerve blocks, which both diagnose and provide therapeutic relief by targeting the nerves carrying pain signals from the knee. And genicular radiofrequency ablation, which ablates those nerves and can provide durable pain relief from a single procedure, particularly valuable for patients trying to delay or avoid knee replacement, those who are not surgical candidates, or those with persistent pain after knee replacement. When knee replacement is the right next step, we coordinate with orthopedic specialists. ## When to See Someone Consider professional evaluation when your knee pain has lasted more than four to six weeks without improvement, when it interferes with activities you want to do, when you are avoiding exercise because of it, when you want to understand non-surgical options, when you want to delay or avoid knee replacement, or when conservative treatments have not provided adequate relief. Seek prompt evaluation if you experience sudden severe knee pain following an injury, inability to bear weight on the leg, significant knee swelling, warmth, or redness, or knee pain accompanied by fever or feeling unwell. ## Why PHI for Knee Arthritis ## Frequently Asked Questions **Q: How do I know which treatment is right for me?** This depends on your stage of arthritis, treatment history, goals, and imaging. Cortisone is fast but cumulative. Hyaluronic acid is FDA-approved for the knee and lasts longer but takes longer to develop. PRP and other regenerative options work over a longer horizon and address tissue rather than only inflammation. Genicular ablation provides durable relief by targeting nerves. Each fits different situations, and we help you understand which fits yours. **Q: How effective is genicular ablation for knee arthritis?** Genicular nerve ablation has strong recent evidence, with trials showing durable relief for a majority of appropriately selected patients. This durability is unusual among non-surgical interventions for knee arthritis and makes it particularly valuable for patients trying to delay knee replacement. **Q: Will I need knee replacement?** This depends on the stage of your arthritis and how it is affecting your life. Many patients with mild to moderate arthritis can delay or avoid replacement through injections, regenerative treatments, genicular ablation, and lifestyle modifications. Patients with severe end-stage arthritis often eventually benefit from replacement, and we are honest about which category fits you. **Q: Are repeated cortisone injections safe for the knee?** Cortisone is well-established and effective. Some studies have raised concerns about potential cartilage effects with frequent repeated injections in the same joint. For most patients occasional cortisone is appropriate. For patients needing frequent repeat injections, longer-lasting options like hyaluronic acid, genicular ablation, or regenerative protocols often make more sense. **Q: How is hyaluronic acid different from cortisone?** Cortisone reduces inflammation and provides faster relief lasting weeks to a few months, with cumulative effects from repeat injections. Hyaluronic acid replenishes the joint's natural lubricating fluid and works through a different mechanism, with relief that develops more gradually but typically lasts longer. Hyaluronic acid is FDA-approved specifically for knee osteoarthritis. **Q: Can regenerative treatments rebuild cartilage?** Rebuild is rarely the right word. Regenerative treatments do not typically grow back lost cartilage. They can support remaining cartilage, reduce inflammation, slow further loss, and address pain through tissue-level mechanisms. For appropriate patients this can produce meaningful, lasting improvement, particularly combined with appropriate exercise. **Q: Should I try multiple treatments at once or one at a time?** This depends on your situation. For most patients we recommend trying one approach at a time so we can evaluate response. For some, combining approaches such as genicular ablation plus regenerative therapy makes sense. We discuss combination strategies during consultation. **Q: Can I exercise with knee arthritis?** Yes, with appropriate adjustments. Continued movement is one of the most important factors for management. Heavy-impact activities may need modification, while low-impact activities like cycling, swimming, walking, and the elliptical are typically beneficial. **Q: Are these treatments covered by insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Knee Arthritis PHI offers the full range of evidence-based treatments for knee arthritis. Your physician will recommend the right option, or combination, based on the stage of your arthritis, your imaging, your goals, and your treatment history. - Knee Injections, image-guided cortisone and hyaluronic acid (Orthovisc) - PRP Therapy - Stem Cell Therapy - A2M Therapy - Exosome Therapy - Genicular Nerve Block, diagnoses and treats knee pain by targeting the genicular nerves - Genicular Radiofrequency Ablation, durable relief from a single procedure > The effectiveness of alpha-2-macroglobulin injections for osteoarthritis of the knee: a randomized controlled trial. Peer-reviewed via PubMed, 2024. — [Thompson K, et al.](https://pubmed.ncbi.nlm.nih.gov/39259950/) > Intra-articular hyaluronic acid for knee osteoarthritis: a systematic umbrella review. Peer-reviewed via PMC, 2025. — [Glinkowski WM, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11856182/) > Clinical practice guideline: management of osteoarthritis of the knee. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-knee/) ## Schedule Your Knee Arthritis Consultation A 60-minute consultation will identify what stage of knee arthritis you are dealing with, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Knee Pain ## Not All Knee Pain Is Arthritis Knee pain is one of the most common reasons people see a doctor for musculoskeletal complaints. It is also one of the most commonly mislabeled. Patients often arrive having been told they have knee arthritis when their actual issue is a meniscus tear, tendinopathy, or post-injury inflammation that responds to different treatments. The knee is a complex joint with many structures that can generate pain: cartilage, ligaments, tendons, menisci, bursa, and the patella. When something goes wrong with any of these, the result can feel similar from the patient's perspective even though the underlying cause is very different. The right treatment depends on the right diagnosis. ## Where the Pain Is Tells Us a Lot The location and pattern of your knee pain often points to the source. #### Pain on the inside or outside of the knee Pain on the inner side can come from medial compartment osteoarthritis, medial meniscus tears, MCL sprains, or pes anserinus bursitis. Pain on the outer side suggests lateral compartment osteoarthritis, lateral meniscus tears, iliotibial band syndrome, or LCL sprains. See our Knee Arthritis page for more on cartilage wear specifically. #### Pain in the front of the knee Pain around or behind the kneecap often involves patellofemoral pain syndrome (runner's knee), patellar tendinopathy (jumper's knee), quadriceps tendinopathy, prepatellar bursitis, or chondromalacia patella. This pattern often improves significantly with regenerative treatments addressing the involved tendons. #### Pain in the back of the knee, or catching and locking Pain behind the knee often involves a Baker's cyst, hamstring tendinopathy, or posterior horn meniscus tears. A knee that catches, locks, or gives way often suggests meniscus tears, loose bodies, or ligament instability, which benefit from imaging-confirmed diagnosis and sometimes coordinated care with orthopedic specialists. #### Pain after a specific injury If your pain developed after a twisting, contact, or fall injury, the pattern combined with the mechanism gives strong clues about which structures are involved. Acute injuries often need both diagnostic imaging and active treatment to support healing. ## When to See Someone Consider professional evaluation when your knee pain has lasted more than four to six weeks without improvement, when it interferes with activities you want to do, when conservative treatments have not helped, when you want to understand the actual source, or when you have been treated for one diagnosis without success. Seek prompt evaluation if you experience sudden severe knee pain following an injury, inability to bear weight, significant swelling, warmth, or redness, a knee that frequently catches or locks, or knee pain accompanied by fever or feeling unwell. ## How PHI Approaches Knee Pain The first step is comprehensive evaluation to identify the actual source: a detailed history including any injury, a physical examination with specific tests for joint, ligament, meniscus, and tendon involvement, review of imaging, and sometimes a diagnostic injection when uncertainty exists. Once the source is clear, options include image-guided knee injections with cortisone for inflammation, hyaluronic acid (Orthovisc) for knee osteoarthritis specifically, PRP therapy for tendon problems and joint conditions, stem cell therapy for moderate to severe conditions, A2M therapy for cartilage involvement, exosome therapy within comprehensive protocols, and genicular nerve blocks and ablation for significant knee pain where nerve-targeted treatment can provide durable relief. For significant ligament tears, large meniscus tears, or end-stage arthritis, we coordinate with surgical specialists. We do not apply the same treatment to every patient regardless of diagnosis. ## Why PHI for Knee Pain ## Frequently Asked Questions **Q: How do I know if my knee pain is arthritis or something else?** A combination of factors helps. Arthritis pain typically worsens with activity, includes morning stiffness, and shows joint space narrowing on imaging. Meniscus tears often involve catching or locking. Tendinopathy is usually localized to a tender spot. Imaging plus examination usually identifies the source, and many patients are surprised their knee pain is not actually arthritis. **Q: My MRI shows a meniscus tear. Do I need surgery?** Not necessarily. Many meniscus tears, particularly degenerative tears more common after 40, do not require surgery. Studies show that for many degenerative tears, physical therapy and conservative treatment produce outcomes similar to arthroscopic surgery. Acute traumatic tears, particularly bucket-handle tears that interfere with movement, are more likely to benefit from repair. We help you understand which category your tear falls into. **Q: I have knee pain from running. What can I do?** Running-related knee pain often involves patellofemoral pain syndrome, IT band syndrome, or patellar tendinopathy. These respond well to PRP and other regenerative treatments alongside form modification, strengthening, and sometimes shoe or training adjustments. Most runners with knee pain can return to running with appropriate treatment. **Q: I've had multiple cortisone shots and they're working less well over time. What now?** This is common and worth taking seriously. Repeated cortisone in the same joint can have cumulative effects and the response often diminishes. For most patients in this situation, transitioning to longer-lasting options like hyaluronic acid or genicular ablation, or regenerative approaches, makes more sense than continuing repeated cortisone. **Q: Will I need a knee replacement?** This depends on what is actually causing your pain and the stage of any underlying arthritis. Most knee pain does not require replacement. Replacement is appropriate for advanced arthritis where non-surgical options have been adequately tried. For other sources, replacement is typically not the answer. **Q: How long does it take treatment to work?** This varies significantly. Cortisone often produces relief within days. Hyaluronic acid develops gradually over weeks. PRP and other regenerative options work over 1 to 3 months. Genicular ablation produces relief that develops over weeks. Your physician will set specific expectations. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. We provide documentation for patients to submit for potential out-of-network reimbursement. **Q: How quickly can I be seen?** Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Knee Pain PHI offers the full range of evidence-based treatments for knee pain. Your physician will recommend the right option, or combination, based on the actual source of your pain, your imaging, and your treatment history. - Knee Injections, image-guided cortisone and hyaluronic acid (Orthovisc) - PRP Therapy, strong evidence for tendinopathy - Stem Cell Therapy - A2M Therapy - Exosome Therapy - Genicular Nerve Block - Genicular Radiofrequency Ablation, durable relief from a single procedure > Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. New England Journal of Medicine. — [Sihvonen R, et al.](https://pubmed.ncbi.nlm.nih.gov/24369076/) > Clinical practice guideline: management of osteoarthritis of the knee. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-knee/) ## Schedule Your Knee Pain Consultation A 60-minute consultation will identify the actual source of your knee pain, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Ligament Injuries ## When a Ligament Lets You Down Ligament injuries usually have a moment. The pivot that did not go right. The tackle. The fall. The twist on uneven ground. The pop you might have actually heard or felt. Then the swelling, the instability, and the realization that something inside the joint is not working the way it is supposed to. Most patients arrive at consultation knowing roughly what happened. The questions are usually about what comes next: Will it heal on its own? Do I need surgery? Can I get back to my sport, and how fast? The honest answer is that ligament injuries vary significantly. Some heal well with conservative care, some respond well to regenerative treatments, and some require surgical evaluation, particularly young active athletes with complete ruptures of certain ligaments. What we offer is comprehensive evaluation and the regenerative side of ligament care, with honesty about which situations fit non-surgical treatment well and which call for surgical input. ## How Ligament Injuries Differ Ligaments connect bone to bone and provide joint stability. Injuries range from mild stretching (Grade I) to partial tearing (Grade II) to complete rupture (Grade III), and they vary significantly by which ligament is involved. ACL injuries are particularly important because the ACL has limited natural healing capacity; complete ruptures in young active athletes typically benefit from surgical reconstruction, while partial injuries and some complete tears in less athletic patients sometimes do well with non-surgical management plus regenerative support. MCL injuries typically heal well non-surgically. Ankle sprains are extremely common and most heal well with conservative care plus rehabilitation, though persistent instability may benefit from regenerative support. Shoulder labral injuries, wrist and hand ligament injuries, and spine ligament strains each vary by location and pattern. The right approach depends entirely on which ligament, the severity, and your activity goals. ## When Regenerative Treatment Fits Regenerative options for ligament injuries are most appropriate for partial tears that are healing slowly or incompletely, chronic ligament problems that have not fully resolved despite appropriate rehabilitation, selected complete tears in patients who are not surgical candidates or who prefer non-surgical paths after careful discussion, and patients with persistent symptoms after appropriate initial care. Regenerative treatment is typically not the primary answer for complete ACL ruptures in young active athletes returning to cutting and pivoting sports, acute injuries with significant instability requiring stabilization, or specific injuries with well-established surgical solutions that produce better outcomes. Honest framing matters: regenerative medicine is a meaningful addition to ligament care for the right patient, but it does not replace surgical reconstruction where surgery genuinely produces better outcomes. ## How PHI Approaches Ligament Injuries The first step is comprehensive evaluation: a detailed history of the injury, an examination assessing the specific ligament and joint stability, review of imaging or a recommendation for MRI when needed, and an honest assessment of whether non-surgical regenerative care, surgical evaluation, or a coordinated approach fits best. PRP therapy delivers concentrated growth factors that support tissue healing, with accumulating evidence for selected ligament injuries, particularly partial tears and chronic problems that have not fully resolved with rehabilitation. A2M therapy is considered where there is joint involvement alongside the ligament injury. Stem cell therapy is considered for selected injuries when PRP has been tried with insufficient response, and exosome therapy is used within comprehensive protocols. PHI uses image-guided technique at our Beverly Hills practice, coordinates with orthopedic surgical specialists for injuries that genuinely benefit from repair or reconstruction, and coordinates with physical therapy as a critical component of comprehensive ligament care. ## When to See Someone Consider professional evaluation when an acute ligament injury has not significantly improved within several weeks, when you have persistent instability after a previous injury, when you are trying to decide between surgical and non-surgical approaches, when you want to understand whether regenerative options fit, or when conservative treatment alone is not producing adequate recovery. Seek prompt evaluation for an acute injury with significant pain, swelling, or inability to bear weight, a sense of instability where the joint gives way, locking or catching that limits motion, or inability to perform basic functional tasks. Acute high-grade ligament injuries benefit from prompt evaluation to make appropriate decisions about acute management. ## Why PHI for Ligament Injuries ## Frequently Asked Questions **Q: Will I need surgery for my ligament injury?** This depends entirely on which ligament, how severe, and your activity goals. Many ligament injuries do not require surgery. Specific situations, such as complete ACL ruptures in young athletes returning to cutting sports or certain shoulder injuries with significant instability, more commonly benefit from surgical reconstruction. We are honest about which category your specific injury fits. **Q: Can PRP fix my torn ligament?** For partial ligament tears, PRP often supports healing meaningfully. For complete ruptures, PRP can support healing in selected situations but does not replace surgical reconstruction in most cases where surgery is the established standard. Realistic expectations matter. **Q: How long does ligament recovery take?** This varies dramatically by ligament and severity. Mild sprains may recover in weeks. Significant partial tears often require 3 to 6 months. Major reconstructions typically require 9 to 12 months for full return to high-level athletic activity. Regenerative treatments do not dramatically shorten these timelines but may support more complete recovery. **Q: I had ACL surgery years ago and my knee still doesn't feel right. Can you help?** Sometimes. Persistent symptoms after ACL reconstruction can have multiple sources including incomplete healing, secondary cartilage damage, residual instability, or other injuries that occurred at the same time. Comprehensive evaluation can identify which factors are involved and whether regenerative treatments may help. **Q: What about ankle sprains that keep happening?** Recurrent ankle sprains often involve incomplete healing of previous injuries, residual instability, and altered biomechanics. PRP combined with structured rehabilitation can support more complete healing, and persistent significant instability sometimes requires surgical evaluation. **Q: How is regenerative treatment different from cortisone for ligament injuries?** Cortisone reduces inflammation but does not support tissue healing and may weaken some tissue with repeated use. Regenerative treatments work over a longer time horizon to support tissue-level healing. For most ligament injuries in active patients, regenerative approaches fit better than repeated cortisone. **Q: Is PRP banned by my sport?** PRP is permitted by WADA and most major sports governing bodies. Some specific organizations have additional considerations for elite athletes; we discuss specifics during consultation if you compete at that level. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Ligament Injuries PHI offers regenerative treatments for selected ligament injuries. Your physician will recommend the right option, or a coordinated approach with surgical specialists, based on your specific injury and goals. - PRP Therapy, for partial tears and chronic ligament problems - Stem Cell Therapy - A2M Therapy, where there is joint involvement alongside the ligament injury - Exosome Therapy > Efficacy of platelet-rich plasma augmentation in anterior cruciate ligament reconstruction: an updated systematic review and meta-analysis of clinical trials. Peer-reviewed via PMC, 2025. — [Tayyab M, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12595583/) > Clinical practice guideline: management of anterior cruciate ligament injuries. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/lower-extremity-programs/anterior-cruciate-ligament-injuries/) > WADA Prohibited List. World Anti-Doping Agency. — [World Anti-Doping Agency](https://www.wada-ama.org/en/prohibited-list) ## Schedule Your Ligament Injury Consultation A 60-minute consultation will identify your specific ligament injury, walk through whether regenerative treatment, surgical evaluation, or a coordinated approach fits best, and give you a clear plan. Call (310) 856-9488 or book online now. ### Lower Back Pain ## You're Tired of Living With This Most patients we see for lower back pain have been managing it for years. They have tried physical therapy at least once, used over-the-counter and sometimes prescription medications, and adjusted how they sleep, sit, and exercise. Some have seen chiropractors. Some have been told it is stress, or weight, or just part of getting older. If the pain is still there, you do not need another reason to manage it. You need someone to figure out where it is actually coming from and treat that specific source. That is what we do. ## What Lower Back Pain Usually Means The lower back is a complex area. Five lumbar vertebrae stack on top of each other, separated by discs and connected by small facet joints, all sitting on the sacrum and pelvis, with nerves traveling through to your legs. Pain can come from any of these structures, and identifying which one is the actual source is the most important step. See which pattern sounds most like yours. #### Pain that is worse with standing, bending backward, or twisting If your pain worsens when you stand, bend backward, or twist, and eases when you sit forward or lie down with knees bent, this often points to the facet joints. Facet pain is one of the most common and most under-recognized causes of chronic lower back pain, tends to develop with age, and often feels deep, achy, or stiff, worse late in the day. #### Deep, aching pain that worsens with sitting If your pain is worse when you sit, especially for long periods, and better when you stand or walk, the source may involve your spinal discs. Disc-related pain often builds during sitting and may flare with bending, lifting, or rolling over in bed. It can come from disc degeneration, disc inflammation, or vertebrogenic pain originating in the bony endplate. #### Pain in the lower back and buttock that is hard to localize If your pain extends into the buttock and has resisted years of general back-pain treatment, the sacroiliac joints may be the source. SI joint pain is frequently mislabeled because the symptoms do not fit a typical lumbar pattern, and it often worsens with prolonged sitting, standing, stair climbing, or rolling over in bed. #### Pain that radiates down your leg If your pain travels down the buttock and leg, sometimes to the foot, this is radiating pain or sciatica, often from a herniated disc or spinal stenosis irritating a spinal nerve. We address this on our Sciatica and Herniated Disc pages. #### Sudden severe pain after a minor activity Sudden severe lower back pain after a minor strain, fall, or bend, particularly if you are over 60 or have osteoporosis, can indicate a vertebral compression fracture and warrants prompt evaluation. ## When to Stop Managing It and Get It Evaluated Acute lower back pain (less than six weeks) often improves with rest, gentle movement, and over-the-counter anti-inflammatories. Consider professional evaluation when: - Your pain has lasted more than six weeks without significant improvement - The pain interferes with sleep, work, or daily activities - You have had recurring episodes over months or years - Conservative treatments have not provided lasting relief - You are tired of relying on medication to function - You want to identify the actual source rather than continue managing symptoms The earlier the source is identified, the more options you typically have, because some treatments work better in earlier stages of certain conditions. ## How PHI Approaches Lower Back Pain Our approach starts with identifying the source. Many patients arrive having been told they have "general" or "non-specific" low back pain, labels that do not point to a treatment. The actual source does. Your physician evaluates your specific pain pattern, reviews any prior imaging, and sometimes uses diagnostic injections to confirm the source. Once the source is clear, the options narrow to the ones likely to actually help. For facet-mediated pain, facet joint injections often help, with radiofrequency ablation for longer-lasting relief. For disc-related pain, epidural steroid injections reduce inflammation, and for vertebrogenic pain the Intracept Procedure is a single-treatment option. For sacroiliac joint pain, SI joint injections both diagnose and treat. Regenerative options including PRP, A2M, and stem cell therapy may address the underlying disc tissue. Most patients leave their first consultation with a specific diagnosis and a clear plan, which is often more clarity than they have had in years. ## Why PHI for Lower Back Pain ## Frequently Asked Questions **Q: I've had lower back pain for years. Is it too late to find an answer?** No. Patients with chronic lower back pain often have more diagnostic clarity than they realize, because the pattern of how the pain has changed over time is itself useful information. Many patients with years of unsuccessful prior treatment find meaningful relief once the actual source is identified. **Q: Will I need surgery?** Most patients with chronic lower back pain do not need surgery. The vast majority find meaningful relief through non-surgical approaches including injections, radiofrequency ablation, the Intracept Procedure, and regenerative medicine. Surgery is reserved for specific situations where it is the right answer. **Q: I've had MRIs that showed problems but treatment didn't help. What now?** This is common. MRI findings do not always correlate with the actual source of pain, and many patients have multiple findings, only one of which is causing symptoms. Identifying which finding is the source often requires diagnostic injections rather than imaging alone, which changes treatment recommendations for many patients. **Q: Should I keep doing physical therapy?** In most cases yes, often alongside other treatments. Physical therapy works best when paired with treatment of the underlying source. Patients who have done PT for months without improvement often benefit from interventional treatment that addresses inflammation or joint dysfunction that PT alone cannot reach. **Q: How long until I feel better?** This varies by treatment. Many injections produce relief within days to weeks. Radiofrequency ablation produces gradual improvement over several weeks. The Intracept Procedure produces durable relief that develops over weeks. Regenerative options work over several months. Your physician will set specific expectations. **Q: What if injections don't work for me?** If targeted injections do not produce meaningful relief, that result is itself diagnostic. It tells your physician the source may not be what was initially thought, and the next step is reconsidering the diagnosis. This is why we use diagnostic injections rather than empirically trying treatments. **Q: How is this different from going to a chiropractor?** Chiropractic care can help specific patients, particularly for muscle-related pain and minor mechanical issues. PHI's approach is medical and interventional. We diagnose the source through imaging, examination, and sometimes diagnostic injections, then deliver treatments targeting that specific source. PHI works with chiropractic care but does not offer it in-house. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Lower Back Pain PHI offers the full range of evidence-based treatments for lower back pain. Your physician will recommend the right option, or combination, based on the source of your pain, your imaging, and your treatment history. - Epidural Steroid Injections, for disc-related and radiating nerve pain - Facet Joint Injections, for facet-mediated pain - Radiofrequency Ablation, for longer-lasting facet relief - Intracept Procedure, a single-treatment option for vertebrogenic pain - Sacroiliac Joint Injections, to diagnose and treat SI joint pain - PRP Therapy - Stem Cell Therapy - A2M Therapy - Exosome Therapy > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PubMed, 2025. — [American Academy of Neurology Guidelines Subcommittee](https://pubmed.ncbi.nlm.nih.gov/39938000/) > Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020. — [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/) ## Schedule Your Lower Back Pain Consultation A 60-minute consultation will identify the specific source of your pain, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Migraines ## Migraine Is Real, Disabling, and Treatable Migraine is one of the leading causes of disability worldwide and one of the most undertreated medical conditions. Patients we see have often been dealing with migraines for years or decades, often having been told it is just headaches, that they need to manage stress better, or that they should take more ibuprofen. Many have been on standard preventive medications without finding adequate relief. Migraine is a neurological condition with specific brain pathways, distinct from tension or cervicogenic headache. It is biologically real, often genetic, and disproportionately affects women. The disability burden is substantial: missed work, missed events, disrupted sleep, and the cumulative wear of living with a condition that can derail your day without warning. For patients with chronic migraine specifically, PHI offers the FDA-approved therapeutic neurotoxin protocol along with several other interventional approaches, working alongside your neurologist or primary care physician rather than replacing the broader migraine care you may need. ## Where PHI Fits in Migraine Care Migraine treatment exists on a spectrum based on frequency and severity. Episodic migraine (fewer than 15 headache days per month) is typically managed by your primary care physician or neurologist with acute and sometimes preventive medications; for most patients with episodic migraine, PHI is not the right starting point. Chronic migraine (15 or more headache days per month with at least 8 migraine days) is a distinct diagnosis with FDA-approved interventional treatment, and this is where PHI's expertise specifically applies. Refractory migraine (chronic or severe migraine that has not responded to multiple preventives including therapeutic neurotoxin) may benefit from additional interventional approaches including ketamine infusion therapy. This page focuses primarily on chronic and refractory migraine. If you have episodic migraine that has not been adequately evaluated, working with a neurologist familiar with current migraine treatments is typically the right first step. ## Therapeutic Neurotoxin for Chronic Migraine Therapeutic neurotoxin is one of the most evidence-supported preventive treatments for chronic migraine. OnabotulinumtoxinA is FDA-approved specifically for the prevention of headaches in adults with chronic migraine, based on the PREEMPT clinical trials, which enrolled 1,384 patients and demonstrated significant reductions in headache frequency and severity. The protocol is specific: the FDA-approved technique involves 155 units delivered across 31 specific injection sites in the head, neck, and upper shoulders, repeated every 12 weeks. PHI follows the FDA-approved PREEMPT protocol with the precise injection technique developed for this indication. This is a medical procedure, not a cosmetic one; the doses, injection sites, and clinical purpose are entirely different from cosmetic neurotoxin, and the brand may be Botox or Xeomin depending on the case. Effects develop over 1 to 2 weeks and typically last 12 weeks per cycle, and most patients require two or three full cycles (6 to 9 months) to fully evaluate response. ## Other Treatments for Refractory Cases For patients with migraine that has not responded adequately to standard preventives including therapeutic neurotoxin, PHI offers several additional options. Occipital nerve blocks target the greater and lesser occipital nerves at the base of the skull, involved in many migraine patterns, particularly when pain begins or radiates from the back of the head. Ketamine infusion therapy has accumulating evidence for refractory chronic migraine and works through different pathways than standard migraine medications; PHI administers physician-monitored ketamine in a clinic setting. IV therapy, delivered in a clinic setting, provides supportive care for some patients during severe attacks or as part of broader treatment. We coordinate with neurology for ongoing preventive medication management and comprehensive migraine care. ## How PHI Approaches Migraine Treatment The first step is comprehensive evaluation: confirmation of your migraine diagnosis and frequency pattern, review of preventive medications you have tried and your response, assessment of whether you meet chronic migraine criteria for therapeutic neurotoxin, a discussion of which interventional approach fits your situation, and coordination with your neurologist or primary care physician. For patients meeting chronic migraine criteria, treatment typically involves the FDA-approved therapeutic neurotoxin protocol every 12 weeks, with response evaluated after two to three full cycles. For patients with refractory migraine, additional approaches including ketamine, occipital nerve blocks, or combinations may be appropriate. ## Why PHI for Migraine Treatment ## Frequently Asked Questions **Q: How is therapeutic neurotoxin for migraine different from cosmetic Botox?** The molecule can be the same, but the doses, injection sites, and purpose are entirely different. Therapeutic migraine treatment uses 155 units across 31 specific medical injection sites in the head, neck, and shoulders. Aesthetic neurotoxin uses much smaller doses in different facial muscles for wrinkle reduction. They are different services performed for different reasons by physicians with different training. **Q: How effective is therapeutic neurotoxin for chronic migraine?** For appropriate candidates, the FDA-approved protocol has Phase III clinical trial evidence demonstrating significant reductions in headache frequency, severity, and migraine-related disability. Most patients require two to three full treatment cycles (6 to 9 months) before fully evaluating response, and those who respond well often experience meaningful, sustained improvement. **Q: How do I know if I have chronic versus episodic migraine?** Chronic migraine is defined as 15 or more headache days per month, with at least 8 being migraine, for at least three months. Episodic migraine is less frequent. The distinction matters because chronic migraine has FDA-approved interventional treatments that episodic migraine typically does not qualify for. **Q: How long does it take neurotoxin to work for migraine?** Effects develop within 1 to 2 weeks of injection, with maximum benefit by 4 to 6 weeks per cycle. Treatment is repeated every 12 weeks, and most patients require two to three full cycles (6 to 9 months) before fully evaluating overall response. **Q: Will I look different after neurotoxin for migraine?** The doses and injection sites used for therapeutic migraine treatment are designed to address the underlying neurological mechanism, not to change facial appearance. Most patients do not notice meaningful aesthetic changes. The injection technique is medical, not cosmetic. **Q: Can ketamine help my migraines?** Ketamine has accumulating evidence for refractory chronic migraine that has not responded adequately to multiple preventives including therapeutic neurotoxin. It is not a first-line migraine treatment. For most chronic migraine patients, neurotoxin and standard preventives are appropriate first; ketamine becomes more relevant for refractory cases. **Q: What about CGRP medications? Do you prescribe those?** CGRP-targeted medications are typically prescribed by neurologists. PHI focuses on interventional treatments rather than oral or injectable preventive medication management. We coordinate with your neurologist on medication management while providing the interventional treatment side of your care, and the two are often used together. **Q: What if I'm in the middle of a migraine attack right now?** Acute migraine treatment is not PHI's primary lane. Acute attacks are typically managed by your existing care team or, for severe attacks, in an emergency setting if needed. PHI's role is in prevention. If you are experiencing a severe migraine that is not responding to your usual acute medications, please contact your neurologist or seek emergency care if appropriate. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. Specifics are discussed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. The 12-week treatment cycle is well-suited to scheduling around travel. ## Treatments We Offer for Migraine PHI offers evidence-based interventional treatments for chronic migraine and refractory migraine, working alongside your neurologist and broader migraine care team. - Neurotoxins for Pain, FDA-approved PREEMPT protocol for chronic migraine - Occipital Nerve Blocks - Ketamine Infusion Therapy, for refractory cases - IV Therapy, supportive care > Botulinum toxin in the management of chronic migraine: clinical evidence and experience. Peer-reviewed via PMC. — [Escher CM, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5367647/) > Botox (onabotulinumtoxinA) prescribing information for chronic migraine prevention. U.S. Food and Drug Administration. — [U.S. Food and Drug Administration](https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/103000s5302lbl.pdf) > Practice guidelines: treatment of migraine. American Academy of Neurology. — [American Academy of Neurology](https://www.aan.com/practice/clinical-practice-guidelines/) ## Schedule Your Migraine Consultation A 60-minute consultation will evaluate whether your migraine pattern is appropriate for PHI's interventional treatments, walk through the protocol options, and coordinate with your neurology team. Call (310) 856-9488 or book online now. ### Neck Pain ## When Your Neck Won't Stop Hurting Neck pain is one of the most common chronic pain complaints, and one of the most under-diagnosed. Many patients arrive having been told their neck pain is stress, poor posture, age, or screen time. Often it is some combination of these contributors. But underneath the lifestyle factors, there is usually a specific structural source generating most of the pain, and identifying that source is the most important step in finding meaningful relief. The neck has multiple structures that can generate pain: the facet joints, the discs, the nerves, and the muscles. Each responds to different treatments. The right approach depends entirely on which structure is actually involved in your specific case. ## Where Your Neck Pain Is Coming From The patterns below describe the most common sources of chronic neck pain. #### Pain that worsens when you look up or twist Pain centered in the neck that worsens when you look up or twist, sometimes with morning stiffness that improves with movement, often suggests cervical facet joint involvement. The pain may refer to the back of the head, upper shoulders, or between the shoulder blades. See our Cervical Facet Syndrome page; treatment options include cervical facet injections and cervical radiofrequency ablation. #### Pain that radiates from your neck into your arm Pain that travels from your neck down the shoulder, arm, or into the hand, often with numbness, tingling, or weakness, usually suggests cervical radiculopathy (a pinched nerve in the neck), commonly from a herniated disc or arthritis. See our Pinched Nerve page; treatment options include cervical epidural steroid injections and selective nerve root blocks. #### Pain after an impact injury, or headaches from the neck Neck pain that developed after a car accident, fall, or impact and has not fully resolved may be persistent whiplash-related pain (see our Whiplash page). Neck pain accompanied by headaches that start from the back of the head or neck may be cervicogenic headache (see our Cervicogenic Headaches page). ## When to See Someone Consider professional evaluation when your neck pain has lasted more than four to six weeks without improvement, when it interferes with sleep, work, or daily activities, when physical therapy or medications have not provided lasting relief, when you have radiating pain, numbness, or weakness in your arms, or when you have headaches alongside your neck pain. Seek prompt evaluation if you experience severe neck pain following major trauma, sudden significant arm weakness or numbness, loss of bladder or bowel control, neck pain with fever or severe headache, or difficulty walking or balance changes. These can indicate conditions requiring urgent evaluation. ## How PHI Approaches Neck Pain The first step is comprehensive evaluation to identify what is actually causing your pain: a detailed history of what makes it worse or better, an examination with specific tests for facet involvement and nerve compression, review of imaging, and sometimes a diagnostic injection to confirm the source when more than one diagnosis is possible. Once the source is clear, treatment options include cervical epidural steroid injections for nerve-related neck pain, cervical facet injections for facet-mediated pain (both diagnostic and therapeutic), and cervical radiofrequency ablation for patients whose facet injections confirm the source but produce shorter-than-desired relief, which can extend relief to 6 to 18 months. The cervical spine is a precise area, so PHI performs every cervical procedure in our surgical suite under image guidance. We coordinate with physical therapy and other specialists for patients whose neck pain involves significant muscle, postural, or biomechanical contributors. ## Why PHI for Neck Pain ## Frequently Asked Questions **Q: How do I know if my neck pain is from facets, discs, or muscles?** The pattern often gives clues. Facet pain typically worsens with neck extension and twisting. Disc-related pain often involves radiating arm symptoms. Muscle pain is usually more diffuse and tied to position or activity. Many patients have combinations. Physical examination plus diagnostic injections can clarify the dominant source. **Q: My MRI shows multiple findings. How do I know which is causing my pain?** This is common. Most adults over 40 have some changes on cervical MRI even without neck pain. Many patients have multiple findings, only one of which is generating their symptoms. Diagnostic injections can directly test which specific structure is producing your pain, which often clarifies treatment recommendations. **Q: Should I keep doing physical therapy?** In most cases yes, often alongside other treatments. Physical therapy works best when paired with treatment of the underlying source. Patients who have done PT for months without improvement often benefit from interventional treatment that addresses inflammation or joint dysfunction PT alone cannot reach. **Q: Will I need surgery?** Most patients with chronic neck pain do not need surgery. The vast majority find meaningful relief through targeted injections, radiofrequency ablation, and other non-surgical approaches. Surgery is reserved for specific situations. **Q: Why do cervical injections need image guidance?** The cervical spine is a precise area with the spinal cord and major nerves in close proximity. Image guidance ensures the medication reaches the intended structure safely. Cervical injections without imaging are less accurate and meaningfully riskier. **Q: How long does it take treatment to work?** This varies by treatment. Cervical injections often produce relief within days to weeks. Radiofrequency ablation produces gradual improvement over several weeks. Your physician will set specific expectations. **Q: What about chiropractic care?** Chiropractic adjustments can help some patients with mechanical neck pain. PHI's interventional approach addresses different mechanisms, the specific nerve or joint sources of pain. Some patients benefit from both, and we do not typically conflict with appropriate chiropractic care for muscle-related contributors. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Neck Pain PHI offers the full range of evidence-based treatments for neck pain. Your physician will recommend the right option, or combination, based on the actual source of your pain, your imaging, and your treatment history. - Cervical Epidural Injections, for nerve-related neck pain - Cervical Facet Injections, diagnostic and therapeutic for facet-mediated pain - Radiofrequency Ablation, extends relief to 6 to 18 months > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PMC, 2022. — [American Academy of Neurology Guidelines Subcommittee](https://pmc.ncbi.nlm.nih.gov/articles/PMC12289388/) > Epidural Steroid Injections. StatPearls, peer-reviewed via NIH/NCBI. — [StatPearls (NIH/NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK470189/) ## Schedule Your Neck Pain Consultation A 60-minute consultation will identify the actual source of your neck pain, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Neuropathy ## When Your Nerves Don't Work the Way They Should Neuropathy has a way of changing daily life that is hard to convey unless you live with it: the persistent burning, tingling, or numbness in your hands or feet, the pins and needles that come and go without warning, the way light touch from a sock or sheet can feel uncomfortable, and the disrupted sleep when symptoms flare at night. Most neuropathy patients we see have been dealing with these symptoms for years. Many are on gabapentin, pregabalin, duloxetine, or similar medications that produce partial relief along with side effects, and many have been told there is not much else to do. What we offer is a comprehensive evaluation of your specific situation and access to interventional and supportive treatments that may complement your existing care. We are honest that neuropathy treatment is challenging and that not every approach works for every patient, and also that some patients find meaningful relief through options they have not yet tried. ## What Neuropathy Actually Is Peripheral neuropathy refers to damage or dysfunction of nerves outside the brain and spinal cord, typically affecting the hands and feet first because the longest nerves in your body run there. The damaged nerves can no longer transmit signals normally, which produces the characteristic symptoms. Common patterns include burning or shooting pain (often in the feet and hands), numbness or reduced sensation, tingling or pins-and-needles, hypersensitivity where light touch or temperature change becomes uncomfortable, unusual temperature sensations, weakness in affected muscles, balance problems when sensory feedback from the feet is affected, and symptoms that often worsen at night or with rest. The pattern, severity, and progression depend significantly on the underlying cause. ## Why Neuropathy Develops Many conditions can damage peripheral nerves. Diabetes is the leading cause worldwide, with high blood sugar over time damaging the small blood vessels supplying nerves. Chemotherapy can cause neuropathy as a side effect of certain cancer treatments. Vitamin deficiencies, particularly B12, can produce neuropathy that may improve with appropriate supplementation if caught early. Alcohol use over time, autoimmune conditions, hereditary conditions, kidney and thyroid disorders, infections, and toxin exposure are other contributors, and a substantial portion of patients have idiopathic neuropathy in whom no specific cause is identified. Identifying and treating the underlying cause is the most important step. PHI works alongside your primary care physician, endocrinologist, or neurologist for that aspect of care while providing complementary interventional options. We do not replace your existing care team; we add specific options that may help where standard approaches have not been enough. ## How PHI Approaches Neuropathy The first step is comprehensive evaluation: a detailed history of your neuropathy and how it has progressed, confirmation of any underlying diagnosis, review of your current treatment and providers, and an honest assessment of which interventional or supportive options may be appropriate. Targeted nerve blocks can help selected patients with focal neuropathy patterns or specific nerve entrapments, and can also identify whether specific nerves are involved beyond generalized neuropathy; we are honest that they are not a primary treatment for diffuse peripheral neuropathy. Regenerative options including PRP, stem cell, A2M, and exosome therapy are sometimes pursued; honest framing matters here, because the evidence for regenerative medicine in peripheral neuropathy specifically is more limited than in joint conditions, and we discuss realistic expectations rather than presenting these as established cures. Effective neuropathy management typically requires coordination across multiple providers, and we work with your existing team rather than duplicating their care. ## Why PHI for Neuropathy ## Frequently Asked Questions **Q: Will neuropathy go away?** This depends entirely on the underlying cause and how long it has persisted. Some neuropathy improves significantly with treatment of the underlying cause, such as B12 deficiency corrected with supplementation or blood sugar brought under tight control early in diabetes. Other neuropathies are more persistent. Treatments aim to manage symptoms and slow progression rather than fully reverse the condition in most cases. **Q: How effective is regenerative medicine for neuropathy?** The evidence for regenerative medicine specifically in peripheral neuropathy is more limited than the evidence for these treatments in joint conditions. Some patients report meaningful improvement with PRP, stem cell, or exosome therapy; others do not experience benefit. We discuss this honestly and do not position regenerative medicine as an established cure for neuropathy. **Q: Should I keep taking my gabapentin or other neuropathy medications?** Generally yes, unless your prescribing physician indicates otherwise. PHI's interventional options typically work alongside standard medications rather than replacing them. Some patients can reduce doses if interventional treatments produce significant relief, but this is a coordinated decision with your prescribing physician. **Q: What if my neuropathy is from chemotherapy?** Chemotherapy-induced neuropathy has its own characteristics and treatment considerations. PHI sees chemotherapy-induced neuropathy patients and coordinates with your oncology team. Approaches depend on whether you are in active treatment, in remission, or post-treatment. **Q: Will my balance and walking improve with treatment?** This depends on the severity and duration of your neuropathy. Some patients experience improved sensation and balance with treatment of underlying causes and supportive interventions. Patients with longer-standing severe neuropathy may have more limited functional improvement, and physical therapy with balance training is often an important component of comprehensive care. **Q: Is there hope for advanced neuropathy?** Yes, though more advanced cases are typically more challenging. Even advanced neuropathy patients often experience meaningful symptom reduction with appropriate care, even if full reversal is not possible. The goal is improved quality of life and slowing progression rather than eliminating the condition entirely. **Q: How does this compare to going to a neurologist?** Neurologists handle the diagnosis, underlying condition management, and standard medication management. PHI provides interventional and regenerative options that complement neurology care. Many patients benefit from both, and we coordinate with your neurologist rather than replacing that care. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Neuropathy PHI offers evidence-based and supportive treatments for neuropathy as part of broader coordinated care. Your physician will recommend the right options based on your underlying cause, symptom pattern, and treatment history. - Nerve Blocks, for focal patterns or specific nerve entrapments - PRP Therapy - Stem Cell Therapy - A2M Therapy - Exosome Therapy > Diabetic neuropathy: a position statement by the American Diabetes Association. Peer-reviewed via PubMed. — [Pop-Busui R, et al.](https://pubmed.ncbi.nlm.nih.gov/27999003/) > Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurology. — [Finnerup NB, et al.](https://pubmed.ncbi.nlm.nih.gov/25575710/) > Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update. Peer-reviewed via PubMed. — [Loprinzi CL, et al.](https://pubmed.ncbi.nlm.nih.gov/32663120/) > Peripheral neuropathy fact sheet. NIH National Institute of Neurological Disorders and Stroke. — [NIH National Institute of Neurological Disorders and Stroke](https://www.ninds.nih.gov/health-information/disorders/peripheral-neuropathy) ## Schedule Your Neuropathy Consultation A 60-minute consultation will evaluate your specific neuropathy situation, walk through the interventional and supportive options that may complement your existing care, and coordinate with your other providers. Call (310) 856-9488 or book online now. ### Phantom Limb Pain ## Your Pain Is Real If you have phantom limb pain, you have probably been told it is not real. The limb is gone, so the pain cannot really be there. Some providers have suggested it is psychological. Others have offered medication that did not help, then more medication that did not help either. The pain is real. It originates in your nervous system, in real biological pathways that continue to function after amputation. It is not in your head in any dismissive sense, and it is one of the most studied and best-understood phenomena in modern pain medicine. It is also treatable. Not always completely eliminated, but meaningfully reduced for most patients with the right approach. We do not approach phantom limb pain as a curiosity or a leftover problem. We approach it as a specific clinical condition with specific treatment options that work. ## What Phantom Limb Pain Actually Is Your nervous system maps your body. Long before any amputation, your brain develops detailed sensory and motor representations of every limb. These representations do not disappear when a limb is removed; the neural pathways persist and continue to fire. When they fire without input from the limb that used to be there, the result is phantom sensations. For most amputees these are not painful, but for a significant portion they are. Phantom limb pain can include burning, electric, cramping, crushing, or stabbing sensations perceived as coming from the missing limb. It may be constant or intermittent, may worsen with stress or weather changes, and may improve over time or persist for years. The pain involves changes in the nervous system at multiple levels: in the residual nerves at the amputation site, in the spinal cord, and in the brain regions that previously mapped the missing limb. Research consistently shows 50 to 80 percent of amputees experience phantom limb pain at some point. This is not a rare condition, and it deserves dedicated treatment. ## How PHI Treats Phantom Limb Pain The first step is comprehensive evaluation: the cause and timing of your amputation, the character and triggers of your pain, examination of your residual limb for local pain sources, and your prior treatment history. Peripheral nerve stimulation is one of the most clinically interesting recent advances for phantom limb pain. A small lead is placed near the targeted nerve, delivering gentle electrical stimulation that interrupts pain signaling. The 60-day Sprint temporary system has specific FDA clearance for post-amputation pain, and clinical trials have shown sustained relief well beyond the active stimulation period for many patients. Targeted nerve blocks can interrupt specific pain pathways and may be diagnostic for identifying which nerves are involved. Ketamine infusion therapy has accumulating evidence for phantom limb pain specifically, acting on a different nervous system pathway to help reset the sensitization that contributes to chronic pain; PHI administers physician-monitored ketamine in a clinic setting. The PNS, nerve block, and procedural treatments are performed in our affiliated surgery center. The right approach depends on your specific situation, sometimes coordinated with prosthetics specialists or physical therapy. ## When to See Someone Consider professional evaluation when you have phantom limb pain that has persisted beyond the early post-amputation period, when the pain interferes with your sleep, daily life, or use of your prosthesis, when standard pain medications have not helped, or when you have not yet been offered specific treatments designed for phantom limb pain. Seek prompt evaluation for new onset or significant worsening of pain at the amputation site, new swelling, redness, or signs of infection at the residual limb, or symptoms that suggest a problem with your prosthesis fit. ## Why PHI for Phantom Limb Pain ## Frequently Asked Questions **Q: Is phantom limb pain real?** Yes, completely. Phantom limb pain originates in real biological pathways in the nervous system that continue to function after amputation. It is one of the most studied phenomena in modern pain medicine and has a clear neurological basis. Anyone who has been told their phantom limb pain is not real has been given outdated and incorrect information. **Q: Will phantom limb pain go away on its own?** For some patients, yes. It often improves over the first months to a year following amputation. For others, it persists or even worsens over time. If your pain has not improved with time and conservative measures, dedicated treatment can help. **Q: How effective is peripheral nerve stimulation for phantom limb pain?** Clinical trials of the 60-day temporary peripheral nerve stimulation system specifically for post-amputation pain have shown meaningful pain reduction with sustained benefit beyond the active stimulation period for many patients. PNS is one of the most evidence-supported treatments for phantom limb pain. **Q: How does ketamine help phantom limb pain?** Ketamine acts on the NMDA receptor, which is involved in chronic pain sensitization. By temporarily interrupting this pathway, ketamine may help reset the nervous system changes that maintain chronic phantom limb pain, and the effect can outlast the infusion itself in some patients. **Q: What if I've already tried multiple medications without success?** Many patients with phantom limb pain have not been offered the specific treatments most likely to help, such as peripheral nerve stimulation, ketamine infusion, and targeted nerve blocks. Failed medication trials are common and do not predict response to these other treatments. Re-evaluation with options that address the underlying mechanism often identifies meaningful paths forward. **Q: Can phantom limb pain be cured?** Cure is not always the right word. For many patients, treatment significantly reduces pain frequency and severity, often to a level that allows full normal activity. For some, the pain resolves completely. The goal is meaningful reduction in pain and improvement in quality of life, which is achievable for the majority of patients with appropriate treatment. **Q: Will treatment affect my prosthesis use?** Most treatments either do not affect prosthesis use or actually improve it by reducing pain that was limiting use. Peripheral nerve stimulation systems are designed to be compatible with prosthesis wear, and your physician will coordinate with your prosthetics team if needed. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. The 60-day system is well-suited to international patients because it provides extended treatment without frequent return visits. ## Treatments We Offer for Phantom Limb Pain PHI offers evidence-based treatments specifically for phantom limb pain. Your physician will recommend the right option, or combination, based on the cause and timing of your amputation and your treatment history. - Peripheral Nerve Stimulation, the 60-day Sprint temporary system - Nerve Blocks, diagnostic and therapeutic - Ketamine Infusion Therapy, in a clinic setting > Consensus guidelines for the use of peripheral nerve stimulation in the treatment of chronic pain and neurological diseases: a Neuron Project from the American Society of Pain and Neuroscience. Peer-reviewed via PMC. — [Latif U, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12614495/) > Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety. Pain and Therapy, 2021. — [Helm S, et al.](https://pubmed.ncbi.nlm.nih.gov/34478120/) ## Schedule Your Phantom Limb Pain Consultation A 60-minute consultation will evaluate your specific situation, walk through the treatment options that may not have been adequately offered, and give you a clear plan. Call (310) 856-9488 or book online now. ### Pinched Nerve ## When Pain Travels From Your Neck Into Your Arm A pinched nerve in your neck has a distinctive pattern. Pain that starts in your neck or shoulder and travels down your arm. Numbness, tingling, or weakness in specific parts of your hand or fingers. Sharp electric sensations with certain movements. Trouble sleeping because you cannot find a comfortable position for your arm. The technical term for this pattern is cervical radiculopathy, meaning irritation of a nerve root in your cervical spine. Most patients call it a pinched nerve. The good news: most pinched nerves in the neck respond well to non-surgical treatment. Many resolve significantly on their own over weeks to months, and many others respond well to targeted interventional treatments that address the underlying inflammation. Surgery is reserved for specific situations and is typically not the first answer. ## What's Actually Happening Your cervical spine has seven vertebrae. Between each pair, nerves exit the spinal cord and travel down your arms to provide sensation and motor function. When one of these nerves becomes irritated or compressed, it can no longer transmit signals normally, producing the symptoms most pinched nerve patients experience. Common causes include a herniated cervical disc (the most common cause in younger patients), cervical spondylosis (age-related arthritis and bone spurs, the most common cause over 50), foraminal stenosis (narrowing of the opening where the nerve exits), and combinations of disc and arthritic changes. The specific pattern of your symptoms, which arm and which fingers, tells your physician which nerve is likely involved: C6 commonly affects the thumb and index finger, C7 the middle finger, and C8 the ring and pinky fingers. ## How Pinched Nerves Usually Progress Without treatment, many cervical radiculopathies improve significantly over six to twelve weeks. The disc herniation or inflammation that triggered the irritation often shrinks or resolves over time, and the body's anti-inflammatory response reduces sensitivity. This natural improvement is real, but waiting is not always the right answer. The pain during severe symptoms can be debilitating, patients who cannot work or sleep suffer real consequences, and for some patients symptoms become chronic. Earlier treatment often produces faster relief and may prevent transition to chronic patterns. ## When to See Someone Consider professional evaluation when your symptoms have lasted more than two to four weeks, when the pain interferes with sleep, work, or daily life, when you have numbness, weakness, or significant tingling, when conservative treatments have not helped, or when you want active treatment rather than continued waiting. Seek prompt evaluation if you experience significant muscle weakness in your arm or hand, loss of fine motor control, loss of bladder or bowel control, difficulty walking or balance changes, or severe symptoms following trauma. These can indicate more significant nerve or spinal cord involvement requiring urgent evaluation. ## How PHI Treats Pinched Nerves The first step is identifying which specific nerve is involved and confirming the diagnosis, through a detailed history, an examination with specific tests for each cervical nerve, review of imaging (typically MRI), and sometimes a diagnostic injection when imaging shows multiple potential sources. Cervical epidural steroid injections are typically the first interventional treatment, delivering anti-inflammatory medication directly to the irritated nerve, with many patients experiencing significant relief from a single injection. Selective nerve root blocks are targeted injections that deliver medication to a specific nerve, particularly useful when imaging shows multiple potential sources; a successful block can both confirm the diagnosis and provide therapeutic relief. PHI performs every cervical procedure in our affiliated surgical suite under image guidance, and coordinates with surgical specialists for the specific situations where surgery is the right answer. ## Why PHI for Pinched Nerve Treatment ## Frequently Asked Questions **Q: How long does cervical radiculopathy usually last?** Many cases improve significantly over six to twelve weeks. With targeted treatment, relief is often faster, and some patients experience substantial improvement within days of their first epidural injection. **Q: Will my symptoms come back?** This depends on the underlying cause. Some patients have a single episode and never experience symptoms again; others have recurring episodes related to ongoing disc or arthritic changes. Treatment addresses current symptoms, while ongoing management of underlying causes affects long-term recurrence. **Q: Should I rest or stay active?** Brief rest during severe acute flares is reasonable, but extended bed rest typically slows recovery. Gentle continued activity is generally better than complete immobility, with avoidance of positions that significantly worsen symptoms. **Q: Will an epidural injection cure my pinched nerve?** The injection does not address the underlying disc or structural cause. It reduces inflammation around the irritated nerve, which often produces meaningful relief. Many patients experience lasting relief because the inflammation cycle is interrupted long enough for natural healing to progress. **Q: Will I need surgery?** Most patients with cervical radiculopathy do not need surgery. The vast majority find meaningful relief through epidural injections, nerve blocks, and conservative management. Surgery is reserved for patients with significant weakness, persistent severe symptoms, or specific structural issues. **Q: What if I have weakness in my arm?** Mild weakness associated with cervical radiculopathy often resolves with appropriate treatment. Significant or progressive weakness warrants more urgent evaluation and may indicate the need for surgical consultation. Your physician will assess this carefully. **Q: Can I exercise with a pinched nerve?** In most cases gentle continued activity is appropriate and helpful. Specific exercises that worsen your symptoms should be avoided during acute flares. A physical therapist familiar with cervical radiculopathy can help guide appropriate activity. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is fully disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Pinched Nerve PHI offers evidence-based non-surgical treatments for cervical radiculopathy. Your physician will recommend the right option based on which specific nerve is involved and your treatment history. - Cervical Epidural Injections, the usual first interventional step - Selective Nerve Root Blocks, confirm and treat a specific nerve > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PMC, 2022. — [American Academy of Neurology Guidelines Subcommittee](https://pmc.ncbi.nlm.nih.gov/articles/PMC12289388/) > Epidural Steroid Injections. StatPearls, peer-reviewed via NIH/NCBI. — [StatPearls (NIH/NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK470189/) ## Schedule Your Pinched Nerve Consultation A 60-minute consultation will identify which specific nerve is involved, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now. ### Poor Sleep & Recovery ## When Sleep Stops Doing Its Job Sleep is the foundation that everything else rests on. Energy, cognitive performance, hormonal balance, immune function, athletic recovery, mood, body composition, and longevity all depend significantly on sleep quality. When sleep stops working, everything else starts breaking down. Most patients we see for sleep concerns have been struggling for years: trouble falling asleep, trouble staying asleep, waking up tired even after eight hours, early morning waking that will not allow them back to sleep. What we offer is the supportive optimization side of sleep care, and we are honest that significant sleep problems often have specific identifiable causes that need proper evaluation. For patients who have addressed major contributors and want supportive interventions, or patients with lifestyle and stress-related sleep issues, our offerings may add meaningful value alongside the foundational work. ## Sleep Issues Have Many Causes Poor sleep is a symptom, not a diagnosis. Sleep disorders requiring specific evaluation include sleep apnea (the most common and often undiagnosed cause, with significant cardiovascular implications), insomnia disorder (for which CBT-I is first-line), restless legs syndrome, and circadian rhythm disorders. Medical conditions affecting sleep include hormonal changes, chronic pain, depression and anxiety, and GERD. Lifestyle and environmental contributors include an inconsistent sleep schedule, caffeine, alcohol, or screen patterns, chronic stress, and the sleep environment. The first step is identifying which categories may be contributing. PHI provides supportive optimization for selected contexts; for most patients with significant or persistent sleep issues, comprehensive evaluation typically comes first. ## What This Page Is and Isn't PHI is an interventional pain and regenerative medicine practice. We are not sleep medicine specialists, primary care physicians, or psychiatrists. For patients with significant sleep concerns, comprehensive care typically involves primary care evaluation, sleep medicine evaluation when a sleep disorder is suspected, behavioral sleep medicine with CBT-I for chronic insomnia, specialty care for hormonal contributors, and mental health care for depression or anxiety. PHI's offerings work best when underlying contributors have been evaluated and addressed. ## How PHI Approaches Sleep and Recovery The first step is comprehensive evaluation: a detailed history of your sleep and how issues started, discussion of potential contributors, screening for sleep apnea risk and other significant disorder symptoms, and an honest assessment of whether wellness optimization fits or whether evaluation should come first. Peptide therapy uses specific compounds that may support sleep architecture, growth hormone signaling, and recovery during sleep, discussed individually without listing specific peptides publicly. NAD+ therapy delivers a coenzyme involved in cellular energy production that may indirectly support sleep-related systems, with evidence we describe as emerging. Red light therapy delivers wavelengths that may support cellular function and recovery, with some research suggesting circadian effects when used at appropriate times; we position this as supportive rather than primary sleep treatment. These are delivered in our clinic setting, and we coordinate with sleep medicine and primary care for evaluation and treatment of identified sleep disorders. ## When This Page Applies to You You may benefit from PHI's offerings if you have had appropriate evaluation for sleep disorders and are addressing identified issues, if your sleep issues appear primarily related to stress, lifestyle, or recovery patterns, if you are already addressing foundational factors, or if you are pursuing comprehensive longevity care that includes sleep optimization. You are typically better served elsewhere first if you have never been evaluated for sleep apnea (loud snoring, witnessed pauses, morning headaches, and daytime sleepiness despite adequate duration are risk factors), if you have chronic insomnia (consider CBT-I as first-line), or if you have significant sleep issues without prior workup. ## Why PHI for Sleep and Recovery Optimization ## Frequently Asked Questions **Q: Should I get a sleep study before pursuing wellness sleep treatments?** For many patients, yes. Sleep apnea is one of the most common causes of poor sleep, has significant health implications beyond fatigue, and is highly treatable when identified. If you have loud snoring, witnessed pauses in breathing, morning headaches, daytime sleepiness despite adequate duration, or high blood pressure, sleep study evaluation is typically warranted before wellness intervention. **Q: Will peptides help me sleep?** Some peptides may support sleep quality through various mechanisms such as growth hormone signaling and recovery support. Effects vary by specific peptide and patient. We discuss options honestly during consultation rather than positioning peptides as a universal sleep solution. **Q: What about CBT-I?** CBT-I (Cognitive Behavioral Therapy for Insomnia) is the first-line evidence-based treatment for chronic insomnia, typically delivered by behavioral sleep medicine specialists. For chronic insomnia, it generally produces better long-term outcomes than wellness interventions or sleep medications. We do not replace it; we may complement it. **Q: Will NAD+ improve my sleep?** NAD+ specifically for sleep has emerging rather than established evidence. Some patients report improved energy and overall function, which may indirectly affect sleep experience. We are honest about realistic expectations. **Q: What about melatonin?** Melatonin has specific applications such as circadian rhythm disorders and jet lag where evidence supports its use. It is less effective for general insomnia than often marketed. Your physician can discuss whether it fits your situation. **Q: Could my sleep issues be perimenopause or menopause?** Yes, very commonly. Hormonal changes significantly affect sleep. For women in this transition, hormonal evaluation and management through your primary care or gynecologist often addresses sleep issues more effectively than wellness interventions alone. **Q: How important is sleep for longevity?** Critically important. Sleep affects nearly every system that matters for healthspan, including hormonal regulation, cognitive function, immune function, cardiovascular health, metabolic health, and tissue repair. Optimizing sleep is one of the highest-leverage interventions for healthy aging. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Sleep and Recovery PHI offers supportive optimization treatments for sleep and recovery. Your physician will recommend the right options based on your specific situation, prior workup, and broader care. - Peptide Therapy - NAD+ Therapy - Red Light Therapy > Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Peer-reviewed via PubMed. — [Trauer JM, et al.](https://pubmed.ncbi.nlm.nih.gov/26054060/) > Clinical practice guidelines for sleep disorders. American Academy of Sleep Medicine. — [American Academy of Sleep Medicine](https://aasm.org/clinical-resources/practice-standards/practice-guidelines/) ## Schedule Your Sleep and Recovery Consultation A 60-minute consultation will evaluate your specific situation, walk through whether wellness optimization fits or whether sleep medicine evaluation should come first, and recommend treatments that match your needs. Call (310) 856-9488 or book online now. ### Post-Surgical Nerve Pain ## When the Surgery Was Supposed to Fix the Pain Most patients undergo surgery hoping to eliminate their pain, and for many it works as planned. For others, something else happens. The original problem is gone, the surgery was technically successful, the imaging looks fine, but a new kind of pain has appeared: burning sensations along the surgical site, electric shocks that come without warning, numbness in some areas combined with hypersensitivity in others, sleep disrupted because no position is comfortable. This is post-surgical nerve pain. It is different from the pain you had before surgery, and it requires different treatment. Most importantly, additional surgery often does not help, because the underlying issue is no longer in the structure that was operated on. It is in the nerves themselves. What we offer is comprehensive evaluation and access to the specific treatments that target nerve dysfunction directly. ## Why Nerve Pain Develops After Surgery Surgery, by its nature, involves cutting through tissue, and even with careful technique this can affect nerves in several ways. Direct nerve injury can occur from cutting, retraction, or stretching; most heal completely, some do not. Scar tissue can develop in the months after surgery, sometimes compressing nerves that were not affected during the procedure. Nerve sensitization can develop when pain signals continue for weeks or months, with the nervous system maintaining pain signaling even after the original tissue has healed. And a neuroma can form when a small cut nerve regenerates abnormally into a painful bundle. Many patients have multiple contributing factors at once. Common patterns include burning or electric pain at the surgical site, pain radiating along specific nerve distributions, sensitivity to light touch, numbness combined with pain, pain that does not respond to standard pain medications like NSAIDs, and pain that worsens with certain movements. Specific examples include persistent pain after hernia repair, post-mastectomy pain syndrome, post-thoracotomy pain, post-knee-replacement nerve pain involving the genicular nerves, and post-spine-surgery nerve pain. ## How PHI Treats Post-Surgical Nerve Pain The first step is comprehensive evaluation: a detailed history of your surgery and how the nerve pain developed, an examination assessing the patterns and distributions of your pain, review of your imaging and prior workup, and identification of which specific nerves are likely involved. Targeted nerve blocks can both diagnose and treat; a successful diagnostic block confirms which nerve is producing your pain, and many patients experience meaningful relief from the block itself. Radiofrequency ablation is appropriate for selected patients whose pain is driven by specific identifiable nerves, providing longer-lasting relief after a successful diagnostic block, particularly relevant for post-knee-replacement genicular pain. Peripheral nerve stimulation is one of the most clinically interesting options; the 60-day Sprint temporary system has FDA clearance specifically for post-surgical pain, and clinical trials have shown sustained relief well beyond the active stimulation period for many patients. PHI performs these procedures in our affiliated surgical suite, and coordinates with your surgeon when surgical re-evaluation genuinely makes sense. ## When to See Someone Consider professional evaluation when pain at or near a surgical site has lasted longer than expected (typically more than three to six months post-surgery), when the pain has nerve-like qualities such as burning, electric, or shooting sensations, when your surgeon has confirmed the surgery was successful and imaging is normal, when standard pain medications have not helped, or when you feel stuck between providers without a clear plan. Seek prompt evaluation for new onset of severe pain at the surgical site, signs of infection (redness, swelling, warmth, fever), or new significant neurological symptoms such as significant weakness or loss of bladder or bowel function. ## Why PHI for Post-Surgical Nerve Pain ## Frequently Asked Questions **Q: Why do some patients develop nerve pain after surgery and others don't?** This is not fully understood. Research has identified factors including the type of surgery, severity of pre-surgical pain, and individual nervous system characteristics. Post-surgical nerve pain develops in a small but real percentage of patients regardless of how well the surgery was performed; it is not generally a sign of surgical error. **Q: Will more surgery fix my post-surgical nerve pain?** Usually not. Post-surgical nerve pain typically involves nerve injury or sensitization, not the underlying structural problem the original surgery addressed. Additional surgery often does not help and sometimes worsens the situation. There are exceptions, such as a significant neuroma or hardware compressing nerves, but most responds better to interventional treatments that target the nerves directly. **Q: How effective is peripheral nerve stimulation for post-surgical pain?** Clinical trials of the 60-day temporary peripheral nerve stimulation system have shown meaningful pain reduction with sustained benefit beyond the active stimulation period for many patients. PNS is one of the most evidence-supported treatments for post-surgical nerve pain. **Q: How is this different from my surgeon's follow-up care?** Surgeons typically focus on whether the surgery was technically successful and the original problem addressed. They are often less equipped to evaluate persistent nerve pain after a successful surgery. Interventional pain physicians specialize in identifying and treating these specific patterns. **Q: Will my post-surgical nerve pain go away on its own?** This varies. Some resolves over months as healing progresses; some persists indefinitely without treatment. Earlier treatment of persistent post-surgical nerve pain often produces better outcomes than waiting, because the longer pain persists, the more nervous system sensitization can develop. **Q: What if I had cancer surgery?** PHI treats post-cancer-surgery nerve pain such as post-mastectomy and post-thoracotomy pain, and coordinates with oncology teams when appropriate. Persistent nerve pain after cancer surgery is increasingly recognized as a treatable condition rather than something patients should expect to live with. **Q: Will I need to be on pain medication forever?** Many patients can reduce or eliminate the need for chronic pain medications when interventional treatments address the underlying source. The goal is the right level of medication for your specific situation. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Post-Surgical Nerve Pain PHI offers evidence-based treatments specifically for post-surgical nerve pain. Your physician will recommend the right option, or combination, based on the type of surgery you had, the pattern of your nerve pain, and your treatment history. - Nerve Blocks, diagnostic and therapeutic - Radiofrequency Ablation, for pain driven by specific identifiable nerves - Peripheral Nerve Stimulation, the 60-day Sprint temporary system > Consensus guidelines for the use of peripheral nerve stimulation in the treatment of chronic pain and neurological diseases: a Neuron Project from the American Society of Pain and Neuroscience. Peer-reviewed via PMC. — [Latif U, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12614495/) > Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety. Pain and Therapy, 2021. — [Helm S, et al.](https://pubmed.ncbi.nlm.nih.gov/34478120/) ## Schedule Your Post-Surgical Nerve Pain Consultation A 60-minute consultation will identify which specific nerves are involved, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now. ### Post-Surgical Pain ## Stuck Between Two Doctors Who Don't Know What to Do If you have persistent pain after surgery, you may have spent the past months or years bouncing between providers who cannot help. Your surgeon says the surgery was successful and your imaging looks fine. Your primary care doctor is not sure what to do with surgical site pain. Pain medications dull the edge but do not address what is actually happening. Meanwhile, you are living with pain that was not supposed to be there. This is one of the most common situations we see at PHI. Patients who had surgery for a specific problem develop persistent pain at or near the surgical site that does not fit anyone's standard treatment algorithm. The pain is real, it has specific biological causes, and it usually responds to specific treatments that target what is actually happening rather than another round of medication or another imaging study. ## What Causes Persistent Pain After Surgery A small but significant percentage of surgical patients develop persistent pain after their procedure, even when the surgery was technically successful. The medical literature calls this persistent post-surgical pain, and it is increasingly recognized as a real and treatable clinical entity. Common causes include nerve injury from the surgery itself (from cutting, retraction, or scar formation), nervous system sensitization (when pain signals continue long enough that the nervous system maintains pain even after the tissue has healed), scar tissue irritating nearby nerves, persistent inflammation, and mechanical changes (lumbar fusion changes how forces transfer through the lower spine; knee replacement changes how the leg and hip function), which can produce pain in adjacent structures even when the surgery itself was successful. Sometimes there is a specific identifiable cause not recognized earlier, such as hardware loosening or recurrent disc herniation. The first step in treatment is identifying which of these is contributing. ## Common Patterns We Treat After back surgery, failed back surgery syndrome and post-surgical SI joint pain are common; lumbar fusion changes how forces transfer through the lower spine, which often produces new SI joint pain months or years later. After joint replacement, persistent post-arthroplasty pain may involve nerve injury or mechanical issues, and genicular nerve blocks and radiofrequency ablation can be particularly helpful for persistent post-knee-replacement pain. After hernia or abdominal surgery, persistent pain near the site often involves nerve injury. After mastectomy or chest surgery, post-mastectomy pain syndrome can develop. After trauma surgery and cancer-related surgery, persistent pain related to nerve damage is increasingly recognized and treated, and we coordinate with oncology teams when appropriate. ## How PHI Treats Post-Surgical Pain The first step is comprehensive evaluation: the surgery you had and the original problem it addressed, the character and pattern of your pain, your prior imaging and treatment history, whether specific identifiable causes need further evaluation, and the nervous system component. Targeted nerve blocks can both diagnose and treat nerve-mediated pain; a successful diagnostic block confirms the specific nerve involved, and many patients experience meaningful relief from the block itself. Radiofrequency ablation of specific nerves can provide longer-lasting relief, particularly for persistent post-knee-replacement pain and certain post-spine-surgery patterns. Peripheral nerve stimulation is often particularly appropriate because post-surgical pain typically has a focal nerve distribution; PHI offers the 60-day Sprint temporary system, FDA-cleared for post-surgical pain. PRP therapy may be appropriate for selected patients with tendon, ligament, or soft tissue components. PHI performs these procedures in our affiliated QUAD A-accredited surgery center and coordinates with surgical specialists when surgical re-evaluation genuinely makes sense. ## When to See Someone Consider professional evaluation when pain at or near a surgical site has persisted longer than expected (typically more than three to six months post-surgery), when it is interfering with sleep, daily life, or recovery, when your surgeon has confirmed the surgery itself was successful and imaging looks normal, when you feel stuck between providers without a clear plan, or when standard pain medications are providing limited relief. Seek prompt evaluation for new onset of severe pain at the surgical site, signs of infection (redness, swelling, warmth, fever), or sudden new neurological symptoms such as significant weakness or changes in bladder or bowel function. These can indicate problems requiring urgent surgical evaluation. ## Why PHI for Post-Surgical Pain ## Frequently Asked Questions **Q: Why do some patients develop persistent pain after surgery and others don't?** This is not fully understood, but research has identified risk factors including the type of surgery, severity of pre-surgical pain, and individual nervous system characteristics. Persistent post-surgical pain develops in a small but real percentage of patients regardless of how well the surgery was performed; it is not generally a sign of surgical error. **Q: Should I get a second opinion on my surgery?** Possibly, depending on your situation. If your imaging shows specific issues such as hardware loosening or recurrent problems, surgical re-evaluation makes sense. If imaging is normal and the pain is consistent with nerve-mediated post-surgical pain, additional surgery is often not the answer. Your physician can help you understand whether further surgical evaluation is appropriate. **Q: Will my post-surgical pain go away on its own?** This varies significantly. Some resolves over months as healing progresses; some persists indefinitely without treatment. Earlier treatment often produces better outcomes than waiting, because the longer pain persists, the more nervous system sensitization can develop. **Q: How effective is peripheral nerve stimulation for post-surgical pain?** Clinical trials have shown meaningful pain reduction, with the 60-day temporary system specifically demonstrating sustained benefit beyond the active stimulation period for many patients. PNS is one of the most evidence-supported treatments for nerve-mediated post-surgical pain. **Q: What if I don't want any more procedures?** The treatments we offer are minimally invasive and generally well-tolerated. Nerve blocks involve injection only. Radiofrequency ablation is a needle procedure under sedation. Peripheral nerve stimulation involves placement of a small lead, sometimes through a temporary system removed after 60 days. We discuss all options thoroughly so you can decide what feels right. **Q: Will I need to be on pain medication forever?** Many patients can reduce or eliminate the need for chronic pain medications when interventional treatments address the underlying source. The goal is the right level of medication for your specific situation. **Q: What if my situation involves cancer surgery?** PHI treats post-cancer-surgery pain such as post-mastectomy and post-thoracotomy pain and coordinates with oncology teams when appropriate. Persistent pain after cancer surgery is increasingly recognized as a treatable condition rather than something patients should expect to live with. **Q: How is this different from my surgeon's follow-up care?** Surgeons typically focus on whether the surgery itself was successful and the original problem addressed. They are often less equipped to evaluate persistent pain after a successful surgery, particularly when imaging looks normal. Interventional pain physicians specialize in identifying and treating these specific patterns. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Post-Surgical Pain PHI offers evidence-based treatments for post-surgical pain. Your physician will recommend the right option, or combination, based on the type of surgery you had, the pattern of your pain, and your prior treatment history. - Nerve Blocks, diagnostic and therapeutic - Radiofrequency Ablation, including genicular ablation for post-knee-replacement pain - Peripheral Nerve Stimulation, the 60-day Sprint temporary system - PRP Therapy, for tendon > Consensus guidelines for the use of peripheral nerve stimulation in the treatment of chronic pain: a Neuron Project from the American Society of Pain and Neuroscience. Peer-reviewed via PMC. — [Latif U, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12614495/) > Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety. Pain and Therapy, 2021. — [Helm S, et al.](https://pubmed.ncbi.nlm.nih.gov/34478120/) ## Schedule Your Post-Surgical Pain Consultation A 60-minute consultation will evaluate your specific situation, identify what may be causing your persistent pain, and walk through the treatment options that match it. Call (310) 856-9488 or book online now. ### PTSD ## What This Page Is If you have been searching for PTSD treatment options that go beyond what you have already tried, this page is for you. We have kept it as direct as possible. We will not ask you to describe your trauma, and we will not include detailed symptom lists that may feel like they are checking off your worst days. PHI offers two specific treatments with growing evidence for PTSD: stellate ganglion block and ketamine infusion therapy. We provide both alongside your existing mental health care. We do not replace your therapist, psychiatrist, or trauma-focused treatment. We add specific medical interventions that may help when standard approaches have not been enough. ## Where PHI Fits in PTSD Care Standard PTSD treatment includes evidence-based therapies such as Cognitive Processing Therapy, Prolonged Exposure, EMDR, and Trauma-Focused CBT, along with medications, typically SSRIs or SNRIs. For many patients this produces meaningful improvement, sometimes substantial. For others, standard treatment helps but does not go far enough. The hyperarousal, intrusive symptoms, sleep disruption, and impact on daily life persist despite ongoing care. Veterans, trauma survivors, and others living with treatment-resistant PTSD often spend years searching for additional options. PHI's role is specifically for this group: patients with established PTSD, ongoing mental health care, and incomplete response to standard treatment. ## Stellate Ganglion Block for PTSD The stellate ganglion is a cluster of sympathetic nerves in the front of the neck that plays a central role in the body's fight-or-flight response. When trauma produces persistent hyperarousal, the sympathetic nervous system can remain in a state of elevated activation that does not fully reset, even years after the original event. Stellate ganglion block is an injection of local anesthetic near this cluster of nerves. It temporarily interrupts sympathetic activation, which appears to allow a reset of the overactive response, and for many patients the effect outlasts the local anesthetic itself, sometimes for weeks or months. The use of SGB for PTSD has accumulating evidence, including extensive work in military veteran populations. The procedure takes approximately 10 to 20 minutes and is performed in our surgical suite under image guidance. We do not perform both sides at one session; blocks are spaced out, with the option for additional blocks if response is positive but begins to diminish. For more detail, see the Stellate Ganglion Block section of our Nerve Blocks treatment page. ## Ketamine Infusion Therapy for PTSD Ketamine has growing evidence for PTSD specifically, with multiple randomized trials showing meaningful symptom reduction. Ketamine works through a different nervous system pathway than SSRIs and SNRIs, which is part of why it can help patients who have not responded adequately to standard medications. At PHI, ketamine is administered in a clinic setting under continuous physician monitoring, not in the Surgical Suite. There is no fixed protocol. The number of sessions and their spacing vary patient to patient, and your treatment is designed individually rather than following a set series. Effects often build across treatment. For more detail, see our Ketamine Infusion Therapy treatment page. ## Combining SGB and Ketamine Some patients with PTSD pursue both SGB and ketamine, either sequentially or in coordinated combination, because the two work through different mechanisms. SGB addresses sympathetic nervous system overactivation, the persistent fight-or-flight state that maintains many PTSD symptoms. Ketamine addresses the broader nervous system pathways that maintain depression, anxiety, and intrusive symptoms. For patients with significant hyperarousal (racing heart, hypervigilance, exaggerated startle, sleep disruption), SGB may be particularly relevant. For patients with significant mood or intrusive cognitive symptoms alongside the hyperarousal, ketamine may be particularly relevant. Many patients have both, and combined treatment can address both pathways. We discuss which path fits your specific pattern during consultation. ## How PHI Approaches PTSD Treatment The first step is a comprehensive evaluation: confirmation of your established PTSD diagnosis and current treatment, discussion of your specific symptom pattern, review of your prior treatment history, coordination with your mental health team, and an honest discussion of which treatment, or combination, may fit your situation. We approach the consultation aware that you have likely already explained your story many times. We ask only what we need to evaluate whether our specific treatments are appropriate. We do not require you to describe traumatic events in detail; that processing happens in your therapy, not at our consultations. You may be a candidate if you have an established PTSD diagnosis, ongoing mental health care, an adequate trial of evidence-based PTSD treatment without sufficient response, and no contraindications. You are typically not a candidate if you are in active crisis, have not yet engaged with PTSD-specific treatment, or are seeking these treatments outside the framework of broader mental health care. ## Why PHI for PTSD Treatment ## Frequently Asked Questions **Q: How is the evidence for SGB versus ketamine for PTSD?** Both have accumulating evidence. SGB has been studied extensively in veteran populations with meaningful symptom reduction in multiple studies. Ketamine has growing evidence specifically for PTSD, with multiple randomized trials. Neither is yet at the level of evidence that exists for trauma-focused therapies, but both represent meaningful additional options when PTSD has not adequately responded to standard treatment. **Q: Will SGB or ketamine cure my PTSD?** Cure is rarely the right word for PTSD. For appropriate candidates, these treatments may produce meaningful symptom reduction that combines with your other treatment to improve overall quality of life. For some patients the response is dramatic; for others, more modest. Neither replaces the broader trauma-focused care that PTSD typically requires. **Q: Should I do SGB or ketamine first?** This depends on your symptom pattern. Patients with prominent hyperarousal may benefit from starting with SGB. Patients with prominent mood or intrusive cognitive symptoms may benefit from starting with ketamine. Patients with both may benefit from sequential or combined treatment. We discuss this individually. **Q: How quickly does SGB work?** For appropriate responders, SGB often produces noticeable effects within hours to days. Many patients report reduced hyperarousal, a calmer baseline state, and improved sleep within the first week. The duration varies, with the option for additional blocks if effects diminish. **Q: How quickly does ketamine work?** Many patients experience meaningful symptom reduction within hours to days of an early session. Because there is no fixed protocol, your physician tailors the number and spacing of sessions to your response, and benefit often builds over the course of treatment. **Q: Will I need to keep doing these treatments forever?** Not necessarily. For SGB, some patients receive a single block or two with sustained benefit; others receive periodic blocks. For ketamine, some patients experience sustained benefit after an initial course; others receive maintenance sessions. Your trajectory depends on your individual response. **Q: Do I need to stop my current PTSD medications?** Generally no. Most patients continue their current medications during these treatments. The goal is typically improved response on the combination rather than replacement. **Q: Is this safe for veterans?** Yes. Both SGB and ketamine have been studied extensively in veteran populations. PHI welcomes veterans and works to make consultation as efficient as possible, recognizing that veterans often prefer minimal repetition of military and trauma history beyond what is clinically necessary. **Q: Do I need to describe my trauma in detail?** No. We need to know that you have an established PTSD diagnosis, what treatments you have tried, and what symptoms you currently experience. We do not require you to describe specific traumatic events. Trauma-focused processing happens in your therapy. **Q: Do you take insurance?** SGB and ketamine for PTSD are cash-pay services and coverage is typically not available. All pricing is fully disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Treatment can be coordinated to fit travel schedules. ## Treatments We Offer for PTSD PHI offers two physician-administered treatments with growing evidence for PTSD, alongside your continuing mental health care. - Ketamine Infusion Therapy, administered in a clinic setting under continuous monitoring - Stellate Ganglion Block, image-guided > Stellate ganglion blockade for the treatment of post-traumatic stress disorder: a systematic review and meta-analysis. Peer-reviewed via PubMed, 2025. — [Yang Y, et al.](https://pubmed.ncbi.nlm.nih.gov/41151498/) > A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry. — [Sanacora G, et al.](https://pubmed.ncbi.nlm.nih.gov/28249076/) ## Schedule Your PTSD Consultation A 60-minute consultation will evaluate whether SGB, ketamine, or both may be appropriate for your specific situation, walk through what to expect, and coordinate with your mental health team. Call (310) 856-9488 or book online now. ### Sacroiliac Joint Dysfunction ## You May Have Been Misdiagnosed for Years If you have been treated for lower back pain for months or years without finding meaningful relief, there is a real possibility your pain is not actually coming from your back at all. It may be coming from your sacroiliac joints. Sacroiliac joint pain is one of the most under-recognized causes of chronic lower back, buttock, and hip pain. Studies suggest the SI joints are the source in roughly 10 to 27 percent of suspected cases of chronic low back pain. That is a substantial group of patients whose pain is being treated as something else. If you have cycled through epidural injections, physical therapy, chiropractic adjustments, and pain medications without lasting relief, your sacroiliac joints may be the source nobody has evaluated yet. We do. ## What the Sacroiliac Joints Are and Why They Matter Your sacroiliac joints connect the base of your spine to your pelvis. There are two of them, one on each side of your tailbone, where the sacrum meets the iliac bones. Despite their small size, they bear significant load: every time you stand, walk, climb stairs, or lift something, the SI joints transfer force between your upper body and your legs. When the SI joints become inflamed, injured, or start moving abnormally, they produce pain that often gets blamed on something else. Standard lumbar MRI often does not capture the SI joints clearly, physical exam tests for SI joint pain are not always part of a standard back exam, the pain pattern overlaps with lumbar and hip pain, and many providers were trained when SI joint pain was considered rare. The result is a population of patients treated for years for general back pain when their actual source is the SI joints. ## What Sacroiliac Joint Pain Feels Like The pain pattern is often distinctive once you know what to look for: - Pain in the lower back, buttock, or back of the upper thigh, often on one side more than the other - Pain that worsens with prolonged sitting, prolonged standing, or stair climbing - Pain that worsens when rolling over in bed or getting out of a car - Pain that may radiate into the back of the thigh but typically not below the knee - Pain that often does not respond to traditional back treatments like epidural steroid injections If your pain pattern matches any combination of these, SI joint involvement is worth evaluating. Many patients are surprised to learn their pattern points clearly to the SI joints once a physician familiar with the condition examines them. ## Why SI Joint Pain Develops The most common causes include pregnancy and childbirth, which loosen the ligaments around the SI joints; previous back surgery, especially lumbar fusion, which changes how forces transfer through the lower spine and increases load on the SI joints; trauma such as falls or car accidents; arthritis, particularly in inflammatory conditions like ankylosing spondylitis; repetitive stress from athletic activity; and hip replacement, which changes how forces transfer through the pelvis. In many patients no specific cause is identified; the joints simply begin generating pain, often gradually, often in middle age. ## How PHI Diagnoses SI Joint Pain Diagnosis is the most important step. Standard imaging often shows nothing definitive, and physical exam tests can suggest SI joint involvement but cannot confirm it alone. The most reliable diagnostic tool is a sacroiliac joint injection performed under image guidance. The injection delivers local anesthetic into the SI joint capsule, and if your typical pain pattern significantly improves in the hours immediately after, the SI joint is confirmed as a primary source. This dual diagnostic-and-therapeutic approach is part of why SI joint injections are usually the first interventional treatment we recommend; they confirm the diagnosis and often provide therapeutic relief simultaneously. ## How PHI Treats SI Joint Pain Once SI joint involvement is confirmed, treatment follows a typical sequence based on response. Sacroiliac joint injections are usually first, delivering local anesthetic and corticosteroid into the joint, often producing relief lasting weeks to several months. Sacroiliac radiofrequency ablation is the natural next step for patients whose injections confirm the diagnosis but produce shorter-than-desired relief; RFA targets the small nerves carrying pain signals from the joint and can extend relief to 6 to 18 months. Regenerative options including PRP, A2M, stem cell therapy, and exosome therapy may be appropriate for patients seeking to support the underlying joint tissue. Sacroiliac joint fusion is reserved for patients with confirmed SI joint pain who have not responded adequately to non-surgical treatments; modern minimally invasive fusion is meaningfully different from older approaches and is performed at our affiliated surgery center as an outpatient procedure. Most patients begin with diagnostic injections and progress to longer-lasting treatments only as needed. ## Why PHI for Sacroiliac Joint Pain ## Frequently Asked Questions **Q: How do I know if my pain is from the SI joint or my lower back?** The pain patterns can overlap, which is part of why SI joint pain is often missed. SI joint pain is typically felt in the lower back and buttock, often more on one side, and worsens with prolonged sitting, standing, stair climbing, or rolling over in bed. Lumbar spine pain often radiates further down the leg with numbness or tingling. The most reliable way to distinguish them is a diagnostic injection. **Q: Why hasn't anyone diagnosed this before?** SI joint pain is genuinely under-diagnosed in primary care and even in some pain practices. Standard imaging often does not capture SI joint involvement clearly, and lumbar causes are more commonly evaluated first. Many patients see multiple providers before someone evaluates the SI joints specifically. **Q: Will an MRI show SI joint pain?** MRI sometimes shows changes in the SI joints, including arthritis or inflammation, but many patients with significant SI joint pain have relatively normal-appearing imaging. The diagnosis often relies more on the pain pattern, physical examination, and response to a diagnostic injection than on imaging alone. **Q: How effective are SI joint injections?** For patients whose pain is genuinely coming from the SI joints, injections often produce significant relief. The duration varies. Some patients experience months of relief from a single injection. Others experience shorter relief that confirms the diagnosis but suggests radiofrequency ablation as a longer-lasting next step. **Q: Will I need fusion?** Most patients with SI joint pain do not need fusion. The vast majority find meaningful relief through injections, radiofrequency ablation, and regenerative options. Fusion is reserved for the subset of patients whose pain has not responded to non-surgical care. **Q: What if I had back surgery and now have SI joint pain?** This is one of the most common scenarios we see. SI joint pain frequently develops after lumbar fusion because the fusion changes how forces transfer through the lower spine. Patients who had successful back surgery and then developed new pain in a different location should be evaluated for SI joint involvement. **Q: Will treatment cure my SI joint pain?** Cure is not always the right word for chronic joint conditions. Many patients experience long-term relief through a combination of treatments and lifestyle modifications. Some require periodic repeat treatment as relief diminishes. The goal is durable, meaningful improvement in your symptoms and function. **Q: Can I exercise with SI joint pain?** In most cases yes, often with modifications. Specific exercises that strengthen the muscles supporting the SI joints can help significantly. Activities involving repetitive impact or asymmetric loading may need temporary modification. Your physician will provide specific guidance. **Q: Do you take insurance?** PHI is a concierge practice and is out-of-network with all insurance plans. We provide detailed invoices that patients may submit to their insurer for potential out-of-network reimbursement. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Sacroiliac Joint Pain PHI offers the full range of evidence-based treatments for sacroiliac joint pain. Your physician will recommend the right option, or combination, based on the severity of your symptoms, your treatment history, and your response to the initial diagnostic injection. - Sacroiliac Joint Injections, diagnostic and therapeutic - Radiofrequency Ablation, extends relief when injections confirm the source - Sacroiliac Joint Fusion, minimally invasive - PRP Therapy - Stem Cell Therapy - A2M Therapy - Exosome Therapy > Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group. Peer-reviewed via PMC, 2025. — [McCormick ZL, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12681192/) > Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Physician, 2015. — [Simopoulos TT, et al.](https://pubmed.ncbi.nlm.nih.gov/26431129/) > Systematic review and meta-analysis of effectiveness of therapeutic sacroiliac joint injections. Pain Physician, 2023. — [Janapala RN, et al.](https://pubmed.ncbi.nlm.nih.gov/37774179/) > Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction. Peer-reviewed via PMC, 2016. — [Polly DW, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5027818/) ## Schedule Your Sacroiliac Joint Consultation A 60-minute consultation will evaluate whether your pain is coming from the SI joints, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now. ### Sciatica ## You Know This Pain When You Feel It Sciatica has a distinctive pattern: pain that starts in your lower back or buttock, then travels down the back of your thigh, sometimes all the way to your foot. It often feels sharp, burning, or electric. Coughing, sneezing, sitting too long, or bending forward can make it dramatically worse. For some patients it is a constant ache; for others it is intermittent shooting pain that arrives without warning. Either way, sciatica interferes with sleep, work, exercise, and the basic mechanics of daily life. The good news: most cases resolve significantly with the right treatment, and most do not require surgery. ## Sciatica Is Actually a Symptom, Not a Diagnosis This nuance matters because it changes how treatment works. Sciatica is the name for the pain pattern, not the underlying cause. The pain happens when one of the nerves traveling from your lower spine into your leg becomes irritated or compressed, so treating it well requires identifying which nerve is involved and what is irritating it. The most common underlying causes: - Herniated disc, the most common cause: a disc presses on or inflames a nearby spinal nerve - Spinal stenosis: the space the nerve travels through narrows with age-related changes - Foraminal stenosis: the specific opening where the nerve exits the spine narrows - Piriformis syndrome: a buttock muscle irritates the sciatic nerve as it passes nearby - Spondylolisthesis: one vertebra slips forward, narrowing the space for the nerve - Less common causes, including tumors, infections, and post-surgical changes Identifying the specific cause guides treatment. Epidural injections work best when the irritation comes from inflammation; selective nerve blocks can both confirm the specific nerve and treat the pain; regenerative options may address the underlying disc tissue. ## How Sciatica Usually Progresses Without treatment, many cases of sciatica improve significantly over six to twelve weeks as the disc herniation or inflammation shrinks and nerve sensitivity settles. This natural improvement is real, and many patients can reasonably wait it out for short periods. But waiting is not always the right answer: severe flares can be debilitating, patients who cannot work or sleep suffer real consequences, and for some patients the symptoms become chronic. Earlier treatment often produces faster relief and may prevent the transition to a chronic pain pattern. ## When to See Someone Consider professional evaluation when your sciatica has lasted more than two to four weeks, the pain interferes with sleep, work, or daily function, you have numbness, weakness, or tingling, conservative treatments have not helped, or you want active treatment rather than continued waiting. Seek prompt evaluation if you experience significant leg or foot weakness, difficulty walking, loss of bladder or bowel control, severe numbness in the groin or inner thighs, or sudden severe pain after a fall or trauma. These can indicate more significant nerve compression that requires urgent attention; call us or go to an emergency department promptly. ## How PHI Treats Sciatica The first step is identifying the specific cause and the specific nerve involved. Your physician evaluates your pain pattern, performs a focused neurological examination, reviews any prior imaging, and sometimes uses diagnostic injections to confirm the source. For most patients whose sciatica is caused by disc herniation, spinal stenosis, or foraminal narrowing, lumbar epidural steroid injections are typically the first interventional treatment, delivering anti-inflammatory medication directly to the irritated nerve. For patients where the source nerve is unclear, selective nerve root blocks can both diagnose and treat. For chronic or recurrent sciatica that has not responded to standard injections, radiofrequency ablation may be appropriate in selected cases. Regenerative options including PRP, A2M, and exosome therapy may address the underlying disc tissue. For the few situations where surgery is the right answer, PHI coordinates with surgical specialists. ## Why PHI for Sciatica ## Frequently Asked Questions **Q: How long does sciatica usually last?** Many cases improve significantly over six to twelve weeks. With targeted treatment, relief is often faster, and some patients improve substantially within days of their first epidural injection. Chronic sciatica lasting more than three months often benefits from interventional treatment to prevent further chronicity. **Q: Will my sciatica come back?** This depends on the underlying cause. Some patients have a single episode and never experience sciatica again; others have recurring episodes related to ongoing disc issues, spinal arthritis, or activity patterns. Treatment addresses current symptoms, while ongoing management of underlying causes affects long-term recurrence. **Q: Should I rest or stay active?** Brief rest during severe acute flares is reasonable, but extended bed rest typically slows recovery. Gentle continued activity is generally better than complete immobility. Your physician will provide specific guidance for your situation. **Q: Will an epidural injection cure my sciatica?** The injection does not address the underlying disc or structural cause; it reduces inflammation around the irritated nerve, which often produces meaningful relief. Many patients experience lasting relief because the inflammation cycle is interrupted long enough for natural healing to progress. Others need additional treatment. **Q: Is sciatica the same as a pinched nerve?** The term pinched nerve is informal language for nerve compression or irritation. Sciatica specifically describes nerve irritation in the lower back radiating down the leg. They overlap but are not exactly synonymous, and cervical radiculopathy is a similar pattern in the neck and arm. **Q: What if I've had sciatica for years?** Chronic sciatica often becomes an established pain pattern even when the original cause has resolved. A comprehensive evaluation can address both the underlying cause and any chronic pain components that have developed. Treatment options are still meaningful even after years of symptoms. **Q: Will I need surgery?** Most patients with sciatica do not need surgery. The vast majority find meaningful relief through non-surgical approaches including injections, nerve blocks, radiofrequency ablation, and regenerative medicine. Surgery is reserved for specific situations. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Sciatica PHI offers the full range of evidence-based treatments for sciatica. Your physician will recommend the right option, or combination, based on the specific underlying cause, the severity of your symptoms, and your treatment history. - Epidural Steroid Injections, the usual first interventional step for radiating nerve pain - Nerve Blocks, selective nerve root blocks that confirm and treat the source nerve - Radiofrequency Ablation, for chronic or recurrent cases in selected patients - PRP Therapy - A2M Therapy - Exosome Therapy > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PubMed, 2025. — [American Academy of Neurology Guidelines Subcommittee](https://pubmed.ncbi.nlm.nih.gov/39938000/) ## Schedule Your Sciatica Consultation A 60-minute consultation will identify the specific cause of your sciatica, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Shoulder Arthritis ## When Your Shoulder Decides You Can't Sleep On That Side Shoulder arthritis tends to announce itself in specific ways. Pain when you reach overhead. Difficulty putting on a shirt or jacket. The realization that you cannot sleep on that shoulder anymore. Tennis or golf shots that do not feel right. Hairstyling, reaching for items on shelves, or buckling a seatbelt becomes an effort. Many shoulder arthritis patients are surprised by how much the condition affects sleep. The shoulder is non-weight-bearing during the day, but lying on it at night puts pressure on the arthritic joint, and patients often describe waking up repeatedly trying to find a comfortable position. Most patients we see have been told either that they will need a replacement eventually or that there is nothing to do but modify activities and take anti-inflammatories. Both framings skip over the meaningful treatment options that exist at most stages. ## What Shoulder Arthritis Actually Is Your shoulder is the most mobile joint in your body. The term shoulder arthritis usually refers to the glenohumeral joint, where the head of your humerus sits in the shallow socket of your shoulder blade. This joint trades stability for mobility: the shallow socket allows enormous range of motion but relies heavily on surrounding structures, especially the rotator cuff, for stability. When arthritis develops, the cartilage between the bones wears down, producing pain, stiffness, and reduced range of motion. Common forms include glenohumeral osteoarthritis (the most common), rheumatoid and other inflammatory arthritis (coordinated with rheumatology), post-traumatic arthritis, cuff tear arthropathy (which develops after long-standing rotator cuff tears), and acromioclavicular joint arthritis at the top of the shoulder. Each requires somewhat different evaluation and treatment. ## A Common Diagnostic Question, Arthritis or Rotator Cuff? One of the most common diagnostic questions for shoulder pain in patients over 50 is whether the primary issue is arthritis, a rotator cuff problem, or both. The two often coexist, and patients labeled with shoulder arthritis sometimes have rotator cuff issues that are actually more responsible for their symptoms. Treatment recommendations vary significantly based on which is dominant. PRP for rotator cuff tendinopathy is different from regenerative treatment for arthritis. Knowing which is driving the pain matters, which is part of why thorough evaluation matters. Many shoulder pain patients arrive having been treated for the wrong primary diagnosis. Common features of shoulder arthritis include pain with overhead activities, night pain when lying on the affected side, gradual stiffness and reduced range of motion, deep pain rather than at a specific surface point, and cracking or grinding with movement. ## How PHI Treats Shoulder Arthritis Treatment begins with a comprehensive evaluation: a detailed history, an examination assessing range of motion, strength, and patterns suggesting joint versus rotator cuff involvement, and review of imaging. Based on that, options include: Image-guided shoulder injections with cortisone for inflammation. The shoulder is a joint where image guidance significantly improves accuracy because surface landmarks often misidentify the precise target, so PHI uses image guidance for every shoulder injection, with cortisone's cumulative considerations discussed honestly. PRP therapy, particularly useful for shoulders with combined arthritis and rotator cuff components. A2M therapy, which neutralizes cartilage-destroying enzymes and is relevant for early-to-moderate arthritis. Stem cell therapy for moderate to severe arthritis or after PRP. Exosome therapy within comprehensive protocols. When shoulder replacement is appropriate, we coordinate with orthopedic specialists; modern reverse shoulder arthroplasty has made replacement possible for patients with cuff tear arthropathy who previously had few options. ## When to See Someone Consider professional evaluation when your shoulder pain has lasted more than four to six weeks without improvement, when it interferes with sleep or daily activities, when you are avoiding overhead activities or work tasks, when you want to understand non-surgical options, or when you are considering replacement and want to explore alternatives first. Seek prompt evaluation if you experience sudden severe shoulder pain following an injury, significant new weakness in the arm, inability to lift the arm, or significant joint swelling, warmth, or redness. ## Why PHI for Shoulder Arthritis ## Frequently Asked Questions **Q: How is shoulder arthritis different from rotator cuff problems?** Shoulder arthritis specifically involves cartilage breakdown in the joint. Rotator cuff problems involve the muscles and tendons that surround and stabilize the shoulder. The two often coexist, and patients sometimes have one labeled as the cause when the other is actually more responsible. Treatment approaches differ significantly, so identifying which is dominant matters. **Q: Will I need a shoulder replacement?** This depends on the stage of your arthritis, the condition of your rotator cuff, and how your shoulder is affecting your life. Many patients with mild to moderate arthritis manage successfully with non-surgical treatment. Patients with advanced arthritis often eventually benefit from replacement, and modern reverse shoulder arthroplasty has made replacement possible for patients who were not candidates for traditional replacement. **Q: Why do shoulder injections need image guidance?** The shoulder has multiple potential injection targets, and surface landmarks alone often misidentify which target the needle is reaching. Image guidance ensures the medication actually goes where intended, which significantly improves both safety and effectiveness. **Q: Are repeated cortisone injections safe for the shoulder?** Cortisone is well-established for shoulder arthritis. Like other joints, repeated frequent cortisone has cumulative considerations. For most patients occasional cortisone is appropriate. For patients requiring frequent repeat injections, regenerative options often make more sense. **Q: Can I exercise with shoulder arthritis?** Yes, with appropriate adjustments. Maintaining shoulder mobility through gentle range-of-motion work is important, and strengthening the rotator cuff and surrounding muscles often helps support the joint. Heavy overhead loading or impact may need modification. A physical therapist who understands shoulder arthritis can help significantly. **Q: Will I get my range of motion back?** This depends on how much range you have lost and what is causing the limitation. Some range loss can be improved with targeted treatment combined with physical therapy. Some range loss from advanced arthritis is structural and may not fully return without surgery. We are honest about realistic expectations. **Q: What about reverse shoulder replacement?** This is a specific type of shoulder replacement designed for patients with significant rotator cuff problems alongside arthritis. It has been a major advance for patients who previously did not have good surgical options. PHI does not perform shoulder replacement but coordinates referral when this evaluation is appropriate. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Shoulder Arthritis PHI offers the full range of evidence-based treatments for shoulder arthritis. Your physician will recommend the right option, or combination, based on the stage of your arthritis, whether other shoulder structures are involved, your goals, and your treatment history. - Shoulder Injections, image-guided cortisone for inflammation - PRP Therapy - Stem Cell Therapy - A2M Therapy - Exosome Therapy > The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Peer-reviewed via PubMed. — [Wernecke C, et al.](https://pubmed.ncbi.nlm.nih.gov/26674652/) > Clinical practice guideline: management of glenohumeral joint osteoarthritis. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/upper-extremity-programs/glenohumeral-joint-osteoarthritis/) ## Schedule Your Shoulder Arthritis Consultation A 60-minute consultation will identify what stage of shoulder arthritis you are dealing with, whether other shoulder structures are involved, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now. ### Shoulder Pain ## Shoulder Pain Has More Causes Than Most Patients Are Told Shoulder pain is one of the most commonly mislabeled musculoskeletal complaints. Patients often arrive having been told they have shoulder arthritis when they actually have a rotator cuff issue. Or they have been told they need surgery when their problem responds well to non-surgical treatment. Or they have been treated with cortisone repeatedly without anyone identifying what is actually causing the pain. The shoulder is a complex joint with multiple structures that can generate pain: the rotator cuff, the labrum, the bursae, the biceps tendon, the joint capsule, the AC joint, and the glenohumeral joint itself. When something goes wrong with any of these, the pain can feel broadly similar but actually has very different causes and treatments. The right treatment depends on the right diagnosis. ## Common Sources of Shoulder Pain The pattern of your pain often points to the source. #### Pain with overhead activities Pain that develops or worsens with reaching, lifting, throwing, or swimming often suggests rotator cuff tendinopathy, rotator cuff tears, subacromial bursitis, or shoulder impingement. These conditions are more common than shoulder arthritis and respond well to PRP therapy, image-guided injections, and structured rehabilitation. #### Pain at night, or stiffness with severe limitation Night pain when lying on the shoulder often involves rotator cuff problems, arthritis, or frozen shoulder. Significant loss of range of motion, particularly the ability to rotate your arm or reach behind your back, often suggests frozen shoulder (adhesive capsulitis), which has a distinctive course over months and responds to specific treatment. See our Shoulder Arthritis page for more on cartilage wear. #### Pain at the top of the shoulder, or catching and clicking Pain at the top of the shoulder, particularly with cross-body movements or carrying, often suggests AC joint arthritis or injury. Sharp catching, clicking, or instability with specific movements can suggest labral tears, biceps tendon problems, or loose bodies, which often benefit from imaging-confirmed diagnosis. #### Pain after a specific injury Shoulder pain that developed after a fall, contact, or twisting injury often involves the structures most stressed by that mechanism. Acute injuries often need both diagnostic imaging and active treatment to support proper healing. ## When to See Someone Consider professional evaluation when your shoulder pain has lasted more than four to six weeks without improvement, when it interferes with sleep, work, or activities, when you are avoiding overhead activities, when conservative treatments have not helped, or when you have been treated for one diagnosis without success. Seek prompt evaluation if you experience sudden severe shoulder pain following a fall, significant new arm weakness, inability to lift the arm at all, visible deformity, significant joint swelling, warmth, or redness, or shoulder pain accompanied by chest pain or other symptoms that can indicate a cardiac cause requiring immediate evaluation. ## How PHI Approaches Shoulder Pain The first step is comprehensive evaluation to identify the actual source: a detailed history of what makes the pain worse or better, an examination with specific tests for rotator cuff involvement, joint pathology, labral issues, and frozen shoulder, review of imaging, and sometimes a diagnostic injection when uncertainty exists. Once the source is clear, options include image-guided shoulder injections with cortisone (the shoulder has multiple targets, so image guidance ensures the medication reaches the right structure), PRP therapy for rotator cuff tendinopathy, partial tears, and AC joint problems, stem cell therapy for moderate to severe conditions, A2M therapy for cartilage involvement, and exosome therapy within comprehensive protocols. For full-thickness rotator cuff tears requiring repair, significant labral injuries, or end-stage arthritis, we coordinate with orthopedic specialists. ## Why PHI for Shoulder Pain ## Frequently Asked Questions **Q: How do I know if my shoulder pain is from rotator cuff or arthritis?** The pattern often gives strong clues. Rotator cuff issues typically involve pain with overhead activities, weakness, and night pain when lying on the shoulder. Arthritis typically involves stiffness, deep aching pain, and gradual loss of range of motion. The two often coexist, and physical examination plus imaging usually identifies which is dominant. **Q: Do I need surgery for a rotator cuff tear?** Not necessarily. Many rotator cuff tears, particularly partial and degenerative tears in patients over 50, respond well to non-surgical treatment including PRP, image-guided injections, and structured rehabilitation. Acute traumatic tears in younger active patients are more likely to benefit from surgical repair. We help you understand which category your tear falls into. **Q: What about frozen shoulder?** Frozen shoulder (adhesive capsulitis) has a specific course and responds to specific treatment. Image-guided injections combined with structured physical therapy is typically the first approach, and some patients benefit from hydrodilatation. Most cases resolve over time with appropriate treatment, though the timeline can be long, months to a year or more. **Q: I have a rotator cuff tear on imaging. Should I be worried?** Many rotator cuff tears identified on imaging in patients over 40 are not the source of their pain and do not require treatment. Patients can have significant rotator cuff changes while remaining functional and pain-free. The relationship between imaging findings and symptoms is not always direct, and your physician can help you understand whether your specific findings are likely causing your pain. **Q: Can PRP help my rotator cuff?** PRP has accumulating evidence for rotator cuff tendinopathy and partial tears. For appropriate candidates, it can produce meaningful improvement in pain and function. It is most appropriate for partial tears and tendinopathy rather than full-thickness tears in active patients. Your physician will discuss whether PRP fits your situation. **Q: I've had multiple cortisone shots in my shoulder. Is that a problem?** Repeated cortisone in the same shoulder location has cumulative considerations. For most patients occasional cortisone is appropriate. For patients requiring frequent repeat injections, regenerative options often make more sense both for the underlying tissue and for managing symptoms. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: How quickly can I be seen?** Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Shoulder Pain PHI offers the full range of evidence-based treatments for shoulder pain. Your physician will recommend the right option, or combination, based on the actual source of your pain, your imaging, and your treatment history. - Shoulder Injections, image-guided - PRP Therapy, strong evidence for rotator cuff tendinopathy - Stem Cell Therapy - A2M Therapy - Exosome Therapy > Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Peer-reviewed via PubMed. — [Kuhn JE, et al.](https://pubmed.ncbi.nlm.nih.gov/23540577/) > Clinical practice guideline: management of rotator cuff injuries. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/upper-extremity-programs/rotator-cuff-injuries/) ## Schedule Your Shoulder Pain Consultation A 60-minute consultation will identify the actual source of your shoulder pain, walk through the treatment options that match it, and give you a clear plan. Call (310) 856-9488 or book online now. ### Skin Health & Aging ## What This Page Is and Isn't Before getting into specifics, we want to be clear about PHI's role in skin care. What PHI offers is the medical wellness side of skin health: red light therapy, IV nutrient protocols, and peptide therapy that may support skin from a cellular and tissue health perspective. What PHI does not offer is cosmetic injectables for aesthetic indications (wrinkle reduction with neurotoxin), dermal fillers, laser treatments, chemical peels, microneedling, or other aesthetic procedures. These are dermatology and medical aesthetics services, typically provided by dermatologists, board-certified plastic surgeons, or specialized aesthetic practices. If you are looking for comprehensive aesthetic treatment, this page will be honest that PHI is not the primary provider you need, and we will explain what we do offer and how it may complement your existing aesthetic care. ## What Skin Health Actually Involves Skin aging has multiple components, and effective skin care typically addresses several of them: collagen and structural integrity, barrier function and hydration, inflammation regulation, oxidative stress, hormonal contributors, lifestyle factors, and skin-specific care through topical products and dermatological treatment. PHI's offerings address some of these, including cellular function, inflammation, nutrient status, and certain hormone-related signaling. They do not replace dermatological care or comprehensive aesthetic treatment. ## What PHI Offers for Skin Health Red light therapy delivers specific wavelengths of red and near-infrared light that may support skin health through several mechanisms; evidence for skin applications is among the most established uses of red light therapy, including collagen stimulation and skin firmness, modest reduction of fine lines and wrinkles, skin tone and texture improvements, and photoaging. It is non-invasive, well-tolerated, and can be used regularly. IV therapy with specific nutrient formulations may support skin from inside; common skin-focused protocols include high-dose vitamin C (which supports collagen production and provides antioxidant effects), glutathione, B-complex vitamins, and zinc. Peptide therapy uses specific compounds, some of which may support skin health, discussed individually without listing specific peptides publicly. These are delivered in our clinic setting, and they work best as part of comprehensive skin care that includes your dermatologist or aesthetic provider. ## When This Page Applies to You You may benefit from PHI's offerings if you are looking for the wellness and cellular-health side of skin care alongside dermatological or aesthetic treatment, if you want to support skin from inside through nutrient and cellular interventions, if you are pursuing comprehensive longevity care that includes skin, or if you want post-procedure recovery support for procedures done elsewhere. You are typically better served elsewhere first if you are looking for cosmetic injectables, fillers, lasers, chemical peels, or microneedling, or if you have specific dermatological concerns such as acne requiring medical management, suspicious lesions, or conditions like eczema or rosacea requiring treatment. For comprehensive aesthetic care, established Beverly Hills resources include dermatology practices, board-certified plastic surgeons, and specialty medical aesthetic practices. ## Why PHI for Skin Health Support ## Frequently Asked Questions **Q: Do you do neurotoxin for wrinkles?** PHI does therapeutic neurotoxin for medical conditions such as chronic migraine and TMJ pain. We do not offer aesthetic neurotoxin for wrinkle reduction. For that, work with a dermatologist or medical aesthetics provider. **Q: Do you do fillers, lasers, or chemical peels?** No. These are dermatology and medical aesthetics services. PHI focuses on the wellness and cellular-health side of skin care, not aesthetic procedures. **Q: How effective is red light therapy for skin?** Red light therapy has accumulating evidence for skin applications including collagen stimulation, photoaging, and skin texture improvement, with studies demonstrating measurable improvements in fine lines, tone, and firmness with consistent use. Effects develop over weeks to months of regular treatment. **Q: Can IV vitamin C improve my skin?** Vitamin C is essential for collagen production and provides antioxidant effects, and IV delivery achieves higher blood levels than oral supplementation. Whether this translates to meaningful clinical skin benefit depends on baseline status and consistency. For patients with documented vitamin C status concerns or specific contexts, IV vitamin C has clearer rationale than for general wellness use. **Q: What about glutathione for skin?** Glutathione is a major antioxidant with skin-relevant effects, used in some wellness contexts for skin support. Evidence for specific aesthetic claims varies and is mixed. We discuss honestly what evidence supports rather than making aesthetic claims that exceed evidence. **Q: Will these treatments work without a good skincare routine?** Less effectively than with one. Topical skincare such as sun protection, retinoids when appropriate, antioxidant serums, and appropriate moisturizers provides foundational support that medical wellness interventions complement rather than replace. We coordinate with your dermatology or skincare resources. **Q: What about menopausal skin changes?** Skin changes around menopause are largely hormonally driven. Comprehensive management often involves dermatology for skin-specific care, gynecology or primary care for hormonal aspects, and supportive interventions like those PHI offers. The biggest leverage is typically in hormonal management when appropriate. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Skin Health Support PHI offers wellness-focused treatments that may support skin health from within. Your physician will recommend the right options based on your specific situation and existing skin care. We do not offer cosmetic injectables, fillers, or laser procedures. - Red Light Therapy, most established for collagen and skin texture - IV Therapy, vitamin C - Peptide Therapy > A controlled trial to determine the efficacy of red and near-infrared light treatment in patient satisfaction, reduction of fine lines, wrinkles, skin roughness, and intradermal collagen density increase. Peer-reviewed via PubMed. — [Wunsch A, Matuschka K](https://pubmed.ncbi.nlm.nih.gov/24286286/) > Low-level laser (light) therapy in skin: stimulating, healing, restoring. Peer-reviewed via PMC. — [Avci P, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC4126803/) > The roles of vitamin C in skin health. Nutrients. — [Pullar JM, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5579659/) > Skin care basics. American Academy of Dermatology. — [American Academy of Dermatology](https://www.aad.org/public/everyday-care/skin-care-basics) ## Schedule Your Skin Health Consultation A 60-minute consultation will evaluate your specific situation, discuss what PHI can offer alongside your dermatology or aesthetic care, and recommend treatments that complement your existing skin care. Call (310) 856-9488 or book online now. ### Spinal Stenosis ## When Walking Becomes Hard Spinal stenosis has a distinctive pattern that most patients recognize quickly once they hear it described. Walking or standing causes pain, weakness, or numbness in your legs. Sitting down or leaning forward gives relief. The pain is rarely worse at rest; it builds when you are upright and active. You may have noticed that you can walk a short distance and then need to stop and sit, that pushing a shopping cart is more comfortable than walking upright, that standing for long periods is increasingly difficult, that walking uphill is somehow easier than flat ground, and that the symptoms have developed gradually over years rather than suddenly. If this sounds like your experience, the pattern is recognizable, the diagnosis is straightforward when it fits, and we can help you understand your options. ## What's Actually Happening The spinal canal is the space inside your spine through which the spinal cord and nerves travel. Spinal stenosis means this space has become narrower than it should be, putting pressure on the nerves passing through. The narrowing is usually caused by age-related changes: thickening of ligaments, arthritis of the spinal joints, bulging discs, and the formation of bone spurs. These changes happen gradually, which is why symptoms typically develop slowly and worsen over time. There are two main types based on location. Lumbar spinal stenosis affects the lower back, with leg pain or weakness on walking and standing, and is the most common type. Cervical spinal stenosis affects the neck and can include arm pain, hand weakness, balance problems, and in more severe cases walking difficulty from spinal cord involvement; cervical stenosis sometimes requires more urgent evaluation. PHI treats both. ## How Spinal Stenosis Progresses Spinal stenosis is a structural condition that typically progresses slowly. Most patients experience gradual worsening over years rather than rapid decline. Some remain stable for long periods; others find their walking distance shrinking from blocks to half-blocks to a few steps. The progression is usually gradual enough to allow real decision-making about treatment timing. The honest part is that no current non-surgical treatment reverses the underlying narrowing. Treatments can manage symptoms and provide meaningful relief, sometimes for years, but they do not widen the spinal canal. Some patients can manage stenosis non-surgically for a long time; for others, surgery eventually becomes the right answer. ## When to See Someone Consider professional evaluation when your walking distance has been decreasing, when you are avoiding activities you used to enjoy because of leg pain or fatigue, when you experience leg weakness or numbness with walking or standing, or when symptoms are interfering with your daily life and independence. Seek prompt evaluation if you experience new or worsening weakness in your legs or arms, loss of bladder or bowel control, difficulty with balance or coordination, or severe symptoms that develop suddenly or rapidly worsen. These can indicate more significant nerve or spinal cord involvement that requires urgent attention. ## How PHI Treats Spinal Stenosis The first step is an honest assessment of where you are. We evaluate your symptoms, review your imaging or recommend imaging if needed, and have a frank conversation about what non-surgical treatment can and cannot do for your specific situation. For patients whose symptoms are driven significantly by inflammation around the compressed nerves, lumbar epidural steroid injections often produce meaningful relief lasting weeks to several months, and some patients manage stenosis for years with periodic injections combined with appropriate activity modification. For patients seeking to support the underlying spinal tissues, regenerative options including PRP, A2M, and exosome therapy may be appropriate in selected cases, though the evidence here is more limited and we discuss that honestly. For patients whose symptoms are severe and not responding to non-surgical treatment, modern decompression surgery can dramatically improve walking distance and quality of life; PHI does not perform lumbar decompression but coordinates with the spine surgeons we work closely with when that step makes sense. ## Why PHI for Spinal Stenosis ## Frequently Asked Questions **Q: Will spinal stenosis get worse?** Most patients experience gradual worsening over years. Some remain stable for long periods. The rate of progression varies significantly between individuals. Your physician can give you a more specific assessment based on your imaging and current symptoms. **Q: Can spinal stenosis be reversed without surgery?** No current non-surgical treatment reverses the underlying narrowing. Non-surgical treatments manage symptoms and can provide meaningful relief, sometimes for years, but they do not widen the spinal canal. Surgery is the only intervention that addresses the structural narrowing directly. **Q: How effective are epidural injections for spinal stenosis?** Injections are most effective for symptoms driven by inflammation around the compressed nerves. For patients with a strong inflammatory component, they often provide relief lasting weeks to several months. For patients whose symptoms are primarily mechanical compression, the response may be less robust. Your physician will give you a realistic estimate. **Q: How do I know if I need surgery?** The decision typically depends on the severity of your symptoms, how they are affecting your life, and your response to non-surgical treatment. Patients with severe walking limitations, persistent symptoms despite injections, or progressive neurological changes are typically reasonable surgical candidates. The decision is yours, made with full understanding of what surgery can and cannot offer. **Q: What kind of surgery is done for spinal stenosis?** The most common surgery is a laminectomy or decompression, which removes the bone or tissue causing the narrowing. Some patients require fusion in addition to decompression. Modern minimally invasive approaches are available for many patients. The spine surgeons we work with can discuss specifics if surgery becomes the right next step. **Q: Can I exercise with spinal stenosis?** Yes, often with modifications. Activities that involve forward bending, such as cycling, swimming, or walking with a cart, are typically more comfortable than activities that involve extension. Many patients benefit from working with a physical therapist who understands spinal stenosis. **Q: Will losing weight help?** Weight management can reduce the load on the spine and may improve symptom severity, though it does not change the underlying narrowing. Combined with appropriate exercise and treatment, it is often a useful component of long-term management. **Q: Do you take insurance?** As a concierge practice, PHI is out-of-network with all insurance plans, ensuring clinical judgment is never dictated by coverage decisions. All pricing is disclosed at consultation. **Q: How quickly can I be seen?** Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Spinal Stenosis PHI offers evidence-based non-surgical treatments for spinal stenosis. Your physician will recommend the right option based on the location of your stenosis, the severity of your symptoms, and your goals. Surgical referral is coordinated when appropriate. - Epidural Steroid Injections, often the first interventional step for inflammation-driven symptoms - PRP Therapy - A2M Therapy - Exosome Therapy > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PMC, 2022. — [American Academy of Neurology Guidelines Subcommittee](https://pmc.ncbi.nlm.nih.gov/articles/PMC12289388/) > Epidural Steroid Injections. StatPearls, peer-reviewed via NIH/NCBI. — [StatPearls (NIH/NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK470189/) ## Schedule Your Spinal Stenosis Consultation A 60-minute consultation will evaluate your specific situation, walk through realistic treatment options, and give you a clear understanding of what to expect from each path. Call (310) 856-9488 or book online now. ### Sports Recovery & Performance ## When You Want More From Your Body Active people who train seriously hit a point where the basics are not enough. You are sleeping well, eating well, and following a sound training program. You are not injured. You are just looking for an edge: faster recovery between training sessions, better performance when it matters, the ability to train hard at 45 the way you trained at 30, resilience through a long season or a demanding event schedule. This page is for that patient, not the injured athlete trying to get back to their sport, and not the patient managing chronic pain. We approach this the same way we approach every clinical question at PHI: honest about what is evidence-supported, honest about what is emerging, and honest about what is wellness-positioning more than scientific reality. The available options are real and meaningful for the right patient. They are also not magic. ## What Recovery and Performance Optimization Actually Looks Like Recovery and performance optimization is not about a single treatment. It is about supporting the systems that affect how you train, recover, and perform: hydration and nutrient status, muscle protein synthesis and tissue repair, inflammation regulation (the goal is appropriate inflammation, not zero), mitochondrial function, sleep quality (one of the most underrated performance factors), and mobility and tissue health. PHI's offerings address several of these systems. We are honest that no medical treatment substitutes for the foundational work of good training programming, sleep, nutrition, and recovery practices. ## How PHI Approaches Performance Optimization The first step is a comprehensive evaluation of your training, sport, performance goals, current recovery patterns, and any factors limiting performance, followed by an honest discussion of what medical optimization can and cannot do, including WADA considerations if you compete at a level where this applies. IV therapy delivers hydration, electrolytes, and specific nutrients directly into circulation, most useful around hard training blocks or recovery from demanding events. Peptide therapy uses specific compounds that may support recovery and tissue repair, discussed individually without listing specific peptides publicly. EMSCULPT NEO is FDA-cleared for muscle building and fat reduction and may complement training for specific muscle groups. Red light therapy delivers wavelengths that may support muscle recovery, with evidence most established for recovery and inflammation. These treatments are delivered in our clinic setting under physician supervision, and they complement rather than replace your training program, physical therapy, and sports medicine providers. ## When This Page Applies to You You may benefit from PHI's offerings if you are training seriously for a specific goal, want to recover faster from hard sessions, are noticing recovery taking longer as you age, are a competitive amateur or professional athlete looking for evidence-based support, or want to integrate medical recovery support with your existing practices. You are typically better served elsewhere first if you have an active injury that should be evaluated and treated before optimization, if you are looking for performance enhancement that conflicts with WADA or your sport's anti-doping rules, or if you are hoping for transformation without the foundational training, sleep, and nutrition work. ## Why PHI for Sports Recovery and Performance ## Frequently Asked Questions **Q: Can these treatments actually make me a better athlete?** Within reason, yes. Medical recovery support helps you train more consistently, recover from hard sessions faster, and maintain performance through long seasons. The improvement is incremental rather than dramatic. The biggest performance factors remain training programming, sleep, nutrition, and time; medical optimization adds value on top of those foundations rather than replacing them. **Q: Is IV therapy worth it for athletes?** For active patients with specific deficits, hard training blocks, or recovery from demanding events, yes. For active patients without specific deficits, the marginal benefit is smaller. We are honest about which category you are in based on evaluation. **Q: Does EMSCULPT NEO replace working out?** No. EMSCULPT NEO produces muscle contractions during the session beyond what voluntary exercise produces, which can support muscle development, but ongoing training is still essential. It complements training; it does not replace it. **Q: Are peptides legal?** Some peptides are appropriately prescribed by physicians for specific applications; others have regulatory considerations that have evolved over time. We discuss the specific peptides we offer and their regulatory status during consultation, and PHI does not offer peptides outside the framework of legitimate medical use. **Q: Will these affect my drug testing for sport?** This depends on your sport's specific rules and what is being administered. Some treatments are universally permitted; others have considerations for elite athletes subject to WADA testing. We discuss specifics during consultation if you compete at that level. **Q: How is red light therapy different from a tanning bed?** Different wavelengths, different mechanisms, different effects. Tanning beds produce UV light with cumulative cancer risk concerns. Red light therapy uses specific red and near-infrared wavelengths that do not produce UV exposure and have different physiological effects on cells. **Q: How often do active patients use these services?** This varies significantly. Some use IV therapy occasionally around hard training periods; others have regular protocols. EMSCULPT NEO typically involves a defined treatment series, and red light therapy can be used regularly. Your physician will help you understand what frequency makes sense. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Treatment can be coordinated to fit competition and travel schedules. ## Treatments We Offer for Sports Recovery and Performance PHI offers evidence-based and supportive treatments for sports recovery and performance optimization. Your physician will recommend the right combination based on your sport, goals, and what you are trying to optimize. - IV Therapy, hydration and targeted nutrients around training - Peptide Therapy - EMSCULPT NEO, FDA-cleared muscle building and fat reduction - Red Light Therapy, most established for muscle recovery > The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials. Peer-reviewed via PMC, 2021. — [Tripodi N, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8364035/) > High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Peer-reviewed via PMC, 2019. — [Kinney BM, Lozanova P](https://pmc.ncbi.nlm.nih.gov/articles/PMC6585690/) > WADA Prohibited List. World Anti-Doping Agency. — [World Anti-Doping Agency](https://www.wada-ama.org/en/prohibited-list) ## Schedule Your Sports Recovery Consultation A 60-minute consultation will evaluate your specific situation, walk through which optimization options match your goals, and give you a clear plan that integrates with your existing training and recovery. Call (310) 856-9488 or book online now. ### Stress & Burnout ## When You've Been Running on Empty for Too Long Burnout has a particular trajectory. It usually starts with high engagement: the role you cared deeply about, the sense you could handle whatever came, long hours that felt productive. Then something shifts. The fatigue stops resolving with weekends. Tasks that used to feel meaningful start feeling pointless. Sleep stops being restorative. Small problems trigger disproportionate reactions. By the time most patients arrive for stress and burnout concerns, they have been pushing through for months or years. They have often tried the obvious things: meditation apps, occasional yoga, vacation that did not feel restorative, lifestyle adjustments. Some of these help; none have been enough. What we offer is the medical wellness side of burnout recovery. We are honest that real recovery typically requires addressing root causes, sometimes including significant changes in work patterns, boundaries, or life structure. Medical support helps; it does not substitute for addressing what is actually driving the burnout. ## Burnout Is a Real Clinical Phenomenon The World Health Organization formally classifies burnout as an occupational phenomenon characterized by three dimensions: feelings of energy depletion or exhaustion; increased mental distance from one's job, or negativity and cynicism related to it; and reduced professional efficacy. Research has demonstrated specific physiological changes associated with chronic stress and burnout, including HPA axis dysregulation, altered cortisol patterns, immune system effects, and sleep architecture changes. These are not imagined; they are measurable biological consequences of chronic stress without adequate recovery. This is why "just relax more" advice often falls flat. The biological changes do not reverse on a long weekend, and recovery typically requires sustained changes alongside support that addresses the cumulative effects. ## When Stress Has Crossed Into Mental Health Territory Severe burnout often overlaps with depression and anxiety. Symptoms that warrant mental health evaluation include persistent low mood lasting more than two weeks, loss of interest in activities you previously enjoyed, significant sleep or appetite changes, difficulty concentrating beyond what is expected, feelings of worthlessness or excessive guilt, thoughts of self-harm, or anxiety that feels disproportionate or unmanageable. If you are experiencing these patterns, please pursue mental health evaluation alongside or before wellness intervention. Your primary care physician, psychiatrist, or therapist is the appropriate first resource. PHI's wellness offerings work best for stress and burnout that has not crossed into significant mental health territory, or as adjuncts alongside appropriate mental health care. ## What Recovery Actually Requires Effective recovery from significant burnout typically involves multiple components: addressing root causes (often workload reduction, boundary changes, or role modifications), adequate recovery time (usually longer than people expect), sleep restoration, mental health support, lifestyle factors, and medical support for the biological aspects of chronic stress. PHI's offerings address the medical support component. The other components require your own commitment and often other providers. Medical support without addressing underlying causes typically produces temporary improvement that does not last. ## How PHI Approaches Stress and Burnout The first step is a comprehensive evaluation: a detailed history of your experience, discussion of contributing factors, screening for mental health symptoms requiring specific care, review of current providers and lifestyle factors, and an honest assessment of which medical interventions may help in your situation. Treatment options include IV therapy, which delivers nutrients directly into circulation and may address depleted nutrient stores from chronic stress; NAD+ therapy, a coenzyme involved in cellular energy production that some patients report improves energy and resilience, with evidence we describe as emerging rather than established; and ketamine infusion therapy for selected patients whose burnout has crossed into significant depression that has not responded adequately to standard treatment. These treatments are delivered in a clinic setting under physician supervision, not in the Surgical Suite. PHI's role is supportive optimization, coordinated with your mental health and primary care providers. ## Why PHI for Stress and Burnout Recovery ## Frequently Asked Questions **Q: How is burnout different from regular stress?** Regular stress responds to recovery such as good sleep, time off, and addressing the stressor. Burnout involves cumulative effects that do not fully resolve with these typical approaches. The WHO classification captures three dimensions, namely exhaustion, cynicism, and reduced efficacy. The biological and psychological changes typically require sustained recovery rather than brief breaks. **Q: Can IV therapy fix burnout?** No. IV therapy can support recovery and address depleted nutrient stores, but it does not fix burnout. Real recovery requires addressing the underlying causes and typically multiple components of support. IV therapy is one tool among many, not a solution. **Q: How long does burnout recovery take?** This varies significantly. Mild cases may resolve over weeks of reduced demands and active recovery. Moderate cases often take several months. Severe cases can require six months to a year or more. Patience matters; trying to rush recovery often extends it. **Q: Should I take time off work?** Often yes, particularly for moderate to severe burnout. The biological recovery typically cannot happen while demands continue at the level that caused the burnout. This may mean reduced workload, vacation, sabbatical, leave, or role changes. We can discuss this during consultation. **Q: Will ketamine help my burnout?** For most patients with stress and burnout, ketamine is not the primary treatment. For burnout patients whose situation has crossed into treatment-resistant depression that has not responded to standard care, ketamine has strong evidence for the depression component. We carefully evaluate whether it is appropriate for each situation rather than offering it broadly for stress. **Q: What about adrenal fatigue?** Adrenal fatigue is a popular but not medically validated term. The actual phenomenon involves HPA axis dysregulation from chronic stress, which is real but more complex than the adrenal-fatigue framing suggests. We discuss this honestly during consultation rather than treating adrenal fatigue as a primary diagnosis. **Q: Can I just push through?** Often this approach extends or worsens burnout rather than resolving it. The biological changes do not respond to willpower. Sustained recovery typically requires actually reducing the load, not just developing better coping mechanisms while maintaining the same demands. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Stress and Burnout PHI offers supportive medical treatments for stress and burnout recovery alongside broader care. Your physician will recommend the right options based on your situation, severity, and existing care. - IV Therapy, targeted nutrient repletion for chronic stress - NAD+ Therapy - Ketamine Infusion Therapy, for selected cases with treatment-resistant depression overlap > Burn-out an occupational phenomenon: International Classification of Diseases. World Health Organization. — [World Health Organization](https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases) > Stress, adaptation, and disease: allostasis and allostatic load. Annals of the New York Academy of Sciences. — [McEwen BS](https://pubmed.ncbi.nlm.nih.gov/9629234/) > Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion. American Journal of Psychiatry. — [McIntyre RS, et al.](https://pubmed.ncbi.nlm.nih.gov/33726522/) > NAD+ metabolism and the control of energy homeostasis. Cell Metabolism. — [Cantó C, et al.](https://pubmed.ncbi.nlm.nih.gov/26118927/) ## Schedule Your Stress and Burnout Consultation A 60-minute consultation will evaluate your specific situation, walk through which medical interventions may complement your broader recovery work, and coordinate with your other providers as appropriate. Call (310) 856-9488 or book online now. ### Tendon Injuries ## When a Tendon Won't Heal Tendon problems have a particular kind of frustration. The pain is usually localized to a specific spot. Movement that involves the tendon makes it worse. Rest helps temporarily. Physical therapy helps somewhat. Anti-inflammatories take the edge off without fixing it. Cortisone might give short-term relief, but the pain comes back, sometimes worse than before. This pattern is common because tendon problems are not actually inflammatory in the way patients are often told. Most chronic tendon issues are degenerative: the tendon tissue itself has developed structural changes that will not resolve through anti-inflammatory treatment alone. What we offer is the regenerative approach to tendon care. Tendon injuries are one of the strongest evidence-based applications of regenerative medicine, and PRP therapy in particular has multiple high-quality clinical studies demonstrating meaningful benefit for chronic tendon problems. ## What Tendon Injuries Actually Are Tendons are the strong fibrous tissues that connect muscle to bone. Tendon problems develop in several patterns. Tendinopathy is the most common chronic condition; despite the older name "tendinitis" suggesting inflammation, most chronic tendon problems are degenerative, with the collagen fibers developing disorganization and structural changes. Tendinitis specifically refers to acute inflammation, which is less common. Partial tears involve some tearing without complete rupture, and complete ruptures often require surgical repair. This distinction matters because treatment differs. Tendinopathy responds well to regenerative treatments and progressive loading rehabilitation. Acute tendinitis may respond to anti-inflammatory measures. Complete ruptures often need surgical evaluation. Common patterns we treat include tennis elbow, golfer's elbow, rotator cuff tendinopathy, patellar tendinopathy (jumper's knee), Achilles tendinopathy, gluteal tendinopathy, hip flexor and hamstring tendinopathy, and de Quervain's tenosynovitis. ## Why Cortisone Is Often the Wrong Answer for Tendons Cortisone is widely used for tendon problems but has specific concerns when used repeatedly. Multiple studies have shown that while cortisone provides short-term pain relief, repeated cortisone in a tendon may actually weaken the tissue and increase the risk of tendon tear, and long-term outcomes from repeated cortisone in tendons are often worse than from other approaches. For most chronic tendinopathies, the better approach involves activity modification and progressive loading rehabilitation, treatments that support tendon tissue health rather than only masking pain, and time for tissue-level healing. This is part of why PRP and other regenerative options have become preferred over repeated cortisone for many tendon problems; they support the tissue rather than working against it. ## How PHI Treats Tendon Injuries The first step is comprehensive evaluation: a detailed history of how long the problem has been present and what has been tried, an examination of the specific tendon, review of imaging (often ultrasound or MRI), and an assessment of whether PRP or other regenerative options fit. PRP therapy is the most evidence-supported regenerative treatment for tendinopathy, with multiple high-quality randomized trials demonstrating improvement in pain and function, particularly for tennis elbow, patellar tendinopathy, and rotator cuff problems; most patients receive a series of injections with progressive improvement over 3 to 6 months. A2M therapy may be appropriate where there is joint involvement alongside the tendinopathy. Stem cell therapy is considered for selected severe or refractory cases that have not responded to PRP, and exosome therapy is used within comprehensive protocols. PHI uses ultrasound-guided technique for tendon injections, performed at our Beverly Hills practice, and coordinates with physical therapy, since eccentric loading and progressive rehabilitation work synergistically with regenerative treatment. ## When to See Someone Consider professional evaluation when your tendon problem has lasted more than four to six weeks without improvement, when it interferes with sports, work, or daily activities, when standard care has not produced lasting relief, when you have had multiple cortisone injections in the same tendon, or when you want regenerative options that support tissue healing rather than just symptom management. Seek prompt evaluation for sudden severe pain with a popping sensation (suggesting possible rupture), significant weakness or inability to perform a movement, visible deformity, or severe swelling or signs of infection. Suspected tendon rupture warrants urgent evaluation because timing affects surgical decision-making. ## Why PHI for Tendon Injuries ## Frequently Asked Questions **Q: How effective is PRP for tendon injuries?** For appropriate candidates with chronic tendinopathy, PRP has accumulating evidence demonstrating meaningful improvement in pain and function. Multiple high-quality randomized trials and meta-analyses support its use, particularly for tennis elbow, patellar tendinopathy, and rotator cuff tendinopathy. Response varies, but PRP is one of the most evidence-supported regenerative applications in musculoskeletal medicine. **Q: How many PRP treatments will I need?** Most patients receive a series rather than a single injection. Typical protocols involve two to three PRP injections spaced several weeks apart, with continued improvement evaluated over 3 to 6 months. Some patients benefit from additional treatments depending on response and specific tendon involvement. **Q: Why shouldn't I just get a cortisone shot?** For acute tendinitis, cortisone may be appropriate. For chronic tendinopathy, repeated cortisone has concerning effects on tendon tissue; studies show that while it provides short-term relief, repeated cortisone may weaken the tissue and increase rupture risk, and long-term outcomes are often worse than with regenerative approaches. **Q: How long until I can return to activity?** This varies by tendon and severity. PRP typically requires several weeks of restricted activity after each injection to allow optimal tissue response. Full return to high-level activity usually takes 3 to 6 months from the start of treatment, with continued lower-impact activity often possible during the treatment period. **Q: Should I keep doing physical therapy?** Yes. Tendon care works best when regenerative treatment is combined with appropriate progressive loading rehabilitation. Eccentric loading exercises in particular have strong evidence for tendinopathy, and PT plus PRP together typically produce better outcomes than either alone. **Q: What if PRP doesn't work?** Most patients with chronic tendinopathy respond at least partially to PRP. For patients with insufficient response, options include additional PRP treatments, transitioning to other regenerative approaches like stem cell therapy, or surgical evaluation for specific situations. **Q: Is PRP banned in my sport?** PRP is permitted by WADA and most major sports governing bodies for musculoskeletal applications. Some specific organizations have additional considerations for elite athletes; we discuss specifics during consultation if you compete at that level. **Q: What's the difference between tendinitis and tendinopathy?** Tendinitis specifically refers to acute inflammation of a tendon. Tendinopathy refers to chronic structural changes in tendon tissue, which is what most patients with chronic tendon problems actually have, despite tendinitis being the older common term. The distinction matters because treatment approaches differ. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Tendon Injuries PHI offers evidence-based regenerative treatments for tendon injuries. Your physician will recommend the right option, or combination, based on your specific tendon, severity, and treatment history. - PRP Therapy, the most evidence-supported regenerative treatment for tendinopathy - Stem Cell Therapy, for selected severe or refractory cases - A2M Therapy, where there is joint involvement alongside the tendinopathy - Exosome Therapy > Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: a systematic review and meta-analysis of randomised injection-controlled trials. Peer-reviewed via PMC, 2017. — [Miller LE, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5687544/) > The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials. American Journal of Sports Medicine, peer-reviewed via PubMed, 2017. — [Fitzpatrick J, et al.](https://pubmed.ncbi.nlm.nih.gov/27268111/) > The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials. Peer-reviewed via PMC, 2021. — [Tripodi N, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8364035/) > Clinical practice guideline: management of rotator cuff injuries. American Academy of Orthopaedic Surgeons. — [American Academy of Orthopaedic Surgeons](https://www.aaos.org/quality/quality-programs/upper-extremity-programs/rotator-cuff-injuries/) ## Schedule Your Tendon Injury Consultation A 60-minute consultation will identify your specific tendon condition, walk through the regenerative options that match it, and give you a clear plan with realistic expectations. Call (310) 856-9488 or book online now. ### Treatment-Resistant Depression ## When Antidepressants Haven't Been Enough If you have tried multiple antidepressants without finding adequate relief, you are not alone, and you have not failed. Approximately one-third of patients with major depression do not achieve adequate response from conventional antidepressants, even after multiple trials. Clinicians describe this as treatment-resistant depression, or TRD. It is a common, recognized clinical situation, not a personal shortcoming. The standard sequence often goes something like this: an SSRI that helped some, then did not. A different SSRI that helped a little. An SNRI that produced side effects. Augmentation with another medication that did or did not help. Therapy throughout, sometimes helping, sometimes not enough. For patients in this situation, ketamine infusion therapy has emerged as one of the most clinically significant developments in mental health care in decades. It is not a miracle cure, and we will not oversell it, but for the right patient it can produce meaningful improvement when nothing else has. ## What This Page Is and Isn't PHI is not a psychiatry practice. We do not manage ongoing depression care, prescribe antidepressants, or provide psychotherapy. What we offer is one specific physician-administered medical intervention: ketamine infusion therapy, which has the strongest evidence base in mental health for treatment-resistant depression specifically. We work alongside your psychiatrist and therapist, not in place of them. ## Why Ketamine Works When Other Treatments Haven't Most antidepressants act on serotonin, norepinephrine, or related neurotransmitter systems. They typically take 4 to 6 weeks to produce noticeable effects, and approximately one-third of patients do not respond adequately to multiple trials. Ketamine acts through a completely different pathway. It modulates the NMDA receptor and glutamate signaling, which are involved in synaptic connections, neuroplasticity, and the neural networks affected in depression. The effects can develop within hours to days rather than weeks. For patients whose depression has not responded to serotonin-targeted treatments, this different mechanism is the central reason ketamine often works when other treatments have not. ## What the Evidence Shows Ketamine for treatment-resistant depression has the strongest evidence base in mental health applications. Randomized controlled trials have consistently demonstrated rapid antidepressant effects, with meaningful symptom reduction within 24 to 72 hours sustained by continued treatment. The 2019 FDA approval of esketamine (intranasal, brand name Spravato) for treatment-resistant depression validated the broader finding that NMDA receptor modulation produces antidepressant effects. IV ketamine, the form PHI provides, has accumulating evidence and is widely used by physicians experienced in its administration. While IV ketamine is used off-label for TRD, its clinical use is supported by a substantial body of research. Effects on suicidal ideation have been documented specifically, with studies showing rapid reductions in suicidal thinking, often within hours, which is meaningfully different from standard antidepressants that take weeks to affect this domain. ## How PHI Approaches Ketamine for TRD The first step is a comprehensive evaluation: a detailed history of your depression and treatment trials, confirmation of your established diagnosis and current providers, review of medication trials and durations, assessment of medical history and contraindications, and an honest discussion of what ketamine can realistically offer for your situation. For appropriate candidates, treatment involves physician-administered IV infusions in a clinic setting under continuous monitoring of vital signs. Sessions are performed in our clinic setting, and the time they take varies by patient, dose, and treatment. There is no fixed protocol: the number of sessions and their spacing are tailored to each patient and discussed during consultation rather than following a set series. We coordinate with your mental health team throughout, and for patients who respond well we discuss maintenance individually. You may be a candidate if you have an established major depression diagnosis, ongoing mental health care, an adequate trial of at least two antidepressants without sufficient response, and no contraindications. You are typically not a candidate if you are in active crisis, have specific medical contraindications, or are seeking ketamine without the framework of broader treatment. ## Why PHI for Treatment-Resistant Depression ## Frequently Asked Questions **Q: How is ketamine for depression different from how it's used in surgery?** The doses are dramatically different. Surgical anesthesia uses ketamine at high doses to produce unconsciousness. Therapeutic ketamine for depression uses subanesthetic doses, typically about one-tenth of surgical doses, that produce mood-modulating effects without unconsciousness. You remain awake, aware, and able to communicate throughout. **Q: Is ketamine FDA-approved for depression?** Esketamine (intranasal, brand name Spravato) is FDA-approved specifically for treatment-resistant depression. IV ketamine, what PHI provides, is used off-label for depression. Off-label use means prescribed based on clinical evidence outside specific FDA approval for that indication, which is common in medicine, particularly for emerging treatments. The clinical evidence for IV ketamine in TRD is substantial. **Q: How fast does ketamine work?** Often within hours to days of an early session. Many patients experience meaningful mood improvement within 24 to 72 hours, with benefit building over the course of treatment. This is meaningfully faster than standard antidepressants, which typically require 4 to 6 weeks. **Q: How long do the effects last?** This varies. Effects from a single session are typically temporary, which is why treatment is delivered as a tailored course rather than a single dose. After an initial course, some patients experience sustained response for months; others receive periodic maintenance. Your physician will help you understand what your trajectory might look like. **Q: Will I be unconscious during the infusion?** No. PHI uses subanesthetic doses that produce dissociative effects, which can include altered perception or a sense of detachment, but not unconsciousness. Most patients describe a mild to moderately altered, dream-like awareness. **Q: Will I need to stop my antidepressants?** Generally no. Most patients continue their current medications during ketamine treatment. The goal is typically improved response on the combination rather than replacement. Some patients eventually reduce other medications under their psychiatrist's guidance after sustained response, a careful process managed by your mental health team. **Q: Will I become addicted?** Recreational ketamine use carries addiction risk. Medical ketamine in a defined, monitored treatment course with subanesthetic dosing has not been associated with significant addiction risk in clinical use. The setting and protocol matter significantly. **Q: What about ECT or TMS?** ECT, TMS, and ketamine each have specific evidence and roles in treatment-resistant depression. ECT has the strongest evidence for severe TRD but requires anesthesia. TMS is non-invasive but typically requires daily sessions over weeks. Ketamine offers rapid effects with a different side effect profile. Your psychiatrist can help you understand which approach might fit best; PHI provides ketamine as one of several options. **Q: How does this compare to ketamine clinics I see advertised?** PHI is a physician-led medical practice, not a standalone wellness clinic. Ketamine is administered by our board-certified physicians under continuous monitoring. We require existing mental health care, coordinate with your providers, and use individualized evidence-based treatment. This is meaningfully different from many freestanding ketamine clinics. **Q: Do you take insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Ketamine treatment can be coordinated to fit travel schedules. ## Treatments We Offer for Treatment-Resistant Depression PHI offers physician-administered ketamine infusion therapy, the most evidence-supported intervention for depression that has not responded to standard antidepressants. We work alongside your mental health team rather than replacing the broader care you need. - Ketamine Infusion Therapy, physician-administered in a clinic setting > Synthesizing the evidence for ketamine and esketamine in treatment-resistant depression: an international expert opinion on the available evidence and implementation. American Journal of Psychiatry. — [McIntyre RS, et al.](https://pubmed.ncbi.nlm.nih.gov/33726522/) > Ketamine for rapid reduction of suicidal thoughts in major depression: a midazolam-controlled randomized clinical trial. American Journal of Psychiatry. — [Grunebaum MF, et al.](https://pubmed.ncbi.nlm.nih.gov/29202655/) > A consensus statement on the use of ketamine in the treatment of mood disorders. JAMA Psychiatry. — [Sanacora G, et al.](https://pubmed.ncbi.nlm.nih.gov/28249076/) > Practice guideline for the treatment of patients with major depressive disorder. American Psychiatric Association. — [American Psychiatric Association](https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890423387.654001) ## Schedule Your TRD Consultation A 60-minute consultation will evaluate whether ketamine infusion therapy is appropriate for your specific situation, walk through what to expect, and coordinate with your mental health team. Call (310) 856-9488 or book online now. ### Trigeminal Neuralgia ## Pain Like Lightning Across Your Face Trigeminal neuralgia has a pain pattern unlike anything else in medicine. Sudden, severe, electric-shock-like attacks of pain on one side of your face, sometimes triggered by light touch, eating, brushing your teeth, talking, smiling, or even a breeze, and sometimes coming without any trigger at all. Each attack lasts seconds to a couple of minutes. Between attacks you may be completely fine, or you may have a constant background ache. The unpredictability is part of what makes trigeminal neuralgia so disabling. You cannot plan around something that strikes without warning. Most patients we see have tried medications first, usually carbamazepine, oxcarbazepine, or gabapentin. For many, the medications help significantly; for others they help partially with significant side effects, or stop working over time. What we offer is one specific category of options: interventional treatments that target the trigeminal nerve directly, alongside your neurologist or neurosurgeon as part of broader care. ## What Trigeminal Neuralgia Actually Is The trigeminal nerve is the main sensory nerve of the face, with three major branches: V1 (forehead and around the eye), V2 (cheek, upper lip, upper teeth), and V3 (lower jaw, lower lip, lower teeth). Trigeminal neuralgia involves dysfunction of this nerve, producing the characteristic attacks of severe facial pain. The most common cause is compression of the nerve by a small blood vessel where it enters the brainstem; other causes include multiple sclerosis, tumors, and idiopathic cases. Attacks are typically brief (seconds to two minutes), severe (often described as the worst pain imaginable), electric-shock-like, stabbing, or burning in quality, one-sided in distribution (most often V2 or V3), triggered by specific stimuli in many patients, and recurrent in clusters with periods of remission and flare. ## What This Page Is and Isn't PHI is an interventional pain practice. We are not neurologists or neurosurgeons. Trigeminal neuralgia care is genuinely multispecialty, typically involving neurology for diagnosis confirmation and medication management, neurosurgery for evaluation of microvascular decompression for appropriate candidates, and radiation oncology for evaluation of gamma knife for selected patients. PHI's role is targeted nerve blocks and radiofrequency ablation of trigeminal branches as additional options. We do not replace the neurology and neurosurgery components of trigeminal neuralgia care; we provide specific interventional procedures that may help when medications are not enough or while patients are evaluating other definitive treatment options. ## How PHI Treats Trigeminal Neuralgia The first step is comprehensive evaluation: confirmation of your diagnosis (typically established by neurology), a detailed history of your attack pattern and triggers, review of your medication history and response, and coordination with your neurology and other specialty providers. Trigeminal nerve blocks target the affected branch and serve multiple purposes: diagnostic (confirming which branch is involved), therapeutic (providing relief lasting weeks to months for some patients), and preparatory (confirming candidacy for radiofrequency ablation if response is positive but short-lived). Radiofrequency ablation of trigeminal branches is appropriate for selected patients whose pain involves specific branches and who have not responded adequately to medications, disrupting the pain-signaling function of the targeted branch for longer-lasting relief that can be repeated when it diminishes. PHI performs these procedures in our affiliated surgical suite under fluoroscopy. For patients whose pain has not responded adequately to medications and interventional treatments, we help coordinate neurosurgical evaluation for microvascular decompression or radiation oncology evaluation for gamma knife. ## When to See Someone Consider professional evaluation when you have severe facial pain attacks consistent with trigeminal neuralgia, when your medications are not providing adequate relief, when side effects are limiting their use, or when you want to understand interventional options. Interventional options are typically considered after adequate medication trials, not as first-line treatment. Seek prompt evaluation for sudden severe facial pain accompanied by other neurological symptoms, facial pain alongside facial weakness or vision changes, or new onset of severe facial pain in a younger patient, which may warrant evaluation for multiple sclerosis or other secondary causes. ## Why PHI for Trigeminal Neuralgia ## Frequently Asked Questions **Q: How is trigeminal neuralgia different from other facial pain?** Trigeminal neuralgia has distinctive features. The attacks are brief (seconds to minutes), severe (often the worst pain imaginable), one-sided, and electric-shock-like in quality, often triggered by specific stimuli. Other causes of facial pain such as sinus issues, dental problems, TMJ, or atypical facial pain typically have different patterns. **Q: Should I try medications first?** Yes, in most cases. Carbamazepine and oxcarbazepine are the first-line medical treatments and produce significant relief in many patients. PHI's interventional options are typically considered after adequate medication trials, not as first-line treatment. **Q: What about microvascular decompression?** Microvascular decompression is a neurosurgical procedure that addresses the most common underlying cause (compression of the nerve by a blood vessel). For appropriate candidates, it has the highest long-term success rate of any trigeminal neuralgia treatment. It is not in PHI's lane, but we coordinate with neurosurgical specialists when this evaluation is appropriate. **Q: What about gamma knife radiosurgery?** Gamma knife uses focused radiation to disrupt trigeminal nerve function, another option for patients who are not surgical candidates or prefer non-surgical alternatives. PHI does not perform gamma knife, but we coordinate with radiation oncology. **Q: How effective are nerve blocks for trigeminal neuralgia?** For appropriate responders, nerve blocks can produce meaningful relief lasting weeks to months. The relief can also be diagnostic, identifying which branches are involved. For patients with positive but short-lived responses, radiofrequency ablation often provides longer-lasting relief. **Q: How effective is radiofrequency ablation?** Radiofrequency ablation of trigeminal branches can provide relief lasting six months to several years for many patients, and it can be repeated when relief diminishes. It is most appropriate after a positive diagnostic block confirms the targeted branch. **Q: Will I have facial numbness after ablation?** Often, yes. Ablation disrupts nerve function in the targeted branch, which typically produces some degree of numbness or altered sensation in that area. Most patients consider this trade-off worthwhile given the severity of the original pain, and your physician will discuss what to expect. **Q: Is trigeminal neuralgia curable?** Cure is sometimes the right word and sometimes not. Some patients experience long-term remissions, particularly after successful microvascular decompression. Others have chronic management situations where medications and procedures provide significant relief but do not eliminate the condition entirely. The goal is meaningful, sustainable improvement. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Trigeminal Neuralgia PHI offers evidence-based interventional treatments for trigeminal neuralgia, working alongside your neurology and neurosurgical care. - Trigeminal Nerve Blocks, diagnostic and therapeutic for the affected branch - Radiofrequency Ablation, longer-lasting relief after a positive diagnostic block > Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Peer-reviewed via PubMed. — [Cruccu G, et al.](https://pubmed.ncbi.nlm.nih.gov/27306631/) > Trigeminal neuralgia information. NIH National Institute of Neurological Disorders and Stroke. — [NIH National Institute of Neurological Disorders and Stroke](https://www.ninds.nih.gov/health-information/disorders/trigeminal-neuralgia) ## Schedule Your Trigeminal Neuralgia Consultation A 60-minute consultation will evaluate whether interventional treatments are appropriate for your specific situation, walk through what to expect, and coordinate with your other specialty providers. Call (310) 856-9488 or book online now. ### Vertebral Compression Fractures ## When Sudden Back Pain Stops You in Your Tracks A vertebral compression fracture often announces itself dramatically: sudden severe back pain after a minor strain, a fall from standing height, or sometimes just bending forward or lifting something light. The pain is usually intense and localized, often making it difficult to stand, walk, or even change position in bed. If this describes your situation, particularly if you are over 60 or have osteoporosis, you may have a vertebral compression fracture. The good news is that this is a treatable condition with rapid relief available through kyphoplasty. The important factor is timing: compression fractures respond best to kyphoplasty when the fracture is recent and the bone is still actively healing. The longer you wait, the more limited your treatment options become. ## What a Compression Fracture Actually Is A vertebral compression fracture occurs when one of the bones of your spine partially collapses. The vertebra fractures and loses height, often forming a wedge shape rather than maintaining its normal rectangular form. These fractures most often occur in patients whose bones have been weakened, typically by osteoporosis. The bones become fragile enough that even minor force, such as sneezing, lifting groceries, or stepping off a curb harder than expected, can cause one to fracture. Many patients cannot identify a specific triggering event at all. The result is severe localized pain at the level of the fracture, typically worse with movement and somewhat better when lying still. Some patients also notice a measurable loss of height or a more rounded posture as multiple vertebrae compress over time. ## Why Time Matters Without treatment, compression fractures generally heal naturally over weeks to months, and the pain typically resolves as the bone heals. But the vertebra usually heals in its collapsed position, which means the associated height loss becomes permanent, posture changes may persist, the collapsed vertebra changes how forces transfer through the spine, and the risk of additional fractures at adjacent levels increases. Kyphoplasty addresses both the pain and the structural problem. It stabilizes the fracture, which produces rapid pain relief, and it restores some of the lost vertebral height, which can prevent long-term postural and structural consequences. The procedure works best on fractures that are recent, typically less than 6 to 12 months old, where the bone is still actively healing and the marrow edema visible on MRI confirms an acute or subacute fracture. Older fractures that have completed healing in their collapsed position are typically not candidates. This is why we emphasize timing; the window for optimal results does not stay open forever. ## When Kyphoplasty Is the Right Treatment Kyphoplasty is typically appropriate for patients who have a vertebral compression fracture confirmed on imaging (MRI is ideal because it shows whether the fracture is acute or healed), significant pain not adequately controlled with rest, medication, and bracing, pain that has not resolved after a reasonable trial of conservative treatment (typically 2 to 6 weeks for acute fractures), a fracture recent enough to remain a candidate, and pain that is significantly limiting daily function. For some patients with very recent fractures, conservative treatment alone is sufficient: the pain resolves over weeks, the fracture heals, and no procedure is needed. Kyphoplasty is most useful for patients whose pain is severe, persistent despite conservative measures, or limiting their ability to function. The decision balances the benefit of rapid relief and partial height restoration against the risks of any procedure, and your physician will discuss this with you frankly. ## Conditions That Cause Compression Fractures Most vertebral compression fractures occur in patients with osteoporosis, the most common cause, particularly in postmenopausal women and older men. Other contributing factors include long-term corticosteroid use, cancer that has spread to bone, multiple myeloma and other blood cancers, trauma in patients with otherwise normal bone density, and other conditions affecting bone strength. The underlying cause matters because it shapes the broader treatment plan. A patient with osteoporosis needs ongoing management to prevent future fractures; a patient with metastatic cancer needs coordinated oncologic care. PHI focuses on treating the compression fracture itself, including related cancer-associated fractures, and coordinates ongoing management of the underlying condition with your other physicians. ## How PHI Treats Compression Fractures The first step is confirming the diagnosis with appropriate imaging. MRI is the most useful test because it shows whether the fracture is acute (still healing) or chronic (already healed), which determines whether kyphoplasty is appropriate. For appropriate candidates, kyphoplasty is a minimally invasive procedure performed at our affiliated surgery center under sedation. The physician advances a small instrument into the fractured vertebra, inflates a balloon to create a cavity and partially restore height, then injects bone cement that hardens within minutes to stabilize the fracture. The procedure typically takes 30 to 60 minutes per vertebra, most patients leave the same day, and the majority experience meaningful pain relief within 24 to 48 hours. For patients whose fractures have already healed or who are not candidates for other reasons, your physician will discuss alternative pain management and coordinate broader bone health management. ## Why PHI for Compression Fracture Treatment ## Frequently Asked Questions **Q: How fast does kyphoplasty work?** Most patients experience meaningful pain relief within 24 to 48 hours of the procedure, though some experience improvement immediately after. This rapid relief is one of the procedure's defining features. **Q: Will the pain come back?** The treated vertebra remains permanently stabilized by the bone cement, and pain at the level of the treated fracture typically does not return. However, kyphoplasty does not prevent fractures at other vertebrae. Patients with osteoporosis remain at risk for additional fractures and need ongoing bone health management. **Q: What if I had my fracture months ago, am I too late?** Possibly, but it depends on your specific situation. Fractures that have completed healing typically do not benefit from kyphoplasty. However, MRI sometimes shows that older-appearing fractures are still actively healing, in which case treatment may still help. Even if kyphoplasty is no longer the right answer, we can discuss other approaches to your pain. **Q: Will kyphoplasty fix my hunched posture?** Kyphoplasty can partially restore height in the treated vertebra, particularly when performed on an acute fracture. It does not reverse posture changes from previously healed fractures. Combined with proper bone health management, it can stop the progression of postural changes. **Q: Is kyphoplasty safe for older patients?** Yes, when performed appropriately. Kyphoplasty has a strong safety profile and is routinely performed on patients in their 70s, 80s, and 90s. The minimally invasive nature of the procedure means recovery is typically straightforward even for older patients. **Q: Will I be in the hospital after the procedure?** Most patients are discharged the same day after a brief observation period. Our affiliated outpatient surgery facility is designed for same-day procedures. **Q: What is recovery like?** Most patients experience significant pain relief within 24 to 48 hours. Activity restrictions for the first week are typically modest, and most patients resume daily activities within several days, with continued limitations on heavy lifting and high-impact movement for several weeks. **Q: What about future fractures?** This is one of the most important questions. Patients with osteoporotic compression fractures are at significantly increased risk for additional fractures elsewhere in the spine. Ongoing bone health management is essential and typically involves medication, supplementation, lifestyle factors, and regular monitoring. We coordinate with your other physicians to ensure this is addressed. **Q: Do you take insurance?** PHI is an out-of-network practice with all insurance plans, reflecting our high-touch concierge model. While PHI does not bill insurance, we can provide documentation to help patients seek potential out-of-network reimbursement for the kyphoplasty procedure. All pricing is disclosed at consultation. **Q: How quickly can I be seen?** Because timing matters with compression fractures, we work to schedule consultation quickly. Contact our concierge team and we'll coordinate your consultation and plan of care. Call (310) 856-9488 to discuss timing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Because compression fractures benefit from prompt treatment, international patients should contact us as soon as possible. ## Treatments We Offer for Vertebral Compression Fractures PHI offers minimally invasive treatment for vertebral compression fractures. Your physician will confirm whether you are a candidate based on imaging, fracture timing, and your specific situation. - Kyphoplasty, minimally invasive stabilization with rapid pain relief > Pain, quality of life, and safety outcomes of kyphoplasty for vertebral compression fractures: report of a task force of the American Society for Bone and Mineral Research. Peer-reviewed via PubMed, 2017. — [American Society for Bone and Mineral Research Task Force](https://pubmed.ncbi.nlm.nih.gov/28513888/) > Effect of vertebral kyphoplasty versus vertebroplasty on pain and imaging parameters of the injured vertebrae in patients with osteoporotic vertebral compression fractures: a meta-analysis. Peer-reviewed via PMC, 2025. — [You Z, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11863920/) ## Schedule Your Compression Fracture Consultation If you are experiencing severe back pain following a recent fall, strain, or no clear triggering event, prompt evaluation matters. A consultation at PHI will confirm the diagnosis, evaluate your specific situation, and determine whether kyphoplasty is the right next step. Call (310) 856-9488 or book online now. ### Vertebrogenic Pain ## The Source of Back Pain Many Doctors Miss If you have had chronic low back pain for years, tried multiple treatments without lasting success, and still do not have a clear answer about where your pain is actually coming from, you may be dealing with vertebrogenic pain. Vertebrogenic pain is one of the most under-recognized causes of chronic low back pain. It is not from your discs in the way most people think, not from your facet joints, and not from nerve compression. It comes from a specific part of the spine that traditional treatments often miss entirely. Until 2017, when the FDA cleared the Intracept Procedure, this source of pain did not have a dedicated treatment, and many patients spent years cycling through epidural injections, facet injections, and physical therapy without lasting relief. Now there is a specific solution, and for appropriate candidates a single procedure can provide durable pain relief that lasts years. ## What Vertebrogenic Pain Actually Is Your spinal discs sit between each pair of vertebrae. Where the disc meets the vertebra, there is a thin layer of bone called the vertebral endplate. When the endplate becomes damaged or inflamed, pain signals travel through a small nerve called the basivertebral nerve, which carries those signals from the vertebral body to your brain. Vertebrogenic pain is pain that travels through this specific nerve from this specific source. The damage typically appears on MRI as Modic Type 1 or Type 2 endplate changes, which can be present for years before they are correctly identified as a primary pain source. This is meaningfully different from disc pain, facet pain, or nerve compression. Each of those has its own pain pattern and its own treatment. Vertebrogenic pain has its own pattern too, but it has been overlooked by mainstream pain treatment for decades. ## What Vertebrogenic Pain Feels Like The pattern is often distinctive once you know what to look for: - Chronic low back pain that has lasted at least six months - Pain that is worse with bending forward or sitting for long periods - Pain that feels deep, achy, and centered in the low back rather than radiating into the legs - Pain that worsens with physical activity and improves with rest - Pain that has not responded adequately to physical therapy, epidural injections, or facet injections - MRI findings showing Modic Type 1 or Type 2 endplate changes If your pain pattern matches several of these, vertebrogenic involvement is worth evaluating. The defining feature is often the lack of response to other interventions, combined with characteristic imaging findings. ## How the Intracept Procedure Works The Intracept Procedure uses radiofrequency energy to ablate the basivertebral nerve, the specific nerve carrying pain signals from the vertebral endplate. Once this nerve is ablated, it cannot transmit pain signals from the affected vertebra. This is a single-treatment procedure. Unlike radiofrequency ablation of facet joint nerves, which requires periodic repeat treatment as nerves regenerate, the basivertebral nerve does not regenerate in a way that requires repeat ablation, so most patients receive durable relief from a single procedure. It is performed at our affiliated surgery center under image guidance and sedation. The physician advances a specialized device through a small access point into the affected vertebra, ablates the nerve with radiofrequency energy, and closes the access point with minimal disruption to surrounding tissue. The procedure typically takes about an hour, and most patients leave the same day. ## Who Is a Candidate The Intracept Procedure is appropriate for patients who meet specific criteria: chronic low back pain lasting at least six months; pain that has not responded adequately to at least six months of conservative treatment; MRI findings consistent with vertebrogenic pain (Modic Type 1 or Type 2 endplate changes at L3 to S1); and a pain pattern consistent with the vertebrogenic source, meaning axial low back pain that worsens with activity, particularly bending forward and prolonged sitting. Patient selection is the most important factor in successful outcomes. Patients who meet all four criteria typically respond well; patients who do not meet the criteria typically do not benefit, and we tell those patients so honestly rather than performing a procedure unlikely to help. The pivotal SMART trial, a randomized controlled trial, demonstrated significant pain reduction compared to sham treatment, with results sustained for years, and multiple long-term follow-up studies have confirmed durable benefit at five years or more. ## How PHI Approaches Vertebrogenic Pain The first step is determining whether your pain is actually vertebrogenic. This requires a focused evaluation of your pain history and pattern, review of your existing imaging to look for Modic endplate changes (or a new MRI if appropriate imaging is not available), confirmation of candidacy across all four criteria, and an honest discussion of expectations. The Intracept Procedure works exceptionally well for the right patient, and we tell you frankly whether you fit the profile rather than pushing the procedure on patients who do not. For appropriate candidates, recovery is typically straightforward, with most patients returning to most normal activities within 1 to 2 weeks. The full benefit develops over several weeks to months as inflammation from the procedure resolves and the ablated nerve no longer transmits pain signals. ## Why PHI for Vertebrogenic Pain ## Frequently Asked Questions **Q: How is vertebrogenic pain different from disc pain?** Disc pain typically comes from the disc tissue itself, often involving disc herniation or degeneration affecting nearby nerves. Vertebrogenic pain comes from the vertebral endplate, the interface between the disc and the bone of the vertebra. The two can coexist, but they have different sources and different treatments. Patients with primary disc pain often respond to epidural injections; patients with vertebrogenic pain typically do not. **Q: How do I know if I have Modic changes on my MRI?** Modic changes are described in the MRI report, typically labeled as Modic Type 1, Type 2, or sometimes Type 3 changes at specific vertebral levels. If you are not sure whether your imaging shows these findings, bring your MRI report and images to consultation and your physician will review them with you. **Q: How effective is the Intracept Procedure?** For appropriately selected patients, clinical trials and long-term follow-up have demonstrated significant pain reduction with sustained benefit at five years post-procedure. The defining feature of Intracept is the durability of relief from a single treatment, which is unusual among interventional pain procedures. **Q: Is Intracept FDA-approved?** The Intracept System is FDA-cleared for the treatment of chronic vertebrogenic low back pain. It is the only device approved for basivertebral nerve ablation, and the procedure has been performed in tens of thousands of patients with consistent safety and efficacy data. **Q: Will I need to repeat the procedure?** Most patients do not. The basivertebral nerve does not regenerate the way some other nerves do, which is why a single procedure typically produces durable, multi-year relief. Long-term studies have shown sustained benefit at five years for the majority of appropriately selected patients. **Q: How is Intracept different from radiofrequency ablation of facet joints?** Both use radiofrequency energy to ablate a nerve, but they target completely different sources. Facet ablation targets the medial branch nerves carrying pain from the facet joints; Intracept targets the basivertebral nerve carrying pain from the vertebral endplate. They are complementary procedures for different conditions, and many patients have one but not the other. **Q: What is recovery like?** Most patients return to most normal activities within 1 to 2 weeks. Heavy lifting and high-impact activity may be restricted for several weeks. The full pain relief benefit develops over several weeks as inflammation resolves and the ablated nerve no longer transmits pain signals, with most patients experiencing meaningful improvement by 4 to 6 weeks. **Q: Can I have Intracept if I have had spine surgery?** This depends on your specific surgical history. Some prior surgeries are compatible with Intracept; others are not. Your physician will evaluate your specific situation during consultation. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. The Intracept Procedure is particularly well-suited to international patients because it is a single procedure with durable benefit, eliminating the need for ongoing return visits. ## Treatments We Offer for Vertebrogenic Pain PHI offers the FDA-cleared, single-treatment procedure specifically designed for chronic vertebrogenic low back pain. - Intracept Procedure, a single FDA-cleared treatment with durable multi-year results > A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. The Spine Journal. — [Khalil JG, et al.](https://pubmed.ncbi.nlm.nih.gov/31229663/) > 510(k) clearance summary for the Intracept Intraosseous Nerve Ablation System (K162176). U.S. Food and Drug Administration. — [U.S. Food and Drug Administration](https://www.accessdata.fda.gov/cdrh_docs/pdf16/K162176.pdf) > Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multicenter study. European Spine Journal, 2020. — [Fischgrund JS, et al.](https://link.springer.com/article/10.1007/s00586-020-06448-x) ## Schedule Your Vertebrogenic Pain Consultation If you have chronic low back pain that has not responded to standard treatments, and your imaging shows Modic endplate changes, you may be a candidate for the Intracept Procedure. A 60-minute consultation will evaluate your candidacy and walk through what to expect from the procedure and recovery. Call (310) 856-9488 or book online now. ### Weight Management & Body Composition ## What This Page Is and Isn't Before getting into specifics, we want to be honest about what PHI offers and does not offer in the weight and body composition space. What PHI offers is body composition support through FDA-cleared EMSCULPT NEO technology and selected peptide therapy that may support metabolic and recovery aspects of body composition goals. What PHI does not offer is comprehensive medical weight loss programs, bariatric surgery referrals as a primary service, or comprehensive nutrition counseling. If you are looking for comprehensive medical weight management, this page will be honest that PHI may not be the primary provider you need, and we will explain what we do offer and how it may complement your existing care. ## Where This Page Fits For patients with weight and body composition goals, comprehensive care typically involves multiple resources: primary care or specialty weight management for medical weight loss when significant weight loss is the goal; endocrinology for metabolic conditions; bariatric surgery evaluation for patients meeting criteria; nutrition and behavioral support for the foundational work; and personal training and fitness for the physical activity component. PHI's role is body composition optimization through EMSCULPT NEO and selected peptide therapy as adjuncts to broader care, particularly relevant for patients near or at their target weight working on body composition rather than significant weight loss. For patients who need comprehensive weight management or specific weight-loss medications, we coordinate with and refer to the appropriate primary care, endocrinology, or specialty weight-management providers. ## What EMSCULPT NEO Actually Does EMSCULPT NEO is FDA-cleared for muscle building and fat reduction. It combines high-intensity focused electromagnetic energy, which produces supramaximal muscle contractions during the session, with radiofrequency, which produces tissue temperature changes that may support fat reduction. Studies have shown measurable changes in muscle thickness and fat layer in treated areas. What it does not do is replace exercise, substitute for weight loss when significant weight loss is needed, or produce dramatic transformation. The best applications are for patients who are already near their target weight and want to enhance muscle definition and reduce fat in specific areas such as the abdomen, buttocks, arms, calves, and thighs. Realistic expectations are modest measurable improvements, typically requiring a defined treatment series with periodic maintenance. For more detail, see our EMSCULPT NEO treatment page. ## Where Peptide Therapy Fits Some peptides may have applications relevant to body composition and metabolic health, including growth hormone-related peptides that may support recovery and selected aspects of body composition, with effects that are typically modest rather than dramatic. We are honest about evidence quality. Peptide therapy for body composition should not be positioned as a weight loss solution, because that framing exceeds the evidence. For patients pursuing comprehensive body composition optimization alongside other approaches, peptide therapy may add value as one component, discussed individually without listing specific peptides publicly. These treatments are delivered in our clinic setting under physician supervision. ## When This Page Applies to You You may benefit from PHI's offerings if you are at or near your target weight and want to enhance body composition in specific areas, if you have achieved significant weight loss and want body recomposition support, if you are pursuing comprehensive longevity care that includes body composition, or if you have established primary care or specialty providers for any underlying medical or weight management needs. You are typically better served elsewhere first if you need to lose significant weight and want medical weight loss support, if you have not had primary care evaluation for metabolic or weight-related concerns, or if you are hoping body composition treatments will substitute for the foundational work of weight loss when significant weight loss is needed. ## Why PHI for Body Composition Support ## Frequently Asked Questions **Q: Can EMSCULPT NEO replace dieting and exercise?** No. EMSCULPT NEO produces measurable changes in muscle and fat in treated areas, but it does not replace the foundational work of nutrition and exercise. It is appropriate for body composition refinement, not as a substitute for the work of weight loss when significant weight loss is needed. **Q: Will EMSCULPT NEO help me lose weight?** Not significantly. EMSCULPT NEO is a body composition tool, not a weight loss treatment. Patients typically do not experience dramatic weight changes on the scale; the changes are in muscle and fat in treated areas rather than total body weight. **Q: I've lost weight and want to address tone. Can you help?** This is one of the situations where PHI's offerings may add value. Patients who have achieved significant weight loss often want body recomposition support including muscle building, where EMSCULPT NEO may help. Significant skin laxity often requires dermatology or plastic surgery, and we refer for what we cannot offer. **Q: How effective is EMSCULPT NEO?** Research demonstrates measurable changes in muscle thickness and fat reduction in treated areas. The effects are real but modest rather than transformative, and most patients require a defined treatment series with ongoing maintenance for sustained results. **Q: How many sessions do I need?** Protocols vary patient to patient and by treated area, and packages are offered after the consultation. Some patients pursue periodic maintenance sessions. **Q: What about loose skin after weight loss?** Significant skin laxity after weight loss typically benefits from dermatology, medical aesthetics, or plastic surgery rather than the wellness interventions PHI offers. We can suggest appropriate referrals. **Q: Should I do EMSCULPT NEO before or after my weight loss goal?** Generally after. EMSCULPT NEO is most effective for body composition refinement when patients are at or near their target weight. Pursuing it during ongoing significant weight loss often produces less satisfying results than waiting until weight is more stable. **Q: Do peptides help with weight loss?** Most peptides PHI offers are not primary weight loss treatments. Some may have modest metabolic or body composition applications as adjuncts. We do not position peptide therapy as a weight loss solution because that framing exceeds the evidence. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Body Composition PHI offers body composition support through FDA-cleared EMSCULPT NEO and selected peptide therapy. We coordinate with your primary care, endocrinology, or weight management providers for comprehensive care. - EMSCULPT NEO, FDA-cleared muscle building and fat reduction - Peptide Therapy, adjunctive support > 510(k) clearance summary for the EMSCULPT NEO device (K212316). U.S. Food and Drug Administration. — [U.S. Food and Drug Administration](https://www.accessdata.fda.gov/cdrh_docs/pdf21/K212316.pdf) > High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Peer-reviewed via PMC, 2019. — [Kinney BM, Lozanova P](https://pmc.ncbi.nlm.nih.gov/articles/PMC6585690/) > Adult obesity causes and consequences. Centers for Disease Control and Prevention. — [Centers for Disease Control and Prevention](https://www.cdc.gov/obesity/adult/causes.html) ## Schedule Your Body Composition Consultation A 60-minute consultation will evaluate whether PHI's offerings fit your specific goals, identify what other resources you may need for comprehensive weight or body composition care, and coordinate with your existing providers. Call (310) 856-9488 or book online now. ### Whiplash ## When the Pain Doesn't Go Away You remember exactly when your whiplash happened. The car accident. The fall. The sports collision. You probably went through the standard sequence: imaging that came back mostly normal, a soft collar for a few days, instructions to take ibuprofen and rest, a referral to physical therapy. For many whiplash patients, this is enough, and symptoms resolve over weeks to a few months. For others, the pain does not go away. Weeks turn into months, months into years. You have been told your imaging looks fine and the pain should have resolved by now. If this describes your experience, you are not alone. Persistent post-whiplash pain is a recognized clinical condition with specific underlying causes and specific effective treatments. The challenge is that those treatments often are not part of standard post-injury care. ## Why Whiplash Sometimes Doesn't Heal Cleanly The mechanism of whiplash produces specific patterns of damage that do not always show clearly on standard imaging. The most common identifiable source of persistent post-whiplash pain is injury to the cervical facet joints, the small joints at the back of each cervical vertebra. The rapid acceleration-deceleration force exceeds the normal range of motion for cervical structures. The facet joints can sustain microscopic damage, ligamentous strain, or capsular injury that is real but does not appear on standard MRI. The body's healing response stabilizes things partially but often leaves the joints inflamed, irritable, or dysfunctional. The result is chronic pain that may be located in the neck (sometimes one-sided), referred to the back of the head, upper shoulders, or between the shoulder blades, worse with certain head positions, associated with stiffness, not visible on imaging, and often accompanied by tension-type or cervicogenic headaches. This pattern is well-documented, and targeted treatment of these joints often produces meaningful relief. ## Common Whiplash Symptoms We See Patients with persistent post-whiplash pain often experience some combination of chronic neck pain at the site of original injury, limited neck range of motion, recurrent or daily headaches that started or worsened after the injury, pain referred to the upper back or shoulders, stiffness that is worst in the morning or after sustained postures, sleep disruption, tension in the upper trapezius and surrounding muscles, and sometimes cognitive symptoms or mood changes related to the persistent pain. The combination varies by patient, but the underlying pattern of cervical facet involvement is common. ## How PHI Treats Persistent Whiplash Pain The first step is comprehensive evaluation: a detailed history of your original injury and symptoms over time, an examination of cervical range of motion and tender points, review of imaging, and sometimes a diagnostic injection to confirm the specific cervical structures involved. Cervical facet injections are typically the first interventional treatment, delivering anti-inflammatory medication into or near the cervical facet joints, with the response itself often confirming facet involvement (see our Cervical Facet Syndrome page). Cervical radiofrequency ablation is the natural next step for patients whose injections confirm the source but produce shorter-than-desired relief, providing relief that typically lasts 6 to 18 months. PRP therapy may be appropriate for selected patients with significant soft tissue components, delivering concentrated growth factors to support healing in injured ligaments and tendons. PHI performs every cervical procedure in our affiliated surgical suite under image guidance, and coordinates with physical therapy and other specialists for patients whose symptoms involve significant biomechanical or functional components. ## Why PHI for Whiplash Treatment ## Frequently Asked Questions **Q: My MRI looked normal but I still have pain. Why?** This is one of the most common scenarios with whiplash. Cervical facet injury, the most common source of persistent post-whiplash pain, does not always appear on standard MRI. The pain is real, the source is identifiable through physical examination and diagnostic injections, and effective treatment exists. **Q: How long should whiplash symptoms last?** Many cases of acute whiplash improve significantly over weeks to a few months with appropriate care. If symptoms persist beyond 3 to 6 months, you have what is called persistent or chronic whiplash-associated disorder, a recognized condition that often benefits from specific interventional evaluation. **Q: Is it too late to get treatment if my injury was years ago?** No. Patients with persistent post-whiplash pain often respond well to targeted treatment regardless of how long they have been dealing with symptoms. The cervical facet structures involved do not heal differently based on how long ago the injury occurred. **Q: Why didn't physical therapy fully resolve my whiplash?** PT is appropriate first-line care and helps many whiplash patients. For patients with significant cervical facet injury, PT alone often is not sufficient because it does not address the underlying joint involvement directly. Combining interventional treatment of the facet joints with continued PT often produces results neither approach achieves alone. **Q: How effective is radiofrequency ablation after whiplash?** For patients whose diagnostic facet injections confirm the source, cervical ablation produces meaningful pain relief lasting 6 to 18 months in most patients. The procedure can be repeated when relief diminishes. **Q: Will my whiplash get better on its own?** Some persistent post-whiplash pain does resolve spontaneously over time. Much does not. The longer symptoms persist, the more chronic pain patterns can become established, and earlier targeted treatment often produces better outcomes than continued waiting. **Q: What if I had a head injury along with my whiplash?** Concurrent concussion alongside whiplash is common. The neck symptoms and any persistent post-concussive symptoms may need to be addressed separately or through coordinated care. PHI handles the cervical component, and coordinated care with neurology may be appropriate for ongoing post-concussive symptoms. **Q: Will I need surgery?** The vast majority of whiplash patients do not need surgery. Persistent post-whiplash pain typically responds well to non-surgical interventional treatment. Surgery is rarely the right answer for whiplash specifically. **Q: Do you take insurance?** Insurance coverage and payment options may vary. Please contact our office to discuss your specific plan, available options, and pricing. All pricing is transparently disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. ## Treatments We Offer for Whiplash PHI offers evidence-based treatments for persistent post-whiplash pain. Your physician will recommend the right option, or combination, based on the specific structures involved in your case. - Cervical Facet Injections, usually the first interventional step - Radiofrequency Ablation, 6 to 18 months of relief when injections confirm the source - PRP Therapy, for significant soft tissue components > Scientific monograph of the Quebec Task Force on Whiplash-Associated Disorders: redefining whiplash and its management. Peer-reviewed via PubMed. — [Spitzer WO, et al.](https://pubmed.ncbi.nlm.nih.gov/7604354/) > Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020. — [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/) ## Schedule Your Whiplash Consultation A 60-minute consultation will identify the specific structures contributing to your persistent post-whiplash pain, walk through the treatment options that match your situation, and give you a clear plan. Call (310) 856-9488 or book online now. ## Treatments ### A2M Therapy ## What A2M Therapy Is Alpha-2-macroglobulin, or A2M, is a large protein produced naturally by your liver and present in your blood. Its primary job is to neutralize harmful enzymes that would otherwise damage tissue. In the joint, A2M acts as a kind of biological filter, capturing and inactivating the specific cartilage-destroying enzymes that drive the progression of osteoarthritis. When a joint is injured, the body produces protein classes that degrade cartilage. A2M is a powerful inhibitor of three of these classes: cytokines, matrix metalloproteinases, and ADAMTS (a disintegrin and metalloproteinase with thrombospondin). By trapping these proteins so the body can clear them, A2M can slow the progression of osteoarthritis and support a healthier environment for cartilage recovery. A2M Therapy delivers a concentrated form of A2M, derived from your own blood, directly into the affected joint. This is a different mechanism than corticosteroid injections (which reduce inflammation broadly) or PRP (which delivers growth factors to support tissue repair). A2M is more specifically targeted at the enzymes that drive cartilage degradation. ## How A2M Therapy Works The procedure begins with a blood draw. Your blood is processed through a specialized filtration system that separates and concentrates the A2M protein. The resulting concentrate is then injected directly into the affected joint under image guidance, most often fluoroscopy with an imaging specialist. The entire process is completed in a single visit. The blood draw, processing, and injection together typically take 60 to 90 minutes. Because A2M is derived from your own blood, the rejection and immune response risks associated with foreign biologics are not a concern. This is one of A2M's clinical advantages. ## Conditions We Treat with A2M Therapy A2M Therapy is most appropriate for: - Knee osteoarthritis, particularly early-to-moderate stages (Kellgren-Lawrence grade 2 or 3) - Hip osteoarthritis, in selected patients - Shoulder arthritis, in selected patients - Other joint conditions where cartilage breakdown is the primary concern - Patients who want to slow disease progression rather than only manage symptoms A2M is generally less appropriate for end-stage arthritis where significant cartilage loss has already occurred. In those cases, your physician may recommend stem cell therapy, joint replacement, or other interventions. ## What the Evidence Shows A2M is an emerging regenerative protocol. The early clinical research is promising, but the body of evidence is smaller than for PRP or corticosteroid injections. A 2024 randomized controlled trial compared A2M-rich injections to PRP and methylprednisolone in patients with mild-to-moderate knee osteoarthritis. The A2M group showed statistically significant improvement on multiple validated pain and function scores at 12 weeks. Importantly, the differences between the A2M, PRP, and corticosteroid groups were not statistically significant in head-to-head comparison, meaning A2M is comparable to but not clearly superior to these alternatives in current trial data. We tell you this because honest framing matters. A2M has a strong biological rationale and emerging supportive evidence. It is not yet established as superior to other regenerative options. Your physician will discuss whether A2M, PRP, stem cell therapy, or a combination fits your specific situation. ## Why Patients Choose PHI for A2M Therapy ## What to Expect ## Frequently Asked Questions **Q: Is A2M Therapy FDA-approved?** A2M Therapy uses your own blood, processed and reinjected, which falls under the FDA's regulations for autologous biologics, similar to PRP. The procedure itself is not FDA-approved as a specific drug for a specific indication; it is a clinical application of an autologous biologic protocol. **Q: How is A2M different from PRP?** PRP delivers growth factors to support tissue repair. A2M delivers a concentrated protease inhibitor that neutralizes cartilage-destroying enzymes. They work through different mechanisms and may be more appropriate for different patients. Some patients receive both. **Q: How is A2M different from cortisone?** Cortisone reduces inflammation broadly. A2M specifically targets the enzymes that destroy joint cartilage. Cortisone provides faster but typically shorter relief; A2M provides slower but potentially more sustained protection of the underlying cartilage. **Q: How long does it take to work?** A2M does not produce immediate relief. Most patients begin to notice improvement at 4 to 6 weeks, with maximum benefit at 8 to 12 weeks. **Q: How long does the relief last?** Duration varies. Some patients experience benefits lasting 6 to 12 months from a single treatment. Repeat treatment can be performed when relief diminishes. **Q: What are the risks?** Because A2M uses your own blood, immune rejection and disease transmission risks are not a concern. Standard procedural risks include temporary pain or swelling at the injection site, bleeding, and rare infection. Your physician will review the complete risk profile during consultation. **Q: Can I have A2M and PRP together?** Yes. Some patients benefit from combined or sequential A2M and PRP protocols. Your physician will discuss whether this fits your specific situation. **Q: How much does A2M Therapy cost at PHI?** PHI is out-of-network with all insurance plans. Pricing varies by joint and protocol, and all costs are disclosed at consultation, with no surprise billing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. > Identification of alpha-2-macroglobulin as a master inhibitor of cartilage-degrading factors that attenuates the progression of posttraumatic osteoarthritis. Arthritis & Rheumatology. — [Wang S, et al.](https://pubmed.ncbi.nlm.nih.gov/24578232/) > The effectiveness of alpha-2-macroglobulin injections for osteoarthritis of the knee. Journal of Knee Surgery, 2024. — [Thompson K, et al.](https://pubmed.ncbi.nlm.nih.gov/39259950/) ### CBD Cream ## What CBD Is Cannabidiol, or CBD, is a non-psychoactive compound derived from the cannabis plant. Unlike THC, CBD does not produce intoxication. It interacts with the body's endocannabinoid system, which plays a role in regulating pain, inflammation, and immune response. Topical CBD preparations are creams, gels, or balms applied directly to the skin over an area of pain or inflammation. The CBD is absorbed locally and acts on receptors in the underlying tissue without entering the bloodstream in significant amounts. This local action is the relevant mechanism for topical use. ## How Topical CBD Works When applied to the skin, CBD interacts with cannabinoid receptors (CB1 and CB2) and other receptors involved in pain signaling, including TRPV-1 receptors that respond to inflammatory pain signals. The result is local reduction in pain signaling and inflammatory response. Because topical CBD does not enter the bloodstream meaningfully, it does not produce systemic effects. It does not cause drowsiness, does not interact with most medications in the way oral CBD might, and does not show up on standard drug tests when properly formulated. ## When Topical CBD Is Useful CBD cream can be a useful component of pain management for: - Localized joint pain (knee, shoulder, hand, elbow) - Tendon inflammation and tendinopathy - Muscle soreness from training, work, or chronic tension - Post-procedure recovery, when cleared by your physician - Adjunct support during physical therapy and rehabilitation It is not a primary treatment for severe or progressive conditions. CBD cream is appropriately positioned as one tool among many in a comprehensive pain management approach, not as a replacement for proper medical evaluation and treatment. ## What the Evidence Shows Topical CBD has accumulating clinical evidence for specific pain conditions. Recent systematic reviews of randomized controlled trials demonstrate that CBD, particularly via topical application, can reduce localized pain and inflammation with a strong safety profile. A 2024 systematic review of clinical and preclinical evidence concluded that CBD demonstrates analgesic and anti-inflammatory properties with potential application in osteoarthritis, chronic pain, and neuropathic pain conditions, with topical administration being effective in many cases. The evidence is positive but should be understood in proportion. Topical CBD is helpful for many patients with localized musculoskeletal pain, particularly alongside other treatments. It is not a cure for arthritis, tendon injury, or chronic pain; it is a supportive intervention with reasonable evidence and a good safety profile. ## Why Patients Choose PHI for CBD-Based Pain Support ## How to Use Topical CBD Application varies by product and preparation. Most topical CBD preparations are applied 2 to 4 times daily to the affected area, with effect typically developing within 30 to 60 minutes of application. For best results: - Apply to clean, dry skin - Use enough to cover the affected area completely - Massage in until absorbed - Reapply as the effect diminishes, typically every 4 to 6 hours - Track which preparations work best for your specific situation Your physician will provide specific guidance for your situation. ## Frequently Asked Questions **Q: Is CBD cream legal?** CBD products derived from hemp containing less than 0.3 percent THC are legal at the federal level in the United States, and topical CBD products meeting this standard are widely available. State regulations vary slightly. PHI uses products that comply with federal regulations. **Q: Will CBD cream show up on a drug test?** Properly formulated topical CBD products with less than 0.3 percent THC are unlikely to produce a positive drug test. However, some CBD products are mislabeled or contain higher THC than stated, so patients in occupations requiring drug testing should be especially careful about product selection. Your physician can recommend products tested for compliance. **Q: Does CBD cream interact with medications?** Topical CBD has minimal systemic absorption and rarely interacts with medications. Oral CBD can interact with several medications, particularly those processed by liver enzymes. Always discuss any CBD use with your physician. **Q: How long does it take to work?** Most patients experience effect within 30 to 60 minutes of application, with peak effect around 1 to 2 hours and duration of 4 to 6 hours. **Q: Are there side effects?** Topical CBD has a strong safety profile. The most common side effects are mild skin reactions (redness, itching) at the application site, usually related to other ingredients in the preparation rather than CBD itself. **Q: Will CBD cream replace my pain medications?** CBD is generally a supportive intervention rather than a replacement for medications addressing significant conditions. For some patients with mild to moderate localized pain, CBD may reduce or replace the need for over-the-counter pain medications; for more significant pain, CBD complements rather than replaces other treatments. **Q: What is the difference between CBD cream and prescription medications for pain?** Prescription pain medications act systemically and target specific pain mechanisms with stronger effects and more side effects. CBD cream acts locally with a milder effect and a much better safety profile. They serve different roles. **Q: How much does CBD cost at PHI?** Pricing varies by product, and all costs are disclosed at consultation. > Cannabidiol (CBD): a systematic review of clinical and preclinical evidence in the treatment of pain. Pharmaceuticals, 2024. — [Cásedas G, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11597428/) > What you need to know about products containing cannabis or cannabis-derived compounds. U.S. Food and Drug Administration. — [U.S. Food and Drug Administration](https://www.fda.gov/consumers/consumer-updates/what-you-need-know-and-what-were-working-find-out-about-products-containing-cannabis-or-cannabis) ### EMSCULPT NEO ## What EMSCULPT NEO Is EMSCULPT NEO is a non-invasive body contouring device that uses two synchronized energy types to reduce fat and build muscle at the same time. It is the only FDA-cleared device that combines high-intensity focused electromagnetic (HIFEM) energy with synchronized radiofrequency (RF) heat. The HIFEM energy induces approximately 20,000 supramaximal muscle contractions per 30-minute session, far beyond what voluntary exercise can produce, forcing muscle fibers to remodel and grow stronger. Simultaneously, the RF heat raises the temperature of subcutaneous fat to 43-45 degrees Celsius, triggering fat cell apoptosis (programmed cell death). The combined effect builds muscle and reduces fat in the same session. This is meaningfully different from other body contouring technologies. CoolSculpting reduces fat only; the original Emsculpt builds muscle only. EMSCULPT NEO does both simultaneously. ## What EMSCULPT NEO Treats #### Body contouring areas PHI treats the abdomen, flanks, buttocks, front, outer, and inner thighs, arms, legs, and back. EMSCULPT NEO is FDA-cleared for fat reduction and muscle toning, and is cleared for use in patients with a BMI up to 35. #### Muscle and joint function support In October 2024, EMSCULPT NEO received additional FDA clearance for muscle and joint function support. It is not just for sculpting; it is used for functional wellness as well. As an adjunctive therapy it can support muscle strengthening, muscle re-education, relaxation of spasms, improved circulation, and maintenance of range of motion, and can help prevent disuse atrophy and venous thrombosis. It may also help relieve chronic, post-traumatic, post-surgical, and diabetic neuropathic pain. https://youtube.com/shorts/fSOcYrqVGMk?si=o7aEomLKA-jALtHz ## What the Evidence Shows EMSCULPT NEO has accumulating clinical trial evidence for both aesthetic and functional applications. Clinical studies report average outcomes of approximately a 25 percent increase in muscle mass and a 30 percent reduction in subcutaneous fat in treated areas after the standard series of four 30-minute sessions over two weeks. Patient satisfaction in published studies has been high, with adverse events typically limited to temporary muscle soreness similar to that following intense exercise. Effect sizes vary based on starting BMI, treatment area, and individual response. Patients with BMI closer to the upper end of the cleared range often see less pronounced fat reduction than patients with lower starting BMI. Your physician will set realistic expectations based on your specific situation. ## Who Is a Candidate Your physician will screen for contraindications, particularly metal implants in the treatment area, during consultation. EMSCULPT NEO is not appropriate for everyone, and we say so when it is not. ## Why Patients Choose PHI for EMSCULPT NEO ## What to Expect ## Frequently Asked Questions **Q: Is EMSCULPT NEO FDA-approved?** EMSCULPT NEO is FDA-cleared for non-invasive lipolysis (fat reduction), improvement of abdominal tone, and strengthening and toning of the abdomen, buttocks, thighs, arms, and calves. In October 2024, it received additional FDA clearance for muscle and joint function support. **Q: How is EMSCULPT NEO different from CoolSculpting?** CoolSculpting reduces fat only by freezing fat cells. EMSCULPT NEO reduces fat and builds muscle simultaneously through a different mechanism. They serve different goals. **Q: How is EMSCULPT NEO different from the original Emsculpt?** The original Emsculpt builds muscle only through HIFEM energy. EMSCULPT NEO adds RF energy for simultaneous fat reduction, producing the muscle-building effects of the original plus measurable fat reduction. **Q: Does it hurt?** Most patients describe the sensation as an intense workout, not painful. The intensity is adjustable, and your physician will find the level that produces effective results without discomfort. **Q: How long do results last?** Muscle and fat changes from a treatment series typically last for months. Maintenance sessions are recommended periodically to sustain results, particularly for the muscle component. Like exercise-induced muscle gains, results require some maintenance to be preserved. **Q: Will EMSCULPT NEO replace my workouts?** No. EMSCULPT NEO is a supplement to, not a replacement for, regular exercise and a healthy lifestyle. It produces effects in specific treated areas that voluntary exercise cannot match, but overall fitness still requires ongoing physical activity. **Q: Can I exercise after a session?** Yes, immediately if desired. Most patients experience some temporary muscle soreness and may prefer a day of recovery, but no formal restrictions apply. **Q: How many sessions do I need?** A common protocol is four 30-minute sessions over two weeks, but every treatment is tailored. One person may need fewer sessions in a single area, another more across multiple areas. Your coordinator will discuss packages. **Q: Is EMSCULPT NEO covered by insurance?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: How much does EMSCULPT NEO cost at PHI?** Every treatment is tailored, and pricing varies by treatment area and number of sessions. All costs are disclosed at consultation. **Q: Do you accept international patients?** Yes. EMSCULPT NEO's compressed treatment timeline makes it well-suited to patients traveling for concentrated treatment. > 510(k) clearance summary for the EMSCULPT NEO device (K212316). U.S. Food and Drug Administration. — [U.S. Food and Drug Administration](https://www.accessdata.fda.gov/cdrh_docs/pdf21/K212316.pdf) > High intensity focused electromagnetic therapy evaluated by magnetic resonance imaging: safety and efficacy study of a dual tissue effect based non-invasive abdominal body shaping. Peer-reviewed via PMC, 2019. — [Kinney BM, Lozanova P](https://pmc.ncbi.nlm.nih.gov/articles/PMC6585690/) > Concomitant use of radiofrequency and high intensity focused electromagnetic energies for full-body remodeling: MRI evidence-based prefatory trial. Peer-reviewed via PMC, 2023. — [Katz B, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC10087156/) ### Epidural Steroid Injections ## What an Epidural Steroid Injection Does An epidural steroid injection delivers a powerful anti-inflammatory medication directly to the source of nerve pain in your spine. The medication is placed in the epidural space, the area immediately surrounding your spinal nerves, where inflammation from a herniated disc, arthritis, or other spinal condition is irritating the nerve and causing pain. Because the medication goes directly to the inflamed area, the dose required is far smaller than what you would need to take orally to achieve the same anti-inflammatory effect at the nerve. This is why an injection often produces meaningful relief that pills cannot. The procedure does not address the underlying anatomical cause of your pain. It addresses the inflammation that the underlying cause is producing. For many patients, that inflammation is the actual source of their daily symptoms, and reducing it produces real relief that lasts months at a time. ## How the Procedure Works The injection is performed in our affiliated surgical suite under fluoroscopic guidance with an imaging specialist. The physician uses real-time imaging to confirm precise needle placement before any medication is delivered. Spinal injections without image guidance carry meaningfully higher risk and lower accuracy. You are positioned comfortably, and the injection site is cleaned and numbed with a local anesthetic. The physician advances a thin needle to the epidural space, confirms position with imaging, and delivers a combination of corticosteroid and local anesthetic. The procedure typically takes about 20 minutes, depending on the levels treated and what is being performed. PHI offers a range of comfort options, from local anesthetic to nitrous oxide, conscious sedation (Versed), or deep sedation (Propofol). You leave the same day; patients who receive only local anesthetic typically drive themselves home, while patients who receive sedation arrange transportation. ## Three Regions We Treat ## When Epidural Steroid Injections Are the Right Option Your physician will tell you which category you fall into during consultation. Some patients arrive for an injection consultation and leave with a different recommendation, including facet injections, radiofrequency ablation, or a regenerative protocol. That is the point of an evaluation. ## Why Patients Choose PHI for Epidural Steroid Injections ## What to Expect: Before, During, and After ## Frequently Asked Questions **Q: How long does the relief last?** Duration varies widely. Some patients experience months of relief from a single injection. Others find injections are part of a longer-term plan with periodic repeat doses. Patients with newer pain generally have better and longer-lasting responses than patients with pain present for a year or more. **Q: Will I be awake during the procedure?** It depends on the option you choose. PHI offers local anesthetic, nitrous oxide, conscious sedation (Versed), and deep sedation (Propofol). Your physician helps you choose the right level of comfort for your procedure. **Q: Is the injection painful?** Most patients describe the procedure as briefly uncomfortable rather than painful. The local anesthetic numbs the skin and tissue along the needle path. The most noticeable sensation is usually a sense of pressure when the medication is delivered. **Q: Will I be able to drive home?** If you receive only local anesthetic, most patients drive themselves home. If you receive any sedation, arrange transportation, as you should not drive the same day. **Q: What are the risks?** Epidural steroid injections are well-established procedures with a strong safety profile when performed under image guidance. Risks include temporary increase in pain, headache (especially with cervical injections), bleeding or infection at the injection site, and rare complications related to inadvertent intravascular injection. Image guidance significantly reduces these risks. Your physician will review the full risk profile at consultation. **Q: Can I have an epidural injection if I am on blood thinners?** It depends on the specific medication. Some blood thinners must be paused before the procedure; others, including aspirin in some doses, can typically be continued. Your physician will review your medications at consultation and provide specific instructions. **Q: What is the difference between an epidural injection and a facet injection?** An epidural injection treats nerve pain that radiates from your spine into an arm or leg. A facet injection treats pain coming from the small joints between your vertebrae, which is usually felt locally in the spine itself. Your physician will recommend which one fits based on your symptom pattern and imaging. **Q: How is an epidural injection different from radiofrequency ablation?** An epidural injection reduces inflammation around an irritated nerve and provides relief for several months. Radiofrequency ablation interrupts the pain signal from a specific nerve for longer-lasting relief, typically 6 to 18 months, but it is appropriate for different pain patterns, most often facet-mediated pain rather than radiating nerve pain. **Q: What if the injection does not help?** If a properly placed epidural injection does not produce meaningful relief, this is diagnostic information. It tells your physician that inflammation around the nerve is likely not the primary driver of your pain. The next step is usually to revisit imaging and consider a different approach, including facet injections, radiofrequency ablation, regenerative options, or surgical evaluation in selected cases. **Q: How much does an epidural steroid injection cost at PHI?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. For patients traveling specifically for an epidural steroid injection, we coordinate consultation, imaging review, and procedure scheduling within a single visit when possible. > Epidural steroids for cervical and lumbar radicular pain and spinal stenosis: systematic review summary. Peer-reviewed via PMC, 2022. — [American Academy of Neurology Guidelines Subcommittee](https://pmc.ncbi.nlm.nih.gov/articles/PMC12289388/) > Epidural injections for lumbar radiculopathy or sciatica: a comparative systematic review and meta-analysis. Peer-reviewed via PubMed, 2021. — [Manchikanti L, et al.](https://pubmed.ncbi.nlm.nih.gov/34323441/) > Epidural Steroid Injections. StatPearls, peer-reviewed via NIH/NCBI. — [StatPearls (NIH/NCBI Bookshelf)](https://www.ncbi.nlm.nih.gov/books/NBK470189/) ### Exosome Therapy ## The Newest Regenerative Option, Framed Honestly Exosome therapy is the newest of the regenerative treatments PHI offers, and it is also the one surrounded by the most marketing noise. Across the industry, exosomes are frequently sold with claims that outrun the science. PHI takes a different approach: we use exosomes where the rationale is sound, within broader regenerative protocols, and we tell patients plainly what the current evidence does and does not support. Exosomes are not a miracle therapy, and they are not a standalone cure for joint or spine problems. What they are is a promising tool that may enhance the body's own repair signaling, most useful as one component of a comprehensive regenerative plan rather than a treatment chosen in isolation. ## What Exosomes Actually Are Exosomes are extracellular vesicles, tiny membrane-bound packages released by cells. Their job in the body is communication: they carry growth factors, proteins, and genetic signaling material from one cell to another, effectively delivering instructions that influence how nearby cells behave. In regenerative medicine, the interest in exosomes comes from this signaling role. Rather than introducing new cells, as in stem cell therapy, exosome preparations aim to deliver the signaling molecules that may prompt the body's existing cells to reduce inflammation and support tissue repair. It is a different mechanism than PRP (which concentrates your own platelets and their growth factors) or A2M (which neutralizes cartilage-destroying enzymes), and PHI matches the approach to the patient rather than defaulting to one therapy for everyone. ## Where Exosomes Fit at PHI PHI uses exosome therapy for musculoskeletal regeneration, joints affected by arthritis, injured or degenerating tendons, and spine-related conditions. This is orthopedic and regenerative use, not cosmetic. PHI does not offer exosome facials or aesthetic skin treatments. Exosomes are typically considered within a comprehensive regenerative protocol rather than as a first or only step. For many patients, PRP or A2M carries a stronger evidence base and is the more appropriate starting point. Exosomes may be discussed for patients pursuing comprehensive regenerative care, those who have not responded fully to other options, or as part of a staged approach over time. Your physician will be direct about whether exosomes add meaningful value to your specific situation. ## An Honest Word on the Evidence PHI believes patients deserve the real picture. The clinical evidence for exosome therapy in musculoskeletal conditions is early and still developing. Laboratory and preliminary studies are encouraging, and the mechanistic rationale is reasonable, but large, high-quality human trials are limited compared with more established options like PRP. There is also a regulatory dimension worth understanding. Exosome products exist in an evolving regulatory landscape, and quality varies significantly between sources. PHI uses screened, quality-controlled preparations and is transparent about sourcing during consultation. We are equally transparent that we cannot promise outcomes, and we are wary of any provider who does. For patients who want a regenerative option with a more mature evidence base, we will say so and point toward PRP or A2M. For patients pursuing comprehensive regenerative care who understand the developing nature of the evidence, exosomes may be a reasonable part of the plan. ## How PHI Approaches Exosome Therapy The first step is a comprehensive evaluation: a detailed history of your condition, examination of the affected joint, tendon, or spinal region, review of imaging, and an honest discussion of whether regenerative medicine in general, and exosomes in particular, fit your situation. If exosome therapy is appropriate, treatment involves an image-guided injection placed precisely at the target site, performed by a board-certified physician. As with other regenerative treatments, effects are not immediate. Most patients are evaluated over a period of weeks to months, and exosomes are often combined with or sequenced alongside PRP, A2M, or other elements of a regenerative plan. ## When to Consider Exosome Therapy You may be a candidate for a regenerative consultation that includes exosome therapy if you have joint, tendon, or spine pain that has not responded fully to conservative care, if you are exploring regenerative options and want an honest assessment of where exosomes fit, if you are pursuing comprehensive regenerative care, or if you want to understand all the tools available before deciding on a plan. You are typically better served by another starting point if you have an acute injury that needs standard evaluation first, if you are seeking a guaranteed outcome (no regenerative therapy offers that), or if a more established option like PRP is the better-evidenced fit for your specific condition. ## Why PHI for Exosome Therapy PHI's approach to exosomes reflects its broader regenerative philosophy: match the therapy to the evidence, place it within a comprehensive plan, and tell patients the truth about what to expect. Board-certified physicians perform every injection under image guidance, exosomes are considered alongside the full regenerative toolkit rather than sold as a standalone fix, and the conversation about evidence is candid rather than promotional. ## Frequently Asked Questions **Q: Are exosomes the same as stem cell therapy?** No. Stem cell therapy introduces cells; exosome therapy delivers the signaling vesicles that cells use to communicate. Exosomes do not contain cells themselves. The two are related areas of regenerative medicine but work through different mechanisms, and your physician will explain which, if either, fits your situation. **Q: Do exosomes regrow cartilage or fully heal my injury?** There is no reliable evidence that exosomes regrow significant cartilage or fully heal established injuries, and PHI will not claim otherwise. The realistic goal is supporting the body's repair signaling and reducing inflammation as part of a broader plan, not regeneration of lost tissue. **Q: How strong is the evidence for exosome therapy?** It is early. Preliminary research and mechanistic rationale are encouraging, but high-quality human trials are limited compared with PRP. PHI is honest that exosomes are the least-established of its regenerative options, which is exactly why we use them within comprehensive protocols rather than as a default. **Q: Are exosome treatments regulated?** The regulatory landscape for exosome products is evolving and product quality varies between sources. PHI uses screened, quality-controlled preparations and discusses sourcing transparently during consultation. **Q: Will exosomes work better than PRP or A2M for me?** Not necessarily. For many conditions, PRP or A2M has a stronger evidence base and is the more appropriate choice. Your physician will recommend the option, or combination, that best fits your specific condition rather than steering you toward the newest therapy. **Q: How many treatments will I need?** This depends on your condition and the overall regenerative plan. Exosomes are often used alongside or in sequence with other regenerative treatments, and your physician will outline a realistic course at consultation rather than committing you to a fixed package upfront. **Q: Do you take insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. ## Schedule Your Regenerative Consultation A 60-minute consultation will evaluate your condition, walk through which regenerative options fit your situation, and give you an honest assessment of where exosome therapy does and does not make sense. Call (310) 856-9488 or book online now. ### Facet Joint Injections ## What Facet Joint Injections Do Your spine has small paired joints called facet joints connecting each vertebra to the one above and below it. These joints control how your spine bends and twists. Like any other joint in your body, they can develop arthritis, become inflamed after injury, or generate pain from wear over time. Facet joint pain is often missed because the symptoms are non-specific. The pain is usually felt in the spine itself rather than radiating down an arm or leg. Many patients receive treatment for a herniated disc or general back pain for years before facet involvement is identified. A facet joint injection delivers a combination of corticosteroid and local anesthetic directly into the joint. This serves two purposes at once. **Diagnostic:** if your pain improves significantly after the injection, the facet joint is confirmed as a primary source of your symptoms, which guides what comes next. **Therapeutic:** the corticosteroid reduces inflammation in the joint, which often produces pain relief lasting several months. For patients whose facet injection confirms the diagnosis but whose relief is shorter than desired, radiofrequency ablation is typically the next step. RFA targets the small nerves carrying pain signals from the facet joint and produces relief lasting 6 to 18 months. ## How the Procedure Works The injection is performed in our affiliated surgical suite under fluoroscopic guidance. The physician uses real-time imaging to confirm precise needle placement before delivering medication. Facet joints are small targets requiring imaging precision; injections without guidance are less accurate. You arrive, are positioned comfortably, and the injection site is cleaned and numbed with a local anesthetic. The physician advances a thin needle into the joint capsule, confirms position with imaging, and delivers the medication. The procedure typically takes about 20 minutes, depending on how many joints are treated. PHI offers a range of comfort options, from local anesthetic to nitrous oxide, conscious sedation (Versed), or deep sedation (Propofol). You leave the same day; patients who receive sedation arrange transportation home. ## Three Regions We Treat ## When Facet Joint Injections Are the Right Option Your physician will tell you which fits during consultation. The diagnostic value of a facet injection is part of why it is recommended: even if the relief is short, the information it provides is often what unlocks the right longer-term treatment. ## Why Patients Choose PHI for Facet Joint Injections ## What to Expect: Before, During, and After ## Frequently Asked Questions **Q: What is the difference between a facet injection and a medial branch block?** Both evaluate facet joint pain. A facet injection delivers medication directly into the joint; a medial branch block targets the small nerves carrying pain signals from it. PHI uses both, choosing the approach that fits your diagnosis and whether radiofrequency ablation is being considered as a next step. **Q: How long does the relief last?** Duration varies. Some patients experience months of relief from a single injection; others experience shorter relief that confirms the diagnosis and suggests RFA as the next step. The duration of your response is itself useful information for your physician. **Q: Will I be awake during the procedure?** It depends on the option you choose. PHI offers local anesthetic, nitrous oxide, conscious sedation (Versed), and deep sedation (Propofol). Your physician helps you choose the right level of comfort for your procedure. **Q: Is the injection painful?** Most patients describe the procedure as briefly uncomfortable rather than painful. The local anesthetic numbs the skin and tissue along the needle path. **Q: Will I be able to drive home?** If you choose local anesthetic only, most patients drive themselves home. If you receive sedation, arrange transportation, as you should not drive the same day. **Q: What are the risks?** Facet joint injections are well-established procedures with a strong safety profile when performed under image guidance. Risks include temporary increase in pain, bleeding or infection at the injection site, and very rare complications related to needle placement. Image guidance significantly reduces these risks. Your physician will review the full risk profile at consultation. **Q: What is the difference between a facet injection and an epidural steroid injection?** A facet injection treats pain coming from the small joints of the spine. An epidural injection treats nerve pain that radiates from the spine into an arm or leg. They target different sources of pain. Your physician recommends which fits based on your symptom pattern and imaging. **Q: What if the facet injection works but the relief is too short?** This is one of the most useful outcomes a facet injection can produce. A clear positive response with shorter-than-desired duration confirms the facet joints as the source of your pain and identifies you as a strong candidate for radiofrequency ablation, which provides relief lasting 6 to 18 months on average. **Q: What if the facet injection doesn't help?** If a properly placed facet injection does not produce meaningful relief, that is diagnostic information. It tells your physician the facet joints are likely not the primary source of your pain. The next step is usually to revisit imaging and consider whether a different treatment approach fits better. **Q: How much does a facet joint injection cost at PHI?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. For patients traveling specifically for facet evaluation, we coordinate consultation, imaging review, and procedure scheduling within a single visit when possible. > Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020. — [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/) > A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain. Peer-reviewed via PubMed, 2015. — [Manchikanti L, et al.](https://pubmed.ncbi.nlm.nih.gov/26218948/) > Medicare Local Coverage Determination L38803: Facet Joint Interventions for Pain Management. CMS. — [Centers for Medicare & Medicaid Services](https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=38803) ### Intracept Procedure ## What Vertebrogenic Pain Is and Why It Often Gets Missed Most chronic low back pain is attributed to the discs, facet joints, or muscles. But for many patients, the actual source is the vertebral endplate, the bony surface where the disc meets the vertebra. When the endplate is damaged or inflamed, signals travel through a small nerve called the basivertebral nerve, which carries pain signals from the vertebral body itself. This source is called vertebrogenic pain. It is typically marked by chronic low back pain that worsens with bending forward, sitting for extended periods, or physical activity. Standard MRI often misses it because the diagnostic finding (Modic Type 1 or Type 2 endplate changes) requires specific interpretation. For patients with vertebrogenic pain, traditional treatments often fail. Epidural injections target a different source, facet injections target a different structure, and disc procedures target a different problem. The Intracept Procedure is the first treatment developed specifically for this source of pain. ## How the Intracept Procedure Works The Intracept Procedure uses radiofrequency energy to ablate the basivertebral nerve, the specific nerve carrying pain signals from the vertebral body. Once the nerve is ablated, it cannot transmit pain signals from the affected vertebra. This is a single-treatment procedure. Unlike radiofrequency ablation of facet joint nerves, the basivertebral nerve does not regenerate in a way that requires repeat ablation, and most patients receive long-term relief from a single Intracept Procedure. The procedure is FDA-cleared and is performed using the Intracept System, the only device approved for basivertebral nerve ablation. It typically takes about an hour and is performed in our affiliated surgery center under image guidance and propofol (IV) sedation. ## Who Is a Candidate The Intracept Procedure is indicated for patients with: - Chronic low back pain lasting at least six months - Pain that has not responded adequately to at least six months of conservative treatment (physical therapy, anti-inflammatory medication, activity modification) - MRI findings consistent with vertebrogenic pain (Modic Type 1 or Type 2 endplate changes at L3-S1) - A pain pattern consistent with the vertebrogenic source (axial low back pain that worsens with activity, particularly bending forward and prolonged sitting) Your physician will review your imaging and history at consultation to determine whether you fit the candidacy profile. Not every patient with chronic low back pain has vertebrogenic pain, and identifying the right patient is the most important factor in a successful Intracept outcome. ## What the Evidence Shows The Intracept Procedure has strong clinical trial evidence. The pivotal SMART trial, a randomized controlled trial published in peer-reviewed literature, demonstrated significant pain reduction compared to sham treatment, with results sustained for years following the single procedure. Multiple long-term follow-up studies have confirmed durable benefits at five years or more. This is meaningfully different from many interventional pain procedures, which produce months of relief and require repeat treatment. Intracept is a single procedure with multi-year benefit for appropriately selected patients. ## Why Patients Choose PHI for the Intracept Procedure ## What to Expect ## Frequently Asked Questions **Q: Is the Intracept Procedure FDA-approved?** The Intracept System is FDA-cleared for the treatment of chronic vertebrogenic low back pain. It is the only device approved for basivertebral nerve ablation. **Q: How is the Intracept Procedure different from radiofrequency ablation of facet joints?** Both use radiofrequency energy to ablate a nerve, but they target different sources of pain. Facet RFA targets the medial branch nerves carrying pain from the facet joints. Intracept targets the basivertebral nerve carrying pain from the vertebral endplate. They are complementary procedures for different conditions, and many patients have one but not the other. **Q: How long does the relief last?** For most patients, Intracept provides durable relief from a single procedure. Long-term follow-up studies have demonstrated sustained pain reduction at five years post-procedure for appropriately selected patients. **Q: Will I be awake during the procedure?** The procedure is performed under propofol (IV) sedation. You will not be fully awake, but general anesthesia is not typically required. **Q: Will I be able to drive home?** No. Because the procedure involves sedation, you must arrange transportation. **Q: How do I know if I'm a candidate?** The most important factor is your MRI findings. Patients with Modic Type 1 or Type 2 endplate changes at the L3-S1 levels, combined with chronic low back pain consistent with the vertebrogenic pattern, are typical candidates. Your physician will review your imaging and confirm whether you fit the criteria during consultation. **Q: What are the risks?** The Intracept Procedure has a strong safety profile. Risks include the standard surgical risks of bleeding, infection, and post-procedure pain at the access site, plus the rare but specific risks of any spinal procedure. Your physician will review the complete risk profile during consultation. **Q: How much does the Intracept Procedure cost at PHI?** PHI is out-of-network with all insurance plans. Pricing varies based on the number of levels treated and other procedural factors, and all costs are disclosed at consultation, with no surprise billing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Intracept is particularly suited to international patients because it is a single procedure with durable benefit, eliminating the need for ongoing return visits. > A prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain. The Spine Journal. — [Khalil JG, et al.](https://pubmed.ncbi.nlm.nih.gov/31229663/) > 510(k) clearance summary for the Intracept Intraosseous Nerve Ablation System (K162176). U.S. Food and Drug Administration. — [U.S. Food and Drug Administration](https://www.accessdata.fda.gov/cdrh_docs/pdf16/K162176.pdf) > Long-term outcomes following intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 5-year treatment arm results from a prospective randomized double-blind sham-controlled multicenter study. European Spine Journal, 2020. — [Fischgrund JS, et al.](https://link.springer.com/article/10.1007/s00586-020-06448-x) ### IV Therapy ## What IV Therapy Is IV therapy delivers fluids, vitamins, minerals, and other nutrients directly into the bloodstream through an intravenous line. Because the nutrients bypass digestion, IV therapy can deliver higher concentrations of specific nutrients than oral supplementation can achieve. This bypass of digestion is the relevant clinical advantage. For patients with digestive conditions that limit absorption, severe nutrient depletion, dehydration, or specific situations where rapid nutrient delivery is needed, IV therapy can produce results oral supplementation cannot. For patients with normal digestion and adequate diet, IV therapy is generally a supportive intervention rather than a replacement for proper nutrition. It can produce real effects, particularly for acute needs like hydration after illness or recovery from athletic exertion, but it does not replace the foundation of good diet, hydration, and lifestyle. ## How PHI Approaches IV Therapy IV therapy at PHI is physician-prescribed, not menu-selected. Many IV providers in Los Angeles offer fixed protocols that patients select from a menu. PHI's approach is different. Each protocol begins with a physician consultation to understand your specific situation, goals, and medical considerations. Some patients benefit from specific protocols; others benefit more from oral supplementation, dietary changes, or addressing an underlying condition. Some patients pursuing IV therapy for general wellness might not benefit meaningfully and would be better served by other interventions. This honest framing is the differentiator. PHI does not push IV therapy as the answer for everyone. We use it where it fits and recommend other approaches where they fit better. ## PHI's IV Cocktail Menu PHI offers six physician-formulated IV cocktails covering the most common clinical and wellness applications, with custom formulations available based on individual goals and lab work. All cocktails include a base of IV fluids for hydration, with sessions running 30 to 90 minutes depending on the protocol. - **The PHI Signature** Our most comprehensive cocktail. IV fluids with Vitamins A, C, D, E and K, B-Complex (B12), Biotin and Folic Acid, formulated for full-spectrum repletion in a single session. May support comprehensive recovery, post-procedure repletion, immune function, and steady energy and mood. - **Energy Booster** The blend. IV fluids with Vitamins A, D, E and K, B-Complex, Vitamin C, Zinc and Glutathione. May support energy, stamina, mood, and recovery from physical exertion or demanding schedules. - **Beauty Booster** The blend. IV fluids with Biotin, Folic Acid, Magnesium and Glutathione. May support skin, hair and nail health, everyday energy, and comfort from occasional headaches. - **Stress Relief** The blend. IV fluids with Calcium Gluconate, Magnesium Chloride and Zinc. May support relaxation during stressful stretches, burnout recovery, and resilience against fatigue. - **The Ultimate Drip** Our most comprehensive recovery drip. IV fluids with Vitamins A, C, D, E and K, Magnesium, and an anti-inflammatory medication (Toradol). May help with body aches and soreness, dehydration, fatigue, and occasional nausea. - **Immune Support** The blend. IV fluids with Vitamin C, Zinc, Magnesium, an anti-inflammatory medication (Toradol), and Glutathione. May support immune function, a healthy inflammatory response, recovery from jet lag and travel, and mental clarity. #### Custom physician-designed cocktails For patients with specific clinical situations, lab findings, or wellness goals not addressed by the standard menu, PHI physicians design custom IV protocols as part of the broader concierge model, determined during consultation. ## Why Patients Choose PHI for IV Therapy ## What to Expect ## Frequently Asked Questions **Q: Is IV therapy FDA-approved?** The individual nutrients used in IV protocols (vitamins, minerals, amino acids) are approved for use in IV preparations through the compounding pharmacy regulatory pathway. The specific cocktails are not FDA-approved as drugs because they are nutrient combinations rather than pharmaceutical drugs. **Q: How is IV therapy different from taking vitamins by mouth?** IV delivery bypasses digestion, allowing higher blood levels of specific nutrients than oral supplementation typically achieves. For some nutrients (notably high-dose vitamin C, glutathione, NAD+), the difference between oral and IV bioavailability is substantial; for others, the difference is more modest. **Q: Will I feel better immediately?** This varies by cocktail and individual situation. Hydration protocols often produce immediate effects within hours, while nutrient repletion protocols typically produce more gradual effects over days. Some protocols require multiple sessions before noticeable benefit develops. **Q: How often should I get IV therapy?** Frequency depends on the cocktail and your goals. Some protocols are one-time interventions for specific situations (recovery from illness, jet lag); others are pursued in series. Maintenance protocols vary by goal. **Q: Are there risks?** IV therapy is generally safe when administered by qualified providers using quality-controlled preparations. Risks include vein irritation at the IV site, mild reactions to specific nutrients, and rare allergic reactions. Patients with certain conditions (kidney disease, heart failure) require careful screening before specific cocktails. **Q: Can I eat before my IV?** Yes. IV therapy does not require fasting. Eating a light meal beforehand may help prevent lightheadedness during longer sessions. **Q: Will IV therapy help me lose weight?** IV therapy is not a weight loss intervention. Patients pursuing weight management should discuss specific approaches with their physician. **Q: How does IV therapy fit with NAD+ therapy or peptides?** IV therapy and NAD+ therapy are often complementary, and many patients pursuing comprehensive longevity protocols use both. Peptides work through different mechanisms and can be coordinated with IV protocols. Your physician will design a comprehensive plan rather than treating each intervention in isolation. **Q: How much does IV therapy cost at PHI?** IV therapy pricing varies by cocktail, and all costs are disclosed at consultation. **Q: Can I choose any cocktail from the menu?** The menu represents PHI's most-prescribed cocktails. Your physician confirms which cocktail is appropriate for your specific situation during consultation, and in some cases a custom formulation may be recommended instead. **Q: Do you accept international patients?** Yes. IV therapy is well-suited to patients traveling to PHI from outside Los Angeles, often as part of comprehensive wellness visits combining IV with peptides, NAD+, regenerative protocols, or other treatments. > Vitamin and mineral fact sheets and clinical evidence summaries. NIH Office of Dietary Supplements. — [NIH Office of Dietary Supplements](https://ods.od.nih.gov/factsheets/list-all/) ### Joint Injections ## What Joint Injections Do Joint injections deliver medication directly into a joint to reduce inflammation, lubricate the joint, or stimulate tissue repair. The right injection depends on what is causing your pain. **Corticosteroid injections** reduce inflammation in the joint. They produce relatively fast relief, typically within a few days, that lasts weeks to months. They are the most established option for sudden flare-ups of arthritis, bursitis, or post-injury inflammation. **Hyaluronic acid injections** (commonly known as viscosupplementation, with Orthovisc as the product option for the knee) replenish the natural lubricating fluid in a joint that has been depleted by arthritis. Used primarily for knee osteoarthritis, the relief is slower to start than cortisone but typically lasts longer. **Regenerative injections** (PRP, A2M, stem cell therapy) use your body's own healing factors or biologic preparations to support tissue repair rather than just reducing inflammation. Relief takes longer to develop but addresses the underlying degeneration rather than the symptom alone. Your physician will recommend which option fits based on your imaging, symptom pattern, prior treatments, and goals. ## How the Procedure Works Joint injections are performed in our affiliated surgical suite under ultrasound guidance. Image guidance significantly improves accuracy compared to landmark-based injections, particularly for joints like the hip and shoulder where the target is deep or difficult to feel from the surface. You are positioned comfortably, and the injection site is cleaned and numbed with a local anesthetic. The physician advances a thin needle into the joint, confirms position with imaging, and delivers the medication. The procedure typically takes 10 to 15 minutes. You leave the same day. Most patients drive themselves home and return to most activities within 24 to 48 hours. ## Three Joints We Treat ## Orthovisc and Hyaluronic Acid for Knee Arthritis Orthovisc is a hyaluronic acid product used specifically for treating knee osteoarthritis. Hyaluronic acid is a natural component of the synovial fluid that lubricates and cushions your knee. In an arthritic knee, this fluid becomes depleted and less effective. Hyaluronic acid injections replenish this lubricating fluid. The relief develops gradually over several weeks rather than immediately, but typically lasts longer than a corticosteroid injection. Many patients report relief lasting six months or more from a single course. At PHI, the hyaluronic acid product used for the knee is Orthovisc. Your physician will recommend the dosing schedule that fits your knee. Hyaluronic acid is most appropriate for patients with mild to moderate knee osteoarthritis who want longer-lasting relief than cortisone provides, or who want to avoid the cumulative effects of repeated steroid injections. It is less effective for end-stage arthritis where the cartilage damage is severe. ## When Joint Injections Are the Right Option For patients with significant degeneration, your physician may recommend skipping cortisone and starting with a regenerative protocol instead. Repeated cortisone injections in a degenerating joint can accelerate cartilage loss in some cases. A regenerative approach addresses the tissue rather than the symptom. ## Why Patients Choose PHI for Joint Injections ## What to Expect: Before, During, and After ## Frequently Asked Questions **Q: How many cortisone joint injections can I have?** Cortisone injections in the same joint can have cumulative effects on cartilage and surrounding tissue, so they are spaced and monitored. If you require frequent injections to control pain, your physician will discuss longer-lasting options including hyaluronic acid or regenerative protocols. **Q: How long does the relief last?** Cortisone typically provides relief lasting weeks to several months. Hyaluronic acid in the knee often provides relief lasting six months or longer. Regenerative options work over a longer time horizon, and the duration depends on how well the underlying tissue responds. **Q: Will I be awake during the procedure?** Yes. Joint injections are performed under local anesthesia. You remain awake throughout. **Q: Is the injection painful?** Most patients describe a brief stinging or pressure sensation rather than pain. The local anesthetic numbs the skin along the needle path, and the injection itself is quick. **Q: Will I be able to drive home?** Yes. Most patients drive themselves home. **Q: Should I choose cortisone, hyaluronic acid, or PRP?** This depends on your specific joint, the severity of your condition, your goals, and your prior treatment history. Cortisone is fastest but cumulative. Hyaluronic acid is longer-lasting but limited primarily to the knee. PRP and other regenerative options address the tissue rather than the symptom. Your physician will recommend the right option after a full evaluation, and patients sometimes use these in sequence or combination. **Q: Will an injection delay or avoid surgery?** For some patients, yes. Patients with mild to moderate arthritis can often delay joint replacement for years through a combination of injections, physical therapy, and lifestyle adjustments. Patients with severe end-stage arthritis may eventually need surgery regardless. Your physician will give you an honest assessment based on your imaging and symptoms. **Q: Is hyaluronic acid (Orthovisc) covered by insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: What are the risks?** Joint injections are well-established procedures with strong safety profiles when performed under image guidance. Risks include temporary increase in pain, bleeding or infection at the injection site, and rare allergic reactions. Cortisone has additional considerations including temporary blood sugar elevation in patients with diabetes. Your physician will review the full risk profile at consultation. **Q: How is a joint injection different from PRP or stem cell therapy?** A standard joint injection delivers medication, cortisone or hyaluronic acid, to reduce inflammation or replenish lubrication. PRP and stem cell therapy use biologic preparations to support tissue repair and address the underlying degeneration. They take longer to produce results but work on the cause rather than the symptom. Many patients use them in combination or sequence. **Q: How much does a joint injection cost at PHI?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. > Efficacy and safety of corticosteroids, hyaluronic acid, and PRP and combination therapy for knee osteoarthritis: a systematic review and network meta-analysis. Peer-reviewed via PMC, 2023. — [Qiao X, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC10687893/) > Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: a meta-analysis. Peer-reviewed via PubMed, 2015. — [Wang F, et al.](https://pubmed.ncbi.nlm.nih.gov/25574222/) > Less pain with intra-articular hyaluronic acid injections for knee osteoarthritis compared to placebo: a systematic review and meta-analysis of RCTs. Peer-reviewed via PMC, 2024. — [Migliorini F, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11597132/) ### Ketamine Infusion Therapy ## How Ketamine Works Ketamine works differently from standard antidepressants and standard pain medications. Instead of slowly adjusting serotonin like an SSRI (which can take six to eight weeks to show benefit), ketamine acts on a different brain system called the glutamate system, which is involved in how nerve cells form new connections. For depression, this often produces a noticeable shift within 24 hours of the first infusion, and a standard treatment course extends and stabilizes that effect. For chronic pain, ketamine quiets nerve signals that have become hypersensitive after injury, surgery, or long-standing pain. Some patients with conditions like CRPS experience pain relief that outlasts the infusion itself by weeks, suggesting ketamine helps reset the nervous system rather than just masking symptoms. PHI uses subanesthetic doses, well below what would be used for surgical anesthesia. You remain conscious throughout the infusion, monitored continuously by your physician. PHI starts with IV infusions to assess your response before considering intramuscular (IM) dosing. ## Conditions We Treat with Ketamine Infusion Therapy #### Mental health and mood - Treatment-resistant depression (depression that has not improved after two or more medications) - Major depressive disorder - Bipolar depression - PTSD - Severe anxiety with depressive features - Suicidal ideation in the context of depression #### Chronic pain - Complex regional pain syndrome (CRPS / RSD) - Neuropathic pain and post-surgical nerve pain - Fibromyalgia - Chronic migraines and refractory headaches - Phantom limb pain - Chronic pain with significant mood overlap If your condition is not listed, your physician will tell you whether ketamine is an appropriate option during consultation. Ketamine is not a first-line treatment; it is most effective for patients who have already tried standard medications without sufficient relief. ## The Evidence Behind Ketamine **For depression.** A 2024 umbrella review analyzing 51 studies and 1,182 participants confirmed that repeated intravenous ketamine produces statistically significant improvements in treatment-resistant depression compared to placebo and other treatments. A pooled patient-level analysis found ketamine's benefits were even greater in patients more resistant to prior medications. **For chronic pain.** Multisociety consensus guidelines from the American Society of Regional Anesthesia (ASRA), American Academy of Pain Medicine (AAPM), and American Society of Anesthesiologists (ASA) support outpatient ketamine infusion for chronic pain conditions, with established protocols for CRPS and other neuropathic pain syndromes. This is not an experimental treatment. It is an established option with two decades of clinical research, performed by physicians trained in pain medicine and anesthesia. ## Why Patients Choose PHI for Ketamine Infusion ## A More Elevated Ketamine Experience PHI treats the whole person, not just the diagnosis. In addition to medically supervised IV ketamine infusions, we offer the option to work with a dedicated Spiritual Guide and Integration Specialist who can help you prepare for and process your experience. For many patients, ketamine therapy provides personal insight, emotional breakthroughs, and opportunities for growth. A trusted guide can help maximize the therapeutic value of treatment and support meaningful, lasting change. This option is available alongside your infusions; your physician and care team will help you decide whether it fits your goals. ## Your Ketamine Treatment Process at PHI ## Frequently Asked Questions **Q: Is ketamine FDA-approved for depression?** The FDA has approved a related medication, intranasal esketamine (Spravato), for treatment-resistant depression. Intravenous ketamine for depression is prescribed off-label, a common and legal practice for medications with strong clinical evidence outside their original FDA approval. The evidence base for IV ketamine in treatment-resistant depression is substantial, including dozens of randomized controlled trials. Your physician will explain the regulatory status during consultation. **Q: How fast does ketamine work?** For depression, many patients notice a shift within 24 hours of the first infusion, and the full benefit of an induction series typically becomes clear by the third or fourth infusion. For chronic pain, response is more variable. Some patients experience meaningful relief from a single infusion, others require a short series. **Q: Is ketamine the same as the street drug?** The molecule is the same; the medical context is not. PHI uses pharmaceutical-grade ketamine at controlled subanesthetic doses, administered intravenously by a physician with continuous monitoring. The dose, the setting, and the medical oversight are what make it a treatment rather than a substance of misuse. **Q: Will I be unconscious or hallucinate?** No. The doses used for depression and pain are far below anesthetic doses. Most patients experience a mild dissociative sensation, sometimes described as feeling slightly distant from the body, that fades shortly after the infusion ends. You remain conscious and able to respond throughout. **Q: Is ketamine addictive?** Recreational ketamine misuse can lead to dependence, but the risk profile in supervised, intermittent medical infusions is very different. PHI uses defined treatment series rather than open-ended dosing, and your physician monitors for any signs of escalating tolerance or psychological dependence. Maintenance infusions, when recommended, follow a clear protocol with appropriate intervals. **Q: Can I keep taking my current antidepressant during ketamine treatment?** In most cases, yes. Your physician will review your current medications at consultation and identify any that need adjustment. Most SSRIs, SNRIs, and mood stabilizers can be continued. **Q: Should I bring someone with me?** Yes. You cannot drive after an infusion, so we recommend a trusted person accompany you to your first infusion. For subsequent infusions, you may use a rideshare service if preferred. **Q: How much does ketamine therapy cost at PHI?** Pricing is structured per consultation, per infusion, and for the standard induction series, and all costs are disclosed at consultation with no hidden fees. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. For ketamine, we coordinate the full induction series timing with your travel schedule, which often means concentrating infusions into a two-week stay. > An umbrella review of effectiveness of intravenous ketamine in treatment-resistant depression. European Psychiatry, 2024. — [Klassen AM, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11859803/) > International pooled patient-level meta-analysis of ketamine infusion for depression: in search of clinical moderators. Peer-reviewed via PMC, 2022. — [Price RB, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC9763119/) > Use of ketamine infusions for treatment of complex regional pain syndrome: a systematic review. Peer-reviewed via PMC, 2021. — [Chitneni A, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8601938/) ### Kyphoplasty ## What Kyphoplasty Is Kyphoplasty is a minimally invasive procedure that treats vertebral compression fractures, breaks in the bones of the spine that occur when a vertebra collapses under its own weight or from minor trauma. These fractures are most common in patients with osteoporosis, but they also occur with cancer that has metastasized to bone, traumatic injuries, and certain other conditions. A vertebral compression fracture causes severe localized back pain that often worsens with movement and makes standing or walking difficult. Without treatment, the pain typically resolves over weeks to months as the fracture heals, but the vertebra often heals in a collapsed position, contributing to height loss, kyphosis (rounded upper-back posture), and increased risk of future fractures. Kyphoplasty addresses both problems. It stabilizes the fracture, which dramatically reduces pain, and it restores some of the lost vertebral height, which can prevent the long-term postural and structural consequences of the fracture. ## How the Procedure Works The procedure is performed in our affiliated surgery center under image guidance and propofol sedation. The physician advances a thin needle through a small access point into the fractured vertebra. A small balloon is inflated within the vertebra, which creates a cavity and partially restores the vertebra's height. The balloon is removed and bone cement is injected into the cavity, which hardens within minutes and stabilizes the fracture. The procedure typically takes 30 to 60 minutes per vertebra treated. Most patients leave the same day. ## Who Is a Candidate Kyphoplasty is typically appropriate for patients with: - A vertebral compression fracture confirmed on imaging (typically MRI showing acute or subacute marrow edema in the affected vertebra) - Significant pain that is inadequately controlled with conservative treatment (rest, bracing, pain medication) - Pain that has not adequately resolved after a reasonable trial of conservative treatment (typically 2 to 6 weeks for acute fractures) - Fracture-related pain that significantly limits daily function The procedure is most effective for fractures that are recent (typically less than 6 to 12 months old) where bone marrow edema is still present on MRI. Older fractures that have completed healing are typically not candidates. ## When to Consider Kyphoplasty For some patients with vertebral compression fractures, conservative treatment is sufficient: pain resolves over weeks, the fracture heals, and no procedure is needed. Kyphoplasty is most useful for patients whose pain is severe, persistent despite conservative treatment, or limiting their ability to function. The decision to proceed involves balancing the benefit of rapid pain relief and partial height restoration against the surgical risks of any procedure. Your physician will discuss this decision frankly during consultation. ## Why Patients Choose PHI for Kyphoplasty ## What to Expect ## Frequently Asked Questions **Q: How fast does kyphoplasty work?** Most patients experience meaningful pain relief within 24 to 48 hours of the procedure, though some experience improvement immediately after. **Q: Is the procedure permanent?** The cement that stabilizes the fractured vertebra remains in place permanently, and the treated vertebra is stable. However, kyphoplasty does not prevent fractures at other vertebrae. Patients with osteoporosis remain at risk for additional fractures and need ongoing bone-health management. **Q: Will I be awake during the procedure?** The procedure is performed under propofol sedation. You will not be fully awake. **Q: What are the risks?** Kyphoplasty has a strong safety profile. Risks include cement leakage outside the vertebra (uncommon and usually clinically insignificant), bleeding, infection, and the rare risks of any spinal procedure. Your physician will review the full risk profile during consultation. **Q: How long do I need to rest after kyphoplasty?** Most patients can resume daily activities within 1 to 2 days. Heavy lifting and high-impact movement should be avoided for several weeks. Your physician will provide specific guidance. **Q: Will kyphoplasty fix my hunched posture from previous fractures?** Kyphoplasty can partially restore height in the treated vertebra, particularly when performed on an acute fracture. It does not reverse posture changes from previously healed fractures. Combined with proper bone-health management to prevent future fractures, it can stop the progression of kyphosis. **Q: What about the fracture risk in other vertebrae?** Patients with osteoporotic compression fractures are at significant risk for additional fractures elsewhere in the spine, so ongoing bone-health management is essential. Your physician will work with your other doctors to optimize your medication, supplementation, and lifestyle factors to reduce future fracture risk. **Q: How much does kyphoplasty cost at PHI?** PHI is out-of-network with all insurance plans. All costs are disclosed at consultation, with no surprise billing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles. Because compression fractures often present acutely, international patients seeking kyphoplasty should contact us promptly to coordinate evaluation and procedure scheduling. > Pain, quality of life, and safety outcomes of kyphoplasty for vertebral compression fractures: report of a task force of the American Society for Bone and Mineral Research. Peer-reviewed via PubMed, 2017. — [American Society for Bone and Mineral Research Task Force](https://pubmed.ncbi.nlm.nih.gov/28513888/) > Effect of vertebral kyphoplasty versus vertebroplasty on pain and imaging parameters of the injured vertebrae in patients with osteoporotic vertebral compression fractures: a meta-analysis. Peer-reviewed via PMC, 2025. — [You Z, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11863920/) ### NAD+ Therapy ## What NAD+ Is Nicotinamide adenine dinucleotide (NAD+) is a coenzyme found in every cell of the body. It plays an essential role in three areas of cellular function: energy production through mitochondrial metabolism, DNA repair, and longevity signaling through pathways involving sirtuins and other regulatory proteins. NAD+ levels decline naturally with age. By age 50, cellular NAD+ levels are estimated to be roughly half of what they were in youth. This decline is associated with reduced cellular energy, impaired DNA repair, and increased markers of biological aging. NAD+ therapy supplements the body's NAD+ pool through direct administration. Unlike oral NAD+ precursors (NMN, NR), which must be converted by the body, IV and IM NAD+ delivers the molecule itself in usable form. ## How PHI Approaches NAD+ Therapy NAD+ therapy at PHI is physician-prescribed, not menu-selected. PHI's approach starts with consultation to determine whether NAD+ therapy fits your specific goals and which protocol is appropriate. The reason this matters: NAD+ therapy at meaningful therapeutic doses can produce side effects (chest pressure, flushing, nausea) particularly during initial infusions, and tolerance varies significantly by individual. PHI's protocols are tiered intentionally, starting at lower doses for new patients and progressing only as tolerance is established. Patients who would benefit more from a different intervention are told so. NAD+ is a powerful tool when it fits, but it is not the right answer for every patient pursuing wellness or longevity goals. https://youtube.com/shorts/Gn7Cws6fPKk?si=QCeYVn9JddEwB6JT ## PHI's NAD+ Protocols and Pricing NAD+ therapy cost in Beverly Hills varies by protocol. PHI publishes pricing for transparency, with five tiered options designed for therapeutic initiation, ongoing optimization, and maintenance. #### Intramuscular NAD+ shots IM injections offer a practical, time-efficient option for sustaining NAD+ levels between IV sessions, ideal for patients on active optimization protocols. **NAD+ Shot 50 mg | $95** (first-timer, intramuscular). An ideal introduction to NAD+ therapy, delivered intramuscularly for rapid uptake with minimal time commitment. **NAD+ Shot 100 mg | $170** (regular user, intramuscular). Recommended for established NAD+ users maintaining levels between IV infusion sessions. #### Intravenous NAD+ infusions IV delivery provides complete bioavailability and systemic distribution. All IV protocols include 500 mL of hydration and electrolytes. **NAD+ IV Lite 250 mg | $400** (first-timer, up to 2 hours). The recommended starting point for IV therapy, allowing tolerance assessment at a therapeutic dose before progressing to higher concentrations. **NAD+ IV Plus 500 mg | $700** (regular use, up to 4 hours, recommended). PHI's standard therapeutic protocol for ongoing optimization, energy restoration, and cellular repair, and the most-prescribed protocol for established patients. **NAD+ IV Ultra 1,000 mg | $1,000** (experienced, up to 6 hours). Reserved for experienced patients seeking maximum cellular replenishment and longevity benefit, appropriate only after lower-tier tolerance is established. ## Choosing the Right Protocol - New to NAD+ therapy: most patients begin with a 50 mg IM shot or the IV Lite (250 mg) to assess tolerance. - Active optimization: the IV Plus (500 mg) is PHI's most-prescribed protocol, often paired with 100 mg IM shots between infusions. - Advanced longevity protocols: the IV Ultra (1,000 mg) is reserved for experienced patients with established tolerance, typically as part of a comprehensive longevity program. Frequency is individualized. Some patients pursue weekly or biweekly infusions during initiation, then transition to monthly maintenance with IM shots between sessions. ## Why Patients Choose PHI for NAD+ Therapy ## What to Expect ## Frequently Asked Questions **Q: Is NAD+ therapy FDA-approved?** NAD+ is administered as a compounded preparation through licensed compounding pharmacies under FDA section 503A. NAD+ itself is not FDA-approved as a drug for specific indications, which is consistent with most regenerative and longevity therapies. **Q: How is IV NAD+ different from oral NAD+ precursors like NMN or NR?** Oral NAD+ precursors (NMN, NR) must be converted by the body into usable NAD+, with variable bioavailability and a conversion pathway that may reduce effective dose. IV and IM NAD+ delivers the molecule itself, bypassing conversion. **Q: How will I feel during my first NAD+ infusion?** Most patients experience some sensation during their first infusion, often described as chest pressure, warmth, or mild nausea. These effects are dose- and rate-dependent, and slowing the infusion typically reduces or resolves them. PHI starts new patients at lower doses (Lite 250 mg) specifically to assess and manage tolerance. **Q: How quickly will I feel benefits?** This varies by individual and protocol. Some patients report increased energy and mental clarity within hours of an IV infusion; others notice more gradual effects over a series of sessions. Longevity benefits develop over longer timeframes and are not directly perceptible. **Q: How often should I receive NAD+ therapy?** Frequency depends on your goals. Initiation protocols often involve weekly or biweekly IV infusions for several weeks, while maintenance protocols typically use monthly IV infusions or weekly IM shots. Your physician will design a schedule based on your goals and response. **Q: Are there risks or contraindications?** NAD+ therapy is generally well-tolerated under physician supervision at appropriate doses. Patients with active cancers, severe kidney or liver disease, or specific cardiovascular conditions require careful screening. NAD+ is not appropriate for everyone, which is why physician evaluation is essential. **Q: Can I eat before my NAD+ infusion?** Yes. NAD+ therapy does not require fasting. A light meal beforehand may help reduce nausea during the infusion. **Q: Does NAD+ therapy reverse aging?** NAD+ therapy supports cellular processes that decline with age (energy production, DNA repair, longevity signaling). It does not reverse aging, but it addresses one of the measurable cellular changes associated with aging. NAD+ is one tool among many in a longevity protocol, not a fountain of youth. **Q: How much does NAD+ therapy cost in Los Angeles?** NAD+ therapy at PHI ranges from $95 for an IM shot to $1,000 for the IV Ultra protocol. Full pricing is published above and confirmed at consultation. Pricing is structured per consultation, per infusion, and for the standard induction series, and all costs are disclosed at consultation with no hidden fees. **Q: Do you accept international patients?** Yes. NAD+ therapy is well-suited to patients traveling to PHI from outside Los Angeles, often as part of comprehensive wellness visits combining NAD+ with peptides, IV protocols, regenerative procedures, or other treatments. ### Nerve Blocks ## What Nerve Blocks Do A nerve block is a precisely targeted injection that interrupts the transmission of pain signals along a specific nerve or group of nerves. Unlike steroid injections that reduce inflammation, nerve blocks act directly on the nerve itself, either temporarily numbing it with local anesthetic or disrupting its pain-signaling function. **Diagnostic.** A successful block confirms that the targeted nerve is the source of your pain. This is critical information when the pain pattern is unclear or when imaging does not point to a single cause. **Therapeutic.** Many nerve blocks produce sustained relief that lasts long after the local anesthetic wears off. The mechanism involves resetting overactive nerve signaling rather than just temporarily numbing. **Bridge to definitive treatment.** Some nerve blocks are used as a step toward a longer-lasting procedure such as radiofrequency ablation, peripheral nerve stimulation, or sympathetic nerve interventions. PHI offers four primary nerve block procedures, each indicated for a different clinical situation. ## Genicular Nerve Block The genicular nerves carry pain signals from the knee joint to the brain. A genicular nerve block delivers local anesthetic to these nerves to temporarily interrupt knee pain signaling, used both diagnostically and therapeutically. Genicular blocks are most often used for patients with chronic knee pain, particularly knee osteoarthritis, who: - Have not responded adequately to conservative treatments - Are not surgical candidates due to age, medical conditions, or personal preference - Want to explore non-surgical options before considering joint replacement - Have already had knee replacement and continue to experience pain The procedure is performed under image guidance. The physician identifies the three primary genicular nerves around the knee and delivers local anesthetic to each. It typically takes 15 to 20 minutes, and most patients experience pain reduction within the first hour. A successful response often qualifies the patient for genicular ablation, a longer-lasting next step. ## Stellate Ganglion Block (SGB) The stellate ganglion is a cluster of sympathetic nerves in the front of the neck, near the spine, central to the body's fight-or-flight response. A stellate ganglion block delivers local anesthetic to this cluster, temporarily interrupting sympathetic signaling. It has expanded well beyond its original use for upper-extremity pain syndromes. SGB is used for several distinct conditions, including complex regional pain syndrome (CRPS) of the upper extremity, post-traumatic upper-extremity pain, phantom limb pain, and sympathetic-mediated facial pain. PHI also uses SGB for post-traumatic stress disorder (PTSD), where growing evidence, including studies in military veteran populations, shows meaningful symptom reduction. For PTSD, SGB is adjunctive to mental health care, not a replacement for it. The procedure is performed under image guidance with the patient awake and typically takes 10 to 20 minutes. Patients often experience immediate, expected effects on the treated side, including a temporary droopy eyelid, slight redness, and warmth, which resolve within several hours. For chronic pain indications, patients often receive a series of blocks. PHI performs one side at a time, not both sides on the same day. ## Ganglion Impar Block The ganglion impar (also called the ganglion of Walther) is a small cluster of sympathetic nerves at the very base of the spine, just in front of the tailbone. It receives sympathetic signals from the pelvic organs and perineal region. Ganglion impar blocks are used for chronic pelvic and perineal pain that is often poorly served by other treatments, including: - Chronic perineal pain - Coccydynia (tailbone pain) that has not responded to conservative treatment - Cancer-related pelvic pain, including rectal, anal, or gynecologic cancers - Post-surgical pelvic pain - Pudendal neuralgia in selected patients - Post-radiation pelvic pain The procedure is performed under image guidance with the patient face down. The physician advances a thin needle to the ganglion impar location, confirms placement with imaging, and delivers local anesthetic with or without a small amount of corticosteroid. It typically takes 15 to 20 minutes. If the response is positive but short-lived, a longer-lasting procedure such as neurolysis or radiofrequency ablation of the ganglion impar may be considered. ## Sympathetic Nerve Block Sympathetic nerve blocks target the sympathetic nervous system at various levels along the spine, depending on the location of pain. The stellate ganglion block is one type. Two other common targets are the lumbar sympathetic block, for sympathetic-mediated pain in the leg, and the celiac plexus block, for severe upper-abdominal pain such as pain related to pancreatic cancer or chronic pancreatitis. The unifying feature of conditions treated with sympathetic blocks is overactive sympathetic signaling that maintains pain or vascular symptoms even after the original injury has healed. Common indications include: - Complex regional pain syndrome (CRPS) of the lower extremity - Vascular insufficiency pain in the leg - Phantom limb pain in the lower extremity - Severe abdominal pain from pancreatic cancer or chronic pancreatitis - Pelvic pain syndromes with sympathetic features The procedure is performed under image guidance, with positioning according to the specific block. It typically takes 15 to 30 minutes depending on the complexity of the target. For chronic pain indications, patients often receive a series of blocks, and successful diagnostic blocks may qualify patients for longer-lasting procedures including radiofrequency neurolysis in selected cases. ## Why Patients Choose PHI for Nerve Blocks ## What to Expect: Before, During, and After ## Frequently Asked Questions **Q: How is a nerve block different from a steroid injection?** A steroid injection reduces inflammation in or around a structure such as a joint, the epidural space, or soft tissue. A nerve block targets a specific nerve to interrupt pain signaling directly. They serve different purposes and treat different pain mechanisms, and some procedures combine both. **Q: Will the block work for me?** For diagnostic blocks, working means a clear reduction in your typical pain within the timeframe the local anesthetic is active, and this information is valuable whether the result is positive or negative. For therapeutic blocks, response varies by individual and indication. Your physician will set realistic expectations for your situation. **Q: Is the block painful?** Most patients describe the procedure as briefly uncomfortable rather than painful. The local anesthetic numbs the skin and tissue along the needle path. Some blocks, particularly the ganglion impar, involve sensitive areas that may feel more prominent during the procedure. **Q: Can I drive after a nerve block?** No. You should not drive yourself home from any nerve block. Local anesthetic effects, any sedation used, and the temporary signs of a successful block make driving inadvisable for at least 24 hours, so arrange transportation in advance. **Q: How many blocks can I have?** This varies by block type and indication. Some blocks are performed once for diagnostic purposes; others are performed in a series of two or three. Therapeutic blocks for chronic pain may be repeated periodically. Your physician will recommend a specific protocol. **Q: What are the risks?** Nerve blocks have low complication rates when performed by experienced physicians under image guidance. Risks vary by block type and may include temporary increase in pain, bleeding, infection at the injection site, and rare complications related to needle placement near critical structures. Your physician will review the specific risk profile for the block they recommend. **Q: Does PHI offer stellate ganglion block for PTSD?** Yes. PHI offers stellate ganglion blocks for both pain and PTSD, following physician evaluation. For patients pursuing SGB for PTSD, our physicians work alongside your existing mental health treatment team. SGB is not a replacement for psychotherapy or psychiatric care; it is an adjunctive procedure that may help patients respond more effectively to other treatments. **Q: Can a nerve block lead to a longer-lasting procedure?** Yes, frequently. A successful diagnostic block often qualifies you for a definitive procedure, such as radiofrequency ablation following a successful diagnostic block, peripheral nerve stimulation following a successful trial, or longer-acting neurolytic procedures in selected cancer pain cases. Your physician will discuss these pathways during consultation. **Q: How much does a nerve block cost at PHI?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. For patients traveling specifically for nerve block evaluation and treatment, we coordinate consultation, imaging review, the procedure, and any follow-up within a single visit when possible. > Stellate ganglion blockade for the treatment of post-traumatic stress disorder: a systematic review and meta-analysis. Autonomic Neuroscience: Basic and Clinical, 2025. — [Wang J, et al.](https://pubmed.ncbi.nlm.nih.gov/41151498/) > Stellate ganglion block for psychiatric disorders: a systematic review of the clinical research landscape. Chronic Stress, 2021. — [Kerzner J, et al.](https://pubmed.ncbi.nlm.nih.gov/34901677/) > Non-neurodestructive ganglion impar blocks for coccydynia and related disorders: a systematic review and meta-analysis. Peer-reviewed via PubMed, 2025. — [Stoneham, et al.](https://pubmed.ncbi.nlm.nih.gov/40081927/) > Improvement in pain following ganglion impar blocks and radiofrequency ablation in coccygodynia patients: a systematic review. Rev Bras Ortop, 2021. — [Choudhary R, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8558944/) ### Neurotoxins for Pain ## Therapeutic Neurotoxin vs. Cosmetic Botox This page covers the medical use of botulinum toxin for pain conditions, performed in a clinical context using FDA-approved products and protocols developed for specific medical indications. The molecule itself is the same one used cosmetically. The doses, injection sites, and clinical purpose are entirely different. Therapeutic neurotoxin is not used to smooth wrinkles or change facial appearance. It is used to interrupt overactive nerve and muscle signaling that contributes to chronic pain. If you are considering cosmetic Botox, that is a different service and a different conversation. This page is about pain. ## How Therapeutic Neurotoxin Works Botulinum toxin works by temporarily blocking the chemical signal between nerves and muscles. When injected at therapeutic doses, it reduces overactive muscle contraction and dampens certain nerve pain pathways. For chronic migraine specifically, the mechanism involves more than muscle relaxation. Botulinum toxin appears to interrupt the release of pain-signaling molecules from nerve endings around the head and neck, which reduces the frequency and severity of migraine attacks over time. The effect is temporary. Therapeutic injections typically last about three months, after which the cycle is repeated to maintain benefit. This treatment cycle is a defining feature of neurotoxin therapy and is built into the standard protocols. ## Conditions We Treat with Therapeutic Neurotoxin #### Chronic Migraine Chronic migraine is defined as 15 or more headache days per month, with at least 8 being migraine, for at least three months. It is distinct from episodic migraine and requires different treatment. OnabotulinumtoxinA is FDA-approved for the prevention of headaches in adults with chronic migraine. The approval was based on the PREEMPT Phase III program, two double-blind, placebo-controlled trials enrolling 1,384 patients across 122 centers in North America and Europe, which showed reduced headache frequency and severity with a tolerable safety profile. The standard protocol delivers 155 units of onabotulinumtoxinA across 31 specific injection sites in the head, neck, and upper shoulders, takes about 15 to 20 minutes, and is repeated every 12 weeks. Most patients require two or three treatment cycles before they can fully evaluate the response; a single cycle is rarely enough. #### Cervicogenic Headache Cervicogenic headache originates from the cervical spine and the muscles, joints, or nerves of the upper neck. The pain is typically felt at the base of the skull and often refers to one side of the head, sometimes mimicking migraine. Neurotoxin injections to specific neck muscles can reduce the muscle-related contribution. The evidence is less robust than for chronic migraine but is supported by clinical experience, and PHI evaluates whether neurotoxin, cervical facet injections, or a combination is the right approach. #### TMJ Disorders Temporomandibular joint (TMJ) disorders cause pain in the jaw, face, ear, and sometimes neck. Some forms are driven by overactive jaw muscles, particularly the masseter and temporalis, and neurotoxin injections to these muscles can reduce the hyperactivity and the pain it generates. Systematic reviews of botulinum toxin for TMJ show evidence of medium to low certainty, and botulinum toxin is not currently FDA-approved specifically for TMJ; it is offered off-label based on clinical judgment. Your physician will set realistic expectations during consultation. #### Other Off-Label Pain Indications Therapeutic neurotoxin is sometimes used for other persistent pain conditions where overactive muscle or nerve signaling is suspected, including persistent occipital neuralgia, cervical dystonia (an FDA-approved indication), selected myofascial pain conditions, plantar fasciitis in selected patients, and spasticity-related pain. Evidence quality varies significantly. A Cochrane review of botulinum toxin for myofascial pain syndromes found inconclusive evidence to support routine use. Where the evidence is weaker, your physician will tell you so directly. ## Why Patients Choose PHI for Therapeutic Neurotoxin ## What to Expect: Before, During, and After ## Frequently Asked Questions **Q: Is therapeutic neurotoxin the same as cosmetic Botox?** The molecule is the same. The dose, injection sites, and purpose are different. Cosmetic Botox uses small doses in specific facial muscles to soften wrinkles. Therapeutic neurotoxin uses larger doses across many sites to interrupt overactive muscle and nerve signaling that contributes to pain. They are different services performed for different reasons. **Q: Is neurotoxin therapy FDA-approved?** For chronic migraine, yes. OnabotulinumtoxinA (Botox) is FDA-approved specifically for the prevention of headaches in adults with chronic migraine. For other pain indications including TMJ, occipital neuralgia, and certain myofascial conditions, neurotoxin is used off-label, meaning it is prescribed based on clinical judgment outside its specific FDA approval. Your physician will tell you the regulatory status of any specific use during consultation. **Q: How long does it last?** Approximately 12 weeks per treatment cycle. To maintain ongoing benefit, treatment is repeated every 12 weeks. Some patients can extend slightly longer between cycles; others find 10 to 11 weeks fits their pattern better. Your physician will adjust based on your response. **Q: How fast does it work?** Effects begin within 7 to 14 days and reach maximum benefit by approximately week 4 to 6. Therapeutic neurotoxin is not a fast-acting treatment. Patients expecting same-day or next-day results often feel that the treatment is not working when it is simply still developing its effect. **Q: Will I have side effects?** Common side effects include temporary mild soreness at injection sites and occasional brief neck or shoulder weakness when neck muscles are injected. Less common effects include eyelid drooping (uncommon with chronic migraine protocols when injected correctly), temporary headache in the first 24 hours, and rare allergic reactions. Your physician will review the specific risk profile during consultation. **Q: How many treatment cycles do I need before I know if it is working?** For chronic migraine specifically, two to three full treatment cycles (about 6 to 9 months) are typically required to fully evaluate response. Some patients respond after the first cycle; many do not show meaningful benefit until the second or third cycle. Stopping after one cycle often misses patients who would have responded. **Q: Is therapeutic neurotoxin covered by insurance?** For chronic migraine specifically, some insurance plans may cover therapeutic Botox as a separate medication benefit when prescribed for an FDA-approved indication. Your physician's office can discuss specific coverage options at consultation. **Q: What is the difference between Botox, Dysport, Xeomin, and Myobloc?** These are different brand-name botulinum toxin products with slightly different formulations. They are not interchangeable on a unit-for-unit basis but are clinically similar. Most clinical evidence for chronic migraine is specifically for onabotulinumtoxinA (Botox), which is the only product FDA-approved for this indication. **Q: Can I have therapeutic neurotoxin and cosmetic Botox at the same time?** PHI does not offer cosmetic neurotoxins. If you receive cosmetic neurotoxins elsewhere, you must inform your physician so the doses can be coordinated to avoid exceeding safe total dosing across a treatment period. **Q: How much does therapeutic neurotoxin cost at PHI?** Pricing depends on the indication, total units required, and specific protocol; chronic migraine treatment uses 155 units per cycle following the FDA-approved protocol. All costs are disclosed at consultation, with no surprise billing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Because therapeutic neurotoxin requires repeat treatment every 12 weeks to maintain benefit, international patients should plan for cycles that fit their travel schedule. > OnabotulinumtoxinA: a review in the prevention of chronic migraine. Peer-reviewed via PMC. — [Frampton JE, Silberstein S.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5367647/) > Botulinum toxin for myofascial pain syndromes in adults. Cochrane Database of Systematic Reviews. — [Soares A, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7202127/) > Effects of botulinum toxin type A in patients with painful temporomandibular joint disorders: a systematic review and meta-analysis. Annals of Medicine and Surgery, 2024. — [Zhu M, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC11230827/) > Botox (onabotulinumtoxinA) prescribing information, chronic migraine prevention. U.S. Food and Drug Administration. — [U.S. Food and Drug Administration](https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/103000s5302lbl.pdf) ### Peptide Therapy ## What Peptides Are Peptides are short chains of amino acids, the same building blocks that make up the proteins in your body. Insulin is a peptide; so is oxytocin. Your body produces thousands of them naturally, each one a signal telling specific cells what to do. Therapeutic peptides are precise versions of these natural signals. Some are identical copies of peptides your body already makes; others are slightly modified to last longer or work more selectively. They work by activating specific receptors rather than overriding your body's systems, which is why peptides are often described as working with your biology rather than against it. This is also why peptide therapy is highly individual. The right peptide depends on what biological signal needs to be reinforced or restored, which varies by age, goals, and the underlying issue. ## How PHI Approaches Peptide Therapy Peptide therapy at PHI starts with a full medical workup, including bloodwork. We do not prescribe peptides without first establishing a baseline of your current health. The workup tells us what is actually happening at the biological level (hormone levels, inflammatory markers, metabolic function) and what protocol, if any, fits for you. Some peptides are FDA-approved medications with decades of clinical data; others are compounded by licensed pharmacies under physician prescription, supported by emerging evidence but not yet FDA-approved for the specific use. Your physician will explain the regulatory status of any peptide they recommend, what the evidence supports, and what it does not. This honesty is the point. Peptide therapy works when it is matched correctly to a real biological need. It does not work as a generic wellness-optimization prescription. We treat it as medicine, not lifestyle. ## Three Areas We Treat with Peptide Therapy #### Longevity and healthy aging As you age, the natural production of certain signaling peptides declines, contributing to slower recovery, changes in body composition, reduced sleep quality, and the visible signs of aging. Peptides used in this area work by gently prompting your body to produce growth hormone at more youthful levels, rather than introducing synthetic growth hormone directly. This preserves your body's natural feedback loops and avoids the side effects associated with growth hormone replacement. Patients typically report better sleep, faster recovery, and gradual changes in body composition over 8 to 12 weeks. #### Recovery, tissue repair, and performance For patients with persistent injuries, post-surgical recovery, or training demands that exceed natural recovery capacity, certain peptides support the body's tissue-repair processes. Patients typically report faster resolution of soft-tissue injuries, reduced post-training soreness, and improved healing after orthopedic procedures. The strongest evidence for these peptides comes from preclinical models and clinical experience; large-scale randomized human trials are still limited, and patients who pursue these protocols are choosing to act on emerging evidence under physician supervision. #### Metabolic support Peptides used for metabolic support are matched to your bloodwork and goals. As with every PHI protocol, your physician will explain what a given peptide is intended to do, the regulatory status, and what the evidence supports before any prescription. ## Conditions We Treat with Peptide Therapy - Age-related decline in growth hormone, energy, sleep quality, and recovery - Muscle preservation and body-composition support - Persistent soft-tissue injuries (tendons, ligaments) - Post-surgical recovery - Athletic performance and recovery demands - Immune system support - Skin and tissue regeneration If your goal is not listed, your physician will tell you whether peptides are an appropriate option during consultation. ## Why Patients Choose PHI for Peptide Therapy ## Your Peptide Therapy Process at PHI ## Frequently Asked Questions **Q: Are peptides FDA-approved?** Some are; others are not. Certain peptides are FDA-approved prescription medications, while many used in longevity and recovery protocols are compounded through licensed pharmacies under specific regulatory pathways rather than being FDA-approved. Your physician will explain the regulatory status of any peptide they recommend. **Q: Are peptides safe?** The safety profile depends on the specific peptide, your individual health, and how it is prescribed. FDA-approved peptides have well-documented safety profiles from large clinical trials; compounded peptides have less large-scale human safety data, though many have been used clinically for years with favorable real-world experience. PHI prescribes peptides only after baseline bloodwork and only with ongoing monitoring, and screens for contraindications during consultation. **Q: How long until I see results?** This varies by peptide and protocol. Growth hormone-releasing peptides typically take 8 to 12 weeks to produce noticeable changes in sleep, recovery, and body composition. Recovery peptides for soft-tissue injuries often show improvement within 4 to 8 weeks. **Q: Do peptides have side effects?** Yes, like any medication. Growth hormone-releasing peptides can cause water retention or mild fatigue at the start of a protocol. Each peptide has its own profile, and your physician will review the relevant side effects for any protocol they recommend. **Q: Can I just buy peptides online?** Peptides sold online without a prescription are typically labeled "for research use only" and are not regulated for human use, and quality, purity, and dosing accuracy vary widely. Self-administering also means no baseline labs, no contraindication screening, and no adjustment if your body responds unexpectedly. The cost savings rarely outweigh the risks. **Q: Is peptide therapy covered by insurance?** PHI is out-of-network with all insurance plans, a concierge model choice so that clinical judgment dictates your care rather than coverage decisions. Compounded peptides typically are not covered by insurance. **Q: How much does peptide therapy cost at PHI?** Pricing varies by protocol and depends on the consultation, lab work, and ongoing peptide costs. All costs are disclosed at consultation, with no hidden fees. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. For peptide protocols, we coordinate the consultation, lab work, and ongoing prescription logistics to fit your travel and home schedule. ### Peripheral Nerve Stimulation ## What Peripheral Nerve Stimulation Is Peripheral nerve stimulation (PNS) uses small electrical signals to interrupt chronic pain signaling along specific peripheral nerves. A thin lead (a flexible wire with electrical contacts) is placed near the nerve causing pain, and the lead delivers gentle electrical stimulation that masks or modulates the pain signal before it reaches the brain. For appropriate patients, PNS produces meaningful pain relief without the systemic side effects of long-term medications. It is most useful for patients with persistent pain along a specific nerve distribution that has not responded adequately to other treatments. PHI uses a temporary 60-day system. This leads-only system delivers stimulation for up to 60 days and is then removed, with many patients experiencing sustained pain relief well beyond the stimulation period. ## How PNS Works A thin flexible lead is placed near the targeted nerve through a single needle insertion, with no incision, stitches, or tunneling required, and connected to a small stimulator worn on the skin. The placement is minimally invasive, non-surgical, and drug-free. PHI uses a temporary 60-day system: the lead stays in place delivering stimulation for up to 60 days, then is removed. There is no separate trial period before placement. Stimulation is non-painful and adjustable. Patients control settings within parameters set by their physician, allowing the stimulation to be optimized for daily activities. The approach is non-destructive and motor-sparing: it does not damage or destroy the nerve, and it targets the pain signal without impairing muscle function. Many patients experience relief that continues beyond the 60-day stimulation period. Sustained stimulation over the treatment period is thought to modulate how the nervous system processes pain, which is the proposed basis for relief that can persist after the lead is removed. ## Who Is a Candidate PNS is typically appropriate for patients with: - Chronic nerve-related pain along a specific peripheral nerve distribution - Pain that has not responded adequately to medications, injections, and other treatments - A pain pattern that fits a specific nerve target rather than a diffuse pain syndrome - A stable medical condition appropriate for an implantable device Common indications include post-surgical nerve pain, occipital neuralgia, post-traumatic peripheral nerve pain, peripheral neuropathy in specific distributions, and certain chronic regional pain syndromes. ## What the Evidence Shows PNS has accumulated evidence for several specific pain indications. Recent randomized trials and prospective cohort studies demonstrate meaningful pain reduction and functional improvement, particularly for post-surgical nerve pain and certain post-amputation pain syndromes. The 60-day temporary stimulation system has shown sustained benefit beyond the active stimulation period in multiple peer-reviewed studies. This is a more recent intervention than traditional spinal cord stimulation, with evidence quality varying by specific indication. Your physician will discuss what the evidence supports for your particular situation. ## Why Patients Choose PHI for Peripheral Nerve Stimulation ## What to Expect ## Frequently Asked Questions **Q: How is peripheral nerve stimulation different from spinal cord stimulation?** Spinal cord stimulation places leads near the spinal cord to treat broader pain patterns, typically the lower back and legs. Peripheral nerve stimulation places leads directly near a specific peripheral nerve to treat pain in that nerve's distribution. PNS is generally appropriate for more focal pain; SCS for more diffuse pain. **Q: How long does the stimulation system stay in place?** PHI uses a temporary 60-day system. The lead delivers stimulation for up to 60 days and is then removed. Many patients experience relief that continues beyond the stimulation period. **Q: Can I drive with PNS?** Most patients can carry on with normal daily activities during the stimulation period, though stimulation may be turned off during driving in some cases. Your physician will discuss specifics for your situation. **Q: What happens if the 60-day system does not give lasting relief?** If the temporary system does not provide lasting relief, your physician will discuss alternative treatment options based on your specific condition. PHI offers the 60-day Sprint peripheral nerve stimulation system and does not place permanent implants. **Q: What are the risks?** The most common effect is temporary skin irritation where the lead exits the skin or where adhesives are applied, which is usually mild and resolves on its own. Other risks include lead migration, infection at the access site (reported in a small percentage of patients), and post-procedure pain. Serious complications are rare. Your physician will review the complete risk profile. **Q: How much does PNS cost at PHI?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. > Consensus guidelines for the use of peripheral nerve stimulation in the treatment of chronic pain and neurological diseases: a Neuron Project from the American Society of Pain and Neuroscience. Peer-reviewed via PMC. — [Latif U, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12614495/) > Peripheral nerve stimulation for chronic pain: a systematic review of effectiveness and safety. Pain and Therapy, 2021. — [Helm S, et al.](https://pubmed.ncbi.nlm.nih.gov/34478120/) ### PRP Therapy ## What PRP Is Platelet-rich plasma is a concentrate prepared from your own blood. Platelets are the components responsible for clotting and tissue repair, and they contain dense concentrations of growth factors that signal damaged tissue to heal. To prepare PRP, a small amount of your blood is drawn and processed in a centrifuge to separate the platelets from other blood components. The resulting concentrate contains 4 to 7 times the platelet density of normal blood, which means a much higher concentration of healing growth factors. This concentrate is then injected directly into the injured or arthritic area. Because PRP is derived from your own blood, the rejection and disease transmission risks associated with foreign biologics are not a concern. ## How PRP Therapy Works The process is performed in a single visit. A small blood sample is drawn, processed in our centrifuge for approximately 15 minutes, and the resulting PRP is injected into the target tissue under image guidance. Different conditions require different PRP formulations and injection techniques. For joint osteoarthritis, PRP is typically injected directly into the joint capsule. For tendon injuries, PRP is injected into and around the affected tendon, often using ultrasound guidance to confirm precise placement. The injection itself takes about 15 minutes. PHI offers a range of comfort options, from local anesthetic to sedation, and the total visit time is typically 60 to 90 minutes from start to finish. ## Concerns We Treat with PRP Therapy #### Joint conditions - Knee osteoarthritis (early to moderate) - Hip osteoarthritis - Shoulder arthritis - Ankle and foot arthritis - Other joint conditions where regenerative support is appropriate #### Tendon and ligament conditions - Rotator cuff tendinopathy and partial tears - Tennis elbow (lateral epicondylitis) and golfer's elbow (medial epicondylitis) - Patellar tendinopathy (jumper's knee) - Achilles tendinopathy - Plantar fasciitis - Ligament injuries and sprains #### Other conditions - Post-surgical recovery, in coordination with the surgical team - Persistent pain following injury where regenerative support is appropriate - Specific cases of degenerative disc disease ## What the Evidence Shows PRP has the strongest evidence base of any autologous regenerative protocol for orthopedic conditions. Multiple high-quality systematic reviews and meta-analyses of randomized controlled trials have demonstrated significant pain relief and functional improvement for knee osteoarthritis at 6 and 12 months after injection. Systematic reviews comparing PRP to hyaluronic acid for knee osteoarthritis have found PRP demonstrated superior outcomes at both 6 and 12 months on standardized pain and function scores. For tendon injuries specifically, PRP has accumulating evidence supporting its use, particularly for chronic conditions where conservative treatment has not produced adequate response. Outcomes vary by specific tendon and clinical situation; your physician will discuss what the evidence supports for your particular condition. This is a meaningfully different evidence base than newer regenerative approaches: PRP is established, well studied, and supported by extensive clinical research. ## Why Patients Choose PHI for PRP Therapy ## What to Expect ## Frequently Asked Questions **Q: Is PRP FDA-approved?** PRP uses your own blood, processed and reinjected, which falls under FDA regulations for autologous biologics. The procedure is regulated but does not require specific FDA drug approval for individual conditions because PRP is derived from your own blood. **Q: How fast does PRP work?** PRP does not produce immediate relief. Healing develops gradually. Most patients begin to notice improvement at 4 to 6 weeks, with maximum benefit typically at 12 weeks. Some conditions continue to improve for months. **Q: How long does the relief last?** Duration varies by condition. For joint osteoarthritis, relief typically lasts 6 to 12 months from a single treatment, with some patients experiencing longer benefit. For tendon injuries that respond well, the relief is often more durable because the underlying tissue has healed rather than just the symptoms being suppressed. **Q: How many PRP injections do I need?** Many patients receive a single injection. For osteoarthritis, some protocols use a series of 2 to 3 injections spaced 2 to 4 weeks apart. Your physician will recommend the protocol that fits your specific condition. **Q: How is PRP different from cortisone?** Cortisone reduces inflammation and provides faster but typically shorter relief, often with cumulative effects from repeat injections. PRP supports tissue healing through a different mechanism, with slower onset but potentially more durable benefit and no cumulative tissue effects. **Q: How is PRP different from stem cell therapy?** PRP delivers growth factors derived from your platelets. Stem cell therapy delivers cells that themselves can support repair. PRP is generally appropriate for early-to-moderate conditions and milder tissue damage; stem cell therapy is generally appropriate for more advanced cartilage damage or conditions where PRP has been tried without sufficient response. **Q: What are the risks?** Because PRP uses your own blood, immune rejection and disease transmission risks are not a concern. Standard procedural risks include temporary pain or swelling at the injection site, bleeding, and rare infection. Many patients experience increased pain in the first week, which is expected. **Q: Will PRP help me avoid surgery?** For some patients with early-to-moderate conditions, PRP can delay or avoid surgery. For more advanced conditions, surgery may eventually be necessary. Your physician will give you an honest assessment of your specific situation. **Q: Why should I avoid NSAIDs before PRP?** NSAIDs (anti-inflammatory medications like ibuprofen and naproxen) can interfere with the platelet response that drives PRP's healing effect. Most protocols recommend pausing NSAIDs for 1 to 2 weeks before and after the procedure. Your physician will provide specific guidance. **Q: Is PRP covered by insurance?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: How much does PRP cost at PHI?** Pricing varies by the joint or tendon being treated. All costs are disclosed at consultation, with no surprise billing. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. > Efficacy and safety of corticosteroids, hyaluronic acid, and PRP and combination therapy for knee osteoarthritis: a systematic review and network meta-analysis. Peer-reviewed via PMC, 2023. — [Qiao X, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12596915/) > Platelet-rich plasma compared to viscosupplementation in the treatment of knee osteoarthritis: a systematic review and meta-analysis of randomised controlled trials. Peer-reviewed via PMC. — [Bagheri K, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12272809/) > Platelet-rich plasma for knee osteoarthritis: a comprehensive narrative review of the mechanisms, preparation protocols, and clinical evidence. Peer-reviewed via PMC, 2025. — [Glinkowski WM, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12156035/) ### Radiofrequency Ablation ## What Radiofrequency Ablation Does Radiofrequency ablation (RFA) uses precisely targeted heat energy to interrupt the small nerves that carry pain signals from a specific joint or region. Unlike a steroid injection, which reduces inflammation, RFA disrupts the pain signaling pathway itself. The interrupted nerves grow back over time, which is why RFA does not produce permanent results. Most patients experience pain relief lasting 6 to 18 months, and the procedure can be repeated when the nerves regenerate and pain returns. A 2022 systematic review and network meta-analysis of randomized controlled trials confirmed that radiofrequency denervation produces meaningful pain relief for facet joint-derived chronic low back pain in both short-term (within 6 months) and long-term (12 months) follow-up. This is why RFA is often described as the longer-term destination for patients whose pain has been confirmed as facet-mediated through a successful diagnostic block. ## When Radiofrequency Ablation Is the Right Option A positive diagnostic block is the most important predictor of RFA success. When a diagnostic injection produces a strong positive response, PHI can often proceed directly to RFA. For cervical RFA, or when the diagnostic response is less certain, a second confirmatory block may be recommended. ## Five Regions We Treat ## Why Patients Choose PHI for Radiofrequency Ablation ## What to Expect: Before, During, and After ## Frequently Asked Questions **Q: How long does the relief from RFA last?** Most patients experience relief lasting 6 to 18 months. Duration varies by individual, technique used, and the underlying condition. When the nerves regenerate and pain returns, the procedure can be repeated. **Q: Can RFA be repeated?** Yes. The targeted nerves regenerate over time, and when pain returns the procedure can be repeated. Many patients have RFA on a recurring schedule as part of long-term pain management. **Q: How do I know if I am a candidate for RFA?** The strongest predictor of RFA success is a positive response to a diagnostic injection that targets the same nerve or joint. PHI typically requires a confirmed diagnostic block before recommending RFA. If your diagnostic block produced meaningful pain relief, you are likely a candidate. **Q: What is the difference between conventional thermal and pulsed RFA?** Conventional thermal RFA uses heat to create a small lesion on the targeted nerve. Pulsed RFA uses brief electrical pulses without sustained heating and is sometimes used in situations where thermal ablation is inadvisable. Your physician recommends the technique that fits your specific procedure. **Q: Is RFA painful?** Most patients describe the procedure as briefly uncomfortable rather than painful. Local anesthetic numbs the skin and tissue, and most procedures are performed under sedation. Some patients experience post-procedure soreness for several days. **Q: Will I be sedated during RFA?** Most RFA procedures at PHI are performed under sedation. Local anesthetic numbs the treatment area, and your physician determines the appropriate level of sedation for your procedure. **Q: Can I drive home after RFA?** No. You should not drive yourself home from RFA. Sedation and local anesthetic effects make driving inadvisable. Plan for transportation. **Q: What are the risks?** RFA is a well-established procedure with a strong safety profile when performed under image guidance by experienced physicians. Risks include temporary increase in pain, bleeding or infection at the procedure site, post-procedure muscle soreness, and rare complications related to needle placement. For genicular RFA specifically, temporary numbness in a small area of the knee can occur. Your physician will review your specific risk profile during consultation. **Q: How is RFA different from a steroid injection?** A steroid injection reduces inflammation around a joint or nerve and typically provides relief lasting weeks to a few months. RFA disrupts the nerve signaling pathway itself and provides longer-lasting relief, typically 6 to 18 months. RFA is generally appropriate as a next step after a diagnostic injection has confirmed the pain source. **Q: Will RFA help me avoid surgery?** This depends on the underlying condition. For facet-mediated pain, RFA often delays or avoids the need for fusion surgery. For knee arthritis, genicular RFA often delays or avoids knee replacement. For some conditions, RFA addresses the symptom but not the underlying anatomy, so it may delay rather than eliminate the need for definitive surgical treatment. Your physician will give you an honest assessment of your specific situation. **Q: How much does radiofrequency ablation cost at PHI?** Pricing varies by region, technique, and number of levels treated, and is disclosed during your consultation. Bilateral treatments are performed on separate days and priced per side. Follow-up appointments are included in the procedure fee. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. For RFA specifically, we coordinate the diagnostic block, the ablation, and follow-up evaluation across visits when needed. > Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Peer-reviewed via PMC, 2020. — [Cohen SP, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC7362874/) > Comparative efficacy of radiofrequency denervation in chronic low back pain: a systematic review and network meta-analysis. Peer-reviewed via PMC, 2022. — [Li X, et al.](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9388860/) > Efficacy of radiofrequency in lumbar facet joint pain: a systematic review and meta-analysis of placebo-controlled randomized controlled trials. Peer-reviewed via PubMed, 2024. — [Sanapati J, et al.](https://pubmed.ncbi.nlm.nih.gov/38512629/) > Medicare Local Coverage Determination L38803: Facet Joint Interventions for Pain Management. CMS. — [Centers for Medicare & Medicaid Services](https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=38803) ### Red Light Therapy ## What Red Light Therapy Is Red light therapy, formally known as photobiomodulation (PBM), uses specific wavelengths of red and near-infrared light (typically 600 to 1100 nanometers) to stimulate cellular activity in the tissues exposed to the light. The mechanism is well-established at the cellular level. Light at these wavelengths penetrates the skin and is absorbed by cytochrome c oxidase, an enzyme in cellular mitochondria. This absorption increases ATP production (the cell's energy currency), modulates inflammatory signaling, and supports tissue repair processes. This is not heat therapy. Red light therapy does not work primarily by warming tissue; the biological effects are specifically due to the wavelength-dependent interaction with cellular components. ## What Red Light Therapy Treats Red light therapy has accumulating clinical evidence for several applications. #### Pain conditions - Neck pain (acute and chronic) - Tendinopathy (rotator cuff, tennis elbow, Achilles, and others) - Joint pain associated with inflammation - Muscle soreness from training or work - Chronic pain conditions including fibromyalgia - Peripheral neuropathy in selected cases #### Recovery applications - Post-procedure recovery support - Athletic recovery from training and competition - Inflammation reduction after injury - Wound healing support, typically as an adjunct #### Skin and tissue applications - Skin health and collagen support - Treatment-related inflammation - Specific dermatologic conditions ## What the Evidence Shows Red light therapy has the strongest clinical evidence for specific pain conditions and tendinopathy. Systematic reviews and meta-analyses have shown pain reduction in both acute and chronic neck pain, with effects sometimes persisting after the treatment period. For tendinopathy specifically, evidence supports red light therapy when properly dosed. The clinical effect is dose-dependent, and inadequate dosing is a primary reason some published trials show no benefit. This is honest framing. Red light therapy works for many patients with specific conditions; it is not a universal solution, and the dosing and protocol matter significantly. Your physician will set realistic expectations for your situation. ## Why Patients Choose PHI for Red Light Therapy ## What to Expect ## Frequently Asked Questions **Q: Is red light therapy FDA-cleared?** Specific red light therapy devices have FDA clearance for various indications including pain reduction, muscle and joint pain relief, and specific dermatologic applications. Clearance varies by device. **Q: How is red light therapy different from an infrared sauna?** An infrared sauna uses heat to raise body temperature broadly. Red light therapy uses specific wavelengths of light to produce biological effects at the cellular level without heating tissue significantly. They produce different effects through different mechanisms. **Q: Does red light therapy actually work?** For specific applications, yes. The clinical evidence is strongest for neck pain, tendinopathy, and certain inflammatory conditions when proper dosing and protocols are used. For other applications, evidence is more variable. Your physician will set realistic expectations for your situation. **Q: How long does it take to work?** Some applications (acute muscle soreness, minor inflammation) produce noticeable effects within sessions. Others (tendon healing, chronic pain reduction) require a series of treatments over weeks before meaningful effect develops. **Q: How often do I need treatments?** Frequency depends on the application. Acute conditions may benefit from daily or near-daily treatments over a 1-to-2-week period, while chronic conditions may benefit from a longer series with periodic maintenance. **Q: Are there risks?** Red light therapy has a strong safety profile. Direct eye exposure to high-intensity red light can cause eye damage, so clinical-grade devices include eye protection. Patients with certain photosensitivity conditions or those taking photosensitizing medications require evaluation. **Q: Can I do red light therapy at home?** Consumer red light therapy devices are widely available but vary significantly in quality, wavelength specificity, and clinical effectiveness, and many provide minimal therapeutic benefit. The clinical-grade equipment used at PHI delivers dosing parameters validated in clinical research. **Q: How does red light therapy fit with other treatments?** Red light therapy integrates well with regenerative procedures (PRP, stem cell), post-procedure recovery, peptide protocols, and other wellness interventions. Your physician will coordinate timing and protocol design, and it can be bundled with EMSCULPT NEO or regenerative procedures. **Q: How much does red light therapy cost at PHI?** As a concierge, out-of-network practice, all costs are transparently disclosed at your consultation. Pricing varies by treatment area and protocol. **Q: Do you accept international patients?** Yes. Red light therapy fits well with concentrated wellness visits, with multiple sessions delivered during a stay. > The effect of low-level red and near-infrared photobiomodulation on pain and function in tendinopathy: a systematic review and meta-analysis of randomized control trials. Peer-reviewed via PMC, 2021. — [Tripodi N, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC8364035/) > Low-intensity LASER and LED (photobiomodulation therapy) for pain control of the most common musculoskeletal conditions. European Journal of Physical and Rehabilitation Medicine, 2022. — [de Oliveira MF, et al.](https://pubmed.ncbi.nlm.nih.gov/34913330/) ### Sacroiliac Joint Fusion ## What SI Joint Fusion Is Sacroiliac joint fusion is a procedure that permanently stabilizes the sacroiliac joint, the joint connecting the base of your spine to your pelvis. It is reserved for patients whose SI joint pain has been confirmed through diagnostic injection and who have not responded adequately to non-surgical treatments including injections, physical therapy, and radiofrequency ablation. Modern SI joint fusion is meaningfully different from older fusion approaches. It is performed minimally invasively through small access points using specialized implants designed for SI joint stabilization. Most patients are home the same day or after a brief stay. ## How the Procedure Works The procedure is performed in our affiliated surgery center under image guidance and propofol sedation. The physician advances specialized implants across the SI joint through small access points. The implants stabilize the joint and promote bone fusion across the joint surfaces over the months following the procedure. The procedure typically takes about an hour. Most patients leave the same day or after a brief observation period. ## Who Is a Candidate SI joint fusion is typically appropriate for patients who: - Have confirmed SI joint pain through positive diagnostic injections - Have not responded adequately to non-surgical treatments including injections, physical therapy, and radiofrequency ablation - Have a pain pattern, exam findings, and imaging that all support SI joint involvement - Are otherwise medically appropriate for a surgical procedure - Understand the procedure is irreversible and have realistic expectations Most patients with SI joint pain do not need fusion; most are managed effectively with injections, RFA, and other interventions. Fusion is reserved for the subset whose pain has not adequately resolved with non-surgical care. ## What the Evidence Shows Modern minimally invasive SI joint fusion has accumulating evidence for appropriately selected patients. Multiple randomized controlled trials and prospective cohort studies have demonstrated meaningful pain reduction, functional improvement, and quality-of-life gains compared to non-surgical management for patients meeting strict candidacy criteria. Patient selection is the dominant factor in fusion success. Patients without confirmed SI joint pain or with multiple competing pain generators have lower success rates, so careful evaluation before recommending fusion is essential. ## Why Patients Choose PHI for SI Joint Fusion ## What to Expect ## Frequently Asked Questions **Q: Is SI joint fusion the same as spinal fusion?** No. Spinal fusion fuses vertebrae together. SI joint fusion fuses the sacroiliac joint specifically. They are different procedures for different conditions. **Q: Will I be in the hospital after surgery?** Most patients are discharged the same day or after a brief observation period. Our affiliated surgery center is designed for same-day or short-stay procedures. **Q: How long is recovery?** Most patients return to most activities within 2 to 3 months, with continued improvement up to 12 months. Full bone fusion across the joint progresses during this period. **Q: Will I have hardware in my body permanently?** Yes. The implants that stabilize the SI joint remain permanently. They become integrated as bone fuses across the joint over time. **Q: What are the risks?** Risks include the standard surgical risks of bleeding, infection, and post-procedure pain, plus the specific risks of any implanted device including potential for implant loosening or failure. Your physician will review the complete risk profile in detail. **Q: What if the fusion doesn't work?** Most patients meeting strict candidacy criteria experience meaningful improvement. For the minority who do not, your physician will work with you on continued management and potential additional interventions. **Q: Can both SI joints be fused?** In some patients, both SI joints contribute to symptoms. Bilateral fusion is performed for selected patients, typically as separate procedures spaced over several months rather than simultaneously. **Q: How much does SI joint fusion cost at PHI?** Insurance coverage and payment options may vary. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. Recovery from SI joint fusion involves multiple post-procedure visits over the following 12 months, so international patients should plan for return visits or coordinated follow-up with a provider in their home location. > Two-year outcomes from a randomized controlled trial of minimally invasive sacroiliac joint fusion vs. non-surgical management for sacroiliac joint dysfunction. Peer-reviewed via PMC, 2016. — [Polly DW, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC5027818/) > Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group. Peer-reviewed via PMC, 2025. — [McCormick ZL, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12681192/) ### Sacroiliac Joint Injections ## What the Sacroiliac Joint Is and Why It's Often Missed Your sacroiliac joints connect the base of your spine (the sacrum) to your pelvis. There are two of them, one on each side, and they bear significant load every time you stand, walk, or move. They have minimal movement but substantial responsibility for transferring force between your upper body and legs. When the sacroiliac joint becomes inflamed, injured, or starts moving abnormally, it produces pain that is frequently mistaken for general low back pain or hip pain. Patients are often treated for years for back pain before anyone considers the sacroiliac joint as the source. Systematic reviews indicate the sacroiliac joint is a source of pain in roughly 10 to 27 percent of suspected cases of chronic low back pain when evaluated with controlled diagnostic blocks. That is a substantial portion of patients whose pain is being treated as something else. ## How Sacroiliac Joint Injections Work A sacroiliac joint injection delivers a combination of local anesthetic and corticosteroid into the joint capsule. Like facet injections, the procedure serves two purposes at once. **Diagnostic.** If your pain improves significantly after the injection, the sacroiliac joint is confirmed as a primary source of your symptoms. This is the most reliable way to identify SI joint pain, because there is no imaging finding or physical exam test that definitively diagnoses it. **Therapeutic.** The corticosteroid reduces inflammation in the joint, which often produces pain relief lasting weeks to several months. For patients whose injection confirms the diagnosis but whose relief is shorter than desired, sacroiliac radiofrequency ablation is typically the next step for longer-lasting relief. Some patients with severe or persistent SI joint dysfunction may eventually be candidates for sacroiliac joint fusion, a surgical procedure also performed at PHI. ## How the Procedure Works The injection is performed in our affiliated surgical suite under fluoroscopic guidance. Image guidance is essential because the SI joint is a deep, irregularly shaped structure that cannot be reliably accessed by feel alone; without imaging, the injection often misses the joint capsule and the diagnostic value is lost. You are positioned face down, and the injection site is cleaned and numbed with a local anesthetic. The physician advances a thin needle into the joint capsule, confirms position with imaging, and delivers the medication. The procedure typically takes 15 to 20 minutes. PHI offers a range of comfort options, from local anesthetic to nitrous oxide, conscious sedation (Versed), or deep sedation (Propofol). You leave the same day; patients who receive only local anesthetic typically drive themselves home, while patients who receive sedation arrange transportation. ## Conditions We Treat with Sacroiliac Joint Injections - Sacroiliac joint dysfunction - Sacroiliac joint arthritis - Post-traumatic SI joint pain, after falls, car accidents, or other injuries - Pregnancy-related SI joint pain that has not resolved postpartum - Post-fusion adjacent segment SI joint pain, a common cause of new pain after lumbar fusion surgery - SI joint pain following hip replacement - Sacroiliitis from inflammatory conditions, in coordination with rheumatology - Persistent SI joint pain that has not responded to physical therapy and conservative treatment If your condition is not listed but your pain pattern suggests SI joint involvement, your physician will evaluate you during consultation. The diagnostic injection itself often resolves uncertainty when other tests have not. ## When Sacroiliac Joint Injections Are the Right Option The diagnostic value of an SI joint injection is part of why it is recommended. Even when relief is short, the information it provides often unlocks the right longer-term treatment, whether that is radiofrequency ablation, regenerative options, or in selected cases sacroiliac joint fusion. ## Why Patients Choose PHI for Sacroiliac Joint Injections ## What to Expect: Before, During, and After ## Frequently Asked Questions **Q: How do I know if my back pain is actually from the SI joint?** You usually do not, until a properly placed diagnostic injection confirms it. There is no imaging test or physical exam finding that definitively diagnoses SI joint pain. The pattern that suggests SI joint involvement includes pain in the lower back or buttock that may worsen with prolonged sitting or standing, sometimes radiating into the back of the thigh but not below the knee. Your physician will evaluate this pattern at consultation. **Q: How many SI joint injections can I have?** Injections are spaced and monitored rather than repeated without limit. If you require more frequent injections to control pain, your physician will discuss longer-lasting options including radiofrequency ablation or, in selected cases, fusion. **Q: How long does the relief last?** Duration varies. Some patients experience months of relief from a single injection. Others experience shorter relief that confirms the diagnosis but suggests RFA or fusion as the next step. The duration of your response is itself useful information for your physician. **Q: Will I be awake during the procedure?** It depends on the option you choose. PHI offers local anesthetic, nitrous oxide, conscious sedation (Versed), and deep sedation (Propofol). Your physician helps you choose the right level of comfort for your procedure. **Q: Is the injection painful?** Most patients describe the procedure as briefly uncomfortable rather than painful. The local anesthetic numbs the skin and tissue along the needle path. **Q: Will I be able to drive home?** If you receive only local anesthetic, most patients drive themselves home. If you receive sedation, arrange transportation, as you should not drive the same day. **Q: What are the risks?** SI joint injections are well-established procedures with strong safety profiles when performed under image guidance. Risks include temporary increase in pain, bleeding or infection at the injection site, and rare complications related to needle placement. Image guidance significantly reduces these risks. Your physician will review the full risk profile at consultation. **Q: What if the SI joint injection works but the relief is too short?** This is one of the most useful outcomes a diagnostic SI joint injection can produce. A clear positive response with shorter-than-desired duration confirms the SI joint as the source of your pain and identifies you as a candidate for sacroiliac radiofrequency ablation, which targets the small nerves carrying pain signals from the joint and can provide relief lasting 6 to 18 months. **Q: What if the injection doesn't help?** If a properly placed SI joint injection does not produce meaningful relief, this is diagnostic information. It tells your physician the SI joint is likely not the primary source of your pain. The next step is to revisit imaging and consider whether a different treatment approach fits. **Q: When would I need sacroiliac joint fusion instead of injections or RFA?** SI joint fusion is reserved for patients with confirmed SI joint pain who have not responded to non-surgical approaches including injections and RFA. It is a more definitive intervention for severe, persistent SI joint dysfunction. Most patients do not need fusion. Your physician will discuss whether it is appropriate for your situation. **Q: How much does an SI joint injection cost at PHI?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. > Systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions. Pain Physician, 2015. — [Simopoulos TT, et al.](https://pubmed.ncbi.nlm.nih.gov/26431129/) > Systematic review and meta-analysis of effectiveness of therapeutic sacroiliac joint injections. Pain Physician, 2023. — [Janapala RN, et al.](https://pubmed.ncbi.nlm.nih.gov/37774179/) > Comparative efficacy of clinical interventions for sacroiliac joint pain: a systematic review and network meta-analysis. Neurospine, 2023. — [Chen CM, et al.](https://www.e-neurospine.org/journal/view.php?doi=10.14245/ns.2346586.293) > Consensus practice guidelines on sacroiliac joint complex pain from a multispecialty, international working group. Peer-reviewed via PMC, 2025. — [McCormick ZL, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC12681192/) ### Stem Cell Therapy ## How Stem Cell Therapy Works Stem cell therapy uses regenerative cells to support the body's natural repair processes. The cells signal damaged tissue to recruit healing factors, modulate inflammation, and in some cases differentiate into the surrounding tissue type. PHI offers both autologous protocols (cells harvested from your own body) and allogeneic protocols (FDA-registered cells from screened tissue sources). The right protocol depends on your condition, your age, your prior treatment history, and the tissue being targeted. We use ultrasound and fluoroscopic guidance for every injection to confirm precise placement. Most patients return to normal activities within 48 to 72 hours, with full benefit typically observed at the 3-to-6-month mark. ## Five Protocol Options at PHI ## Conditions We Treat with Stem Cell Therapy Stem cell therapy at PHI is used for orthopedic, spine, and soft-tissue conditions, including: - Knee osteoarthritis and cartilage damage - Hip osteoarthritis and labral tears - Shoulder arthritis and rotator cuff disease - Tendon injuries (Achilles, patellar, rotator cuff, lateral epicondyle) - Ligament injuries - Degenerative disc disease - Sacroiliac joint dysfunction - Chronic post-surgical joint pain If your condition is not listed, your physician will tell you whether stem cell therapy is appropriate during consultation. Some conditions are better treated with PRP, A2M, exosomes, or interventional pain procedures. ## Why Patients Choose PHI for Stem Cell Therapy ## Your Stem Cell Therapy Process at PHI ## Frequently Asked Questions **Q: Is stem cell therapy FDA-approved?** Stem cell therapies vary in FDA classification depending on protocol. Autologous treatments (BMAC, fat-derived) using minimal manipulation are not classified as drugs under FDA Section 361. Allogeneic protocols use FDA-registered tissue sources. Your physician will explain the regulatory classification of any protocol they recommend. **Q: How much does stem cell therapy cost at PHI?** Insurance coverage and payment options may vary. We provide documentation for you to seek reimbursement through your out-of-network benefits, which may apply to certain services. All pricing is disclosed at consultation. **Q: Stem cell therapy versus PRP, which is right for me?** PRP is generally appropriate for early-stage tendon, ligament, and mild joint conditions. Stem cell therapy is typically used for more advanced cartilage damage, degenerative joint disease, and conditions where PRP has been tried without sufficient response. Your physician will recommend the right starting point based on your imaging and symptoms. **Q: Should I try stem cell therapy before considering joint replacement?** For many patients with moderate joint disease, stem cell therapy is a meaningful option to explore before surgical intervention. Joint replacement is irreversible; stem cell therapy is not. Patients with severe end-stage arthritis may still ultimately need surgery, but many delay or avoid it through regenerative protocols. Your physician will give you an honest assessment for your stage of disease. **Q: Where are PHI's stem cell procedures performed?** In-clinic at our Beverly Hills practice, performed by your physician under image guidance with sterile technique. Stem cell therapy is a regenerative injection and does not require a surgical facility. For interventional procedures that do, PHI is affiliated with an outpatient surgical suite. **Q: How long until I see results?** Most patients report meaningful improvement at the 3-month mark, with continued progression through 6 months. Some report earlier symptom changes. Stem cell therapy supports a biological repair process, which takes time, and your physician will set specific expectations based on your protocol and condition. **Q: Do you accept international patients?** Yes. PHI regularly treats patients from outside Los Angeles, including Las Vegas, Palm Springs, London, and other international locations. Travel coordination, treatment sequencing, and follow-up logistics are handled by our concierge team. > Adipose tissue stem cells for therapy: an update on the progress of isolation, culture, storage, and clinical application. Peer-reviewed via PMC. — [Chu DT, et al.](https://pmc.ncbi.nlm.nih.gov/articles/PMC6678927/) > 21 CFR Part 1271: Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps). U.S. Code of Federal Regulations. — [U.S. Code of Federal Regulations](https://www.ecfr.gov/current/title-21/chapter-I/subchapter-L/part-1271) ## Providers ### Faisal Lalani ## An advanced, precision-based approach. Dr. Lalani is recognized for an advanced, precision-based approach to treating pain and restoring function. Patients travel to his Beverly Hills practice from across the country and internationally, drawn by his focus on innovative, non-surgical solutions for complex pain conditions. His work blends the highest level of clinical expertise with leading regenerative therapies, giving patients a comprehensive path to pain relief, recovery, and long-term wellness. ![Dr. Lalanni with a patient](https://painandhealing.com/wp-content/uploads/2026/09/drlalani-with-patient.webp) ## Why precision matters. Dr. Lalani is a longstanding advocate for ultrasound-guided procedures in pain medicine. Ultrasound allows for targeted, accurate treatment while reducing unnecessary radiation exposure where clinically appropriate. This commitment to precision shapes every aspect of his practice. ### Nadiv Y. Samimi ## A practice built on listening. Dr. Samimi is known for a thoughtful, deeply personalized approach to pain care. Patients travel from across Los Angeles, throughout the country, and internationally for his combination of advanced clinical expertise and exceptional bedside manner. His practice is built on a single principle: pain should never be dismissed. Every patient deserves a physician who listens, investigates, educates, and keeps searching for solutions. ![Dr. Samimi with a patient](https://painandhealing.com/wp-content/uploads/2026/09/drsamimi-with-patient.webp) ## Why listening matters. Every patient has a unique story, and Dr. Samimi takes the time to understand not only where the pain is coming from, but how it affects mobility, sleep, mood, work, and overall well-being. Known for a warm, engaging bedside manner, he often uses anatomical models and visual explanations to help patients understand their condition and treatment options. ## Articles ### 4 Things You Didn’t Know about Ketamine and Pain Relief Ketamine is counted as one of the most versatile drugs. The original purpose behind its synthesis was as a phencyclidine (an anesthetic) substitute. But that was 50 years ago. Today, it has gained popularity in [multiple clinical settings](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126726/), including psychiatry and anesthesia. Doctors are also using Ketamine Infusion Therapy in Chronic Pain Management, as well as, for providing acute [pain](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014022/) relief. Its potency and rapid mode of action have also made ketamine a boon for patients with therapy-resistant [depression](https://www.ncbi.nlm.nih.gov/pubmed/26707087). Predominantly, ketamine is supplied to patients in the form of infusions. If you have been wondering whether you should consider getting, say an Infusion for Back Pain, here are some answers: ## Who can take low-dose ketamine and benefit from it? While there would be other groups for whom ketamine would be beneficial, usually it is used to treat patients with: - Chronic pain that isn’t alleviated with the usual medication - Chronic pain before they have a painful surgery - A chance of benefitting from ketamine therapy ## Who shouldn’t take low-dose ketamine it? Besides pregnant and lactating mothers, patients experiencing the following medical conditions shouldn’t use ketamine to manage their pain: - A closed head injury in the past - Seizure disorder ## What does ketamine treatment have to do with opioid dependency? According to the [guidelines](https://www.ncbi.nlm.nih.gov/pubmed/29870457) for ketamine use in relief from acute pain, it can be quite effective in reducing the dependency of individuals on opioids! Imagine someone who is about to go through a rather serious and painful surgery. Or, someone who has become opioid-dependent and is unable to perform everyday functions in life without it. Then there are also opioid-tolerant patients who are about to undergo surgery. You will see many reports about Ketamine Helped My Pain. From sickle cell pain to sleep apnea, ketamine has the potential to limit or remove the need of opioid use. This can greatly help patients who will be under going treatment such as [stem cell therapy](https://painandhealing.com/things-to-know-about-stem-cell-therapy/) or [PRP therapy](https://painandhealing.com/what-is-prp-therapy/). ## Are there any other benefits of ketamine infusion treatment? Firstly, we apply the subcutaneous infusions in a slow and steady manner. A low dose of ketamine is given to a patient and increased gradually, depending on their body’s response to it. This makes it easier to predict the side effects ketamine may cause in some and reduce their intensity. Secondly, unlike similar treatments, the ketamine infusions aren’t intravenous. This reduces the risk of contracting any hospital-acquired infections. Read up on some [conditions](https://painandhealing.com/ketamine-infusion-treatments/) that could greatly benefit from ketamine infusions. If any of your family member or you suffer from any of those disorders, it is time to [contact us](https://painandhealing.com/contact/) and discuss Infusion Therapy Cost and treatment. Our Los Angeles doctors at Pain and Healing Institute are here for you. ### Should I get an MRI? One of the first questions we are asked by patients is if they should get an MRI for the new onset of back pain. It just so happens that someone did a study to find out.  In a study that reviewed a large number of cases (1,226), that looked at patients with new onset back pain who got immediate MRIs. It turned out that people who got MRI’s versus people who did not get an MRI had no difference in outcomes and sometimes ended up doing worse. Sounds like the opposite of what should have happened, how could this be? Back pain could be caused by many different problems in the back. A good diagnostic doctor will take the time to examine you and treat your symptoms. However, some doctors can choose to treat the MRI scan and not the patient. Anyone who gets an MRI scan will likely show some pathology in their back, but it does not always mean that the found pathology is what is causing the pain. For example, [if back pain is caused by the spine, the root of the problem might be bad smoking habits](https://painandhealing.com/smoking-and-spine-pain/). The moral of the story, treat the symptoms and listen to the patient! ### Smoking and Spine Pain Add this one to the long list of reasons to quit smoking! Recent studies with a large number of participants have shown that people who have quit smoking demonstrated greater improvements in pain symptoms than those who continued to smoke. Those people who did not quit smoking did not show any improvement in their pain. We have seen many patients who believe that their smoking helped them to cope with their pain, however, this data shows that in fact the opposite is true. The study also shows that people who quit smoking have improvement in pain after surgery and procedures. Quitting smoking is hard! However, there are many resources out there. The Pain & Healing institute highly recommends [quitnet.com](http://quitnet.com/). While [examinations and procedures like an MRI may come in hand](https://painandhealing.com/should-i-get-an-mri/)y, it is important to consider other external factors that are a part of your lifestyle. There are many links to resources and under the expert support tab, you can can get daily help with your goal for quitting, don’t do it alone! ### The Latest in Healthcare – Regenerative Medicine being used to Treat Sports Injuries ## Introduction to Regenerative Medicine Various treatment methods are being used in the field of regenerative medicine. Some of these techniques include platelet rich plasma (PRP) therapy, [prolotherapy](http://www.aaomed.org/prolotherapy), stem cell therapy, and [cartilage regeneration](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426098/) for the treatment of sports injuries. Read more about [platelet rich plasma (PRP) therapy](https://painandhealing.com/what-is-prp-therapy/) and [stem cell therapy](https://painandhealing.com/things-to-know-about-stem-cell-therapy/) here. A regenerative medicine treatment can used on its own, such as a PRP injection, or it may be used in combination with another, such as the injection being applied during cartilage regeneration surgery. ## How Is Regenerative Medicine Used for Sports Injuries? Sports injuries may entail the repairing or replacement of damaged tendon, cartilage, and ligament tissues. Stem Cell Therapy for Sports Injuries and other regenerative medicine treatments can be used to speed up the process of healing because they amplify the body’s natural abilities. They also encourage the [growth](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555618/) of new tissue. However, regenerative medicine should not be considered a substitute for other nonsurgical treatments. Traditionally, athletes practice rest, taping, bracing, and physical therapy for improved strength and flexibility. Instead of replacing a kind of treatment with the other, it is best to use both treatments together for synergistic and optimal healing. ## Other Applications The techniques in regenerative medicine aren’t just useful for treating sports injuries. For example, Stem Cell Treatment Injury is equally effective for tissue engineering. Thus, it can be used to create skin tissue for burn victims. Their potential in artificial organ development is also under research. Many [celebs](https://novusspinecenter.com/pain-treatments/regenerative-therapy-for-sports-athletic-injuries) have opted for and became Regenerative Medicine Examples when conventional methods of treatments failed them. ## Reasons you should Choose Regenerative Medicine Sports Therapy - Unlike most methods, regenerative medicine usually consists of an injection that consists of biological material from your own blood and tissues. That is why it has a greater chance of success. These methods also present a lower risk of adverse reaction or rejection by your body to the injection. - Similarly, due to the absence of any foreign agent, regenerative medicine drastically reduces the risk of infection. - Since the procedures don’t involve surgery, they are virtually painless. Moreover, they don’t take more than several hours to complete. - Additional therapy can be provided with ease. - Many common orthopedic injuries and conditions will effectively heal with regenerative techniques. They also present a non-surgical alternative for patients. - Besides therapeutic benefits, the stem cell and PRP techniques are also good for pain alleviation. - Another advantage of these techniques is that they don’t require a prolonged post-procedural recovery period. A patient can return to their daily activities in a short time. That is why regenerative medicine is ideal for athletes who cannot afford to stay out of sports for longer than several weeks. Do you find the benefits of regenerative medicine appealing? Do you have more questions for us? Then call (310) 856-9488 for more information on Regenerative Medicine for Sports Injuries or fill this brief [form](https://painandhealing.com/contact/) to get in touch with us! ### Three Things You’d Want to Know About Stem Cell Therapy ## Introduction to Stem Cell Therapy The body exclusively uses the stem cells as raw materials to create other cells. Simply, a cell that generates cells with specialized functions is a stem cell. The daughter cells created by the stem cells will either go through the process of self-renewal to form more stem cells or through differentiation to become blood, brain, bone, and heart muscle cells, etc. Adult stem cells, known as the [mesenchymal stem cells](https://www.eurostemcell.org/mesenchymal-stem-cells-other-bone-marrow-stem-cells) (MSCs), were originally separated from bone marrow. They have now been isolated from almost [every tissue](https://www.ncbi.nlm.nih.gov/pubmed/16684817) in the body, like the [adipose tissue](https://www.ncbi.nlm.nih.gov/pubmed/11304456). Adipose Stem Cells (ASCs) show great potential for use in regenerative medicine and tissue engineering. ## How can stem cells treat disease? Most people confuse Stem Cell Therapy with a [stem cell transplant](https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/stem-cell-transplant.html). But treatment based on the embryonic stem cells can achieve much more. For instance, they are used in Orthopedic Stem Cell Therapy to treat sports injuries. Research into treatment of [mental disorders](http://www.nature.com/nm/journal/v10/n7s/full/nm1064.html?viewType=Print&viewClass=Print) like Parkinson’s, Alzheimer’s, and Huntington’s has also begun. The results look promising. By studying how embryonic stem cell repair heart muscles, knowledge can be gleaned about achieving that in patients who have had a stroke. The same could be done for repairing damaged brain cells due to age-related cognitive decline. Thus, there is a lot to be gained without a need of transplanting a single cell. ## Benefits of Stem Cell Therapy Stem cell therapy delivers results. However, with a wide range of treatments available, you’d want to weigh both options. Knowing the benefits that you may enjoy on choosing stem cell therapy could make that decision easier. As any Stem Cell Therapy Doctors would tell you, this treatment method uses your body’s own cells. These cells are a part of the natural healing process. The therapy just speeds up healing. That right there indicates there will be minimal risk of your body rejecting this treatment. Aside from that, let us look at some other benefits of stem cell therapy: - It is a minimally invasive procedure that doesn’t require surgery. The stem cells are extracted from the bone marrow in your pelvis. Thus, it lacks the usual complications and risks associated with surgical procedures. - Often the treatment method used to treat an injury might not be as long but the post-procedural recovery time is. With stem cell therapy, you’d be looking at minimal recovery time. Thus, you can expect a minimal interruption in your daily responsibilities with this treatment. - Since the cells originate from your own body, you won’t run a risk of catching any communicable disease from another person. - Don’t like being put under? Does the thought of being given anesthesia make you nervous or downright uncomfortable? Well, with stem cell therapy, you won’t need any anesthesia. Do you feel that stem cell therapy is the right choice for you? Then the Best Stem Cell Therapy Clinic awaits your call. Dial (310) 856-9488 today or connect with us on [Facebook](https://www.facebook.com/Painandhealing) to get more information about this revolutionary procedure! [Continue reading to learn more about the applications of regenerative medicine](https://painandhealing.com/regenerative-medicine-for-sports-injuries/). ### Topical Analgesic in treating Neuropathic and Musculoskeletal Pain In the recent article in PainMedicine discusses the role of topical administration of anesthetics and analgesics.  One of the benefits is that it allows for the efficient, painless delivery of medications that may reduce systemic side effects associated with the medication while providing clinical advantages over [injected or oral administration for the same clinical situation such as ketamine](https://painandhealing.com/things-you-didnt-know-about-ketamine-infusion-therapy/). Topical administration of nonsteroidal anti-inflammatory drugs (NSAIDs), lidocaine, capsaicin, and other agents is useful for a range of conditions including acute and chronic musculoskeletal pain. Speak to your doctors at Pain and Healing Institute regarding various topical analgesics ### What is PRP Therapy and Why Should You Get It? ## Introduction to PRP Therapy PRP or Platelet Rich Plasma therapy involves injecting platelet enriched plasma extracted from a patient’s blood into their own body’s tissues. The result is a quicker alleviation or reduction in pain and recovery rate from an injury, including those from a surgical procedure. Platelet-rich plasma is derived when blood is spun in a centrifuge. The liquid constituent of the blood, i.e., the plasma separates from the solid components, such as red and white blood cells and platelets. The latter are removed while the former are recombined with the plasma. ## Conditions Treated with PRP Therapy Besides [aiding in healing](https://www.ncbi.nlm.nih.gov/pubmed/18508453) by speeding up the process of clotting, platelets also help in Pain Management. Doctors have also been using PRP therapy to treat the following conditions: - Slowing down osteoarthritis progression by reduction of inflammation - Stimulation of new cartilage formation - Easing joint friction by the production of joint fluid and thus reducing pain - Alteration of pain receptors through protein production to reduce pain sensation Looking for a Pain Clinic Near Me? [Try us](https://painandhealing.com/prp/)! ## Benefits of PRP Therapy Besides being used to treat a wide range of conditions, PRP therapy has other benefits to offer to patients. Let us look at some of them: ### Treating Chronic and Unresponsive Issues One of the main reasons why PRP therapy has gained popularity today is because of its effectiveness in treating unresponsive issues. You might have a wound that hasn’t healed the way it should or know someone whose injuries aren’t healing as fast they normally do. This is where the platelet-rich plasma from their own body can to the aid of the body’s natural healing system. Once the latter kicks in, the healing will begin and continue until the wound or injury is gone. The same is true for individuals battling with chronic pain. If you or they are in search of Pain Specialist Near Me because of the relentless pain, PRP can help. ### Non-invasive Treatment Unlike many other treatment methods, PRP therapy is non-invasive. The extraction and injecting of blood are both done via injections. The enriched plasma is injected directly into the problem area. That’s why you can expect quick results. It also reduces the chances of complications since your body will recognize the blood as yours! ### Scar-free Results Scarring as a result of surgery or due to some accident can be unattractive. But even more importantly, it can serve as a reminder of the pain you went through. PRP therapy is a scar-free method. It doesn’t even require stitches that you’d have to have removed later. It is another reason why research on PRP’s use in cosmetic surgery has started. If you are looking for affordable and long-lasting Pain Management Solutions and think PRP therapy could be the right choice for you, call (310) 856-9488 today! Next, [learn about some of the benefits of Stem Cell Therapy.](https://painandhealing.com/things-to-know-about-stem-cell-therapy/)