About

Dr. Saint-Georges desk

Dr. Saint-Georges

Dr. Saint-Georges has 25 years of experience in emergency medecine and 15 years in musculokeletal pain management.

He has an expertise to infiltrate most of the anatomical sites provoking pain.

He can manage all your minor emergency situations rapidly as an alternative to consulting an ER.

Method

Minor Emergency Services backed by evidence-based medicine and 25 years of emergency practice.

Interventionist chronic pain management based on a 15 year experience with the pharmacology of pain, and more importantly, the art of infiltrations of most anatomical sites causing pain:

  • Corticoid infiltrations of tendons, ligaments, joints and epidural spaces.
    • An infiltration can be defined as the injection of a substance, often cortisone, that has the purpose to relieve pain related to local inflammation/spasm. For more information…
  • Myofascial and ligamentous trigger point injections (see www.triggerpoints.net AAFP). They are done mostly with Xylocaine and occasionally with a botulinic agent.

  • Caudal epidurals (cortisone based) for lumbago (discal hernias, spinal stenosis, degenerative discopathies, etc.)

  • PRP ( platelet rich plasma ) is used for knee arthrosis and tendinitis / tendinosis. Hyaluronic acid is also used for knee arthrosis.

All of these, when needed, are accompanied by pharmacology and physiotherapy, chiropracty, osteopathy, massotherapy, psychotherapy, etc.

Patient information :

I can address all forms of chronic pain:

  • Articular (arthritis, arthrosis, osteoarthritis, synovitis, capsulitis, chondropathy)
  • Tendinous (tendinitis, tendinopathy, enthesopathy)
  • Ligamentous (enthesopathy), fascia (plantar fasciitis, carpal tunnel)
  • Visceral (chronic pancreatitis, irritable bowel, interstitial cystitis).
  • Neuropathic (facial trigeminal neuralgia, post herpetic/zona neuralgia, diabetic, multiple sclerosis, CRPS/chronic regional pain syndrome/algodystrophy/reflex sympathetic pain syndrome)
  • Neuro-physiologic (fibromyalgia, Parkinson)
  • Systemic inflammation (arthritis/rheumatoid/seronegative/polymyalgia rheumatica)
  • Lumbar (discopathy, discal hernia, diskarthrosis, arthrosis, spinal and foraminal stenosis, facettal arthrosis)

 

About chronic pain :

Pain is the most frequent reason for consulting a doctor. It is classified as acute (less than 3–6 months) or chronic. 30% of the population suffers from chronic pain. The estimated cost for the US society was $60 billion US in 2002.

Acute pain is usually the result of a trauma, surgery or disease. It disappears as the natural healing process occurs. Chronic pain persists beyond this healing process. It is considered a disease in itself, and is often a bio-psycho- social process. It can cause a multitude of negative impacts on family, marriage work, and psyche (anxiety, depression, anger, despair, low self- esteem, sleep disorders, chronic fatigue syndrome).

Past emotional trauma (PTSD/post-traumatic stress disorder) can favour chronic pain. There are many forms of medical and non-medical treatments. The most recommended forms of treatments/therapies are those that improve general health habits and favour physical conditioning. A healthy body is always better adapted to fight and adapt to chronic pain. However, in practice, it is usually very difficult to recondition a body in chronic pain. That is why medical therapies are important, both pharmacologic and interventional, they favour a pain control that will then permit physical reconditioning through non-medical therapies such as physiotherapy, kinesiology, osteopathy, massotherapy, chiropraxy, ergotherapy, psychotherapy, and the support of a nutritionist.

The initial goal in chronic pain management is pain control at night. Interestingly, a sleep disorder can be responsible for or aggravate chronic pain (sleep apnea), and rarely some food intolerances can cause chronic pain (milk and gluten intolerances). The second goal is pain control at rest, and lastly during effort. This process can take months. It is important to note that the success is often more dependent on patient than doctor. The doctor proposes; the patient disposes.

Narcodependancy is a bio-psycho-social phenomenon. Studies claim it affects 3–5% of the population. Narcotherapy is only initiated when all other options have been attempted/considered. It is not a right but a privilege that has its side effects and risks. The privilege is revoked when non-compliance is observed.

Cannabinoids are not encouraged by the « CMQ » for the moment, and I respect their position.

Corticoid infiltrations (cortisone needles), when practiced according to a well- recognized standard, do not cause significant side effects as is the case with prolonged oral cortisone/prednisone therapies. Oral cortisone therapies in chronic pain are reserved for systemic inflammatory processes such a rheumatoid arthritis and polymyalgia rheumatica.

Cortisone infiltrations often relieve pain for 3 months or more. They sometimes relieve pain permanently.

Occasionally, cortisone infiltrations can be a stimulant for some individuals and will cause flushing, palpitations and insomnia for a day or two.

The ideal standard is 1–3 rapidly sequenced infiltrations followed by quarterly infiltrations if necessary. Combining infiltrations with non-medical therapies is most effective.

It is noted that when a lone therapy, either medical or non-medical, lacks efficiency, it should immediately be coupled with a non-medical or medical counterpart. In other words, combining therapies are superior to isolated therapies.

Update:
I have attended a Harvard Sports Medecine conference in May 2018 ( which included a ultradound guiding seminar ). The general consensus appears to be to offer high level athletes a first corticoïd infiltration followed by PRP if needed. My conclusion from this conference is now to propose to the general population no more then 2 corticoïd infiltrations followed by PRP all sites confounded with the exception of epidurals that remain exclusively corticoïd.

Xylocaine trigger point infiltrations can relieve pain for 3–6 weeks. They occasionally relieve pain permanently. The xylocaine sometimes needs to be completed with cortisone or a botulinic agent when pain relief is less than 3 weeks. Many patients prefer trigger point infiltrations to the side-effects of medication. For more information...

Xylocaine used for trigger point infiltrations often causes a feeling of drunkenness that usually lasts 15–30 minutes. It rarely causes a fatigue that can last a few days.

Viscosuppleance with hyaluronic acid is required on occasion when an articular cortisone infiltration result is short lived or absent.

The risk of infection from an infiltration is very low. It is of the order of 1/100,000.

I invite you to take a look at the section “For Professionals” where I present in much more detail the pathological processes involved and the techniques that I have developed over the years.

A comment is needed on the current fad over ultra-sound and fluoroscopic guided infiltrations. I will quote in my own words an IASP (see link) declaration:

There is greater profit for society in spreading a simple, even if considered moderately effective (in certain hands) to the multitude rather than to promote a more effective but expensive and much less accessible approach.

This paraphrase must be understood in the light of its technician dependency (technician bias). I have had a 2-day training on ultra-sound guided infiltrations at the University of Toronto. I can honestly declare that my manual anatomical referenced infiltrations are superior to what I have witnessed. I therefore choose to ignore this technology, having mastered a very high level of competence with manual anatomical referenced infiltrations.

I encourage you, if in pain and waiting on a ultrasound or fluoroscopic guided infiltration to consider a manual anatomical guided infiltration performed by an expert hand. The best way to prevent a chronic pain is to address it as an acute pain of less than 6-8 weeks.

I suggest you consult the following sites for more information on chronic pain and offered therapies: 

Pain conditions

Chronic pain Canada

Canadian pain society

Facial pain association

Pelvic pain society

For professionals ( and patients )