Hackbarth, Mark, MD

Physicians & Surgeons, Mental Health Services, Physical Therapists

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(903) 531-2500Call Visit WebsiteVisit Website Map & DirectionsDirections1814 Roseland Blvd Ste 200Tyler, TX 75701 Write a ReviewWrite Review

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Mon - Fri:	9:00 am - 5:00 pm

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Specialties

Primary: Anesthesiologist

Sub-Specialty: Pain Medicine

Additional Specialties: Pain Management, Anesthesiology

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Fax: (903) 597-8997

Fax: (903) 595-3785

TollFree: (866) 647-3200

Phone: (903) 253-9920

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Bergfeld Shopping Ctr

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Mark A Hackbarth, MD

DR Mark Hackbarth MD

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http://www.drhackbarth.yourmd.com

http://precisionspinecare.com

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Physicians & Surgeons, Mental Health Services, Physical Therapists, Physicians & Surgeons, Allergy & Immunology, Physicians & Surgeons, Anesthesiology, Physicians & Surgeons, Cardiology, Physicians & Surgeons, Dermatology, Physicians & Surgeons, Emergency Medicine, Physicians & Surgeons, Endocrinology, Diabetes & Metabolism, Physicians & Surgeons, Family Medicine & General Practice, Physicians & Surgeons, Gynecologic Oncology, Physicians & Surgeons, Gynecology, Physicians & Surgeons, Internal Medicine, Physicians & Surgeons, Neurology, Physicians & Surgeons, Obstetrics And Gynecology, Physicians & Surgeons, Oncology, Physicians & Surgeons, Orthopedics, Physicians & Surgeons, Pain Management, Physicians & Surgeons, Psychiatry, Physicians & Surgeons, Radiology, Physicians & Surgeons, Rheumatology (Arthritis), Physicians & Surgeons, Surgery-General, Skin Care

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Phone: (903) 531-2500

Address: 1814 Roseland Blvd Ste 200, Tyler, TX 75701

Website: http://www.drhackbarth.yourmd.com

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Hackbarth, Mark, MD

General Practitioners

Arthritis
Contrary to popular opinion, osteoarthritis is not caused by aging in and of itself; although it is a common condition among those in the aged population. On the other hand, rheumatoid arthritis is not caused by deterioration. It is caused by an auto-immune disorder that causes the body to attack its own tissues. This causes the deterioration that is similar to those caused by other arthritic disorders.
Fibromyalgia
Fibromyalgia is a poorly understood chronic musculoskeletal syndrome involving widespread pain (Abeles et al, 2008). It may affect 2% of the population, or an estimated 200 million or more people worldwide, and is estimated to occur seven times more frequently in females than in males (Bartels et al, 2009).
Rheumatology
Wise, C. (2008). Arthrocentesis and Injection of Joints and Soft Tissue. Firestein: Kelley’s Textbook of Rheumatology, 8th Ed. MD Consult Web site, Core Collection.
Primary Care
The average fibromyalgia patient sees five different healthcare providers over an eight-year period before receiving a fibromyalgia diagnosis (Firestone et al, 2012). In fact, a study found that over 27% of patients reported feeling that their healthcare provider did not view fibromyalgia as a “very legitimate” disorder (Firestone et al, 2012), and research on United States-based primary care physicians (PCPs) in seven cities found 46% of PCPs reported some uncertainty when diagnosing fibromyalgia (Hadker et al, 2011). The results of these and other studies suggest that patients experiencing fibromyalgia symptoms should seek advice from a pain management specialist familiar with treatment of fibromyalgia syndrome. A pain management specialist is trained in a range of newer pain relief techniques and can tailor a treatment plan to meet individual needs.
Emergency Care
Scattoni L, Di Stani F, Villani V, Dugoni D, Mostardini C, Reale C, & Cerbo R. (2006). Great occipital nerve blockade for cluster headache in the emergency department: case report.
Constipation
Irritable Bowel Syndrome
Beyond pain, fibromyalgia patients frequently report fatigue, joint stiffness, and sleep disturbances, which research suggests may be both a cause and a consequence of the disorder (Prados & Miro, 2012). Less frequently, patients with fibromyalgia may report dysphagia (problems with swallowing), bowel and bladder problems, numbness and tingling, and cognitive difficulties. In addition, fibromyalgia is often comorbid with conditions such as depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, temporomandibular joint disorder (TMJ), rheumatoid arthritis, painful menstrual periods, and other pain syndromes (Weir et al, 2006). Not all people with fibromyalgia experience all of the associated symptoms and conditions (Yunus, 1983).
Electrocardiogram
Diarrhea

Female Infertility
Endometriosis
These positive outcomes in treating chronic pelvic pain associated with cancer motivated researchers to investigate how effective a treatment superior hypogastric plexus block could be for nonmalignant pelvic pain. A report by Rosenberg et al. in 1998 noted a patient experiencing severe chronic nonmalignant penile pain caused by transurethral resection of the prostate achieved at least 6 months pain relief from a superior hypogastric plexus block. A report published in 2001 showed successful relief of pain caused by metastatic cervical cancer achieved by combining superior hypogastric block with ganglion impar block. Also, at least two studies document partial to complete relief of pain in patients afflicted by endometriosis who received a superior hypogastric plexus block.
Pelvic Pain
The superior hypogastric plexus block is a quick, minimally invasive, low-risk procedure proven successful in relieving some chronic pelvic pain, most notably pain related to cancer. The literature also shows superior hypogastric plexus block effective in relieving nonmalignant pain of the organs and tissues innervated by the superior hypogastric plexus nerves.
Pregnancy
Labor and Delivery
The epidural space is the same space in which women in labor receive “an epidural,” or a continuous infusion of anesthetic into the epidural space administered to numb the pain of childbirth. It is also the same space where epidural steroid injections (ESIs) are administered to treat chronic low back pain and radiculopathy. However, adhesions can physically prevent the therapeutic medications in ESIs from reaching painful tissues. The goal of epidural adhesiolysis is to eradicate these adhesions, freeing nerve roots and reopening the epidural space so that therapeutic medications can circulate freely (Trescot et al, 2007).

Internal Medicine
Cervical Cancer
Endoscopy
Sphenopalatine ganglion block is well documented as an effective treatment for acute and chronic head and facial pain. Patients with head and neck cancer can benefit from sphenopalatine ganglion block, which is proven to relieve pain. For example, Varghese et al. (2001) used neurolytic sphenopalatine ganglion block (with endoscopy guidance) to successfully treat 17 of 22 patients with advanced cancer of the head and neck whose cancer-associated pain was not relieved by standard oral medications. These patients continued to report reduced pain at their one month follow up. A study published in 1997 reported that sphenopalatine ganglion block was proven to relieve vasomotor rhinitis in 29 of 30 patients who reported no recurrence of symptoms through the follow up period of 12-20 months. These patients require 3 blocks each week to experience completely get rid of their symptoms. However, in the treatment of facial pain caused by fibromyalgia, sphenopalatine ganglion block is no more effective than placebo. As a whole, pain relief from sphenopalatine ganglion block may be only temporary for some patients, and the effectiveness and duration of relief varies. A nerve block may result in years of pain relief, or only weeks. On the positive side, this is a low risk, minimally invasive treatment that may be successful in pain relief.

Neurology
Interventional Pain Management. Retrieved April 18, 2012, from MD Consult. Daroff: Bradley’s Neurology in Clinical Practice, 6th ed.: http://www.mdconsult.com.ezproxy1.library.arizona.edu/books/page.do?sid=1303407254&eid=4-u1.0-B978-1-4377-0434-1..00051-7–s0130&isbn=978-1-4377-0434-1&uniqId=331991798-2#4-u1.0-B978-1-4377-0434-1..00051-7–s0150
Neurolysis
Positive outcomes in occipital nerve block are typically defined as pain relief of 50 percent or greater, as well as patient satisfaction with the procedure. Once pain relief from an occipital nerve block is confirmed in an individual, he or she may receive future therapeutic blocks to maintain results. Alternatively, he or she may be eligible for more permanent pain relief through procedures such as radiofrequency ablation, neurolysis or implantation of an occipital nerve stimulator to attain more prolonged pain relief.
Multiple Sclerosis
Morphine is the drug most commonly used in intraspinal analgesia because of its history, duration of action, and ease of use (Knight et al, 2007). However, during the last 20 years other agents have been incorporated into intraspinal therapy. Alternative opioids such as hydromorphone, alpha adrenergic agents, baclofen for neuropathic pain local anesthetics, adrenergic agonists, N-methyl-D-aspartate receptor agonists, and other agents are currently being used in implantable drug delivery systems (Knight et al, 2007). Muscle relaxants such as baclofen are also used in cases of spasticity, as in cerebral palsy, multiple sclerosis, and spinal injuries.

Depression
Mental Health
The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques. In regards to adhesiolysis, the guidelines state that there is strong evidence to indicate effectiveness of adhesiolysis with epidural steroids for short and long term pain control in refractory pain and radiculopathy. One of the large retrospective studies showed at less than three months 100% of the patients treated had pain relief (Boswell 2007). Further long-term observation showed results including the following: % of patients who achieved pain relief: < 3 months 3 months 6 months 12 months 100 90 72 52 Another study indicated that overall health status improved significantly in the patients treated with the Racz procedure. Patients stated that their pain and pain medication use were decreased and their physical health, mental health, functional status, and psychological status were all increased after undergoing adhesiolysis therapy (Manchikanti 2001). Drs Lynch and McJunkin trained under Dr. Gabor Racz the inventor of the Adhesiolysis Procedure (Racz Procedure) and learned this safe innovative technique from him first-hand. If you are suffering from chronic back or neck pain that has been refractory to other treatments contact Texas Pain today to see if you can benefit from this innovative treatment.
Psychiatry
Anxiety

Endocrinologist

Diabetes Care

Ultrasound
The classic technique for performing a CPB involves a posterior approach with needle placement through the back; however other newer techniques use imaging technology to approach the plexus from other directions (Mehta & Rathmell, 2011). In general, radiographic guidance such as fluoroscopy (real-time x-ray), ultrasound or CT imaging is recommended to perform the procedure.
MRI
Before performing a procedure your pain physician will review your MRI in order to identify which nerves are likely affected and are responsible for your pain. Initially a series of epidural steroid injections are often performed to localize and treat your pain. If scar tissue is the cause for your pain then the response to the epidural steroid injections may be limited. Once scar tissue is thought to be the cause of you pain you will be schedule for the Racz Procedure. This procedure is performed by injecting a local anesthetic with a small needle into the skin above your buttock. Once the area is numb, then using a larger needle a catheter/guide wire is placed into the epidural space using x-ray guidance for proper placement. Once the catheter is in the proper location where the scar tissue is affecting the nerve root, multiple medications (omnipaque, hypertonic saline, hyaluronidase, local anesthetics, and steroids) are injected into the space in order to dissolve the scar tissue and reduce the inflammation and irritation on the nerve. This procedure can be performed over a two-day period with another injection of materials through the catheter the following day to ensure lysis of scar tissue has been achieved. The entire procedure typically is finished in less than an hour and is performed on an outpatient basis, so typically you are able to go home within a few hours of the procedure. Immediately after the injection you may notice that your legs feel heavy and may have some sensory changes, but these are temporary. The local numbing anesthetic wears off in a few hours so you may feel some discomfort once that wears off at the injection site. The inflammation-reducing steroid generally starts working at about forty-eight hours.
Radiology
Grooten W. Predictors for persistent neck/shoulder pain, medical care-seeking due to neck/shoulder pain and sickness absence.
X-Rays
Computed Tomography
Fluoroscopy, a type of real-time x-ray which can track needles as they move through tissue, is used to guide needle placement during the procedure. The needle is guided into a disc and used to administer an injection. The injection consists of a liquid contrast material and in some cases a prophylactic antibiotic if a patient may be prone to infection (Walker III & al., 2008). This process is repeated in discs at all spinal levels to be tested. As the fluid injection is performed, the patient is asked to report whether or not the pain is reproduced, and characteristics of the pain as delineated by a pre-defined scale. Disc pressure is also measured. A positive discogram in one in which injection of an inter-vertebral disc reproduces pain, while injection of adjacent, healthy discs does not. After injection, a CT scan is performed to visualize the injected contrast solution and identify any leaks in the disk.
Chemotherapy
Spinal tap ), for example, is a procedure commonly used to collect samples of cerebrospinal fluid (CSF) or to inject medications directly into the CSF, such as during chemotherapy or when administering spinal anesthesia. During this procedure, a hollow needle, known as a cannula, is inserted in between two vertebrae within the lumbar region of the spinal cord. Patients may experience headaches or back pain as a result of this procedure.
Radiation Therapy
Treatments involving both chemical or radiation therapy can be particularly painful for cancer patients. The goal of these types of treatment is to damage or destroy the cancer cells, and there are significant side effects associated with both. Patients undergoing chemotherapy frequently report side effects of joint or muscle pain, mucositis, and peripheral neuropathy.
Interventional Radiology

Sciatica
The SIJ can cause low back pain when its joint capsule and ligamentous tissue are irritated or damaged (Hamauchi et al, 2010). Damage to these components results in sacroiliitis, or inflammation of one or both of the SIJs. Sacroiliitis usually manifests as pain in the low back and buttocks. The pain may be radicular, meaning that it radiates down one or both legs (sciatica) (Buijs et al, 2007).
Whiplash
Whiplash commonly causes neck pain as well and may be caused by blunt force trauma such as a car accident that causes the head and neck to quickly jolt back and forth. Rollercoasters have also been known to cause whiplash. Whiplash is not fatal, but can lead to chronic pain. This is because it causes damage to muscles in the neck as well as the ligaments and spinal bones due to the abnormal whipping motion of the neck.
Joint Replacement
Severe cases of arthritis may require a more aggressive intervention. In these cases, the only hope of relief is through full joint replacement. Replacing damaged joints with plastic, or metal prosthetics offers a patient the opportunity to return to a pain free lifestyle; one that makes possible the ability to resume activities from which he or she had previously abstained from.
Neurosurgery
Knee Replacement
Studies in support of CCNB are bountiful according to one systematic review (Fowler & al., 2008). In one study amongst 540 patients undergoing knee surgery, patients receiving continuous medication infusions had equivalent pain relief with fewer side effects. Another study compared CCNB with single injection blockade, IV morphine and epidural analgesia in patients undergoing total knee replacement surgery, in which patients receiving CCNB reported improved pain control, less cardiovascular instability during the procedure, and reduced nausea and vomiting following the procedure. Another study of CCNB on the lumbar plexus noted improved outcomes when compared to control groups. Finally, a large study conducted with children suffering from CRPS evaluated the use of CCNB for pain management (Dadure al., 2005). The study authors found CCNB to be an innovative treatment approach that allowed for significant pain relief, early mobilization and a rapid return home.
Laparoscopy
Adhesiolysis for bowel obstruction and uterine pathology is generally more invasive requiring generally anesthesia. Intra-abdominal adhesiolysis can be performed with sharp scissors or a scalpel after openly and surgically exposing the tissue (referred to as a laparotomy), or it can be performed much less invasively with a technique known as laparoscopy (Shannon, 2010). With laparoscopy, cameras and instruments are inserted through smaller openings into internal tissues, and adhesions can be grasped and cut with scissor or cauterization attachments to the instruments (Hodin & Bordeianou, 2011). By avoiding large surgical incisions, laparoscopy can lower the potential for future post-surgical adhesions.

Plastic Surgeons

Botox
Injections with Botox are becoming more popular as well in terms of treating various types of pain. Botox refers to a purified form of a botulinum neurotoxin. This toxic enzyme is produced by bacteria called Clostridium botulinum and it temporarily paralyzes muscle tissue in small quantities. This treatment has been reported to alleviate neck and shoulder pain by inhibiting nerves that have been overstimulated due to injury. Furthermore, Botox stops the release of specific neurotransmitters that govern pain signal transmission. The effects of these injections tend to last between three to eight weeks. Research shows that patients respond much better to Botox than those who were given a placebo.

Lesions
During the silent intervals used in pulsed ablation, the heat dissipates and the targeted tissue remains below 42°C. Due to this fact, the degree of tissue damage that is achieved in the continuous method of radiofrequency ablation is not achieved using the pulsed method. The pulsed method essentially stuns the nerves as opposed to cutting or damaging them, which is what the continuous approach aims to do. According to clinical research, the alternating bursts of heat and silence weaken the membranes of the targeted tissues, but does not cause lesions. Pulsed radiofrequency therefore results in a temporary inhibition of the nerve’s ability to transmit pain signals from the spine to the brain, without causing significant nerve damage.

Physical Therapists

Physical Therapy
Cervical Epidural Steroid Injections are a commonly performed intervention for chronic neck and head pain in the United States (Abdi, et al., 2007). Cervical epidural steroid injections (CESI) are used in the management of chronic pain experienced in the head, neck and upper extremities, particularly when more conservative therapies such as rest, oral pain relievers such as ibuprofen (Advil™) or acetaminophen (Tylenol™), or in some cases opioid narcotics, and physical therapy have failed. Common indications for treatment with CESI’s include...
Shoulder Pain
Neck Pain
Back Pain
Manual Therapy
Park CH, Lee SH, Lee SC. Preliminary results of the clinical effectiveness of percutaneous adhesiolysis using a Racz catheter in the management of chronic pain due to cervical central stenosis.

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