At SWCA, we believe the best results come from mutual trust between physician and patient. Our team of Double Board-Certified physicians aims to put their extensive knowledge and combined years of experience towards helping you get back to being you. All of our patients can achieve optimum health with the right support system.



SWCA is a world-recognized team of spine experts offering revolutionary, professional, and effective healthcare. We specialize in minimally invasive treatments and our innovative practices are geared towards your health and wellness. From sophisticated and cutting-edge options to treat pain and optimize function to individualized treatment plans, SWCA looks forward to being a part of your healthy lifestyle. 

Is Ketamine an option?

The evolution of the definition of pain has evolved due to research and a more comprehensive understanding of etiology. The definition of pain by the International Association for the Study of Pain (IASP) includes “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."

Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors. Pain cannot be inferred only from activity in sensory neurons. Through their life experiences, individuals learn the concept of pain. A person’s report of an experience as pain should be respected. Although pain usually serves as an adaptive role, it may have adverse effects on function and social and psychological well-being.

Ketamine is an NMDA receptor antagonist and an AMPA receptor stimulator. By blocking glutamate reuptake and increasing it in the synapse, ketamine resets the hyperalgesic hyperexcitatory pathway. AMPA stimulation is necessary for increasing brain-derived neurotrophic factor (BDNF) which in turn stimulates the formation of new receptors and synapses called synaptogenesis. This process is critical for making connections between neurons and is often severely compromised among those suffering from PTSD and depression. In addition, Ketamine also may reduce signals involved in inflammation.

Ketamine Assisted Psychotherapy (KAP) utilizes a dosage escalation strategy to achieve different levels of consciousness increasing to full out-of-body experiences. We find an individual “sweet spot” with respect to dosage to aid in psychotherapy. Maintenance of the observing self and personal elucidation is fundamental to the success of KAP and dosage selection and results in a decrease in symptomatology. Ketamine can act as a "reset" to the pain, depression or anxiety created by the disorganization of one's central nervous system.

I believe that using intramuscular or IV ketamine with psychotherapy and optimizing lifestyle choices will lead to long-lasting pain and antidepressant relief, especially in the Fibromyalgia population.

Please contact our office at 305.974.5533 if you have chronic pain with depression or Fibromyalgia, are interested in feeling well again, and want to address the root cause of your suffering.

When joints are painful, it becomes more difficult to perform everyday tasks. One of the more debilitating conditions we see in our office is known as Sacroiliitis or the inflammation of one or both of your sacroiliac joints. The sacroiliac joint is found in the area where the sacrum and the ilium (a part of the pelvis) meet. It’s a very common source of pain found in the lower back, buttocks, or thighs, and about 10-25% of people who experience back pain are found to suffer from this condition.

Sufferers will typically report increased pain after prolonged periods of sitting or standing and after rotating one’s hips. The pain is marked as dull, achy, sharp, and stabbing.

Patients who visit Dr. De La Peña for joint pain relief are often in the office to receive steroid injections. This actually serves as a way for Dr. De La Peña to diagnose patients with Sacroiliitis, as the unresponsiveness to the shots signifies something deeper than regular joint inflammation. Blood work, a physical exam, and imaging tests can all also be used to diagnose Sacroiliitis as the cause of pain in a patient.

Along with diagnosing Sacroiliitis, the injections can help treat the pain. These injections include epidural steroid injections, trigger point injections, or soft tissue injections. You can only receive a few injections a year to protect the bones and tendons of a joint, so if you are not responding, it’s time to move on to other treatments. If a patient does not respond to any of the treatments, we use Radiofrequency Ablation or denervation to treat the joint pain, which heats the area of nerve tissue in order for it to stop sending pain signals.

There are three types of Radiofrequency Ablation that can be used to produce these heat lesions that halt sacroiliac pain. Conventional continuous Radiofrequency ablation uses continuous high-voltage current to produce a heat lesion, whereas pulsed Radiofrequency ablation delivers short bursts of high-voltage current with breaks in between. Lastly, water-cooled Radiofrequency ablation, which uses the hottest temperature of all 3 methods, cools the nerve with a flow of water in between heatings, which keeps it from overheating.

As with other common joint pain, the most organic method of treating Sacroiliitis is physical therapy. Dr. De La Peña will work with you to increase strength in your muscles and range of motion while stabilizing the muscles that surround the sacroiliac joint.

A steady, consistent plan of movement will over time help to relieve pain and improve the quality of daily living and activities.

Over-the-counter medications such as acetaminophen or ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) help support the pain relief process and are highly recommended in addition to regular physical therapy. Medications such as cyclobenzaprine (Amrix, Fexmid) are also recommended to help reduce the muscle spasms stemming from Sacroiliitis.

When our most common methods aren’t providing a patient with relief, we turn to more innovative options, like the LinQ SI Joint Stabilization System. This minimally invasive procedure is done through one single incision in the patient’s back and involves placing an almond-size metal implant into the sacroiliac joint to stabilize it. Patients are able to leave the hospital the same day and resume daily activities within a few short weeks.

Although we rarely turn to surgery to treat Sacroiliitis, it is an option should the patient not respond to other treatments. Joint fusion fuses the two bones together with metal hardware which can help relieve pain in the sacroiliac joint.

To make an appointment with Dr. De La Peña please call 305.974.5533. Dr. De La Peña directs a team approach from diagnosing any underlying cause to progressing to coming up with an individualized treatment that takes the patient and circumstance into consideration.