Pain Treatments and Services
Our pain management and rehabilitation services include treatment for a wide range of chronic pain conditions.
Overall Treatments and Services
- Functional restoration
- Interventional therapies
- Orthopedic rehabilitation
- Spinal cord injury rehabilitation
Myofascial Pain (Trigger Points)
The fascia is the connective tissue that covers the muscles. Myofacial pain is a chronic pain that affects the fascia. The pain can involve a single muscle or a group of muscles. Sometimes the pain might be in a different location than where the myofascial pain generator is located. The actual site of injury or the strain can cause trigger points to develop. A trigger point is a painful area(s) of muscle that have knots that form when the muscles do not relax. Trigger point injections are sometimes used to treat those painful areas of muscle to help them relax. An ultrasound may be used to guide the injections for trigger point therapy. Myofacial Release Therapy can also be used to help muscles relax.
An EMG measures the electrical activity of your muscles, both at rest and during contraction. This test is usually ordered when you are having problems with your muscles or nerves. Typically the test is done on the extremities to identify a pinched nerve in the back or neck.
Nerve Conduction Study (NCS)
This test tells how well and how fast a nerve sends an electrical signal. It may be ordered when the patient is experiencing numbness, tingling, weakness or pain that suggests nerve or muscle issues. The test is used to detect if there are any significant abnormalities or to clarify the exact nature of the problem.
Conservative medications such as Nonsteroidal Anti-inflammatory Drugs (NSAIDs), topical analgesics, neuropathic medications, antidepressants and other appropriate analgesics are helpful in patients returning to functionality. Our doctors use combinations of these non-addictive medications in low doses to help the healing process. Narcotic pain medications are used judiciously. New guidelines shows the longer a person takes opiods, the less chance they will return to gainful employment. The goal of our doctors is to help patients return to a normal lifestyle.
Botulinum toxin (ex BOTOX®) is used to reduce painful muscle spasm. After the injection, a gradual relaxation of muscle spasm develops over one to two weeks. This reduction in spasm lasts for 3-4 months and pain relief can last even longer. BOTOX® is a registered trademark owned by Allergan.
Acupuncture is a Chinese medical procedure where small needles are inserted into various points on the body. It has been used successfully for various types of pain including back pain, joint pain, neck pain and headaches.
Epidural injections are often used to treat pain and/or reduce inflammation which can help the tissue to heal. The resulting relief may last several months or longer.
Facet joints are tiny joints in the back of the spine that can be the cause of pain after trauma, surgery, amd with arthritis of the spine. A combination of numbing medicine and cortisone type medication is placed into these joints to relieve pain under x-ray guidance. Facet joint injections can both help with pain and inflammation of the joints as well as improve the accuracy of the diagnosis.
Medial Branch Blocks
"The nerves that send pain signals from the facet joints to the spinal cord are called "medial branches". During a medial branch block, numbing medicine is placed where these tiny nerves are located. Then, the patient's response to the block is recorded. This is the most accurate way of determining if the facet joint is the cause of pain. If the block is positive, then he or she may be a candidate for an ablation procedure.
This procedure is used to reduce pain from the joints for a long period of time (months to years). An electrical current produced by a radio wave heats up a small area around the nerve tissue which decreases the pain signals from that nerve. Occasionally the procedure needs to be repeated but if it is successful, pain relief can last six months or longer. Also known as:
- Radio frequency ablation
- Radio frequency procedure
- Radio frequency thermal ablation
- Radiofrequency ablation
- RFTC neurolytic ablation
Sometimes disc problems are suspected, but it is hard to see on an MRI, CAT scan or an EMG. This is when a discogram may be recommended. Although pictures are taken during the procedure, it is the patient’s pain during the test that helps determine the discs that are generating the pain. A small amount of fluid is injected into discs in the neck or low back. Pain, if present, is recorded and then a CT scan (special x-rays) are taken of the discs to see if any of the fluid is leaking out. Also known as cervical discograms, lumbar discograms or discography.
Spinal Cord Stimulation
A spinal cord stimulation trial might be recommended if the pain is coming from particular nerves in the spine. During a trial, special electrodes are temporarily placed in the spine. After the electrodes are placed, low level stimulation is delivered by the electrodes to help turn the pain signal off. The electrodes are in place for a few to several days to see how well the procedure works. If it is helpful, permanent electrodes are then implanted in the spine for long term relief.
There are several different types of nerve blocks and each serves a different purpose. A nerve block is an injection that places a numbing medication into a specific area of the body that is causing pain to a specific organ or that body region.
We specialize in Worker’s Compensation cases, as well as Independent Medical Evaluations, Second Opinions and Medical Record Reviews.
An IME is an examination in which the physician generates a report explaining the current status of a person’s injury. It will include the cause, the extent of the health problem and sometime the best treatment plan for the injury. An IME, which is conducted post-treatment, is designed to provide a picture of how the patient responded to medical treatment and whether he/she derived maximum benefit from it.
Our certified IME doctors will extensively review the patient’s medical records and diagnostic reports such as MRI scans, etc, interview the patient about the injury, and conduct a thorough examination. The report is sent to the requesting party.
Medical Record Reviews
This is a formal examination of a patient’s medical records. It is conducted for a variety of reasons such as validating a diagnosis or to facilitate paying a claim. However, the most common reason a medical record review is performed is to appraise the need for certain medical procedures.
Physical Capacity Evaluations or Functional Capacity Evaluations
This is an assessment of a patient’s ability to perform work-related activities.