Physiatrists, or rehabilitation physicians, are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move
Rehabilitation physicians are medical doctors who have completed training in the medical specialty of physical medicine and rehabilitation (PM&R). Specifically, rehabilitation physicians:
The job of a rehabilitation physician is to treat any disability resulting from disease or injury, from sore shoulders to spinal cord injuries. The focus is on the development of a comprehensive program for putting the pieces of a person's life back together after injury or disease – without surgery.
Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician's medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person's lifetime.
Common Non-Surgical Treatments:
Interventional Pain Management Procedures:
Epidural steroid injections are spine injections in the neck (cervical), mid back (thoracic spine), and low back (lumbar spine). These injections are done under x-ray guidance placing steroid (strong antiinflammatory) into the spinal canal to help with inflammation problems involving the discs and nerves of the spine. These injections can be done in the midline of the spine (interlaminar) or along side of the spine (transforaminal/selective nerve root block). These injections are mostly therapeutic (helps to treat your pain), but the selective nerve root block often times can have diagnostic use (helps to find the source of your pain).
Neck, mid back, and low back pain is often generated by the small joints of the spine (facets/zygo apophyseal joints). These can be successfully injected under x-ray guidance with steroid reducing joint inflammation and pain. These injections are quite helpful in alleviating localized neck, mid back, and low back pain. If the injection only helps temporarily, facet joint radiofrequency lesioning (RFL) is often considered.
Trigger point therapy is a temporary block of myofascial pain involving injection of local anesthetic and/or steroids. It is used in combination with therapy program to treat various muscle pain problems involving the spine and extremity. It is quite safe and can easily be performed in the office.
RFL is a procedure involving the selective blocking of pain in the neck and low back region coming from the facet joints. It involves placing a specialized needle on the small medial branch nerves that carry the pain input from the facet joints. This area is subsequently anesthetized and electricity through the needle heats the tip, burning and killing the small nerves providing pain relief 6-12 months or longer. This procedure can also be done for chronic sacroiliac joint pain.
Prolotherapy is an injection technique done to help strengthen weak tendons and ligaments. Injection is done in multiple areas stimulating new growth and strengthening the tendons and ligaments of the areas injected. It is used typically for chronic spine pain as well as chronic peripheral joint pain involving the shoulders, elbows, wrists, hips, knees, feet and ankles.
Sympathetic blocks are provided for specific nerve pain involving reflex sympathetic dystrophy/complex regional pain syndrome. These are unusual pain problems involving abnormal nerve response to injury with subsequent severe pain of the arms or legs. Sympathetic block can often times block this pain resetting the neurological system for more normal functioning and less chronic pain. Sympathetic nerve blocks are done in the neck (stellate ganglion block), and low back (lumbar sympathetic block). These are done with x-ray guidance very successfully alleviating pain from RSD/CRPS.
Spinal cord stimulator is an advanced treatment technique for refractory nerve pain involving the arm or legs with or without spine pain. A wire is implanted within the spinal canal providing stimulation on the nerves in order to block the pain input to the brain. It is often used for difficult chronic nerve pain as well as chronic back pain that has not responded to multiple surgeries. It has also been used quite successfully for pain and limitations from peripheral vascular disease.
Botox is an injection therapy into the muscle, which helps to temporarily relax the muscle. It is often used for treatment of chronic myofascial pain syndromes as well as spasticity and headache.
Percutaneous discectomy is a minimally invasive procedure in the lumbar spine for small disc herniations with radiculopathy/sciatica. It can successfully alleviate the pressure of the small disc upon the nerves without surgical intervention. It is safe and effective in the appropriate patient population.
IDET is used to treat primarily back pain coming from the disc due to torn ligaments of the disc. It is a minimally invasive procedure involved with placement of a coiled wire within the disc. This wire is then heated causing shrinkage and tightening of the disc ligaments, as well as reduction of painful nerve stimulus. This is a safe procedure for people with chronic back pain due to minimal degenerative disc disease.
A discogram is a diagnostic examination performed under x-ray guidance, in which dye is injected into the center of one or more injured discs. The doctor uses a fluoroscope (special x-ray screen) in order to see the dye in the disc(s) and assess the structural damage. During the procedure, the doctor can determine the degree of pain caused by the disc injury, as well as a diagnosis such as a ruptured, torn, or degenerated disc. Discograms are commonly performed prior to surgery in order to pinpoint the location and severity of the disc problem.
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