Services


Our state-of-the-art spectrum of care will include the following treatments:

  • Adult & Geriatric Pain
  • Acute & Chronic Pain
  • Electrodiagnostic Testing (EMG/Nerve Conduction Studies)
  • Cervical, Thoracic and Lumbar Pain
  • Failed Back Surgery Syndrome
  • Peripheral Joint and Extremity Pain
  • Headache (other than migraine headaches)
  • Sports Injuries
  • Whiplash Injuries /Auto Injuries
  • Myofascial Pain Syndrome
  • Interstitial Cystitis/Pelvic Pain
  • Complex Regional Pain Syndrome/ Reflex Sympathetic Dystrophy
  • Management of Cancer Pain
  • Compression Fractures
  • Narcotic Medication Management
  • Worker's Compensation
  • Independent Medical Examinations

About Pain Management
Pain Medicine is a multidisciplinary approach to the prevention, diagnosis and treatment of pain. A physician who is practicing pain medicine or pain management is usually a physical medicine and rehabilitation physician or anesthesiologist who has been trained on the relief and/or management of pain. Pain physicians typically utilize modalities, analgesic medications, physical therapy and pain relieving injections, among others to treat pain. Click on this link for more information about pain management, About Pain Management

For painful spine and musculoskeletal disorders, pain medicine is employed as an aggressive conservative care program that helps to identify the source of pain and rehabilitate the patient as an alternative or follow-up to surgery.

Information of Spinal Anatomy
The spine is broken down into five regions (starting from the top) which are: cervical (neck), thoracic (mid back), lumbar (low back), sacral (between the hips), and coccygeal (tail bone). Since > 90% of all spinal pain comes from the cervical, thoracic, and/or lumbar spine region, the information provided here will provide generalities about the anatomy of these segments.

The anatomy of the cervical, thoracic, and lumbar spine vary, but in general, each segment is made up of the following structures: muscle, ligaments, joints, intervertebral discs, bone and nerve tissue. The muscles and ligaments hold the spine together, the joints allow the spine to move, the discs act as "shock absorbers," and the bone protects the important nerve structures. Click on this link for more information about spinal anatomy, Spine Anatomy

Pain comes from damaged tissues that have nerve endings. The spine tissues that have nerve endings are muscle, the posterior longitudinal ligament, nerve roots, joint capsules (facet joints), and the outer surface of the discs.

Specific Conditions and Non Surgical Treatment Options:
Myofascial pain syndrome
Myofascial pain syndrome is a chronic, localized form of muscle pain. The pain arises from "taut" bands in muscle that are called "trigger points." The trigger points in the muscle are painful when touched. Myofascial pain caused by trigger points has been linked to many types of pain, including headaches, jaw pain, neck pain, low back pain, pelvic pain, and arm and leg pain. Click on this link for more information about myofascial pain syndrome, About Myofascial Pain Syndrome

Fibromyalgia is a chronic, widespread form of myofascial pain. Fibromyalgia symptoms often begin after a physical or emotional trauma, but in many cases there appears to be no triggering event. The condition is associated with trigger points and sleep disturbance. Click on this link for more information about fibromyalgia, About Fibromyalgia

Treatment options for myofascial pain syndrome and fibromyalgia include medications, physical therapy, and trigger point injections. Click on this link for more information about trigger point injections, Trigger Point Injections

Cervical, Thoracic and Lumbar Spondylosis (Facet joint Syndrome)
Spondylosis is a general term for age-related wear and tear affecting the joints in your spine. This condition is better known as osteoarthritis. Usually it appears in men and women older than 40 and progresses with age. Symptoms include spinal pain and stiffness. Click on this link for more information about spondylosis, About Facet Joint Syndrome (Arthritis)

Certain medical conditions can accelerate the age-related changes of the spine. One very common condition is scoliosis. Scoliosis is an abnormal curvature of the spine. Click on this link for more information about scoliosis, About Scoliosis

A traumatic event can also accelerate the age-related changes of the spine. One of the most common traumatic events is a whiplash injury. This type of injury occurs when a segment of the spine is forced backward and then forward. These extreme motions push your spinal muscles, ligaments, and spinal bones beyond their normal range of motion and can cause a traumatic collision of your spinal facet joints. Click on this link for more information about whiplash injuries, About Whiplash (CAD Syndrome)

Typically, a whiplash injury affects the neck and occurs during rear-end automobile collisions. When this happens, patients will complain of upper neck pain and headaches. Click on this link for more information about whiplash or cervicogenic headaches, About Whiplash Headache

Treatment for any of the above spondylitic conditions consists of medications, physical therapy, and injections. Injections that can minimize or cure the underlying pain are facet joint injections or facet joint nerve blocks and radiofrequency ablation.

A facet joint injection is an injection where a needle is placed in the facet joint and cortisone (steroid) is injected. Click on this link for more information about facet joint injections, Facet Joint Injections

Alternatively, instead of injecting the facet joint, an anesthetic can be used to block the nerve that innervates the facet joint. This is a diagnostic procedure only and will not give a patient long term relief. Typically, this type of injection is done twice to confirm the diagnosis. Click on this link for more information about diagnostic injections, Medial Branch Block If the facet joint nerve injections are diagnostic (a patient gets relief with both injections), then a therapeutic procedure can be done which is called a radiofrequency ablation. To learn more about radiofrequency ablation, Click on the appropriate spinal segment for an informational video.

Cervical, Thoracic and Lumbar Herniated Discs and Radiculopathy aka "Pinched Nerve"
A radiculopathy occurs when too much pressure is applied to a nerve. This can occur anywhere in the spine. Usually it is a herniated disc that is the source of the pressure but it can occur by other surrounding tissues — such as bones, cartilage, muscles or tendons. Click on this link for more information about herniated discs, About Herniated Discs This pressure disrupts the nerves function, causing pain, tingling, numbness or weakness. Symptoms will vary depending on the location of where the nerve is being pinched in the spine. If the compression occurs in the neck or lower back, pain will radiate down the arm or leg in the distribution of the nerve. If the compression occurs in the thoracic spine, pain will radiate around the ribs. Click on this link for more information about radiculopathies, About Lumbar Radiculopathy (Sciatica)

Treatment for a radiculopathy consists of medications, physical therapy, and injections. The injection that is used typically is an epidural. For more information on epidurals, Click on the appropriate spinal segment for an informational video.
 

If an epidural is not beneficial, the same medication can then be injected using a more direct approach to get the medication right next to where the disc herniation is applying pressure on the nerve. This is called a transforaminal injection. This is done only in the lumbar region because doing this type of injection is dangerous to do in the thoracic or cervical spine region. Click on this link for more information about transforaminal injections, Lumbar Transforaminal Epidural Steroid Injection

If neither an epidural and/or a transforaminal injection helps the symptoms, then either a percutaneous disc decompression (PDD) and/or an intradiscal electrothermal disc (IDET) procedure can be considered. A PDD is done by inserting a probe into the herniated disc, the probe is then rotated resulting in aspiration of the disc tissue and mechanical evacuation back through the probe. A "void"is created in the disc which results in "negative pressure"which reduces the disc herniation and the related spinal nerve compression. Click on this link for more information about PDD, Dekompressor Discectomy

IDET can be considered as well but is rarely approved by insurance. In this treatment a catheter is inserted through a needle into the herniated disc. The catheter is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disc wall, reducing the disc herniation and the related spinal nerve compression. Click on this link for more information about IDET, Intradiscal Electrothermal Therapy (IDET)

Degenerative Disc Disease
Degenerative disc disease is not really a disease but a term used to describe the normal age-related changes in your spinal discs as you age. The discs act as "shock absorbers" for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region). What causes degenerative disc disease? As we age, our spinal discs break down, or degenerate, which may result in degenerative disc disease in some people. These age-related changes include loss of fluid in the disc and tiny tears or cracks in the outer layer (annulus or capsule) of the the disc. These changes alone do not result in pain. If pain results it is do to inflammation or abnormal micromotion instability. Click on this link for more information about degenerative disc disease, About Degenerative Disc Disease

If degenerative disc disease is part of the normal aging process and may not result in pain, how is it determined that the disc is the source of the pain? This is done by a procedure called a discogram. A discogram is a procedure where normal and abnormal discs are "pressurized" independently in hopes that the pain is only reproduced when the abnormal disc is "pressurized." Click on this link for more information about lumbar discograms, Discography

Treatment options include medications, physical therapy and injections. The injection that is used typically to treat this condition is an epidural. For more information on epidurals, Click on the appropriate spinal segment for an informational video.

If an epidural is not beneficial, the same medication can then be injected using a more direct approach to get the medication right next to the painful disc. This is called a transforaminal injection. This is done only in the lumbar region because doing this type of injection is dangerous to do in the thoracic or cervical spine region. Click on this link for more information about transforaminal injections, Lumbar Transforaminal Epidural Steroid Injection

Another procedure that can be considered but is rarely approved by insurance is intradiscal electrothermal therapy (IDET). In this treatment a catheter is inserted through a needle into the herniated disc. The catheter is heated to a high temperature for up to 20 minutes. The heat thickens and seals the disc wall, reducing the disc herniation and the related spinal nerve compression. Click on this link for more information about IDET, Intradiscal Electrothermal Therapy (IDET)

Spinal Stenosis
Spinal stenosis is a narrowing of one or more areas in the spinal canal. This narrowing can put pressure on your spinal cord and/or on the nerves that branch out from the spinal cord. The stenosis is usually due to a combination of factors that included a bulging or disk herniation, arthritic bony changes, and/or hypertrophy (swelling) of spinal ligaments. Symptoms that are experienced typically are cramping, pain or numbness in your back and legs (if the stenosis is in the lower back), or cramping, pain or numbness in the neck, shoulders or arms (if the stenosis is in the neck). Click on this link for more information about spinal stenosis, About Spinal Stenosis

Treatment options include medications, physical therapy or injections. The injection that is used typically to treat this condition is an epidural. For more information on epidurals, Click on the appropriate spinal segment for an informational video. 
 

If an epidural is not helpful and surgery is not an option, then spinal cord stimulation (neuromodulation) can be considered. This procedure is done by inserting electrodes through an epidural needle into the epidural space over the spinal cord. The electrodes are then used to transmit a signal to the spinal cord that blocks pain and replaces the pain with a more pleasant feeling. Click on this link for more information about spinal cord stimulation, Spinal Cord Stimulator Implant

Spondylolisthesis
A spondylolisthesis is a condition where one vertebra slips slightly forward or backward over another vertebra. This condition is usually a result of degenerative disc disease or an underlying spinal fracture (a pars fracture). The displaced vertebra then can result in spinal stenosis and/or a radiculopathy ("pinched nerve") where a nerve exits the spinal canal. Click on this link for more information about spondylolisthesis, About Spondylolisthesis

Treatment options include medications, physical therapy and injections. Injections that are considered are an epidural or facet joint injections/ facet blocks and ablation. The symptoms that are experienced will determine which injection is done.

For more information on epidurals, Click on the appropriate spinal segment for an informational video.

Click on this link for more information about facet joint injections, Facet Joint Injections

Facet joint nerve blocks and ablation are another option to treat facet mediated pain. Diagnostic facet nerve blocks are called medial branch blocks. Click on this link for more information about Medial Branck blocks, Medial Branch Block If the facet joint nerve injections are diagnostic (a patient gets relief with both injections), then a therapeutic procedure can be done which is called a radiofrequency ablation. To learn more about radiofrequency ablation, Click on the appropriate spinal segment for an informational video.
 

Failed Back Surgical Syndrome/Post Laminectomy Syndrome
Failed back surgical syndrome is a term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery. Unfortunately, back surgery or spine surgery cannot literally cut out a patient's pain. It is only able to change anatomy. Even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result. Click on this link for more information about failed back surgical syndrome, Post Laminectomy Syndrome

Treatment options include medications, physical therapy, caudal adhesiolysis and/or spinal cord stimulation (neuromodulation).

Caudal adhesiolysis is considered if post surgical scar tissue is the suspected source of pain after a spinal surgery. This procedure is done by inserting a catheter in the region of the spinal scar tissue. Then catheter manipulation and intermittent hypertonic saline injections are done to "break up" the scar tissue. Click on this link for more information about caudal adhesiolysis, RACZ Caudal Neurolysis

Spinal cord stimulation is a procedure where electrodes are placed through an epidural needle into the epidural space over the spinal cord. The electrodes are then used to transmit a signal to the spinal cord that blocks pain and replaces the pain with a more pleasant feeling. Click on this link for more information about spinal cord stimulation, Spinal Cord Stimulator Implant

Sacroiliac Joint Dysfunction
The sacroiliac joints are the joints that connect your lower spine and pelvis. When the sacroiliac joints have abnormal motion or develop inflammation, pain can occur. Sacroiliac joint dysfunction can be difficult to diagnose, and it may be mistaken for other causes of low back pain such as: myofascial pain syndrome, lumbar spondylosis, herniated disc with radiculopathy, and/or degenerative disc disease.

Treatment options include medications, physical therapy and injections. The injection that is used to help this condition is a sacroiliac joint injection. A sacroiliac joint injection is an injection where a needle is placed in the sacroiliac joint and cortisone (steroid) is injected. Usually this injection is both diagnostic and therapeutic. Click on this link for more information about sacroiliac joint injections, Sacroiliac Joint Steroid Injection

Peripheral Neuralgia/Neuropathy
Peripheral neuropathy is a disease that causes the nerves outside of the brain and spinal cord not to work properly. This usually results in a loss of function in the nerve which can result in pain, dysaesthesias (painful tingling sensations) and numbness in the distribution of the nerve. Click on this link for more information about peripheral neuralgia/neuropathy, Peripheral Neuralgia

Treatment options are medications, physical therapy, and spinal cord or peripheral nerve stimulation (neuromodulation). Spinal cord stimulation is a procedure where electrodes are placed in the epidural space over the spinal cord through an epidural needle. Peripheral nerve stimulation is a procedure where electrodes are placed along a damaged peripheral nerve. The electrodes in both cases are then used to transmit a signal that blocks pain and replaces the pain with a more pleasant feeling. To learn more about spinal cord stimulation and peripheral nerve stimulation, click on this informational video.Spinal Cord Stimulator Implant

Sympathetic Mediated Pain
Sympathetic nerve pain is now commonly known as complex regional pain syndrome or reflex sympathetic dystrophy. This is an uncommon, chronic condition that usually affects your arm or leg. Complex regional pain syndrome is marked by intense burning or aching pain. You may also experience swelling, skin discoloration, altered temperature, abnormal sweating and hypersensitivity in the affected area. The cause of complex regional pain syndrome isn clearly understood, though it often follows an illness or injury.

Treatment options include medications, physical therapy, sympathetic nerve blocks or spinal cord stimulation.

The specific sympathetic nerve block that can help is determined on the location of the symptoms. The following sympathetic blocks can be used: stellate ganglion block (for arm pain), celiac plexus block (for abdominal pain), lumbar sympathetic block (for leg pain), superior hypogastric block (for pelvic pain), and ganglion impars block (for coccyx or perineal pain).

Click on this link for more information about a stellate ganglion block, Stellate Ganglion Block
Click on this link for more information about a celiac plexus block, Celiac Plexus Block
Click on this link for more information about a lumbar sympathetic block, Lumbar Sympathetic Block

If a specific sympathetic block does not help then spinal cord stimulation may be considered. Spinal cord stimulation is a procedure where electrodes are placed through an epidural needle into the epidural space over the spinal cord. The electrodes are then used to transmit a signal to the spinal cord that blocks pain and replaces the pain with a more pleasant feeling. Click on this link for more information about spinal cord stimulation, Spinal Cord Stimulator Implant

Compression Fractures
A compression fracture is a fracture of the thoracic and/or lumbar vertebral body. This is usually caused by a traumatic injury or from osteoporosis.

Treatment options include immobilization/ bracing, medications, physical therapy, and/or a vertebroplasty or kyphoplasty.

A vertebroplasty is a procedure where a needle is placed in the vertebral body and cement is injected to secure the painful fracture. Click on this link for more information about vertebroplasties, Vertebroplasty A kyphoplasty is similar to a vertebroplasty except a balloon is used to create space in the vertebral body before cement is injected to secure the painful fracture. Click on this link for more information about, Kyphoplasty