Physical Medicine

Pain Physician Services

A pain physician deals with the prevention, evaluation, diagnosis, treatment, and rehabilitation of painful disorders. These disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem, such as neuropathic pains or headaches.

The diagnosis of painful syndromes relies on interpretation of historical data, review of previous laboratory, imaging, and electro-diagnostic studies; behavioral, social, occupational and a vocational assessment; interview and examination by the pain specialist; and may require specialized diagnostic procedures, including central and peripheral neural blockade or monitored drug infusions. The special needs of the pediatric and geriatric populations are also considered when formulating a comprehensive treatment plan for these patients.

The pain physician serves as a consultant to other physicians but is often the principal treating physician. They provide care at various levels, such as direct treatment, prescribing medication, prescribing rehabilitative services, performing pain relieving procedures, and counseling of patients and families. In addition, a pain physician may also provide direction for a multidisciplinary team, coordination of care with other healthcare providers, and consultative services to public and private agencies pursuant to optimal healthcare delivery to the patient suffering from a painful disorder.


Treatments, Medications, and Procedures

Medications

The physician may use a variety of different medications, based on your particular medical and/or psychological condition, allergies, financial resources, and insurance plan. Medications can vary from anti-inflammatory medicines to opioid pain medicines, nerve medications to anti-depressants, anti-seizure medications to muscle relaxants, and many others.

Each person is different and if medicines are to be used, the treatment will be uniquely tailored to your specific needs. If any controlled substances are used in your treatment plan, you will be required to complete a Prescription Drug Agreement with your doctor.


Trigger Point Injections

This involves injecting an anesthetic medication into a painful muscle area. This decreases pain and relaxes the muscle. This is a very easy and effective way to treat muscle pain.


Tendon Injections

This involves injecting an anesthetic medication and usually a cortisone-like steroid medication into a tendon insertion area. This decreases pain and inflammation, and is a very easy and effective way to treat tendonitis pain.


Joint Injections

Since every joint in the body is susceptible to arthritis and chronic pain, sometimes a cortisone and/or anesthetic injection directly into the joint is necessary for relief. Some of these injections are performed under a type of x-ray guidance called fluoroscopy, which lets the physician see moving internal structures to determine exactly where the medication needs to be directed.


Spinal Facet Joint Injections

The strength and flexibility of the spine depends on the unique interaction of the discs in the front and back area (facet joints) of the spinal column. Spinal facet joints have a joint capsule lubricated with fluid and richly innervated by a network of pain-sensitive nerve fibers. Facet joints are numerous and can become vulnerable when the intervertebral disc is injured. Injections of steroids directly into the facet joints may reduce pain and facilitate rehab therapy.


Hyaluronate Injections

This is a medication that is injected into the knee joint only for osteoarthritis of the knee. Hyaluronate is a protein substance that provides lubrication to the knee, and thus pain relief. It is extremely effective. Hyaluronate injection relief periods are variable – usually from about six months to upwards of two years.


Epidural Steroid Injections

The purpose of an epidural steriod injection is to try to provide a nerve block and to suppress the inflammation that is affecting the nerves that are carrying the painful nerve signal to the brain. For most spinal conditions, this is a very effective way to decrease pain.

An epidural steroid injection is a procedure performed under fluoroscopic guidance where the physician inserts a needle into the spinal canal and injects a cortisone-type medication and local anesthetic. The epidural space is a space inside the spinal canal between the bony canal of the vertebrae and the sac that contains the nerves, spinal cord and spinal fluid. There are several different approaches to this space that the physician may use.

The relief period varies but injections typically last from three months to one year. Depending on the medical problem, the injection may completely stop the pain and it may never have to be repeated. If the pain returns, injections can be performed in a series of two or three injections 2-3 weeks apart.


SI Point Injections

The SI joint is a large joint between the tail bone and the hip bone. Inflammation of this joint is a common cause of lower back pain. This is a simple procedure in which the physician places a needle into this joint and injects anesthetic and cortisone-like steroid to suppress inflammation and relieve pain.


Discography (Hospital-Based)

A discography is a diagnostic test, and in some cases the best way to make an accurate diagnosis of a disc problem. The physician inserts a needle into the intervertebral disc, and contrast, or dye, is injected into the disc. During the contrast injection, the patient is asked to report if the additional pressure on the disc reproduces his or her pain. This lets the physician know which particular discs are painful.

Once the procedure is completed, the patient is taken to a diagnostic center for a CAT scan of the area, which will reveal any disc that is disrupted. A disrupted disc indicates there may be tears in the outer ring of the disk that were not seen on an MRI scan or other test.


Diagnostic Blocks, Radiofrequency (Hospital-Based), Sympathetic Blocks

A diagnostic nerve block is used to determine sources of pain. These blocks typically contain an anesthetic with a known duration of relief. A sympathetic nerve block is performed to determine if the pain has sympathetic component. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body, such as opening and narrowing blood vessels.


Physical Therapy and Rehabilitation

Physical Therapy and Rehabilitation Services are available in both our Rocky Mount and Tarboro offices. Our physicians will evaluate your individual rehabilitation for your diagnosis, and design an individual program to strengthen core musculature and promote new neuromuscular patterns.

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