We provide a variety of services to treat pain and weakness. Services to help you get your life back.
Often, when people come to see us with pain, they believe that their only options are surgery or to take pills for pain for the rest of their lives. We at Comprehensive Rehabilitation and Pain Specialists want you to know that you have other options.
Lumbar epidural injections are used to treat sciatica (leg pain coming from the back) as well as low back pain coming from the lumbar discs. When the discs bulge or herniate they release some inflammatory chemicals inside of them. When these get on the nerves and ligaments of the low back, they cause a lot of irritation and pain. It’s kind of like a very hot pepper. So what do you normally do when your mouth is burning from a hot pepper? Some people try to rinse their mouth out by drinking water. Some savvy people know to neutralize the chemicals in the pepper, they can drink some milk. Well, we spine specialists do the same thing in epidural injections. We give a volume of fluid injected near the area of inflammation to wash away some of those chemicals and we mix it with a steroid to decrease the inflammation for the chemicals that are not washed away.
Facet Injections are given to those suffering with low back pain from arthritis of the spine. The vertebral bones meet together with each other and with the bones above in the thoracic spine and below in the sacrum at joints called the facet joints. These are major weight-bearing joints that support about 60% of your upper body weight. They are also shockingly small – about the size of your thumb joint. Facet joints can develop arthritis just like a knee or hip. In a facet joint injection, anti-inflammatory medication is injected into the arthritic facet joints while using fluoroscopic guidance to improve low back pain. Sometimes this procedure works for many months. If, however, the procedure helps significantly, but for only a brief period of time, a radiofrequency ablation can be considered (see below).
Rhizotomy or Radiofrequency Ablation is a treatment to offer lasting pain relief to those suffering from low back pain from arthritis. It does not involve the usage of steroids for treatment. For the rhizotomy procedure, the small nerves that supply the facet joints in the back are actually blocked for a long period of time by performing a selective burn to the nerve. Relief from this procedure can be long-term lasting 9-12 months. When the procedure wears off, it may be repeated.
The sacroiliac joints are joints on the left and right side of the body between the sacrum (part of the spine) and the pelvis. People with pain here will complain of pain in the back, groin or hip. Injection to these joints with fluoroscopic guidance can be performed to improve pain. If the injection helps, but does not last, a rhizotomy or radiofrequency ablation can be performed for this joint. This procedure is used to give 9-12 months of relief at a time. When it wears off, the procedure may be repeated.
Horizontal Therapy is an integrative health treatment that helps those suffering from a wide variety of pain conditions including fibromyalgia, arthritis, neck, or back pain, pain after an injury, as well as diabetic neuropathy. It is FDA approved to treat pain and studies have shown that Horizontal Therapy is an effective treatment. Our brain talks to our nerves with electricity and our nerves talk to our muscles with electricity. Horizontal Therapy takes advantage of this by stimulating the site of injury with electrical potentials to increase chemical reactions and possibly stimulate healing reactions that have slowed. It is a pleasurable experience for most people as you sit in a comfortable chair for 45 minutes while the stimulation proceeds with electrode pads. You may read, listen to music, sleep or just relax while receiving the therapy. Many patients see a reduction in their pain and improved range of motion over several treatments.
Electrodiagnostic Testing is a test performed by a certified physician or provider to more accurately diagnose nerve diseases and ensure that the best treatment is provided. We offer this service at our practice.
One of the strengths of our practice is our dedication to listening to each person that entrusts us with their care. We pride ourselves on taking a comprehensive history, performing a thorough physical examination, and personally reviewing and/or ordering appropriate testing and records to accurately diagnose and therefore treat you. Our consultations are never double booked and during your visit, you are our only concern.
Sometimes physical therapy, braces, injections, and other best practices are unable to treat pain completely. In cases such as these, our providers may recommend a trial of medication. There are a wide variety of medications that are available to treat pain. Please schedule an appointment with one of our providers to discuss these options with you.
Orthotic Fitting is prescribing properly fitted braces to knees, hands, or low back to improve pain and function. The purpose of these braces is to improve pain as well as restore function, for instance a back brace along with other appropriate treatments may allow you to stand and walk longer.
These treatments are indicated for pain in joints such as knee, shoulder, hip, wrist, elbow, foot, as well as others. Our board certified physicians and providers are experienced to properly diagnose and treat the source of your pain. All injections are not the same. Proper selection of type of injection and placement are crucial. Our providers utilize fluoroscopic guidance when indicated to ensure you receive the injected medication with proper placement each time.
Joint Injections can be performed with either viscosupplementation (a treatment that restores a key component of natural knee joint fluid and reduce inflammation) or with a steroid anti-inflammatory.
Currently only indicated for knee pain, this is the injection of a naturally occurring substance called hyaluronic acid. Hyaluronic acid is a gel-like substance that the cartilage cells make in the knee and other joints. This medication decreases knee pain by blocking some chemicals that cause pain and inflammation. Hyaluronic acid also provides some cushioning and lubrication due to its thick viscosity. These injections are like an oil change for the knee.
Our providers are experienced at taking extensive histories, reviewing prior records and performing thorough physical examinations to arrive at the proper diagnosis and treatment for each person who entrusts us with their care.
Trigger Point Injections are used to treat pain from muscle tightness and sometimes from fibromyalgia. Trigger points are tight tender muscles that cause pain at the area and sometimes will refer pain to other areas. This source of pain has to be treated by loosening the tight muscle. Trigger point injections accomplish this by the injection of sterile fluid, usually lidocaine, along with the movement of a very small needle to loosen up the muscle. They are the injection equivalent of a super deep tissue massage and are covered by most insurances.
We are available to provide this service upon requesting individuals after a work related injury.
Knee pain is one of the most common pain complaints. It can come with or without injury. The common causes of knee pain include:
Osteoarthritis is the type of arthritis that most of us will develop as we age. If you have this condition, you may have knee pain that has increased gradually over time. You may experience stiffness when first arising in the morning or after prolonged sitting (a symptom known as gelling). This condition comes from the destruction and loss of cartilage between the knee bones. There are treatments that our providers offer to help with arthritis knee pain without surgery.
Injuries can cause resultant ligament tears or sprains such as in ACL, PCL, or meniscus. Injuries may also cause dislocations and fractures. Do not wait for a scheduled medical evaluation if you have had an injury with severe pain and swelling, especially if you are unable to bear weight on the knee. You should be seen urgently at the ER, urgent care, or your primary doctor’s office. If the symptoms persist after urgent treatment, please give us a call, we may be able to help.
This condition comes on suddenly in the form of an attack where an individual will have very severe pain in a joint such as the knee. It is caused by a metabolic condition where a substance called uric acid is deposited into body tissues. Uric acid actually crystallizes in the joints into needle-like crystals that causes severe pain in the joint, swelling and inflammation. How did the uric acid get there? Uric acid is a byproduct of the breakdown of a substance called purines. Purines are found in a lot of different foods. Food that are high in protein are in general high in purines too. Food such as anchovies, gravies, kidneys, liver, sardines, and sweetbreads are particularly high.
Bursitis can cause knee pain as well. Bursas are fluid filled sacs on the outside of some bones and joints that allow tendons to glide smoothly over them. The knee joint has bursas that can become inflamed and cause knee pain. Our providers can diagnose this and other causes of knee pain to decrease the inflammation and treat the problem – not just treat pain.
This is an inflammatory disease that results in painful, swollen joints such as the knee joint. There are medications that treat Rheumatoid arthritis, but sometime other treatments are required. Our practice has providers trained in the treatment of knee pain.
Sometimes knee pain can come from an imbalance of the muscles that supply the knee. This imbalance can lead to the kneecap pulling to far to the left or right. It may also cause the knee joint to wear out faster on one side or the other and cause pain. As Physiatrists, we are trained to assess an individual’s gait (walking), evaluate, and treat muscle imbalances without surgery.
Infections in the knee can be very serious, even life-threatening. If you have fevers or chills, or if the knee feels hot and is red, do not wait for an evaluation. Proceed to your primary doctor’s office, urgent care, or emergency room immediately.
After you receive treatment and your knee is feeling better, let us help you by giving you the tools to keep your knee healthy and pain relieved.
Fibromyalgia affects about 5.8 million Americans. It is a disease that causes generalized pain throughout the body. The pain is both above and below the waist, on right and left sides of the body and present for at least 3 months. Individuals with fibromyalgia have a wide variety of symptoms including:
Sometimes it can be triggered by a traumatic event or surgery, but usually starts on its own. It is believed to be a disorder of the central nervous system (meaning the brain and spinal cord). It affects women more often than men and occurs usually between the ages of 20-60 years.
There have been studies called functional MRIs where a person’s brain is scanned with a special type of machine while they perform a task or are asked questions. Some researchers applied pressure with their fingers on normal people and those with fibromyalgia. The normal people just felt pressure and the part of their brains that was active was normal for pressure sensation. The people with fibromyalgia felt pain and the part of their brains that was active was the part that processes pain.
People with fibromyalgia will often come to our office and tell us that they hurt and others think it’s in their head. Our providers understand that these individuals are in pain, but it is in their heads… Not in the way that has been implied, but there is actually a problem with their brain and how they process information both from their bodies and from the world around them. They have a wiring problem.
A recent study on fibromyalgia patients also conducted with one of those special head scans (a functional MRI) showed that patients with fibromyalgia had less active processing portions of their brains when shown a picture than normal people. Their brain activity was increased in the portion that deals with pain, though.
They are consumed with internal complaints all of the time coming from their brains, so no wonder they are tired, distracted, have trouble with their memory, and have headaches.
To understand treatment, you must truly understand that this condition can affect all body systems since it is coming from the brain. This means that treatment just for headaches, or just for abdominal pain, or just for muscle pain are not going to be successful. These individuals truly need a multidisciplinary approach to pain management. As board certified physicians specializing in diseases of the muscles, bones, and nerves, we are uniquely qualified to treat fibromyalgia. If we may be of assistance to you, please do not hesitate to call.
Neck pain can be a particularly difficult thing to live with. It interferes with all of your daily activities and life.
Neck pain can come from many different conditions.
Osteoarthritis is the most common type of arthritis. It is the type that most of us will develop as we age. Osteoarthritis affects the small joints of the neck where the cervical vertebral bones meet – the facet joints. If this is the case, you may feel some popping or cracking in the neck when you turn your head. You may also have stiffness or soreness in the neck when you wake that eases off as the morning progresses. There are a wide variety of treatments for arthritis that a provider at our practice will be happy to discuss with you.
This is pain coming from the cervical discs, which are the shock absorbers and spacers for the bones. Sometimes these discs can become irritated and/or herniate to cause pain. The discs are like a jelly donut. They have cake on the outside (which is called the annulus) and jelly in the center (the nucleus pulposus). Unfortunately, the jelly in the disc is filled with all kinds of inflammatory chemicals that serve a function while in the disc, but are like a very hot pepper when they get out. Due to an accident, a fall, sleeping the wrong way one night, or for a reason that we never understand, the disc can get a tear in the outer cake part, or become squished and change shape. The hot pepper from the center (the nucleus pulposus) gets out and irritates the surrounding ligaments, soft tissue and nerves and causes pain. This pain can remain in the neck, cause neck pain and arm pain, or sometimes only cause arm pain. If this is the case, the pain will often be severe, sudden, and associated with tingling, numbness, or even weakness in the arm. We at Comprehensive Rehabilitation will listen to your history, perform a thorough examination, diagnose your pain and treat you.
A term to describe narrowing of the spinal canal, where the spinal cord lives. This condition can cause pain in the neck and/or arms as well as significant weakness in the arms and hands. Spinal stenosis requires a thorough history and examination for treatment. Our team at Comprehensive Rehabilitation will provide accurate diagnosis, education, and treatment options for your specific care.
This is characterized by muscle tightness and pain in the muscles that surround the neck and upper shoulder area. This pain can start upon awakening – the so called crick in the neck. The muscles become tight and sore as well as feel sharp or throb. The pain can be referred up to the ear or even along the back of your head up to the crown of the head. This is because the same muscles that come down the back of the neck and shoulder area also go to the top of the head. If the muscles have a tight enough spasm, they can actually trigger a headache. As board certified physiatric physicians, we specialize in diseases of the muscles, bones, and nerves and are able to treat muscular pain with a unique perspective.
These require an accurate diagnosis for a tailored treatment to experience the best recovery.
Rarely diseases such as meningitis or cancer can cause neck pain. This is the reason why it is important to see a physician for a thorough evaluation. Please let us know if we can help.
Give us a call at (252) 333-1277 to schedule an appointment. A physician referral is required.
