Physical Medicine and Rehabilitation
At Pain and Spine Specialists of Maryland and Pennsylvania, we are Doctors and Physiatrists who believe in a balanced and multi-disciplinary approach to diagnose and treat the pain our patients are dealing with. We treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. Continue reading below for a list of treatments we offer. If you have questions about these or other possible treatments, please contact us and we’d be happy to answer your questions or set up a consultation.
Spinal Cord Stimulation
Spinal Cord Stimulation is an excellent modality to treat chronic neuropathic (nerve-related) pain which has not responded to alternative treatment options which include medications, physical therapy, chiropractic therapy, injection therapy, and/ or surgery.
The spinal cord stimulator blocks pain transmission to the brain and replaces it with a parasthesia (tingling sensation). The stimulator is initially placed on a trial basis for 5 days and if the patient responds well during the trial then the permanent device will be implanted.
Ultrasound Guided Injections
Pain and Spine Specialists of Maryland is proud to offer ultrasound guided injections for joint injections, evaluations, and nerve blocks. The utilization of ultrasound provides excellent soft tissue enhancement and visualization without any x-ray exposure.
Vertebroplasty & Kyphoplasty
Vertebroplasty & kyphoplasty are minimally invasive procedures for the treatment of vertebral compression fractures (VCF), which are fractures involving the vertebral bodies that make up the spinal column.
When a vertebral body fractures, the usual rectangular shape of the bone becomes compressed, causing pain. These compression fractures may involve the collapse of one or more vertebrae in the spine and are a common result of osteoporosis. Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous, and vulnerable to breaking. Vertebrae may also become weakened by cancer.
In vertebroplasty, we use image guidance to inject a cement mixture into the fractured bone through a hollow needle. In kyphohplasty, a balloon is first inserted into the fractured bone through the hollow needle to create a cavity or space. The cement is injected into the cavity once the balloon is removed.
Radio Frequency Ablation
Radio Frequency Ablation is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.
Trigger Point Injection
Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
Epidural Steroid Injections
An epidural steroid injection is a common procedure to treat spinal nerve irritation that is caused by tissues next to the nerve pressing against it. An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain.
During an epidural steroid injection, a needle and syringe are used to enter the epidural space (area outside of the protective membrane that houses cerebrospinal fluid? my words) and deposit small amounts of the medicine around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the inflamed area and treats it with a maximal amount of steroids, thereby minimizing exposure of the rest of the body to the steroids.
A discogram is used to determine if a particular disc is the source of pain. Discograms are provocative tests, meaning that they attempt to reproduce rather than remove pain. The reproduction of pain during a discogram can help determine if injury to a particular disc is the source of a person?s pain.
During the procedure, a needle is inserted into the disc and a contrast dye is injected. This extra fluid in the disc increases the pressure in the disc. Patients with an injured disc may then experience pain that can mimic the pain they have been experiencing. The intensity of the pain is recorded on a 0-10 scale. Based upon this information, the diagnosis of a particular disc injury can be made. It can then be determined what the optimal treatment options are for relief of the underlying pain.
Occipital Nerve Blocks
Often a group of nerves, called a plexus or ganglion, that causes pain to a specific organ or body region can be blocked with the injection of medication into a specific area of the body. Various areas of pain require different nerve block types.
- Trigeminal nerve blocks (face)
- Ophthalmic nerve block (eyelids and scalp)
- Supraorbital nerve block (forehead)
- Maxillary nerve block (upper jaw)
- Sphenopalatine nerve block (nose and palate)
- Cervical epidural, thoracic epidural, and lumbar epidural block (neck and back)
- Cervical plexus block and cervical paravertebral block (shoulder and upper neck)
- Brachial plexus block, elbow block, and wrist block (shoulder/arm/hand, elbow, and wrist)
- Subarachnoid block and celiac plexus block (abdomen and pelvis)
Advances in regenerative medicine: Exosomes are small packages of cellular signals that allows the body to stay optimized. They contain proteins such as growth factors, enzymes, transcription factors that stabilize cell structure, function and signaling.
Exosomes contain messenger RNA (mRNA- Blueprint for proteins) and micro RNA (miRNA- Assists in sending signals between cells). They allow for transportation of these proteins to their target cells to assist in optimizing cell function.
Exosomes can have anti-inflammatory, regenerative and tissue remodeling effects.
We take a whole body approach and practice medicine that deeply values the importance of the relationship between the doctor and patient. Our integrative medicine approach is supported by years of research, allowing for the use of numerous forms of therapy aimed at treating the body as a whole to help you reach optimal health and healing.
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