Our services include interventional pain management with a multitude of cutting-edge procedures. We recently added a fluoroscopy suite to better accommodate our patients.
When a patient has chronic pain, it is imperative that the exact cause of the pain be determined. Therefore, initial consultation, examination, and review of records is essential in determining which treatments can best help you. It is essential that you have an experienced pain physician who understands all of these potential modalities. It is certainly a benefit when they are offered under one roof. The Pain Evaluation & Management Center of Ohio is such a facility and our physicians are extensively qualified. Once a comprehensive assessment and diagnosis is made, the physician will discuss with you which of the above potential options are best for you. If you have specific questions about any of those, you should write them down and bring them to the consultation.
Vertebroplasty is the placement of intervertebral cement for spinal compression fractures. This is a safe and simple procedure for fractures of varying age that still show edema or swelling in the vertebrae. This procedure is completed on an outpatient basis and generally takes only about a half-hour with one to two hours of postoperative observation. Simply rest for 24 hours and you can resume reasonable activities. This is a safe, simple, and very effective treatment for acute pain from compression fractures. If you have a vertebral compression fracture, your referring physician or you need to notify our staff so that we can work you in immediately.
SPINAL CORD STIMULATORS
Spinal cord stimulator trials and placement of interspinal electrodes for the treatment of RSD, failed spinal surgery, peripheral neuropathy, and phantom pain are completed in our office. These procedures are outpatient and safe and effective. A small electrode is placed over the spinal cord in the epidural space and advanced under fluoroscopic guidance. A small electrical stimulus is then used to block your pain as it enters the spinal cord. This is a very effective treatment that involves a two-step process, starting with a trial when the leads are externally linked and you can use it at home for four days. If this is significantly effective in reducing your pain and improving functioning, a permanent stimulator can be placed, which is buried under the skin and there are no visible wires or instruments.
Spinal pump trials and full spinal pump managements are offered. Spinal pumps are indicated for a variety of chronic pain conditions relating to the back, neck, and extremities. A spinal pump applies medications directly to the spine at the source of the pain which can potentially provide much better pain control for patients who have pain that is not responsive to normal treatment.
MYOBLOC is the use of Botox. We use EMG guidance when indicated to treat a variety of chronic muscle spasm conditions that can be very painful including severe muscle spasms, torticollis, and fibromyalgia with muscle spasm.
Radiofrequency neurolysis is used when nerves have been identified as specific pain generators primarily in patients who have paraspinal pain that is related to facet neuritis and spondylosis of the spine. There is a simple procedure to diagnose whether or not that is the cause of your pain and if so then radiofrequency can be applied to those nerves and potentially provide long-term pain improvement.
Epidural steroid injections, trigger point injections, nerve blocks, and facet blocks are also performed for a variety of different medical conditions. These include lumbar radiculitis, lumbar facet neuritis, spondylosis, degenerative disc disease, disc herniations, chronic muscle spasms, and peripheral nerve pain including but not limited to carpal tunnel syndrome, epicondylitis, and ulnar and radial neuritis.
Prolotherapy is the treatment of soft-tissue damage through the use of injections. This involves the treatment of two specific kinds of tissue: tendons and ligaments. A tendon attaches a muscle to the bone and involves movement of the joint. A ligament connects two bones and is involved in the stability of the joint.
The injections lead to inflammation in the area, and the body reacts by increasing the blood supply and sending more nutrients to the area. Special cells from the immune system (macrophages) are drawn to this area and in turn they release biochemical agents that attract another cell type (fibroblasts) that lay down new building blocks (collagen), resulting in tissue repair. The term prolotherapy is derived from the word prolo, short for proliferation, as the therapy is intended to proliferate tissue growth in the damaged area.
A strain is defined as a stretched or injured tendon; a sprain, a stretched or injured ligament. Once these structures are injured, the immune system is stimulated to repair the injured area. Because ligaments and tendons generally have a poor blood supply, incomplete healing is common after injury. This incomplete healing, results in these normally taut, strong bands of fibrous or connective tissue becoming relaxed and weak. The relaxed and inefficient ligament or tendon then becomes the source of chronic pain and weakness.
The greatest stresses to the ligaments and tendons are where they attach to the bone, the fibro-osseous junction. These are some of the most sensitive structures that produce pain, more so than muscle. It is now easy to understand why these areas hurt so much. This is where the prolotherapy injections occur, thus eliminating the chronic pain of many conditions including arthritis, mechanical low back pain, degenerative spinal joints, other joints such as the shoulders, wrists, hips, knees or ankles including sports injuries.
Prolotherapy works by exactly the same process that the human body naturally uses to stimulate the body’s healing system, a process called inflammation. The technique involves the injection of a proliferant (a mild irritant solution) that causes an inflammatory response which “turns on” the healing process. The ligaments and tendons produced after prolotherapy appear much the same as normal tissues, except that they are thicker, stronger, and contain fibers of varying thickness, testifying to the new and ongoing creation of tissue. This has been documented with gross biopsy and electron microscopy studies (looking at these tissues in whole and at a very microscopic level). The “force lines” of the tissue appear to follow that of undamaged healthy tissue.
A few notes regarding this treatment: 1) results are typically not immediate since we are waiting for the full healing response 2) these injections usually increase pain and soreness for up to 4 days, so extra pain medications may be needed 3) please do not take any anti-inflammatory medications the day before, day of and the next 4 days after the procedure; this may lessen the healing response. This includes Advil, Motrin, aspirin and prescription NSAIDs or steroids.
Our physical therapy department provides extensive modalities that include segmental traction, ultrasound, muscle stimulation, laser light treatment, infrared light treatment (particularly beneficial for peripheral neuropathy), TNS units, and rehabilitation as well as strengthening treatment. TNS units are transcutaneous nerve stimulation that can reduce inflammation and spasm and help block nerve pain. TNS units are a portable peripherally placed device that can be used on a daily basis. Normally this device is tried for several weeks and if effective, most insurance will allow one to be purchased for you. Lumbar spinal bracing is when we use a special lumbar spinal brace that supports the spine and is effective in treating conditions of the spine, particularly degenerative disc disease and lumbar spondylolisthesis, or slippage of the spine. You can contact our physical therapy department directly at (937) 432-6330.
We have a state licensed massage therapist who provides medical massage therapy. Some of this is covered by insurance. You can ask our physical therapy department specifically about insurance issues.
Acupuncture is offered by our state certified acupuncturist. Acupuncture has been indicated and proven effective by significant studies that have been completed. Acupuncture is covered by some insurance and is an alternative and effective way of treating multiple chronic pain conditions. If you would like to see our acupuncturist, you can call our main office number at (937) 439-4949 to make an appointment.
Dr. Heitkemper, our psychologist, provides extensive psychological treatment in this office that includes counseling, self-regulation training, and other psychological modalities for the treatment of chronic pain and the depression/anxiety related to chronic pain.
Patients who require medications to manage their pain are treated in this office. Appropriate patients who cannot find alternative treatments and wish to use medications can benefit greatly from the use of a variety of different medications including a host of new medications that help with nerve pain, a new medication that has been approved for fibromyalgia, and in some cases the use of opiates for the treatment of chronic pain. Careful observation and management is required and all patient sign medication agreements and routinely submit to urine drug screens if a decision is made to use an opiate for the treatment of chronic pain.
Through our physical therapy department, we provide and most insurance will cover the use of a TNS unit (transcutaneous nerve stimulator). This is used for the treatment of acute and chronic pain and is a drug-free way of improving circulation, metabolic clearing, and pain relief.
Drug addiction here is treated as a disease of the brain and the body. The determination of addiction is based upon an individual assessment looking at a history of loss of control, compulsion, and continued use despite harmful consequences. Once one has become addicted to drugs, the medical focus is to deal with physical dependency that impairs the person’s ability to focus on the many areas of their life that have been affected by their drug use. This is stabilized either by detoxification or maintenance treatments.
In the addiction treatment field, studies have found the best long-term success is attained by combining psycho-social treatment components with medical stabilization. We believe this is best achieved by using the individual psychological, social, spiritual, and physical strengths that each person possesses and identifying each person’s unique set of obstacles to attaining sobriety. Identifying these obstacles is necessary to alter the long term pattern of drug abuse.
It is common to find the people who struggle with drug addiction also struggle with mental health disorders such as anxiety, depression, or even psychotic disorders. It is our goal to identify these coexisting disorders and help the patient to have their best chance of obtaining sobriety.