New Advances in Pain Treatment at the PM&R Center

Jeff R. Pavell, DO, Clinical Instructor in Rehabilitation, Columbia Medical Center N.Y.C., Diplomate, American Board of Physical Medicine and Rehabilitation, Board Certified in Specialty of Pain Medicine

There was a time when pain was considered a normal part of life and nothing was done to treat it. This is no longer the case. Physicians today have many treatment options for pain, ranging from medications to physical therapy to injections. At PM&R, all of these options are offered. The past 10 years have seen the development of many effective medications. Some reduce nerve and muscle pain by boosting healthy hormonal levels of norepinephrine and serotonin; others improve the action of the body's own natural anti-pain chemical GABA. Still others improve sleeping patterns and relax muscle fibers, allowing the patient to wake up refreshed and start the day in less pain. Physical therapy reduces the muscular component of

the pain, improves joint mobility, and strengthens weaker areas so pain does not return once treated. Additional techniques help quell pains from nerves by gently stretching the tissue around these nerves, which gives the nerves more room and promotes healing. When necessary, injections are available to treat pain. Several types of epidural injections are available to treat the many types of spinal pain. In a transforaminal nerve root injection, the physician uses real time x-ray to place medication around specific nerves. This can extinguish the arm and leg pain caused by a disc herniation or pinched nerve. An interlaminar injection places medication over a larger area, coating the back of many intervertebral discs to treat

patients experiencing low back and leg pain while walking. A newer advance employs radiowaves to disable painful nerves caused by arthritic changes or whiplash. A sacroiliac injection can be administered to reduce pain of the groin and buttocks. The advanced-trained in pain medicine physicians of the PM&R Center can perform all of these advanced injections in an outpatient center that combines the safety of a fully staffed operating-room setting with a warm, healing environment. Nowadays, no one should accept pain as a normal part of life. When the many treatment options are prescribed and performed by your Physiatrist, pain can be a thing of the past.

Now you can see a Doctor on Saturday! We know how hard it is at times to balance work responsibilities with medical needs. That is why we are pleased to announce that PMR now has Doctor's Hours on Saturdays. Congratulations Dr. Mendez Congratulations to our own Dr. Daniel Mendez on becoming Board Certified in Pain Management.

Meet PMR's Newest Doctors Dr. Angela Ryan - Medical Degree from University of Connecticut School of Medicine * Residency at Spaulding Rehabilitation Hospital/Harvard Medical School (Exemplary Leadership Award) * Graduated Hamilton College magna cum laude and Phi Beta Kappa * Published in the periodical Physical Medicine and Rehabilitation Clinics of North America a chapter on ãThe Role of Acupuncture in Pain Managementä * Attending physician at the Columbia Presbyterian Medical Center's Pediatric Rehabilitation Clinic. Dr. Sang Ho Song - Doctor of Osteopathic Medicine degree at University of Medicine and Dentistry of New Jersey Residency in Physical Medicine and Rehabilitation at JFK Johnson Rehabilitation Institute * Graduated Johns Hopkins University Phi Beta Kappa (member - Golden Key National Honor Society) * Specialty trained in osteopathic manipulation. Conversationally fluent in Korean. Dr. Philip Tasca - Medical Degree from Temple University School of Medicine * Residency in Physical Medicine and Rehabilitation at Temple University Hospital * Fellowship trained at The Penn Spine Center - The Hospital of the University of Pennsylvania * Performs epidural injections and other pain management procedures at our surgicenter

Pain-Free Gardening

Doug Holczer, PT, Assistant Chief of Physical Therapy, PMR Center

As spring approaches, many of you have probably begun tending to your gardens. What many of you don't realize is that gardening improperly can result in low back pain. To prevent low back pain, the most important structures to protect are the lumbar discs, small jelly-doughnut-like cushions between the vertebrae. There are three types of movements which raise the pressure between these discs and cause back pain by slowly squeezing the gelatinous substance out of the disc. Bending the spine, lifting, and twisting all tend to increase intradiscal pressure, leading to injury and back pain. Typically, gardening involves all three of these potentially injurious movements, but by approaching the task properly, you can protect your lower back.

Prior to initiating the gardening task at hand, ask yourself some important questions. What needs to be accomplished? Do I need help accomplishing it? Do I possess the proper tools for the job? What are the proper tools? For digging, the round point shovel is the tool of choice, as it allows for increased ease with moving through the soil. Using a rototiller prior to digging can loosen the soil and lessen the workload. For edging a bed or for shoveling loose material from a level surface, a square point shovel is best. For spading dry soil, a square tined digging fork works well. No matter which tool you choose, proper bending and lifting techniques should be employed. Always bend at the knees and keep the back relaxed. Bending the lumbar spine forwards markedly

increases the interdiscal pressures of the lower spine and can subsequently increase one's sciatica. During the course of gardening, take your time and work smart. You may be able to move the same amount of dirt in a few less trips but your back may not appreciate the extra stress. Your doctor or physical therapist may also be able to offer you some additional advice regarding pre or post gardening exercises for the prevention of low back pain. Frequent positional changes are always recommended. Please consult your physician or physical therapist so that your unique situation may be addressed.