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Treatments

Taking Aim at Nerve Pain

While the exact number is unknown, many Americans - perhaps over three million - experience neuropathic pain, which results from a nervous system malfunction. This is set off by nerve damage from diseases such as diabetes, trauma or toxic doses of drugs.

For years, neuropathic pain has baffled scientists. Traditional pain treatments, including powerful medications like morphine, rarely help. Descriptions of neuropathic pain by patients typically include words such as "burning," "shooting," "stabbing" or "electric-like." The distribution of pain will be along the course of a particular peripheral nerve or a group of nerves of similar length.

Starting in 1988, researchers began to identify animal models that mimic the clinical signs of the ailment. For example, one rat model with nerve injuries has a super-sensitive reaction to a hair tapped on its hind paw. The rat will quickly jerk away. Some people with neuropathic pain experience a similar reaction. For them, the tickle of a hair can translate into a long-lasting, burning pain.

Dr. Stein offers a variety of treatments that can help reduce neuropathic or verve pain. He uses advanced medical management, sympathetic blocks, spinal cord stimulation and intrathecal pumps.

Neck Pain

For many people, neck pain is a temporary condition that disappears with time. Others need medical diagnosis and proper treatment to relieve their symptoms.

Neck pain may result from soft tissue abnormalities in the muscles, ligaments and nerves, as well as in the bones and joints of the spine. The most common causes of neck pain are injury or prolonged wear and tear. In rare cases, infection or tumors may cause neck pain.

Degenerative diseases that cause neck pain include osteoarthritis and rheumatoid arthritis. Osteoarthritis usually occurs in older people as a result of wear of the joints between the bones in the neck. Rheumatoid arthritis can cause destruction of the joints of the neck. Both of these major types of arthritis can cause stiffness and pain.

Cervical disc degeneration also can cause neck pain. The disc acts as a shock absorber between the bones in the neck. In cervical disc degeneration (typically over age 40), the normal gelatin-like center of the disc degenerates and the space between the vertebrae narrows.

Automobile accidents, contact sports and falls may cause neck injury. A "rear end" automobile collision may cause hypertension, or backward motion of the neck beyond normal limits, or hyper flexion, forward motion of the neck beyond normal limits. Call Dr. David I. Stein immediately if your neck pain is:

 

  • Severe
  • Continuous & persistent
  • Accompanied by pain radiating down the arms
  • Accompanied by headaches, numbness, tingling or weakness

 

Dr. Stein offers a variety of effective treatments, including cervical facet injections, radiofrequency, epidural steroid injections and cervical nucleoplasty that can help reduce your pain or eliminate it entirely. Dr. Stein is one of the few physicians in Wisconsin currently offering cervical nucleoplasty.


Dr. David I. Stein has treated thousands of headache sufferers with a variety of treatments and with very good results.

 

Back & Lumbar Pain

Four out of five (80%) of American adults experience back pain sometime during their lives. That's millions of Americans who suffer from chronic back pain and the lost mobility it causes.

Back pain is one of the most common (and most costly) ailments in our society. The cost of treating back problems, time lost from work, insurance, therapy and surgery runs into the billions of dollars.

Back pain can be a nuisance. Or it can be quite disabling.

Dr. David I. Stein can help tremendously. He is dual-board-certified anesthesiologist and pain medicine specialist dedicated to relieving pain and getting you back to your life again. And his rehabilitation team includes a highly trained physical therapist. Among the many treatments we use are:

 

  • Medical management
  • Physical therapy
  • Physical therapy modalities
  • Epidural steroid infections
  • Epidural lysis of adhesions
  • Selective nerve root injections
  • Discography - cervical, thoracic, lumbar
  • Facet & medial branch blocks
  • Sympathetic & peripheral nerve blocks
  • Joint injections - hip, knee, shoulder
  • Cervical & lumbar radio-frequency lesioning
  • Cervical & lumbar nucleoplasty
  • Lumbar mechanical decompression - Nucleotome
  • Lumbar Dekomressor & laser disc decompression
  • Spinal cord stimulation
  • Intrathecal pumps
  • Sacro-iliac Joint Injections
  • Opoids

 

Dr. Stein helps patients overcome their back trouble and avoid future back problems through a variety of advanced therapies. Most patients are able to avoid invasive surgery and large doses of medication. He uses the most advanced nonsurgical and minimally invasive surgical treatments for chronic and acute pain. He also has vast expertise and experience in rehabilitation for all kinds of back and lumbar injuries; his techniques often result in less time off from work.

He always puts patients first. If you have not responded well to other treatments and therapies, you may experience significant pain relief through his comprehensive therapies and personal care.

Call and take advantage of the most advanced, complete and compassionate spine and back care in the country.

Commonly Asked Questions About Physical Therapy


What is physical therapy?
Physical therapy is a process by which trained professionals use hands-on methods, modalities (i.e. heat, electrical stimulation, massage etc.) and education to reduce pain, restore function and prevent further injury.

What kind of training do physical therapy professionals have?
A physical therapist (PT) has a minimum of four years in a professional program with a bachelor’s degree. Many programs are now six years with masters programs. The coursework is extensive and includes anatomy, physiology, pathophysiology, Kinesiology, diagnostic testing and evaluations, treatment planning and treatment techniques. The physical therapy assistant (PTA) has an associate’s degree after two years. Training includes anatomy, treatment techniques and assessment. Both the PT & PTA undergo internships in several different settings. The PT is required to take a licensing examination before practicing.

What are the benefits of physical therapy?
Physical therapy can provide pain reduction, prevent further injury, while increasing strength, motion and function.

How much time does physical therapy require?
The average session for physical therapy last anywhere from 30 to 60 minutes depending on the needs of the patient. The total number of sessions needed depends on the patient and can range from a minimum of one or two visits to over 18 visits. The frequency of treatment is anywhere from one to three times per week. A specific idea of the patient’s physical therapy needs is obtained following the therapist's evaluation. The total number of sessions depends on the complexity of the patient’s problem, compliance of the patient with prescribed exercises and overall response to treatment.

What sorts of treatments are available?
Generally, there are two categories of treatment. One involves passive modalities that are designed to reduce pain while the patient progresses through exercises. The other involves the actual exercises and body mechanics education. Physical therapy modalities include ultrasound, electrical stimulation techniques, iontophoresis, manual therapy and application of heat or cold.

What type of physical therapy modalities are available?

 

  1. Ultrasound. This machine produces sound waves which can penetrate tissue and cause vibration of molecules resulting in heat from friction. A small instrument called a transducer applies sound waves through a gel that is applied to the patient skin. The strength and depth of penetration can be varied by the operator of the machine. Ultrasound useful in relaxing muscles, increasing blood flow and promoting healing. Commonly treated conditions include myofascial pain syndrome, bursitis, tendonitis, muscle spasms, scar tissue and joint contractures.
  2. Electrical stimulation techniques. Electrical currents in small increments can help excite nerves or muscle tissue to help promote the restoration of lost function. The flow of a electrons is able to transfer the flow of ions within biological tissues to the application of electrodes to the patient's skin. Studies have shown that the application of electrical modalities can increase local blood flow, stimulate soft tissue regeneration, increase the level of endorphins (the body’s own pain-controlling substances) and increase absorption of excess fluid from the affected site.
  3. Iontophoresis. This modality uses continuous low voltage current in one direction to drive medications applied to the skins surface into deeper tissues. Typically, medications used are local anesthetics and corticosteroids. Local anesthetics are used to provide anesthesia and increase blood flow. Corticosteroids are typically used to reduce inflammation.
  4. Transcutaneous Electrical Nerve Stimulation (TENS). This form of treatment helps to decrease pain by release of endorphins and stimulating other pain-inhibiting nerve pathways. TENS units are used for both acute and chronic pain. Small adhesive gel pads are placed over the patient’s area of pain. Electrical stimulation flows from the device to gel pads. The frequency and amplitude of stimulation can be adjusted. Patients can use these devices at home or work.
  5. Cryotherapy (the application of cold). Cold is used to help decrease edema, inflammation and pain, as well as reducing spasticity. The application of cold results in constriction of blood vessels and reduction of nerve transmission. Cold is usually applied in the form of cold packs, ice packs, ice massage and coolant sprays.
  6. Heat. Heat is used to reduce stiffness, pain and muscle spasms, as well as improving the range of motion at joints. Collagen fibers which are a major component of ligaments and attendance typically resist stretch. Heat can help to relax these fibers and promote stretch. Hot packs are most commonly used to apply heat.
  7. Manual Therapy. This involves the movement of muscle and ligamentous tissue to reduce muscle spasm and improve body mechanics.


What types of exercises are usually required?
Exercise is any physical activity that is planned, purposeful and structured. It includes aerobic, anaerobic, isometric, isotonic, stretching, relaxation and passive movement. Aerobic exercises involve the utilization of large amount of oxygen. Repetitive movements of major muscle groups such as in walking, running and swimming are common forms of aerobic exercise. Anaerobic exercise typically requires less oxygen consumption. Isotonic exercise involves contraction which moves a body part. Isometric exercise involves contraction that does not result in movement of the body part. A careful evaluation by a physician and physical therapist is necessary in designing the optimal exercise program for the patient.

 

What sort of things need to be done for an exercise program to be successful?


To obtain meaningful results from physical therapy, it is important to consider the following:

  1. The patient should have a reasonable degree of pain control. This can be accomplished by medical management, interventional pain management techniques, as well as other conservative modalities. Because pain can indicate other serious conditions, an accurate diagnosis is essential.
  2. The exercise should be meaningful to the patient.
  3. The exercise should be incorporated into the client’s everyday schedule. A general target goal would be for the patient to engage in moderate exercise 30-35 minutes per day.
  4. The patient should keep a diary and evaluate the effects of the exercise.
  5. The patient should also incorporate aerobic, stretching and relaxation techniques in the morning or early evening.


What sort of conditions can physical therapy be used to help?
Physical therapy can benefit almost any person. It is well-known that exercise can control weight and improve mood. At our clinic, physical therapy is an integral part of the patient’s treatment. Common diagnoses include neck and lower back pain, sciatica from herniated discs, osteoarthritis, fibromyalgia, headaches, reflex sympathetic dystrophy, myofascial pain syndrome. Both acute and chronic conditions are treated.

What is required of a physical therapy patient?
In order to get the full benefit of physical therapy, it is important that the patient is compliant in attending sessions, as well as doing home exercises as instructed by the therapist.

Will the treatment hurt?
Sometimes the patient may experience increased pain or soreness after the initial evaluation because specific movements are being tested. This is important in helping to make a diagnosis and formulate a treatment plan. At times, patients may be sore after certain specific exercises or manual therapy (deep tissue work).

Does the doctor know what the physical therapist is doing?
Yes. The physical therapist typically works under a physician's prescription. The doctor receives notes and updates as to the patient’s progress. At Milwaukee Pain Treatment Services, the physical therapist and physical therapy assistant have daily contact with the physician and can make adjustments in treatment right away.

What if physical therapy doesn’t work?
Physical therapy is not the answer for every patient. If the patient tries physical therapy and doesn’t make any progress in exercise progression, pain control or functional abilities, the physician is re-consulted. Physical therapy may be discontinued or the doctor may need to intervene medically or with other interventional pain management procedures before continuing physical therapy.

Does insurance cover physical therapy services?
Most insurance companies cover physical therapy services. However, you should understand that certain insurance companies specifically dictate where patients may receive physical therapy. Obviously, we will check to see if your insurance company covers physical therapy services at our clinic before receiving treatment.

 

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