Treat your pain and live a better life…

best-pain-doctor-nycWelcome to my blog about pain. Unfortunately, many people suffer from chronic pain. As a board certified physician in physical medicine and rehabilitation, my specialty is treating these people with both acute and chronic pain.

A majority of my practice is working with patients that are experiencing back and neck pain.

My goal with this blog is to help patients who are experiencing any type of back or neck pain to understand what is causing their pain and discuss options that are available to end their pain. I hope to be able to provide readers with a portal that they can can use to educate themselves and facilitate treatment.

My specialty is my Interventional Spine Skills including cervical and lumbar epidural steroid injections, facet injections, medial branch blocks, Radiofrequency ablation, sympathetic ganglion blocks, spinal cord stimulator trials, sacroiliac joint injection, piriformis muscle block and musculoskeletal joint injection. I also perform many other procedures to alleviate acute and chronic pain.

I hope you enjoy reading my blog as much as I enjoy writing it and observing people from all over the world reading it.

– Matthew Grimm, M.D.

Category Archives: back pain doctor nyc

Cervical Nerve Root Blocks

Cervical Nerve Root Blocks

best-nyc-doctor-for-pain-management-injections-relief-specialist-03Pain in the neck or spine can be difficult to pinpoint. Pain can radiate and come from a variety of sources. Due to the complexity of the spinal cord and nervous system, the utmost care must be exercised when medical treatment is provided in this area. Cervical nerve root blocks can be used both to diagnose the source of pain and to eliminate pain.

How Cervical Nerve Root Blocks Helps Diagnose Pain

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A cervical nerve block serves to inhibit all signal coming to and going from the region treated. This allows doctors to correctly identify the location and cause of cervical pain. This is done by injecting a small needle into the region of the spine suspected. The region of the spine this medication is applied to is determined based on patient reports of pain, visible signs of swelling, and distal reports of pain and regions of the body innervated by that section of the spine. For example, if nerve pain is suspected to be affecting the legs, the cervical region of the spine would not likely be the cause. Instead, the patient may report pain in the thoracic or lumbar region of the spine. Once the region is grossly identified, the doctor May inject an anesthetic to numb a specific region of the spine. Once this part of the spine is numb, the doctor will use sensory testing to determine if the area questioned is indeed the cause of pain. This procedure is done on an outpatient basis, meaning the patient will be able to coming to a clinic, undergo the procedure, and leave. It is still recommended that someone accompany them, as one should not drive for 24 to 48 hours after receiving anesthetics.

How Cervical Nerve Root Blocks Help Treat Pain

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Cervical nerve root blocks can also be used to effectively treat pain. Once the source and region of the pain has been correctly identified, cervical nerve root blocks can numb the region of pain and reduce further swelling. The medication injected in the case of a cervical nerve root block is a localized anesthetic. The same anesthetic will reduce the pain signal leaving the nerve to the brain. For some, this treatment is very effective on the first dose and has long-lasting effects. For others, more frequent treatment is needed in order to see results. Dr. Grimm will be able to give you an anticipated schedule for treatment, but every case is different. It is important to regularly communicate progress and potential side effects in order to ensure safety. As with diagnostic cervical nerve root blocks, this treatment can be done on an outpatient basis. Still, someone else should always accompany the patient to drive. Whenever anesthetics or sedatives are used, it is vitally important that one not operate heavy machinery or drive until the effects have worn off.

Would you benefit from cervical nerve root blocks, either to diagnose or to treat pain? Call Dr. Grimm and schedule an appointment to talk about it.

Doctor Drug Testing in Pain Management

Pain Management Doctor Drug Test

What is Doctor Drug Testing?

Urine is the basic body fluid tested for drug screening because it is easy to collect and easily handled and tested by medical and laboratory staff. The collection of urine in drug tests is preferred over blood sampling because the period of detection of a particular drug in the urine is increased, while drugs may only be detectable for a short period in blood samples. Additionally, Urinary Drug Testing (UDT) is far cheaper and non-invasive compared to blood tests collection.pain doctor pain management doctor drug test 2

There are two types of drug testing used in clinical practice: Immunoassay Test and Fluorescence Polarization Immunoassay (FPIA). The drugs detected in the tests include marijuana, cocaine, opiates, phencyclidine (PCP), amphetamines and methamphetamines. Additionally, these drug tests detect benzodiazepines and barbiturates.

The specimen is usually collected at a clinic or in the hospital to maintain the integrity of the urine drug test. Patients who refuse to undergo urinary drug screening should not be allowed to participate in chronic drug therapy.

Why Doctor Drug Testing?

The use of long term drug therapy for chronic pain management is now accepted as standard medical practice. Typically this applies to patients with moderate to severe pain levels who did not respond to more conservative therapies. The issue that has resulted is that patient self-reporting of drug use is frequently unreliable and it becomes necessary to use additional sources of information:

  • Patient drug use to include pharmacy profiling

  • Review of medical records

  • Interview with patient’s family

A policy adopted the Federation of State Medical Boards (FSMB) for prescribing controlled substances stresses the critical importance in documenting, evaluating and monitoring drugs in the pain management of patients. As a result, pain management doctors have been forced to evaluate professional risk in selecting treatment methods when treating patients for chronic pain. Concerns include civil, administrative and even criminal liability. So far urinary drug testing is considered the cheapest insurance for liability protection in clinical practice for pain doctors.

Benefits of the Doctor Drug Testing for Patientspain doctor pain management doctor drug test 3

Drug testing by a doctor also has benefits for patients. First, it reduces the risk of over dosage in patients, detects non-compliance by patient, therapeutic failure and avoiding or detecting interaction of multiple drugs. Secondly, UDT enhances the pain doctor’s ability to prescribe drugs more effectively and minimizes treatment costs for patients.

Doctor Drug Test Concerns

pain doctorPatients who have concerns over the use of doctor drug test need to keep in mind that the results are protected by the physician-patient confidentiality rule. Therefore, the results of the test cannot be given to other persons without the expressed consent of the patient.

Patients should know that doctors are advised against using drug testing as punishment but rather to enhance patient care. The drug tests are used in detecting patients who may be supplementing or abusing the prescribed drugs in their pain management.


Contact us today to schedule an appointment to get further information on pain management and drug testing with the best Pain doctor in NYC.

What Is a Decompressive Discectomy?

Spine Anatomy

Best-Pain-Doctor-NYC-1The spine is composed of a column of vertebrae that houses the spinal cord. The bony vertebrae are separated by intervertebral discs. The discs, in turn, are composed of a semi-fluid gelatinous material surrounded by a cartilaginous outer ring. The discs permit movement of the vertebrae and act as cushions which absorb compressive and rotational forces.

Disc diseaseBest-Pain-Doctor-NYC-2

Over time, repetitive loading forces on the disc structures lead to degenerative disc changes. The outer cartilaginous ring (annulus fibrosus) undergoes microscopic tears which can cause “bulging” of the disc. An accumulation of these small tears can sometimes lead to a “rupture” of the annulus (also called a disc herniation). When a disc “herniates,” the inner semifluid material (nucleus pulposus) can escape the confines of the disc and enter the spinal canal. The herniated material can press on the spinal nerves as they leave the spinal cord.

Best-Pain-Doctor-NYC-3Symptoms and signs of disc disease

Pressure on the spinal nerves can cause pain which “radiates” into the arm (in the case of cervical disc rupture) or leg (in the case of lumbar disc rupture). Spinal nerve root irritation can cause numbness and/or weakness of the arm (cervical disc disease) or leg (lumbar disc disease).

Treatment of a herniated disc: decompressive discectomyBest-Pain-Doctor-NYC-4

When conservative measures fail to control neck/arm or low back/leg pain, the aim of surgery is to relieve pressure against the spinal nerve. This surgical procedure is called a decompressive discectomy. The herniated portion of the disc is removed which “decompresses” the spinal nerve. Sometimes, the interior of the offending disc is explored and any loose fragments within the disc are also removed with the intention of preventing “repeat” herniation.

The initial goal of treatment is to prevent the need for surgery including decompressive discectomy. Dr. Grimm specializes in non surgical treatments that help relive back pain and alleviate the need for surgery.

Please contact the best pain doctor in NYC, Dr. Matthew Grimm, to schedule an appointment.

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How to avoid the need for disc surgery. Alternatives to neck or low back surgery:

What are my alternative options to disc surgery?

 

Treatment options for neck or low back pain

When a patient presents with a herniated cervical or lumbar disc with clinical evidence of nerve root irritation (cervical or lumbar radiculopathy), he or she has several choices: no surgery, traditional open surgery, microscopic surgery or micro-endoscopic surgery. If he or she chooses no surgery, evidence shows that the herniated disc may decrease in size or disappear within a few weeks or months. Epidural injections may also prevent the need for neck or back surgery.

Types of surgical treatment: open discectomy vs. micro-discectomy

Surgery is generally reserved for patients who fail to respond to conservative treatment or have significant or progressive weakness or loss of sensation due to irritation of a nerve root by a herniated disc.

Traditional Open Discectomy

A traditional open discectomy causes considerably more disruption of spinal tissues than a microsurgical procedure usually resulting in a longer recovery time.

Microsurgical Discectomy

A microsurgical discectomy is minimally invasive and is less disruptive of spinal tissues usually resulting in a shorter recovery time.

The goal of surgery is the removal of any material (usually disc material) pressing on the spinal nerve. At the least, the portion of the disc which protrudes into the spinal canal is removed. More aggressive surgery involves exploring the ruptured disc for any loose fragments. The aim of the more aggressive approach is the prevention of recurrent disc herniation.

Micro-endoscopic discectomy

An even less invasive form of cervical or lumbar disc surgery involves the use of endoscopes. An endoscope is a long thin tube which contains a light and a video camera allowing the surgeon to visualize the spinal structures on a monitor. The surgery is performed using very fine instruments through the same tube (also called a cannula).

How to avoid the need for disc surgery

Dr. Grimm often will prevent the need for disc surgery by performing epidural injections and/or prescribing physical therapy.

Contact us today to schedule an appointment with best back pain doctor in NYC, and hopefully avoid the need for disc surgery.