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: neck pain

The Neck Pain Specialist

pain doctor Doctor for neck pain 1

Doctor for Neck Pain

If you have neck pain, your general practitioner will refer you to see an orthopedist, a medical doctor for neck pain specializing in musculoskeletal system problems. The musculoskeletal system is composed of muscles, tendons, joints, ligaments and bones that support your body and allow fluid movement. An orthopedist is a highly trained surgeon, specializing in the treatment of the skeleton and its structures.

Orthopedists complete more than 12 years of formal education that includes college, medical school and five years of postgraduate work including residency at a major medical facility. Some orthopedists pursue further specialization in orthopedics such as sports medicine or choose to concentrate in specific part of the body such as the spine.

When it comes to diagnosing neck pain, orthopedic care is the optimal standard in receiving treatment.

Getting a Diagnosis of Neck Pain Symptoms

The cervical spine (neck) is made up of bones, disks, ligaments, muscles, spinal cord and nerves. Neck pain can be caused by minor or serious injury to or an abnormality of any part along these structures. Neck pain is often caused by problems within the musculoskeletal system.

Orthopedists will work closely with patients to get an accurate diagnosis. Your complete medical history will be documented, including any previous neck pain or problems and any other illnesses or injuries that might have contributed to the current pain.

After the medical history, the orthopedist will perform a physical examination that can include an evaluation of your neck motion and how sensitive your neck has become. The function of the nerves and muscles in your arms and legs will also be tested to evaluate if there are nerve problems that may be contributing to your neck pain.

Blood tests, X-rays and other imaging procedures may be ordered to evaluate the bones, disks, spinal cord, nerve roots and muscles in your neck.

pain doctor Doctor for neck pain 4Neck Pain Treatment

After the cause of your neck pain has been established by the orthopedist, treatment may include rest for a few days and avoiding activities that strain the neck. Medication may also be prescribed to reduce inflammation, relax neck muscles and relieve pain. Some patients may need to wear a neck brace for a prescribed amount of time to heal and to avoid further injury to the neck.

Orthopedist will sometimes refer patients to a physical therapist who will customize an exercise program of stretching and strengthening to relieve your neck pain and help prevent future neck problems. Some people may be hesitant to exercise when having neck pain, but careful neck exercises can help alleviate the muscles in the neck area that may be causing pain.

Surgery for Neck Pain

In serious cases, such as a herniated disk, the orthopedist might recommend surgery to help relieve the pressure the protrusion is placing on your spinal cord or nerve roots.

Neck pain usually requires some form of treatment to help reduce pain and to prevent further damage. If you are experiencing pain in the neck that does not go away or have recently suffered an injury, you should visit a doctor for neck pain. Contact us today to schedule an appointment with the best neck pain doctor in NYC.

Trigger Point Injections

 

Best Pain Management Doctor NYC3Trigger point injections are used to treat chronic pain in discrete, focal muscle groups in the neck, arms, legs, and lower back. These multiple muscle groups have trigger points, which are hyperirritable knots of muscle that are taut and which fail to relax. These cause local pain, which may also radiate or spread to other parts of the body. Although trigger points may be treated using nonsteroidal anti-inflammatory drugs, antidepressants, physical therapy and acupuncture, their effects are often short lasting compared to trigger point injections.

Trigger point injections may also be used to treat a variety of conditions, including fibromyalgia, tension headaches, temporomandibular joint pain, and myofascial pain syndrome.

How Trigger Point Injections WorkBest Pain Management Doctor NYC2

Trigger-point injection is a minimally invasive, safe, and effective way to inactivate trigger points and provide prompt, symptomatic pain relief. The procedure involves inserting a small needle into the patient’s trigger points, which are located in muscle groups in the neck, arms, legs and lower back. The injection contains a local anesthetic and may include a corticosteroid to reduce inflammation. Usually, a brief course of treatment that is given in a doctor’s office will result in sustained relief. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.

Patients benefit from this procedure because after the injection, trigger points are inactivated and inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

Best Pain Management Doctor NYC4General Procedure

A trigger point injection is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

The patient is placed in a comfortable recumbent position (either prone or supine) to allow muscle relaxation. Trigger points are located by palpating the muscles and finding knots under the skin. Once a trigger point is located the overlying skin is cleansed. The doctor isolates the point with a pinch between the thumb and index finger to stabilize it and inserts a needle directed to the point. The doctor warns the patient of the possibility of a sharp pain, muscle twitching, or unpleasant sensation when the needle touches the tight muscular band.

A small amount of local anesthetic is injected into the trigger point. The doctor then withdraws the needle a little and redirects it in different directions under the skin, injecting small amounts of anesthetic in each direction. This is done until the local twitch response is no longer elicited or muscle tautness is no longer felt. Pressure is applied on the skin after the needle is completely withdrawn to stop any bleeding. A simple bandage is applied to cover the area.

Post-injection soreness may be experienced, but this is expected to resolve in a few days. Patients are encouraged to remain active, using a full range of motion in the muscles, but are advised to avoid strenuous activity a few days after injection.

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Trigger Point Injection is a minimally invasive, safe, and effective means of treating muscle pain that is unresponsive to other forms of treatment. If you want more information about treating painful trigger points, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if trigger point injections are a treatment option for you.

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Treatment of Acute and Chronic Pain

Treatment of acute and chronic pain p02Pain is an unpleasant symptom that sends a signal that something may be wrong or that damaging stimuli may be present in the body. This uncomfortable feeling may range from mild to severe, and may last for a short moment, come and go, or persist for a long time.

A variety of conditions can cause pain, including injury, degenerative processes, and disease. Its treatment depends on many factors, and while some types of pain respond to single treatments, others may need a combination of treatment modalities.

Treatment of Acute Pain

Treatment of acute and chronic pain p01Acute pain often occurs suddenly and is usually localized and sharp in quality. It warns an individual of a disease or a threat to the body, or it may be caused by injury, surgery, or natural processes like childbirth. Acute pain may be mild and short lasting, or it may be severe and long lasting. In most cases, however, it disappears when the underlying cause has resolved. If unrelieved, acute pain may lead to chronic pain.

Treatment of acute and chronic pain p03The treatment of acute pain often involves identifying an underlying cause and treating it. Options for symptomatic treatment of pain may include the use of:

· Hot compress

· Ice packs

· Oral medications like Acetaminophen (ex. Tylenol®)

· Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen

· Local anesthetic injection (ex. lidocaine)

· Nerve blocks (epidural anesthesia)

· Physical therapy, including massage and exercise

· Surgery

Depending on the type and cause of acute pain, symptoms may be managed by general practitioner, an internist, a surgeon, or a pain management specialist.

Treatment of Chronic Pain

Pain that persists despite healing of an injury or disease may be considered as chronic pain because pain signals in the nervous system remain active for several weeks, months, or even years. The pain may lead to other symptoms like muscle tension, limited mobility, depression, lack of energy, anxiety, sleep disturbances, and changes in appetite. These symptoms may also affect an individual’s daily activities and relationship with others. Common complaints include low back pain, chronic headaches, arthritis, cancer pain, neurogenic pain, and psychogenic pain.

Although chronic pain may originate from an injury or disease process, some people suffer from long lasting pain in the absence of physical injury or damage. The cause of chronic pain may be unknown or undiagnosed; however, treatments may be given to relieve the individual’s symptoms and to improve the quality of their life. Usually, a combination of treatments is needed, and these are often given to suit individual needs. These may include:

· Oral pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs), although its use may be limited because of potential side effects from chronic use

· Narcotics (such as morphine or codeine), although its use is limited by its potential for abuse and side effects

· Other medications, such as anticonvulsants, antidepressants, and anxiolytic drugs

· Localized anesthetic injections, like trigger point injections and hip joint injections

· Nerve blocks, like stellate ganglion block and epidural block

· Electrical stimulation, like spinal cord stimulation

· Radiofrequency ablation

· Physical therapy

· Psychotherapy

· Relaxation techniques such as deep breathing

· Biofeedback

· Behavior modification

Because of the complexity of the character of chronic pain, its treatment has evolved into a specialty. The management of chronic pain in most cases involves a multidisciplinary approach. This means that a team of specialists may be needed to evaluate, diagnose, and treat one’s condition, including internists, surgeons, anesthesiologists, psychiatrists, and physical therapists. Most patients who suffer from persistent pain that does not respond to conventional treatments are referred to a Chronic Pain Clinic, which is managed by a Chronic Pain Specialist, a highly trained physician to diagnose and treat difficult cases of pain syndromes.Tallahassee pain doctor

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If you need more information about pain and its associated symptoms, make an appointment with NYC’s top Pain Management Specialist who will help improve your symptoms, increase your mobility, and take control of your life.

Implantable Spinal Cord Stimulator Doctor NYC

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Spinal cord stimulator implantation NYC for Chronic Pain.

Spinal cord stimulation is a safe and effective method of blocking chronic spinal pain that uses low voltage electrical currents to stimulate the spinal nerves. It helps patients to better manage their pain and decrease the use of pain medication. It is an option for patients who have chronic leg or arm pain, failed back surgery syndrome, complex regional pain syndrome, and other severe nerve-related pain or numbness.

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How Spinal Cord Stimulation Works

A small battery-powered spinal cord stimulator is implanted in the body to transmit an electrical current to the spinal cord. A trial stimulator used percutaneously (through the skin) may be done to give the treatment a trial run. If patient response is successful, a ‘permanent’ stimulator may be implanted under the skin of the abdomen, with the small, coated wires (leads) inserted under the skin to the point where they are placed into the spinal canal.

After the procedure, the patient and the doctor determine the best pulse strength to be applied. The patient is instructed on how to use the stimulator at home, which usually consists of stimulation for 1 to 2 hours, 3 to 4 times a day. Spinal cord stimulation creates a tingling feeling, which blocks the pain signals to the brain. The goal of treatment is a 50-70% reduction in pain. Patients benefit even with incomplete removal of pain, which allow them to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

General Procedure – Spinal Cord Stimulator Implant Procedure

Implantation of a spinal cord stimulator is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed. He may be lightly sedated or placed under general anesthesia during the procedure.

The patient is placed lying on his side or on his stomach on the operative table. The areas of your back and abdomen where the leads and the generator are to be placed are shaved and sterilized. Local anesthetic is injected where incisions are to be made to numb the area.

The placement of surgical leads is performed with x-ray guidance (fluoroscopy). A small skin incision is made in the middle of the back and the leads are inserted in the epidural space above the spinal cord using a small needle or through a small incision. The generator is usually implanted in the abdomen.Spinal cord stimulator doctor nyc 03

The patient is monitored in the recovery area after the procedure. Most patients are discharged on the same day, but some physicians request an overnight stay in the hospital. The pulse generator will be programmed before the patient leaves. He will receive instructions on how to care for the incision area and how to program and regulate the device.

Contact Us to schedule a consultation for a spinal cord stimulator  implant.

Spinal Cord Stimulation is a safe and effective means of treating chronic spinal pain that is unresponsive to other forms of treatment. If you want more information about treating chronic spinal pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if Spinal Cord Stimulation is a treatment option for you.

Cervical Epidural

Cervical Spine Epidural Injection 01Cervical epidural injections are commonly given to patients who suffer from nerve root inflammation and irritation in the neck, causing them to experience neck pain and arm pain. These symptoms may be caused by a neck injury or normal wear and tear, which leads to damage of the discs found between the cervical or neck bones. These changes affect the nearby nerve roots that give sensation to the neck, shoulders, and arms, thereby causing severe pain that is often unrelieved by medications or conservative management.

How a Cervical Epidural Works

The aim of treatment with a cervical epidural is to reduce inflammation from the damaged intervertebral discs, which is causing irritation to the spinal nerves. An anti-inflammatory medication consisting of local anesthetics and steroids is therefore injected into the upper spine or neck, to bathe the affected nerves and discs, targeting the painful areas in the neck and arms. Since the treatment uses locally administered medications, it does not have a widespread effect on the body; rather, only painful areas are targeted, and no systemic side effects are expected.

Cervical Spine Epidural Injection 02Patients benefit from this procedure because after the injection, inflammation and pain are reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

General Procedure

A cervical epidural is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

Cervical Spine Epidural Injection 03The patient sits on a chair in a position that allows the physician to visualize the cervical vertebrae (neck bones) using x-ray guidance. The skin at the back of the patient’s neck is cleansed thoroughly with sterile scrub. A small amount of local anesthesia is administered on the skin and underlying tissues to numb the area before treatment.

When ready, the physician directs a special needle with x-rayCervical Spine Epidural Injection 04 guidance into the epidural space, which surrounds the outer covering of the spinal cord in the neck. Proper positioning of the needle is ensured with the use of a small amount of contrast medium or dye injected before the medication is given.

Finally, a small mixture of local anesthetic and anti-inflammatory (steroid) drug is injected into the epidural space. The patient may experience temporary numbing and weakness of the arms and hands for a few hours, which is an expected result.

Patients are allowed to stay in a recovery area where they will be monitored for about an hour. After discharge, they will be asked to evaluate their improvement in the succeeding week and report for follow-up. Repeat injections may be performed up to three times, if needed, every two weeks.

 

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A cervical epidural injection is a minimally invasive, safe, and effective means of treating neck pain that is unresponsive to other forms of treatment. If you want more information about treating chronic pain in the neck and arms, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your neck pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if cervical epidural injections are a treatment option for you.