Treatment Options

Physical Therapy

Most of the conditions outlined in this website require a pragmatic approach to their treatment. A crucial pillar of this treatment is physical therapy. We should change that old saying to “an exercise a day, keeps the doctor away.” In most patients no management is complete without proper physical therapy. The techniques’ goals include relaxing the damaged area, decreasing inflammation and pain, stretching shortened ligaments, tendons, and muscles, strengthening and then preserving and enhancing the functional activities of the damaged area. The treatment program may last from a few weeks to a few months.

Patients are taught a variety of exercises to accomplish these goals. From this wide spectrum of exercises, the patients should be guided to choose a small appropriate number of exercises that are found to be simple and effective for them. This core of exercises must be performed at home daily or almost daily for their lifetime.

This focal fitness will help prevent recurrences of the conditions. The idea is that from then on, the patient will be mindful of two different and complimentary goals: first, their general fitness by performing daily or almost daily aerobic activities such as walking, biking, swimming, golfing, and others and second, the real fitness of the weakened body area by performing therapeutic exercises.

Medication Therapy

There are many medications that intend to correct or prevent recurrences of a condition. For example, topiramide prevents migraines or Naproxen decreases the inflammation of arthritis.

Another group of medications control chemicals or nervous pathways that enhance the perception of pain, for example pregabalin decreases the irritability of the nerve, or antidepressant medications that increase transmitters in the brain.

Whenever possible, patients should limit their medication intake of these two groups of drugs.

There remains a large group of patients who only experience partial relief or no relief with these medications. These patients should not be condemned to suffer.

A proper amount of analgesic, non-opiate, and opiates, might be needed for them to function better at home or at work. The amount should be commensurate with the severity of their condition as well as reasonable. For most patients with chronic pain, once the appropriate amount is reached, their pain may inch away a step ahead of analgesics that patients might be receiving. This does not mean that the opiate medication has to be increased. Changing the medication might do the trick. One must weigh the risks against the possible benefits. Excessive amounts of these medications carry a high risk for damaging the body and might increase the frequency of sudden death.

Addiction is always a danger. Patients should take analgesics only for pain. If they take it for non-prescribed reason, they should be considered abusers. Patients are expected to comply with the dosages and frequency recommended by their physicians.

Any changes to their prescribed medication must be discussed with their physician before they institute it themselves.

Appointments must be kept. Only one physician should be prescribing pain medication for a patient. It is also important that the same pharmacy be used for the purchase of all prescriptions.

The Illinois Department of Human Services has created the Illinois Prescription Monitoring Program that allows physicians to examine all prescriptions filled for controlled substances for any patient. The data base provides all pertinent information including physician, quantity, strength, and frequency. If a person has a problem with analgesic abuse, he/she should seek help from an appropriate substance abuse program.

A compassionate and reasonable approach to pain control must be exercised. In the end, the patient should be able to achieve the quality of life they deserve without undue danger to their health.

Trigger Point Injections

Trigger points are areas of extreme tenderness in the muscles, tendons or ligaments with radiation of pain to nearby areas. Anesthetic injections of these points have been found to be very effective in the control of pain.

Most patients will begin to feel improvement within 48 hours. One set of injections will usually suffice. Some patients may need to return for more sets.

Paravertebral Nerve Blocks

Inflamed nerve roots cause pain. Blocking these nerve roots with an anesthetic and an anti-inflammatory medication successfully decreases the pain. This technique may temporarily or permanently resolve the pain. This procedure is low-risk and can prevent surgical intervention.

Most patients will begin to feel relief within one week of receiving the above injections. Patients can improve anywhere from 50% –80%.

Therapeutic Nerve Blocks

Peripheral nerves or roots involved are injected with anesthetic to decrease pain or anesthetic and steroid to decrease pain and inflammation. This technique may result in permanent control of pain.

Most patients will begin to feel relief within one week of receiving the above injections. Patients can improve anywhere from 50% –80%.

Tendon and Ligament Injections

When tendons or ligaments are inflamed, a combination of anesthetic and steroid medication can be injected to decrease their inflammation and pain.

Most patients will begin to feel relief within one week of receiving these injections. Patients can improve anywhere from 50% –80%.

Joint Injections

Painful inflammatory conditions of the joints can sometimes be treated with steroid injection to eliminate the inflammation. Frequent areas treated include the shoulder, elbow, wrist, hands, fingers, hip, knee, and foot.

Most patients will begin to feel relief within one week of receiving the above injections. Patients can improve anywhere from 50% –80%.

Epidural Steroid Injections

Epidural injections consist of injecting Depomedrol (a cortical steroid) in the epidural space inside the spine. The solution will bath nerve roots and decrease their inflammation to control pain. Patients may need one, two or a maximum of three injections. These injections may permanently or temporarily improve the patient’s condition. They are often used as an alternative to surgery when physical therapy and medications are not helping. About 80% of patients improve with these properly selected injections.

Patients will experience significant improvement (50% - 80% improvement) within one to two weeks of receiving these injections.

Carpal Tunnel and Tarsal Tunnel Injections

These injections are directed to decrease the inflammation and swelling of the affected nerve with subsequent improvement of compression. These injections can forestall the performance of surgery.

Patients will experience significant improvement (50% - 80% improvement) within one week of receiving these injections. The relief may last for several months or may be permanent.

Botox Injections

Botox is used as a medication in very low amounts to control severe muscle spasms such as facial spasms, focal dystonia, torticollis, occupational cramps and thoracic outlet syndromes.

Patients will experience improvement within a few days of receiving these injections. The number of injections that will need to be administered depends on each patient. The locations of the injection depend of where the abnormal spasms are located.

Hyaluronan (Synvisc)

This is a viscous substance that is injected in the knee to repair to some degree the cartilage and improve the lubrication of the joint. It may be given in a single dose or distributed into three injections. The procedure is highly effective in improving the arthritic knee. It helps 75% of the patients.