Pain Management combines the expertise of the Anesthesiologist, the Physiatrist and several types of therapists. The goal is to diagnose the cause of the pain and plan for conservative management options. Injections, oral medications as well as physical or psychological modalities are utilized singly or in combination to manage pain. Injection techniques by the Anesthesiologist include steroid epidural and facet blocks under fluoroscopic guidance as well as local soft tissue injections.

Headaches are evaluated and managed by an expert Neurologist subspecializing in this area. Treatment plans are designed for migraines, tension headaches, cluster headaches or for any type of head pain. Electrodiagnosis is the scientific study of muscle and nerve function using state of the art equipment. The Physiatrist has highly specialized training to diagnose nerve and muscle pathology within weeks after an injury. These studies are most useful to differentiate nerve injuries in the extremities from those of the spine.

X-RAY/MRI studies are completed using the most advanced equipment with the strongest magnets in the area. The films are read by highly specialized Neuroradiologists with expertise in pathology of the spinal column.

Therapeutic BOTOX injections are performed by highly trained physicians for management of pain and spasms. The use of this type of treatment has been approved for headaches, back spasms and spasticity management. Patients with chronic spasticity, pain or back spasms are typically treated two to three times per year.

TRIGGER POINT INJECTIONS (TPI) This is an area of specialty of Dr. Cash and a highly effective way of providing instant pain relief. Trigger points are “taut bands” of muscle tissue that are formed after an overstretch injury. A trigger point is actually the formation of fibrous bands of collagen as a result of tearing of muscle fibers. The fibers are scar tissue that are not as extensible as regular muscle tissue. A trigger point is actually a “knot” that is felt deep in muscle tissue. They are very common in the neck, back and shoulders but may be found anywhere in the body. The trigger point results in a local pain in the muscle tissue with a typical pattern of referred pain. Many times the muscle becomes spastic and numbness in the limb, hand or foot may occur as a result. It is important to distinguish these from pinched nerves. Trigger points are a disorder known as Myofascial Pain Syndrome.

Trigger points respond well to local injections. The purpose of the injection is to mechanically break up the “knot” or trigger point. The use of a mid-sized needle is important to penetrate the skin directly into the trigger point in the muscle and in a clockwise manner, repetitive penetration into the area provides loosening of the tissue, with consequent pain relief. The needle itself is doing the mechanical work but a local anesthetic is used to reduce the pain of the injection, and a low dose steroid may be used to reduce swelling in the area. The injections are safe, not harmful, with no side effects and complications are extremely rare. Repeat injections may be given daily to weekly with no short or long term negative consequence.

Massage The manual manipulation of soft tissue to increase circulation to an area in order to relieve muscle spasm, tension and pain. Massage can be relaxing or invigorating, depending on the style. We offer Medical, Deep Tissue, Swedish, Shiatsu, and Thai massage.

Cranio-Sacral Therapy is a subtle, hands on therapy used to diagnose and correct disturbances in the normal rhythm of the fluid system surrounding the brain and spinal cord. Results can be profound in the alleviation of chronic pain.

Alexander Technique The goal is to improve postural and physical movement for everyday activities by developing balance and coordination between the brain, spinal cord and muscles. It is used most widely for neck pain, back pain and headaches. It involves a teaching which increases the awareness of abnormal tensions and releases them along with some gentle manipulations.

Stretching These are a series of exercises taught by therapists to improve body flexibility. The use of stretching reduces tension in the “core” or spinal cord which permits improved mobility and less pain.

Reflexology is based on the principle that there are reflexes in the feet and sometimes hands or ears that correspond to every organ and body part. The foot surface contains an entire map of the body. Reflexologists apply pressure to these reflex areas to relieve tension, improve circulation and promote natural function of the related body areas.

Pilates Method A series of exercises which strengthen the back, lengthen the spine, build muscle tone, increase flexibility and reduce tension and strain on the joints. Pilates strengthens and lengthens without creating muscle bulk.

Reiki is a traditional Japanese technique of relieving pain by re-channeling energy through the hands of the therapist to the body. This method utilizes different hand positions and symbols while moving the hands close to the body surface for pain management and restoration of natural energy flow.

Yoga is a useful method for pain alleviation using a combination of physical exercise, breathing techniques and meditation. The belief is to provide the ultimate balance and harmony between the mind and the body. The postures used increase flexibility and relieve muscle tension.

Mental Imagery is a relaxation technique taught by well trained psychologists. It is a therapy offered to those suffering extreme pain from muscle tensions without an obvious mechanical cause. The Psychologists therapy focuses on the minds awareness of the body and redirection of energy with mental images.

Biofeedback is a belief that the body and mind have the ability to control bodily functions that are automatic. Sensors and special machines are used to record this activity and further reinforce the technique. This is a technique used in conjunction with other therapies for the treatment of neck pain, back pain and chronic headaches.