Sleep, exercise, diet, and mood all play their part. Addressing each of these factors is part of treating your whole person, not just the direct symptoms of your pain. It is called the biopsychosocial approach, and it is the most advanced standard of care for pain. We don’t want to leave any stone unturned when it comes to identifying what may be leading to your pain. And most importantly, we’re here to support you in your recovery!
Our team of doctors approaches each patient with one goal in mind: to help patients return to normal daily activities. Our multidisciplinary group of physicians and providers offer treatment options personalized for each patient recognizing that no two patients are alike, and neither is their pain. Services range from advanced interventional pain management procedures and psychological support to functional restoration – a rehabilitation program for chronic pain sufferers.
Work Conditioning Program
Return to Work Programs
Cognitive Behavioral Therapy
Pain Management and Interventional Pain
Opioid Treatment Program
IPM is dedicated to fully educating patients about various options for pain management. We want to partner with you on your diagnosis and treatment and encourage you to learn more about the various sources of pain, conditions we treat, services we provide and procedure options.
This condition is an irritation or compression of one or more nerve roots in the cervical spine. Because these nerves travel to the shoulders, arms and hands, an injury in the cervical spine can cause symptoms in these areas. Cervical radiculopathy may result from a variety of problems with the bones and tissues of the cervical spinal column. Common causes of Cervical radiculopathy are herniated disks, degenerative disc disease, and spinal stenosis. Symptoms may include pain, weakness, numbness and tingling, and may vary depending on the level of the injury.
Cervical Spinal Stenosis affects the spinal nerves in your neck. It’s a narrowing of the spinal canal. That’s the space your spinal nerves travel through. In a healthy spine, the spinal canal protects these nerves. It keeps them free from injury. But with spinal stenosis, the spinal canal is too narrow, and your nerves get compressed. Spinal stenosis can happen because of disease or injury. Your spinal canal can be narrowed by bone spurs, a bulging disc, or thickened ligaments. Your symptoms depend on which nerves are involved, and how badly they’re compressed. Symptoms include pain, numbness or weakness, problems with balance and coordination, and problems with your bladder or bowels.
This condition is a weakening of one or more vertebral discs, which normally act as a cushion between the vertebrae. This condition can develop as a natural part of the aging process, but it may also result from injury to the back. Some people experience pain, numbness or tingling in the legs. Strong pain tends to come and go. Bending, twisting and sitting may make the pain worse. Lying down relieves pressure on the spine.
Facet joint syndrome is an arthritis-like condition of the spine that can be a significant source of back and neck pain. It is caused by degenerative changes to the joints between the spine bones. The cartilage inside the facet joint can break down and become inflamed, triggering pain signals in nearby nerve endings. Medication, physical therapy, joint injections, nerve blocks, and nerve ablations may be used to manage symptoms. Chronic symptoms may require surgery to fuse the joint.
A herniated disk refers to a problem with one of the rubbery cushions (disks) that sit between the individual bones (vertebrae) that stack to make your spine. A herniated disc can be caused by the normal wear and tear of aging, traumatic injury, and heavy lifting. A herniated disk presses against nerves in your spine. This can cause pain, numbness, weakness and tingling. You may feel these in your buttocks, leg or foot. A herniation in your cervical spine can cause problems in your neck, shoulders, arms and hands.
This condition is an irritation or compression of one or more nerve roots in the lumbar spine. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column. Common causes of Sciatica are herniated disks, degenerative disc disease, and spinal stenosis. Symptoms may include pain, weakness, numbness and tingling, and may vary depending on the level of the injury.
This condition, also called “failed back surgery syndrome,” is a type of chronic pain. This pain most often develops in some people after spine surgery. After a laminectomy, a procedure to relieve pressure on spinal nerves, bone or soft tissue may still press on nerves and scar tissue may form. Symptoms may include pain in your back at the site of your surgery. The pain may also radiate down to your buttock and leg. This pain may feel sharp, or it may feel dull and achy.
The spinal column contains open spaces that create passageways for the spinal cord and the spinal nerves. Spinal stenosis is a narrowing of (or an intrusion into) these openings. This can cause a compression of the nerves. Stenosis is commonly caused by an excess growth of bone around the spinal nerves. This excess bone growth often results from osteoarthritis. Stenosis can also result from a dislocation or a fracture of the vertebral bone. Symptoms of spinal stenosis can vary depending on the location and severity of the problem. Spinal stenosis can cause pain, weakness, numbness and tingling in the arms and legs.
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area. Some treatments for CRPS include rehabilitation and physical therapy, psychotherapy, medication, injections, and in some cases surgery.
Orofacial pain refers to a variety of unpleasant physical sensations involving the muscles, bones or joints of the face and mouth. Common causes of orofacial pain are migraine headaches, Involuntary muscle spasms in the head, jaw or neck, complications following certain surgeries, missing teeth, excessive tooth decay or gum disease, and injury to the face or jaw. Symptoms of orofacial pain include, a dull or sharp pain around or behind the eyes, a nearly constant ache deep in the jaw; clicking or locking of the jaw; persistent headaches and pain while chewing, speaking or swallowing.
Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event. PTSD symptoms are generally grouped into four types: intrusive memories, avoidance, negative changes in thinking and mood, and changes in physical and emotional reactions. Symptoms can vary over time or vary from person to person.
Knee pain can be caused by a sudden injury, an overuse injury, or by an underlying condition, such as arthritis. Treatment will vary depending on the cause. Symptoms of a knee injury can include pain, swelling, and stiffness. One of the most common types of knee injury is a torn meniscus. Any activity that causes you to forcefully twist or rotate your knee, especially when putting your full weight on it, can lead to a torn meniscus. Symptoms of a torn meniscus include a popping sensation, swelling or stiffness, and the feeling of your knee giving way.
One of the most common causes of shoulder pain is a rotator cuff injury. The two main causes of rotator cuff injuries is trauma and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities that put stress on the shoulders. Rotator cuff tears may also happen due to aging, with degeneration of the tissues. Symptoms of a rotator cuff injury include shoulder pain when lifting objects, shoulder pain when sleeping on your injured side, grating or cracking sounds when moving your arm, limited ability to move your arm, and muscle weakness.
Back pain is a very common condition that may affect all areas or be isolated to certain regions of the lower, middle, and upper back. Muscular problems, degenerative disc disease, and arthritis are some common causes of back pain. Back pain can have many symptoms, including a dull aching sensation in the lower back, a stabbing or shooting pain that can radiate down the leg to the foot, an inability to stand up straight without pain, a decreased range of motion and diminished ability to flex the back.
Neck pain or stiffness may be caused by a variety of reasons including but not limited to muscle tension and strain, injury, arthritis, osteoporosis, and fibromyalgia. Muscle tension and strain in the neck can be cause by poor posture, sleeping in a bad position, and jerking your neck during exercise. Injuries to the neck also commonly occur in falls, lifting heavy objects, and sports, where the muscles and ligaments of the neck are forced to move outside of their normal range. Neck pain may cause numbness or tingling, muscle tightness and spasms, decreased ability to move your head, and headache.
Chronic pain is pain that is ongoing and usually lasts longer than six months. This type of pain can continue even after the injury or illness that caused it has healed or gone away. Pain signals remain active in the nervous system for weeks, months, or years. Some people suffer chronic pain even when there is no past injury or apparent body damage. Chronic pain is linked to conditions including nerve pain, back pain, fibromyalgia pain, Cancer pain, and arthritis.
Most cancer pain is caused by the tumor pressing on bones, nerves or other organs in the body. Sometimes pain is due to cancer treatment and procedures. Cancer pain may be nociceptive (affecting tissue) or neuropathic (affecting the nerves). Cancer patients may experience neck pain, back pain, and headaches. Initial pain may also induce muscle cramps, or being in bad positions and result in stress pain.
An intrathecal pump relieves chronic pain. It uses small amounts of medicine applied directly to the intrathecal space (the area surrounding the spinal cord) to prevent pain signals from being perceived by the brain. Pump candidates include people for whom conservative treatments have failed and surgery is not likely to help.
This injection procedure is performed to relieve low back and radiating leg pain. Steroid medication can reduce the swelling and inflammation caused by spinal conditions. Using a fluoroscope for guidance, the physician slides the needle toward the epidural space between the L-4 and L-5 vertebra. A contrast solution is injected. The physician uses the fluoroscope to confirm the correct location of the needle tip. A steroid-anesthetics mix is injected into the epidural space, bathing the painful nerve root with soothing medication.
During this minimally invasive procedure, the physician uses heat from radio waves to treat painful facet joints in your lower back. This procedure is also called radiofrequency rhizotomy. It can treat pain that doesn’t respond to medications or to physical therapy. The physician inserts an electrode through the cannula. A weak electric jolt is used to test its position. If the jolt recreates the pain but does not cause any other muscular effects, it is positioned correctly. Then the physician uses the electrode to heat the nerve. This disrupts its ability to transmit pain signals. Several nerves may be treated if necessary.
This outpatient procedure is an injection of a steroid-anesthetic medication. The medication can reduce swelling and inflammation of irritated spinal nerves. This procedure is performed to relieve pain in the lower back and pain that radiates from the back to the legs. When the area is numb, the physician carefully guides a needle into the foraminal space that surrounds the irritated nerve root. After the needle’s position has been confirmed, the physician injects a steroid-anesthetic medication. This medication bathes the irritated nerve roots. It will help alleviate the patient’s pain. The injection only takes a few minutes to complete.
This is an injection of numbing medicine. It bathes the medial branch nerves, which attach to the facet joints of your spine. These nerves hurt when facet joints are injured or diseased. The injection helps find the source of your pain. And it may relieve your pain for a brief time.
A cervical epidural steroid injection consists of an anesthetic and a steroid being injected into the epidural space in order to reduce inflammation and pain. When it is injected from the side it’s considered a transforaminal injection and it places the medication near the source of inflammation. The injection may begin with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a thin needle into the epidural space. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement and a dye may also be injected to make sure the needle is in the correct spot. Once the needle is correctly placed the physician injects the anesthetic and steroid.
A lumbar sympathetic block is an injection of a local anesthetic that can help relieve chronic leg and foot pain caused by conditions such as complex regional pain syndrome, reflex sympathetic dystrophy, vascular insufficiency, and shingles. Medications are delivered to the sympathetic nerves – a cluster of nerve cell bodies – along the front side of the spine. The goal is to reduce pain so that you can resume normal activities and physical therapy.
This injection procedure is performed to relieve pain caused by arthritis in the sacroiliac joint where the spine and hip bone meet. The steroid medication can reduce swelling and inflammation in the joint. A local anesthetic numbs the skin and all the tissue down to the surface of the sacroiliac joint.
Spinal cord stimulation (also called SCS) uses electrical impulses to relieve chronic pain of the back, arms and legs. It is believed that electrical pulses prevent pain signals from being received by the brain. SCS candidates include people who suffer from neuropathic pain and for whom conservative treatments have failed. The injection site is anesthetized. One or more insulated wire leads are inserted through an epidural needle or through a small incision into the space surrounding the spinal cord, called the epidural space. If the patient and the physician determine that the amount of pain relief is acceptable, the system may be permanently implanted. At the end of the trial implantation, the leads are removed. The permanent implantation may be performed while the patient is under sedation or general anesthesia. First, one or more permanent leads are inserted through an epidural needle or a small incision into the predetermined location in the epidural space. Next, a small incision is created, and the implantable pulse generator (IPG) battery is positioned beneath the skin. It is most often implanted in the buttocks or the abdomen. The leads are then connected to the IPG battery.
Stellate Ganglion Block
A stellate ganglion nerve block is an injection that numbs branches of nerves in your neck. This helps doctors find and treat several problems linked to the nerves. Treatment may require a series of injections. The physician inserts a needle and carefully guides it to the nerves of the stellate ganglion. The physician typically uses an x-ray device called a “fluoroscope.” This shows a video image of the needle’s position. Contrast dye may be injected to help confirm that the needle is placed correctly. Next, the physician injects medicine. It bathes the nerves. It can numb the nerves and reduce inflammation. If these nerves have been a source of pain, the medicine can relieve it. The injection may also provide other benefits, depending on your needs.
The physician uses an x-ray device called a fluoroscope to guide a needle down to the vertebra that is causing the pain. The needle is carefully pushed into the epidural space, which is the area surrounding the spinal cord. A contrast solution is injected to confirm the needle’s position. The physician injects a steroid-anesthetic mix into the epidural space, bathing the painful areas with soothing medication. The mixture will help reduce inflammation and reduce pain.
This outpatient procedure is designed to reduce or relieve the pain of trigger points. These small, tender knots can form in muscles or in the fascia (the soft, stretchy connective tissue that surrounds muscles and organs). The physician carefully inserts a needle through the skin and into the trigger point. The physician injects an anesthetic mixture into the trigger point. This causes the trigger point to relax. If the trigger point does not relax completely after the first injection, the physician may adjust the needle’s position and give additional injections. The trigger point injection procedure takes only a few minutes to complete.
A CRFA is a noninvasive procedure used to treat neck, back, and shoulder pain. The procedure may start with an IV to help you relax and a local anesthetic to numb your skin. The physician then inserts a very thin needle near the facet joint. Fluoroscopy, a type of X-ray, is used to ensure proper needle placement. The physician then checks to make sure it is at the correct nerve by stimulating it. This may cause muscle twitching. When the needle is in the proper place, the area is numbed. Radio frequency energy is then used to disrupt the medial branch nerve, which is often repeated at multiple levels of the spine.
Coccygeal injections are used to treat pain around the tail bone in the lower back. It involves an injection of a local anaesthetic and steroid around this area. Your procedure may be performed under X Ray guidance. You will be asked to sit or lie in a comfortable position. A small amount of local anaesthetic is injected to numb the skin overlying the injection site. The local anaesthetic/ steroid injection is then given. You may feel some discomfort during the injection, but this normally settles quickly.
EMDR (Eye Movement Desensitization and Reprocessing) is a psychotherapy that enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Repeated studies show that by using EMDR therapy people can experience the benefits of psychotherapy that once took years to make a difference. It is widely assumed that severe emotional pain requires a long time to heal. EMDR therapy shows that the mind can in fact heal from psychological trauma much as the body recovers from physical trauma. When you cut your hand, your body works to close the wound. If a foreign object or repeated injury irritates the wound, it festers and causes pain. Once the block is removed, healing resumes. EMDR therapy demonstrates that a similar sequence of events occurs with mental processes. The brain’s information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes. Using the detailed protocols and procedures learned in EMDR therapy training sessions, clinicians help clients activate their natural healing processes.ww
Myofascial release is a type of physical therapy often used to treat myofascial pain syndrome. Myofascial pain syndrome is a chronic pain disorder caused by sensitivity and tightness in your myofascial tissues. These tissues surround and support the muscles throughout your body. The pain usually originates from specific points within your myofascial tissues called “trigger points.”
Evaluation of back and neck pain requires a physician experienced in diagnosing spinal conditions. The work-up begins with a detailed history and physical examination. Your medical history helps the doctor understand your back and neck pain and the influence of your lifestyle on your pain.
During your physical exam, your physician will try to pinpoint the source of pain. Simple tests for flexibility and muscle strength may also be conducted. Diagnostic tests may be ordered to confirm the location and source of your pain.
Orthopedic surgery corrects problems that arise in the skeleton and its attachments, the ligaments and tendons. It may also deal with some problems of the nervous system, such as those that arise from injury of the spine. These problems can occur at birth, through injury, or as the result of aging. They may be acute, as in injury, or chronic, as in many aging-related problems.
With the development of anesthesia and an understanding of the importance of aseptic technique in surgery, orthopedic surgeons extended their role to include surgery involving the bones and related nerves and connective tissue.
The terms orthopedic surgeon and orthopedist are used interchangeably today to indicate a medical doctor with special certification in orthopedics.
Many orthopedic surgeons maintain a general practice, while some specialize in one aspect of orthopedics, such as hand surgery, joint replacements, or disorders of the spine. Orthopedics treats both acute and chronic disorders. Some orthopedists specialize in trauma medicine and can be found in emergency rooms and trauma centers treating injuries. Others find their work overlapping with plastic surgeons, geriatric specialists, pediatricians, or podiatrists. A rapidly growing area of orthopedics is sports medicine, and many sports medicine doctors are board certified orthopedists.
Caudal epidural injections are steroid injections that are given in the coccyx (tailbone or caudal) region to treat chronic lower back pain and chronic pain in the legs. The pain specialist cleans and then numbs the area of the lower back located just above the buttocks with a topical anesthetic before inserting a needle and injecting contrast dye into the caudal area. The contrast dye is visible in the x-ray images and allows the pain specialist to see exactly where the dye is being delivered. Finally, the medication is injected into the caudal space.
Facet joint injections are injections, which we perform using X-ray guidance, that help us diagnose and treat pain that comes from the small joints of the spine (facet joints). Disease in these joints, including arthritis, can cause pain in the head, neck, upper and lower back, and buttocks. These procedures take about five minutes and we can use either local anesthesia or comfortable sedation.
Botox injections are a minimally invasive treatment option for patients suffering from migraine headaches, spasticity, myofascial pain, back pain, neck pain, or neuropathy. While this injection procedure is most commonly known for its effect on wrinkles, it is also a highly effective pain therapy that can provide three to four months of pain relief. These injections typically contain a mixture of botulinum toxin and saline solution or local anesthetic. Between five and 10 injections in multiple areas may be needed to successfully relax tense muscles.