Physical Medicine and Rehabilitation Services

Pain Management

The Institute for Advanced Reconstruction is proud to offer physical medicine and rehabilitation (PM&R) services focusing on pain management. Our pain management specialist, Dr. Nicole Ferro, works in conjunction with our reconstructive surgeons to properly diagnose pain disorders and create a comprehensive treatment plan utilizing non-surgical and surgical methods. Dr. Ferro works alongside our surgeons to determine the best surgical interventions and maximize outcomes via preoperative and postoperative rehabilitation methods. Dr. Ferro utilizes a multimodal approach to pain management with an emphasis on restoring functionality.

Conditions Treated:

  • Neck Pain
  • Back Pain
  • Joint Pain
  • CRPS (Complex Regional Pain Syndrome)
  • Myofascial Pain

Pain Management Services

Non-opiate Management with Interventional Procedures

Epidural Steroid Injections

When completed properly, epidural injections are a safe and effective way to minimize burning pain that originates in the spine and radiates down the arms and legs. Using X-ray guidance, a small amount of corticosteroid is injected into the space above the spinal cord and spinal nerves, which helps to reduce nerve irritation due to inflammation and provide pain relief.

Facet Joint Injections

Arthritis can affect even the smallest joints of the body. Arthritic facet joints can cause referred pain of the neck, low back, and buttocks. Using X-ray guidance, these joints are targeted with a fine needle, and a mixture of anesthetic and corticosteroid is injected to provide pain relief.

Radiofrequency Ablations

If pain relief is obtained with diagnostic injections to block the small nerves that innervate (provide feeling to) the facet joints, then radiofrequency ablation may be considered to achieve longer lasting pain relief. Similar to the diagnostic injections, needle-like probes are guided towards the medial branch nerves. Once in place, a quick stimulation test ensures accuracy. Local anesthetic is then provided, and the probes are connected to a machine that allows a current to reach the probe tips and create a thermal lesion in the nerve. Over time, the nerve will no longer have the full capability to transmit sensory pain signals back up to the brain.

Spinal Cord Stimulator Trials

Trials are completed with local anesthesia and mild sedation if necessary. The entire trial process takes about an hour and allows for you to try out a stimulation device prior to implantation. Education regarding these devices and how they may help with pain relief and function are provided during office visits prior to setting up a trial. Using X-ray guidance, a needle cannula is used to access the epidural space. Wires are guided up through the epidural space to the targeted area of the spine. The device is then taped to the skin on your back and worn for 5-7 days to assess for changes in pain level and functionality, and ultimately ensuring if the device will be right for you.

Lysis of Adhesions

Multiple surgeries can often lead to increased scar tissue, which may entrap spinal nerves triggering pain and inflammation. After local anesthesia with lidocaine, x-ray guidance is used to access the epidural space from the tailbone area. A guide wire is then inserted into the epidural space and contrast dye is used to identify areas of scar tissue adhesions surrounding the spinal nerves. A high volume of injectate is used to break up these adhesions and minimize inflammation to provide pain relief.

Diagnostic Nerve Blocks

Ultrasound guidance can be used to properly identify different peripheral nerves that provide sensory innervation to regions of the knee, shoulder, occiput, arms, legs, and pelvis. Once isolated, a thin needle is guided towards the nerve and a mixture of steroid and anesthetic medication is injected into the area to provide pain relief.

Peripheral Joint Injections

Using either ultrasound or X-ray guidance for improved accuracy, peripheral joints including elbow, shoulder, knee, hip, and ankle are targeted with medications to help alleviate joint pain.

Tendon Sheath / Bursa Injections

Repetitive use injures can prove to be very painful and take several months to heal. Using ultrasound guidance, a mixture of corticosteroid and local anesthetic can be administered to the painful areas surrounding the tendons and joint spaces. This process in combination with consistent physical therapies, often results in pain relief and allows for improved functional use.

Botox for Migraines

If abortive and preventative migraine medications prove to be ineffective then injections might be a good next step in migraine management. A very fine needle is used to inject Onabotulinum toxinA (Botox) into various muscles surrounding the face, neck, shoulders, and temple. With time, these muscles lose some of their ability to contract and the relaxation is found to help alleviate migraine frequency.

Medication Management

Dr. Ferro is able to provide comprehensive treatment by working together with our plastic and reconstructive surgeons specializing in peripheral nerve conditions to appropriately diagnose and manage complex peripheral neuralgias. This unique collaboration at The Institute for Advanced Reconstruction allows us to coordinate world-class care for patients from diagnosis and surgical planning to surgery and post-operative rehabilitation.


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