Chronic Neck and Back Pain:
Our staff are broadly trained and can expertly find the cause of your discomfort, whether it is from a simple strain, a herniated disk, or a complication of failed back surgery, or, even an underlying medical condition such as infection or tumor.
Radiculopathy:
There are many potential causes of pain radiating into the arm or leg from the spine. Some of the common ones include herniated disks, facet disease, Tarlov cysts, tumor and abscess. Medical imaging with x-rays and MRI’s may be helpful but cannot always establish the reason for your pain. A carefully performed history and physical exam is the first prerequisite to proper care and this must be correlated to the laboratory, imaging and electrodiagnostic studies performed. Dr. Shapiro is one of the most broadly trained physicians in the Midwest and has expertise in multiple specialties.
Peripheral Nerve Disorders:
Conditions typically include carpal tunnel syndrome, tardy ulnar palsy, cubital tunnel syndrome, meralgia parasthetica, and other compression neuropathies. Conditions such as these are especially amenable to diagnosis and treatment with in-office ultrasound techniques and EMG/NCV. We perform these test on-site, in the office, as extensions of the history and physical that established your care when indicated. Most physicians refer out to other practitioners who only see you for the specific evaluation requested by the treating physician. We make sure we know the specifics of problem and provide on-going comprehensive evaluation and care.
Generalized Neuropathies:
These include diabetic mono or polyneuropathies, alcoholic neuropathy, neuropathies associated with thyroid disease and other metabolic neuropathies as well as hereditary genetic neuropathies, such as Charcot-Marie-Tooth disease and its variants.
Pain associated with neurologic diseases:
Such as MS, Stroke, Traumatic Brain injury and Spinal Cord Injury. These often generate more global problems and can be associated with a myriad of musculoskeletal and neurologic complaints. As a physical medicine and rehabilitation physician, Dr. Shapiro is trained in all aspects regarding the care and management of these complex, often lifetime problems.
Pain associated with vascular diseases:
Including pre- and post-amputation pain, phantom pain, and ischemic limb pain. During residency most physiatrists, or, physical medicine and rehabilitation physicians partake in multispecialty amputee clinics, along with surgeons, prosthetists and orthotists, physical therapists and occupational therapists. Physiatrists, such as Dr. Shapiro are well versed in all of the modalities available to help patients with these issues. Dr. Shapiro trained in a large county hospital associated with a VA Medical Center with an extensive draw area, ranging from the Canadian border to the mid-lower Hudson Valley and has had a broad range of clinical experiences with amputees.
Pain from general medical and surgical causes:
Such as, pain associated with abdominal adhesions, pancreatitis, interstitial cystitis and colitis. This can be due to tissue destruction and scarring. It can involve multiple structures and involve nerve pain, ischemic pain, and distention pain. It is often refractory to most medical or surgical treatments and it is challenging to patients and their doctors. We have several patients in our practice like this. Most pain management practices limit their caseload to musculoskeletal, spine and neurologic conditions focusing on procedural care. We are here to relieve suffering.
Arthritis, ligament and tendon disorders:
Such as rotator cuff issues and meniscal tears or systemic joint pain from generalized disorders including osteoarthritis, rheumatoid arthritis, lupus, sarcoidosis, or inflammatory arthritis. We are not rheumatologists and do not prescribe DMARDS for RA, lupus and other similar conditions, but we are versed in all of the ancillary treatments for these conditions, such as PT, OT, bracing and injections to control swelling and pain. We also recognize when something can be managed conservatively and when it becomes reasonable to consult an orthopedist or neurosurgeon.
Headaches:
Including migraine, mixed headache, occipital neuralgia and headaches associated with Whiplash Associated Disorder or post-cervical fusion.
Spasticity:
These disorders are painful conditions that thought to be due to dysfunctions affecting the central (spinal cord and brain) and/or peripheral nervous system (nerves in the extremities). These are unusual poorly understood syndromes but share several commonalities. Among them are vascular and skin changes causing discoloration and temperature changes in the affected extremities with swelling and edema initially, and later, atrophy if not caught early.
The pain is diffuse and deep, often poorly localized and often described as burning, stinging or tearing. Two defining characteristics are hyperalgesia or increased sensitivity to painful stimuli and, allodynia or pain from normally non-painful stimuli, such as light touch. Numbness may also be present. Changes in hair and nail growth may also occur and the pain can travel to otherwise previously unaffected areas.
Common causes include bone fractures, surgery, sprains or strains, burns, bruises or cuts and CRPS usually develops four to six weeks after the injury should have healed, and, it can develop without a known cause. Diagnosis is made by excluding other causes of the pain and this is often delayed or inaccurate.
Treatment goals are controlling pain and restoring function and can include multiple classes of medications, PT, OT, counseling and psychological support, injections, biofeedback, acupuncture, hypnosis and manual medicine. More severe advanced cases may be treated with spinal cord or peripheral nerve stimulation, sympathetic nerve blocks and intravenous ketamine infusions for 3-5 days in the hospital.
These are obviously challenging syndromes and treatment may require the gamut of known rehabilitation and pain management techniques. The good news is that severe or prolonged cases are rare and when CRPS is caught early it usually responds to treatment.
Chronic Regional Pain Syndrome Type I (Reflex Sympathetic Dystrophy) &Type II (Causalgia):
This is a velocity dependent increase in muscle tone and is typically seen with injuries proximal to the spinal nerve roots, affecting the spinal cord proper and or the brain. Common causes include high spinal cord injury, stroke or traumatic brain injury. Spasticity often limits coordination, movement and balance and can cause pain due to muscle cramping and metabolic exhaustion. Good treatment involves multiple modalities including medications, stretching, bracing and energy conservation techniques. If incapacitating or extensive enough to promote joint contractures, treatment with nerve blocks and neurotoxins, such as botulinum toxin may be employed to reduce joints and control spasms, allowing restoration of function and pain relief.
TOP 25 DIAGNOSES WE SEE:
- Failed back surgery syndrome
- Lumbar radiculopathy
- Lumbar spondylosis
- Degenerative disk disease
- Herniated lumbar disk
- Cervical radiculopathy
- Cervical degenerative disk disease
- Cervical spondylosis
- Herniated cervical disk
- Whiplash Associated Disorder
- Brachial plexus injury
- Carpal tunnel syndrome
- Tardy ulnar palsy and cubital tunnel syndrome
- Pain after total knee replacement
- Common peroneal nerve entrapment
- Tibial tunnel syndrome
- Rotator cuff injury
- Osteoarthritis of any joint
- Chondromalacia patellae and meniscus tears
- Migraine
- Occipital neuralgia
- Chemotherapy induced neuropathy
- Pain associated with interstitial bladder disease
- Traumatic brain injury
- Stroke
