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Patient Forms When Pain Attacks, Attack Back! The physicians at RPG want you to be well informed about all aspects of your care. If you have additional questions, or to schedule an appointment, please call us at 404-659-5909 
You can print and fill out the forms below to save time when you visit our office. ( you need Adobe Acrobat Reader to view and print forms )
RPG has provided the extensive information below to aid in your education about pain management - please click on the title to read about each subject:
“Doc, I was just bending over to pick up an envelope and when I stood up, Oh Boy!” A back attack can occur without warning and you don’t need to be a piano mover or a weight lifter to have an acute episode. You can fight back however. Here’s how.
Put out the fire: Assuming that you have no allergies to anti-inflammatory medications you should immediately begin taking an over-the-counter variety such as Motrin, Nuprin, Alleve, or Advil, but any generic brand of ibuprofen will do fine. Always follow the instructions on the label regarding dosage, frequency and contra-indications. Keep taking the medication even if you begin to feel better as anti-inflammatories tend to work best after they have been in the blood system for 1-2 weeks. Apply ice and heat: Apply ice during the first 24 hours of the attack and then switch to heat for the next 24 hours. A zip lock plastic bag with ice cubes wrapped in a thin towel works great. Use the ice for 20 minutes 3-5 times during the first 24 hours. Any variety heating pad will do for the next 24 hour period, again 20 minutes 3-5 times. After the first 48 hours alternate heat and ice. Use ice for 20 minutes, wait an hour or so and apply heat for 20 minutes. Alternate for 3-5 times daily.
1. Light Rotation: While on all fours gently sway side to side, increasing range as you feel comfortable doing so. Do 30 repetitions.
Get back: Gradually increase your activities. Taking a short (5-10 minute) walk on level ground while swinging your arms is a good way to get started. Do the lumbar roll: Take an ordinary bath towel, fold it in half lengthwise and roll it up. When sitting or driving place this “lumbar roll” in the small of your back between you and your seat. This helps to keep the spine aligned. The following are danger signals. The bad news about back pain is that almost everyone has some during their lifetime, the good news is that most of it gets better without ever having to see a physician. Sometimes however back pain can be very serious and require immediate emergency medical attention. If you experience a new onset of any of the following symptoms, you should seek medical attention immediately.
Caution if your practitioner:
Most back pain problems will resolve themselves in one to two weeks without the help of any medical practitioner. The information on this web site for handling a back attack will usually do the trick. However, in those instances when you need to see a doctor it is important that you choose wisely. First, there are two kinds of physicians practicing medicine in America, Medical Doctors (M.D.’s) and Doctors of Osteopathy (D.O.’s). Both are similarly trained in chemistry and anatomy and other clinical skills. Both have equal rights and both are subject to the same board certification standards and licensing requirements. Whether you choose a M.D. or a D.O., select a physician that is “board certified” in their medical specialty. Board certification means that they have passed a rigorous series of written and verbal tests in their specialty and are recognized for their superior command of the subject matter. “Board eligible” indicates that the physician has completed all or the required training but has not yet passed the test. This is perfectly acceptable for a young physician who has recently completed residency. Physicians are not eligible to complete board certification (verbal exams) until they have completed a period of practice after their residency (usually one year). It is equally important that you work with a physician who believes in and practices a multidisciplinary treatment approach. This means that your treatment may consist of several different disciplines. For example, you may use some prescribed medications, some physical therapy, some aerobic exercise and yoga or relaxation exercises. Choose a physician who will help you organize the different treatment approaches. You can think of this as the “using every tool in the toolbox” approach. Find out if the doctor uses a conservative treatment approach. Conservative treatment is non-surgical. This is particularly important if you are considering a physician who has training in surgery such as an orthopaedic surgeon. In addition, ask the following questions of the office staff before you choose a physician:
How to get the most out of your doctor visit In our experience, most folks are very satisfied with the care they receive from their doctors. Nonetheless, we have all heard the tales of long times spent in waiting rooms reading old magazines. Most people understand that inherent in the practice of medicine is an unpredictable schedule. Doctor’s days are often interrupted by medical emergencies or a circumstance that requires more of their time than anticipated. Having said that, a well-run doctor’s office will respect your time as being just as valuable as theirs is. So how do you prepare to get the most out of your time with the physician? Take responsibility for your health care: Approach your health care with the same seriousness you would when purchasing a house or car or preparing for a job interview. After all, what is more important than your health and physical well being? Managing pain requires considerable patient participation. Let the doctor know that you are serious about getting better and that you will work both hard and smart to do so. Doctors, like most of us, respond better to people who are motivated. Let your doctor know that you consider he or she an important part of your health but that ultimately it is you who is responsible for your physical well-being. Separate administrative and clinical concerns: For example if you have a question about billing or insurance be sure to discuss this with the administrative staff rather than the doctor. Try to maximize your time with the doctor discussing specific clinical issues. Fill out your paperwork in advance: Have your medical history and billing information sent to you in advance by mail or fax or access it online and print it off. Take plenty of time to review and complete all the information carefully and completely. This will ensure that the doctor has a good sense of your situation well in advance of your visit. This is also a good time to make a short, clear listing of the questions you have for the doctor. Write them down and submit them with your paperwork.
Confirm your appointment: This may save you valuable time off from work or from needless waiting time at the doctor’s office. If the doctor does experience an emergency despite your good planning be prepared with a good book, some work or needlepoint to effectively utilize your wait time. Plan to arrive ten minutes early just in case there is any other paper work that needs to be completed. Confirm Referrals: If you have been referred to a specialist by another doctor most managed care plans require you to have a written or emailed referral and/or authorization code. If you do not have this the doctor is not authorized to see you. So be prepared well in advance with a complete referral. Bring all test results with you: This may save you time and expense. Remember if you paid for the test then you are entitled to the report. Once you are with the doctor:
EMG & Nerve Conduction Study: What to Expect Your Doctor has ordered an EMG and NCS, here is some information on what to expect. What: Electromyography (EMG) and NCS indicate how well your nerves and muscles are working. EMG’s measure the electrical activity of your muscles. Nerve conduction studies indicate whether and how fast the nerves are conducting impulses. In medical terminology, the procedures are different types of “electrodiagnostic testing.” Why: The tests can determine whether ongoing nerve injury or muscle damage are contributing to your current symptoms. They provide objective documentation for many pre-surgical diagnoses such as Carpal Tunnel Syndrome, Tardy Ulnar Palsy, and Tarsal Tunnel Syndrome. How: In an NCS, electrodes send a barely perceptible static-electric impulse through selected nerves in the arm, leg, neck or back region and measure a response. You will feel a mild tingling sensation lasting less than ¼ of a second. During an EMG, one or more electrodes the size of a pin are inserted into the skin of the muscles in the arm, leg, or back area. The electrodes cause a slight prickling sensation as they take readings of the condition of your muscles. The combined tests take between 20 and 40 minutes. Who: The studies are performed by board certified physician specialists who have received special training in this area of diagnostic medicine. Where: The tests are performed in an examination room at the doctor’s office. If you would like to bring your spouse, a friend or a relative to keep you company during the procedures you are welcome to do so. When: Your Doctor will receive the test results in a formal report. Preparation: There is no special preparation needed, except that you should not apply any lotions or oils on the day of your test. If you have a pacemaker or have had a mastectomy, please notify the doctor before beginning the tests. The tests can still be done, but modifications must be made. If you wish, you may take pain medication before the tests, and you are encouraged to continue your usual medications because they will not affect the test results. Other than a mild tenderness where the pins are placed, there are no significant complications. Epidural procedure pain relief
You have been scheduled to have an injection or a series of injections to help control your pain. The following information is provided so that you may be well informed about the procedure. Please follow the instructions closely as failure to comply could result in the cancellation of your appointment. During the procedure you will lie comfortably on an x-ray table. The area to be injected will be thoroughly cleaned and then a sterile drape will be applied. Using a special x-ray machine, the Doctor will carefully guide a very thin needle into the appropriate area. He will then instill a combination of solutions – a contrast dye (to verify correct needle placement), an anesthetic (to decrease your pain), and both short and long acting steroids (to decrease your inflammation). You can expect the procedure to take approximately 30 minutes.
More patients visit their physicians for back pain than for almost any other problem. Most people have had back pain at some time and 50 percent of the back pain population has repeated episodes. Back pain may be caused by injury to various structures, arthritis of specific joints of the spine or disc herniations. Many diseases can cause low back pain including heart disease or heart attacks, ulcers, infections, or cancer. The physician must always be on the lookout for life-threatening causes of pain. The majority of cases, however, are related to mechanical factors, often a combination of muscular overuse and injury to the spinal supporting ligaments. This may occur as a onetime trauma or over time as an overuse/strain injury. A physician must take a thorough history which includes questioning regarding the initial event causing symptoms, aggravating and alleviating movements and positions, intensity and pattern of pain and related symptoms such as numbness and tingling. The doctor will ask questions about work and recreational history, other medical problems and medications used. Important also is any history of previous back pain treatments. The physician needs a complete examination of the back. Assessment of posture, movement, strength, sensation and movements to provoke symptoms along with full evaluation of arms and legs is performed. Various tests are used such as x-rays, which gives information regarding bone. MRI's are utilized when there is abnormality of soft tissues such as discs. EMG and NCS testing gives information regarding muscle and nerve root disease. Most cases of low back pain respond very well to conservative treatment. Exercising is important to both avoid and reduce low back pain. Exercises may include stretching, flexibility, strengthening and aerobic programs. Even with pain bed rest is seldom recommended. Reversing risk factors is paramount. Reducing stress and anxiety, weight loss, cessation of smoking as well as education to prevent osteoporosis are all important. Instruction in proper lifting techniques, review of biomechanics and ergonomics for both home and job functions are performed. Physicians have effective tools to deal with back pain. The medications utilized may include Non-steroidal anti-inflammatory. These are sometimes used in combination with other types of pain medications, both systemic and applied directly to skin. Some specialized physicians may perform various injection techniques. Trigger point or local injections using anesthetics or steroids are very successful for pain relief. Injections using x-ray guidance are performed in specific disease states. Steroids can be injected in small joints of the back along specific nerves pathways to give long term pain relief. Epidural injections using steroids can be very effective for long term pain relief as well. Fortunately, in the majority of cases patients respond very well to Non-surgical approach. For a minority of patients, such as those with acute disc herniation with significant or deteriorating neurologic status, or with loss of bowel or bladder control surgery may be an option. The treatment of low back disorders has come a long way in recent years and patients are no longer expected to have prolonged or disabling pain. The latest in medical technology in combination with a good common sense approach can get most patients back to their normal level of functioning. Multiple Sclerosis (MS) - Where Can I Get Help? Who are the MS Rehabilitation experts? Physical Medicine and Rehabilitation (PM&R) The Physiatrist Physiatrists are physicians (M.D.’s - medical doctors & D.O.’s - osteopathic doctors) who specialize in Physical Medicine and Rehabilitation (PM&R). The specialty was incorporated in 1947 upon approval from the Advisory Board of Medical Specialties. Board certification requires at least one year of internship in an accredited medical/surgical residency program followed by an additional 3 years of residency training and an exhaustive series of written and oral exams. There are less than 10,000 board certified Physiatrists currently practicing in the United States. Physiatrists help those suffering from MS restore optimum physical function, provide pain relief and minimize the psychological, social and vocational effects of temporary or permanent disability. Physiatrists focus on the patient’s functional outcomes, treating the whole person rather than a single organ system or disease. Physiatrists are the medical community’s experts in the rehabilitation aspects of MS, and musculoskeletal pain syndromes and are uniquely qualified in pain relief measures, and spasticity reduction techniques such as trigger point injections, major joint injections and paravertebral injection therapy. They provide a complete range of electrodiagnostic testing such as electromyography (EMG) and Nerve Conduction Studies (NCS). Some Physiatrists are also specially trained to perform pain-relieving procedures such as epidural steroid injections & facet blocks. Physiatrists are experts in determining the appropriate rehabilitation treatment plan for patients recovering from any disease process which results in a functional impairment. Physiatrists treat patients with prescription medications; prescribe treatment modalities such as heat, cold, electrical stimulation, and specific forms of specialized therapeutic exercise in conjunction with physical, occupational and speech therapists. Physiatrists lead and directly coordinate the multidisciplinary treatment of physical and functional impairments across all age and gender groups. Physiatrists also provide expertise in prescribing prosthetic and orthotic devices and electrical or mechanical assistive devices (i.e. wheelchairs). For the person with MS the integration of multiple healthcare professionals is essential to help the patient regain a sense of control and increase self-esteem; in PM&R this may include neurology, occupational therapy, physical therapy, speech therapy, rehabilitation nursing, diet/nutrition, social services, and case management. Physiatrists are leaders in the care, treatment and independence training of millions of people facing short-term, intermediate and long-term physical impairments and challenges. Physical medicine intervention speeds recovery, facilitates maximum functional capacity, and helps restore quality of life. What should I expect? Your doctor will first take a detailed history and begin the process of understanding the needs and priorities of the person with MS, including, a complete listing of all current medicines both prescription and over-the-counter including all vitamins and supplements. Your doctor will then conduct a careful and complete neuromusculoskeletal evaluation, order any appropriate diagnostic studies and begin involving other members of the rehab team. Special attention will be focused on the following target impairments.
Will I be cured? No. MS is a chronic disease and although significant progress has been made in disease-modifying therapies that help slow the progression of MS, most people with MS will continue to have some physical limitations. The progressive course of MS demands rehabilitation interventions designed to help people realistically address the symptoms, maintain maximum function, prevent unnecessary complications and promote wellness. What is a realistic goal? The complexity and individuality of MS demands a multi-disciplinary or team approach requiring joint communication with neurologists, MS primary care physicians, therapists and other healthcare experts. Regardless of the approach however the goal is always the same; helping decrease the patient’s impairment and pain and increase their level of function. Of course every patient is different as MS’s accompaniments and effects vary considerably from person to person. Medicaid and Medicare Accepted. Patient Information In patients with severe muscle spasms around the spine area the pain may be caused by an irritable area of the muscle the result of over activity of the spinal nerves from the dorsal primary ramus of the paravertebral nerve located near the facet joint. An injection can be performed in the physician’s outpatient clinic using a local anesthetic (usually Marcaine 0.5%). Generally two or three injections are given at a time and can be repeated on a weekly basis for up to three weeks. It is at this point that your physician can more accurately determine if additional injections should be performed. The likelihood of success is good and the practical alternatives are oral medicine or physical therapy. The prognosis if you do not agree to these injections is still good. The risks involved in this procedure are very minimal. Patient Information In patients with severe muscle spasms, the muscle area is characterized by trigger points. These are irritable areas of the muscle that can cause pain in that area and can also refer pain to other areas of the body. Their location can be confirmed by touching the tender area in the muscle. An injection can be performed in the physician’s outpatient clinic using a local anesthetic (usually Marcaine 0.5%). Generally two or three injections are given at a time and can be repeated on a weekly basis for up to three weeks. It is at this point that your physician can more accurately determine if additional injections should be performed. The risks involved in this procedure are very minimal. There are no routine orders necessary for the injection. You can drive home after the injection and do not need to alter your diet prior to the time of the injection. |
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Get 90 – 90: Lie on the floor with your legs bent at a 90 degree angle on a couch, chair or pillows. This takes much of the pressure off the spine and will give you surprising relief. Maintain this position for up to 30 minutes. If necessary you can even sleep in this position by stacking pillows underneath your knees. Do not stay in bed too long however, usually 1-2 days at most. As you begin to recover you can use this position to continue to give you relief by using it for 30 minutes three-five times daily. We have even seen people in airports using the 90 – 90 approach and while they make look a little odd we know they’re fighting back.
Try to perform these exercises as soon as possible after your back attack 3-10 times per day even though it hurts a little. However, please note that if performing these exercises causes severe or intolerable pain consult your doctor.
2. Cat Stretch: Perform this exercise very slowly, inhale as you curve your spine upwards and exhale as you slowly rest your spine towards the floor. Do 10 repetitions.