Spinal Segmental Sensitization
The purpose of this section is to discuss new approaches in pain management invented by Dr. Andrew Fischer, who is Dr. Bieber’s mentor.
The first goal in treatment is to alleviate pain immediately, so that the patient can leave the office pain free or at least substantially improved.
This new approach is based on diagnosis of the affected segment in the spinal cord and treatment focused on its components.
Spinal segmental sensitization (SSS) is a new clinical entity, which is present in every painful condition. Sensitized nerves are commonly linked to the immediate cause of pain. Sensitization is considered when an exaggerated pain response occurs to painful stimuli or mechanical pressure over the area supplied by the sensitized nerve.
All painful conditions, ranging from acute to chronic injuries, inflammation, arthritis, muscle spasm, headaches, fibromyalgia, and other musculoskeletal disorders demonstrate the presence of SSS that mediates the pain.
New diagnostic examination techniques are utilized so that Dr. Bieber can precisely diagnose the cause of your pain so that the treatment can be most specific and effective. Electric Skin Conductance is a test that quantifies sensitization and nerve dysfunction. Pressure Algometry quantifies tenderness over trigger points. The Scratch Test also aids in identification of the sensitized spinal segment; and the Pinch and Roll Technique provides the most sensitive test for detection of nerve sensitization.
Once the level of SSS that is related to your painful condition is diagnosed Dr. Bieber is trained in three new injection techniques that can immediately alleviate or completely eradicate your painful condition(s) prior to leaving the office.
After the sensitized nerve related to your painful condition causing your pain is diagnosed, special injection techniques are utilized for instant and long-term pain relief.
- Paraspinous block is used to completely desensitize the affected spinal segment.
- Pre-injection block is used prior to the trigger point injection to anesthetize the area to be infiltrated, so the patient will have minimal discomfort from the injection.
- Trigger Point Injection using 1% lidocaine is administered to mechanically break up the abnormal (fibrotic) tissue. The 1% lidocaine is used to decrease the soreness from the injection as well as aids in the mechanical eradication of the trigger point or tender spot.
There are multiple factors that cause trigger points and muscle spasms, which must be identified to prevent recurrence. Such factors may be poor posture, psychological tension, endocrine abnormalities (thyroid, estrogen), vitamin deficiencies, mineral disorders and others.
At Cross Bay PMR, the combination of administering these injection techniques with physical therapy decreases the recovery time needed and improves functional outcome.