Archives: Specialties

Spine Program

Why Should You Continue to Suffer with Back or Neck Pain?

At the NENA Comprehensive Spine Program, we have many levels of treatment options available to alleviate discomfort. Whether you have a slipped disc or have had chronic, nagging pain, we can treat all spine-related problems.

Early Intervention is Critical

After a complete medical history and physical examination, we generally begin with conservative treatment, such as anti-inflammatory medications, muscle relaxants, nerve stabilizers or prescription pain patches.

If needed, our physiatrists work hand in hand with rehabilitation trained chiropractors based in our practice, a unique and innovative approach in this region. When appropriate, referrals will be made to physical therapists in your community.

Comprehensive Diagnosis

We have a unique, interdisciplinary team approach, working closely not only with our own specialists, but also with board-certified neuro-radiologists to provide you with a comprehensive diagnosis and treatment plan. As necessary, we will order diagnostic tests, such as x-rays, CT scans, MRIs or nerve studies.

 

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Pain Management

Many people find relief from pain through non-surgical interventional procedures.

Fluoroscopic-guided epidural or facet joint injections can be extremely effective in relieving chronic pain, sometimes permanently, and various types of nerve blocks may be used to avoid surgery.

Spine Surgery

When non-surgical options have been unsuccessful, surgical treatment can decompress the nerves, stabilize the spine and help to correct spinal deformities.

Some spinal procedures can be done with minimally invasive techniques, such as microdiscectomy and laminectomy with spinal fusion. Degenerative spondylolisthesis, spinal instability, sciatica or radiation of pain into the extremities are common disorders that respond very well to surgical intervention.

Spinal Disorders Treated

We provide a full spectrum of spine care, from conservative measures and pain management to minimally invasive procedures and large scale reconstruction of spinal deformity.

  • Back and Neck Pain
  • Arthritis
  • Cervical Radiculopathy
  • Cervicogenic Headaches
  • Compression Fractures
  • Congenital Disorders of the spine
  • Degenerative Disc Disease (DDD)
  • Disc Herniation
  • Fractures
  • Sciatica
  • Spinal Cord Injury
  • Spinal Deformity
  • Spinal Stenosis
  • Spondylolisthesis
  • Tumors of the spine and nerves

Rheumatology

The Rheumatology Division at New England Neurological Associates (NENA), P.C., offers a wide range of services for the diagnosis and treatment of diseases affecting the bones, joints and muscles, including arthritis.

What Does a Rheumatologist Do?

A rheumatology doctor is also referred to as a rheumatologist or a rheumatoid arthritis doctor. A rheumatology doctor is a board-certified pediatrician or internist who has postgraduate training related to the prevention, diagnosis and non-surgical treatment of rheumatologic disorders.

NENA’s Rheumatology Division Diagnoses and Treats:

  • Rheumatoid arthritis, which is usually associated with severe joint pain and swelling.
  • Degenerative, ‘wear and tear’ arthritis (i.e., osteoarthritis).
  • Arthritis that develops in association with some type of inflammatory bowel disease (IBD), ulcerative colitis and Crohn’s disease.
  • Systemic inflammatory arthritis including psoriatic arthritis (PsA) and ankylosing spondylitis (AS).
  • Bone diseases, such as osteoporosis.
  • Joint pain.
  • Musculoskeletal pain syndromes (e.g., fibromyalgia, myofascial pain syndrome, tendonitis).
  • Local and systemic sclerosis (i.e., scleroderma).
  • Raynaud’s phenomenon--Finger and toe color changes associated with pain especially when exposed to cold.
  • Crystal-induced arthritis, which is also referred to as gout and CPPD arthritis (pseudo-gout).
  • Diseases that cause the blood vessels to become inflamed (i.e., vasculitis). These diseases include hypersensitivity vasculitis, Wegener’s granulomatosis, cryoglobulinemia and giant cell (temporal) arteritis.
  • Inflammatory diseases that involve the muscular system (e.g., dermatomyositis/polymyositis and polymyalgia rheumatica).
  • Autoimmune diseases, such as Sjogren’s syndrome as well as various forms of lupus (e.g., systemic lupus erythematosus) and antiphospholipid syndrome

Arthritis and Rheumatology

A rheumatoid arthritis treatment plan is usually multifaceted.

A patient's arthritis treatment plan may include:

Disease-modifying anti-rheumatic drugs (DMARDs) – When treatment begins during the early stages of a disease, the rheumatologist may be able to use DMARDs to slow down or even stop the disease processes associated with the inflammatory forms of arthritis. Commonly used DMARDs include Trexall, Arava, Azulfidine and Plaquenil.

Biologic response modifiers – This is a newer class of disease-modifying anti-rheumatic drugs that work in conjunction with one of the conventional DMARDs. Biologic response modifiers include Orencia, Kineret and Humira.

Targeted synthetic disease-modifying anti-rheumatic drugs – These drugs are used when conventional DMARDS in conjunction with the biologic response modifiers have been ineffective. These medications include Olumiant, Rinvoq and Xeljanz.

Steroids – Medications such as oral prednisone and steroid injection help reduce the swelling that slowly damages the joint. Since the inflammation decreases, so does the patient's pain level.

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) – Advil, Aleve and Motrin IB. When necessary, the rheumatologist can prescribe stronger NSAIDs.

Physical and occupational therapy – During these sessions, patients learn specific exercises designed to keep their joints flexible. In addition, new ways to complete daily tasks and reduce the amount of stress placed on the joints may also be explored.

Assistive device recommendations – Assistive devices include a knife with a handgrip to protect the joints of the wrist and hand while cutting, as well as buttonhooks to help the patient while dressing.

If these non-surgical, conventional treatments are ineffective, surgical intervention may be necessary. Since rheumatologists do not perform surgery, patients are referred to one of NENA's orthopedic surgeons.

Osteoporosis and Rheumatology

Osteoporosis is a disease that causes thinning of the bones. In order to help increase the density of the bones, a patient's osteoporosis treatment plan will include medication designed to increase his or her bone density.

Bisphosphonates

These medications are taken to increase bone density.

Osteoporosis medicines include:

  • Fosamax (Alendronate).
  • Zometa (Zoledronic acid).
  • Boniva (Ibandronate).

Taking these medications as prescribed reduces the likelihood of the patient experiencing side effects (e.g., abdominal pain, nausea).

Denosumab (Xgeva, Prolia).

Patients receive this osteoporosis treatment every six months via an injection.

Bone-building medications include:

  • Tymlos (Abaloparatide) – This drug is similar to the hormones released from the parathyroid gland. The hormones the gland releases regulate calcium. Tymlos is injected daily. Its use is limited to two years.
  • Forteo (Teriparatide) – This medication stimulates bone growth. It is administered via an injection. Use is limited to two years.
  • Evenity (Romosozumab) – This drug is administered via a monthly injection. Use is limited to a year.

 

Once a patient stops taking bone-building medications, he or she will usually need to take another osteoporosis medication to maintain the new bone that grew in during the osteoporosis treatment.

 

Pain Medicine

What Is Pain Medicine?

Pain medicine is a medical specialty like neurology or internal medicine. A physician with this specialty studies pain, pain management, prevention, evaluation, treatment, and rehabilitation for people in pain.

People suffer pain for many reasons, but it typically falls into three categories:

  • Direct tissue injury or disease
  • Nerve injury or disease
  • Mixed tissue and nerve injury or disease

 

Pain management doctors create a care plan to manage the pain based on the cause. The treatment plan for arthritis would likely differ from that for a stroke or chronic back pain. It’s the job of a pain management specialist to create a treatment based on each patient's specific needs.

Benefits of Pain Management Clinics

The NENA Division of Pain Medicine consists of pain management specialists with advanced training in the evaluation and treatment of a variety of painful conditions. Pain specialists are physicians who most commonly begin training in anesthesiology or physiatry.  Board Certification is achieved after a Fellowship in Pain Medicine accredited by the American College of Graduate Medical Education.

We serve the needs of patients suffering from a wide range of painful disorders. Pain can be a multidimensional problem, as varied as the individuals who suffer from pain. Treatment works best when patients are evaluated and treated with access to an integrated team.

The ability of NENA Pain Medicine specialists to coordinate care with our Neurosurgeons, Neurologists, Physiatrists, Rheumatologist, Psychologist and Psychiatrists is unique and truly exceptional to find outside of the large academic medical centers in Boston. Treatment is designed to meet the physical, psychosocial, and vocational needs of each person.

The ultimate goal is to increase function and diminish pain and its influence over daily activities. Each patient is encouraged to learn how to participate in treatment for his or her own well-being.

Seeking treatment at a pain management clinic ensures you meet with a specialist who has extensive pain management training. 

Pain can have a significant impact on your overall health and healing. The staff at a pain management clinic have the skill set to control pain so that you can feel and heal better.

Neurosurgery

What Is Neurosurgery?

Differing from neurology, Neurosurgery is the medical specialty concerned with the diagnosis and treatment of patients with injury to, or diseases/disorders of the brain, spinal cord and spinal column, and peripheral nerves within all parts of the body.

Neurosurgery refers to surgery of the nervous system. The nervous system is made up of two core parts:

  • The central nervous system — The brain and spinal cord
  • The peripheral nervous system — Nerves that branch off from the spinal cord and go throughout the body. 

 

Neurosurgery could involve surgery on either of these two core sections. For example, surgery on the brain would be a form of neurosurgery. So, would the surgical repair of nerves in the hand. 

Neurosurgery is done by neurosurgeons who train and specialize in this unique kind of surgery. A neurosurgeon must graduate from an accredited medical school then complete one year of surgical internship in neurosurgery. After that first year, they must complete a seven-year residency program in neurosurgery.

What Is a Neurosurgeon? What does a Neurosurgeon do?

A physician who specializes in neurosurgery.  Neurosurgeons are not just brain surgeons, they are medically trained neurosurgical specialists who help patients suffering from back and neck pain as well as a host of other illnesses ranging from trigeminal neuralgia to head injury and Parkinson's disease. Dependent upon the nature of the injury or disease a neurological surgeon may provide surgical and/or non-surgical care.

Neurosurgery and Spine

Along with being skilled brain surgeons able to diagnose head injuries and a number of other conditions, our team of neurosurgeons are also talented spine surgeons with the ability to diagnose and treat lower back pain and upper back pain. All our providers work closely together in diagnosing back and spine issues. Read about our comprehensive spine program to learn more.

What is the Difference Between Neurosurgeons and Orthopedic Spine Surgeons?

Both neurosurgeons and orthopedic surgeons who have completed fellowship training in spine surgery are equally well qualified for most of the typical spine operations. There are a few types of spine surgeries in which one specialty tends to be more qualified than the other, such as:

  • Neurosurgeons tend to be more qualified to perform intradural surgery (surgery inside of the dura in the spinal cord), such as thecal sac tumors.
  • Orthopedic surgeons tend to be better qualified to do spinal deformity surgery, such as scoliosis.

A neurosurgeon is trained to operate on the nervous system, including the spinal cord but is not limited to it. An orthopedic spine surgeon specializes in the spinal cord and all its structures. That would include the bony areas, the supportive connective tissue, and the cord itself.

Today, neurosurgeons and the best spine surgeons both do any procedure involving the spine.

 

Questions about neurosurgery or spine surgery? Contact New England Neurological Associates today to learn more.

 

 

 

Questions to ask your Spine Surgeon

Neurology

What is Neurology?

Neurology is an area of medicine that relates to the structure, function, and diseases affecting nerves and the nervous system, including the brain and spinal cord.

Doctors who specialize in neurology, called neurologists, go through extensive education and training before they can become board-certified physicians. The typical path for a neurologist includes four years of college, four years of medical school, and four years of residency.

Many neurologists choose to spend an additional one to two years in fellowship programs where they can receive training in specific subspecialties or diagnoses, including epilepsy, sleep medicine, and pediatric neurology.

Additional information can be found under Health Topics.

Our Diagnosis Process

When a doctor suspects that a person's signs and symptoms could be caused by a neurological condition, they will rely on a range of techniques and tests to help confirm a diagnosis.

Most likely, the first technique is a neurological exam. During this exam, your doctor will ask you questions about your personal and family medical history, and use a number of tests to evaluate your coordination, balance, reflexes, vision, speech, hearing, movement, sensation, and in many cases your memory, mood, and behavior.

In some cases, a neurological exam may be enough on its own to confirm a diagnosis. Doctors may also order or perform additional imaging or testing techniques, including:

  • Angiography
  • Biopsy
  • Brain scan (MRI and CT scan)
  • Brainstem auditory evoked potential (BAEP)
  • Electroencephalogram (EEG)
  • Electromyogram (EMG)
  • Evoked potential (EP)
  • Genetic testing
  • Laboratory testing, including blood, urine, and cerebrospinal fluid tests
  • Myelography
  • Neurological scan of the spine
  • Neurological CT scan (brain and spine CT scan)
  • Positron emission tomography (PET)
  • Polysomnogram
  • Somatosensory evoked potential (SEP or SSEP)
  • Ultrasonography
  • Visual evoked potential (VEP)

 

These aren't all the tests your doctor may order for you or your loved one if they suspect a neurological condition. Additional tests could be useful to rule out other conditions. Sometimes, your doctor might refer you to other medical specialists, as well, in case other underlying health issues are suspected.

Before you undergo any test or diagnostic procedure, your doctor will go over what to expect during the test and give you a chance to ask any questions you might have

Neurology Treatments

Thanks to exciting advances in the field of neurology, we now have a wide range of treatments available to help people living with neurological conditions. Selecting the right treatment depends on factors like a patient's condition, health status, age and goals.

Medications are often prescribed to help slow the progression of a neurological condition or manage its symptoms. Sometimes, surgery is beneficial for removing tumors or other invasive procedures that may help control or improve a person's function and quality of life.

A neurologist also helps coordinate and collaborate with other healthcare providers to ensure patients receive multidisciplinary and individualized care for their condition, including physical, occupational, and speech therapy, lifestyle modifications, and psychotherapy.

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