denver-musculoskeletal-pain-management

Spinal procedures are minimally invasive injections used to treat or diagnose various conditions that cause pain and impaired function in the back, neck, shoulders, arms, buttocks and legs. Spinal procedures are a conservative treatment option to manage pain in lieu of back surgery, or when the patient is not a candidate for surgery. CROM physicians perform spinal procedures to all levels of the spine; Cervical, Thoracic, and Lumbar. Our injectionist physicians are board-certified in Physical Medicine & Rehabilitation, and perform spinal procedures under the safety of fluoroscopic guidance in a surgical suite. We perform the following spinal procedures:

Epidural Steroid Injections

Epidural Steroid Injections are used to treat symptoms of radiculopathy and sciatica. Radiculopathy can be caused by Stenosis, the narrowing of the openings through which nerves exit the spine. Stenosis can exert pressure on the nerves of the spine, which can cause pain in many parts of the body. Stenosis can be caused by herniated disc (bulging disk), degenerative disc disease, and arthritis.

Epidural Steroid Injections deliver low doses of long-lasting corticosteroids directly to the source of the pain. Corticosteroids are potent anti-inflammatory pain medications that reduce the swelling caused by stenosis, thereby reliving pressure on the nerves, and relieving pain.

Facet Joint Injections/ Medial Branch Blocks

The small joints of the spine, which support the body when bending, flexing and twisting, are called facet joints. Like all joints in the body, they can become injured or arthritic, and can produce chronic and acute pain known as facet syndrome. Facet Joint Injections deliver low doses of long-lasting corticosteroids directly to the source of the pain around the nerves to reduce inflammation and manage pain.

Medial Branch Nerves feed out from the spine around the facet joints. Inflamed facet joints can cause pain in these nerves. A Medial Branch Block is a diagnostic procedure that delivers temporary anesthetic to the Medial Branch Nerve suspected of generating pain. If the patient experiences immediate relief of pain following the Medial branch Block, then the source of pain has been identified, and a Facet Joint Injection or Radiofrequency Neuro Ablation may be performed to achieve long-lasting pain management.

Selective Nerve Root Blocks

Selective Nerve Root Blocks deliver anesthetic to a pain generating nerve. They can either be diagnostic, or therapeutic.

Radiofrequency Neuro Ablation (Rhizotomy)

Radiofrequency Neuro Ablation uses high frequency radio waves to heat the tip of a specialized needle which is precisely applied to a pain generating Medial Branch Nerve. The heat interrupts the nerve’s ability to send pain signals, which effectively “turns it off”, giving the patient long-term relief from the pain.

Occipital Nerve Blocks

An Occipital Nerve Block an office-based injection used to treat various types of headaches, including migraines. Local anesthetic with or without a small dose of corticosteroid may be used, which is administered to the back of the head.

Sacroiliac Joint Injection

The Sacroiliac Joint is where the spine joins the pelvis. An inflamed Sacroiliac Joint can cause pain in the low back as well as the groin, abdomen, hip, buttock or leg. An injection containing anesthetic or low doses of long-lasting corticosteroids can manage the pain.

Discography (Discogram)

This is a diagnostic procedure used to determine your source of pain. Under live fluoroscopic guidance, the Discography injects a small amount of dye into an intervertebral disc, which then exposes structural damage in the disc. Discography is often ordered by spine surgeons for surgery planning.

Spinal Cord Stimulator Trials

A Spinal Cord Stimulator is a small implanted device that sends electrical surges to the spinal cord through electrodes to manage pain in the back. The stimulator consists of several small components, including a battery that lasts up to 10 years, which can be passively recharged. The patient self-adjusts an external remote to control the strength of the stimulator. CROM performs Spinal Cord Stumulator Trials, where the electrodes are inserted to the area of pain for a short period of time, before the actual device is surgically implanted.

For what conditions can Spinal Procedures treat/diagnose pain?

  • Herniated Disc
  • Degenerative Disc Disease
  • Sciatica
  • Facet Syndrome
  • CRPS (Chronic Regional Pain Syndrome)
  • Radiculopathy
  • Facet Joint Arthritis
  • Hip Joint Arthritis
  • Sacroiliac Joint Dysfunction
  • Chronic Back Pain
  • Migraine Headache

How should you prepare for your Spinal Procedure?

Please do not eat or drink anything 8 hours prior to your injection. If you have any questions regarding taking your medications the day of your procedure, please call our office prior to your appointment so that we can check with the physician.

Please make arrangements to have someone available to drive you home after your injection. This is to ensure your ultimate safety and comfort following your procedure. It is our policy not to perform a spine procedure if a patient has not arranged for transportation home.

Children are prohibited from being present in the procedure room. Please make necessary child care arrangements in advance of your appointment.

Please notify the CROM physician performing your procedure if you have any allergies to medications.

What to expect from the Spinal Procedure:

The entire procedure generally takes 45 to 60 minutes. Your physician will clean your back and position you either sitting up, bent over a table, or lying on your side with your knees bent and tucked up under your chin. Once you are properly positioned, your physician will perform your interventional spine procedure. You may feel some pressure in your spine during your injection. We will continue to monitor you after your procedure. You will be advised on ways to diminish any soreness or discomfort you may feel after your procedure. Once the monitoring period is completed, you are free to leave. You are advised to eat within an hour or two after your procedure. Our office will contact you the day after your injection to check on you.

CROM performs Electrodiagnositc testing, including Elctromyograph (EMG) and Nerve Velocity Conduction (NVC) studies. Electrodiagnostic medicine tests nerve transmissions between muscles and nerves, or how well your nerves and muscles “communicate”.

Electrodiagnstic studies generally take approximately 60 minutes. There are no activity restrictions before or after the test, and there are no lasting effects. Electrodiagnostic scans evaluate weakness, numbness, pain, and symptoms such as fatigue, cramps, and abnormal sensations in the muscles.

During an EMG, the physician studies the electrical activity in muscles by inserting a fine needle electrode into selected muscles. Needle insertion may cause mild, temporary discomfort. The needle is not used for injection and no shocks are given. The physician can determine whether the muscle is working normally by viewing the electrical activity displayed on a screen, while listening to audible transmissions.

To perform the Nerve Conduction Study, the physician tapes small metal electrodes onto the skin and applies a brief electric stimulus to one portion of the nerve. Nerve stimulation will cause a tingling sensation. The physician can then evaluate the electrical response of the nerve or muscle and determine if the nerve impulse is conducted normally.

Download/Print Refferal Form for Autonomic testing Battery and Thermography

CROM provides 2 diagnostic tests for Complex Regional Pain Syndrome (CRPS); Quantitative Sudomotor Axon Reflex Test (QSART) and Infrared Stress Thermography.

What is Complex Regional Pain Syndrome ?

Complex regional pain syndrome (CRPS) is an uncommon neurological condition characterized by pain, inflammation and changes in the skin sensation and appearance. Patients may have a burning sensation in the arms, legs, hands or feet. Treatments are available for this condition, and the disease can be mild or severe, and wide variation is seen in different patients in the course of this condition over time.

The condition has been known by many different names in the past including, most recently, reflex sympathetic dystrophy (RSD). There is no agreement on the cause of CRPS.

Generally, injury, immobilization, or previous surgery may be a catalyst for the onset of symptoms, but it is not understood why or how complex regional pain syndrome uncommonly occurs in some patients, even though most patients heal without problems. In very rare cases, no evidence of prior injury can be identified prior to the occurrence of CRPS.In general, treatment is more successful when initiated early in the course of the condition, so early and accurate diagnosis is very important.

Diagnostic Tests for Complex Regional Pain Syndrome

Stress Thermography

In patients with Complex Regional Pain Syndrome, abnormalities of the sympathetic nervous system are present. Generally, there is more variability than normal in the function of this part of the nervous system. Since the blood vessels, which control skin temperature, are controlled by the sympathetic nervous system, there are often abnormalities in skin temperature present in patients with this problem which can be used to diagnose the presence or absence of Complex Regional Pain Syndrome.

Normally, the body maintains quite similar temperatures from side to side. Even if slight temperature differences are present, these differences usually are not persistent when the overall body is exposed to cold stress. Different specific patterns of side to side temperature differences may reflect medical problems in the underlying muscle, joints, nerves, or blood vessels. There are some patterns of temperature differences which can indicate the presence of complex regional pain syndrome.

Thermography is a visual mapping of skin temperature recorded by a specialized camera sensitive to the infrared spectrum. To diagnosis CRPS, three sets of 10 to 12 images each are recorded with the patient exposed to a cold stress (67 degrees Fahrenheit) environment. When a specially trained physician evaluates thermographic images obtained in accordance with specific standard protocols, a determination can be made in most cases whether CRPS is present or not.

The Colorado Division of Workers Compensation Medical Treatment Guidelines require that two objective tests be positive to diagnose confirmed CRPS. Both Stress Thermography and the Autonomic Testing Battery (see below) are listed as objective tests which may be used to diagnose CRPS. Colorado Rehabilitation and Occupational Medicine is the only medical practice in Colorado performing both diagnostic evaluations. CROM physicians Dr. Tashof Bernton and Dr. George Schakaraschwili have received advanced training in obtaining and interpreting diagnostic thermographic testing and are both physicians are certified by the American Academy of Thermology.

Autonomic Testing Battery/ Quantitative Sudomotor Axon Reflex Test

Colorado Rehabilitation and Occupational Medicine also offers the Autonomic Testing Battery as a diagnostic test for Complex Regional Pain Syndrome.

Temperature and sweating are both controlled by the sympathetic nervous system and normally both functions are symmetric from side to side in the arms and in the legs. In Complex Regional Pain Syndrome, the sympathetic nervous system has abnormalities resulting in greater than normal variation in these functions. By measuring baseline temperature, baseline sweating, and sweating after stimulation with acetyl choline (a naturally occurring neurotransmitter which stimulates the sweat glands) the amount of variation in these functions from side to side can be evaluated in a quantitative manner. This last test (measurement of sweating after stimulation with acetyl choline), is also known as the Quantitative Sudomotor Axon Reflex Test or QSART. Sometimes, the entire Autonomic Testing Battery is referred to informally as a “QSART” test, although technically the QSART is only one component of the Autonomic Testing Battery.

The results of the entire Autonomic Testing Battery are integrated with a clinical examination of the patient to determine whether or not the patient meets diagnostic criteria for Complex Regional Pain Syndrome.

Colorado Rehabilitation and Occupational Medicine Physicians Dr. George Schakaraschwili and Dr. Tashof Bernton have attended advanced training at the Mayo Clinic in the administration and evaluation of the Autonomic Testing Battery and have performed Autonomic Testing for over 10 years.

The Autonomic Testing Battery begins with thermographic imaging to measure resting skin temperatures. Next, small plastic cups will be placed on the patient’s skin to measure resting sweat output. The procedure is painless.

After these baselines have been established, physical therapy iontophoresis pads are placed on the skin to deliver a naturally occurring nerve chemical, acetylcholine, to stimulate the sweat glands. Sweat output is measured after this stimulation and side to side comparisons are performed. You may experience slight tingling in this test, but it is not painful and needles are not used. The entire process will takes 2-3 hours.

Testing Requirements-Both Thermography and ATB

All medications must be reviewed by CROM physicians prior to your testing. There are some medications which can interfere with the testing protocol, and these medications may need to be stopped for a period of time prior to the test. If you are on any medications which may interfere with the test, CROM physicians can speak with you or your physician if there are any questions regarding the safety of temporarily stopping specific medications, or if alternative medications that do not interfere with the test are appropriate for the few day period that some specific medications may need to be held.

Before the test:

  • Do not smoke at least 20 minutes before the test.
  • Do not take over the counter medications 7 days prior to the test without consulting our physician.
  • Do not use any lotions, deodorants, creams or any topical medications for 48 hours prior to the testing.
  • Avoid excessive amounts of caffeine for 4 hours prior to the test.
  • Eat lightly and do not drink hot or iced beverages for 2 hours prior to the test.

Treatment of Complex Regional Pain Syndrome

Treatment of CRPS generally includes mobilization of the involved area and physical therapy. This may be a difficult balance, as activity may be painful, but immobilization or splinting of the involved area generally predisposes to further progression of the condition. Medications are employed that are targeted at different aspects of the problem. Generally, treatment involves use of anti-neuritic medications such as gabapentin or pregabalin, as well as centrally acting agents such as duloxetine (or use all trade names), and frequently topical agents are utilized which target receptors directly in the areas of involved skin. Analgesic medications may be required to treat pain.

An important aspect of the treatment of Complex Regional Pain Syndrome is the use of injections that temporarily interrupt the function of the sympathetic nervous system. Improvement following these “blocks” may vary from mild response to resolution of symptoms, and may last from short periods to long term improvement. Frequently, if a patient receives improvement from an initial block, repeat blocks may provide more marked and longer term relief. Frequently used injections include injections to anesthetize the sympathetic nervous system for either a right or left arm or leg (sympathetic block). Some patients respond better to more central injections (epidural steroid injections) together with blocks of involved peripheral nerves.

Blocks are used more frequently in the initial and early treatment of CRPS, and have a much more limited role in chronic management of the condition. Multiple Colorado Rehabilitation and Occupational Medicine physicians are skilled in performing these injections.

As the cause of Complex Regional Pain Syndrome is not understood, the severity of the condition varies greatly, and there are multiple different potential treatment approaches, treatment of this condition is individualized, and there is no single approach to treatment that is appropriate for all patients with this condition.

Diagnostic Musculoskeletal Ultrasound

Musculoskeletal ultrasound offers an excellent complimentary imaging technique to traditional methods such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) studies. The reasons are simple; ultrasound is the most cost effective imaging procedure available other than plain x-ray. Unlike CT and x-ray, ultrasound is effective at imaging soft tissue. In addition, musculoskeletal ultrasound is a dynamic imaging technique – allowing the physician to evaluate function through range of motion planes. This allows pathology to be seen that may not be visible in a static CT or MRI, such as shoulder impingement. Most importantly, ultrasound is non-painful, non-invasive, emits no radiation, and allows the patient to watch while his/her anatomic structures are being imaged on a video monitor. Unlike other imaging modalities, claustrophobia is not a concern for patients who undergo a sonogram. Likewise, there are no contraindications (like allergic reactions or fasting restrictions) associated with a sonographic analysis.

Interventional Musculoskeletal Ultrasound

Musculoskeletal ultrasound is also an excellent guidance technique for injections into joints or other musculoskeletal regions. CROM physicians regularly use ultrasound guidance for in-office injections, including peripheral joint injections, Piriformis injections, Platelet Rich Plasma therapy, and Stem Cell therapy.

What Are Stem Cells?

Stem cells are cells that can locate injuries within the body and are capable of transforming into cartilage, muscle and other specialized cells. This is why they are so appealing for regenerative medicine solutions.

What Is CROM Stem Cell Therapy?

CROM physicians are Board Certified in Physical Medicine and Rehabilitation. Our Musculo-skeletal specialists administer tissue grafts containing Stem Cells directly into an injury site (through ultrasound or X ray guidance) to help regenerate cartilage, tendons and muscle in order to provide pain relief and increased function.

Who Is a Good Candidate for CROM Stem Cell Therapy?

Patients who have chronic joint, muscle or tendon conditions that have not responded to traditional treatment. Also, patients who do not wish to consider surgery for labral tears, partial thickness rotator cuff tears, a knee or hip replacement or have other severe arthritic or tendon problems may wish to consider stem cell therapy. In some cases, stem cell therapy may be appropriate for treatment of spinal conditions.

Why Use Stem Cell Therapy?

Under usual circumstances, the body’s ability to repair and replace damaged cartilage, tendons, or other specialized tissue in adults is limited. Use of bone marrow concentrate or amniotic tissue grafts may offer the ability to help repair these tissues. Stem Cell Therapy is only performed after an initial consultation by a CROM Physician specializing in Musculo-Skeletal Care. The physician will review your medical history, perform a clinical examination, and discuss stem cell treatments as well as other potential treatments in order to give you the information necessary for you to determine if stem cell therapy is the best option.

How Is Stem Cell Therapy Performed?

1. Obtain tissue containing stem cells through a simple procedure that concentrates your own bone marrow. This marrow contains stem cells, platelets, and other factors which promote tissue growth. Or, a graft of amniotic tissue from a specially selected and screened donor (which also contains stem cells) may be used. This is obtained in advance and – because of the unique properties of amniotic tissue – no tissue typing is required, and there is no rejection of this type of graft.

2. Whichever approach you and your CROM Physician specialist select, your doctor will numb the site of injection with a local anesthetic.

3.The Bone Marrow Concentrate or amniotic tissue graft will be administered by your CROM Physician through an ultrasound-guided injection. In some cases, X-ray guidance may be used.

4.You will then be able to relax and let the tissue graft get to work. Your CROM Physician Specialists will discuss an appropriate follow up and, if indicated, rehabilitation program with you. In most cases, there are few activity restrictions required, and no restrictions on usual activities such as driving.

Where Do Your Stem Cells Come From?

We utilize two types of tissue grafts containing stem cells:

Amniotic Tissue Graft Stem Cells- Amniotic tissue is collected under sterile technique from screened donors at the time of cesarean section.

Grafts of amniotic tissue (which include stem cells) from a donor do not involve fetal tissue, nor is there any harm to a fetus, baby, or mother in obtaining these stem cells from the donor. This type of stem cell therapy is not opposed by the Catholic Church or any other group on religious or ethical grounds.

Bone Marrow Graft Stem Cells-Bone marrow tissue containing stem cells is obtained by a simple aspiration procedure from your own bone marrow, and then concentrated before injection at the site of injury.

Does insurance cover Stem cell Therapy/How Much Will It Cost?

Most insurance companies do not cover Bone Marrow Aspirate Concentrate or Amniotic Tissue Graft at this time. However, we have had some success with worker’s compensation coverage for this treatment, and many insurance companies may cover the initial consultation as well as some aspects of the treatment, such as the ultrasound or X-ray guidance and follow up appointments.

CROM’s self-pay pricing is very competitive and we strive to provide this treatment as cost-effectively as possible. The cost of Bone Marrow Aspirate or Amniotic Tissue Graft Stem Cell treatments varies depending on the site of injury, the amount of graft material required, and whether or not Bone Marrow Aspirate or Amniotic Tissue Graft is utilized. Because of this, final prices can be determined after an initial consultation with your CROM Physician Specialist. Please contact us for more information.

What is Platelet Rich Plasma Therapy?

Platelets are small biological packages that normally circulate in the blood. They contain blood clotting factors as well as many growth factors. The growth factors promote healing by encouraging the growth of news blood vessels to help heal tendons, ligaments, and cartilage. This healing ability can be harnessed by drawing a small amount of your blood, placing it in a centrifuge to concentrate the platelets, and re-injecting the concentrated platelet-rich plasma (PRP) where your body needs help healing muscles, joints, or tendons. Because joint linings, tendons and ligaments receive very limited blood supply, injecting them platelet-rich plasma can encourage the growth of new blood vessels and be of great benefit.

Who is a good Candidate for CROM PRP Injections?

Patients with osteoarthritis, chronic tendonitis (tennis elbow, Achilles tendonitis, rotator cuff tendonitis etc), plantar fasciitis, or other chronic injuries or musculoskeletal or arthritic conditions including knees, ankles, and wrists that have not gotten better with traditional therapy. Increasingly, medical research is demonstrating that steroid injections may have some negative long term effects on tendon strength and joint surface. Recent studies have shown PRP injections are a superior treatment in some circumstances.

Why use PRP?

The body’s ability to repair and replace damaged cartilage, tendon, or other specialized tissue in adults is limited. Injured joints or tendons can be a source of chronic pain and can limit activities. PRP therapy can harness the body’s own healing ability to allow more complete healing than other alternatives. Furthermore, PRP is a natural treatment that uses nothing more than your body’s own blood.

How are PRP injections performed?

First, you will be seen by a CROM physician to determine if you are an appropriate candidate for PRP. This may include an ultrasound examination to determine the condition of your joints and/or tendons.

If PRP is deemed an appropriate treatment for you, it will be performed on a second appointment, which is a brief, simple, in-office procedure.

Step 1: A small amount of healthy blood is drawn from your arm.

Step 2: The platelet-rich plasma is separated from your blood using a centrifuge.

Step 3: The platelet-rich plasma is re-injected to the injured area, usually under ultrasound guidance.

The treated area will be numb for about an hour, and you may experience soreness or moderate pain for a few days after the injection. Your doctor will discuss rehabilitation with you and whether any bracing, physical therapy or limitations on activities will be required. In most cases normal activities, including driving, can be resumed immediately after the injection.

I’ve heard of Stem Cells…What’s the difference between Stem Cells and PRP?

CROM also performs Stem Cell Therapy. Stem cells are capable of transforming into cartilage, muscle, and other specialized cells. Stem Cells may offer a more powerful regenerative healing approach to more seriously damaged tissue, but are more expensive than PRP injections. CROM obtains stem cells either from the patient’s own bone marrow or from Amniotic Tissue Grafts containing Stem Cells from a screened donor. While stem cell injections may be optimal in severe cases, PRP provides sufficient healing potential for patients with more moderate conditions.

How Much Will it Cost?

In general, insurance covers the initial physician consultation, ultrasound diagnostic evaluations, and follow up medical visits. Most insurance does not cover the cost of the PRP injection itself, but CROM costs are competitive and are available by calling. If you have no insurance, cash prices for all of the services involved are available as well.

Does Insurance Cover PRP Injections?

PRP injections are included in the Colorado Workers’ Compensation Treatment Guidelines, and generally, Workers’ Compensation Insurance covers PRP injections. Other commercial insurances do not usually cover PRP injections. If you have commercial insurance that does not cover the PRP injections, you will still pay no more than the cash pay price above for the injections alone.

How do I get Started?

CROM Physicians perform PRP injections (as well as Stem Cell Therapy) at multiple offices in the Denver area. Our offices are listed on our website at Coloradorehab.com, or you can call 720-279-4497 ext 0552 to find out more about PRP injections and to schedule an appointment.

For out-of-state patients, you can call the above number for more information and, if you wish, one of our physicians will review your records and set up a phone conference to help you determine if you are an appropriate candidate for this treatment. There is a one-time fee for this service for patients who are unable to come in for an initial consultation.

Spasticity is a disorder resulting in abnormal muscle contractions and stiffness that is caused by damage to the spinal cord or brain. It is a common condition in people with brain and spinal cord trauma, stroke, multiple sclerosis, aneurysm, tumors, and hypoxia. In spasticity, overactive neurotransmitter uptake causes constant or abnormal muscle contractions. Spasticity can be managed with various medications, and muscular therapeutic Botox injections. Therapeutic Botox is an agent known to inhibit the abnormal uptake of neurotransmitters, thus giving temporary relief of spasticity symptoms for 3-10 months. CROM physicians manage the following incidences of spasticity:

  • Upper Limb Spasticity
  • Cervical Dystonia
  • Myofacial Pain

CROM also treats chronic migraines with therapeutic Botox injections. Therapeutic Botox can relieve chronic migraine by relaxing tense muscles in the head and blocking pain signals. therapeutic Botox treatment for chronic migraines is typically administered every 12 weeks.

CROM offers comprehensive consultations for traumatic brain injuries as well as neurological disorders including Botox injections for cervical dystonia, upper extremity spacticity, and chronic migraine, and Electrodiagnostic Medicine (EMG/NVC).

What Defines a Mild Traumatic Brain Injury?

  • Any period of loss of consciousness
  • Any loss of memory for events immediately before or after the accident
  • Any alteration in mental state at the time of the accident (e.g. feeling dazed, disoriented or confused)
  • Focal neurological deficit(s) that may or may not be transient
  • The severity of the injury does not exceed the following:
    1. Post traumatic amnesia (PTA) less than 24 hours
    2. After 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15
    3. Loss of consciousness of 30 minutes or less

Determining Grades of Concussion

  • Grade 1: Signs and Symptoms of Concussion that last < 15 Minutes
  • Grade 2: Signs and Symptoms of Concussion that last > 15 Minutes
  • Grade 3: Any loss of consciousness

Signs & Symptoms of Concussion

  • Loss of consciousness
  • Vacant stare
  • Delayed responses
  • Incoherent speech
  • In-coordination
  • Inappropriate
    Emotionality
  • Memory Problems

DSM-IV Definition of Post-Concussive Syndrome:

  • Fatigue
  • Sleep disorder
  • Headache
  • Anxiety
  • Apathy
  • Irritability / Aggression
  • Vertigo / Dizziness
  • Depression / Lability
  • Personality changes

Outcome for Mild TBI Patients

A majority of mild TBI patients make a full recovery within three months of the injury. (Binder, Rohling, and Larrabee 1997; Rutherford, et.al., 1979; McLean, et.al., 1983)

However, the size of the minority who become chronically symptomatic varies from 7-8% (Binder, 1997) to 10-20% (Alexander, 1995) to an even higher estimate of approximately one third (Rimel, et al, 1981).

General agreement exists in the literature that a minority of mild TBI patients experience persistent symptoms.

CROM’s mission for patients in pain is to help them recover as much function as possible and return to a happy, active life. Our approach with pain management is to facilitate healing the source of pain rather than suppressing pain symptoms with sedating medications. CROM uses musculoskeletal treatments that initiate the body’s own healing mechanisms, which reduce the inflammation that causes pain, and ultimately heal the source of the pain. This is in contrast to using narcotics/opiods/sedating medications as the staple to mitigate pain.

While short term medications may help, particularly with acute pain, CROM’s goal with long term pain management
is to avoid, reduce, and, as often as possible, eliminate the patient’s reliance on sedating or narcotic medications. In many cases of long-term medication use, pain-producing pathology is no longer evident, and the use of medications exists out of dependency. In these cases of “medication management”, CROM chooses not to perpetuate this potentially harmful practice to patients. In situations where patients come to us on levels of pain medications that are not congruent with the pain-producing pathology present, musculoskeletal treatment options will be given to the patient to reduce their reliance on medications.

CROM endeavors to treat pain using our spectrum of safe, non-invasive treatments performed by specially trained, board certified physicians. These may include Interventional Musculoskeletal Procedures (back and joint anti-inflammatory injections), Stem Cell Therapy and Platelet Rich Plasma injections, and Medical Acupuncture and Osteopathic Manipulation. CROM also provides psychological services to help patients take control of and overcome their pain, in order to return to a more normal level of functioning. CROM also refers patients to our trusted network of Physical Therapists and exercise program specialists to engage the body’s own healing processes.

CROM does not treat pain that is not musculoskeletal in origin.

Automobile accidents affect the whole person-in addition to pain, there may be financial or medical worries that create anxiety. Furthermore, some component of post concussion syndrome may be present, even without loss of consciousness. Patients need to have access to a spectrum of care-expert care of musculoskeletal injuries, of course, but also access to psychological services, and alternative care such as manipulation and acupuncture. For more significant injuries, expert specialized services such as spinal facet or epidural injections may be necessary.

Why should you refer your patient to CROM?

CROM provides a complete spectrum of musculoskeletal and psychological care in one practice, reducing the need for subsequent referrals to multiple specialists. We have physicians of multiple specializations, including Physical Medicine and Rehabilitation; specialists in treating patients with acute pain, injuries and stiffness associated with automobile accident injuries.

Our psychologist is board certified in Neurorehabilitation, and specializes in treating patients with head injuries and pain. For alternative treatments, CROM has board certified Doctors of Osteopathy who perform acupuncture and manipulative treatments. If rehabilitation is necessary, CROM works with an excellent cadre of external Physical Therapists to promote healing.

If your patient requires more advanced care, including non-surgical spinal procedures, CROM’s injectionists are fellowship trained, including in pain management, from some of the finest programs in the country to provide these services.

How is CROM different from other specialized providers of care to patients in Automobile Accidents?

CROM physicians are true experts in their fields. In addition to providing care for patients with automobile injuries, our physicians treat a wide spectrum of acute and chronic musculoskeletal conditions incorporating both traditional and alternative care-as well as cutting edge treatments such as Platelet Rich Plasma and Stem Cell Therapy. There is no “cookie cutter” approach to the treatment of automobile injuries at CROM. With a complete spectrum of care available, our goal is to select the right individual program for each patient. For example, while we have fellowship-trained physicians available to provide spinal injections-most of our patients do not require these treatments. Our goal is treat your patient the same way we would treat our own family.

How soon can my patient be seen?

We know what it’s like to be in pain, and we want to help. We have a special hotline for appointments for patients in automobile accidents. For patients with acute injuries within the previous 10 days we will have an appointment available with two business days. For all other patients with automobile accident related injuries, appointments are available within one week (although if you want to refer to one specific CROM physician, the timing of the appointment will be based upon that physician’s availability).

How does the CROM Cares Program relate to my care of the Patient?

You continue to play the role that you choose as the patient’s primary care provider. You will receive regular medical reports from the CROM care of your patient, and you can either continue to see the patient and direct care as the primary care provider, or if you wish, CROM physicians can assume care for the patient’s automobile accident-related injuries. In either case, CROM does not offer primary care medical services, and you continue as the patient’s primary care provider.

How do I make an appointment?

Call our Auto Accident Referral Hotline at (303) 306.2407. We accept all patients with a recent automobile accident for an initial evaluation without regard to insurance status.

What about payment?

All patients are accepted for an initial consultation and treatment. Most commercial insurances are accepted. For patients who are injured in accidents where they are not at fault, treatment can usually be provided at no up-front cost to the patient through injury finance companies who will work with patient and an attorney to arrange deferred payment out of the settlement of legal action. For patients who have no coverage of any kind, CROM will see the patient for a special cash pay charge of $100 for the initial visit and will discuss payment options for further care.

To schedule an appointment or for more info:

Phone: (303) 306.2407

Email: CROMAuto@coloradorehab.com

CROM provides a number of psychological services including pain evaluations, neuropsychological evaluations, pre-surgical assessments, IME evaluations, cognitive/behavioral therapy in individual and group settings, and cognitive rehabilitation.

Pain evaluations include a 90-minute interview for gathering injury information, medical history, family and social history, and day-to-day functioning issues. Standardized psychological testing is administered on another date in order to determine diagnoses and recommendations. When this information is compiled, the patient meets with Dr. Boyd to review the results and treatment recommendations, if indicated.

The neuropsychological evaluation is the objective measurement of cognitive functioning including memory, attention, and abstract reasoning skills, motor/sensory skills, among others. These skills may be affected by such things as a traumatic brain injury, stroke, and dementia. Cognitive skills may also be affected by such things as stress and anxiety and we include a standardized psychological test to help determine if emotional factors may be interfering with optimum cognitive functioning.

Pre-surgical evaluations to determine a person’s psychological readiness to undergo a surgical procedure.

IME evaluations determine the presence of any mental health diagnoses, including possible etiologies; the functional capacity to perform work duties; the extent to which the mental health diagnoses identified are related to any functional impairments; and any treatment or rehabilitation needs of the claimant, including estimated length of treatment.

Cognitive/Behavioral Therapy is offered in individual or group settings, typically meeting one time per week. Patients usually attend a total of eight sessions, with the possibility of attending two or three monthly sessions after completing the entire course to maintain the skills learned. Examples of Cognitive/Behavioral Therapy topics include: Models of Chronic Pain, Rational Thinking Strategies, Diaphragmatic Breathing, Distraction techniques, Pacing and Scheduling, the Role of Values in Chronic Pain, and Improving Physical Conditioning and Activity Levels.

Cognitive rehabilitation addresses mild/moderate cognitive impairment in order to improve functioning for improvement in day-to-day living situations.

We are available to assist with legal cases that require an expert witness, particularly in areas of mild traumatic brain injury and post-concussion syndrome.