Help Available for Patients
With Complex Back Pain

By Vanessa Orr

For many people with back pain, conservative therapy can be the answer. Yet there are some people whose pain is so severe that it cannot be treated by traditional means, leading to a decrease in overall function, and limiting that person’s ability to participate in activities of daily living.
“While many patients respond to first-line treatment, including activity modification, pain medications, muscle relaxants and physical therapy, there is a subset of patients who do not respond to conservative care and whose pain is quite debilitating,” explained David Provenzano, M.D., medical director of the Institute for Pain Diagnostics and Care at Ohio Valley General Hospital. “These people may have difficulty sleeping, walking or even getting out of bed. Or they may not be able to tolerate the pain medications that they need to take to feel better.”
One innovative treatment offered at the Institute for patients suffering from vertebral compression fractures is percutaneous vertebroplasty, in which bone cement is injected into the weakened or collapsed vertebral body. “What this does is help seal the fracture,” explained Dr. Provenzano, adding that patients feel pain relief in the first 24 to 48 hours after the procedure. “This treatment allows patients to function, to get off of pain medications and to return to their regular activities.”
This treatment can help limit other medical problems that may develop as a result of compression fractures. In the U.S. alone, more than 10 million people have osteoporosis, and an estimated 700,000 osteoporosis related compression fractures occur annually. Compression fractures also result in more than 150,000 hospitalizations each year.
“Percutaneous vertebroplasty can be performed in our office and only requires mild sedation,” said Dr. Provenzano of the procedure. “The cement actually hardens before the person even leaves our office.”
Patients are evaluated two to three hours after the procedure, and come to a follow-up appointment the next week. Approximately 85 to 90 percent of the operations are a success. The procedure is not recommended for patients with bleeding disorders, neurological or anatomical contraindications, and cannot be used to repair old fractures.
Another option for patients who do not respond to conservative treatment is spinal cord stimulation. This treatment is often used for patients who have undergone previous back surgery, have complex regional pain syndrome, or peripheral neuropathic pain. “During this procedure, we stimulate the spinal cord to block the pain signals from reaching the brain,” explained Dr. Provenzano. “We change the chemical makeup of the spinal cord which can help substantially in pain reduction.”
This minimally invasive, outpatient procedure can actually be ‘tested’ by the patient for five days. “We put a small, electric wire within the bony spinal canal, which is connected to an external power generator that is programmed by computer,” said Dr. Provenzano. “The patient wears this for five days, and if it substantially helps to reduce pain and increase function, we progress to putting in an implant.”
The Institute for Pain Diagnostics and Care offers a variety of other options for back pain. Epidural steroid injections can help patients suffering from acute herniated discs in the neck and lower back, and minimally invasive rhizotomy can be used to relieve back pain caused by arthritic joints in the spine.
Cancer pain can be treated through the use of an intrathecal pump, which is a small catheter that is placed into a fluid sac within the spinal canal. “Through this catheter, we release a small quantity of concentrated pain medications to that area,” said Dr. Provenzano. “This treatment has fewer side effects than higher doses of oral medications.”
In all cases and with all treatments, a multimodal pain program is designed for the patient that includes the consideration of minimally invasive interventional pain procedures, physical therapy, medication, relaxation techniques, counseling and more.

For more information on the Institute for Pain Diagnostics and Care at Ohio Valley General Hospital, call (412) 777-6400 or visit www.IFPDAC.org.

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Preventing Falls in Community Dwelling …
The Physical Therapist’s Role
By Nicole Byers, DPT

In 2005, approximately 1.8 million people age 65 and older were treated in emergency departments for nonfatal injuries from falling. Injuries included: bruising, fractures, and traumatic brain injury. In addition to physical injury, people may also acquire a fear of subsequent falls resulting in a decrease in their overall activity level (CDC 2008).
As physical therapists, we have direct contact with people age 65 and older on a daily basis. Our role in working to decrease one’s risk of falling involves identifying those at risk and modifying factors within our scope of practice. We may utilize traditional musculoskeletal tests of strength and flexibility as well as quantifiable functional tests and measures to identify those at risk for falling. Traditional tests and measures help physical therapists determine patient specific programs for improved strength and flexibility. Functional tests are helpful in guiding treatment strategies as well as objectively demonstrating progress toward physical therapy goals.
Centers for Rehab Services physical therapists provide customized rehabilitation programs addressing a multitude of potential factors that may contribute to one falling. Physical therapists may also provide recommendations for assistive devices for safe and independent ambulation. With the expertise of physical therapists specializing in the areas of balance/vestibular, neurological, orthopedic, and women’s health physical therapy, patients are well served in the area of fall prevention.
In addition to the presence of diagnoses physical therapists typically treat, non-musculoskeletal or neuromuscular factors may also contribute to one’s risk of falling. Additional factors may include: visual disturbance, use of multiple prescription medications, poor attention task, and environmental hazards. Consequently, physical therapists may refer patients to other health care practitioners for a multi-factorial approach to fall prevention.
Simple recommendations for improved safety include:
• adequate lighting and clear walkways in the home
• removal of throw rugs
• use of appropriate safety and assistive devices for activities
of daily living.

Nicole Byers is a Physical Therapist at Centers for Rehab Services. For more information, call 1-888-723-4277 or visit www.upmc.com/crs.

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Team Concept Leads HealthSouth Harmarville
By Ron Paglia

Ask him about the importance of teamwork in treating patients and Thomas A. Franz, M.D., will tell you its more than just a buzz word at HealthSouth Harmarville Rehabilitation Hospital at 320 Guys Run Road in Indiana Township. Much more.
“Our physicians, nurses and therapists definitely work as a team in assessing the needs of our patients,” Dr. Franz, medical director and director of brain injury services at HealthSouth Harmarville, said. “Each patient is different and it’s important that everyone on our staff has input in evaluating what works for the individual we are treating. We take great pride in our staff’s training, experience, knowledge and capabilities in jointly determining the care of our patients.”
Those services include, but are not limited to, physical, occupational and speech therapy and psychological aspects of treating patients.
HealthSouth Harmarville Rehabilitation Hospital is a 202-bed acute rehabilitation facility offering comprehensive inpatient, outpatient and home health services. In 1954 HealthSouth Harmarville became the first comprehensive inpatient rehabilitation facility in western Pennsylvania. With more than 2,000 patients treated annually, it remains one of the largest acute inpatient rehabilitation centers in the country and is the only freestanding rehabilitation hospital between Chicago and New York City.
Dr. Franz, who also serves as president and CEO of ChoiceCare Physicians, PC, is a specialist in the field of physical medicine and rehabilitation with a focus on brain injury rehabilitation, spinal cord injury and controlling spasticity (disorders of the body motor system, specifically the central nervous system.
HealthSouth Harmarville is one of the facilities operated by HealthSouth Metropolitan Hospitals of Pittsburgh.
A physician since 1987 who received his Medical Degree at Indiana University in Bloomington, IN, Dr. Franz has seen many advancements and enhancements in his profession, especially in his specialty areas.
“It’s truly amazing how technology has leaped forward to address the needs of individuals affected by stroke, brain or spinal cord injury, amputation and neurological disorders,” he said. “We are able to do far more than we might have dreamed 10 or 15 years ago.”
A prime example of cutting-edge technology in the rehabilitation process at HealthSouth is the AutoAmbulator™, an innovative therapeutic device designed to help rehabilitate patients who experience difficulty walking.
Similar computer-based technology also advances treatment of patients with speech disorders.
As an acute care rehabilitation hospital, HealthSouth Harmarville offers a “more intense regimen and higher level of care” such as greater physician involvement and therapy time as well as increased availability of pharmacy and laboratory services.
“Our team approach engages rehabilitation experts from many disciplines and includes the latest technology for an advanced continuum of care for our patients,” Dr. Franz said. “We work with the patients’ primary care physicians to coordinate care, provide early intervention and treatment and help each patient reach his or her maximum potential.”

For more information about HealthSouth Harmarville or other HealthSouth Metropolitan Hospitals of Pittsburgh, contact Ann M. Ciotoli at (412) 826-2707 or E-mail: Ann.Ciotoli@healthsouth.com.

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