Top Doctors 2010: The Evolution
Medicine keeps moving forward, thanks to practitioners such as these.
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Low back pain ranks second only to colds for the number of doctor visits it prompts, so it keeps pain management doctors like Ginger Chiang busy. Chiang typically sees patients who are referred to her when their primary care physicians are unable to alleviate pain with anti-inflammatory drugs, physical therapy, or other therapies such as chiropractic care or acupuncture.
Intractable problems such as these call for a multidisciplinary approach, says Chiang, who practices at Delaware Back Pain & Sports Rehabilitation Centers in Wilmington. “I take a traditional medical history, physical exam and imaging studies or other studies and look for the pain generator,” she says. Chiang says she treats the whole patient, not just the location of the pain. “Sometimes back pain is complicated by depression or fibromyalgia. If the patient is not also treated for these problems, then the pain won’t get better.”
In addition to low back pain, Chiang treats other back pain, neck pain, and pain in the shoulders, elbows, knees and other joints. One of the more unusual pains she deals with is coccydynia, or tail bone pain. “Most traditional pain treatments won’t work with coccydynia, so patients need to see a pain specialist,” she says. She also sees patients with complex regional pain syndrome, a debilitating disease that can cause swelling, burning, and pain in an entire limb or just hands, fingers, feet or toes. Typical treatment is sympathetic nerve blocks combined with physical therapy and pain medications.
Injection techniques have also improved, Chiang says. In radio-frequency denervation, for example, Chiang places a needle on the facet nerve to burn it and cut off the source of the pain.
Among the newer pain medications are Cymbalta, which treats pain and depression, and Lyrica, designed for nerve-related pain. Also new is FlectorPatch, a nonsteroidal anti-inflammatory pain relief patch that delivers relief directly to the site, bypassing the gastrointestinal system and preventing such side effects as kidney damage.
Page 7: Peter Panzer | Dermatology