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Dr. Raj uses a spine model while discussing a treatment plan with a patient. A Phased Process Dr. Raj's expertise enables him to call upon a number of treatment options, ranging from injections to spinal cord stimulation. The least-invasive mode of treatment is always the frontline approach, and Dr. Raj provides guid- ance and offers techniques patients can perform at home. Physical therapy. Dr. Raj often begins with physical therapy trials and makes adjustments to the regimen according to the patient's progress. "I start with stretches and perhaps a referral to an expert," he says. "If a patient is still experiencing pain after three weeks, I may move to other strategies." Dr. Raj also works as part of the treat- ment team for patients recovering from spine surgery, offering complementary home exercises to enhance the heal- ing process. A lter n at ive mo d a l it ies. A long with physical therapy, Dr. Raj recom- mends yoga, massage, acupuncture and other approaches that may help patients heal through gentle guidance and manipulation. Prescription medications. In con- junction with physical therapy, Dr. Raj may recommend muscle relaxers and oral pain medications. However, as he describes it, these measures are always taken as part of a multimodal strategy that might include physical medicine or interventional approaches. He refers patients on long-term oral pain medica- tions to a pain psychologist, as well. Fluoroscopy-guided epidural injec- tions. After several weeks of physical therapy, Dr. Raj may recommend a series of injections. Typically performed as in- office procedures administered in two or three half-hour sessions, injections of analgesic agents, steroids or nerve blocks directly into the afflicted area may produce long-term results. Fluoroscopic g uidance, in which a contrast medium is advanced into the injection site before the active medication is administered, allows the practitioner to use X-ray to confirm the exact placement of the injection. Once the location is confirmed, the appropriate treatment is administered. "Fluoroscopy is the gold standard for treatment," Dr. Raj says. "When epidur- als are performed without guidance, the success rate is low because we don't know the precise location in which the injection is going. Fluoroscopy enhances precision when administering nerve blocks and joint injections and produces excellent pain relief." Injections can provide long-term relief, pa r t ic u la rly for facet joint M D N E W S . CO M ■ MD NEWS Long Island | 9