General Practitioners

• Headaches
• Arthritis
  Carpal tunnel syndrome is a disorder affecting the middle nerve of the wrist. This nerve is important because it helps operate our hand and supplies sensation to the skin of the hand. This nerve can get pinched where it passes over the bones of the wrist and underneath a strong ligament through an area called the carpal tunnel. The tunnel and surrounding tissues can get inflamed from repetitive use. This inflammation causes the tissues to swell, which puts pressure on the nerve and results in nerve damage. This compression of the median nerve is called carpal tunnel syndrome. Carpal tunnel syndrome is common in people who use their hands for repetitive activity, such as meat packers, computer keyboard operators, mechanics, carpenters and hairdressers. It is associated with diabetes, pregnancy and rheumatoid arthritis.
• Fibromyalgia
• Medical Weight Loss
  Treatment of osteoarthritis should include medications, strength training, weight loss, minimal joint impact and surgical replacement of certain joints when necessary. Strength training is extremely important in patients with osteoarthritis. Avoiding physical activity causes the muscles around the joint to decrease in size or atrophy. As the muscles atrophy, the joint becomes less stable and that can have a negative effect on osteoarthritis. It is important to keep our body weight at ideal levels. Excessive body weight puts additional stress on the joint causing more pain. Using a walker or cane can make the joint feel better.
• Primary Care
  For your future pain care, we recommend that you contact your primary care provider and/or your insurance company to find an in-network pain management provider in your area.

Gynecologists

• Pregnancy

Neurologists

• Carpal Tunnel Syndrome
  The symptoms of carpal tunnel are numbness, pain and tingling in the hand, which is confined to the thumb, index finder and middle finger. This pain can occasionally shoot up the arm as far as the shoulder. The patient may also complain of weakness in the hand and decreased grip strength. There are certain physical signs the doctor will look for when he examines the patient with possible carpal tunnel syndrome.  These are called Tinels and Phalens. During both of these tests, the doctor will stress the median nerve by either tapping it or bending the hand. He will look for increased symptoms and pain. The diagnosis can be confirmed with a nerve conduction study, in which the electrical potential of the nerve is recorded with a fine needle. The neurologist will look for a decreased velocity of conduction in the median nerve. If this is present, the diagnosis is confirmed.
• Multiple Sclerosis
  Physicians will examine the face to determine the sensitive points in an effort to help determine which branch or branches of the trigeminal nerve are involved. They will be careful to distinguish this disorder from other disorders that cause facial pain, such as shingles. Doctors should complete a comprehensive ear, nose and throat exam to eliminate the possibility of other disease processes. X-ray studies that are used to diagnose TMJ (Temporomandibular Joint Disorder) are often used. An MRI may find an underlying cause within the head such as multiple sclerosis or other disorders. Sometimes laboratory studies will be used to rule out the possibility of an underlying infection. In many cases, the use of nerve block procedures or the injection of anesthetic medicine around the branches of the trigeminal nerve will help confirm the diagnosis of trigeminal neuralgia.
• Epilepsy
  When a patient first sees a doctor complaining of a headache, it is the doctor’s responsibility to make sure nothing serious is going on. The doctor will take a careful history and do a thorough physical and neurologic evaluation. If there is some doubt as to the nature of the headaches, the doctor may order blood work and X-ray studies. A test called an encephalogram (EEG) can be used to measure brain activity and rule out the possibility of epilepsy. The primary X-rays used in evaluating the head are the CAT scan and the MRI. Sometimes dye is injected through the vein prior to a CAT scan or MRI to enhance the pictures further. On the basis of the history, physical examination and radiographic tests, the physicians are almost always able to determine abnormalities in the brain. The vast majority of patients will not have headaches secondary to tumor, infection, etc. These patients will have what is referred to as chronic benign headaches. There are two primary types of benign headaches: migraines which are vascular headaches, and muscle tension headaches.

Psychiatrists

• Stress Management

Endocrinologist

• Diabetes Care

Radiologist

• Ultrasound
  Erik Voogd, MD, is trained and experienced in the latest interventional pain management techniques and has board certifications in both Anesthesiology and Pain Medicine. Dr. Voogd received his Bachelor’s Degree in Molecular and Cellular Biology from the University of Arizona. He received his Medical Degree from the Uniformed Services University of Health Sciences in Bethesda, MD.  Dr. Voogd then went on to complete his Anesthesiology Residency along with his Pain Medicine Fellowship at Naval Medical Center Portsmouth, in Portsmouth, VA. As an Assistant Clinical Professor of Anesthesiology and Pain Medicine at the Uniformed Services University of the Health Sciences he has trained fellows, residents, interns, and medical students.  He also travels nationally and teaches advanced ultrasound and fluoroscopically guided interventional procedures for the Society of Pain Practice Management as a member of their faculty.  He has contributed to the advancement of interventional pain medicine authoring nationally and internationally peer-reviewed posters and presentations as well as chapters in pain medicine board review texts. Commander (Ret.) Voogd recently retired after 30 years of Naval service and has proudly served with the United States Navy, United States Marine Corps, and the United States Army in support of Operation Desert Storm, Operation Iraqi Freedom, and Operation Enduring Freedom respectively.
• MRI
  During a physical examination the piriformis muscle is tender. Stretching the muscle will often cause a painful reaction. The neurologic exam is usually normal.  Symptoms of piriformis syndrome can be similar to symptoms for spinal disorders that affect the sciatic nerve such as a ruptured disk. X-ray studies of the spine such as a CT scan and a MRI are used to insure there is not a spinal pathology causing the pain. MRI scanning of the piriformis area itself can sometimes show enlargement of the piriformis muscle with compression of the sciatic nerve. An injection of anesthetic medications around the piriformis muscle and sciatic nerve helps confirm the diagnosis. A biomechanical screen performed by the physical therapist can also help confirm the diagnosis.
• X-Rays
• Computed Tomography
  Spinal arthritis is a very common disorder affecting millions of Americans. When it occurs in the neck it is called cervical spinal arthritis. When it involves the low back it is called lumbar spinal arthritis. It begins to affect many people in their 30’s. By the age of 40, 50% of people will have evidence of spinal arthritis on an X-ray or CT scan. By the age of 50, that number rises to 100 percent.

Surgeons

• Whiplash
  Cervicogenic Headaches – are usually due to arthritis of the spine. The arthritis originates in the small joints of the neck or upper (cervical) spine called the cervical facet joints.  This type of Headache is usually seen in older patients who suffer from arthritis, but may also be present in patients who have suffered neck trauma such as whiplash.
• Pinched Nerve
  A ruptured disk does not produce low back pain, but instead causes pain at the end of the pinched nerve at the arm or leg into the hand or foot. It can be associated with tingling, numbness or weakness in the extremity. The onset may have been associated with excessive physical activity or a traumatic incident such as a car accident. When the doctor examines the patient, he or she will look for signs of nerve involvement through a careful neurologic exam, checking sensation, strength and reflexes. To confirm the presence of a ruptured disk, the doctor will order a myelogram, CAT scan or a magnetic resonance test (MRI) to visualize the spinal column.
• Joint Replacement
  Depending on the location of the arthritis, injections can sometimes be given into the joint or adjacent nerve to help relieve the pain associated with a sudden flare up. The injection may require the use of an X-ray machine for accurate placement. If the injection is painful to administer, a light intravenous sedative such as Valium can be used to make the procedure comfortable. In some patients the joint function deteriorates so badly that surgery is the best option. Surgery is commonly used to replace the joints of the knees, hips and fingers. Other joint replacement surgeries such as the shoulder are being developed and with time may be as successful as hip and knee replacement.
• Knee Replacement

Dermatologists

• Ulcer
  Many patients can find meaningful relief with a combination of therapies. The initial approach to early arthritis should involve a modest exercise program to keep the joints flexible; usually non-weight bearing exercises such as water aerobics to put the spine through a gentle range of motion and to enhance its flexibility. As arthritis progresses, medications such as aspirin may be necessary. There are now over 17 different types of compounds resembling aspirin on the market. These include drugs like Motrin or Naprosyn. Many patients with spinal arthritis find excellent relief with these anti-inflammatories, however there are some troublesome side effects such as stomach ulcer formation, high blood pressure, and deterioration of the liver or kidneys. Patients on these drugs have to be monitored by their doctor with blood tests taken at least once a year.
• Lesions

Physical Therapists

• Physical Therapy
  SMPC is prepared to approach these patients in a variety of ways. Treatment with our practice may involve injections, medications, behavioral medicine, physical therapy and/or Osteopathic Manipulative Medicine. Often it is a combination of these techniques that brings the best results. Since opening our first pain clinic in 2000, SMPC has used a multidisciplinary approach to pain problems, and our recommendations are always based on a thorough assessment of the patient’s current health and goals for improvement.
• Back Pain
• Manual Therapy
  One of the greatest concerns to doctors treating this problem is to make sure that these symptoms do not indicate an increase in intracranial pressure within the skull, which could signal a vascular, infectious or other significant problem. Some patients will find temporary relief from the pain with the use of non-steroidal anti-inflammatory drugs and muscle relaxants. Physical therapy exercises will also provide some limited effectiveness. Doctors believe the best approach for long-term relief is the use of nerve block treatments. In some cases, an injection of local anesthetic combined with medication to reduce inflammation can result in long-term relief following a series of treatments. At times, the pain at the base of the skull is related to other disorders or arthritis in the joints of the upper portion of the spine. Doctors may use nerve block injections around these structures to help in the treatment of occipital neuralgia. Surgery can sometimes provide relief for several months, but most patients find the pain may return. Surgery is usually reserved as a last option. Some patients will find additional help through a combination of muscle relaxation techniques, known as biofeedback, in conjunction with physical therapy that focuses on manual therapy to the muscles at the back of the neck and head.    Newer block treatments at the occipital nerves can also be utilized for long-term treatment at appropriate intervals.
• TMJ Dysfunction
  Treatment of temporomandibular joint dysfunction (TMJ) often involves a team of specialists for best results. Dental specialists help with splints applied in the mouth. Injections of anesthetic medications around the muscles over the joint can be helpful in reducing the pain from TMJ dysfunction. Nerve block treatments to help reduce pain in regions of the head, neck and shoulders related to this disorder are also helpful in long-term treatment. Physical therapy methods to reduce muscle irritability in the jaw as well as in the neck and shoulders are also useful treatments for TMJ dysfunction. The utilization of biofeedback training and relaxation therapy in conjunction with these other measures can provide additional relief in selected patients.