Douglas Chang, M.D., Ph.D., a board-certified physiatrist, provides physical medicine and rehabilitation services for musculoskeletal pain. The goal of this non-surgical treatment is to restore function and improve quality of life for a variety of conditions.

Dr. Chang specializes in the diagnosis and treatment of musculoskeletal injuries and pain syndromes (from sports and/or work injuries to degenerative conditions as common as arthritis or low back pain).

The initial step in the treatment process is getting an accurate diagnosis through a detailed history of previous treatment attempts and assessing the patient’s current level of pain and quality of life. A thorough physical examination will be performed any previous imaging studies will be reviewed.

After Dr. Chang and the patient meet a few times, and a treatment plan is in place, the patient returns to his or primary care physician for long-term supervision.

Electrodiagnostic medicine

Physical Medicine and Rehabilitation is only one of two medical specialties in which there is formal training in electromyography (EMG) and nerve conduction studies. These studies are used for evaluation of various neurologic disorders. If indicated, Dr. Chang will use electrodiagnostic studies, imaging or other procedures to assess or confirm a diagnosis.

Spinal injections

After the clinical examination and imaging studies, it often is possible to localize the cause of pain. In this case, an injection can be administered directly into the vertebral joints in order to alleviate the pain, at least temporarily. This injection always takes place with radiological imaging to insure proper needle placement. The needle is carefully inserted into the joint and a small dose of local anesthetic is injected. The reaction and the alleviation of pain experienced by the patient over time provide valuable diagnostic information.

The same technology can also be applied for the therapeutic purposes. In this case, another medication, such as cortisone, can be used in the case of painful facet joint arthroses for axial back pain. A similar approach can be adopted with the spinal nerve roots for so-called radicular pain.

Caudal epidural injections

In patients with a suspected disorder of the lumbar spine canal (a narrowing of the spinal canal called spinal stenosis), a caudal epidural injection can be performed to differentiate between other disorders, such as those of the hip. A needle can be used to access the spinal column via the sacrum. Medication (cortisone and local anesthetic, dissolved in sodium chloride solution) is then injected.

Studies have shown that, in the majority of patients, the medication spreads throughout the lumbar spine region and to all the nerve roots. In properly selected patients, there is often an alleviation of symptoms, and they are able to walk better without pain. As a result, it is possible to delay an operation time and time again.

The epidural injection can be applied therapeutically if patients are not yet ready for an operation or if, for other reasons, an operation does not appear to be the best solution. This diagnostic and therapeutic epidural injection is associated with minimal pain on administration of the injection. In the vast majority of patients, it is tolerated extremely well. Side effects are very rare with this kind of injection. Occasionally, the patient may experience dizziness or a slight headache (probably as a result of the change of pressure in the spinal canal).

Rehabilitation of patients with severe impairments

Dr. Chang can provide consultations for patients who have had brain injury, a stroke, spinal cord injury, amputations, cancer and rheumatoid arthritis as well as patients with neuromuscular conditions, including Parkinson’s disease, multiple sclerosis, Guillain-Barre’ syndrome and ALS.

Benefits Of Exercise

For more information on physical medicine and rehabilitation, visit http://www.aapmr.org/.