Do I Need A Referral?
We require referrals for:
- Acute or chronic treatment of pain
- EMG (electromyography) study
- Procedural therapy
- Implantable drug delivery
- Spinal cord stimulation
A referral is NOT required for:
- Concussion evaluation
- Mindset PrTMS
- Regenerative Medicine
At PMC, your insurance should be accepted UNLESS it is one of the following. If you have questions about your insurance coverage at PMC, give us a call today.
We do have several insurance plans we need authorization for to apply. These include BCBS-MI: Blue Care Network and IU Health Plan: Medicare Advantage (as long as there is an in-network physician referral).
We do NOT accept:
UHC MEDICAID PLANS
Including FAMILY PLANNING, EMERGENCY, and METHODIST, or OUT OF STATE MEDICAID PLANS.
THE FOLLOWING COMMERCIAL PLANS:
Advantage Health Solutions
United Healthcare (Navigate and Nexus ACO only),
Priority Health HMO.
We also do NOT accept “Charity Care” through Parkview.
THE FOLLOWING OUT-OF-NETWORK INSURANCE PLANS:
Non-PHCS / Multiplan Priority Health.
Our doctors have additional training and education that qualifies them as physiatrists. Physiatrists are board-certified medical doctors who are skilled at diagnosing and treating pain. A physiatrist treats the whole person, not just the problem area, spending the time needed to accurately pinpoint the source of an ailment.
We often team up with neurologists, orthopedic surgeons, or occupational and physical therapists to provide a non-surgical treatment plan that focuses on decreasing pain, enhancing performance, restoring maximum function lost through injury, illness, or disabling conditions, and prevention of future pain.
Electromyography, or EMG, is a diagnostic test completed by doctors trained to perform and interpret the procedure. An EMG will diagnose nerve and muscle injuries and disease. The test helps your doctor make an accurate diagnosis to treat your symptoms. Most patients will experience minimal discomfort during the test. There are two parts to an EMG. The first part involves stimulating the nerve with a small electrical shock and recording the response. The second part involves placing a thin needle into a specific muscle to analyze the electrical activity in the muscle. An EMG is a beneficial test used to pinpoint the problem so your doctor can help restore you to optimal health.
A spinal cord stimulator is an implantable device much like a pacemaker. This implant has one or two leads that are positioned over an area of the spine, with the other ends tunneled through the skin to a battery that is just under the skin in the soft tissues. An electrical stimulus is delivered over the back of the spinal cord to help in diminishing the intensity of the pain. The perception is a low-level tingling or “buzzing” sensation that replaces the pain. For people that are believed to be good candidates for this type of device, a trial lead is placed that is connected to an external battery that the patient wears for 3-7 days. If the patient finds the device beneficial, a permanent implant is placed. This involves placing similar leads as the trial and connecting them to either a rechargeable battery that lasts up to 10 years or a non-rechargeable battery that lasts 1-4 years. This can be used for many different types of painful conditions, including radiculopathy, neuropathy, and complex regional pain syndrome.
Spinal stenosis is a narrowing of the spinal canal caused by either degenerating discs which lose height and bulge into the canal or the formation of bone spurs which crowd the canal. Central stenosis occurs when the canal through which the spinal cord and multiple nerve roots run is narrowed. Foraminal stenosis occurs when the hole through which a nerve exits the spine is narrowed. Stenosis causes the experience of pain in the distribution of the nerves being pinched. Nerves pinched in the neck will result in arm pain. Nerves pinched in the lower back will result in leg pain.
Neuropathic pain is a complex pain state and is caused by damage to or dysfunction of the nervous system. Damaged nerve fibers send incorrect signals of pain to the body. Common symptoms include burning, coldness, pins and needle sensation, numbness, and itching. Common causes of neuropathic pain include alcoholism, amputation, chemotherapy, diabetes, thyroid dysfunction, facial nerve problems, HIV infection, shingles, and spine abnormalities. In chronic form, symptoms often begin subtly and progress slowly. Treatment by a pain specialist may include electrical stimulation, topical medications like capsaicin, oral medications that may include certain anticonvulsant medicines, and certain antidepressant medications. Cortisone injections can also be used in certain cases. Better control of diabetes and thyroid problems can also help in improving symptoms.
Complex regional pain syndrome (CRPS) is a condition that presents as an intense pain that can occur spontaneously or after mild trauma. This regional syndrome presents with continuous intense pain out of proportion to the tissue trauma. Presenting symptoms include burning pain, swelling and stiffness of the affected region, motor disability, changes in hair and nail growth patterns, and skin changes. The extremity can feel warmer or cooler than the opposite limb and present with a blotchy appearance. The condition is diagnosed based on the clinical findings, as a definitive test does not exist. Treatment includes psychotherapy, physical therapy, medication management with topical analgesics, narcotics, corticosteroids, antidepressants, and anti-seizure drugs. Advanced treatments include sympathetic nerve blocks, surgical sympathectomy, intrathecal drug pumps, and spinal cord stimulation.
A frozen shoulder, or adhesive capsulitis, is the unexplained loss of both active and passive range of motion of a shoulder. Typically this affects patients between the ages of 40 and 60. Diabetes is a risk factor, as well as hypothyroidism, cervical disc herniation, Parkinson’s disease, strokes, and rarely tumors. Typically on physical exam, there is substantial decreased range of motion of the shoulder and tenderness can occur. “Typically, x-rays are obtained to rule out any other causes…”, i.e. bone spurs, loose bodies, calcium deposits, or tumors. Treatment involves nonsteroidal anti-inflammatory medications and moist heat followed by a gentle stretching program. Intra-articular steroid injections can also help the situation. Ideally, the stretching should be performed at least three to four times per day and may take an extended period of time until range of motion is fully restored and pain completely relieved, i.e., one to two years. However, if there is a lack of progress and substantially impaired range of motion, occasionally, patients need to be taken to surgery to “break up” the adhesions.
A bone spur, or osteophyte, is a bony growth formed on normal bone in response to pressure, rubbing, or stress that continues over a long period of time. Some spurs form as part of the aging process, such as in osteoarthritis of the hips and knees. In the spine, spurs form as discs degenerate and can lead to impingement of nerves as they exit the spine. A spur causes pain if it presses or rubs on other bones or soft tissues such as ligaments, tendons, or nerves. Common places for bone spurs include the spine, shoulders, hands, hips, knees, and feet. Bone spurs also form as a response to repetitive trauma such as in the feet in response to activities such as dancing and running or due to increased pressure from being overweight. While spurs can be seen on an x-ray and can support a diagnosis, the condition that leads to the development of the spur is the patient’s diagnosis. Most bone spurs do not cause problems. Treatment of the underlying condition that causes the bone spur to develop may include weight loss to take pressure off the joints and stretching the affected area to increase the flexibility of ligaments and tendons that pull on the attachment points to the bone. Seeing a physical therapist for an ultrasound or deep tissue massage may be helpful to assist in the development and tolerance of these stretching programs. Inflammation at the spur site is treated with rest, ice, stretching, and nonsteroidal anti-inflammatory drugs (NSAIDs). If the bone spur continues to cause symptoms, your doctor may suggest a corticosteroid injection into the painful area next to the bone spur. Sometimes surgery is required to remove a spur as part of the treatment to replace a joint when osteoarthritis has caused considerable damage. A spur can also be removed if it continues to irritate surrounding soft tissues, such as occurs in the shoulder with rotator cuff impingement or in the spine with stenosis.
Spinal nerves exit from the lower spine and travel down your legs to your feet. Some of these spinal nerves form the sciatic nerve. The sciatic nerve is one of the main nerves in your leg. When the spinal nerves become injured or inflamed, you may feel pain, tingling, or numbness down your leg. This is called “sciatica” or lumbar radiculopathy. Damage to the spinal nerves is often caused by a disc bulge. Sciatica can also be caused by bone spurs that pinch the nerves. X-rays or MRIs are sometimes ordered to help find the cause of the lumbar radiculopathy. Conservative treatment ranges from anti-inflammatory medications and exercise to physical therapy and steroid injections which will reduce the pain caused by the nerve irritation.
Tennis elbow is a common term to describe lateral epicondylitis. This condition is one that produces pain and tenderness on the outside (lateral) aspect of the elbow. The typical patient with lateral epicondylitis or tennis elbow is between 35 and 50 years of age. Patients typically report the gradual onset of pain in the lateral aspect, i.e., outside aspect, of the elbow and forearm during activities involving wrist extension, such as lifting, turning a screwdriver, or hitting a backhand in tennis. As a matter of fact, most people diagnosed with “tennis elbow” do not play tennis, and it typically can occur in the workplace with repetitive-type activity. With time, occasionally, the pain can become fairly severe and even occur at rest. Individuals with lateral epicondylitis typically have pain when lifting with their palm down. Treatment can include modifying or eliminating any activities that caused the symptoms. Nonsteroidal anti-inflammatory medications can also be used for acute exacerbations. A tennis elbow strap can be beneficial during any heavy lifting-type activities, as well as any application of ice or heat, whichever works best, to relieve the pain. Once the pain has decreased, then gentle stretching and strengthening exercises can occur through therapy, as well as a home program. If the pain continues, cortisone injections can occur. If pain is not relieved after one or two injections, other options include Sonorex, i.e., high energy wave treatment (similar to lithotripsy), as well as surgical intervention; however, most cases resolve with conservative care.
Six months ago, I fell and landed on my buttock. Since then, I have had pain in my lower back and buttock and find it difficult to sit for longer than fifteen minutes. My doctor has diagnosed my condition as SI joint dysfunction. What is this, and what can be done?
The sacroiliac joint, more commonly known as the SI joint, is the largest joint in the spine and is the point where the spine and pelvis come together. The SI joint is lined with cartilage and is supported by strong ligaments which limit the motion of this joint to 2-3 degrees of rotation. Pain can originate from the joint as a result of direct trauma from your situation, repetitive trauma from performing an activity repeatedly in the same direction, or as a result of weakening of the ligamentous support as commonly occurs in the third trimester of pregnancy when a hormone is released that allows the pelvis to expand in preparation for childbirth. Treatment of SI joint dysfunction begins with a course of physical therapy to stabilize the joint and educate the patient to avoid activities that increase the instability of the joint. An injection can be performed with a steroid/anesthetic mixture to reduce the inflammation of the joint as well as confirm the diagnosis by numbing the joint to see if the pain dissipates. If conservative measures fail, a radiofrequency ablation can be performed to denervate the joint and block the patient’s ability to perceive pain coming from the SI joint.
Yes. We can inject a substance called hyaluronate into the knee. Arthritis in the knee causes this molecule to decrease in the joint fluid. Hyaluronate acts as a lubricant and cushion for the knee joint. There are several different manufacturers of this substance. Your doctor can decide which brand is best for you. It’s not indicated for everyone, so you will need to be evaluated by a physician to see if it is right for you. Typically the knee is injected once a week for three weeks. It can take several weeks after the last injection to get the full effect. Results usually last for six months. The series can be repeated if needed. This type of injection may help prevent or prolong the need for knee surgery.
There are two types of arthritis that affect joints, rheumatoid arthritis, and osteoarthritis. A joint is the point where two bones come together and where motion occurs. The ends of the bones are covered by articular cartilage, which provides a smooth surface for the two bones to articulate. The joint is surrounded by a capsule made of connective tissue. The synovial membrane is within the joint capsule and produces a fluid that lubricates the joint. In rheumatoid arthritis, the joint’s connective tissues, such as the synovial membrane and the capsule, become inflamed, causing the joint to become stiff and painful. The body’s immune system plays a role in attacking the connective tissues leading to the destruction of the articular cartilage. Medications that inhibit the immune system and manage pain are typically used to limit the damage and discomfort caused by this condition. Osteoarthritis, on the other hand, is a deterioration of the articular cartilage due to “wear and tear” and leads to bone overgrowth and the formation of spurs. Osteoarthritis is more common in the elderly, whereas rheumatoid arthritis can affect an individual at any age. Treatment of osteoarthritis typically starts with the use of anti-inflammatory drugs such as NSAIDS or steroids and physical therapy to improve strength and range of motion. As the condition progresses, intra-articular injections of steroids or viscosuplementation can be performed in larger joints prior to proceeding to total joint replacement.
Here are three diagnostic terms in the lumbar spine that are often confused: spondylosis, spondylolysis, and spondylolisthesis. Spondylosis, more commonly known as osteoarthritis, is an erosion of the cartilaginous surface of the facet joints that causes local back and buttock pain. Treatment consists of physical therapy to strengthen the supporting muscles, anti-inflammatory medications or intervention injection procedures. Spondylolysis is a stable fracture of a portion of the vertebra called the pars interarticularis. This typically occurs due to a hyperextension of the lumbar spine and is commonly seen in gymnasts, football linemen and wrestlers. Occasionally, these fractures will cause pain and are typically treated with physical therapy, bracing and anti-inflammatory medications. Both degenerative spondylosis and spondylolysis can lead to the last condition: spondylolisthesis. This is a forward slip of one vertebral body in relation to another. This can lead to back pain and, if a nerve is pinched, leg pain. Treatment of this condition includes medication to manage the pain, bracing and physical therapy to stabilize the spine. If these fail, surgery can be performed to fuse the vertebrae together and decompress the nerve impingement.
Carpal Tunnel Syndrome (CTS) is caused when the nerve in the carpal tunnel is pinched or inflamed. The carpal tunnel consists of the carpal bones and the transverse ligament. There are nine tendons and one nerve within the tunnel. The nerve is called the median nerve. When the median nerve is pinched, symptoms can develop and cause CTS. Symptoms typically involve the palm side of the thumb, index finger, middle finger, and half of the ring finger. Treatment depends on the severity of the damage, which is usually determined by electrodiagnostic testing. If the damage is mild, treatment may consist of splints at night, anti-inflammatory medicines, and hand therapy. If the damage is more severe, injections and surgery may be helpful. If you think you have CTS, it is important to see a physician who will properly diagnose and treat your symptoms.
There is a good chance it’s not arthritis. Bursitis is a more likely diagnosis. The trochanteric bursa is located on the lateral or outer part of the hip. It normally functions to keep the soft tissues around the hip moving smoothly. Sometimes the bursa gets inflamed and can cause pain. An inflamed bursa is tender to the touch. The pain is worse with activities such as side-lying, climbing stairs, or walking for long distances. There are many causes for bursitis. Some of these causes include trauma to the hip from falling, a shorter leg on one side, and overuse. It can also develop spontaneously. Treatment involves anti-inflammatory medications, proper stretching and strengthening exercises, cold application, and a local cortisone injection. Persistent cases may require surgery to remove the bursa.
When neurons in the brain are injured, traumatized, or exposed to prolonged stress, they may react by entering a form of “self-preservation” mode in which they drift off-frequency. These neurons fall out of sync with the rest of the brain and interfere with normal electrical rhythms.
When regions of the brain associated with focus, critical thought, emotions, or regulating impulses no longer perform normally, the resulting symptoms can be significant. Neurons that respond by slowing down contribute to depression, inability to focus, and/or social withdrawal. Conversely, neurons that become agitated are associated with anxiety, hyper-vigilance, sleep disruption, enhanced awareness of pain, self-medication with controlled substances, emotional outbursts, or OCD.
MindSET PrTMS uses a series of magnetic pulses personalized to the patient’s brain activity to restore affected neurons to the brain’s primary frequency. Brain tissue converts the magnetic energy into an electrical impulse at a defined frequency, training neurons to fire in alignment with the patient’s optimal “brain beat.”
In a word, yes. The MindSET PrTMS personalized protocol involves physician-supervised “off-label” investigational use of a device cleared by the FDA to treat drug-resistant major depressive disorder. More than 4,000 patients have been treated to date at the PeakLogic research clinic in San Diego and other clinics around the country.
Personalized repetitive Transcranial Magnetic Stimulation is an innovative, patient-specific version of Transcranial Magnetic Stimulation (TMS), a treatment for clinical depression first cleared by the FDA more than two decades ago.
Traditional TMS is “one-size-fits-all,” treating all patients with a fixed level and pattern of brain stimulation.
MindSET PrTMS stimulation levels are far below traditional TMS treatments but achieve symptom improvement for many patients because the treatment protocol is personalized to the unique electrical activity in their brains. This reduced stimulation level allows for treatment of regions that traditional TMS cannot address and, therefore, results in patients suffering many different symptoms, not just depression.
Most patients feel nothing other than a slight tapping sensation. Patients relax in a specialized treatment chair while a trained technician guides a magnetic emitter to areas of the brain requiring stimulation. Patients hear a clicking sound when stimulation is underway.
We provide snacks containing sugar after treatment. The enhanced brain activity associated with PrTMS may temporarily cause blood sugar levels to drop, and the ingestion of sugar quickly remedies this. On rare occasions, this drop in blood sugar may also bring on a very mild headache, but these usually pass speedily or can be alleviated with over-the-counter medications.
The majority of patients return to school, work, or everyday activities following treatment.
Patients typically receive one or two 25-minute treatments per day, five days a week, for several weeks. The number of treatments recommended will depend upon the patient’s reason for seeking treatment, the severity of symptoms, and how the brain responds.
Many patients tell us they notice symptoms improving after a few days of treatment. Improvement in sleep quality is generally the first change patients describe. Autism spectrum disorders typically are the most resistant to treatment. Several months of treatment may be necessary for maximum benefits.
MindSET PrTMs may be fully or partially covered for those diagnosed with drug-resistant major depressive disorder (MDD). Treatment for most other conditions is seldom reimbursed.
Our staff will be happy to help with any necessary paperwork you may need to submit to your insurance for prior authorization and reimbursement. Our office partners with Advance Care can offer affordable financing options for those interested.