Dr. Stuart Krost | Leads the pack in Pain Management and Care In MiamiDadeCounty - PowerPoint PPT Presentation

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Dr. Stuart Krost | Leads the pack in Pain Management and Care In MiamiDadeCounty

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(1888 PressRelease) Dr. Krost runs his own practice and is a dedicated physiatrist. He is board certified by the American Board of Physical Medicine and Rehabilitation. Patients visit him for a variety of reasons including, spondylolysis, spinal muscular atrophy (SMA), spasticity, fibromyalgia, and chronic pain. – PowerPoint PPT presentation

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Title: Dr. Stuart Krost | Leads the pack in Pain Management and Care In MiamiDadeCounty


1
Dr. Stuart Krost Leads the pack in Pain
Management and Care In MiamiDadeCounty and Number
1 Rated with 25 years Experience
(1888 PressRelease) Dr. Krost runs his own
practice and is a dedicated physiatrist. He is
board certified by the American Board of Physical
Medicine and Rehabilitation. Patients visit him
for a variety of reasons including,
spondylolysis, spinal muscular atrophy (SMA),
spasticity, fibromyalgia, and chronic
pain. Miami, FL - Dr. Stuart B Krost is Board
Certified in the following Physical Medicine and
Rehabilitation Acute chronic pain
management Sports medicine State-of-the-art
physical therapy Headaches Neck back
pain Carpal Tunnel Syndrome Myofascial pain and
fibromyalgia Work and auto-related
injuries Disability assessment TRIGGER POINT
INJECTIONS Trigger point injections are
injections to the muscle belly. Injections are
aimed at taut bands or areas of spasm within the
muscle belly. Taut bands can be painful and the
underlying cause of pain generation. Trigger
point injections are diagnostic and therapeutic.
If there is significant relief after trigger
point injections, certainly one can consider that
the muscle spasm is a pain generator. The
injection consists of anesthetic as well as
antiinflammatory medication.
2
EPIDURAL STEROID INJECTION Epidural steroid
injections are a procedure to place medication
both antiinflammatory as well as anesthetic in
the epidural space. The epidural space is located
within the spine around the spinal cord and nerve
roots. The goal of epidural injections is
diagnostic and therapeutic. Epidural injections
can relieve pain that is generating from disc
herniations as well as irritated or pinched nerve
roots. These procedures are performed under
fluoroscopic guidance. FACET BLOCK Facet blocks
are performed under fluoroscopic guidance and can
be diagnostic and therapeutic. Injections are
performed at the facet joint or the medial branch
nerve. Improvement after this type of injection
would be diagnostic for facet joint related
pain. FACET RHIZOTOMY Facet rhizotomy is a long
acting facet block either done chemically or with
thermal heat. This procedure is indicated if the
patient does receive benefits from the facet
block, however does not offer prolonged
relief. STELLATE BLOCK This procedure is done in
the neck, anesthetic blockade is performed at the
stellate ganglion. The goal of this procedure is
for blockade of the sympathetic chain. This is
diagnostic and therapeutic for evaluation and
treatment of RSD. LUMBAR SYMPATHETIC
BLOCK Lumbar sympathetic block is performed about
the lumbar area. The goal of this procedure is
for blockade of the sympathetic chain. This would
be diagnostic and therapeutic for evaluation and
treatment of RSD. DISCOGRAM A discogram was
performed for diagnostic purposes to identify
pain if a pathologic disc is acting as a pain
generator.
3
IDET PROCEDURE An IDET procedure is a procedure
done for a pathologic disc usually with annular
tear that has been identified as a pain
generator. The goal of procedure is to destroy
sensory nerve endings that are transmitting
painful signal. The ultimate goal is to relieve
pain from discogenic pathology. PERCUTANEOUS
DISCECTOMY This is a minimally invasive procedure
for treatment of a herniated disc. This is a
procedure that could be done in an outpatient
setting under fluoroscopic guidance to remove
herniated disc material. The ultimate goal is to
relieve pressure on the exiting nerve root as
well as relieve pain. BOTOX INJECTIONS Botox is
a long acting treatment for muscular pain. Botox
acts locally at the injection site to relieve
muscle spasm and to relieve pain. Benefits of
this can last up to three to six months. This is
also used for intractable headaches that do not
respond to more conservative measures. OCCIPITAL
NERVE BLOCK Occipital nerve is located in the
back of the neck at the junction of the head.
Occipital entrapments can occur with underlying
spasm commonly causing occipital headaches. This
can subsequently produce symptoms radiating to
the top of the head as well as in back of the
eyes. Occipital blocks can be diagnostic and
therapeutic for occipital neuralgia/occipital
headaches. ELECTRODIAGNOSTIC TESTING Electrodiagn
ostic studies are a diagnostic procedure to
assess underlying neuropathic problems. EMG/NCS
can be diagnostic for cervical or lumbar
radiculopathy/pinched nerve, neuropathy or distal
nerve entrapment such as carpal tunnel syndrome.
EMG/NCS can be helpful in determining acute
versus chronic conditions and identify
neuropathic recovery. EMG/NCS are commonly used
in conjunction with MRIs to correlate anatomical
findings and neuropathic function.
4
PHYSICAL THERAPY Physical therapy combines
passive and active treatment. Passive treatments
include moist head pad, ice packs for analgesia
Ultrasound treatment for production of heat at
the muscle bone interphase and stimulate blood
flow Electrostimulation to improve blood flow as
well as muscle relaxation and analgesia Massage
treatment for muscle relaxation as well as
analgesia to increase extensibility of soft
tissue. Active treatments include exercising and
stretching as well as cardiovascular treatment to
improve strength, range of motion as well as
endurance. Physical therapy is a treatment as
well as an education and experience to learn how
to do things on your own and eventually be
progressed to a home exercise program LIFE CARE
PLANNING Future care needs and life care planning
are based on physical impairments as well as
functional disabilities. This plan can outline
what a patient will need in the future in terms
of active and passive treatments, durable medical
equipments, medical care medication as well as
interventional injections and surgery. Costs can
be included in a life care plan. DISABILITY
EVALUATION A physiatrist/physical medicine
rehabilitation specialist is a specialty of
identifying physical impairments and how those
physical impairments result in physical
disabilities and subsequent handicap. A physical
medicine rehabilitation specialist specializes in
the neuromuscular and skeletal system to identify
physical impairments and functional disabilities.
A disability evaluation may lead to conclusions
of physical restrictions as well as compensatory
strategies to maximize functional
independence. SPHENOPALATINE GANGLION BLOCK A
sphenopalatine ganglion block (SPG) is performed
with a cotton tip probe with saturation of
anesthetic at the SPG ganglion, which is located
in the posterior aspect of the nose. This
procedure is commonly used in relieving headaches
as well as an adjuvant for pain management.
5
FUNCTIONAL CAPACITY EVALUATION Functional
capacity evaluation is an assessment of physical
function to identify physical capacity within
safe parameters to prevent injury. EPIDURAL
LYSIS OF ADHESIONS Epidural lysis of adhesions
indicated typically in a postoperative patient
who has epidural scarring formation. Epidural
scarring can cause irritation, inflammation and
swelling around the nerve roots. Epidural lysis
of adhesions are performed to breakup scar tissue
and relieve irritative focus of nerve When
managing the patient with opioids, it is
important to establish the differences among
physical dependence, tolerance and addiction. The
American Society of Addiction Medicine as well as
the American Pain Society and American Academy of
Pain Management define physical dependence as a
state of adaption that is manifested by a drug
class for which specific withdrawal syndrome can
be produced by abrupt cessation, rapid dose
reduction, decreasing blood levels of the drug,
and/or administration of an antagonist.
Tolerance, however, refers to a state of adaption
in which exposure to a drug induces changes that
result in diminution of one or more of the drug
effects over time. Neither dependence or
tolerance in and of itself is indicative of
addiction. Addiction is defined by the American
Academy of Pain Management and American Pain
Society as well as the American Society of
Addiction Medicine as a primary chronic,
neurobiological disease, with genetic,
psychosocial, and environmental factors
influencing its development and manifestations.
It is characterized by behaviors that include one
or more of the following Impaired control over
drug use, compulsive use, continued use despite
harm, and cravings. Abuse, however, is generally
characterized by conscious, often psychosocial
motivated use of illicit substances and
medication outside the scope of usual medical
practices, but the patient has the ability to
stop the drug when harmed. Addicts, however,
cannot stop use despite harm. The majority of
legitimate pain patients do not develop an
addiction to their analgesic medication. There is
a biological normal phenomenon to develop issues
related to tolerance and dependence. It is the
physicians responsibility to address issues
related to tolerance and dependence by monitoring
patients carefully on a regular basis and adjust
medication accordingly to avoid sequelae of
tolerance as well as dependence. Dictated but not
proof read.
6
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