OSMS Board Certified Physical Medicine & Rehabilitation (PM&R) and Pain Management Physician, Dr. Paul Bruhnding, joined Dr. Larry Loewen, chiropractor, and host of the Dr. Larry Radio Show, recently to discuss what PM&R and Pain Management is, the difference between an MD and DO, arthritis of the spine and sciatica, along with treatment options.

Dr. Bruhnding is a Doctor of Osteopathic Medicine (DO) with board certifications in PM&R and Pain Management. Being a DO allows Dr. Bruhnding to view his patients and their conditions through an osteopathic lens. This means that he takes a holistic approach and uses osteopathic techniques to understand the foundation or reasoning behind how or why pain is occurring.

Dr. Larry takes the time to explain what the differences are between a Doctor of Medicine (MD) and a Doctor of Osteopathic Medicine (DO), along with the history of how and why DO license’ were created.

The goal of Physical Medicine & Rehabilitation, otherwise known as PM&R, is to get one’s musculoskeletal functions back to normal, so that everyday things are done in the most functional way possible. PM&R is a type of residency, where Pain Management is a fellowship. Pain Management takes the musculoskeletal and spine conditions dealt with in PM&R and takes it a step further. Training with invasive procedures becomes more in depth, as well as the literature, exposure of patients and pathology.

Arthritis is a standard aging process of a joint where inflammation can cause cartilage, joint capsules and articular surface damage that leads to limited ranges of motion, an increase in pain, and eventually can lead to chronic pain.

There are two different types of pain, somatic and visceral. Dr. Bruhnding takes the time to explain the difference between the two and explains how arthritis pain is a form of somatic pain. Arthritis will become more painful due to the loss of articular cartilage. This is when the cushion, or cartilage, between two joints starts to damage. This can downstream into cartilage loss, then, causing the small nerve endings to become sensitized.

The first two steps to treatment of neck or back arthritis that Dr. Bruhnding provides is getting the right diagnosis and manual or indirect soft tissue techniques. Dr. Bruhnding explains that getting the right diagnosis is where the physician takes the time to sit down with the patient, talks with them about their pain, provides a physical exam, and figures out what the specific problem or source of pain is.

After it is proven that a patient has symptomatic arthritis, then the first two steps to medicated treatment is injecting the arthritis nerves with an anesthetic like Novocain to see if the pain improves. If the pain improves, then the patient will go back in for a second injection two to three weeks later. If this process goes well, then the third and final step is a radiofrequency ablation (RFA). RFA is where an electron is placed on the arthritic nerve to then burn the nerve and change the ability to feel the arthritic pain.

Dr. Bruhnding explains that this injection typically lasts 5-6 months, however, he has seen it last up to one year. After this RFA is completed, patients can continue to go in for yearly injections to manage the pain.

Furthermore, another condition that Dr. Bruhnding sees and treats is sciatica. Sciatica is where the spinal nerves at the lower part of the back are pinched, causing pain, numbness, and weakness to travel down the legs. Anthemia or pressure on the nerves restrict the blood flow and nutrients to the nerves which then causes pain.

Treatment is determined by the amount of pain the patient is experiencing. If the patient is in debilitating pain, then they may be started on one to two neuropathic or nerve pain medicines or receive an epidural steroid injection. The epidural steroid injection is used to calm down the pain by numbing it and decreasing the sensitivity. Dr. Bruhnding goes into further detail on how he targets the location of where to inject the epidural steroid, along with what the process will look like.

Finally, a treatment option for acute sciatica is nerve glide therapy or nerve flossing. This is where one can work to manipulate and stretch the pinched nerve in order to alleviate pain. 

If you are suffering from neck or back arthritis or sciatica, Schedule an Appointment with Dr. Bruhnding.

To watch Part 2 of Dr. Bruhnding’s interview with Dr. Larry, click here: https://youtu.be/RJciDn-enE4