Dr. Michael Derr has steady hands.
That’s evidenced by the thousands of injections he’s performed to stop pain in the back or neck, pain in the joints, as well as pains in the rear.
As a physician specializing in Physical Medicine and Rehabilitation, Dr. Derr doesn’t treat pain as much as he intervenes to alleviate pain. His patients are those individuals who grab their backs when they bend or wince as they lift their arms to comb hair.
His patients are often fighting arthritis, laid low by a sports mishap, or still aching from a hernia repair.
As a physiatrist, Dr. Derr is a nerve, muscle and bone expert who treats injuries or illnesses that affect how we move. His goal, he explains, is improving an individual’s function. “We want to get people back doing the things they want to do,” he said.
“Some people,” he adds, “tend to focus more on the pain — but the goal is function. If we can cut the pain down and improve function — as far as satisfaction and lifestyle — that’s what we’re looking for.”
No chronic narcotic use, however; Dr. Derr primarily uses injections, nerve blocks, physical therapy and other non-surgical ways to prevent pain.
Finding the pain generators
First, however, Dr. Derr targets “pain generators”. In the spine area alone, these can include the discs, the nerves, the facet joints between each vertebra, as well as the sacroiliac joint and piriformis muscle, all common culprits in back pain.
Among his methods are: joint injections of anesthetic agents, spinal injections, nerve blocks, epidurals and denervation (disabling) of misbehaving nerves.
A typical patient of Dr. Derr’s “has low back pain, followed by neck pain,” he said. “They may have what’s called stenosis (narrowing) in the spine, or a herniated disc, or other causes of back pain.” He also sees patients with shoulder, knee and hip pain, as well as arthritis in various joints.
Back pain a big motivator
Dr. Derr often performs joint and peripheral nerve injections with the help of an ultrasound to guide the needle. Ultrasound adds an extra measure of safety, he said, “because I can see the muscle and nerve, as well as the blood vessels.”
Osteoarthritis of the spinal joints can be debilitating. And that’s what brings many people to Dr. Derr. With these cases and other back pain, Dr. Derr takes a comprehensive and conservative approach. “We evaluate the patient and make sure there’s no red flags,” he said. “We may look at doing physical therapy or different injections, depending on where the pain is. Many times we’ll get an MRI to help us for diagnostics. And if there’s any indication the patient needs to see a surgeon, we refer them.”
Breaking the pain cycle
Many of his patients find complete pain relief, and some may get 50 percent relief. There are also those patients who get no relief. That can actually be helpful because it helps him target the pain. “If we do an epidural steroid injection for nerve and disc issues, and if the patient doesn’t get any benefit, then we think, ‘What else is going on?’ It helps us guide and pinpoint the area the main pain generator is coming from.”
Many times, his patients arrive with stiffness that has come on because they’ve been compensating in some way to relieve chronic pain that’s can be helped by “breaking the pain cycle,” said Dr. Derr.
The other thing that helps is staying active. “The worst thing to do for back or neck pain in general is to sit and do nothing,” he said. “The best thing to do is to stay active — doing regular chores around the home, getting into a pool, or walking. That’s the key.”
Here’s the big question: Do those needles hurt?
Depending on the injection, Dr. Derr will use local anesthetics like lidocaine to numb the skin. “Most of the nerve endings are in the skin,” he said, “so that tends to be the worst part.” Most injections, he adds, feel like a bee sting. When you anesthetize the skin, he adds, “it makes it more comfortable for deeper injections.”