Letter to Patients

To my clients and patients;

Thank you for your continued business and support of our clinic. We opened our doors in 2001, and thanks to you, we have been able to grow and serve you for 11 years . With your valued and continued support, we hope to be serving you and the community for many more years.

In the coming years, starting now in 2013, there will be many challenges that we in the healthcare field will face. The costs of doing business, the costs of patient care, and overall management of complicated cases will be dramatically affected by continuous changes in the laws. There are many changes to come in the healthcare field, along with the economic uncertainties that the country will face. In order to get the maximum value for your health care dollar expenditures, you can evaluate your policies and procedures to control your overall risk management. Making the best use of your current providers will also add value, and maximize the overall health of not only your business, but your employees. I have continued to use evidence based medicine to the best of my knowledge, and continue to follow Worker’s Compensation Guidelines that are constantly changing. I also routinely participate in many medical education classes, in order to keep my knowledge of treating various complicated injuries and traumatic events current. Because I believe we can maximize cost effectiveness and make use of time and resources in order to provide the best value for you , I employ a Nurse Practitioner whom I am confident understands Worker’s Compensation Guidelines and participates in continuing education as well.

As you know, I am a Board Certified Pain Management Physician. I am also a Physiatrist, who is a Physician trained in physical medicine and rehabilitation. There are some fundamental differences in the care provided by Primary Care Physicians and the type of Specialist that I am. A Physiatrist has extra education and training enabling him to be very familiar with musculoskeletal injuries and has in-depth knowledge of injury management and pain control that the Primary Care Physician may not be familiar with. A Physiatrist possesses special skills that Primary Care Physicians and DO’s do not learn in their Residency Training programs. As a Physiatrist, for instance, I can evaluate patients with severe back pain appropriately, order and evaluate MRIs or other diagnostic testing, such as EMG/nerve conduction studies, and pin point the exact cause of the pain. I can provide continuous pain management care and treatment, then make an evaluation to refer IF referral to a Surgeon is needed. However, the Primary Care Physician often refers patients to Surgeons without making an appropriate referral to a specialty practice such as mine. Referral to a Surgeon is not always a pleasant experience for the patient; sometimes they feel alienated and they feel left out. They also may develop physiologic issues, which often are a result of feeling that there is no other option. In this clinic, because of my Specialty, which deals with musculoskeletal medicine and chronic pain issues, I have been able to manage tough and complicated injuries to keep the cost to the employers and to the patients significantly lower than if the patient is referred to a physician that does not possess these special qualification and skills.

Some recent examples of issues in my clinic involve the use of EMG/NCV, which is a test for nerve conditions that can diagnose pinched nerves, carpal tunnel syndrome, and diabetic neuropathy. It can guide the treatment, as well as rule out a severe injury versus other issues that are not work related. I use this tool effectively to diagnose nerve conditions in all the extremities, not just for carpal tunnel syndrome. Neuropathic processes that are not related to metabolic disorders such as diabetes are also found. I had a patient who came in for blood work to be dome prior to carpal tunnel surgery. She was told by another provider that she had severe carpal tunnel syndrome and was scheduled for surgery. Based on my knowledge of similar cases, I elected to re-do the testing and to her surprise the EMG/NCV showed no evidence of carpal tunnel nerve pathology. She eventually did well with medications and physical therapy. In another recent instance, a patient had a severe injury to his foot. The wound needed to be sutured, but he could not tolerate a local injection to the affected extremity. Instead of referring him to the emergency room, because of my extensive knowledge of nerves and pain management, I was able to block the nerve that goes to the extremity without directly injecting the laceration site. We were able to successfully close the laceration without any need for referral. In another example of services I can provide, a patient came to the clinic for a second opinion for lower back pain. He had been told he needed back surgery. I reviewed the actual MRI film and after careful physical examination, determined that the problem was not coming from the disc injury. The patient received injections, and the problem resolved without any need for surgical intervention. The actual surgery would not have resulted in any improvement and the cost to the patient and employer would have been significant.

By performing similar procedures, and having an in-depth knowledge of such injuries, we manage the cost to your firm and keep the patient satisfaction high. Our goal is to improve a person’s function so they can return to full duty work as quickly possible. This keeps your company and the employee productive with minimal lost time, wages, and expense. If you should have any question regarding services that we provide to employers or employees, I invite you to stop by, at your convenience, for a tour of the clinic and to speak to our staff . I look forward to continuing to provide services to you and your employees . Thank you for your continued support.


Manouchehr Refaeian, MD
Board Certified Pain Management
Board Certified Physical Medicine and Rehab