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For more information about resolution of pain issues, contact:


Catherine A. Duncan, DO

1031 West Williams St., #102
Apex Hill, NC 27502
Telephone: (919) 439-7867

Recovering from Injury Can Be Traumatic

Being injured on the job can be a scary and difficult ordeal. In addition to the injury itself, the questions of “Am I at fault?” “Will my company be supportive during my recovery?” “Will I lose my job?” and “What if I can no longer provide for my family?” all complicate the process of treatment and recovery. Few understand these struggles better than Dr. Catherine Duncan, a physiatrist, an Interventional Spine Specialist, and owner of Atlantic Spine & Pain in Apex.

Dr. Duncan Dr. Duncan uses a patient’s platelet rich plasma to enhance healing in a very painful, arthritic knee.

“Injured workers are the most complex patients I see for many reasons,” she says. “Not only do they have to deal with the injury itself, but also there are the issues of how their injury affects them psychologically, financially, socially, and legally—all are huge factors that deserve careful attention and positive resolution. In fact, the greatest trauma these patients face is often in the recovery process.”

To gain perspective on this issue of workplace injury, Dr. Duncan described the steps and hoops that a typical injured patient may go through, and why it is important to see a pain/rehabilitation specialist as early as possible in the treatment/recovery process.

Joe’s Trials and Tribulations

“Let us imagine a typical scenario that is repeated countless times every day,” Dr. Duncan suggests.

Joe the construction worker injures his lower back while lifting a heavy object on the job. He complains to his boss about his pain and gets an indifferent response, so he gamely continues to work. He works, in fact, until the pain becomes unbearable—and he then files a Worker's Compensation claim, and goes to an urgent care center where he gets an X-ray and pain medication, and is told to take a few days off from work to rest. He is also advised to follow up with an orthopedic surgeon.

What Is a Physiatrist?

Physiatrists such as Dr. Duncan are medical doctors who have completed training in physical medicine and rehabilitation, with a variety of subspecialty offerings. Specifically, PM&R physicians:

  • Treat patients of all ages
  • Focus treatment on function
  • Have a broad medical expertise that allows them to treat disabling conditions
  • Determine and lead a treatment/prevention plan
  • Lead a team of medical professionals, which may include physical therapists, occupational therapists, and physician extenders to optimize patient care
  • Work with other physicians, which may include primary care physicians, neurologists, orthopedic surgeons, and many others
  • Treat the whole person, not just the problem area

Joe, who has a very strong work ethic, wants to return to work promptly, but is understandably concerned about why his back continues to hurt so badly. He visits an orthopedic surgeon, and an MRI exam does not reveal a condition that would require surgery—and Joe is then referred on to physical therapy.

Added Pressure

Despite physical therapy, Joe continues to have severe low-back pain. Soon he begins feeling added pressure from his employer to return to work, and on top of that he is, of course, concerned for his family's welfare. So Joe gets a lawyer, who tells him he should not return to work until he is 100 percent better, to stop all communications with his employer, and to let his lawyer handle things from then on.

Joe is escorted by his Workers’ Comp case manager from one doctor to another, all of whom have different opinions about what is causing his continued pain, and what treatment he should try next. After three months of continued pain and frustration, Joe becomes depressed. Since he is not working and is receiving Worker's Compensation benefits—only a fraction of his previous income—Joe has lost his sense of self-worth and is having financial problems. This creates tension in his marriage. He thinks about going to a psychologist to help him cope, however he has lost his health insurance and Workers’ Comp refuses to pay for psychological treatment, since it is not part of his original Workers’ Comp claim.

Joe is angry at his employer for not taking him seriously at the time of his injury, and has now lost contact with his coworkers—who he once considered his buddies and a major part of his support system.

A Familiar Tale

As Dr. Duncan concludes this too familiar tale of pain and frustration, she emphasizes that there is a more productive path for patients in pain.

“I am a physiatrist,” she notes, “a physical medicine and rehabilitation specialist, trained to treat a wide variety of medical conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons.
“Through communication with Workers Comp case managers,” Dr. Duncan explains, “we can make recommendations to various ancillary services including psychology for pain coping strategies, and provide work restrictions so that these injured patients can return to some type of gainful employment.

“Studies show,” she concludes, “that the longer Joe is out of work, the less likely he is to ever return to work; a scenario that leads to a life of disability, chronic depression, and financial distress.”

The take-home message is this: early intervention by a specialist such as  Dr. Duncan, a physical medicine and rehabilitation specialist, is key to a successful outcome in treating a great variety of painful injuries and/or conditions.

Notes Dr. Duncan: “There is a broad understanding that the most important thing a workers’ comp patient should do is to see a pain specialist ASAP—as soon as possible.” She adds with a slight smile, “. . . as it happens, ASAP are the initials for our practice: Atlantic Spine and Pain. ASAP is a message to remember.

Relieving Pain

Dr. Duncan offers many approaches to help patients overcome pain, including:

    • Radiofrequency ablation: An electrical current produced by a radio wave to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.
    • Botox injections for the treatment and prevention of migraine headaches.
    • Electromyography (EMG), to measure muscle response or electrical activity in response to a nerve’s stimulation of the muscle. The test is used to help detect neuromuscular abnormalities.
    • Epidural Steroid Injections (ESIs), a common method of treating inflammation associated with low back related leg pain, or neck related arm pain.
    • FACET Joint Injections of a steroid medication to reduce inflammation in the small joints at each segment of the spine that provide stability and help guide motion.
    • Spinal Cord Stimulation, applying an electrical current to the source of chronic pain. This creates a pleasant sensation that blocks the brain’s ability to sense the previously perceived pain.
    • Viscosupplementation, an injection of hyaluronic acid into the knee and into the synovial fluid for the treatment of knee osteoarthritis—to increase lubrication in the joint, making joint movement much easier.
    • Prolotherapy, an injection technique that stimulates growth of cells and tissue that stabilize and strengthen weakened joints, cartilage, ligaments and tendons.
    • A sacroiliac (SI) joint injection—also called a sacroiliac joint block—primarily used to diagnose or treat low back pain and/or sciatica symptoms associated with sacroiliac joint dysfunction.