Pain Management

Degenerative disc disease is one of the most common causes of low back pain and neck pain, and also one of the most misunderstood. Degenerative disc disease describes the symptoms of pain. Which may include the sensation of radiating weakness or numbness. A diagnosis of “degenerative disc disease” is alarming to many patients because it sounds like a progressive, threatening disease. In reality, it is not really a disease, and it is not strictly degenerative. For most people the term “degenerative” understandably implies that the symptoms will get worse over time and with age. However, this does not necessarily apply to the symptoms and pain, but rather describes the process of the disc degenerating over time. While it may be true that the disc degeneration is could progress over time, the pain from degenerative disc disease usually does not get worse and in fact may plateau with time. Disc degeneration is actually a natural part of aging, and over time most people will exhibit changes in their discs consistent with degeneration. However, not all people will develop symptoms and pain. Degenerative disc disease is quite variable in its course and severity. For some patients epidural steroid injections can provide significant benefit.

Having cancer does not always mean having pain. But if you do have pain, there are many different kinds of medicines, different ways to take the medicines, and non-drug methods that can help relieve the associated pain. Talk with your doctor about potential treatments.

Arthritis is the swelling and tenderness of one or more of joints in the body and decreased range of motion. There are more than 100 types and related conditions. Arthritis does not discriminate among gender, age or race. It is the leading cause of disability in America. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-Ray.

Facial pain is pain felt in any part of the face, including the mouth and eyes. Although it’s normally due to an injury or a headache, facial pain may also be the result of a serious medical condition. Talk with your doctor about potential treatment options.

Neck pain maybe mild, or it could be so excruciating that a person avoids any and all movement. Oftentimes neck pain is located in one spot and goes away on its own within a few days or weeks. Unfortunately, in some cases the pain becomes constant or radiates into other body parts, such as the shoulder and arms. Common symptoms associated with neck pain usually involves one or more of the following: Stiff neck. Soreness and difficulty moving the neck, especially when trying to turn the head from side to side. Sharp pain. This symptom can be pain localized to one spot and might feel like it’s stabbing or stinging. Soreness. The pain can be described as tender or achy, as opposed to sharp. Radiating pain. The pain can travel along a nerve from the neck into the shoulders and arms and may be described as a burning sensation. Tingling, numbness, or weakness . These symptoms can travel beyond the neck and radiate into the shoulder, arm or finger. Often times a sensation of “pins-and-needles” is described. This may occur in a single arm or both arms simultaneously. Trouble with gripping or lifting objects. This is a troubling symptom suggesting weakness and can be a sign that surgical intervention is imminent. Headaches. Sometimes an irritation in the neck can also affect muscles and nerves connected to the head. This could be a tension headache, such as from neck muscles tightening; or occipital neuralgia, where a pinched occipital nerve in the neck causes pain to radiate up into the head’s sides and scalp. If neck pain symptoms progress, it can become difficult to sleep. This type of pain may also interfere with other activities of daily living such as dressing, working, and driving. Typical treatments may include but are not limited to Facet blocks, Medial Branch Blocks, Selective Nerve Blocks, Epidural Steroid Injections, and Radiofrequency Nerve Ablations.

Dysfunction in the sacroiliac joint, or SI joint, is thought to cause low back and/or leg pain. This pain may mimic that of sciatica or pain caused by a lumbar disc herniation. While it is not 100% clear what causes sacroiliac pain; it is thought that an alteration in the normal joint motion may be involved Too much movement (hypermobility or instability): The pain is typically felt in the lower back and/or hip and may radiate into groin area. Too little movement (hypomobility or fixation): The pain is typically felt on one side of the low back or buttocks, and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot. Sacroiliac Pain and dysfunction is generally more common in young and middle-aged women. Talk with your doctor about the role of sacroiliac joint injections and radio-frequency ablations in your treatment plan.

Is a condition, mostly in adults 50 and older, in which your spinal canal starts to narrow. This can cause pain and other problems. Your spine is made up of a series of connected bones (or “vertebrae”) and shock-absorbing discs. For most people, the stenosis (narrowing) results from changes because of arthritis, disc degeneration, and/or thickening of the spinal ligaments. These changes lead to open spaces between vertebrae becoming smaller. This tightness can pinch the spinal cord or the nerves around it, causing pain, tingling, or numbness in your legs, arms, or torso. Generally there is no absolute cure, but there are a variety of nonsurgical treatments (Epidural Steroid Injections and Nerve Blocks) and exercises to keep the pain at bay. Symptoms Spinal stenosis usually affects your neck or lower back. Not everyone has symptoms, but if you do, they tend to be the same: stiffness, numbness, and back pain. More specific symptoms include: Sciatica. These shooting pains down your leg start as an ache in the lower back or buttocks. A hard time standing or walking. When you’re upright, it tends to compress the vertebrae, causing pain. Loss of bladder or bowel control. In extreme cases, it weakens the nerves to the bladder or bowel. If you’re having symptoms, you might want to talk them over with your doctor. If you’re having a loss of bladder or bowel control, call your doctor at once.

Lower back pain can be caused by a variety of problems. Typical sources of low back pain include: Large nerve root irritation Muscle Strain or Sprain Damage to the bones, ligaments or joints. Disc degenerating or herniation. Often times underlying structural damage may result in muscle spasms, which can cause severe pain and disability. While lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly. A simple lower back muscle strainmight be excruciating enough to necessitate an emergency room visit, while a degenerating disc might cause only mild, intermittent discomfort. Identifying the symptoms and getting a diagnosis that pinpoints the underlying cause of the pain is the first step in obtaining effective pain relief. Typical treatments include conservative therapies such as rest, physical therapy, anti-inflammatories, muscle relaxers. In some instances minimally invasive injections can be helpful. Such as facet blocks, epidural steroid injections, and nerve blocks. Talk with your physician regarding the role of these injections in your treatment plan.

Shoulder pain is often caused by fractures, dislocation, impingment, arthritis, sprains, tendinitis, tears, frozen shoulder, rotator cuff injury and over-use.

The most common causes of knee pain are associated with acute injuries, arthritis, gout, over-use, tendonitis, dislocation, bursitis and tears.

Reflex Sympathetic Dystrophy (RSD) is an older term used to describe one form of Complex Regional Pain Syndrome (CRPS). Both RSD and CRPS are chronic conditions characterized by severe burning pain, most often affecting one of the extremities (arms, legs, hands, or feet). There are often pathological changes in bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch (Allodynia). RSD is sometimes called Type I CRPS, which starts with an injury (and no identifiable nerve damage). Type II CRPS refers to cases that occurred at the site of a nerve injury. Type II used to be called “causalgia” and was first documented over 100 years ago by doctors concerned about the pain that Civil War veterans suffered even after their wounds had healed. RSD is unusual in that it affects the nerves, skin, muscles, blood vessels and bones at the same time. What are symptoms of RSD/CRPS? The key symptom is, chronic, intense pain that is out of proportion to the severity of the injury (if an injury occurred) and which gets worse over time rather than better. It most often affects the arms, legs, hands or feet and is accompanied by: burning pain increased skin sensitivity to touch changes in skin temperature: warmer or cooler compared to the opposite extremity changes in skin color: often blotchy, purple, pale or red changes in skin texture: shiny and thin, sometimes excessively sweaty changes in nail and hair growth patterns swelling and stiffness in affected joint motor disability, with decreased ability to move affected body part What causes RSD? The cause of RSD is not known. The condition is thought to be a malfunctioning of the sympathetic nervous system, but some researchers are questioning this. Since RSD most often follows trauma to the extremities, some conditions that can trigger RSD are sprains, fractures, surgery, damage to blood vessels or nerves and certain brain injuries. How is RSD diagnosed? There is no single laboratory test to diagnose RSD. Sometimes imaging studies (x-rays, MRI) or nerve conduction tests are useful, Diagnosis can be made by the healthcare provider when certain conditions are met, including the absence of any other diagnosis that better explains the signs and symptoms. Early diagnosis is thought to be important in preventing progression of the syndrome. How is RSD treated? Physical therapy is a primary component of treatment. There also are several types of medications that can be used. Surgical procedures may also help reduce symptoms. Treatment plans are individualized and often incorporate several of these measures. Typical interventions include Lumbar Sympathetic Plexus Blocks, Stellate Ganglion Blocks, Epidural Steroid Injections, and Spinal Cord Stimulation. Is there a cure? There’s no cure at this time, but early treatment is pivotal and research continues to advance.

Coccydynia refers to any type of persistent tailbone pain. The condition is much more common in women than men. It is usually caused by trauma to the tailbone or surrounding area, such as a backward fall or childbirth. On rare occasions, an infection or tumor can also cause pain in the coccyx (the tailbone). Coccydynia is typically worsens when sitting or with any activity that puts pressure on the bottom of the spine. Typical treatments include NSAIDS, topical agents, aggressive ice, and Nerve blocks (Ganglion of Impar Block).

Fibromyalgia is a condition that causes widespread pain, sleep problems, fatigue, and often emotional and mental distress. People with fibromyalgia may be more sensitive to pain than others, referred to as abnormal pain perception processing. Symptoms may include pain and stiffness all over the body, fatigue, depression and or anxiety, problems sleeping, cognitive issues with memory, thinking and focus, and headaches.

Hip pain is associated with arthritis, fractures, tears, sprains, tendonitits, bursitis, pinched nerves, cancer, osteoporosis and hernias.

The term “sciatica” describes the symptom of leg pain, tingling, numbness, and/or weakness—that originate in the lower back and travel through the buttock and down the large sciatic nerve in the back of each leg. Sciatica is often characterized by one or more of the following symptoms: Constant pain in one side of the buttock or leg (rarely in both legs), weakness, numbness, or difficulty moving the leg, foot, and/or toes. It can be a sharp pain that may make it difficult to stand up or walk. The pain can vary from infrequent to constant and incapacitating. Symptoms are usually based on the location of the nerve being pinched. Typical treatments include physical therapy, rest, NSAIDS, heat & Ice, and injection therapy. Such as epidural steroid injections and nerve blocks.

Headaches There are many types of headaches these may include: migraines, tension-type headaches, and cluster headaches. Frequent headaches can affect relationships and employment. There is also an increased risk of depression in those with severe headaches. Headaches can occur as a result of many conditions some serious or not. Causes of headaches may include fatigue, sleep deprivation, stress, medications, sinus issues, facet disease, occipital neuralgia, and/or trigeminal neuralgia. Treatment of a headache depends on the underlying cause, but commonly medications and injections can be helpful. Typical injections offered include Botox, Facet Blocks, and Occipital Blocks depending on the cause and location.

A migraine is a type of severe headache. It generally involves throbbing pain or an intense pulsing sensation on one side of the head. Other symptoms can include nausea, vomiting, and extreme sensitivity to light and sound. These attacks can last for hours to days, and often prevent normal daily activities like working, going to school, driving, and shopping. For some warning signs come days before an onset including, constipation, mood swings, cravings, frequent yawning, and increased thirst.

Phantom limb pain Phantom pain is pain that feels like it’s coming from a body part that’s no longer there. These sensations originate in the spinal cord and brain. Although phantom pain occurs most often in people who’ve had an arm or leg removed, the disorder may also occur after surgeries to remove other body parts. For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain effectively with medication or other therapies, such as injection therapy and/or spinal cord stimulation.

The pelvic organs include the vagina, cervix, uterus, bladder, urethra, and rectum. Several types of diseases and conditions can cause pelvic pain involving digestive, reproductive or urinary system, and muscles and ligaments in the structures of the pelvic floor.

Bulging Disc Bulging discs, also known as a disc protrusion typically remain asymptomatic. However, often times, they can cause discomfort and disability in various parts of the body. Generally this occurs if the disc or material of the disc touches or compresses an adjacent nerve root or the spinal cord. With age, the outer fibrous portion of our discs can weaken. Pressure from the central core of the disc can then stretch to the outer rim, causing the disc to bulge. If left untreated, the disc can continue to bulge until it tears, which is classified as a herniated disc. When the bulging disc does cause a pinched nerve, however, you may begin to experience symptoms. In the lower back, the damaged disc can cause pain to travel to the hips, buttocks, legs and feet. In the cervical spine, pain can radiate from the neck, down the arm and to the fingers. Approximately 90 percent of bulging discs occur in the lower back, or lumbar area, of the spine. The most common lumbar bulging disc is seen between lumbar vertebrae L4 and L5, and between vertebrae L5 and S1, causing pain in the L5 nerve or S1 spinal nerve, respectively. The sciatic nerve receives neurons from spinal nerves L3 through S3. If the bulging disc impinges upon one or more of these six spinal nerves, then sciatic pain could result. Sciatic pain originates in the low back, radiates through the buttocks, down the back to the leg and could extend all the way to the foot. The discs between cervical vertebrae may also bulge. If nerve root compression occurs in the cervical, or upper, region of the spine, symptoms are experienced in the neck with radiation to the scapular area, shoulder, arm, forearm and hand. Some activities speed up the development of disc bulges and are to be avoided. Protect your back when lifting, use good posture, maintain a healthy weight and exercise regularly to strengthen core muscles supporting body weight. Following the diagnosis of a symptomatic bulging disc, your physician will recommend treatments designed to relieve symptoms, such as rest, warm compresses, exercises and medication. Most of the time, symptoms arising from a bulging disc will abate with this conservative treatment. However, if pain does not abate, Epidural Steroid Injections and/or nerve blocks can be beneficial. In some cases, surgical intervention is required.

Nerve pain after surgery and other types of chronic postoperative pain can be very dissabeling. What Is Chronic Postoperative Pain? Most of us anticipate pain immediately after surgery. When you are cut, your body responds with tissue swelling and a certain amount of discomfort. This is called “acute” postoperative pain. Chronic postoperative pain persists after the expected healing time from surgery. What Causes It? The cause of chronic postoperative pain, also known as chronic post surgical pain, is not completely understood. However, most researchers agree on a few potential causes: peripheral nerve damage during surgery inflammation at the site of the wound damage to bodily tissues during surgery While there is not much research pinpointing the risk factors for chronic postoperative pain, there are a few things that may predispose certain individuals to this condition. These include: prior history of chronic pain disorders a history of anxiety and/or depression excessive fear of the surgery pre-operative pain extensive (lasting more than three hours) or complicated surgeries Common Types of Chronic Postoperative Pain You can experience chronic postoperative pain from almost any type of surgery, including outpatient procedures. Examples of postoperative pain include: Phantom limb pain Post-mastectomy pain Pain following hernia repair Postoperative pelvic pain Postoperative back pain Treating Nerve Pain and Other Types of Chronic Pain After Surgery Chronic postoperative pain can be treated with any of the following medications: NSAIDs. Anti-inflammatories such as ibuprofen may be used to control mild to moderate postoperative pain. They may be used to treat severe pain as well, in combination with other painkillers. Acetaminophen. Acetaminophen is another option in treating mild, moderate or severe postoperative pain. It may be used alone or in conjunction with other painkillers. Opioids. Weaker opioids may be used to treat moderate postoperative pain, while stronger ones may be utilized for more severe cases. Anticonvulsants. Anticonvulsants may be used to manage certain types of postoperative pain, especially those associated with nerve damage. Nerve blocks. In some cases of severe postoperative pain, nerve blocks may be used to reduce pain sensations. Chronic postoperative pain treatment is often multimodal. This means that treatments are often combined to provide maximal pain relief.

Facet joint disorders are some of the most common of all the recurrent, disabling low back and neck problems, and can cause serious symptoms and disability for patients. Interestingly, when the acute lumbar or cervical facet joint inflammation is at its peak, the symptoms may closely imitate those of a herniated disc and can be very disabling and scary. Symptoms may include the following: Acute episodes of lumbar and cervical facet joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year. Most patients will have a persisting point tenderness overlying the inflamed facet joints and some degree of loss in the spinal muscle flexibility (called guarding). Typically, there will be more discomfort while leaning backward than while leaning forward. Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. Similarly, cervical facet joint problems may radiate pain locally or into the shoulders or upper back.

Failed back surgery syndrome is a generalized term that used to describe the condition of patients who have experienced continued pain after surgery. This can be a difficult condition to treat. In some instances, epidural steroid injections, nerve blocks, and spinal cord stimulation can be beneficial in restoring functioning and reducing pain. Vertebral Compression Fractures May be due to trauma or due to a weakening of the bones of the spine from osteoporosis or cancer. When these fractures occur, nerves can become irritated and painful. In some instances, epidural steroid injections and nerve blocks can be beneficial to treat the pain and discomfort. In certain cases Vertebral Augmentation (Vertebroplasty/Kyphoplasty) is required to stabilize the spine and reduce pain.

Peripheral Neuropathy Peripheral neuropathy, a result of damage to your peripheral nerves, often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body. Your peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body. Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes mellitus. People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. Medications can reduce the pain of peripheral neuropathy. In severe and refractory cases Spinal Cord Stimulation can be helpful. Talk with your doctor about various treatment options.

Cluster Headaches Cluster headache (CH) is a neurological disorder characterized by recurrent, severe headaches on one side of the head, typically around the eye. Often accompanying symptoms may occur such as eye watering, nasal congestion and swelling. The cause of cluster headache has not been identified. While there is no known cure, cluster headaches can sometimes be prevented and acute attacks treated. Steroids may be used as a transitional treatment and may prevent attack recurrence until preventative treatments take effect. The condition affects approximately 0.2% of the general population and men are more commonly affected than women.

Whiplash Whiplash is sometimes referred to as a sprained neck or neck strain. It is an acute injury to the neck, usually caused by a high velocity injury (such as a Motor Vehicle Accident). Whiplash is characterized by a collection of symptoms that occur following damage to the neck. In whiplash, the intervertebral joints (located between vertebrae), discs, and ligaments, cervical muscles, and nerve roots may become damaged. What Causes Whiplash? Whiplash is caused by an abrupt backward and/or forward jerking motion of the head. What Are the Symptoms of Whiplash? Symptoms of whiplash may be delayed for 24 hours or more after the initial trauma. However, people who experience whiplash may develop one or more of the following symptoms, usually within the first few days after the injury: Neck pain and stiffness Headaches Pain in the shoulder or between the shoulder blades Pain or numbness in the arm and/or hand Dizziness Difficulty concentrating or remembering Irritability, sleep disturbances, fatigue Typical treatments include – anti-inflammatories, Ice, rest, muscle relaxers. In some cases physical therapy can be beneficial along with injection therapy. In persistent cases of pain, facet blocks and/or radio-frequency ablations can provide great benefit.

Abdominal (belly) pain is pain or discomfort that is felt below the ribs and above the pelvis or groin. It comes from organs within the abdomen or organs adjacent to the belly. It is caused by inflammation, distention of an organ, or by loss of the blood supply to an organ. In irritable bowel syndrome (IBS) it may be caused by contraction of the intestinal muscles or hyper-sensitivity to normal intestinal activities. Symptoms associated with it may include: Bloating Belching Gas (flatus, farting) Indigestion Discomfort in the upper left or right; middle; or lower left or right abdomen Constipation Diarrhea GERD (gastro-esophageal reflux disease) Heartburn Chest discomfort Pelvic discomfort The cause of abdominal pain is diagnosed on the basis of its characteristics of the, physical examination, and testing. Occasionally, surgery is necessary for diagnosis. The medical diagnosis of the cause is challenging because the characteristics may be atypical, tests are not always abnormal, diseases causing pain may mimic each other, and the characteristics may change over time. Medical treatment depends upon the patient’s history of disease or other health conditions that may be the cause. Sometimes injection therapy is helpful in confirming the diagnosis, or treating the underlying condition. For instance chronic pancreatitis can be alleviated with a Celiac Plexus Block. Pelvic Pain may respond to Sympathetic Plexus Blocks.

Stump pain typically occurs following an amputation. Stump pain is usually caused by nerve injury within the amputation stump. It is described as sharp, shooting, achy, burning, or cramping pain. Over time, it may become more or less severe. This problem often precludes the use of prosthesis or crutches; thereby, significantly affecting one’s quality of life. Talk with your physician about the role various medications and injections may play in assisting you with your pain.