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Common Conditions

Acute & Chronic Pain

Sudden and/or intense pain is referred to as acute pain. Acute pain often follows an injury to the body, or recent surgery or medical illness, and dissipates when pain medication is administered and/or the injury is treated. When serious pain is present, a pain medicine physician may be necessary to help manage the pain and offer relief.

Pain that lasts beyond the normal time expected for an injury to heal or an illness to resolve is referred to as chronic or persistent pain. This type of pain can be very stressful to a patient both physically and mentally and usually requires careful ongoing treatment.

Facet Joint Inflammation

A source of lower back and neck pain include anatomical structures such as zygapophysial joints, or facet joints. These small, stabilizing joints are located behind and between adjacent vertebrae, and act as a guide to limit spine movement.

As with hip and knee joints, wear and tear on these facet joints, through aging, can eventually lead to arthritis. Joint inflammation is the chief characteristic of this sometimes painful condition. Facet joint inflammation following surgery or trauma to the spine can lead to back and neck pain. Neck pain is attributed to facet joint disease more often than to disc herniations or degenerative disc disease.

Herniated Disc

Terms such as ‘slipped’ or ‘ruptured disc,’ ‘pinched nerve,’ ‘sciatica’, or ‘scithe atica’ most often refer to irritation to the nerve root as it exits the spine as a result of herniated disc compression. Although there are other causes of nerve root irritation, disc herniations, especially in the lower back, are more common.

Sacroiliac Joint Dysfunction

Inflammation of the sacroiliac joint may result in the lower back and/or leg pain, which can mimic pain caused by a number of other spinal structures including lumbar discs, nerve roots, facet joints, or hips. The pain usually occurs low on one side of the back or buttocks and can radiate down the leg. Pain is usually contained above the knee, but at times can extend all the way to the ankle or foot.

Compression Fractures

Osteoporosis is a condition characterized by bone density loss, which leaves bones weak and at increased risk of fractures. A common complication of osteoporosis is vertebral compression fractures, which occur when the vertebral body collapses from the weight of the structures above it. Oftentimes, people do not realize they have a compression fracture or seek medical care, assuming their symptoms are just part of the aging process.

Sometimes, however, compression fractures may be very painful and debilitating. Even without pain, vertebral compression fractures can lead to additional fractures, spinal deformity, and the loss of functioning ability. At times, they may even cause breathing difficulties. Those diagnosed with osteoporosis are at higher risk for compression fractures resulting from a minor fall, or even from simple daily activities, such as bending or lifting.
In addition to pain, signs, and symptoms of a compression fracture may include:
  • Kyphosis or ‘humpback’
  • Loss of height—one reason many older people seem to shrink as they age
  • Neurological symptoms, including numbness, tingling, or weakness
  • Loss of balance

Degenerative Disc Disease

DDD is a common affliction in aging adults. Intervertebral discs, made up of protein, cartilage, and water, serve as shock absorbers for the spine. Aging causes these discs to become dry and lose their strength and resilience. These changes are gradual, and most people do not know they have degenerative disc disease–only a small portion of the general population actually experiences symptoms from their degenerated discs.

The most helpful tool used to screen for this condition is an MRI (magnetic resonance imaging) study. The MRI may reveal characteristics common to DDD, such as:
  • Bulging disc
  • Dehydration (loss of water from the center of disc)
  • Decreased disc height (flattening of the disc)
  • Endplate changes – or changes to the vertebral body above and below the disc

Spinal Stenosis

Stenosis is the medical term used to describe the constriction or narrowing of an opening or passageway in the body. The term can apply to many different parts of the body including blood vessels, intestines, and the spinal column. While stenosis can affect different parts of the spine, the term ‘spinal stenosis’ usually refers to the central canal of the spinal column.

Spinal stenosis occurs when pressure is placed on the spinal nerves and/or spinal cord. While some patients are born with this narrowing, most cases of spinal stenosis occur in patients over the age of 50 as a result of aging or wear and tear on the spine. Many patients with spinal stenosis do not experience symptoms until other conditions cause further compression. Other conditions may include:
  • Calcification (thickening and hardening of the spinal ligaments)
  • Osteophytes (hard bony growths on bones and joints)
  • Herniated or bulging discs
  • Spondylolisthesis (slipping of one vertebra onto another)
  • Trauma (such as from an accident)

Symptoms of spinal stenosis include:

  • Low back pain sometimes relieved by bending forward or sitting
  • Neck pain
  • Pain, weakness, or numbness in upper or lower extremities
  • Burning sensations, tingling, and pins and needles in the extremity.
  • Hand clumsiness.
  • Gait and balance problems
  • Bladder and bowel problems (in severe cases).
  • Although rare, a severe case could result in significant loss of function or even paralysis.

Procedures

  • Epidural Steroid Injections
  • Facet Joint Injections
  • Sacroiliac Joint Injections/Coccyx Joint Injections
  • Therapeutic Joint Injections with or without fluoroscopy: All Joints
  • Viscosupplementation Knee Injections
  • Carpal Tunnel Injections
  • Trigger Point Injections
  • Protein Rich Plasma (PRP) Injections
  • Radiofrequency Ablation

Nerve blocks are used to prevent or manage many different types of pain. Often, these are injections containing medicine that keep pain signals from reaching the brain. Nerve blocks can help relieve pain temporarily or long-term. In some cases, they may be used to diagnose a patient. For example, a specific nerve may be blocked to see if it is still working properly.

Occipital Nerve Blocks

Peripheral Nerve Blocks

Patients suffering from back or neck pain caused by facet joint problems may benefit from Radiofrequency Ablation (RA), a procedure whereby radio waves or electric current is used to block affected nerves. RA may also be used to treat leg and arm pain, degenerative disc pain, as well as neuralgia and certain types of abdominal pain.

The skin is numbed under sterile conditions using a local anesthetic. Since nerves cannot be seen under x-ray, introducer needles are positioned using landmarks to indicate the usual location of nerves. Once the x-ray shows the introducer needle in a good position, a special electrically active needle tip is inserted. Radio waves or electric current generate sufficient heat to interrupt pain signals, which can last from 3-18 months, with a typical range of 6-9 months. Approximately 70 percent of patients will get a good block of the intended nerve. Depending on the areas to be treated, the procedure can take from twenty minutes to an hour.

Most patients who undergo radiofrequency ablation have typically tried other, more conservative treatments such as anti-inflammatory medication, physical or chiropractic therapy.

Patients experiencing chronic and severe neuropathic pain due to damaged nerve tissue may benefit from a Spinal Cord Stimulator Trial. During this procedure, a special device called a Spinal Stimulator uses temporary electrodes to stimulate the spinal cord and spinal nerves. A small electrical wire or lead-containing these electrodes are placed behind and just outside the spinal cord in the epidural space. Tiny electrical impulses act to interrupt nerve conduction of pain signals to the brain.

The placement of the trial electrodes is done under sterile conditions with patients mildly sedated. Patients are monitored with an EKG, blood pressure cuff, and an oxygen-monitoring device. The process takes from fifteen minutes to an hour and the trial can last from several days to a week.

Patients who have failed more conservative treatment options may be candidates for a Spinal Cord Stimulation trial. Insertion of a temporary wire gives the patient an opportunity to experience Spinal Cord Stimulation without having to undergo a full implantation. If the patient experiences a significant increase in pain tolerance and a decrease in the need for pain medication, the physician may recommend a permanent device be placed at a later date.

Regenerative Medicine (regenerative tissue) are present in all of us and serve as a natural repair system to the body. As we age, a decrease in cell numbers may leave an insufficient amount for repairing an injury. Stem cell therapy is a form of regenerative medicine that supports this natural repair system by increasing the numbers of stem cells at injury sites.

Some conditions which may be treated using stem cell therapy are:

  • Back or joint pain
  • Cartilage damage
  • Arthritis
  • Knee injuries
  • Soft tissue injuries (muscle, ligaments, and tendons)

Utilizing highly advanced image guiding technology, a concentrated cluster of stem cells is injected into the affected area. This minimally evasive procedure may help to delay or avoid surgery, and because it uses cells from the patient’s own body, the chances of immune rejection are reduced. Recovery times can vary depending on the severity of the injury and your personal health. Many patients have shown improvement in pain and mobility after just one treatment. Typically, the process of full regeneration takes 10-12 weeks. You may be a good candidate for stem cell therapy if you want pain relief without the complications related to invasive surgical procedures.

Suffering from pain?
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