Back pain / Slipped Disc

Back pain is a common complaint. Four out of five people in the United States will experience low back pain at least once during their lives. It's one of the most common reasons people go to the doctor or miss work.

On the bright side, you can prevent most back pain. If prevention fails, simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back pain

When back pain does not subside, and the injury or illness that caused it has had sufficient time to heal, it is termed chronic back pain.

Chronic back pain usually lasts more than three months and may be mild or severe. Amongst the common causes for your back pain may be facet joint or herniated intervertebral disc (slipped disc).

Causes may be

  • Bulging Or herniated (slipped disc)

  • Sciatica - Herniated disc pressing over the nerve going to your leg causing sharp shooting pain the back & leg

  • Arthritis - It can lead to narrowing of the space around the spinal cord called spinal canal stenosis. This can cause back & leg pain.

  • Structural irregularity - Your spine may have abnormal curvature either side to side or excessive curve in front/ back.

  • Osteoporosis can cause vertebra fracture & can cause back pain. common in old age.

  • Rare causes include Cancer, infection, cauda equina syndrome.

Contact your physician immediately when you have constant unrelieved pain, pain going in legs specially below knee, causing weakness & numbness, or loss of bowel / bladder  control, follows fall or trauma, associated with abdominal pain or fever or associated with unexpected weight loss.

Commonly done tests are X-rays, MRI, Nerve conduction studies, Bone scan, blood tests.

Treatment includes medicines, physical therapies for the first 4 weeks.

Injections for spine pain like epidural steroid injections, facet joint or its nerve block, radiofrequency ablation (RFA), Provocative discography, Dekompressor / ozone discectomy.

Surgery for spine pain is the last resort therapy and can be avoided in majority of patients with interventional pain procedures.
 

Neck pain is described as an aching, burning, stabbing, shooting, or cramping pain and frequently spreads into the Head, upper back, the arm or the hand. It is frequently made worse by activities that require one to be static or perform repetitive tasks like typing and answering the phone. It might be post trauma or a degenerative problem. Common sources of neck pain include Facet joints, Herniated discs, Muscles etc. The causes are almost similar to that for back pain (see above)

  

Injections for spine pain like cervical epidural steroid injections, facet joint or its nerve block, radiofrequency, Provocative discography, Dekompressor / ozone discectomy.

Surgery for spine pain is the last resort therapy & should always be avoided.

Headaches
 

Headaches are one of the most common physical problem people experience. When headaches are severe, they often control the life of their victim by disrupting job performance, daily activities and sleep. Common types of headaches are: tension, migraine, cluster and sinus. Many a time's pain arising from upper neck structures (like C1-2, 2-3 joints/ nerves) might travel in the head as a referred pain. It is vital to differentiate and treat the condition accordingly. At PCI we differentiate & treat complex types of headache effectively.

  
 

Common treatments used at the Center include Medications, Physical Therapy and cervical epidural steroid injections, radiofrequency nerve ablation, Botox® Injections.

 

Post Herpetic Neuralgia (Shingles)

 

One of the most common complications of shingles is persistence of pain in the affected area of the body after the rash has healed. This is often called post-herpetic neuralgia . It may be very severe and prolonged, particularly in older patients.

  
 

Post-herpetic neuralgia is most likely to occur when the patient with shingles is older (more than 50 years old), there is severe or moderately severe pain when the rash appears and/or there is pain before the rash appears.

  
 
Through years of experience, Dr. Kailash Kothari has developed a treatment that has proved successful and effective. Please call our office to find out more.
  

 
 

Shoulder Pain

  
  The shoulder is the most movable joint in the body. However, it is an unstable joint because of the range of motion allowed. It is easily subject to injury because the ball of the upper arm is larger than the shoulder socket that holds it. To remain stable, the shoulder must be anchored by its muscles, tendons, and ligaments. Some shoulder problems arise from the disruption of these soft tissues as a result of injury or from overuse or underuse of the shoulder. Other problems arise from a degenerative process in which tissues break down and no longer function well.  
  Shoulder pain may be localized or may be referred to areas around the shoulder or down the arm. Disease within the body (such as gallbladder, liver, or heart disease, or disease of the cervical spine of the neck) also may generate pain that travels along nerves to the shoulder.  
X-rays, MRI, arthrogramme are usual tests to diagnose cause of shoulder pain.
  Tendinitis, Bursitis & Impingement of soft tissues in & around shoulder are some of the common causes of shoulder pain.  
  Intra-articular, peri-articular, intrabursal  injection of steroid or prolotherapy agents are some of the very effective treatment options for moderate to severe shoulder  pain. Physical rehabilitation programme with this therapy is very effective for pain relief.  

 
Diabetic Neuropathy
 

Diabetic neuropathy is a common complication of both Type 1 diabetes and Type 2 diabetes. Neuropathy plays a major role in the development of foot ulcers, which cause an enormous burden on quality of life for the patient (especially if amputation becomes necessary) and is also responsible for a very large health and social services expenditure. Optimal control of all metabolic factors and regular organised surveillance of all people with diabetes is essential to reduce the risk of both development and progression of diabetic neuropathy and therefore reduce the risk of disability for the patient. Motor, sensory, and autonomic fibres may all be affected by diabetic neuropathy.

  
 

Medical management with different drugs in most patients and interventional pain procedures like sympathetic blocks & spinal cord stimulators in some intractable cases can be very helpful for these patients. Our pain physicians are specialized in managing these painful conditions.

  
What is complex regional pain syndrome (CRPS)?
 
Complex regional pain syndrome is pain that may occur after an injury to an arm or a leg. In rare cases, the syndrome develops after surgery, a heart attack, a stroke or other medical problem. The pain is often described as a burning feeling and is much worse than expected for the injury. Your doctor may also call this condition reflex sympathetic dystrophy or causalgia. The cause of the syndrome is not known.
  
 

Symptoms include -

  • "Burning" pain in your arm, leg, hand or foot.

  • Skin sensitivity.

  • Changes in skin temperature, color and texture. At times your skin may be sweaty; at other times it may be cold. Skin color can range from white and mottled to red or blue. Skin may become tender, thin or shiny in the affected area.

  • Changes in hair and nail growth.

  • Joint stiffness, swelling and damage.

  • Muscle spasms, weakness and loss (atrophy).

  • Decreased ability to move the affected body part.

Symptoms may change over time and vary from person to person. Most commonly, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first. Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

CRPS can be Type I (RSD) occurs after an illness or injury that didn't directly damage the nerves in your affected limb Or Type II (Causalgia) - this type follows a distinct nerve injury.

  
  If you experience constant, severe pain that affects a limb and makes touching or moving that limb seem intolerable, see your doctor to determine the cause. It's important to treat complex regional pain syndrome early.  

If complex regional pain syndrome isn't diagnosed and treated at an early stage, the disease may progress to more disabling signs and symptoms. These may include: Muscle wasting (atrophy), Contracture.

Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body in these patterns: Continuity type. The symptoms may migrate from the initial site of the pain — for example, from your hand to your shoulder, trunk and face.Mirror-image type. The symptoms may spread from one limb to the opposite limb. Independent type. Sometimes, the symptoms may leap to a distant part of your body.
  Diagnosis - based on a physical exam and your medical history. The following procedures can help in reaching the diagnosis
  • Bone scan
  • Sympathetic nervous system tests. These tests look for disturbances in your sympathetic nervous system. For example, thermography measures the skin temperature and blood flow of your affected and unaffected limbs. Other tests can measure the amount of sweat on both limbs. Dissimilar results can indicate complex regional pain syndrome.
  • X-rays. Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
  • Magnetic resonance imaging (MRI). Images captured by an MRI device may show a number of tissue changes.
  • Sympathetic nerve diagnostic block
  
 

Management

Dramatic improvement and even remission of complex regional pain syndrome is possible if treatment begins within a few months of your first symptoms. Often, a combination of various therapies is necessary. Your doctor will tailor your treatment based on your specific case. Treatment options include:

Medications -
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen sodium may ease pain and inflammation. In some cases, antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain). Corticosteroids, such as prednisone, may reduce inflammation.

Your doctor may suggest bone-loss medications, such as alendronate and calcitonin. Opioid medications may be another option. Taken in appropriate doses, they may provide acceptable control of pain.

 

Therapies

  • Applying heat and cold

  • Topical analgesics may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.

  • Physical therapy. Gentle, guided exercising of the affected limbs may improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.

  • Sympathetic nerve-blocking medication

  • Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.

  • Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.

  • Spinal cord stimulation

  

Trigeminal neuralgia (TN)
  Tic doloureux (also known as proeopalgia) is a neuropathic disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead, and jaw. TN usually develops after the age of 50, more commonly in females, although there have been cases with patients being as young as three years of age.  
  The episodes of pain may occur paroxysmally. To describe the pain sensation, patients may describe a trigger area on the face, so sensitive that touching or even air currents can trigger an episode of pain. It affects lifestyle as it can be triggered by common activities in a patient's daily life, such as eating, talking, shaving and toothbrushing. The attacks are said to feel like stabbing electric shocks, burning, pressing, crushing or shooting pain that becomes intractable. Individual attacks affect one side of the face at a time, last several seconds, hours or longer, and repeat up to hundreds of times throughout the day. The pain also tends to occur in cycles with complete remissions lasting months or even years. 10-12% of cases are bilateral, or occurring on both sides. This normally indicates problems with both trigeminal nerves since one serves strictly the left side of the face and the other serves the right side. Pain attacks typically worsen in frequency or severity over time. A great deal of patients develop the pain in one branch, then over years the pain will travel through the other nerve branches.  
  Once the correct diagnosis is made, typical trigeminal neuralgia can be effectively treated. Many people find relief from medication, Percutaneous procedures like RF ablation, Baloon decompression or surgical options named microvascular decompression (MVD). Atypical trigeminal neuralgia, which involves a more constant and burning pain, is more difficult to treat, both with medications and surgery.  

Cancer Pain
  Pain in cancer is one of the most common symptoms. It is of vital importance to provide adequate pain relief so that cancer patient can live the last stages of their life comfortable & happily. There are various nerve block techniques used by pain specialist at PCI to achieve this goal. In cases with intractable pain is not responding to simple nerve block, our pain physician treat it by implanting a highly specialized intra spinal drug delivery pump. Our pain physicians are specialized in opioid management for these patients.  

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