Arthritis

What is Arthritis?

Arthritis is a joint disorder which causes inflammation, as well as a many other associated symptoms. Any area where two bones meet can become inflamed and termed to have arthritis. When this happens, patients begin to report joint pain and other common symptoms of arthritis. More than 100 types of arthritis exist; degenerative osteoarthritis, rheumatoid arthritis, and gout are the most common.

Symptoms of Arthritis

Pain and stiffness of the joint are the most common symptoms, but it can be associated with host of other common experience such as, joint swelling, hand pain, ankle pain, red joints, and painful movements. It can also affect other connective tissue and skin.

The severity of symptoms will depend on each person. Other associated symptoms also vary depending on the type of arthritis; rheumatoid arthritis and osteoarthritis are the two most common types of arthritis.

Risk factors and causes of arthritis include:

Possible Causes of Arthritis?

Different type of arthritis will have different causes. Additionally, there are certain risk factors that may make patients more likely to develop arthritis.

  • age

  • gender

  • family history (hereditary factors)

  • previous joint injuries

  • obesity (excess weight on joints)

  • metabolic abnormalities

  • indirect and direct consequences of infections

  • dysregulated immune system (i.e. a misdirected immune system)

Treatment and Care for Arthritis

Arthritis is the most common cause of disability in United States, generally it is a progressive disease. When it becomes severe it can restrict your daily functional abilities. If arthritis affects your weight-bearing joints (Hips, knees, ankles, feet, etc.), patients can experience difficulty with walking and sitting up straight.

Treatment and at-home care can be very helpful to cope with arthritis. It is important to note that some types of arthritis respond well to treatment, but other types of arthritis do not. The goal of arthritis treatment is: to improve joint function, to relieve symptoms, to reduce pain, and to prevent more joint damage. Three main types of arthritis treatment exist: medications, rehabilitation therapy, and surgery.

  1. Arthritis Medications

Common medications for arthritis treatment include:

  • non-steroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen

  • analgesics

  • counterirritants like capsaicin or menthol

  • biologics: targeting particular cells or chemical involved in body immune system

  • steroids: oral or injectable

  • disease-modifying anti-rheumatic drugs (DMARDs)

Medications aim to reduce symptoms, such as inflammation, as much as possible.

  1. Rehabilitation therapy

The second type of treatment option is physical or occupational therapy. Physical therapy can significantly improve function, decrease pain, and delay need for surgery.

Physical therapy is especially important and beneficial for patients who show the most need for improving range of motion and for strengthening the muscles near the joints.

Occupational therapy can aid with activities especially arm and hand movements.

  1. Surgery for Arthritis

Surgery (i.e. Arthroscopic surgery, joint replacement or joint fusion) is an option for arthritis treatment especially when there is joint erosion by arthritis.

Our goal at Cornell pain clinic is to try other treatment methods, minimally invasive procedures before major joint replacement surgeries.

 

Alternative Remedies for Treating Arthritis

Alternative remedies you can try may potentially be effective to treat arthritis and its symptoms.

Some remedies you can try:

  • yoga or tai chi

  • massage

  • glucosamine and chondroitin

  • acupuncture

  • transcutaneous electrical nerve stimulation (TENS)


Managing and Living with Arthritis

If you have to live with arthritis, you probably want to live as pain-free and symptom-free. Certain strategies mentioned here you may find helpful:

  • Anti-inflammatory diet. While there is no specific “diet” that people with rheumatoid arthritis should follow. Certain foods can help control inflammation. Many of these things are found in Mediterranean food.

  • Maintain a healthy weight.You do not want to carry around extra weight all day. Extra weight puts a lot of stress on the joints, which can potentially cause arthritis down the road. Instead, lose the excess weight and experience how it feels to have healthy joints.

  • Use heat and cold therapy.For days when you experience joint pain or other arthritis-related symptoms, use a combination of heat and cold therapies to relieve the pain. We recommend using ice packs or heating pads.

  • Exercise as much as possible. We know it may be physically difficult to exercise if you are experiencing arthritis pain. We are not saying to push your limits. What we are saying is to keep up with a regular exercise routine, whether that means stretching, chair-yoga, taking a leisure walk a few times per week, riding a bicycle, swimming, or water aerobics.

Choose the exercises that produce the least amount of stress on the joints causing you pain, and stick with an exercise plan to keep the joints moving and to lose extra pounds.

  • Use of assistive devices, if needed.If walking becomes too difficult, for instance, try using a walking cane to help you move along. Assistive devices are there to help you function more successfully.

Back Pain

Back pain is pain felt in your back, which is extremely common condition. It is divided into neck pain (cervical), middle back pain (thoracic), low back pain (lumbar), coccydynia (tailbone or sacral pain) based on the segment of the spine affected. Low back pain is most common type of back pain as lumbar spine supports most of your upper body weight.

Muscular Man suffering from neck and back pain from variety of different causes.

 

Episodes of back pain can be categorized into acute, sub-acute, chronic based on duration.

Studies have shown that up to 80% of general population has experienced Low back pain at some point in their life. Chronic back pain is experienced by 15-20% of people in United States. Back pain is common in adults ranging in age from 35 to 60. However, back pain can affect anyone at any age.

 


Common Symptoms of Back Pain

 

  • persistent achiness or stiffness along your spine

  • sharp, localized neck, upper back or lower back pain

  • feeling of back giving out

  • numbness or tingling in leg or foot

  • difficulty moving (sometimes can prevent standing or walking)

  • inability to stand straight without having pain or muscle spasms in lower back

Although most causes of back pain are relatively benign and self-improving. You should seek medical help as soon as possible if you experience any of the following symptom.

  • difficulty urinating or incontinence

  • fecal incontinence

  • Significant trauma or injury to your spine

  • back pain not improving with conservative management

  • minor fall or injury with history of osteoporosis or prolonged steroid use

  • shooting pain down to the legs

  • pain or numbness in buttocks, genitals, thighs, or legs

  • inflammation or swelling on the upper or lower back

  • fever

  • unexplained weight loss

If you are experiencing any of these symptoms, call Cornell Pain Clinic. We can help determine the cause(s) of your back pain so we can provide proper, effective treatment.

 


 

Causes of Back Pain

 

There are many things that can cause back pain, regardless of whether it is lower or upper back pain. Here are a few common causes of back pain:

  • strained muscles or ligaments

  • muscle spasms

    Herniated disc causing impingement of nerve root. Close view of Human Spine. 

  • ruptured, slipped, or herniated disks

  • degenerative disc or degenerated disc (DDD)

  • bulging disks

  • pinched nerve

  • arthritis

  • sacroiliitis

  • lumbar radiculopathy

  • pain after back surgery

  • facet syndrome

  • shingles

  • osteoporosis

Risk factors for back pain

  • standing, driving a vehicle, or bending for prolonged periods of time

  • overstretching

  • tobacco use

  • lack of physical activity

  • bad posture

  • strenuous physical work

  • obesity or being overweight

  • depression

  • anxiety

  • pregnancy


Treatment and Care Options

Complementary and alternative therapies for upper and lower back pain include:

  • Heat therapy

    • Yoga and Pilates

  • Yoga and Pilates

  • Massage therapy

  • Physical therapy

  • Acupuncture

  • Gentle stretching

  • Spinal manipulation (Chiropractic care)

  • TENS therapy (Transcutaneous electrical nerve stimulation)

  • Cognitive Behavioral therapy (CBT)

 

Medication therapy: If non-pharmacological therapy is not helpful, medication therapy may be tried

  • Tylenol

  • Non-steroidal anti-inflammatory drugs (NSAIDs)

  • Muscle relaxants

  • Opioid therapy: Although short term use of opioids may be helpful, long-term use comes with host of other problems

  • Psychotropic medications: targeting nerve related pain

Minimally Invasive Interventional procedures: If above mentioned conservative treatment doesn’t help you enough you may benefit by consulting a pain specialist.

  • Sacroiliac joint injection

    Minimally Invasive Interventional Procedures

  • Interventional procedures (i.e. Botox, Cortisone, epidural steroid injection, transforaminal steroid injection)

  • Median Branch diagnostic block

  • Radiofrequency nerve ablation

  • Vertebroplasty/ Kyphoplasty

  • Spinal cord stimulator

Surgical Options: If conservative treatment including repeated minimally invasive interventions aren’t helpful, you may be candidate for spine surgery. Following different kind of surgeries are available

  • Discectomy (partial removal of a disk)

  • Lumbar artificial disk (insertion of an artificial disk)

  • Decompression surgery (laminectomy, foraminotomy)

  • Spinal fusion (two or more vertebrae are fused to reduce tractional movement)

 

 


 

Managing and Living with Chronic Back Pain

 

If you are experiencing chronic back pain, it is tough to focus on your everyday life. You must know that around 20 million people in united states are experiencing chronic back pain. Many a times when pain becomes chronic, our goal becomes to improve functioning without altering pain levels. Here are few ways to manage your back pain more effectively

  • Learn deep breathing and Meditation to help you relax

  • Wear comfortable, low heeled shoes

  • Lighten your purse, briefcase or handbag:

    • By reducing the amount of weight you’re carrying, you reduce the amount of pressure on the spine.

  • Practice good posture:

    • The back provides optimal support when we stand properly and do not slouch. Sitting with proper support for the low back with shoulders back and even a foot rest can prevent low back pain. Proper balance on the feet when standing can also minimize the risk of developing low back pain while up.

Physical Therapy exercises, strengthening your core

  • Ask your physical therapist about proper exercises

    • Warm-up and stretch before exercise or other strenuous physical activity.

    • Exercise releases natural endorphins in your brain which block pain signals and improves your mood

    • To strengthen the back muscles. It is very important to keep good core muscle strength, as this will help to lessen the amount of back pain you may experience. Good exercises should target the hips, back, abdominals, and the pelvic region. McKenzie extension exercises may be helpful in relieving disc related pain

  • Avoid twisting while lifting heavy objects.

    • When lifting something, use your knees instead of using your back. This will take the pressure off of your back so your back doesn’t become strained or injured, while lifting or bending.

  • Cutback on alcohol, which may worsen sleep quality

  • Quit smoking:

    • Smoking can worsen your blood circulation problems affecting your pain level

  • Learn biofeedback:

    • It’s possible to consciously control your muscle tension through biofeedback. it’s an effective treatment for migraine and tension headache

  • Eat balanced healthy diet

If pain intensifies and become severe, consult with your physician to find out cause of your back pain.

Cervical Radiculopathy
(Pinched Nerve)

What is cervical radiculopathy?

 

Radiculopathy, refers to a set of conditions where one or more nerves are affected and do not work properly (a neuropathy). This can result in pain (radicular pain), weakness, numbness, difficulty controlling specific muscles.

It is commonly referred as pinched nerve, as nerves can be pinched by bone spur or herniated disc leading to shooting pain and other symptoms.

On average, 85 out of 100,000 people are affected by pinched nerve or cervical radiculopathy. Age group of 45-64 is most commonly affected.


Overview

Workers who use vibrating machinery repeatedly, heavy laborers, athletes, office workers with long sitting hours, and people who have arthritis in the neck regions are most commonly affected.

  • For young patients, a cervical disc herniation due to trauma/ whiplash injury can cause cervical radiculopathy.

  • For older patients, cervical radiculopathy can occur due to arthritis or a decreased disc height in the neck.

Causes of Cervical Radiculopathy

Any condition which irritates/injures the cervical nerves can cause cervical radiculopathy. Radiculopathy is usually caused when nerve is pinched, generally while exiting from spinal cord. It is commonly caused by

  • cervical degenerative disc disease

    Herniated disc in human spine in details

  • cervical spinal stenosis

  • cervical herniated disc

  • osteoarthritis

  • cervical facet joint degeneration/hypertrophy

Occurring at a less frequent rate, tumors, fractures, or sarcoidosis can cause cervical radiculopathy


 

Common Symptoms of Cervical Radiculopathy

The main symptom of cervical radiculopathy is pain that spreads into arm, neck, chest, upper back and/or shoulders. Even though problem is located in spine, you may experience symptoms at hands, arm or shoulders only.

  • sharp neck pain

  • arm pain

  • arm weakness

  • lack of coordination in the arm and hand

  • neck pain after surgery

  • tingling or numbness in the back of the arm

  • shoulder pain, numbness, or weakness

  • pain described as “pins and needles”

  • general, dull achiness near the affected nerve

  • pain that progressively gets worse with specific neck movements

  • pain that improves when the patient’s arm is lifted over and behind the head—this action relieves the tension from the spinal nerve


Treatment and Care Options

Several conservative treatment options exist for cervical radiculopathy. Two main goals for treatment are to relieve pain and to prevent re-injury.

 

Conservative treatment:

  • Medications: Combination of medications to reduce inflammation, pain, muscle spasms, and sleep disturbances.

  • Cervical collar: Wearing a cervical collar to stabilize neck movement while the spinal or neck injury is healing.

  • Avoid re-injury: Using a cervical pillow at night to help ease the pain and to sleep better.

  • Physical therapy:manual therapy, posture education, strengthening exercises, range-of-motion exercises, and functional training.

Minimal Invasive Interventions: If above mentioned conservative methods hasn’t helped you enough, you may benefit to consult a pain specialist.

Epidural Steroid injection: Cervical interlaminar or transforaminal epidural steroid injection, also called cervical nerve block

 

  • During this injection, steroid which is powerful anti-inflammatory medication is injected surrounding the dura (membrane covering the spinal cord) to reduce particular nerve sensitivity

Surgery

If conservative treatment does not help enough and repeated cervical injections doesn’t help either, surgery may be needed. Surgery may also be needed if a patient shows signs of:

  • muscle wasting

  • progressing numbness or weakness

  • unbearable pain


Managing and Living with Cervical Radiculopathy

 

Many people in united states are successfully living and managing symptoms of pinched nerve (cervical radiculopathy). These are few ways to prevent cervical radiculopathy from recurring.

  • Deep breathing and meditation: reduce muscles tension and thus chronic pain

  • Proper posture: maintain good posture while sitting, head properly aligned and resting on your shoulders.

  • Ergonomic workstation throughout your workday.

  • Maintain a healthy weight.

  • Maintain a regular stretching or exercise regimen.

If you are experiencing symptoms of cervical radiculopathy/pinched nerve and wanted to know more about your specific case. We encourage you to schedule an appointment with our physician.

Coccydynia

Are you having difficulty sitting down or feeling pain around your tail bone?

Maybe it was a sharp pain, or just a dull, throbbing pain that made it difficult or painful to sit.

Either way, it could be a sign that you have coccydynia, more commonly referred to as inflammation of the tailbone.


What is Coccydynia?

Coccydynia is inflammation of the tailbone(coccyx), commonly caused by some form of injury or trauma. Typically, individuals who experience tailbone inflammation complain of pain and discomfort at the bottom of your spine (tailbone area)

Overview

  • Coccyx(tailbone) is triangular bone sitting at bottom of our spine. It is composed of 3 to 5 fused bony segments held together by joints and ligament.

  • Tailbone inflammation or coccydynia is common after some form of trauma/ injury

  • This type of pain is five times more common in females due to wider pelvis and more exposed coccyx (tailbone)

What Causes Coccydynia?

Tailbone inflammation typically occurs from one of the following:

  • sports-related injuries like cycling, skateboarding, horseback riding, rowing

  • sitting for prolonged periods of time

  • After child-birth

In some cases, the cause of tailbone inflammation is seemingly unknown, and other conditions such as fractured bone, sciatica may cause symptoms around tailbone or hips. You may need to consult a Pain specialist to confirm your diagnosis and develop a treatment plan.


Common Signs and Symptoms

If you have following signs or symptoms, you may be suffering from tailbone inflammation:

  • difficulty or pain sitting

  • tenderness in the tailbone region

  • painful bowel movements

  • pain in the buttock’s region

  • some may experience pain after sexual intercourse


Treatment and Care options

 

Conservative treatment: Majority of people feel better after following non-surgical treatment:

  • Using Ice-packs around tailbone area

  • Medications: short course of nonsteroidal anti-inflammatory medications (NSAIDs) like Aspirin, ibuprofen or Naproxen.

  • Avoid prolonged sitting, and use a comfortable doughnut cushion when sitting.

  • Avoid re-injury by avoiding frictional activities like cycling, horseback riding, contact sports.

  • You may benefit from physical therapy if experiencing chronic or severe coccydynia.

Minimal Invasive Interventional procedures

  • Ganglion impar block or injection may be used to provide prolonged pain relief and treatment.

Surgery

  • If nonsurgical treatment fails to provide relief or in case of cancer, Coccygectomy (removal of tail bone) may be required.

When do you need Specialist help?

  • Majority of people don’t need specialist help if their symptoms are improving with medical treatment

  • If you failed conservative first line treatment methods and experiencing debilitating severe pain, please consult your nearest pain management specialist.

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a neurological disease leading to chronic pain affecting an arm or a leg. CRPS typically develops after an injury, surgery, stroke or heart attack. The pain is out of proportion to inciting event or trauma.

This occurs due to nerves and sympathetic nervous system dysfunction. These dysfunctional nerve endings often misfire which is interpreted by our body as extreme pain signals. It is often associated with swelling, skin color changes, hair and nail changes.


 

CRPS (also called reflex sympathetic dystrophy—RSD) commonly affects the arms or legs, but it can occur anywhere in the body. These symptoms may start in one area of the body, but then transition to a different part.

People in their 40s are most commonly affected, with women getting affected 3 times more commonly than men.

Early and aggressive multimodal treatment of CRPS is key to prevent long term disability, so early diagnosis of CRPS is crucial for its management.

Common Symptoms of Complex Regional Pain Syndrome

  • continuous and intense pain

  • sensitive skin when touched

  • sensitive skin when other objects touch (i.e. bed sheets)

  • burning skin

  • burning pain

  • swollen arms

  • swollen legs

  • swollen (affected) joints

  • cold arm

  • cold leg

  • stiff (affected) joints

  • decreased mobility in the affected body part

  • changes in hair and nail growth

  • excessively sweaty skin

  • changes in skin temperature

  • blotchy, purple, red, or pale skin color changes

  • skin that becomes thin and shiny in texture

Symptom may change over time and it varies from person to person. Pain, swelling, redness, noticeable changes in temperature, hypersensitivity (particularly to cold and touch) usually occur first.


What Causes Complex Regional Pain Syndrome?

CRPS has been classified into CRPS 1 and CRPS 2 (Causalgia). CRPS 1 have no history or evidence of peripheral nerve injury, whereas CRPS 2 usually has history of peripheral nerve injury by trauma, surgery etc.

What actually goes wrong; through research multiple different hypothesis has been formed but actual causal mechanism of CRPS is still unclear. Some hypothesized NMDA receptor activation at your nervous system.

Many experts believe it occurs because of a dysfunction in the peripheral or central nervous system and inappropriate inflammatory response.

Complications of longstanding CRPS

Untreated or improperly treated CRPS can lead to following complications

  • Tissue wasting (atrophy): your skin, bone, muscle begin to deteriorate or weaken if you are unable to move your arm or leg for long time due to pain and stiffness.

  • Muscle tightening (contractures): you may experience tightening of your muscles, leading to your hand, fingers or foot in a contract into fixed position.

Prevention

There are few studies showing benefit of following strategies

  • Taking vitamin C after wrist fracture: Research have shown people taking daily dose of Vitamin C 500mg, had lower risk of developing CRPS than who don’t.

  • Early mobilization after stroke: Studies show that people who are able to get out of bed, walk around soon (early mobilization) lower their risk of developing CRPS.


Treatment and Care Options

 

Early diagnosis and multidisciplinary (Medical, Psychological, Physical/ occupational therapy) treatment are recommended for maximum benefit.

Even though there is no definitive cure for CRPS, many treatment and care options exist.

Physical and Occupational therapy

  • Aim to improve function and avoid atrophy, contractures

Other activity-oriented therapy; graded motor therapy and mirror therapy

 

Medications

  • Lidocaine patches

  • Nerve membrane stabilizers

  • Antidepressants to reduce central sensitivity

  • Clonidine to relieve pain

  • ketamine infusion therapy

  • lidocaine infusion therapy

  • injection therapy

Some experts believe, combination of nerve blocks and ketamine infusion may be best available treatment currently for CRPS.

 

Minimal Invasive Interventions:

Often in combination of medications, these interventions can be very helpful to regain function and avoid late complications

  • sympathetic block

  • stellate ganglion block

  • lumbar sympathetic block

  • neuromodulation techniques

  • spinal cord stimulation

  • dorsal root ganglion (DRG) stimulation

  • intrathecal medication pump

  • surgical sympathectomy

Experiencing symptoms of CRPS can be emotionally challenging on anybody. Emotional stress often makes their symptom worse but not actually cause of their symptoms.

We will evaluate you with thorough review of history, physical exam and make a customize treatment plan for you in collaboration with your other providers.


 

Managing and Living with CRPS

Living with complex regional pain syndrome can be very challenging. It is hard for patients to explain and make understand their symptoms to family and friends as it is an uncommon condition in general population.

Some strategies for daily living to cope with CRPS:

  • Take up yoga or other meditation and relaxation techniques to reduce your stress.

  • Maintain your daily tasks and activities as best as possible.

  • Continue talking to and meeting with family and friends.

  • Emotional healing therapies: Talk to a psychologist, therapist, or another professional if needed. They can help you with more coping skills.

  • Join a support group to interact with other CRPS or chronic pain patients.

Degenerative Disc Disease

Degenerative disc disease (DDD) describes a normal wear and tear of intervertebral disc. Despite its name, DDD is not considered a disease, nor is it progressively degenerative.

Intervertebral discs are little shock absorbers, filled with cushion like aqueous material in between 2 spine’s vertebrae. With natural daily stress and minor injuries these discs lose their hydration (water content) and lose their shock absorbing capacity. Also, as the disc weaken and lose water, they begin to collapse. This can result in pressure being put on the nerves in spinal column, causing pain and weakness.

This degeneration of disc or spine, makes the spine less supple, which means patients cannot twist or bend their back as much as they once used to.

Additionally, when the spinal discs wear down, it leads to further problems in our spine such as herniated discs, bone spurs, spinal stenosis or osteoarthritis.

Medical professionals use several terms interchangeably to describe spinal disc problems and associated pain. Terms include:

  • Degenerative disc

  • Prolapsed disc

  • Extruded Disc

  • herniated disc

  • collapsed disc

  • disc protrusion

  • slipped disc

  • torn disc

  • ruptured disc

  • disc disease

  • black disc

  • bulging disc

Use of these terms often cause confusion among people. However, you only need to be concerned with understanding the precise medical diagnosis given by your doctor. This diagnosis will identify the actual cause of your back pain and other pain problems, and this is what’s most important.

What Causes Degenerative Disc Disease?

A healthy well hydrated disc contains a great deal of water in its center (nucleus pulposus), which provides cushioning and flexibility to our spine. At birth typically center of our disc contain 80% water. However natural daily stress and minor injuries can cause these discs to gradually loose water and lose their flexibility.

This water loss makes the discs less flexible and gradual collapse and narrowing of gap in our spinal column. Lower back (lumbar spine) is most susceptible for this wear and tear as it transmits most of our upper body weight to legs.

Due to this degeneration discs, our body compensates by bony spur formation to in an attempt to reduce excess motion of our spine. These bony spurs may lead to spinal stenosis or nerve impingement.

There is good evidence that menopause and related estrogen loss are associated with lumbar disc degeneration. Many research studies have also shown family history of disc degeneration to be an important predictor in causing disc degeneration in young age.


Common Symptoms of Degenerative Disc Disease

Many people have no symptoms in spite of having degenerative discs in their spine. Whether a patient experiences pain or not largely depends on the location of the affected disk and amount of pressure that is being put on spinal column or surrounding nerves.

  • back muscles stiffness or spasms

  • back stiffness

  • back gives out

  • back pain (often described as painful aches)

  • pain after back surgery

  • intermittent pain during certain activities

  • pain centered in the lower back, but then radiates to legs and hips

  • continuous lower back pain with a duration of more than six weeks

  • pain that seems worse when sitting, standing for long periods of time, bending forward, or lifting objects

  • numbness/tingling in the legs or difficulty walking (severe symptoms of DDD)

It is important to note that DDD-related pain typically does not progress with age. The pain associated with degenerated discs lessens as time goes on.

It is also important to note many other causes of back pain presents similarly. It is always best to report all your symptoms to your treating doctor to make a proper diagnosis. You may need a thorough physical exam, diagnostic imaging and testing to make a proper diagnosis of Degenerative disc disease.

Degenerative disc disease can worsen with injury or trauma and present with whole host of other symptoms. A couple of these conditions include:

  • cervical radiculopathy (pinched nerve)

  • lumbar radiculopathy (sciatica)

  • spinal stenosis

 


 

Treatment and Care Options

A few different options exist in order to effectively treat DDD. These options include:

Conservative treatment

  • specific exercises (i.e. hamstring stretching, stabilization exercises, aerobics)

  • physical therapy

  • anti-inflammatory medications

  • TENS therapy

  • acupuncture

  • chiropractic care (spinal manipulation)

  • massage

Regenerative Therapy

  • Platelet Rich Plasma ( PRP)

  • Mesenchymal Stem Cell Therapy (MSCs)

Minimal Invasive Interventional treatment

  • epidural steroid injection

  • median branch block

  • radiofrequency nerve ablation

  • spinal cord stimulation

  • cortisone shots

 

Spine Surgery

If conventional, non-invasive treatments are unsuccessful and repeated minimally invasive interventions not helpful enough.


Managing and Living with Degenerative Disc Disease

With proper pain management, typically most of people can manage their symptoms of DDD. Actually 90% of patients diagnosed with DDD report that symptoms usually lessen with time.

There are a few activities and actions you can do to help with your daily living.

  • Incorporate an exercise regimen into your daily routine, which should include rehabilitation if necessary.

  • Find out the best ways to relieve your pain to a level you can tolerate.

  • Modify any activities if you determine the activity is aggravating the pain.

  • Make behavioral changes if necessary.

  • Eat a nutritious diet to promote a healthy spine.

  • Drink plenty of water for proper hydration.

Facet Joint Syndrome (Facet Arthritis or Facet Hypertrophy)

Have you been experiencing deep aching back pain at your back, along with muscle spasms? You may be having Facet joint arthritis, which along with Degenerative disc disease (DDD) believed to be most common cause of neck and low back pain.

What is Facet Joint Syndrome?

Facet joint syndrome (also known as facet joint disease, facet osteoarthritis, facet hypertrophy or facet arthritis) is a syndrome in which facet joints degenerate to the point of causing painful symptoms.

Facet arthritis is inflammation of one or more of the face joints, which link your vertebrae(spine). These small joints in your spine provide stability and flexible movement of your spine. We move through our facet joints when we twist our back, look around and perform daily tasks of bending and lifting.

Just like other parts of the spine, the facet joints deteriorate over time (due to normal daily stress or minor injuries). This deterioration causes many painful symptoms over time.


What Causes Facet Joint Syndrome?

Risk factors and causes of facet joint syndrome include:

  • Age: Arthritis affects over 90% of people over age 55

  • Gender: Women are more likely to be affected by arthritis than men

  • Obesity: Being overweight puts additional pressure on these facet joints

  • Genes: family history of facet joint syndrome puts you at risk of arthritis at earlier age

  • Work or sports related injuries: Repeated overuse like bending or twisting required of many sports and professions, can cause accelerated wearing of these facet joints

  • Diseases: Arthritis or gout at other joints may lead to arthritis to your spine also

  • Trauma: whiplash injuries during car accidents, work related injury make the spine susceptible to develop facet arthritis

Common Symptoms of Facet Joint Syndrome

As mentioned earlier, facet degeneration(arthritis) along with degenerative disc disease is most common cause of neck and lower back pain. Facet joint pain is often referred or spread to other area from its original location, like cervical(neck) facet arthritis causing pain at upper arm, shoulders, headache.

If you have facet arthritis in your spine, you may be experiencing one or more of the following symptoms.

  • lower back pain

  • burning sensation of the nerves in the back

  • painful back when extending

  • painful back when bending backward

  • a popping noise that results in a painful back

  • limited spinal muscle flexibility

  • pain in the buttocks area

  • pain running down the back of the upper leg

  • pain in the shoulders

  • pain in the upper back or neck

  • headache at the base of the skull

  • muscle spasms

  • pain that is worse in the morning and at the end of the day

  • pain that hurts during a change in weather

  • pain that gets worse when standing, sitting, or riding in the car for extended periods of time

Inability to turn your neck sideways due to pain


Treatment and Care Options

Consult with your physician if you are experiencing performing your routine daily activities. Your physician can confirm that your symptoms are due to facet arthritis (spine arthritis) and not from any other serious problem.  At this point most cases of arthritis are treated by conservative approach first.

Conservative treatment

  • Anti-inflammatory medications like Aleve, Motrin if approved by your physician.

  • Exercise and physical therapy

  • Heat and cold therapy

  • Massage

  • Acupuncture

  • TENS therapy

 

Minimally Invasive Interventional treatment

If conservative treatment doesn’t help you enough, you may be a candidate for following interventional treatment.

  • diagnostic nerve block

  • radiofrequency nerve ablation (RFA)

  • face joint injection

  • medial branch block

  • radiofrequency neurotomy

  • spinal injection

  • rhizotomy


Managing and Living with Facet Joint Syndrome

Continuing your daily activities with reduced pain are two goals to manage and live with spinal arthritis. You can try one or more of following strategies.

  • Always practice good posture when sitting or standing. A good posture goes a long way, sit with your ears aligned with your shoulder blade especially if you have prolonged office hour job.

  • Practice the exercises recommended by your doctor and/or physical therapist.

  • Use heat and/or cold to increase blood flow to muscles and reduce inflammation.

  • Get chiropractic care, massage if needed.

  • Use cushion/pillow for supporting your back for long drives or flights.

  • Take anti-inflammatory medications if approved by your doctor.

  • Take breaks during activities; pace yourself.

Headache

If you suffer from headaches or migraines, you’re not alone. Every 10 seconds, someone in the U.S. goes to the emergency room complaining of head pain, according to the Migraine Research Foundation. Headache is a broad category which presents with painful symptoms in head or neck region.

Types of headaches:

  • migraine

  • tension headache

  • cluster headache

  • cervicogenic headache

  • rebound headache

  • sinus headache

As suggested from above headache may arise from cause within the head or neck (primary headache) or some other causes (secondary headache).


What Causes Headaches?

Many factors can trigger a headache or migraine. The good news is that most are not the result of a serious illness. However, if they are frequent or sudden, this could be a symptom of a bigger problem such as a brain tumor or aneurysm. As a safety precaution, you should seek the help of a medical professional right away to rule out any underlying major health issues.

Some of the more common causes for headaches include:

  • irregular sleep patterns

  • caffeine withdrawal

  • alcohol

  • overusing certain medications

  • premenstrual syndrome

  • stress

  • depression

  • anxiety

  • whiplash injuries

  • head injury

  • abnormal head or neck position for an extended period of time

  • tight muscles in the jaw, scalp, neck, or shoulders

  • an underlying illness

  • genetics

  • cigarette smoking

  • certain foods (chocolate, certain cheeses, MSG, etc.)

There are some cases in which headaches can be a sign of a more serious problem. Such instances include:

  • high blood pressure

  • brain tumor

  • brain infection

  • fluid buildup inside of the skull

  • pressure buildup inside of the skull

  • carbon monoxide poisoning

  • sleep apnea (lack of oxygen while sleeping)

  • bleeding between the brain the thin tissue covering the brain

  • problems with blood vessels or bleeding in the brain

You need to consult with your physician, if you are experiencing frequent or sudden headaches.


 

Common Symptoms of Headaches

Depending on the type of headache you have, the symptoms will vary from person to person

 

Tension headache symptoms

  • headache on both sides of the head

  • band like sensation around your head

  • dull or squeezing pain

  • tight or sore jaw, neck, or shoulders

  • loss of appetite

  • loss of sleep

  • pain in the eyes or sinuses

 

Migraine headache symptoms

  • severe headache on one side of your head (throbbing, pulsating, or pounding pain)

  • vision changes

  • sensitivity to light or sound

  • nausea or vomiting

Cluster headache symptoms

  • headache pain episodes that last from 30-90 minutes each

  • headache pain that awakes you from sleeping

  • headache pain that occurs at approximately the same time each day

  • excruciating pain

  • headache pain around or behind one eye

  • the affected eye may become watery, red, or inflamed

  • the nostril on the affected side can become runny or congested


Treatment and Care Options

Many treatment options exist for headache and migraine sufferers. Treatment options include:

  • Over-the-counter medications (aspirin, ibuprofen, acetaminophen, naproxen).

  • Massages

  • Biofeedback

  • Stress management techniques

  • BOTOX®

  • Occipital nerve block

  • Diagnostic cervical median branch block

  • Radiofrequency nerve ablation (RFA)

  • Ketamine infusions

For patients who are good candidates for BOTOX®, the neurotoxin works by blocking the release of chemicals involved in pain transmission. In an occipital nerve block, nerves are made less sensitive with a steroid injection. This stops the flow of information, especially pain signals, from these nerves, resulting in a decrease in chronic headaches. Ask our pain specialist for details on these therapies for management of your pain


Managing and Living with Headaches

Living with frequent headaches can be very taxing, especially when you have to work, study or perform other daily tasks. However, there are few things you can practice to reduce the burden of these headaches.

  • Learn sleep hygiene to have enough restful sleep every night. Avoid sedatives or alcohol to have good quality of sleep.

  • Learn ways to relax and relieve daily stress. You may find practicing yoga, meditation, deep breathing, or lying in quit dark room relaxing.

  • Take over-the-counter (OTC) medications, if needed. Check with your doctor if you are needing frequent or daily OTC medications. You may be having more headaches due to overuse of these medications.

  • Try to treat your symptoms right away. If you start to feel a headache especially migraine coming on, start doing any of these at-home remedies instead of waiting until you have a full-blown, pounding headache.

  • Always drink plenty of water. It is very important to stay hydrated.

  • Keep a diary to keep track of your headaches, especially if you experience frequent headaches or migraines. Doing so will help you and your doctor determine your triggers.

Herniated or Slipped Disc

Have you been experiencing numbness or tingling in your back, arm or legs? Have you been experiencing sharp, shooting pain in your back, arms or legs? Do you have weakness of arm and leg muscles?

Hernaited disc in human spine in details

These are all classic symptoms and signs of herniated discs (disks), and should be evaluated as soon as possible by your doctor.

What is a Herniated or Slipped Disc?

Herniated disc is a medical condition affecting the spine in which soft inner portion of rubbery cushions (called the disks) leaks or bulge out in between two bones(vertebrae) of the spine.

Herniated discs (often called a slipped disk or ruptured disk) usually occur in the neck region (called the cervical spine), or in the lower back region (lumbar spine). However, herniated discs can occur anywhere along the spine.


Common Symptoms of Herniated or Slipped Discs

 

Symptoms of disc herniation varies from location of disc herniation and type of tissue involved. It can range from little or no pain to severe unrelenting neck or low back pain

Classic signs and symptoms of a herniated disc include:

  • arm or leg pain

  • numbness in the affected body part

  • tingling in the affected body part

  • weakness of the muscles

If you notice pain frequently spreading down your leg or arm, call your doctor right away. If this pain is accompanied by weakness, bowel or bladder symptoms, be sure to call your doctor right away.


What Causes Herniated or Slipped Discs?

Disk degeneration often leads to in disc herniation for some patients. The discs suffer wear and tear over time with natural daily stress and minor injuries, which leads to more disc bulging or protrusion and then more problematic disc herniation.

Other times, patients cannot pinpoint a specific cause of disc herniation. Any of the following causes may be possibilities, though:

  • lifting or moving heavy loads—twisting or turning while lifting

  • Professional athletes: especially those playing contact sports are prone to disc herniations

  • a traumatic injury

  • an excessive strain to the back

Risk factors that may increase the chances of a herniated risk:

  • excess weight

  • genetics: several genes are associated with Degenerative disc disease


Treatment and Care Options

 

It is possible to treat herniated discs without the need for addictive medications or surgery. Treatment options include:

Conservative management

  • physical therapy

  • anti-inflammatory medications

  • pain medications (over-the-counter and prescription)

  • muscle relaxant medications

  • nerve pain medications

  • heat or ice therapy

 

Minimal Invasive Interventional treatment

 

Interlaminar Epidural steroid injections

Transforaminal Epidural steroid injections

  • During acute or severe pain, you may need more than 1 epidural injection to feel adequate pain relief.

Epidural injections help by injecting steroids, powerful anti-inflammatory medications near the source of injury (herniated disc) and thereby reducing inflammation and reduces particular nerve sensitivity.

Surgical Intervention

 

You may be a candidate for surgical interventions if you failed conservative treatment, including a series of epidural injections. Please discuss with your surgeon best course of action for you, who may recommend following surgical intervention for you.

 

Microdiscectomy

Open Discectomy

Foraminotomy


Managing and Living with a Herniated Disc

 

Most painful symptom of acute disc herniation reduces with time and conservative therapy. While going through symptoms of disc bulge or herniation you may find these tips helpful.

  • Take over-the-counter pain medications, if helpful and approved by your physician.

  • Use ice and/or heat when needed. These options can provide relief and comfort, as well as reduce inflammation and pain.

  • Continue your daily activities as much as possible. Doing so will prevent stiffness, as well as prevent muscle weakness.

  • As you recover from surgery (if you have undergone surgery), ask your doctor about resuming light activities and exercises.

  • Maintain a healthy diet and weight.

  • Practice good posture while standing and sitting.

  • Do not lift things that are too heavy or awkward. Always practice good techniques when lifting and moving items.

  • Take care of your emotional and psychological well-being. This is especially important when dealing with chronic pain issues.

  • You may benefit from antidepressants, nerve pain medications if you continue to have chronic nerve related pain issues.

Peripheral Neuropathy

Have you been diagnosed with peripheral neuropathy? If you have been experiencing severe symptoms of neuropathy in spite of trying traditional therapies, there is still hope with neuromodulation and other minimally invasive treatment options.

What is Neuropathy?

 

Peripheral neuropathy (PN) is damage to or disease affecting nerves, which may impair sensation, movement, gland or organ function depending on type of nerve affected. Neuropathy affecting only one nerve is called mononeuropathy, whereas neuropathy affecting same areas on both sides of body is called “symmetrical polyneuropathy” or simply “polyneuropathy”.

When people suffer from neuropathy, he or she may have difficulties with strength, movements, balance, and sensation in the lower and upper extremities.

There are many types of neuropathy exist depending upon the cause, such as diabetic neuropathy and autonomic neuropathy. Symptoms and treatment for each type of neuropathy remain similar apart from treating the cause of neuropathy.


Common Symptoms of Neuropathy

Symptoms will vary from person to person and depends upon types of nerves involved. Most commonly it causes pain and abnormal sensation in both legs and feet. It may present with following symptoms in general.

  • burning sensation in legs

  • numbness in legs

  • itchy legs

  • sleeping problems due to burning legs (or other symptoms)

  • pain, numbness, and/or tingling in the affected area(s)

  • tingling hands, fingers, and/or feet (similar to “pins and needles”)

  • blisters or calluses

  • slow reflexes

  • muscle weakness or poor balance

  • coordination problems

  • difficulties with walking

  • sensitivity to pain


What Causes Neuropathy?

Neuropathy can be caused by many things, such as:

  • diabetes

  • exposure to toxins (heavy metals, and certain cancer chemotherapy agents)

  • illness like thyroid disease, liver disease or shingles

  • pressure or physical trauma

  • alcohol abuse

  • autoimmune diseases like systemic lupus erythematosus

  • infections like Lyme disease through tick bite

  • vitamin deficiencies

  • bone marrow disorders

  • Medications like chemotherapy, antiretroviral medications


Treatment and Care Options

 

Treatment and care options typically depend on the type of nerves involved and the cause(s).

Conservative treatment:

Range of medications which works on central nervous system have been used to manage neuropathic pain

  • Tricyclic Antidepressants: Amitriptyline or Nortriptyline

  • Serotonin-Norepinephrine reuptake inhibitors: like Cymbalta

  • Antiepileptic medications (nerve membrane stabilizers): Gabapentin (Neurontin) or Pregabalin (Lyrica)

  • Alpha-lipoic acid

  • Amino acids

  • Fish oil

  • Transcutaneous electrical nerve stimulation (TENS)

  • Physical therapy

  • Acupuncture

Minimally Invasive Interventional treatment

  • Ketamine infusions

  • Spinal cord stimulation

If all the above mentioned first line treatment methods fail to provide adequate relief or functioning. You may be a candidate for spinal cord stimulation or ketamine infusions.


Managing and Living with Neuropathy

Several creams and over-the-counter medications can be used to combat the symptoms of neuropathy. You may need to take special care of legs and feet if you have been experiencing numbness.

  • Capsaicin cream or lidocaine cream can be used on the affected areas to help reduce symptoms.

  • Take care of your feet and hands, especially if you have been diagnosed with diabetes.

  • Exercise as much as possible.

  • Stop smoking as soon as possible.

  • Eat healthy, nutritious meals.

  • Limit the amount of alcohol you drink.

  • Monitor your blood glucose levels, if needed.

Post-Herpetic Neuralgia

Approximately 1 in 3 adults will contract shingles at some point in their life. The rash and pain usually subside in 3 to 6 weeks in most individuals but 1 in 5 people develop a painful condition called Post-herpetic neuralgia.

What is post-herpetic neuralgia?

This condition is a complication of shingles, which stems from having chicken pox (varicella zoster virus) at a younger age either through infection or live virus immunization. When a person has the herpes zoster (chicken pox) virus inside them, there is a chance they will contract shingles in adulthood.

Post-herpetic neuralgia is chronic debilitating pain along the affected nerve distribution after healing of herpes zoster rash.

What are the symptoms of post herpetic neuralgia?

Post-herpetic neuralgia typically manifests itself in the form of an intense burning sensation on the surface of the skin. Many patients describe it as feeling like the worst sunburn they’ve ever had.

Pain may be severe enough to affect sleep and other daily activities. Pain usually localized to affected rash, around eyes or flank but may spread to other areas like ribs.

What causes postherpetic neuralgia?

While anyone who has had chicken pox in the past can contract shingles, the majority of individuals who experience painful shingles complications are in their 60s due to reduced immunity.

  • Likely risk factors for Post-herpetic neuralgia.

  • Older age

  • Greater acute zoster pain

  • Greater acute zoster rash severity

  • Acute zoster rash around eyes (ophthalmic location)


Treatment and Care options

While there is no cure for post-herpetic neuralgia, there are several treatment options that have been effective for patients who are suffering from this condition.

  • Antiviral medication: During acute zoster rash(shingles) early aggressive treatment is recommended to prevent onset of Post-herpetic neuralgia

  • Lidocaine patches

  • Antidepressant Medications and other pain relievers (such an an FDA approved treatment like Qutenza)

  • Corticosteroid Injections to prevent permanent nerve damage by zoster virus

  • Spinal cord stimulation (in severe cases)

If you are experiencing pain due to the shingles virus and traditional treatment methods are not helpful. There is still hope with minimally invasive Interventional pain management.

When should you seek treatment?

In some cases, home remedies are enough to effectively treat shingles pain. In moderate to severe cases especially with severe painful blisters you should seek immediate help to start antiviral medications. Early treatment is crucial to prevent permanent nerve damage by this (varicella zoster) virus.

When your pain starts to significantly impact your daily life, you should see a pain management specialist to seek non-conventional treatment methods.

Our focus is on conservative, minimally-invasive techniques and procedures designed to do help alleviate the pain you are experiencing.

Sacroiliitis " Other Hip Pain"

Sacroiliac (SI) joint is a joint where your spine meets your hip bone, in a way it transmits your upper body weight to your legs.

Any misalignment or inflammation in this joint causes lower back and buttock pain. SI joint pain is often a under recognized source of back pain

Normally there is very little (2-4mm) movement at this joint except in pregnancy when it moves more which is necessary for child birth. Therefore, SI joint pain is among most common cause of lower back pain during pregnancy

What is sacroiliitis?

SI joint may degenerate and may become arthritic like any other joints in our body and be a source of pain. Sacroiliac joint inflammation is known as sacroiliitis.

It is important to note that SI joint pain may often mimic pain coming from herniated disc in your spine or hip joint. You many need to see your physician to make a proper diagnosis of sacroiliitis (sacroiliac joint inflammation)


Common Symptoms of SI Joint pain

  • Pain at lower back

  • Pain at your buttock

  • Pain at your lower hip

  • Back pain radiating to your groin

  • pain radiating to upper thigh

  • Pain on prolonged sitting

  • Pain going from sitting to standing

  • May cause numbness or tingling down your leg

  • May cause weakness of your leg

Typically, SI joint pain is more on one side, but it may occur on both sides equally. Severity of pain varies from person to person and due to underlying cause of pain.


Causes of SI Joint pain

 SI joint is supported by strong ligament and muscles to maintain stability, it may become source of pain due to following common causes

  • Hip/ Spine surgery (laminectomy, Fusion surgery)

  • Trauma or injury causing misalignment of SI joint

  • Pregnancy and childbirth

  • Car accident

  • Uneven pelvic movement due to various reasons

    • One leg longer than other

    • Arthritis of hip or knee, favoring one side over other

    • Wearing a walking boot after ankle or foot surgery

  • Arthritis: Ankylosing spondylitis or any other type of arthritis


 

Treatment and Care of SI Joint pain

Conservative / Nonsurgical treatment

Stretching/ Yoga

Physical therapy

Chiropractic manipulation

Anti-inflammatory medications

Topical creams/ patches

Minimally Invasive Interventional methods

  • Image guided (fluoroscopy) Sacroiliac joint injection:

Combination of Steroid and numbing agent may reduce inflammation and swelling. These injections can be used for diagnostic as well as therapeutic purpose.

  • Sacroiliac joint radiofrequency nerve ablation:

If Sacroiliac joint injections are helpful but effect of injections doesn’t last long enough. Nerve ablation of nerves around this joint can provide sustained long pain relief.

Surgical Treatment: if conservative treatment, along with repeated injections doesn’t help enough and pain continues to be debilitating surgery may be needed.

  • Sacroiliac joint fusion

     


Managing and Living with Sacroiliac joint pain

SI joint pain can be quite debilitating affecting your daily activities. However, following these tips may be helpful.

  • Continue your daily tasks and routine as much as possible.

  • Avoid prolonged sitting, using doughnut cushion to reduce pressure on the joint

  • Maintain healthy diet and weight

  • Take up yoga, meditation or other relaxation techniques to reduce stress

  • Regular exercise with stretching/ strengthening

  • Practice good posture while sitting, standing, walking and sleeping

  • Proper lifting techniques: use of knees instead of your spine

  • An ergonomic work area