Epidural steroid injections (ESI) are a minimally invasive procedure performed to help reduce inflammation and pain caused by nerve root compression. Herniated discs, bone spurs, or spinal stenosis cause nerve compressions. Pain, numbness, or weakness along the nerve are symptoms of nerve compression, referred to as radiculopathy. This pain can last for days or even years if left untreated.
An epidural steroid injection aims to help reduce inflammation along the nerve root. Medication is injected in the fat-filled area between the bone and the protective layer of the spinal nerve, called the epidural space. These injections are intended to reduce pain so that normal activity and a physical therapy program can be resumed.
What is an Epidural Steroid Injection
What is an Epidural Steroid Injection?
There are multiple types of steroid injections, most commonly described according to where they are injected. Steroid injections in the neck are called cervical epidural injections. Injections performed in the middle back are thoracic epidural steroid injections, and injections in the lower back are lumbar epidural injections.
The injections can also be labeled according to the direction of the needle. Most epidural steroid injections are placed between the lamina. This is called an interlaminar epidural steroid injection. The needle is aimed upwards toward the head and goes in between two laminae. Another type of injection is a transforaminal steroid injection. The needle travels along the course of a nerve and enters the spine from a diagonal direction. A caudal approach to ESIs allows the needle to enter directly into the epidural space through the sacral hiatus – a small boney opening directly above the tailbone.
The steroid injection contains a corticosteroid, such as triamcinolone, methyl-prednisolone, or dexamethasone, and an anesthetic numbing agent like lidocaine. They are injected into the area between the vertebra and the protective sac surrounding the spinal cord and nerves.
Why Are They Used?
These steroid injections are used in patients who suffer from pain in the neck, arm, lower back, or have sciatica. This treatment has proven beneficial to those with severe inflammatory conditions. Patients who have the following conditions are candidates for epidural steroid injections:
- Spinal Stenosis – a narrowing of the spinal canal and nerve root canal
- Herniated Disc – the material inside a disc can bulge or rupture through a weak area in the cartilage and come in contact with a spinal nerve.
- Degenerative Disc – breakdown or aging of a spinal disc causing the disc space to collapse or growth of bone spurs.
- Sciatica – compression of nerves that causes pain to travel into the buttocks and down the legs.
In some cases, ESI can be used to determine whether surgery will be successful in patients who have a herniated disc. The injections can ease pain enough so a physical therapy routine can be established.
Risks Involved with Epidural Steroid Injections
ESI procedures have been performed for many years and is considered a safe and effective treatment. Although uncommon, some patients do experience side effects from the medication. Patients may experience a “steroid flush” which is a flushing of the face and chest that can be accompanied by a low-grade fever.
Other side effects may include:
- Trouble sleeping
- Temporary water retention
- Anxiety
Serious complications are very rare, but could include an allergic reaction to the contrast dye, infection, nerve damage, or bleeding. When this procedure is performed with fluoroscopic guidance, the risk is minimized. Generally, this type of procedure and injection is very well tolerated by most patients.
To learn more about epidural steroid injections and how they can help back pain, fill out the form below:
Failed back surgery syndrome (FBSS) is the term for a patient’s continued pain after an unsuccessful back surgery. The patient is usually referred to a pain management specialist to treat pain.
The goal of spinal surgery is to decompress a nerve root or to stabilize a painful joint. FBSS occurs when surgery is unsuccessful or negatively affects a structure near the problem area.
Spinal surgery is complicated because it can be hard to diagnose the cause of the pain. X-Rays and MRIs limit what doctors can see because the pain often occurs when the patient is moving and active. Imaging only provides still images.
Failed Back Surgery Syndrome: Signs, Symptoms, and Treatment
Signs & Symptoms of FBSS
One common complaint physicians hear from patients is chronic back pain. However, not everyone experiences the same pain, and the type of pain they experience can vary, based on their spinal disorder, their previous procedure, or underlying cause of FBSS.
Other types of pain that can be associated with FBSS are:
- Nociceptive Pain – Localized pain that may be dull or sharp.
- Neuropathic Pain – Nerve-related pain is caused by nerve or spinal cord damage.
- Radicular Pain – Radicular pain radiates from one area to another
Other common symptoms of Failed Back Surgery Syndrome include:
- Return of original symptoms & pain – When the symptoms return that the original procedure was intended to correct, it may be a sign of FBSS.
- Reduced mobility – Recovering from back surgery is a process. However, if mobility is reduced or limitations arise that are different than predicted by your physician, it could be a sign of FBSS.
- New problems arise – While the surgery may correct the original symptoms, new pain in a different part of the spine should be discussed with your doctor.
- Onset of Headaches – If headaches were not a part of your medical history prior to having surgery, this may be a sign of nerve damage after a spinal procedure.
Diagnosing Failed Back Surgery Syndrome
The first step to diagnosing FBSS pain is to see a doctor for a physical exam. Motion, sensitivity, and strength help doctors decide the next steps to correctly diagnose the pain. Your medical history, pain levels, and previous treatments are discussed with your doctor to help them define the pain and decide on a treatment method.
Having tests like CT scans, MRIs, and X-Rays help doctors take an inside look at your pain. The images don’t always show the root cause of the pain, making FBSS hard to diagnose.
Since imaging is not always reliable, doctors may use another form of testing to diagnose your pain. This is called an aware state surgical examination. A doctor uses a small probe and stimulates the spinal cord, mimicking the pain, and triggering a response from the patient. This informs the doctor what type of pain the patient has and how it is caused.
Back pain patients are referred to pain management specialists who treat their pain and help improve their quality of life through short-term techniques.
Conservative Treatments for Failed Back Surgery Syndrome
There are many conservative treatments for FBSS.Besides the physical therapy and pharmacological therapy with over the counter or prescription medications, doctors use minimally invasive interventional modalities such as epidural steroid injections and injections of the lumbar facet joints or associated medial branches, with or without radiofrequency ablation rhizotomy (RFA).What makes these a consrvative first choice option is the minimally invasive nature of the procedures.These therapeutic interventions are designed to treat the pain and provide temporary symptomatic relief.
Neuromodulation in the Treatment of FBSS
In the treatment of Failed Back Surgery Syndrome, one of the most successful treatment options is Spinal Cord Stimulation. Treatment efficacy for FBSS has increased over the years with the majority of patients experiencing pain relief and reduced medicinal load. Improved quality of life can also be achieved using SCS.
For patients with unrelenting back pain due to mechanical instability of the spine, degenerative disc disease, spinal injury, or deformity, spinal surgery is a well-accepted treatment option; however, even after surgical intervention, many patients continue to experience chronic back pain that can be notoriously difficult to treat. Clinical evidence suggests that for patients with FBSS, repeated surgery will not likely offer relief. Additionally, evidence suggests long-term use of opioid pain medications is not effective in this population, likely presents additional complications, and requires strict management.
SCS has been shown to be a safe and efficacious treatment for this patient population. Recent technological developments in SCS offer even greater pain relief to patients’ refractory to other treatment options, allowing patients to regain functionality and improve their quality of life with significant reductions in pain.
To learn more about FBSS and how the team at Progressive Pain Management can help treat your pain, fill out the form below.
Facet joints are small, bony joints that sit along the spine. They are paired up from the neck to the lower back area. When the joints get inflamed, they cause pain that can be severe. The pain can be acute or chronic, caused by a variety of conditions.
The pain radiates to other parts of the body and causes indirect pain. For pain that starts in the lower back, it’s common for the pain to move to the thighs and buttocks. If the pain starts in the neck or upper back region, it can transfer to the shoulders, and arms, and even cause headaches.
Facet Joint Injections for Chronic Pain
What is a Facet Joint Injection?
The injection is a strong anti-inflammatory steroid that gets inserted into the facet joint. The medication is a mixture of a local anesthetic and a steroid, similar to a cortisone injection. Before performing the injection, your doctor will explain the procedure, have you sign all the appropriate consent forms, and then have you lie on your stomach.
The procedure is minimally invasive. X-ray guidance is used to locate the facet joints and helps guide the needle to the exact location. The actual injection only takes a few minutes, but you may want to allow for additional recovery time depending on the type of anesthetic you choose. Some doctors will let you choose a local anesthetic or a stronger general anesthetic. The general anesthetic may cause drowsiness and sedation will take longer to wear off.
What to Expect After the Injection?
Right after the injection, you will feel relief from pain. That is due to the anesthetic in the injection, and only lasts for a few hours. The injection site may become sore after a few days, and the pain is not uncommon to resume the day after the injection. About 1-2 days after the injection, the medication will begin to take effect and help reduce your pain on a daily basis.
It is advised to take it easy following the injection and only to resume normal activity when it is comfortable to do so. Your doctor may recommend applying ice to the injection site. This will help reduce any swelling and soreness following the procedure.
How Long Does a Facet Joint Injection Last?
Immediately following the injection, you may feel lessened pain. However, this is temporary relief until the medication kicks in. That can take between 2-7 days after the injection.
If the first injection is successful in managing your pain, your doctor may perform additional injections. The amount of relief depends on your specific pain and because there are a variety of pain receptors in the spine, the long-term effect of these injections cannot be predicted. Everyone’s pain is different, so the treatment effectiveness will vary.
There are very few risks associated with this type of injection. The most common being tenderness and pain at the injection site, although this is temporary. Side effects of steroids may include weight gain, water retention, and temporary increase in blood sugar.
Facet joint injections are an excellent alternative to undergoing serious back surgery. Talk with your doctor today to discuss your options for getting relief from your pain and taking one step closer to bettering your quality of life.
Risks Associated with the Facet Joint Injection Procedure
As with any type of injection or invasive procedure, there are certain risks or complications that could arise:
- Allergies: In most cases, the allergic reaction is caused by the X-ray contrast or steroid, not the local anesthetic. Severe allergies are rare.
- Bleeding: In patients who are taking blood thinners or have a bleeding disorder, it is possible to have some bleeding as a result of the injection.
- Discomfort at the Injection Site: Worsened pain or discomfort at the injection site. Long-term pain is uncommon.
- Infection: Minor infections occur in less than 2% of facet joint injections. More complex infections are rare, only happening in 0.1% of injections.
Fill out the form below to contact the Progressive Pain Management team and learn more about facet joint injections.
Treating pain with hot and cold therapy can be very effective for a variety of conditions and injuries. This affordable, at-home therapy is often recommended to help relieve aches and pains from muscle or joint damage.
Heat therapy can utilize hot water bottles, heat pads, or warm baths. Cold therapy involves ice packs, cool water, or cold compresses. However, it can be confusing what type of aches and conditions call for hot therapy and which ones call for cold therapy. In some cases, using both may be a successful combination. Alternating heat and cold helps increase blood flow to the site of the pain.
Treating pain with heat and cold therapy
Cold Therapy
Cold therapy, also known as cryotherapy, helps reduce inflammation and swelling. It aids in slowing the rate of reducing tissue damage around a joint or tendon. Cold therapy can numb sore muscle tissue, almost acting as an anesthetic. It has the ability to slow down the pain signals that are transmitted to the brain.
Cold compresses are a common at-home treatment for standard injuries – RICE – Rest, ice, compression, elevation.
This treatment helps conditions such as osteoarthritis, injuries, gout, muscle strains, and tendinitis. It can also help reduce the pain induced by headaches or migraines.
Types of Cold Therapy
Cold therapy can be applied in a number of ways to an affected area. Common treatment options for at-home pain relief include:
- Ice packs: Cold compress or cold packs applied to an affected area for 20 minutes every 4-6 hours can reduce inflammation and swelling.
- Ice baths: Soaking in a cold (but not freezing) bath helps slow blood flow and reduce pain
- Coolant sprays
Other types of advanced cold therapy include:
- Using cold during stretching helps reduce muscle spasms. This is called try stretching.
- Cryokinetics combines active exercises and cold treatment to help ligament sprains.
- Whole-body cold therapy chambers
Heat Therapy
Heat therapy increases blood flow to a specific area and improves circulation. This is because heat on an inflamed area causes the blood vessels to dilate, promoting blood flow to the injured area. Applying heat to an affected area can provide comfort, increase muscle flexibility, and heal damaged tissue.
Improving circulation to a specific area is important in soothing discomfort and eliminating lactic acid waste that builds up after certain types of exercise.
Heat therapy is effective in treating chronic muscle pain or sore joints caused by arthritis, strains, and sprains, relieving pain or spasms due to neck or back injury, or tendonitis.
Types of Heat Therapy
There are two types of heat therapy: dry heat and moist heat. Regardless of the type of heat you choose, the heat should always be warm – not hot.
- Dry heat: This type of therapy includes heating pads, warm compresses, or hot water bottles. Dry heat is easily applied and simple to do at home.
- Moist heat: This version of heat therapy includes using steamed towels, warm baths (between 92 and 100 degrees Fahrenheit).
Moist heat often requires less application time and is considered to be more effective than dry heat. Professional heat therapies can also be utilized. This may include heat from an ultrasound, and is especially helpful when the pain is caused by tendonitis.
Minor stiffness and pain can often be relieved with 15-20 minutes of applied heat therapy.Heat should only be used no longer than 20 minutes at a time, up to three times a day, unless instructed otherwise by a medical professional.
Moderate-to-severe pain may be relieved by longer heat sessions, such as a soaking bath that lasts anywhere from 30 minutes to two hours.
Alternating Heat and Cold Therapy
In some cases, such as exercise-induced injuries, pain, or osteoarthritis, alternating between heat and cold therapy is most effective.
Cold therapy causes the blood vessels to contract and reduces circulation, decreasing pain. Removing the cold causes the veins to expand, increasing circulation. Heat therapy can assist circulation and the incoming flow of nutrients that can heal the injured tissues.
Contact the team at Progressive Pain Management to learn more about heat and cold therapy and how it can help temporarily relieve chronic pain.
Headaches are a common occurrence in adults. So much so that they are the most frequent complaint doctors hear from their patients. Headaches can be truly painful and debilitating from time to time, but are typically treated with over-the-counter NSAIDs or rest. However, in some cases, headaches can become so severe that medical attention is necessary.
It is important to understand the kind of headache you are experiencing and to know when to seek a doctor’s medical help.
The International Classification of Headache Disorders defines over 100 different types of headaches. Some headaches are caused by underlying conditions (secondary headaches) while others are the main medical concern. Those are called primary headaches, and there are three main types of primary headaches that cause people to seek the help of a doctor.
Types of Headaches
Three Most Common Types of Primary Headaches
Tension Headache
Tension headaches are the most common type of headache – 3 out of 4 adults experience this type of headache. Generally, tension headaches cause a dull pain on both sides of their head, sometimes with a squeezing pressure like your head is in a vice. The pain is usually mild-to-moderate, lasting anywhere between 20 minutes and 2 hours.
Stress and muscle tension, as well as genetics and environment are thought to cause these headaches. Fatigue is also thought to play a role.
Tension headaches are typically treated with over-the-counter medications like acetaminophen (Tylenol) or NSAIDs like aspirin (Aleve) or ibuprofen (Motrin). Always follow the directions on the label as misuse could result in severe side effects to your internal organs. If your headache is mild, a snack or short rest may help.
Migraine
Migraines are less common than tension headaches, but the symptoms are much more severe and intense. This throbbing pain is frequently accompanied by nausea, light sensitivity, and lack of appetite.
Women are 2-3 times more likely to suffer from migraines than men. Neurologists believe that migraines are caused by changes of blood flow to the brain and nerve cell activity, with genetics playing a large role. Many people who experience migraines have one or more family member with the same condition.
Migraines often come without warning and is commonly set off by a trigger. These triggers can vary from person to person. Some common triggers are:
- Changes in weather and humidity
- Fatigue
- Emotional stress
- Sensory triggers like flickering lights, strong smells, or loud noises
- Dietary triggers: chocolate, red wine, MSG, change in caffeine intake
Treatment for migraine headaches depends on the severity of your pain and frequency of this type of headache. Most migraines can be dissolved with over-the-counter medication. Although, if they become severe enough and are debilitating, doctors may prescribe medication for immediate relief, as well as a preventative drug to ward off future migraines.
Cluster Headaches
Cluster headaches are uncommon, but cause sudden onset severe pain that is felt behind the eyes. These headaches are much more severe than tension headaches or migraines and last between 1 to 3 hours. The pain may cause your eyes to become red and watery and eyelids may droop. Nausea may accompany the pain.
They are called cluster headaches because they come in clusters: a person can experience 1-8 headaches a day during a 2-month period every year or so. They typically occur at the same time of year with the pain being the same.
Unlike migraines, cluster headaches are 5 times more common in men than women. While there is no direct cause, they are frequently triggered by alcohol or tobacco use, foods that contain nitrates, or bright light. Certain lifestyle changes are recommended to reduce symptoms and the chances of having onset cluster headaches:
- Quitting smoking
- Prednisone; medication to reduce inflammation or swelling
- Diet changes – limiting food that is high in nitrates like lunch meat or bacon
- Limited alcohol
If those changes do not seem to improve your cluster headaches, doctors may prescribe medications such as lidocaine nose drops, verapamil, or sumatriptan. These drugs are often administered by injection.
If you suffer from any type of headache frequently, you should see a doctor. Frequent, constant headaches may be a sign of an underlying medical condition or lifestyle choice. It is important to work with your doctor and communicate your pain levels and symptoms with your physician so an effective treatment plan can be created.
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Chronic neck pain affects the lives of many adults and seniors, and it is the fourth leading cause of disability globally. In fact, it has a prevalence rate that exceeds 30% annually in the US. In addition, approximately 50% of individuals will experience a degree of chronic neck pain at some point in life. And 20% to 70% among adults, will experience neck pain which will affect their activities.
Neck pain can be acute or chronic and is usually the result of a nerve injury. Fortunately, neck pain doesn’t indicate a serious problem and can be relieved in a few days. Read on to discover the symptoms, causes, treatments, and prevention of chronic neck pain.
Treating and Preventing Chronic Neck Pain
What is Neck Pain?
Neck pain is the pain or stiffness in or around the cervical spine found underneath your head. It is a common symptom of medical conditions and many different injuries.
Symptoms
- Stabbing or burning pain
- A persistent ache
- Stiff neck
- Numbness or tingling in the arms
- Increased sensitivity to mild pressure
What Causes Neck Pain?
Your neck consists of ligaments, bones, and muscles, and any abnormalities, inflammation, or injury can cause neck pain. However, about 10% of neck pain is associated with rheumatoid arthritis, tumors, polymyalgia rheumatica, pinched nerve, herniated disc, and infections. The pain occurs due to many different injuries and medical issues. Some of the common causes of neck pain include:
- Neck Injury: Car accidents, contact sports, and falls cause severe neck injuries. The trauma caused forces your neck or head to suddenly move in the opposite direction (whiplash), leading to soreness or pain.
- Aging: Degenerative issues like narrowing of the spine spaces (spinal stenosis) and tear and wear of the joint cartilage (osteoarthritis) cause neck pain as you age.
- Physical Muscle Strain: Engaging in repetitive tasks or strenuous activities daily causes neck muscles to strain, resulting in pain.
- Mental stress: Tightening neck muscles when tense causes neck pain.
- Poor Posture: Sitting for prolonged periods causes neck muscles and tissues to tighten up, causing severe pain.
What Treatments are Available?
Chronic neck pain treatments vary depending on the cause. They help ease pain and enhance function. Some of the common treatments for severe pain include:
- Pain Medication: Over-the-counter pain medications like acetaminophen, ibuprofen, and aspirin help ease the pain. Your doctor will recommend prescription pain medications like:
- Antidepressants
- Muscle relaxers
- Anti-inflammatory medicines
- Opioid analgesics
- Anticonvulsants
- Physical Therapy: Neck strengthening and stretching exercises like side-to-side, backward, and forward bends help ease severe pain. Once your doctor diagnoses your pain level, they may advise you to see a physical therapist for stretching exercises.
- Transcutaneous Electric Nerve Stimulation (TENS): This treatment involves releasing mild electric pulses under the affected area’s skin. It aims to block the nerve endings in the region from sending pain signals to your brain, easing pain.
- Topical Anesthetic Cream: Camphor or menthol products temporarily relieve joint and muscle pain.
- Injections: Your doctor injects pain medications into the neck joints or muscles to relieve severe neck pain. They may use injections such as numbing medications or a steroid, like cortisone.
How To Prevent Neck Pain
Nearly 72% of all neck pain stems from repetitive (work-related) injury and poor posture. To prevent chronic neck pain, adopt practices that help keep your back straight and your head centered over your spine. Here are a few things to try:
- Maintain good posture when standing and sitting
- Adopt a healthy sleeping position
- Adjust your computer, chair, or desk to avoid straining your neck
- Perform physical therapy exercises to help stretch and strengthen your neck muscles
- Take frequent breaks and rests
- Avoid lifting heavy objects to prevent straining your neck
Let Our Team Help You Today
With conventional medications, chronic neck pain isn’t severe in most cases and disappears in a few days. If the pain continues for over a week, you must see a doctor. The pain could be a symptom of an illness or injury.
At Progressive Pain Management, we offer interventional pain procedures and medications to manage and relieve chronic neck pain. Our certified physicians have incredible expertise and experience in providing the best pain management treatments. Ready to meet our physicians? Fill out the form below to contact us.
Spinal cord stimulation therapy is a pain treatment that masks the pain signal before they reach the brain. A device similar to a pacemaker is implanted in the body and delivers electrical pulses to the spinal cord. This is an option for patients with chronic, leg, or arm pain.
What is Spinal Cord Stimulation?
A spinal cord stimulator (SCS) is a small device that is placed under the skin and transmits a mild, low-frequency electric current to the spinal cord. A tiny wire transfers the pulse to the nerve fibers. The SCS minimizes pain because the current modifies and hides the pain signals from reaching the brain.
Spinal Cord Stimulation for Chronic Pain
It is important to note that spinal cord stimulation therapy does not get rid of the source of the pain. It simply runs interference with the signal to the brain. This means that pain relief can vary depending on the patient. The SCS device produces a slight tingling sensation.. It is this sensation that overrides the pain signals. Pain signals travel on the small nerve fibers, whereas the fabricated signals from the SCS travel on larger, more dominant nerves fibers.
The goal of spinal cord stimulation is not to completely erase pain, but to provide a 50-70% reduction. Even the slightest bit of pain relief can be helpful to someone who suffers regularly. Before a permanent spinal cord stimulator is implanted, each patient undergoes a trial to make sure this type of therapy will be effective and reduce their pain.
Why is SCS Used?
Spinal cord stimulation is used to treat neuropathic pain. This is pain that originates from nerve damage. The nerve damage could be caused by injury, accident, or trauma. Patients who are prime candidates for SCS have typically suffered from chronic pain in the lower back, leg, or arm. Commonly, these patients have also had previous surgeries.
More frequently, SCS is being used to avoid back surgery. Other leading causes for receiving SCS therapy is complex regional pain syndrome and peripheral neuropathic pain. Nerve pain that spans beyond damage to the brain and spinal cord, such as from an infection or even amputation or diabetes, is another reason that SCS may be recommended by your physician.
More recently, SCS therapy has been proven to treat a number of chronic visceral pain types, such as abdominal or pelvic pain.
Spinal cord stimulation therapy is used when other treatment types have not been effective in reducing chronic pain or if the patient does not want to undergo surgery. Fortunately, there are no pre-existing medical conditions that would prevent someone from receiving this type of therapy. If you have pain that is caused by a correctable problem (meaning it could be fixed by having surgery or other interventional treatments), SCS is a viable option for reducing your pain.
This type of therapy is more effective when utilized in the earlier stages of a chronic disease or condition, rather than later when a disability has been established.
SCS therapy is used to reduce these types of pain:
- Failed Back Surgery Syndrome: When initial surgery (or surgeries) have been ineffective in reducing pain on a consistent basis.
- Sciatica or Arm Pain: Persistent pain caused by arthritis, spinal stenosis, or extensive nerve damage.
- Complex Regional Pain Syndrome: When patients experience severe chronic pain, typically in their hands or feet.
- Arachnoiditis: This is painful inflammation and scarring of the protective lining of spinal nerves
Other types of pain caused by stump pain, peripheral vascular disease, multiple sclerosis, or a spinal cord injury may be reduced by the use of a spinal cord stimulator.
Benefits of Spinal Cord Stimulation
Spinal cord stimulation therapy reduces the number of abnormal pain signals from reaching the brain. However, it also helps the body restore pain-inhibition pathways that have been lost. Pain-inhibitory pathways essentially work as a gate-keeper. They control how much pain is received by the brain. SCS therapy harnesses the body’s natural pain-relieving chemicals that are used by nerve fibers to communicate with each other. Not only does this whole process reduce pain, but it increases microcirculation.
It is reported that 50-70% of patients who are candidates for SCS therapy experience 50% reduction in pain. An even higher proportion can expect to experience a 30% reduction in pain levels. For many patients who suffer from chronic pain, even the smallest amount of pain relief is welcomed. This has a profound effect on improving the quality of life in patients who have suffered from long-term chronic pain.
Learn more about spinal cord stimulation and how it works for treating chronic pain, fill out the form below and get in touch with the team at Progressive Pain Management today.
Over 26% of Americans suffer from arthritis pain. And while there are medications for reducing arthritis pain, many patients want relief from their pain without taking pills.
Finding Relief from Your Arthritis Pain
Fortunately, treatment options are evolving, and arthritis patients can decide their treatment path alongside their physicians. Having options means creating a treatment plan that fits the patient’s lifestyle, their needs, wants, and corresponds to the severity of their pain.
Commonly, a combination of treatments is most effective for alleviating pain.
Treatment Options for Arthritis Pain
- Physical Therapy
Pain specialists often recommend physical therapy to ease arthritis pain. This type of exercise helps strengthen muscles, reduces joint stiffness, and improves range of motion. Your physical therapist will create an exercise plan to improve your ability to perform daily activities like walking, standing, climbing stairs, and getting in and out of the bathtub.
Physical therapy does not always reduce pain in all arthritis patients, but it can help strengthen the ligaments and muscles that support joints and bones causing pain.
- Transcutaneous electrical nerve stimulation (TENS)
All pain is transferred on small fibers of the nervous system. Those fibers travel from the affected area to the brain where pain is perceived. What Transcutaneous electrical nerve stimulation does is transmit a signal that masks the pain signals. The electrical current triggers the brain to release endorphins and enkephalins, opiate-like chemicals in the body that relieve pain.
TENS effectively treats any kind of arthritis pain.
- Trigger Point Injections
Trigger points are hard “knots” of painful muscles. When arthritis causes muscle pain, trigger points are a common symptom. These injections consist of an anesthesia and corticosteroid that is injected into the painful trigger points. Inserting a needle into the bundle of painful muscles allow the muscle tissue to go back to its normal structure.
- Heat/Cold Therapy
Heat and cold therapy is a temporary fix, but may relieve pain. Heat increases blood flow to the painful area and relaxes the muscles. Cold reduces swelling and inflammation. Cold sensations travel on large nerve fibers, whereas pain signals travel on small nerve fibers. This masks the pain signals.
Heat should be applied two or three times a day for 15-minute intervals. Cold compresses can be applied three or four times a day for 15-minute intervals or until the swelling has reduced.
- Mind-Body Relaxation Techniques
Learning techniques that help relax your body and your mind can help manage your pain. There is a psychological aspect of chronic pain that can be controlled through the use of meditation, breathing exercises, guided imagery, and relaxation. These methods help decrease stress, therefore decreasing inflammation and pain. Meditating for 20 minutes a day helps relax muscles that tense up with pain.
Breathing exercises have been associated with a decrease in depression, another common symptom of chronic pain like arthritis. Mind-body techniques work on focusing your mind and harnessing negative thoughts that can increase your perception of pain. Practicing meditation and regular relaxation techniques reduces the brain’s response to pain.
Progressive Pain Management has a team of experts skilled in treating all forms of chronic pain caused by arthritis and can help you find the relief you are looking for. Fill out the form below to get started.
Often, a group of nerves – called a plexus or ganglion – causes pain to an area of the body. This pain can be “turned off” by using a specific injection that blocks the pain signals from reaching the brain. This is called a nerve block.
Nerve block injections are used to treat chronic pain when medications or other treatments prove to be ineffective or cause negative side effects. They allow a damaged nerve proper time to heal, provide temporary pain relief, and can be used to identify a specific cause of pain. Oftentimes, your physician will perform a test block with a local anesthetic. If you have positive results and pain relief from the test block, your doctor will move forward with an injectable nerve block.
Nerve Block Injections for Treating Chronic Pain
Why are Nerve Block Injections Used?
Nerve block injections are used for a variety of purposes. Patients who suffer from acute or chronic pain may receive a nerve block injection for temporary pain relief. Since pain is such an individual experience, nerve blocks are also used to help physicians diagnose the source of pain by measuring the patient’s response to the injection. This is helpful to determine a treatment plan.
Other purposes for nerve blocks are:
- To predict the outcome of any given treatment. Prognostic nerve blocks are performed to determine if a more permanent treatment (surgery) would be more successful in treating pain.
- To avoid surgery, in some cases.
- To prevent additional pain from a procedure or surgery that can cause negative side effects, such as phantom limb pain.
Types of Nerve Blocks
Since nerve block injections can be used for a variety of purposes to help reduce, treat, and prevent pain, it is no surprise that there are many different types of nerve blocks.
The benefit of nerve blocks is that they can be used in almost every area of the body to treat pain. Because of this, there are different nerve block types. Notype of pain should be treated equally. Here are few types of nerve blocks that are available and why they may be utilized in your pain management treatments:
- Therapeutic nerve block: This type of nerve block contains a local anesthetic to control acute pain.
- Prognostic nerve blocks: These are used to help your physician predict the effectiveness and outcome of a given treatment.
- Diagnostic nerve block: This block contains an anesthetic that helps relieve pain and helps pain specialists determine the root cause of chronic or acute pain.
- Sympathetic nerve block: This type of block is used to determine if there is any type of damage or injury to the sympathetic nerve chain – the network of nerves that extends the length of the spine.
- Preemptive nerve blocks: These types of nerve blocks are meant to prevent pain after a surgery that can cause issues like phantom limb pain.
How are Nerve Blocks Performed?
Nerve block injections use imaging guidance – such as fluoroscopy or CT scans – to guide the needle into the injection site. This allows the physician to place the needle in the most accurate location for the injection to be most beneficial. The syringe will be filled with medication, depending on what the patient needs.
A small needle will be inserted through the skin and directed towards the injection site. A small amount of contrast material may be used to confirm needle placement in the appropriate location. The injection itself will be administered with a syringe much like one that would be used for a routine vaccination. The doctor will fill the syringe from a small vial of medication. The type of medication used depends on individual patient needs.
This is typically performed as an outpatient procedure and only takes a few minutes to administer.
Your physician will position you on the table or surface to allow access to the site to be injected. Using imaging guidance, the doctor will identify where the needle needs to be placed. In some cases, more than one injection may be required, depending on the area of pain that needs to be covered. The medication will go into effect rather quickly, but the doctor will have you stay in the office to ensure no immediate and unexpected side effects.
Side Effects and Risks of Nerve Block Injections
Nerve blocks are safe; however, like any procedure and injection, there is always a risk involved. Typically, nerve blocks carry fewer side effects than other types of medication.
Some side effects include:
- Infection
- Bleeding
- Injection site soreness and tenderness
- Bruising
- Damage to nerves
- Elevated blood sugar
- Horner’s syndrome
Nerve blocks provide temporary relief from pain; the results can vary from patient to patient. Speak to your doctor about your options when it comes to relieving your pain so you can determine a course of action. Nerve blocks are among a variety of anesthetics used to treat pain caused by a group of nerves.
Contact Progressive Pain Management to learn more about nerve block injections and how they can help combat your chronic pain. Fill out the form below.
Complex regional pain syndrome (CRPS) is a chronic pain condition that typically affects a limb, like a leg or an arm. Damage or malfunction to the central nervous system is what is believed to cause complex regional pain syndrome. The central nervous system contains the brain and spinal cord. Things like injuries, surgeries, strokes, or heart attacks are common causes.
What is Complex Regional Pain Syndrome
This condition is not common. In fact, it is difficult to diagnose and is historically tricky to treat. The affected area is not only extremely painful but other symptoms can include a change of body temperature, discoloration, and swelling in the affected area.
CPRS can be divided into two types: CRPS-I and CRPS-II. CRPS-I is previously known as reflex sympathetic dystrophy (RSD) syndrome. This type is when patients do not have a confirmed nerve injury or disorder. CRPS-II (also known as causalgia) is when the condition stems from a confirmed nerve injury. Despite there being two types of CRPS, treatments are similar.
Symptoms of Complex Regional Pain Syndrome
The symptoms of CRPS vary. The main symptom that is present is long-term severe pain that may be constant. This pain is often described as burning or a pins-and-needles sensation. Symptoms may change over time, but pain, swelling, redness, and hypersensitivity (allodynia) are typically the first symptoms that occur. Pain has been known to spread, even if the affected area is only a hand or even finger. While this is rare, complex regional pain syndrome may spread to other extremities, such as the opposite limb or other area of the body.
Symptoms can go away on their own, overtime.
Other symptoms of CRPS include:
- Changes in hair growth patterns
- Joint stiffness
- Decreased muscle coordination
- Abnormal sweating pattern in the affected area
- Tremors or jerking of the affected limb
Diagnosis and Treatment Options
Diagnosis
CRPS is diagnosed based on a patient’s medical history and present symptoms. It is especially difficult to diagnose because the symptoms are common to other conditions as well. As a person’s symptoms improve, it is even more difficult to diagnose.
Certain tests are used to rule out other disorders and conditions that display similar symptoms, such as arthritis, Lyme disease, a clotted vein, or a general muscle disease. These tests can provide your physician with clues about what is causing your pain. A careful examination should be performed to determine if an injury is the root cause of the pain – the key feature to CRPS. Thorough examinations help assess the pain and determine if other treatable conditions are present and not ignored.
Imaging tests such as magnetic resonance imaging or triple-phase bone scans may be used to confirm a diagnosis. CRPS is often related to a process where certain cells break down bone and release calcium into the blood. However, this symptom can be caused by other diseases as well. X-Rays are used to show a loss of minerals from your bones. This is common in later phases of the disease. Sympathetic nervous systems tests look for disturbances in your sympathetic nervous system by using thermography to measure your skin temperature and blood flow. Other tests can measure the amount of sweat on your limbs. Irregular results can lead to an accurate prognosis of complex regional pain syndrome.
Treatment Options
The goal of treatments is to lower the intensity of pain and reduce muscle spasms. Your physician may recommend different types of treatment options depending on the severity of your pain and symptoms you experience.
Therapies include:
- Physical Therapy: Physical therapy is used to keep the painful body part moving to increase blood flow. Exercise helps increase flexibility, builds strength, and improves the function of the affected area.
- Nerve Blocks: Sympathetic nerve blocks can provide temporary relief from pain, but does not have any long-term benefits. Nerve blocks involve injecting an anesthetic next to the spine to block the nerves from communicating pain signals with the brain.
- Medications: Various medications are used to help reduce pain. Your doctor may recommend over-the-counter pain relievers such as Naproxen, Ibuprofen, or Aspirin. If a patient is suffering from neuropathic pain, antidepressants may be prescribed. Corticosteroids, such as prednisone, are used to reduce inflammation and improve mobility.
- Heat Therapy: Applying heat may reduce swelling and discomfort on skin that has varying temperatures.
- Biofeedback: Biofeedback techniques help you become more aware of your body so you can train it to relax and reduce pain. This involved being hooked up to an electrical sensors that measure your bodily functions like heart rate. This information helps train your mind and body to understand your pain on a deeper level.
Contact Progressive Pain Management to learn more about complex regional pain syndrome treatment options. Fill out the form below to get started.