Pain We Cure

Low Back Pain

Focal Back Pain

Low back pain is more common than you may think…so don't worry, you are not alone. Just check out the following statistics:

  • 80-90% of all adults will suffer with low back pain at some time in their life
  • lower back pain is the leading cause of disability for people under 45 years of age
  • lower back pain is the second leading cause of visits to doctors' office
  • lower back pain is the third leading reason for hospital admissions

What Causes Low Back Pain?

The lower back is a complex area that connects the upper body (including the chest and arms) to the lower body (including the pelvis and legs) and is comprised of several vertebrae, soft cartilage discs, muscles, joints, ligaments, and nerve tissue. Lower back pain is extremely common for people of all ages, often triggered by some combination of overuse, strain, or injury. Heavy lifting, stretching and exercise can cause a strain, spasm or sprain of the lower back. Occasionally, a spinal disc may rupture or bulge outward, causing pressure on the nerves located in the lumbar region. Low back pain may also be caused by sciatica or degenerative disorders like arthritis and osteoporosis, a disease characterized by thinning of the bones. Lifestyle factors such as lack of exercise, obesity, poor posture, stress, and bad work practices can also contribute to lower back pain.

How Is Low Back Pain Treated?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Our doctors and staff specialize in treating pain and the disorders that cause pain. Here we diagnose the aetiology of pain and start managing it with least invasive way. If you are experiencing lower back pain, please contact us to help relieve your pain and cure its cause.

Radiculopathy

Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy).

What Causes Radiculopathy?

Radiculopathy is caused by compression or irritation of the nerves as they exit the spine. This can be due to mechanical compression of the nerve by a disk herniation, a bone spur (osteophytes) from osteoarthritis, or from thickening of surrounding ligaments. Other less common causes of mechanical compression of the nerves is from a tumor or infection. Either of these can reduce the amount of space in the spinal canal and compress the exiting nerve. Scoliosis can cause the nerves on one side of the spine to become compressed by the abnormal curve of the spine. Still other causes of radiculopathy include diabetes which can decrease the normal blood flow to the spinal nerves and inflammation from trauma or degeneration can lead to radiculopathy from direct irritation of the nerves.

How Is Radiculopathy Treated?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. We diagnose the aetiology of radiculopathy and start managing it with least invasive way. With the help of an X-ray machine (IITV) , a physician injects steroid and local anesthetic medication between the bones of the spine adjacent to the involved nerves. This can help to rapidly reduce the inflammation and irritation of the nerve and help reduce the symptoms of radiculopathy. If you have been diagnosed with radiculopathy, please contact us so we can help treat and manage your pain and get you some relief.

Facet Disease

What causes Facet Disease?

Facet Disease is caused by the cartilage in the joints being worn down as a result of wear and tear, aging, injury or misuse. This type of injury to the spine can be attributed to certain types of occupations, over-use, arthritis of the spine, or an accident. Another cause of facet disease is spondylolithesis, which is when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine.

How do we treat Facet Disease?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Pain related to facet disease can be easily diagnosed. This is accomplished by either a thorough physical exam or a diagnostic facet injection, a numbing medication injected into the facet joint. If your pain is caused from the facet joint, then the pain should resolve immediately. If you still have pain after the injection, then your pain may be caused by something else such as spinal stenosis or a herniated/bulging disc, which may require a different procedure to correct. We diagnose the aetiology of facet disease and start managing it with least invasive way. If you are experiencing spinal pain, please contact us to help relieve your pain and cure its cause.

Spinal Stenosis

Spinal Stenosis

Spinal Stenosis

Spinal Stenosis is a narrowing of the spinal canal. The diagram above shows the vertebra and the canal located in the center. The canal is really a long tube created by the hole or canal in the middle of each of the vertebrae. These vertebrae that form your spine are stacked on top of one another. The canal gets smaller because parts that make up the front, back or sides of the canal start to grow, thicken or bulge into the open canal space.

The spinal nerves that go to your legs are located in your canal and when the space becomes smaller it can pinch them. Patients complain of low back pain, along with pain, numbness and weakness in one or both legs with spinal stenosis. Commonly their pain is worse with standing and walking and relieved by bending over or sitting. The pain can become unrelenting and the mental and physical toll this puts on those who suffer with spinal stenosis should not be understated.

How Do We Treat Spinal Stenosis?

Because Spinal Stenosis can involve poor muscle support, spinal alignment, loss of normal low back curve (bad posture), spinal flexibility along with the other factors discussed above – an effective treatment program must address each of these problems. Spinal surgery is just not the best choice for most spinal stenosis patients. Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Medications – NSAID's (Ibuprofen like drugs), membrane stabilizing drugs and other analgesics are often used in the management of pain associated with sciatica. Other procedures including epidural steroid injections may provide better results. Whatever the cause of your neck or back pain, We diagnose the condition and start managing it with least invasive way. If you are experiencing lower back pain, please contact us to help relieve your pain and cure its cause.

Disckogenic Back Pain

In Approximately 45% of the low Back Pain complaints, Low Back pain appears to be of Diskogenic in origin. There are differences that can be seen between a normal disc and degenerative disc however, Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).

What Causes Degenerative Disc Disease?

The leading cause of degenerative disc disease is something that simply cannot be avoided: the natural aging process and the vast majority of degenerative discs cause no symptoms at all. Causes of internal disc derangement usually involve an accumulation of traumatic events ranging in significance from minor disc injuries to more severe types of injuries, causing degeneration of annulus. Axial rotation of the spine or rotation of a flexed spine may isolate some of the annular fibers and cause small annular tears. In time they may coalesce to weaken the annulus fibrosus. This can lead to disc bulging, disc space narrowing or even frank herniation.

How Do We Treat Degenerative Disc Disease?

For patients who have been diagnosed with degenerative disc disease in their Low Back, a number of treatment options may be considered. In order to determine which course of treatment is best for the patient, the doctor will take into account a variety of factors, such as the patient's overall health, current medications, the cause of the degenerative disc disease, and the patient's age, among others. Low Back pain from a herniated or bulging disc can be managed with a series of conservative, noninvasive techniques that are designed to alleviate painful nerve compression and abate the patient's pain. The use of over-the-counter or prescription pain medication or anti-inflammatories may be recommended in addition to regularly applying heat or ice, participating in low-impact exercises, using various stretching techniques, getting rest, and other similar treatments. Here we diagnose the aetiology of Low Back Pain and start managing it with least invasive way. If you are experiencing Low Back pain, please contact us to help relieve your pain and cure its cause.

Sacroiliac Joint Pain

Sacroiliac Joint Pain

What Causes Sacroiliac Joint Pain?

There are several causes of Sacroiliac Joint Pain. One such cause are traumatic injuries. Traumatic injuries to the Sacroiliac Joint are caused when there is a sudden impact which 'jolts' the joint. A common example is landing on the buttocks. This kind of injury usually causes damage to the ligaments which support the joint. Other causes include hormonal changes, which most notably during pregnancy can cause sacroiliac pain. In preparation for giving birth, the ligaments of the pelvis especially increase in laxity. Combining this with an increase in weight putting extra strain on the spine, may lead to mechanical changes which can result in pain. Other potential causes of sacroiliac joint pain include leg length discrepancy, a twisted pelvis and inflammatory joint disease.

How Is Low Back Pain Treated?

Doctor-prescribed medications may be effective in reducing the inflammation. However, if the medications are ineffective or if they produce undesirable side effects, an injection into the joint may be effective. Our approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Here we diagnose the aetiology of pain and start managing it with least invasive way. If you are experiencing symptoms of Sacroiliac Joint Pain, please contact us to help relieve your pain and cure its cause.

Coccygodynia

The spine is composed of a series of bones called vertebrae. Joints that allow movement while providing stability connect the vertebrae. The end of the spine, the coccyx, has 3-5 small bones. The coccyx bones align in a curve like a small tail. Some of the coccyx bones may be fused together. However, fewer than 10% of people have a completely fused coccyx. Muscles, ligaments, and tendons attach to the coccyx. It plays a role in weight bearing when seated. Coccydynia is an uncommon painful condition that originates from the coccyx, the tailbone at the end of the spine. Trauma and falls are the most frequent causes of coccydynia.

What are the symptoms of Coccygodynia ?

The primary symptom of coccydynia is pain. You may experience increased sensitivity to pressure, especially when sitting and leaning backwards. The area around your tailbone may ache. Coccydynia can cause pain that shoots down the legs. It can also contribute to pain during sexual intercourse or bowel movements.

How do we treat Coccygodynia ?

A doctor can diagnose coccydynia by reviewing your medical history and examining you. You should tell your doctor if you have fallen or given birth recently. Imaging tests, such as X-ray or MRI, may be used to rule out other sources of pain. Electromyography (EMG) and nerve conduction studies may be used to assess nerve function. Coccygodynia is typically first treated with non-steroidal anti-inflammatory medications. Your doctor may recommend that you sit on a donut shaped pillow to help relieve tailbone pressure. It may take several weeks or months for the pain to decrease.

For persistent or severe pain, your doctor may prescribe pain medications. Local medication injections are used to place numbing and anti-inflammatory medications near the source (joint or bursa) of the pain. Nerve blocks are used to interrupt a nerve's ability to transmit pain signals.Your doctor may gently move (manipulate) the coccyx after you receive a pain relieving injection. You may be referred to physical therapy for gentle stretching. Ultrasound therapy may be used, which soothes pain with warmth. If treatments fail to relieve symptoms, surgery may be used to remove a portion of the coccyx (coccygectomy). The short outpatient surgery is successful for relieving symptoms for most people. However, surgery is very rarely used. Here we diagnose the condition and start managing it with least invasive way. If you are experiencing symptoms of Coccygodynia, please contact us to help relieve your pain and cure its cause.

Pyriformis Syndrome

What cause the Pyriformis Syndrome?

The piriformis muscle begins inside the pelvis and connects to the triangular-shaped bone that sits between the pelvic bones at the base of the spine known as the sacrum. The other end of the piriformis muscle connects to the greater trochanter, the bump of bone on the top side of your hip. The pyriformis muscle helps to turn the foot and leg outward. Problems in the piriformis muscle can cause problems with the sciatic nerve. This is because the sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis. The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica. Pain may be felt in affected buttock, thigh and leg.

How do we treat Pyriformis Syndrome?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. The diagnosis is largely clinical and is one of exclusion. The use of multimodal approach, such as medications, interventional procedure and rehabilitation is best one. We diagnose the condition and start managing it with least invasive way. If you are experiencing symptoms of Pyriformis Syndrome, please contact us to help relieve your pain and cure its cause.

Neck Pain

Neck/Shoulder Pain

Nearly everyone will suffer from some form of neck and shoulder pain at some point in their lives.

What Causes Neck Pain?

The neck is the most flexible region of the spine, containing muscles, bones, nerves, arteries, and veins, as well as many ligaments and other supporting structures. Neck pain can begin in any of these structures or may come from other regions near the neck, like the shoulder, jaw, head, and upper arms. Injury or stress can cause damage to the bones and discs in the neck, causing pain, discomfort, numbness and/or tingling sensations. The neck also has many muscles and connective tissues that can be adversely affected by stretching, spasm, or strain. Sudden injury from sports or accidents, herniated discs, blood vessel damage and pressure on the spinal cord are conditions that require medical attention, while less serious causes like stress, poor posture, natural aging, and too much exercise can also produce neck pain.

According to the American College of Rheumatology, about 10% of the population has an episode of neck pain each year. Neck pain may occur slightly more frequently in women than in men.

How Do We Treat Neck Pain?

Our physicians and staff specialize in treating neck pain and the disorders that cause pain. Whether your neck pain comes from simple wear and tear, accident or injury, the professionals at Pain Care Specialists will diagnose and treat it using cutting-edge technology and the finest medical attention. Management of neck pain depends on the etiology of the pain. Minimally invasive procedures are numerous and can be the most helpful to control pain and improve daily functioning. If you are experiencing neck pain, please contact us to help relieve your pain and cure its cause.

Radiculopathy

Radiculopathy is a condition due to a compressed nerve in the spine that can cause pain, numbness, tingling, or weakness along the course of the nerve. Radiculopathy can occur in any part of the spine, but it is most common in the lower back (lumbar radiculopathy) and in the neck (cervical radiculopathy). It is less commonly found in the middle portion of the spine (thoracic radiculopathy).

What Causes Radiculopathy?

Radiculopathy is caused by compression or irritation of the nerves as they exit the spine. This can be due to mechanical compression of the nerve by a disk herniation, a bone spur (osteophytes) from osteoarthritis, or from thickening of surrounding ligaments. Other less common causes of mechanical compression of the nerves is from a tumor or infection. Either of these can reduce the amount of space in the spinal canal and compress the exiting nerve. Scoliosis can cause the nerves on one side of the spine to become compressed by the abnormal curve of the spine. Still other causes of radiculopathy include diabetes which can decrease the normal blood flow to the spinal nerves and inflammation from trauma or degeneration can lead to radiculopathy from direct irritation of the nerves.

How Is Radiculopathy Treated?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. We diagnose the aetiology of radiculopathy and start managing it with least invasive way. With the help of an X-ray machine (IITV) , a physician injects steroid and local anesthetic medication between the bones of the spine adjacent to the involved nerves. This can help to rapidly reduce the inflammation and irritation of the nerve and help reduce the symptoms of radiculopathy. If you have been diagnosed with radiculopathy, please contact us so we can help treat and manage your pain and get you some relief.

Facet Disease

What causes Facet Disease?

Facet Disease is caused by the cartilage in the joints being worn down as a result of wear and tear, aging, injury or misuse. This type of injury to the spine can be attributed to certain types of occupations, over-use, arthritis of the spine, or an accident. Another cause of facet disease is spondylolithesis, which is when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine.

How do we treat Facet Disease?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Pain related to facet disease can be easily diagnosed. This is accomplished by either a thorough physical exam or a diagnostic facet injection, a numbing medication injected into the facet joint. If your pain is caused from the facet joint, then the pain should resolve immediately. If you still have pain after the injection, then your pain may be caused by something else such as spinal stenosis or a herniated/bulging disc, which may require a different procedure to correct. We diagnose the aetiology of facet disease and start managing it with least invasive way. If you are experiencing spinal pain, please contact us to help relieve your pain and cure its cause.

Cervical Diskogenic Pain

Cervical Diskogenic Pain

In Approximately 45% of the low Back Pain complaints, Low Back pain appears to be of Diskogenic in origin. There are differences that can be seen between a normal disc and degenerative disc however, Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region).

What Causes Degenerative Disc Disease?

The leading cause of degenerative disc disease is something that simply cannot be avoided: the natural aging process. As we grow older, the anatomical components of the neck, including the intervertebral discs, naturally begin to deteriorate as a result of years of regular wear and tear. This is particularly common in the cervical spine (neck), where the spine must support the weight of the skull and also provide full range of motion.

However, aging isn't the only factor that can lead to degenerative disc disease in the neck. Other lifestyle factors and events can also exacerbate or accelerate the onset of degenerative disc disease. Essentially, any activity that puts additional strain on the neck can lead to disc deterioration. Careers that require frequent bending, twisting, or lifting, for example, are likely to lead to disc problems later in life. Participation in high-impact sports is also a leading contributor to neck problems. Traumatic injury can further cause degenerative neck problems even after the neck has otherwise healed. It is these factors that begin to explain the variance in the ages of patients who are initially diagnosed with degenerative disc disease, although it should be noted that the majority of the cases of this condition are first exhibited at middle age.

How Do We Treat Degenerative Disc Disease?

For patients who have been diagnosed with degenerative disc disease in their neck, a number of treatment options may be considered. In order to determine which course of treatment is best for the patient, the doctor will take into account a variety of factors, such as the patient's overall health, current medications, the cause of the degenerative disc disease, and the patient's age, among others. Neck pain from a herniated or bulging disc can be managed with a series of conservative, noninvasive techniques that are designed to alleviate painful nerve compression and abate the patient's pain. The use of over-the-counter or prescription pain medication or anti-inflammatories may be recommended in addition to regularly applying heat or ice, participating in low-impact exercises, using various stretching techniques, getting rest, and other similar treatments. Whether your neck pain comes from simple wear and tear, accident or injury, We diagnose the aetiology of Neck Pain and start managing it with least invasive way. If you are experiencing neck pain, please contact us to help relieve your pain and cure its cause.

Trigeminal Neuralgia

What is Trigeminal Neuralgia?

Trigeminal Neuralgia

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain

What Causes Trigeminal Neuralgia?

The most frequent cause of trigeminal neuralgia is a blood vessel pressing on the nerve near the brain stem. Over time, changes in the blood vessels of the brain can result in blood vessels rubbing against the trigeminal nerve root. The constant rubbing with each heartbeat wears away the insulating membrane of the nerve, resulting in nerve irritation.

How do we treat Trigeminal Neuralgia?

Doctor-prescribed medications may be effective. However, if the medications are ineffective or if they produce undesirable side effects, one has to take recourse to invasive procedures to relieve pressure on the nerve or to reduce nerve sensitivity. Our approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Here we diagnose the condition and start managing it with least invasive way. If you are experiencing symptoms of Trigeminal Neuralgia, please contact us to help relieve your pain and cure its cause.

Joint Pain

Knee Pain

Knee Pain

What Causes Knee Pain?

As the principal weight-bearing joint in the human body, the knee is susceptible to a wide range of difficulties. Awkward movements, falls and collisions, sudden twists, excessive force or overuse can result in a range of injuries to the knee joint and the structures supporting it. Knee pain can also come from inflammatory and degenerative conditions such as bursitis, tendinitis, or gout, with the most common of these conditions being osteoarthritis, which creates a loss of cartilage and damages the cushioning fluid in the knee joint. Sprain, strain, dislocation of the kneecap, or disorders of other parts of the body, such as the hip, may also cause knee pain.

How do we treat knee pain?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. There are several injections that may help knee pain, including directly into the knee joint. This type of injection reduces inflammation and pain. Certain types provide lubrication to the knee joint for persons with degenerative conditions such as osteoarthritis. There are also several nerve blocks that may be beneficial. We diagnose the aetiology of Knee Joint Pain and start managing it with least invasive way. If you are experiencing knee pain, please contact us to help relieve your pain and cure its cause.

Hip Pain

Hip Pain

Hip pain is the sensation of discomfort in or around the hip joint, where the upper end (head) of the thigh bone (femur) fits into the socket of the hip bone.

What Causes Hip Pain?

The hip joint is a large weight bearing joint that attaches the leg bone (femur) to the pelvis. It is an extremely important joint, as it allows the body to walk, run, and sit. The hip is a very strong structure, but still can be damaged. Hip pain truly has a number of causes, most of which are related to degeneration, injury, or inflammation of the muscles, bones, joints, and tendons located in the hip area. Common causes of hip pain include arthritis, bursitis, bone fracture, muscle spasms, and strains. Hip pain can also result from disorders causing pain radiating from the spine and back, such as sciatica and herniated discs. Sports-related injuries, motor vehicle accidents and falls in the elderly are subject to the most crucial hip injuries. However, severe chronic hip pain is often due to arthritis.

How do we treat hip pain?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. There are many surgical and interventional options for severe causes of arthritis and joint pain. The most common and recommended methods to treating arthritis are conservative alternative therapy provided by a pain specialist. Staying active and physical therapy as well as NSAIDs and Acetaminophen, have also proven to be beneficial. A joint injection may be considered for patients with symptoms suggesting arthritis. The injection can help relieve pain by reducing the inflammation and numbing the joint and can also help diagnose the source of pain. The most important and greatest success achieved with the use of joint injections is the rapid relief of symptoms that allows you to experience enough relief to become active again. With this you regain the ability to resume your normal daily activities that was not achieved with oral medications and physical therapy. We diagnose the aetiology of Hip Pain and start managing it with least invasive way. If you are experiencing hip pain, please contact us to help relieve your pain and cure its cause.

Cancer Pain

Approximately 19 million people worldwide experience cancer pain every year. At any given time, about half of all patients with malignant cancer are experiencing pain and more than a third of those experience moderate or severe pain that diminishes their quality of life by adversely affecting sleep, social relations and activities of daily living. Pain is more common in the later stages of the illness.

What causes cancer pain?

Cancer pain can result from the cancer itself. Cancer can cause pain by growing into or destroying tissue near the cancer. Cancer pain can come from the primary cancer itself — where the cancer started — or from other areas in the body where the cancer has spread (metastases). As a tumor grows, it may put pressure on nerves, bones or organs, causing pain.

Cancer pain may not just be from the physical effect of the cancer on a region of the body, but also due to chemicals that the cancer may secrete in the region of the tumor. Treatment of the cancer can help the pain in these situations.

Cancer treatments — such as chemotherapy, radiation and surgery — are another potential source of cancer pain. Surgery can be painful, and it may take time to recover. Radiation may leave behind a burning sensation or painful scars. And chemotherapy can cause many potentially painful side effects, including mouth sores, diarrhea and nerve damage.

How do we treat cancer pain?

Cancer pain can be eliminated or well controlled in 80 to 90 percent of cases by the use of drugs (such as morphine) and other interventions, but nearly one in two patients receives less-than-optimal care.

Unfortunately cancer pain is often undertreaed. There are many factors that may contribute to that, some of which include:

  • Reluctance of doctors to ask about pain or offer treatment
  • Reluctance of patients to speak up about pain
  • Fear of addiction.
  • Fear of side effects

There are many different ways to treat cancer pain. The ideal way is to remove the source of the pain, for example, through surgery, chemotherapy, radiation or some other form of treatment. If that can't be done, pain medications can usually control the pain. WHO recommends a three step approach :

  • For mild pain – nonopioid analgesics such as aspirin, acetaminophen and/or NSAID ( ibuprofen).
  • For moderate pain – Weak oral opioid medications, such as codeine and oxycodone
  • For severe pain - Stronger opioid medications, such as morphine, hydromorphone

These drugs can often be taken orally, so they're easy to use. Medications may come in tablet form, or they may be made to dissolve quickly in your mouth. However, if you're unable to take medications orally, they may also be taken intravenously, rectally or through the skin using a patch.

Adjuvant drug therapy – Antidepressants and anxiolytics etcs.

International Procedures

If analgesics and adjuvant regimen recommended above does not adequately relieve pain, additional modes of intervention are available.

Radiation

Radiotherapy is used when drug treatment is failing to control the pain of a growing tumor, such as in bone metastisis (most commonly), penetration of soft tissue, or compression of sensory nerves. Often, low doses are adequate to produce analgesia, thought to be due to reduction in pressure or, possibly, interference with the tumor's production of pain-promoting chemicals.

Nerve blocks

Neurolysis is the injury of a nerve. Chemicals, laser, freezing or heating may be used to injure a sensory nerve and so produce degeneration of the nerve's fibers and the fibers' myelin sheaths, and temporary interference with the transmission of pain signals. In this procedure, the protective casing around the myelin sheath, the basal lamina, is preserved so that, as a damaged fiber (and its myelin sheath) regrows, it travels within its basal lamina and connects with the correct loose end, and function may be restored. Surgical cutting of a nerve severs the basal laminae, and without these tubes to channel the regrowing fibers to their lost connections, deafferentation pain (spontaneous pain due to loss of signal to the spinal cord) may develop. This is why neurolysis is preferred over surgically blocking nerves. A brief "rehearsal" block using local anesthesia should be tried before the actual neurolytic block, to determine efficacy and detect side effects. The aim of this treatment is pain elimination, or the reduction of pain to the point where opioids may be effective. Though neurolysis lacks long-term outcome studies and evidence-based guidelines for its use, for patients with progressive cancer and otherwise incurable pain, it can play an essential role.

Targets for neurolytic block include the celiac plexus, most commonly for cancer of the gastrointestinal tract up to the transverse colon, and pancreatic cancer, but also for stomach cancer, gall bladder cancer, adrenal mass, common bile duct cancer, chronic pancreatitis and active intermittent porphyria; the splanchnic nerve, for retroperitoneal pain, and similar conditions to those addressed by the celiac plexus block but, because of its higher rate of complications, used only if the celiac plexus block is not producing adequate relief; hypogastric plexus, for cancer of the descending colon, sigmoid colon and rectum, as well as cancers of the bladder, prostatic urethra, prostate, seminal vesicles, testicles, uterus, ovary and vaginal fundus (the inner end of the vagina); ganglion impar, for the perinium, vulva, anus, distal (outer end of the) rectum, distal urethra, and distal third of the vagina; the stellate ganglion, usually for head and neck cancer or sympathetically mediated arm and hand pain; the intercostal nerves, which serve the skin of the chest and abdomen; and a dorsal root ganglion may be injured by targeting the root inside the subarachnoid cavity .most effective for pain in the chest or abdominal wall, but also used for other areas including arm/hand or leg/foot pain.

Cutting or destruction of nervous tissue

Surgical cutting or destruction of peripheral or central nervous tissue is now rarely used in the treatment of pain.

Intrathecal programmable pump

Delivery of an opioid such as morphine, hydromorphone, fentanyl, sufentanyl and meperidine directly into the subarachnoid cavity provides enhanced analgesia with reduced systemic side effects, and has reduced the level of pain in otherwise intractable cases. The anxiolytic clonidine or the nonopioid analgesic, and local anesthetics such as bupivacaine, ropivacaine or tetracaine may also be infused along with the opioid.

Long-term epidural catheter

The outer layer of the sheath surrounding the spinal cord is called the dura mater . Between this and the surrounding vertebrae is the epidural space, filled with connective tissue, fat and blood vessels, and crossed by the spinal nerve roots. A catheter may be inserted into this space for three to six months, to deliver anesthetics or analgesics. The line carrying the drug may be threaded under the skin to emerge at the front of the patient, a process called tunneling, and this is recommended with long term use so as to reduce the chance of any infection at the exit site reaching the epidural space.

Complex Regional Pain Syndrome

What are the symptoms of CRPS

Complex regional pain syndrome (CRPS) is an uncommon form of chronic pain that usually affects an arm or leg. CPRS typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury, if any. The cause of complex regional pain syndrome isn't clearly understood. It can get worse over time, and may spread to other parts of the body. We know that injury or surgery may have occurred before the onset of symptoms. However, in many cases no previous injury took place and there is no evidence of neurological or physical damage to the affected area.

What are the symptoms of CRPS?

Symptoms in the affected area are

  • Dramatic changes in temperature and color
  • Intense burning pain
  • Extreme skin sensitivity

How Do We Treat CRPS?

Because there is no cure for CRPS, treatment is aimed at relieving painful symptoms. We prescribe topical analgesics, antidepressants, corticosteroids, and opioids to relieve pain. However, no single drug or combination of drugs has produced consistent long-lasting improvement in symptoms. Other treatments may include physical therapy, sympathetic nerve block, spinal cord stimulation, and intrathecal drug pumps to deliver opioids and local anesthetic agents via the spinal cord. If you are experiencing the symptoms of CRPS, Please contact us to help relieve your pain.

Failed Back Surgery Syndrome

Failed Back Surgery Syndrome

Failed back surgery syndrome (FBSS) is a misnomer, as it is not actually a syndrome – it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain after surgery. There is no equivalent term for failed back surgery syndrome in any other type of surgery (e.g. there is no failed cardiac surgery syndrome, failed knee surgery syndrome, etc.).

There are many reasons that a back surgery may or may not work, and even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.

What Causes Failed Back Surgery Syndrome?

There are several reasons that a patient may feel pain after back surgery which results in failed back surgery syndrome.

Improper preoperative patient selection before back surgery. This is the most common cause of failed back surgery syndrome. Surgeons look for an anatomic lesion in the spine that they can correlate with a patients pain pattern. Some lesions are more reliable than others. For example, degenerative disc disease is less commonly correlated with patients back pain than leg pain from a disc herniation pinching a nerve root. There are other sources of pain that can mimic back pathology such as piriformis syndrome, sacroiliac joint pain and hip pathology (such as hip osteoarthritis).

Recurrent disc herniation after spine surgery. This is another common cause of recurrent pain after a discectomy/microdiscectomy spine surgery. The typical clinical picture is one where the patient initially has substantial pain relief, followed by a sudden recurrence of leg pain. In contrast to symptomatic pain caused by scar tissue (epidural fibrosis), in which symptoms tend to appear gradually, the symptoms of recurrent disc herniation tend to occur acutely. In addition to clinical history and presentation, an MRI scan is also useful in distinguishing the two pathologies.

Technical error during spine surgery. The spine surgeon must also consider technical error if there is continued pain after a discectomy or microdiscectomy or a laminectomy. For example, was a fragment of herniated disc material missed, or a piece of bone left adjacent to the nerve? In either case, the resulting compression of the nerve root could cause pain. Were the correct operative levels chosen during surgical planning? If not, an adjacent disc may be the true source of the pain. Again, postoperative imaging and clinical presentation will help answer these questions.

How Do We Treat Failed Back Surgery Syndrome?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. We diagnose the condition and start managing it with least invasive way. If you are experiencing pain, please contact us to help relieve your pain and cure its cause.

Postherpetic Neuralgia

Postherpetic Neuralgia

Postherpetic neuralgia is a painful condition affecting your nerve fibers and skin. The burning pain associated with this can be severe enough to interfere with sleep and appetite.

What Causes Postherpetic Neuralgia?

Postherpetic neuralgia is a complication of shingles, which is caused by the chickenpox virus. Most cases of shingles clear up within a few weeks. But if the pain lasts long after the shingles rash and blisters have disappeared, it's called postherpetic neuralgia. The risk of postherpetic neuralgia increases with age, primarily affecting people over the age of 60. Effective treatment is difficult, and the pain can last for months or even years.

How Is Postherpetic Neuralgia Treated?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. We diagnose the condition and start managing it with least invasive way. Furthermore, the doctor may prescribe pain relievers, anticonvulsants, and antidepressants. If you are experiencing postherpetic neuralgia, please contact us to help relieve your pain.

Headache

Headache

Headaches come in a variety of forms. It is important to correctly diagnose the headache type in order to treat it effectively so you can get some relief. One of the most common types of headaches is the cervicogenic headache, so called because it originates due to tension and stress in the neck (cervical spine.) This type of headache is very responsive to physical medicine and is something we are very effective at treating.

Headaches and head pain can occur in a variety of areas around the face and head. The pain can be especially severe and range from spot locations to wide bands of pain and discomfort around the head. Headaches can become so severe that you may experience nausea or difficulty seeing.

What are the Causes of Headaches?

Headaches can come in a variety of forms, including a migraine, cluster or tension headache. They may be the result of physical or emotional stress, a chemically-related disorder, or can be a sign of a more serious condition. But no matter the cause, every headache sufferer will agree: the pain is unwelcome.

How Do We Treat Headaches?

Migraine treatment varies depending on the patient and symptoms. Most migraine specialists try to determine environments to avoid by identifying triggers. For example, those who experience migraines when exposed to bright lights may be instructed to wear protective eyewear in the sun and consciously avoid staring into artificial light. Other common preventive lifestyle changes include avoiding certain odors and beverages, or adjusting sleeping conditions. These preemptive strategies can help eliminate migraines all together. At Pain Care Specialists, we can prescribe preventative drugs that can also help fight off migraines. Cardiovascular drugs, such as beta-blockers, and anti-depression can prevent attacks. Once migraines hit, there are number of pain management options. Anti-nausea medications, opiates, and pain relievers treat specific symptoms to reduce the discomfort of migraines. Like many internal ailments, healthy living is one of the most effective treatments. Avoiding too much stress, exercising and eating properly will reduce the chance of migraines and dismiss the need for more complicated, expensive options. If you are experiencing headaches or migraines, please contact us to help relieve your pain.

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuralgia

Diabetic neuropathy can be called an impairment of the nerves that occurs because of the diabetic subjects. If this impairment is related to the injuries of the hands, arms and legs and feet, it is identified as diabetic peripheral neuropathy. Diabetic peripheral neuropathy can be difficult to diagnose. A thorough neurological and physical exam, as well as a thorough history are pertinent. Certain lab tests may be ordered by your physician in order to rule out other potential causes of peripheral neuropathy. Nerve conduction studies as well as an electromyography (EMG) may also help your physician make your diagnosis. Often times, diabetic peripheral neuropathy is based on exclusion of other possibilities and a strong history that is suggestive of it.

What Causes Diabetic Peripheral Neuropathy?

Diabetes is the leading cause of peripheral Neuropathy, but doctors must rule out other possible culprits:

  • hereditary disorders, such as disease Charcot-Marie-Tooth disease (peroneal muscular atrophy)
  • nerve damage by trauma
  • tumor, infection
  • exposure to toxic substances
  • autoimmune diseases
  • nutritional deficiencies
  • alcoholism

What are the symptoms of Diabetic Peripheral Neuropathy?

Common symptoms include:

  • paralysis
  • tingling or stabbing pain
  • burning sensation
  • inability to feel intense heat or cold
  • cramps
  • extreme sensitivity to touch
  • loss of coordination
  • weakness and loss of reflexes

How Is Diabetic Peripheral Neuropathy Treated??

While diagnosing diabetic peripheral neuropathy has proven to be difficult, treating it has proven to be even more challenging. The goal of treatment is to control the blood sugar level that is causing the neuropathy, and provide symptom relief. There are no quick fixes for diabetic peripheral neuropathy, so several recommendations may be prescribed including certain medications to control the pain as well as maintaining normal blood sugar levels.

Here we have successfully treated patients with painful peripheral neuropathies with a modality called Spinal Cord Stimulation (SCS). Spinal cord stimulation is often thought of as "a pacemaker for pain management" and can be a very effective long-term treatment modality for neuropathies and other difficult to treat pain syndromes. Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. Whatever the cause of your pain, We diagnose the condition and start managing it with least invasive way. If you are experiencing symptoms of diabetic peripheral neuropathy, please contact us to help relieve your pain and cure its cause./p>

Myofascial Pain

Myofascial Pain

What Causes Myofascial Pain?

Myofascial pain is a condition characterized by chronic pain in the muscle tissues, similar tofibromyalgia. This pain is sometimes the aftermath of injury. Pain medication, anti-inflammatory medication, and therapies aimed at relaxing the muscles tissues (such as massage, chiropracty, and some forms of acupuncture) have been reported as beneficial in some cases. Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament or tendon. Other causes include injury to intervertebral disc, general fatigue, repetitive motions, lack of activity (such as a broken arm in a sling) and specific medical conditions.

How do we treat Myofascial pain?

Our multidisciplinary approach incorporates state-of-the-art medical technology and the finest healthcare expertise to return you to a pain-free and active lifestyle. In some chronic cases of myofascial pain, combinations of physical therapy, trigger point injections, and massage are needed. In select cases, medication is used to treat other conditions that often occur with myofascial pain, such as insomnia and depression. Whatever the cause of your pain, we diagnose the condition and start managing it with least invasive way. If you are experiencing myofascial pain, please contact us to help relieve your pain and cure its cause.