Pain Management Info

Back Pain

The back is a complex system of muscles, bones (vertebrae), tendons, discs,and ligaments. It provides balance, mobility and support for the entire body. It also protects the spinal cord and nerves. Because of the support it provides the body, dealing with back pain can be a difficult journey.

What causes back pain?

Besides as specific pain causing injury, daily lifting and normal wear over time makes the back susceptible to injury. Genetics can also factor into deterioration of the spine.

Back pain may also occur due to fractures (including those from osteoporosis), developmental disorders, tumors, or infectious and inflammatory disorders.

Your doctor may diagnose your back pain as either acute or chronic.

Acute Back Pain

Acute back pain is often sharp and severe. It tends to come on suddenly. It also may improve over time and with the use of short-term treatments like exercise, medication, physical therapy or rest.

Many sudden attacks of acute back pain are the result of straining and overstretching muscles or ligaments. Usually, back pain resulting from strain or sprain requires treatment over a few weeks. The pain is often then resolved (provided there are no other underlying medical conditions to complicate the process).

Chronic Back Pain

Chronic back pain lasts at least 12 weeks. It is an aching, dull, deep or burning pain. Chronic pain usually occurs over time as the body ages and from routine wear and tear.

Chronic back pain may be a mechanical pain. This means that a specific part of the spine, including a disc, ligament, or a joint is damaged. Mechanical pain also include spondylolisthesis, degenerative disc disease, spinal stenosis, facet joint degeneration and herniated discs.

What are some symptoms indicating my back pain could benefit from treatment?

Please reach out to us if your back pain results from physical trauma to the spine. Other concerning symptoms include numbness, having difficulty moving, and bladder control loss or impairment.

How will my MMG Provider manage my back pain?

Acute back pain requiring treatment often consists of epidural steroid injections and/ or physical therapy. Your physician may offer surgery if these methods fail. Chronic back pain often requires more invasive treatment, depending on the problem being addressed.

To design your treatment plan, your physician may also order:

• X-rays
• MRI or CT scans
• Bone scans
• EMGs
• NCS

Does back pain always lead to surgery?

Few patients undergo surgery for back pain. Surgery is usually for pain from structural problems. For example, this may include spinal stenosis (narrowing of the spine) or a herniated disk that doesn’t respond to therapy.

Neck Pain

Neck pain occurs from stress on the spine. This stress may occur due to:

• Disease
• Injury or trauma (whiplash, falls, sports injuries etc.)
• Poor posture or spine alignment
• Bulging or herniated disc
• Improper lifting
• Normal wear and tear
• Pinched nerve
• Osteoarthritis (degenerative disc disease)
• Stenosis (narrowing of the bony canals in the spine which compresses the cord and nerves, causing inflammation and swelling)

How will my MMG Pain Management Specialist diagnose my neck pain?

After completing a physical exam and learning your medical history, your doctor may use tests to judge your muscle reflexes and strength. He or she may also order imaging scans such as CT scans, x-rays, EMG, NCS or MRIs.

Acute Neck Pain

Acute neck pain is abrupt and intense. It occurs suddenly. The source of pain is usually in the muscles and ligaments, joints, or discs.

Chronic Neck Pain

Chronic neck pain lasts for more than 3 months. It may be felt constantly or worsen after certain activities. Factors that influence neck pain may include tissue scarring, nerve damage or arthritis.

Which symptoms indicate I may need to make an appointment with an MMG Physician?

Concerning symptoms of neck pain may include:

• Aching
• Tightness
• Stiffness
• Burning, stabbing or shooting pains
• Tingling
• Pressure

Do not delay seeking care if you have any of the following severe symptoms:

• Loss of coordination or strength
• Tingling, numbness or pain in the legs or arms
• Loss of bowel or bladder control

How will my MMG Physician treat my neck pain?

Most likely, your initial treatment plan will begin with non-surgical and self-care strategies. Our goal is to help correct the problem, restore function, and prevent re-injury. Your treatment plan may include a combination of the following:

• Ttrengthening exercises and stretches
• Reaching ideal weight
• Ice or heat
• Pain relievers

Will I need neck surgery?

Surgery is rarely needed. Your doctor may recommend surgery in the following cases:

• Cervical cord compression
• Muscle weakness
• Disc herniation
• Problems with balance and coordination

Nerve Pain

Nerve (Neuropathic) pain is a chronic pain. It begins in the nerve fibers when they are damaged or dysfunctional. This damage can happen in the central nervous system or the peripheral nerves. The damaged nerve fibers give incorrect signals to other pain centers.

What causes nerve pain?

There are multiple reasons someone may develop neuropathic pain. For example, some types of neuropathic pain are due to medications such as chemotherapies. Others may experience nerve pain as a result of a disease that affects the nervous system, like cancer, Guillain-Barré syndrome, multiple myeloma, multiple sclerosis, HIV and alcoholism.

Nerve pain is often present in diseases that attack sensory nerves. Patients with diabetes and conditions where certain nerves are compressed or inflamed such as carpal tunnel syndrome or sciatica may experience neuropathic pain. Nerve pain may also result from trauma if nerves are severed or damaged. For example, patients suffering from spinal cord injury may experience neuropathic pain.

Phantom limb pain is another neuropathic pain disorder when pain feels like it is coming from an amputated limb.

Unfortunately, little is understood about some types of neuropathic pain, such as reflex sympathetic dystrophy. This is a very real pain with an unknown cause.

What are the symptoms of nerve pain?

Patients often experience nerve pain in the feet and hands as well as:

• Weakness
• Numbness
• Pins-and-needles sensation

The pain varies greatly in intensity for many patients and often worsens at night. It is a very concerning condition for many patients. Dealing with this chronic pain day in and day out can lead to anxiety and depression.

How will my MMG Physician diagnose my neuropathic pain?

Your doctor will first conduct a physical exam, learn your medical history and details of your pain history. He or she may also request neuropsychological assessments and neurological exams or order an EMG or NCS.

MRIs, electrophysiological tests and blood analyses may also help your Physician investigate your reason for pain.

What are the treatment options for my nerve pain?

A variety of treatment options exist for neuropathic pain depending on the location of the pain.

Your doctor may prescribe medication or pain patches. Your doctor may also recommend surgery in some cases. For example, a patient may need surgery to release a compressed nerve, as in carpal tunnel syndrome. An epidural steroid injection into the spine may relieve pain caused by a herniated disc.

Various therapies can help relieve neuropathic pain including:

• Acupuncture
• Physical or occupational therapy
• Massage therapy
• Relaxation therapy

Migraines

Migraines are often misunderstood, and can cause much more severe pain than a typical headache. They cause severe throbbing or pulsing pain, usually on one side of the head. Nausea, vomiting, and sensitivity to light and sound often accompany migraines.

Migraine pain is disabling and often lasts for hours or even days. 

What are the symptoms of a migraine? 

Migraines frequently begin somewhere between childhood and early adulthood. 

Some patients experience “warning symptoms” before a migraine begins.This includes blind spots, flashes of light or tingling on one side of the leg, arm or face. Some patients even experience symptoms such as food cravings, increased thirst and urination, constipation and neck stiffness one to two days before a migraine attacks. 

What causes my migraines? 

The reason for migraines can be vastly different from patient to patient. For some, a medication or food may be the cause. For others, it can be environment causes such as weather changes or sensory stimuli. 

Women are also more susceptible to migraines due to hormonal causes. 

Should I see an MMG Pain Management Specialist  for my migraines? 

Migraines often go untreated and are underdiagnosed. If you regularly experience migraine symptoms, try to keep a record of when they occur and possible causes. Then, make an appointment to discuss them with your doctor. 

How will my MMG Provider treat my migraines? 

Your doctor may recommend medications to help prevent your migraines and decrease their intensity. Finding migraine relief is often a process, not a one-time fix. Your doctor will work with you to help discover the right medication, self-help remedies and lifestyle changes to seek relief. 

Stroke Pain

A stroke is an attack on the brain. A stroke occurs when blood flow to an area of the brain is cut off. When this happens, the brain is deprived of oxygen and brain cells begin to die. As brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.

Post-stroke pain can occur at anytime. For some patients, it occurs immediately. For others, it occurs weeks or even months after their stroke. Some have chronic pain while others have pain that comes and goes.

What types of pain can patients experience post-stroke, and what are the symptoms?

Many stroke patients experience local pain in the joints. Local shoulder pain is especially common.

Other patients experience central post-stroke pain (CPSP). It is a constant pain due to the brain damage that occurred during the stroke.

After a stroke, your brain does not understand normal messages from the body in response to stimuli. For example, the brain may register a light touch on your skin as painful.

You may feel post-stroke pain on the side of your body affected by the stroke, your arm, leg or torso. The pain can vary from aching, burning, being sharp, stabbing, or itching.

If you have central pain, normal touch may seem painful or unpleasant. You may also feel nothing when heat, cold or other stimuli are applied to your skin. You may even experience more pain when cold, moving or emotionally stressed.

How will my MMG Pain Management Specialist treat my post-stroke pain?

Depending on the location of your pain and the severity, there are a variety of treatments your doctor may recommend:

• Medications
• Physical therapy
• Cortisone injections (steroid shots)
• Electrical nerve stimulation
• Heat and stretching exercises (for shoulder pain)

Joint Pain

Joint pain can arise from any part of a joint. This includes bone, cartilage, ligaments, muscles or tendons. Usually, joint pain refers to arthralgia or arthritis, pain or inflammation within the joint. Joint pain may be mild and cause soreness after activity only, or it may be severe and constant.

What is the cause of my joint pain?

A large number of diseases and conditions may cause joint pain. Some of the more common causes are:

• Arthritis
• Broken bone
• Cancer
• Sprains
• Tendinitis
• Fibromyalgia
• Hemarthrosis
• Hypothyroidism
• Depression

How will my MMG pain management specialist diagnose my joint pain?

After reviewing your medical history and conducting a physical examination, your doctor may order any of the following:

• Blood tests
• Imaging tests
• Joint aspiration procedure
• Biopsy (in rare cases)
• EMG
• NCS

How will my doctor treat my joint pain?

Your doctor will work with you to devise a treatment plan that may include any of the following:

• Medication
• Physical therapy
• Self-care strategies (exercise, a healthy diet, losing weight if necessary)
• Surgery (uncommon)

Fibromyalgia

Fibromyalgia is a condition that causes widespread pain in the body. It is accompanied by fatigue, difficulty sleeping, and emotional and mental distress. Patients with fibromyalgia may have abnormal pain perception processing, meaning they are more sensitive to pain than people without fibromyalgia.

The cause of fibromyalgia is not known. However; with regular care, it can be treated and managed.

What are the symptoms of fibromyalgia?

Common symptoms of fibromyalgia are:

• Widespread stiffness and pain
• Tiredness and fatigue
• Anxiety and depression
• Difficulty sleeping
• Difficulty remembering, concentrating, and thinking
• Headaches and migraines

Fibromyalgia symptoms may also include:

• Digestive problems or disorders
• Numb or tingling hands and feet
• Pain in the face or jaw, including disorders of the jaw such as temporomandibular joint

How will my MMG Pain Management specialist diagnose fibromyalgia?

Your doctor will review your history and complete a physical examination. He/ she may also order blood tests and x-rays.

How will my MMG Provider treat my fibromyalgia?

Your doctor will help manage your fibromyalgia with medication and self-care strategies.

Your treatment plan may include:

• Medications
• Stress management techniques
• Exercise
• Good sleep habits

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a form of chronic pain. It usually affects a leg or arm. CRPS usually develops after surgery, injury, stroke or heart attack. The pain felt during CRPS is out of proportion to the severity of the injury causing it.

Complex regional pain syndrome is not common. Its cause isn’t clearly understood. We do know however, that the earlier treatment is started, the more effective it will be.

Symptoms

Symptoms of complex regional pain syndrome include:

• Sensitivity to cold or touch
• Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
• Changes in skin temperature — alternating between cold and sweaty
• Changes in skin texture
• Swelling in the area that hurts
• Changes in nail and hair growth
• Joint swelling, damage and stiffness
• Changes in skin color that range from white and mottled to blue or red
• Muscle spasms, tremors, weakness and atrophy
• Decreased ability to move the affected body part

Symptoms may change over time and vary among patients. Redness, swelling, pain and noticeable changes in temperature and hypersensitivity to touch and cold usually happen first.

Affected limbs can eventually become cold and pale. They may experience nail and skin changes as well as tightening and muscle spasms. After this occurs, the condition often cannot be reversed.

Complex regional pain syndrome sometimes spreads to other areas of the body such as the opposite limb.

How will my MMG Physician diagnose CRPS?

Diagnosis of complex regional pain syndrome occurs with a physical exam and your medical history. No single test can definitively diagnose complex regional pain syndrome. However, these tests may help provide important insights:

• Bone scan
• X-rays
• Magnetic resonance imaging (MRI)
• EMG
• NCS

How will my MMG Pain Management Specialist treat CRPS?

Early treatment is key to curing CRPS. It may include:

• Medications
• Heat therapy
• Topical analgesics
• Physical therapy
• Mirror therapy
• Transcut electrical nerve stimulation (TENS)
• Biofeedback
• Spinal cord stimulation
• Intrathecal drug pumps

Opioid Dependency/ Addiction Treatment

Opioids act in the nervous system to produce pain relief and pleasure. Opioid addiction is a compulsive urge to use opioid drugs, even when they are no longer medically necessary. Opioid addiction is a chronic disease that can lead to major social, health and economic problems.

Some opioids are legally prescribed by healthcare providers to manage pain, while others, such as heroin, are illegal drugs.

Addicted individuals prioritize using these drugs over other activities in their lives. Some are more likely to become addicted than others, although we do not know why.

Opioids change the chemistry of the brain and create drug tolerance. This means that over time the dose needs to increase to achieve the same effect. Taking opioids over an extended time produces dependence. During dependence, when people stop taking the drug, they have physical and psychological symptoms of withdrawal.

Dependence is not the same as addiction. Everyone who takes opioids for an extended time becomes dependent. However, only a small number also experience a compulsive, continuing need for the drug that characterizes addiction.

If you are struggling with opioid usage, our MMG Providers would love to work with you to help you gently and effectively remove your addiction or dependence.

Nerve Conduction Studies

A nerve conduction study (also known as nerve conduction velocity) measures how fast electrical impulses move through the nerves. Your doctor may order this test to identify nerve damage.

What happens during a nerve conduction study?

Electrode patches attached to your skin stimulate the nerves. One electrode stimulates your nerve with a very mild electrical impulse while the other records it. This process repeats for each nerve tested.

The speed is determined by measuring the distance between electrodes as well as the time it takes for electrical impulses to move between electrodes.

Why might my doctor order a nerve conduction velocity test?

Your doctor may order a nerve conduction velocity test to evaluate the following:

• Herniated disk disease
• Guillain-Barré syndrome
• Charcot-Marie-Tooth disease
• Carpal tunnel syndrome
• Chronic inflammatory polyneuropathy and neuropathy
• Sciatic nerve problems

Nerve conduction studies may also help discover the reason for continuous pain, numbness,and tingling.