The post Osteoarthritis Treatments first appeared on Brandon Pain Clinic.
]]>Osteoarthritis is also known as degenerative joint disease. It is a condition in which the protective cartilage that cushions the tops of bones degenerates, or wears down. This causes swelling and pain. It may also cause the development of osteophytes, or bone spurs.
Osteoarthritis of the spine is a breakdown of the cartilage of the joints and discs in the neck and lower back.
Sometimes, osteoarthritis produces spurs that put pressure on the nerves leaving the spinal column. This can cause weakness and pain in the arms or legs.
In general, osteoarthritis happens as people get older. Younger people may get it from one of several different causes:
For people younger than age 45, osteoarthritis is more common among men. After age 45, osteoarthritis is more common among women. Osteoarthritis occurs more often among people who are overweight. It also occurs more frequently in those who have jobs or do sports that put repetitive stress on certain joints.
Osteoarthritis of the spine may cause stiffness or pain in the neck or back. It may also cause weakness or numbness in the legs or arms if it is severe enough to affect spinal nerves or the spinal cord itself. Usually, the back discomfort is relieved when the person is lying down.
Some people experience little interference with the activities of their lives. Others become more severely disabled.
In addition to the physical effects, a person with osteoarthritis might also experience social and emotional problems. For instance, a person with osteoarthritis that hinders daily activities and job performance might feel depressed or helpless.
The best way to confirm a diagnosis of osteoarthritis is by X-ray. The doctor will take a medical history and perform a physical exam to see if the person has pain, tenderness, loss of motion involving the neck or lower back, or if symptoms are suggestive, signs of nerve involvement such as weakness, reflex changes, or loss of sensation.
The doctor may order certain tests to aid in the diagnosis of osteoarthritis of the spine. These tests include:
In most cases, treatment of spinal osteoarthritis is geared toward relieving the symptoms of pain and increasing a person’s ability to function. The goal is to have a healthy lifestyle.
Initial treatment may include losing weight if needed and then, for everyone, maintaining a healthy weight. It may also include exercise. Besides helping with weight management, exercise can also help:
Some of the exercises associated with osteoarthritis treatment include swimming, walking, and water aerobics. Exercise may be broken down into the following categories:
Including rest periods in the overall treatment plan is necessary. But bed rest, splints, bracing, or traction for long periods of time is not recommended.
There are non-drug treatments available for osteoarthritis, including:
Pain medications may also be used to treat osteoarthritis. Over-the-counter products include acetaminophen (Tylenol).
Nonsteroidal anti-inflammatory drugs (NSAIDs) are also available over-the-counter in certain strengths. Examples include aspirin, naproxen sodium (Aleve), and ibuprofen (Motrin or Advil). NSAIDs may have serious side effects. Those include heart attack, stroke, stomach irritation and bleeding, and less frequently, kidney damage.
Topical ointments and creams are also available to treat pain. They are applied to the skin in the area that hurts, but generally, these are not effective. Examples of topical drugs include Ben-Gay and Aspercreme.
Your doctor may also recommend prescription drugs to treat symptoms, as there are no medications that reverse the process. These may include prescription painkillers, mild narcotics, or injections of corticosteroids around the spinal column called epidural steroid injections. It is important to understand that these injections do not correct the underlying problem and are sometimes used without clear indication of long-term benefit. Oral steroids are not commonly used.
Most cases of spinal osteoarthritis can be treated without surgery, but surgery is sometimes performed. Spinal osteoarthritis is one of the causes of spinal stenosis, or narrowing of the spinal canal. In cases where bladder and bowel function is impaired, where the nervous system is damaged, or when walking becomes very difficult, surgery will likely be recommended.
The post Osteoarthritis Treatments first appeared on Brandon Pain Clinic.
]]>The post Back Pain Medications first appeared on Brandon Pain Clinic.
]]>Pain relievers are generally available in three forms: oral, topical, and injection
.
While there are many over-the-counter pain medications used to address back pain, the two most common types are acetaminophen (for example, brand name Tylenol) and non-steroidal anti-inflammatory drugs or NSAIDs (for example, brand name Advil). Because acetaminophen and NSAIDs work differently to address the pain, they may be taken at the same time. For example, a patient in severe pain may take the recommended dose of acetaminophen, and then two to three hours later take the recommended dose of ibuprofen, and repeat this pattern as appropriate.
For short periods of time, prescription medications (such as narcotic pain medications or muscle relaxants) may be helpful to alleviate pain or related complications. Other classes of drugs (such as antidepressants or anti-seizure medications) can also help modulate the sensation of pain and can be taken on a prolonged basis.
There are risks, side effects, and drug interactions with any medication, so a medical professional should always be consulted prior to taking medications. Patients should be especially cautious with medications if they are on other medications or have any significant medical conditions (e.g. diabetes).
While a few major risks and side effects are outlined for some medications on this site, patients should always read the label and package inserts and consult with a physician for a complete understanding of risks, side effects, and drug interactions.
The post Back Pain Medications first appeared on Brandon Pain Clinic.
]]>The post CRPS Treatment and Care first appeared on Brandon Pain Clinic.
]]>Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury.
Complex regional pain syndrome is uncommon, and its cause isn’t clearly understood. Treatment is most effective when started early. In such cases, improvement and even remission are possible.
Signs and symptoms of complex regional pain syndrome include:
Symptoms may change over time and vary from person to person. Pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) usually occur first.
Over time, the affected limb can become cold and pale. It may undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.
Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body, such as the opposite limb.
In some people, signs and symptoms of complex regional pain syndrome go away on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.
If you experience constant, severe pain that affects a limb and makes touching or moving that limb seem intolerable, see your doctor to determine the cause. It’s important to treat complex regional pain syndrome early.
The cause of complex regional pain syndrome isn’t completely understood. It’s thought to be caused by an injury to or an abnormality of the peripheral and central nervous systems. CRPS typically occurs as a result of a trauma or an injury.
Complex regional pain syndrome occurs in two types, with similar signs and symptoms, but different causes:
Many cases of complex regional pain syndrome occur after a forceful trauma to an arm or a leg. This can include a crushing injury, fracture or amputation.
Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — can also lead to complex regional pain syndrome.
It’s not well-understood why these injuries can trigger complex regional pain syndrome. Not everyone who has such an injury will go on to develop complex regional pain syndrome. It might be due to a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses.
If complex regional pain syndrome isn’t diagnosed and treated early, the disease may progress to more-disabling signs and symptoms. These may include:
These steps might help you reduce the risk of developing complex regional pain syndrome:
The post CRPS Treatment and Care first appeared on Brandon Pain Clinic.
]]>The post What do you do when your back surgery has failed? first appeared on Brandon Pain Clinic.
]]>Orthopaedic spine surgeon Ralph Rashbaum, MD continues his discussion about failed back surgery syndrome (FBSS). In this segment, Dr. Rashbaum explains his approach to proper patient care when back surgery is not successful.
SpineUniverse: When a patient comes to you and their surgery was not successful, what do you do?
Dr. Rashbaum:
We find out what went wrong. Typically, the patients I see that clearly have failed back surgery syndrome (FBSS) go back to their doctor, only to find that their doctors are totally disengaged in finding the truth. Unfortunately, this is common.
One of the biggest concerns pertains to whether or not the patient is being subjected to a robust reassessment by the operating surgeon. I’d like to think that they were, but they’re not – at least not uniformly. They’re just sending these people down the road, where the problem could easily be assessed by repeating diagnostic studies like an MRI with gadolinium; an enhancer that helps us ferret out scar tissue from a recurrent disc herniation. You can’t get anywhere if you operate on somebody with scar tissue for leg pain, but you certainly can if they have a recurrent disc herniation.
SpineUniverse: Once you find out what went wrong, what are the next steps?
Dr. Rashbaum:
Sometimes we’ll do injection therapy to help us figure out where the pain is coming from. We need to determine if the pain now is mechanical facet joint pain, mechanical disc degeneration, or painful disc syndrome. Above all, we don’t give up on these patients. We do whatever is needed to re-investigate, because the important issue with FBSS is that time is of the essence.
Pain is a signal that something is wrong. It’s like taking our hand off the hotplate. If we leave our hand on the hotplate too long, then that pain can go from being an acute signal to chronic indolent pain. Over time, it becomes a disease called Chronic Pain Syndrome Disease. The longer we live with pain that’s unabated, the more we suffer psychosocial, financial, and physical issues. We also lose conditioning.
So the message is, that if the patient doesn’t do well with the planned surgery, figure out what went wrong. Get your ego out of the way and say, “Okay, this is what happened, this is what I need to do.” And that becomes the most important thing in trying to rectify the situation. The single most important thing for failed back surgery syndrome is to do the right surgery on the right patient at the right time, and execute it in the right way. Simple.
SpineUniverse: Do many of these patients need to undergo revision surgery?
Dr. Rashbaum:
What you’re asking is what percentage of FBSS patients could undergo a second surgery and recover with improvement. I hate to say this, but the number of those people that are likely to successfully recover from a second surgery, let alone a third, is not great. Every time you have a re-operation, the likelihood of success diminishes substantially, so by the time you get to the third and fourth surgery, you’re not doing very well. Patients who have failed to benefit from surgery and/or revision surgery and continue to have pain are often good candidates for neuromodulation–spinal cord stimulation.
SpineUniverse: What does the data show regarding the success rate of spinal cord stimulation?
Dr. Rashbaum:
Studies both in Canada and in the United States indicate that the satisfaction and benefit rate of patients with failed back surgery syndrome initially implanted with a spinal cord stimulator were statistically better than patients who underwent revision surgery. Clearly, there are certain surgeries that can’t be revised with the expectation of having good results. With spinal cord stimulation, we have an alternative. Physicians from the family practitioner on up to the sophisticated spine surgeon need to recognize that surgery is not he be-all and end-all. In surgeon training, one of the mantras we’re taught, which now sounds like nonsense, is A chance to cut is a chance to cure. It’s simply not true anymore.
The post What do you do when your back surgery has failed? first appeared on Brandon Pain Clinic.
]]>The post Symptoms of sciatica first appeared on Brandon Pain Clinic.
]]>The patient’s pain and specific sciatica symptoms can usually be traced to where the injured/irritated nerve originates in the lower back. Typical symptoms include:
While the above types of symptoms are common, symptoms can vary depending on a number of factors, such as unique anatomical variances, and the degree and characteristics of the specific pathology.
A variety of lower back conditions may lead to sciatica. Most commonly, a lumbar herniated disc will cause sciatic nerve pain. Other common disorders that cause sciatic pain include lumbar degenerative disc disease, spondylolisthesis, spinal stenosis, or osteophytes and arthritis in the spine.
While it is most common for sciatica symptoms to be caused by a problem in the lower back, there are other conditions that may lead to sciatica-like symptoms.
The post Symptoms of sciatica first appeared on Brandon Pain Clinic.
]]>