Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What is the anatomy of the disc of the spine (intervertebral disc)?
The disc is an important structure that rests between the bony building
blocks of the spine (vertebrae). The disc in the spine is sometimes referred to
as the intervertebral disc. Intervertebral discs help provide flexibility to our
spine. They also lessen the effect of impact on our spine by cushioning the bony
vertebrae. The disc is designed somewhat like a jelly donut. The disc has a
stronger outer layer (the annulus) that is
rather like a radial tire, and an inner gel (the nucleus) that acts as a sort of
shock absorber or cushion between
the bones of the spine.
What happens to the disc with injury or age?
With injury or age, these discs can become damaged, and the supporting
ligaments surrounding them weaken. One of the reasons we lose height as we age
is that the intervertebral discs lose their water content. This leads to
shrinkage of the disc and, as a result, height diminishes.
What is a discogram used for?
An injured disc can be a source of pain. A discogram is
used to determine if a particular disc is the source of pain. Discograms are
provocative tests, meaning that they attempt to reproduce rather than remove
pain. The reproduction
of pain during a discogram can help determine if injury to a particular disc is
the source of a person's pain.
How is a discogram performed?
When performing a discogram, a needle is inserted into
the disc and a contrast dye is injected. This extra fluid in the disc increases the pressure in
the disc. Patients with an injured disc may then experience pain that can mimic
the pain they have been experiencing. The intensity of the pain is recorded on a
0-10 scale. Based upon this information, the diagnosis of a particular disc
injury can be made. The doctor can then determine what the optimal treatment
options are for relief of the underlying pain.
[An actual discogram as visualized using an x-ray viewing instrument called a
fluoroscope]
What happens after the procedure?
Patients may be sore for several days after the procedure. Any discomfort can
be treated with the local application of ice packs or with a cooling pad on and
off for periods of twenty minutes.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Neck pain (cervical pain) may be caused by any number of disorders and diseases. Tenderness is another symptom of neck pain. Though treatment for neck pain really depends upon the cause, treatment typically may involve heat/ice application, traction, physical therapy, cortisone injection, topical anesthetic creams, and muscle relaxants.
Neuropathic pain is chronic pain resulting from injury to the nervous system. The injury can be to the central nervous system (brain and spinal cord) or the peripheral nervous system (nerves outside the brain and spinal cord).
When vertebrae are broken or dislocated, the result can cause traumatic injury to the spinal cord. A spinal cord injury can have significant physiological consequences. One indication of the severity of a spinal cord injury are respiratory complications. Spinal cord injuries are classified as either complete or incomplete. A spinal cord injury can affect breathing, lead to pneumonia, low blood pressure, irregular heart beat, blood clots, spasms, autonomic dysreflexia, bed sores (pressure sores), chronic pain, bladder and bowel problems, and reproductive and sexual function issues. Rehabilitation and recovery of a spinal cord injury is dependant upon the type of injury.
Neuropathic pain is a complex, chronic pain state that usually is
accompanied by tissue injury. With neuropathic pain, the nerve fibers
themselves may be damaged, dysfunctional or injured. These damaged nerve fibers
send incorrect signals to other pain centers. The impact of nerve fiber injury
includes a change in nerve function both at the site of injury and areas around
the injury.
One example of neuropathic pain is called phantom limb syndrome. This occurs
when an arm or a leg has been removed because of illness or injury, but the
brain still gets pain messages from the nerves that originally carried impulses
from the missing limb. These nerves now misfire and cause pain.
What causes neuropathic pain?
Neuropathic pain often seems to have no obvious cause; but, some common causes of neuropathic pain include:
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