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.
An epidural steroid injection is a common procedure to treat spinal nerve
irritation that is caused by tissues next to the nerve pressing against it. The
beginning of the nerve (nerve root) is most often irritated by an
inflamed
intervertebral disc, or disc contents, directly touching the spinal nerve.
[Drawing of a disc herniation compressing the spinal nerve root]
An epidural steroid injection involves bathing an
inflamed nerve root in steroids (potent anti-inflammation medicine) in order to
decrease the irritation of the nerve root that is causing pain.
How is an epidural steroid injection performed?
The epidural steroid injection procedure is quick and simple. While it is
common for people to be concerned prior to the procedure, it is actually
frequent to hear from patients afterwards: "Is that all?"
The spinal cord rests in the spinal canal. The nerve roots branch out from
the spinal cord at each level of a spinal vertebra (the bony
building blocks of the spine). The cord is protected by cerebrospinal fluid (CSF), which serves as a
shock absorber for the cord. The CSF is held in place by a membrane with
several layers, one of which is called the
dura, from the Greek
for tough (think of "durable"). The Greek word "epi" means "outside of." So, the
epidural space is outside of this tough membrane. During an epidural steroid
injection, a needle and syringe are used to enter the epidural space and deposit
small amounts of long-lasting steroids around the inflamed spinal nerve. A
fluoroscope (a viewing instrument using X-rays) is used to visualize the local
anatomy during the injection. The epidural steroid injection specifically
targets the inflamed area and treats it with a maximal amount of steroids,
thereby minimizing exposure of the rest of the body to the steroids.
[Epidural steroid injection with injection needle visible in the epidural
space using a fluoroscope)
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.
A herniated disc may be caused by injury or degeneration from age. Symptoms depend on the location of the herniation and whether nerve tissue is being irritated. An MRI or CT scan is performed to diagnose a herniated disc. Treatment may involve physical therapy, cortisone injection, pain medications, antiinflammatory medications, muscle relaxants, and surgery.
Lumbar stenosis can be caused by degenerative arthritis (the most common cause), tumor, infection, or metabolic disorders (Paget's disease of the bone). Symptoms include low back pain, weakness, pain, numbness, and loss of sensation in the legs. Other conditions may cause similar symptoms of lumbar stenosis, including diabetic neuropathy, claudication, and peripheral vascular disease. Diagnosis, is a medical history and imaging studies. Lumbar stenosis may be treated with medication or surgery.
Radiculopathy, a condition in which a nerve or nerves along the spine are compressed causing pain, numbness, weakenss, and tingling along the nerve(s). Some causes of radiculopathy include bone spurs, disc hernation, osteoarthritis, tumors, infection, and neuropathy. Treatment depends on the are of nerve compression. Surgery is generally not required.
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).
The five types of spondylolisthesis include 1) dysplastic, 2) isthmic, 3) degenerative, 4) traumatic, and 5) pathologic. The most common symptom of spondylolisthesis is lower back pain. Treatment depends on the type and severity of spondylolisthesis. Surgery is required in some cases of spondylolisthesis.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
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.
Functions of the low back, or lumbar area, include
structural support, movement, and protection of certain body tissues.
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.
Treatment of low back pain is optimally directed toward a diagnosed or suspected
specific cause. For acute lumbar strain, use of a home remedy initially can be beneficial.
What is the anatomy of the low back?
The first step to understanding the various causes of low back pain is learning about the normal
design (anatomy) of the tissues of this area. Important structures of the low
back that can be related to symptoms there include the bony lumbar spine (vertebrae,
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