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.
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.
Pain is an unpleasant sensation
in animals that is caused by actual or perceived injury to body
tissues and produces physical and emotional reactions. Presumably,
pain sensation has evolved to protect our bodies from harm by
causing us to perform certain actions and avoid others. Pain might
be called a protector, a predictor, or simply a hassle. In this
article, I will discuss some basic concepts of pain.
We all experience pain to greater or lesser degrees at
various points of our lives. It is said that pain is the most common reason
patients seek medical attention. But, each of us perceives a given pain stimulus in our own unique
manner. The intensity of the response to a pain stimulus is largely subjective,
meaning the severity of the pain can most accurately be defined by the person
with the pain, rather than by other observers.
Our individual pain perception can vary at different
times, even in response to the identical stimulus. For example, an athlete
during competition may not be able to feel the tissue injury of a cut or a
bruise until the competition has finished. We may feel more or less pain
depending on our mood, sleep pattern,
hunger, or activity.
Pain management can be simple or complex,
depending on the cause of the pain. An example of pain that is typically less complex would
be nerve root irritation
from a herniated disc with pain radiating down the leg. This condition
can often be alleviated with an epidural steroid injection and
physical therapy. Sometimes, however, the pain does not go away. This can
require a wide variety of skills and techniques to treat the pain. These skills
and techniques include:
All of these skills and services are necessary because pain can involve many
aspects of a person's daily life.
How is pain treatment guided?
The treatment of pain is guided by the history of the pain, its intensity,
duration, aggravating and relieving conditions, and structures involved in
causing the pain. In order for a structure to cause pain, it must have a
nerve supply, be susceptible to injury, and stimulation of the structure should
cause pain. The concept behind most interventional procedures for
treating pain is that there is a specific structure in the body with nerves of
sensation that is
generating the pain. Pain management has a role in identifying the precise
source of the problem and isolating the optimal treatment.
Fluoroscopy is an X-ray
guided viewing method. Fluoroscopy is often used to
assist the doctor in precisely locating the injection so that the medication
reaches the appropriate spot and only the appropriate spot.
Pain Management - Type of Pain and Effective TreatmentsQuestion: Please describe the type of pain you suffer from, and what treatments have been effective for the pain.
Sciatica pain, caused by irritation of the sciatic nerve, typically radiates from the low back to behind the thigh to below the knee. Disc herniation is usually the cause of sciatica. Medication to alleviate pain, physical therapy, and bed rest are treatments for sciatica.
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.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Migraine is usually periodic attacks of headaches on one or both sides of the head. These may be accompanied by nausea, vomiting, increased sensitivity of the eyes to light (photophobia), increased sensitivity to sound (phonophobia), dizziness, blurred vision, cognitive disturbances, and other symptoms. Treatments for migraine headache include therapies that may or may not involve medications.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
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.
Sacroiliac joint (SI) dysfunction is a general term to reflect pain in the SI joints. Causes of SI joint pain include osteoarthritis, abnormal walking pattern, and disorders that can cause SI joint inflammation including gout, rheumatoid arthritis, psoriasis, and ankylosing spondylitis. Treatment includes oral medications, cortisone injections, and surgery.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Peripheral neuropathy is a problem with the functioning of the nerves outside of the spinal cord. Symptoms may include numbness, weakness, burning pain (especially at night), and loss of reflexes. Possible causes may include carpel tunnel syndrome, meralgia paresthetica, vitamin or nutritional deficiencies, and illnesses like diabetes, syphilis, AIDS, and kidney failure. Most causes of peripheral neuropathy can be successfully treated or prevented.
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.
Chondromalacia patella (housemaid's knee or secretary's knee) results from misalignment of the kneecap as it slides over the lower end of the thigh bone. Symptoms include tightness or fullness in the knee area, swelling, and mild discomfort. Treatment includes the use of anti-inflammatory medications, in addition to stretching, strengthening and icing the knee.
Degenerative disc disease makes the disc more susceptible to herniation (rupture) which can lead to localized or radiating pain. The pain from degenerative disc or joint disease of the spine is usually treated conservatively with intermittent heat, rest, rehabilitative exercises and medications to relieve pain, muscle spasm and inflammation.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Whiplash is a common injury to a person's neck following a car accident (in most cases). Symptoms include: headache, neck pain, neck and shoulder stiffness, shoulder pain, fatigue, dizziness, jaw pain, arm pain, weakness of the arm(s), visual disturbances, and tinnitus. Diagnosis is generally with a physical exam, x-rays, or possibly an MRI. Treatment generally includes physical therapy and time.
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.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Facial nerve disorders affect the muscles of the face. There are many causes of facial nerve disorders including: trauma, nervous system disease, infection, metabolic disorders, tumors, toxins, or Bell's palsy. Symptoms of facial nerve problems include: facial muscle paralysis, weakness, or twitching of the face; dryness of the eye or mouth, or taste alteration.
Pain that originates in the face is referred to as trigeminal neuralgia. This pain may be caused by an injury, and infection in the face, a nerve disorder, or it can occur for no known reason. Trigeminal neuralgia can be treated with antiseizure medications. Some antidepressant drugs also have significant pain relieving effects.
Natural menopause is the permanent ending of menstruation that is not brought on by any type of medical treatment. For women undergoing natural menopause, the process is described in three stages: perimenopause, menopause, and postmenopause.
However, not all women undergo natural menopause. Some women experience induced menopause as a result of surgery or medical treatments, such as chemotherapy and pelvic radiation therapy.
Complex regional pain syndrome is a chronic pain condition in which high levels of nerve impulses are sent to an affected site is called complex regional pain syndrome (CRPS). CRPS is most common in people aged 20-35. The syndrome also can occur in children; it affect women more often than men.
Hospice is a service that offers support, resources, and assistance to terminally ill patients and their families. In such late stages of diseases, especially when there is "nothing left to do," hospice can offer help for patients and families. There are many aspects of a patient's well-being that can be addressed. Hospice can play a key role in managing physical symptoms of a disease (palliative care) and supporting patients and families emotionally and spiritually.
Spondylolisthesis (spon + dee + lo + lis + thee + sis) is a condition of the spine whereby one of the vertebra
slips forward or backward compared to the next vertebra. Forward slippage of one
vertebra on another is referred to as anterolisthesis, while backward slippage
is referred to as retrolisthesis. Spondylolisthesis can lead to a deformity of
the spine as well as a narrowing of the spinal canal (central
spinal stenosis)
or compression of the exiting nerve roots (foraminal stenosis).
What causes spondylolisthesis?
There are five major types of lumbar spondylolisthesis.
Dysplastic spondylolisthesis: Dysplastic spondylolisthesis is caused by a defect in
the formation of part of the vertebra called the facet that allows it to slip
forward. This is a condition that a patient is born with (congenital).
Isthmic spondylolisthesis: In Isthmic spondylolist...
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