Pain Management (cont.)
What are types of neuropathic pain?
Neuropathic pain includes:
Treatment of neuropathic pain
The various neuropathic pains can be difficult to treat. However, with
careful diagnosis and often a combination of methods of treatments, there is an
excellent chance of improving the pain and return of function.
One of the most powerful tools in treating neuropathic
pain is the spinal cord stimulator, which delivers tiny amounts of electrical
energy directly onto the spine. The effect of this stimulation of the spinal
cord is to allow the spinal cord to function normally even during a painful
condition. It works by
interrupting inappropriate pain information being sent up to the brain.
What are other causes of pain?
Other causes of pain include headaches and facial pain,
peripheral nerve
pain, coccydynia, compression fractures , post-herpetic neuralgia, myofasciitis,
torticollis, piriformis syndrome, plantar fasciitis and lateral epicondylitis,
and cancer pain .
Headaches and facial pain, including atypical facial pain
and trigeminal
neuralgia.
Headaches are a major source of discomfort and lost productivity in the
workplace. Many effective treatments exist for persisting headaches, including
medication, biofeedback,
injections and implants, depending upon the precise type of headache. Botox also provides a useful means of effectively and safely
treating headaches.
Atypical facial pain can be debilitating. Often times it
can be treated by injections into local nerve tissue (such as the sphenopalatine
ganglion).
Trigeminal neuralgia, also called tic douloureux, is a condition that most
commonly causes very intense intermittent shooting pain in the face. For more,
please read the Trigeminal
Neuralgia article.
Peripheral nerve pain
Peripheral
nerve pain, or neuropathy, can be debilitating. It can respond well to
simple treatments such a trigger point injections with anesthetic
medicines and cryoablation (an office based procedure which involves freezing
the nerves). Examples of peripheral nerve pain include intercostal neuralgia,
ilioinguinal neuroma, hypogastric neuroma, lateral femoral cutaneous nerve
entrapment, interdigital neuroma and related nerve entrapments.
Coccydynia
Coccydynia is simply pain in the region on the tailbone, or coccyx. It can result
from trauma or arise without apparent cause. The initial treatment is
conservative, with oral pain relief medicines (analgesics). Oftentimes, the pain
originates in the portion of the nervous system that we have no control of
(involuntary or autonomic nervous system) and can respond to either a local
anesthetic injection of the head of a nerve called Ganglion Impar, which is
located by the coccyx or by medically destroying (ablating) the Ganglion Impar,
usually using radiofrequency.
Compression fractures
Compression fractures of the bony building blocks
(vertebral bodies) are common in the elderly as a result of osteoporosis, or loss of
calcium in the bone.
With less calcium, the bone becomes weak and can break. Like any fracture,
compression fractures hurt. Like any fracture, they are treated by
stabilization, in this case, by injecting cement into the bone in a procedure
known as a vertebroplasty. Vertebroplasty is an effective way to treat the pain
of compression fractures.
Post-herpetic neuralgia
Post herpetic neuralgia (PHN) is a painful condition
occurring after a bout of shingles. When we are
young, we are almost all exposed to chickenpox, caused by the Herpes Zoster virus. Our
immune system controls
the virus, but it lives in a dormant state in the spinal cord. When we age, or
become ill or stressed, the virus can reactivate and attack the nerve infected
and adjacent skin. However, in this second attack, the body usually recognizes
the Herpes Zoster
virus and contains the pain to a localized area, along the course of one nerve.
A patient may have the characteristic blisters, which normally heal. Sometimes,
however, the Herpes Zoster virus damages the nerve, causing ongoing nerve pain
that persists after the skin blisters from the shingles have healed.
The best way to treat the post herpetic neuralgia is to treat it before it
sets in. Medications, such as acyclovir (Zovirax),
steroids and injections such as sympathetic injections can help prevent the
onset of PHN. After the pain is present, injections, local anesthetics,
medications (duloxetine
[Cymbalta]
,
amitriptyline, [Elavil, Endep]) and pain medications or topical patches can be useful.
Myofasciitis and Torticollis
Myofasciitis (pain in the muscles, whether in the neck or back) often
responds to conservative physical therapy treatments,
massage and
exercise.
If the pain persists, trigger point injections can be used. If the
trigger point
injections provide temporary relief, sometimes Botox injections can help. Botox,
which is botulinum toxin, can relax the muscles for six or more months, with
long-term relief of pain. It provides a safe, effective treatment for what can
otherwise be a difficult, ongoing problem.
Torticollis is spasm of
the muscles in the neck, forcing the sufferer to hold his or her neck tilted or
rotated to the side. Botox is approved for treatment of this problem. For more,
please read the Botox Treatment
article.
Piriformis Syndrome
The piriformis muscle goes from the hip to sacrum (tailbone). It is important
in that the sciatic nerve passes through it.
Piriformis syndrome is a spasm of the Piriformis
muscle. When the muscle goes into spasm, it can squeeze the
sciatic nerve, causing pain going down the leg. Piriformis syndrome will usually
respond to physical therapy. When pain persists, local anesthetic and/or steroid
injection can help. If the pain persists, injecting Botox or Myobloc, which are
both botulinum toxins, into the muscle can provide effective, safe treatment.
Plantar fasciitis and Lateral
epicondylitis
Plantar fasciitis (heel pain) and lateral epicondylitis (tennis elbow) are two
common pain problems. Treatment starts with conservative options, such as rest,
non-steroidal anti-inflammatory medications, steroid injections, over-the
counter pain medications, physical therapy and, for heel pain, shoe inserts.
If the pain lasts for more than six months,
Extracorporeal
Shockwave Treatment is an effective, FDA approved treatment. Extracorporeal
Shockwave Treatment is not recommended for pregnant women, children, anyone with a
pacemaker, anyone on anti-coagulant therapy or anyone with a history of bleeding
problems.
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From the Doctors at MedicineNet.com  |
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- Cortisone Injection - Read about cortisone injection treatment for inflammation, allergic reaction, sciatica and arthritis. Learn about side effects and complications of a cortisone shot. Source:MedicineNet
- Spinal Fusion - Minimally invasive lumbar spinal fusion is an operation that is less invasive to the traditional lumbar spinal fusion to treat degenerative disc disease and other vertebral problems. There are advantages and disadvantages to the procedure.
Source:MedicineNet
- Botox - Botox is the brand name of a toxin produced by the bacterium Clostridium botulinum.Small, diluted amounts can be directly injected into specific muscles causing controlled weakening of the muscles. Source:WebMD Medical Reference from The Cleveland Clinic
- Read 90 more Pain Management related articles ...
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