Pain Management (cont.)
What are other causes of pain?
Other causes of pain include:
- headaches,
- facial pain,
- peripheral nerve
pain,
- coccydynia,
- compression fractures ,
- post-herpetic neuralgia,
- myofasciitis,
- torticollis,
- piriformis syndrome,
- plantar fasciitis,
- 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.
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 ideal 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 (for example,
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.
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.
Cancer pain
Cancer
pain can arise from many different causes, including the cancer
itself, compression of a nerve or other body part, fractures or treatment of the
cancer. There are many techniques to assist with treating the various pains from
cancer, including medications and injections. In particular, medical destruction
of nerve tissue (ablative therapies) and the use of pumps surgically placed into
the body to deliver pain medication into the subarachnoid space can
be used. Pain pumps deliver medication that is targeted to pain receptors on the
spinal cord. The advantage to the cancer patient is chronic pain control with decreased
side effects.
Last Editorial Review: 10/21/2008
- tramadol, Ultram - Read about tramadol (Ultram), a drug prescribed for chronic pain, and moderate to severe pain. Side effects, dosage, and drug interaction information included.
- Cortisone Injection - Read about cortisone injection treatment for inflammation, allergic reaction, sciatica and arthritis. Learn about side effects and complications of a cortisone shot.
- Headache - Learn about the different types of headaches, migraine, tension, cluster, menstrual, and spinal headaches; and their causes, symptoms, diagnosis and treatment.
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