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.
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.
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.
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