Category: Adam Sewell MD

VERTEBRAL COMPRESSION FRACTURES

Post author By Jasmeet Singh
Post date April 9, 2020
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Vertebral Compression Fractures is commonly referred to as an achy back. One of the more common causes of back pain is a vertebral compression fracture where one or more of the vertebrae in the spine have either broken or collapsed. While the majority of these injuries remarkably cause no significant pain they can result in limited movement and long term nagging pain.

The most common cause of compression fractures is osteoporosis. This condition is caused when bones soften. A compression fracture of this sort may cause sudden pain or it may cause nagging, long-term pain felt after attempting minor movements. Vertebral compression fractures do not present in one consistent manner. They can cause no pain or they can cause severe discomfort.

These cracked vertebrae are most common in the upper back, down to the lower back. While pain normally resolves within a month, severe pain or pain that lasts longer than four weeks will require medical attention. In this circumstance a physician will likely conduct an exam and possibly diagnostic imaging. Key indicators are kyphosis – or having a humpback – and loss of height with age. An x-ray can see if vertebrae are compressed or broken, though a bone scan for osteoporosis may also be required.

Conservative care may include medications, physical therapy and lifestyle changes. A calcium rich diet is recommended. Some surgical procedures for more severe cases may be offered.

Two minimally invasive, surgical procedures include a percutaneous vertebroplasty and a kyphoplasty. A vertebroplasty is a procedure where cement is pushed into the fractured bone to provide more support and allow for healing. A kyphoplasty is when a small balloon is injected into the injured vertebrae and slowly inflated to the original size.

References

Adam Sewell MD

VERTEBRAL BODY FRACTURES

Vertebral Body Fractures are a fracture of the vertebrae (bones of the spine) that eventually cause a collapse of the vertebral body. These fractures are most commonly located in the thoracic spine (the middle portion of the spine). The major risk factor for vertebral body fractures are increasing age and occur when the upper body weight exceeds the ability of vertebrae to support the load. Although more frequently seen in women, men can be affected as well (Old, 2004).

Certain conditions that can produce chronic pain affecting the vertebrae include spinal stenosis, vertebral body fractures, Osteoporosis, Osteoarthritis, spondylolisthesis, neoplasms (Primary vs. metastatic lesions), and infections. Vertebroplasty and Kyphoplasty are extremely effective treatments for many of these conditions.

Diagnosis

Your physician will perform a physical exam and may find tenderness over the vertebrae as well as kyphosis (curving of the spine). Other manifestations of nerve involvement include constipation, loss of lower extremity reflexes, and the sensory function. The physician may also order radiological imaging. An x-ray commonly ordered to see the classic wedge-shaped vertebral body with narrowing of the anterior portion in most compression fractures. However, the physician may want to order additional studies such as MRI, CT scan, or a bone scan.

Treatment

NSAID’s and analgesics are used in the acute management of pain to help relieve discomfort. Patients can also be treated with some bed rest.

Patients that do not respond to the more conservative management described above may be good candidates for minimally invasive procedures by your pain physician that have been proven effective, including Vertebroplasty and Kyphoplasty (Old 2004). Results of a clinical research trial concluded that both Vertebroplasty and Kyphoplasty significantly reduce pain and improve mobility in patients with vertebral fracture (De Negri 2007). Vertebroplasty is a procedure which involves injecting acrylic cement into the fractured vertebra to stabilize and strengthen the vertebrae. Kyphoplasty is a method that involves placing an inflatable balloon into the vertebral body. When the balloon is inflated, it makes a space in the center of the vertebrae where an acrylic is injected.

There is good evidence that diagnosing and treating Osteoporosis reduces the incidence of compression fractures of the spine (Kim 2006). Consistent exercise and activity to help with muscle strengthening and flexibility should also be done to help decrease vertebral fractures and back pain associated with Osteoporosis.

Journal Articles

Adam Sewell MD

UPPER BACK PAIN

Upper back pain occurs in the thoracic region of the spine, and is less common than lower back pain due to the stability, strength and limited movement of the upper back. The pain may be acute or chronic, a dull ache or a sharp stabbing sensation, and may be accompanied by stiffness. Typically the discomfort interferes with the activities of daily living, whether it is a constant pain or brought on only by specific movements. However, if upper back pain is present along with difficulty breathing or chest pain, this may indicate a heart attack and requires immediate emergency treatment.

The causes of upper back pain include:

Arthritis, a condition causing deterioration of the bony structures and cushioning discs between bones.
Physical injury to the muscles, tendons, or ligaments of the vertebrae.
Fibromyalgia, a type of rheumatism, which affects the soft tissues and muscles.
Herniated disc.
Referred organ pain from the heart or lungs.
Bone cancer.

Injury to the muscles and ligaments of the upper back may be caused by:

Traumatic situation, such as a car accident or other physical trauma
Incorrect posture, especially while sitting at a desk with a computer
Sporting activity, particularly sudden or extreme movements
Overuse injury

Another less common cause of upper back pain is joint dysfunction, which may be a result of any of the following conditions:

Arthritis, leading to damaged cartilage and decreased lubrication between bony structures of the spine
Bulging discs, due to pressure on vertebrae forcing spinal discs to bulge out of position
Herniated disc, marked by weakness and internal damage to the disc
Spinal stenosis, or narrowing of the spinal canal due to arthritis, herniated discs, Paget’s disease, or congenital defects

All the conditions mentioned above result in pinched nerves, inflammation and impaired movement leading to upper back pain.

Bone cancer, pulmonary disease and referred organ pain may also be the root cause of upper back pain.

Diagnosis

The doctor will need to know how movement affects the pain and how the upper back pain has interfered with activities of daily living. A physical exam will be performed, in which the physician will look for signs of inflammation such as tenderness, redness and swelling and with an assessment of range of motion. Imaging studies, such as X-rays, CT scans or MRIs may be performed to help the physician diagnose joint dysfunction or problems with surrounding muscles, ligaments and tendons. Discography, an imaging tool using contrast dye, may be used to help the physician visualize details of the intervertebral discs.

Treatment

In the case of upper back pain caused my myofascial injury, treatment is based on strengthening muscles, improving alignment of the spine and increasing flexibility.

These noninvasive treatments include:

Physical therapy
Massage therapy
Chiropractic or osteopathic manipulation
Acupuncture

Medications to reduce inflammation and decrease upper back pain may be prescribed:

COX-2 inhibitors
NSAIDs — Nonsteroidal Anti-Inflammatory Drugs
Acetaminophen
Ibuprofen

Muscle relaxants reduce pain by treating muscle spasms.

If the pain is severe or if it’s caused by joint dysfunction, local injections to the joint are a minimally invasive treatment:

Medical Branch Blocks (MBBs) for arthritis related pain
Facet Injections to reduce inflammation in the facet joints of the vertebrae
Epidural Steroid Injections for degenerative disc disease

Selective nerve blocks are a procedure performed by physicians to identify which nerves are responsible for transmitting pain signals. Identifying the route of pain signals may help the physician find the cause of pain to assist in treatment determination.

The goal of treating upper back pain is to relieve discomfort by treating the underlying cause. Noninvasive treatments are usually effective in relieving pain and returning the patient to an active lifestyle.

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Adam Sewell MD

TRIGEMINAL NEURALGIA

Trigeminal Neuralgia (TN) is defined by the International Association for the Study of Pain (IASP) as sudden, usually unilateral, severe, brief stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve (Merskey et al.). Less often patients may have a constant, aching or burning sensation. A tingling sensation or aching may also precede the pain episodes. Vibration or contact with the face may trigger the intense flashes of pain. The attacks usually last several seconds to a couple of minutes, and repeat over hours to weeks. The episodes then disappear for months to years before recurring. It can be bilateral, but does not involve both sides simultaneously. Rarely does the pain occur at night when the patient is sleeping. It tends to affect females slightly more than males at a ratio of 1.5:1, and increases slightly with age. Attacks can worsen over time, and the latent periods become more infrequent and shorter.

Pathology

The cause of trigeminal neuralgia is the compression of the trigeminal nerve root. Causes of compression are tumors (vestibular schwannoma or meningioma), epidermoid cyst, or aneurysm (out pouching of a blood vessel). The compression then leads to damage of the protective covering of the nerve, called myelin. As a result, the nerve acts in an erratic manner, causing pain signals to be sent sporadically at the trigger of light touch, chewing, or brushing the teeth. Rarely, traumatic injuries of the trigeminal nerve, such as a car accident, can lead to similar damage. Multiple sclerosis is a condition where the loss of myelin in one or more of the trigeminal nerve nuclei can also cause trigeminal neuralgia.

Diagnosis

Diagnostic criteria for classic trigeminal neuralgia have been developed and published by the International Headache Society (IHS),

Attacks of pain lasting from a fraction of a second to two minutes, affecting one or more of the subdivisions of the trigeminal nerve
Pain has at least one of the following characteristics:
- Intense, sharp, superficial, or stabbing
- Precipitated from trigger areas or by trigger factors
Attacks are stereotyped in the individual patient
There are no clinically evident neurologic deficit
Not attributed to another disorder

It can be difficult to diagnose TN and the Pain Physicians at Arkansas Pain have received extra training to examine and diagnose your painful condition. The physician may be able to demonstrate the trigger zones, while the neurological examination is normal. Most neurologic deficits indicate an alternative cause of pain. The physician may also order radiological imaging depending on his clinical suspicion and the history obtained. Other causes of facial pain can be differentiated by these factors:

Post herpetic pain – has persistent, typical rash that tends to involve the ophthalmic branch.
Migraine – pain is more prolonged and often throbbing.

Treatments Options

The standard medical approaches are anti-inflammatory, anticonvulsant, and antidepressant medications. If these fail, local anesthetic blocks are attempted. Lastly, percutaneous or open procedures may be done. Peripheral nerve stimulation may be a viable option earlier in the treatment of chronic facial pain. In patients not responded to medical treatment, there are several options for surgical procedures (Jannetta and Nurmikko et al).

These surgeries include:

Microvascular decompression – an invasive procedure involving removal or separation of vasculature, which is often the superior cerebellar artery, away from the trigeminal nerve.
Balloon compression – a balloon catheter is inflated and used to compress the gasserian ganglion.
Gamma knife radiosurgery – a noninvasive treatment that creates lesions by using focused gamma radiation. The radiation is targeted at the proximal trigeminal root with the aid of stereotactic frame and MRI.
Electrolytic rhizotomy – a percutaneous procedure that creates a lesion in the gasserian ganglion of the trigeminal nerve by using the heat of radiofrequency.
Linear accelerator radiosurgery – a noninvasive approach similar to gamma knife, but uses a different form of radiation, linear acceleration.
Peripheral neurectomy – an incision, radiofrequency lesioning, alcohol injection, or cryotherapy is used on a peripheral branch of the trigeminal nerve.
Chemical rhizotomy – an injection of glycerol into the trigeminal cistern. Tingling or burning is felt in the face, and pain relief is usually immediate, but may take up to a week.

All of the above mentioned treatments have a high recurrence of pain.

Here at Arkansas Pain, your physician may talk to you about peripheral nerve stimulation (PNS) or spinal cord stimulation (SCS) of the nucleus caudalis for severe facial pain. These treatments may offer the potential for long-term management of the pain and may offer obvious benefit and less risk than neuro-destructive procedures. Because there is a trial period for SCS or PNS the procedure is often less invasive, reversible, adjustable, and testable for patients in pain.

Articles

Adam Sewell MD

TESTICULAR PAIN

Testicular pain, or orchialgia, is typically caused by some kind of trauma. Some other causes of testicular pain include infection, and inflammation. Testicular torsion is a traumatic condition in which the testicle twists inside of the scrotum, cutting off the blood supply. This is a medical emergency, and typically requires surgical intervention. Trauma can also cause testicular rupture. Some symptoms of testicular torsion or testicular rupture include sudden, severe pain as well as redness and swelling of the scrotum.

A common infection of the testicles is called epididymitits, an infection or inflammation of the epididymis. This condition is frequently caused by sexually transmitted disease, including chlamydia or gonorrhea. Epididymitis in older men may be related to an enlarged prostate. This condition usually results in a gradual onset of pain, including redness and swelling of the scrotum. Some other symptoms associated with epididymitis are nausea, vomiting, fever, painful urination, and painful intercourse. The typical treatment for this condition is antibiotics.

Orchitis is an inflammation of the testicle. Orchitis may be caused by epididymitis that has gone untreated. Symptoms of orchitis are similar to epididymitis, and are typically treated with pain medications, antibiotics, and ice. Occasionally orchitis needs to be surgically drained.

Another type of inflammation in the testicular region is an inguinal hernia. An inguinal hernia occurs when a loop of bowel protrudes into the scrotum through a weakened part of the abdominal muscles, and is typically treated by surgical intervention. Symptoms include pain and bulging in the groin and scrotum especially during heavy lifting activities. If the intestine becomes trapped, or strangulated it will require immediate medical attention.

Treatment

When testicular pain has been present for three or more months, it is considered chronic orchialgia. Chronic orchialgia may be treated with medications, acupuncture, biofeedback, physical therapy and muscle relaxation techniques, nerve blocks, and spinal cord stimulation. Common types of medications used to treat pelvic pain include anti-inflammatories, anti-depressants, neuropathic medications, and occasionally opioids.

For male pelvic pain that does not respond to more conservative treatment modalities, a spinal cord stimulator (typically with sacral leads) may be beneficial. Spinal Cord Stimulation (SCS) is when a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.

If you suffer from chronic pelvic pain, Arkansas Pain can help. We offer advanced and comprehensive treatment options that encompass all of your pain management needs. Call us today to schedule an appointment!

References

Adam Sewell MD

TENSION HEADACHES

Tension Headaches are generally a sharp, steady, throbbing or tight, lingering headache pain. Tension headaches occur often by untraceable triggers. Approximately 45 million Americans suffer from chronic headaches. Tension headaches are the most common form of headaches. While it was believed tension headaches were the result of neck or scalp muscles becoming tense and contracting, researchers have only found this to be true in some tension headaches. A new theory describes interference in nerve pathways to the brain as a more likely commonality of tension headaches.

Tension headaches can be set off in response to some sort of habitual trigger. Staring at a screen for too long or working under great stress are some of the simple common triggers of tension headaches. Certain foods and beverages can also trigger pain. Alcohol, caffeine and nicotine are indigestible products that can cause tension headaches upon consumption or withdrawal.

Symptoms are pain which is usually dull and all over the head. A tight, band-like feeling in the forehead can also accompany the pain. Other reports are irritability, disrupted concentration, and sensitivity to noise or light. Tension headaches are chronic if they occur in sufferers more than 15 times per month. Over 90% of women report suffering from tension headaches at some point in lives versus 70% of men. These headaches are most common for middle-aged people, presumably because of the connection to stress.

Over-the-counter pain medication such as ibuprofen and aspirin can temporarily relieve pain and sometimes outlast the headache. Additionally, doctors can prescribe antidepressants and muscle relaxants as preventative medications for chronic headaches. Some lifestyle changes may also help alleviate the frequency and severity of the headaches.

Acupuncture, massage therapy and biofeedback have also become viable treatment options for chronic headaches.

Those with headaches may wish to download the Arkansas Pain Headache Journal to document what you are experiencing. Use our journal to document the details of your headaches, possible causes, what treatment you attempted (medication, herbal remedies, dark room, etc.) and the effects of that treatment. This record can be extremely useful during your next visit.

References

Adam Sewell MD

SPINAL STENOSIS

Spinal Stenosis is a disorder due to the narrowing of the spinal canal causing nerve and spinal cord impingement. Often this results in persistent pain in the lower back and extremities. Difficulty walking, decreased sensation in the lower extremities, and decreased physical activity may also be seen. Spinal stenosis most commonly affects people over the age of 65. Scoliosis and hypertension are considered to be risk factors. Interestingly increasing age alone increases the risk for spinal stenosis without pre-existing pathology (Coronado 2007).

Pathology

Symptoms develop due to complications from the narrowing of the spinal canal where the spinal cord is located. This constriction produces symptoms of impingement on the spinal cord, spinal vasculature, and surrounding peripheral nerves. Disc bulging and herniation as well as arthritic changes of the vertebrae can cause narrowing of the canal. The pain and decreased mobility that is produced by this condition may cause a disability that can significantly impair a patient’s lifestyle (Boswell 2007). Another common complication of chronic pain due to spinal stenosis is Central Sensitization. Central sensitization occurs when there is an increase in the excitability of neurons within the central nervous system at the level of the spinal cord and higher. Symptoms of progressive and severe spinal stenosis include bladder or bowel incontinence, lower extremity weakness, or loss of sensation. These symptoms can be a medical emergency and require immediate evaluation.

Diagnosis

A physician most likely will order radiological imaging such as CT scan or MRI to confirm the level of stenosis.

Treatment

Medications such as NSAID’s, membrane stabilizing drugs and other analgesics

Epidural Steroid Injections involves injecting a medication into the epidural space, which includes both a long-lasting steroid.

Percutaneous Adhesiolysis also known as the Racz catheter uses a needle inserted into the caudal epidural space (by the tailbone). A catheter is advanced into the epidural space under fluoroscopy guidance where corticosteroid, local anesthetic, Wydase, and Hypertonic Saline are injected to aid in breaking up scar tissue.

Spinal Cord Stimulation (SCS) – a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.
Surgical Treatments al laminectomy or foraminotomy may be necessary to take pressure off the spinal cord and surrounding nerves. Often surgical decompression is recommended in acute spinal stenosis and especially in patients who rapidly develop loss of bladder/bowel function, weakness, and decreased sensation.

Journal Articles

Adam Sewell MD

SHINGLES

Shingles is a rash caused from the varicella-zoster virus, which is also the cause of chickenpox. The virus remains inactive after chickenpox, but can reactivate in the nerves in adulthood, causing the painful rash. It is not understood why some people develop shingles. Typically there is just one attack and Shingles is not infectious, but the virus can be passed to others who have never had chickenpox.

Symptoms of shingles include tingling and burning prior to the appearance of a rash. A rash will develop and will intensify to small blisters. The blisters can burst and create small ulcers. Within two to three weeks, the ulcers will heal. The rash is often seen on the spine, stomach and chest, although it may also be found on the face and mouth. Other symptoms include abdominal pain, chills, facial distortion due to muscle cramping, fever, headaches, joint pain, swollen glands and impaired vision.

Signs and tests

Tests are rarely needed, but if required it may include taking a skin sample to see if the skin is infected with the virus that causes shingles. Blood tests may show an increase in white blood cells and antibodies to the chickenpox virus but is not conclusive for diagnosis.

Shingles Treatment

Your doctor may prescribe an antiviral. The drug helps reduce pain and complications and shorten the course of the disease.

The medications should be started within 24 hours of feeling pain or burning, and preferably before the blisters appear. Some people may need to receive the medicine intravenously.

Strong anti-inflammatory medicines or corticosteroids, may be used to reduce swelling and the risk of continued pain.

Other medicines may include:

Antihistamines to reduce itching
Pain medications
Creams containing capsaicin (an extract of pepper)

Cool wet compresses can be used to reduce pain. Soothing baths and lotions, such as colloidal oatmeal bath, starch baths, and calamine lotion, may help to relieve itching and discomfort and plenty of bed rest is recommended.

The skin should be kept clean, and contaminated items should not be reused. Non-disposable items should be washed in boiling water or otherwise disinfected before reuse. The person may need to be isolated while lesions are oozing to prevent infecting other people who have never had chickenpox and especially pregnant women.

Complications

Sometimes, the pain in the area where the shingles occurred may last for months or years. This pain is called post herpetic neuralgia. It occurs when the nerves have been damaged after an outbreak of shingles. Pain ranges from mild to very severe pain. It is more likely to occur in people over 60 years.

Other complications may include:

Another attack of shingles
Blindness (if shingles occurs in the eye)
Deafness
Infection, including encephalitis or sepsis (blood infection) in persons with weakened immune systems
Bacterial skin infections
Ramsay Hunt syndrome if shingles affected the nerves in the face

Prevention

Call your health care provider if you have symptoms of shingles, particularly if you have a weakened immune system or if your symptoms persist or worsen. Shingles that affects the eye may lead to permanent blindness if you do not receive immediate medical attention.

References

Adam Sewell MD

SCOLIOSIS

Scoliosis is a condition involving abnormal curvature of the spine and affects 5-7 million people in the US.

Scoliosis can begin at any age is more prominent among females and can be genetic, occurring in about 1-2% of adolescents and more than 50% in persons over age 60.

Scoliosis may be idiopathic, congenital, or occur as a consequence of another condition. It is called idiopathic when no underlying cause can be identified. Most cases of scoliosis are considered idiopathic. Congenital scoliosis is present at birth. Scoliosis as a secondary symptom of another condition may occur in concert with neuromuscular diseases such as spina bifida and cerebral palsy, and hereditary musculoskeletal disorders including osteogenesis imperfecta, Marfan syndrome, Stickler syndrome, Ehlers-Danlos syndrome, and muscular dystrophies. In other cases, scoliosis may arise from physical trauma, spinal stenosis, and bone collapse from osteoporosis.

Scoliosis may produce specific, progressive signs and symptoms. The main diagnostic criterion for scoliosis is spinal curvature exceeding 10 degrees in a single plane. The spine may appear to bend in a “C” or “S” shape. Other signs of scoliosis may include uneven musculature on one side of the spine, uneven hips, uneven leg lengths, imbalance, anxiety, and a prominent rib or shoulder blade caused by rotation of the ribcage. In severe cases, which involve angles of greater than 25 degrees, patients may experience difficulty breathing, pain, and reduced functionality, and infections that can cause damage to the heart and lungs.

If scoliosis is neglected, spinal deformity may progress dramatically. In general, treatment is based upon severity and location of the curvature, as well as the age of the individual. Recommended treatment programs include physical therapy, occupational therapy, and chiropractic care. Surgery is usually reserved for patients whose curves are greater than 45 degrees or have a high likelihood of progression, and impaired physiological functions such as breathing. Fortunately, most curves can be treated non-operatively if they are detected before they become too severe.

References

Adam Sewell MD

SCIATICA

Sciatica

Sciatica is a condition that refers to a group of pain symptoms or unusual sensations, typically manifesting on one side of the body, lasting for a period of weeks to months.

The pain and other sensations result from an irritation or compression of one or more nerve roots in the lumbar spine, or lower back. Pain often starts in the lower back or in the buttocks, down the leg, the ankle, and into the foot.

The symptoms range from pain, cramping, weakness, tingling, or numbness. Sometimes the pain is described as a having a “pins and needles” sensation. The discomfort follows the same pathway as the sciatic nerve—down the leg.

Most patients fully recover from sciatica; and in most cases, the nerve is not permanently damaged. Although not typically considered an emergency, medical attention is needed if the symptoms are severe and don’t improve. If more serious symptoms arise, consult your physician, or go to the emergency room immediately.

Serious symptoms may include:

Severe pain
High body temperature
Bladder or bowel incontinence
Lower extremity weakness
Profound loss of sensation
Inability or difficulty in walking

The sciatic nerve is the longest and largest nerve in the body. It controls motor and sensory functions for the lower extremities (legs, ankles and feet). As such, the sciatic nerve can be compromised by a variety of conditions and diseases. Many of these conditions can ultimately lead the nerve to become inflamed, pinched, stretched or damaged.

Conditions that cause lower back pain and sciatica include:

Herniated or bulging disc
Degenerative disc disease
Spinal stenosis
Piriformis syndrome
Facet hypertrophy

Additionally, sciatica and lower-back pain may also result from pregnancy, tumor, pelvic infections, and other causes.

To diagnose this condition, a pain physician performs various muscle tests to note any limitations in movement in the lower extremities. The pain physician most likely will order one or more diagnostic tests, such as X-ray, Computerized tomography (CT) scan, Magnetic resonance imaging (MRI) or bone scan. MRIs are considered the best procedure to detect causes of chronic lower-back pain and sciatica. Depending on medical history and other factors, additional tests may be required.

There are many treatment options available for pain relief, reduction and management.

Pharmacotherapy – over-the-counter non-steroidal anti-inflammatories (NSAIDs), acetaminophen and other analgesics. Prescription medications such as, membrane stabilizing drugs and muscle relaxants may be prescribed for pain relief or management associated with lower-back pain and sciatica.

Epidural steroid injections (ESI) – this procedure involves injecting a medication into the epidural space. The injection includes both a long-lasting corticosteroid and a local anesthetic. The corticosteroid is long-lasting and works to reduce inflammation and irritation. The anesthetic works immediately to interrupt the pain-spasm cycle.

Lysis of adhesions – also know as the “Racz Procedure.” Using an epidural needle, a catheter is placed into the injection site to administer fluids and medication, during the procedure, and to break-up scar tissue.

Trigger point injections (TPIs) – this involves injecting a local anesthetic and corticosteroid into one or more trigger points. TPI addresses areas of muscle containing trigger points, such as knots of muscle formed through muscles spasms.

Disc decompression – a needle is inserted through the skin into the herniated or bulging disc with a local anesthetic and possible sedative. The protruding material is suctioned out of the disc and pressure on the nerves or ligaments are eliminated.

Infusions techniques– a local anesthetic and other medicines are administered through the catheter for extended time periods.

Transcutaneous Electrical Stimulation (TENs) – TENs is the use of electric current produced by a device to stimulate the nerves for pain management.

Spinal Cord Stimulation (SCS) – a small electrical pulse generator is implanted under the skin. A low-voltage electrical current is administered and decreases the perception of pain by confusing the spinal cord and brain pain processing centers. This is done on a trial basis.

Intrathecal Pump Implants – an intrathecal pump is a computerized device, which delivers concentrated amounts of medication(s) into the spinal cord area via a small catheter.

Botox injections – injections of small amounts of Botox ease pain through paralyzing nerves or muscles. They should only be administered by a licensed physician, with experience using Botox as a pain relief treatment.

Other alternative and supplemental therapies for sciatica pain relief include, massage, acupuncture, biofeedback, physical therapy and exercise.

Nutrition and healthy eating habits offer many benefits for pain and overall good health. A nutritionist may prescribe a specific nutritional program. This may include the addition of vitamins, minerals, or supplements.