Category: Adam Sewell MD

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Adam Sewell MD

ROTATOR CUFF TEAR

Rotator cuff tears can cause nagging, aching pain that limits daily activities.  A rotator cuff becomes torn when one of the tendons is injured. The tendon no longer attaches properly to the top of the humerus, or upper arm bone. The most common tear is in the supraspinatus muscle and tendon. This can cause an inflammation of the acromion, which may cause additional pain. There are several types of tears: partial, full-thickness, acute and degenerative.

The causes of these tears are most often an injury resulting from lifting something too heavy over-head, or repetitive stress. A lack of blood supply to the area, caused with age, can also reduce the body’s natural ability to repair itself. If a tendon is already slightly injured and the blood supply is diminished, a tear can occur. Most rotator cuff tears are caused from a combination of repetitive and degenerative causes.  People age 40 and older are most at risk.

Symptoms include: pain if lying on the shoulder at rest, or when lifting and lowering the arm; weakness in the limb, especially when rotating the arm; or a crackling noise when moving the arm. When a tear is caused from a sudden injury, such as falling off a ladder or a car accident, there may be a snapping noise, followed by intense pain and a weakness in the arm.

A pain physician will rule out arthritis and a pinched nerve during examination.  An MRI and ultrasound will likely be ordered to confirm the tear diagnosis. The MRI should provide the size and location of the tear.

Non-surgical treatment for rotator cuff tears include: rest, avoiding activities that cause pain, nonsteroidal anti-inflammatory over the counter medications, physical therapy and steroid injections. Half of all rotator cuff tear patients report pain relief without surgery. If a patient’s pain doesn’t improve, the physician may recommend surgery to repair the tendon and tear.

Rotator Cuff Tear – PainDoctor.com

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Adam Sewell MD

REFLEX SYMPATHETIC DYSTROPHY

Reflex sympathetic dystrophy (RSD) is also referred to as Complex Regional Pain Syndrome (CRPS), and typically occurs in the upper or lower extremities. There are two types of CRPS, CRPS 1, and CRPS 2.  CRP1 occurs when pain stems from an initial painful event that may or may not be traumatic.  CRPS 2 occurs when pain stems from an identifiable painful event or nerve injury. Both CRPS 1 and CRPS 2 cause continuous, intense pain out of proportion to the severity of the injury. Some common symptoms include drastic changes in the temperature and color of the skin over the affected limb or body part.  The pain can be accompanied by severe burning, skin sensitivity, sweating, and swelling. Some other key features of CRPS include hyperalgesia, which is an increased sensitivity to painful stimuli, and allodynia, a painful response to a typically non-painful stimulus.

Diagnosis

CRPS is a very complex pain disorder, which can be very difficult to treat. CRPS often begins in the hand or the foot, and spreads to the affected arm or leg. CRPS can also spread to the opposite arm or leg. The cause of CRPS is unclear. There are no specific tests to diagnose CRPS, but testing can be done to rule out other diagnoses that may explain the symptoms. Blood testing can be ordered to rule out other inflammatory or rheumatologic conditions. Nerve conduction studies can also be ordered to rule out peripheral neuropathy or nerve entrapment conditions. Finally, a magnetic resonance imaging (MRI) can be ordered to rule out any soft tissue causes for the patient’s neuropathic symptoms. The diagnosis of CRPS is made in the absence of these other possible causes for the patient’s pain.

Treatment

The typical treatment for CRPS includes nerve blocks for pain reduction, desensitization treatments with a physical therapist, and medications that help with neuropathic pain. Some nerve blocks for upper extremity pain include stellate ganglion blocks, cervical epidural steroid injections, and interscalene blocks, followed by physical therapy. Injections for lower extremity CRPS include lumbar sympathetic nerve blocks, lumbar epidural steroid injections, and femoral sciatic nerve blocks, followed by physical therapy. Some medications used for CRPS include gabapentin, pregabalin, duloxetine and amitriptyline. If a patient does not respond to the physical therapy or medications, spinal cord stimulation may also be considered.

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Adam Sewell MD

PROLAPSED DISC

Prolapsed discs is the condition of a vertebral disc pushing outside of its designated space, which typically puts pressure on nearby nerves.

A prolapsed disc, also known as herniated or bulging discs, can be caused from back trauma, or regular back strain from heavy lifting. Researchers report some 5% of lower back pain is due to prolapsed discs. While a small percentage, this condition is one of the leading causes for back surgery.

When a disc is prolapsed, the inner liquid layer of the spine presses against the outer thick tissue layer causing a bulge. This bulge presses on a spinal nerve root, causing pain, numbness or weakness. The most common prolapsed discs are found in the lumbar, or lower, spine. They can also occur in the neck. When a disc is prolapsed in the lumber spine, it can cause radiating nerve pain; the pain is actually felt in another area of the body, typically the lower extremities or groin. This can also cause bowel and bladder incontinence, however this is most likely seen in patients with a more advanced form of prolapsed disc called Cauda Equina.

To assist with diagnosis, an X-ray should be ordered to search for possible fractures which could be a cause of the pain.  A CT or MRI scan can be ordered to produce images of the inter-vertebral discs to look for possible nerve root compression.  Finally, a nerve conduction study could also be ordered.

Initial treatment for low back pain is physical therapy, in addition other treatments options are:

  • Lifestyle changes, including weight loss, a healthy diet and regular exercise
  • Over-the-counter non-steroidal anti-inflammatory medications (NSAIDS) for management of pain
  • Opioid medications or muscle relaxants for more severe pain
  • Epidural steroid injections

For the 10% of patients who do not respond to these conservative treatment options, surgery may be required to alleviate pressure on the nerve root and ease pain. The most common surgeries are open discectomy, micro-discectomy and endoscopic.

To prevent prolapsed discs, patients should practice good posture and use proper lifting techniques to avoid injuries and strains to the lower back.

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Adam Sewell MD

POST LAMINECTOMY SYNDROME

Post-Laminectomy Syndrome (PLS), also known as failed back syndrome, is a chronic and painful condition that some patients experience after undergoing laminectomy back surgery.

A laminectomy is a surgical procedure that removes the lamina, a portion of the vertebrae that connects the spinous process (the protrusions felt on the back through the skin) to the main body of the bone, and any associated bone spurs to relieve pressure on spinal nerves that can occur in many back conditions.

PLS is not a diagnosis, but rather a general term to describe the chronic pain symptoms experienced by patients as they emerge from back surgery. The exact cause of PLS is unknown, however one prominent theory points to epidural fibrosis, in which the development of scar tissue during post-surgical healing compresses nearby nerve roots and causes pain.

Other possible causes include:

  • Surgical intervention at the wrong spinal level
  • Incomplete removal of the lamina
  • Arachnoiditis – inflammation within the protective layers of the spinal cord
  • Psychosocial problems, such as depression

Diagnosis and Treatment

Diagnosis of PLS is made difficult due to the many possible presentations of chronic pain post-surgery. A doctor must recognize the developing pattern of chronic pain and poor post-surgical outcomes. A physician may order laboratory or imaging studies to identify possible inflammation or other structural abnormalities where the lamina was removed. The physician may also perform a mental health screening to rule out any psychosocial causes. Treatment options will be different for every patient.

Some of the possible treatment options include:

  • Opioids can be used for pain management
  • Spinal cord stimulation
  • Adhesiolysis – the disconnection of fibrotic scar tissue after surgery

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Adam Sewell MD

POST HERPETIC NEURALGIA

Post herpetic neuralgia is a side effect of shingles.  It presents as a painful nerve and skin condition caused by the virus herpes zoster. The same virus is responsible for chickenpox in youth and inexplicably causes shingles in some adults. Post herpetic neuralgia is the persistent, often quality of life altering pain associated with a shingles outbreak.

The most common symptom is a burning pain as nerves are damaged during a shingles outbreak. The nerves no longer communicate properly with the brain. The result is sharp, annoying pain that can intensify with even a light touch. Post herpetic neuralgia pain is typically located at the same site as the shingles outbreak.  Usually it’s located on one side of the back, chest or stomach.

Other common symptoms include:

  • Itching or numbness
  • Muscle weakness or paralysis

There is no specific test for post herpetic neuralgia, nor is there a specific cure.  A variety of pain medications and options may be prescribed until the patient and physician find the right combination. These may include: antidepressants, anticonvulsants, pain relieving skin patches, opioids, and topical pain creams.  It’s important to note, that shingles patients who are able to see a pain physician within the first 72 hours of the signature rash appearing and can start a course of antivirals are half as likely to develop post herpetic neuralgia.  Additionally, shingles and related post herpetic neuralgia are entirely preventable via vaccine.

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Adam Sewell MD

PLANTAR FASCIITIS

Fascia is a thick tissue that connects the ball of the foot to the heel. The tissue is responsible for the arch of the foot. When this connective tissue becomes inflamed to the point of pain, it’s called plantar fasciitis.

Patients who suffer with plantar fasciitis often experience sharp pain in the morning. When the fascia loosens during normal physical activity such as walking, the pain will subside a bit. The first few steps of the day are often the most painful because the fascia is not used during sleep.

Risk factors include arch problems such as flat and high arches. Other causes are obesity or sudden weight gain, long distance running, or running on uneven surfaces, and having a tight Achilles tendon. Finally, wearing shoes without proper arch support can cause fascia inflammation as fascia can adjust only so far before it is stretched to the point of pain.

This condition is most commonly found in men age 40-70.  It’s the leading cause of orthopedic care. While heel spurs caused by calcium deposits are commonly found in plantar fasciitis patients, they are not the cause of the pain. They are a reaction by the bone to the fascia’s inflammation.

Symptoms include stiffness on the bottom of the heel, an ache on the arch and a sharp pain or burn when first putting weight on the foot. The pain may be more severe if climbing stairs or performing intense activity. The pain may come over a period of time or may be intense and sudden. It is not uncommon for swelling and redness to also be present.

To diagnose plantar fasciitis, a pain physician will take a series of X-rays of the foot. If a bone spur is present, plantar fasciitis is a likely diagnosis. Additionally, physicians will look for a thickening and inflammation of the fascia from the ball of the foot to the heel. The physician may also look for hairpin fractures in the bones around the foot, which are also a common source for this type of pain.

Treatment options range from over-the-counter NSAIDS, such as acetaminophen and ibuprofen to reduce inflammation and stretching.  Cortisone shots and sonic wave procedures are also used. Depending on the severity of the inflammation, the patient may respond favorably to stretching, ice, rest, or wearing orthotics when standing. Additionally, athletic tape and splints specifically manufactured for fascia stretching can ease plantar fasciitis-related pain.

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Adam Sewell MD

PHANTOM LIMB PAIN

Phantom limb pain is a sensation felt when a body part or limb has been amputated, but still feels as if it is attached. Many amputees will have phantom sensations that are not painful. It is estimated that 85% of people experience phantom limb sensations in the first several weeks following amputation.  However, a smaller population will continue to feel these sensations for prolonged periods of time. It is reported that 60% of people will continue to experience sensations one year after surgery (Manchikanti and Singh, 2004). 

Some patients have severe painful and debilitating phantom limb sensations. Some of the sensations include tingling, numbness, hot or cold sensations, cramping, stabbing, and burning. The most common sensation that patients continue to feel is pain in the missing limb area. These painful sensations often diminish over time, but some suffer from long-term pain, which can be difficult to treat.

Treatment

Some treatments for phantom limb pain include:

  • Medications
  • Physical Therapy
  • Mirror Therapy
  • Interventional Injections
  • Spinal Cord Stimulation

Medications: Studies have shown that tricyclic antidepressants, sodium channel blockers, and anticonvulsant medications can be useful in neuropathic pain conditions like phantom limb pain. Currently, gabapentin is the most commonly used medication for phantom limb pain. Many studies have shown that oral opioid medications are not effective at treating neuropathic pain. However, other studies have shown that intrathecal administration of buprenorphine was effective in many patients, and provided them with prolonged resolution of their phantom limb symptoms.

Physical Therapy: Desensitization therapies along with sympathetic nerve blocks may provide relief for patients who have “sympathetically mediated pain.” Proper fit of any prosthetic is also important in decreasing pain for many who suffer from phantom limb pain.

Mirror Therapy: One of the more promising treatments for phantom limb pain is mirror therapy. Mirror therapy involves the use of a mirrored box with two openings: One for the amputated limb, and one for the other limb. The patient then performs isometric exercises with the non-amputated limb, so it appears as though the amputated limb is moving. In a randomized controlled study by Chan, et al. (2007), it was found that the patients who had mirror therapy for four weeks experienced a significant reduction in pain.

Interventional Injections: Injection therapy such as interscalene blocks or stellate ganglion blocks can be used for upper extremity phantom limb pain.  Lumbar sympathetic blocks are used for lower extremity phantom limb pain. Neuroma injections can also be beneficial for those who suffer with extremity neuromas. The blocks are often combined with physical therapy.

Spinal Cord Stimulation: Transcutaneous Electrical Nerve Stimulation (TENS) or spinal cord stimulation offers significant relief too many patients who have not had success with other treatments. Spinal Cord Stimulation (SCS) is often described as a “pacemaker for pain” and uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of chronic pain. After a local anesthetic and minimal sedation your doctor will first place the trial SCS leads into the epidural space. The SCS lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the epidural space. The trial stimulator is typically worn for 5-7 days.  The lead is taped to your back and connected to a stimulating device. If the trial successfully relieves your pain you can decide to undergo a permanent SCS.

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Adam Sewell MD

PELVIC PAIN

It is estimated that approximately 33% of all women will suffer from pelvic pain at least one time in their lives. For 12-20% of these women, pelvic pain may become chronic. The causes of pelvic pain, include infection, ectopic pregnancy, ovarian cysts, and endometriosis. 

A common type of pelvic infection is pelvic inflammatory disease (PID). PID is an infection of the uterus, ovaries, or fallopian tubes, and may be caused by sexually transmitted disease. Infections of the kidneys, bladder, or urethra can also cause pelvic pain. If an infection is suspected, treatment with antibiotics is necessary in order to alleviate the pain.

Ectopic pregnancy is a pregnancy that occurs outside of the uterus, typically in the fallopian tubes, and can be very painful. Ectopic pregnancy can lead to serious complications, and warrants surgical intervention.

Ovarian cysts are fluid-filled sacs within the ovaries, and typically cause pain during mid-menstrual cycle. These cysts usually resolve spontaneously, but sometimes require surgery to remove.

Endometriosis is a condition in which uterine tissue grows on other reproductive organs, and can cause severe pain and cramping during menses. Certain medications and surgical procedures can help to lessen the pain associated with endometriosis.

Diagnosis and Treatment

Pelvic pain can also be neuropathic. It is extremely important to establish an accurate diagnosis, because some of the causes for pelvic pain can be reversible. The diagnosis is usually made by an OB/GYN, and involves pelvic examination, lab testing, ultrasounds or CT scans of the abdomen and pelvis. Treatment is based on the underlying cause, and can include medications and physical therapy.

Common types of medications used to treat pelvic pain include anti-inflammatories, anti-depressants, neuropathic medications and occasionally opioids. Physical therapy for pelvic pain can include muscle training, hot and cold applications, ultrasound therapy, and stretching.

Biofeedback is a technique in which a person learns to control pain through thoughts, and can be very helpful for treating pelvic pain. A licensed therapist can teach biofeedback, relaxation techniques, and guided imagery, all of which are very effective techniques in controlling chronic pain.

Neuropathic pelvic pain can also responds very well to various nerve blocks.  Nerve blocks are determined by location of pelvic pain and symptomatology. A study by Weschler, Maurer, Harpern, and Frank (1995) showed that superior hypogastric plexus blocks are very effective in treating chronic pelvic pain related to endometriosis. Another type of nerve block used to treat pelvic pain is an ilioinguinal nerve block which is especially useful in treating pain in the lower pelvic region and groin.

For pelvic pain that does not respond to more conservative treatment modalities, a spinal cord stimulator may be beneficial. Spinal Cord Stimulation (SCS) is often described as a “pacemaker for pain” and uses groundbreaking technology that works by introducing an electrical current into the epidural space near the source of the chronic pain. With a local anesthetic and minimal sedation your doctor will first place the trial SCS leads into the epidural space. The SCS lead is a soft, thin wire with electrical leads on its tip and is placed through a needle in the back into the epidural space. The trial stimulator is typically worn for 5-7 days.  The lead is taped to your back and connected to a stimulating device. If the trial successfully relieves your pain you can decide to undergo a permanent SCS.

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Adam Sewell MD

OSTEOARTHRITIS

The most common cause of joint pain is osteoarthritis (OA), a chronic (long term) disease characterized by a loss of cartilage and bony spur (osteophyte) formation in joint spaces.  Normally cartilage cushions the joints preventing adjacent bones from contacting each other. The cartilage can’t be repaired.  Bony spur formations rub together causing pain and inflammation.

The specific cause of OA is unknown; however it is not just a disease of aging, but rather the result of a combination of factors including genetics and joint degeneration. Symptoms of OA typically include joint pain with movement, limited range of motion, joint swelling or joint stiffness after periods of inactivity. This pain usually occurs within minutes, and can last hours. As OA progresses, pain can occur during rest or sleep.

Joints most affected by OA include the knee, hip, and joints in the hand closest to the fingertips, the thumb, and the spine in both the neck and lower back regions.  Besides aging other risk factors include obesity, muscle weakness,  joint overuse or repetitive use, joint trauma, and joint instability. OA is also more prominent in females than males.

Diagnosis of OA is primarily confirmed by x-ray showing narrowing of the joint spaces, cartilage loss and spur formation.  A doctor will also perform a comprehensive physical exam, paying close attention to joint tenderness, limited range of motion, joint deformity and enlargement, swelling and crackling sounds heard in joints. A doctor may order additional laboratory tests to rule out other potential causes of arthritis.

The goal for treating OA is to control pain and minimize. Treatment options depend on the progression of the disease and the severity of pain, and may include lifestyle changes, medications or surgery.

At early stages of OA, pain can be alleviated with conservative treatment; primarily rest and over-the-counter analgesics such as acetaminophen and non-steroidal anti-inflammatory drugs such as ibuprofen.  For severe cases of pain and inflammation, more selective anti-inflammatory and opioid medications can be prescribed.

For certain joints, steroid and hyaluronic acid injections may help for the temporary control of pain. If OA progresses to the point where surgical intervention is necessary, joint replacement, arthroscopy, or an osteotomy, in which bone is removed from the joint, may be beneficial. Surgery always involves certain risks.  If diagnosed with OA, a pain management specialist can help navigate the proper course of treatment.

The best way to treat OA is to prevent progression of the disease through lifestyle changes with regular exercise, a proper diet and weight management.

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Adam Sewell MD

NECK PAIN

Neck pain is one of the most common medical complaints and occurs slightly more often in women than men. However, many people experience some level of neck pain in the course of their lifetimes, and most of the time, it isn’t serious and may occur as a result of stress, improper body mechanics, like poor posture, or muscle strain from unusual or awkward positions. 

Some serious symptoms that constitute a medical emergency that require immediate care include:

  • Loss of, or altered, consciousness
  • Changes in vision, such as blindness
  • Changes in bowel or urination
  • Nausea or vomiting
  • Fever
  • Weight Changes

The root cause or causes of neck pain can vary, but sudden severe pain, lasting less than three months, is classified as “acute.” Acute neck pain is commonly caused by facet syndrome (joint degeneration), muscle strain, or injuries, like whiplash. Pain lasting for more than three months, is classified as “chronic” neck pain and can originate from multiple locations, but is often from facet joints irritation, discs, ligaments, and muscles.

Anatomy

The cervical spine (neck) is complex and has many important functions, which include providing support and mobility to the head and neck, as well as protecting the spinal cord.

Bone structures

The cervical spine has seven small vertebrae and starts at the base of the skull. These small vertebrae provide a support structure that protects the spinal cord, the skull, and allows for movement.

Vertebral Discs

In between each of the vertebrae are jelly-like discs that cushion and minimize impact to the cervical spinal column. The same cushion that minimizes impact can cause discs to herniate “collapse backwards” or bulge through adjacent ligaments, nerves, or the spinal column itself. It’s this irritation or inflammation that leads to neck pain.

Spinal Ligaments and Muscles

Ligaments and muscles attach to each vertebra, providing support, mobility, and movement for the cervical spine. Spinal nerves are attached to the cervical spinal cord. These ligaments and muscles innervate the skin and surrounding structures of the neck and upper extremities (arms and hands). Damage to these structures is one of the major sources of neck pain.

Atlas and Axis

The Atlas and Axis are the first two cervical vertebrae, starting at the base of the head. These two vertebrae form pivot-type joints that support the head, control movement, and connect to the spine. They are part of the body’s coordination and balance system as well. The cervical spine is the most flexible portion of the spinal cord, and therefore, the most vulnerable to injury or trauma.If the first through third cervical nerves are compromised, compressed or inflamed, they cause neck pain and sensory issues in some head and face areas.

Greater and Lesser Occipital Nerves

If these nerves are injured, they can cause radiating pain to the face and head. The other nerves lower in the cervical spine form a large nerve group, which provides motor and sensory support to the upper extremities. Symptoms may include, weakness, pain, loss of feeling, or other issues in the arms, if they are damaged.

Procedure

Cervical epidural steroid injections (CESIs)

This procedure involves injecting a steroid into the epidural space within the cervical spinal canal. Two medications are used to complete this process – a long-lasting steroid and a local anesthetic (lidocaine, bupivacaine). The steroid reduces inflammation and irritation, while the anesthetic interrupts the pain cycle.

Benefits

Cervical steroid injections may provide immediate and longer-lasting pain relief and are considered simple and relatively painless.

Risks

Mainly considered a low-risk procedure, but with any procedure, there is the risk of infection

Pathology

The most common causes of neck pain include:

  • Muscle strains
  • Trauma or injury
  • Herniated or bulging cervical disc
  • Stress

Muscle overuse, and sleeping in awkward positions, often produce neck pain.  When the muscles in the back of the neck tighten and become strained, chronic pain may develop. “Whiplash” is a common example of this kind of neck pain, and it occurs in motor vehicle accidents, most often in rear-end collisions. The pain results from the stretching and straining of soft neck tissues. This caused localized inflammation, muscle tension, and ligament strain. When ligaments and tendons become inflamed or damaged, they cause additional pain that worsens with certain movements. Neck facet joints are also commonly involved.

Conditions

Myofascial (muscle related) and ligament injury are the most common cause of neck pain, as ligaments are susceptible to strain and irritation from strenuous lifting and prolonged overuse.

Degenerative disc disease (DDD)

In degenerative disc disease, the discs begin to fall apart or shrink. It’s one of the more common reasons for spinal surgery. Disc disease can be acute, but more often, it’s chronic and the pain is caused by a slow degeneration, occurring as part of the aging process. DDD is progressive disease that develops after spinal discs begin to from disc thin. This can lead to compression of the vertebrae, or adjacent structures, and cause neck pain.

Cervical Spondylosis (neck arthritis)

Cervical Spondylosisis caused by degenerative cervical vertebrae and nearby facet joints. Symptoms typically start around the age of 40, but may start earlier with trauma or is a person has a genetic predisposition to it. Arthritis is a progressive disease, and degenerative disc changes occur as a result of the aging process. The disc may decay, herniate, or bulge, causing local nerve root irritation or spinal cord compression. The pain is often worse when the head is extended backwards.

Spinal Stenosis

Spinal Stenosis is another common cause of neck pain that occurs, from a narrowing of the central spinal canal. It may cause the compression of surrounding nerves roots, and some symptoms may include, cramping or shooting pain, and numbness in the legs, back, neck, shoulders or arms. Symptoms typically depend on the area of the spine that is compromised.  In cervical spinal stenosis, the upper extremities (arms) and shoulders are most commonly affected.

Mental health

Mental health issues, like depression, anxiety and stress, all have a tendency to exacerbate neck pain and other chronic pain syndromes, and emotional issues often cause neck pain to grow worse. There are several identified risk factors in the development of spine pain. They include, but are not limited to, physical, socioeconomic status, general medical health and psychological state. Occupational environmental factors contribute to the risk for experiencing pain as well (Rubin 2007).

Central Sensitization

Central Sensitization (sensory hypersensitivity) is a common complication for those suffering from chronic pain syndromes. It involves both the peripheral nervous system (PNS) and the central nervous system (CNS) and occurs when a local tissue injury and inflammation activate the PNS. This action sends pain signals through the spinal cord to the brain. Central sensitization occurs when there is an increase in the excitability of neurons within the CNS at the level of the spinal cord and higher.

The once normal PNS signals begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate neurons in the spinal cord that should only respond to pain. Sensations that normally produce a harmless reaction now produce significant pain.

Other Conditions

Less common causes of neck pain include vertebral compression fractures, spinal cord disorders, tumors, and infection. Metastatic tumors (cancer spread from another organ system) are the most common type of malignant lesions of the spine, but are still very rare among the general population. Up to 10% of patients with a primary cancer suffer spinal metastases. Breast, lung, prostate, and renal cell carcinomas are the most common tumors that metastasize into to the spine. However, myeloma, lymphoma, and gastrointestinal carcinoma can also invade the vertebral column as well (James 2003). Oropharyngeal cancers of the oral cavities and neck may also cause neck pain.

Diagnosis

To diagnose neck pain, a physician will perform a medical history and physical exam, looking over certain areas of the spine. He or she will perform various muscle tests, as well, to find any limitations in movement in the upper extremities.

The doctor will, also, most likely order some imaging like, X-ray, computerized magnetic resonance imaging (MRI) or a bone scan. MRI’s are considered the standard of care to detect the cause acute or chronic neck pain.

Treatments

Before beginning any treatment, please consult a physician.

It’s vital to not only treat the physical symptoms, but the emotional stressors as well. Massage, acupuncture, biofeedback, and behavioral therapy can all be extremely beneficial those suffering from chronic neck pain.

Alternative or Complimentary Options

Alternative therapies offer very little risk and are successful in many individuals with chronic neck pain.

In acupuncture, the acupuncturist inserts small needles just under the skin. It’s thought that the needles trigger the release of hormones called “endorphins“, which are the body’s natural pain reliever. Acupuncture may aid in relaxation and decrease stress and tension.

Physical therapy is often helpful in reducing or alleviating neck pain as well.

Pain Relievers

Over-the-counter Pain relievers such as ibuprofen (like Motrin), or acetaminophen (like Tylenol) may provide neck pain relief.

Benefits

May offer pain relief for mild to moderate neck pain caused by muscle or ligament strain

Risks

Prolonged and frequent use of over-the-counter medications may lead to gastrointestinal conditions, such as ulcers; or liver damage in the case of acetaminophen.

For more information about neck pain, or the pain relief options described, please see your pain physician.

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