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For many patients who are dealing with neuropathy pain, finding answers may often be hard to come by due to lack of adequate testing. Questions such as “why is my neuropathy worse at night?” can only be answered by understanding how much the autonomic nervous system is damaged. Our nervous system is combined of two parts: the somatic nervous system (SNS) and the Autonomic Nervous system (ANS).

The autonomic nervous system is very important. The ANS supplies smooth muscle and glands, and influences the function of our internal organs. The ANS is a nervous system that acts largely unconsciously and regulates bodily functions, such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. The best way to see this system in action is when you get startled or sense there is danger you will often receive a fight-or-flight response. Think about how your body changes if you become suddenly aware of a threat, that is your ANS at work.

Before treating any form of neuropathy it is wise to perform a comprehensive, autonomic nervous test. This is very useful to determine the cause of the neuropathy and uncover hidden disease.

Testing the autonomic nervous system can identify clinical disorders and uncover major illness and other hidden diseases, such as:

• Sudden Death
• Silent Heart Attack
• Hypertension (high blood pressure
• Cardiac Autonomic Neuropathy (problems with heart rate and rhythm)
• Vascular Abnormalities (problems with blood vessels)
• Orthostatic Hypotension (feeling dizzy or lightheaded when standing suddenly)
• Syncope (passing out)

Why it is important to test your Autonomic Nervous System (ANS):

According to Published Studies:

• Nerve damage to the nerves around the heart occurs in about 17% of patients with type 1 diabetes and about 22% of people with type 2 diabetes.
• Some research has indicated that in patients with ANS dysfunction that has symptoms, 25% to 50% die within 1 to 5 years of diagnosis. It is very important to determine how far the neuropathy has gone and if it has affected the heart and blood vessels.
• A patient’s history and physical examination often don’t show problems with the autonomic nervous system (ANS).

It is recommended that all patients with Diabetes receive screening. The specific recommendations are that screening for problems with the Autonomic nervous system should be performed at the diagnosis of Type 2 Diabetes and after the diagnosis of type 1 Diabetes according to the 2005 ADA Standard of Diabetes Care

People with diabetes may have problems with the nerves around their heart and this can cause severe heart problems and sudden death, surveys show that only 2% of people with diabetes are tested for ANS neuropathy

If you have neuropathy and have not been tested please reach out to our office we would be happy to help you on your road to recovery and defeating neuropathy.

The only condition more common, in the United States, than common headache is back pain (National Institutes of Health, 2011). It is estimated that nearly a quarter of the population is suffers from it. Billions of dollars are spent each year on back pain treatments (Jones et al, 2010; National Institutes of Health, 2011). Both men and women suffer equally from this common annoyance that interferes with functioning, daily activities, work performance and leisure (National Institutes of Health, 2011). It is the leading cause of missed days at work and job-related disability (National Institutes of Health, 2011). Often, back pain will go away on its own, but sometimes it returns and a qualified pain physician needs to be consulted.

Common Causes of Back Pain

Pain that lasts several weeks is acute, or severe, and this is different than chronic back pain which lasts for more than three months progressively (National Institutes of Health, 2011). Back pain can be the result of trauma, disease, spinal stress, muscle strain, car accidents, sports or work related injuries, and herniated or ruptured discs (National Institutes of Health, 2011). Non-traumatic medical issues can include, malignancy, osteoporosis, degeneration, nerve tissue damage, arthritis, viral infections, bone diseases, disc disease, congenital abnormalities, vascular dysfunction, bone infection, or joint or disc irritation (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011).

Symptoms of Back Pain

Any part of the back may experience acute to chronic levels of pain, though the most common form of back pain is found in the lower portion of the spine. Symptoms may present as restricted range of motion, the inability to stand straight, limited flexibility, sharp shooting pains, sudden stabbing pains, stiffness, soreness, tenderness, numbness, tingling and muscle aches (National Institutes of Health, 2011). The pain often radiates to other areas and/or extremities or becomes aggravated with strenuous activity or movement (Jones et al, 2010). Any of symptoms of back pain can cause serious damage if left untreated by a physician (National Institutes of Health, 2011).

Immediate Attention Required

Some back pain symptoms are indicate an emergency and require immediate attention from a medical professional. These are – fever, pain when coughing, weight loss, numbness or tingling, loss of bladder control, bowel dysfunction, pain that radiates into the legs or progressive weakness in the legs, and increasing pain that lasts more than three months (National Institutes of Health, 2011).

Back Pain Diagnosis

A physician will perform a comprehensive evaluation before back pain treatment can begin. The initial exam should include a thorough patient history, a full neurological workup, and a physical examination. Blood work, scans and imaging, may be ordered, based upon levels of pain and symptoms. Additional tests may reveal broken bones, fractures, injury, disc herniation, bone infections, tumors, ruptured disc, malignancy, spinal stenosis, vertebral damage or degeneration (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011).

Back Pain Treatment

Back pain treatments are meant to alleviate pain and improve daily functioning (Lin, 2009). Within a few weeks of conservative back pain treatments, pain is usually reduced (Jones et al, 2010; National Institutes of Health, 2011). Physicians may prescribe several conservative back pain treatment methods (Jones et al, 2010; Lin, 2009; National Institutes of Health, 2011). These may include muscle relaxants, anticonvulsants (to treat nerve pain), antidepressants (relieves pain and aids in sleep) or pain medications (National Institutes of Health, 2011). Physical therapy may be recommended to stretch and relax muscles, strengthen the back and speed recovery (National Institutes of Health, 2011). Reducing risk factors, losing weight, and eliminating strenuous activities that aggravate pain, are all important in aiding back pain relief. Massage, acupuncture, biofeedback, or yoga may be suggested as alternative therapies as well (National Institutes of Health, 2011).

Invasive Back Pain Treatment for Serious Pain Sufferers

Physicians might suggest more aggressive pain management treatments if conservative treatments are not producing adequate results. Pain can be reduced or, even completely eliminated, with interventional therapy using injections that pain signals from getting to already irritated nerves (National Institutes of Health, 2011). These include narcotic, steroid or local anesthetic injections (National Institutes of Health, 2011). For more severe pain, nerve blocks, spinal cord stimulation or drugs administered by catheter into the spinal cord (National Institutes of Health, 2011). Pain management procedures such as spinal fusion, discectomy, foraminotomy, rhizotomy, cordotomy or spinal laminectomy are surgical options used in cases of extreme chronic back pain (National Institutes of Health, 2011).

References

1. Jones, R.; et al. (2010). Back Pain. First Consult. MD Consult Web site, Core Collection. Retrieved from 
2. Lin, M. (2009). Upper Back Pain. Marx: Rosen’s Emergency Medicine, 7th Ed. MD Consult Web site, Core Collection. Retrieved from 
3. National Institutes of Health 2011. Low Back Pain Fact Sheet. NINDS. Available at  NIH Publication No. 03-5161
4. Nidus Information Services 2010: Low Back Pain – Chronic. Patient Handouts page. MD Consult Web site, Core Collection. Available at Accessed January 14, 2011

According to the Centers for Disease Control and Prevention, half of all adults, over the age of 65, are diagnosed with arthritis each year. Arthritis is an inflammation of one or more joints, and it can be crippling in its later stages. There are different forms of arthritis, but osteoarthritis is the most common. There is no cure for arthritis. However, there are medications, procedures, and treatments that can assist with the pain caused by the disease.

Osteoarthritis is a chronic condition that is caused by gradual wear-and-tear on the joints. Obesity is usually a factor in osteoarthritis, as it causes additional stress to weight-bearing joints in the body. The hips and the knees are most effected. Rheumatoid arthritis is not caused by deterioration, rather, it is an auto-immune disorder that causes the body to attack its own tissues, and this results in the deterioration of the joints.

Treatments for arthritis are generally minimally invasive and are conservative in nature. Most arthritis treatments begin with non-steroidal anti-inflammatory medications, otherwise known as NSAIDs, including ibuprofen and naproxen. These medications can help to minimize the chronic inflammation and pain that is associated with arthritis.

Consistent exercise is important in alleviating the pain of arthritis and keeping the joints flexible and more fluid. Walking, yoga, and water aerobics are very helpful, low-impact exercises, for arthritis sufferers. Physical therapy is helpful as well, and a physical therapist can devise an exercise and stretching regimen specific to the patient’s abilities and pain level.

Speaking with an occupational therapist about what kind of accommodations can be made for arthritis in the finger joints can be helpful. He or she can make a recommendation to purchase special grips for pens, doorknobs, or a reacher for grabbing objects out of reach.

Many arthritis patients experience improvement in pain through joint injections. These consist of a corticosteroid that reduces inflammation and pain in the joint. A physician will recommend a series of joint injections that can improve a patient’s range of motion and quality of life.

Medial branch blocks have shown much success for those who are suffering pain from back and neck arthritis. Facet joint arthritis is one of the leading causes of low back pain in adults in the United States. A medial branch block can reduce inflammation and irritation in the joints of the spine. Often, relief from this kind of pain is immediate. Medial branch blocks may be performed several times in order to reach optimum pain relief.

Sometimes, the only remedy for severe arthritis is complete joint replacement. By replacing the damaged joint with a plastic and/or metal prosthesis, the patient successfully returns to a pain free lifestyle, and they may be able to resume the activities that arthritis has robbed them of for years. Knee and hip replacements are the most common, but medical technology has advanced to include shoulder joint replacements, elbow joint replacements and finger joint replacements as well. Replacement surgery may alleviate arthritis associated pain, but recovery time post-surgery is often long and it can have complications that are not a risk with non-invasive treatments.

According to the Centers for Disease Control and Prevention, half of all adults, over the age of 65, are diagnosed with arthritis each year. Arthritis is an inflammation of one or more joints, and it can be crippling in its later stages. There are different forms of arthritis, but osteoarthritis is the most common. There is no cure for arthritis. However, there are medications, procedures, and treatments that can assist with the pain caused by the disease.

Osteoarthritis is a chronic condition that is caused by gradual wear-and-tear on the joints. Obesity is usually a factor in osteoarthritis, as it causes additional stress to weight-bearing joints in the body. The hips and the knees are most effected. Rheumatoid arthritis is not caused by deterioration, rather, it is an auto-immune disorder that causes the body to attack its own tissues, and this results in the deterioration of the joints.

Treatments for arthritis are generally minimally invasive and are conservative in nature. Most arthritis treatments begin with non-steroidal anti-inflammatory medications, otherwise known as NSAIDs, including ibuprofen and naproxen. These medications can help to minimize the chronic inflammation and pain that is associated with arthritis.

Consistent exercise is important in alleviating the pain of arthritis and keeping the joints flexible and more fluid. Walking, yoga, and water aerobics are very helpful, low-impact exercises, for arthritis sufferers. Physical therapy is helpful as well, and a physical therapist can devise an exercise and stretching regimen specific to the patient’s abilities and pain level.

Speaking with an occupational therapist about what kind of accommodations can be made for arthritis in the finger joints can be helpful. He or she can make a recommendation to purchase special grips for pens, doorknobs, or a reacher for grabbing objects out of reach.

Many arthritis patients experience improvement in pain through joint injections. These consist of a corticosteroid that reduces inflammation and pain in the joint. A physician will recommend a series of joint injections that can improve a patient’s range of motion and quality of life.

Medial branch blocks have shown much success for those who are suffering pain from back and neck arthritis. Facet joint arthritis is one of the leading causes of low back pain in adults in the United States. A medial branch block can reduce inflammation and irritation in the joints of the spine. Often, relief from this kind of pain is immediate. Medial branch blocks may be performed several times in order to reach optimum pain relief.

Sometimes, the only remedy for severe arthritis is complete joint replacement. By replacing the damaged joint with a plastic and/or metal prosthesis, the patient successfully returns to a pain free lifestyle, and they may be able to resume the activities that arthritis has robbed them of for years. Knee and hip replacements are the most common, but medical technology has advanced to include shoulder joint replacements, elbow joint replacements and finger joint replacements as well. Replacement surgery may alleviate arthritis associated pain, but recovery time post-surgery is often long and it can have complications that are not a risk with non-invasive treatments.