Pain Relief Centers - Cervical epidural, Pinellas pain, Nerve block, RSD, Complex regional pain syndrome

Arachnoiditis is a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. It is characterized by severe stinging, "burning pain," and neurological problems.

Causes of Arachnoiditis
Inflammation of the arachnoid can lead to the formation of scar tissue and can cause the spinal nerves to stick together and malfunction. The arachnoid can become inflamed because of an irritation from one of the following sources: direct injury, chemicals previously used in myelograms, infection, chronic spinal nerve compression and complications from spinal surgery or invasive procedures.

Symptoms of Arachnoiditis
Arachnoiditis has no consistent pattern of symptoms, but in many people it affects the nerves connecting to the lower back and legs. The most common symptom is pain; but, arachnoiditis can also cause other symptoms. These include the following: tingling, numbness, weakness in the legs. Abnormal sensations like crawling insects, electric shocks, spasms, twitching, as well as bowel, bladder or sexual dysfunction may also occur. The condition is difficulty to diagnosis, but tests such as a CT scan (computerized axial tomography) or MRI (magnetic resonance imaging) are helpful. A test called an electromyogram (EMG) can assess the severity of the ongoing damage to affected nerve roots by using electrical impulses to check nerve function.

Treatment of Arachnoiditis
There is no cure for arachnoiditis. Treatment options for arachnoiditis are similar to those for other chronic pain conditions. Most treatments focus on relieving pain and improving symptoms that impair daily activities. Often, health care professionals recommend a program of pain management, physiotherapy, exercise, and psychotherapy. Surgery for arachnoiditis is controversial because outcomes can be poor and provide only short-term relief. Clinical trials of steroid injections and electrical stimulation are needed to determine whether those treatments are effective.

Complex Regional Pain Syndrome (CRPS) is a chronic disease characterized by severe pain, swelling and changes in the skin. CRPS into two types based on the presence of nerve lesion following the injury.

Type I, also known as Reflex Sympathetic Dystrophy (RSD), Sudeck's atrophy, Reflex Neurovascular Dystrophy (RND) or Algoneurodystrophy, does not have demonstrable nerve lesions. Type II, also known as Causalgia, has evidence of obvious nerve damage.

Causes of Complex Regional Pain Syndrome

The cause of this syndrome is currently unknown. Precipitating factors include illness, injury and surgery, although there are documented cases that have no documentable injury to the place originally affected by complex regional pain syndrome.

Symptoms of Complex Regional Pain Syndrome
The symptoms of CRPS usually begin near the site of an injury, either major or minor, and usually spread beyond the original area. Symptoms may spread to involve the entire limb and, rarely, the opposite limb. The most common symptom is burning pain. The patient may also experience muscle spasms, local swelling, increased sweating, softening of bones, joint tenderness or stiffness, restricted or painful movement, and changes in the nails and skin.

The pain of CRPS is continuous and may be heightened by emotional stress. Moving or touching the limb is often intolerable. Eventually the joints become stiff from disuse, and the skin, muscles, and bone atrophy. The symptoms of CRPS vary in severity and duration. There are three variants of CRPS, previously thought of as stages. It is now believed that patients with CRPS do not progress through these stages sequentially and/or that these stages are not time-limited. Instead, patients are likely to have one of the three following types of disease progression:

Type one is characterized by severe, burning pain at the site of the injury. Muscle spasm, joint stiffness, restricted mobility, rapid hair and nail growth, and vasospasm (a constriction of the blood vessels) that affects color and temperature of the skin can also occur.
Type two is characterized by more intense pain. Swelling spreads, hair growth diminishes, nails become cracked, brittle, grooved, and spotty, osteoporosis becomes severe and diffuse, joints thicken, and muscles atrophy.
Type three is characterized by irreversible changes in the skin and bones, while the pain becomes unyielding and may involve the entire limb. There is marked muscle atrophy, severely limited mobility of the affected area, and flexor tendon contractions (contractions of the muscles and tendons that flex the joints). Occasionally the limb is displaced from its normal position, and marked bone softening is more dispersed.

No specific test is available for CRPS, which is diagnosed primarily through observation of the symptoms. However, thermography, sweat testing, x-rays, electrodiagnostics, and sympathetic blocks can be used to build up a picture of the disorder. Diagnosis is complicated by the fact that some patients improve without treatment. A delay in diagnosis and/or treatment for this syndrome can result in severe physical and psychological problems. Early recognition and prompt treatment provide the greatest opportunity for recovery. It is not usual for the course of this syndrome to change suddenly.

Treatment of Complex Regional Pain Syndrome
The general strategy in CRPS treatment is often multi-disciplinary, with the use of different types of medications combined with distinct physical therapies. The goal of treatment is to manage the symptoms and maintain or improve function of the affected area. The quicker the diagnosis is made and the area is treated, the more likely the problem is to go into remission.

Physicians use a variety of drugs to treat CRPS, including antidepressants, anti-inflammatories such as corticosteroids and COX-inhibitors such as piroxicam, vasodilators, GABA analogs such gabapentin and pregabalin, and alpha- or beta-adrenergic-blocking compounds.

Sympathetic blocks of the affected area can be helpful to decrease symptoms and allow more effective rehabilitation. These include lumbar sympathetic blocks, stellate ganglion blocks, and are some cases, sympathetic radiofrequency sympathectomy.

Neurostimulation (spinal cord stimulators) may also be surgically implanted to reduce the pain by directly stimulating the spinal cord. These devices place electrodes either in the epidural space (space above the spinal cord) or directly over nerves located outside the central nervous system. Implantable drug pumps may also be used to deliver pain medication directly to the cerebrospinal fluid which allows powerful opioids to be used in a much smaller dose than when taken orally.

Alternative treatments for complex regional pain syndrome include accupuncture or Ketamine therapy. Ketamine is a potent anesthetic, and is administered in different doses in an attempt to “reboot” the abnormal brain activity. These treatments are controversial, and some forms of Ketamine therapy are not approved for use in the United States.

Causes of Degenerative Disc Disease
Everyone experiences degeneration of the intervertebral discs with age. Injuries, either large or small, are the most common cause of disc degeneration. After injury, the discs in the spine dehydrate, or dry out, and lose their ability to act as shock absorbers between the vertebrae. There is minimal blood supply to the discs so they are unable to heal or repair themselves.

Symptoms of Degenerative Disc Disease
With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, or there is pain in the buttocks or thighs while walking; sporadic tingling or weakness through the knees may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, and twisting.

Treatment of Degenerative Disc Disease
Conservative treatment is the first choice for degenerative disc disease. One or a combination of treatments such as physical therapy, home exercise, osteopathic manipulation, anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs and spinal injections often provide adequate relief of these troubling symptoms. By completing diagnostic median branch blocks, doctors can evaluate how much of the discomfort is coming from the facet joints. If this is found to be one of the sources of pain, the nerves sending pain signals from those joints can be treated with radiofrequency rhizotomy.

Surgery is rarely considered unless the degenerative changes in the spine cause a progressive neurological problem and the symptoms to not respond to conservative care.

Failed Back Syndrome (FBS) or Post-laminectomy Syndrome is a condition characterized by persistent pain following back surgeries.

Failed back syndrome (FBS), more commonly referred to as "failed back surgery syndrome" (FBSS), refers to chronic back and/or leg pain that occurs after back (spinal) surgery. Multiple things can contribute to FBS. These include residual or recurrent disc herniation, continued post-operative pressure on a spinal nerve, joint hypermobility with instability, scar tissue (fibrosis), depression, anxiety, sleeplessness and loss of spinal muscle tone. Patients may be more at risk for the problem because of diabetes, autoimmune disease and peripheral blood vessels (vascular) disease. Smoking is a risk for poor recovery from such an operation.

Causes of the Failed Back Syndrome
Surgeons will argue that the cause of FBSS "can be poor patient selection, incorrect diagnosis, suboptimal selection of surgery, poor technique ...and/or recurrent pathology", as well as including "failure to achieve surgical goals". Unfortunately the causes of continued pain are difficult to identify and pain can become chronic. Repeated surgical intervention is not usually helpful. For those contemplating more surgery additional complications must be considered. Complications of spinal fusion surgery may include instrument failure, bone-donor site infection or chronic pain; neural injuries, pulmonary embolus, infections, vascular complications (rare but potentially very serious) and failure to achieve a solid fusion.

Symptoms of Failed Back Syndrome
Common symptoms associated with FBS include generalized, dull and aching pain involving the back and/or legs. Abnormal sensations may include sharp, pricking, and stabbing pain in the legs. The term “post-laminectomy syndrome” is used by some doctors to indicate the same condition as failed back syndrome.

Treatment of Failed Back Syndrome
The goal of the treatment for FBS is based on helping the patient control the symptoms and improve their quality of life. Gradually increasing exercise and changing the lifestyle to avoid things that increase the pain are very important. Treatment can include medications for pain and inflammation. Medications to change the way pain signals are sent in the body, such as gabapentin (Neurontin), pregabilin (Lyrica) and amitriptyline (Elavil) may improve the pain. Medications for depression may also be helpful. Interventional (injection) treatments to treat some of the sources of pain include diagnostic blocks to evaluate the pain sources. Pain coming from the facet joints may improve with radiofrequency rhizotomy. Epidural steroid injections may also help improve pain, particularly if it goes into the legs.

In addition, more invasive modalities, such as spinal cord stimulation, may offer relief for certain patients with FBSS, but these modalities, although often referred to as “minimally invasive", require additional surgery, and have complications of their own.

A herniated disc is a disc that pushes into the spinal canal. It may also be called a ruptured disc or slipped disc. As a disc degenerates (breaks down with time), it can herniate (the inner core pushes out) into the spinal canal. This occurs when a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out. This tear in the disc may result in the release of inflammatory chemical chemicals which may directly cause severe pain, even in the nerves are not directly compressed. This is called “chemical radiculitis”.

Causes of a Herniated Disc
The discs in your spine act like cushions, or shock absorbers. With age, the discs start to dry out and become flatter. If a disc becomes too weak, the outer part (annulus) may tear. The inside (nucleus pulposus) part of the disc pushes through the tear and can press on the nerves beside it. Herniated discs most frequently occur in the lumbar (lower back) area, but can also occur in the cervical (neck) and thoracic (mid-back) spine.

Symptoms of a Herniated Disc
Symptoms of a herniated disc vary from person to person. Pain usually occurs at the level of the herniated disc, but can also be referred to other areas. If the herniated disc puts pressure on one of the nerves in the spine, it may cause pain to radiate to the legs (from the back) or the arms (from the neck). When the disc herniates, it can also release chemicals that can be very irritating to the surrounding tissues and cause pain to radiate into the arms or legs. This is called “chemical radiculitis”. Pain from lumbar herniated discs commonly spreads into the buttock, down the thigh and into the calf. This is commonly referred to as sciatica.

Other symptoms can include weakness, numbness, tingling, loss of reflexes or muscle tone, foot drop, and loss of bowel and bladder control. Pain usually worsens with activity, coughing, sitting, bending forward and straining to have a bowel movement.

Treatment of a Herniated Disc
Treatment of a herniated disc usually begins with a period of conservative treatment that may include medications, physical therapy, home exercise and lifestyle modification. Patients who do not improve with these conservative measures may respond to epidural steroid or nerve root injections. In certain cases, patients respond to disc decompression with devices such as the DRX 9000. IDET can be helpful for selected patients. Patients with herniated discs may also have facet related pain, which responds to diagnostic blocks and radiofrequency.

Patients with severe symptoms that do not respond to other treatment, or those that have symptoms that show nerve damage is becoming progressively worse (i.e. loss of bowel or bladder control, muscle wasting, progressive weakness) may be candidates for surgery. Surgical procedures include laminectomy, discectomy or fusion. Unfortunately, surgery is not recommended or effective for all patients, and carries its own risks.

Spinal Stenosis is the narrowing of the spinal canal by a piece of bone or disc material.
This narrowing can put pressure on the spinal cord and/or nerves. This can cause weakness or numbness in your arms or legs. Spinal stenosis can occur in a variety of ways in the spine. Most cases of spinal stenosis occur in the lower back (lumbar spine) and will affect the nerves that run along the back of the leg and cause pain or abnormal sensations.

Causes of Spinal Stenosis
Age related changes in the spine are the most common cause of spinal stenosis. Over time, ligaments (strong tissues that connect bones) get thicker. The disks between the vertebrae (bones of the spine) may begin to break down, putting pressure on other parts of the spine. The facet joints (small joints between each vertebra) become thicker and decrease the space around the nerves or spinal canal.

Spinal stenosis can also be found in younger people whose spinal canal was smaller than usual, or who had deformed vertebrae at birth. Spondylolisthesis (a slip of one vertebrae on another), tumors of the spine and diffuse idiopathic skeletal hyperostosis (DISH) can all also narrow the spinal canal and cause spinal stenosis.

Symptoms of Spinal Stenosis
Spinal stenosis may result in low back pain or neck pain. The pain may also occur in the arms or legs. It can cause the weakness, numbness, decreased muscle size, loss of reflexes in the arms or legs. Some people will notice a heavy, tired feeling in the legs and symptoms can get severe enough to make standing and walking difficult. Many patients notice their pain improves with rest, sitting, or leaning forward on things such as a shopping cart.

Treatment of Spinal Stenosis
Spinal stenosis treatment includes weight loss, and lifestyle and activity changes. Epidural steroid injections may also help relieve the symptoms. Lumbar facet blocks and radiofrequency rhizotomy may help improve the back pain and some leg symptoms. If the symptoms are severe enough to cause a progressive neurological problem, a laminectomy or foraminotomy may be indicated to take pressure off the spinal nerve.