Pain is often misleading. It can radiate and travel throughout the body leaving a patient unsure of the actual source of pain or injury this is the case with cervical radiculopathy.
Impingement of a nerve in the cervical spine (neck) can often cause cervical radiculopathy or cervical radiculitis.
This type of pain is particularly deceiving as it may present as shooting pain, tingling, numbness and muscle weakness and may be felt in the neck, upper back, shoulders, arms, hands and/or fingers.
Cervical radiculitis usually occurs as a result of some underlying condition affecting the cervical discs or vertebrae. Such conditions may be; herniated disc in the neck, spondylolisthesis, or a buldging disc for example. In some cases the cause of these conditions is due to an injury or trauma of some kind, however, very often cervical pain is due to degeneration in the spine. Age, poor body mechanics, smoking, and genetics are all factors that contribute to neck pain.
Treatment of cervical radiculopathy
Radiating pain can mask the underlying cause or source of pain which could lead to an inaccurate diagnosis and mistreatment of the pain.
Therefore it is imperative that patients seek the medical attention of a qualified pain specialist who can perform appropriate diagnostic tests and order MRIs or XRAYs to pinpoint the true source of their pain.
The conservative, non-surgical and minimally invasive treatments offered by interventional pain specialists often solve the pain associated with cervical radiculitis at the source of the problem.
Interventional pain management offers advanced injection based procedures that reduce the need for medications, provide longer term pain relief and reduce the likelihood of expensive surgeries with long recovery times.
Procedures designed specifically for the cervical spine include:
The Surgeon General, Vivek H. Murthy, M.D., M.B.A. recently sent out a letter to all American physicians urging us to do everything in our power to address the opioid epidemic.
The opioid epidemic is a very real and serious situation, so too is the need to treat pain responsibly.
Newbridge Spine & Pain Center is one of the Greater Washington area’s premier interventional pain management facilities dedicated to treating pain. Our physicians are Anesthesiologists with sub-specialty training in pain management.
There are many misconceptions about the ‘pain management’ specialty resulting from the mismanagement and over-prescribing of addictive painkillers. However, our specialization, interventional pain management, addresses both the rising opioid epidemic and the need to treat pain.
Treating pain in a conservative, responsible manner is our daily commitment.
We do this by:
- Utilizing non-surgical, interventional pain procedures to quickly and effectively reduce pain levels.
- In cases where medication management is unavoidable, we aim to reduce reliance on pharmacologic substances, opioids & narcotics by maintaining low doses and outlining treatment plans that take a multidisciplinary approach to include; weight-loss, physical therapy and/or counseling for example.
The Newbridge team spends a significant amount of energy encouraging our fellow healthcare providers to refer to interventional pain management before prescribing or laying out a treatment plan. This is because our therapeutic procedures work at the onset of pain as well as for chronic pain conditions.
We firmly believe that the sooner a patient can be treated by a pain specialist using interventional methods the less likely that patient is to be prescribed a long-term medication schedule.
Most pain complaints relate to pain originating throughout the spine, however, an interventional pain doctor can treat acute and chronic pain all throughout the body to include the limbs and joints in the peripheral body.
September is Pain Awareness month!
Post traumatic stress disorder (PTSD) is often known to occur in military veterans and those who have suffered traumatic events involving either physical harm or the threat of physical harm [ Source: www.nimh.nih.gov]. PTSD is defined as having at least 1 month of re-experiencing trauma symptoms, 3 avoidance symptoms and/or two or more hyperarousal symptoms.
Symptoms of PTSD make it difficult for patients to function throughout their regular daily lives and is often found to co-occur with chronic pain. A recent study published in the Journal of Pain [Vol. 16, No. 10, Oct 2015) found that the two conditions exacerbate each other. Chronic pain intensity was associated with anxiety and anxiety sensitivity, a symptom of PTSD.
We have long known that depression and chronic pain have a similar co-occurrence. However, the study showed that PTSD had a unique profile for hyper-responsiveness and hypersensitivity to pain.
Chronic pain was reported to be 2-5 times more likely to affect PTSD patients than the general population. Conversely chronic pain patients were 2-4 times more likely to exhibit PTSD symptoms than the general population.
PTSD is not the only type of stress that has been linked with pain. Psychological factors of stress have been long known to impact the central nervous system feeding into the stress cycle and exacerbating chronic pain.
The journal of pain article indicates that a reduction in stressful episodes may lead to a reduction in pain over time.
The US Department of Veteran’s affairs suggests that patients experiencing PTSD may benefit from therapy sessions and provide several resources, including the Veteran Combat Center 1-877-WAR-VETS for 24/7 support and the Vet Center for military vets transitioning into civilian life.
There are many other stress reduction techniques including; meditation, yoga, and exercise. For those in severe immediate pain interventional pain management can help improve mobility and the ability to participate in some of the above stress reduction techniques.
5 misconceptions about Pain Management
We asked our Doctors to set the record straight and clarify 5 common misconceptions about Pain Management, pain medicine and what we do. Here’s what they had to say:
1) It just entails a doctor writing for pain medications:
Most people have the misconception that pain management specialists primarily and solely write for pain medications as their means of treating acute/chronic pain. This couldn’t be farther from the truth. In fact, it is our goal to keep people from requiring chronic dosing of pain medications as this in itself has long term side effects and changes how our bodies work.
Our intention is to start with an accurate diagnosis of the cause of a patient’s main source of pain and to then implement interventional procedures that can either treat or moderate a patient’s pain. The idea is to either resolve or, at the least, temporize a patients level of chronic pain so that they have more tolerance to physical therapy and require less daily pain medication in the future.
Another common misconception is that a Pain Physician’s use of the term “pain medication” refers to controlled narcotic substances. It is always our initiative to use a combination of different types of medications which are not necessarily narcotics.
As Pain Physicians we avoid the initiation of these pain medications as narcotics carry inherent risks and can become a long term burden on the patient.
There are certain cases where patients have causes of pain that cannot be treated with interventional procedures, and in these few cases we then explore different types and combinations of medications.
We reserve the use of narcotics, for a short time, for cases where procedures do not provide adequate relief, however, hoping not to introduce controlled substances on a long term basis.
2) It’s only for people with neck and back problems:
When people think of pain management, they usually first think of neck and low back pain limited to the spine. Although this can describe a majority of our patients, we also treat many other sites and sources of pain such as chronic headaches, knee, shoulder, abdominal, pelvic pain and facial pain.
We can also treat peripheral neuropathic pain such as that caused by diabetes and chemotherapy or postherpetic neuralgia as a result of having had shingles.
3) It’s a last resort:
Unfortunately, most people come to pain management after having dealt with chronic pain for a long time and seeing physicians whose therapies might be limited to pain medications. Chronic pain along with prolonged use of narcotics causes multiple changes in the body such as changes in normal levels of circulating hormones and sleep cycles. Therapeautic interventions work best the sooner we see a patient as these other physiologic changes have not yet occurred and there is less to reverse.
These chronic physiologic changes can cause mood changes along with how our bodies perceive pain, sometimes making us more sensitive to painful sensations. In short, seeking a consult with a pain specialist as soon as pain persists is the best way to manage your pain in the long term.
4) Pain procedures are only a short term fix and only mask the pain until it returns:
In many cases this statement is actually true. Our goal in interventional pain management is to alleviate or minimize the pain that a patient feels on a daily basis so that they can be more functional and participate in modalities such as physical therapy. Our purpose in pain management is to prepare a patient’s body for building strength so that there are less acute and severe painful episodes.
Although sometimes we are unable to relieve pain completely, we can provide intermittent episodes of relief and eliminate the need for surgery if the patient is a poor surgical candidate or chooses not to undergo surgery.
The longevity of the pain relief a patient experiences depends on the cause of their pain and available therapies that can be offered to the patient. Although some of our therapies do not give prolonged relief, some do.
It is all on a case by case basis, and depends on the age and pathology of a patient’s pain. It is important that patients get assessed by an interventional pain physician to determine if there is a long term relief option for their source of pain.
In many cases, the earlier a patient seeks treatment for their pain the longer their pain relief experience may be.
5) All pain management specialists are the same, if you’ve tried one, there is no use exploring your options with another:
As with any specialty, outcomes are based on a physician’s individual skill and training. Because pain management is an evolving specialty, there are many new procedures that could be introduced to patient’s treatment plan.
Sometimes patients have a failed procedure or had a bad experience and assume that any future interventions will continue to be unfruitful. This is not usually the case. Therefore, it is important to do your research.
Seeking a more interventional driven pain physician who might have more skill or experience in different therapies may be an option to better treat your pain.
Dr. Sana Shaikh is a Pain Management Specialist in Frederick MD
Sana Shaikh, MD is one of the newest additions to the Newbridge pain management and anesthesia teams. Dr. Sana Shaikh is an experienced pain management provider and ABA board-certified Anesthesiologist, read Dr. Sana Shaikh’s bio. We asked Dr. Sana Shaikh about the practice of pain management, her philosophy and the treatment of chronic pain. Here is her response:
What can a pain management specialist do for pain?
A common misconception about pain management is that it is primarily pain medication management. As pain specialists we are actually are able to treat many kinds of chronic pain by doing x-ray, fluoroscopic and ultrasound guided procedures in hopes of minimizing the need for pain medications and injections. These minimally-invasive procedures allow people to return to their daily activities without being tied to a medication schedule.
Why is it important for patients to see a pain specialist at the earliest opportunity?
As a pain management physician, I find patients come to me after years of dealing with their pain and having seen many physicians but having minimal improvement in their symptom. As the source of pain becomes a chronic problem, it starts to affects other aspects of a your health. The social, emotional and psychological impacts of chronic pain start to play a role in the perception of your pain and thus start adding to the impact of pain in a persons daily life.
Limiting activity, restricting social engagements and the stress and barriers that severe pain imposes starts to change a patients outlook on improvement and hope for a pain free future. There are actually documented physical and chemical changes that occur in a patient with chronic pain. Changes are seen in circulating cortisol levels, along with other normal transmitters involved with sleep cycles and mood.
I am a great believer in treating pain as early as it starts as I find we can prevent pain from progressing into a debilitating hindrance for many patients. Once a patient’s pain has already become chronic, I always make sure the treatment is a multimodal plan, involving interventional techniques that treat the initial source of the pain along with the incorporation of physical rehabilitation and psychosocial therapies to help get the patient back to the quality of life they strive for.
Healthy sleep behaviors are also significantly impacted by chronic pain. Typically patients experience frequent awakening at night and unrestful sleep. Patients with fibromyalgia, a disorder which causes chronic pain have documented changes seen in their sleep EMG studies. The lack of deep sleep in these patients has been linked to decreased levels of healthy neurotransmitters which affect the way a patient’s body copes with and perceives pain.
The chronic pain patient starts to experience a hindrance to their daily life, work, financial ability as well as their interpersonal relationships due to the many ways chronic pain affects the human body. As healthcare develops and our patient population ages, it is important to effectively treat acute pain as soon as possible before it takes such a great toll on people’s lives.
What happens when pain becomes chronic?
Once pain becomes chronic, the treatment changes as well. Although we start by focusing on the main source of the pain, it becomes important to also address the other aspects of a patient’s health that have been affected. Chronic pain patients typically avoid behaviors and movements that trigger their pain, however, these adjustments in a patient’s behavior & movement often leads to further muscle wasting and usually leads to additional myofascial pain.
Because of this, a multimodal / multidisciplinary care plan for treating pain, such as we provide at Newbridge Spine & Pain, is often crucial in long term pain management. Developing a care plan that includes physical therapy and rehabilitation are crucial to changing learned behaviors that may have contributed to a patient’s pain.
As part of my pain management care plans I also assess how pain has affected my patient’s coping skills and objectivity. Typically there is also a level of depression that accompanies the changes seen with chronic pain. Many times, incorporating behavioral and psychological therapy can help patients change their perspective and outlook on their pain allowing them to be more positive and proactive towards improvement.
Chronic pain is defined as a pain lasting more than 3-6 months. It happens to be a great source of healthcare cost per year and affects 100 million adult Americans as reported in 2011 by the Institute of Medicine. On February 2014, it even got the attention of USA Today News which highlighted the prevalence, impact and missed treatment options throughout the nation.
Phantom pain is an elusive concept to some, however, this condition is very real and affects between 50%-80% of all amputees regardless of age or gender. Phantom pain is a neuropathic pain condition where the nervous system is malfunctioning and triggering real pain sensations in patients with amputated limbs.
When does phantom limb pain occur?
Image Courtesy of ashlandhumanbio.blogspot.com
Studies have shown that patients who had pain in the limb prior to amputation have a higher likelihood of experiencing phantom limb pain following amputation. Usually phantom pain occurs within an few days of amputation, however, in some cases phantom pain can develop months or even years later.
What does phantom pain feel like?
Cases of reported phantom pain have described excruciating sensations including, hands or feet being crushed, toes or fingers being stretched, bones feeling as though they have been shattered and hot pokers being thrust through the foot or hand.
What can be done to treat phantom pains?
There are a variety of treatments available for this pain condition including non-surgical interventional procedures and alternative treatments. The appropraite course of treatment is always dependant on the individual patient.
Non-Surgical Pain Procedures:
- TENS units
- Physical Therapy
At Newbridge Spine & Pain Center our initial consultation always includes an assessment of your current treatments as well as your condition. We treat the person and their pain and employ a multi-disciplinary approach to managing pain that is highly personalized.
One of the most common symptoms we see patients for in pain management is radiculitis. Radicular pain or radiculitis is defined as, “pain “radiated” along the dermatome (sensory distribution) of a nerve due to inflammation or other irritation of the nerve root (radiculopathy) at its connection to the spinal column.” [Source: Wikipedia].
Down both sides of the spinal column are nerves that exit through holes in the bone of the spine these are called nerve roots. At each level of the spine these nerve roots branch out to different parts of our bodies. The nerve roots are susceptible to changes or damage to the spine, such damage results in the sensation of, sometimes severe, pain.
What is radicular pain?
Radiculitis, Radiculopathy, and Radicular Pain are not a diagnosis exactly but a description of a pain sensation caused by a pinched, compressed, inflamed or otherwise irritated nerve root. Common conditions that result in radicular pain include sciatica, lumbosacral spondylosis, degeneration of the lumbar spine and spinal stenosis.
Where is radiculitis felt?
It is common for radicular pain to be felt in the buttocks and legs as a shooting pain sensation, however radicular pain is not always due to problems in the lumbar spine or lower back.
Radicular pain is also extremely common in the cervical spine, known as cervical radiculopathy, this pain, due to pinched nerves in the neck, is sometimes caused by herniated or degenerative discs in the neck area resulting in pain, tingling or prickling sensations in the hand and down the arm.
How can radicilitis develop?
Spasm, low trauma car accident such as a fender bender can result in damage to the nerve root causing radiating pains.
What can be done to treat radicular pain?
At Newbridge we often perform nerve block injections to treat radicular pain. Nerve blocks are an injection of steroids and anesthetics that help heal the nerve and restore normal function. When a nerve block is successful in offering relief your specialist may suggest the longer lasting radiofrequency procedure.
In severe cases a patient may require surgery, if this is discovered during a procedure the patient will be referred to an appropriate surgeon.
Stress and Chronic Pain Management
Researchers have recently been discovering the link between stress and chronic pain. Our traditional understanding of pain as a signal being sent to the brain from a periphery, such as a stubbing your toe, is applicable when it comes to acute pain, pain caused by an accident or injury and usually lasting six weeks or less. However, experts continue to learn that for chronic or long-lasting pain this explanation doesn’t suffice.
The brain, being what it is, is a two way system, not only do pain signals go to the brain but the brain sends signals through the spinal cord affecting our perception of pain also. The brains perception of what is dangerous to our well-being and what thresholds and tolerance to pain we should have directly impacts the central nervous system. This impact often leads to the persistence of pain even after an injury has healed. Pain signals can remain active in the nervous system for weeks, months, or even years resulting in chronic pain conditions.
In light of this information it comes as no surprise that psychological factors invariably triggers our brains defenses and thus our perception of pain. One such example of psychological factors impacting chronic pain is stress.
What is Stress?
- Perceived inability to cope with an unpleasant or painful life situation,
- Non specific response to demands placed on the body,
- Internal/external force causing a person to be tense, upset, or anxious,
- Stress can be physical or emotional,
- Stress can come as a result of threat – whether that threat is perceived or actual,
It is well documented that stress produces physical, emotional, and behavioral responses in a person and can trigger the fight or flight response, releasing steroid hormones and chemicals including corticoid, and epinephrine (adrenaline).
Stress has been known to increase the intensity of pain, contribute to depression and anxiety ultimately decreasing a persons ability to tolerate pain, and diminish a persons ability to cope with pain. However stress is not credited with causing prolonged or chronic pain but rather feeds into it.
Stress/ Pain Cycle
Stress has both emotional and physical impacts often resulting in increased sensitivity to pain.
There are many stress reduction techniques to help you manage your response to stress factors, these include but are not limited to:
- communicating with a professional or a loved one,
- engaging in humorous or pleasurable activities,
- and in some cases medications may help.
[Sources: aspmn, webmd, cleveland clinic]
Managing the Holidays with Chronic Pain
For most of us the holidays are a wonderful time full of food, family & festivities. However, if you suffer from chronic pain or any condition or injury that results in severe pain symptoms the holidays can be daunting, depressing and stressful. One of the most common complaints we hear from patients and pain sufferers alike is that they feel guilt during the holidays guilt that they are not participating or living up to expectations be that their own or someone elses. These feelings of guilt and stress can actually make managing chronic pain more difficult and creates unnecessary anxiety potentially exacerbating pain symptoms. Here are a few tips from around the web to act as reminders when feeling the pressures of the holidays.
Give yourself a G.I.F.T
Healthcentral.com provides a great article focusing on the GIFT principle:
- Guilt: Accept the fact that you have a chronic illness and make a firm decision not to entertain any feelings of guilt because of what you cannot do. Instead, focus your attention on what you can do.
- Importance: Pick your battles – decide what aspects of the holidays are most important to you and your immediate family. Focus on accomplishing only these things and that way you may avoid overwhelming yourself and creating unrealistic expectations for the holidays.
- Family Matters: It’s great to see the extended family, if you can, but it’s important to make sure that if you can’t you communicate this to your family. The only explanation you need is that your health is your first priority and you will join in the festivities when your health allows.
- Think Ahead: Planning is key to avoiding last minute stress. Write your plans down, make to-do lists and agendas and make sure you give yourself ample time to achieve your plans.
Avoiding “over-doing” it during the holidays
There are multiple ways in which new injuries can be caused and old injuries resurfaced. Reaching to hang the ornaments, dragging that old tree out from the attic, lifting luggage as the relatives arrive, standing, bending turning, the list goes on. Much pain, particularly back pain, and many injuries can be avoided by adhering to proper lifting techniques. What is a proper lifting technique? Bend at the knees, grasp the object firmly, engage your core muscles to support your lower back and lift up using your quad, thigh and gluteal muscles.
This guide from WebMD gives a more detailed explanation of the perfect lift:
- Keep a wide base of support. Your feet should be shoulder-width apart, with one foot slightly ahead of the other (karate stance).
- Squat down, bending at the hips and knees only. If necessary, put one knee to the floor and your other knee in front of you, bent at a right angle (half kneeling).
- Maintain good posture. Look straight ahead, and keep your back straight, your chest out, and your shoulders back. This helps keep your upper back straight while maintaining a slight arch in your lower back.
- Slowly lift by straightening your hips and knees (not your back). Keep your back straight, and don’t twist as you lift.
- Hold the load as close to your body as possible, at the level of your belly button.
- Use your feet to change direction, taking small steps.
- Lead with your hips as you change direction. Keep your shoulders in line with your hips as you move.
- Set down your load carefully, squatting with the knees and hips only
Don’t be afraid to ask for help – it’s simple -somethings just should not be done alone ask for help and offer help to others.
Newbridge Spine & Pain Center treats the symptoms of chronic and acute pain. With three locations in Maryland & a new location opening in Leesburg, VA in 2014 Newbridge Spine & Pain Center’s group of trusted and experienced Anesthesiologists have been treating pain since 1996.