Posts made in August 2018

Second most common reason why adults in the US visit the doctor, it’s the most common type of chronic pain problem. Depending on the duration of symptoms, back pain can be classified as Chronic (more than 6 months) and acute (meaning short term). Conservative measures are usually successful in treating acute pain. These include the use of ice or heat therapy or compresses, physical or massage therapy, short-term rest and over-the-counter pain relievers. If the pain problem fails to respond appropriately to these treatment modalities and progresses to chronic, the pain and spine specialists at Florida Coast Pain and Spine Center can advise a variety of alternative and interventional treatment modalities to achieve long lasting pain relief.

Symptoms:

Vary depending on the underlying conditions. Of course, the most common symptom is pain, but due to patient-to-patient variability, the type and level of pain a patient experiences as well as the duration will differ. The character of the pain could be described differently with descriptors as such as electric shock-like pain, stabbing, sharp pain and dull or achy pain. The duration also could differ between seconds to days. Additionally, patients can present with associated symptoms, which include limb numbness, decrease mobility, decrease strength, muscle spasms and pelvis, hips and back tightness. It is advised to patients suffering from back pain that has lasted more than 3 months to seek care from a specialist, as this type of pain is considered chronic in nature.

Causes:

Back pain can be due to a number of different conditions, injuries and disease processes. Underlying conditions that can cause back pain include sciatica, degenerative disc disease, degenerative facet joint arthritis, spinal stenosis, arthritis, osteoporosis, and vertebral fractures. Also, direct trauma to the back and overuse injuries are associated with back pain. Always in the differential infection and cancerous tumors are rare possibilities.

Treatment modalities:

Once the cause has been identified an adequate treatment plan can be formulated. Always the treatment should be tailored to the specific patient and individualized. The use of conservative measures in conjunction with alternative and interventional therapies should be considered a priority in the therapeutic plan. The recommendations will vary but may include the use of intervals of rest, ice/hot therapy, pain medications over-the-counter and/or prescription strength in between recommended and indicated interventional pain treatments. The pain and spine specialists at Florida Coast Pain and Spine Center would include as indicated the use of minimally invasive non-surgical procedures including the use of steroid injections, Epidural injections, selective nerve blocks, radiofrequency ablation, nerve stimulation, regenerative therapies and trigger point injections.

The most common types of arthritis are Osteoarthritis and rheumatoid. The difference is what is causing the inflammation in the joints. Osteoarthritis is a degenerative disorder while rheumatoid arthritis is an autoimmune condition. Both diseases affect the joints causing breakage in the cartilage lining of the joints. Eventually and depending on severity and specific patient factors chronic pain can develop. The pain is due to chronic inflammation or even articular bony surfaces rubbing against each other. Osteoarthritis is most common in patients over 65; however, anyone can be diagnosed with osteoarthritis. There are different types of rheumatoid arthritis, but it may affect patients as young as 40 years old or even younger. These conditions affect the knees, hips, hands, and other joints.

Causes:

In general, Osteoarthritis develops due to normal and natural “wear and tear” of the joints but it can be the result of previous injuries to the affected joint. Additionally, overuse of the joint could also lead to joint decline. Rheumatoid arthritis is not caused by wear and tear. This condition occurs due to an autoimmune disorder in which the body starts to attack the lining that surrounds the joints. Researchers do not know exactly why people develop Rheumatoid arthritis, but it’s believed that there is a genetic component that may make people more susceptible to develop this condition.

Symptoms:

One of the most common complaints is stiffness of the affected joint(s), especially in the morning. Patients may also exhibit limited or decreased range of motion in the involved joint. The stiffness could be accompanied by constant aching pain or pain that flares up throughout the day. The joint may also show warmth and swelling. Due to decrease in range of motion, patients may also experience difficulties completing activities of daily living, such as, writing, grabbing objects, walking, cooking and dressing. Due to progression of symptoms, patient may develop weight gain, muscle weakness, and an increased risk of heart disease due to inactivity and lack of aerobic exercise.

Treatments:

The goal in the treatment is to slow down joint degeneration and to adequately manage the chronic pain associated with these conditions. At this point, there is no cure for osteoarthritis or rheumatoid arthritis. We will provide, if indicated, anti-inflammatory medications to reduce the swelling of the joint in order to control the patient’s symptoms. Our specialist physicians also offer joint injections that include nerve blocks, radiofrequency ablation, regenerative therapies and steroid medications targeting the damaged, painful joint. These injections can be repeated if necessary. We will help the patient increase range of motion and strength with the use of a physical therapy protocol or alternative therapies to help relieve pain. In extreme cases, appropriate referral to an orthopedic surgeon would be given to have the joint replaced if the degeneration is severe.

What started as a well intended effort many decades ago to help patients suffering from chronic pain achieve pain relief, has led to national crisis. We have a situation where unfortunately, a significant amount of patients have been harmed due to the use of opioid pain medications. We have learned that the potential for addiction for opioid medications is higher than what we initially thought. We also learned that despite the patient’s best efforts, they are harmed from either unintentional overdose or from unintended consequences of the use of these medications.

Extensive technological advances in our field today have allowed us to use a number of different options to help patients obtain relief from severe pain. These types of options include but are not limited to coordinated physical therapy, non-opioid medications including medical cannabis, behavioral techniques, minimally invasive procedures and surgery at times when appropriate.  These treatments have allowed us to help patients get relief whereas before these options didn’t exist.

At times, despite our best efforts and the availability of better technologies, potent opioid medications may be needed to assist with patient’s pain relief. We have learned how to safely manage these medications such that we can obtain relief and help patients seek the outcome that they are looking for. A relief that helps them get better, overcome the challenges and really enjoy life again.