Degenerative disk disease is a wear-and-tear process of the intervertebral disks, which are the buffers/connectors of the main bones of the spine, called the vertebral bodies.
When they start degenerating, mostly due to aging, and occasionally after trauma, disks lose their supporting structure that was conferring them strength and flexibility. Sometimes, acute events can rapidly create injuries triggering sudden onset of pain, or promote a longer process of accelerated degeneration. Then, they can undergo a gradual process of thinning out or bulging/herniation backward, into the spinal canal, where the spinal nerve roots are located.
Pain can originate from the damaged disks themselves, or from the compression of the nerve roots (pinched nerves).
Diabetic peripheral neuropathy is a widespread condition manifested by relentless and progressive pain in the upper and lower extremities. It may feel like pins and needles, throbbing or burning and frequently intensifies at night. It is believed to be the result of progressive nerve damage caused by high blood sugar levels when diabetes is not or poorly controlled. Sometimes, it may be the first symptom of diabetes and may appear long before the full-blown clinical picture is clear.
A primary goal is to maintain sugar levels in a tight normal range in order to minimize further spikes that predispose to further nerve damage, which is unfortunately irreversible. But solutions exist to minimize discomfort and enable increased activities and better rest. They are mostly temporary interventions interfering (slowing down or blocking) the transmission of pain signals to the brain. When performed regularly, they may decrease discomfort and improve painful symptoms and overall well-being.
A spinal disc is made out of two parts: one made of onion-like layers of fibrous tissue surrounding the other one called the nucleus, which is centrally located, filled with a combination of a thick paste-like and hard boggy material, conferring the disc shock buffering and flexibility properties. On certain occasions, the outer layers suffer a tear, with the inner material pushing through it and creating a bulge (herniation) on the outside of the disc. Causes for this condition include trauma, lifting injuries, or gradual failing due to age-related degeneration.
Tears are almost always posterior in nature. This tear in the disc ring may result in leaks of inflammatory chemical substances from the nucleus which may directly cause severe pain by irritating the nearby nerve roots or by exerting pressure on them; sometimes, these chemicals can cause vascular changes interfering with the normal supply of nutrients to the sensitive tissues of the nerve roots; when these changes persist or progress, progressive loss of nerve function may occur, causing loss of sensation (numbness) and strength (weakness).
When adequately and timely treated, these herniations heal, tears may seal off and shrink and retract back, thereby relieving both irritation and pressure, while normal blood flow and nutrition of nerve tissue resume.
All joints undergo degenerative changes associated with the wear and tear of the aging process. Every motion will involve the joints in the spine, likely subjected to sudden/traumatic, repetitive or continuous strain. This syndrome is commonly known as facet joint arthritis or facet arthropathy. It can involve all segments of the spine (neck-cervical, thoracic, lumbo-sacral). Facet joint arthritis often manifests as a deep seated, dull or stabbing/drilling ache across the back, frequently associated with significant stiffness. This pain can spread from the neck into the back of the head and shoulder girdle and from the lower back to the buttocks and thighs. While this pain can be very disabling, we are fairly successful in addressing its root causes and improve both activity and pain level, and overall quality of life.
Failed back syndrome, also called “failed back surgery syndrome”, refers to chronic back and/or leg pain that occurs after back surgery, usually after. It is characterized as a chronic pain syndrome. Contributing factors include but are not limited to residual or recurrent disc herniation causing ongoing persistent post-operative pressure on a spinal nerve; altered joint mobility, joint hypermobility with instability; loss of bony support caused by removal of the lamina, which is part of the tissues compounding the initial pressure on the nerve (laminectomy); scar tissue (fibrosis) whose growth is beyond medical control and which can create a new type of pressure on nerve roots; altered vascular supply to spinal tissues, probably due at least in part to the same process of fibrosis; spinal muscular deconditioning caused by both muscle, ligament and tendon injury during surgery, as well as deconditioning during recovery; and finally, anxiety, sleeplessness, depression.
Sciatica (sciatic neuritis, sciatic neuralgia, or lumbar-sacral radiculopathy) is caused by a pinched nerve root as it makes its way from spinal canal towards the lower extremity. It can also occur in the cervical region, where symptoms would involve the upper extremities. Features including pain that may be caused by compression or irritation of one of spinal nerve roots or their vascular supply (blood flow). Symptoms include lower back pain, buttock pain, and pain, numbness or weakness in various parts of the leg and foot. Other symptoms include pins and needles or tingling and difficulty in moving or controlling the lower limbs. When the problem occurs in the cervical region, similar complaints involve the upper extremities. Typically, the symptoms are only felt on one side of the body. While healing can occur spontaneously, in some cases that are not treated promptly the pressure on the nerve roots can result in long-term or irreversible impairment (numbness or weakness).
Fortunately, when timely diagnosis and treatment are available, the pressure can be relieved, while the inflammatory storm is kept at bay and improved blood flow allows the natural healing process to occur, especially when promoted by gradual rehabilitation exercises.
Lumbago or low back pain is a common musculo-skeletal disorder affecting 80% of people at some point in their lives. In the United States, it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neuro-muscular ailment—only headache is more common. It can be either acute, sub-acute or chronic in duration. With conservative measures, the symptoms of low back pain typically show significant improvement within a few weeks from onset.But if symptoms persist or worsen despite conservative options (rest, stretching, strengthening exercises and over-the-counter medications), they have a high probability they will become chronic and likely affect all aspects of one's life. In such situation, it is justified to adopt an aggressive approach to turn things around.
Neck pain is a common problem, with two-thirds of the population having neck pain at some point in their lives. It is frequently associated with headaches, upper back, and shoulder pain.
Neck pain and headaches may arise from numerous sources: muscular tightness in both the neck and upper back; arthritis, both age-related (degenerative) as well as inflammatory/auto-immune (rheumatoid arthritis, lupus); pinching of the nerves originating from the cervical spine; and trauma, frequently associated with high-impact incidents (car accidents-whiplash or lifting). When left untreated despite failure of simple measures (rest, stretching and over-the-counter meds), all aspects of a person's life can be dramatically affected.
A series of diagnostic steps and interventions, guided by a thorough discussion about the initial circumstances, a targeted examination and a battery of tests are very helpful in identifying the causes and mechanisms.
Treatment is frequently very effective, combining carefully chosen medications, interventions, and aggressive training and rehabilitation, frequently bypassinging the need for surgery and allow a timely return to regular activities and improved quality of life.
Failed back surgery syndrome or post-laminectomy syndrome is characterized by persistent,seemingly unexplained back and leg pain that occurs after back surgery (laminectomy or fusion, with or without the use of hardware). While surgery may be successful in addressing major risks and preventing catastrophic developments, it may leave behind a lot of pain, weakness or other unusual sensations and disabilities. It is a very difficult problem with multiple contributing factors include residual or recurrent disc herniation, persistent post-operative pressure on a spinal nerve, altered joint mobility with instability or progressive arthritis, scar tissue (fibrosis), local tissue blood flow abnormalities (ischemia), spinal muscular deconditioning. Subsequent sleeplessness, depression, anxiety further complicate this complex syndrome.
A careful and thorough approach to identifying the root causes of ongoing pain is essential. A vast clinical experience is necessary to understand the deep implications of this life-altering condition. A close collaboration between the clinicians, the patient and the assisting providers (PT, occupational, psychology specialists) offers a good chance for meaningful recovery for this previously hopeless condition.
Herpes zoster (or simply zoster), commonly known as shingles, is a viral disease characterized by a painful skin rash with blisters developing in the territory served by the afflicted nerve, giving the limited involved area a stripe-like appearance.
The initial infection with varicella zoster virus (VZV) causes the acute, short-lived illness chickenpox which generally occurs in children and young adults, as well in elderly or persons with immune (natural self-defence) deficiencies. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to lodge in a nerve root where it stays dormant, probably forever, somewhat kept in check by our natural defending mechanisms. During episodes of bodily stress (both physical and mental) the defense mechanisms of the body are weakened, allowing the virus to resurface and wreak havoc (burning, throbbing, extreme tenderness) often many years after the initial infection.
A series of medications and interventions are frequently effective in minimizing and eventually resolving these severe symptoms, although occasionally there are recurrences.Still, it helps to know there is always a solution one call away.
Both abdominal and pelvic pain are some of the most disabling conditions we encounter in the clinic. A dull or sharp, throbbing pain or overwhelming pressure can range from mild to severe. Pelvic pain refers to any pain experienced from the navel to the upper thigh region. Some pelvic pain symptoms include:
Certain body functions and activities such as urination, sexual activity or menstruation can make pelvic pain more noticeable. Ligaments, muscles nerves or even internal organs’ problems in the pelvic area can cause pain in the pelvic area. Many factors including but not limited to gynecologic conditions, irritable bowel syndrome, interstitial cystitis, surgery, chemotherapy or radiation therapy, visceral organ (internal organ) disorders, inflamed spinal joints or pinched nerves.
Women are at greater risk of getting pelvic pain due to menstruation and sexual activity. In addition, psychological factors seem to play a role and increase risk of chronic pelvic pain. Depression, chronic anxiety and stress, history of sexual and/or physical abuse increase the risk for pelvic pain.
There are a number of pelvic pain management treatment options, which, used wisely and in the proper order, can identify protocols to decrease pain and improve quality of life.