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At Tri-County Pain Consultants we believe that chronic pain should be treated like other chronic medical conditions such as diabetes, asthma or congestive heart failure.
Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care.
Chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic. The back is an intricate structure of bones, muscles, and other tissues that form the posterior part of the body’s trunk, from the neck to the pelvis. The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.
Pain can occur when, for example, someone lifts something too heavy or over stretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.
Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength.
Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column.
Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the pain. X-ray imaging includes conventional and enhanced methods that can help diagnose the cause and site of back pain. Discography involves the injection of a special contrast dye into a spinal disc thought to be causing low back pain. Computerized tomography (CT) is a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of low back pain. Magnetic resonance imaging (MRI) is used to evaluate the lumbar region for bone degeneration or injury or disease in tissues and nerves, muscles, ligaments, and blood vessels. Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. Ultrasound imaging, also called ultrasound scanning or sonography, uses high-frequency sound waves to obtain images inside the body.
Although ice and heat (the use of cold and hot compresses) have never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals.
Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Over-the-counter analgesics, including nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and ibuprofen), are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain. Some antidepressants, particularly tricyclic antidepressants such as amitriptyline and desipramine, have been shown to relieve pain (independent of their effect on depression) and assist with sleep. Opioids such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician’s supervision. Acupuncture involves the insertion of needles the width of a human hair along precise points throughout the body. Biofeedback is used to treat many acute pain problems, most notably back pain and headache. Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Transcutaneous electrical nerve stimulation (TENS) is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Ultrasound is a noninvasive therapy used to warm the body’s internal tissues, which causes muscles to relax.
Minimally invasive outpatient treatments to seal fractures of the vertebrae caused by osteoporosis include vertebroplasty and kyphoplasty.
In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.
Discectomy is one of the more common ways to remove pressure on a nerve root from a bulging disc or bone spur.
Nucleoplasty uses radiofrequency energy to treat patients with low back pain from contained, or mildly herniated, discs. Radiofrequency lesioning is a procedure using electrical impulses to interrupt nerve conduction (including the conduction of pain signals) for 6 to12 months. Spinal laminectomy (also known as spinal decompression) involves the removal of the lamina (usually both sides) to increase the size of the spinal canal and relieve pressure on the spinal cord and nerve roots. Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object, such as resting a wrist against the edge of a hard desk or repeated tasks using a hammering motion), vibration, repetitive motion, and awkward posture.
Although there have been anecdotal case reports of injury reduction among workers using back belts, many companies that have back belt programs also have training and ergonomic awareness programs. Following any period of prolonged inactivity, begin a program of regular low-impact exercises. Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed. Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. Originally from Houston, Kim earned her Bachelor of Science in Nursing from the University of Texas Medical Branch at Galveston.
In an effort to continue to provide South Florida with industry leading pain management diagnostic and treatment services, PMC has successfully relocated its main headquarters and pain management center to a brand new, State-of-the-Art treatment center, located directly on the campus of West Boca Medical Center, a “nation’s top-50 hospital,” which has been serving South Florida since the 1986. Pain Management Consultants has been a leading Practice in South Florida, serving the Boca Raton, and Delray Beach communities for over 21 years.
Through age, injury, or disease the small sacks of fluid can shrink and do not allow the vertebrae to move easily. Chronic pain requires chronic treatment.A Our team of pain management specialists employ a comprehensive multidisciplinary approach to pain care, offering non-surgical treatment options for the treatment of chronic pain conditions. Timchenko utilizes an all-encompassing approach to treatment, which includes development of a custom plan for each patient with supplementation of the appropriate remedies, interventional procedures and physical therapy.
Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. The doctors at Pain Medicine Consultants are experts in the non-surgical treatment of low back pain. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation.
Most acute back pain is mechanical in nature — the result of trauma to the lower back or a disorder such as arthritis.
The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.
Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine.
Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition.
However, a backpack overloaded with schoolbooks and supplies can quickly strain the back and cause muscle fatigue. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot.

A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).
A conventional x-ray, often the first imaging technique used, looks for broken bones or an injured vertebra. X-rays are passed through the body at various angles and are detected by a computerized scanner to produce two-dimensional slices (1 mm each) of internal structures of the back. MRI scanning equipment creates a magnetic field around the body strong enough to temporarily realign water molecules in the tissues. EMG assesses the electrical activity in a nerve and can detect if muscle weakness results from injury or a problem with the nerves that control the muscles.
A small amount of radioactive material is injected into the bloodstream and will collect in the bones, particularly in areas with some abnormality. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury.
As soon as possible following trauma, patients should apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes. A 1996 Finnish study found that persons who continued their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities.
Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies.
Counter-irritants applied topically to the skin as a cream or spray stimulate the nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain.
Side effects can include drowsiness, decreased reaction time, impaired judgment, and potential for addiction. Practitioners believe this process triggers the release of naturally occurring painkilling molecules called peptides and keeps the body’s normal flow of energy unblocked. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature (by controlling local blood flow patterns). Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves.
Vertebroplasty uses three-dimensional imaging to help a doctor guide a fine needle into the vertebral body. Some surgical procedures may be performed in a doctor’s office under local anesthesia, while others require hospitalization. During the procedure the surgeon takes out a small piece of the lamina (the arched bony roof of the spinal canal) to remove the obstruction below. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg. Guided by x-ray imaging, a wand-like instrument is inserted through a needle into the disc to create a channel that allows inner disc material to be removed. A combination of exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries. A landmark study of the use of lumbar support or abdominal support belts worn by persons who lift or move merchandise found no evidence that the belts reduce back injury or back pain.
Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
She worked for several years in the Houston Medical Center and received sixteen years of registered nurse training in emergency nursing, perioperative nursing, and case management. The new location also gives PMC physicians immediate access to a fully accredited Ambulatory Surgery Center downstairs in the same building,” PMC CEO, Scott A.
The nerves near the facets can become irritated and inflamed from the rough, rubbing facets. The goal of treatment is to optimize the management of your pain, restoring functionality and getting you back to living your life.
He earned his medical degree from Rostov State Medical University in Russia and completed fellowships at the University of Washington School of Medicine and St.
Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Treatment involves using over-the-counter pain relievers to reduce discomfort and anti-inflammatory drugs to reduce inflammation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain.
Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. It occurs most often between ages 30 and 50, due in part to the aging process but also as a result of sedentary life styles with too little (sometimes punctuated by too much) exercise. As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling.
The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment.
A technician passes a concentrated beam of low-dose ionized radiation through the back and takes pictures that, within minutes, clearly show the bony structure and any vertebral misalignment or fractures.
This procedure is often suggested for patients who are considering lumbar surgery or whose pain has not responded to conventional treatments. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body. Scanner-generated images are sent to a computer to identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Ultrasound imaging can show tears in ligaments, muscles, tendons, and other soft tissue masses in the back. After 2 to 3 days of cold treatment, they should then apply heat (such as a heating lamp or hot pad) for brief periods to relax muscles and increase blood flow. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. Many of the new antidepressants, such as the selective serotonin reuptake inhibitors, are being studied for their effectiveness in pain relief. Many specialists are convinced that chronic use of these drugs is detrimental to the back pain patient, adding to depression and even increasing pain. Clinical studies are measuring the effectiveness of acupuncture in comparison to more conventional procedures in the treatment of acute low back pain.
The patient can then learn to effect a change in his or her response to pain, for example, by using relaxation techniques. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord.

TENS may also help stimulate the brain’s production of endorphins (chemicals that have pain-relieving properties).
A glue-like epoxy is injected, which quickly hardens to stabilize and strengthen the bone and provide immediate pain relief.
It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve the pressure on the nerve.
Tissue surrounding the needle tip is heated for 90-120 seconds, resulting in localized destruction of the nerves.
Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. More companies and homebuilders are promoting ergonomically designed tools, products, workstations, and living space to reduce the risk of musculoskeletal injury and pain.
The 2-year study, reported by the National Institute for Occupational Safety and Health (NIOSH) in December 2000, found no statistically significant difference in either the incidence of workers’ compensation claims for job-related back injuries or the incidence of self-reported pain among workers who reported they wore back belts daily compared to those workers who reported never using back belts or reported using them only once or twice a month.
Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight.
Back pain is the second most common neurological ailment in the United States — only headache is more common. Each of these bones contains a roundish hole that, when stacked in register with all the others, creates a channel that surrounds the spinal cord. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. People with these symptoms should contact a doctor immediately to help prevent permanent damage.
The risk of experiencing low back pain from disc disease or spinal degeneration increases with age.
Consumer Product Safety Commission estimates that more than 13,260 injuries related to backpacks were treated at doctors’ offices, clinics, and emergency rooms in the year 2000. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root.
Caucasian women of northern European heritage are at the highest risk of developing the condition. Tissue masses such as injured muscles and ligaments or painful conditions such as a bulging disc are not visible on conventional x-rays. With nerve conduction studies the doctor uses two sets of electrodes (similar to those used during an electrocardiogram) that are placed on the skin over the muscles.
Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Certain medicines, even those sold over the counter, are unsafe during pregnancy, may conflict with other medications, may cause side effects including drowsiness, or may lead to liver damage.
Many of these compounds contain salicylates, the same ingredient found in oral pain medications containing aspirin.
Biofeedback is often used in combination with other treatment methods, generally without side effects. In kyphoplasty, prior to injecting the epoxy, a special balloon is inserted and gently inflated to restore height to the bone and reduce spinal deformity. Since invasive back surgery is not always successful, it should be performed only in patients with progressive neurologic disease or damage to the peripheral nerves.
Ask your physician or orthopedist for a list of low-impact exercises appropriate for your age and designed to strengthen lower back and abdominal muscles. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. She coauthored the clinical practice guideline, Managing Chronic Gout in Adults, May 2012, published in the National Guideline Clearing House for the Agency for Healthcare Research and Quality.
After pursuing an anesthesiology residency through Yale School of Medicine at New Haven Medical Center, Dr. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury. To avoid back strain, children carrying backpacks should bend both knees when lifting heavy packs, visit their locker or desk between classes to lighten loads or replace books, or purchase a backpack or airline tote on wheels.
This fast, noninvasive, painless procedure is usually performed in a doctor’s office or at a clinic. In this procedure, the contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray. This noninvasive procedure is often used to identify a condition requiring prompt surgical treatment. The first set gives the patient a mild shock to stimulate the nerve that runs to a particular muscle.
Patients should avoid sleeping on a heating pad, which can cause burns and lead to additional tissue damage.
At night or during rest, patients should lie on one side, with a pillow between the knees (some doctors suggest resting on the back and putting a pillow beneath the knees). If you must sit for a long period of time, rest your feet on a low stool or a stack of books. Kim received her Family Nurse Practitioner certification from the American Academy of Nurse Practitioners. Timchenko completed a fellowship in pain medicine at the Medical College of Wisconsin in Milwaukee. The second set of electrodes is used to make a recording of the nerve’s electrical signals, and from this information the doctor can determine if there is nerve damage. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger.
He belongs to the American Society of Anesthesiologists and the American Academy of Pain Medicine.
Because the bones of the spinal column continue growing long after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting.
EP tests also involve two sets of electrodes — one set to stimulate a sensory nerve and the other set on the scalp to record the speed of nerve signal transmissions to the brain.
But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor.
This large bundle of nerve roots was dubbed by early anatomists as the cauda equina, or horse’s tail.
The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.

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