Chronic headache can be divided into various categories including migraine, cluster, tension, cervical-genic, etc. Diagnostic workup may include blood tests, MRI, MRA, EEG, and diagnostic injections. Treatments may include medications, physical therapy, massage therapy, biofeedback, and therapeutic injections such as cervical facet injections, occipital nerve blocks, trigeminal nerve, sphenopalatine ganglion blocks, trigger point/Botox injections and occipital nerve stimulator implantation.
Chronic facial pain can be devastating in a person’s life. Oftentimes, chewing, eating, kissing, smiling, and brushing teeth can trigger severe pain. Causes may include shingles, trigeminal neuralgia, TMJ syndrome, stroke pain, etc. Treatments may include oral medications, physical therapy, psychotherapy, trigeminal ganglion injections, sphenopalatine ganglion injections and surgery.
The trigeminal nerve provides sensation to the face. When the nerve is damaged, severe facial pain can be unrelenting. See causes and treatment options in the link for Facial Pain.
Cervical Spinal Stenosis
This is caused by narrowing of the spinal canal of the neck. It can cause pain in the neck which can travel to the shoulders, arms, hands and occasionally the head. MRI is the gold standard in diagnosis. Conservative treatment options may include physical therapy, medications and epidural steroid injections. Surgery may be warranted depending on the severity.
There are many causes to neck pain, including stenosis, bulging/herniated disc, pinched nerve, arthritis, degeneration of the spine, degenerative disc disease, facet joint arthritis, and failed neck surgery, etc. Workup for chronic neck pain may include imaging studies, laboratory tests and diagnostic nerve blocks. Therapies may include anti-inflammatory medications, muscle relaxants, oral anticonvulsant medications, epidural steroid injections, facet joint injections, trigger point injections, Botox injections, and spinal cord stimulator implantation.
Whiplash Neck Pain
Injuries caused by car accidents, falls, and pulling injuries can cause severe neck pain that may not be visible on x ray or MRI. Nonetheless, the ligaments, muscles, and small joints in the neck can be pain generators after an acute injury such as these. Studies have shown that besides oral medications and physical therapy, cervical facet injections and trigger point injections minimize the whiplash pain and restore function.
Failed Neck Surgery
Rarely, pain may persist after neck surgeries. Besides medications and physical therapy, cervical epidural steroid injections and spinal cord stimulator implantation may help alleviate pain.
This is caused by inflammation, overuse, and degeneration of the tendons and muscles around the shoulder joint. Diagnosis is done with good physical examination, x rays, and MRI. If oral anti-inflammatory medications are not helpful, injections with steroids can be a treatment option.
Arthritis and Bursitis
Degenerative process of the shoulder joint can cause shoulder pain. Imaging studies can be helpful to differentiate the various pain syndromes of the shoulder. Occasionally, injections into the shoulder joint is warranted when all other conservative treatments fail. Surgical options may be the cure to severe arthritis of the shoulder joint.
Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS)
This is also called phantom limb pain. This can occur after injuries, surgeries or for no apparent reason. The symptoms can be life-shattering. Oral anticonvulsant medications can reduce the pain, as well as desensitization physical therapy and stellate and thoracic sympathetic ganglion blocks. Recent advances in medical technology allow pain specialists to provide pain relief through implantation of spinal cord stimulator when all else fails.
Caused by osteoporosis, cancer, and trauma, pain from this type of spinal column fracture can be severe. If conservative treatments fail, vertebroplasty procedures can alleviate the pain immediately. Vertebroplasty procedures are done with minimal sedation. No open incisions is done on the skin. Specialized needles are placed into the vertebral bone under live X-ray and medical cement called PMMA is injected to "glue" the fragments of bone together. Once the PMMA restores the bone fragments, patients immediately feel pain relief.
Scoliosis can be something one is born with or acquired later in life. Causes are numerous. Often, bracing, physical therapy and sometimes surgeries are the treatment options to correct the anatomical abnormalities. Pain can often be overlooked while trying to restore the anatomy. A pain specialist who is trained in musculoskeletal and physical medicine can accurately diagnose and treat these patients’ pain.
Shingles Pain or Post-herpetic Neuralgia
This is caused by the varicella-zoster virus which is the same virus that causes chickenpox. Acute pain can be burning, shooting and severe. Acute shingles pain must be treated aggressively and immediately. Chronic shingles pain can be difficult to treat. Besides medications and physical therapy, interventional pain specialists can perform epidural steroid injections , and intercostal nerve blocks or radiofrequency ablation of the nerve to help minimize the pain.
This can be caused by aging, trauma, falls, injuries and unknown reasons. The pain can radiate from the low back to the leg(s), with numbness, weakness or tingling. Anti-inflammatory, muscle relaxants, anticonvulsants, antidepressant medications have all been used to treat the pain. Sometimes, epidural injections may be part of the comprehensive treatment in order to facilitate healing, physical therapy regimen and alleviate the pain.
This is caused by narrowing of the lumbar spine. Aging, arthritis, bone spurs, scarring, space occupying lesions, etc. can all cause this syndrome. The pain is usually worse with walking long distances and going downhill/downstairs. The pain is usually relieved with rest or sitting. Nerves can be “pinched” and cause pain in the legs. Prior to surgery, medications, physical therapy and epidural steroid injections may be tried.
Failed Back Surgery Pain
Sometimes, surgeries can fail to relieve low back pain. When oral medications and physical therapy also fail to relieve the pain, epidural steroid injections, lysis of adhesions with a Racz catheter or a spinal cord stimulator can restore the patient’s quality of life.
Causes may include stretching and inflammation of the nerves during surgeries or other unknown reasons. Even if a workup does not find a cause, a pain specialist can help diagnose and treat these painful conditions
Chronic Abdominal Pain
Causes can include chronic pancreatitis, nerve pain and cancer pain. A pain specialist can help diagnose and alleviate these painful conditions through celiac plexus blocks, hypogastric nerve blocks or rizotomy.
Chronic Pelvic and Genital Pain
Causes can include prior infections, childbirth, benign tumors, cancer, trauma, or unknown causes. Accurate diagnosis and treatment of these painful disorders by a pain specialist can be a life changing event.
This can be caused by herniated lumbar discs, tight piriformis muscles, spinal arthritis, bone spurs, etc. The pain can radiate from the low back to the leg(s), with numbness, weakness or tingling. Anti-inflammatories, muscle relaxants, anticonvulsants and antidepressant medications have all been used to treat this pain. Sometimes, epidural injections may be part of a comprehensive treatment plan in order to facilitate physical therapy and help alleviate the pain
Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome (CRPS)
This is also called phantom limb pain. This can occur after injuries, surgeries or for no apparent reason. The symptoms can be life-shattering. Oral anticonvulsant medications can reduce the pain, as well as desensitization therapy and lumbar sympathetic blocks. Recent advances in medical technology allow pain specialists to provide pain relief through implantation of spinal cord stimulators when all else fails.
Vascular Leg Pain
Causes may include blocked arteries, inflammation of the arteries, circulation diseases and more. Pain from lack of circulation can be very severe. Surgical bypass is usually the cure for these diseases, however there are cases when surgeries are not feasible. Pain relief may be achieved with oral medications, sympathetic blocks, and spinal cord stimulators.
Diabetic Nerve Pain
With longstanding elevated blood sugar, some of the diabetic patients may develop pain in the feet/legs. The so called "diabetic neuropathy" can be very painful. Burning, shooting, tingling pain is the usual description. A pain specialist can work with your primary care provider or endocrinologist to help you deal with this type of unrelenting pain.