Chronic regional pain syndrome (CRPS) is a rare form of chronic pain that typically affects an arm or leg. CRPS usually occurs after an injury, a surgery, or a stroke. There are two types. CRPS I, also known as reflex sympathetic dystrophy (RDS) occurs after an injury that did not directly involve a nerve. CRPS II, also known as causalgia, occurs after a distinct nerve injury.

Symptoms of CRPS

Signs and symptoms of CRPS typically include several of the following in the affected area:

• Sensory:
  • Pain to light touch or temperature sensation
  • Exaggerated pain to normally tolerable pain (such as a pinprick)
• Vasomotor:
  • Changes in temperature to the affected area, or skin color changes
• Sudomotor/edema:
  • Edema and/or sweating changes or sweating asymmetry
• Motor/trophic:
  • Decreased range of motion of the affected limb
  • Weakness, tremor of the affected limb
  • Muscle spasms or atrophy
  • Changes in the hair, nails, or skin of the limb

Treatment for CRPS

The foundation of treatment is physical therapy. This is essential in order to prevent the decreased range of motion, weakness, and muscle atrophy, that can lead to lasting disability.

Pain relievers, such as NSAIDs can be helpful. Often, prescription medications are required. Some example would be gabapentin and pregabalin, which are nerve pain medications. Many other medications have been used as well.

Spinal Cord Stimulation

One of the most effective treatments is spinal cord stimulation. This involves placing leads that lightly stimulate the spinal cord to block pain signals from the painful limb to the brain, where pain is processed. This process starts with a trial period, typically of 7 days, where the device is placed. This is done in the office as an out-patient procedure. If you experience pain relief, this device can be implanted, which is done at a surgical center as an out-patient procedure.

Spinal cord stimulation is an effective treatment, but it is not the first-line treatment. It is important to see a pain physician early so that you can try other treatments first. It’s important not to wait! As symptoms progress, people with CRPS often experience so much muscle wasting and decreased range of motion that any type of therapy is very difficult. This is why it’s important to seek treatment early.

Low back pain is a debilitating and unfortunately common issue that affects most people at some point in their lives. If you are experiencing low back pain, there are multiple potential causes. Perhaps you have strained a muscle, or you may even have a compression fracture.

Causes of Low Back Pain

A common cause of low back pain is arthritis in the joints in your spine. This is often treated successfully with radiofrequency ablations to the nerves that go to the painful, arthritic joints. A similarly common cause of low back is pain from degenerated discs. This is often diagnosed initially with x-rays, but an MRI can give a better idea of how degenerated the disc is.

Intracept: New Treatment for Pain

Fortunately, Valley Pain Consultants offers new treatments for pain due to degenerated discs. This is called a Basivertebral nerve radiofrequency ablation, also known as the Intracept procedure. This is a cutting-edge treatment that has only recently been available due to technological advances. Valley Pain Consultants is one of the few groups in the Phoenix metropolitan area to offer this treatment.

Many people struggle for years with low back pain. They go from doctor to doctor looking for relief. They try multiple rounds of physical therapy, medications, and injections. These treatments may not give relief, and the relief may be short-lived.

Are You a Candidate for Intracept

If you are struggling with low back pain and can’t seem to find a treatment option that works, you may be a candidate for the Intracept procedure. This is a radiofrequency ablation of the nerve that go to the painful disc. It is an out-patient procedure done under conscious sedation at a surgical center. If you have painful degenerated discs, then the Intracept procedure may offer you relief. Make an appointment with Valley Pain Consultants today to learn more.

If you or a loved one had spine surgery hoping to alleviate or completely relieve your pain, but unfortunately immediately after or a few months after the surgery, the pain came back – a phenomenon known as failed back surgery syndrome (FBSS) – this can be a very frustrating experience for both patients and surgeons alike.

FBSS Risk Factors

Having failed back surgery doesn’t suggest that you or your surgeon have failed. Many factors that lead to FBSS are out of your control. There are multiple reasons and risk factors for that, to mention some:

• Smoking
• Obesity
• Creating too much space, or not enough space, around nerves
• Recurrent original diagnosis (e.g. recurrent disc herniation at the same site or at a nearby level)
• Adjacent segment disease(after spinal fusion where the level above and/or below the fusion level has increased stress and therefore can degenerate in an accelerated fashion)
• Epidural fibrosis (when nerve roots are trapped by scar tissue)
• Spinal infection
• Pseudoarthrosis (lack of fusion which results in loosening of the screws)

Some surgeries have a higher rate of failure, like fusion surgery for multi-level lumbar degenerative disc disease, with estimated failure rates ranging from 30% to 46%.

Learning your spine surgery did not produce the outcomes you expected can be extremely disappointing, but there are therapies that may help reduce your pain and restore your ability to function in everyday life. Establishing a relationship with a Pain Doctor is your first step to reaching that goal.

Multidisciplinary Approach to Address Pain

Your doctor may use a multidisciplinary approach to address your pain and limitation in function, this means that instead of relying on one treatment (e.g. medications or surgery), he or she may recommend a mix of therapies that comprehensively address different aspects of your pain. Your doctor may use one or more of the following therapies:

• refer you to a physical therapy and rehabilitation program.
• refer you to a behavioral health professional to address mental and emotional health.
• Your doctor may prescribe medications to help you manage your pain, this may include non-steroidal anti-inflammatory drugs, oral steroids, antidepressants, nerve-pain medications, and muscle relaxants.
• There are multiple interventional options that could be helpful, like Epidural Steroid Injection (ESI), Sacroiliac Joint (SI) injection or Radiofrequency Ablation (RFA).
• Luckily with the advancement in science, research, and technology; Neuromodulation is a very promising therapy to help treat failed back surgery syndrome. Your doctor may recommend Spinal Cord Stimulator (SCS) as a very effective therapy and long-term solution to your pain.

Many people notice that as they age, they have a tendency to be “hunched over” when they stand or walk. Perhaps they have tried to correct this and stand up straight but feel that it is difficult and even painful. These same people typically also note that they have become shorter as they age. This is often a source of concern and frustration for people because they feel a loss of pride with a change in posture and stature and they feel that it may be related to the loss of vitality and activity that they have also experienced with age.

What causes a hunched over posture?

Fortunately, we know that there is often an anatomical cause for these changes with age, and we also know that there are treatments.

Lumbar Facet Arthropathy

Lumbar facet arthropathy is a medical term for arthritis in the spine, and it is one of the most common reasons why people feel more comfortable when hunched over as they age. This arthritis is typically present in the back portion of the spine, where there are multiple joints that allow you to bend forward and backward. With age, these joints become arthritic and painful. Typically, the first symptom that people notice is that it hurts when they lean back. This is because with the lumbar facet joints become narrower with leaning back. Eventually, these joints become so arthritis that they are bone-on-bone, even when you are simply standing up straight. To create more space, people will find themselves leaning forward.

Compression Fractures

Compression fractures are a cause of both height-loss as well as hunching over. The spine is made up of bone, and bones tend to become thinner with age. As the bone thins, it can no longer hold up under stress and can become compressed. Due to body mechanics, these compression fractures occur more frequently in the front of the spine than in the back. This can contribute to feeling hunched over. Unfortunately, people that experience one compression fracture are more likely to have multiple compression fractures. While we can never fully restore the height of a compressed vertebra, we can sometimes partially restore the height and help prevent additional compression fractures from occurring.

Lumbar Spinal Stenosis

Lumbar spinal stenosis refers to a narrowing around your spinal cord. The spinal cord is housed in a protective structure called the spinal canal. This runs from your brain all the way to your tailbone. As people age, inflammation throughout the spine leads to bony overgrowth and thickened ligaments. Since your lumbar spine (the low back portion) bears most of your weight, it tends to develop the boniest overgrowth and the thickest ligaments. This can put pressure on your spinal cord and cause pain, especially when you’re standing or walking for prolonged periods. Due to natural biomechanics, this pressure can be relieved by leaning forward. Many people find themselves leaning forward when they walk and even relying on walkers and shopping carts to help them lean forward and relieve the pressure on their spinal cord. Doctors even learn about this in medical school and call it, “the shopping cart sign.”

What can I do?

The first step is to talk to your doctor. You may need x-rays or even an MRI. These tests can help determine why you are hunched over.

Fortunately, there are treatments for these issues. Whether it’s selectively cauterizing painful nerves, restoring height to a compressed vertebra and injecting cement so that it doesn’t get worse, injecting steroids around a compressed spinal cord, or even supporting the spinal canal so that it isn’t pressuring the spinal cord, there are safe and minimally-invasive treatments available – and many of these can even be done in your doctor’s office.

David G. Currie, MD

The Chest (which is sometimes referred to as the Thorax), the Abdomen, and the Pelvis host many vital organs, like the heart, lungs, kidneys, bowels, and bladder. Acute pain in these areas is usually an alarming sign that directs our attention to seek medical care to make sure nothing serious is going on that needs immediate intervention. But how about when all the tests come back negative and the pain is becoming the disease itself, or when there is some underlying disease that is causing a lot of pain that is affecting the quality of life?

Here comes the role of Pain Physicians to evaluate the different sources of pain and suggest possible treatments and therapies. Some of these pain syndromes could be divided into different areas:

Chronic Pain of the Chest:

-Any injury to the ribs could cause a long and lasting pain, e.g. Fracture after a fall, or an injury after surgery (Post-Thoracotomy Syndrome). This can lead to chronic pain in the nerves adjacent to the ribs, a condition called Intercostal Neuralgia. Your physician may suggest interventions like Intercostal nerve block or neuropathic pain medications or sometimes both. In refractory cases, the physician may suggest Spinal Cord Stimulator (SCS) or Peripheral Nerve Stimulator (PNS).

-Another common chronic pain condition that affects especially elderly patients is Shingles (also called Herpes Zoster caused by Varicella Zoster Virus), could linger for many weeks or months after the initial lesions appear and could be very painful. Your physician could recommend a combination of injections, medications or a new topical therapy that uses high doses of Capsaicin applied through patches at the doctor’s office.

Chronic Pain of the Abdomen:

-Not uncommon after certain surgeries, like after hernia repairs, some patients may develop ongoing pain at the incision site, here a specific Ultrasound-Guided Nerve Block could help to relieve the pain, or in refractory cases, a specific type of Spinal Cord Stimulator called DRG (Dorsal Root Ganglion) Stimulator could be recommended by your doctor.

-Some of the Gastrointestinal pathologies like Chronic Pancreatitis, Pancreatic cancer, or other sympathetically mediated syndromes could respond well to targeted sympathetic chain blocks like Celiac Plexus Block or Superior Hypogastric Plexus Block.

Chronic Pain of the Pelvis:

-Chronic Pelvic Pain sometimes could be a very challenging problem that requires the collaboration of multiple specialists like Gynecologists, Gastroenterologists, and Urologists along with pain physicians for proper diagnosis and treatment. Chronic pelvic pain can have multiple causes, it can be a symptom of another disease, or it can be a condition in its own right. If the pain appears to be caused by another medical problem, treating that problem may be enough to eliminate the pain. However, in many cases, it’s not possible to identify a single cause of chronic pelvic pain. In that case, the goal of treatment is to reduce your pain and other symptoms and improve your quality of life. Some of these syndromes are Endometriosis, Interstitial nephritis, Irritable Bowel Syndrome, or Pudendal Neuralgia.

-After proper evaluation and testing your pain doctor may recommend different treatment modalities like physical therapy, psychotherapy, neuropathic pain medications or specific type of injections like image-guided nerve blocks that may include Ganglion of Impar block.

-Luckily there are new treatments and therapies that are emerging to help in managing these challenging syndromes like DRG-Spinal Cord Stimulator and Peripheral Nerve Stimulator. Please discuss with your doctor if you qualify for one of these therapies.

Our physicians at Valley Pain Consultants will help you and offer a fast, safe and effective treatment. To schedule an appointment, please call (480) 467-2273 or complete the contact form.

Headaches are very common conditions that most people experience in their lives. Headaches are one of the most common pain conditions. Up to 75% of adults experience headaches in one year. There are many different kinds of headaches (more than 150 types) and some can be more complicated than they seem.

How are headaches treated?

Despite the many different types of headaches, they fall into two main categories: primary and secondary headaches.

Primary headaches

Primary headaches are headaches that are not caused by a secondary medical condition

• Cluster headaches
• Migraines
• Tension headaches

Secondary headaches

Secondary headaches are caused by a medical condition such as:

• Head injury
• High blood pressure (hypertension)
• Infection
• Medication overuse
• Sinus congestion
• Trauma
• Tumor
• Neck arthritis (cervicogenic headaches)

What causes headaches?

Headaches, especially migraines, have a tendency to run in families. Headaches can also be triggered by environmental factors, such as certain foods (caffeine, alcohol, etc.). During a headache, a certain mechanism will activate specific nerves that affect muscles and blood vessels in the brain, triggering an episode.

Signs and symptoms of headaches?

Headache symptoms vary, depending on the type of headache you have.

Tension headaches

Tension headaches are the most common type of headache.

• Come and go over time
• Aching, not throbbing
• Bilateral (affect both sides)
• Mild to moderate in intensity
• Responsive to over-the-counter treatment
• Worse during routine activities

Migraines

Migraines are the second most common type of primary headaches. Symptoms include:

• Moderate to severe pain
• Associated with nausea and/or vomiting
• Pounding or throbbing pain
• Can last from hours to days
• Sensitivity to light (photophobia), noise (phonophobia) or odors

Cluster headaches

Cluster headaches are the most severe type of primary headache. Cluster headaches are episodic and occur in clusters. They occur one to eight times per day during a cluster period. Symptoms include:

• Intense pain with a burning or stabbing sensation
• Located behind one of the eyes
• Can cause tearing or redness in the eye
• Throbbing or constant.

When to seek immediate medical attention?

• A sudden, new, severe headache
• A headache that is associated with neurological deficits such as weakness, numbness, tingling, difficulty speaking, paralysis, confusion
• If there is a fever, rash or stiff neck
• Headaches with severe nausea or vomiting

How are headaches treated?

Treatment of headaches can be simple with over-the-counter medications or it may require more complex medical procedures. One of the most crucial aspect of treating headaches is determining the triggers (for example stress) and avoiding them.

A range of treatments is available. Depending on your headache type, frequency and cause, treatment options include:

• Stress management
• Biofeedback
• Over-the-counter medications
• Prescription drugs
• Interventional procedures

Interventional Procedures

Depending on the type of headaches, you may be a candidate for specific interventional procedures. For example, patients with migraines who fail to respond to prescription drugs may be a candidate for Botox injections. Alternatively, patients with headaches related to occipital neuralgia or trigeminal neuralgia may be a candidate for nerve blocks. Headaches that are caused by arthritis of the neck joints can be treated radiofrequency ablation of the cervical medial branches. Patients who fail to have sustained relief from nerve blocks may be a candidate for a peripheral nerve stimulator to treat their headaches.

Joint discomfort is a very common complaint and usually felt in the hands, feet, hips, knees, or spine. Pain may be constant, or it can come and go. Some patients complain of a burning, throbbing, or “grinding” sensation. In addition, the joint may feel stiff in the morning but loosen up and feel better with movement and activity. Severe joint pain can affect the quality of life.

Some of the risk factors for joints pain are:

• Age
• Having previous injuries or trauma to a joint
• Repeatedly use and/or overuse of a muscle
• Having Arthritis or other chronic medical conditions
• Overweight and Obesity

The most common causes of chronic pain in joints are:

• Osteoarthritis which is the most common type of arthritis, happens over time when the cartilage, the protective cushion in between the bones, wears away. The joints become painful and stiff.
• Rheumatoid arthritis is a type of Autoimmune disease, that causes swelling and pain in the joints. Often the joints become deformed (usually occurring in the fingers and wrists).
• Bursitis is caused by overuse. It is usually found in the hip, knee, elbow, or shoulder.
• Tendinitis is an inflammation of the tendons, or the flexible bands that connect bone and muscle. It is typically seen in the elbow, heel, or shoulder and is usually caused by overuse.

Treatment usually depends on the underlying cause, but usually starts with:

• Simple at-home treatments, such as applying a heating pad or ice on the affected area
• Exercise can help get back strength and function. Walking, swimming, or other low-impact aerobic exercise is best.
• Weight loss may also be suggested, if needed, to lessen strain on joints.
• Acetaminophen (Tylenol®) or anti-inflammatory drugs (ibuprofen), may help ease the pain
• Topical treatments, such as ointments or gels that can be rubbed into the skin over the affected joint area, may also help ease pain.
• Dietary supplements, like glucosamine, may help relieve pain. Ask the doctor before taking any over-the-counter supplements.
• Physical or Occupational Therapy, along with a balanced fitness program, may gradually help ease pain and improve flexibility.
• Steroid injection: this procedure will decrease inflammation and make physical therapy and activity easier.
• Visco-supplementation (for knee pain): in this procedure, a gel-like fluid called hyaluronic acid will be injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding the joint’s cartilages.

Our physicians at Valley Pain Consultants will help you and offer a fast, safe and effective treatment. To schedule an appointment, please call (480) 467-2273 or complete the contact form.

Peripheral neuropathy results from damage to the peripheral nerves (nerves outside the brain and spinal cord). It usually presents as pain, numbness and weakness. It most commonly involves the hands and feet, although it could affect any other parts of the body including digestion and circulation.

Peripheral neuropathy can be caused by different reasons including metabolic abnormalities, trauma, infection or autoimmune causes.

Peripheral Neuropathy Symptoms

Peripheral neuropathy can affect a single nerve (mononeuropathy, such as carpal tunnel) or multiple nerves (polyneuropathy, such as diabetes). Signs and symptoms of peripheral neuropathy include:

• Sharp, burning, or throbbing pain
• Numbness and tingling, usually in hands/feet that start distally and spread up
• Sensitivity to touch or pain with activities that are not normally pain (pain with wearing shoes)
• Lack of coordination or falls
• Weakness
• Wounds in feet due to loss of sensation
• Bowel, bladder or digestive problems

Peripheral Neuropathy Causes

Peripheral neuropathy can be used by different conditions including:

• Diabetes Mellitus: This is the most common cause of neuropathy and usually develops in advanced disease or in patients who had diabetes for a while.
• Autoimmune disease: These include Guillain-Barre Syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
• Medications: certain medications such as chemotherapy can lead to peripheral neuropathy (PN)
• Toxins: toxic substances or metal poisoning
• Alcoholism
• Vitamin deficiencies: such as vitamin B, Niacin or vitamin E
• Inherited conditions: such as Charcot-Marie-Tooth disease

Peripheral Neuropathy Diagnosis

Your doctor will start by obtaining a history and physical exam. Blood work, nerve function test (electromyography), nerve biopsy or skin biopsy can help confirm the diagnosis.

Pain Management for Peripheral Neuropathy

In addition to treating the underlying cause of peripheral neuropathy (i.e. controlling blood sugars in case of diabetic neuropathy), you may be referred to pain physicians to manage your pain symptoms.

Pain related to PN can be debilitating and may affect your daily function. Treatment options include medications, interventions and alternative approaches.

Medications include “neuropathy agents” which particularly help with nerve-related pain as well as numbness/burning associated with PN. These agents include gabapentin, pregabalin, tricyclic antidepressants or duloxetine. Other second-line agents may include topiramate.

Interventional options depend on the location of the pain. Your doctor may start with a sympathetic block. A sympathetic block targets the sympathetic nervous system, a series of nerves that spread out from your spine to your body to help control several body functions including temperature and sweating. This is a safe procedure, and you can normally return to your normal activities after a day of rest. Other options include spinal cord stimulation (SCS). This includes the implantation of a small device outside your spinal cord to “modulate” the nerve signal coming from the periphery (feet or hands) to your brain. Before implantation of the device, there is a “trial” period where the device is tested out for 7 days before permanent implantation.

Other treatment options include acupuncture, physical therapy or transcutaneous electrical nerve stimulation (TENS). A “multimodal” approach including a combination of different therapies will provide the best results.

The neck, sometimes referred to as the Cervical Spine, is a delicate and remarkable structure of interconnected vertebrae, joints, muscles, ligaments and tendons – all of which work together to provide support while allowing a wide range of motion.

However, any of these anatomical structures can wear down or become injured, causing neck pain (we call it Axial Cervical Pain) and, possibly, pain that radiates down the arms (we call it Cervical Radicular Pain).

What Causes Neck Pain

There are many different causes for neck pain:

Acute neck pain usually involves a tear to a muscle or ligament in the neck. Trauma from sudden forced movement of the neck or head and rebound in the opposite direction (whiplash) can cause pain and soreness.

Neck pain that lasts or keeps coming back over a period of at least 3 months is considered chronic.

Aging and degenerative conditions such as osteoarthritis (the wearing down of the joints) and spinal stenosis (narrowing of the spaces in the spine) can lead to neck pain. Over time, stress and motion can lead to spinal disc degeneration, causing a herniated disc or pinched nerve.

A facet joint can become a source of pain if its protective cartilage starts to wear down or the joint capsule gets a tear. As the joint degenerates, bone spurs grow, increasing inflammation and stiffness.

These degenerative changes to discs and facet joints in the cervical spine can cause a nerve root to become compressed which can result in cervical radiculopathy symptoms of pain, tingling, numbness, and/or weakness to radiate down the arm.

Neck Pain Diagnosis

The doctors will diagnose your neck pain with a physical exam and medical history, they will also check your muscle strength and reflexes. To diagnose the cause of the pain, your doctor may use imaging tests such as X-ray, magnetic resonance imaging (MRI) or computed tomography (CT). These tests can show damage and other issues in the bones and surrounding tissues in your neck.

Neck Pain Treatments

After making the correct diagnosis, treatment for neck pain varies depending on the cause. It aims to relieve pain and improve function. Some of these treatments include:

• Medications – including nonsteroidal anti-inflammatory drugs (NSAIDs) to ease pain and inflammation and muscle relaxants to help the healing process.
• Physical therapy (exercises to stretch and strengthen muscles and tendons in the neck).
• Facet joint injections of Medial nerve blocks – to help alleviate the pain from the inflamed joints.
• Radiofrequency ablation (or Nerve ablation) – to provide longer pain relief.
• Epidural Steroid injections near the nerve roots – to help relieve pain and inflammation.
• Finally, If the injury is advanced – your doctor may recommend surgery to repair compressed or damaged spinal disks or fuse some vertebrae in the spine.

Back pain is one of the most common complaints for patients to seek medical care. And one of the most common causes for back pain is Degenerative Disease of The Spine, commonly known as “Arthritis of the spine.”

The spine has small joints (called Facet Joints) that connect each vertebra to the other, and like other joints in our body, inflammation could affect these joints and cause pain. There are many reasons for this inflammation, but the most common cause is Osteoarthritis (degenerative arthritis) which is the result of the normal “wear and tear” with advancing age. In some cases, degeneration of the spinal discs (degenerative disc disease) may contribute to facet joint arthritis. As discs between the vertebrae become thinner, more pressure is transferred to the facet joints, which leads to more friction and more damage to these joints.

Arthritis can occur anywhere along the spine but is more frequent in the lower back and neck. Some of the risk factors to develop this condition are age, excess weight/obesity and the presence of certain conditions such as diabetes and gout.

Signs and Symptoms

The symptoms of spinal arthritis may differ from person to person. In general, they may include neck and back pain, especially in the lower back. Stiffness and loss of flexibility in the spine, such as being unable to straighten your back or turn your neck, and the feeling of “grinding” when moving the spine.

If the inflammation is really bad, spinal arthritis may cause bone spurs (overgrowths on the edges of the bones), and although bone spurs on their own are not harmful, they may narrow the passages for the spinal cord inside the spinal canal causing spinal stenosis or pinching of the peripheral nerves as they exit the spine and cause radiculopathy (sciatica is one type of radiculopathy).

To diagnose spinal arthritis your doctor will listen to your medical history and perform a physical exam and may order some imaging like X-ray of the spine, CT-Scan or MRI.

Treatments

The treatment for spinal arthritis depends on many factors. Usually starts with conservative measures like Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy to improve back muscle strength and range of motion in the spine, lifestyle changes to reduce inflammation or stress on your spine: losing weight, quitting smoking, changing your posture, etc.

But if these measures failed your physician may recommend the Medial Branch Block procedure, in which the physician use fluoroscopy (x-ray guidance) to inject numbing medication near the facet joints in order to numb the nerves that innervate that facet joint. If the patient experiences significant pain relief immediately after this procedure, radiofrequency ablation (nerve burning) can be done at a later date to provide more long-lasting relief (typically six months to two years).

In very severe cases, surgery may be recommended for spinal arthritis if other treatments don’t sufficiently relieve pain.

Call Valley Pain to schedule a consultation with one of our pain physicians or request an appointment.