Tag Archives: pain management

WHY IS BACK PAIN SO COMMON

back pain2

Up to 80% of Americans will experience low back pain at some point in their life. Why is it so common and is there anything that can be done about it?

It has to do with the shape of the spine, specifically the part of the spine in the lower back called the lumbar spine. The spine is made of vertebrae bones stacked on top of each other separated by spongy cartilage-like discs acting like shock absorbers.   The spine supports all the upper body weight which puts a lot of load on the lumbar spine and results in mechanical stress and strain. The lumbar spine is curved at the bottom. This is normal anatomy, however, it predisposes the lowest segments of the lumbar spine to extra wear and tear. The cumulative wear and tear can cause longer lasting and constant low back pain that may become chronic (lasting at least 3 months). The most common reasons for low back pain include:

  • Degenerative disc disease is when the lumbar discs wear down over time from cumulative wear and tear and no longer do their job of providing a cushion between the vertebra bone.
  • Herniated disc is sometimes called a “slipped disc”. In this case part of the disc bulges out from its normal location. This may result in not only back pain but also pain that radiates down the leg if the bulge pushes on a nearby nerve, commonly referred to as “sciatica.”
  • Spinal stenosis is when the spinal canal has become narrowed over time resulting in less room for the nerves. Often this is due to a combination of arthritis of the spine as well bulging discs. Over time it leads to pain in the lower back as well as in the legs, especially with walking and standing for long periods of time.
  • Vertebral compression fracture – In this case the cause is fractured vertebrae bone due to osteoporosis (brittle bones due to low bone density).
  • Facet joint pain – Here the pain is due to arthritic pain stemming from the spinal joints called facet joints. These attach vertebra bones to one another. The pain here is typically in the lower back and mostly with prolonged standing and walking.

Prevention is probably the most important type of treatment for low back pain and is not emphasized nearly enough in our society. Good posture, proper ergonomics and biomechanics, and daily exercise, especially core strengthening, is crucial in the prevention of back injury and unnecessary extra wear and tear. Once a back problem develops the treatments can vary, are usually diagnosis specific, and can be very effective. Most important, surgery is rarely needed and should be reserved for when conservative modalities are not effective or, when there is neurologic emergency such as weakness, numbness, incontinence, tumors, or infections.

If you are suffering from back pain it is important to see a skilled physician who offers you conservative treatment options. Ashot Kotcharian, MD is a Physical Medicine & Rehabilitation physician with a specialty in Interventional Pain Management. He is accepting new patients at Sarasota Orthopedic Associates where we offer same or next day appointments in any of our three locations.

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IS THERE SUCH A THING AS TOO MUCH GOLF?

golf-pain

Frequent rounds of golf can cause a number of painful conditions from chronic overuse of the muscles and tendons. Back pain resulting from improper form is one of the more common complaints in orthopedics. First and foremost, having a golf pro will help avoid injuries as well as improve your game. Despite how hard you try, at some point you may fall victim to a back injury just like the golf professionals. When injuries do occur there are non-surgical and minimally invasive treatments to alleviate discomfort.

Simply avoiding the exacerbating repetitive task may alleviate pain, however, giving up your golf game is not practical. NSAIDs and the RICE (rest, ice, compression, elevate) provide temporary relief but do not necessarily address the primary reason for discomfort.

The key to preventing a back injury is working with your golf pro to optimize the mechanics of your swing. Muscle stains can be caused by an over-powerful swing or an incorrect weight shift on the follow through, thus causing your lower back pain. When this happens and, if the condition is beyond the assistance of RICE and anti-inflammatories, there are non-surgical treatments we provide to get you back in the game.

Some of the many options are:

  • Radiofrequency Ablation, otherwise known as RFA, is a safe, effective means to treat pain from arthritic joints in the neck and low back. The procedure uses heat to disable only the sensory nerves that transmit pain impulses in the spine. Benefits of this therapy may last up to a year and sometimes longer.
  • Epidural injections are used to reduce inflammation and pain from nerve root compression in the neck and low back. In many cases this provides immediate relief and may provide relief lasting up to a year.
  • PRP, platelet rich plasma, is a conservative approach to natural healing. A small amount of blood is drawn from the patient’s arm and placed into a centrifuge to separate the layers of blood. The PRP layer is then injected into the localized area to be treated. The purpose is to merge this technology with the body’s natural ability to heal itself quickly.

Dr Justin Raye is a Physical Medicine and Rehabilitation physician with a specialty in Interventional Pain Medicine at Sarasota Orthopedic Associates. While his treatment focus on pain is vast, some of the more common conditions include back/neck pain, herniated discs, sciatica, spinal compression fractures, and sports injuries. Treatment therapies include image guided injections, kyphoplasty, spinal cord stimulation, radiofrequency ablation, and regenerative medicine (Platelet Rich Plasma and Stem Cell Therapy). Dr. Raye sees patients in all three SOA locations. When needed, patients are seen on a same or next day basis.  Visit our website to make an appointment or call 941-951-BONE.

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backpain

CERVICOGENIC HEADACHES

Headache1      cervicogenic headache

Cervicogenic headaches are characterized as head and neck pain originating from the cervical region, a type of secondary headache. This classification is due to the source of the headache being in the neck.  Cervicogenic headaches may be from muscle pain and spasms of the neck muscles, cervical facet joints, or the occipital nerve, located at the base of the skull.  Multiple studies have indicated that cervicogenic headaches may be under-diagnosed, with estimates of prevalence ranging from 2% up to 22%.

Any injury to the neck or cervical region of the spine can lead to cervicogenic headaches. This injury may be an acute, sudden injury resulting from an automobile accident, a sports-related injury, or a fall, or it may be the result of a long-term sustained injury caused by bad posture or degenerative changes with age.

Cervicogenic headaches rarely present auras or nausea that are commonly associated migraine headaches and the pain is not responsive to traditional migraine medications.  However, cervicogenic headaches have been known to precipitate migraine headaches. Appropriate diagnosis of cervicogenic headaches is done by a thorough history and physical exam. Another way in which cervicogenic headaches can be readily diagnosed is if treatment of the neck is able to provide rapid relief from the headache.

PT myofascial release

The specific treatment for cervicogenic headaches varies by patient and by what is found to be the cause of the headaches. If the problem found in the neck is a result of musculature, then muscle-specific treatment options may provide relief. Such treatments include muscle relaxants, physical therapy including myofascial release, and/or trigger point injections into the muscle. For patients whose cervicogenic headaches are a result of damage to the cervical facet joints, there is often underlying inflammation contributing to pain generation. In this case, an interventional procedure known as a radiofrequency ablation (RFA) can block the pain signal being generated from the joints. To directly address the nerve triggering the cervicogenic headache, the occipital nerve, nerve blocks can be administered to inhibit the problematic signaling.

Appointments are made by calling 941.951.BONE (2663). Visit our website by clicking  here for more information about Sarasota Orthopedic Associates.