South Lake Pain Institute. Treating you, differently.

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RHEUMATOID ARTHRITIS

Rheumatoid arthritis is a disease that affects the joints. It causes pain, swelling, and stiffness. If one knee or hand has rheumatoid arthritis, usually the other does too. This disease often occurs in more than one joint and can affect any joint in the body. People with this disease may feel sick and tired, sometimes developing fevers.

Some people have this disease for only a few months, or a year or two. Then it goes away without causing damage. Other people have times when the symptoms get worse (flares), and times when they get better (remissions). Others have a severe form of the disease that can last for many years or a lifetime. Severe arthritis can cause serious joint damage.

Doctors don’t know the exact cause of rheumatoid arthritis. They do know that with this arthritis, a person’s immune system attacks his or her own body tissues. Researchers are learning many things about why and how this happens. Rheumatoid arthritis is treated by a rheumatologist. If pain is severe, then NSAID’s and opioids may be of help. At times, selected joint injections, nerve blocks, and epidurals may be indicated.

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ACNES (ANTERIOR CUTANEOUS NERVE ENTRAPMENT SYNDROME)

Anterior cutaneous nerve entrapment syndrome is a condition that causes chronic pain of the abdominal wall. Around 20% of patients with chronic abdominal pain have abdominal wall pain, which is often caused by ACNES. The primary symptom of anterior cutaneous nerve entrapment syndrome is a sharp stabbing pain that typically increases with exercise and the use of the abdominal muscles. A telltale sign that a patient may have ACNES is that the reoccurring pain is always in the same spot.

This painful condition typically affects young women, but it can occur at any age. History of trauma, pregnancy and delivery, or abdominal surgery is sometimes present. A substantial number of ACNES patients report previous visits to the ER with acute pain. Treatment will usually consist of injections of local anesthetic, and in some severe cases, surgery is needed.

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FACE PAIN CAN BE QUITE SERIOUS

Several conditions may be associated with face pain. Nerves, muscles, tendons, and bones may be implicated. Infections, herpes, trauma, nerve damage, stroke, and surgery may be a cause. If nerves are causing the face pain, it may be a condition referred to as Trigeminal Neuralgia. Trigeminal neuralgia occurs when a blood vessel presses down on the nerve near the brain stem. Over time, changes in the brain’s blood vessels can result in them rubbing against the trigeminal nerve root. This rubbing eventually wears away the insulating membrane of the nerve and results in irritation.

Identifying the problem will help delineate therapy. Your doctor may choose a trial period of antineuropathics, opioids, or antidepressants. If medications fail some injections may be of benefit; including stellate ganglia, trigger point, and selected nerves such as facial, trigeminal, supraoptical, etc. As well as epidurals, TMJ, and facet joints.

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EYE PAIN – IS IT SERIOUS?

Several conditions may be associated with eye pain, such as infection, trauma, surgery, cancer, and unknown causes. Different structures within the eye may contribute to pain including the eye globe, eyelids, nerves, arteries, and muscles.

Identifying the cause of pain becomes paramount in treating the condition. Therapy is tailored to the cause. At times, it may just require flushing out with warm water or eye drops. But if the condition is more severe, especially when accompanied by loss of vision or nausea, it may require immediate medical attention. Your doctor may choose a regimen including medications that treat neuropathic and nerve pain, opioids, or antidepressants. In selected cases injections may be of benefit. Stellate ganglion blocks, or nerve blocks, may be offered.

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DISCOGENIC BACK PAIN

Discogenic back pain refers to lower back pain that originates from a damaged vertebral disc. This condition is typically due to degenerative disc disease, which occurs naturally as the body ages. The vertebral disc cushions in between two spine vertebrae. Disruption of its normal anatomy may cause pain. Discomfort will be felt in the lower back and occasionally in the legs.

It is important to promptly diagnose discogenic back pain to avoid unnecessary procedures and delay of treatment. Epidural injections may be tried; if not effective, then your doctor may recommend a diagnostic procedure that consists of placing a needle inside the disc and directly assessing the status of the disc under fluoroscopy. Other therapies may include IDET and nucleoplasty. Both procedures are performed by a pain specialist and at times surgery may be avoided. A needle is placed in the disc and small pieces are taken out or the disc is subjected to heat. Your doctor will determine if you may be helped by these procedures. Ultimately, surgery may be the only option.

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WHAT IS DIABETIC PERIPHERAL NEUROPATHY?

Diabetic Peripheral Neuropathy is a progressive and painful condition of peripheral nerves, typically in the arms and legs. High levels of circulating sugars in blood are thought to cause injury to nerves. The most important treatment of peripheral neuropathy is to maintain normal levels of glucose in blood. Some medications considered to be beneficial include anticonvulsants and antidepressants. These include tricyclic antidepressants like amitryptilin, nortryptiline and desipramine. The most widely used anticonvulsant is gabapentin, more commonly known as Neurontin. These medications may have side effects including dizziness, difficulty concentrating, somnolence, and loss of balance. These effects will subside with time.

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COMPLEX REGIONAL PAIN SYNDROME

Complex Regional Pain Syndrome (CRPS), formerly known as regional pain syndrome, is a constellation of symptoms usually involving extremities. The hallmark of the condition is pain and inflammation that may progress to complete loss of function of the limb. It may be caused by a minor injury like an ankle twist or a more severe one like bone fractures. Surgery, nerve injury, burns, and intramuscular injection have all been implicated with this condition. The initial injury may be so small that it goes unnoticed by the patients. Complex Regional Pain Syndrome could be difficult to diagnose and may go unrecognized until evaluated by the trained specialist. At times, it is confused with early infection and time is wasted with antibiotic therapy. Symptoms are exaggerated in relation to the suspected injury. Therapy can be equally challenging for this. Tricyclic antidepressants and anti-neuropathics are among the initial medications used. To help with diagnosis, sympathetic blockade injections (neck or back) are given. If injections are effective, it helps in supporting the diagnosis. If pain is difficult to control and medications and injections have failed to help, then further therapy may include spinal cord stimulator and intrathecal pumps.

South Lake Pain Institute is currently conducting clinical trials to help find a cure for CRPS.

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WHAT IS HOLISTIC HEALING?

Holistic healing is a gentle, long-term support to enable the body’s own innate powers to do the healing.

It aims to restore balance by replacing or complementing traditional medications. South Lake Pain Institute devotes an entire branch of practice to holistic healing. Every one of our patients will be treated individually, even if they have the same illness. In almost all cases using alternative medicine, it is required that the patient takes a highly active part in both prevention and treatment. Within the Holistic Medicine banner, one may find many different techniques, some considered esoteric and without scientific background. At our clinic we have chosen to offer those techniques that provide better results, have passed the test of time, and are safe.

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DO YOU SUFFER WITH CHRONIC PAIN?

While acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different in that the pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap (sprained back or serious infection) or there may be an ongoing cause of pain (arthritis, cancer, or ear infection), but some people suffer chronic pain in the absence of any past injury or evidence of body damage.

Many chronic pain conditions affect older adults.

Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), and psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).

There are many options for treating this condition, including certain medications, injections, and therapies.

 

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FACET JOINT ARTHROPATHY

As we age, the cartilage naturally begins to deteriorate from wear and tear over the years. Eventually, this can cause the vertebrae to rub together and lead to facet joint arthropathy. Pain is achy, sore, tender, and diffuse. It may be worse in the morning, also presented with stiffness. As the joints warm up, pain decreases and by the end of the day, after sitting and standing for too long, pain exacerbates. In certain cases, pain may be felt radiating to the front and back of the legs. This pattern may be confused with sciatica.

The importance of being evaluated by a trained pain specialist cannot be stressed enough. Treatment is aimed to decrease inflammation of the joints, promote mobility, and increase function. Physical therapy, coordinated exercise, NSAID’s, and the new COX 2 inhibitors (Celebrex) are all cornerstones of therapy. Severe cases may need injections into the nerve and/or facet rhizotomy (RFA).

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