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Pain Syndromes

Pain Syndromes We Treat

South lake pain institute treats many different pain syndromes, which are listed below. Please click the link for an in-depth look, including descriptions, symptoms, and treatment methods.


Abdominal pain is pain that occurs between the chest and pelvic regions. Commonly referred to as a stomach ache, abdominal pain can be crampy, achy, dull, intermittent, or sharp.

Whether it’s cramps, a mild stomach ache, or a sharp throb, abdominal pain can have numerous causes. Most of the causes are not serious and can be easily diagnosed and treated. However, pain in your abdomen can also be a sign of a more serious illness.

2520235MMDMBJZp-400x200It is imperative to be able to recognize symptoms that are severe and know when to call a doctor. Severe symptoms of abdominal pain are typically accompanied by:

  • Fever
  • Dehydration
  • Inability to keep food down for more than 2 days
  • Inability to pass stool, especially if you are also vomiting
  • Painful or unusually frequent urination
  • The abdomen is tender to the touch
  • The pain is the result of an injury to the abdomen
  • The pain lasts for more than a few hours

If you are vomiting blood, have bloody stool, having difficulty breathing, or experiencing abdominal pain while pregnant, seek medical care immediately!

Treating abdominal pain really depends on the cause and severity of the pain. Some common causes include:

  • Gas/Indigestion
  • Constipation
  • Stomach virus
  • Menstrual cramps
  • Food poisoning/allergies
  • Lactose intolerance
  • Ulcers
  • Pelvic inflammatory disease
  • Hernia
  • Gallstones/Kidney stones
  • Gastroesophageal reflux disease
  • Appendicitis

Anal rectal pain is a pain felt in or around the perianal region (anus and rectom). Because the perianal region contains many nerve endings, anal rectal pain can be severe, though most causes are benign.

7c94e52e579c3ec8af66e96a4b6eeebc-400x300Typically, the causes of anal rectal pain can be diagnosed fairly easily and treated with over-the-counter pain relievers and hot baths. Many of the conditions that cause the pain may also cause rectal bleeding, but it often seems worse than it actually is. The most common causes of anal rectal pain and discomfort include hemorrhoids, anal fissures (or tears), and both temporary and constant anal muscle spasms. Other common causes may include:

  • Diarrhea
  • Cancer
  • Chronic constipation
  • Trauma
  • Ulcers
  • Perianal hematoma
  • Crohn’s Disease

Anal rectal pain can be distressing, but it is often just the result of a minor treatable condition.

Treating anal rectal pain varies depending on the cause and severity of the pain. Consult your doctor for a diagnosis of your condition first. Some treatments for anal rectal pain may include:

  • hot baths
  • pain relievers (i.e. Tylenol, Advil, Motrin)
  • hemorrhoid cream
  • hydrocortisone cream
  • using a “donut” cushion
  • acupuncture
  • nerve block injection

Seek immediate medical attention if you develop a significant amount of bleeding, particularly if accompanied by dizziness, or if the pain gets much worse, spreads, or is accompanied by fever, chills, or anal discharge. See your doctor for rectal bleeding, particularly if you’re older than 40, to rule out rare, but serious, conditions, such as colon cancer.

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Ankle pain refers to any type of pain or discomfort in your ankles. This pain could be caused by an injury or by a medical condition, such as arthritis. The ankle is composed of bones, muscles, tendons, and ligaments that support the weight of your body and allow you to move.  The most common cause of ankle pain tends to be from a sprain, which is an injury where the ligaments in your ankle tear or stretch.  Your ankle may also be suffering from arthritis, particularly rheumatoid arthritis, as a result of a previous injury or simply just the wear and tear of your everyday life. When inflamed, rheumatoid arthritis may limit your ability to do your everyday routines and activities.

The first thing a doctor will typically do to diagnose the ankle pain is ask if and how the injury occurred. Then the doctor will examine the ankle, noting the amount of swelling and bruising. The doctor may order an ankle X-ray to determine whether there are any broken bones. He/she may also X-ray the leg to see if there is another related injury. This diagnosis will help your doctor determine whether or not you need traditional treatment or possible surgery.

 injured-runner-300x200Traditional treatments include:

  • Resting the ankle, keeping any unnecessary weight off of it.
  • Using ice to reduce any swelling and numb the soreness.
  • Wrapping the ankle with a bandage for support.
  • Elevating the injured or sore ankle to reduce swelling and pain.
  • Using non-steroidal anti-inflammatory medication, if necessary.
  • Using pain medication, if necessary

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Ankylosing spondylitis causes inflammation of the vertebrae that can lead to severe, chronic pain and discomfort that often comes in acute, painful episodes followed by temporary periods of remission.

Ankylosing spondylitis is an inflammatory disease that affects men more than women and can cause some of the vertebrae in the spine to fuse together. When the vertebrae fuse, it makes the spine less flexible and results in a hunched-forward posture. Signs and symptoms of this condition typically begin in early adulthood.

inflammation-spine-400x280Ankylosing spondylitis is a form of arthritis that primarily affects the spine, although other joints can become affected by the condition, including shoulders, hips, ribs and heels, as well as the joints in hands and feet. When it affects the ribs, it may become difficult to breathe deeply. In rare cases, the eyes, heart, and lungs may also be affected by ankylosing spondylitis.

There is no cure for ankylosing spondylitis, but treatments can decrease your pain and lessen your symptoms.

The goal of treating ankylosing spondylitis is to relieve your pain and stiffness, and prevent or delay complications and spinal deformity. Ankylosing spondylitis treatment is most successful before the disease causes irreversible damage to your joints. Nonsteroidal anti-inflammatory drugs, like naproxen and indomethacin, are the medications doctors most commonly use to relieve inflammation, pain, and stiffness.

Your doctor may suggest a physical therapist to provide you with specific exercises designed for your needs. Physical therapy provides patients suffering from ankylosing spondylitis with a number of benefits, from pain relief to improved physical strength and flexibility. Range-of-motion and stretching exercises will help maintain flexibility and preserve good posture.

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Anterior cutaneous nerve entrapment syndrome, more commonly known as acnes, 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.

ACNES is characterized by a sharp stabbing pain, always in the same area, which typically increases with the use of abdominal muscles. The condition most commonly 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 patients report previous visits to the ER with acute pain.

woman-stomach-pain-141027-400x300Diagnosing ACNES is very difficult and it usually involves imaging and lab tests, as well as the injection of local anesthetic. Although the injection serves as a tool for diagnosis, it will sometimes reduce the patient’s pain. Physical examination will reveal altered skin sensibility in the affected area, with one specific painful spot, and reproducibility of pain by pinching the affected skin area.

Acnes often produces misleading diagnoses, like hernia, tumors, tears and endometriosis of abdominal wall, radiculopathy, and herniated discs.

Treating ACNES isn’t easy, as most pain killers have no effect on this type of neuropathic pain. Treatment is typically by injection of the anterior cutaneous nerve with a local anesthetic at the point at which it pierces the fascia by free hand or under ultrasound guidance. Neuropathic pain killers like pregabaline or amitryptilline may be helpful.

In patients whose pain persists after several injections, surgical exploration and neurectomy is recommended. This strategy of injections followed by neurectomy is curative in about 80% of patients.

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Most commonly resulting from direct injury to the spine, arachnoiditis is caused by the inflammation of the arachnoid, which is one of the membranes that surround and protect the nerves of the spinal cord.

The arachnoid can also become inflamed due to an irritation from chemicals, infection from bacteria or viruses, chronic compression of spinal nerves, or complications from spinal surgery or other invasive spinal procedures.

 Inflammation can sometimes lead to the formation of scar tissue and adhesions, which cause the spinal nerves to “stick” together. If arachnoiditis begins to interfere with the function of one or more of these nerves, it can cause a number of symptoms, including numbness, tingling, and a characteristic stinging or burning pain in the lower back or legs.

The most common symptom of this condition is pain, but arachnoiditis can also cause:

  • Sensations that may feel like insects crawling on the skin or water trickling down the leg
  • Severe shooting pain that can be similar to an electric shock sensation
  • Muscle cramps, spasms, and uncontrollable twitching
  • Bladder, bowel, and sexual problems

In very extreme cases, arachnoiditis has also been known to cause paralysis of the lower limbs.

Arachnoiditis-340x450Arachnoiditis remains a difficult condition to treat, and long-term outcomes are unpredictable. Most treatments for arachnoiditis are focused on pain relief and the improvement of symptoms that impair daily function.

A regimen of pain management, physiotherapy, exercise, and psychotherapy is often recommended. Surgical intervention is controversial since the outcomes are generally poor and provide only short-term relief. Clinical trials of steroid injections and electrical stimulation are needed to determine the efficacy of these treatments.

Arachnoiditis appears to be a disorder that causes chronic pain and neurological deficits and does not improve significantly with treatment. Surgery may only provide temporary relief. Aging and pre-existing spinal disorders can make an accurate prognosis problematic. The outlook for someone with arachnoiditis is complicated by the fact that the disorder has no predictable pattern or severity of symptoms.

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Arthritis is a disease that causes pain, swelling, and stiffness in the body’s joints – often occurring in more than one joint.

Because there are more than 100 different forms of arthritis, a proper diagnosis is necessary in order to develop a treatment plan.

Common forms of arthritis

Arthritis

Osteoarthritis

Also known as degenerative joint disease, osteoarthritis is the most common form. It is typically caused by aging joints, injury, and obesity. Unlike many other forms of arthritis, this one does not affect other organs of the body.
Common symptoms of osteoarthritis include joint pain and stiffness. In severe cases, complete loss of cartilage causes friction between bones, causing pain at rest or pain with limited motion.

Gout

Gout is a rheumatic disease resulting from deposition of uric acid crystals in tissues and fluids within the body. It causes sudden attacks of burning pain, stiffness, and swelling in a joint, usually a big toe. Over time, these attacks harm your joints, tendons, and other tissues.
Your chances of getting gout are higher if you are overweight, drink too much alcohol, or eat too much meat and fish that are high in chemicals called purines. Gout is more common in men.

Rheumatoid arthritis

Rheumatoid arthritis is a long-term disease. Its symptoms can come and go, and it’s different for each person. Some people have long periods when their disease isn’t active. They have few or no symptoms during this time. Others feel it for months at a time.
Rheumatoid arthritis affects joints on both sides of the body, i.e. Both hands or both knees. This symmetry helps to set it apart from other types of arthritis.

Lupus

Lupus is an autoimmune disease that occurs when the immune system attacks its tissues, causing inflammation, swelling, pain, and damage. Symptoms of this disease include fatigue, joint pain, fever, and a lupus rash.
The causes of lupus are unknown but are believed to be linked to genetic, environmental, and hormonal factors. Patients of this condition may have periods of illness and remission.

Fibromyalgia

Fibromyalgia is a condition that causes widespread pain, sleep problems, fatigue, and often psychological distress. Other symptoms may include morning stiffness, tingling in the hands or feet, headaches, migraines, ibs, sleep disturbances, loss of memory, and painful menstrual periods.
Fibromyalgia often occurs with other conditions such as rheumatoid arthritis, lupus, and ankylosing spondylitis.

Juvenile arthritis

Juvenile arthritis is an autoimmune disease in which there is inflammation of the tissue that lines the inside of joints in children. Researchers believe it may be related to genetics, certain infections, and environmental triggers.
One of the more common chronic diseases of childhood, juvenile arthritis comes in several forms, including: systemic arthritis, oligoarthritis, polyarthritis, psoriatic arthritis, and enthesitis-related arthritis.

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Back pain is the most common reason why people see a doctor because it affects everybody at some point in their life and it can happen with no warning.

Back pain includes the lower back, middle back, upper back, or low back pain with sciatica.
The causes of back pain are numerous. Some are self-inflicted due to a lifetime of bad habits, like carrying heavy objects incorrectly or having your back in a bent position for a long period of time, while others may include damage to the discs between the vertebrae, osteoporosis, and osteoarthritis. Trauma, such as accident or sports injuries, may also be the cause of back pain. Although the causes may be different, most often they share the same symptoms.
Symptoms of back pain may include:

  • Back-pain-400x250Persistent aching or stiffness anywhere along your spine, from the base of the neck to the tail bone
  • Sharp, localized pain in the neck, upper back, or lower back — especially after lifting heavy objects or engaging in other strenuous activity
  • Chronic ache in the middle or lower back, especially after sitting or standing for extended periods.
  • Pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes
  • Inability to stand straight without having pain or muscle spasms in the lower back.

Most back pain gets better with a few weeks of home treatment. Over-the-counter pain relievers and the use of heat or ice might be all you need.

When to be concerned

Seek immediate medical attention if:

  • You feel numbness, tingling, or weakness in your groin, arms or legs; this may signal damage to the spinal cord.
  • The pain in your back extends downward along the back of the leg; you may be suffering from sciatica.
  • The pain increases when you cough or bend forward at the waist; this can be the sign of a herniated disc.
  • The pain is accompanied by fever, burning during urination, or frequent and/or urgent urination. You may have an infection.
  • You begin to have problems controlling your bowels or bladder.

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Cancer pain may be dull, achy, or sharp. It can be constant, intermittent, mild, moderate, or severe. Not every patient experiences cancer pain, although one out of every three patients undergoing treatment does.

Cancer pain may be due to many factors, including the disease itself. Cancer can cause pain by growing into or destroying tissue near the affected area of the body. It can come from the primary cancer itself (where the disease started) or from other areas in the body where the disease has spread. As a tumor grows, it may put pressure on nerves, bones, or organs, which can also cause pain.

Cancer pain may not just be from the physical effect of the cancer, but also due to chemicals that it may release in the area of the tumor. Treatment can help the pain in these situations.
Analgesics cancer pain
Cancer treatments, such as chemotherapy and radiation, are another potential source of cancer pain. Radiation may cause a burning sensation, while chemotherapy can cause many painful side effects, including mouth sores, diarrhea, and nerve damage.

At times, patients undergo surgery to remove cancerous cells. After surgery, recovery may be slow and painful.

Cancer-Pain-400x266There are many different methods of treating cancer pain. One of which is to remove the source of the pain through surgery, chemotherapy, radiation, or some other form of treatment. If that can’t be done, pain medications can usually control the pain.
Medications used to treat symptoms of cancer pain typically include:

  • Over-the-counter and prescription-strength pain relievers, such as aspirin, acetaminophen (tylenol, others) and ibuprofen (advil, motrin, others)
  • Weak opioid (derived from opium) medications, such as codeine
  • Strong opioid medications, such as morphine (avinza, ms contin, others), oxycodone (oxycontin, roxicodone, others), hydromorphone (dilaudid, exalgo), fentanyl (actiq, fentora, others), methadone (dolophine, methadose) or oxymorphone (opana)

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Central pain syndrome is a neurological condition caused by damage to the central nervous system, which includes the brain, brainstem, and spinal cord.

Central pain syndrome can be caused by many things, including strokes, multiple sclerosis, parkinson’s disease, brain tumors, limb amputations, brain injuries, or spinal cord injuries. Although it can appear immediately after an injury, cps may develop months or years after damage to the central nervous system.

foot-pain-400x250Symptoms of central pain syndrome can be identified by a mixture of pain sensations, the most prominent being a constant burning that is sometimes increased by touch. Pain also increases in the presence of temperature changes, most often cold temperatures. A loss of sensation may occur in affected areas, mostly on distant parts of the body like the hands and feet. There may also be brief, intolerable bursts of sharp pain on occasion. The disorder can be limited to a specific area of the body (such as the hands or feet) or may be widespread over a large portion of the body. Some areas of the body may be more intensely affected than other areas and pain may fluctuate throughout the day.

In most cases, the pain is constant and usually moderate to severe in intensity. Though in some cases, pain has been described as agonizing. Some affected individuals may experience short bursts of sharp pain, not unlike the pain that occurs when a dental probe hits an exposed nerve. In some cases, the constant the pain affects the patient’s ability to perform daily tasks and significantly impairs quality of life.

In most circumstances, central pain syndrome remains a lifelong condition. Though, there are ways to treat the symptoms to make it much more tolerable.

Treating central pain syndrome can prove to be a challenge. Therapies that have proven beneficial for some patients may have zero benefits for others. Pain medications and anti-inflammatories often provide some reduction of pain, but not complete relief. However, some antidepressants and anticonvulsants have proven to be useful. Two drugs in particular, lamotrigine and amitriptyline, have proven beneficial, especially for patients with central pain of brain origin. Lamotrigine is an anti-seizure (or anti-convulsant) medication and amitriptyline is an antidepressant. Antiarrhythmics and local anesthetics such as lidocaine can be effective as well. In most cases, the effectiveness of medications are limited because of the associated side effects. Some patients may find temporary relief from sedation or stress reduction techniques.

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Cheiralgia paresthetica, also called wartenberg’s syndrome, is a pain syndrome that typically affects the back or side of the hand at the base of the thumb.

Cheiralgia paresthetica is usually caused by compression or trauma to the superficial sensory branch of the radial nerve in the arm. Other common causes of this condition are repetitive motion or overuse of the affected arm, as well as constriction of the wrist from wristbands, watches, and athletic taping. Symptoms may also be the result of injury or surgery in the wrist.

Symptoms of cheiralgia paresthetica will typically include numbness, tingling, burning, or pain at the base of the thumb. In some cases, these symptoms may travel up the back of the thumb and index finger to the back of the hand. Because the nerve branch is sensory, there is no motor impairment associated with the injury.

Cheiralgia paresthetica will commonly resolve itself within several months once the constriction is removed, though permanent damage is possible.

numb-hand-400x266Properly treating cheiralgia paresthetica enhances recovery and nerve repair. Treatment is often straightforward, especially if the condition was caused by a poor fitting brace or wrist constraint. In that case, removing the constraint is an important and easy fix. When the condition is a direct result of chronic repetitive motions or movements, rest is an important recovery factor.

Non-steroidal anti-inflammatory drugs, like ibuprofen and aspirin are commonly used in treatment. Patients usually respond well to massage therapy as well, in order to reduce muscle and tendon irritation. In some cases surgical decompression may be recommended.

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Described as pain that lasts longer than six months, chronic pain can be mild or excruciating, at times it can be completely incapacitating. Somewhere around 100 million Americans a day suffer from this condition.

Although chronic pain may result from an initial trauma, injury, or infection, there may be another ongoing cause of pain not associated with injury or damage. The most common sources of this type of pain include:

  • Injury/trauma
  • Headache
  • Backache
  • Joint pain
  • Shoulder pain
  • Neck pain
  • Pelvic pain
  • Tendinitis
  • Sinus pain
  • Carpal tunnel syndrome

In some cases, generalized muscle and nerve pain may develop into a chronic condition.

Because the pain signals remain active in the nervous system for months or sometimes even years, chronic pain can take both a physical and emotional toll on a person .

sinus-pain-400x300There are a variety of options for the treatment of chronic pain, including both oral and topical medication, physical therapy, holistic healing (such as acupuncture), tens unit therapy, and epidural injections.
Helpful medications for chronic pain relief may include:

  • Nsaids (i.e. Ibuprofen)
  • Acetaminophens
  • Tricyclic anti-depressants
  • Anti-seizure medications
  • Muscle relaxants
  • Opioids
  • Lidocaine and fentanyl patches

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Tension headaches are the most common type of headache, in which the pain is typically throbbing and affects the front, top, or sides of the head. Chronic tension headaches refer to pain that comes and goes over a prolonged period of time.

Although the pain of chronic tension headaches is almost always present throughout the day, it doesn’t affect a person’s vision or balance. Therefore, they usually won’t prevent a person from performing their daily activities.
There is no single cause of chronic tension headaches, but they are most commonly the result of stress. Other common causes may include:

  • Anxiety
  • Depression
  • Inadequate rest
  • Poor posture
  • Fatigue
  • Hunger
  • Overexertion
  • Chronic tension headache

Sufferers of chronic tension headaches have typically had the headaches for more than 2 or 3 months. Women are twice as likely to suffer from them than men.

Some symptoms of chronic tension headaches may include mild to moderate pain or pressure, difficulty falling asleep, chronic fatigue, and a mild sensitivity to light or noise.tension-headache-400x266

Tension headaches are most effectively treated when the symptoms first begin, before they become more frequent and painful. Treatment typically consists of:

  • Medications – pain relievers, muscle relaxers, and antidepressants
  • Avoiding stress
  • Relaxation training
  • Biofeedback training
  • Although sometimes a chronic tension headache can be self-treated with an ice pack, warm bath, neck massage, or as simple as taking a nap.

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Complex regional pain syndrome, more commonly known as CRPS, is a chronic pain condition that affects one of the limbs (arms, legs, hands, or feet). It typically occurs after an injury or trauma to the limb.

Researchers and professionals believe that CRPS is caused by damage to the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord, and the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body.

CRPS is characterized by prolonged or excessive pain and mild or dramatic changes in skin color, temperature, and swelling in the affected area.

swollen-hand-400x266CRPS is classified in two ways, CRPS-i and CRPS-ii, both with the same symptoms and treatments. CRPS-ii, also known as causalgia, is the term used for patients with confirmed nerve injuries. Individuals without confirmed nerve injury are classified as having CRPS-i, also known as reflex sympathetic dystrophy syndrome. Although researchers have recently found evidence of nerve injury in CRPS-i, so the validity of the different forms is being investigated.

CRPS affects both men and women, although it’s a lot more common in women. The average age of affected individuals is about 40, though CRPS can occur to anyone older than five years.

CRPS symptoms vary in severity and duration. The main symptom is prolonged pain that can be constant and extremely uncomfortable for some people. Other symptoms may include:

  • Changes in skin texture on the affected area; it may appear shiny and thin
  • Abnormal sweating pattern in the affected area or surrounding areas
  • Changes in nail and hair growth patterns
  • Stiffness in affected joints

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Diabetic peripheral neuropathy refers to nerve damage that is caused by high blood sugar and diabetes. Although not all people experience pain, about 60-70 percent of people with diabetes eventually develop peripheral neuropathy.

There are four main types of diabetic neuropathy – peripheral, autonomic, radiculoplexus, and mononeuropathy. The most common form is peripheral neuropathy.

diabetic-blood-test-400x266Symptoms of peripheral neuropathy are typically worse at night. The feet and legs are often first to show signs, followed by the hands and arms. Symptoms of diabetic peripheral neuropathy may include:

  • Reduced ability to feel pain or temperature changes
  • A tingling or burning sensation
  • Sharp pains or cramps
  • An increased sensitivity to touch
  • Muscle weakness
  • Loss of reflexes, particularly in the ankle
  • Loss of coordination and balance
  • Ulcers, infections, deformities, and bone/joint pain in the foot
  • Diabetic peripheral neuropathy

Patients with diabetes can reduce their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible.

Because there is no known cure for diabetic peripheral neuropathy, treatment typically focuses on slowing any nerve damage and relieving any pain.

In order to slow the progression of nerve damage, the patient should:

  • Follow the doctor’s advice for proper foot care
  • Keep blood pressure under control
  • Maintain a healthy diet
  • Stay physically active
  • Maintain a healthy weight
  • Avoid smoking
  • Avoid alcohol completely or drink it only in moderation

Relieving pain consists of:

  • Anti-depression medication
  • Anti-seizure medication
  • Physical therapy
  • Acupunctureproblems coordinating muscle movement, with a decreased ability to move the affected body part
  • Abnormal movement in the affected limb

South lake pain institute is now conducting clinical trials for CRPS to try and come up with new approaches to treat the disease, as well as limit the symptoms associated with it.

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