Patients who receive high, escalating doses of opioids (for example: morphine or oxycodone) may experience an increase in pain as a result of their medication. This phenomenon, called Opioid Induced Hyperalgesia (OIH), is different than developing a tolerance to medication in several ways The nature of the pain is different than the pain for which […]
Dean was a 41-year-old, married executive when he was involved in a motor vehicle accident where his car was totally wrecked. X-rays revealed no fractures. Over the next five years he experienced progressively increasing aching and tightness in his low back which sometimes radiated into his buttocks and down into both legs to the soles
The Cinderella Hypothesis postulates that damage to the muscles can occur when the muscle fibers which are activated first are also the last to deactivate. Like Cinderella, they are always working, and not given adequate amounts of time to recover. These damaged muscle fibers can be a source of pain. Low intensity, continuous activation of
Oliver is an 84-year-old publisher who came to see me for pain in the middle of his low back, which sometimes radiated to his right hip and down his right thigh. He described this pain as an intermittent aching, stabbing, shooting sensation, made worse by sitting for more than 30 minutes, standing for more than
Back pain relief achieved when soft tissue was addressed Read Post »
Anna is a 40 year old married woman, who had been on bed rest for approximately 3 years because of her pain. After a spinal fusion, discectomy, facet blocks and physical therapy, she was still having severe pain in her low back. Another surgery was suggested. When I examined Anna, I identified and treated 5
Donna, a 43 year old married mother with a one year old son saw me for evaluation of severe low back and buttock pain. Her MRIs showed a disc herniation at L4-5 and moderate-to-severe spinal stenosis at the same level. She received physical therapy, 3 epidural steroids and chiropractic treatments with transient or no pain
Physical Examinations Result in Better Outcomes for Back Pain Read Post »
James was a 67-year-old, married entrepreneur with bilateral thigh and calf pain that prevented him from walking for more than one block on a flat surface or sitting for more than 30 minutes. He couldn’t leave his house for a walk and was unable to sit in a restaurant. His pain was 7/10. I evaluated
A step care model for pain management is often the best choice Read Post »
Nearly all individuals experience degenerative changes in the spine as they age, with nearly 20% of the population exhibiting disc herniations without any symptoms or pain by the age of 50(1). This means that even though your X-ray or MRI shows an abnormality, it doesn’t mean that this is what is causing your pain. Though
Over 90% of spine MRIs are interpreted as abnormal. Read Post »
Impairment is the clinical term for a loss of function due to pain or injury. Being unable to lift more than 10 lbs because of low back pain is an example of impairment. Disability is closely related to impairment, but is distinct because it involves choice. Though your impairment may not allow you to lift
For people suffering chronic pain, pain intensity is not the only factor that should be considered when treating the patient. Many assume that once the pain is reduced, the patient will go back to living their normal life. However, this is often not the case. Many chronic pain patients have decreased muscle flexibility and strength,
I have a friend who has been complaining of weakness in his legs. He has a history of high cholesterol and has been on statins. He was seen by a spine surgeon and after an MRI showed spinal stenosis, decompressive surgery was suggested. His internist recommended stopping the statin since it can cause leg pain
Many chronic pain patients report frustration with the attitudes they face from friends, family, and health care practitioners. Most often, patients report feeling stigmatized for experiencing pain that doesn’t have a readily identifiable cause. Pain can have a variety of causes, and there is currently no set standard for diagnosing and treating chronic pain. This
Patients feeling stigmatized for experiencing pain Read Post »
You may have read or heard on the news about the new healthcare laws being put into place. I have met many people who have said that they have no idea what will happen, so I thought I would provide some information. I am not an expert, nor am I placing an opinion on it.
Some thoughts about the Affordable Health Care Act Read Post »
There has been an increase in the number of hours we sit in front of a computer for leisure and work. Does your job require you to stare at a computer for hours at a time? One study found that workers sitting for 95% of the day, and/or worked with their neck at 20˚ or
Increased risk of neck pain from extensive computer use Read Post »
Studies have shown that obese patients have more problems with musculoskeletal pain than the general population (http://bit.ly/Hh3usQ). Obesity and pain show a strong relationship even when insulin resistance, inflammation, and pain-related comorbidities are accounted for (http://1.usa.gov/17jGHqj). A study of 215 fibromyalgia (FMS) patients found that obese patients had greater pain sensitivity, poorer sleep quality, and
Last week, we discussed some of the psychological components of pain, and the potent effect emotion and attitude can have on the day-to-day management of your pain. Many patients coping with chronic pain experience kinesiophobia, an irrational fear of reinjuring oneself or exacerbating pain by participating in physical activity. One study of patients with foot
Fear may be the greatest predictor of disability status Read Post »
Several different variables have been studied: Catastrophizing, depression, kinesiophobia, and self-efficacy. Catastrophizing is a type of dysfunctional thought in which the patient exaggerates the severity of a situation. Examples of catastrophizing are thoughts like “I can’t take it!” “What did I do to deserve this?” “What’s the use?” “I might as well be dead!” One study
How does one’s psychological state affect outcomes of pain treatments? Read Post »
One of our colleagues, Ronnie Gonzalez, a bereavement counselor, sent us a comment about her clients, who often felt physical pain while struggling with the loss of a loved one. Very often, emotional stress and negative thoughts can manifest physically as tension in the muscles, which is one of the most common causes of pain.
We see that in some patients who have central sensitization, treating the peripheral pain generators may results in a decrease or elimination of the widespread pain. Widespread pain is often addressed with medication. It is common for a patient to be given an anticonvulsant, such as pregabalin (Lyrica) or gabapentin (Neurontin), or a serotonin-norepinephrine reuptake
A patient with widespread pain is a challenge to understand and treat Read Post »
Considering the possible effects of central sensitization may affect the treatment plan (and in turn the outcome) for a patient in pain. For example, take someone who injured a joint – let’s say a hip – which led to osteoarthritis and in addition diffuse, widespread hyperalgesia (increased sensitivity to pain). Sometimes when a patient is
Treating widespread pain vs. the original pain generator Read Post »
