Pain related to fibromyalgia, chronic neck and chronic lower back pain interrupt life and functioning of many patients. In our practice, we employ effective strategies to fight acute or chronic pains related to these disorders.
It is well-known that the brain pain centers of these patients become sensitized, maintaining the level of pain and creating a "vicious cycle" of pain.
Fibromyalgia is a chronic illness. The disorder may be perpetuated by chronic stressors, psychological or physiological, lack of sleep and many other factors.
Fibromyalgia is not easy to treat, There are many effective ways to improve and control it. Improving sleep and modifying the lifestyle to reduce stress and overtiredness are some of there. Muscle relaxation and exercise are definitely important. Exercise usually includes stretching and aerobic exercise. The physical therapist employed by our practice is trained to design an appropriate, individually-tuned program for each patient.
Psychological counseling to reduce stress, anxiety and depression and otherwise modify lifestyle, is an important part of pain management. In our practice, most chronic pain patients and fibromyalgia patients receive significant relief using the above outlined strategies. Treatment with medications is also an important aspect of management.
Myofascial trigger points are a primary mechanism in myofascial pain. These are localized spots of tenderness and pain on the injured muscles and are involved in the central mechanisms of myofascial pain. Usually, injury of some sort, or repetitive and cumulative stress is the direct cause of development of trigger points.
In fibromyalgia, tenderness of the muscles is widespread, even in places other than muscles. Besides widespread tenderness, patients report generalized aching pain, insomnia, fatigue, depression and anxiety. Many scientists believe that the cause of fibromyalgia lies in an abnormality of the central nervous system. It is related to a neurotransmitter imbalance, primarily serotonin. Treatment of fibromyalgia consists of improving sleep hygiene, using anti-depressants, such as Tricyclics and, as mentioned above, stretching and aerobic exercise.
Approximately 80% of people will have back pain or back ache at some point in their lives. For many of us, back pain is interrupting and sometimes even considerably disabling.
The sources of lower back pain can be varied and quite challenging to diagnose. They could be related to the spinal column itself or to the neighboring organs. For example, urinary tract infection or gynecologic disorders may cause lower back pain.
Our job is first to determine whether the pain comes from the spinal structures or the adjacent organs. If we diagnose lower back pain coming from the spine, we check that this pain is not caused by any serious neurologic disease, such as spinal tumor, metastatic disease of the vertebral body or central spinal canal, vertebral body fracture, etc. Usually, x-ray or MRI helps in this respect.
Generators of pain in the lower back could be an inter-vertebral disc which has ruptured or extruded, a facet joint, or a compressed nerve root. There can be other sources of pain, but at this time there is no uniform opinion among neurologists, neurosurgeons, pain management specialists and physical therapy and rehabilitation specialists on this issue.
Treatment of lower back pain and pain radiating into the leg is not always an easy task. If pain is acute and not severe, a few days of bed rest and anti-inflammatory nonsteroidal medications usually help. If pain is diagnosed as a radicular pain, or chronic lower back pain with exacerbation, usually physical therapy, an exercise program and non-steroidal anti-inflammatory medications may be successfully used. We effectively utilize such treatments as axial traction, trigger point injections with or without steroids, massage, ultrasound, electrical stimulation, manual therapy, performed by a licensed physical therapist, application of local anesthetic creams and sometimes medications, such as Tricyclics or Neurontin.
If diagnostic testing demonstrates disc herniation with resultant radiculopathy ("pinched nerve"), then epidural steroid injection can be very effective.
If we diagnose facet joint disease as a source of lower back pain, we perform facet joint injection, or a radiofrequency ablation procedure. Sometimes, lower back pain arises from inflammation/arthropathy of the sacroiliac joint. Steroid injection into the involved joint may be highly effective. If pain is caused by a hip joint problem, orthopedic evaluation and treatment would be indicated.
Sometimes even epidural or other steroid injections result in no significant improvement. A variety of surgical procedures, performed by an orthopedist or a neurosurgeon remain an option for this group of patients. With improvement of surgical techniques, an excellent response is the most typical outcome.
All Neurological Services, P.C.