at 3810 WBounous St, Wichita, 67213 United States
Back pain management. Accident and work injuries pain.
Work and accident injuries and occupational medicine are our primary service. Here are highlights: All types of physicals (DOT/medical cards, Pre-Employment, Hazmat, Respirator, Asbestos, Child care, school/sports physicals and much more), Work comp employee medical injury care, drug and alcohol testing, drug testing consortiums, Audiograms/hearing tests, Immediate Care/Acute care, Respirator fit testing, Pulmonary Function/Spirometry, blood tests and some immunizations/vaccines.
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What is TENS? Transcutaneous electrical nerve stimulation (TENS) is a therapy that uses low-voltage electrical current for pain relief. You do TENS with a small, battery-powered machine about the size of a pocket radio. Usually, you connect two electrodes (wires that conduct electrical current) from the machine to your skin. The electrodes are often placed on the area of pain or at a pressure point, creating a circuit of electrical impulses that travels along nerve fibers. When the current is delivered, some people experience less pain. This may be because the electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that block or "scramble" normal pain signals. Another theory is that the electrical stimulation of the nerves may help the body to produce natural painkillers called endorphins, which may block the perception of pain. You can set the TENS machine for different wavelength frequencies, such as a steady flow of electrical current or a burst of electrical current, and for intensity of electrical current. Your physical therapist, acupuncturist, or doctor usually determines these settings. After you receive an introduction to and instruction in this therapy, you can do TENS at home. People use TENS to relieve pain for several different types of illnesses and conditions. They use it most often to treat muscle, joint, or bone problems that occur with illnesses such as osteoarthritis or fibromyalgia, or for conditions such as low back pain, neck pain, tendinitis, or bursitis. People have also used TENS to treat sudden (acute) pain, such as labor pain, and long-lasting (chronic) pain, such as cancer pain. Although TENS may help relieve pain for some people, its effectiveness has not been proved. Is TENS safe? Experts generally consider TENS to be safe, although the machine could cause harm if misused. Have your physical therapist or doctor show you the proper way to use the machine, and follow these instructions carefully. Always tell your doctor if you are using an alternative therapy or if you are thinking about combining an alternative therapy with your conventional medical treatment. It may not be safe to forgo your conventional medical treatment and rely only on an alternative therapy.
316 686 0400- 1-855-70-PAINDOC
How Common is Back Pain? While it is estimated that four out of five people will experience back pain at some point in their lives, back pain that lasts longer than a few weeks is not normal. Back Pain Symptoms Back pain symptoms may include feelings of muscle ache, stabbing or shooting pain, stiff or limited flexibility in the back or lower back, inability to stand with proper posture and radiating pain down one or both legs. Where is my back pain coming from? Muscle Strains Did you know that muscle related pain is one of the most common reasons for overall back pain? It is true. Muscle related pain can be caused by improper lifting techniques, overuse, poor posture or a sudden awkward movement or fall. Spinal or Disc Problems Bulging or Herniated Discs: Spinal discs are soft cushions between vertebra. Sometimes, the soft jelly like substance inside the disc can bulge out of place or rupture, putting pressure on the surrounding nerves causing back pain. Disc related pain can be caused by an injury. Interestingly, some people who have bulging or herniated discs will never experience any back pain. Sciatica Sciatica refers to pain that stems from the sciatic nerve, a large nerve extending from the lower back down the back of each leg. Sciatica is not a disorder, but a symptom of another underlying problem, such as a spinal stenosis, a pinched/irritated nerve in the lower back or a herniated disc. Learn more about sciatica. Other Painful Conditions If you have spinal stenosis, degenerative disc disease, scoliosis, compression fractures, arthritis or osteoporosis you may also experience pain in the back. These conditions can be treated with conservative, minimally invasive procedures. Risk Factors for Back Pain There are a few factors that can increase your risk of developing back pain, such as: smoking, obesity, age, physical labor, sedentary work and depression. Preparing for Your Doctor Appointment Before you meet with your clinic doctor, take note of some important facts. Is your back pain the result of an injury? What movements increase or decrease your back pain? What are the symptoms you have been feeling? How long have you had this back pain? What does your back pain feel like? Dull, aching, stabbing or shooting? What type of work do you do? What treatments or medications have you already tried to resolve your back pain? Diagnosis Testing To help determine the cause of your back pain, your provider may ask you a lot of questions and ask for some diagnostic testing. Some common diagnostic imaging includes: X-Ray – an x-ray shows the alignment of the bones in your spine and whether you have any broken or arthritic bones that may be causing pain. Always bring your x-ray images with you to an appointment to help your provider understand your full history. Magnetic resonance imaging (MRI) or computerized tomography (CT) scans – These tests show images of bone, muscle, tissue, nerves, blood vessels, tendons and ligaments. These tests can show disc herniation, muscle tears, ligament problems and can help your provider understand your back pain. Nerve Studies – Electromyography (EMG) – Electromyography (EMG) is a test used to study nerve and muscle function. There are two parts to EMG testing; a nerve conduction study and a needle exam for muscle testing. The nerve conduction study involves stimulating the nerves at different points with small electric stimulation so their function can be measured. The needle exam involves inserting very fine needles into several muscles. These needles pick up both normal and abnormal electrical signals given off by a muscle. The EMG can provide information about the extent of nerve and/or muscle injury and can give some indication as to whether the damage is reversible. An EMG may be performed when the patient has unexplained muscle weakness to distinguish if the problem is in the muscle or if it due to nerve disorders. The EMG can detect abnormal electrical activity of muscles and nerves that can occur in many diseases and conditions, including muscular dystrophy, muscle inflammation, pinched nerves, damage to nerves in the arms and legs (peripheral nerve damage), multiple sclerosis and carpal tunnel syndrome. Back Pain Treatment Options: There are a number of treatment options that help reduce back pain, which include: Epidural Steroid Injection Discogram Facet Joint Injection Trigger Point Injection Radiofrequency Neuroablation Minimally Invasive Posterior Facet Fusion Sacroiliac Joint Injection.
Fibromyalgia Pain Symptoms: Fibromyalgia pain is a chronic pain condition that causes widespread pain in muscles, tendons and joints with feelings of fatigue, sleep problems and fibromyalgia pain can even be associated with irritable bowel syndrome. Fibromyalgia can also create tender points — places on the body where even slight pressure is very painful. Fatigue is seen in up to 90 percent of fibromyalgia patients and can be related to abnormal sleep patterns. Patients with fibromyalgia do not get enough restorative sleep, also called rapid eye moving (REM) sleep, leading to chronic fatigue symptoms. The following symptoms can also be seen in fibromyalgia patients in different combinations: Poor concentration Forgetfulness Memory problems Irritability Depression Anxiety Mood changes Abdominal pain associated with irritable bowel syndrome (IBS) Bladder problems including frequent urination Migraines and tension headaches Paresthesias – numbness and tingling sensations in different parts of the body Fibromyalgia Pain Causes: There is no known cause for fibromyalgia pain, but fibromyalgia symptoms can often develop after a physical or emotional trauma. Additionally, genetics and infections can trigger fibromyalgia pain. It is believed that a process called central sensitization is the reason behind the painful symptoms, causing those with fibromyalgia to have a lower threshold for pain. Central sensitization leads to increased sensitivity in the brain to pain signals. Current research has found that there are elevated levels of a nerve chemical, called substance P, in patients with fibromyalgia. In addition, another chemical, serotonin, is lower in patients with fibromyalgia. With repeated nerve stimulation, fibromyalgia can lead to changes in the brain and processing of pain signals. These changes can cause disturbances of pain perception leading fibromyalgia patients to become over reactive to pain signals. Fibromyalgia Risk Factors: Women are more susceptible to getting fibromyalgia, as well as those with a family history of fibromyalgia or rheumatic diseases, such as rheumatoid arthritis or lupus. Testing: To be diagnosed with fibromyalgia, a person must have widespread pain lasting at least three months and at least 11 out of 18 total possible tender points. Blood tests also are done to rule out conditions with similar symptoms. Once these are excluded, then the diagnosis of fibromyalgia (a diagnosis of exclusion) can be made. Fibromyalgia Pain Treatment Options: There are a number of treatment options that help with pain management from fibromyalgia, which include: Myofascial Release Medication Management Trigger Point Injection Biofeedback Acupuncture Massage Therapy Treatment of Underlying Contributing Pain Generators Physical Therapy Pain Psychology
Knee Pain Symptoms: Knee pain is a common complaint affecting people of all ages. This may be a result of an injury or due to medical conditions such as arthritis, gout and even infection. The knee joint is made up of bones, ligaments, tendons, cartilage and bursae. Injury or inflammation to one of these structures can lead to knee pain. Some signs and symptoms of knee pain include swelling and stiffness, redness and warmth, weakness, popping or crunching sounds or locking of the knee in the affected area. Knee Pain Causes: Knee pain can result from a number of different things including an injury, pulled or torn ligaments and tendons, damaged cartilage, gait, and even muscle and back injuries. Knee pain also may simply occur following years of wear and tear playing sports, working or from general leisure activities. Injuries to the knee can affect the cartilage, ligaments, tendons and the bursae (fluid-filled sacs) that support, stabilize and cushion the knee joint. Some common injuries to the knee include: ACL injury – The anterior cruciate ligament (ACL) is one of four ligaments in the knee that provides stability to the knee. Most often this ligament is injured with sudden directional changes with the knee bending inward and forward, tearing the ligament. This is seen in football, basketball and skiing injuries frequently. Torn meniscus – The meniscus is tough cartilage that acts as the shock absorber between the femur (thigh bone) and the tibia (shin bone). This also can be torn with sudden twisting injury to the knee. Bursitis – There are small sacs of fluid filled cushion that surround the knee joint. When these become irritated and inflamed, pain occurs especially with movement. Loose body – An injury or general wear and tear can cause pieces of bone or cartilage to become loose and break off. The loose body can interfere with the normal movements of the knee and cause pain with movement. Patellar tendinitis – This occurs when there is irritation or inflammation of the tendon around the patella (knee cap). Typically, runners, skiers, cyclists and sports involving heavy jumping and stress on the knees are prone to this injury. Patellar dislocation – The patella (knee cap) covers the front of the knee and glides through the normal range of motion. If the patella becomes dislocated pain occurs as there is excessive lateral, or side to side, movement of the patella. Certain medical conditions also lead to knee pain. These include: Osteoarthritis – This is the most common type of arthritis. This is usually the result of wear and tear injury where the cartilage breaks down over a period of years from use and with age. As the cartilage disappears, the cushion is destroyed and bone on bone grinding can occur, leading to knee pain. Rheumatoid arthritis – This is an autoimmune condition that can affect many other joints in the body besides the knee. This is a chronic disease condition and the severity and impact on a patient is variable from mild to severe. Gout – This condition results from excessive uric acid crystal build up in the joints of the body. Typically patients have the big toe affected as well as the knee. Pseudogout – This condition is similar to gout; however, there is a buildup of crystals of calcium pyrophosphate instead of uric acid. Knees are commonly affected by this condition. Knee Pain Risk Factors: A person may be more likely to experience certain types of knee pain and knee problems common to their age and sex group. Excess weight increases stress on the knee joints on a daily basis. Being involved in sports or having a previous knee injury also increases the chance of experiencing knee pain. Certain activities and sports tend to create more stress on the knees causing injury such as skiing, basketball and football. Testing: A physical exam by a doctor is often the first step to determine the source of knee pain. Following a doctor's assessment, imaging tests including x-rays, CT scans, ultrasounds and MRI’s may be necessary to help pin-point the cause of knee pain and determine the best knee pain treatment plan. Knee Pain Treatment Options: Advanced minimally invasive treatment options for knee pain have improved outcomes and can help you return to the activities you enjoy. There are a number of treatment options that help reduce knee pain, which include: Steroid Injection Percutaneous Tenotomy or Fasciotomy Nerve Blocks Acupuncture Massage Therapy Physical Therapy Medication Management Pain Psychology.
Low Back Pain is a common ailment that affects most people at least once in their lives. This part of the anatomy has so many complex moving parts, it's no wonder that it requires special care. The best ways to prevent back pain and maintain a healthy back are by keeping muscles strong and flexible, practicing lifting techniques and maintaining a healthy body weight. Call for an appointment at 316 686-0400 316 462-1070
Call for an appointment at 316 686-0400 316 462-1070 EXPERIENCED IN: treating patients suffering from work injuries and car accidents. We welcome worker's compensation patients. Our experienced doctors and medical staff works with your insurance company to make sure you receive the treatment you need. Work Injury/ Car Accident Symptoms: Often, car accidents and work injuries may not result in immediate pain. It is important to be seen by a doctor after any collision or work accident in case of internal injury or spine misalignment. As in most cases, early intervention can lead to a proper recovery. Work Injury Causes: Lifting, falling, cutting and repetitive motion can all result in work related injury. Work Injury Risk Factors: Those working in more physically demanding industries are at greater risk for getting a work related injury. Testing: Because the symptoms of work injuries are so broad, testing must be determined by a doctor in order to properly diagnose an injury. Work Injury/ Car Accident Treatment Options: There are a number of treatment options that help the painful symptoms following a work injury or a car accident, which include: Full Medical Exam Disability Evaluation Functional Capacity Evaluation Minimally invasive treatment options, such as Epidural Steroid Injection Acupuncture Massage Therapy Maintenance Care (after care) Rx Dispensary (minimizes patient out-of-pocket costs, more convenient) Electromyogram (EMG) and/or Electromyogram Neurostimulation Therapy Diagnostic Injections Therapeutic Injections Medication Management Physical Therapy
Neck Pain Symptoms: Neck pain can occur from the top of your shoulders to the bottom of your head. Neck pain symptoms may be mild to severe and may limit your range of motion. Neck Pain Causes: As we age, neck pain can be caused by the wear and tear of tissues and joints. Neck pain can have many causes, but most of these are not serious conditions. Neck muscles can be strained or pulled from poor posture or even from sleeping in an awkward position. Over time, normal wear and tear or arthritis can also lead to neck pain. Certain injuries can lead to neck pain as well as nerve compression in the area. Risk Factors: The weaker or more degenerated the tissue or joints in the neck become, the more susceptible the neck is to injury. Age-As you age, you are more likely to have increased wear and tear on vertebrae, discs, muscles and joints. This can often lead to neck pain and arthritis. Occupation- If your job requires you to hold your head in the same position for prolonged periods (professional driver, computer work), you may increase your risk for neck pain. The good news is that simple stretching and strengthening exercises can help you reduce your risk for neck pain. Download some simple exercises now. Testing: There are many diagnostic tests that can be performed to determine the cause of neck pain. These include facet joint injections, medial branch block and EMG testing. Imaging scans done by a specialist may be used to identify neck pain or rule out other conditions with similar symptoms. Neck Pain Treatment Options: There are a number of pain management treatment options that help reduce neck pain, which include: Cervical Epidural Steroid Injection Facet Joint Injection or Selective Nerve Root Block Trigger Point Injection Massage Therapy Discography for Appropriate Surgical Evaluation Neurostimulation Therapy Pain Psychology Acupuncture Physical Therapy Medication Management Radiofrequency Ablation
Neck Pain Management Neck Pain Symptoms: Neck pain can occur from the top of your shoulders to the bottom of your head. Neck pain symptoms may be mild to severe and may limit your range of motion. Neck Pain Causes: As we age, neck pain can be caused by the wear and tear of tissues and joints. Neck pain can have many causes, but most of these are not serious conditions. Neck muscles can be strained or pulled from poor posture or even from sleeping in an awkward position. Over time, normal wear and tear or arthritis can also lead to neck pain. Certain injuries can lead to neck pain as well as nerve compression in the area. Risk Factors: The weaker or more degenerated the tissue or joints in the neck become, the more susceptible the neck is to injury. Age-As you age, you are more likely to have increased wear and tear on vertebrae, discs, muscles and joints. This can often lead to neck pain and arthritis. Occupation- If your job requires you to hold your head in the same position for prolonged periods (professional driver, computer work), you may increase your risk for neck pain. The good news is that simple stretching and strengthening exercises can help you reduce your risk for neck pain. Download some simple exercises now. Testing: There are many diagnostic tests that can be performed to determine the cause of neck pain. These include facet joint injections, medial branch block and EMG testing. Imaging scans done by a specialist may be used to identify neck pain or rule out other conditions with similar symptoms. Neck Pain Treatment Options: There are a number of pain management treatment options that help reduce neck pain, which include: Cervical Epidural Steroid Injection Facet Joint Injection or Selective Nerve Root Block Trigger Point Injection Massage Therapy Discography for Appropriate Surgical Evaluation Neurostimulation Therapy Pain Psychology Acupuncture Physical Therapy Medication Management Radiofrequency Ablation
Acute, Chronic, and Neuropathic Pain Acute pain is sudden and sharp pain that is directly related to tissue damage. It's the sensation felt when a hand is caught in a door or a head is bumped. The pain felt during childbirth is also acute pain. It can subside instantly or last three to six months. Acute pain is often the symptom of injured or diseased tissue, and it disappears when the tissue heals or is treated. If acute pain is not relieved, it can lead to chronic pain. Chronic pain continues even after an injury has healed and lasts more than three to six months. The source of chronic pain can be something identifiable, like an ongoing injury, or something unidentifiable, like when no injury is present. Chronic pain is described as an aching, deep, burning or dull feeling that carries into the extremities. Neuropathic pain occurs after signs of injury to tissue are no longer visible. With this pain, nerve fibers may be damaged or dysfunctional, causing them to send incorrect pain signals to the brain. Neuropathic pain, or neuropathy, could be placed in the chronic pain category, but the sensations felt are very different from musculoskeletal pain. Neuropathic pain is described as severe, lightning-like, burning or cold, with ongoing numbness, tingling, or weakness. Neuropathy may be felt traveling along the nerve path from the spine down to the arms and hands or legs and feet. Phantom limb syndrome is one example of neuropathy. NSAIDs like ibuprofen and opioids like morphine are usually not effective in treating neuropathy. Certain medications, nerve "block" injections, and a variety of chronic pain treatments are used for neuropathic pain.
Complex Regional Pain Syndrome (CRPS) Symptoms: Complex Regional Pain Syndrome (CRPS), previously called Reflex Sympathetic Dystrophy (RSD), is a condition that generally affects arms and legs. CRPS pain symptoms can cause significant aching and burning pain in the arms or legs and may cause the limb to swell or feel hot or cold. In addition, CRPS may cause the skin on the arm or leg may change texture and color or become thin and shiny. There also may be noticeable hair pattern changes (rapid hair growth or loss of hair), as well as increased sweating in the area of pain. The symptoms in Complex Regional Pain Syndrome can vary in their severity and duration. Complex Regional Pain Syndrome pain symptoms can become continuous and intense over a period of time. If CRPS pain symptoms develop after an injury, the pain seems more intense or out of proportion to the severity of injury. Pain symptoms can also spread from the original site of injury to encompass the entire arm or leg. Complex Regional Pain Syndrome pain symptoms can also be seen to affect the opposite extremity as well. Emotional stress can also cause the pain to worsen. Typical symptoms of CRPS include: Pain described as “burning” or “throbbing” that can be continuous. Hypersensitivity to cold or touch. Swelling and stiffness in the joints. Decreased motor function and disability. Changes in hair and nail growth pattern. Skin changes such as increased skin temperature, color changes (red, blotchy, pale, dark coloring), increased sweating, thin and shiny skin. Complex Regional Pain Syndrome (CRPS) Causes: Complex Regional Pain Syndrome likely occurs from multiple factors producing the above pain symptoms. CRPS pain symptoms often occur after forceful trauma to a limb, such as a fracture, amputation or crush injury. Other “traumas” to the body can also cause CRPS whether it is major or minor including; surgery, heart attacks, infections and sprains. Emotional stress can also bring about or aggravate CRPS. It is not currently known why and exactly how CRPS is triggered but it is believed that there is a dysfunction in the nervous system causing inappropriate response and inflammation. Another thought is that CRPS may be caused by an immune response and healing process that has become disrupted and abnormal causing symptoms of swelling, warmth and redness in the affected area. There are two types of CRPS, each having similar signs and symptoms, but different causes. CRPS Type 1 occurs after an illness or injury without a known, direct damage to nerves in the affected limb. It is believed that the pain receptors in these patients become very sensitive to catecholamines, chemicals that work as messengers in the nervous system and are associated with the sympathetic limb of the nervous system often called the “fight or flight” system. CRPS Type 2 occurs after a distinct nerve injury. Most patients, estimated to be around 90% of people, have CRPS Type 1. Complex Regional Pain Syndrome (CRPS) Risk Factors: It is important that Complex Regional Pain Syndrome is diagnosed and treated early; otherwise it could progress to become more disabling. Symptoms of CRPS include atrophy (loss of muscle mass), or tissue wasting and contracture, or muscle tightening. Once an affected limb becomes cold, pale and undergoes skin and nail changes and decreased mobility due to muscle spasms and tightening, the condition is often irreversible. It is important that patients seek treatment in a timely manner, as treatment is most effective when started early in the course of this condition. Testing: No single test can diagnose CRPS. A physical exam and a medical history will be the first step of diagnosis, followed by procedures that may provide insight. Some of these procedures include a bone scan, sympathetic nervous system test, x-rays and MRI. Complex Regional Pain Syndrome Treatment Options: As with many conditions, if Complex Regional Pain Syndrome is treated in the early stages CRPS can be treated much more effectively than if left for long periods of time untreated. Various treatment medications can be used to treat CRPS symptoms including pain relievers, corticosteroids, bone-loss medication and sympathetic nerve-blocking medication. Hot and cold applications to the site and topical analgesics can be done at home, and physical therapy treatment may be suggested to maintain limb mobility and desensitization therapy. There are a number of pain treatment options that help pain from CRPS, which include: Lumbar Sympathetic Block Stellate Ganglion Block Biofeedback Neurostimulation Therapy Intrathecal Pump Implant
Low Back Pain - Symptoms Back sprain or strain Symptoms typically include: Muscle spasms, cramping, and stiffness. Pain in the back and sometimes in the buttock. It may come on quickly or gradually. It most often occurs in episodes. Certain movements make it worse, and doing light activities such as walking makes it feel better. The worst pain usually lasts 48 to 72 hours and may be followed by days or weeks of less severe pain. Nerve-root pressure Symptoms typically include: Leg pain. If pain extends below the knee, it is more likely to be due to pressure on a nerve than to a muscle problem. Most commonly, it's a pain that starts in the buttock and travels down the back of the leg as far as the ankle or foot. This pain pattern is known as sciatica (say "sy-AT-ih-kuh"). For more information, see the topic Sciatica. Nerve-related problems, such as tingling, numbness, or weakness in one leg or in the foot, lower leg, or both legs. Tingling may begin in the buttock and extend to the ankle or foot. Weakness or numbness in both legs, or loss of bladder and/or bowel control, are symptoms of cauda equina syndrome, which requires immediate medical attention.
Terminology about a herniated disc can be confusing. There are many different terms to describe a herniated disc, such as a pinched nerve, bulging disc, ruptured disc or slipped disc. These terms tend to be used somewhat differently among health professionals because there are no generally agreed upon definitions for many disc problems. Interchangeable terminology can be confusing and frustrating for patients who hear their condition referred to in different terms by different practitioners, causing the patients to remain unclear as to the real diagnosis. The extent of disc problem or disc herniation does not necessarily correlate to the patient’s level of pain. Although it may seem contrary to common sense, the severity of pain from a herniated disc does not always correlate to the amount of physical damage to the disc. Additionally, less serious back problems may cause more pain than a herniated disc. For example, a large herniated disc can be completely painless, while a muscle spasm from a simple back strain may cause excruciating pain. This means that the severity of pain is not a determining factor for identifying a herniated disc.
Two causes of pain: pinched nerve or. disc pain In identifying the cause of the patient’s pain, there are two general types of spinal disc problems used by physicians: Pinched nerve. When a patient has a symptomatic herniated disc, the disc itself is not painful, but rather the material that is leaking out of the inside of the disc is pinching or irritating a nearby nerve. This type of pathology produces pain called radicular pain (e.g., nerve root pain) leading to pain that may radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is usually described as sciatica. This nerve root pain is called a herniated disc. (Other common causes of a pinched nerve may include spinal stenosis and bone spurs from spinal arthritis). Disc pain. When a patient has a symptomatic degenerated disc (one that causes low back pain and/or leg pain), it is the disc space itself that is painful and the source of pain. This type of pain is typically called axial pain.
We provide state-of-the-art evaluation and treatment for people suffering from pain caused by all kinds of accident injuries including car accidents, work accidents, slip and fall and other types of accidents that may result in herniated discs, neuropathy and many other conditions. We utilize an integrated approach to provide patients with the best treatment for their pain and injuries working closely with a variety of health-care specialists including; Neurosurgeons, Orthopedic Surgeons, Neurologists, Pain Management.
Pain Management Back pain By Mayo Clinic Staff Definition Back pain is a common complaint. Four out of five people in the United States will experience low back pain at least once during their lives. It's one of the most common reasons people go to the doctor or miss work. On the bright side, you can prevent most back pain. If prevention fails, simple home treatment and proper body mechanics will often heal your back within a few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back pain. Causes Your back is an intricate structure composed of bones, muscles, ligaments, tendons and disks — the cartilage-like pads that act as cushions between the segments of your spine. Back pain can arise from problems with any of these component parts. In some people, no specific cause for their back pain can be found. Strains Back pain most often occurs from strained muscles and ligaments, from improper or heavy lifting, or after a sudden awkward movement. Sometimes a muscle spasm can cause back pain. Structural problems In some cases, back pain may be caused by structural problems, such as: • Bulging or ruptured disks. Disks act as cushions between the vertebrae in your spine. Sometimes, the soft material inside a disk may bulge out of place or rupture and press on a nerve. But many people who have bulging or herniated disks experience no pain from the condition. • Sciatica. If a bulging or herniated disk presses on the main nerve that travels down your leg, it can cause sciatica — sharp, shooting pain through the buttock and back of the leg. • Arthritis. The joints most commonly affected by osteoarthritis are the hips, hands, knees and lower back. In some cases arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis. • Skeletal irregularities. Back pain can occur if your spine curves in an abnormal way. If the natural curves in your spine become exaggerated, your upper back may look abnormally rounded or your lower back may arch excessively. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain. • Osteoporosis. Compression fractures of your spine's vertebrae can occur if your bones become porous and brittle. Rare but serious conditions In rare cases, back pain may be related to: • Cauda equina syndrome. This is a serious neurological problem affecting a bundle of nerve roots that serve your lower back and legs. It can cause weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control. • Cancer in the spine. A tumor on the spine can press on a nerve, causing back pain. • Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be an infection. Risk factors Factors that increase your risk of developing low back pain include: • Smoking • Obesity • Older age • Female gender • Physically strenuous work • Sedentary work • Stressful job • Anxiety • Depression When to seek medical advice Most back pain gradually improves with home treatment and self-care. Although the pain may take several weeks to disappear completely, you should notice some improvement within the first 72 hours of self-care. If not, see your doctor. In rare cases, back pain can signal a serious medical problem. See a doctor immediately if your back pain: • Is constant or intense, especially at night or when you lie down • Spreads down one or both legs, especially if the pain extends below the knee • Causes weakness, numbness or tingling in one or both legs • Causes new bowel or bladder problems • Is associated with pain or pulsation (throbbing) in the abdomen, or fever • Follows a fall, blow to your back or other injury • Is accompanied by unexplained weight loss Also, see your doctor if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse. Tests and diagnosis Diagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you do see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rubber reflex hammer. These assessments help determine where the pain comes from, how much you can move before pain forces you to stop and whether you have muscle spasms. They will also help rule out more serious causes of back pain. If there is reason to suspect that you have a tumor, fracture, infection or other specific condition that may be causing your back pain, your doctor may order one or more tests: • X-ray. These images show the alignment of your bones and whether you have arthritis or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, nerves or disks. • Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels. • Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera. • Nerve studies (electromyography, or EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis). Treatments and drugs Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of over-the-counter pain relievers may be all that you need to improve your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy. Medications Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain that doesn't get better with over-the-counter pain relievers. Narcotics, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor. Low doses of certain types of antidepressants — particularly tricyclic antidepressants, such as amitriptyline — have been shown to relieve chronic back pain, independent of their effect on depression. Physical therapy and exercise A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help prevent pain from coming back. Injections If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than six weeks. In some cases, your doctor may inject numbing medication into or near the structures believed to be causing your back pain. Early studies indicate that botulism toxin (Botox) also may help relieve back pain, perhaps by paralyzing strained muscles in spasm. Botox injections typically wear off within three to four months. Surgery Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Types of back surgery include: • Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A bone graft is inserted between the two vertebrae, which may then be splinted together with metal plates, screws or cages. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae. • Disk replacement. An alternative to fusion, this surgery inserts an artificial disk as a replacement cushion between two vertebrae. • Partial removal of disk. If disk material is pressing or squeezing a nerve, your doctor may be able to remove just the portion of the disk that's causing the problem. • Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, surgeons can remove a small section of the offending vertebra, to open up the passage. Prevention You may be able to avoid back pain by improving your physical condition and learning and practicing proper body mechanics. To keep your back healthy and strong: • Exercise. Regular low-impact aerobic activities — those that don't strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices. Talk with your doctor about which activities are best for you. • Build muscle strength and flexibility. Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels. • Quit smoking. Smokers have diminished oxygen levels in their spinal tissues, which can hinder the healing process. • Maintain a healthy weight. Being overweight puts strain on your back muscles. If you're overweight, trimming down can prevent back pain. Use proper body mechanics: • Stand smart. Maintain a neutral pelvic position. If you must stand for long periods of time, alternate placing your feet on a low footstool to take some of the load off your lower back. • Sit smart. Choose a seat with good lower back support, arm rests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level. • Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward. Alternative medicine Many people choose hands-on therapies to ease their back pain: • Chiropractic care. Back pain is one of the most common reasons that people see a chiropractor. If you're considering chiropractic care, talk to your doctor about the most appropriate specialist for your type of problem. In addition to chiropractors, many osteopathic doctors and some physical therapists have training in spinal manipulation. • Acupuncture. Some people with low back pain report that acupuncture helps relieve their symptoms.
Low Back Pain Exercise Guide Regular exercises to restore the strength of your back and a gradual return to everyday activities are important for your full recovery. Your orthopaedic surgeon and physical therapist may recommend that you exercise 10 to 30 minutes a day 1 to 3 times a day during your early recovery. They may suggest some of the following exercises. This guide can help you better understand your exercise and activity program. Ankle Pumps Lie on your back. Move ankles up and down. Repeat 10 times. Repeat 10 times. Heel Slides Lie on your back. Slowly bend and straighten knee. Repeat 10 times. Abdominal Contraction Lie on your back with knees bent and hands resting below ribs. Tighten abdominal muscles to squeeze ribs down toward back. Be sure not to hold breath. Hold 5 seconds. Relax. Repeat 10 times. Wall Squats Stand with back leaning against wall. Walk feet 12 inches in front of body. Keep abdominal muscles tight while slowly bending both knees 45 degrees. Hold 5 seconds. Slowly return to upright position. Repeat 10 times. Heel Raises Stand with weight even on both feet. Slowly raise heels up and down. Repeat 10 times. Straight Leg Raises Lie on your back with one leg straight and one knee bent. Tighten abdominal muscles to stabilize low back. Slowly lift leg straight up about 6 to 12 inches and hold 1 to 5 seconds. Lower leg slowly. Repeat 10 times. Top of page Intermediate Exercise Program Single Knee to Chest Stretch Lie on your back with both knees bent. Hold thigh behind knee and bring one knee up to chest. Hold 20 seconds. Relax. Repeat 5 times on each side. Hamstring Stretch Lie on your back with legs bent. Hold one thigh behind knee. Slowly straighten knee until a stretch is felt in back of thigh. Hold 20 seconds. Relax. Repeat 5 times on each side. Lumbar Stabilization Exercises With Swiss Ball Abdominal muscles must remain contracted during each exercise (see Abdominal Contraction). Perform each exercise for 60 seconds. The farther the ball is from your body, the harder the exercise. Lying on Floor Lie on your back with knees bent and calves resting on ball. Slowly raise arm over head and lower arm, alternating right and left sides. Slowly straighten one knee and relax, alternating right and left sides. Slowly straighten one knee and raise opposite arm over head. Alternate opposite arms and legs. Slowly "walk" ball forward and backward with legs. Sitting on Ball Sit on ball with hips and knees bent 90°and feet resting on floor. Slowly raise arm over head and lower arm, alternating right and left sides. Slowly raise and lower heel, alternating right and left sides. Slowly raise one heel and raise opposite arm over head. Alternate opposite arm and heel. Marching: Slowly raise one foot 2 inches from floor, alternating right and left sides. Standing Stand with ball between your low back and wall. Slowly bend knees 45 ° to 90 ° . Hold 5 seconds. Straighten knees. Slowly bend knees 45 ° to 90 ° while raising both arms over head. Lying on Ball Lie on your stomach over ball Slowly raise alternate arms over head. Slowly raise alternate legs 2 to 4 inches from floor. Combine 1 and 2, alternating opposite arms and legs. Bend one knee. Slowly lift this leg up, alternating right and left legs. NOTE: Be careful not to arch your low back! Advanced Exercise Program Hip Flexor Stretch Lie on your back near edge of bed, holding knees to chest. Slowly lower one leg down, keeping knee bent, until a stretch is felt across top of the hip/thigh. Hold 20 seconds. Relax. Repeat 5 times on each side. Piriformis Stretch Lie on back with both knees bent. Cross one leg on top of the other. Pull opposite knee to chest until a stretch is felt in the buttock/hip area. Hold 20 seconds. Relax. Repeat 5 times each side. Lumbar Stabilization Exercise With Swiss Ball Lie on stomach over ball. " Walk " hands out in front of ball until ball is under legs. Reverse to starting position. " Walk " hands out in front of ball until ball is under legs and slowly raise alternating arms over head. " Walk " hands out in front of ball and slowly perform push-ups.
Pain Medications Mistake No. 5: Drugged Driving Pain medications can make you drowsy. Different people react differently to different drugs. "How I react to a pain medication is different from how you react," "It may not make me drowsy, but may make you drowsy. So I recommend trying it at home first, and see how you feel. Don't take two pills and go out driving." Pain Medications Mistake No. 6: Sharing Prescription Medicines Unfortunately, it's very common for people to share prescription medications with friends, relatives, and co-workers. Not smart, Haynes and Binaso say -- particularly when it comes to pain medications. "If a fairly healthy person is taking a medicine because she is in pain, and wants to give some pills to Uncle Joe because he is hurting -- well, this is a potential problem, "Uncle Joe may have a problem that keeps his body from eliminating the drug, or he may have an allergic reaction, or the drug may interact with a medication he is taking, with life-threatening results." Pain Medications Mistake No. 7: Not Talking to the Pharmacist It's not easy to read drug labels, even if you can make out the small print. If you have a question about either a prescription or OTC drug, ask the pharmacist. "That's why I'm in the store, "You may have to wait a couple of minutes for me to finish what I'm doing. But you'll get the information you need to take the right medicine the right way. Just say, 'Tell me about this medicine; what should I be on the lookout for?'"