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More About Failed Back Surgery Syndrome

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istock 1171010146 1
In this month’s first blog, we got into the problem where a patient has had spinal surgery but continues to have pain. The term for this is failed back surgery syndrome. This is not a true “syndrome,” such as carpal tunnel syndrome, but more of an overall term. Regardless, ongoing chronic pain after back surgery is difficult and disappointing.  In July’s second blog, let’s get into this a bit more, especially in the situations of lumbar decompression surgeries. 

Time frames for success 

When a person has a surgery to relieve nerve compression in the lumbar spine (procedures such as microdiscectomies or laminectomies) the nerve roots have been compressed and at least partially damaged. They take some time to heal, even after the source of the decompression seems to have been removed. 
  •     In general, if a patient is getting better within three months of the surgery, he or she should continue to get better.
  •     If there has not been any improvement in the pain approximately three months after the decompression procedure, then the back surgery can be assumed to be unsuccessful and further action will be necessary.
  •     During the first three months after surgery, the success of the procedure cannot be judged, as enough time has not passed to allow for healing and decreased inflammation.

Considerations 

There are a couple other things to consider with these lumbar procedures.  Decompression of the lumbar spine will usually relieve the patient’s leg pain directly after the surgery. However, for 10-20% of patients, the pain will continue until the nerve starts to heal. In some cases, the pain may even be worse for a while after the back surgery because operating around the nerve root creates some increased swelling and this leads to pain.  It usually takes far longer for symptoms of numbness, tingling, or weakness to resolve. It may take up to a year after surgery for these symptoms to subside. If these symptoms persist after a year, they probably are signs of permanent nerve damage and they are now unlikely to improve in any length of time.  Also, after decompression surgery, such as a discectomy, the stenosis can return at the same vertebra or at a new level. After all, the conditions that caused the initial development of compression and bone spurs may still be present.  Pain that is relieved right after surgery but then returns abruptly is often due to recurrent lumbar disc herniation. Recurrent lumbar disc herniations happen to about 5% to 10% of patients, and they are most likely to occur during the first three months after the patient’s back surgery.  If you’re still having pain after your back surgery, that’s something we can help with at Summit Healthcare Pain Clinic Associates. Call us at (855) 768-4968 to schedule a consultation with Dr. Trujillo.

You’ve Had Back Surgery but You Still Have Pain

istock 1055538506 1 Unlike some surgeries, such as removing a tooth or repairing a torn ligament, back surgery is not as cut and dried. Pain is a tricky thing, and even under the best circumstances with the various possible back surgeries, spine surgery is no more than 95 percent predictive of successfully removing the patient’s pain. 

When a patient has surgery, but they continue to have pain, there is a term for this — failed back surgery syndrome. This isn’t actually a syndrome, but rather simply a term to describe situations where patients have had back surgery, but they continue to experience pain afterwards. 

Since we see many of these patients at Summit Healthcare Pain Clinic Associates, let’s get into this during these toasty July blogs in Slow Low. 

What are reasons for failed back surgery? 

Spine surgery can really only do two things: 

  •     It can decompress a nerve root that is pinched or compressed
  •     It can stabilize a painful joint

Unlike a surgery like removing a painfully decayed tooth, you cannot simply go in and cut out exactly what is causing a patient’s pain. Instead, back surgeries seek to change the anatomy that is behind the pain. The goal may be to remove the lamina at the back of a vertebra that is thought to be compressing a nerve root. Or it could be to remove a disc that has herniated and is pushing on the spinal cord or a nerve root. 

Prior to these procedures, the probable source of the patient’s pain is identified. This is likely a lesion or something out of the normal that has changed and is now impacting the nerves. This is difficult because pain can radiate far from its source. Plus, the nature of nerves and the ways they can create pain is far from exact. 

By far the number one reason back surgeries are not effective in some cases and patients continue to experience pain is because the area/lesion operated on turned out to not be the cause of the patient’s pain. Or at least it wasn’t the entire cause. 

Some surgeries can be more predictable 

Some forms of back surgery tend to have more predictable results. 

A microdiscectomy for a lumbar disc herniation that is causing leg pain is highly predictable and will likely have good success. The nerve creating the leg pain is easy to identify. That same procedure for herniation that is causing lower back pain has far less likelihood of successfully removing most or all of the patient’s pain. That’s because the nerve or nerves involved in the lower back pain are far from easy to isolate and identify. 

If you’re having continuing pain even having back surgery performed elsewhere, Dr. Trujillo can help with your pain. Please call us at (855) 768-4968 and let’s see how we can help and keep you from having another surgery.

More About Complex Regional Pain Syndrome

istock 847976942 In June’s first blog, we introduced complex regional pain syndrome, a mysterious condition that causes chronic pain usually in an arm or leg. We discussed symptoms and some basics of CRPS. In June’s second blog, let’s get into some more detail of this chronic pain producer and what can be done by the team at Summit Healthcare Pain Clinic to help. 

What causes complex regional pain syndrome? 

This isn’t a common condition, which is good because it’s not well understood. It is thought to be triggered by an injury to or an abnormality of the peripheral and central nervous systems. This occurs after trauma or another type of injury. 

There are two types of CRPS. Both have similar symptoms, but it’s thought the causes are different. 

  •     Type 1 — This is the type of CRPS in about 90 percent of patients. Also known as reflex sympathetic dystrophy (RSD), type 1 CRPS occurs after an illness or injury that did not directly damage the nerves in the affected limb.
  •     Type 2 — This type of CRPS has similar symptoms, but it occurs after the person has suffered a distinct nerve injury.

CRPS occurs after forceful trauma to an arm or leg, such as a fracture. It can also follow surgery, heart attacks, infections, even a sprained ankle. It is a mystery, however, as to why one person develops CRPS while another doesn’t. It’s thought there is dysfunctional interaction between the central and peripheral nervous systems, leading to overactive inflammatory responses. 

How does Dr. Trujillo treat CRPS? 

It appears that early intervention has the most success treating CRPS. Medications used can range from antidepressants and anticonvulsants to nerve-blocking medications and corticosteroids. 

From there, various therapies can be used. The success varies with the patient, so different methods may be used and then replaced if not effective: 

  •     Heat therapy — Applying heat to the skin that feels cool.
  •     Topical analgesics — Analgesics, such as lidocaine cream, can reduce hypersensitivity.
  •     Physical therapy — Early physical therapy can decrease pain and maintain range of motion.
  •     Mirror therapy — This uses a mirror to help trick the brain. The patient sits in front of a mirror and moves the healthy limb, and the brain perceives this (due to the reverse image of the mirror) as the limb affect by CRPS.
  •     TENS — Transcutaneous electrical nerve stimulation is applied to active nerve endings.
  •     Biofeedback — This involves helping you learn techniques to better control your body, which helps you relax and can relieve pain.
  •     Spinal cord stimulation — Electrodes are inserted along the spinal cord and can stop some of the pain messages being sent to the brain.
  •     Pain pumps — These inserted pumps deliver medication directly into the spinal cord fluid.
  •     Acupuncture — This form of treatment uses long, very thin needles to help stimulate nerves, muscles, and connective tissues to increase blood flow and relieve pain.

If you have symptoms of CRPS, please give Dr. Trujillo a call at Summit Healthcare Pain Clinic, (855) 768-4968, to schedule an appointment.

The Mystery of Complex Regional Pain Syndrome

istock 1215529369 Certain things that occur with the human body remain a bit beyond our understanding. The overreaction of the body to allergens and why it affects some people but not others is a mystery. Rheumatoid arthritis is also a mystery as to why the body attacks its own joints. 

Complex regional pain syndrome is in that same realm. This form of chronic pain usually affects an arm or a leg, and the onset usually develops after an injury or other medical condition, but the true cause of the pain isn’t understood. 

Dr. Trujillo treats patients with complex regional pain syndrome, so let’s get more into detail in these two June blogs. 

What is complex regional pain syndrome? 

When a person has complex regional pain syndrome (CRPS), the chronic pain that affects an arm or leg is out of proportion with the severity of the injury that happened before the onset of the pain. CRPS typically develops after an injury, a surgery, a stroke, or a heart attack. 

CRPS can be treated, and remission is possible, but treatment is most effective when started at the onset of symptoms. 

What are the symptoms of CRPS? 

  •     Continuous burning or throbbing pain, usually in an arm, leg, hand, or foot
  •     Sensitivity to touch or cold
  •     Swelling of the painful area
  •     Changes in skin temperature, alternating between sweaty and cold
  •     Changes in skin color, ranging from white and blotchy to red or blue
  •     Changes in skin texture, which may become tender, thin, or shiny in the affected area
  •     Changes in hair and nail growth
  •     Joint stiffness, swelling, and damage
  •     Muscle spasms, tremors, weakness, and atrophy
  •     Decreased ability to move the affected body part

The first symptoms are usually pain, swelling, redness, noticeable changes in temperature, and hypersensitivity. 

As CRPS continues, the affected limb can become cold and pale. It may undergo skin and nail changes as well as muscle spasms and tightening. When these changes occur, CRPS is often irreversible at this point. 

If you have any of the symptoms listed above, please give Dr. Trujillo a call at Summit Healthcare Pain Clinic Associates, (855) 768-4968. We can help with the pain.

Lower the Pain with Radiofrequency Energy

istock 876497390 Chronic pain isn’t any fun. Plus, the constant pain begins to keep the person from enjoying the things they used to do. Something as simple as walking the dog or going to the grocery store can be an exercise in pain. 

Most chronic back pain is caused by compression of the spinal nerves. The area of the compression will radiate out from beyond the section of the back to the area served by the nerve or nerves. For instance, nerve compression in the lower back will show up in leg pain. 

Dr. Trujillo often uses radiofrequency ablation to help our patients from the Show Low area overcome their chronic back pain. 

When would I need RF ablation? 

When your chronic neck or back pain is due to arthritis in your spine, radiofrequency ablation could be a good option. The goal of RF ablation is to eliminate or reduce the pain signals that are coming from where a spinal nerve root is being compressed where it leaves the spinal column. This is often due to degeneration of the facet joints at the back of the vertebrae, or in the sacroiliac joints at the bottom of the spine where it enters the pelvis. 

How does Dr. Trujillo perform RF ablation? 

Although it sounds scary to some patients, they will be awake during these procedures. That is because Dr. Trujillo needs the patient to provide feedback to verify that the correct nerve is being treated. For these treatments, patients receive a combination of IV sedation and local anesthesia in the treatment area. 

Using x-ray guidance, Dr. Trujillo inserts the radiofrequency needle into the correct area. He moves the needle into position alongside the inflamed nerves. To test placement, a mild electrical current is passed through the needle. If the needle is in the right location, the patient will feel a brief tingling sensation and there may be a muscle twitch in the neck or back. 

Now that the target nerves are located, local anesthesia is administered to them to minimize any pain during the ablation. 

Dr. Trujillo then passes the radiofrequency energy through the needle, creating a lesion on the nerve. This lesion disrupts the pain signals sent to the brain. This process is repeated for additional nerves as needed. 

Recovery and pain relief 

Patients have some soreness in the area Dr. Trujillo treated. There isn’t any absolute restriction on activity, but patients will want to avoid pain-causing activities. Rest is important. Most patients experience full pain relief two to three weeks after Dr. Trujillo performs their ablation. 

Want to do something about your chronic back pain? Call the pain specialists at Summit Healthcare Pain Clinic Associates, (855) 768-4968, to make an appointment.

Your Back Pain Demands MILD Treatment

istock 684957938 1 “Wait a minute. That headline. My back pain is extreme, so exactly how is a mild treatment going to do anything? I’ve been trying lots of mild treatments to no avail.”

Ah, but you haven’t tried Dr. Trujillo’s MILD pain-relieving treatments at Summit Healthcare. These may be minimally invasive, but they’re not mild in what they can do. MILD actually is an acronym standing for minimally invasive lumbar decompression. These treatments have proven very effective for treating lumbar spinal stenosis for our patients.

The problem — nerve compression

At some point, we all have lower back pain. But occasional lower back pain from overuse, a muscle strain, and other causes is different than chronic pain. Spinal stenosis, particularly in the lower back, the lumbar spine, is common. It’s estimated that over two million Americans are diagnosed with lumbar spinal stenosis and having some treatment performed to address it each year. LSS is a narrowing of the lower spinal canal that creates compression of the spinal cord or other nerve roots exiting the spinal canal.

When we’re young, our spinal canal has plenty of room for our spinal cord, the bundle of nerve tissues that run from your brain to your lower body, and ligaments, bones, and our spinal discs to all coexist in harmony. As we age, however, natural wear and tear take a toll. A combination of factors works together to narrow the spinal canal. Ligament tissue thickens, bone spurs form on the lamina (the back of the vertebrae), spinal discs bulge or fully herniate (push through their outer covering). All of these factors can push on the spinal cord and nerve roots. This is spinal stenosis, and it is common in both the cervical and lumbar spine. Our MILD treatments target stenosis in the lumbar spine.

What is the MILD procedure?

Dr. Trujillo makes a tiny incision above the area of the spine where the compression is happening. He uses fluoroscopy to direct him to the target area of the patient’s lumbar spine. Then, using tools specially designed for the MILD procedure, he removes small pieces of bones spurs and excess ligament tissue that is reducing the space in the spinal canal. This returns space to the spinal canal and decreases compression. This reduces pain and give the patient back the mobility that he or she has been losing due to the pain.

Details of the MILD procedure: 

  •     This is an outpatient procedure performed in under 1 hour
  •     Patients are able to resume light activities in just a few days
  •     Doesn’t require general anesthesia, implants, stitches, or subsequent physical therapy

Want a MILD treatment for that chronic lower back and leg pain? Call us at Summit Healthcare Pain Clinic, (855) 768-4968, to schedule a consultation.   

More about Injection Therapy

istock 503597451 In April’s first blog, we discussed why Dr. Trujillo uses injection therapy for certain patients in certain situations. We discussed the use of corticosteroid injections to treat the ongoing joint inflammation of arthritis.

In April’s second springy blog, let’s get into two other injection therapies, epidural steroid injections and trigger point injections.

Epidural steroid injections

Epidural steroid injections may be used to treat chronic neck and back pain caused by bulging discs, herniated discs, and spinal stenosis. These conditions work to place pressure on the spinal cord itself, or on the nerve roots exiting the spinal canal down into the arms and legs. When these nerves become compressed by bulging spinal discs or bone spurs, the result will be back or neck pain, and pain that will likely radiate down to the area served by the compressed nerve or nerves.

Dr. Trujillo places epidural injections into the epidural space that surrounds the dura, the membrane that covers the nerve roots in the spine. For these injections x-ray guidance is a necessity. Local anesthetic is then injected into the target area, followed by the injection of the corticosteroid into the space where the nerve is inflamed. These injections can relieve pain for several months.

Trigger point injections

Trigger points are small, hypersensitive knots in the muscle tissue. They can cause pain in the area surrounding the knot and can also refer pain to other parts of the body. Trigger points are most common in the back and shoulders, but they can occur in other muscles, as well.

Trigger point injections can break down the knot in singular cases. In cases such as myofascial pain syndrome or fibromyalgia it’s likely additional trigger points will form. Still, these injections can be very effective for relieving the pain.

To administer a trigger pint injection, Dr. Trujillo locates the trigger point by feeling the knot with his fingertips. He may use a local anesthetic to numb the area prior to the injection. Then he inserts a needle into the trigger point and injects a mix of corticosteroid and lidocaine.

In many cases, patients experience relief from their trigger point after just one injection. As mentioned, for chronic conditions, these injections may be an ongoing process.

If you’re dealing with chronic pain, please give us a call at Summit Healthcare Pain Clinic, (855) 768-4968. We can help.

Injections for Pain

istock 508301579 1 Dr. Trujillo utilizes different methods to help his patients get past their chronic pain. From pain pumps to radiofrequency ablation to surgery, he has various tools at his disposal.

But in some cases, the best option turns out to be injections of corticosteroids. These work to decrease the nerve inflammation that is behind the pain. These aren’t usually viewed as long-term or permanent solutions, but these injections can calm issues such as tendinitis to the degree that the condition resolves. In other cases, they are a good bridge to reduce the pain and inflammation while the patient uses exercise or physical therapy to build strength in the muscles surrounding the painful joints.

In April’s two blogs, let’s get into the injection therapies we use at Summit Healthcare Pain Clinic.

Why injections?

Obviously, no one wants to deal with chronic pain. It begins to impact the patient’s quality of life. But at the same time, most patients hope to avoid surgery, such as joint replacement, or at least to delay the need. Corticosteroid injections can provide an effective treatment to help patients manage their pain without surgery. It can also be a good alternative to long-term oral medication use. These injections can enable patients to perform the exercises and build the strength needed to help decrease the causes of their pain moving forward.

Corticosteroid injections

Although all of these injections involve some amount of corticosteroid, they can also be the main ingredient. That’s the case when Dr. Trujillo uses these injections for arthritis pain. Because arthritis is, by definition, inflammation of the joint, the direct injection of steroid into the joint can make inroads against the inflammation.

For these injections, Dr. Trujillo often uses x-ray guidance to ensure the proper placement of the injection.

Because arthritis isn’t a condition that will reverse itself, the use of steroid injections is helpful to allow the patient to employ other means to try and protect their joints. Corticosteroid injections can be repeated, but they need to be spaced out at least 4-6 weeks. Patients cannot receive more than four injections within a year, as more frequency can lead to cartilage damage in the joint.

In April’s second blog, we’ll get into two other injection options we use at Summit Healthcare Pain Clinic. Until then, if you’re dealing with chronic pain, please call Dr. Trujillo at (855) 768-4968 to schedule a consultation.

Repetitive Strain Injuries

adobestock 331416842 1 As its name implies, a repetitive strain injury is a result of prolonged, repetitive, and forceful movement. Such movements tend to be seemingly harmless at first — typing on a keyboard, hitting a tennis ball, hand movements by assembly line workers — but become increasingly harmful as the same movements are repeated over and over, day after day.

These repeated movements cause damage (also known as micro tears) to the muscles, tendons, and nerves of the body part involved. The most commonly affected parts include the fingers, wrists, forearms, and elbows. Repetitive strain injuries are not a specific medical disorder but rather a collective term of conditions such as carpal tunnel syndrome, bursitis, and tendonitis. Most of us will suffer the pain from one of these at some point in their life.

At Summit Healthcare Pain Clinic, Dr. Trujillo treats the pain from many issues caused by repetitive stress.

Common signs and symptoms of repetitive strain injuries

  • Numbness and tingling sensations
  • Weakness
  • Loss of grip strength
  • Sharp pain
  • Restricted mobility in the affected joints, tendons, and muscles

Are you at risk?

There are three basic components that increase your risk for repetitive strain injury: poor posture, poor technique, and overuse. The following factors can further put you at risk for these injuries:

  • Your job requires heavy computer use all day
  • Infrequent breaks
  • Lack of exercise
  • A stressful work environment
  • Long fingernails (These put the fingers in an unnatural position, consequently putting stress on your fingers.)
  • Chronic lack of sleep
  • Overweight or obese
  • Poor ergonomics
  • Existing health conditions such as diabetes, arthritis, thyroid disorders, or any condition that involves swelling

At Summit Healthcare Pain Clinic, we help you understand what movements or stresses are behind your tendinitis or other sources of pain. From there, we’ll work with you to correct the movements, if possible, and to help you deal with the pain in the meantime. Call us at (855) 768-4968 to schedule an appointment with Dr. Trujillo.

Problems with Your Hips

adobestock 236181436 1 Because the hips feature large bones, many people don’t think of them when it comes to chronic pain. The knees, shoulders, and even the ankles can seem more destined for overuse and damage.

Ah, but your hips will let you know when they’re not happy. At Summit Healthcare Pain Clinic, Dr. Trujillo helps patients get past their chronic hip pain so they can get back to doing the things they love.

What makes up the hips?

The hip is a ball-and-socket joint that joins the ball of the thigh bone (femur) to the socket of your pelvis. Inside the hip joint is a cartilage lining that cushions impacts between the femur and the hip socket. But those impacts can be pretty intense in the hips, and they can be very repetitive. That’s why dancers, gymnasts, and other athletes that participate in sports with impact often have damage to their hip cartilage, not to mention strains, bursitis, and the effects of osteoarthritis.

Common hip conditions

These are some common hip problems that lead to chronic hip pain:

  • Bursitis of the hip — Bursitis is the painful swelling of the bursae, the fluid-filled sacs that cushion areas where tendons and muscles slide across bone. When a patient has hip bursitis, the bursa at the top of the femur is affected. Because it is involved in so many movements, when this bursa is inflamed it can be very painful.
  • Arthritis in the hip — Osteoarthritis in the hip is gradual loss of cartilage due to daily wear and tear. As the cartilage wears down, or tears, it leads to chronic inflammation that can make it difficult to sleep, let alone perform certain normal activities. Usually, arthritis in the hip is in the form of osteoarthritis, but it can also develop after a traumatic injury.
  • Osteoporosis in the hip — When a person develops osteoporosis, their bone density drops. This leads to the bones weakening and breaking much more easily than is normal. A precursor of osteoporosis is known as osteopenia.
  • Avascular necrosis of the hip — If you’re old enough to know about Bo Jackson (if not, watch the ESPN 30-for-30 show or check out highlights on YouTube), this is the injury that sent him into retirement. A seemingly simple tackle led to dislocation of his hip. This led to avascular necrosis, where the bone tissue begins to die because it isn’t receiving enough blood. This eventually led Mr. Jackson to full hip replacement.

Having pain in your hips? Let’s see how we can help at Summit Healthcare Pain Clinic. Call us at (855) 768-4968 to schedule an appointment with Dr. Trujillo.

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