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The Mystery of Fibromyalgia

iStock 640218792 Fibromyalgia is a chronic disorder that causes pain in the muscles and bones, areas of tenderness, general fatigue, and sleep and cognitive problems. Fibromyalgia is not fully understood, but research shows that when a person has fibromyalgia their pain sensations become amplified.  Many doctors don’t understand this chronic condition and they misdiagnose what’s going on, as symptoms of fibromyalgia can mimic those of other conditions.  Dr. Trujillo has extensive experience with fibromyalgia and can help you manage the condition. 

What are the symptoms of fibromyalgia? 

Fibromyalgia causes what is now referred to as “regions of pain.” Some of these regions overlap with what was previously referred to as areas of tenderness called “trigger points” or “tender points.”  The pain in these regions feels like a consistent dull ache. The agreed upon diagnosis of fibromyalgia is if you have pain in 4 out of 5 regions of pain. This 2016 revision of the diagnosis of fibromyalgia updated the former criteria laid out in 1990 of “chronic widespread pain.”  Other symptoms of fibromyalgia include: 
  •     Fatigue
  •     Sleep difficulty
  •     Long periods of sleep without feeling rested
  •     Headaches
  •     Depression
  •     Anxiety
  •     Trouble focusing
  •     Pain or dull ache in the lower body
  •     Dry Eyes
  •     Bladder problems, like interstitial cystitis

How is fibromyalgia diagnosed? 

When diagnosing fibromyalgia, Dr. Trujillo looks for widespread pain that has plagued the patient for over three months. This pain should be occurring in 4 out of the 5 areas of pain that have been used since 2016 in lieu of the former evaluation of trigger points.  There isn’t a lab test for fibromyalgia, but Dr. Trujillo may order certain tests so that he is able to rule out other conditions that can display similar symptoms. These will usually be any of the following blood tests: 
  •     Complete blood count
  •     Erythrocyte sedimentation rate
  •     Cyclic citrullinated peptide test
  •     Rheumatoid factor
  •     Thyroid function tests
Diagnosing fibromyalgia is easier for Dr. Trujillo, who is a pain specialist, compared to most typical physicians who have little experience with the condition.  In October’s second blog, we’ll get into how Dr. Trujillo treats fibromyalgia at Summit Healthcare Pain Clinic Associates. Until then, if you’re dealing with chronic pain of any sort, we need to hear from you. Call us at (855) 768-4968.

Tell Those Muscles to Relax

shutterstock 566470942 Sometimes when we’re tense or when we overuse a muscle it can stay tight and is difficult to relax. A knot forms in the muscle that can be quite painful. These knots can actually be felt through the skin. These are trigger points. 

At Summit Healthcare Pain Clinic Associates, Dr. Trujillo uses trigger point injections for our patients from Show Low and the surrounding areas. Trigger point injections encourage knotted muscles to relax, eliminating the pain they were causing. 

What is a trigger point? 

A trigger point is a highly sensitive bundle of muscle fibers that have been tensed for such a period, whether due to overuse or enduring stress, that they cannot relax, and they turn into a small knot. Unlike an area of muscle tightness or fatigue that can be wide in scope, trigger points are very specific spots that can be quite painful to the touch. 

Are there other reasons for developing trigger points? 

The main reason you develop these muscle knots is from overuse or from continued clenching due to anxiety or stress. But other factors can also increase your odds of developing a trigger point: 

  •     Repetitive movements
  •     Hunched or slouching posture
  •     Joint problems, such as with arthritis

What are trigger point injections? 

At Summit Healthcare Pain Clinic Associates, we help our patients with this acute muscle pain with trigger point injections. Here’s how Dr. Trujillo delivers these. 

He first feels for the trigger point. He’ll ask for your feedback as he pushes on the area of your pain. When he locates the trigger point, we clean the surface skin. In most cases, we then apply a topical numbing cream. Once the skin is numb, Dr. Trujillo inserts a needle containing a mixture of Lidocaine (anesthetic) and a corticosteroid down into the knot of the muscle and dispense the mixture into the location. The Lidocaine instantly provides pain relief; the corticosteroid reduces inflammation, which causes the muscle to relax and release the trigger point. 

We find that trigger point injections, thanks to the longevity of corticosteroid effects, often fully relieve the patient’s pain for months or even permanently. We can target various trigger points in a single session, if needed. 

Do you have a knot in back or neck? Call us at Summit Healthcare Pain Clinic, (855) 768-4968, and let’s see if trigger point injections could help.

More About the Pain of Sciatica

iStock 1203043225 In this month’s first blog, we got into sciatica, the painful nerve condition that causes pain to radiate down into the hips, buttocks, and legs. Since sciatica is a common condition, let’s give you some more information about it in this blog to start the fall. 

If you’re suffering from sciatica, Dr. Trujillo has many options for helping you get past the pain. 

What should I avoid if I am suffering from sciatica? 

You could think that moving as little as possible would be the best thing for sciatica. Actually, exercise and movement are better for relieving sciatica than bed rest. Inactivity makes the pain worse in most cases. In general, you’ll need to feel your way through movements or activities that seem to exacerbate your pain. 

There are certain exercises you’ll need to avoid, however. 

  •     Bent-over row
  •     Leg lifts and leg circles
  •     Full-body squats
  •     Weightlifting
  •     Abdominal stretches
  •     Rotating stretches
  •     Touch the toes stretches
  •     Running

What Are the Exercises That Help Sciatica? 

Sciatica exercise involves three keys: strengthening, stretching, and aerobic conditioning. 

  •     Strengthening exercises focus on the spinal column and supporting muscles, ligaments, and tendons. Beyond the back, these exercises focus on the abdominal, gluteal, and hip muscles.
  •     Stretching is important for sciatica, especially the hamstrings. The target of these stretching exercises are the muscles that are causing pain due to being overly tight and inflexible.
  •     Low-impact aerobic exercise is a component of treatment; it encourages the exchange of fluids and nutrients. Plus, aerobic exercise releases endorphins, the body’s natural painkillers.

Here’s a link to a variety of exercises for sciatica.

How long can sciatica last? 

The duration of sciatica typically depends on the type and severity of the underlying problem. In most cases, sciatica usually resolves in 4-8 weeks. This would be acute sciatica. Chronic sciatica can last up to two years. 

If you have pain in your hips, buttocks, and leg, typically on one side, please call us at Summit Healthcare Pain Clinic. We can help reduce the nerve compression that is causing your sciatica. Call us at (855) 768-4968 to schedule a consultation with Dr. Trujillo.

Sciatica Is a Pain…In the Leg

Copy of Copy of Copy of iStock 1166298317 1 The pain caused by sciatica is a common reason patients come see Dr. Trujillo and our team at Summit Healthcare Pain Clinic Associates. Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. It’s rare for sciatica to affect both sides, as the part of the nerve affected by the compression is usually only on one side of the body. 

Sciatica can cause debilitating pain, but the good news is that for most people they get better within 6 to 12 weeks. 

Dr. Trujillo helps our patients overcome the pain of sciatica. 

What causes sciatica? 

Sciatica most commonly occurs when a herniated disc, bone spur on the spine, or narrowing of the spinal column (spinal stenosis) compresses part of the nerve. This results in inflammation, pain, tingling, and often numbness down the affected leg served by the nerve. The term sciatica comes from the nerve that is being pinched, the sciatic nerve. 

What are the risk factors for sciatica? 

These conditions make it more likely that you may develop sciatica: 

  •     Age — Age-related changes in the spine (issues such as herniated discs and bone spurs) are the most common causes of sciatica.
  •     Obesity — Excess weight places more stress on the spine.
  •     Occupation — There is some thinking that jobs that require you to twist your back, carry heavy loads, or drive a vehicle for long periods of time contribute to sciatica.
  •     Prolonged sitting — If you have a sedentary lifestyle or have to sit for prolonged periods of time, you’re more likely to develop sciatica.
  •     Diabetes — Because diabetes affects the way your body uses blood sugar, this increases your risk for nerve damage.

Will Sciatica Go Away on Its Own? 

Whether your sciatica will resolve on its own is dependent on how bad the disc herniation or spinal compression is. It also depends on lifestyle issues. For instance, if you have a job that involves a good deal of heavy lifting, or prolonged sitting without breaks, both of those activities can damage discs. 

The key is to not take it easy. Movement is important to start the healing, coupled with ice/heat and anti-inflammatory medications. If you start exercising, particularly stretching your hamstrings and strengthening your core, there’s a good chance your sciatica will get better in a few weeks. 

Do you have pain in your buttocks and down a leg? You may have the nerve compression of sciatica. Please give us a call at Summit Healthcare Pain Clinic Associates, (855) 768-4968, to schedule an appointment so we can help you get past the pain.

Blocking Troublesome Nerves in the Neck

Copy of iStock 849157490 Our nervous system has a part in everything our body does, from sensing touch or temperature to controlling sweating and breathing. There are three types of nerves: autonomic nerves that control the involuntary or partially voluntary activities of your body (including heart rate, blood pressure, digestion, and temperature regulation), motor nerves that control your movements and actions passing information from your brain and spinal cord to your muscles, and sensory nerves that relay information from your skin and muscles back to your spinal cord and brain where the information is processed to let you feel sensations like pain. 

Nerves play such a critical role in all we do that when they become damaged or otherwise begin to malfunction it can be helpful to block certain nerves. That’s the case in a stellate ganglion nerve block performed at Summit Healthcare Pain Clinic. 

What are the stellate ganglion nerves? 

The stellate ganglion nerves travel along both sides of our spine. They are associated with a wide range of bodily functions, particularly those associated with the “fight or flight” reaction in humans, that you don’t consciously control. These include sweating, heart rate, blushing, dilation of the pupils, among others. 

What is a stellate ganglion block? 

A stellate ganglion block is an injection of local anesthetic into the nerves of the stellate ganglion. These are located in the neck on either side of the voice box. 

Why is this done? 

These injections block the sympathetic nerves that go to the arms, and, to some degree the nerves that go to the face. This may work to reduce pain, swelling, color and sweating changes in the upper extremities, and may improve mobility. Dr. Trujillo uses stellate ganglion blocks as part of the treatment for complex regional pain syndrome. 

How is a stellate ganglion block performed? 

For these blocks, Dr. Trujillo has the patient lie on our procedure table. We provide intravenous sedation and Dr. Trujillo locally anesthetizes the area to be injected. Next, he inserts a needle and, using fluoroscopic (x-ray) guidance, he tracks the needle to ensure it is placed in the right areas. The video images detail the needle’s position. 

When the needle is in position, Dr. Trujillo injects the combination of local anesthetic and corticosteroid medication. This bathes the nerves of the stellate ganglion. This provides immediate pain relief, and the steroid works to decrease inflammation for a period of months. 

If you have complex regional pain syndrome, a stellate ganglion nerve block could be a good treatment option. Call us at Summit Healthcare Pain Clinic Associates, (855) 768-4968, to schedule your appointment.

Stabilizing a Fractured Vertebra

iStock 898597376 Osteoporosis can weaken our bones to the degree that a movement as seemingly harmless as sneezing can cause a compression fracture in a vertebra. Compression fractures are more common in the mid-back, the thoracic spine. These are the vertebrae numbers T1-T12. These fractures can also occur in the lumbar spine in the lower back. 

To stabilize the fractured vertebra, Dr. Trujillo may use kyphoplasty. Kyphoplasty is a form of vertebroplasty where the fractured bone is stabilized using bone cement made specifically for medical use. 

What is kyphoplasty? 

When a person suffers from a spinal compression fracture, it can be almost impossible to move freely. The bone fragments can rub against each other, and the pain can be severe. 

In kyphoplasty, the goal is to insert bone cement into the compressed vertebra to return strength to the bone. These are outpatient procedures that Dr. Trujillo can perform right in our Show Lo offices. 

Here’s how it is done: 

  1. Dr. Trujillo inserts a hollow needle (trocar) into your skin. With the aid of fluoroscopy, a type of x-ray, he guides the needle through your muscles and into the correct position in your vertebra.
  2. He then inserts an inflatable balloon into the trocar, and the balloon is inflated. This returns space to your collapsed vertebra. Now the balloon is deflated and removed. Because you are lying down, the space created remains.
  3. Now bone cement is injected through the trocar into the space created by the balloon. The x-ray shows if the mixture is distributed properly. The cement fully hardens in about 10 minutes.
  4. The needle is then removed, and a bandage is applied.

With a single vertebra, the procedure takes less than an hour. 

Who would be a good candidate for kyphoplasty? 

Kyphoplasty can be effective in treating people whose bones are weakened by cancer or whose vertebrae have collapsed due to osteoporosis. This is a repair treatment for a damaged vertebra; it is not meant as a preventive treatment. Kyphoplasty is not used for herniated discs, back arthritis, or curvature of the spine due to scoliosis. These treatments are not intended for younger patients, as the long-term effects of bone cement have not been extensively tested. 

If you have osteoporosis, there is a real risk of a spinal compression fracture. Dr. Trujillo can help if that happens with kyphoplasty. If you have questions or would like to set up an appointment, please call us at (855) 768-4968.

More About Failed Back Surgery Syndrome

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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.

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