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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.

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.   

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