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The Chronic Pain of CRPS

Pain Management Specialties Show Low AZ In some conditions that involve chronic pain, the causes aren’t fully understood. One of these is called complex regional pain syndrome (CRPS). But when a patient comes to us at Summit Healthcare Pain Clinic, he or she’s not as interested in the cause of their pain as they are about getting rid of it. We treat the pain of CRPS.

What is complex regional pain syndrome?

CRPS is a form of chronic pain that usually affects an arm or a leg. It typically develops after an injury, surgery, a stroke, or a heart attack. But for some reason the corresponding pain that develops is out of proportion with the severity of the initial injury. The condition, also known as reflex sympathetic dystrophy, often begins in the hand or foot and then spreads to affect the entire limb.

What are the symptoms of CRPS?

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

What causes CRPS?

The causes of CRPS aren’t fully understood. It typically occurs after an injury or trauma, but it can also be attributed to an abnormality of the peripheral and central nervous systems. There are two types and they have different causes:
  • Type 1 — This form makes up about 90 percent of cases of CRPS. This type occurs after an illness or injury that did notdamage the nerves in the affected limb.
  • Type 2 — While the symptoms are similar to type 1, type 2 CRPS comes after a distinct nerve injury.

Treatment

At Summit Healthcare Pain Clinic, Dr. Trujillo has the most success treating CRPS if it is diagnosed early on. There are a variety of possible treatments: hot and cold compresses, anti-inflammatory and pain relief medications, physical therapy, nerve block injections, and nerve stimulation. Do you have the symptoms of CRPS? As mentioned above, treatment is most successful if it begins early in the process. Call us at Summit Healthcare Pain Clinic Associates, (928) 532-1605, to make an appointment.

Herniated Discs Treatment for Pain Management

What To Know About Herniated Disc | Summit Health Care When we think of our spine, we usually think of the vertebrae. The spine consists of a total of 33 bones, but in adults nine of them are no longer separated. That’s right — seven vertebrae in the cervical/neck portion, 12 in the thoracic/torso portion, and five in the lumbar/lower back. That equals 24 vertebrae, but the spine also technically includes five bones in the sacral region and four in the coccygeal region. Both of these start as individual bones, and then fuse sometime in early adulthood.

That’s the boney part of the equation. In between the 24 remaining, unfused vertebrae are an important part of the spine for those suffering from back pain. It’s the spinal discs. The discs are composed of two parts. There is a tough outer shell and a soft inner core. Kind of like a jelly donut. The discs have three functions:

  • They act as shock absorbers between each bony vertebra.
  • They act as tough ligaments, holding the individual vertebrae together to make the spine function as a single element.
  • They are malleable and allow mobility in the spine.

But trouble occurs when a disc ruptures or herniates. That is often the cause of our back pain.

What causes a disc to herniate?

A disc “herniates” when the softer center pushes out through a tear in the outer annulus fibrosus. An exact cause, such as a car wreck or a fall, usually isn’t obvious. Instead, our discs usually herniate simply due to aging. Interestingly, after the age of 50 most people don’t have herniated discs any longer, as their discs have become so solid that they don’t herniate.

These are typical causes of a herniated disc:

  • Wear and tear — The cause of most herniations is simply gradual wear-and-tear that occurs with our discs, due to their continual use. This is called disc degeneration. As we age and our discs lose more and more of their water content, they become less flexible. This makes them more prone to tearing or rupturing, sometimes from the simplest twisting motion.
  • Injury — It’s easy to assume a disc herniates due to trauma, such as a fall or blow to the back, but this is rare. Disc injury that leads to herniation is more likely to the most seemingly mundane movements. It can happen if a person lifts items using the back muscles rather than the legs. It can happen when combining lifting and twisting at the same time.
  • Combination — The reality is that most herniated discs are a combination of discs becoming less flexible with age and a movement that stressed the disc making it push through the outer shell.

Certain factors can increase your chances of developing a herniated disc:

  • Weight — Excess weight produces more stress on the discs in your lower back.
  • Occupation — Jobs that involve a lot of lifting, pulling, pushing, and bending and twisting have increased chances of herniating discs.

At Summit Healthcare Pain Clinic, much of what Dr. Trujillo addresses starts with a herniated disc. Now you understand the hows and whys. Do you have pain that could be caused by a herniated disc? Call us at (928) 532-1605 and let’s check it out.

Refilling a Compressed Vertebra with Kyphoplasty

Back pain Compressed Vertebra with Kyphoplasty | Summit Health Care and aging don’t necessarily have to go hand in hand. In many patients, their back pain isn’t chronic; it’s instead due to a compression fracture in a vertebra. Compression fractures usually result from a series of small hairline fractures that eventually lead to a collapse of the vertebra, a compression fracture.

Dr. Trujillo treats compression fractures with an exciting new treatment known as kyphoplasty, where bone cement is delivered into the compressed vertebra to restore its correct height and eliminate the pain.

Where do spinal compressions happen and why?

These fractures occur most often in the thoracic spine, which makes up the middle of the spine, the T1 through T12 vertebrae. It can also occur in the lumbar spine, the lower spine consisting of vertebrae L1 through L5.

These compression fractures are usually due to osteoporosis, a bone-thinning condition especially common in women over 50 who have gone through menopause. As the bones become more brittle, the vertebrae aren’t strong enough to support your spine through everyday activities. Bending over to pick something up, an inadvertent slight slip, even a cough or sneeze can all cause a compression fracture in a person with osteoporosis.

These fractures usually occur in the front of the vertebra, and as they accumulate the vertebra eventually collapses forward. The back of the vertebrae are made of harder bone, so they don’t usually collapse. When the front collapses, the vertebra is now tilted forward and this can impact nearby nerve roots resulting in serious acute pain.

How does kyphoplasty fix the problem?

In the procedure, the patient lays on the surgical table on his or her face. Dr. Trujillo makes a small, half-inch incision over the affected vertebra. Using x-ray guidance, he inserts a narrow tube through the pedicle into one side of the fractured vertebra. Once inside the vertebra, a balloon tamp is then inserted through the tube down into the fractured vertebra. Dr. Trujillo then inflates the balloon to open a cavity inside the vertebra, restoring it to the proper height. The balloon is then deflated and removed, but the cavity remains open.

Next, bone cement is injected into the cavity until it is full. This cement hardens incredibly quickly, usually within 10 minutes. This now adds mass back to the vertebra, stabilizing the fracture and restoring the proper spacing and height.

Most patients report immediate improvement with kyphoplasty. Amazingly, they can resume normal activities in just a day or two, with the exception of heavy lifting or strenuous physical exertion, which need to wait for about six weeks.

Interested in kyphoplasty with Dr. Trujillo? Call us at Summit Healthcare Pain Clinic, (928) 532-1605 to schedule a consultation.

Is Your Office Chair the Enemy?

Back Pain Show Low AZ You don’t have to be Charles Darwin to understand our modern lifestyles weren’t exactly the way evolution planned things for our spines. Instead of being on our feet chasing around after dinner, we’re stuck in an office in a chair that could be torturing our collective backs.

At Summit Healthcare Pain Clinic Associates, Dr. Trujillo and our team spend much of our time helping patients work through their back pain. Toward that end, maybe your office chair is a culprit in some of these problems. Here’s what is the potential problem with your chair, along with what to look for when you request a new one.

Sitting isn’t the best thing

Sitting all day in a chair that doesn’t provide adequate back support can cause or exacerbate lower back pain. Why does it do this? When you are seated, the lumbosacral discs at the base of the spine are loaded three times more than when you are standing. At first thought, this makes no sense. But when sitting, your legs aren’t helping carry the load; it’s mostly impacting your lower spine. If your chair doesn’t have adequate spine support, this will lead to poor posture, which stresses the soft tissues and joints in the spine leading to pain.

Part of the problem is also the way we sit. If we sit and shift our weight forward in our desk chair, this also increases stress on the soft tissue, joints, and discs. This leads to muscle tension and back pain.

And it’s not just at work. We’re sitting at night watching TV or when watching a kid’s baseball game. This can lead to habitual bad posture such as hunching or slouching.

What you want in your office chair

It’s easy to think that our spine is relatively straight, but the lower portion of the spine just above the buttocks naturally curves inward toward the belly. This is known as the lordotic curve. What’s important is to provide support to this area of the back. A lumbar back support helps promote good posture by filling the gap between the lumbar spin (which is curving inward) and the seat.

When your chair provides this kind of support, the muscles surrounding the spine are relieved of much of their job of having to keep the spine naturally curved. The lumbar support does the job, taking pressure off the muscles, reducing the muscle tension that can lead to back pain.

But when your chair doesn’t provide lumbar support, it’s difficult to maintain correct posture. Without support, your lumbar spine and the large muscles in your lower back have to work to support the proper spine curvature and alignment. Over the day, as the body tires, the muscles holding the spine in the correct position weaken. To compensate, we tend to push our head and upper back forward. This forward lean leads to more muscle tension and eventual back pain.

What you can do

Beyond having lumbar support in your chair (which can be supplied by a simple pillow if the chair doesn’t provide it), there are positions to best support your back and neck.

  • Your office chair should have elbow supports to limit neck strain. Elbows should rest on the elbow supports at right angles.
  • Your knees should be bent at a right angle. Use a footrest to attain this, if necessary.
  • Your eyes should look straight ahead at your computer screen, not downward.

A new desk chair should be in your future. But if your back pain still endures, it could be a good time to come see us at Summit Healthcare Pain Clinic Associates. Call us at (928) 532-1605 to make an appointment.

Why Your Lower Back Hurts

Back Pain Show Low AZ Lower back pain is universal; just about everyone has suffered at least a stint or two where they can barely move, walk hunched over, can’t get up from a chair, and the other fun associated with lower back pain. Because the pain can be so severe and debilitating, people often believe a serious injury must have occurred to either one of the vertebrae or to a disc (the soft oval cushioning pads between the vertebrae). Otherwise, how can the pain be so intense?

The reality of most lower back pain is far less traumatic (although your nerves aren’t telling you that!), and that’s a good thing. Most lower back pain is caused by a torn or pulled muscle or ligament. These kinds of injuries can happen suddenly, or they can develop slowly over time from repetitive movements. One of these types of back injuries can occur when lifting a heavy object, a sudden movement, poor back posture, a sports injury, or even seemingly light lifting done at an improper angle. Back strains or sprains will usually heal themselves and don’t lead to chronic pain (as damage to the vertebrae and discs can), but they sure can be painful. Who hasn’t lifted something or made the most seemingly harmless move only to feel that twinge and the next thing you know you’re flat on the floor almost unable to move?

Ligament or muscle strains

Whether you’ve injured your muscle or a ligament isn’t important — the symptoms and treatment are the same. But for the record here’s the difference:

  • A sprain happens from over-stretching and tearing ligaments. These are the connective tissues that connect the bones.
  • A strain happens when a muscle is stretched too far and tears, damaging the muscle itself.

Common causes of sprains and strains:

  • Lifting a heavy object
  • Twisting while lifting
  • Poor posture over time
  • Sudden movements that overload the lower back (such as a fall)
  • Sports injuries with twisting or force impact

When you strain a muscle or ligament

The muscles of the hips, pelvis, buttocks, and hamstrings all work together to assist the muscles of the lower back to support the lumbar spine. When these muscles or the ligaments in the area are injured, pain or tightness can be felt across the lower back and through the hips or buttocks.

Symptoms usually follow a pattern

Pain is most intense for the initial few hours and days. Certain movements such as bending forward or backward, or standing upright will be painful.

The pain continues for one to two weeks as the muscles or ligaments heal. Certain movements or positions such as standing for a long time or stiffness when getting up from sitting will continue.

The good thing about these injuries is that they usually heal themselves. It may take four to six weeks to fully heal, but you’ll feel progressively better.

If your pain isn’t getting better, however, you’re headed into the area of chronic pain and that can be caused by issues with the vertebrae, discs, and the nerves exiting the spinal column. That’s where Dr. Trujillo and the team at Summit Healthcare come into play. We have various strategies to help you manage your pain. If you hurt your back a few weeks ago, but the pain is still with you, give us a call at (928) 532-1605 and let’s see how we can help.

Resolve to Take Care of Your Back

Back Pain Show Low AZ People usually assume they caused their back pain. That can be true, especially if yesterday you helped your brother move a refrigerator. But back injuries can also simply occur from normal behaviors such as bending over to tie your shoe or even brushing your teeth and bending over at the sink.

There are things we tell our patients at Summit Healthcare to avoid/be careful of when dealing with their backs. After all, we see the aftermath. So, maybe a good resolution, and one you will keep hopefully, is to try and protect your back in 2019. Here are some tips for doing just that from your friends at Summit Healthcare.

Lifting

Everyone knows you should lift by squatting, not bending over. Not everyone knows of a far riskier movement, though, even if you bend your knees. Lifting and twisting at the same time is no good. If you must lift that box from the floor and then turn to put it on a shelf, do it this way — squat and lift the box, but then instead of twisting your body around with the box, use your feet to turn your entire body.

Even more sound advice is to not lift many of those things in the first place. For instance, the refrigerator mentioned above. Just say no. It’s your brother — tell him to hire a mover!

Sitting versus standing

Everyone’s back issues are different. For some, sitting for prolonged periods is torture. For others, standing too long is the problem. What’s up with that? It depends on the type of damage that has been done to your back, as to what bothers it. If you have disk cartilage problems, sitting is the enemy. This is because when you sit there is increased pressure in the abdomen. Standing feels better.

Avoiding sitting is often easier said than done. But at least use a good lumbar cushion in your chair or recline the back of the chair more than normal to spread out the weight/stress on the spine. Also, try and make sure your knees are at least as high as your hips when your feet are flat on the floor.

If your issue is standing, it’s likely you are developing arthritis in the tiny facet joints on the back of the spine. To avoid the pain, you’ll see people with this problem hunch over when they walk, or you can see them using something like a supermarket cart for support. Sitting feels better.

To alleviate the issues with standing, try and wear comfortable shoes and stand on a soft surface. If you have a standing desk, make sure it is positioned high enough that you’re not bending over at all. Rest one leg on a stool or something else to reduce the stress on your spine. Change positions often.

Push don’t pull

If you have something big you need to move, say a bookcase or chair. The best way to do this for your back is to push it and not pull it. Get close to it, tighten your stomach muscles, and push it. When you push you utilize your stomach muscles, while you use your back when you pull.

Dr. Trujillo and our entire team at Summit Healthcare hope you have a back pain-free 2019. But if you do run into some pain, we’re the place to turn to for relief. If you have any questions, or need to schedule an appointment, call us at (928) 532-1605.

Putting Radiofrequency Energy to Work on Chronic Pain

RadioFrequency Ablation For Back Pain Show Low AZ If you have chronic low-back or neck pain, you know how it can impact your daily life. It can make even the simplest tasks incredibly painful, and can make patients become overly sedentary.

As a pain specialist, Dr. Trujillo has a variety of treatments he can use to address this chronic pain. But if these don’t provide relief, he may opt for radiofrequency ablation. Radiofrequency ablation is effective for reducing pain. An electrical current produced by a radio wave is used to heat the area of the nerve sending the pain signals. It can provide effective pain relief for a period of months or even years in some patients.

Who may need radiofrequency ablation?

Radiofrequency ablation (RFA) is usually used when patients have chronic low-back and neck pain that is caused by nerve compression in the spine. This compression usually occurs as the joints degenerate from the effects of arthritis. When the facet joints at the back of the spine break down, nerve compression is common on the nerves exiting the spinal column in that area.

How is radiofrequency ablation done?

Dr. Trujillo typically uses a combination of IV sedation and local anesthetic for this procedure. Patients usually need to be awake during the procedure to provide feedback to ensure we locate the nerves causing the pain.

After the patient is sedated, Dr. Trujillo uses an x-ray to guide him to the insertion point for the radiofrequency needle. To be sure of the location, a small amount of electrical current is sent into the area. This creates a tingling sensation, or it may cause a muscle twitch in the neck or back. Now the area is locally anesthetized.

Once the RF needle placement is confirmed, Dr. Trujillo delivers a small radiofrequency current into the surrounding tissue. This instantly converts to heat as it enters the body, and the heat creates a lesion on the nerve. This lesion disrupts the pain signals sent from the nerve to the brain. If additional nerves need ablation, Dr. Trujillo repeats the process.

The RFA typically takes between 30 and 90 minutes.

How long does the pain relief last?

The degree and longevity of the pain relief varies from patient to patient. Most patients experience full pain relief within two to three weeks after the RFA procedure. Most patients have pain relief for 6-12 months. The nerves will gradually regenerate, however, and the pain can recur. But in some patients the pain relief can last for years, or it may never return.

If you have chronic back or neck pain, please call Dr. Trujillo at (928) 532-1605, and let’s do something about it.

Spinal Disc Problems

Back Pain Show Low AZ Our spinal discs have a tough job. They need to be pliable enough to act as cushions between our vertebrae. But they also have to be tough enough to withstand some extreme loads. They don’t always pull off the job perfectly.

If you’ve had issues with your spinal discs you understand how excruciating the pain can be. At Summit Healthcare Pain Clinic, we deal with the aftermath of bulging discs and disc herniation. So, here’s some information behind disc herniation and disk degeneration.

What are spinal discs?

Spinal discs are rubbery pads located between the vertebrae, the bones that make up the spinal column. Each disc is a flat, circular capsule about an inch in diameter and one-quarter inch thick. They have a strong, fibrous, outer membrane and an elastic core.

People hear the term “slipped disc” all the time, but that’s kind of a misnomer. There isn’t really much room for the discs to move. They are firmly embedded between the vertebrae and are held in place by the ligaments connecting the spinal bones and the surrounding sheaths of muscle.

Sometimes you also hear the discs described as the shock absorbers for the spine, but this gives them the characteristic of being more soft and pliable than they really are. The discs are only soft in children when they are still fully gel. By the time a person becomes an adult, the blood supply to the discs has stopped and the soft inner material is hardening. By middle age, the discs are tough and non-malleable, similar to a circle of hard rubber.

This is where the trouble comes in because as the discs become harder the protective lining becomes weaker and the discs are more prone to injury.

Herniated discs

You’ve heard of when a disc “herniates.” This happens when the disc’s inner material swells and pushes through the outer membrane. Or the disc can become distorted and bulge in spots. The inner core then protrudes and can press against surrounding nerves. If this happens and you keep placing stress on the disc the membrane can rupture or tear, allowing the inner disc material to push out further causing extreme pain. This is a herniated disc.

This happens predominantly in the lower back, rarely in the cervical spine of the neck. Sometimes, the herniated disc doesn’t press on the nerves and the person won’t feel pain. Herniated discs are most common between the ages of 30 and 50. Because their discs no longer have fluid cores, older people are much less likely to have a herniated disc.

What causes a herniated disc?

Herniated discs can result from a violent injury, but more often they are a result of normal aging combined with everyday activities such as lifting a heavy object the wrong way or over-extending in a sport. Sudden moves, such as falling on an icy sidewalk or missing a step on a stair, can also herniate a disc.

Can you prevent them?

Regular, moderate exercise can prevent many of the issues that cause a herniated disc. Anything that strengthens the muscles that support the spine helps. Flexibility is also a plus. People who are more sedentary are more likely to have disc problems. Carrying excess weight also puts more stress on the spine, making disc herniation more likely.

Are you suffering from back pain? You could have a herniated disc. Call us at Summit Healthcare Pain Clinic, and let’s have Dr. Trujillo check it out, (928) 532-1605.

Spinal Cord Stimulation Procedure

Spinal Cord Stimulation Show Low AZ Chronic neck and back pain can take over a person’s life. Every movement can involve pain. Pain relief methods, from conservative options all the way to decompression surgery, may not always be successful. For patients who have tried other options, including surgery, electrical spinal cord stimulation with Dr. Trujillo could be the next step.

What is spinal cord stimulation?

Spinal cord stimulation involves the implantation of electrical wires and a generator in the epidural space surrounding the spinal column. Once in place, the generator sends mild electric pulses to the wire leads. These impulses can modify or block pain message sent to the brain by the nerves.

Spinal cord stimulation with Dr. Trujillo can be an effective solution for patients who still have chronic back or neck pain despite having tried various other treatments.

What conditions can spinal cord stimulation help?

Spinal cord stimulation is often used to treat a condition known as “failed back surgery syndrome.” This refers to patients who have had one or more surgical procedures to address their pain, yet still continue to experience the pain. It may also be effective for patients with chronic back or neck pain, or for patients with conditions such as arachnoiditis, complex regional pain syndrome, peripheral neuropathy, and refractory angina.

While spinal cord stimulation usually doesn’t completely relieve the pain, it significantly reduces pain. This allows the patient to usually reduce or stop taking opioid pain medications.

How is this procedure done?

Patients usually opt to “demo” this system before fully implanting it. For this, Dr. Trujillo inserts the wires (also called leads), but not the transmitter/generator. This is worn outside the body during the trial period. To implant the leads, Dr. Trujillo inserts a hollow needle into the epidural space and then passes the leads through those tiny punctures. The leads are placed at the corresponding areas where pain is emanating. They are then connected to the external neurostimulator that is worn on a belt. These trials usually last for one week.

The full implantation is similar. First the permanent leads are inserted, except this time they are fully inserted into the body cavity. The generator is then implanted through a small incision. Generators are usually about the size of a stopwatch, and they can be placed in the abdomen, upper buttocks, or upper chest, depending on patient preference. The wires are then tunneled through the body and connected to the generator. Patients then receive a remote controller to initiate the stimulation and adjust it as needed. These devices usually last from 10-25 years, so this is a long-term solution.

Are you at your wit’s end with chronic back or neck pain? Call us at Summit Healthcare Pain Clinic, (928) 532-1605, to schedule an appointment.

The Shooting Pain of Sciatica

Back Pain Show Low AZ OK, so you’re out on Long Lake trying to outsmart the trout and suddenly your leg starts burning and is painful. Or your butt has the same. You may even have shooting pain down one or both legs.

Not the best thing to happen when you’re out on a flimsy little fishing boat.

Sounds like you may be having a bout of sciatica. Sciatica is pain originating in the sciatic nerve, which runs from the lower back down the back of your legs. At Summit Healthcare, we can help you with your sciatica pain.

What is sciatica?

The sciatic nerve is the longest nerve in the human body, stretching from the spinal cord to the end of each leg. Sciatica is inflammation of the sciatic nerve. It generally develops over time as the nerve is compressed. Sciatica is characterized by pain along the nerve pathway, as well as numbness, tingling, and muscle weakness in the affected muscles.

What causes sciatica?

Sciatica is usually the result of compression of the sciatic nerve from a herniated disc or spinal stenosis. In a herniated disc, the bulging disc can push on the sciatic nerve. In stenosis, the spinal canal narrows over time usually due to a bone spur and begins to push on the nerve. There can be other causes ranging from nerve damage from diabetes to a tumor or pelvic injury, but most sciatica is from nerve compression.

Symptoms of sciatica

These are the common symptoms associated with sciatica:

  • Lower back pain
  • Pain in the butt or leg that occurs when sitting
  • Hip pain
  • Burning or tingling down the leg
  • Weakness or numbness when moving a leg or foot
  • A shooting pain that makes it difficult to stand up
  • A constant pain on one side of the buttocks

Treatment of sciatica

At Summit Healthcare, Dr. Trujillo treats sciatica with a variety of approaches — everything from ice packs, physical therapy, pain medication, anti-inflammatory corticosteroid injections, and even nerve blocks.

 

If you have shooting pain down your legs while sitting or driving, call us at Summit Healthcare, (928) 532-1605, to make an appointment.

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