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Nerve Blocks: What Are They and Should I Get One?

4/20/2017 - written by Perlman Clinic

If you have chronic pain, you’ve probably asked around for pain treatment options that might be more effective. In your research, you might have heard of something called a “nerve block.”

There are different types of nerve blocks, varying by the location and intensity of pain. Remember that chronic pain is defined as pain lasting longer than three months. If this describes your pain, and doctors haven’t been able to offer much in the way of a pain solution, a pain management clinic—where nerve blocks are often an option for treatment—might be what you’ve been looking for.

What are nerve blocks?

The goal of a nerve block is pretty clear from the name of this treatment: to block pain signals from nerves. For many, chronic pain is derived from an autoimmune disease, arthritis, an old injury, or another source (usually nerve related). In these cases, there is no specific cure, and a patient’s only option may be to simply manage the pain.

Good thing there are pain management specialists! Many medical companies exist solely to develop pain treatment options, which are in turn provided to the general public through doctors and pain management clinics.

A nerve block, then, becomes an appealing option. This treatment option functions as a local anesthetic or anti-inflammatory treatment, depending on the cause of pain. Nerve blocks are usually administered via injections with the aim of “turning off” the pain signal. Your physician will use image guidance to pinpoint the exact location of the nerve for better results. This type of pain relief is temporary and often administered to the spine, neck, legs, or buttocks. 

 

Diagnostic Nerve Blocks

Diagnostic nerve blocks are used to discover the nerve sending the pain signals. In a diagnostic nerve block session, a doctor injects anesthesia in one section of skin where they think the pain might be originating. After the injection is complete, they allow time to determine how much the pain has decreased. If the pain is still present, they will inject another site, repeating the process until the pain has significantly decreased.

Diagnostic nerve blocks may take a little time in office, but once a patient shows significant improvement in pain levels after injection to one place, the patient can then plan to receive additional nerve blocks or a radiofrequency ablation to this area in the future without having to repeat a diagnostic session.

Sympathetic Plexus Blocks

It might sound funny to call something inside the body “sympathetic”—it’s like we’re personifying tissue and organs. But that’s not the case at all. The sympathetic nerves are bundles of nerves that run the length of the spine from the neck to the tailbone. These nerves run pretty much all of the body’s organs. Keep in mind that a plexus is defined as “a network of…interlacing blood vessels or nerves,” which is how the sympathetic nerves can be described.

When it is determined that pain signals have been transmitting through these sympathetic nerves, a sympathetic plexus block can be helpful. A sympathetic plexus block is a type of nerve block that seeks to stop the pain signals in these nerves. The plexus block is usually administered with local anesthesia, a needle, and x-rays to determine the exact location of the pain-causing nerve.

Medial Facet Joint Blocks

Facet joint blocks involve injection of anesthetic in order to numb a nerve, just like any nerve block. The important thing about this type of nerve block is its location. The name of this type of block is derived from both the medial branch nerves and the facet joint, where the medial branch nerves send pain signals from injured facet joints—located in the neck or back—to the brain.

Usually a medial facet joint block is injected into one of the small joints which can be found on either side of the vertebrae in the spine. A lumbar facet joint block, for example, is injected into a facet joint on both sides of the lower spine. If more than one joint is involved, you may receive more than one injection. This type of block is common for patients with arthritis in their lower backs.

Do I need a nerve block?

The only way to determine if a nerve block is for you is to talk to your doctor and pain management specialist. If you have chronic pain that might be related to nerves near the spine, a nerve block might very well be within the realm of possibility for your treatment.

 

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The Chronic Pain Miracle of Spinal Cord Stimulation

4/6/2017 - written by Perlman Clinic

The Chronic Pain Miracle of Spinal Cord Stimulation

Spinal cord stimulation (SCS) is what some might call a wave of the future. A treatment option for those who suffer with chronic back pain, this specialized type of injection therapy might be a real solution to pain without risk of opiate addiction and other long-term side effects.

Sound too good to be true? Read through the facts before making a judgement call, then decide for yourself. SCS might be the treatment that you have been waiting for.

What is SCS and how does it work?

SCS has actually been around for a long time. First implemented in 1967, it was not approved by the FDA until 1989 after discovering its ability to relieve pain in areas of the body such as the arms, legs, and trunk. As a treatment option at pain management facilities, SCS offers a non-medicinal alternative that really works. Its recent surge in popularity is due to this fascinating aspect.

SCS sends pulses of electricity through the spinal cord. Each pulse delivers a message to the nerves to stop sending pain signals to the brain. These pulses are delivered via small electrodes or wires situated along the spinal cord. The electrodes in turn are connected to a battery-powered generator implanted strategically under the skin. Usually, this implanted generator also creates a buzzing or tingling sensation that removes pain but is always present. The tingling or buzzing is called paresthesia, and medical companies who develop SCS therapies have been working on ways to eliminate this side effect. However, for those who live in extreme pain, paresthesia is a welcome alternative to the pain.

What types of pain does it treat?

You know by now that SCS treats chronic pain, mainly pain in the back and legs. Remember that chronic pain is defined as any pain that lingers in the body beyond three months, or after the body’s natural healing time frame for most acute injuries.

Chronic pain can be caused by a variety of things, from old injuries to autoimmune diseases to spinal misalignment. Since SCS is centered on the spine, the pain signals it reaches are local to any nerve running directly through the spine, such as the spinal cord or sciatic nerve. That is why SCS is most effective for chronic back or leg pain, like spinal stenosis.

However, SCS can treat a lot of other conditions, and the list is growing. You might find relief for pain related to failed back surgery, scarring along spinal nerves, chronic neck pain, chronic back pain, complex regional pain syndrome, refractory angina, nerve death caused by peripheral neuropathy, and more.

How is SCS delivered?

We’ve already discussed how SCS delivers electrical pulses through a battery powered generator. But you might be interested to know what it looks like. A company called Nuvectra has designed a new SCS system that comes in a small silver square. On top of the thin metal square sits a plastic piece where the wires, called leads, are connected to the battery. Nuvectra calls their device Algovita.

An SCS system is installed along your spine. The battery pack itself is implanted under your skin near the base of the spine. The leads (thin wires) are placed along your spinal cord in strategic locations so that the electrical impulses can reach the nerves that keep sending pain signals. The electrical stimulation overrides the pain signals, leaving you with the slight buzzing or tingling of paresthesia instead of pain.

The Benefits of SCS

As a pain management technique, SCS is far superior to medications. There are other non-medication options at pain management clinics of course, including lifestyle changes, physical therapy, chiropractic, acupuncture, massage, and even counseling. For many chronic pain sufferers, however, these techniques are not enough. Many feel they need medication to live a normal life, but medications come at a high cost.

Although some medications are certainly worth it, some are not. For example, opiate pain killers are highly addictive. If patients become reliant on these pills, they can suffer side effects like slowed breathing, drowsiness, withdrawal symptoms, tolerance, sleep disorders, increased risk of bone fracture, and even tooth decay. In fact, there is something of an opioid crisis on our hands in the US, and the surgeon general has even said that opioids are not a solution for chronic pain.

SCS is a treatment option that is as effective as pain killers, but without affecting the rest of your body.

Is SCS right for you?

There are many non-medicinal alternatives to chronic pain management, but none are quite as effective as SCS. And since doctors are continuing to work on more efficient delivery methods, SCS is fast becoming a better solution. Is SCS right for you? If you have chronic pain in your neck, back, or legs, ask your doctor or pain management specialist if you can try SCS therapy.

How To Treat a Sports Injury

3/3/2017 - written by Perlman Clinic

Sports injuries can happen at any time to anyone, not just dedicated athletes. That’s why it’s important to know what to do if you find yourself knocked down on the field or court.

Whether you’re practicing for a big game or just playing after work with some colleagues, a sports injury can happen to any of us. You need to know how to evaluate the injury and determine where you need to seek assistance—whether at home, at an urgent care, or at the ER. Some of the most common sports injuries include:

athlete with sports injury in San Diego, CA

What types of sports injuries are most common?
Sports injuries run the gamut, from collisions to tendonitis. Some are obvious results of collisions, while others cause constant pain over the long term. So what kinds of injuries should you be looking for on the field or court?

There are several main categories of sports injuries, such as sprains, strains, pulls, and tears. Sports injuries can be either “acute” or “chronic”. For example, “acute” injuries occur as a result of an obvious collision or accident during play. “Chronic” injuries arise from repeated injuries to the same joint, ligament, or muscle that isn’t obvious at first, but eventually lead to constant pain. They are often called overuse injuries.

Acute injuries can include ankle sprains, ACL tears, pulling the groin, a concussion, or pulling a hamstring. Chronic injuries include tendonitis, tennis elbow, or shin splints. While chronic or overuse injuries aren’t as easy to spot because they don’t suddenly occur during a sporting event, they are just as painful—perhaps more so because they occur everyday. So what should you do if you’ve encountered an acute or chronic sports injury?

Evaluating the Injury
Before you decide what treatment you need for your sports injury, it’s important to gather some basic knowledge about the source of the pain. Make sure that the injured person has stopped using their injured body part, whether after an accident during play or if an overuse injury has been identified.

Next, ask the patient (or yourself) about their pain level. Try the following line of questions:

  • Can they put weight on it?
  • Is the pain severe/unbearable?
  • Is there swelling?
  • Is there numbness?
  • Is the pain on the site of an old injury? If so, is there swelling, joint abnormality, or instability here?

The answer to these questions will tell you where you need to go next.

How to Know You Can Treat It at Home
If you have an accident while playing sports, you can quickly tell if you will able to treat the injury at home or not. The bottom line is that if you don’t have any of the symptoms mentioned above, then you’re probably all set to treat the injury at home, at least at first.

For example, if you have minimal swelling and can put weight on your injury, there is not much more an urgent care facility or ER can do for you besides what you can do at home. Use the RICE method to treat less painful injuries at home: Rest, Ice, Compression, and Elevation. Remember that if your pain worsens or does not get better after a few days, it may be time to seek medical attention.

When to Go to an Urgent Care Facility
At the site of a sports injury, you can quickly evaluate whether or not you need to go to an urgent care facility. The bottom line here is whether or not you need a doctor. Once it is established that you do need to see a doctor, the next step is to evaluate whether this need requires an urgent care visit or an ER visit.

Think of an urgent care facility as the less expensive brother to the ER. An urgent care is often equipped with x-ray machines, triage care, and other things you’ll get at the ER for a fraction of the cost. This doesn’t replace your primary care doctor—an urgent care won’t refill your prescriptions, for instance—but if you are bleeding (unless it’s a sensitive area), you’re having unexplained joint pain, or even suspect a concussion, an urgent care is the place to go.

It’s also often more convenient to go to an urgent care facility than a doctor for sports injuries. Sports are often played after hours and on weekends, when primary care doctors are closed.

Should you go to the ER?
Save an ER visit for actual emergencies, when you can tell that the injury is life-threatening. That’s really what an ER is for. Go to an ER for a sports injury when:

  • You think you may be having a heart attack
  • You’re having a hard time breathing
  • Your severe pain is located in the abdomen or halfway down the back
  • You faint
  • You have a sudden and severe headache
  • You have a broken or dislodged bone
  • The injury is to your eye
  • You suddenly get a high fever
  • You vomit uncontrollably
  • You have a seizure without a history of them

As you can see, there are different levels of injuries involved with sports. If you’re ever injured while playing sports, or have a flare-up of a chronic condition that is worse than usual, you need to take a moment and evaluate the situation. Do you need to go home, to an urgent care facility, or to the ER?

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