- Osteoporosis
- Arthritis
- Medical Weight LossAcute muscle strain is a common cause of low back pain after exertion, and without neurological deficits (numbness, weakness, or changes in the knee or ankle reflexes). The vast majority of the general population will have acute back pain at some time in their lives. More than 90% resolve without any specific treatment and in less than 2 weeks. No clear cause of the pain is typically found in “back strain.” The most important aspect of muscle strain is to make sure it is acute muscle strain and not a medically emergent condition. Focal spinal tenderness, fever, weight loss, or loss of bowel or bladder (incontinence) may be signs of an impending disaster and one should see their doctor.
- Constipation
- Labor and DeliveryI completed my undergraduate studies at the University of Virginia in 1991 and medical school training at the Virginia Commonwealth University-Medical College of Virginia in 1995. I went on to complete an Anesthesiology Residency and Interventional Pain Medicine Fellowship at the University of Virginia. I am Board Certified in Anesthesiology with a Subspecialty Certification in Pain Medicine by the American Board of Anesthesiology. While in medical school, I discovered that I not only liked helping my patients, but I truly enjoyed working with my hands and talking with my patients. Prior to my Fellowship in Interventional Pain Medicine, I worked in the operating rooms practicing Anesthesiology. While I enjoyed the hospital environment and the practice of Anesthesiology, there was limited verbal communication with my patients, as they were asleep, under anesthesia. In the hospital, I enjoyed working on the Labor and Delivery Suite and placing epidural catheters for my obstetrical patients. These patients were awake and I was able to use my hands. Also, most importantly, I was able to constantly talk with my patients as I placed their epidural catheters for their labor pains.
- NeurologyAnother important question regards the specific residency or fellowship training programs completed by your physician. Once again, anesthesiology, interventional radiology and some PMR programs offer specific training in interventional pain medicine. While other specialties offer training in pain medicine such as neurology, these are generally medically oriented and not specific interventional programs. Names such
- UltrasoundYes. You will not be able to undergo MRI, therapeutic ultrasound diathermy, or microwave or short-wave diathermy once the stimulator is permanently implanted. Most spinal cord stimulator leads do not contain ferrous (iron-containing) material to be significantly affected by the static magnetic field induced in a MRI. However, the gradient magnetic fields and radiofrequency fields from MRI (both pulsed during imaging) can cause device malfunctions or failure by induced currents caused by rapid changes in the magnetic field or thermal and electrical burns as a result of RF-induced currents. Additionally, devices that have a magnetic (reed) switch may be activated, causing the device to reset, potentially affecting therapy
- MRIIf you are taking blood thinning medications (coumadin, arixtra, fragmin, innohep, lovenox, normiflo, orgaran, acova, angiomay, ipravask, pradaxa, plavix, heparin, ticlid or in some cases aspirin) or have an active infection, you should not have the procedure. Also, if you are pregnant, have a serious neurological deficit with a surgically correctable pathology, and anatomic spine instability at risk for progression, you should not have the procedure. Finally, if you need future MRI (magnetic resonance imaging) or are immunosuppressed, you may not have the procedure.
- RadiologyMedical World News that there were still only 17 pain clinics in the United States. The next year there were over 300 such clinics. The late 1970’s and early 1980’s was a period of phenomenal growth for interventional pain medicine which continues to grow both in numbers as well as treatment options to this day. The early pain management centers depended upon a small number of injections such as epidural steroid injections to treat pain. Today, interventional pain centers offer many different types of injections and implanted devices now performed with direct, live X-ray imaging (fluoroscopy). At present, nearly all medical training programs offer interventional pain management programs. Most are still anesthesiology based however now the specialties of physical medicine and rehabilitation and interventional radiology also have formal training programs in interventional pain management.
- X-Rays
- Interventional Radiology
- SciaticaA lumbar epidural steroid injection is the injection of steroid in the epidural space (the area which surrounds the spinal cord and the nerves coming out of it). This injection is administered to relieve pain in the low back, hips, and legs caused by pinched nerves in the low back (sciatica). The pinched nerves are typically caused by spinal stenosis or herniated discs.
- Pinched NerveA herniated disc is often caused by injury such as lifting a heavy object or an accident. However “spontaneous” disc herniations are also common. It is thought that this occurs as the result of “wear and tear” from daily activity and small injuries. One factor that can result in a pinched nerve is the mechanical effects of the ruptured disc. In other words, the tissue of the disc directly pinches the nerve. Another effect of the ruptured disc is inflammation and swelling. The annulus tissue is a very irritating material. The annulus is referred to as an immunological sequestered tissue. This means that due to the characteristics and location of the annulus, the immune system does not recognize this tissue as self. This is important because this results in significant inflammation when the disc ruptures. The inflammation causes swelling and more pain. Since the nerve is directly next to the disc the nerve root also becomes inflamed and swollen. These two factors result in a pinched nerve causing pain in the back and leg.
- Burns
- Physical TherapyPrognostic: to help decide the next step ie. do nothing, perform a second type of injection, schedule radio frequency denervation, physical therapy, or even an evaluation by a surgeon.
- Slipped DiscThe bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. These discs act as shock absorbers for the spine and keep the spine flexible. But when a disc is damaged many terms are used for this condition including disc rupture, disc protrusion, disc extrusion, slipped disc and herniated disc. All terms describe the same basic process. The disc has two primary components. Outer rings of tough connective tissue called the annulus and a soft central core of jell-like substance called the nucleus. A tear or weakness of the annulus can allow some of the central nucleus to protrude or herniated through the annulus. The herniated portion of the disc can cause pressure or impingement of the nerve at that level causing both back and leg pain. The leg pain is caused by a pinching of the nerve at the level of the disc. Some people only have leg pain associated with a disc herniation
- Back Pain