Lumbar facet arthropathy

Axial low back pain is often due to arthritic pain of spine facet joints, which sustain wear-and-tear from daily activities. The joints can hurt and cause pain across the low back. Ablating the small “medial branch nerve endings” to the facets can help kick-start recovery. Axial low back pain Axial low back pain — involving only the back…

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Treating pain at nerve-body interface

Small sensory nerves throughout the body gather information & interact with the body directly. This nerve-body interface underlies many diseases. In chronic pain, nerves cause “neurogenic inflammation” by activating blood vessels, skin, & immune cells. This is the site of action of many pain treatments. Key nerve-body interfaces Neural-vascular: Sensory nerves open blood vessels. This…

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Stylohyoid (Eagle’s) syndrome

Entrapment of nerves by the “stylohyoid complex” is an uncommon cause of neuropathic jaw & neck pain. This can be due to congenitally long styloid processes, or scarring after surgery or traumatic injury. The stylohyoid complex connects the hyoid bone — important in swallowing & tongue movement — to the head. Made of tough cartilage & bone, the complex…

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Breaking the cycles of pain

Patients with pain often feel that pain causes more pain. Pain is persistent and many treatments that seem at first effective stop working. Research shows Medications alone cannot break the pain cycles Injections alone cannot break the pain cycles Direct brain and nerve treatments are promising Interdisciplinary treatment is the only reliable treatment for chronic…

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Activating the brainstem to treat pain

Pain signals converge in the core of the brainstem where they deeply influence behavior. For checks & balances, the brainstem uses “descending inhibition” as a volume control to reduce pain. Pain physicians leverage this for treatment, via antidepressants, acupuncture, & meditation. Descending inhibition systems To keep pain signals from running out of control, the brainstem…

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Medication overuse headache

Headache medications taken too regularly can paradoxically cause a new headache, called medication overuse headache (MOH), that is constant, over & above the primary headache. The treatment is to stop the medications & treat the primary headache. Central sensitization Using rescue headache medications every day changes the balance of neurochemistry (in particular serotonin) in the…

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Sympathetic blocks for pain

The sympathetic nervous system lets the brain control the organs to maintain overall balance of body systems. In many chronic pain conditions, it worsens inflammation & pain; in some, they even become pathologic. Sympathetic blocks help reduce these effects. Sympathetically Maintained Pain Sympathetic nerves release norepinephrine and: Sensitize painful nerve endings Widen arteries causing redness…

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Painful scar neuroma

Sometimes long after surgical wounds have healed, the scars remain painful due to sensitized nerve endings in the scars. While visually obvious, painful scar can be surprisingly hard to diagnose, because the pain is perceived to be coming from another “referred” location. Scar Pain Referral Patterns Midline Neck scar refers to the neck & head, often…

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Pain signal networks

Pain signal is sent from tissue to the brain. Once in the brain, the signal causes pain. At each stage of its transmission, pain signals are modified and interact with each other in the “pain signal network”. This network consists of 2 major components, in the body & in the brain. Chronic abdominal pain and…

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