Pain medicine
The medical specialty of Pain treats chronic pain using interventions & interdisciplinary care.
Fibromyalgia
Patients with fibromyalgia experience chronic, diffuse pain across the body, due to exquisitely sensitivity of the brain & spinal cord (“central sensitization”). The keys to relief are prompt diagnosis, interdisciplinary pain care, & not overlooking co-existing pain conditions. Total body pain The best way to describe the experience of fibromyalgia is total body pain including a…
Diet and pain
While the science of nutrition continues to evolve, I have seen many patients with pain profoundly improve after making one of the following dietary changes. Such changes are low-cost, & are low-risk when made under medical guidance. Patients with chronic pain may find it worthwhile to try one or more of these diets. Gluten-free diet…
Lumbar radiculopathy
The vertebrae, which protect the spinal cord and spinal nerves, through daily activities experience normal wear-and-tear. Sometimes this causes slight impingement of nerves, in turn causing spinal nerve inflammation and shooting pain down to the feet. Radiating back pain Back pain that shoots down the leg into some (not all) toes can be due to lumbar…
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…
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…
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…
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…
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…
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…
