Conditions

Definition:
Rheumatoid arthritis and osteoarthritis are diseases of the joints. When arthritis occurs, damaged joints no longer cushion the bones, and as a result, the bones rub together and cause pain. The two conditions are among hundreds of different variations of arthritis. Osteoarthritis is the most common form, while rheumatoid arthritis is diagnosed less frequently.

Causes:
The main differences between the two conditions are the origins of the joint damage. Rheumatoid arthritis is an autoimmune disease, which means that the body’s immune system targets the joints and attacks them. Arthritis experts cannot pinpoint exactly what causes it, but they do suggest that family history and lifestyle factors like smoking or excessive weight gain may give patients a higher risk of having it.

Osteoarthritis is caused by the natural deterioration of the joints. As we age, the joints may begin to be less smooth and wear out over time. For this reason, symptoms may not appear until later in life.

Symptoms:
Both rheumatoid arthritis and osteoarthritis cause pain in the joints. Skin may feel warm to the touch and appear swollen, although people with osteoarthritis may experience less swelling than a patient with rheumatoid arthritis. Patients typically feel stiffness in the mornings that can last an hour or longer. Patients may also find that they are less flexible than before, and have limited range of motion around the affected joint.

Osteoarthritis symptoms tend to relate to the joints, but patients with rheumatoid arthritis might experience systemic symptoms. For example, one might feel fatigued or run a fever often. 

Both conditions are susceptible to flare ups, meaning that the arthritis symptoms do not stay static and become worse from time to time. 

Treatments:
The first step to managing arthritis is to get the pain under control. Patients may be prescribed pain medication in order to reduce joint pain and swelling, as well as receive information about caring for pain at home with conservative measures like ice or bracing. The TriState Pain Institute also offers joint injections as another option to manage pain. Joint injections deliver soothing medication directly into the joint to get direct pain relief. Joint injections can be administered on an outpatient basis and can be repeated a few times each year. If patients have been suffering from arthritis for a while, we may suggest seeing a specialist for joint replacement surgery. This procedure gives the longest lasting results because it removes the damaged joint and replaces it with a prosthetic joint. 

Definition:
Bursitis is a condition that causes inflammation of the bursa, which are fluid-filled sacs in the joints. Bursitis typically develops in the shoulders, elbows, hips, and knees from frequent, repetitive motions. This condition is also common in the heels and base of the big toe. Bursitis can be treated through conservative techniques, interventional pain care, or minimally invasive surgery, and treatment is dependent upon the severity of the condition. A provider at TriState Pain Institute will evaluate your symptoms and deliver an appropriate diagnosis before recommending a treatment option.

Causes:
The most common cause of bursitis is overuse of a particular joint. Possible scenarios of overuse include throwing a baseball or football frequently, lifting objects overhead repeatedly, applying pressure to the elbows or shoulders for an extended period of time, and extensive kneeling on hard surfaces. Bursitis can also develop from a traumatic injury to a joint, rheumatoid arthritis, gout, or an infection. However, more often than not, repetitive motions cause bursitis.

Symptoms:
Symptoms of bursitis may develop gradually, and in the very early stages, patients may experience sharp, intense pains, redness, and swelling in the affected joint(s). Over time, the pain may spread to surrounding areas and become a dull ache that worsens at night, while lying down, or after sitting for several hours. Patients should schedule an appointment with their TriState Pain Institute physician if they begin to experience debilitating joint pain that lasts more than one or two weeks, a fever, or a rash in the affected area. 

Treatments:
Before administering treatment, a TriState Pain Institute physician will review your medical history and perform a physical examination. Should further testing be needed, imaging tests such as an ultrasound or MRI may be ordered, as well as a blood or fluid analysis. After being diagnosed with bursitis, your TSPI provider may recommend conservative therapies such as rest, ice, and over-the-counter pain relievers to reduce inflammation and minimize discomfort. If these treatment methods don’t work, you may be prescribed an antibiotic, given injections or assistive devices, or enrolled in a physical therapy program. Lastly, a TSPI provider may suggest minimally invasive surgery if the patient's bursitis does not resolve itself after receiving interventional pain care.

Definition:
Cancer pain can be described as either acute or chronic and can be pain that is from cancer treatment or cancer itself. Whether the patient has cancer or is experiencing pain after cancer has gone into remission, patients can see the best results if they treat their cancer pain sooner rather than waiting until the condition turns into chronic pain.

Causes:
There are a number of reasons why patients may experience cancer pain. Sometimes, the source of the pain may be from cancer treatment. Radiation and chemotherapy may cause sores in the mouth and other parts of the body. Surgeries to remove limbs may also result in a condition known as phantom limb pain, a chronic condition where patients feel pain in their missing body parts. However, the cancer may influence the pain as well. Sometimes tumors can spread to the spinal cord and pinch nerves. When nerves are damaged, there is the possibility of nerves misfiring, sending pain signals to the brain.

Symptoms:
Patients with cancer pain can have a variety of symptoms depending on the condition their cancer or treatment has resulted in. For neuropathic pain, patients can experience a tingling feeling that travels up the arms and legs. Neuropathy can also leave patients with a sudden, sharp pain paired with weakness.  Patients with cancer pain may have a difficult time falling asleep due to the inability to relax. Finally, cancer pain is known to bring on feelings of frustration, anger, or depression.

Treatment:
Cancer treatment can be overwhelming at times, but with concurrent pain treatment from TriState Pain Institute, we can help make it easier. Depending on the cause of the cancer pain, our pain experts can carefully select a treatment plan that is the best fit for patients. We will make sure that any prescriptions that are provided do not interfere with existing prescriptions that are managing and treating cancer. Visit our treatments page to see the many options available to patients with cancer pain, including nerve blocks and medical marijuana. 

Definition:
Carpal tunnel syndrome is a relatively common condition that causes inflammation of the tendons and tissues in the wrist. This swelling occurs when prolonged pressure is applied to the median nerve and synovium in the carpal tunnel. In most patients, carpal tunnel syndrome develops gradually and causes moderate to severe pain on the thumb side of the hand. However, symptoms can change and vary in intensity depending on the severity of the condition. If left untreated, carpal tunnel syndrome could lead to permanent nerve and muscle damage.

Causes:
This condition typically develops from repetitive wrist and hand motions that cause compression of the median nerve. A number of other health, anatomic, and workplace factors may increase a person’s risk of developing this condition. Nerve-damaging conditions, inflammatory diseases, pregnancy, menopause, obesity, and thyroid disorders can all lead to carpal tunnel syndrome as well. When the median nerve in the carpal tunnel becomes irritated and crowded, swelling ensues, resulting in pain and other symptoms.

Symptoms:
Symptoms of carpal tunnel syndrome may begin as numbness or tingling in the thumb that radiates toward the index and middle fingers. This sensation may come and go, or worsen as the condition progresses. Patients may experience relief after shaking out their hands or stopping activities that exacerbate symptoms. Pain or discomfort may be present, but more often than not, patients experience tingling, numbness, and muscle weakness in the wrist and hand.

Treatments:
While conservative therapies can effectively mitigate carpal tunnel syndrome, interventional pain care and minimally invasive surgery are often the preferred treatment methods. This is especially true for patients who cannot stop or modify the behavior that caused the condition in the first place. Nonsurgical treatment of carpal tunnel syndrome generally includes over-the-counter pain relievers, wrist splinting, ice, and rest. Oral medications or interventional (injections) corticosteroids may also help decrease inflammation and pain related to carpal tunnel syndrome. If the patient’s symptoms continue, endoscopic surgery may be recommended for treatment.

Definition:
Radiculopathy is the clinical term for a condition of the nerves, and cervical means that the affected nerve is located in the neck. Cervical radiculopathy is usually a result of a pinched or compressed nerve, and for this reason, patients usually have an underlying condition causing the nerve to send pain signals.

Causes:
Cervical radiculopathy is often caused by aging. As we get older, patients are more susceptible to conditions like degenerative disc disease or arthritis. Both naturally occur as the spine experiences normal wear and tear, but if the spinal discs and joints cannot properly support the spine, the nerves can be affected by these anatomical changes and leave patients in a lot of pain. This is also true of herniated discs. However, the difference is that herniated discs can be a result of aging and the natural wear of the spinal disc, but it can also be caused by injury. Lifting heavy objects or twisting the spine may result in injury causing one of the discs in the neck to compress a nerve.

Symptoms:
Since cervical radiculopathy is a condition of the nerves, patients are likely to feel pain that extends from the neck into the upper body. Patients may experience weakness and pain in the shoulders, arms, and even fingers. Cervical radiculopathy can be associated with symptoms of shooting pain along the inside of the arm as well as a weak grip or loss of coordination. 

Treatments:
In order to treat cervical radiculopathy, the team at TriState Pain Institute must treat the underlying condition that is irritating the nerve. To diagnose the source of neck pain, patients may need to undergo a physical examination and have some diagnostic imaging done. As another step to confirm the condition, one of our pain management experts may perform a nerve block to temporarily stop a nerve from firing. If the patient experiences less pain, the physician can confirm which nerve in the cervical spine is causing the issue. If a disc issue is present, the disc that is pinching the nerve needs to be identified, and so patients may need to undergo a discography. 

If the patient feels significantly better after the nerve block, they can come back for routine steroid injections every few months. Depending on the severity of pain, our team may suggest spinal bracing, spinal cord stimulation for neck pain, and more. At TriState Pain Institute, we want patients to have a full continuum of care. If needed, our physicians can work with you for any additional needs you may have including workman’s compensation and referrals to specialized care, including massage or physical therapy.

Definition:
Complex regional pain syndrome (CRPS) is a chronic condition that causes severe, debilitating pain in a limb, like an arm or leg. While the cause of CRPS is relatively unknown, the condition typically develops in patients who’ve suffered a traumatic injury, undergone surgery, or had a heart attack or stroke. Whatever the cause, complex regional pain syndrome is often characterized by pain that is out of proportion with the severity of the initial injury. If caught early, the improvement of symptoms and going into remission are possible. Patients will need to have their medical history and current symptoms evaluated by a pain specialist before a diagnosis of CRPS can be made.

Causes:
Currently, there are no known causes of complex regional pain syndrome. Regardless, there are certain factors that can increase your risk of developing this condition. Over the last several years, researchers have determined major traumas to the arms or legs, such as a crush injury, severe fracture, amputation, or surgery, can result in CRPS. A heart attack, stroke, infection, or sprained ankle may also increase a person’s risk of developing this condition. Complex regional pain syndrome manifests two different ways with similar symptoms but different causes. CRPS Type 1 usually develops after an illness or injury that didn’t directly damage the affected limb. CRPS Type 2 develops from a distinct nerve injury.

Symptoms:
Symptoms of complex regional pain syndrome may vary in location and intensity. Nevertheless, patients could experience the following: a burning pain in the affected hand, arm, leg, or foot; changes in skin temperature, texture, and color; increased sensitivity to cold temperatures and touch; swelling, muscle spasms, joint stiffness, and muscle atrophy of the affected limb; changes in hair and nail growth; and decreased mobility of the affected limb. In its later stages, complex regional pain syndrome may spread to other parts of the body and worsen from emotional stress. A TriState Pain Institute physician should evaluate pain that is considered constant and intolerable.

Treatments:
At TriState Pain Institute, patients often benefit most from a multidisciplinary approach to treatment. Various medications and therapies may be recommended to mitigate symptoms associated with complex regional pain syndrome. Over-the-counter pain relievers, antidepressants, anticonvulsants, corticosteroid injections, topical analgesics, physical therapy, TENS/PENS units, spinal cord stimulation, and more, may help reduce CRPS symptoms. 

Definition:
It's important to note that degenerative disc disease is not actually a disease at all but is a term used to describe the degeneration of the spinal discs over time and frequently is secondary to another condition. However, almost everyone faces some level of degeneration as they age. This is because as time goes on, the jelly-like discs between our vertebrae experience normal wear and tear and naturally lose their water content.

Causes:
Degenerative disc disease is caused by the spinal discs losing their volume, but pain is caused when the discs are unable to absorb shock or have migrated outward, irritating the nerves of the spine. Pain can be a result of inflammation within the disc space, instability in the spine, bone spurs from bones rubbing against each other, or compression of the nerves in the spinal cord. Aside from natural wear and tear, degenerative disc disease may be caused from injury or anything that might have brought trauma to the spine. 

Symptoms:
Degenerative disc disease can cause pain in all regions of the spine, but it is most common in the low back. Symptoms may begin as mild, but get worse if you bend down or twist the spine. Sitting for long periods of time have been known to worsen symptoms, but lying down often is found to relieve pain. If a nerve is compressed, patients may experience symptoms of sciatica, such as shooting pain down the buttocks and back legs. If degenerative disc disease occurs in the cervical spine, pain and weakness may travel down the shoulders and arms.

Treatments:
At home, patients may find pain relief with over-the-counter pain medications, ice, and rest. However, if pain persists more than a few weeks, patients should come to TriState Pain Institute for degenerative disc disease treatment. Our team will determine the best course of treatment, but often recommend steroid injections for longer lasting pain relief, depending on how the condition has affected the spine. For example, an epidural steroid injection can help those suffering from low back pain and sciatica, while a facet joint injection can reduce swelling of the facet joints. At TriState Pain, we believe in listening to the patient to meet their needs, so we offer a number of other services to treat degenerative disc disease including spinal cord stimulation, nerve stimulation, and many more. If the level of degeneration is high, the physician may advise patients to move away from conventional treatment options and get an evaluation to determine if a spinal fusion is needed to restore the disc space and stabilize the spine. 

Definition:
Failed spine surgery syndrome is a general medical term that describes pain felt after back surgery. While many spine surgeries produce pain-free outcomes, it is possible that surgery will not provide patients with adequate pain relief. Spine surgery is often performed to decompress a nerve root or stabilize a joint. These repairs may subsequently reduce pain, but the primary purpose of spine surgery is not to reduce a patient's back discomfort; it's to correct a malformation. Still, many patients undergo surgery to reduce chronic back pain, and they typically experience optimal results. A TriState Pain Institute physician will evaluate your health history and symptoms before recommending treatment options for failed spine surgery syndrome.

Causes:
Spine surgery can fail for many reasons, but the team at TriState Pain Institute wants patients to understand that pain relief can be achieved through other means, such as interventional pain care. Regardless, possible causes of failed spine surgery syndrome may include an incorrect initial diagnosis; performing surgery at an incorrect level or location; scar tissue formation; failure of spinal fusion with bone grafts and other materials; or nerve damage that occurs during surgery. Traditional, open back surgery may also increase a patient’s risk of developing failed spine surgery syndrome.

Symptoms:
A notable symptom of failed spine surgery syndrome is continued chronic pain after spine surgery. Other signs of this condition may include limited mobility and flexibility; pain that radiates toward other parts of the body; muscle spasms in the back; pain felt above or below the treated spine location; anxiety; depression; dependence on prescription pain medication for treatment; and an inability to heal from surgery. These symptoms may begin shortly after surgery and continue until treatment is sought.

Treatments:
There are many minimally invasive treatment options that may help mitigate pain from failed spine surgery syndrome. Treatment typically depends on the exact cause of the condition, but patients often find relief through physical therapy, steroid injections, radiofrequency ablation, nerve blocks, spinal cord stimulation, or another minimally invasive spine surgery. 

Definition:
Fibromyalgia is a condition of the muscles and tissues in the body. On top of chronic pain, fibromyalgia is known to impact many other aspects of life, including sleep, mood, and memory. Researchers do not know a lot about this condition, but we do know that the majority of cases are found in women.

Causes:
The exact cause of fibromyalgia remains a mystery. However, it is believed that fibromyalgia has a hereditary link, meaning that fibromyalgia may run in the family. Fibromyalgia symptoms usually begin after a stressful or traumatic event, so another theory suggests that these events (such as an injury, giving birth, or an emotional situation) may trigger the condition. However, these are not the only theories, and researchers continue to learn more about fibromyalgia to get a more exact cause.  

Symptoms:
It can be difficult to diagnose fibromyalgia because it shares symptoms with many other conditions. However, fibromyalgia is unique in the fact that fibromyalgia patients have common “tender points,” which are areas of the body where most fibromyalgia patients feel pain. Besides the tender points, patients can have pain just about anywhere, often having widespread pain in multiple locations at once. In addition to pain, patients may also feel fatigue, restless sleep, depression, stomach cramps, or have concentration problems. Patients may experience what is known as a “fibro fog” where they cannot focus or remember the task they were working on.

Treatments:
Since fibromyalgia affects many different aspects of life, physicians at TriState Pain recommend trying a variety of different treatments to improve all aspects of life.

Generally, the first step is to get the pain under control. Patients can begin drug therapy with a number of FDA-approved pain medications designed for fibromyalgia patients. If needed, trigger point injections may be administered to treat painful muscles. TriState Pain Institute offers a number of alternative therapies as well to complement drug therapy, like medical food agents to help patients maintain a healthy weight. Excess weight may put more pressure on the joints and cause additional pain, so Dr. Venger recommends medical food agents to help patients struggling with this issue. We can also refer patients to a specialized care facility to receive massage therapy, chiropractic care, and other therapies in an effort to relieve pain and promote relaxation to combat symptoms of depression and insomnia. 

Definition:
A spinal disc herniation occurs when the soft, inner portion of a spinal disc seeps through its tough exterior, irritating surrounding nerves, and tissues. Herniated discs typically develop in the lumbar spine (low back), but they can occur in the thoracic (mid-back) and cervical (neck) spine as well. While not every herniated disc requires treatment, interventional pain care and conservative therapy may be recommended to patients to prevent worsening symptoms. If a herniated disc is left untreated, serious complications can arise, such as numbness or weakness that interferes with daily activities and bladder or bowel dysfunction. Talk to a TriState Pain Institute physician about undergoing treatment for a herniated disc.

Causes:
Herniated discs are typically caused by age-related wear and tear to the body. With age, spinal discs lose their water content, making them increasingly susceptible to tears from minor movements or injuries. Once the spinal disc tears, the jelly-like center pushes through and causes pain, numbness, and weakness in the body. Individuals with occupations that are physically demanding and require frequent, heavy lifting are at risk of spinal degeneration, which can result in herniated discs. Other factors that may lead to spinal disc herniation include excess body weight, trauma, and genetics.

Symptoms:
Minor tears in a spinal disc may produce little to no symptoms, but large tears will generally produce referred pain. More often than not, patients with a herniated disc will experience an intense pain around the affected area. For example, herniated discs in the low back typically produce symptoms of pain, numbness, tingling, and weakness in the buttocks, and thighs. Herniated discs in the neck may produce similar symptoms, but in the shoulders and arms. Pain from a herniated disc may fluctuate in severity, location, and duration depending on the extent of damage. Patients who experience neck and back pain that courses throughout the body and is accompanied by any kind of numbness or tingling should seek immediate medical attention.

Treatments:
Conservative therapy is usually the first-line of defense for patients with a herniated disc. This includes over-the-counter pain relievers, avoiding painful positions, and participating in a consistent, but low-impact exercise regimen. If these techniques provide inadequate relief, a TriState Pain Institute physician may recommend steroid injections, nerve blocks, radiofrequency ablation, electrical stimulation, or minimally invasive surgery. Rarely, surgery will be necessary for a herniated disc. However, if patients begin to experience numbness, difficulty standing or walking, or a loss of bladder and bowel function, they will likely need to undergo a surgical procedure. 

Definition:
Migraines cause pain and other symptoms such as nausea, vomiting, sensitivity to light and sound, dizziness, and fatigue. They are usually characterized as frequent, recurrent headaches that vary in intensity, location, and duration. Most migraine headaches affect one area of the head and last several hours. It is possible, however, for the pain to last a few days and be felt in more than one area of the brain. Some migraines produce sensory warning signs called auras, which can cause auditory and visual disturbances. Treatments for chronic migraines vary depending on the patient's condition and their possible triggers.

Causes:
While the cause of migraines is still unknown, many researchers believe chemical imbalances in the brain lead to migraine headaches. Migraines can also arise from various environmental factors, such as bright lights, smells, allergies, and changes in barometric pressure. Additionally, genetics, food additives, hormonal changes, medications, alcoholic and caffeinated beverages, stress, sleep pattern changes, and physical activity can all trigger a migraine. Patients may be asked to document their symptoms in a headache journal to help pinpoint the exact cause or trigger of their migraine.  

Symptoms:
Chronic migraine is a complex condition that produces a number of painful symptoms. Generally speaking, most migraines produce an intense, throbbing pain in one area of the head, nausea, vomiting, blurred vision, lightheadedness, and sensitivity to light, sounds, and smells. As mentioned previously, migraines can also produce auras, which are visual and auditory disturbances that develop 20 to 60 minutes before an actual migraine takes place. Examples of aura include seeing bright spots or flashing lights, temporarily losing vision in one or both eyes, feeling numbness or tingling in the arms or legs, or experiencing speech problems. Patients with headache pain that is accompanied by a fever, stiff neck, mental confusion, seizures, or difficulty speaking should seek immediate medical attention. 

Treatments:
Although there is no cure for migraines, the providers at TriState Pain Institute can recommend treatments to help keep their frequency and intensity under control. A combination of preventative, pain-relieving, and anti-nausea medications may be prescribed to help patients combat symptoms. Additionally, injections such as Botox and nerve blocks could be used to reduce pain. 

Definition:
Neuropathy also called neuropathic pain, is a complex condition that causes weakness, numbness, and pain in areas of the body that have experienced nerve and tissue damage. More often than not, this disease affects the hands and feet, but it can also develop in the legs and arms. Neuropathic pain may be caused by injuries, infections, and inherited diseases, but the most common source of neuropathy is diabetes mellitus. Symptoms of neuropathy often improve when the underlying cause is treated. A TriState Pain Institute physician may recommend a combination of interventional pain care options to treat the underlying condition and reduce pain caused by neuropathy.

Causes:
There are many health and environmental factors that increase your risk of developing neuropathy. Some of the most common causes of neuropathic pain include viral or bacterial infections like Lyme disease, shingles, and hepatitis C; exposure to toxic substances such as heavy metals or chemicals; trauma to the peripheral nerves; diabetes; and autoimmune diseases such as lupus, rheumatoid arthritis, and Sjogren's syndrome. Other causes may include alcoholism, certain medications, cancer, vitamin deficiencies, and inherited diseases. A family history of neuropathy may also increase your risk of developing the condition.

Symptoms:
There are three different kinds of nerves within the peripheral system: sensory, motor, and autonomic. Depending on the type of nerve that’s damaged, patients may begin to experience symptoms such as numbness, tingling, and sharp, jabbing pains in the feet and hands. Over time, these symptoms may progress and cause extreme sensitivity to touch, reduced coordination, muscle weakness, or partial paralysis. If the autonomic nerves are affected, patients may develop a heat intolerance and experience bowel, bladder or digestive problems. Lastly, changes in a patient’s blood pressure may also occur, resulting in dizziness and fatigue.

Treatments:
Treatment plans will be developed based on the cause of the patient’s neuropathy. If lifestyle factors such as drinking alcohol or being exposed to toxins led to the development of this condition, a TriState Pain Institute physician will probably recommend avoiding these substances, as well as undergoing treatment. If a patient’s diabetes caused their neuropathy, a provider at the clinic will likely coordinate care with the patient’s primary physician. Regardless, interventional pain care for neuropathic pain generally includes pain medication management, peripheral nerve blocks, percutaneous electrical nerve stimulation (PENS), and pain-relieving creams. 

Definition:
The occipital nerves are located at the top of the spinal cord and travel through the top of the head. When this group of nerves is damaged or inflamed, people can feel intense pain from what seems like a headache or migraine. But unlike migraines or headaches, occipital neuralgia is a neurologic condition. Occipital neuralgia is a rare but extremely painful condition that may interfere with daily tasks like brushing and washing hair or lying down.

Causes:
Occipital neuralgia occurs when the occipital nerve is pinched. There are numerous reasons why this may happen. A previous injury to the head or neck could have put pressure on the nerve, especially if it caused the muscles to stiffen. Another condition could also cause occipital neuralgia; an example is when bone spurs from osteoarthritis or damage from diabetic neuropathy cause pressure on the occipital nerves. Migraines may also interfere with the occipital nerve the condition caused inflammation around the nerve. Occipital neuralgia very rarely occurs as an isolated condition (with no other conditions present), but if no other causes are found, additional diagnostic testing may need to be performed.

Symptoms:
The occipital nerves do not extend all the way to the face, so symptoms can be limited to the neck, back, and sides of the head. Patients may feel a sudden sharp pain that shoots or radiates from the neck to the head and is sensitive to the touch. Some patients may develop sensitivity to light as well. Pain can be felt on both sides of the head, although it is possible to only experience pain on one side. Some patients may feel pain behind the eyes, but never from the forehead around the eyes.

Treatments:
At the TriState Pain Institute, a number of treatment options are available for patients with occipital neuralgia to help them get the back to doing the day-to-day activities they were able to do before their head and neck pain began. Our physicians can prescribe medication to not only control pain, but reduce the inflammation around the nerve to keep the nerve from sending pain signals in the first place. For more long term results, patients can have a series of occipital nerve blocks. Occipital nerve blocks are a form of injection therapy that may provide pain relief for months at a time. The injection goes just under the hairline at the base of the skull and puts soothing anti-inflammatory medication directly into the area surrounding the nerve. Radiofrequency ablation is another option for patients and been proven effective at reducing neck pain. The procedure uses radio waves to heat the nerve so it can no longer send pain signals to the brain.

Definition:
Phantom limb pain is a chronic condition that commonly affects patients with amputated body parts. This disorder most often occurs in patients with arm or leg amputations, but it can also develop in people who’ve had surgery to remove their breasts, genitalia, eyes, or tongue. Phantom limb pain is characterized as pain coming from a body part that no longer exists. This condition can also produce painless sensations such as tingling, numbness, coldness, warmth, or itchiness near the area of the missing limb. At one time, phantom limb pain was considered a psychological problem. Now, physicians understand these symptoms originate from mixed signals in the spinal cord and brain.

Causes:
There is no exact cause of phantom limb pain, but researchers speculate the condition develops in patients with damaged nerve endings or scar tissue near the site of an amputated limb. There are also theories that the brain and spinal cord’s inner circuitry misfire sensory signals to body parts that are no longer present. Experts believe the brain loses input from the missing limb, so it sends a warning sign that something is not right, which is often experienced as pain. There is still much to learn about this unique condition, but the most common cause of phantom limb pain is a surgical amputation.

Symptoms:
Phantom limb pain is an unpredictable condition that can develop immediately after an amputation or several years after a body part has been removed. Most people with phantom limb pain report painless sensations near the remaining stump of the amputated limb, such as tingling, numbness, itchiness, coldness, or warmth. Over time, these sensations may progress and become shooting, stabbing, burning, or throbbing pains. Other characteristics of this condition include pain that is continuous or sudden; pain that develops in the farthest part of the amputated limb, such as pain in the hand of an amputated arm; or pain that’s trigged by pressure or emotional stress.

Treatments:
Phantom limb pain is a complex condition that can be difficult to treat. Nevertheless, medications and conservative therapies may be recommended to help minimize a patient’s discomfort. The specialists at TriState Pain Institute may also suggest steroid injections, nerve blocks, transcutaneous electrical nerve stimulation (TENS), or spinal cord stimulation for pain relief. If these interventional pain care methods do not work, a physician may provide the patient with a referral for specialized care. In the case of phantom limb pain, specialized care may be a stump revision, neurectomy, or deep brain stimulation.

Definition:
Postherpetic neuralgia is a chronic pain condition that is caused by shingles, a viral disease that reactivates the chickenpox (herpes zoster) virus in the body. Shingles cause a painful rash in the form of blisters along the chest and abdomen. Postherpetic neuralgia is characterized as pain that lasts after the shingles rash has disappeared. This condition causes a burning pain within the nerve fibers and skin affected by the herpes zoster virus. While there is no cure for postherpetic neuralgia, there are interventional treatment options for patients suffering from this condition. The TriState Pain Institute team may recommend interventional and alternative therapies in conjunction with home remedies to mitigate a patient’s shingles pain.

Causes:
Postherpetic neuralgia is a complication of shingles. It occurs when the nerve fibers near a shingles outbreak become damaged; sending exaggerated or confused pain signals to the brain. This condition is most common in patients over the age of 50 who had severe cases of shingles. Patients suffering from other chronic illness (like diabetes) and have a suppressed immune system may also be at risk of developing postherpetic neuralgia. Despite some of these risks, anyone who’s had the chickenpox and shingles could develop postherpetic neuralgia.

Symptoms:
Symptoms of postherpetic neuralgia are typically limited to the area where a patient’s shingles outbreak first occurred. The most common sign of this condition is pain that lasts three or more months after the shingles rash has healed. Patients often describe the pain as burning, sharp, and jabbing; or dull and aching. Rarely, patients may experience sensitivity to touch, itchiness, or numbness.

Treatments:
As mentioned previously, there are a number of treatment options for patients with shingles pain. A topical ointment or skin patch containing lidocaine or capsaicin may be applied to the affected area during an office visit at the TriState Pain Institute. These patches are typically left on the skin for up to two hours, and patients may experience pain relief for up to three months. Should these patches be unsuccessful at providing long lasting relief, a pain management specialist may recommend steroid injections to reduce inflammation in the area. Home remedies such as taking over-the-counter pain medications, applying nonprescription strength capsaicin or lidocaine cream, and icing the affected area, may be suggested in conjunction with interventional treatment at the TriState Pain Institute. 

Definition:
Sciatica is classified as pain that radiates along the sciatic nerve. This nerve starts in the lower back and travels down the hips, buttocks, and legs. Sciatica typically develops from a herniated disc or bone spur in the spine and usually affects one side of the body. Sciatica may also occur in patients with spinal stenosis, a condition characterized by the narrowing of the spinal canal. To effectively mitigate sciatica, the underlying condition that is initially causing the pain must be addressed first. More often than not, minimally invasive spine surgery is suggested for sciatica patients who have a herniated disc, bone spur, or spinal stenosis. If a patient does not wish to have surgery, they may want to consider interventional pain care at TriState Pain Institute to treat their sciatica.

Causes:
Sciatica is a repercussion of other spinal conditions, such as a herniated disc, bone spur, or spinal stenosis. When the sciatic nerve becomes pinched, usually by a damaged spinal disc compressing the spinal cord, it can cause pain and other uncomfortable symptoms. In rare instances, sciatica can be caused by diabetes or a tumor developing in the spine. A physician at TriState Pain Institute will perform a physical examination and imaging tests before recommending treatment for a patient’s sciatica.

Symptoms:
The most notable symptom of sciatica is radiating pain that begins in the lower spine and travels down the hips, buttocks, and back of a leg. Patients may experience other symptoms such as pain anywhere along the sciatic nerve; pain that is dull and aching, or sharp and burning; pain that worsens when coughing or sneezing; numbness, tingling, and muscle weakness in the affected leg or foot; and pain that worsens after prolonged sitting or standing. Immediate medical attention should be sought by patients with severe numbness in the lower back and legs and difficulty controlling bladder and bowel movements. 

Treatments:
Treatment for sciatica typically includes conservative, alternative, and interventional pain care methods. Anti-inflammatories, muscle relaxants, or pain medications may be recommended to patients with sciatica, as well as physical therapy, steroid injections, nerve blocks, and minimally invasive procedures. A TriState Pain Institute physician will recommend treatment based on the patient’s underlying condition and current symptoms.  

Definition:
Spinal stenosis is a condition found most often in the lumbar (low) and cervical (neck) spine. The condition occurs when the open spaces of the spinal canal become narrow. As a result, the nerves and spinal cord can get compressed and cause significant chronic pain.

Causes:
Simple anatomy may cause spinal stenosis, as some people are born with a narrower spinal canal. Spinal stenosis also can develop as a person ages. Bone spurs from arthritic conditions of the spine may grow into the spine and compress the nerves. Similarly, herniated discs may press onto the nerves as well. Injury may also lead to spinal stenosis. Trauma to the spine could result in fractured vertebrae or swollen tissues that may also affect the nerves.

Symptoms:
With spinal stenosis, the spinal canal is narrowed, placing pressure on the nerves, causing numbness or weakness. If the nerves in the lower spine are compressed, this feeling can travel from the low back and into the legs and buttocks. In the neck, weakness can spread through the upper extremities. Patients with spinal stenosis typically feel worse after bending over, sitting, or standing for long periods of time. Patients may experience symptoms intermittently at first and then gradually feel more constant pain. Patients generally report that pain can be eased by lying down and resting.

Treatments:
At the TriState Pain Institute, our physicians are experts at treating pain caused by spinal stenosis. One of the critical factors of treatment often depends on the underlying cause. If a herniated disc or swollen tissue is compressing the nerves, providers may recommend anti-inflammatory medication or injections to relieve the pressure that is causing pain. Our team administeres injections in all regions of the spine, and these injections can provide pain relief for several months. If necessary, patients can be referred to a surgeon to have bone spurs removed and the vertebrae repaired. The TriState Pain Institute also offers a number of alternative therapies including electrotherapy and physical therapy, which are just two methods proven to help reduce back pain. 

Definition:
Trigeminal neuralgia is a chronic pain condition that causes mild to severe facial pain along the trigeminal nerve. This nerve is the largest cranial nerve, and it is made up of three major nerve branches: the ophthalmic nerve, the maxillary nerve, and the mandibular nerve. When combined, all three nerves are responsible for motor functions and sensations in the face. For patients with trigeminal neuralgia, small, simple tasks like chewing food, brushing teeth, or speaking can cause debilitating pain. While this condition is generally more common in women than men and typically occurs in patients over the age of 50, it can be present in both genders and people of all ages. Treatment for trigeminal neuralgia depends on the severity of the condition, but generally speaking, medications, injections, and other therapies may be recommended to mitigate facial pain.

Causes:
Trigeminal neuralgia is caused by damage or injury to the trigeminal nerve. Most physicians believe this condition is caused by a vein or artery compressing the nerve, but other possible causes include deterioration to the protective sheath of the trigeminal nerve. Despite these differences, there are several factors that may increase a person’s risk of developing this condition. Age, multiple sclerosis, and less commonly, a tumor, may cause trigeminal neuralgia. Brain lesions, facial abnormalities, surgical injuries, stroke, or facial trauma could also cause this condition.

Symptoms:
Trigeminal neuralgia typically produces severe, shooting pains that feel like an electric shock to the face. Other characteristics of this condition include pain that is triggered by shaving, light touch, eating, drinking, brushing the teeth, talking, putting on makeup, smiling, and washing the face. Patients may also experience bouts of pain that last several days, weeks, or months; constant aching in the face; pain that increases in frequency and intensity, and pain that is felt in one area of the face before it spreads to another area. Patients with facial pain that recurs and lasts several weeks should seek treatment from the pain management specialists at TriState Pain Institute.

Treatments:
Because trigeminal neuralgia is a complex condition, a number of conservative, alternative, and interventional pain treatments may be considered to effectively reduce a patient’s pain symptoms. If patients stop responding to over-the-counter pain relievers or prescription pain medications, steroid injections, Botox injections, and nerve blocks may be recommended to control pain. Minimally invasive surgery may also be suggested to patients who have found little or no relief from interventional pain care options.

Definition:
Myofascial trigger points, commonly referred to simply as trigger points, are a common condition. Because this is a condition of the muscles and the surrounding tissue, trigger points can develop just about anywhere in the body. It is sometimes described as a “knot” or “kink” in the muscles. Patients can have trigger points as a single diagnosis, and these are often associated with other painful musculoskeletal conditions.

Causes:
Trigger points are caused by injury to the fascia, which can best be described as a specialized type of tissue that covers muscle and resembles shrink-wrap. While acute incidents of trauma can damage the fascia, trigger points can also be a result of overuse of the muscle. If repetitive strain is put on the muscles, the fascia stretches and contracts. Patients can also develop trigger points if they have poor posture or hold their bodies in certain positions for too long. This type of overuse injury is called postural overload. For example, excess weight may pull the back inwards or patients with arthritis may alter their posture to avoid pain.

Symptoms:
Trigger points are known for causing referred pain. This means that pain is felt in one area of the body, but the original source is somewhere else, which can sometimes make it difficult to form a diagnosis. When pressed, trigger points will cause pain in predictable places that are related to that trigger point. 

Treatments:
Patients with trigger points often are advised to begin with massage therapy. Many patients can find relief by seeing a professional massage therapist who specializes in fascial therapy. However, this is typically recommended for acute trigger point pain. Patients whose trigger points are recurring and have had the condition for a while may benefit from other forms of treatment offered at TriState Pain Institute. Trigger point injections have been proven to be one of the most effective treatments for this condition. These injections are designed to treat muscle pain and can provide pain relief for months at a time. The mixture of anesthetic and steroid medication work quickly to help relax the muscle. If needed, our physicians can treat multiple trigger points at a time using injection therapy.