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2018-05-25 (1)

Treating shoulder pain

Treating shoulder pain

Quick Facts

  • Shoulder pain is the third most reported cause of the musculoskeletal consultancy in the primary care
  • 1% of the adults with developing shoulder pain, consult their general physician every year

Risk factors that aggravate shoulder pain

Physical risk factors that are associated with occupation involves repetitive movements and vulnerability to  heavy machines and tools

Psychosocial factors pertinent to work may also be the risk factor for shoulder pain, involving stress, working hours and pressurizing environment, social support and job satisfaction. However, the influence of these factors is a bit weaker

Athletes whose sports activities involve intense pressure and high influencing contact sports are at a higher risk of shoulder pain

Causes of shoulder pain

Patients appearing in primary care usually report a combination of various shoulder problems such as;

Underlying shoulder pain

  • Rotator cuff disorders:
  • Rotator cuff tears.
  • Sub acromial pain, Subacromial bursitis, tendonitis or Tendinopathy.
  • Frozen shoulder
  • Arthritis
  • Infection (rare)
  • Shoulder instability or Shoulder Dislocation

External shoulder pain

  • Pain arises from the neck, spreading to the shoulder
  • Rheumatoid arthritis
  • Lung cancer

The four most common reasons of shoulder pain and impairment in the primary care are the rotator cuff disorders, joint disease and neck pain

Assessment of shoulder pain

At The Pain Management Institute while diagnosing the shoulder Dr Zaki Anwar MD, Pain Management Specialist and founder of the Pain Management Institute asking you a few questions about your historical medical condition

Shoulder Pain Management

Management of shoulder pain in primary care has been often conservative and reduce and prevent overhead activities, medications for pain relief include Corticosteroid injections. If triggers doesn’t settle quickly or are severe, physiotherapy is more helpful to treat any focused cause

Rotator cuff disorders:

  • Can be managed by modifying the lifestyle and activities, involving the movements such as reaching overhead
  • Taking NSAIDs and over the counter pain medications

Rotator cuff tears

  • Physiotherapy and steroid injections may be helpful for minor tears.
  • For larger tears symptoms may benefit from early reference to a Pain Management Specialist or orthopedics
  • Surgical treatment usually involves arthroscopic rotator cuff tendon repair.

 Expectancy

The risk of developing chronic shoulder pain depends on the intrinsic cause

Elderly age, female gender, triggers of gradual onset, long term symptoms, severe or repetitive symptoms and related neck pain are responsible to produce worst outcomes

Recovery for chronic shoulder pain is usually slow, studies have complete recovery in one month in 23 % of patients and 18 months in 59% of patients

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2018-05-19

What is causing you uneasiness in the hip?

The hip joint is strong enough to bear repeated movements and a substantial amount of  wear and tear. The hip joint is comprised of the ball and socket is known to be the body’s largest fixed together in a manner that facilitate for fluid movement

Whenever we use the hip, such as for running, walking a cushion of cartilage helps  avoid friction as the hip bone rotates in its socket

In spite of its persistence, the hip joint isn’t non perishable. With age and constant use, the cartilage can deplete and becomes damaged. Muscles and tendons in the hip can also get excessively used, bones can break during a fall or other injury and any of these situations can cause hip pain. If your hips are inflamed, here is a run through of what is causing you uneasiness, also it may help you know the quick tips to get relief from hip pain

Reasons  for hip pain

There are some common conditions that can augment hip pain;

Arthritis

Osteoarthritis and rheumatoid arthritis are known to be the most common cause of hip pain particularly in  older adults. Arthritis brings the inflammation of the hip joint and damages the cartilage that supports your hip bone. The pain eventually gets severe. People with arthritis also encounter immobility and tightness in the joints

Hip fractures

As we age our bones become weak and porous. Weakened bones are at a higher chance to fracture during certain injuries

Bursitis

The bursae are pockets filled with fluid placed between tissues such as bone, muscles and tendons. These small pockets are responsible to ease friction from these bony areas while working together. When bursae get inflamed they provoke the pain receptors, causing severe pain. Inflammation of the bursae has been often because of excessive activities of the hip joint

Tendonitis

Tendons are the thick bands of tissues that surrounds the bones to muscles. Tendonitis is the soreness and uneasiness of the tendons

Strained muscles             

Strain on the muscles, tendons and ligaments that support the hips is caused by certain sudden movements and injuries. These muscles get pinched putting a substantial amount of pressure on the nerves restricting the normal hip functioning

Hip Pain Relief

Using over the counter medication, non steroidal anti inflammatory drugs, heat and ice therapy, plenty of rest along with physical therapy and exercising can help you achieve potential relief from your hip pain and increase range of motion

However, any deformities caused by arthritis or fracture may need to be dealt with surgeries such as total hip replacement or partial hip replacement

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2018-05-10 (1)

Treating cancer pain

An Intrathecal drug administration or Intrathecal pain therapy has been the backbone for the management of excruciating uncontrollable pain to systematic pain treatments. Since the therapy is well accepted in there are still some complications observed in clinical practices to its implementation with patients with cancer.

With advanced clinical practices, there are potential chances that access to therapy for the management of cancer pain will increase

Cancer pain continues untreated and a potential number of patients with cancer perish while enduring severe untreated pain every year. Moreover, on an average at least 1.7 million new cases of cancer are diagnosed, which are expected to rise

A wide range of chronic cancer pain can be managed by drug therapies, still many patients fail to achieve adequate relief  despite of the availability of many conventional methods. Treatment of cancer pain has taken a new turn to chronic pain management strategies, particularly among cancer pain survivors.

An Intrathecal drug therapy is one of the game changing treatment and provide a substitute for the administration of  pain killers and relieve pain while minimizing side effects

Candidates for ITT

Since a range of cancers is accompanied with greater onset of pain, appropriate patient screening for Intrathecal drug therapy is crucial to evaluate who may benefit from Intrathecal pain pump

The patient selection procedure involves

  • Patient diagnoses and survival chances
  • History of Opoids taken
  • Location and type of pain
  • Catheter location
  • Tolerance of an Intrathecal pain pump’s treatment
  • Psychological and cognitive status

Prior to implantation, it is important to get a clear diagnosis, a complete physical exam and psychological evaluation. Once it is conclusively proved that an Intrathecal Pain Pump therapy beneficial for the patient, the patient must address psychiatric issues that can negatively impact treatment outcome

In addition, all patients should have realistic expectations of  Intrathecal Pain pump therapy for pain relief and understand how it may impact their daily life

Generally an Intrathecal pain pump is recommended after several attempts of conventional pain relieving treatments. Intrathecal drug delivery involves the implantation of highly concentrated solutions in the intrathecal space. The medication restricts pain signals to the brain. When administered Intrathecaly the Opioids may offer greater pain relief at the potentially lower doses with minimal side effect

Complications

In spite of its comparatively small doses of Opiods, increased doses of Intrathecal Opioids may lead to complications including, nausea, vomiting, constipation, respiration problems , sexual dysfunction, urinary retention, and sedation.

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2018-05-05

Keeping up with a healthy workforce, shapes into a better society

Keeping up with a healthy workforce can lower direct and indirect health care expenses by developing your employees’ health and maximizing their productivity

Occupational cares at The Pain Management Institute

At The Pain Management Institute, Dr Zaki Anwar, MD,anesthesiologist and Founder of The Pain Management Institute  and his fellows ensure the program includes several key aspects

Adaptation

We offer highly flexible, extensible service that is tailored to fit the unique needs of your business and can easily widen with your business

Competence

We help you create an occupational health care and offer the expertise directly to your work place

Observations

Information and trends help you observe how the campaign is congregating with your goals and enhancing the health of your workers

The Pain Management Institute offers employees easy access to health care, developing patient’s engagement and improving long term care results. With an onset employees get health care in their workplace, can access to health and wellness resource, easy appointment scheduling. We give your employees and their families to the expert occupational health care network across Chicago. The pain management institute offers occupational medicine, emergency care, physical therapy and a wide combination of treatments.

We strive our best to offer you easy access to optimal health care, increased workforce productivity and potentially lower health care expenses

“Well-functioning occupational health care benefits everyone” Dr Zaki Anwar, MD

Did you know?

You as an employer or a large corporate organization can reduce your expenses up to 20% as workers’ compensation injuries within a year after adopting to occupational care program

Either you are an employee, an entrepreneur or a self employed individual you have the right to enjoy an occupational health care. Self employed is a person who runs his own business and is not employed by anyone. Occupational health care supports an employee’s work capacity throughout his/her working career.

The degree of and measures taken in occupational health care, tailored to the need of the workplace, are mutually planned by the employer, a personnel representative and the occupational health care service provider. They also observe and judge the efficiency and implementation of the occupational health care service

  • The aims of occupational health care;
  • A healthy and safe working environment
  • A well-functioning work community
  • Preventing work-related illnesses

Maintaining and promoting employees’ work capacity and functional capacity.

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2018-04-27

Nerve pain? Experience an intercostal nerve block

An intercostal nerve block is a unique method to combat pain, persistent pain syndromes, either acute or chronic in the area of the chest. The procedure was first introduced by Heinrich Braun. Intercostal nerves lie below the lower margins of the ribs. Intercostal nerve blocks involves the injection of a local anesthetic, with or without a steroid in the area near to intercostal nerves. The procedure is a component of an integral method for the treatment and management of pain. Intercostal nerve blocks are sometimes the only prescribed treatment and blended with other treatments such as anti inflammatory medicines, chiropractic care, oral or intravenous Opioids, occupational therapy and antidepressants

Intercostal nerve blocks are often for treatment purpose, but it can be also used for diagnosis in some conditions. If pain is not reduced with injections an intercostal nerve might not be the root cause of the pain

If the pain is acute, an intercostal nerve may be the cause, with insufficient pain, recovery performed by the Co injected steroid. If the pain is alleviated for longer  periods such as hours, days and weeks an intercostal nerve is the root cause. If this is the situation repeat injections of the local anesthesia with or without a steroid

When should I avoid an intercostal nerve block?

Intercostal nerve blocks should not be taken by patients having any of the following symptoms

  • Allergy to any local anesthetic
  • Infections breakout whether bacterial or viral
  • Influenza A or B
  • Poorly controlled hypertension
  • Treatment with blood thinners
  • Poorly controlled diabetes

If you are taking any blood thinners, it is advised to stop taking the blood thinners at least a week before the  procedure

Risks and complications

An intercostal nerve block is a safe procedure, however, there are possibility of complications, which may include;

  • Bruising or soreness at injection site
  • Infection
  • Nerve damage
  • Collapsed lung
  • Bleeding
  • Systemic toxic reactions
  • Death (very rare)
  • Increased blood sugar levels

What conditions are treated with the intercostal nerve blocks?

There are several conditions that are treated from an intercostal nerve block which includes;

  • Post-traumatic pain from rib fracture, shingles (herpes zoster), or post herpetic neuralgia
  • Postoperative pain from chest wall surgeries or procedures
  • Chronic non-malignant pain
  • Pain from malignancies involving the chest wall

The above discussed conditions compresses the intercostal nerves and causes inflammation, which leads to pain in the chest wall

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2018-04-20

Dress up by your spinal disc wall with IDET

Intradiscal electrothermal therapy or IDET is a comparatively new procedure devised to manage chronic lower back pain. It is slightly invasive surgery that makes use of heat delivered through the electrical device straight to the problem areas of your spine. Sometimes scar tissue formation and excessively grown nerve fibers from injury or chronic illness can cause debilitating disc pain. The fibers and nerve network get pinched by the disc causing severe pain

IDET works heating the outer most covering of the damaged disc. The heat helps reduce the fibers within the disc and impairs the pain receptors. Patients have reported significant pain relief in as quickly as three days and it can last up to six months

What is actually Intradiscal Electrothermal Therapy?

The slightly invasive procedure takes an hour and done on an outpatient basis. The procedure helps eliminate and manage lumbar back pain occur from a disease, injury or mild herniated disc. At the Pain Management Institute our Board Certified Anesthesiologist Dr Zaki Anwar. MD performs the procedure on an outpatient basis. During the procedure you can remain awake as he often uses local anesthesia and light sedation to minimize any discomfort. Discuss with your physician prior to the procedure about risk recovery and expectations. The detailed procedure is discussed in this blog, keep reading

Administering the needle

At The Pain Management Institute, we take advantage of the most modern technology to diagnose the precise point of the damaged disc in your spine. Once Dr. Zaki Anwar verifies the aimed point, he uses fluoroscopy X-ray imaging to administer a hollow needle straight to the disc

Inserting the heating wire

He then introduces the heating wire, that is an electrothermal catheter, with the needle steering it to precisely reach the damaged portion of the disc. You might not feel any pain at this point in the procedure

Dressing the disc wall

When the electrothermal catheter reached its aimed location, the power is turned on and the temperature of the wire is slowly increased to 90 degree Celcius. Dr. Zaki Anwar carefully monitors the process warming the damaged disc wall for about 15 to 20 minutes

Repairing the disc wall

The heat gradually shrinks and repairs the damage and torn disc wall area, it also slightly burns the nerve endings to make them less sensitive to pain. If you experience any pain during the procedure, it’s because of the heat applied to the disc

Recovery

Dr. Zaki Anwar, MD removes the electrothermal catheter and needle within 15 to 20 minutes. The injection point is covered with a small bandage and you can return home the same day

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2018-04-16

A twenty five year old talked about her painful journey to Intercostal Nerve Blocks

For the past few months I felt like someone has been piercing in my lower right rib. Or sometimes it felt like someone has just hit me in the ribs with a baseball bat. The pain often varies during the day in intensity. The recent diagnosis showed up nerve pain from post procedure scar tissue formation from my gall bladder surgery. During my surgery a few years ago I wasn’t even aware of the scar tissue formation as a possible side effect. During the whole day the pain makes me feel like being stabbed in the ribs with an imaginary knife

Last week I had a very slightly invasive procedure called an Intercostal Nerve Block performed by Dr Zaki Anwar, Founder of the Pain Management Institute Anesthesiologist and Pain Management Specialist, which is what I can say was the only hope for me. And to my expectation the pain relieved I had my mother and brother accompanied me an hour drive to The Pain Management Institute, Chicago, Frankfort as, at first the procedure seems like a bit frightening

Dr Zaki Anwar, MD told me in advance that I may be put to sleep, but when I reached there on the day of the procedure he only discussed my medical history and gave me some relaxants and local anesthetics

The procedure was split into a few steps

The very first I was given an IV sedation that helped me relax without putting me to sleep, I was directed to lay on my stomach on the examination table wearing a hospital gown. The my back and rib area was marked and I was told, I was about to be injected with local anesthesia. At first the injected anesthesia burned really bad, all in all the local anesthetics were three. And after a burning sensation I felt like my ribs and back has been numbed.

The most important part of the whole procedure was the intercostal nerve blocks, I was lying still stomach down as if I had moved there might be chances of needle damage my lungs, and Dr. Zaki Anwar, MD uses the X-ray guidance for the intercostal nerve blocks. When Dr. Zaki administered the injection I felt pressure as I was told before. During the whole procedure of performing Intercostal Nerve Blocks Dr. Zaki Anwar kept asking me if it hurts and I answered that I only felt pressure

After the intercostal nerve blocks I was under observation for half an hour, meanwhile the sedation wear off. Dr Zaki Anwar already told me for a couple of days the pain may increase, but soon after I will feel better

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2018-04-07 (1)

Kyphoplasty help patients regain lost mobility and become more active

Kyphoplasty is the procedure used to treat painful vertebral fractures caused by excessive pressure in the spinal column, which commonly results in osteoporosis. The kypholplasty is done by a physician using imaging guidance to inject a cement mixture in the fracture bone. With the help of Kyphoplasty the patients regain lost mobility and become more active

At the Pain Management Institute, the Kyphoplasty procedure is done by Dr Zaki Anwar, Anesthesiologist,  Founder of the Pain Management Institute. He will first diagnose your condition with  the help of imaging or physical exam. He will instruct you how to prepare and discuss with your physician if there is any possibility of you being pregnant or any prior medical records and breakout. He might advise you to stop taking any blood thinning medications or pain killers are restricting you from eating or drinking anything a few hours before the procedure take regular medications with a sip of water, don’t wear any jewelry or metallic objects, wear light loose clothes take someone to drive you home

What is Kyphoplasty?

When the vertebral disc is fractured the bone becomes compressed causing severe pain. These compression fractures leads to collapse the disc space between one or two vertebrae and result in osteoporosis in the long term. Osteoporosis is a disease that causes the normal bone to decay and becomes vulnerable to breaking easily

During the Kyphoplasty an air balloon is first inserted to create a space in the fracture and then the cement is injected into the space following the removal of the balloon. Generally Kyphoplasty is recommended after other conventional treatments have failed such as plenty of bed rest, wearing a brace, physical workout and pain killers. Kyphoplasty can be performed instantly in patients with unbearable pain who require hospitalization or other conventional treatments have failed

Kyphoplasty is also performed on patients who:

  • Are elderly or frail and will likely have impaired bone healing after a fracture
  • Have a vertebral compression due to a malignant tumor
  • Suffer from osteoporosis due to long-term steroid treatment or a metabolic disorder

Kyphoplasty should be completed within eight weeks of the acute fracture for the highest chances of successful treatment.

Risks

Any procedure where the skin is injected involves a risk of infection, however this only happens in 1 of 1000 patients. A very negligible amount of cement can leak from the vertebral bone, potentially it doesn’t cause any problem, but if the leakage spreads to the spinal canal, blood vessels and lungs resulting in perilous consequences

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2018-04-03

The Microdiscectomy procedure reduces the stress on the spinal nerves

Commonly performed for a Herniated disc, the microdiscectomy procedure reduces the stress on the spinal nerve network by removing the substance that is the root cause of pain

The Microdiscectomy procedure as elaborated by Dr.Zaki Anwar, MD:

A microdiscectomy procedure uses minimally invasive techniques to provide relief from pain caused by a lower herniated disc.

During the course of procedure, a tiny part of the bone over the nerve root or the disc substance from beneath  the nerve root is removed out. A microdiscectomy is also known as the micro decompression as compared to other conventional treatments  is potentially efficient  for reducing leg pain that is sciatica or radiculopathy

Outcomes

  • For leg pain, patients report relief in leg pain immediately after the microdiscectomy. They leave for home with potential pain relief
  • For deadness, feebleness, and other nuerological symptoms in the leg and foot. It may take several weeks and months for the nerve root to completely heal and any numbness and weakness may subside

Usually, microdiscectomy is known as quite reliable surgery for quick relief or almost quick relief of sciatica pain from lower herniated disc

Slightly Invasive Microdiscectomy

There are generally two common options in an outpatient lower spinal Discectomy

  • Microdiscectomy
  • Endoscopic Discectomy

A Microdiscectomy is often treated as the most remarkable and pocket friendly procedure for removing the herniated part of the spinal disc that puts pressure on the nerve. Compared to other open surgical procedures the Microdiscectomy involves a slightly small incision and insignificant tissue damage and disturbance. A handful of surgeons has now achieved the adequate experience and skills with endoscopic and slightly invasive techniques which include performing surgery through tubes administered into the targeted area, instead of an open incision. A Microdiscectomy is generally performed by an orthopedic surgeon and pain management specialist

Implications for Microdiscectomy

If an individual’s leg pain is due to disc herniation, it will alleviate within 6 to twelve weeks of the pain arising. As long as the pain is bearable and the patient does not lose mobility , it is highly advisable to delay surgery for a short period of time to determine if the pain will resolve with nonsurgical treatment alone. If the pain is debilitating and severe, it is practical to consider surgery sooner

There are potential reasons why microdiscectomy is beneficial :

  • Leg pain has been experienced for at least six weeks
  • An MRI scan or other test shows a herniated disc
  • Leg pain (sciatica) is the patient’s main symptom, rather than simply lower back pain
  • Non surgical treatments such as oral steroids, NSAIDs, and physical therapy have not brought sufficient pain relief
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2018-03-29 (1)

The best features of the P-Stim makes it stand among the pain sufferers

P Stim is a tiny battery operated device created to serve auricular point stimulation treatment for several days. P-Stim is placed behind the patient’s ear and connected to stimulation needles on the auricles. The benefit of using the ear for such treatment is that it grants several points of stimulation within such as small area. The P- Stim device transfers low intensity electric pulses to bare nerve endings, which stimulate the release of endorphins a natural pain killer. The installed microchips create intervals of stimulation and rest. Each stimulation last on an average of 3 hours

Use, indications and treatment

Point stimulation with the help of P-Stim is primarily used to treat pain. Application of the device is recommended for pre-operative, intra- operative and post operative pain management as well as a remedy for the chronic pain. P-Stim is non- drug treatment for pain and wound healing. Simultaneously, there are also prospects of using this device in the future for the treatment of addiction and severe allergies in the spheres of anesthesiology. P-Stim is also helpful in treating gangrene and the severe pain arising from it

Current clinical studies show that P-Stim is highly effective in treating

  • Fibromyalgia
  • Diabetes
  • Blood pressure
  • Anxiety and Depression
  • Insomnia
  • Allergies
  • Increased cholesterol in the blood
  • Slimming
  • Crohn’s disease

Patients’ quality of life

P-Stim helps facilitate continuous point stimulation over a span of several days and provides the patient with high potency comfort and mobility. An advantage of P-Stim over drug therapy is that the patients, don’t suffer any of the potential side effects of pain killers such as harmful reactions. Conversely the patients can continue to lead his life as usual, without the losing quality of life

How will your pain patients benefit from The P-STIM™?

Some of the best features of the P-Stim makes it stand among the pain sufferers. The P-Stim is non invasive and can be applied within the minimum time frame and is pocket friendly. The device is removable and disposable by the patient after four days. It’s light weight that is equal to 7 grams, granting patients to enjoy their routinely activities without hindrance or pain. The patients no longer suffer any potential after the affect as associated with the pain killers such as damaging reactions. In many cases, the patient reported an enhancement in overall clarity and quality of life. The P-Stim is often well, bearable and can be blended with other kinds of remedies. After the initial treatment, most patients report a remarkable reduction in pain symptoms

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