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Intercostal nerve block and your rib pain


An intercostal nerve block is a medical procedure followed  by injections given with a small amount of local anesthetic in the intercostal  nerves to relieve severe pain arising from rib fractures, nerve damage, injuries to the chest wall, postoperative pain along the rib nerves, and shingles

The intercostal nerves are placed under each rib, the pain arises when one of these nerves gets inflamed or irritated. The steroid medications and local anesthetic intercostal nerve blocks  can help reduce pain and inflammation

The procedure

The procedure is done with  the patient lying face down with the arms stretched upwards, if convenient. The blood pressure and the oxygen level are constantly observed, the physician will ask questions to make sure if the patient is not feeling any discomfort during the whole procedure. The area to be treated around the ribs is cleaned with an antiseptic solution, a  very small, thin and lightly blunt needle is attentively placed under the rib and a different colored substance is injected to the intercostal nerves, the injections are guided by X-ray

The intercostal nerve block injections are a blend, of local anesthetic and steroids, the injections only take a  few minutes, however, the whole procedure takes about an hour to complete. The intercostal nerve blocks feels like a little pinching and stinging effect soon after the skin in numbed the feeling fades, the injection needle exerts a little pressure at the site of injection

What to expect after the intercostal nerve block injections?

Soon after the intercostal nerve block the patient will experience a potential reduction in pain, the patient will be kept in observation for a short period. The physician might advise to take rest for a few days, however, the patient can carry with light activities. The intercostal nerve block will provide relief for the period of effectiveness of the local anesthetic

Risks and side effects

The intercostals nerve block exhibit a minimal amount of risks, however, any procedure that involves injection brings some complications that  may include pain at the site of injections, a puncture in the sack containing CSF because of mishandling that may result in headaches, infection, excessive bleeding, nerve rupture or sometimes no reduction in pain. In very rare cases there might be a complication of collapsed lungs. If you experience difficulty in breathing soon after the procedure of the intercostal nerve block, call your doctor immediately

If you or your loved ones are suffering from rib pain, and looking for potentially safe and affordable treatment, know the benefits of intercostal nerve block by a professional advice from Dr. Zaki Anwar, by placing an appointment at 815-464-7212. He is a world renowned Pain Medicine Physician who has been practicing regenerative injection therapies for the past several years with remarkable results.



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What you need to know about the benefits and risks of Intrathecal pump therapy?


The Intrathecal pump therapy is the process of providing medications directly into the spinal cord. The therapy is followed by the use of a small device attached to a thin tube called catheter. The device is surgically implanted under the skin the basic purpose of the pump is to relive pain and  reduce side effects from oral medications


There are several advantages of Intrathecal pump therapy that may include

Immediate and long term pain relief, Increased mobility of the spinal cord, participation in routinely activities and physical workouts,  Less intake of oral medications, resulting in lower side effects and reducing dependency on oral medications. The Intrathecal pump therapy is potentially safe and highly effective. The Intrathecal pump therapy does not include any permanent changes in the spinal cord or the nerve network.  The therapy is reversible and easily testable and can be adjusted according to your needs

Risks of the Intrathecal pump therapy

Since the Intrathecal pump therapy is surgically implanted under the skin, there might be complications  that may include; infection, cerebro spinal fluid leakage and headaches. In case of any active infections or allergic reactions it is strictly advised to avoid the Intrathecal pump therapy

The implantation of the drug pump can create several complications that sometimes require surgery to settle, the complications can also be caused by inadequate dosage of the drug an can bring life threatening consequences

The most observed complications include;

The displacement of the drug pump, the leakage from the catheter, tearing or loosen contact of the catheter with the device. The device stops working or in some cases growth of inflamed tissues at the end of the catheter that may result in paralysis

Intrathecal Pump therapy and other chronic pain treatments

Intrathecal pump therapy enjoys priority over other treatments offered for chronic pain due to its uncommon benefits

Prior to implanting the drug pump for permanent bases, a temporary testing period is considered to check if the pain is relieved. The therapy is not permanent such as back pain surgery and can be easily adjustable and reversed, if not needed by the patient, Intrathecal pump therapy dissimilar to oral medication release potentially small amounts of dosage  straight into the spinal cord, reducing pain abruptly. The Intrathecal pump therapy works wonders when all the other medications have failed

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Get rid of the spinal fracture pain by Kyphoplasty

The Kyphoplasty procedure is done to alleviate the pain arising due to spinal compression fractures, to support the bone and to bring back significant lost spinal body height due to compression fracture

Performing Kyphoplasty Surgery

The Kyphoplasty surgery is carried out by making a very minimal incision in the back by the means of which the physician places a slim tube under the guidance of fluoroscopy so that the tube can reach the fractured part of the spinal disc cutting through the skin into the bone

With the guidance of  an X-ray images the physician injects a specialized balloon with the help of a tube and delicately blow up the balloon. As the balloon enlarges, it raises the broken pieces of the fracture bone, restoring it to the correct position, also the balloon tightens the soft inner bone to produce a gap in the spine. The balloon  is taken out by the physician using a specialized tool exerting a small amount of stress and fill up the cavity with a cement resembling substance. The material hardens soon after supporting the bone. The procedure usually takes an hour to be completed for each disc. The procedure is less complicated and need patient to stay one day at the hospital. The Kyphoplasty is generally works best for the patients undergoing fractures  from osteoarthritis


For some patients the pain can be easily and instantly eliminated, however, some patients experience relief  within a day or two. Soon after the therapy the patients can return to their routinely activities, though heavy exercises and weight lifting should  be avoided for a period of two months.

Candidates for Kyphoplasty

Kyphoplasty does not give permanent relief from certain abnormalities of the spinal column, and certain  patients with osteoporosis are not recommended for Kyphoplasty

Risks and Complications of Kyphoplasty

As with the invasive procedure, there are some risks attached that may generally include reactions from anesthesia and infections. Other risks that are particularly associated with Kyphoplasty treatment may be;

  • Nerve damage or a spinal cord injury from wrongly inserted instruments placed in the back
  • Nerve injury or spinal cord compression from leaking of the cement into veins or epidural space
  • Allergic reaction to the solution used to see the balloon on the X-ray image as it inflates

Patients suffering from Osteoporosis are certainly at risks of more fractures with the procedure due to weakened bones from Osteopororsis.

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Recover your spine with Microdiscectomy spine surgery


Microdiscectomy spine surgery is commonly known as the slightly invasive therapy, as there is slight interruption with the tissues and the muscles in the lower back

The Microdiscectomy spine surgery is potentially beneficial for addressing legs pain, sciatica. The surgery allows the patients to cope up with their routinely activities soon after


For the Micodiscectomy spine surgery the patient lies face down on the examination table for surgery, local anesthetic is given the surgery takes a couple of hours

The basic steps of microdiscectomy spine surgery include;

An incision of 1or 1 and half inch in the center of the lower spine, then the muscles covering the bone, of lower spine are pulled and retained at a side, since the muscles run vertically so they are not required to be cut off during the surgery, the physician is able to reach the spine by removing thin layer off the spinal cord and with the help of operating microscope nerves can be clearly seen, the nerve root is delicately retained and so the small pieces of  disc material that has, ejected out is removed. The muscles and the nerve roots are put back to the place and the surgical incision is closed and allowed to heal

Post surgical care

Patients are commonly advised to remain at the physicians clinic for a couple of hours, the physician might observe your vital signs before you leave the clinic Soon after the surgery  the sufferer can return to their daily activities, patients are usually advised to go for a walk after a few hours of  Microdiscectomy spine surgery

The other postoperative care instructions might include, instructions for home based care, pain medications and antibiotics to avoid any infections and a follow up check up

Microdiscectomy spine surgery, risks and complications

As in other sorts of spine surgery, there are some potential risks attached to the Microdiscectomy spine surgery

In very rare cases of Microdiscectomy spine surgery a dural tear may occur,  causing Cerebrospinal fluid leakage. However, the CSF leakage might not bring any harm to the effects of the surgery, but the candidate must take several careful steps to allow the leak to seal

Other risks and complications include the following:

  • Nerve root damage
  • Bowel/bladder incontinence
  • Bleeding
  • Infection
  • Possible buildup of fluid in the lungs that may lead to pneumonia
  • Deep vein thrombosis, which occurs when blood clots form in the leg
  • Pain that persists after the surgery
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The best therapy for chronic back pain and sciatic pain; Racz Epidural Nuerolysis

Racz Epidural Neurolysis is a minimally invasive procedure followed by a course of injections into the vertebral column, as the remedy for chronic back pain and sciatic pain, the injection is repeated twice a day for optimum results

Back pain is complicated and can be the reason of several underlying causes, studies have shown that the pain often arises due to the excessive growth of scar tissues that might the reactive process of an injury, disc herniation or preceding back surgery

Racz epidural Neurolysis prevents the necessity of surgery in many sufferers experiencing chronic back pain and sciatica pain

The therapy has the ability to grant instant and noticeable ease from long term pain and irritation in the lumbar spine, without any invasive procedure

Conditions leading to Epidural Neurolysis therapy

  • Disc herniation
  • Spinal disc bump
  • Radiculopathy
  • Scar tissue formations

All the above condition leads to common consequences that is nerve pinching or nerve root irritation causing non tolerable pain

Is the Racz Epidural Infusion treatment right for you?

The therapy is advised if the pain lasts longer than 3 months, you should be a patient for  Racz epidural therapy if you have tried all the traditional treatments and experience no reduction in your  pain

The step by step procedure of Racz epidural  Nuerolysis

The procedure is carried out by giving a local anesthesia is given at the base of the spine, the patient is allowed to lie face down the procedure is performed as an inpatient approach the numbing medicine injected is to ensure that the patient does not feel any discomfort during the entire therapy ,using a blunt edged surgical instrument is used to infuse a catheter in to the epidural space around the spinal cord, the catheter contains a combination of numbing and anti inflammatory medications that grants immediate relief from pain and inflammation, reduces spinal bumps and ease nerve pressure, that leads to sciatica, the medications injected are responsible to dilute the scar tissues and adhesion deposited around the spinal cord, the physician observes the whole procedure by fluoroscopy to maintain precision. It takes 30 to 60 minutes for the Racz Epidural Procedure to be carried out.

In a few cases the treatment is necessary to repeat within a few months if the scar tissues need to be dissolved

Post procedure care

  • Weight and diet control
  • Limited weight lifting
  • Physical therapy and light workout
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Radiofrequency Lesioning and your pain symptoms


Radio frequency is a surgical process in which special needles are used to produce lesions along the certain nerves, the needles are subjected to, give a high temperature up to 80 degrees Celsius, when the heat is given to the nerves from  2 to 3 minutes the nerves become resistant of delivering pain signals, once the nerves are damaged the body works to regenerate the nerves but the process takes a whole year

Who are the candidates for Radio frequency Lesioning?

Radio frequency lesioning procedure, is recommended for the patients who experience a specific type of lower back or neck pain, mainly it treats the pain arising from the facet joints, before the radio frequency lesioning some nerve block injections is given fro diagnostic and therapeutic purpose temporarily, it’s the candidate responds well to the diagnostic local anesthetic, then it may work wonders

Benefits of radio frequency lesioning

The procedure is beneficial breaking the channel for carrying pain signals, which in turn reduce  pain and other symptoms related, the procedure is observed to be beneficial for most patients, it also indicates other painful areas once a certain nerve is blocked

How long does the procedure take?

The procedure can take about 30 minutes to an hour, but it can vary depending upon the area to be treated

The procedure is performed as:

As we know the X-ray cannot display the nerves, but the X-ray guidance is taken to identify the bony landmarks that expose, where the nerves are situated, after the needle infusion, severely low temperature is applied to the needles to examine whether the needles have reached the suitable nerves, after the verification of the needle tip has reached the desired point a local anesthetic is given to numb the nerves, soon after the nerves are appropriately numbed, higher radio frequency heat is applied to the nerves

Is the procedure painful?

The procedure starts by inserting a local anesthetic with a very small needle, which feels like a small pinch and slight burning effect as the anesthesia starts working, the procedure needle seems like exerting a little pressure on the injection site


Broadly, the procedure is safe, however, there are some certain risks, complications and side effects  attached to the procedures in which injections are involved, these risks also depended upon the areas to be treated. The needles pass through the skin and soft tissues that can cause soreness and tissue damage. The radio frequency lesion can also bring the risks of damage of the surrounding nerves

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Spinal cord stimulation for back pain relief


Candidates who have tried all the other traditional treatments and surgery and still experience back pain can have an option to once think of the spinal cord stimulation

Spinal cord stimulation proclaims minimal electrical stimulation to nerves along the vertebral column, altering or blocking the nerve activity in a distinguished manner  to reduce and sometimes eliminate the feeling of pain reaching the brain

The treatment was first used to treat severe back pain in 1967. Later it became medically approved by the FDA. The spinal cord stimulation is used to treat pain in the trunk, arm or legs

Spinal cord stimulation process is also called neuro stimulation, that is managed by gentle electrical vibrations to that interrupt with pain messages and divert them from reaching the brain, a small device is inserted near the vertebral column, the device has the similar function as the cardiac pacemaker, which can be called by some people as the pacemaker device for pain

The chronic pain conditions that respond well to spinal cord stimulation

The spinal cord stimulation is used to treat a number of painful conditions that include;

  • Failed back surgery syndrome
  • Cervical and lumbar radiculitis
  • Neuropathy
  • Complex regional pain syndrome
  • Other painful conditions that respond well to spinal cord stimulation process area;
  • Inflammation and scarring of the outer layers of the spinal nerves
  • Back pain that continues to the legs
  • Neck pain with or without arm pain
  • Complex regional pain syndrome
  • Angina pains

Trial Period

Distinctive of other treatment that requires surgery, spinal cord stimulation can be done as a trial for a few days before a candidate decides for implantation of the device and experience any negative effects, the experimental period is a part of two step verification process  to identify if the candidate is suitable for therapy, if the patient does not decide to continue with the treatment the device is taken out with the help of small incision which is covered with a bandage

The imaging test is necessary to be done because the spinal cord stimulation does not work for every individual, the people who are suitable candidates for the treatment experience almost half reduction in pain, and improved routinely task

Specialists who can perform spinal cord stimulation

The specialist who can well perform  spinal cord stimulation process can be

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Selective nerve root block for diagnosis and back pain management


A selective nerve root block is a slightest invasive procedure that is done for the diagnosis and treatment of cervical pain, thoracic and the lumbar pain and other pain associated with the spine

The procedure involves injecting a local anesthesia directly into a certain targeted nerve of the vertebral column to help indicate the source of patient’s pain causes

When a spinal nerve root become inflamed or pinched it can cause back pain, additionally the, symptom might be felt in the upper or the lower area of the spinal cord

For instance;

  • Cervical spine nerve inflammation may bring pain, numbness and weakness in the neck shoulder and arms
  • Where as the thoracic nerve pinching can cause inflammation in the upper back and the lower back along with the chest wall and the ribs
  • The lumbar nerve root can cause pain and weakness in the lower back, hips, buttock and the legs
  • In some cases the source of patient’s pain cannot be identified even the physical examination and imaging may not be as helpful to identify which nerve is causing pain

The purpose of selective nerve root block is to disengage the nerve root that is the cause of discomfort to the patient, moreover the selective nerve root serves as the remedy to comfort various painful conditions

The Selective nerve root block is carried by injecting a local anesthetic along with steroids in the targeted nerve root. The local anesthetic numbs the nerve and the steroid helps to reduce swelling and discomfort, the medications are specifically directed at the nerve root.

The results of selective nerve root block may vary case to case as some nerve roots are very complex to treat due to their location and surrounding conditions

Conditions that are treated with selective nerve root blocks

The conditions that are commonly well treated with selective nerve root blocks include

  • Cervical pain
  • Lumbar nerve root pain
  • Failed back surgery syndrome
  • Shrinking of the spinal canal
  • Bulging intervertebral disc
  • Herniated disc
  • Arthritis


A selective nerve root block is less invasive therapy that can potentially diagnose and treat many symptoms that result from spinal nerve root inflammation. These procedures are considered safe and beneficial therapy for several chronic pain conditions

The desired results can be observed within days to months, the selective nerve root therapy can be repeated if required

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Symptoms, causes and treatment of musculoskeletal pain

The pain that affects the muscles, ligaments, tendons and bones is referred as musculoskeletal pain.

Causes of musculoskeletal pain

There are several different causes of musculoskeletal pain, muscles and tissues can be damaged with the daily activities. Jerking movements, sudden falls, fractures, spasms, dislocations and direct hit to the muscles can cause musculoskeletal pain. Other causes may include posture strain, repetitive movements, excessive use and continued confinement, poor posture and poor workplace setting may bring vertebral alignment problems and muscle contraction, therefore causing pressure on other muscles and affecting their function causing severe pain, since pain is the most common indication of most musculoskeletal disorders. The pain varies from mild to severe and from acute to chronic and if stays for a long time can diffuse to other organs

Musculoskeletal disorder often causes pain by pinching nerves, these conditions may include carpal tunnel syndrome, the pain causes a burning sensation and diffuse along the nerve path, accompanied by tingling, weakness and numbness

In some cases the muscle pain is often a consequence of dysfunction of other organ systems

What Are the Symptoms of Musculoskeletal Pain?

The symptoms of musculoskeletal pain are accompanied with pain in the whole body as muscles are excessively used or pulled, sometimes the muscles seems to shiver or become inflamed, the symptoms may vary from person to person but the common symptoms are;

  • Pain
  • Fatigues
  • Sleep disorders

How the pain is diagnosed?

Your physician will conduct a thorough physical examination and medical history, additionally the doctor will  conduct a diagnostic study to confirm the diagnosis


  • Blood tests
  • X-rays
  • Magnetic resonance imaging (MRI),
  • CT scans
  • Joint fluid testing


How Is Musculoskeletal Pain Treated?

Several manual therapies and mobilization techniques have been used to treat people with spinal arrangement problems, for the acute musculoskeletal pain these manual techniques have been very effective and showed rapid results

Medications such as NSAID may be used to treat inflammation, sensation and pain

Other treatments may include:

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Botox treatment in a nut shell

Botox treatment has been proved an astonishing mediation for naturally occurring aging signs somehow the early aging signs also occur due to excessive expressions such as forehead frown, smile lines gleaming from the corners of your eye. These wrinkles and lines can be controlled and treated with the help of micro doses of Botox treatment your face can get it youthfulness back. Treating with the expert physician Botox treatment can work wonders

There is a misconception regarding the Botox treatment as it becomes alarming to the individuals, that Botox paralysis the face muscles as it contain Neurotoxin since the last 3 decades Botox treatment have been proven as the best anti aging medicine, working in good faith

How the Botox is done?

Botox treatment is very simple, it will be started by a physical examination of your face by asking you to give some expressions such as frown, looking up, smile, curl your nose, make a sad face, whistle, grind your teeth, and other expressions. After a thorough examination of your facial expressions the physician will acknowledge you about the vital areas that contribute to aging faster. After the examination the physician will draw a personalized treatment plan

Once the treatment plan is outlined skin is cleaned and local anesthesia is applied on the area to be treated. A very thin needle likely to be an insulin needle is injected to deliver the correct amount of dosage in the contracted muscles. The process takes 20 to 40 minutes to be completed

Is the Botox treatment painful?

After the application of anesthesia, most individuals can tolerate with the needle pricks well. Botox medications when injected into the affected area can cause a slight burning sensation and pressure, most candidates interpret as uncomfortable and not painful. For sensitive patients numbing cream with local anesthesia to minimize pain

What are the common side effects?

Side effects with Botox treatment are minor if taken under the guidance of an expert physician. After the procedure the injected might look light scars, which can be cured within 20 to 30 minutes. Other side effects may include risks of bruising, which will last 4 to 5 days. To minimize the chances of bruising it is recommended to avoid blood thinners, vitamin E, green tea, fish oil supplements etc.

If injected in the wrong area Botox can cause the lid to fall off or droopy eyes, moreover injecting in the wrong muscles can cause facial disfigurement

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