Welcome to Pain Management Institute

To make an appointment for any of our locations, please call
  (815) 464-7212

All Posts in Category: Blog


What Is Selective Nerve Root Block And What Are The Risks And Complications?

Selective nerve root block is another standard injection is fundamentally utilized to analyze the particular source of nerve root pain and, secondarily, for therapeutic help of low back pain and additionally leg pain.

At the point when a nerve root ends up compressed and inflamed, as a result, it can create back or leg pain. At times, an imaging study may not obviously demonstrate which nerve is triggering the pain and selective nerve root block is performed with an objective to help with disconnecting the cause of pain. Additional to its analytic function, this sort of injection for pain management can likewise be utilized as a treatment for a far lateral disc herniation.

The Experience during Selective Nerve Root Block 

The procedure is carried out by a specialist with the patient requiring lying on the stomach on an X-Ray table. The doctor utilizes fluoroscopy with an objective to find the particular nerve root. Moving forward with the procedure, the doctor inserts a needle into the area, then the medication and an anesthetic are inserted. This step requires only a couple of minutes.

After the injection, the patient is observed for around 15-20 minutes and after that discharged. Most individuals begin observing relief after the third to seventh day, which can endure weeks or months. On the off chance that the initial injection does not produce fruitful results within one to two weeks, the specialist may prescribe another injection. In most cases, specialists limit in injections to three in a year time.

Selective Nerve Root Block Outcomes

Instantly after the injection, the patient may feel legs or arms, along with that particular nerve root, getting slightly heavy or numb. The patient may observe that the pain might be gone or significantly less. This is because of the impact of the local anesthetic and keeps going just for a couple of hours. The pain may return and the patient may have some soreness at the injection site for a day or so.

The patients are usually advised to relax for a day or so after the selective nerve root block. Execute the activities as endured by them. The recuperation room nurse will recommend applying ice to the site.

Risks and Complications after Selective Nerve Root Block 

Comparatively, the selective nerve root block does not have many risks. Though, similarly as with any procedure, there are a few risks and complications. Most observed adverse effects are enhanced pain from the injection (normally short term), hardly ever inadvertent puncture of the “sack” containing spinal fluid (may result in headaches). Further complications include:

  • Infection
  • Bleeding
  • Nerve damage
  • Or no easiness from usual pain
Read More

What Is Sympathetic Nerve Block And For What Reason Is It Useful?

In the case of sympathetic nerve block, numbing medicine is injected nearby the sympathetic nerves in the area of low back or neck. The purpose of the sympathetic nerve block procedure is to turn off that area for the time being with an objective to diminish or eliminate the pain. On the off chance that pain is considerably improved after the procedure, at that point, a diagnosis of sympathetically mediated pain is built up.

The therapeutic impacts of the anesthetic can take place, it sometimes can be time-consuming than would be typically anticipated. The objective is to reset the sympathetic tone to an average condition. On the off chance that the initial block is effective, at that point more sympathetic nerve block might be repeated if the pain keeps on to successively lessen.

When Can A Sympathetic Nerve Block Be Utilized?

A sympathetic nerve block can be utilized to analyze or treat pain linking the nerves of the sympathetic system. Instances of circumstances for which a sympathetic nerve block may be utilized include:

  • Pain Taking Place from Spasms in the Blood Vessels
  • Complex Regional Pain Syndrome, Formerly Named Reflex Sympathetic Dystrophy and Causalgia
  • Raynaud’s Disorder
  • Some Kinds of Chronic Stomach Pain
  • Unnecessary Sweating

What Will Happen During The Procedure?

As a security measure, an IV will begin, thus relaxation medicine can be given if necessary. When lying on an X-Ray table, the skin over the region to be injected will be thoroughly cleaned. Moving forward with the procedure, the doctor will numb a little region of skin with numbing medicine (anesthetic) which stings for a couple of seconds.

The doctor will utilize X-Ray direction in order to guide a needle to the sympathetic plexus of nerves. After that, the doctor will insert a contrast dye to make sure that the medicine only goes over the targeted area. When this happens, numbing medicine (anesthetic) will be gradually inserted.

What Happens After The Sympathetic Nerve Block Procedure?

This is comparatively a protected procedure. Patients are usually allowed to go home after the procedure and return to normal doings after a day of rest. On the off chance that the patient had IV sedation, they’ll most likely need somebody drive them home.

The treatment could include physical therapy, talk therapy, and pain medication. In some circumstances, patients will be given a series of bocks to get the most ideal response.

However, this is to take in the notice that the sympathetic nerve block doesn’t turn out to be effective for everybody. Additionally, the help with discomfort they give may decrease after some time. In some cases, a sympathetic nerve block may give weeks or months of ease of pain.

Read More

Anatomy of Cervical Dystonia, Cervical Dystonia Causes and Treatment

Spasmodic torticollis is another name of cervical dystonia. It is an uncommon neurological disorder that takes place in the brain. It is the most widely recognized type of focal dystonia in an office setting. Cervical dystonia can be categorized by uncontrolled muscle contractions in the neck that result in irregular movements and postures of the neck and head. However, in the case of some individuals these strange contractions might be sustained or consistent, in some cases, they might be available as spasms that can look like a tremor.

On the other hand, in the case of cervical dystonia, the seriousness can differ, yet the disorder can result in critical pain and discomfort along with trouble because of the irregular postures. As a result, it can disturb the quality of life and doings of day by day living including employment. Cervical dystonia ordinarily starts in middle age and hardly starts in adolescence. Though, the reason is obscure, in spite of the fact that genetic vulnerability is thought to underlie a few cases. On the off chance that cervical dystonia starts in early stages or early childhood, secondary causes ought to be examined.

Causes of Cervical Dystonia

In most cases, there is no particular cause. It appears to be associated with an issue in the basal ganglia. That is the part of the brain that is in charge of starting muscle contractions. The issue includes the manner in which the nerve cells communicate.

The basal ganglia become the cause of acquired dystonia. The damage could be the consequence of:

  • Brain trauma
  • Stroke
  • Tumor
  • Oxygen deprivation
  • Infection
  • Drug responses
  • Poisoning due to lead or carbon monoxide

Idiopathic or primary dystonia is frequently transferred from a parent. A few carriers of the condition may never build up dystonia themselves. Moreover, the indications may differ broadly amongst individuals from a similar family.

Cervical Dystonia Treatment

The most common Cervical Dystonia treatments are listed below:

  • Physical procedures
  • Injections of botulinum toxin
  • At times drugs taken by mouth

Some physical procedures can at times briefly ease spasms. Physical therapy may work in a way to help by enhancing adaptability. Therapists may likewise enable individuals to distinguish which movements work in a way to worsen spasms and which ones work in a way to ease them. Biofeedback (utilizing relaxation procedures in order to control unconscious body processes, for example, heart rate and muscle tension) or massage may work in a way to help a few people.

Read More

The framework of Spinal Disc and How the Spinal Disc Herniation Occurs?

In the case of spinal disc herniation, the indications, for the most part, incorporate pain that moves into one or both arms or legs, numbness or tingling in parts of extremities, muscle weakness, and loss of the reflexes in extremities.

This transpires due to increased pressure and irritation of the nerves. Numerous individuals may not suffer from neck or back pain in the case of a herniated disc. The symptoms of spinal disc herniation rely upon where the herniation took place. The area of the symptoms helps determine the analysis as nerves generally travel in specific patterns.

The framework of Spinal Disc

The spine consists of 24 bones, named vertebrae that are set over each other. The way these bones link, as a result, make a canal that secures the spinal cord. A total of five vertebrae frame the lower back and this part is known as the lumbar spine.

The Spine Also Includes Other Parts:

This includes spinal cord and nerves that are categorized as the “electrical cables”. They move through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal string through openings in the vertebrae.

Further parts include intervertebral discs. In the middle of vertebrae, these are flexible discs. These are flat and round in shape, and about a half inch thick. These discs have a purpose to absorb shocks at the time when you walk or run. They are based on two segments:

Annulus Fibrosus

This is a sturdy, flexible external ring of the disc.

Nucleus Pulposus

This component is the soft, jelly-like center of the disc.

How the Spinal Disc Herniation Occurs?

A disc starts to herniate in the event that its jelly-like nucleus drives against its external ring because of wear and tear or unexpected damage. The lower back pain can take place due to this pressure against the external ring.

In the event that the pressure lasts, as a result, the jelly-like core may extend out through disc’s external ring or cause the ring to swell. Consequently, this causes pressure on the spinal cord and neighboring nerve roots. Likewise, the disc material discharges chemical annoyances that add to nerve inflammation. At the point when a nerve root is disturbed, there might be pain, numbness, and faintness in either of the legs, a condition termed as “sciatica.”

Causes of Spinal Disc Herniation

A herniated disc is frequently the consequence of natural, age-related wear and tear on the spine. This procedure is known as disc degeneration. In the case of children and young adults, discs contain high water content. As individuals age, the water content in the discs diminishes and the discs turn out to be less flexible.

Furthermore, these discs start to shrink and the spaces in the middle of the vertebrae get smaller. This usual aging process creates the discs increasingly inclined to herniation. On the other hand, a distressing mishap, for example, a fall, can likewise cause a herniated disc.

Read More

Explore Non-Surgical Hip Pain Treatment Relief Alternatives

As per the fact, hip pain can turn out to be restricting mobility and functioning of everyday routine. Regardless of the fact that the pain is related to sports injury, a fracture, or osteoarthritis, however, hip pain treatment relief will be a top priority. One of the options to deal with hip pain is the physical therapy, yet there are other non-surgical treatment alternatives available that can work in a way to help limit the uneasiness and increment range of movement to make it stress-free and increasingly lovely to move. Pain Management Institute possesses significant expertise in helping patients regain their dynamic ways of life through non-surgical treatments.

Hip Pain Treatment Alternatives

Hip injuries include the loss of essential cartilage in the joint, which work in a way to cushion the moving pieces of the hip. Without sufficient cartilage, individuals suffer from pain and stiffness with each movement and when carrying weight. These disorders generally turned out to be more terrible after some time as the cartilage wears out more.

Over-the-counter medications, for example, acetaminophen and ibuprofen is a common treatment in order to deal with hip pain, and these medicines can likewise help decrease some amount of inflammation. Steroid hip injections can likewise be suggested by a doctor, which can work in a way to help decrease pain and inflammation while additionally adding lubrication to the joint. However, this treatment has a tendency to last for a short time, the symptoms will return inside a few days or weeks. Moreover, some individuals don’t feel any relief whatsoever after this procedure.

Furthermore, low impact exercises can likewise turn out to be helpful in the case of hip pain. Physical therapy normally includes a therapist overseeing and helping with rehabilitative stretches and exercises. Many individuals find it conceivable to engage in moderate stationary biking or swimming, which enables the hips to move smoothly with minimal effect.

Regenerative Medicine for Hip Pain Treatment

Most of the people opt for regenerative treatments when they require non-surgical treatments for hip pain. In this case, the viable options are:

  • Stem Cell Therapy
  • Platelet-Rich Plasma (PRP)

These two are innovative regenerative medicine alternatives that include utilizing a patient’s own tissues or blood for recuperating. The reason behind it is that stem cells have the ability to renew themselves and really turn into any other cell as per the requirements that are successful for fixing the damage and regenerating tissues in the body. On the other hand, platelets in the blood likewise contain growth factors. At the point when these platelets are injected in the hip, they can work in a way to help repair of the joints.

Explore Viable Regenerative Treatment Options with Pain Management Institute

Dr Zaki Anwar, MD is a reputable pain management specialist for acute and chronic pain. Whether you are suffering from hip injury or an illness, for example, arthritis, he offers regenerative non-surgical recuperating treatments that can ease pain and increase mobility. Just fill in the contact form to get an appointment with Dr Zaki Anwar.

Read More

What is Occupational Care? A brief guide for Employers, Employees and Self Employed

Occupational care is for the employee, entrepreneur as well as the self-employed individual. Self-employed is referred to a person who is not in the employ of any other person but rather maintains their own business.

The measures considered in occupational care, applicable to the necessities of the work environment, are together planned by the employer, a personal representative and the occupational health care service provider. They additionally screen and assess the viability and application of the occupational care service.

The objectives of occupational health care are as following:

  • A sound and safe workplace environment
  • A well-working work community
  • Avoiding work associated sicknesses
  • Keeping up and advancing employees’ work capacity and efficiency

The work-related safety authority specialist performs assessments to screen that businesses have structured and provided the legal occupational care services.

Responsibilities of Employers for Occupational Care 

In this manner, employers have a responsibility to arrange protective occupational health care coverage for their workers. Moreover, they have a choice to offer employees with access to medical care at the general consultant level.

In the event that your inability is lengthy, your employer must consult you and the occupational care service in order to evaluate your remaining work capacity and your capability to come back to work. An occupational health care specialist must issue a statement concerning the employee’s remaining work ability and potential to come back to work at the most recent when the employee has accumulated 90 illness allowance days over a time of two years.


Employees are eligible for a preventive word related health care services financed and arranged by the employer. The provision of medical care is intentional for employers.

In order to sort out what sort of occupational health care is accessible to you, you are required to consult your employer. Through the co-determination process, employees can have a say in the occupational care services accessible at their work environment.

In case it is obligatory, your health and work capacity will be assessed through measurements, performance tests or laboratory tests. The occupational care service will recommend you on the health possibilities regarding your work and how to advance your own health.

Self-Employed Persons

In the event that you are self-employed, you can opt:

  • Precautionary work-related health care services for yourself. You can opt to get it from a public health center, a private medical center, or self-employed health services specialists.
  • Health care services at the general practitioner level as a feature of word-related medical services.
Read More

Non-Surgical Treatment Options for Carpal Tunnel Syndrome

In the case of carpal tunnel syndrome, the common reasons of pain, numbness, and tingling in the hand and arm. The disorder happens when one of the main nerves to the hand (the middle nerve) is pressed or compressed as it goes through the wrist.

Carpal tunnel syndrome gets worse after some time in many individuals, so it is recommended to get early carpal tunnel syndrome diagnoses and carpal tunnel syndrome treatment. Initial symptoms can frequently be dealt with self-treatments such as wearing a wrist splint or avoiding specific actions.

On the off chance that pressure on the middle nerve proceeds, in any case, it can drive towards nerve damage and worsening indications. In order to avoid enduring damage, surgery may be recommended to take pressure off the middle nerve in some cases.

Non-Surgical Carpal Tunnel Syndrome Treatments

At the beginning of Carpal Tunnel Syndrome symptoms, it is strongly recommended to treat as early as possible.

To start with, take regular breaks in order to rest the hands. It is best to stay away from actions that work in a way to worsen the symptoms side by side applying cold packs to decrease swelling likewise may help.

Further treatment alternatives incorporate wrist splinting and medications. However, splinting and other traditional medications are more likely to help in the event that you’ve had mild to moderate symptoms for under 10 months.

On the off chance that the condition is identified early, nonsurgical techniques may help relieve carpal tunnel syndrome, such as:

Wrist Splinting

In order to deal with nighttime symptoms of tingling and numbness, the splint can work in a way to keep the wrist still while sleeping. During pregnancy, nighttime splinting turn out to be a good choice.


Nonsteroidal anti-inflammatory drugs, for example, ibuprofen (Advil, Motrin IB, others), may work in a way to help ease carpal tunnel syndrome pain for the time being.


In some cases, the doctor may inject a corticosteroid, for example, cortisone to ease carpal tunnel syndrome pain. Moreover, in some cases, the doctor utilizes an ultrasound to guide these injections.

Corticosteroids work in a way to decrease inflammation and swelling, which as a result, eases pressure on the middle nerve. On the other hand, oral corticosteroids aren’t considered as viable as corticosteroid injections in this case.

On the off chance that carpal tunnel syndrome is caused by arthritis or other inflammatory arthritis, at that point treating arthritis may decrease carpal tunnel syndrome symptoms.

The Need for Surgery

In some cases of carpal tunnel syndrome, surgery may be an appropriate option on the off chance that the symptoms are extreme or don’t respond to different non-surgical treatments. The objective of carpal tunnel surgery is to diminish pressure by cutting the ligament pressing on the middle nerve.

Read More

What Is Epidural Steroid Injection and Why Do You Need Epidural Steroid Injections?

In order to diminish the inflammation and ease pain associated with nerve root compression, an epidural steroid injection is performed. A herniated disc, spinal stenosis, and bone spurs disorders can cause nerve roots compression. The inflammation takes place at the point when the nerve is compressed. This, as a result, can drive towards pain, numbness, tingling or faintness along the course of the nerve. This is categorized as radiculopathy. The objective of the epidural steroid injection is to help diminish the inflammation of the nerve root. The place of the epidural space is above the external layer and it surrounds the spinal cord and nerve roots. The epidural steroid injection is injection with the purpose to reach the epidural space, specifically over the compressed nerve root.

Why Do You Need Epidural Steroid Injection?

There are a number of reasons that can work in a way to narrow the spinal passages, comprising disc herniations, bone spurs, thickening of the ligaments in the spine, joint cysts, or even irregular alignment of the vertebrae. A fat filled ‘sleeve’ is the epidural space that covers the spinal sac and works in a way to give cushioning to the nerves and spinal cord. The pain can be decreased and an improvement in the functionality can be obtained as steroids (‘cortisone’) put into the epidural space because they have an exceptionally strong action. In spite of the fact that steroids don’t change the fundamental condition, however, they can work in a way to break the cycle of pain and inflammation and prepare the body to compensate for the condition. Thus, the epidural steroid injections can work in a way to give benefits that survive the impacts of the steroid itself.

Risks and Complications of Epidural Steroid Injections

The injections are generally safe with minimal risk of complexities. A standout amongst the most widely recognized risk is the accidental puncture of the tissue coving the spinal cord named the dura mater. In the event that this occurs, the liquid can spill out and result in a spinal headache. According to its name, headache is the essential side effect. Afterward, the injury is commonly treated with bed rest either or both a process is known as a blood patch in which blood is infused over the hole in order to form a seal as it coagulates.

On the off chance that the needle contacts the spinal cord or nerve root, it can result in short-term neurologic damage showing with numbness or tingling in the extremities points for a considerable length of time. With the arrival of X-ray-guided injections, the occurrence of this has dropped significantly.

On the other hand, allergic responses are uncommon, approx. 0.3 to 0.5% yet may require emergency treatment on the off chance that you go through wheezing, shortness of breath, hives, facial swelling, quick breathing, and a sporadic heart rate. Infection is likewise rare.

Read More

How Advantageous Is Epidural Lysis Procedure? Epidural Lysis Related Conditions & Procedure

Epidural Lysis is performed in order to get rid of extreme scarring in the epidural space. The Epidural Lysis of Adhesions occurs at the point when the scar tissue limits the natural movement of nerves resulting in inflammation and pain. Individuals who have already gone through neck or back surgery, however, still have persistent pain possibly epidural lysis procedure will be advantageous for them along with patients who have herniated discs.

Related Conditions for Epidural Lysis

In the cases of epidural lysis, this generally incorporates chronic pain associated with the accumulation of scar tissue near the spine or spinal nerves. Regions of the spine that might be affected by this may include the sacroiliac joint or the junction at which the spine meets the pelvis. Scar tissue taking place after spinal surgery or distinctive sorts of harm may result in new-beginning pain.

In addition, stenosis is a condition associated with spinal scar tissue, where nerve tissue is mechanically affected upon or compressed by the accumulation of this tissue around it. Stenosis is the place where pain can occur, sensory disarranges, or on the other hand, the loss of motor control. The elimination of these attachments through lysis may result in a return to regular activities and relief from pain for patients affected by these conditions.

How Is The Epidural Lysis Procedure Performed?

You will be asked to lie down in a position where you will be facing down for the procedure. In order to numb the skin, a local anesthetic will be utilized over the buttock region. A needle is inserted which is a small caliber, flexible catheter through an opening at the tailbone with the guidance of X-Ray towards the affected nerve root.

Medications Utilized For This Procedure?

The medications include:

  • Local Anaesthetics
  • Steroids
  • Hyaluronidase

Or a blend of the three will be utilized to inject through the catheter to the influenced nerve root. Steroids are powerful in decreasing the swelling and inflammation around the nerve roots. Hyaluronidase is a chemical that works in a way to lessen adhesions.

Safety measures After Procedure

The doctor will recommend you straightforward exercises in order to help you keep up the movement of nerves all through the spinal canal. These exercises work in a way to encourage nerve root movement is referred to as Neural Flossing. These exercises work in a way to recapture adaptability and quality and avoid the limitation of influenced nerve roots and the subsequent return of your pain.

Advantages of Epidural Lysis Procedure

  • Slightly Invasive
  • Speedy Recovery
  • Great Success Rate
  • Same Day Procedure
  • Small Cut and Slight Scar Tissue Formation
Read More

What Is Discography And Deciding The Need For Discography Treatment?

Disc stimulation is another term of discography and is a diagnostic process utilized precisely to recognize the pain taking place because of a damaged disc and to decide on discography treatment. On the other hand, back pain is an exceptionally common disorder resulted from various kinds of conditions. These conditions frequently share comparable side effects. Therefore, an exact analysis becomes straightforward in deciding the best treatment.

What Are The Discs?

Considering a fact that the discs are soft (cushion-like pads), which separate the hard vertebral bones of the spine. In case of the disc swells, as a result, it starts hurting, herniates, tears or declines and may likewise result in a pain in neck, mid-back, low back as well as arms, chest wall, abdomen, and legs. Different structures in the spine may likewise turn out to be painful, for example, the muscles, joints, and nerves.

Commonly, few tests will be carried out in order to determine that these structures are not the only source of pain and through history and physical examination, furthermore, the tests could include:

  • X-Rays
  • Ct/Mri
  • Diagnostic Injection Procedures (Facet, Sacroiliac Joint Injections, Nerve Root Blocks)

What is Discography?

This is a testing procedure that works in a way to enable doctors to see and evaluate the inner structure of a disc so as to decide the correct source of back pain. With age or injury, the walls of the spinal discs can end up damaged or fissured. This condition is known as Internal Disc Disruption or Degenerative Disc Disease and can end up discogenic back pain. At the point when the disc causes pain, it is normally a deep pain that occasionally transmits into the buttocks or thigh. Pain from facet joints in the back and from the sacroiliac (SI) joints can be hard to recognize from disc pain dependent on medical history, physical test, or MRI alone. Discography will work in a way enable the doctor to decide whether the pain is from a damaged disc.

Deciding the Need for Discography

Discography lets interventional pain doctors see a disc’s inner structure and set up whether it is the reason for pain or not. Despite the fact that discography has turned out to be dependable in helping doctors make a pain diagnosis, it is done only after other tests when they have proven to be questionable in indicative the source of pain.

An individual who is a decent candidate for discography is one who has been going through continuous spinal pain, is associated with having a disc abnormality and has had non- invasive tests that demonstrated questionably. The patient must be willing to go through discography treatment engaged at the disc.

Read More