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2018-06-27

Sympathetic Nerve Block, good solution?

A sympathetic nerve block is firmly believed upon by many pain health specialists to be an efficient method for controlling chronic pain.  However, there is not a great deal of medical evidence to show whether these blocks are actually helpful. This therapy targets the sympathetic nervous system.  The sympathetic nerves are a group of nerves that are found along the front side of the spinal column that help control several involuntary functions of the body. The involuntary actions are referred as the actions you have no control over. These include blood flow, digestion, and sweating.

A sympathetic nerve block is an injection that can be used to treat pain which is a consequence of Complex Regional Pain Syndrome (CPRS), Raynaud’s syndrome, and some types of abdominal pain. This injection involves injecting local anesthetic in the area where several nerves meet. The target is to reduce or abolish the pain signals being sent to the brain.

The location of your pain typically determines where you’ll receive the nerve block. Your sympathetic nerves come together outside your spine area in thick networks of nerves called ganglions. If you have pain in the upper part of your body, you may get pain relief from blocking the stellate ganglion in your neck area. If you have pain in the lower part of your body, a ganglion near the lower spine may be targeted with a lumbar sympathetic block.

An experienced pain physician will locate the exact position of the target nerves using x-ray or fluoroscopic guidance to guarantee procedure’s truthfulness. Once the exact area of nerve pain has been located, the physician will inject an anesthetic solution. The procedure typically takes less than 30 minutes and patients are able to leave shortly after their procedure is complete.

Precautions:

Complications are exceptional, but can include infection, bleeding, spinal or epidural block and injection into a blood vessel. The procedure cannot be performed if:

  • You have the flu, cold or fever
  • High blood pressure or if you are on blood thinners.
  • If you have consumed solid food or fluids after midnight a day before the procedure is to be held.
  • If you are a diabetic patient

A sympathetic nerve block is a relatively safe procedure. You can usually go home afterwards and return to your normal activities after a day of rest. If you had IV sedation, you’ll probably need to have someone drive you home. Sympathetic blocks don’t work for everyone. Also, the pain relief they give may lessen over time. But for some, a sympathetic block may provide weeks or months of pain relief.

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2018-06-25 (2)

Feeling of Discomfort Around the Hip?

The hip is a ball and socket joint that attaches the leg to the torso of the body. In the hip joint, the head of the femur (thigh bone) swivels within the acetabulum, the socket, made up of pelvic bones. While many causes of hip pain can arise from the joint itself, there are numerous structures surrounding the hip that can also be the source of pain.

Trauma is often the cause of hip pain, but any source of inflammation may cause pain in the hip area. Pain is one of the symptoms of inflammation, along with swelling, warmth, and redness; together these are signs and symptoms that a problem may exist. Hip pain is a common complaint among women of the population. The precise location of your hip pain can provide valuable clues about the underlying cause.

Problems within the hip joint itself tend to result in pain on the inside of your hip or your groin. Hip pain on the outside of your hip, upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround your hip joint. Hip pain can sometimes be caused by diseases and conditions in other areas of your body, such as your lower back. This type of pain is called referred pain.

Causes of Hip Pain

These are some of the conditions that commonly cause hip pain:

  1. Arthritis
  2. Hip fractures
  3. Muscle or tendon strain
  4. Cancers
  5. Avascular necrosis

Treatment:

If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication such as acetaminophen or a nonsteroidal anti-inflammatory drug such as ibuprofen or naproxen. Rheumatoid arthritis treatments also include prescription anti-inflammatory medications such as corticosteroids, disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and sulfasalazine, and biologics, which target the immune system.

Another way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better. You may also try heating the area. A warm bath or shower can help ready your muscle for stretching exercises that can lessen pain.

If you have arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion. When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement (arthroplasty) may be a consideration. People who fracture their hip sometimes need surgery to fix the fracture or replace the hip.

Call your health care provider if your pain doesn’t go away, or if you notice swelling, redness, or warmth around the joint. Also call if you have hip pain at night or when you are resting. Treatment for hip pain depends on the diagnosis, but pain that’s caused by overuse or sports injuries is often treated with heat, rest, and over-the-counter anti-inflammatory medication. To prevent injuries, it is important to stretch before exercising and wear appropriate clothing, especially good shoes when running.

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2018-06-21

Is Carpel Tunnel Sysndrome a normal Condition?

Carpal tunnel syndrome is a prevailing condition that causes numbness, tingling and other symptoms in the hand and arm. Carpal tunnel syndrome takes place when the nerves of the hand (also known as the median nerve) are constricted and compressed as it travels through the wrist along the carpal tunnel. The carpal tunnel protects the median nerve and flexor tendons that bend the fingers and thumb. A carpel tunnel is a narrow passageway on the palm side of the wrist. The carpal tunnel protects the median nerve and flexor tendons that bend the fingers and thumb.

In most patients, carpal tunnel syndrome gets worse over time, therefore an early diagnosis and treatment is necessary. Over time, the obstruction of the carpel tunnel exerts abnormal pressure on the nerves which results in pain, numbness, tingling, and weakness in the hand.  The early symptoms can often be relieved with simple measures like wearing a wrist splint or avoiding certain activities. But, in case when the condition lasts too long, a surgery to take pressure off the median nerve may be recommended for some patients in order to avoid permanent damage. Carpal Tunnel rarely causes permanent nerve damage. Permanent, irreversible nerve damage is possible with Carpal Tunnel Syndrome. However, Carpal tunnel syndrome usually isn’t very serious. With treatment, the pain will typically go away and you’ll have no lasting damage to your hand or wrist.

Carpal tunnel syndrome symptoms usually start gradually. The first symptoms often include numbness or tingling in your thumb, index and middle fingers that comes and goes. Carpal tunnel syndrome may also cause discomfort in your wrist and the palm of your hand. These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep. Many people “shake out” their hands to try to get rid of the numbness, but this feeling may become constant over time.

The most common causes include:

  • Anatomic factors
  • Sex
  • Nerve-damaging conditions
  • Inflammatory conditions
  • Obesity
  • Alterations in the balance of body fluids
  • Other medical factors
  • Workplace factors

Prevention Majors:

  • Reduce your force and relax your grip
  • Take frequent breaks
  • Watch your form
  • Improve your posture
  • Change your computer mouse
  • Keep your hands warm

Visit the doctor if you you observe persistent signs and symptoms suggestive of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment hence, making it more worse!

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2018-06-14

Is it the growl of your back pain or punch?

The growl of low back pain is often more excruciating than its punch. The pain most of the times make it worse than it actually is

MRI and X-ray for lower back pain and astonishingly deceptive, because conditions such as bulging disc is  not that harmful and most of the back pain is relieved on its own. Muscle spasms are very common and can be critically intense, but aren’t serious.

What are the conditions when back pain becomes a scary part of your life?

There are cases of low back pain that have critical cases, but it occurs less often. Meanwhile, back pain is a warning sign of cancer, autoimmune disease, infection and a bundle of other scary offenders. Above the age of 55, almost one in twenty cases diagnosed with fracture and one in hundred is more sinister. The more you are far from 55 the better your condition is.

But how will you know about your back pain? It can be quite tricky, here we have brought you to the friendly guide to the red flags that need better safe than sorry investigation with your physician. This article will help you distinguish between the dangerous and just painful as smoothly as possible

The ordinary back pain is excruciating and debilitating, but not always alarming. Its growl is often much louder than its punch

Chronic low back pain is alarming, but rarely sinister

Back pain can absorb your happy days or even weeks, months and years. It is for sure very serious, even if it is not sinister. “I have dealt many doubtlessly tragic chronic low back pain patients, and a huge part of their savings ends up dealing with back pain. However, your critical case of chronic low back pain, as excruciating as it can be has never killed anyone,”Says Dr Zaki Anwar, MD Pain Management Specialist and Anesthesiologist. Founder of the Pain Management Center

Low back pain is sinister when it is caused by something that can handicap or kill you. Such cases occur less often, but bad things do happen, even the best doctors can overlook

Possible causes of sinister back pain and symptoms

These causes are not very common and usually brings serious symptoms that are easy enough to be alarmed. Some of the causes remain  silent in the early stages, but not for too long

Cause Description Symptoms
Cancer A tumor develops in or around the  spine The pain increases consistently, position and activity does not influence. Worsens at night and brings other symptoms as well
Spinal infection Infections in or around the spine Remains hidden for longer periods. The spot of infection is tender, with excruciating ongoing pain and immobile spine, along with fever and illness
Abdominal Aneurysm Swelling in the artery adjacent to spine Pain may be throbbing and pulsating. Often happens to people with the risk of heart disease, smokers and diabetic patients
Ankilosing Spondylitis Rheumatic arthritis of spine and the pelvic region Chronic back pain started in middle age and increase slowly. Relieves with activity but not rest and may spread to other areas
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2018-06-01

What causes a spinal disc herniation?

The vertebral column is also called the spinal column is comprised of 33 bones. Each vertebrae is detached from the adjacent vertebrae by an intervertebral disc a, along with ligaments and the facet joints, which help each vertebrae to maintain the spine’s normal alignment and curve meanwhile also facilitating movement

In the middle of the spinal column there is an open carrier called the spinal canal. The spinal cord and the spinal nerves rests in the spinal canal, where they bath in the spinal fluid sheltered in the small spinal column

Herniated disc

A herniated disc happens when the fibrous outer part of the disc ruptures or is torn and the jelly like inner material is forced out. When the herniated disc exerts pressure consequently it gives rise to a pinched nerve condition that cause pain, numbness, tingling and weakness in the arms and legs. The inner squeezed substance in addition to pinching the nerve also give rise to inflammation and severe pain

Bulging disc

A bulging disc happens when the outer protective layer of the disc is depleted, but isn’t torn and pinches outwards. A herniated disc may evidently start as a bulging disc, eventually the outer wall is then torn by a potential amount of pressure

Disc herniation can arise in the cervical, thoracic and lower spine. The spot of pain is contingent to the location of the herniated disc. If the herniation arises in the cervical area, it can cause pain that spreads into the shoulder and the arm, it it arises in the lower back, the pain generated can spread into the hips and legs.

Hallmarks

A cervical herniated disc may cause pressure on the cervical nerves and can give rise to triggers like pain, pins and needle sensation, numbness or weakness in the shoulder, neck and arm. A potential disc herniation in the cervical spine may pinch the spinal cord within the spinal canal and cause numbness, stiffness and immobility in the legs and conceivably some complications in bowel and bladder control

A thoracic disc herniation may give rise to severe pain in the back, if the disc herniation travels through the forearm. The pain and the numbness may spread near the rib cage from the back to the front of the chest and the upper abdomen.

A lower herniated disc may cause the following symptoms;

  • Intermittent or continuous back pain
  • Spasm of the back muscles
  • Sciatica
  • Muscle weakness in the legs
  • Numbness in the leg or foot
  • Decreased reflexes at the knee or ankle
  • Changes in bladder or bowel function
  • Difficulty walking

The symptoms of the disc disease may mask other medical conditions and medical problems. You must consult a physician for a complete diagnosis

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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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