Complex Regional Pain Syndrome in Minnesota

CRPS in MinnesotaComplex regional pain syndrome (CRPS) is a difficult medical issue to treat. If you think you may have it, you want it gone. Unfortunately, there are few physicians and even less specialists who understand it and are able to manage the problem. Pain specialists, neurologists, and many other experts struggle with the diagnosis and treatment of the condition. In any field of work, 90% of people do a good job, however with CRPS, you need to find the 10% who are superior in their skill level. They are the artists, they put in a phenomenal effort to find a cause and a set of solutions to cover all the complex interrelated issues.

The starting point with complex regional pain syndrome is finding a Pain Specialist certified by the American Board of Physical Medicine and Rehabilitation. These are medical doctors with the extensive qualifications in all aspects of understanding pain. Board subspecialty qualifications insures a higher level of knowledge. The next quality is that the physician sees and treats the problem frequently. If they only see a couple of cases a year, it is unlikely they will have the interest and skill needed to successfully manage the problem. If the doctor walks into the room, immediately knows what is wrong and can talk to you sensibly about the problem, you have found the expert. He will also take a team approach to treating you, guiding you through any additional diagnosis and the variety of treatment options.

Treatment of CRPS

A CRPS expert will also understand this is a not a final diagnosis. CRPS is being caused by some sort of damage to the a particular region of the body. Finding the cause behind CRPS is essential in finding the route to managing and possibly resolving some or most of the pain. Treating symptoms rarely treats the CRPS. An expert will dig deep to find the all the issues that stimulate the sympathetic nervous system maintaining the pain. At times, treating the underlying problems resolves the CRPS. Unfortunately, at times, the damage to structures cannot all be solved and residual issues remain despite the best management.

Complex regional pain syndrome affects both the upper and lower extremities. Finding the diagnosis that is causing the problems is essential in treating CRPS. Treating the symptoms is helpful initially, but treating the underlying problem is essential in improving the outcome. In the lower extremity, orthopedic injuries especially to the foot and ankle cause CRPS in about five percent of individuals. Common causes include injuries to the ligaments and tendons of the ankle and foot that caused instability. Surgical management of the foot and ankle problems, along with aggressive simultaneous lumbar sympathetic injections may resolve the issues. Complex regional pain syndrome is less common in the upper extremities, but is also related to ongoing, unresolved injuries that are continuing to stimulate pain signals.

Finding a pain specialist who understands the complex issues related to the pain is difficult. Experience and training is essential to achieve a good outcome. Look for the physician who sees many patients with this problem on a regular basis. If the physician has not seen these patients frequently, it is unlikely that you will be satisfied with your treatment results. CRPS is a difficult problem to treat and finding the pain specialist with experience is necessary for a satisfactory outcome.

The Link Between Obesity and Chronic Pain

Obesity and PainA large portion of individuals who suffer from chronic pain are also obese. The question is often asked which comes first, and will solving one issue make the other go away? The answer is obviously not a simple one, but both of these subjects are related.

Obesity is a severe problem in developed countries like the USA.  Once obese, people do not move as much, and overloading the body can lead to pain in areas like the back and joints in the legs. Having pain in the low back or joints and being obese does not mean that losing weight will resolve the problem since permanent injury may already be present.

Obesity and Pain

Obesity is a primary problem affecting a large segment of society. Treatment is varied, and one single strategy does not help everyone. Since obesity leads to many health problems that cause pain, like diabetes, vascular disease and early osteoarthritis or degenerative arthritis, treating obesity before these problems occur is important. Once permanent damage to the body is done, reversing the injury is often impossible and treatment can only be aimed at symptom management. If you are obese, work with professionals to bring your weight under control to prevent permanent side effects.

Having low back pain and obesity often makes symptoms worse. If you are overweight by 50 pounds, this is like constantly carrying 5 one-gallon jugs of water with you 24 hours/day without ever having a break. Every time you do anything, there is that 50 pounds you have to lift and move, and it becomes easy to see why you would hurt. However, low back pain is often related to permanent changes in the lumbar region including the joints, discs, and bones. Losing weight will not reverse the permanent changes present but may allow easier pain management.

Joint pain, especially degeneration of the knees and hips, can occur with obesity. Increased weight is a common factor that promotes increased wear and tear on the knees and hips. Once the damage has occurred, the changes are usually permanent. Weight loss will make the symptoms more manageable, but will reverse the degeneration that has occurred.

Obesity is a major health issue. If it were easy to solve, then we would not be facing such challenges in society today. Treating obesity early helps reduce the secondary problems it causes. Solving obesity will often not solve a pain problem. Keeping healthy, strong, and mobile will make many things better, and hopefully decrease obesity and possibly pain.

Treatment of Sacroiliac Joint Pain

SI JointThe sacroiliac (SI) joint is the large joint that joins the pelvis to the sacrum of the spine. It has limited movement, and helps in maintaining proper spine and pelvic alignment. Multiple ligaments and core muscles keep the pelvic bones and sacrum moving correctly. The joint is innervated by small branches of nerves from the sacral levels of the spine. Normally the joint is not painful. When the joint is not aligned properly or if it has become osteoarthritic, it may feedback painful signals. Pain from the joint is felt most commonly in the buttock region on the side of the dysfunction.

Many structures in the body can cause low back pain. The sacroiliac is a critical structure in helping transmit and cushion forces between the upper body and the pelvis and legs. When the joint does not move correctly, it may become a source of pain. Similarly,  pain to the joint may also come from any nearby structure, including muscles, bursas, lumbar discs, lumbar facets, pelvic organs, and any of the nerves in the lumbar and sacral region. Furthermore, pain from another structure may cause muscles in the region to tighten and cause the sacroiliac joint to move abnormally and become painful as a secondary problem. Treating the SI joint then is only successful if the other problems are being managed.

Diagnosing Sacroiliac Pain

The diagnosis of sacroiliac joint pain is based on a combination of patient history, physical exams, radiologic studies and on diagnostic and therapeutic joint injection. Typical history is for pain in the region of the joint without a history of another problem in the area. An exam is not overly reliable, but stressing the joint region and direct palpation of the area often produces pain. X-rays and MRI scans sometimes show degeneration of the joint, but pain is not well correlated to changes seen on any of these studies. Unfortunately, the only reliable proof of pain from the SI joint is actual joint injection with subsequent pain relief after placing anesthetic into the joint.

Treatment of the sacroiliac joint ranges from the most conservative management to aggressive surgical interventions. The first line of treatment is with Physical Therapy. Strengthening and stretching of the muscles in the region is necessary. Anti-inflammatory medications and muscle relaxants may help control symptoms. Chiropractic or osteopathic type adjustments of the region may restore and improve mobility. If the above conservative management is not adequate, then consideration of injection of the joint under fluoroscopy with steroid and being evaluated by a Physical Medicine Pain Specialist would be reasonable. A Pain Specialist can help determine if there are multiple factors contributing to the SI joint pain and that more than just the joint needs further treatment. Recently, some surgeons have also been fusing the SI joint, but the outcome at best is guarded.

Pain in the sacroiliac joint can be simple or complex. It may be just the joint or it may be related to any combination of irritated structures in the lumbar region. If the simple management is not improving the pain, a full evaluation by a Pain Specialist may significant improve the outcome.

What Types of Patients Do Pain Doctors Treat?

Pain Doctor patientsFinding the right care for each individual patient who is dealing with chronic pain can be difficult. If a patient has ongoing difficulties with pain symptoms, additional medical expertise is often helpful with symptom management. The comprehensive Pain Care program at CDI is designed to help manage these complex and difficult problems.

The Pain Care program at CDI will see any patient who has ongoing problems with pain. The program is run by a Board Certified Physical Medicine and Rehabilitation specialists with subspecialty training in Pain. We are available to help evaluate and diagnose medical problems that are causing ongoing pain symptoms in any region of the body. Common problems that we usually see include patients with:

  • neck pain
  • headaches
  • joint pain
  • neuropathy
  • low back pain
  • mid back pain
  • multilevel pain problems.

The goal is to develop an individualized comprehensive treatment plan to better control symptoms on a conservative basis. Early management of pain problems often leads to solutions that completely solve the issues.

Treating Pain Problems

A typical low back pain patient may have muscles strains, disc issues, nerve irritation, lumbar facet joint pain, or even pelvic problems. A comprehensive evaluation and examination often leads to an appropriate diagnosis and a number of treatment options. A Physiatrist can work with a patient to complete further testing, and if necessary, assist with physical therapy, medication, and interventions to overcome the medical problems causing low back pain. Muscle strains for instance may only need physical therapy and appropriate short-term medications. Lumbar facet joint problems cause axial low back pain and may benefit from a combination of injections, radio-frequency neurolysis/lesioning, and physical therapy. Depending on the diagnosis, a comprehensive treatment plan with the available options for management can be discussed and implemented with the patient.

Neck pain issues often cause headaches and can be treated with a number of conservative interventions. The Pain Care team can help diagnose and develop a comprehensive management strategy. One common problem causing headaches is irritation of the cervical facets, and this often occurs after trauma, especially motor vehicle accidents. This pain is often known as a whiplash injury. It often resolves with conservative physical therapy and short-term medication, but about 10% of cases require more intense intervention. These patients are often helped with injections and sometimes radio-frequency lesioning of nerves in the neck. Successful management often cures the problems for a prolonged time.

Pain is a complex problems, and every patient is unique with their own set of important issues. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, having the skills of a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient.  Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new field.  At CDI we have recognized the need to provide a more comprehensive service to help with the management of these complex and difficult patients. With a comprehensive approach to the evaluation and management of these patients by a Physiatrist, we hope to bring a successful approach to resolving these difficult problems within the community. At CDI we hope to partner with a community of physicians to better serve these patients and their providers.

Pain Care: The Benefits of Pain Management

Pain Care BenefitsPain is a complex problem with physical and emotional components. It can affect all aspects of a person’s life. When pain is treated early and aggressively, often it can be cured. Sometimes the injury that has caused the pain cannot be completely reversed and the damage needs to be managed on a long-term basis. Medically, we are always looking to find a diagnosis and treatment for every problem. Pain Care is aimed at finding the individualized, comprehensive diagnosis and management plan for a patient’s symptoms and problems.

Pain Care has been developed to take the next step in managing a patient’s symptoms. A new patient will undergo a comprehensive evaluation by a Board Certified specialist in Physical Medicine and Rehabilitation with a subspecialty in Pain Care. These physicians are medical doctors with extensive special training in the musculoskeletal, medical and neurologic systems, which allows them to better diagnose and treat almost any painful condition.  As Physical Medicine doctors, they are the “Family “ physicians coordinating and delivering care to those with pain.

Since pain often is a complex problem, Pain Care is designed to help the patient move forward with management. Every patient is unique with their own set of important problems. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, consulting a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient. Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new medical field, however there are not many providers with the Physical Medicine and Pain specialty skills. Pain is complex and Pain Care is designed to address these issues and bring a solution to the patient and community.

Sciatica Pain: Causes, Symptoms, and Treatments

Sciatic Nerve PainSciatica is a term used to describe pain that radiates down the back of the leg. The name comes from the main large nerve, the sciatic nerve, that travels from the pelvis down the back of the leg. The sciatic nerve forms from the nerve roots in the lumbar and sacral region of the spine, and it is home to the motor and sensory nerves of the leg. The term sciatica is used to describe the sensation of pain in the leg generally from the buttock to the foot.

Causes of Sciatica

The causes of sciatica are numerous, and they are often the same causes of most low back and leg pain. Any structure that relays sensation through the sciatic nerve can produce sciatica pain. Low back, gluteal (butt), and leg muscles when irritated or strained, tendons, bones, and nerves can all produce these sensations. The pain can be acute or it can be chronic. Everyone describes their pain in different terms, as it is a personal experience. Most of these pains are self-limited, temporary and often resolve quickly within days with rest and possibly over-the-counter medications, heat or ice.

If the pain is due to trauma or is not resolving in a week or two, then seeing a physician may be worthwhile. The benefit of seeing a doctor is to get a good treatment strategy to resolve the problem as quickly and easily as possible. A full medical history, a history about the onset and course of the symptoms, and what has been done in treatment is necessary. An accompanying exam will include looking at the low back, pelvis, legs, and evaluating all the structures, including performing test of muscles, joints, nerves, and overall neurologic status. From a history and exam, a good physician can determine a starting diagnosis and treatment plan. 98% of the issues should resolve with good conservative treatment such as ice, heat, over-the-counter medications, physical therapy, massage and manipulation or adjustments.  X-rays, CT scans and MRI scans early on in treatment are usually not necessary.

Long-Term Treatment

If the sciatica is continuing despite conservative care for 6-8 weeks, then the skills of a Physical Medicine and Rehabilitation Pain Specialist can be especially beneficial. These physicians are experts in musculoskeletal medicine and can usually figure out what is wrong and the best treatment options for you that will help resolve the problems.  They also can determine if further tests are necessary such as MRI scans or nerve studies, and they can also perform specialized injections that may speed the healing. There are many physicians that treat back pain, but a Physical Medicine Pain Specialist has the added expertise needed to help find the conservative options and guide the decisions for the more complex problems when issues are prolonged.

Sciatica pain can be especially challenging, especially since 85% of the population does have this problem at some point in their lives. If the simple treatment is not working, the best solution is finding the expert with experience. Every person has different circumstances, and a pain specialist has the broadest set of tools to find the matching solution to each puzzle.

Medical Marijuana For Chronic Pain in Minnesota

Medical marijuana mnMinnesota has taken a conservative approach to the use of marijuana for medical purposes. Only a little quality research has been done with regards to the use of marijuana for pain. Most of these studies have been done for patients with cancer or eye problems, and current research is focused on seizures.

The reason why marijuana research is moving slowly is because there are all over 100 compounds that may be an active in cannabis. Most medical professionals would like to know both the positive and negative aspects of any intervention. Since there is no significant marijuana research available, it is hard for medical professionals to recommend the use of this compound.

Marijuana in Minnesota

Minnesota’s new marijuana laws allow the use of marijuana for only limited medical diagnoses. At this time, chronic pain is not included in the list of treatment recommendations. Chronic pain is extremely complex, and has multiple causes in most people. A single compound like marijuana is unlikely to be helpful and every person. Determining which group of patients would be helped by such a compound will be difficult due to the variety of conditions that cause pain.

Most physicians in Minnesota will not be prescribing medical marijuana. If you have chronic pain, do not expect a physician to write you a prescription for marijuana, especially since it isn’t approved for recreational use in Minnesota or even nationally. Furthermore, the drug enforcement administration (DEA) can stop a physician from being able to prescribe any medications if they prescribe to known drug abusers. The use of marijuana is not considered a legal medication, and physicians can lose their license if they prescribe to a patient who abuses marijuana.

Alleviating Symptoms

Pain symptoms in some patients may seem to improve with the use of marijuana. There are many compounds in marijuana that may help control a variety of symptoms including anxiety and pain. Most physicians who are prescribing control medications such as narcotics will do a urine drug screen to determine whether street drugs are being used by the patient. Most physicians have a zero tolerance rule for the use of street drugs since they could lose their license if they prescribe to an abuser. If you use marijuana, do not expect to be prescribed narcotic medication. Most pain physicians will work with you to control your symptoms with other treatments that are very effective in managing your problems.

In the distant future, when we know which compounds in marijuana are effective, we may be able to develop more comprehensive treatment plans for patients with chronic pain. Until that time, hopefully the change in laws will promote good research with regards to the active compounds that will be effective in managing pain. More tools to treat pain will always be helpful. Unfortunately, research takes time and these new compounds may take up to 10 years or longer to develop.