Common Causes of Pelvic Pain

/ Thomas Cohn, MD

pelvic painPelvic pain can occur in both men and women. It can be caused by a variety of conditions. Some of the more common causes of pelvic pain include:

  • Bladder infections such as interstitial cystitis
  • Hernias
  • Kidney stones
  • Bowel issues
  • Endometrial issues, and ovarian cysts (in women)

Treatment is based on the cause, and these pains usually resolve once the acute condition resolves.  Read on the learn more about these specific conditions that can result in pelvic pain.

Endometriosis and Fibroids

Chronic pelvic pain in women is often related to several problems related to the unique pelvic anatomy.   Endometriosis and fibroids are uterine tissue that forms outside the normal uterine location.  Its growth is stimulated by the normal hormonal cycles.  The tissue eventually causes scar tissue in the pelvic region and the scarring can cause diffuse pelvic pain.  Surgery is often used to help resolve some of the problems related to this condition.  Physical therapy and neuropathic medications can be helpful for long-term management.

Chronic Interstitial Cystitis

Chronic interstitial cystitis is an issue seen mainly in women with irritability of the bladder.  The lining in the bladder becomes scarred, has pinpoint bleeding, and then becomes shrunken and stiff.  Frequent urination (up to 60 or more times a day) and constant pelvic pain are common with chronic interstitial cystitis.  Bladder distention is sometimes helpful and sometimes medication is instilled into the bladder.  Bladder stimulators sometimes are implanted to help control symptoms.

Hernias

Hernias more commonly appear in men than in women.  The muscle wall in the groin region weakens and abdominal contents push out of the area.  Surgical repair is the treatment of choice, however there are nerves in the region that in 2% of the population can become entrapped in scar tissue and be painful.  Physical therapy to release scarring, medications, and sometimes steroid injections are used to relieve symptoms.

Do Pain Medications Cause Kidney Stones?

/ Thomas Cohn, MD

kidney stoneKidney stones are tiny pieces of mineral or salt in the urine that are incredibly painful when passed. Pain meds are often used to ease discomfort during stone passage. But can these pain medications also cause kidney stones?

What are Kidney Stones?

Kidney stones are considered one of the most painful acute conditions.  They are caused by a variety of things such as:

  • How the body metabolizes various compounds (calcium, for example).
  • Not drinking enough water
  • Other medical conditions like gout
  • Genetic predisposition

As stones are passed from the kidney through the ureters to the bladder, they can be extremely painful.  Stones are often as small as a grain of sand. As they are passed from the kidney they irritate the structures on the way out of the body.

Identifying & Preventing Kidney Stones

Stones are often suspected when there is blood in the urine without any additional signs of infection.  In most cases, once you have a kidney stone you have no choice but to pass it. The only thing you can do is take pain meds to manage the pain during passage. In more severe cases, surgical procedure may be necessary to remove the stone. Analysis of the stone after it is passed can determine a prevention strategy moving forward.

Pain Medications & Kidney Stones

Pain medications are often used to control the extreme pain caused during the passage of a kidney stone.  It is common that people when passing a stone have such severe pain that they go to a hospital.  Powerful opioid and narcotic medications are useful to control the severe discomfort.

Pain medications themselves have not been known to cause kidney stones.  They have been used as an essential tool in the treatment of acute passing of stones.  Treatment is usually only necessary for a few hours to several days with opioid medications.  In rare cases with people who have recurrent stones, frequent use of opioid medication on a temporary basis is necessary. This should only be a temporary solution until a renal specialist can develop a more definitive management strategy.

How to Prepare for a CT Scan

/ Thomas Cohn, MD

ct scanA CT scan is a medical imaging tool widely used by medical professionals to gain better insight into afflicted areas of the body.  In this article, we’ll explain what a CT scan is, how it works, and how to best prepare for one.

For more information, read our blog on when CT scans, MRIs, and x-rays are useful in treating pain.

What is a CT Scan?

Computerized Tomography (CT) scans are a series of x-ray views taken of a body part at different angles. Computer processing of the views is used to create a cross-sectional picture of the scanned body part.  A number of “slices” (x-ray images) are taken, and the computer combines the images to create a 3-dimensional view of the region examined.  When the test was first introduced, the brain was the most common area examined by CT scan. Now, CT scans are used to examine many areas of the body.

When are CT Scans Helpful?

CT scans are x-ray images of a body region.  Therefore, radiation exposure does occur during these studies.  They are very fast to obtain and often provide very detailed information.  CT scans are often used when detailed information is needed rapidly to make a diagnosis and initiate treatment.  This makes them useful in acute illness, trauma, and brain injury where data needs to be collected fast and treatment cannot be delayed.  MRI scans may provide more detailed information, but can take a long time to obtain.  CT scans are also used in people who have metal implants in their bodies like pacemakers that can not placed in strong magnetic fields.

The risk of CT scans is similar to the risk associated with x-ray radiation.  This is generally a small risk if exposure is limited.  Frequent or multiple x-rays and CT scans can be a concern due to radiation and cancer.  Scans also should not be done during pregnancy due to possible radiation damage to the fetus.

How to Prepare for a CT Scan

Preparing for a CT scan depends on the area being scanned.  Since they are used in cases of trauma, often no special preparation is necessary.  Sometimes, a special contrast is needed to increase visualization of an area.  It may be swallowed, or injected in a vein or body cavity.  The scanning process is fast, and the scanner is fairly open, so claustrophobia is generally not an issue.  Most people will be required to wear a hospital gown for the scan so that clothing does not interfere with the imaging.

After the scan, a radiologist will interpret the results and report their findings to the doctor who ordered the scan (your physician).  Combining the results of the scan with clinical information (including patient history and physical examination) is critical.  Since the picture is only one part of the story, all the information needs to be combined to give an adequate explanation of the condition and the treatments that will work.

Discograms – What are they & When are they Useful?

/ Thomas Cohn, MD

discogramA discogram is a special x-ray study of the intervertebral discs in the spine.  The test is used to determine the structural integrity of the disc and whether the disc is painful when pressurized.

The Procedure

During the study, a needle is placed in the disc and dye is injected into the disc.  The study is done under real-time fluoroscopy. Normal discs are not painful.  Abnormal discs may or may not be painful.  Tears in the outer layers of the disc and whether the disc actually leaks contents can be determined with a Discogram.  Any disc in the spine can be examined in this way but it is most useful in the lumbar region.

When Discograms are Useful

Discograms are not common tests. They are used when other tests are inconclusive and surgery is being considered.  MRI scans can give a physician a wealth of information about the structural integrity of a disc, but it cannot determine if it is causing pain.  It can show a herniated disc that is pressing on a spinal nerve root and from that it may be inferred whether it is causing damage.  Combining the information from a MRI scan with other studies, like an EMG that can determine whether a specific nerve is damaged, can limit the need for a Discogram.

Today, discograms are used mostly to identify abnormal and painful discs in the lumbar region prior to surgery when other studies are not providing adequate information, and conservative care has failed.  Performing discograms in the thoracic region and cervical region is often considered very questionable, since the disc structure is different and the information provided may not be accurate.  The most useful information provided from a Discogram is that only a single abnormal disc is present and that it is causing symptoms perceived by the patient.  When multiple abnormal discs are present, surgery is usually a poor option since pain is likely to be generated from multiple sources and will not be improved with intervention.

The Future of Discograms

In the future, abnormal discs that have cracks and bulges, but are not herniated and causing pressure, may be able to be treated without surgery.  The center of the discs contain acid, when cracks develop as they age and are stressed, the acid can leak out and cause a chemical irritation to nerves.  At this time, researchers are developing compounds known as bio-sealants to seal cracks and prevent this leaks that are causing pain.  Discograms will be useful in the future if these materials being studied actually work.

An experienced interventionalist – either a radiologist or pain physician, should perform a Discogram.  Discograms are very painful studies for most patients, and sedation can be used to control the pain.  They do have risks, especially for serious infection if not performed properly.

9 Tips for Communicating Effectively with your Doctor

/ Thomas Cohn, MD

doctor communicationEffectively communicating with your doctor is important whenever you have an appointment.  The time during a doctor visit is important and both the patient and doctor want it to be worthwhile.  Every person has a different style of communicating.  Most doctor visits today are too short (often because doctors are overscheduled).  Because of these time limits, it is necessary for the patient to be prepared for the visit. Below are some tips for effectively communicating with your physician.

Be Concise

Remember that all healthcare providers have limited be time to be with you.  Tell the provider about the problems you are experiencing. You can leave out the details about your most recent vacation that does not pertain to the visit.

Be Honest

Do not exaggerate or lie.  If you overused your medications, tell them why it happened.  Do not lie about losing your drugs. Most doctors will know if a story does not make sense.

Don’t Leave Anything Important Out

Do not leave out important details about your back pain. If you have had multiple back surgeries, tell that to your doctor.  Also keep track of the treatments that you have tried and what did or did not help.

If you have psychological problems, such as depression, these are also important issues to bring up.  Psychological problems are just as important as physical problems, so do not forget to include these in your history if you want successful treatment.

Medications

Medications are often an important aspect of treatment.  Keep track of what you are currently taking (including dose and frequency).  Nonprescription medications are equally important since many drugs may interact with each other negatively.

Be on Time

If you want your doctor to be on time, you must be on time.  If you are going to be late, notify the doctor’s office as soon as you can.

Ask Questions

If you have questions about your treatment or problem, ask them.  Doctors try to anticipate some of the questions and answer them when they explain the treatment plan, but we are not mind readers. We are trying to determine what is wrong and what needs treatment.  If you don’t tell us what you are concerned about, we cannot fully help.

Most Visits end with a Treatment Plan

This is a joint venture between the healthcare provider and the patient to solve the patient’s problems.  If you have questions about your treatment plan, ask them.  Please follow the advice given and the plan. Picking and choosing only parts of the plan will not lead to a good relationship or a successful resolution of your problems.

Respect the Office Staff

Everyone who has pain is uncomfortable at times, but do not be abusive or rude to the office staff when you are having a bad time. We understand you want to feel better, but everyone deserves a degree of respect.  In today’s world, both patient and doctor deserve respect, if the patient shows no respect to others, it is unlikely that you will receive ongoing treatment.

Remember that not all Problems are Curable

We are listening and trying to find an effective solution that is specific for your circumstances.  It is a team effort, and the patient is the most important member of the team.  You have to be involved, not passive, and need to participate in your treatment if you expect to improve.  In pain management, you need to be both physically and psychologically involved since the brain is an equal partner in pain.