The unfortunate reality is that many of us have either experienced debilitating & chronic neuropathic pain or know someone who has. It’s not easy to live with and it can greatly affect your overall quality of life.
For those dealing with chronic pain, it can be hard to complete even the most simple day-to-day tasks or even find joy in playing with the grandchildren.
How do you deal with it? Traditional prescription pain management can often consist of replacing the pain with all kinds of potential side effects like diarrhea, dizziness, fatigue, heart issues, nausea, rash, constipation, headache, insomnia. These are just a few of the milder side effects of prescription pills.
Instead of swapping pain for pain, there are alternative paths to neuropathic and oncologic pain relief to consider.
Alternatives to Prescription Pain Management
Since chronic pain varies, there are several treatment options available as alternatives to prescription pain management. It’s important to consider many factors when making this decision, including the cause of pain, location of the pain, and duration of the pain. They are much safer approaches to pain than prescription drugs that also have longer lasting effects overall. Well-known modern alternative treatments include acupuncture, chiropractic care, massage therapy, yoga, and aromatherapy, to name a few.
Acupuncture is known to relieve neck and lower back pain, osteoarthritis, and migraines. While
Chiropractic care can help relieve neck and back pain, headaches, and muscle pain.
These types of treatments and therapies have been proven successful in providing pain relief for certain types of pain, but what about chronic neuropathy?
For neuropathic pain relief, the best choice is Calmare Pain Scrambler Therapy, which is becoming much more well-known throughout the United States and Europe because of its amazing results in treating chronic neuropathic pain.
What Is Pain Scrambler Therapy?
The Calmare Scrambler Therapy device, commonly known as a Pain Scrambler, treats nerve pain as an alternative to prescription pain management. The device uses a biophysical approach rather than a more common biochemical approach, treating the root of the pain and providing rapid pain relief.
The Pain Scrambler creates and sends a no-pain signal through multiple surface electrodes placed on the skin. This signal becomes the dominant signal received by the brain, overriding the pain signal and providing extended relief of pain.
Patients experiencing chronic neck and back pain or pain from cancer and chemotherapy, as well as chronic conditions such as diabetic peripheral neuropathy, sciatica, CRPS, and more have been successfully treated with Scrambler Therapy treatments.
Pain Scrambler Therapy is safe and highly effective. Over 80% of patients treated have had extremely reduced pain. Some patients are even permanently pain-free after just 10-12 sessions!
Is This Treatment Safe?
This type of therapy offers pain relief and control without the potentially dangerous side effects of prescription drugs. While the therapy is relatively new and cutting edge, The Calmare Therapy device has successfully treated over 7,000 patients and has become known for its success in treating neuropathic and oncologic pain.
In fact, Scrambler Therapy has been cleared by the FDA in the United States and Europe in 2009, and awareness of this highly effective treatment is growing rapidly. This has been found to be the safest and most effective treatment for neuropathic pain.
What Does The Treatment Plan Consist Of?
The best results of Calmare Scrambler Therapy are often achieved over multiple treatment sessions. While the Carolina Pain Scrambler Center can begin to deliver pain relief in just one treatment, the best results have shown from cumulative treatments over 10-12 sessions.
Each session lasts about 45 minutes, and the pain-free interval can last up to several months, depending on the severity and cause of initial pain.
In between sessions, if the severity of pain was fairly high, periodic booster treatments may be needed. This is especially true for anyone experiencing the recurrence of pain. Over time, after a series of treatments with Calmare Scrambler Therapy, patients typically experience a gradual decrease in overall pain.
Conclusion
If you are tired of living with pain day in and day out, or if you’re ready to say goodbye to ongoing use of prescription medication, and you are looking for a safe and effective way to rid yourself of your chronic nerve pain for good, we believe you would be a great candidate for our therapy.
Calmare Pain Scrambler Therapy has helped many patients be able to get back to truly living.
Wouldn’t it be nice to be living pain-free once again?
We would love to answer any questions you may have about The Pain Scrambler. Contact us today if you’re ready to improve your health and experience a pain-free life!
Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.
The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time.
Symptoms
The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred — most commonly in a band around your trunk, usually on one side of your body.
Signs and symptoms might include:
Pain that lasts three months or longer after the shingles rash has healed. The associated pain has been described as burning, sharp and jabbing, or deep and aching.
Sensitivity to light touch. People with the condition often can’t bear even the touch of clothing on the affected skin (allodynia).
Itching and numbness. Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.
When to see a doctor
See a doctor at the first sign of shingles. Often the pain starts before you notice a rash. Your risk of developing postherpetic neuralgia is lessened if you begin taking antiviral medications within 72 hours of developing the shingles rash.
Causes
Once you’ve had chickenpox, the virus remains in your body for the rest of your life. As you age or if your immune system is suppressed, such as from medications or chemotherapy, the virus can reactivate, causing shingles.
Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers can’t send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that can last months — or even years.
Risk factors
When you have shingles, you might be at greater risk of developing postherpetic neuralgia as a result of:
Age. You’re older than 50.
Severity of shingles. You had a severe rash and severe pain.
Other illness. You have a chronic disease, such as diabetes.
Shingles location. You had shingles on your face or torso.
Your shingles antiviral treatment was delayed for more than 72 hours after your rash appeared.
Complications
Depending on how long postherpetic neuralgia lasts and how painful it is, people with the condition can develop other symptoms that are common with chronic pain such as:
Depression
Fatigue
Difficulty sleeping
Lack of appetite
Difficulty concentrating
Prevention
The Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get a Shingrix vaccine to prevent shingles, even if they’ve had shingles or the older vaccine Zostavax. Shingrix is given in two doses, two to six months apart.
The CDC says two doses of Shingrix is more than 90 percent effective in preventing shingles and postherpetic neuralgia. Shingrix is preferred over Zostavax. The effectiveness may be sustained for a longer period of time than Zostavax. Zostavax may still be used sometimes for healthy adults age 60 and older who aren’t allergic to Zostavax and who don’t take immune-suppressing medications.
By Mayo Clinic Staff
Article Provided By: mayo clinic If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Is Your Sciatica Coming From Your Spine or Your SI Joint?
If you have pain radiating down your leg, you may immediately think: “I have a pinched nerve in my back.” But sacroiliac (SI) joint dysfunction can also cause pain that radiates down the leg. So, how do you tell the difference?
First, it’s important to understand that sciatica is not a diagnosis: it’s a symptom related to an underlying condition. Sciatica is the sensation of pain, tingling, weakness, and/or numbness in the lower extremities that is typically caused by compression or irritation of a spinal nerve(s) or of the sciatic nerve itself (see diagram). Usually, the nerve compression or irritation occurs in the lumbar spine.
The tricky thing is, the real source of the pain might be something else: your SI joint.
Start here to better understand your symptoms and what to do about them:
Nerve Compression or Irritation from the Spine Versus Nerve Irritation Related to the SI Joint:
SI Joint and Sciatica: Understand the Definitions
View Causes of Sciatica
Tests that Determine the Source of Your Leg or Lower Back Pain
Potential Treatments to Relieve the Pain
Nerve Compression or Irritation from the Spine Versus Nerve Irritation Related to the SI joint:
Even if you’ve determined that you have sciatica, the cause could be nerve irritation or compression in the spine OR you may have an SI joint problem OR a combination of both. The L5 and S1 spinal nerves are located very close to the SI joint, and SI joint dysfunction could result in irritation of those nearby nerves.
How can you be certain what’s causing the pain?
The only way to truly know what’s going on is to see your doctor and describe what you are feeling and experiencing. Your doctor will likely ask many questions, ask you to point to the source of your pain, and perform a physical exam.
Here are a few subtle differences that he or she may be looking for:
Sciatica and other symptoms
from Nerve Compression in the Spine
Sciatica and other symptoms
from the SI Joint
Pain that starts in the lower back and goes down one leg (the leg pain is usually greater than the low back pain)
Lower back pain (below L5) that is off to one side that you can typically point to
Pelvis/buttock pain
Hip/groin pain
Pain, weakness, and/or numbness or a tingling sensation radiating to the calf, foot, or toes along the back of your buttock, thigh, and calf. You may have actual weakness and/or numbness as a result of compressed nerves.
Pain can be mild to excruciating; it may feel like an “electric shock”
Sensation in lower extremity: pain, numbness, tingling, weakness. Upon exam, patients do not usually have true weakness or numbness.
Typically, the pain stays above the knee, but can radiate down the leg to the calf or foot.
Severe cases may result in significant leg weakness
(Weakness, numbness, and reflex changes are called radiculopathy.)
Feeling of pain and leg instability (buckling, giving way) when standing.
The leg isn’t actually weak; the leg gives way because of the severe pain you may experience when the SI joint is loaded.
Sitting for a long time can make symptoms worse.
Pain going from sitting to standing. Unable to sit for long periods of time or sitting or sleeping on one side due to the pain. (Disturbed sitting and sleeping patterns.)
Typically felt on one side.
Can be on one or both sides, although typically on one side.
It’s rare for someone with sciatica from an SI joint problem to have real numbness, weakness, or reflex changes. This is because there is rarely a physical compression of the nerve. The L5 and/or S1 nerves are irritated (called radiculitis) when they cross near the SI joint, but these nerves are not compressed.
Your radiating leg pain (sciatica) can be from your spine or from your SI joint. However, it is possible to be diagnosed with problems in both areas. That’s why it’s so important to visit your doctor to truly determine what is causing your low back or leg pain.
SI Joint and Sciatica Definitions
Let’s back up a step and make sure we fully understand the definitions of sciatica and SI joint dysfunction.
What Is Sciatica?
Sciatica is a symptom (radiating leg pain) caused by a problem with the spinal nerve(s) or sciatic nerve, such as compression or irritation, which sends signals of pain, numbness, tingling, or weakness. The sciatic nerve is a made up of several nerves from your lower spine; it extends down the back of your leg to the bottom of your foot. You have one on each side. Sometimes, the compression in the spine affects nerves on both the left and right sides of the body.
The sciatic nerve carries nerve signals down to the muscles and sensation signals up to the spinal cord. These signals tell your muscles to move; when these signals are disrupted, this is why you might sometimes feel weakness or buckling in the knee.
What Is SI Joint Dysfunction?
Sacroiliac (SI) joint dysfunction is caused by trauma or degeneration of the SI joint. The SI joint is where your iliac bone (pelvis) connects to the sacrum (lowest part of the spine above the tailbone).
The SI joint is responsible for transferring the weight from your upper body to your pelvis and legs. Pain caused by SI joint dysfunction can be felt in the lower back or spine, buttocks, pelvis, groin, and sometimes in the legs, which makes it seem like the cause could be nerve compression in the spine.
The L5 and S1 nerves are near the SI joint and studies have shown that SI joint dysfunction can cause pain and other symptoms in the distribution of these nerves.
The SI joint is separate from the sciatic or spinal nerve(s); however, the SI joint can cause sciatica-like symptoms.
Underlying Causes of Sciatica Pain and SI Joint Pain
Oftentimes, it’s difficult to pinpoint the exact cause of pain. Nerve compression in the spine and SI joint dysfunction are two areas that often cause pain running down the back of the leg.
Spine Problems that Can Result in Sciatica
A bulging, ruptured, or herniated disc in the spine
Central spinal stenosis or when your central spinal canal is constricted
Foraminal stenosis, when the openings where the nerves leave the spine become tight
Spondylolisthesis (or segmental instability), when one vertebra slips forward in the lower back
Facet arthropathy, a wearing down of the cartilage between the facet joints in the back of the spine
Injury or infection
Nutritional deficiencies and genetic problems (less common)
SI Joint Dysfunction: Potential Causes
Trauma to the SI joint from a fall, car accident, or giving birth
Degeneration of the SI joint
Both situations can be acute (lasting a couple weeks and resolving on its own) or chronic (lasting a very long time).
People with chronic SI joint dysfunction can suffer with the pain for years before they receive the correct diagnosis and treatment.
If your pain has lasted more than a couple weeks or is impacting your daily life, see a doctor right away.
Testing to Determine the Source of Your Leg or Lower Back Pain
Your doctor will likely ask many questions, such as when the pain started, how long it lasts, and what causes it to get worse or better. Answers to these questions will provide clues to which tests you should get first.
For example, if your pain started after a fall on the buttocks or if it extends to the groin area, that might be a clue that it’s SI-joint-related, and you may require physical examination including provocative tests.
Provocative tests help determine whether the pain is caused by the SI joint. A diagnostic injection can help confirm diagnosis. If you are experiencing true muscle weakness, this could indicate that you have a pinched nerve in the spine. When nerves are compressed/irritated in the spine, patients will frequently have a positive passive straight leg raising test.
Your doctor will also likely rule out potential causes of nerve compression in the spine, such as a bulging disc, with an MRI of the spine and other radiological and laboratory testing.
Sometimes patients are misdiagnosed, like in the case of Keith, who was diagnosed with a pinched nerve in the spine but in reality, had SI joint dysfunction. The pain was coming from his SI joint. See Keith’s Sciatica from SI Joint Pain Story.
Treatments to Relieve the Pain
Conservative therapies to treat sciatica from both the spine or the SI joint may include therapeutic injections of steroids, which may offer temporary relief. For sciatica related to the spine, the injection will be targeted in the lumbar spine at the site of the nerve compression. For sciatica related to SI joint dysfunction, the injection will be targeted in the SI joint.
Treatment of spinal conditions may include medications, physical therapy (including exercises specific for sciatic pain), and in extreme cases, surgery to remove the pressure from the pinched nerve(s) in the spine.
SI joint dysfunction treatments also include medications, physical therapy and other non-surgical treatments, and if non-surgical treatments no longer work, minimally invasive SI joint fusion may be an option.
If you suspect your lower back and leg pain is caused by your sacroiliac joint or your spine, visit your doctor with a list of symptoms, including when the pain started, and what makes it worse. If it turns out you need an SI joint specialist, you can find one in your area here.
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Sciatica is a form of radiculopathy—a mild to severe pain caused by the compression or pinching of a spinal nerve root. Sciatica radiates pain down the legs and feet, away from the source, and is a sign of nerve irritation or inflammation. It causes an electric shock sensation and numbness in the legs and feet.
While “sciatica” is often used to describe a sharp pain in the lower back and legs, not all sciatic nerve pain is sciatica. While the symptoms are similar from case-to-case, minor details signal different causes, such as whether your pain begins in your back versus your legs. Knowing the root of the issue is vital to treating sciatic nerve pain, as certain diagnoses require different treatments.
We discuss the most common types of sciatic nerve pain and an overview of what sciatic nerve pain is, its potential causes and risk factors, and various treatment options to give you a stronger understanding of the issue.
Neurogenic
Neurogenic sciatica is when the sciatic nerve is compressed or pinched, leading to pressure along the spine. The symptoms generally include sharp, shooting pain down the legs and weakened legs and feet. While the issue is rooted in the spine, the pain is usually worse in your legs than in your back.
Along with physical pain, neurogenic sciatica causes abnormal neurological changes. Individuals may suffer from a loss of reflexes, sensory issues, muscle weakness, and paresthesia (“pins-and-needles”) due to improper nerve conduction.
Referred
Referred sciatica is not a true form of sciatica, but mirrors the pain and symptoms. Rather than being a spinal issue, referred sciatica is pain related to a muscle or joint problem. Referred pain is one of the main reasons why a diagnosis for sciatica is vital, as it may need further evaluation treatment beyond home remedies.
As opposed to shooting pains, people with referred sciatica may feel dull and achy and their pain may be worse in their back than in their legs. Referred pain also does not cause abnormal neurological changes, either, such as worsened reflexes, sensory issues, or tingling.
Alternating Sciatica
Sciatica typically only affects one leg as the sciatic nerve is only pinched on one side of the body. However, alternating sciatica affects both legs successively. It may be a result of degenerative issues in the sacroiliac joint, the joint connecting the spine to the hips, or sacroiliac arthritis.
Bilateral Sciatica
Bilateral sciatica is when both ends of the sciatic nerve are pinched. This results in pain and symptoms occurring in both legs and buttocks at once. It’s a rarer form of sciatica, and the pain in one leg can be worse than in the other. Bilateral sciatica may be the result of multiple herniated discs or disc degeneration.
Sources of Sciatic Pain
There are 33 individual bones in your spine known as vertebrae. Each vertebra is divided into regions and classified according to the number of vertebra per region. The vertebrae are then labeled by a number and letter based on their placement, such as C1 for the first vertebra in the cervical spine. There are five regions of the spine: cervical, thoracic, lumbar spine, sacrum, and coccyx.
The most common regions associated with sciatica are the lumbar spine and sacrum, and the source of your sciatic pain slightly alters your symptoms.
L4 Nerve Root
Irritation to the L4 nerve root causes pain to the hips, thighs, inner knees, calf, and foot. Thigh and hips muscles may feel weak, and calves numb. When sciatica is in the L4 level, a person may be unable to flex their foot or walk on their heels, and they may have a reduced knee-jerk reflex.
L5 Nerve Root
Individuals with sciatica from the L5 nerve root typically experience pain in the buttocks, outer, thigh, and leg, as well as difficulty flexing their ankle or lifting their big toe. Sciatica from the L5 level might also cause numbness, mainly on the top of the foot and between the big toe and second toe.
S1 Nerve Root
Sciatica from the S1 nerve root is also known as classic sciatica as it’s most commonly rooted in the sacrum. Sciatica from the S1 level specifically causes pain and weakness in the buttocks, back of the calf, and outside of the foot. Individuals with sciatica from the S1 level may have numbness or tingling in their third, fourth, and fifth toes, and have difficulty walking on their tiptoes or raising their heels off of the ground. Individuals may also find they have a weakened ankle-jerk reflex.
Duration of Sciatic Pain
Sciatica and sciatic pain are categorized based on how long the symptoms and pain have occurred. The duration of your pain may be a signifier for the necessary treatment options you need.
Acute Sciatica
Acute sciatica lasts between a few days to a few weeks. Typically, it does not require medical attention from a doctor, and home remedies are usually enough to treat the pain. However, acute sciatica can be severe during the brief period of time it is present.
Chronic Sciatica
Chronic sciatica is characterized by symptoms lasting longer than 12 weeks. It’s often less severe than acute pain, but it may not respond well to self-management nor does it pass on its own. Chronic sciatica may require surgical or non-surgical treatment to improve.
Common Causes of Sciatic Pain
Sciatic pain is a result of different conditions or diseases aggravating the sciatic nerve. Not all the conditions listed are guaranteed to cause sciatic pain, but sciatic pain is a frequent symptom.
Herniated or Bulging Discs
Herniated or bulging discs occur when the spongy discs between your spinal vertebrae are compressed and bulge out of place. They can occur at any age, but become more common as you grow older or if you have degenerative disc disease, a condition where the discs lose fluid and wear down. Herniated discs are most common in the lumbar spine and near the sciatic nerve, so they can cause sciatic pain.
Bone Spurs
Bone spurs are small bone growths appearing near joints and are increasingly common with age. Bone spurs are the result of joint damage and linked to osteoarthritis, rheumatoid arthritis, and degenerative joint disease. After an injury or damage has occurred, your body attempts to heal the area by growing extra bone.
Typically, bone spurs cause no symptoms at all, though depending on where they’ve developed, a growth can compress your sciatic nerve and lead to pain.
Spinal Stenosis
The spinal canal is the spinal cord’s pathway down the back. With spinal stenosis, the spinal canal becomes narrower, placing pressure on the spinal cord. There are two types of spinal stenosis: lumbar and cervical stenosis. Cervical spinal stenosis affects the neck, while lumbar spinal stenosis affects the lower back and may cause sciatica.
Lumbar spinal stenosis can be the result of arthritis, spinal degeneration with age, tumors, or cysts.
Spondylolisthesis
Spondylolisthesis is a condition where one vertebra in the spine slips over the one below it, particularly in the lumbar spine region. The condition is typically a result of disc degeneration, arthritis, certain cancers, and certain surgeries.
Stress fractures are another common cause of spondylolisthesis, especially in young people and athletes, though they can happen to anybody. Repeated stress to the vertebra, injuries from motor vehicle accidents, or heavy lifting, can cause the vertebrae to fracture, leading to spondylolisthesis and sciatica.
Piriformis Syndrome
Piriformis syndrome is a neuromuscular disorder where the piriformis muscle (located where the femur and pelvis meet) compresses the sciatic nerve, resulting in spasms and pain in the buttocks and legs.
While the pain mimics sciatic pain, with tingling and numbness from the leg to the foot, it’s not sciatica since it’s not caused by spinal issues. Instead, it’s a referred pain beginning from the buttocks as opposed to the lower back.
Risk Factors
Roughly 40 percent of people experience sciatica at some point in time, and while it’s most common for people 40 to 50 years old, it can happen at any age.
Pre-existing spinal condition(s): Conditions such as degenerative disc disease or spinal stenosis, while they may not initially trigger sciatic pain, can eventually progress and cause sciatica.
Diabetes: As a diabetic, your body becomes more vulnerable to nerve damage, increasing the possibility of sciatic nerve damage and sciatica.
A sedentary lifestyle: Sitting for long periods of time, such as at work or school, can weaken your muscles and cause them to become stiff over time. A weak back and core puts pressure on your lumbar spine and leaves you at risk for sciatica.
Heavy lifting: Heavy lifting such as at work, at the gym, or when gardening, can strain your back and lead to lower back issues, especially if you have improper form. When lifting heavy objects, carry the brunt of the weight with your legs as opposed to your back.
Age: As you age, your spinal discs and tissues wear down, leaving you at risk for herniated discs. You also are more prone to physical health conditions, such as spinal stenosis or arthritis, resulting in sciatic pain.
Weight: If you are overweight or obese, the extra weight in your midsection puts pressure and stress on your spine, leading to back strains and sciatica.
How to Treat Sciatic Pain
In some instances, simple home remedies are enough to ease and treat mild-to-moderate sciatic pain. However, if your sciatic pain is chronic or severe, receiving medical attention is the best step to take for proper treatment. Nearly all treatments—with a doctor or otherwise—are nonsurgical.
Massage Therapy
Massages improve blood circulation, relax muscles, reduce muscle tightness, and release endorphins, all of which are natural pain-relievers and can ease irritation. You can self-massage at home or visit a massage therapist for treatment.
Topical Treatments
A simple way to reduce this pain is to use topical treatments such as analgesic (pain-relief) ointments or hot and cold therapies. They provide temporary relief for localized pain and can be used throughout the day as needed.
For hot and cold therapies, use ice packs (wrapped in a towel to prevent ice burns), heat pads, or hot towels for twenty-minute intervals. Hot and cold ointments are another simple treatment and can be used on the go if needed.
Exercise
Physical activity can strengthen your back and core muscles and relieve pressure on your lower spine. Stretching and light aerobic exercises increase your body’s flexibility and potentially alleviate symptoms. However, avoid strenuous or heavy exercises and be sure your form is correct at all times so as not to worsen your pain.
Medications
While medications don’t directly treat sciatica, they can relieve pain temporarily and make daily activities easier. You can use over-the-counter (OTC) anti-inflammatory medications such as ibuprofen or aspirin, or your doctor might prescribe muscle relaxants, antidepressants, or higher doses of anti-inflammatory drugs. For more severe pain, your doctor may inject corticosteroids or epidural steroid injections in your lumbar spine to relieve inflammation for one to two months.
Chiropractic or Physical Therapy
Your doctor might refer you to a chiropractor or physical therapist for physical rehabilitation.
With a physical therapist, you learn techniques and exercises to strengthen your back and core, improve your posture, and how to avoid aggravating your sciatic nerve. Your physical therapist makes a home exercise routine for you to follow to reduce symptoms.
Chiropractors have an excellent understanding of the body’s musculoskeletal system and how to manipulate it to ease any pain. They complete different treatments to take the pressure off your sciatic nerve, including massage, hot and cold therapy, and spinal adjustments.
Surgery
It’s rare for sciatica patients to need surgery and is typically the final step if other nonsurgical treatment options have not shown improvement. If you have severe pain lasting beyond 6 to 12 weeks or you are debilitated by your pain, your doctor may suggest surgery.
The most common surgeries to treat sciatic pain are microdiscectomy, laminectomy, a spinal fusion, or disc replacement, and the surgery you are referred to is based on your diagnosis.
FAQs
When is sciatic pain a medical emergency?
Sciatic pain is rarely an emergency, but if your sciatic pain is paired with incontinence, fever, loss of appetite, worsening numbness and tingling, swollen legs or lower back, or it began after an accident, seek immediate medical care.
What causes sciatica to flare up?
Some potential triggers for sciatica flare-ups include:
Stress and anxiety: Sciatica can be exacerbated by anxious thoughts as, when stressed, the brain deprives the nerves of needed oxygen and can result in weakness and tingling in the legs.
Wallet sciatica: Wallet sciatica is a term used to describe sciatica aggravated by sitting on your wallet, keys, or cellphone. When an item is in your back pocket, it directly presses up against the sciatica nerve and causes a flare-up.
High heels: When wearing high heels, your center of gravity shifts and stretches your hamstring and sciatic nerve. Walking on your toes, as you do in heels, might also irritate your sciatica.
Poor posture: Having poor posture when sitting or standing puts stress on your lower back and spine, resulting in a flare-up.
Tight clothing: Some clothing may be just tight enough to press against your sciatic nerve and trigger your sciatica pain.
Why is sciatica so painful at night?
Sciatica pain can be aggravated when lying down, making it difficult to sleep and find a comfortable position. In some instances, sciatic pain can be severe to the point of waking you up at night. Adjusting your sleep position, as well as using a supportive mattress, can ease your pain.
Side sleeping may place pressure directly onto the nerve roots and tilt your hips out of alignment with your spine. It’s best to lay on your unaffected side and use a pillow between your knees to keep your spine aligned and prevent pain.
Lying on your back emphasizes the lumbar spine’s curve, potentially pinching the sciatic nerve’s roots and causing pain. Elevate your legs using a pillow under your knees or an adjustable base to reduce the pressure and relieve your symptoms.
Stomach sleeping can overextend your lower back and irritate your sciatica, so it’s best to try a different sleeping position. However, if it’s too difficult to switch positions, temporarily use a pillow under your hips to protect your back.
Can sciatica be caused by a bad mattress?
While it’s unlikely a bad mattress is the cause of your sciatica, your mattress can definitely worsen pain if it’s unsupportive. Older mattresses tend to be rather unsupportive and lumpy, but even new mattresses can aggravate your sciatica if they’re not suited for your sleeping position.
It’s best to use a high-quality mattress built for your sleeping position and body weight to keep your spine aligned and minimize your pain as much as possible.
Should I push through sciatic pain?
If you’re experiencing any sciatic pain while exercising or completing any daily activities, don’t ignore it. Instead, take a few minutes to rest and allow your pain to pass. However, if your sciatic pain makes it difficult to complete daily activities as normal, speak with your doctor for treatment options.
Conclusion
If you’re experiencing sciatic nerve pain, it’s best to get diagnosed and figure out what type of sciatic pain it truly is, as it can be a sign of a larger underlying condition. Although what you’re experiencing may feel like sciatica, it can be caused by an unrelated issue such as piriformis syndrome. In order to protect your body and prevent worsening the issue, always get a doctor’s opinion if you are unsure.
This article is for informational purposes and should not replace advice from your doctor or other medical professional.
Photo by Joseph Chan on Unsplash If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
Medically Reviewed by Melinda Ratini, DO, MS on September 16, 2020
Reflex sympathetic dystrophy syndrome (RSD) is a disorder that causes lasting pain, usually in an arm or leg, and it shows up after an injury, stroke, or even heart attack. But the severity of pain is typically worse than the original injury itself. Doctors don’t know exactly what causes it, but they are able to treat many cases.The term reflex sympathetic dystrophy syndrome is actually not a name that doctors use anymore. It’s an older term used to describe one form of Complex Regional Pain Syndrome (CRPS). RSD is sometimes called Type I CRPS, and it’s caused by injury to tissue with no related nerve damage.
What Causes RSD?
Doctors think the pain caused by RSD comes from problems in your sympathetic nervous system. Your sympathetic nervous system controls blood flow movements that help regulate your heart rate and blood pressure.
When you get hurt, your sympathetic nervous system tells your blood vessels to get smaller so you don’t lose too much blood at your injury site. Later, it tells them to open back up so blood can get to damaged tissue and repair it.
When you have RSD, your sympathetic nervous system gets mixed signals. It turns on after an injury, but doesn’t turn back off. This causes a lot of pain and swelling at your injury site.Sometimes, you can get RSD even if you haven’t had an injury, although it’s not as common.
RSD is a little more typical in women than in men. Children can get it, too, but usually it shows up between ages 30 and 60.
Symptoms
When you get RSD, your symptoms may show up slowly. You may have pain first, and then it may get worse over time. You may not realize your pain is abnormal at first.
The types of injuries that can cause RSD include:
Amputation
Bruises
Burns
Cuts
Fractures
Minor surgery
Needle sticks
Radiation therapy
Sprains
It’s most common to get RSD in your arm, shoulder, leg, or hip. Usually the pain spreads beyond your injury site. In some cases, symptoms can spread to other parts of your body, too.
RSD can also affect your immune system. This can cause:
Redness
Skin that’s warm to the touch around the injury
Swelling
The pain you get with RSD is usually constant and severe. Many people describe RSD pain as:
Your skin may also feel sensitive when you do things that don’t normally hurt it, like taking a shower. Or it might hurt just to wear your clothes.
Other symptoms of RSD include:
Changes in your hair or nail growth, or skin’s texture
Excess sweat in certain areas of your body
Muscle weakness or spasms
Stiff joints
Trouble moving the injured area
White, mottled, red, or blue skin
Diagnosis
Often, doctors don’t know your pain is being caused by RSD until you’ve had it for some time. When pain doesn’t go away, or is more severe than it should be for your type of injury, it can be the first clue that it could be RSD.
There’s no single test that can tell your doctor whether you have RSD. Instead, they’ll rely on a physical exam and your medical history information. There are also a few tests that can provide clues to see if you have certain signs of the condition. These include:
Bone scan. This test can detect if any of your bones are wearing away at the ends or whether there are issues with regular blood flow.
MRI. Your doctor might order an MRI to look inside your body, specifically at your tissues, for noticeable changes.
Sweat test. This test can tell your doctor if you sweat more on one side of your body than the other.
Thermography test. This sympathetic nervous system test checks to see if the temperature or blood flow is different at your injury site than in other parts of your body.
X-rays. These are typically ordered if your syndrome is in later stages to look for mineral loss in your bones.
Treatment
Early detection is key in RSD treatment. The earlier you’re able to catch it, the better your treatment will work. Some cases of RSD don’t respond to treatment. RSD doesn’t have a cure, but it’s possible to recover from many of the symptoms.
Some of the medications your doctor may suggest include:
Anesthetic creams like lidocaine
Antidepressants
Anti-inflammatory drugs, called NSAIDs
Anti-seizure medications that may help treat pain
Nasal spray that treats bone loss
Nerve blocking injections
Over-the-counter options like aspirin, ibuprofen, or naproxen for pain
Electrodes on your spinal cord that send small electric shocks to relieve pain
Physical therapy to help you move around more easily and take away pain
Psychotherapy that can teach you relaxation methods
Splints to help with hand pain
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Postherpetic neuralgia is a painful condition that affects your nerves and skin. It’s a complication of herpes zoster, commonly called shingles.
Shingles is a painful, blistering skin rash caused by a reactivation of the varicella-zoster virus.
People usually contract this virus in childhood or adolescence as chickenpox. The virus can remain dormant in the body’s nerve cells after childhood and reactivate decades later.
When the pain caused by shingles doesn’t go away after the rash and blisters clear up, the condition is called postherpetic neuralgia.
Postherpetic neuralgia is the most common shingles complication. It occurs when a shingles outbreak damages the nerves.
The damaged nerves can’t send messages from the skin to the brain, and the messages become confused. This results in chronic, severe pain that can last for months.
According to a 2017 review, about 20 percent of people who get shingles also develop postherpetic neuralgia. Additionally, this condition is more likely to occur in people over the age of 50.
What are the symptoms of postherpetic neuralgia?
Shingles typically causes a painful, blistering rash. Postherpetic neuralgia is a complication that only occurs in people who have already had shingles.
Common signs and symptoms of postherpetic neuralgia include:
severe pain that continues for more than 1 to 3 months in the same place that the shingles occurred, even after the rash goes away
What are the risk factors for postherpetic neuralgia?
Age is a major risk factor for getting both shingles and postherpetic neuralgia. Risk begins to increase at age 50 and rises exponentially the older you get.
People who have acute pain and severe rash during shingles also have a higher risk for developing postherpetic neuralgia.
People with lowered immunity due to conditions like HIV or Hodgkin’s lymphoma have an increased risk for developing shingles. The risk of shingles is 20 to 100 greater in this group.
How is postherpetic neuralgia diagnosed and treated?
Most of the time, your doctor is able to make a diagnosis of postherpetic neuralgia based on how long you’ve experienced pain following shingles. Tests are unnecessary in confirming a diagnosis.
Two doses of a herpes zoster vaccine called Shingrix reduce the risk of shingles by more than 90 percentTrusted Source. The vaccine also protects against postherpetic neuralgia.
The Centers for Disease Control and Prevention (CDC)Trusted Source recommends healthy people ages 50 and up get the Shingrix vaccine.
Postherpetic neuralgia is treatable and preventable. Most cases disappear in 1 to 2 months. In rare cases, it can last longer than a year.
If you’re older than 50, it’s wise to get vaccinated against shingles and postherpetic neuralgia.
If you do develop postherpetic neuralgia, you have many treatment options to manage the pain. Talk with your doctor to find the best treatment for you.
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Mayo Clinic researchers test scrambler therapy for pain
Scrambler therapy is a pain management approach that uses a machine to block the transmission of pain signals by providing non-pain information to nerve fibers that have been receiving pain messages.
The first study on scrambler therapy was published in 2003 by a team of researchers led by Giuseppe Marineo, professor in delta research and development at University of Rome Tor Vergata in Italy. He and colleagues reported that scrambler therapy was effective at reducing pain symptoms in patients with severe, drug-resistant pain from terminal cancer.
Charles L. Loprinzi
The Calmare scrambler therapy device has since received FDA clearance in the United States for use in patients experiencing pain from cancer and chemotherapy, pain as a result of chronic diseases such as diabetes, multiple sclerosis and arthritis, back and neck pain, failed back surgery syndrome, and phantom limb pain among others.
HemOnc Today asked Charles L. Loprinzi, MD, Regis professor of breast cancer research at Mayo Clinic in Rochester, Minnesota, about the safety and efficacy of scrambler therapy, as well as his ongoing research efforts.
Question: Can you describe scrambler therapy and how it came about?
Answer: Scrambler therapy is an electro-cutaneous treatment. Although people may think of it as being similar to transcutaneous electrical nerve stimulation (TENS) therapy, scrambler therapy is felt to work through a different mechanism. TENS is thought to work through the gateway theory of pain relief, whereby normal touch sensations blocks pain sensations. Scrambler therapy, on the other hand, is proposed to provide normal-self, non-pain electrical information via nerves that have been transmitting chronic pain information. Through a process termed plasticity, this is able to retrain the brain so that it does not ascribe pain to the chronic pain area. Scrambler therapy consists of a machine, which looks somewhat like an electrocardiogram machine. Leads are placed on patients, around the areas of chronic pain. Scrambled electrical signals are then sent to the brain that perceives them as normal, non-pain signals. Via this process, the brain is retrained to think that there really is not pain in the area that is being treated.
Q: How and when did you become involved with this treatment approach?
A: I was introduced to scrambler therapy in 2010 by Thomas J. Smith, MD, now at Johns Hopkins University, who had heard about scrambler therapy and decided to try it in patients with chemotherapy-induced peripheral neuropathy (CIPN). He subsequently published a pilot trial that supported that scrambler therapy was an effective approach for treating established CIPN. After some internal debate as to whether I should look further into this treatment approach, which sounded quite strange to me, I did agree to study it. Having now treated more than 200 patients at Mayo, we published a paper on the use of this treatment for chemotherapy neuropathy, which concurred with Dr. Smith’s report, further supporting that this therapy was helpful for CIPN.
Q: What other published data support the value of scrambler therapy?
A: I am aware of 19 published reports regarding scrambler therapy, involving more than 800 patients. Seventeen of these are published manuscripts, whereas two are only published as meeting abstracts. These reports include clinical practice summaries, prospective non-randomized clinical trials and randomized controlled trials, including two trials that sought to double blind patients and investigators. The authors of 18 of the 19 reports concluded that scrambler therapy was a beneficial treatment approach, whereas one report — published only as a meeting abstract and only involving 14 patients — concluded that this was not an effective treatment. Of note, one relatively large randomized trial, with a non-blinded control arm consisting of optimizing medical management of pain, reported substantially more benefit from scrambler therapy than was observed in the control arm. Additionally, a relatively small placebo-controlled, patient-blinded trial reported a statistically significantly beneficial effect for scrambler therapy in a small number of patients with chronic low back pain. Thus, there are substantial data that support the value of scrambler therapy. Having said this, I readily admit that scrambler therapy has not yet been clearly proven to be beneficial. Ideally, additional randomized clinical trials will be reported to provide for more substantial clinical data regarding the true value of scrambler therapy. Dr. Smith is conducting one trial at Johns Hopkins and we, at Mayo, are gearing up for another one. This all takes time, energy and funds.
Q: Can you briefly discuss the findings from the clinical study you reported regarding the use of scrambler therapy in patients with established CIPN?
A: When we received the scrambler therapy machine, we decided to treat patients on a clinical trial as opposed to just using it for routine clinical practice. For this, we developed an open-label clinical trial to document our results and to learn how to provide this therapy. Prior to treating patients on this trial, we went to Rome for training. We then treated patients on this clinical trial, who had chronic pain or neuropathy with a pain and/or tingling score of at least 4 out of 10. In order to report data on a series of these patients, we took the first 37 patients who entered on this clinical trial who had CIPN as their designated clinical problem. We prospectively collected patient-reported outcome data on each of 10 days of treatment and then weekly for 10 weeks following that. Results, reported in Supportive Care in Cancer, illustrated that, during the treatment days, there was approximately a 50% reduction from baseline for pain, tingling and numbness scores. When we then followed the patients weekly, after the 10 days of therapy, the benefit, on the whole, persisted.
Q: Can you describe the treatment process and when beneficial results appear?
A: The area of pain/neuropathy is first defined and a set of leads is placed in normal sensation skin sites, close to the area of pain/neuropathy. The electrodes are then turned on with a gradual increase in intensity to a point where the patient is able to feel sensations, short of pain. When successful, the patient reports that the buzzing sensation has replaced an area of pain/neuropathy. This generally occurs within a minute or two. At times, electrodes need to be moved to obtain this sort of success. Sometimes, several sets of electrodes are needed to cover the area of discomfort. The scrambler machine stays on for about 30 minutes following successful electrode placements. The electricity is then turned off and the patient commonly reports that the pain/tingling is still markedly improved. After one treatment, the benefit is often relatively short-lived, lasting for minutes to hours. With repetitive days of treatment (standardly up to 10 treatments, although stopped earlier if the problem goes away completely and lasts overnight), the period of benefit increases until it lasts for a couple days. The benefit largely persists for weeks to months. Some patients relapse and can be successfully retreated, oftentimes only needing an additional few doses.
Q: Is this therapy routinely offered at Mayo Clinic?
A: Mayo recently began offering scrambler therapy as part of clinical practice. As with many new practice approaches, there are many questions that arise: How effective is the therapy? Who should be treated and for which conditions? How well is this approach covered by different insurance carriers? Admittedly, we do not have ideal answers for these and many other questions, but we are cautiously proceeding forward. There is considerable demand for scrambler therapy along with concerns that efficacy has not been proven and that the reported results from it sound too good to be true. But, these concerns are not too surprising, as there is often a wariness when a new therapy is initiated.
Q: Is this therapy routinely offered at places other than Mayo Clinic?
A: Yes, it is available at other select places. I understand there are more than 30 institutions in Italy and even more institutions in South Korea that provide scrambler therapy as a part of clinical practice. Multiple United States military institutions also offer scrambler therapy. In the United States, I estimate that there are between 15 and 30 sites that are actively offering this treatment. It should be noted that there is a learning curve in terms of making this therapy work. For example, in our paper where we looked at CIPN, even though we had reasonably good experience which included visiting the inventor in Rome and being trained by him, we did a whole lot better with the later patients we treated than we did the first 25% we treated.
Q: What type of feedback have you received on the therapy?
A: There are patient testimonials, which can be found on the Internet, whereby patients swear by this therapy. In line with this, I have seen some phenomenal results in patients. We have clinical trial data that asked patients, daily while they were receiving 2 weeks of outpatient therapy and then weekly for 10 weeks of follow-up, whether they would recommend this treatment to others. Approximately 80% of the replies noted that they would recommend it, 1% said that they would not and the rest said that they were unsure. There, admittedly, are some people who say this therapy did not work for them.
Q: How much of an issue is cost?
A: There are the issues regarding the cost of the machine, the cost of training and whether insurance companies cover this therapy. There are some insurance companies that cover the therapy, having realized that it is a lot cheaper than alternative therapies that might be employed for the same patient problem. This is certainly an evolving process. The cost can run anywhere between $200 and $500 per session, and up to 10 sessions may be recommended. This is less expensive than some other procedures and therapies employed for chronic pain, such as spinal cord stimulators. There are some patients who choose to pay for the treatments on their own, if not covered by insurance.
Q: Are there any side effects associated with this therapy? Do they outweigh the benefit, in your opinion?
A: There have not been many documented side effects with this therapy. People feel a buzzing sensation when the machine is working and sometimes this can be uncomfortable. If pain happens during the procedure, the signal intensity should be turned down and/or off. At times the electrode leads can be moved to an alternative site, sometimes by just a couple centimeters. Occasionally, patients may develop some skin irritation or bruising under the sites of the leads. There have been some patients who report more pain in the day or days following the treatment, but it is not apparent that this is more than the normal process of a waxing and waning of the baseline pain. Overall, the reports in the literature have been largely free of side effects.
Q: Is there anything else you would like to add?
A: Although if I consider myself to be a fairly conservative clinician and have not been shy about publishing negative results from many clinical trials, I do believe that scrambler therapy works. This contention is based on the knowledge that the majority of the reports in the literature are positive an also the personal experience I have observed in many patients, including seeing dramatic reductions of symptoms in some patients that did not derive similar benefit from previous treatment approaches. – by Jennifer Southal
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Trigeminal Neuralgia Trigeminal neuralgia (TN), also known as tic douloureux, is sometimes described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw. It usually is limited to one side of the face. The pain can be triggered by an action as routine and minor as brushing your teeth, eating or the wind. Attacks may begin mild and short, but if left untreated, trigeminal neuralgia can progressively worsen.
Although trigeminal neuralgia cannot always be cured, there are treatments available to alleviate the debilitating pain. Normally, anticonvulsive medications are the first treatment choice. Surgery can be an effective option for those who become unresponsive to medications or for those who suffer serious side effects from the medications.
The Trigeminal Nerve
The trigeminal nerve is one set of the cranial nerves in the head. It is the nerve responsible for providing sensation to the face. One trigeminal nerve runs to the right side of the head, while the other runs to the left. Each of these nerves has three distinct branches. “Trigeminal” derives from the Latin word “tria,” which means three, and “geminus,” which means twin. After the trigeminal nerve leaves the brain and travels inside the skull, it divides into three smaller branches, controlling sensations throughout the face:
Ophthalmic Nerve (V1): The first branch controls sensation in a person’s eye, upper eyelid and forehead.
Maxillary Nerve (V2): The second branch controls sensation in the lower eyelid, cheek, nostril, upper lip and upper gum.
Mandibular Nerve (V3): The third branch controls sensations in the jaw, lower lip, lower gum and some of the muscles used for chewing.
Prevalence and Incidence
It is reported that 150,000 people are diagnosed with trigeminal neuralgia (TN) every year. While the disorder can occur at any age, it is most common in people over the age of 50. The National Institute of Neurological Disorders and Stroke (NINDS) notes that TN is twice as common in women than in men. A form of TN is associated with multiple sclerosis (MS).
Causes
There are two types of TN — primary and secondary. The exact cause of TN is still unknown, but the pain associated with it represents an irritation of the nerve. Primary trigeminal neuralgia has been linked to the compression of the nerve, typically in the base of the head where the brain meets the spinal cord. This is usually due to contact between a healthy artery or vein and the trigeminal nerve at the base of the brain. This places pressure on the nerve as it enters the brain and causes the nerve to misfire. Secondary TN is caused by pressure on the nerve from a tumor, MS, a cyst, facial injury or another medical condition that damages the myelin sheaths.
Symptoms
Most patients report that their pain begins spontaneously and seemingly out of nowhere. Other patients say their pain follows a car accident, a blow to the face or dental work. In the cases of dental work, it is more likely that the disorder was already developing and then caused the initial symptoms to be triggered. Pain often is first experienced along the upper or lower jaw, so many patients assume they have a dental abscess. Some patients see their dentists and actually have a root canal performed, which inevitably brings no relief. When the pain persists, patients realize the problem is not dental-related.
The pain of TN is defined as either type 1 (TN1) or type 2 (TN2). TN1 is characterized by intensely sharp, throbbing, sporadic, burning or shock-like pain around the eyes, lips, nose, jaw, forehead and scalp. TN1 can get worse resulting in more pain spells that last longer. TN2 pain often is present as a constant, burning, aching and may also have stabbing less intense than TN1.
TN tends to run in cycles. Patients often suffer long stretches of frequent attacks, followed by weeks, months or even years of little or no pain. The usual pattern, however, is for the attacks to intensify over time with shorter pain-free periods. Some patients suffer less than one attack a day, while others experience a dozen or more every hour. The pain typically begins with a sensation of electrical shocks that culminates in an excruciating stabbing pain within less than 20 seconds. The pain often leaves patients with uncontrollable facial twitching, which is why the disorder is also known as tic douloureux.
Pain can be focused in one spot or it can spread throughout the face. Typically, it is only on one side of the face; however, in rare occasions and sometimes when associated with multiple sclerosis, patients may feel pain in both sides of their face. Pain areas include the cheeks, jaw, teeth, gums, lips, eyes and forehead.
Attacks of TN may be triggered by the following:
Touching the skin lightly
Washing
Shaving
Brushing teeth
Blowing the nose
Drinking hot or cold beverages
Encountering a light breeze
Applying makeup
Smiling
Talking
The symptoms of several pain disorders are similar to those of trigeminal neuralgia. The most common mimicker of TN is trigeminal neuropathic pain (TNP). TNP results from an injury or damage to the trigeminal nerve. TNP pain is generally described as being constant, dull and burning. Attacks of sharp pain can also occur, commonly triggered by touch. Additional mimickers include:
Temporal tendinitis
Ernest syndrome (injury of the stylomandibular ligament
Occipital neuralgia
Cluster headaches/ migraines
Giant cell arteritis
Dental pain
Post-herpetic neuralgia
Glossopharyngeal neuralgia
Sinus infection
Ear infection
Temporomandibular joint syndrome (TMJ)
Diagnosis
TN can be very difficult to diagnose, because there are no specific diagnostic tests and symptoms are very similar to other facial pain disorders. Therefore, it is important to seek medical care when feeling unusual, sharp pain around the eyes, lips, nose, jaw, forehead and scalp, especially if you have not had dental or other facial surgery recently. The patient should begin by addressing the problem with their primary care physician. They may refer the patient to a specialist later.
Testing
Magnetic resonance imaging (MRI) can detect if a tumor or MS is affecting the trigeminal nerve. A high-resolution, thin-slice or three-dimensional MRI can reveal if there is compression caused by a blood vessel. Newer scanning techniques can show if a vessel is pressing on the nerve and may even show the degree of compression. Compression due to veins is not as easily identified on these scans. Tests can help rule out other causes of facial disorders. TN usually is diagnosed based on the description of the symptoms provided by the patient, detailed patient history and clinical evaluation. There are no specific diagnostic tests for TN, so physicians must rely heavily on symptoms and history. Physicians base their diagnosis on the type pain (sudden, quick and shock-like), the location of the pain and things that trigger the pain. Physical and neurological examinations may also be done in which the doctor will touch and examine parts of your face to better understand where the pain is located.
Treatment Non-Surgical Treatments
There are several effective ways to alleviate the pain, including a variety of medications. Medications are generally started at low doses and increased gradually based on patient’s response to the drug.
Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat TN. In the early stages of the disease, carbamazepine controls pain for most people. When a patient shows no relief from this medication, a physician has cause to doubt whether TN is present. However, the effectiveness of carbamazepine decreases over time. Possible side effects include dizziness, double vision, drowsiness and nausea.
Gabapentin, an anticonvulsant drug, which is most commonly used to treat epilepsy or migraines can also treat TN. Side effects of this drug are minor and include dizziness and/or drowsiness which go away on their own.
Oxcarbazepine, a newer medication, has been used more recently as the first line of treatment. It is structurally related to carbamazepine and may be preferred, because it generally has fewer side effects. Possible side effects include dizziness and double vision.
Other medications include: baclofen, amitriptyline, nortriptyline, pregabalin, phenytoin, valproic acid, clonazepam, sodium valporate, lamotrigine, topiramate, phenytoin and opioids.
There are drawbacks to these medications, other than side effects. Some patients may need relatively high doses to alleviate the pain, and the side effects can become more pronounced at higher doses. Anticonvulsant drugs may lose their effectiveness over time. Some patients may need a higher dose to reduce the pain or a second anticonvulsant, which can lead to adverse drug reactions. Many of these drugs can have a toxic effect on some patients, particularly people with a history of bone marrow suppression and kidney and liver toxicity. These patients must have their blood monitored to ensure their safety.
Surgery
If medications have proven ineffective in treating TN, several surgical procedures may help control the pain. Surgical treatment is divided into two categories: 1) open cranial surgery or 2) lesioning procedures. In general, open surgery is performed for patients found to have pressure on the trigeminal nerve from a nearby blood vessel, which can be diagnosed with imaging of the brain, such as a special MRI. This surgery is thought to take away the underlying problem causing the TN. In contrast, lesioning procedures include interventions that injure the trigeminal nerve on purpose, in order to prevent the nerve from delivering pain to the face. The effects of lesioning may be shorter lasting and in some keys may result in numbness to the face.
Open Surgery
Microvascular decompression involves microsurgical exposure of the trigeminal nerve root, identification of a blood vessel that may be compressing the nerve and gentle movement of the blood vessel away from the point of compression. Decompression may reduce sensitivity and allow the trigeminal nerve to recover and return to a more normal, pain-free condition. While this generally is the most effective surgery, it also is the most invasive, because it requires opening the skull through a craniotomy. There is a small risk of decreased hearing, facial weakness, facial numbness, double vision, stroke or death.
Lesioning Procedures
Percutaneous radiofrequency rhizotomy treats TN through the use of electrocoagulation (heat). It can relieve nerve pain by destroying the part of the nerve that causes pain and suppressing the pain signal to the brain. The surgeon passes a hollow needle through the cheek into the trigeminal nerve. A heating current, which is passed through an electrode, destroys some of the nerve fibers.
Percutaneous balloon compression utilizes a needle that is passed through the cheek to the trigeminal nerve. The neurosurgeon places a balloon in the trigeminal nerve through a catheter. The balloon is inflated where fibers produce pain. The balloon compresses the nerve, injuring the pain-causing fibers, and is then removed.
Percutaneous glycerol rhizotomy utilizes glycerol injected through a needle into the area where the nerve divides into three main branches. The goal is to damage the nerve selectively in order to interfere with the transmission of the pain signals to the brain.
Stereotactic radiosurgery (through such procedures as Gamma Knife, Cyberknife, Linear Accelerator (LINAC) delivers a single highly concentrated dose of ionizing radiation to a small, precise target at the trigeminal nerve root. This treatment is noninvasive and avoids many of the risks and complications of open surgery and other treatments. Over a period of time and as a result of radiation exposure, the slow formation of a lesion in the nerve interrupts transmission of pain signals to the brain.
Overall, the benefits of surgery or lesioning techniques should always be weighed carefully against its risks. Although a large percentage of TN patients report pain relief after procedures, there is no guarantee that they will help every individual.
Neuromodulation
For patients with TNP, another surgical procedure can be done that includes placement of one or more electrodes in the soft tissue near the nerves, under the skull on the covering of the brain and sometimes deeper into the brain, to deliver electrical stimulation to the part of the brain responsible for sensation of the face. In peripheral nerve stimulation, the leads are placed under the skin on branches of the trigeminal nerve. In motor cortex stimulation (MCS), the area which innervates the face is stimulated. In deep brain stimulation (DBS), regions that affect sensation pathways to the face may be stimulated.
How to Prepare for a Neurosurgical Appointment
Write down symptoms. This should include: What the pain feels like (for example, is it sharp, shooting, aching, burning or other), where exactly the pain is located (lower jaw, cheek, eye/forehead), if it is accompanied by other symptoms (headache, numbness, facial spasms), duration of pain (weeks, months, years), pain-free intervals (longest period of time without pain or in between episodes), severity of pain (0=no pain, 10=worst pain)
Note any triggers of pain (e.g. brushing teeth, touching face, cold air)
Make a list of medications and surgeries related to the face pain (prior medications, did they work, were there side effects), current medications (duration and dose)
Write down questions in advance
Understand that the diagnosis and treatment process for TN is not simple. Having realistic expectations can greatly improve overall outcomes.
Follow-up
Patients should follow-up with their primary care providers and specialists regularly to maintain their treatment. Typically, neuromodulation surgical patients are asked to return to the clinic every few months in the year following the surgery. During these visits, they may adjust the stimulation settings and assess the patient’s recovery from surgery. Routinely following-up with a doctor ensures that the care is correct and effective. Patients who undergo any form of neurostimulation surgery will also follow-up with a device representative who will adjust the device settings and parameters as needed alongside their doctors.
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After any spine surgery, a percentage of patients may still experience pain. This is called failed back or failed fusion syndrome, which is characterized by intractable pain and an inability to return to normal activities. Surgery may be able to fix the condition but not eliminate the pain.
Symptoms
The main symptom is pain following back surgery. Additionally, the patient’s ability to complete activities of daily living may be altered.
Causes and Risk Factors
Smoking
Formation of scar tissue
Recurring or persistent disc disease at adjacent levels
Continued pressure from spinal stenosis
Instability or abnormal movement
Pseudoarthrosis or failure of the fusion
Nerve damage within the nerve, arachnoiditis
Diagnosis
A diagnosis will be based on the patient’s symptoms and medical history.
Additional tests that may be useful include:
Magnetic resonance imaging (MRI)
Computed tomography (CT scans)
Treatment
Treatment of these conditions, once they have occurred, will vary depending on the nature of the condition and what caused prior surgery to fail.
Some patients fail to improve even after the best surgical intervention. In spite of careful diagnosis and a successful operation, patients may continue to experience pain or limitations in performing daily activities. This continuation of symptoms is known as “failed back syndrome.” A spinal fusion occurs after the surgeon creates the conditions for the bones of the spine to unite into an immobile block. The union of the fusion mass occurs over time. When the time for healing is extended or the fusion fails to unite, this is a called a “failed fusion” or pseudoarthrosis.
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Nerves in the leg may become inflamed, compressed, or degenerated as a result of mechanical or chemical irritants. Nerves may also become damaged due to associated conditions such as diabetes or nutritional deficiencies. Depending on the cause of nerve damage, the specific leg symptoms may differ.
Nerve pain is typically described as sharp, shooting, electric-like, or searing pain. It may also produce a sensation of hot or warm water running down the thigh and/or leg. In some individuals, a dull ache may occur. The pain may be intermittent or constant.
The most common types of nerve pain in the leg are described below.
Sciatica is radicular nerve pain that occurs when the sciatic nerve roots in the lower back are irritated or compressed.
Radiculopathy
The medical term for leg pain that originates from a problem in the nerve roots of the lumbar and/or sacral spine is radiculopathy (the lay term is sciatica). This pain may be caused when the nerve roots are inflamed, irritated, or compressed. The characteristics of this pain depend on the specific nerve root(s) affected.
Research indicates 95% of radiculopathy in the lumbosacral spine occurs at the L4-L5 and L5-S1 levels. The pain from these nerve roots is characterized by:
Pain that originates in the lower back or buttock and travels down the thigh, calf, and foot.
Numbness in the calf, foot, and/or toes.
Weakness in the hip, thigh, and/or foot muscles.
Depending on the individual, additional sensations may occur, such as a feeling of pins-and-needles in the leg, warm water running down the thigh, or the foot immersed in hot water. Radiculopathy typically affects one leg.
Peripheral Neuropathy
Damage to one or more nerves in the peripheral nervous system (outside the brain and spinal cord) is called peripheral neuropathy. This form of neuropathy in the leg most commonly occurs due to diabetes.
Pain that originates in the toes and gradually spreads toward the knee (also called stocking-glove pattern; the action of putting on a stocking)
Numbness in the legs and feet
Weakness in the toes and ankles during the later stages of the condition
Peripheral neuropathy pain typically affects both legs.
Lumbosacral Radiculoplexus Neuropathy
This condition occurs due to inflammation of small blood vessels in the legs leading to reduced blood supply to the nerves, resulting in nerve damage. This condition is commonly seen in diabetic individuals and may also be caused by other issues. Common symptoms include:
Pain that usually begins in a specific location, such as the buttock, hip, thigh, leg, or foot and gradually spreads to other areas of the leg
Numbness and a prickling feeling in the affected areas
Weakness in the leg muscles
Loss of balance, which may cause falls.
Typically, several nerves are affected together. The condition may develop in one leg and over time involve both legs.
Peroneal Neuropathy
Compression of the peroneal nerve near the knee may cause symptoms in the leg. Typical symptoms include:
Foot drop, characterized by the inability to lift the foot, or a catch in the toes while walking
Numbness along the side of the leg, the upper part of the foot, and/or the first toe web space
Pain is not a typical feature of this condition but may be present when peroneal neuropathy occurs as a result of trauma.
Meralgia Paresthetica
Compression of the lateral femoral cutaneous nerve in the thigh may cause a condition called meralgia paresthetica. Symptoms typically include:
Burning or achy pain in the outer side and/or front of the thigh
Coldness in the affected areas
Buzzing or vibrations (such as from a cell phone) in the thigh region
Meralgia paresthetica pain typically increases while standing or walking and alleviates while sitting.
Tarsal Tunnel Syndrome
Dysfunction of the tibial nerve due to nerve compression within the foot’s tarsal tunnel causes this syndrome. Common symptoms include:
Sharp, shooting pain in the inner ankle joint and along the sole of the foot
Numbness in the sole of the foot
Tingling and/or burning sensation in the foot
The symptoms typically worsen at night, with walking or standing, and/or after physical activity; and get better with rest.
Neurogenic Claudication
This type of leg pain occurs due to narrowing of the spinal canal (spinal stenosis) causing compression of the spinal cord. This compression may occur due to bone spurs (abnormal bone growth), lumbar disc herniation, or spondylolisthesis (forward slippage of a vertebra).
The symptoms of neurogenic claudication typically occur in both legs and include:
Pain and numbness while walking, standing, or performing upright exercises
Weakness during leg movements
Neurogenic claudication pain typically increases while bending the spine backward and decreases while bending forward at the waist, sitting, or lying down.
A qualified medical professional can help diagnose the exact cause of nerve pain in the leg based on the type of presenting symptoms, medical history, and by performing certain clinical tests.
Article Provided By: spine-helath.com If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com
