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Is Your Sciatica Coming From Your Spine or Your SI Joint?

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.

 

Sciatic anterior

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.

Sciatic posterior

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.

 

Article Provided By: SI-Bone.com

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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

 

 

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Four Types of Sciatic Nerve Pain

Four Types of Sciatic Nerve Pain

By April Mayer
Last Updated On January 25th, 2021

 

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

Sciatic Nerve Pain

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.

 

Article Provided By: amerisleep

Photo by Joseph Chan on Unsplash
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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

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What Is Reflex Sympathetic Dystrophy Syndrome?

What Is Reflex Sympathetic Dystrophy Syndrome?

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.

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.

  • 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:

  • Aching
  • Burning
  • Cold
  • Deep
  • Throbbing

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.

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.

  • 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

Other ways to treat symptoms include:

  • 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

 

 

Article Provided By: webmd
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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

 

 

 

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What You Should Know About Neuropathic Pain

What You Should Know About Neuropathic Pain

Neuropathic pain is a pain condition that’s usually chronic. It’s usually caused by chronic, progressive nerve disease, and it can also occur as the result of injury or infection.
If you have chronic neuropathic pain, it can flare up at any time without an obvious pain-inducing event or factor. Acute neuropathic pain, while uncommon, can occur as well.
Typically, non-neuropathic pain (nociceptive pain) is due to an injury or illness. For example, if you drop a heavy book on your foot, your nervous system sends signals of pain immediately after the book hits.
With neuropathic pain, the pain isn’t typically triggered by an event or injury. Instead, the body just sends pain signals to your brain unprompted.
People with this pain condition may experience shooting, burning pain. The pain may be constant, or may occur intermittently. A feeling of numbness or a loss of sensation is common, too.
Neuropathic pain tends to get worse over time.
About 1 in 3 Americans experience chronic pain. Of those, 1 in 5 experience neuropathic pain.
A 2014 study estimated that as many as 10 percent of Americans experience some form of neuropathic pain.
Understanding the possible causes can help you find better treatments and ways to prevent the pain from getting worse over time.
What causes neuropathic pain?
The most common causes for neuropathic pain can be divided into four main categories: disease, injury, infection, and loss of limb.
Disease
Neuropathic pain can be a symptom or complication of several diseases and conditions. These include multiple sclerosis, multiple myeloma, and other types of cancer.
Not everyone with these conditions will experience neuropathic pain, but it can be an issue for some.
Diabetes is responsible for 30 percent of neuropathic cases, according to the Cleveland Clinic. Chronic diabetes can impact how your nerves work.
People with diabetes commonly experience loss of feeling and numbness, following by pain, burning, and stinging, in their limbs and digits.
Long-term excessive alcohol intake can cause many complications, including chronic neuropathic pain. Damage to nerves from chronic alcohol use can have long-lasting and painful effects.
Trigeminal neuralgia is a painful condition with severe neuropathic pain of one side of the face. It’s one of the more common types of neuropathic pain and it can occur without a known reason.
Lastly, cancer treatment may cause neuropathic pain. Chemotherapy and radiation can both impact the nervous system and cause unusual pain signals.
Injuries
Injuries to tissue, muscles, or joints are an uncommon cause of neuropathic pain. Likewise, back, leg, and hip problems or injuries can cause lasting damage to nerves.
While the injury may heal, the damage to the nervous system may not. As a result, you may experience persistent pain for many years after the accident.
Accidents or injuries that affect the spine can cause neuropathic pain, too. Herniated discs and spinal cord compression can damage the nerve fibers around your spine.
Infection
Infections rarely cause neuropathic pain.
Shingles, which is caused by reactivation of the chicken pox virus, can trigger several weeks of neuropathic pain along a nerve. Postherpetic neuralgia is a rare complication of shingles, involving persistent neuropathic pain.
A syphilis infection can also lead to the burning, stinging unexplained pain. People with HIV may experience this unexplained pain.
Limb loss
An uncommon form of neuropathic pain called phantom limb syndrome can occur when an arm or leg has been amputated. Despite the loss of that limb, your brain still thinks it’s receiving pain signals from the removed body part.
What’s actually happening, however, is that the nerves near the amputation are misfiring and sending faulty signals to your brain.
In addition to arms or legs, phantom pain may be felt in the fingers, toes, penis, ears, and other body parts.
Other causes
Other causes of neuropathic pain include:
vitamin B deficiency
carpal tunnel syndrome
thyroid problems
facial nerve problems
arthritis in the spine

What are the symptoms?
Each person’s symptoms of neuropathic pain may vary slightly, but these symptoms are common:
shooting, burning, or stabbing pain
tingling and numbness, or a “pins and needles” feeling
spontaneous pain, or pain that occurs without a trigger
evoked pain, or pain that’s caused by events that are typically not painful — such as rubbing against something, being in cold temperatures, or brushing your hair
a chronic sensation of feeling unpleasant or abnormal
difficulty sleeping or resting
emotional problems as a result of chronic pain, loss of sleep, and difficulty expressing how you’re feeling

How’s it treated?
A goal of neuropathic pain treatment is to identify the underlying disease or condition that’s responsible for the pain, and treat it, if possible.
An important goal is that your doctor will aim to provide pain relief, help you maintain typical capabilities despite the pain, and improve your quality of life.
The most common treatments for neuropathic pain include:
Over-the-counter pain medication
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve and Motrin, are sometimes used to treat neuropathic pain.
However, many people find these medicines aren’t effective for neuropathic pain because they don’t target the source of the pain.
Prescription medication
Opioid pain medications don’t usually reduce neuropathic pain as well as they reduce other types of pain. Plus, doctors may hesitate to prescribe them for fear that a person may become dependent.
Topical pain relievers can be used, too. These include lidocaine patches, capsaicin patches, and prescription-strength ointments and creams.
Antidepressant drugs
Antidepressant medications have shown great promise in treating symptoms of neuropathic pain.
Two common types of antidepressant drugs are prescribed to people with this condition:
tricyclic antidepressants
serotonin-norepinephrine reuptake inhibitors
These may treat both the pain and symptoms of depression or anxiety caused by chronic pain.
Anticonvulsants
Anti-seizure medications and anticonvulsants are often used to treat neuropathic pain. Gabapentinoids are most commonly prescribed for neuropathic pain.
It’s not clear why anti-seizure drugs work for this condition, but researchers believe the medications interfere with pain signals and stop faulty transmissions.
Nerve blocks
Your doctor may inject steroids, local anesthetics, or other pain medications into the nerves that are thought to be responsible for the wayward pain signals. These blocks are temporary, so they must be repeated in order to keep working.
Implantable device
This invasive procedure requires a surgeon to implant a device in your body. Some devices are used in the brain and some are used in the spine.
Once a device is in place, it can send electrical impulses into the brain, spinal cord, or nerves. The impulses may stop the irregular nerve signals and control symptoms.
These devices are typically used only in individuals who haven’t responded well to other treatment options.
Lifestyle treatments
Physical, relaxation, and massage therapies are all used to relieve symptoms of neuropathic pain. These forms of treatment can help ease muscles.
Your healthcare provider can also teach you ways to cope with your pain.
For example, some people with neuropathic pain may experience increased symptoms after sitting for several hours. This might make desk jobs difficult to perform.
A physical therapist or occupational therapist can teach you techniques for sitting, stretching, standing, and moving to prevent pain.

 

How can this pain be managed?
If your doctor is able to identify an underlying cause for the neuropathic pain, treating it may reduce and even eliminate the pain.
For example, diabetes is a common cause of neuropathic pain. Proper diabetes care — which includes a healthy diet and regular exercise — may eliminate or reduce neuropathic pain.
Taking care of blood sugar levels can also prevent worsening pain and numbness.
Multimodal therapy
A multipronged approach can be an effective way to manage the condition.
A combination of medications, physical therapy, psychological treatment, and even surgery or implants may be used to bring about the best results.

Outlook
Neuropathic pain can negatively impact your life if you don’t take steps to treat it and prevent worsening symptoms.
Over time, this can lead to serious disability and complications, including depression, problems sleeping, anxiety, and more.
Fortunately, researchers are learning more about why this condition develops and what can be done to effectively treat it. That’s leading to better treatment options.
Finding the correct treatment options for you can take time, but you and your doctor can work together to find relief from the symptoms of this painful condition.

Article Provided By: healthline
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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

 

 

 

 

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Causalgia

Complex Regional Pain Syndrome Type II (Causalgia)

What is causalgia?
Causalgia is technically known as complex regional pain syndrome type II (CRPS II). It’s a neurological disorder that can produce long-lasting, intense pain.
CRPS II arises after an injury or trauma to a peripheral nerve. Peripheral nerves run from your spine and brain to your extremities. The most common site of CRPS II pain is in what’s called the “brachial plexus.” This is the bunch of nerves that run from your neck to your arm. CRPS II is rare, affecting slightly fewer than 1 person out of 100,000
.
Symptoms of causalgia
Unlike CRPS I (formerly known as reflexive sympathetic dystrophy), CRPS II pain is generally localized to the area around the injured nerve. If the injury occurred to a nerve in your leg, for example, then pain settles in your leg. Conversely, with CRPS I, which doesn’t involve an apparent nerve injury, pain from a hurt finger can radiate throughout your body.
CRPS II can occur wherever there’s a peripheral nerve injury. Peripheral nerves run from your spine to your extremities, which means CRPS II is usually found in your:
arms
legs
hands
feet
Regardless of what peripheral nerve is injured, symptoms of CRPS II tend to remain the same and include:
burning, aching, excruciating pain that lasts six months or longer and seems disproportionate to the injury that brought it on
pins and needles sensation
hypersensitivity around the area of injury, in which being touched or even wearing clothes can trigger sensitivity
swelling or stiffness of the affected limb
abnormal sweating around the injured site
skin color or temperature changes around the injured area, such as skin that looks pale and feels cold and then red and warm and back again

Causes of causalgia
At the root of CRPS II is peripheral nerve injury. That injury can result from a fracture, sprain, or surgery. In fact, according to one investigation, 1.8 percent
of nearly 400 elective foot and ankle surgery patients developed CRPS II after surgery. Other causes of CRPS II include:
soft-tissue trauma, such as a burn
crushing injury, such as slamming your finger in a car door
amputation
However, it’s still unknown why some people respond so dramatically to these events and others don’t.
It’s possible that people with CRPS (either I or II) have abnormalities in the linings of their nerve fibers, making them hypersensitive to pain signals. These abnormalities can also initiate an inflammatory response and induce changes to blood vessels. This is why so many people with CRPS II can have swelling and skin discoloration at the site of the injury.

How causalgia is diagnosed
There is no one test that can definitively diagnose CRPS II. Your doctor will perform a physical exam, record your medical history, and then order tests that may include:
an X-ray to check for broken bones and loss of bone minerals
an MRI to look at soft tissues
thermography to test skin temperature and blood flow between injured and noninjured limbs
Once other more common conditions such as fibromyalgia are eliminated, your doctor can make a CRPS II diagnosis more confidently.

Treatment options for causalgia
CRPS II treatment generally consists of medications and certain types of physical and nerve-stimulating therapies.
If over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil) aren’t providing relief, your doctor may prescribe stronger drugs. These can include:
steroids to reduce inflammation
certain antidepressants and anticonvulsants, such as Neurontin, that have pain-relieving effects
nerve blocks, which involve injecting an anesthetic directly into the affected nerve
opioids and pumps that inject drugs directly into your spine to block pain signals from nerves
Physical therapy, used to sustain or improve range of motion in painful limbs, is also often used. Your physical therapist may also try what’s called transcutaneous electrical nerve stimulation (TENS), which sends electrical impulses through fibers in your body to block pain signals. In research studying people with CRPS I, those receiving TENS therapy reported more pain relief than those not receiving it. Battery-operated TENS machines are available for at-home use.
Some people have found that heat therapy — using a heating pad periodically throughout the day — can also help. Here’s how you can make your own heating pad.

The outlook
Whenever you experience prolonged pain that interferes with your life and isn’t relieved by over-the-counter medications, you should see your doctor.
CRPS II is a complex syndrome that may need a variety of specialists to treat it. These specialists may include experts in orthopedics, pain management, and even psychiatry, as chronic pain can take a toll on your mental health.
While CRPS II is a serious condition, there are effective treatments. The sooner it’s diagnosed and treated, the better your chances are for a positive outcome.

Article Provided By: healthline
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Trigeminal Neuralgia

Trigeminal Neuralgia

Trigeminal Neuralgia
Trigeminal neuralgia is a condition characterized by pain coming from the trigeminal nerve, which affects the face — most commonly one side of the jaw or cheek.
The pain of trigeminal neuralgia is unlike facial pain caused by other problems. It is often described as stabbing, lancinating or electrical in sensation and so severe that the affected person cannot eat or drink.
Trigeminal neuralgia is sometimes known as tic douloureux, which means “painful tic.”

What You Need to Know
Trigeminal neuralgia most frequently affects people older than 50, and the condition is more common in women than men.
Trigeminal neuralgia is the most common cause of facial pain and is diagnosed in approximately 15,000 people per year in the United States.
Trigeminal neuralgia pain is exceptionally severe. Although the condition is not life-threatening, the intensity of the pain can be debilitating.
Trigeminal neuralgia relief is possible: Medical and surgical treatments can bring the pain under control, especially when managed by an expert physician and surgeon.
Causes of Trigeminal Neuralgia
Trigeminal neuralgia may be caused by a blood vessel pressing against the trigeminal nerve. Over time, the pulse of an artery rubbing against the nerve can wear away the insulation, which is called myelin, leaving the nerve exposed and highly sensitive.
These symptoms can be similar to those caused by dental problems, and sometimes people with undiagnosed trigeminal neuralgia explore multiple dental procedures in an effort to control the pain.
Multiple sclerosis or rarely a tumor can cause trigeminal neuralgia. Researchers are exploring whether or not postherpetic neuralgia (caused by shingles) can be related to this condition.

Trigeminal Neuralgia Symptoms
Episodes of sharp, stabbing pain in the cheek or jaw that may feel like an electric shock
Pain episodes that may be triggered by anything touching the face or teeth, including shaving, applying makeup, brushing teeth, eating, drinking or talking — or even a light breeze
Periods of relief between episodes
Anxiety from the thought of the pain returning
A flare-up of trigeminal neuralgia may begin with tingling or numbness in the face. Pain occurs in intermittent bursts that last anywhere from a few seconds to two minutes, becoming more and more frequent until the pain is almost continuous.
Flare-ups may continue for a few weeks or months followed by a pain-free period that can last a year or more.
Trigeminal Neuralgia Diagnosis
Diagnosing trigeminal neuralgia involves a physical exam and a detailed medical history to rule out other causes of facial pain. The health care provider will ask what the pain is like, what seems to set it off and what makes it feel better or worse.
The provider may recommend imaging or laboratory tests to determine if the pain is caused by a tumor or blood vessel abnormality or by undiagnosed multiple sclerosis. Certain advanced MRI techniques may help the doctor see where a blood vessel is pressing against a branch of the trigeminal nerve.
Treatment for Trigeminal Neuralgia
Most common over-the-counter and prescription pain medicines don’t work for people with trigeminal neuralgia, but many modern treatments can reduce or eliminate the pain. The doctor may recommend one or more of these approaches:
Medications: Seizure drugs like carbamazepine, gabapentin or other agents can be helpful. It is important to work closely with a neurologist or primary care provider to monitor dosages and side effects.
Surgery: Several procedures can often help bring trigeminal neuralgia pain under control.
Rhizotomy
There are several kinds of rhizotomies, which are all outpatient procedures performed under general anesthesia in the operating room. The surgeon inserts a long needle through the cheek on the affected side and uses an electrical current or a chemical to deaden the pain fibers of the trigeminal nerve.
Stereotactic Radiosurgery
Stereotactic radiosurgery, sometimes known as CyberKnife treatment, is another outpatient procedure that involves a very concentrated and precise beam of radiation that is directed at the trigeminal nerve to relieve the pain.
Microvascular Decompression (MVD) Surgery
This procedure is currently regarded as the most long-lasting treatment for trigeminal neuralgia and may be suitable for people in good health who can tolerate surgery and general anesthesia and whose lifestyles can accommodate a recovery period of four to six weeks.
The surgeon makes an incision behind the ear and removes a small piece of the skull to gain access to the nerve and blood vessels. Then, the surgeon places a cushion of insulation around the blood vessel so it no longer compresses or rubs against the nerve.
In about one third of people treated with MVD surgeries, trigeminal neuralgia pain returns, possibly due to the blood vessels growing back. The doctor will help individuals with recurring pain choose other options or may recommend repeating procedures.
Managing Trigeminal Neuralgia
Although not fatal, trigeminal neuralgia pain and the anxiety it causes can erode a person’s quality of life. It is essential to work closely with experienced and compassionate health care providers who can help find the best therapeutic approach for each individual.
The surgery for trigeminal neuralgia is delicate and precise since the involved area is very small. Look for experienced neurosurgeons who see and treat a large number of people with trigeminal neuralgia.

 

Article Provided By: hopkinsmedicine
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Why Is Neuropathy Worse at Night?

January 3, 2020 / Brain & Spine
Why Is Neuropathy Worse at Night?
Reasons why nerve pain is more painful at night
Peripheral neuropathy is when a nerve or group of nerves outside of the brain and spinal cord is injured or dysfunctions. It could be because of an injury to a single nerve, like carpal tunnel syndrome, or because a group of nerves have become defective, like with peripheral neuropathy of the feet.
“Across the board we know that neuropathy can cause pain depending on what type of nerves are involved,” says neurologist Benjamin Claytor, MD. “When people describe worsening symptoms at night they’re describing discomfort – pins and needles, tingling and burning pain.”
Here Dr. Claytor discusses what might be causing this nightly pain and how to find relief.
Distraction
Our attention level can influence how we perceive pain. So during the day when we’re at work or taking care of the kids – we’re distracted and busy. Although there hasn’t been much research around it, the idea is that we aren’t focusing on the pain during the day because we’re busy, we pay less attention to it and perceive less pain.
“Many patients will tell me that after they get home from work, have dinner and sit down to watch TV for the night that their pain flares up,” says Dr. Claytor. “This could be because the daytime distractions are now gone and you’re starting to unwind for the night.”
Temperature and sleep
Another thought behind nightly neuropathy has to do with temperature. At night our body temperature fluctuates and goes down a bit. Most people tend to sleep in a cooler room as well. The thought is that damaged nerves might interpret the temperature change as pain or tingling, which can heighten the sense of neuropathy.
Also consider poor sleep quality. If you’re not sleeping very well to begin with, either due to poor sleep habits or sleep related disorders, this could lead to increased pain perception.
Emotions and stress
Our emotional state can also influence how we perceive pain. Stress and anxiety can feed in to and amplify pain signaling. Living in a chronic state of stress wreaks havoc on your physical and mental health.
Medication
Sometimes medication dosing and timing might need to be adjusted, which could be particularly true for some short acting medications used for neuropathy pain.
How to stop neuropathy pain at night
“There are options we can explore if your neuropathy pain seems to be worsening at night,” explains Dr. Claytor. “There might be oral or topical medications we can prescribe, or maybe it’s getting your stress under control and being more mindful.”
Cognitive behavioral therapy, physical therapy and meditation may be complementary tools to reduce pain as well.
Dr. Claytor stresses the importance of talking to your doctor sooner rather than later. Often time’s people will wait so long to see their physician that there’s permanent nerve damage that might have been avoided.
“I think one of the most important things I can discuss with a patient who comes in with neuropathy pain at night is getting to the root cause of what is actually driving it,” says Dr. Claytor. “Depending on what the underlying cause is, treating that first and foremost can usually help reduce the pain overall – especially at night.”

 

Article Provided By: health.clevelandclinic
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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

 

 

 

 

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Neuropathic Pain

Neuropathic Pain

What is neuropathic pain?
Neuropathic pain can result after damage or dysfunction of the nervous system. Pain can rise from any level of the nervous system. These levels are the peripheral nerves, spinal cord, and brain. Pain centers receive the wrong signals from the damaged nerve fibers. Nerve function may change at the site of the nerve damage, as well as areas in the central nervous system (central sensitization).
Neuropathy is a disturbance of function or a change in one or several nerves. About 30% of neuropathy cases is caused by diabetes. It is not always easy to tell the source of the neuropathic pain. There are hundreds of diseases that are linked to this kind of pain.
What are some of the sources of neuropathic pain?
Alcoholism
Amputation (results in phantom pain)
Chemotherapy drugs (Cisplatin®, Paclitaxel®, Vincristine®, etc.)
Radiation therapy
Complex regional pain syndrome
Diabetes
Facial nerve problems
HIV infection or AIDS
Shingles
Spinal nerve compression or inflammation
Trauma or surgeries with resulting nerve damage
Nerve compression or infiltration by tumors
Central nervous system disorders (stroke, Parkinson’s disease, multiple sclerosis, etc.)
What are the symptoms of neuropathic pain?
Many symptoms may be present in the case of neuropathic pain. These symptoms include:
Spontaneous pain (pain that comes without stimulation): Shooting, burning, stabbing, or electric shock-like pain; tingling, numbness, or a “pins and needles” feeling
Evoked pain: Pain brought on by normally non-painful stimuli such as cold, gentle brushing against the skin, pressure, etc. This is called allodynia. Evoked pain also may mean the increase of pain by normally painful stimuli such as pinpricks and heat. This type of pain is called hyperalgesia.
An unpleasant, abnormal sensation whether spontaneous or evoked (dysesthesia)
Trouble sleeping
Emotional problems due to disturbed sleep and pain
Pain that may be lessened in response to a normally painful stimulus (hypoalgesia)
Diagnosis and Tests
How is neuropathic pain diagnosed?
Your doctor will take a medical history and do a physical exam. Neuropathic pain is suggested by its typical symptoms when nerve injury is known or suspected. Your doctor will then try to find the underlying cause of the neuropathy and then trace the symptoms.
Management and Treatment
How is neuropathic pain treated?
The goals of treatment are to:
Treat the underlying disease (for example, radiation or surgery to shrink a tumor that is pressing on a nerve)
Provide pain relief
Maintain functionality
Improve quality of life
Multimodal therapy (including medicines, physical therapy, psychological treatment, and sometimes surgery) is usually required to treat neuropathic pain.
Medicines commonly prescribed for neuropathic pain include anti-seizure drugs such as Neurontin®, Lyrica®, Topamax®, Tegretol®, and Lamictal®. Doctors also prescribe antidepressants such as Elavil®, Pamelor®, Effexor®, and Cymbalta®. A doctor’s prescription for anti-seizure drugs or antidepressants does not mean you have seizures or are depressed.
A topical patch (Lidocaine® or Capsaicin®) or a cream or ointment can be used on the painful area. Opioid analgesics can provide some relief. However, they generally are less effective in treating neuropathic pain. Negative effects may prevent their long-term use.
The pain can also be treated with nerve blocks given by pain specialists, including injections of steroids, local anesthetics, or other medicines into the affected nerves.
Neuropathic pain that has not responded to the therapies mentioned above can be treated with spinal cord stimulation, peripheral nerve stimulation, and brain stimulation.
Outlook / Prognosis
What is the outlook for people with neuropathic pain?
Neuropathic pain is difficult to get rid of, but is not life-threatening. Without rehabilitation and sometimes psychosocial support, treatment has a limited chance of success. With help from a pain specialist using the multimodal approaches listed above, your neuropathic pain can be managed to a level that improves your quality of life.
© Copyright 1995-2020 The Cleveland Clinic Foundation. All rights reserved.

Article Provided By: clevelandclinic
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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

 

 

 

 

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Pudendal Neuralgia

What Is Pudendal Neuralgia?
Pudendal neuralgia is a condition that causes pain, discomfort, or numbness in your pelvis or genitals. It happens when a major nerve in the lower body is damaged or irritated, and it can make it hard to use the bathroom, have sex, or sit down. The pain comes and goes.
It’s not clear exactly how many people have this condition, but experts believe it’s rare.
The pudendal nerve runs from the back of the pelvis to near the base of your penis or vagina, where it branches off into other nerves.
It sends messages to the brain from your genitals, anus, and other nearby body parts. It controls the sphincter muscles that open and close when you use the bathroom.
Causes
There are several things that can damage your pudendal nerve.
It can happen when you’re injured, have surgery, or give birth. A tumor or an infection can squeeze or irritate it. And sometimes, certain types of exercise, like spending a lot of time on a bicycle, can cause the problem.
Symptoms
You usually feel pudendal neuralgia symptoms in your lower body, genitals, or perineum (the area between your genitals and anus). These may include:

A sharp or burning pain
More sensitivity
Numbness or a pins-and-needles feeling, like when your leg falls asleep
A swollen feeling
These feelings might be worse when you sit down. Or you may have symptoms on both sides of your body, and they might go into your belly, buttocks, or legs.
You also may have problems such as:
A sudden or frequent need to go to the bathroom
Trouble or pain during sex
For men, problems getting an erection

Diagnosis
If you have pelvic pain, tell your doctor. At your appointment, you’ll answer questions about your symptoms and get a physical examination. Your doctor will put a finger into your vagina or rectum and put pressure on the nerve to check on it.
You might also get an imaging test with an MRI machine. It uses powerful magnets and radio waves to take a picture of your body’s internal organs.
Your doctor may also give you a pudendal nerve block. This is a shot you get in your pelvis to numb the nerve and see if your symptoms go away.
Treatment
Most people with pudendal neuralgia get treatment with a combination of physical therapy, lifestyle changes, and medicines.
Sit up straight or stand more often to help with nerve pain. This can take pressure off the pudendal nerve.
Don’t do squats or cycle. Certain exercises can make pudendal neuralgia worse.
Go for physical therapy. It relaxes and stretches the muscles at the lower end of your pelvis, known as the pelvic floor. This can ease pressure that may irritate the pudendal nerve. If pudendal neuralgia makes it hard to control your bladder or bowels, physical therapy can help with that, too.
Try prescription medication. Muscle relaxants may help relieve symptoms of pudendal neuralgia. Drugs used to treat other conditions, like depression or epilepsy, might also help.
If these don’t work, your doctor may give you a shot of medications that numb the nerve or lower inflammation, which lessens pressure. These may take several weeks to fully take effect.
In rare cases, your doctor may recommend surgery to remove anything that presses on the nerve. You may also get a small electrical device put under your skin to stimulate the nerve and interrupt the pain signals it sends to the brain.
WebMD Medical Reference Reviewed by Tyler Wheeler, MD on January 27, 2020
Sources
SOURCES:
National Institutes of Health, Genetic and Rare Diseases Information Center: “Pudendal Neuralgia.”
Health Organization for Pudendal Education: “Anatomy of the pudendal nerve.”
Obstetrical and Gynecological Survey: “Diagnostic criteria for pudendal neuralgia by pudendal nerve entrapment (Nantes criteria).”
U.K. National Health Service: “Pudendal neuralgia.”
University of Rochester Medical Center: “Pudendal neuralgia,” “Pudendal nerve block.”
Women’s Health Research Institute of Australia: “Pudendal Neuralgia.”
© 2020 WebMD, LLC. All rights reserved.

Article Provided By: webmd
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Sciatica

Sciatica

Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.
Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that’s associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.

Symptoms
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it’s especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.
The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.
Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.
When to see a doctor
Mild sciatica usually goes away over time. Call your doctor if self-care measures fail to ease your symptoms or if your pain lasts longer than a week, is severe or becomes progressively worse. Get immediate medical care if:
You have sudden, severe pain in your low back or leg and numbness or muscle weakness in your leg
The pain follows a violent injury, such as a traffic accident
You have trouble controlling your bowels or bladder

Causes
Herniated disk
Bone spurs on spine
Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae. More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.

Risk factors
Risk factors for sciatica include:
Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.
Obesity. By increasing the stress on your spine, excess body weight can contribute to the spinal changes that trigger sciatica.
Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods might play a role in sciatica, but there’s no conclusive evidence of this link.
Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

Complications
Although most people recover fully from sciatica, often without treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you have:
Loss of feeling in the affected leg
Weakness in the affected leg
Loss of bowel or bladder function

Prevention
It’s not always possible to prevent sciatica, and the condition may recur. The following can play a key role in protecting your back:
Exercise regularly. To keep your back strong, pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. Ask your doctor to recommend specific activities.
Maintain proper posture when you sit. Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
Use good body mechanics. If you stand for long periods, rest one foot on a stool or small box from time to time. When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

Diagnosis
During the physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time. Pain that results from sciatica will usually worsen during these activities.

Imaging tests
Many people have herniated disks or bone spurs that will show up on X-rays and other imaging tests but have no symptoms. So doctors don’t typically order these tests unless your pain is severe, or it doesn’t improve within a few weeks.
X-ray. An X-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks. During the test, you lie on a table that moves into the MRI machine.
CT scan. When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
More Information
CT scan
MRI
X-ray

Treatment
If your pain doesn’t improve with self-care measures, your doctor might suggest some of the following treatments.
Medications
The types of drugs that might be prescribed for sciatica pain include:
Anti-inflammatories
Muscle relaxants
Narcotics
Tricyclic antidepressants
Anti-seizure medications
Physical therapy
Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility.
Steroid injections
In some cases, your doctor might recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently.
Surgery
This option is usually reserved for when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.

Lifestyle and home remedies
For most people, sciatica responds to self-care measures. Although resting for a day or so may provide some relief, prolonged inactivity will make your signs and symptoms worse.
Other self-care treatments that might help include:
Cold packs. Initially, you might get relief from a cold pack placed on the painful area for up to 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
Stretching. Stretching exercises for your low back can help you feel better and might help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch, and try to hold the stretch for at least 30 seconds.
Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica.
Alternative medicine
Alternative therapies commonly used for low back pain include:
Acupuncture. In acupuncture, the practitioner inserts hair-thin needles into your skin at specific points on your body. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.
Chiropractic. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation appears to be as effective and safe as standard treatments for low back pain, but might not be appropriate for radiating pain.

Preparing for your appointment
Not everyone who has sciatica needs medical care. If your symptoms are severe or persist for more than a month, though, make an appointment with your primary care doctor.
What you can do
Write down your symptoms and when they began.
List key medical information, including other conditions you have and the names of medications, vitamins or supplements you take.
Note recent accidents or injuries that might have damaged your back.
Take a family member or friend along, if possible. Someone who accompanies you can help you remember what your doctor tells you.
Write down questions to ask your doctor to make the most of your appointment time.
For radiating low back pain, some basic questions to ask your doctor include:
What’s the most likely cause of my back pain?
Are there other possible causes?
Do I need diagnostic tests?
What treatment do you recommend?
If you’re recommending medications, what are the possible side effects?
For how long will I need to take medication?
Am I a candidate for surgery? Why or why not?
Are there restrictions I need to follow?
What self-care measures should I take?
What can I do to prevent my symptoms from recurring?
Don’t hesitate to ask other questions.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
Do you have numbness or weakness in your legs?
Do certain body positions or activities make your pain better or worse?
How limiting is your pain?
Do you do heavy physical work?
Do you exercise regularly? If yes, with what types of activities?
What treatments or self-care measures have you tried? Has anything helped?

Article Provided By: Mayoclinic
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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

 

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