by Pain Doc | Nov 30, 2014 | Uncategorized
I am constantly looking for topics on pain and pain management to address on this blog for the benefit of my readers. When it comes to pain, numbness and other abnormal sensations, it understandably is a cause for concern, especially for cases where the diagnosis is not clear or certain.
I know that some of you have already seen your doctor, but are not satisfied with the answer you received. Maybe your doctor unintentionally trivialized your complaint, saying it would work itself out over time. But in your mind you did give it enough time, and it’s still there.
Or perhaps you are getting physical therapy, chiropractic, massage or acupuncture, but your symptoms remain. Be aware that pain appearing as musculoskeletal in origin (sprain, strain, arthritis, pinched nerve, fracture, muscle spasm, trigger point and so on) may actually be a sign of something more serious.
For example, I know of a woman who had gradual onset sciatica (nerve pain in the buttock going down the back of the leg). She had massages, chiropractic, acupuncture and physical therapy, but they did not resolve her pain. To make a long story short, she was diagnosed with a brain tumor that was pressing against the motor neurons in her brain that eventually formed the sciatic nerve. Luckily for her, her tumor was operable and her symptoms gradually cleared.
Remember, nerves start from and return to the brain, because that is where the perception of all sensations, not just pain, is processed. If there is a pathology in the brain, it may manifest as symptoms commonly associated with common muscle and nerve conditions.
A second patient I recall complained of a severe headache centered on the right side of her head. The headaches came on rather suddenly, and they were not of the migraine variety. I referred her for an MRI and it turned out that she had a cerebral aneurysm. Although the majority of headaches are not dangerous, it is still important to err on the side of caution if the headache is especially acute, doesn’t respond to medications and if you have a familial history of vascular disease.
Bone pathology/ injury can be a source of pain that may appear muscle/ligament in origin. This can include vertebral compression fractures, bone cysts and bone cancers like osteosarcoma. If you have pain somewhere in your back or believe you have “muscle” pain in an extremity long bone that does not respond at all to physical medicine (chiropractic, physical therapy, massage, stretches, ice/heat, ultrasound etc.) then it is prudent to have diagnostic tests performed to rule out any red flag conditions.
Advanced diagnostic tests for this purpose include:
X-rays, which can show the location, size, and shape of a bone tumor. If x-rays suggest that an abnormal area may be cancer, the doctor is likely to recommend special imaging tests. Even if x-rays suggest that an abnormal area is benign, the doctor may want to do further tests, especially if the patient is experiencing unusual or persistent pain.
A bone scan, which is a test in which a small amount of radioactive material is injected into a blood vessel and travels through the bloodstream; it then collects in the bones and is detected by a scanner.
A computed tomography (CT or CAT) scan, which is a series of detailed pictures of areas inside the body, taken from different angles, that are created by a computer linked to an x-ray machine.
A magnetic resonance imaging (MRI) procedure, which uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body without using x-rays.
A positron emission tomography (PET) scan, in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is used. Because cancer cells often use more glucose than normal cells, the pictures can be used to find cancer cells in the body. ~ National Cancer Institute
If you are seeing a physical medicine provider or alternative practitioner who insists you continue with their treatment despite not experiencing any appreciable results after a few sessions, see your doctor. If you feel like your primary care doctor’s treatment plan isn’t working, don’t be afraid to ask for a referral to a neurologist or orthopedic specialist. Express your concerns, and ask if any of these tests should be ordered to rule out potential, serious conditions.
by Pain Doc | Nov 19, 2014 | Uncategorized
Chronic pain affects more than 100 million American adults, according to the Institute of Medicine. That’s more than the total affected by heart disease, cancer and diabetes combined. A diagnosis of chronic pain spells trouble, as it implies that it cannot be cured– sort of like a perpetual, terminal illness. While chronic pain does not have the scary reputation of a terminal disease where one is told he has x-months left to live, it is nonetheless devastating to those who suffer from it; relentlessly sapping quality of life for years on end.
The conventional approach to chronic pain treatment is prescribing powerful drugs; i.e. opiod analgesics and non-steroidal anti-inflammatory medications (NSAIDs). But taking these powerful drugs comes at a price. For opiods, it’s addiction, nausea and constipation primarily; for NSAIDs, its gastrointestinal bleeding, increased heart attack risk and kidney damage.
But there is a school of thought that says what is really needed is a transformation in the way chronic pain is viewed.
A program at Mercy Hospital in Portland strives to do that by shifting chronic pain sufferers away from medication and toward behavioral therapy.
The Living Life Well Pain Rehabilitation program is a 12-week, group-based program that helps people learn to cope with chronic pain. Medical director Dr. Stephen Hull says it combines multiple strategies: behavioral therapy, medication management, and physical exercise. The goal at Living Life Well is less about reducing pain and more about helping people resume the activities that are important to them. Participants in the program see an average of about a 40 percent increase in function and a 20 percent improvement in pain.
According to Dr. Hull, when patients make a conscious effort to carry pain with them and move towards the people and things important to them, they actually do better. They have improved function and less pain– and it’s not clear which one enables the other. The pain becomes less of a directing force in their lives.
With pain, the natural tendency, encoded in our genes, is to stop doing the activity that causes it. This is a primitive protective mechanism, and is indeed one of the reasons we need pain. However, with chronic pain the damage has been done, and what people are dealing with is the residual effects of it. In other words, it’s like a perpetual fire alarm that continues to ring, despite the f ire being put out years ago, and all that is left is smoldering embers that are manageable.
So the strategy involves talking to patients and suggesting that they view their pain differently.
Joe Guarna, the program’s psychologist, spends hours in class teaching participants to stop interpreting their pain as a threat; that they can do many of the things they want– basically, make a strong, conscious effort to liberate themselves from their pain. When the patient embraces this and gives it her best effort, most of the time the results are positive. Call it psychosomatic, the power of mind over matter, or other nebulous phenomena of the human body, what matters most is that chronic pain patients get a part of their life back, without the help of powerful drugs that take away other parts of one’s life in exchange for pain relief, a trade more and more people are refusing to take.
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If you experience chronic pain, my suggestion is to talk to your doctor to see how much physical activity you can attempt without adding too much risk to aggravating your condition. You can also consider seeing a personal trainer at your local gym. Personal trainers have more hands-on training and intimate knowledge than most medical providers on the various ranges of motion of joints, muscle function, balance and strength, and they can evaluate your level of physical ability and recommend a customized program for you.
As always, cleansing the body’s tissues and organs is important in the battle against chronic pain. You want to do all that is within your power to give your body a fighting chance to heal and regenerate. Limit your diet to naturally occurring, organic food sources; eliminate overly processed food (which includes all wheat and grain-based food and added sugar and its derivatives); avoid environmental toxins in your environment (there are many!), get adequate rest, keep yourself busy, find a good cause, associate with positive people, and tell yourself you refuse to be hostage to your pain.
Lastly, Tai Chi, Qi Gong, yoga, conscious breathing exercises and meditation can be helpful in reducing the effects of chronic pain.
Dr. P
by Pain Doc | Jun 27, 2014 | Uncategorized
The underlying theme of this blog is that by making strategic changes in your daily routine, you can save yourself a lot of pain and dysfunction now and later on in your life. And it’s my desire to share with you some of these simple changes.
Isn’t this a simpler and smarter way to live, rather than being indifferent or oblivious to the fact that your body slowly loses its resiliency as you age, and not taking appropriate, protective measures? If you perform regularly scheduled maintenance to your car, it will last a lot longer than if you do not. The same goes for your body, but the stakes are a lot higher.
One Popular Reason Why People Develop Pain
The problem I see is that most people forget that when you are in your 20s and 30s you can get away with things like prolonged sitting, staying out late and eating unhealthy things like burgers and fries frequently. At that age your human growth hormone is still giving you that fountain of youth energy and your musculoskeletal system, especially your joints, is still in good working order.
However, through your 40s-60s, your job and/or family responsibilities increase and you have less time for yourself, and you think you can take the same abuse that you took in your earlier years. This is where problems start to manifest.
You see, health problems such as degenerative disc disease take years to develop. Take an x-ray or MRI of your neck or low back, 
and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.
So, you are either in a situation where you can do lifestyle modifications to reduce the chances of disorders like this from affecting your health and quality of life; or, you already have the disorder, but need to find ways to stop it from progressing and/or reduce its impact on your health and quality of life.
You see, as long as you are alive, your cells have the capacity to regenerate or transform. Depending on the current state of your health and therefore your body’s recuperative capacity, it could take a long time or a relatively shorter time to see results.
For example, if you are overweight; a smoker and drinker and have a negative impression of life, those serve as extra barriers to healing. Get rid of them, and you’ve got a better chance.
A Simple Exercise to Do Daily if You Sit a Lot
Back to those “lifestyle modification” tips that can help you avoid a life of pain.
Here is today’s example, an exercise called Wall Angels. If you find yourself having a slouched upper back, rounded lower back and forward lunging neck, you’ve got to try these. When done regularly, they can help restore and maintain good posture.
Posture affects your spine, joints, muscles, breathing, energy levels and sometimes even mindset. It is critical to have good posture if you expect to achieve optimal health in your life.
Give it a try; all you need is an empty wall with no obstructions:
by Pain Doc | Jun 19, 2014 | Neck Pain
Do you experience neck pain or stiffness? Tension headaches?
Do your upper shoulders feel like bricks and have tight, sensitive knots as big as golf balls?
Any pain, strain or weakness in your upper back between your shoulder blades?
If so, you likely have Anterior Weight Bearing of the head, or Forward Head Posture.
Appearance is the least of your worries when it comes to poor posture.
Yes, people tend to look much better when standing up straight and confident as opposed to looking like Quasimodo in his advanced years. But looks are not the main problem with a slouched posture.
You see, posture has a direct impact on your breathing quality. If your rib cage and spine are hindering your diaphragm movement and lung expansion, then your breaths will be more shallow. You’ll be getting less oxygen to your muscles and organs; you’ll expend more effort breathing, and you will likely feel fatigued more often than not.
On average, a person at rest takes about 16 breaths per minute. This means we breathe about 960 breaths an hour and 23,040 breaths a day! That’s a lot of energy expenditure, which is hindered by poor posture.
Anterior weight bearing of the head, unfortunately, is very hard to avoid. Because your eyes are in front of your body and not in the back of your head, you naturally flex your neck forward to focus your eyes on what you are doing. This means bending your neck forward as you look at a computer monitor, when reading a book, or when doing just about every activity of daily living: brushing your teeth in front of the mirror, working on a hobby, playing with your children and so on. All these activities will cause you to bend your neck forward.
Bad posture can lead to advanced arthritis and spine decay.
Your spine, when viewed from the side, has curvatures that work like springs on a car’s suspension system. They dampen shock to the spine. Do you know that the simple act of walking puts significant forces into your spine, thanks to gravity? If you are a runner, those forces are multiplied exponentially.
In a strong, healthy spine, these forces are adequately absorbed by the curves, discs and supporting soft tissues. If you have lost some of your spinal curvatures, then the forces generated from walking, running, jumping, and yes, sitting are not going to be dispersed as well and your delicate joint surfaces will have to bear more of this burden. Over time, this can make your spinal segments look like the one below (left spinal segment):
Spinal degeneration occurs mostly in the neck and lumbar spine.
Your neck and lumbar spine are where the nerves that go to your arms and legs branch out from, so adverse alterations to these areas can lead to symptoms in your extremities: pain, numbness, tingling or weakness.
With forward head posture, your head, which weighs 10-12 pounds translates several inches in front of the spinal axis. This creates a “moment force” that is placed mostly on the back neck muscles, upper shoulder muscles and cervical discs.
To get an appreciation of this, imagine balancing an eight pound shot put in your hand, with your wrist bent and your elbow resting on a table; forearm pointing straight up supporting the shot put. It takes little effort to keep that shot put steady.
Now, while still holding the shot put, straighten your wrist and flex it forward so that the shot put is no longer in line with your wrist and forearm (analogous to forward head posture).
All of a sudden, this shift in weight changes everything: your forearm muscles tense up (analogous to your spinal muscles) and your wrist will soon experience strain (analogous to your neck muscles).
This is what happens when the center of gravity of your head moves even just a few inches forward of your spine (reference point at the base of your neck).
Here I illustrate this using a therapy weight pad:
Normal neck curve = strong biomechanics and support, while…
Flattened or reversed neck curve = poor biomechanics and tissue strain
If you have persistently bad posture; especially forward head posture, you are setting the stage for problems. Abnormal stresses to the spine weakens discs, ligaments and cartilaginous surfaces. This is the recipe for spinal decay and increased chance of spinal cord or nerve root impingement.
So if you have forward head posture, start doing exercises that strengthen the back of your neck muscles; stretch shortened, anterior (front) neck muscles, and strengthen your lower back muscles and core. It also helps to stretch shortened muscles in your legs and pelvis that might be restricting your lumbar spine of proper movement. More on this later.
So what do you think? Do you do any exercises and stretches to improve your posture? Let me know!
Dr. P
by Pain Doc | Jun 12, 2014 | Uncategorized
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It is estimated that at any given time, about 40% of the adult population experiences lower back pain. That means, today when you walk on a busy street full of pedestrians, four out of ten people you see are experiencing some degree of lower back pain. 50-85% of all people will experience lower back pain at some time in their lives.
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For many cases of low back pain, the source of the pain emanates for the
intervertebral disc, or IVD. This is the fibro-cartilagenous material that connects vertebrae together and is responsible for bearing most of the weight placed on the spine. Its architecture is designed to absorb shocks using the incompressible nature of water (hydrostatic pressure), which is mostly contained in the nucleus pulposus of the disc. The nucleus serves to redistribute and dampen the forces placed on the spine so as to avoid damage. This comes in handy when walking, jumping, sitting, standing, and of course picking up heavy things.
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Problems arise when the disc weakens, allowing internal derangements to occur. Basically this means shifts in the shape of the disc that alter the proper alignment and movement of the spinal joint segment, and/or block or partially block nerve pathways, causing nerve root impingement and pain down the leg.
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One of the home care accessories I prescribe for my low back pain patients is the
PosturePump™ Spine Retrainer. This innovative device helps to rehydrate weak and bulging disc derangements by increasing the space between vertebrae using an air bladder controlled by a hand aspirator. As the disc volume increases, a negative pressure develops and a pressure gradient forms, which draws fluids (capillary blood), nutrients, oxygen and reparatory cells into the disc. This can help the disc regenerate, and the lumbar extension forced by the
PosturePump™ Spine Retrainer can mechanically force the posterior disc bulge back to center at the same time, relieving symptoms.
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Even if you don’t have a bulging disc, the PosturePump™ can serve as a good preventive measure to keep your discs healthy and strong.
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Watch the video to see how this works.
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If you have recurrent pain of any type, stay tuned for further posts…you just might run into something that will make a significant impact on your quality of life. Please consider sharing this information, as it may be helpful to someone in your social circles. Thanks for reading!
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Dr. Perez
I am constantly looking for topics on pain and pain management to address on this blog for the benefit of my readers. When it comes to pain, numbness and other abnormal sensations, it understandably is a cause for concern, especially for cases where the diagnosis is not clear or certain.
and all those nasty osteophytes, thinning discs and crooked spines you see didn’t start yesterday. They started perhaps ten or more years prior.
