Treat your pain and live a better life…

best-pain-doctor-nycWelcome to my blog about pain. Unfortunately, many people suffer from chronic pain. As a board certified physician in physical medicine and rehabilitation, my specialty is treating these people with both acute and chronic pain.

A majority of my practice is working with patients that are experiencing back and neck pain.

My goal with this blog is to help patients who are experiencing any type of back or neck pain to understand what is causing their pain and discuss options that are available to end their pain. I hope to be able to provide readers with a portal that they can can use to educate themselves and facilitate treatment.

My specialty is my Interventional Spine Skills including cervical and lumbar epidural steroid injections, facet injections, medial branch blocks, Radiofrequency ablation, sympathetic ganglion blocks, spinal cord stimulator trials, sacroiliac joint injection, piriformis muscle block and musculoskeletal joint injection. I also perform many other procedures to alleviate acute and chronic pain.

I hope you enjoy reading my blog as much as I enjoy writing it and observing people from all over the world reading it.

– Matthew Grimm, M.D.

Category Archives: Low Back Pain

Lumbar Steroid Injections Doctor NYC

Lumbar Steroid Injections

nyc-doctor-specialist-for-lumbar-steroid-injection-01Pain in the lumbar region of the spine can be difficult to eradicate. Millions of people suffer from acute lumbar pain every year. There are many available treatments, ranging from something as minimal as occasional medications or massage, to more extreme steps such as surgery. When treating lumbar pain, and one should begin with them most minimally invasive and lowest risk potential treatments. If these do not work, further treatments can be looked into along the scale. Before surgery is attempted, all other options should be looked over. One option that many people make use of with great success is lumbar steroid injections. This is a minimally-invasive low-risk treatment that can offer lasting results.

How Lumbar Steroid Injections Work

lumbar-steroid-injection-information-nyc-02Steroids can be injected into the lumbar region of the spine through a minimally-invasive process. This procedure can be undertaken by a physician on an outpatient basis. What this means is that the patient will not be required to stay on-site overnight, but will be able to come into a clinic for the procedure, undergo the procedure, then return home. However, it must be noted that this procedure involves the use of anesthetics and potentially sedatives. Whenever these types of medications are in use, care must be demonstrated when using Motor Vehicles. It is recommended that one not operate machinery for the next 24 to 48 hours. Dr. Grimm will give you more specific instructions on your personal case.

What Causes Lumbar Pain?

lumbar-steroid-injection-graphic-information-nyc-03Lumbar pain can be caused by any number of potential problems. This includes injury, poor posture, or medical reasons. Injuries to the lumbar region are frequently caused by simple, repetitive motions completed improperly. This includes things like bending over, twisting, lifting. The human body is designed to be able to complete these necessary motions, however when we do them improperly they can cause damage to the spine and surrounding tissues. For example, the phrase “lift with your legs, not with your back” is more commonly said than done. All too often, people can be seen lifting while using the muscles in their back. When overexerted, the back will swell with redness and pain. This pain can be alleviated with the use of lumbar steroid injections.

Other causes of lumbar pain can be more medically based. Problems that arise during growth, autoimmune disorders, and tumors can cause swelling and pain in the lumbar region of the back. These symptoms can also be treated through lumbar steroid injections.

How to Maintain Lumbar Pain Relief

Once lumbar pain has been dealt with through lumbar steroid injections, it is essential that every step possible is taken to keep the pain away. The way this is done varies depending on the underlying cause of initial pain. If the pain is caused by poor posture, such as slouching when sitting, exercises and lifestyle modifications can be undertaken to reverse symptoms and prevent further pain in the future. If the underlying cause is a medical diagnosis that is systemic, individual steps to be taken can be discussed.

Are you ready for a life without lumbar pain? Call Dr. Grimm to schedule an appointment to discuss lumbar steroid injections for you.

Lumbar Radiculopathy

BestPainDoctorNYC2What Is Lumbar Radiculopathy?

Lumbar radiculopathy is the medical term for what is commonly known as sciatica. Sciatica or lumbar radiculopathy results from mechanical irritation of one of the nerve roots in the lumbar spine and most typically presents as low back pain radiating into the buttock and/or into the leg.

Causes of lumbar radiculopathyBest-Pain-Doctor-NYC-4

Radiculopathy or irritation of a lumbar nerve root is usually caused by a herniated lumbar disc (also called a prolapsed or ruptured disc). The intervertebral discs are composed of an inner semi-fluid material enclosed in a cartilaginous outer ring. Normally, they act as cushions or shock-absorbers for compressive or rotational forces on the spine.

Increased compressive forces on the lumbar intervertebral discs occur with bending and lifting. Many years of cumulative stress can lead to small tears in the outer cartilaginous ring (called annulus). Eventually, these tears can progress to bulging of the disc or a complete rupture of the annulus (ruptured or herniated disc). A prominent disc bulge or a herniation of the disc can impinge on one of the nerves exiting the lumbar spinal cord and cause radiculopathy (sciatica).

Best-Pain-Doctor-NYC-5Signs and symptoms of lumbar radiculopathy

Mechanical irritation of a lumbar nerve root can cause numbness and/or weakness of leg on the affected side. For example, irritation of the fifth lumbar nerve root typically presents with numbness or pain in the lateral (outside) lower leg and/or weakness of the ankle (which causes the foot to drag during swing phase of that leg).

TreatmentBest-Pain-Doctor-NYC-6

Initial conservative treatment of lumbar radiculopathy consists of oral nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) and bedrest. Physical therapy is prescribed for strengthening exercise of the abdomen and lumbar spinal muscles. For intense pain, oral narcotics are often required. Lumbar epidural steroid injections which have a powerful anti-inflammatory effect on the irritated nerve root can be beneficial.

Surgery is reserved for unrelenting symptoms and significant neurologic impairment (e.g., leg weakness). A decompressive discectomy removes any disc material impinging on the lumbar nerve root. Alternatively, the minimally invasive intralaminar microendoscopic lumbar discectomy can be performed.

For the management of pain due to lumbar radiculopathy, contact Dr. Matthew Grimm, best pain doctor in NYC.

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Dr. Grimm answers the question: What is an EMG test?

What Is an EMG?

Best-EMG-Testing-Doctor-NYC-1Electromyography or EMG is a study of the electrical activity of muscles. If you have numbness or weakness your doctor may request an EMG to determine the cause. In cases of neck or low back pain associated with numbness or weakness of an arm or leg, an EMG can help to identify which nerve root is compressed or irritated. This can help guide treatment decisions.

An EMG test is routinely accompanied by a nerve conduction study in order to definitively identify the level of nerve involvement. In other words, your doctor wants to make sure that your leg numbness or weakness is not caused by a problem of your peripheral nerves.

Procedure: How is an EMG done?

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Under sterile conditions, a very fine electrode is inserted into select muscle groups to measure their electrical activity at rest and during contraction. The electrical activity is visualized on a computer monitor and analyzed by the performing physician.

During the nerve conduction portion of the exam, select peripheral nerves are stimulated electrically and responses of the appropriate muscle groups are recorded. This test determines the integrity and function of your peripheral nerves.

Indications for an EMG

Best-EMG-Testing-Doctor-NYC-3An EMG and nerve conduction study is frequently performed in cases of neck or low back pain specifically for the purpose of identifying cervical or lumbar nerve root irritation. Assuming that nerve root irritation has been present for at least three weeks, the test can aid in localizing the level and severity of nerve root involvement. An EMG is a valuable adjunctive test in the evaluation of neck or low back pain when nerve root irritation is suspected.

If you suffer from neck or back pain, contact the best pain doctor in NYC, Dr. Matthew Grimm to schedule an examination.

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How to avoid the need for disc surgery. Alternatives to neck or low back surgery:

What are my alternative options to disc surgery?

 

Treatment options for neck or low back pain

When a patient presents with a herniated cervical or lumbar disc with clinical evidence of nerve root irritation (cervical or lumbar radiculopathy), he or she has several choices: no surgery, traditional open surgery, microscopic surgery or micro-endoscopic surgery. If he or she chooses no surgery, evidence shows that the herniated disc may decrease in size or disappear within a few weeks or months. Epidural injections may also prevent the need for neck or back surgery.

Types of surgical treatment: open discectomy vs. micro-discectomy

Surgery is generally reserved for patients who fail to respond to conservative treatment or have significant or progressive weakness or loss of sensation due to irritation of a nerve root by a herniated disc.

Traditional Open Discectomy

A traditional open discectomy causes considerably more disruption of spinal tissues than a microsurgical procedure usually resulting in a longer recovery time.

Microsurgical Discectomy

A microsurgical discectomy is minimally invasive and is less disruptive of spinal tissues usually resulting in a shorter recovery time.

The goal of surgery is the removal of any material (usually disc material) pressing on the spinal nerve. At the least, the portion of the disc which protrudes into the spinal canal is removed. More aggressive surgery involves exploring the ruptured disc for any loose fragments. The aim of the more aggressive approach is the prevention of recurrent disc herniation.

Micro-endoscopic discectomy

An even less invasive form of cervical or lumbar disc surgery involves the use of endoscopes. An endoscope is a long thin tube which contains a light and a video camera allowing the surgeon to visualize the spinal structures on a monitor. The surgery is performed using very fine instruments through the same tube (also called a cannula).

How to avoid the need for disc surgery

Dr. Grimm often will prevent the need for disc surgery by performing epidural injections and/or prescribing physical therapy.

Contact us today to schedule an appointment with best back pain doctor in NYC, and hopefully avoid the need for disc surgery.

Treatment of Acute and Chronic Pain

Treatment of acute and chronic pain p02Pain is an unpleasant symptom that sends a signal that something may be wrong or that damaging stimuli may be present in the body. This uncomfortable feeling may range from mild to severe, and may last for a short moment, come and go, or persist for a long time.

A variety of conditions can cause pain, including injury, degenerative processes, and disease. Its treatment depends on many factors, and while some types of pain respond to single treatments, others may need a combination of treatment modalities.

Treatment of Acute Pain

Treatment of acute and chronic pain p01Acute pain often occurs suddenly and is usually localized and sharp in quality. It warns an individual of a disease or a threat to the body, or it may be caused by injury, surgery, or natural processes like childbirth. Acute pain may be mild and short lasting, or it may be severe and long lasting. In most cases, however, it disappears when the underlying cause has resolved. If unrelieved, acute pain may lead to chronic pain.

Treatment of acute and chronic pain p03The treatment of acute pain often involves identifying an underlying cause and treating it. Options for symptomatic treatment of pain may include the use of:

· Hot compress

· Ice packs

· Oral medications like Acetaminophen (ex. Tylenol®)

· Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen

· Local anesthetic injection (ex. lidocaine)

· Nerve blocks (epidural anesthesia)

· Physical therapy, including massage and exercise

· Surgery

Depending on the type and cause of acute pain, symptoms may be managed by general practitioner, an internist, a surgeon, or a pain management specialist.

Treatment of Chronic Pain

Pain that persists despite healing of an injury or disease may be considered as chronic pain because pain signals in the nervous system remain active for several weeks, months, or even years. The pain may lead to other symptoms like muscle tension, limited mobility, depression, lack of energy, anxiety, sleep disturbances, and changes in appetite. These symptoms may also affect an individual’s daily activities and relationship with others. Common complaints include low back pain, chronic headaches, arthritis, cancer pain, neurogenic pain, and psychogenic pain.

Although chronic pain may originate from an injury or disease process, some people suffer from long lasting pain in the absence of physical injury or damage. The cause of chronic pain may be unknown or undiagnosed; however, treatments may be given to relieve the individual’s symptoms and to improve the quality of their life. Usually, a combination of treatments is needed, and these are often given to suit individual needs. These may include:

· Oral pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs), although its use may be limited because of potential side effects from chronic use

· Narcotics (such as morphine or codeine), although its use is limited by its potential for abuse and side effects

· Other medications, such as anticonvulsants, antidepressants, and anxiolytic drugs

· Localized anesthetic injections, like trigger point injections and hip joint injections

· Nerve blocks, like stellate ganglion block and epidural block

· Electrical stimulation, like spinal cord stimulation

· Radiofrequency ablation

· Physical therapy

· Psychotherapy

· Relaxation techniques such as deep breathing

· Biofeedback

· Behavior modification

Because of the complexity of the character of chronic pain, its treatment has evolved into a specialty. The management of chronic pain in most cases involves a multidisciplinary approach. This means that a team of specialists may be needed to evaluate, diagnose, and treat one’s condition, including internists, surgeons, anesthesiologists, psychiatrists, and physical therapists. Most patients who suffer from persistent pain that does not respond to conventional treatments are referred to a Chronic Pain Clinic, which is managed by a Chronic Pain Specialist, a highly trained physician to diagnose and treat difficult cases of pain syndromes.Tallahassee pain doctor

Contact Us

If you need more information about pain and its associated symptoms, make an appointment with NYC’s top Pain Management Specialist who will help improve your symptoms, increase your mobility, and take control of your life.

Implantable Spinal Cord Stimulator Doctor NYC

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Spinal cord stimulator implantation NYC for Chronic Pain.

Spinal cord stimulation is a safe and effective method of blocking chronic spinal pain that uses low voltage electrical currents to stimulate the spinal nerves. It helps patients to better manage their pain and decrease the use of pain medication. It is an option for patients who have chronic leg or arm pain, failed back surgery syndrome, complex regional pain syndrome, and other severe nerve-related pain or numbness.

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How Spinal Cord Stimulation Works

A small battery-powered spinal cord stimulator is implanted in the body to transmit an electrical current to the spinal cord. A trial stimulator used percutaneously (through the skin) may be done to give the treatment a trial run. If patient response is successful, a ‘permanent’ stimulator may be implanted under the skin of the abdomen, with the small, coated wires (leads) inserted under the skin to the point where they are placed into the spinal canal.

After the procedure, the patient and the doctor determine the best pulse strength to be applied. The patient is instructed on how to use the stimulator at home, which usually consists of stimulation for 1 to 2 hours, 3 to 4 times a day. Spinal cord stimulation creates a tingling feeling, which blocks the pain signals to the brain. The goal of treatment is a 50-70% reduction in pain. Patients benefit even with incomplete removal of pain, which allow them to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

General Procedure – Spinal Cord Stimulator Implant Procedure

Implantation of a spinal cord stimulator is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed. He may be lightly sedated or placed under general anesthesia during the procedure.

The patient is placed lying on his side or on his stomach on the operative table. The areas of your back and abdomen where the leads and the generator are to be placed are shaved and sterilized. Local anesthetic is injected where incisions are to be made to numb the area.

The placement of surgical leads is performed with x-ray guidance (fluoroscopy). A small skin incision is made in the middle of the back and the leads are inserted in the epidural space above the spinal cord using a small needle or through a small incision. The generator is usually implanted in the abdomen.Spinal cord stimulator doctor nyc 03

The patient is monitored in the recovery area after the procedure. Most patients are discharged on the same day, but some physicians request an overnight stay in the hospital. The pulse generator will be programmed before the patient leaves. He will receive instructions on how to care for the incision area and how to program and regulate the device.

Contact Us to schedule a consultation for a spinal cord stimulator  implant.

Spinal Cord Stimulation is a safe and effective means of treating chronic spinal pain that is unresponsive to other forms of treatment. If you want more information about treating chronic spinal pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if Spinal Cord Stimulation is a treatment option for you.

Radiofrequency Ablation of the Medial Branch Nerves

Radiofrequency Ablation of the Medial Branch Nerves 01

Radiofrequency Ablation of the Medial Branch Nerves

is a safe and effective way to relieve chronic lumbar (lower back) pain using radio waves to create heat. These radiofrequency waves are electromagnetic waves that travel at the speed of light and Radiofrequency Ablation of the Medial Branch Nerves 03blocks nerve tissue from transmitting pain signals to the brain. The medial branch nerves are sensory nerves that carry pain signals from injured facet joints to the brain. Facet joints are parts of the spinal bones (vertebrae) that allow one to do a wide range of motions. Injury or degenerative changes in these joints, particularly in the lower back, can cause inflammation and severe pain, which may not respond to conservative medical therapy. (click picture to enlarge)

How Radiofrequency Ablation Works

Radiofrequency ablation provides long-term pain relief that exceeds the effects of a nerve block or other types of injections. Various types of chronic pain conditions respond well to radiofrequency ablation including pain from previous spinal surgery, whiplash injury, complex regional pain syndrome and spondylitis (arthritis of the spine).

The procedure involves the placement of insulated needles with a tiny electrode next to the medial nerve branch. A small radiofrequency current is directed to the medial branch nerve of the facet joint for 60-90 seconds, which generates heat (60-80 degrees Celsius) that destroys the nerve tissue. The result is blockage of pain signals to the brain.

Radiofrequency Ablation of the Medial Branch Nerves 05Radiofrequency ablation is a relatively safe and common technique that can provide dramatic and long-lasting pain relief without systemic side effects. Patients benefit from this procedure because pain is reduced for several months, allowing the patient to resume normal activities and undergo rehabilitation or physical therapy while healing takes place.

Radio Frequency Ablation for Back Pain: General Procedure

Radiofrequency ablation is an outpatient procedure performed by a qualified Chronic Pain Specialist who is an expert with the treatment. The patient is initially briefed about the procedure and prepared beforehand so that he is relaxed.

The patient needs to be relaxed but alert during the procedure to help the doctor correctly place the electrode used during nerve ablation. The procedure will take 20-45 minutes, with the patient lying on their stomach (prone). After the skin is properly sterilized, local anesthesia is injected to numb the area.

Radiofrequency Ablation of the Medial Branch Nerves 02Using x-ray guidance, insulated needles are directed next to the targeted medial nerves. The doctor will use X-rays to guide twin, insulated needles with an electrode are placed next to the nerve. During the procedure, the doctor asks the patient if he feels a tingling sensation or a muscle twitching. These signs will help ensure the electrode isRadiofrequency Ablation of the Medial Branch Nerves 04 properly positioned. Once the needle and electrode are placed correctly, the nerve is heated with radio waves until pain signals to the brain are blocked.

Post Operative Recovery after Radiofrequency Ablation Procedure for Back Pain:

After the procedure, the patient is monitored in a recovery area and discharged when stable. The patient may feel some local pain for several days after the procedure, which may be relieved by oral medications. Some swelling or bruising may occur where the needle was inserted and this may be reduced by applying a cold pack. It may take weeks for the full effects of radiofrequency ablation to be felt, but the pain relief may last for six months or even longer. Some nerves grow back, and radiofrequency ablation may need to be repeated.

Contact Us

Radiofrequency Ablation of the Medial Branch Nerves is a minimally invasive, safe, and effective means of treating low back pain that is unresponsive to other forms of treatment. If you want more information about treating chronic low back pain, contact our Pain Management Specialist who will examine you and conduct tests to determine the cause of your back pain.  Make an appointment with the NYC’s top board-certified interventional pain management physician to know if radiofrequency ablation is a treatment option for you.

Low Back Pain AKA Lumbago

…is a common disorder affecting over 80% of the general population at some point in their life.  In addition to causing emotional and physical strain onthe body, it also causes a great amount of financial strain as it is the number one cause of job-related disability.

In this blog I hope to discuss various treatment options as well as explain why I feel that I am best suited to treat your low back pain and how I am the best low back pain specialist!

Causes of Low Back Pain:

First lets discuss one of the most common causes of  low back pain.  It can be acute, subacute or chronic.  Acute low back pain duration is generally less than 4 weeks, subacute is from 4-12 weeks and chronic is low back pain lasting longer than 12 weeks.  Also in addition to the duration of low back pain it can be defined as axial or radicular low back pain.

In this first article we will discuss radicular or radiating lower extremity low back pain. Radicular low back pain is pain that originates in your low back and shoots in an electricity like sensation down your posterior legs, at times all the way to your toes.

Back Anatomy:

Next we will discuss some basic anatomy of your lumbar spine. The Lumbar spine (or lower back region) is made up of five vertebrae (L1-L5) and in between each of these vertebrae lies fibrocartilage discs called intervertebral discs.  These discs act as cushions or “shock absorbers” for the spine, preventing the vertebrae from rubbing together allowing the vertebrae to comfortably protect the spinal cord as well as provide active range of motion for your lower back.

Your bodies motor and sensory functions are controlled by nerves.  These nerves stem from the spinal cord and exit the cord through small holes called foramina which lie within the vertebrae.

Ligaments and musculature of the lower back and abdomen provide stability for the spine and small joints, called facet joints, direct the motion of the spine and is how each vertebrae interact with each other.  Facet joints can be thought of like any other joint in the body, just like your finger joint is made up of a number of small bones each connecting with each other through a joint.

Radiculopathy:

Now that we have the basic anatomy of the Lumbar Spine down, we can discuss one of the most common causes of low back pain which are caused by one of the above mentioned structures. One of the most common causes radiating lower extremity or “radicular” low back pain as due to a disc herniation impinging on your spine or nerve roots as they exit the spine.

Herniated Disc:

What is a herniated disc you may ask?  Well let me explain.  As described above in your spine in between each vertebrae lies a fibrocartilage disc which acts as a shock absorber for the spine.  You can think of the discs structure as a jelly donut, with a soft center encased within a tougher exterior. The cause of a disc herniation can result from general wear and tear on the disc,such as while performing jobs that require constant sitting.  Disc herniations often result from jobs that require any type of lifting or repetitive bending activities.

If you are someone with complaints of general minor back pain or chronic back tiredness it makes you susceptible to a herniation from only a mild activity such as bending over to pick up a pencil or simple gardening!  Disc herniations can also occur from trauma to the body when subjected to any type of accident, be it from a motor vehicle accident or a slip and fall accident.

Lumbar Disc Herniation:

I will now discuss pain symptoms related to lumbar disc herniations.  Pain can range from little or no pain if the disc is the only tissue injured, to severe and unrelenting low back pain that radiates into the lower leg regions innervated by the affected nerve roots or spinal cord segments irritated or impinged by the herniated disc material.

Pain complaints often are described to the thighs, knees, calves or all the way to the toes.  Other pain symptoms include numbness, tingling, muscular weakness and decreased weakness in the same affected areas as the pain complaints.

Treatment for Radicular Low Back Pain:

Now lets discuss treatment of radicular low back pain.  If a disc herniation causes extreme weakness, paralysis or bowel or bladder dysfunction it is considered a surgical emergency and treatment should be sought at the nearest emergency department.

If your symptoms are less severe which is the case in 99% of radiating low back pain patients we start with conservative management of the pain with anti-inflammatory medication treatment, muscle relaxer medication treatment and physical therapy with emphasis on core abdominal muscle strengthening, heat, ice, massage and ultrasound with transition into a home exercise program.

If symptoms persist despite conservative management as detailed above the next step is further diagnostic steps to confirm the location of the disc herniations.  To do this generally Magnetic Resonance Imaging or MRI is utilized.

The most common locations of lumbar disc herniations is at L4-L5 or L5-S1 as diagnosed by MRI.  Your pain complaints will be to your posterior legs at times all the way to your toes as described above with associated numbness and tingling in the same areas.

Once diagnosis has been confirmed by MRI and conservative treatment measures have failed with anti-inflammatory medications and physical therapy the next step in treatment in treatment is injections directly to the location of the nerve impingement utilizing epidural steroid injections which are performed by a pain management specialist.  Of which I consider myself to be one of the best in Manhattan.

Epidural Steroid Injection:

An epidural steroid injection is a minimally invasive  procedure that can help relieve radiating low back and leg pain caused by inflamed spinal nerves.  Medicines are delivered to the affected spinal nerve through the epidural space, which is the area between the protective covering of the spinal cord, known as the dura, and the vertebrae.  The medicine used is generally a combination of a long acting corticosteroid and either saline or a anesthetic numbing agent.

Expected Results:

You may ask what results can be expected with lumbar epidural injections.  The relief is dependent on both the severity of the herniation as well as each individual patient as well as the expertise and technique of the physician performing the procedure which it is very important to choose a physician who has been fellowship trained in pain management, which I have been, rather than someone who just took a weekend course in epidural injection treatment.

After Epidural Injection:

Following a first epidural injection you will have a follow up appointment to evaluate your response.  Pending your bodies response to the first injection up to 3 injections spaced 1-3 weeks apart may be needed for maximum efficacy.

How Long Does an Epidural Last?

Duration of pain relief varies from weeks to years.  Most importantly post injection therapy should be instituted for transition into a home exercise program focusing on strengthening abdominal and low back muscles in hopes of preventing future low back pain episodes. Now finally patients need to know the risks of epidural steroid injections.

Risks of Epidural Injection:

If you choose the correct physician there are few risks involved with the procedure.  The correct pain management specialist knows how to screen patients for the appropriate patients for this procedure to ensure that it is not performed on a patient in which it is not beneficial.  The proper physician also knows proper technique to ensure appropriate needle position for steroid placement.

Complications generally involve risks associated with needle insertion which involve bleeding, dural puncture, infection, allergic reaction and nerve damage.  As described above risk can be mitigated with selection of a skilled physician who knows proper technique and proper patient selection.

The Top Doctor for Epidural Injection?

I have performed thousands of epidural steroid injection procedures without a single complication.  So you can be sure you are in skilled hands.  Should a complication ever arise, be rest assured that I have been trained to deal with any and every complication. Contact Us today to schedule an appointment.

Additional Causes of Low Back Pain

Non-Mechanical Causes of Low Back Pain

200177292-001Mechanical injury is the leading cause of low back pain (please see my previous post titled, “Mechanical Causes of Low Back Pain.”) Today, I’m going to focus on other less common causes including neoplasm, inflammatory, metabolic, Paget’s disease, psychosomatic, depression and referred pain. No matter the cause, it is important to seek medical attention to workup low back pain immediately to prevent acute pain from becoming a chronic condition.

Neoplasm – Low Back Pain

The growth of a tumor can lead to chronic back pain. For this reason, it is important to consult with a pain specialist in order to determine the cause of your back pain. Surgery and adjuvant therapy may be necessary in the case of neoplastic back pain. Simple imaging studies such as an XRAY would be the first step in identifying neoplastic disease.

Inflammatory – Low Back Pain

best pain doctor low back pain 3Many cases of back pain are caused by inflammation. When prolonged inflammation occurs, chronic low back pain can result. These include inflammatory arthropathies such as Rheumatoid Arthritis. Rheumatoid Arthritis is an autoimmune disease that can cause primary low back pain, specifically when it affects the sacroiliac joints.

Metabolic Disease– Low Back Pain

Metabolic diseases of the muscle interfere with important chemical reactions that draw energy from food sources. Since muscles use a tremendous amount of energy to work properly, metabolic disease, while rare, can manifest into low back pain symptoms. Metabolic diseases such as myopathies, can be accurately diagnosed using electrodiagnostic studies such as electromyography. A consultation with a pain specialist is an important step in diagnosis.

Paget’s Disease – Low Back Pain

Paget’s disease is a chronic disorder that causes abnormal bone growth in the spine, pelvis, chest, skull, and legs. When people suffer from Paget’s disease, the bone tissue begins to break down faster than it can rebuild. As the body tries to catch up with the rebuilding process, the new bone is usually weak and fractures easily. Paget’s disease should be treated by both a primary care physician and rheumatologist. If pain symptoms cannot be managed, a pain consultation to a specialist is appropriate.

Psychosomatic – Low Back Pain

There are psychosocial factors that can cause ongoing stress to the body eventually leading to chronic low back pain. Examples may include dissatisfaction with work or home life, financial worries, and any number of other problems. In most cases, psychological stresses amplify the perception of the painful condition and often lead patients to seek medical attention.

Depression – Low Back Pain

As demonstrated above, people’s state of mind can greatly affect their perception of pain. Those who are suffering from depression or chronic stress are more likely to experience long-lasting back pain.

Referred Pain – Low Back Pain

Referred pain describes instances where pain is perceived to take place in an area of the body that is actually adjacent to the actual site of injury. When pain arises from other organs in the body, it can be referred to the spine. Intra-abdominal problems such as kidney disease, pelvic diseases involving reproductive organs or pancreatitis can be referred as back pain. These pain symptoms are also commonly referred to as viscero-somatic.

Seeking the Help of a Pain Specialist

best pain doctor low back pain 1If you are experiencing back pain symptoms, it is important to seek the help of a pain specialist such as myself. Getting a proper history and performing a physical examination will be able to determine an appropriate course of treatment. While many cases can be resolved with adequate rest and pain medication, as listed above, it is important to rule out unusual catalysts for back pain.

I offer safe and effective methods for alleviating chronic low back pain and any other ongoing pain issues. Resolve your pain symptoms by making a visit to our office as soon as possible.

Mechanical Causes of Low Back Pain

‘Mechanical low back pain’

 

originates in the vertebrae, soft tissues, cartilage, spinal joints or discs, and supportive structures around the spine. This condition is also known as lumbar syndrome, lumbosacral strain or pain, lumbago, and idiopathic low back pain. Chronic low clip_image001[4]back pain is one of the leading reasons people seek medical help. About four out of five adults will have experienced low back pain during their lifetime. While the most common cause is lumbar strain, symptoms can develop after cumulative repetitive trauma.

Acute and Cumulative Trauma can Cause Chronic Low Back PainLifting back pain

Strains in the muscles, tendons and ligaments around the spine causes 70% of lower back pain incidences. This can arise from a sudden acute injury such as a motor vehicle accident or by ongoing trauma that often occurs in the workplace. Patients may cross a threshold and develop symptoms without significant injury.

There are a number of other conditions that can lead to chronic low back pain. These include sciatica, osteoarthritis, degenerative discs, kyphosis, scoliosis, arthritis, disc herniation, slipped disc, spinal stenosis, spondylolisthesis, fractures, trauma, pelvic anteversion, and pelvic retroversion.

Osteoarthritis, also known as degenerative joint disease, is a progressive condition caused by excessive stress along the discs and the bony structures of the spine responsible for maintaining posture. The other conditions mentioned also cause functional or anatomical abnormalities of the spine. We will address each of these topics in more detail in future blog posts.

In addition to mechanical factors, there are a number of non-mechanical causes of low back pain. Although non-mechanical causes are far less common, it is important to rule out the possibility of any diseases that may be affecting the body. If symptoms persist, then it is time to make an appointment with a pain doctor such as myself, to find out if there are any underlying issues that you may not be aware of.

Symptoms of Low Back Pain

Back Arthritis Back Pain

Symptoms of low back pain can vary quite a bit. Generally, symptoms involve cramping, stiffness, or muscle spasms. Pain in the back or buttocks can come on suddenly or can extend over long periods of time. When performing weight-bearing movements or other movement that add pressure to your spine, symptoms will increase. Often, symptoms are relieved within two or three days, but can persist for several weeks if left untreated. Avoiding triggering mechanisms is the best way to allow symptoms to dissipate initially.

If you experience an injury that causes nerve-root pressure, you may feel pain in your leg in addition to your lower back and/or buttock. Pain may arise gradually or come on quite suddenly. Nerve-related issues may also cause numbness or tingling in your legs.

If you are experiencing low back pain for greater than one week, seek treatment before the problem worsens and becomes a chronic condition. Often patients wait weeks and suffer needlessly when treatment is available. Great relief can be found with proper treatment administered by a professional. In addition, a doctor who specializes in back pain will be able to rule out any underlying conditions that may be aggravating the problem further.

Do not live with back pain any longer. Call our office today at 646-862-5555 to schedule a consultation and take the first step toward ending your back pain.