Complex Regional Pain Syndrome

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Difficult-to-Diagnose Pain Condition Needs Early Intervention

Posted by Scott Gottlieb
 
Paula Abdul has been open about the difficult-to-diagnose pain syndrome she has been battling for 25 years. The former “American Idol” judge announced in 2005 that she has Complex Regional Pain Syndrome, in the hopes of bringing awareness to the obscure, often misunderstood, condition. According to a USA Today article published, she said after the announcement her occasionally hyper-animated behavior on the show was caused by her joy at finally being pain-free; she had found the right medication. CRPS is chronic pain that usually results from trauma to a nerve after an injury: falls, strains, sprains, burns or even bruises. Someone who has undergone surgery or had a stroke is also at risk. Fortunately, it is not very common; in my practice, only 8 percent of our patients have CRPS. While the condition can afflict anyone, including children and teens, it generally affects women in their 40s. There is no known cause of CRPS and it has gone by many names over the past 150 years. The USA Today article said it was first described by a doctor treating soldiers with cannonball injuries in the Civil War: Causalgia. It has had several other names since then, including algodystrophy, Sudeck’s Atrophy, variable pain syndrome, shoulder-hand syndrome and more recently and perhaps the most common: reflex sympathetic dystrophy. There are two kinds of CRPS: Type 1 and Type 2. The leg, arm hand or foot are the most affected body parts. For example, if someone hurts his toe, the pain can radiate through the entire foot and leg even after the toe is healed. For some reason, the sympathetic nervous system gets the wrong signal and supports the painful response to the injury. Unfortunately, there is no single test for CRPS. The diagnosis is based primarily on physical exam findings. The pain is often described as a sharp stabbing pain, electrical current or tingling sensation. Light touch or movement can be very painful for someone with CRPS. Also there are often changes around the affected area, such as a change in skin color, temperature, and excessive swelling and sweating. In some cases, it can attack the bone and muscle. The prognosis is different for each patient. Some get relief if it is treated very early. (Treatments range from anesthesia injections to electrical stimulators implanted in the spine). If the diagnosis is delayed, the disorder is harder to treat and the condition may become irreversible. About Dr. Scott Gottlieb: Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management. He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

Phantom Limb Pain: Phenomenon or Reality?

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Phantom Limb Pain (PLP) was once believed to be a psychological problem, but is now considered a very real issue for those who suffer from this affliction.

PLP is a mild to severe pain felt at the area of amputation. Experts say the sensations experienced derive from the brain and spinal cord. A person with PLP may be subjected to these symptoms because pain receptors transmit signals to the brain where it can be modified to either enhance or inhibit the sensation levels. This burden can most often occur when a leg or an arm has been surgically removed. It can also occur when a tongue, breast, or eye is lost.

Some symptoms that a PLP sufferer may feel post-amputation include:

  • Tingling
  • Cramping
  • Feelings of hot and cold
  • Itchiness, throbbing, shooting and burning pains

Not everyone who loses a limb suffers from PLP. It is still unknown why some experience these symptoms and others do not.

Treatment is available for someone who is being affected by this hardship, they include:

  • Medications – pain-relievers, antidepressants, beta-blockers
  • Heat application
  • Relaxation techniques
  • Massage of the amputated area
  • Surgery to remove scar tissue trapping a nerve
  • Physical therapy
  • Neurostimulation – spinal cord or deep brain stimulation

For some, the pain disappears over time.

Another option for a person with PLP is to receive a spinal cord stimulator; tiny electrodes inserted along the spinal cord. A small electrical current delivered to the spinal cord can sometimes relieve pain.

Accepting to live with the loss of a body part can be difficult. Staying active and finding distractions is known to help sufferers cope with PLP.

Radiofrequency Ablation: Say Goodbye to Chronic Pain

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Chronic pain is not an easy issue to live with. With today’s advanced technology, Radiofrequency Ablation (RFA) has made it possible to eliminate this debilitating ailment.

RFA is a procedure used to reduce pain by utilizing electrical currents produced by radio waves that heat up a small area of nerve tissue and decrease pain signals from the pungent area.

More than 70 percent of patients treated with RFA experience relief. The alleviation can last six to 12 months, sometimes even years.

People who are treated using RFA are often long-time chronic low-back and neck pain sufferers due to the deterioration of joints from arthritis.

During the RFA procedure, an IV is placed into a sufferer’s arm vein along with anesthesia, to ease discomfort. The person will be awake while the doctor inserts a small needle into the chronic area. The doctor then uses an X-ray machine to guide the needle in to the specific region.

A microelectrode (a small electrode with a tip that can be inserted into the wall of a single cell) is then inserted through the needle to begin the stimulation process. A small radiofrequency current is then sent through the electrode into the nearby tissue, heating it.

The side effects of RFA may include:

  • Leg numbness: This may occur because of the anesthesia given during the procedure and should only last a few hours.
  • Mild back discomfort: Patient can develop this when the anesthesia wears off and usually lasts two or three days. Applying ice to the area the day of the procedure and moist heat the day after can help decrease the ache.
  • Discomfort: This can include swelling and bruising at the site of treatment

This procedure has been proven to be a safe and successful way to treat some forms of pain. RFA is not recommended for people who have active infections or the ability to form blood clots.

 

About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

Homework, Sports, and Back Pain? What Parents Need to Know

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It’s officially back to school and you know what that means – homework, sports… and back pain?  The new school year brings a whole new slew of problems facing students.  Before you just jump to the medicine cabinet, it is important to understand the possible different sources of pain and what they might mean.

Backpacks:

Heavy backpacks on young, growing bodies can cause poor posture, muscle spasms, as well as shoulder, neck, and back pain.  Besides buying backpacks that are properly sized and feature padded shoulder straps, it is important to make sure children carry no more then three normal sized books in their backpacks.  If your child is still feeling pain after reducing the strain on their bodies, you should seek medical attention.

Sports:

Regardless of whether it’s a high impact or low impact sport, all athletes are still subject to pain and injuries.  While athletes may take precautions warming up, stretching, and staying hydrated, problems may still be inevitable.  Different pains can arise throughout the body causing discomfort but it is important to know what kinds of pains will work themselves out and what signal medical help.

Usually, pains in the back, shoulders, and knees and cramps in the muscles will ease or be gone within a day and leave little to worry about.  What can be a cause for concern are pains that don’t diminish and start to inhibit normal daily routines or worsen with training.  This lingering pain can’t be cured with over the counter pain relievers and can signal more serious problems.  It is important not to ignore these signs and to have them assessed by a medical professional who can help formulate the best form of treatment to get you back in the game in no time.

 

About Dr. Scott Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, N.Y. in Rockland County.

6 Questions Diabetics Should Ask Their Pain Management Doctor

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According to the American Diabetes Association, 8.3 percent of the United Statespopulation is living with diabetes. Dr. Scott Gottlieb of Gramercy Pain Management inNew York City offers his insight as to what diabetic patients should ask their doctor.

1.  How does diabetes cause pain?

The reason patients feel pain is because the diabetes attacks the small blood vessels which ultimately damage the nervous system. The pain that patients are feeling comes from the damaged nerves.

2. What are the symptoms of diabetes?

The symptoms of Type 1 diabetes include but are not limited to: increased thirst and hunger, dry mouth, nausea, abdominal pain, frequent urination, fatigue, heavy breathing and frequent infections of the skin and urinary tract. The symptoms of Type 2 diabetes a patient can experience are similar to Type 1 diabetes with the addition of possible blurred vision, numbness or tingling of the hands and feet and sores that are slow to heal.

3.  What kind of treatment is available to help with diabetic pain?

There is a wide array of medications available to try to help with diabetic pain such as Non-Steroidal Anti-Inflammatory (NSAIDS) pills like Aspirin and Advil. Anti-seizure drugs such as Lyrica or Nerontin are also available to help with pain because it can calm sensitive nerves. Along with NSAIDS and anti-seizure drugs, antidepressant medications can alleviate the pain as well. For patients who do not wish to take pills orally, there are also topical creams available.

4.  If I do not want to take pain medications, what other types of ways can pain doctors alleviate diabetic pain?

If the patient does not wish to take pain medications, the pain management doctor can work with the patient to come up with a diet/exercise regimen and a possible regimen of massage, acupressure, or biofeedback to help with the pain.

5. What non-traditional methods could help with diabetic pain? 

The non-traditional methods to help with diabetic pain include regimens of diet/exercise, massage, acupressure or biofeedback (a technique that trains people to improve their health by controlling certain bodily processes that normally happen involuntarily).

6. How can diet/exercise help with diabetes and diabetic pain?

It is important for a diabetic to always eat a balanced diet. Instead of choosing carbohydrates that consist of only white flour, eat whole-wheat, which are considered “slow-release” and “high-fiber” foods that benefit a diabetics health more than white flour. Also, patients think that when they have diabetes they have to avoid sugar at all cost. Wrong. Diabetic patients can eat sugar, but in moderation and not everyday. Exercise is just as important as maintaining a balanced diet. Any type of physical activity such as hiking, walking, biking and swimming can control diabetes.

About Dr. Gottlieb:

Dr. Scott Gottlieb is a pain management expert and the founder of Gramercy Pain Management.  He is the director of Pain Management at New York Eye and Ear Infirmary (NYEE) and has treated over 3,000 patients. Dr. Gottlieb is board certified in both pain management and anesthesiology. He has offices in both Manhattan and Montebello, New York in Rockland County.