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Nerve Injury

Back Clinic Nerve Injury Team. Nerves are fragile and can be damaged by pressure, stretching, or cutting. Injury to a nerve can stop signals to and from the brain, causing muscles not to work properly and losing feeling in the injured area. The nervous system manages a great majority of the body’s functions, from regulating an individual’s breathing to controlling their muscles as well as sensing heat and cold. But, when trauma from an injury or an underlying condition causes nerve injury, an individual’s quality of life may be greatly affected. Dr. Alex Jimenez explains various concepts through his collection of archives revolving around the types of injuries and condition which can cause nerve complications as well as discuss the different form of treatments and solutions to ease nerve pain and restore the individual’s quality of life.

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

 


Understanding Nerve Blocks: Diagnosing and Managing Injury Pain

Understanding Nerve Blocks: Diagnosing and Managing Injury Pain

For individuals dealing with chronic pain, can undergoing a nerve block procedure help alleviate and manage symptoms?

Understanding Nerve Blocks: Diagnosing and Managing Injury Pain

Nerve Blocks

A nerve block is a procedure done to interrupt/block pain signals due to nerve dysfunction or injury. They can be used for diagnostic or treatment purposes, and their effects can be short or long-term, depending on the type being used.

  • A temporary nerve block may involve the application or injection that stops pain signals from transmitting for a short time.
  • For example, in pregnancy, an epidural injection can be used during labor and delivery.
  • Permanent nerve blocks involve cutting/severing or removing certain parts of a nerve to stop pain signals.
  • These are used in cases with severe injuries or other chronic pain conditions that have not improved with other treatment approaches.

Treatment Usage

When healthcare providers diagnose a chronic pain condition caused by nerve injury or dysfunction, they may use a nerve block to locate the area generating pain signals. They may perform electromyography and/or a nerve conduction velocity/NCV test to pinpoint the cause of chronic nerve pain. Nerve blocks can also treat chronic neuropathic pain, such as pain caused by nerve damage or compression. Nerve blocks are regularly used to treat back and neck pain caused by herniated discs or spinal stenosis. (Johns Hopkins Medicine. 2024)

Types

Three types include:

  • Local
  • Neurolytic
  • Surgical

All three can be used for conditions that cause chronic pain. However, neurolytic and surgical blocks are permanent and are only used for severe pain that has worsened with other treatments unable to provide relief.

Temporary Blocks

  • A local block is done by injecting or applying local anesthetics, like lidocaine, to a certain area.
  • An epidural is a local nerve block that injects steroids or analgesics into an area around the spinal cord.
  • These are common during pregnancy, labor, and delivery.
  • Epidurals can also be used to treat chronic neck or back pain due to a compressed spinal nerve.
  • Local blocks are usually temporary, but in a treatment plan, they can be repeated over time to manage chronic pain from conditions like arthritis, sciatica, and migraines. (NYU Langone Health. 2023)

Permanent Blocks

  • A neurolytic block uses alcohol, phenol, or thermal agents to treat chronic nerve pain. (National Institute of Neurological Disorders and Stroke. 2023) These procedures damage certain areas of the nerve pathway on purpose so that pain signals cannot be transmitted. A neurolytic block is mainly used for severe chronic pain cases, like pain from cancer or complex regional pain syndrome/CRPS. They are sometimes used to treat ongoing pain from chronic pancreatitis and pain in the chest wall after surgery. (Johns Hopkins Medicine. 2024) (Alberto M. Cappellari et al., 2018)
  • The neurosurgeon performs a surgical nerve block that involves surgically removing or damaging specific areas of the nerve. (National Institute of Neurological Disorders and Stroke. 2023) A surgical nerve block is only used for severe pain cases, such as cancer pain or trigeminal neuralgia.
  • Although neurolytic and surgical nerve blocks are permanent procedures, pain symptoms, and sensations can come back if the nerves are able to regrow and repair themselves. (Eun Ji Choi et al., 2016) However, symptoms and sensations may not return months or years after the procedure.

Different Body Areas

They can be administered in most body areas, including: (Hospital for Special Surgery. 2023) (Stanford Medicine. 2024)

  • Scalp
  • Face
  • Neck
  • Collarbone
  • Shoulders
  • Arms
  • Back
  • Chest
  • Ribcage
  • Abdomen
  • Pelvis
  • Buttocks
  • Legs
  • Ankle
  • Feet

Side Effects

These procedures can have the potential risk of permanent nerve damage. (Anthem BlueCross. 2023) Nerves are sensitive and regenerate slowly, so a tiny error can cause side effects. (D O’Flaherty et al., 2018) Common side effects include:

  • Muscle paralysis
  • Weakness
  • Frequent numbness
  • In rare cases, the block could irritate the nerve and cause added pain.
  • Skilled and licensed health practitioners like surgeons, pain management physicians, anesthesiologists, and dentists are trained to perform these procedures carefully.
  • There is always a risk of nerve damage or injury, but the majority of nerve blocks safely and successfully decrease and help manage chronic pain. (Anthem BlueCross. 2023)

What to Expect

  • Individuals may feel numbness or soreness and/or notice redness or irritation near or around the area that is temporary.
  • There can also be swelling, which compresses the nerve and requires time to improve. (Stanford Medicine. 2024)
  • Individuals may be asked to rest for a certain amount of time after the procedure.
  • Depending on the type of procedure, individuals may have to spend a few days in a hospital.
  • Some pain may still be present, but that does not mean the procedure did not work.

Individuals should consult with a healthcare provider about the risks and benefits to ensure it is the right treatment.


Sciatica, Causes, Symptoms, and Tips


References

Johns Hopkins Medicine. (2024). Nerve blocks. (Health, Issue. www.hopkinsmedicine.org/health/conditions-and-diseases/nerve-blocks

NYU Langone Health. (2023). Nerve block for migraine (Education and Research, Issue. nyulangone.org/conditions/migraine/treatments/nerve-block-for-migraine

National Institute of Neurological Disorders and Stroke. (2023). Pain. Retrieved from www.ninds.nih.gov/health-information/disorders/pain#3084_9

Johns Hopkins Medicine. (2024). Chronic pancreatitis treatment (Health, Issue. www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-pancreatitis/chronic-pancreatitis-treatment

Cappellari, A. M., Tiberio, F., Alicandro, G., Spagnoli, D., & Grimoldi, N. (2018). Intercostal Neurolysis for The Treatment of Postsurgical Thoracic Pain: a Case Series. Muscle & nerve, 58(5), 671–675. doi.org/10.1002/mus.26298

Choi, E. J., Choi, Y. M., Jang, E. J., Kim, J. Y., Kim, T. K., & Kim, K. H. (2016). Neural Ablation and Regeneration in Pain Practice. The Korean journal of pain, 29(1), 3–11. doi.org/10.3344/kjp.2016.29.1.3

Hospital for Special Surgery. (2023). Regional anesthesia. www.hss.edu/condition-list_regional-anesthesia.asp

Stanford Medicine. (2024). Types of nerve blocks (For Patients, Issue. med.stanford.edu/ra-apm/for-patients/nerve-block-types.html

Anthem BlueCross. (2023). Peripheral nerve blocks for treatment of neuropathic pain. (Medical Policy, Issue. www.anthem.com/dam/medpolicies/abc/active/policies/mp_pw_c181196.html

O’Flaherty, D., McCartney, C. J. L., & Ng, S. C. (2018). Nerve injury after peripheral nerve blockade-current understanding and guidelines. BJA education, 18(12), 384–390. doi.org/10.1016/j.bjae.2018.09.004

Stanford Medicine. (2024). Common patient questions about nerve blocks. (For Patients, Issue. med.stanford.edu/ra-apm/for-patients/nerve-block-questions.html

A Comprehensive Look at the Thoracodorsal Nerve

A Comprehensive Look at the Thoracodorsal Nerve

Individuals experiencing pain symptoms like shooting, stabbing, or electrical sensations to the latissimus dorsi of the upper back could be caused by a nerve injury to the thoracodorsal nerve. Can knowing the anatomy and symptoms help healthcare providers develop an effective treatment plan?

A Comprehensive Look at the Thoracodorsal Nerve

Thoracodorsal Nerve

Also known as the middle subscapular nerve or the long subscapular nerve, it branches out from a part of the brachial plexus and provides motor innervation/function to the latissimus dorsi muscle.

Anatomy

The brachial plexus is a network of nerves that stem from the spinal cord in the neck. The nerves supply most of the sensation and movement of the arms and hands, with one on each side. Its five roots come from the spaces between the fifth through eighth cervical vertebrae and the first thoracic vertebra. From there, they form a larger structure, then divide, re-combine, and divide again to form smaller nerves and nerve structures as they travel down the armpit. Through the neck and chest, the nerves eventually join and form three cords that include:

  • Lateral cord
  • Medial cord
  • Posterior cord

The posterior cord produces major and minor branches that include:

  • Axillary nerve
  • Radial nerve

The minor branches include:

  • Superior subscapular nerve
  • Inferior subscapular nerve
  • Thoracodorsal nerve

Structure and Position

  • The thoracodorsal nerve branches off the posterior cord in the armpit and travels down, following the subscapular artery, to the latissimus dorsi muscle.
  • It connects to the upper arm, stretches across the back of the armpit, forming the axillary arch, and then expands into a large triangle that wraps around the ribs and the back.
  • The thoracodorsal nerve lies deep in the latissimus dorsi, and the lower edge typically reaches close to the waist.

Variations

  • There is a standard location and course of the thoracodorsal nerve, but individual nerves are not the same in everyone.
  • The nerve typically branches off the posterior cord of the brachial plexus from three different points.
  •  However, different subtypes have been identified.
  • The thoracodorsal nerve supplies the teres major muscle in about 13% of individuals. (Brianna Chu, Bruno Bordoni. 2023)
  • The lats can have a rare anatomical variation known as a Langer’s arch, which is an extra part that connects to muscles or connective tissue of the upper arm beneath the common connecting point.
  • In individuals with this abnormality, the thoracodorsal nerve supplies function/innervation) to the arch. (Ahmed M. Al Maksoud et al., 2015)

Function

The latissimus dorsi muscle cannot function without the thoracodorsal nerve. The muscle and nerve help:

  • Stabilize the back.
  • Pull the body weight up when climbing, swimming, or doing pull-ups.
  • Assist with breathing by expanding the rib cage during inhalation and contracting when exhaling. (Encyclopaedia Britannica. 2023)
  • Rotate the arm inward.
  • Pull the arm toward the center of the body.
  • Extend the shoulders by working with the teres major, teres minor, and posterior deltoid muscles.
  • Bring down the shoulder girdle by arching the spine.
  • To bend to the side by arching the spine.
  • Tilt the pelvis forward.

Conditions

The thoracodorsal nerve can be injured anywhere along its path by trauma or disease. Symptoms of nerve damage can include: (U.S. National Library of Medicine: MedlinePlus. 2022)

  • Pain that can be shooting, stabbing, or electrical sensations.
  • Numbness, tingling.
  • Weakness and loss of function in the associated muscles and body parts, including wrist and finger drop.
  • Because of the nerve’s path through the armpit, doctors have to be cautious of the anatomical variants so they don’t inadvertently damage a nerve during breast cancer procedures, including axillary dissection.
  • The procedure is performed to examine or remove lymph nodes and is used in staging breast cancer and in treatment.
  • According to a study, 11% of individuals with axillary lymph node dissection suffered damage to the nerve. (Roser Belmonte et al., 2015)

Breast Reconstruction

  • In breast reconstruction surgery, the lats can be used as a flap over the implant.
  • Depending on the circumstances, the thoracodorsal nerve can be left intact or severed.
  • The medical community has not agreed on which method has the best outcomes. (Sung-Tack Kwon et al., 2011)
  • There is some evidence that leaving the nerve intact can cause the muscle to contract and dislocate the implant.
  • An intact thoracodorsal nerve may also cause atrophy of the muscle, which can lead to shoulder and arm weakness.

Graft Uses

A portion of the thoracodorsal nerve is commonly used in nerve graft reconstruction to restore function after injury, which includes the following:

  • Musculocutaneous nerve
  • Accessory nerve
  • Axillary nerve
  • The nerve can also be used to restore nerve function to the triceps muscle in the arm.

Rehabilitation

If the thoracodorsal nerve is injured or damaged, treatments can include:

  • Braces or splints.
  • Physical therapy to improve range of motion, flexibility, and muscle strength.
  • If there is compression, surgery may be required to alleviate the pressure.

Exploring Integrative Medicine


References

Chu B, Bordoni B. Anatomy, Thorax, Thoracodorsal Nerves. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK539761/

Al Maksoud, A. M., Barsoum, A. K., & Moneer, M. M. (2015). Langer’s arch: a rare anomaly affects axillary lymphadenectomy. Journal of surgical case reports, 2015(12), rjv159. doi.org/10.1093/jscr/rjv159

Britannica, The Editors of Encyclopaedia. “latissimus dorsi“. Encyclopedia Britannica, 30 Nov. 2023, www.britannica.com/science/latissimus-dorsi. Accessed 2 January 2024.

U.S. National Library of Medicine: MedlinePlus. Peripheral neuropathy.

Belmonte, R., Monleon, S., Bofill, N., Alvarado, M. L., Espadaler, J., & Royo, I. (2015). Long thoracic nerve injury in breast cancer patients treated with axillary lymph node dissection. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 23(1), 169–175. doi.org/10.1007/s00520-014-2338-5

Kwon, S. T., Chang, H., & Oh, M. (2011). Anatomic basis of interfascicular nerve splitting of innervated partial latissimus dorsi muscle flap. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 64(5), e109–e114. doi.org/10.1016/j.bjps.2010.12.008

The Benefits of Nonsurgical Decompression for Nerve Dysfunction

The Benefits of Nonsurgical Decompression for Nerve Dysfunction

Can individuals with sensory nerve dysfunction incorporate nonsurgical decompression to restore sensory-mobility function to their bodies?

Introduction

The spinal column in the musculoskeletal system comprises bones, joints, and nerves that work together with various muscles and tissues to ensure that the spinal cord is protected. The spinal cord is part of the central nervous system where the nerve roots are spread out to the upper and lower body parts that supply sensory-motor functions. This allows the body to move and function without pain or discomfort. However, when the body and spine ages or when a person is dealing with injuries, the nerve roots can become irritated and cause weird sensations like numbness or tingling, often correlating with body pain. This can cause a socio-economic burden on many individuals and, if not treated right away, can lead to chronic pain. To that point, it can lead to many individuals dealing with body extremity pain associated with sensory nerve dysfunction. This causes many individuals dealing with musculoskeletal disorders to start looking for treatment. Today’s article examines how nerve dysfunction affects the extremities and how nonsurgical decompression can help reduce nerve dysfunction to allow mobility back to the upper and lower limbs. We speak with certified medical providers who incorporate our patients’ information to provide nonsurgical solutions like decompression to help individuals with nerve dysfunction. We also inform patients how nonsurgical decompression can restore mobility-sensory to the upper and lower extremities. We encourage our patients to ask intricated and educational questions to our associated medical providers about the pain-like symptoms they are experiencing correlating with the sensory nerve dysfunction. Dr. Alex Jimenez, D.C., utilizes this information as an academic service. Disclaimer.

 

How Nerve Dysfunction Affects The Extremities

Do you experience tingling or numb sensations in your hands or feet that don’t want to go away? Do you feel pain in different back portions that can only be relieved through stretching or resting? Or does it hurt to walk for long distances that you feel like you need to rest constantly? Many pain-like scenarios are associated with sensory nerve dysfunction that can affect the upper and lower extremities. When many individuals experience sensory nerve dysfunction and deal with weird sensations in their extremities, many think it is due to musculoskeletal pain in their neck, shoulders, or back. This is only part of the issue, as many environmental factors can be associated with sensory nerve pain, as the nerve roots are being compressed and agitated, causing sensory nerve dysfunction in the extremities. Since the nerve roots are spread out from the spinal cord, the brain sends the neuron information to the nerve roots to allow sensory-mobility function in the upper and lower extremities. This allows the body to be mobile without discomfort or pain and functional through daily activities. However, when many individuals start to do repetitive motions that cause the spinal disc to be compressed constantly, it can lead to potential disc herniation and musculoskeletal disorders. Since numerous nerve roots are spread to the different extremities, when the main nerve roots are aggravated, it can send pain signals to each extremity. Hence, many people are dealing with nerve entrapment that leads to lower back, buttock, and leg pain that can affect their daily routine. (Karl et al., 2022) At the same time, many people with sciatica are dealing with sensory nerve dysfunction that affects their walking ability. With sciatica, it can be associated with spinal disc pathology and causes many individuals to seek treatment. (Bush et al., 1992)

 


Sciatica Secrets Revealed-Video

When it comes to looking for treatment to reduce sensory nerve dysfunction, many individuals will opt for nonsurgical solutions to minimize the pain-like symptoms and reduce the pain signals that are causing the upper and lower extremities to suffer. Nonsurgical treatment solutions like decompression can help restore sensory nerve function through gentle traction by causing the spinal disc to lay off the aggravated nerve root and start the body’s natural healing process. At the same time, it helps reduce musculoskeletal disorders from returning. The video above shows how sciatica associated with sensory nerve dysfunction can be decreased through nonsurgical treatments to allow the body’s extremities to feel better.


Nonsurgical Decompression Reducing Nerve Dysfunction

Nonsurgical treatments can help reduce low back pain associated with sensory nerve dysfunction to restore sensory-motor function to the upper and lower extremities. Many individuals who incorporate nonsurgical treatments like decompression as part of their health and wellness routine can see improvement after consecutive treatment. (Chou et al., 2007) Since many healthcare practitioners incorporate nonsurgical treatments like decompression into their practices, there has been quite an improvement in pain management. (Bronfort et al., 2008

 

 

When many individuals start to use nonsurgical decompression for sensory nerve dysfunction, many will see improvement in their pain, mobility, and activities of their daily living. (Gose et al., 1998). What spinal decompression does for the nerve roots is that it helps the affected disc that is aggravating the nerve root, pulls the disc back to its original position, and rehydrates it. (Ramos & Martin, 1994) When many individuals start thinking about their health and wellness, nonsurgical treatments can be effective for them due to their affordable cost and how they can be combined with other therapies to manage better the pain associated with nerve dysfunction affecting their body extremities.

 


References

Bronfort, G., Haas, M., Evans, R., Kawchuk, G., & Dagenais, S. (2008). Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. Spine J, 8(1), 213-225. doi.org/10.1016/j.spinee.2007.10.023

Bush, K., Cowan, N., Katz, D. E., & Gishen, P. (1992). The natural history of sciatica associated with disc pathology. A prospective study with clinical and independent radiologic follow-up. Spine (Phila Pa 1976), 17(10), 1205-1212. doi.org/10.1097/00007632-199210000-00013

Chou, R., Huffman, L. H., American Pain, S., & American College of, P. (2007). Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med, 147(7), 492-504. doi.org/10.7326/0003-4819-147-7-200710020-00007

Gose, E. E., Naguszewski, W. K., & Naguszewski, R. K. (1998). Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study. Neurol Res, 20(3), 186-190. doi.org/10.1080/01616412.1998.11740504

Karl, H. W., Helm, S., & Trescot, A. M. (2022). Superior and Middle Cluneal Nerve Entrapment: A Cause of Low Back and Radicular Pain. Pain Physician, 25(4), E503-E521. www.ncbi.nlm.nih.gov/pubmed/35793175

Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg, 81(3), 350-353. doi.org/10.3171/jns.1994.81.3.0350

Disclaimer

Choosing the Right Pain Management Specialist

Choosing the Right Pain Management Specialist

For individuals dealing with chronic pain conditions can having a better understanding of pain management specialists help in developing effective multidisciplinary treatment plans?

Choosing the Right Pain Management Specialist

Pain Management Specialists

Pain management is a growing medical specialty that takes a multi-disciplinary approach to treating all types of pain. It is a branch of medicine that applies scientifically proven techniques and methods to relieve, reduce, and manage pain symptoms and sensations. Pain management specialists evaluate, rehabilitate, and treat a spectrum of conditions, including neuropathic pain, sciatica, postoperative pain, chronic pain conditions, and more. Many primary healthcare providers refer their patients to pain management specialists if pain symptoms are ongoing or significant in their manifestation.

Specialists

Healthcare providers specializing in pain management recognize the complex nature of pain and approach the problem from all directions. Treatment at a pain clinic is patient-centric but depends on the clinic’s available resources. Currently, there are no set standards for the types of disciplines needed, another reason treatment options vary from clinic to clinic. Experts say that a facility should offer patients:

  • A coordinating practitioner specializing in pain management and consulting specialists on the patient’s behalf.
  • A physical rehabilitation specialist.
  • A psychiatrist to help the individual deal with any accompanying depression or anxiety, especially when dealing with chronic pain. (American Society of Regional Anesthesia and Pain Medicine. 2023)

Other Medical Specialties

Other specialties represented in pain management are anesthesiology, neurosurgery, and internal medicine. A coordinating healthcare provider may refer an individual for services from:

A healthcare provider should have completed additional training and credentialing in pain medicine and be an MD with board certification in at least one of the following (American Board of Medical Specialties. 2023)

  • Anesthesiology
  • Physical rehabilitation
  • Psychiatry
  • Neurology

A pain management physician should also have their practice limited to the specialty they hold the certification.

Management Goals

The field of pain management treats all types of pain as a disease. Chronic, such as headaches; acute, from surgery, and more. This allows for applying science and the latest medical advances to pain relief. There are now many modalities, including:

  • Medication
  • Interventional pain management techniques – nerve blocks, spinal cord stimulators, and similar treatments.
  • Physical therapy
  • Alternative medicine
  1. The objective is to minimize and make symptoms manageable.
  2. Improve function.
  3. Increase the quality of life. (Srinivas Nalamachu. 2013)

A pain management clinic will go through the following:

  • Evaluation.
  • Diagnostic tests, if necessary.
  • Physical therapy – increases the range of motion, strengthens the body, and prepares individuals to return to work and daily activities.
  • Interventional treatment – injections or spinal cord stimulation.
  • Referral to a surgeon if indicated by the tests and evaluation.
  • Psychiatry to deal with depression, anxiety, and/or other issues that accompany chronic pain symptoms.
  • Alternative medicine to support and enhance the other treatments.

Individuals who do well with a pain management program

Individuals who have:

  • Back pain
  • Neck pain
  • Had multiple back surgeries
  • Failed surgeries
  • Neuropathy
  • Individuals determined that surgery does not benefit their condition.

A better understanding of pain syndromes by communities and insurance companies and increased pain studies will help increase insurance coverage for treatments and technology to improve interventional outcomes.


Chiropractic Care for Leg Instability


References

American Society of Regional Anesthesia and Pain Medicine. (2023). The specialty of chronic pain management.

American Academy of Pain Medicine (2023). About the American Academy of Pain Medicine.

American Board of Medical Specialties. (2023). The Most Trusted Medical Specialty Certification Organization.

Nalamachu S. (2013). An overview of pain management: the clinical efficacy and value of treatment. The American journal of managed care, 19(14 Suppl), s261–s266.

American Society of Interventional Pain Physicians. (2023). Pain Physician.

Managing Paresthesia: Relieve Numbness and Tingling in the Body

Managing Paresthesia: Relieve Numbness and Tingling in the Body

Individuals feeling tingling or pins and needles sensations that overtake the arms or legs could be experiencing paresthesia, which occurs when a nerve has been compressed or damaged. Can knowing the symptoms and causes help in diagnosis and treatment?

Managing Paresthesia: Relieve Numbness and Tingling in the Body

Paresthesia Body Sensations

The numbness or tingling feeling when an arm, leg, or foot has fallen asleep is not so much about blood circulation but nerve function.

  • Paresthesia is an abnormal sensation felt in the body due to the compression or irritation of nerves.
  • It can be a mechanical cause like a compressed/pinched nerve.
  • Or it may be due to a medical condition, injury, or illness.

Symptoms

Paresthesia can cause various symptoms. These symptoms can range from mild to severe and can be brief or long-lasting. Signs can include: (National Institute of Neurological Disorders and Stroke. 2023)

  • Tingling
  • Pins and needles sensations
  • Feeling like the arm or leg has fallen asleep.
  • Numbness
  • Itching.
  • Burning sensations.
  • Difficulty contracting the muscles.
  • Difficulty using the affected arm or leg.
  1. The symptoms typically last for 30 minutes or less.
  2. Shaking the affected limb often relieves the sensations.
  3. Paresthesia usually affects only one arm or leg at a time.
  4. However, both arms and legs can be affected, depending on the cause.

Consult a healthcare provider if the symptoms last for more than 30 minutes. Treatment may be required if paresthesia body sensations are brought on by a serious underlying cause.

Causes

Sitting with incorrect and unhealthy postures can compress a nerve and generate symptoms. However, some causes are more concerning and can include:

Seeking Medical Assistance

If the symptoms don’t go away after 30 minutes or keep returning for unknown reasons, call a healthcare provider to find out what is causing the abnormal sensations. A worsening case should be monitored by a healthcare provider.

Diagnosis

A healthcare provider will work with the individual to understand the symptoms and perform the appropriate diagnostic tests to determine the cause. A healthcare provider will choose the tests based on a physical examination. Common diagnostic procedures include: (Merck Manual Professional Version. 2022)

  • Magnetic resonance imaging – MRI of the spine, brain, or extremities.
  • X-ray to rule out bone abnormalities, like a fracture.
  • Blood tests.
  • Electromyography – EMG studies.
  • Nerve conduction velocity – NCV test.
  1. If paresthesia is accompanied by back or neck pain, a healthcare provider may suspect a compressed/pinched spinal nerve.
  2. If the individual has a history of diabetes that is poorly controlled, they may suspect peripheral neuropathy.

Treatment

Treatment for paresthesia depends on the diagnosis. A healthcare provider can help determine the best course of action for the specific condition.

Nervous System

  • If symptoms are triggered by a central nervous condition like MS, individuals will work closely with their healthcare provider to get the appropriate treatment.
  • Physical therapy could be recommended to help improve overall functional mobility. (Nazanin Razazian, et al., 2016)

Spinal Nerve

  • If paresthesia is caused by compression of a spinal nerve, like sciatica, individuals may be referred to a chiropractor and physical therapy team to release the nerve and pressure. (Julie M. Fritz, et al., 2021)
  • A physical therapist may prescribe spinal exercises to relieve compression of the nerve and restore normal sensations and motion.
  • Strengthening exercises to restore flexibility and mobility may be prescribed if weakness presents along with paresthesia body sensations.

Herniated Disc

  • If a herniated disc is causing the abnormal sensations, and there has been no improvement with conservative measures, a healthcare provider may suggest surgery to relieve pressure on the nerve/s. (American Association of Neurological Surgeons. 2023)
  • In surgical procedures like a laminectomy or discectomy, the objective is to restore nerve function.
  • Post-surgery, individuals may be recommended to a physical therapist to help regain mobility.

Peripheral Neuropathy


What Is Plantar Fasciitis?


References

National Institute of Neurological Disorders and Stroke. (2023) Paresthesia.

American Association of Neurological Surgeons. (2023) Herniated disc.

National Institute of Diabetes and Digestive and Kidney Diseases. (2018) Peripheral neuropathy.

Merck Manual Professional Version. (2022) Numbness.

Razazian, N., Yavari, Z., Farnia, V., Azizi, A., Kordavani, L., Bahmani, D. S., Holsboer-Trachsler, E., & Brand, S. (2016). Exercising Impacts on Fatigue, Depression, and Paresthesia in Female Patients with Multiple Sclerosis. Medicine and science in sports and exercise, 48(5), 796–803. doi.org/10.1249/MSS.0000000000000834

Fritz, J. M., Lane, E., McFadden, M., Brennan, G., Magel, J. S., Thackeray, A., Minick, K., Meier, W., & Greene, T. (2021). Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica : A Randomized Controlled Trial. Annals of internal medicine, 174(1), 8–17. doi.org/10.7326/M20-4187

Small Fiber Neuropathy: What You Need to Know

Small Fiber Neuropathy: What You Need to Know

Individuals diagnosed with peripheral neuropathy, or with small fiber neuropathy, can understanding symptoms and causes help with potential treatments?

Small Fiber Neuropathy: What You Need to Know

Small Fiber Neuropathy

Small fiber neuropathy is a specific classification of neuropathy, as there are different types, which are nerve injury, damage, disease, and/or dysfunction. Symptoms can result in pain, loss of sensation, and digestive and urinary symptoms. Most cases of neuropathy like peripheral neuropathy involve small and large fibers. Common causes include long-term diabetes, nutritional deficiencies, alcohol consumption, and chemotherapy.

  • Small fiber neuropathy is diagnosed after diagnostic testing showing it is clear that the small nerve fibers are involved.
  • The small nerve fibers detect sensation, temperature, and pain and help regulate involuntary functions.
  • Isolated small-fiber neuropathy is rare, but research is ongoing on the type of nerve damage and potential treatments. (Stephen A. Johnson, et al., 2021)
  • Small fiber neuropathy is not specifically dangerous but is a sign/symptom of an underlying cause/condition that is damaging the body’s nerves.

Symptoms

Symptoms include: (Heidrun H. Krämer, et al., 2023)

  • Pain – symptoms can range from mild or moderate discomfort to severe distress and can happen at any time.
  • Loss of sensation.
  • Because the small nerve fibers help with digestion, blood pressure, and bladder control – symptoms of autonomic dysfunction can vary and can include:
  • Constipation, diarrhea, incontinence, urinary retention – the inability to completely drain the bladder.
  • If there is progressing nerve damage, the intensity of the pain can decrease, but the loss of normal sensation and autonomic symptoms can worsen. (Josef Finsterer, Fulvio A. Scorza. 2022)
  • Hypersensitivity to touch and pain sensations can cause pain without a trigger.
  • The loss of sensation can make individuals unable to accurately detect sensations of touch, temperature, and pain in affected areas, which can lead to various types of injuries.
  • Although more research is needed, certain disorders that were not considered neuropathies may have small fiber neuropathy components involved.
  • A study suggested that neurogenic rosacea, a skin condition, could have some elements of small fiber neuropathy. (Min Li, et al., 2023)

Small Nerve Fibers

  • There are several types of small nerve fibers; two in small fiber neuropathy include A-delta and C. (Josef Finsterer, Fulvio A. Scorza. 2022)
  • These small nerve fibers are distributed throughout the body including the tops of the fingers and toes, trunk, and internal organs.
  • These fibers are usually located in the superficial areas of the body, such as close to the skin’s surface. (Mohammad A. Khoshnoodi, et al., 2016)
  • The small nerve fibers that get damaged are involved in transmitting pain and temperature sensations.
  • Most nerves have a special type of insulation called myelin that protects them and increases the speed of nerve impulses.
  • Small nerve fibers may have a thin sheath, making them more susceptible to injury and damage at earlier stages of conditions and diseases. (Heidrun H. Krämer, et al., 2023)

Individuals At Risk

Most types of peripheral neuropathy cause damage to the small and large peripheral nerve fibers. Because of this, most neuropathies are a mix of small-fiber and large-fiber neuropathy. Common risk factors for mixed fiber neuropathy include: (Stephen A. Johnson, et al., 2021)

  • Diabetes
  • Nutritional deficiencies
  • Overconsumption of alcohol
  • Autoimmune disorders
  • Medication toxicity

Isolated small-fiber neuropathy is rare, but there are conditions that are known to contribute to the cause and include: (Stephen A. Johnson, et al., 2021)

Sjogren Syndrome

  • This autoimmune disorder causes dry eyes and mouth, dental problems, and joint pain.
  • It can also cause nerve damage throughout the body.

Fabry Disease

  • This condition causes a buildup of certain fats/lipids in the body that can lead to neurological effects.

Amyloidosis

  • This is a rare disorder that causes a buildup of proteins in the body.
  • The proteins can damage tissues like the heart or nerves.

Lewy Body Disease

  • This is a neurological disorder that causes dementia and impaired movement and can lead to nerve damage.

Lupus

  • This is an autoimmune disease that affects joints, skin, and sometimes nerve tissue.

Viral Infection

  • These infections typically cause a cold or gastrointestinal/GI upsetness.
  • Less often they can cause other effects like small fiber neuropathy.

These conditions have been seen to cause isolated small-fiber neuropathy or begin as small-fiber neuropathy before progressing to the large nerve fibers. They can also begin as a mixed neuropathy, with small and large fibers.

Progression

Often the damage progresses at a relatively moderate rate, leading to added symptoms within months or years. The fiber nerves that are affected by the underlying condition usually progressively deteriorate, regardless of where they are located. (Mohammad A. Khoshnoodi, et al., 2016) Medications can help alleviate damage to the peripheral nerves. For individuals that are diagnosed in the early stage, it is possible to stop the progression, and potentially prevent involvement of the large fibers.

Treatments

Treatment toward preventing the progression requires controlling the underlying medical condition with treatment options depending on the cause. Treatments that can help prevent the progression include:

  • Blood sugar control for individuals with diabetes.
  • Nutritional supplementation for the treatment of vitamin deficiencies.
  • Quitting alcohol consumption.
  • Immune suppression for control of autoimmune diseases.
  • Plasmapheresis – blood is taken and the plasma is treated and returned or exchanged for the treatment of autoimmune diseases.

Symptom Treatment

Individuals can get treatment for the symptoms that will not reverse or cure the condition but can help with temporary relief. Symptomatic treatment can include: (Josef Finsterer, Fulvio A. Scorza. 2022)

  • Pain management can include medications and/or topical analgesics.
  • Physical therapy – stretching, massage, decompression, and adjustments to keep the body relaxed and flexible.
  • Rehabilitation to help improve coordination, which can be impaired by loss of sensation.
  • Medications to relieve GI symptoms.
  • Wearing specialized clothes such as neuropathy socks to help with foot pain symptoms.

Treatment and medical management of neuropathies usually involve a neurologist. A neurologist may prescribe medication to help alleviate pain symptoms and provide medical interventions like immunotherapy if there is concern that an autoimmune process could be the cause. Additionally, treatment could include the care of a physical medicine and rehabilitation physician or a physical therapy team to provide stretches and exercises to help strengthen the body and maintain mobility and flexibility.



References

Johnson, S. A., Shouman, K., Shelly, S., Sandroni, P., Berini, S. E., Dyck, P. J. B., Hoffman, E. M., Mandrekar, J., Niu, Z., Lamb, C. J., Low, P. A., Singer, W., Mauermann, M. L., Mills, J., Dubey, D., Staff, N. P., & Klein, C. J. (2021). Small Fiber Neuropathy Incidence, Prevalence, Longitudinal Impairments, and Disability. Neurology, 97(22), e2236–e2247. doi.org/10.1212/WNL.0000000000012894

Finsterer, J., & Scorza, F. A. (2022). Small fiber neuropathy. Acta neurologica Scandinavica, 145(5), 493–503. doi.org/10.1111/ane.13591

Krämer, H. H., Bücker, P., Jeibmann, A., Richter, H., Rosenbohm, A., Jeske, J., Baka, P., Geber, C., Wassenberg, M., Fangerau, T., Karst, U., Schänzer, A., & van Thriel, C. (2023). Gadolinium contrast agents: dermal deposits and potential effects on epidermal small nerve fibers. Journal of neurology, 270(8), 3981–3991. doi.org/10.1007/s00415-023-11740-z

Li, M., Tao, M., Zhang, Y., Pan, R., Gu, D., & Xu, Y. (2023). Neurogenic rosacea could be a small fiber neuropathy. Frontiers in pain research (Lausanne, Switzerland), 4, 1122134. doi.org/10.3389/fpain.2023.1122134

Khoshnoodi, M. A., Truelove, S., Burakgazi, A., Hoke, A., Mammen, A. L., & Polydefkis, M. (2016). Longitudinal Assessment of Small Fiber Neuropathy: Evidence of a Non-Length-Dependent Distal Axonopathy. JAMA neurology, 73(6), 684–690. doi.org/10.1001/jamaneurol.2016.0057

Reducing Somatosensory Pain With Spinal Decompression

Reducing Somatosensory Pain With Spinal Decompression

How does spinal decompression help reduce somatosensory pain associated with individuals dealing with back and leg pain?

Introduction

As we all know, the human body is a complex system that works together to perform various actions without feeling pain or discomfort. With muscles, organs, tissues, ligaments, bones, and nerve roots, each component has its job and interacts with other body parts. For instance, the spine collaborates with the central nervous system to instruct the muscles and organs to function correctly. Meanwhile, the nerve roots and muscles work together to provide mobility, stability, and flexibility to the upper and lower body extremities. However, as time passes, the body ages naturally, and this can lead to unwanted issues. Normal and traumatic factors can interfere with the neuron signals from the brain and cause somatosensory pain in the upper and lower extremities. This pain-like sensation can affect each body section, making the individual miserable. Luckily, there are ways to reduce somatosensory pain and provide relief to the body. Today’s article explores how somatosensory pain can impact the lower extremities, particularly the legs and back, and how non-surgical treatments like spinal decompression can alleviate somatosensory pain in the lower extremities. At the same time, we work hand-in-hand with certified medical providers who use our patient’s information to treat and mitigate somatosensory pain affecting the legs and back. We also inform them that non-surgical treatments like spinal decompression can help alleviate residual pain-like symptoms from the lower extremities. We encourage our patients to ask essential and important questions while seeking education from our associated medical providers about their pain. Dr. Alex Jimenez, D.C., incorporates this information as an educational service. Disclaimer

 

How Does Somatosensory Pain Affect The Legs & Back?

Are you experiencing numbness or tingling in your legs or back that disappears after a few minutes? Do you feel questionable pain in your lumbar spine after work? Or do you feel a warm sensation in the back of your legs that turns into sharp shooting pain? These issues may be related to the somatosensory system within the central nervous system, which provides voluntary reflexes to muscle groups. When normal movements or traumatic forces cause problems to the somatosensory system over time, it can lead to pain that affects the body’s extremities. (Finnerup, Kuner, & Jensen, 2021) This pain may be accompanied by burning, pricking, or squeezing sensations that affect the lumbar region. Many factors can be associated with somatosensory pain, which is part of the central nervous system and works with the spinal cord. When the spinal cord becomes compressed or aggravated due to injury or normal factors, it can lead to low back and leg pain. For example, a herniated disc in the lumbosacral area can cause nerve roots to send pain signals to the brain and cause abnormalities in the back and legs. (Aminoff & Goodin, 1988)

 

 

When people are dealing with back and leg pain from somatosensory pain, it can cause them to be miserable by reducing their quality of life and leading to a life of disability. (Rosenberger et al., 2020) At the same time, individuals dealing with somatosensory pain will also begin to feel inflammatory effects from the affected muscle area in the legs and back. Since inflammation is a body’s natural response when dealing with pain, the inflammatory cytokines can cause a cascading effect from the brain through the spinal cord, causing leg and back pain. (Matsuda, Huh, & Ji, 2019) To that point, somatosensory pain is associated with inflammation caused by normal or traumatic factors that can cause overlapping risk factors contributing to leg and back pain. Luckily, numerous treatments can reduce these overlapping risk factors caused by somatosensory pain and help restore the lower body extremities’ function.

 


Move Better, Live Better- Video

When the body is dealing with somatosensory pain, it can cause many individuals to think they are only dealing with one source of pain from one muscle area. Still, it can lead to multifactorial issues that affect different body locations. This is known as referred pain, where one body section deals with pain but is in a different area. Referred pain can also be combined with somato-visceral/visceral-somatic pain, where the affected muscle or organ affects one or the other, causing more pain-like issues. However, numerous treatments can reduce somatosensory pain from causing more leg and back problems. Non-surgical therapies like chiropractic care and spinal decompression can help mitigate the effects of somatosensory pain affecting the lower body extremities causing leg and back pain. These treatments allow the pain specialist to incorporate various therapeutic techniques to stretch the affected muscles and realign the spine to its original position. Many individuals can see an improvement in their mobility and daily activities as the pain-like symptoms associated with somatosensory pain are reduced. (Gose, Naguszewski, & Naguszewski, 1998) When individuals dealing with somatosensory pain start thinking about their health and wellness to ease the pain they are experiencing, they can look into non-surgical treatments as they are cost-effective, safe, and provide a positive outcome. Additionally, non-surgical treatments can be personalized to the individual’s pain and begin to see improvement after a few treatment sessions. (Saal & Saal, 1989) Check out the video above to learn more about how non-surgical treatments can be combined with other therapies to improve a person’s well-being.


Spinal Decompression Reduces Somatosenosory Pain

Now spinal decompression is a non-surgical treatment that can help reduce somatosensory pain affecting the legs and back. Since somatosensory pain correlates with the spinal cord, it can affect the lumbosacral spine and lead to back and leg pain. With spinal decompression, it utilizes gentle traction to gently pull the spine, which then can reduce the symptoms associated with somatosensory pain. Spinal decompression can help improve the somatosensory system by reducing pain and alleviating aggravated nerve root compression to relieve the legs and back. (Daniel, 2007)

 

 

 

Additionally, spinal decompression can be combined with other non-surgical treatments, like chiropractic, as it can help with reducing the effects of nerve entrapment and help restore the joint’s ROM (range of motion). (Kirkaldy-Willis & Cassidy, 1985) Spinal decompression can create a positive experience for many individuals dealing with leg and back pain associated with somatosensory pain while getting back their health and wellness.


References

Aminoff, M. J., & Goodin, D. S. (1988). Dermatomal somatosensory evoked potentials in lumbosacral root compression. J Neurol Neurosurg Psychiatry, 51(5), 740-742. doi.org/10.1136/jnnp.51.5.740-a

 

Daniel, D. M. (2007). Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media? Chiropr Osteopat, 15, 7. doi.org/10.1186/1746-1340-15-7

 

Finnerup, N. B., Kuner, R., & Jensen, T. S. (2021). Neuropathic Pain: From Mechanisms to Treatment. Physiol Rev, 101(1), 259-301. doi.org/10.1152/physrev.00045.2019

 

Gose, E. E., Naguszewski, W. K., & Naguszewski, R. K. (1998). Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study. Neurol Res, 20(3), 186-190. doi.org/10.1080/01616412.1998.11740504

 

Kirkaldy-Willis, W. H., & Cassidy, J. D. (1985). Spinal manipulation in the treatment of low-back pain. Can Fam Physician, 31, 535-540. www.ncbi.nlm.nih.gov/pubmed/21274223

www.ncbi.nlm.nih.gov/pmc/articles/PMC2327983/pdf/canfamphys00205-0107.pdf

 

Matsuda, M., Huh, Y., & Ji, R. R. (2019). Roles of inflammation, neurogenic inflammation, and neuroinflammation in pain. J Anesth, 33(1), 131-139. doi.org/10.1007/s00540-018-2579-4

 

Rosenberger, D. C., Blechschmidt, V., Timmerman, H., Wolff, A., & Treede, R. D. (2020). Challenges of neuropathic pain: focus on diabetic neuropathy. J Neural Transm (Vienna), 127(4), 589-624. doi.org/10.1007/s00702-020-02145-7

 

Saal, J. A., & Saal, J. S. (1989). Nonoperative treatment of herniated lumbar intervertebral disc with radiculopathy. An outcome study. Spine (Phila Pa 1976), 14(4), 431-437. doi.org/10.1097/00007632-198904000-00018

 

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