Pain Management
Rely on Midwest Orthopedic and Musculoskeletal Alliance for expert diagnosis and treatment of the most common causes of pain.
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Most Commonly Treated Pain Diagnoses
Sciatica or Radicular Pain
Can occur at multiple levels along the spinal canal. “Sciatica” is a general term which refers to low back or low back and leg pain down one leg or both legs. These types of pains can be caused by multiple entities. The most common reasons are mechanical compression from a disc herniation, chemical irritation from disc material, foraminal stenosis secondary to arthritis and vascular compromise. Typical treatment for this type of pain includes physical therapy, chiropractic, and spinal injections including epidural steroid injections or selective nerve root injections.
Low Back, Mid Back, and Neck Pain
Cervical, Thoracic, Lumbar Arthritis — Common causes of low back, mid back, and neck pain include facet arthropathy or spondylosis. This type of pain can localize more to the midline of the spine, however, referred pain can also occur in multiple areas extending beyond the midline. This is typical pain that occurs with extension, leaning backwards, or twisting causing irritation of the joints on the side of the lumbar, thoracic, or cervical spine. Typical treatment for this includes diagnostic medial branch blocks followed by radiofrequency ablation which can give the patient 50% improvement or better for 6 months to 2 years.
Joint Pain/Bursitis/Arthritis-Osteoarthritis
Or inflammation that is occurring in the joint or in and around the joint. Inflammation of bursa sacs found all over the body. Typical treatment for this includes physical therapy, chiropractic, and intra-articular steroid injections, Hyaluronic acid injections and more recently diagnostic tests for associated nerves followed by radiofrequency ablation. Common areas of pain are included below.
Lumbar Stenosis with and without Neurogenic Claudication
Lumbar stenosis with neurogenic claudication is a common source of low back pain. This type of pain can originate from congenital deformities of the spinal canal creating “tightness” around the central canal or along the foramina where nerves exit. This also includes a normal process of aging and degeneration or dehydration creating “tightness”. Classic symptoms include significant improvement in pain, weakness, numbness, or general symptoms when the patient sits down. It worsens when standing or walking. The typical patient will do very well with a grocery cart at the grocery store and bending forward. Typical treatment for this includes epidural steroid injections, medial branch blocks and radiofrequency ablation, and more recently the interspinous spacer procedure.
Failed Back Surgical Syndrome or Post Laminectomy Syndrome
Occurs when patient outcome following a surgery has not resulted in a satisfactory outcome as determined by the patient. Typical treatment includes physical therapy, chiropractic, epidural steroid injections, medial branch blocks and radiofrequency ablation, and in more severe cases or persistent cases spinal cord stimulation trial and implantation or pain pump.
Complex Regional Pain Syndrome
This is a disease that includes a number of signs and symptoms that occur after trauma. Most commonly after surgery. However, this disease can occur with trauma in general. Classic signs and symptoms by the International Association for the Study of Pain include Sensory – Hyperaesthesia and/or allodynia. Vasomotor – Temperature asymmetry and/or skin colour changes and/or skin colour asymmetry. Sudomotor/Edema – Edema and/or sweating changes and/or sweating asymmetry. The treatment is focused on desensitization and mobility with physical therapy. Common treatments include multiple different types of medications including neuromodulators, NSAIDs, steroids, more recently ketamine infusions and naltrexone. In more severe cases, sympathetic blocks including lumbar sympathetic blocks as well as stellate ganglion blocks for upper extremity CRPS followed by physical therapy. If continued pain occurs in spite of multiple modalities, the patient may be a candidate for dorsal root ganglion stimulation or spinal cord stimulation.
Chronic Abdominal/Pelvic Pain
Fibromyalgia
A complex syndrome causing chronic widespread pain, may also include fatigue, sleep disturbances are common, and impaired physical function. This occurs in approximately 2 to 4% of the general population. It is the second most common rheumatologic disorder behind osteoarthritis. Criteria continue to be 11/18 tender points. Common treatments for fibromyalgia include physical therapy, good sleep hygiene, smoking cessation, weight loss, as well as neuromodulators and injections including trigger point injections.
Compression Fractures
Compression fractures are common occurrences in the elderly. Osteoporosis versus pathologic fractures are common. This includes a fracture of the spinal/vertebral bones creating significant pain with movement. Typical treatment includes physical therapy, bracing, and in more severe cases kyphoplasty or vertebroplasty.
Cancer Associated Pain
Cancer associated pain occurs in a significant number of the cancer population. General versus more localized pain from surgery, mass-effect, as well as side effects from medication can occur. Treatment includes multimodal management which likely includes medications as well as multiple different types of injections that may be beneficial for the patient with cancer.
Treatments
- Epidural steroid injections
- Medial branch blocks and radiofrequency ablations neck, mid back, and low back
- Hyaluronic acid joint injections
- Steroid injections in joints
- Radiofrequency and Coolief ablations for knees, hips, and shoulders
- Sympathetic blocks stellate ganglion, celiac plexus, lumbar sympathetic, superior hypogastric plexus, ganglion impar
- Spinal cord stimulation
- Pain pumps
- Interspinous spacer procedures
- Kyphoplasty and vertebroplasty
- Various nerve blocks throughout the body
Find Lasting Pain Relief
Call us at 414-384-6700 to connect with our interventional pain specialists at Midwest Orthopedic and Musculoskeletal Alliance in Southeastern Wisconsin.
