I live and ski in Sun Valley approximately 60 days/season. I have developed knee pain and I am wondering if I am a candidate for PRP (Platelet-Rich Plasma)?

You may be a good candidate for Regenerative Medicine, either PRP or Stem Cell.  Stem Cell is done primarily for osteoarthritis of the larger joints-knee, hips, shoulder.  Whereas PRP is more typically done for a partial tear or sprain of tendons/ligaments.  However, PRP can also be done for osteoarthritis (and degenerative discs of the spine).  Call Pain Care Boise at 208-342-8200 to set up an evaluation.

Do nerve blocks with steroids cure the problem for which they are used in chronic pain conditions?

Nerve blocks for chronic pain generally do not “cure” the problem but rather decrease the inflammation. We typically see a more manageable pain level and, therefore, improved function. This will allow the body time to heal itself. There are numerous examples of clinical conditions that can be treated with nerve blocks. For examples, when treating a herniated disc with epidural steroids, we decrease the inflammation of the nerve roots. Whether one gets long term relief depends on what actually happens with the herniated disc. A herniated disc will resorb up to 60% of time. However, this means 40% of the time the disc will stay the same or even get worse.

Why would a celiac plexus block be done for a patient with pancreatic cancer?

The celiac plexus innervates the lower esophagus, stomach, small intestines, most of the large intestines, liver, pancreas, spleen, adrenal glands, and kidneys. Therefore, by blocking the celiac plexus, you can interrupt the pain fibers from these abdominal organs. The celiac plexus is actually a series of ganglia just in front of the aorta and the 1st and 2nd lumbar vertebrae. A diagnostic block is done first with local anesthetic only. If the patient has a good response, we then consider proceeding with a neurolytic block (usually alcohol). This is most commonly done for patients with pancreatic cancer with upper abdominal pain, but can also be tried for cancer of the other above organs.

What is piriformis syndrome?

The piriformis muscle lies in the lower buttocks area between the sacrum and hip. The sciatic nerve runs below or through the piriformis muscle. Piriformis syndrome will mimic sciatica. With piriformis syndrome, there is no weakness or numbness. Piriformis syndrome is typically caused by an injury to the piriformis muscle and often does result in irritation of the sciatic nerve that runs near it. It is typically treated with anti-inflammatories, stretching exercises, and sometime massage techniques such as sitting with a tennis ball underneath the affected area. Resistant problems can be treated with steroid injections, sometimes Botox injections, and /or even surgical resection of the piriformis muscle.

What is interventional pain management?

Interventional pain management refers to a group of minimally invasive surgical procedures typically done as an outpatient to alleviate acute, chronic, or cancer- related pain conditions. These include, but are not limited to; trigger points injections, epidural steroids, facet injections, peripheral nerve blocks, sympathetic blocks, intravenous infusions, neurolytic procedures (radiofrequency lesioning, cryotherapy, chemical neurolysis), Botulinum Toxin injections, intradiscal treatments (IDET, Loblation/Nucleoplasty, LASE), intraspinal analgesics, and spinal cord stimulation techniques. Specific training is required to perform each of these types of procedures and management of potential complications. Interventional pain management procedures are often an important component of an interdisciplinary pain treatment program.

When is spinal cord stimulation utilized in pain management?

Spinal cord stimulation is considered for neuropathic pain or pain due to a nerve injury when other more conservative modalities have failed. It is most commonly used when one has a difficult to treat extremity pain, arm or leg pain. Examples of arm or leg pain can be after spine surgery due to continued scar tissue about the nerve roots, with reflex sympathetic dystrophy problems, following injuries to peripheral nerves, and sometimes even for people with peripheral vascular disease. Potential patients must be able to understand how to regulate and control the stimulations, as treatment success involves active participation by the patient.

Is a nerve root injection different than an epidural steroid injection?

A nerve root injection is a transformational epidural steroid injection. An epidural steroid injection is usually an interlaminar (between two vertebrae) approach. With an interlaminar steroid injection the needle is placed to the epidural space typically near the middle of the spinal canal. With an interlaminar approach, a high volume technique is utilized to bathe several nerve roots at several levels. With a nerve root injection, a needle is placed adjacent to the specific nerve root in question with the aid of a x-ray machine to bathe primarily the one specific nerve root. Nerve root injections are most commonly done when one has a lateral herniated disc or foraminal stenosis.

What is and when is a neurolytic block used in pain medicine?

Neurolysis can be achieved through injection of chemicals (Phenol, Glycerol, or Alcohol), the use of cryotherapy (cold), or the use of radiofrequency lesioning (heat). All of these therapies are typically used as an end of the road type of treatment. Cryotherapy can be used for some peripheral neuropathies of nerves that are a sensory nerve only. Radiofrequency lesioning is most commonly used to denervate facet joints. These two types of neurolysis are much more selective than the use of chemical solutions. However, the spread of the liquid chemical agents is beneficial for the interruption of large nerve ganglia for some intractable pain states and/ or terminal illnesses.

If my herniated disc is not pressing on a nerve root, could it still cause my low back pain and leg pain?

Although controversial, it is possible. A herniated disc is felt to cause lower extremity or radicular pain by potentially two different mechanisms. The most obvious is by physical or mechanical pressure on the nerve root. The second is by a chemical irritant and/or acid \ base changes due to the contents of the inner part of a disc reaching the nerve root through a herniation or even a simple fissure through the disc. The end result of both mechanisms is inflammation and irritation of the nerve root, which goes down your leg.

Is sciatica only caused by a herniated disc?

No. First, sciatica is a bit of a misnomer. Strictly, sciatica means pain in the distribution of the sciatic nerve. In medicine, sciatica commonly is used to describe lower extremity pain caused by the irritation of the nerve roots that form the sciatic nerve. This can be caused by a herniated disc or anything that puts pressure on the nerve root; such as spinal stenosis, severe facet arthritis, bone spurs, tumor, or cyst. Any of the above can cause inflammation of the involved nerve roots that typically will cause low back and lower extremity pain or “sciatica”.

How is sacroiliac (SI) pain diagnosed and treated?

The diagnosis is based on history, tenderness over the SI joint, and exclusion of other diagnoses. One needs to evaluate rheumatological disorders, most commonly ankylosing spondylitis. There are no good physical exam tests, laboratory tests, and or radiographic tests for SI diagnosis. However, if there is evidence noted on plain film x-rays, bone scans and/or MRI, it is felt to be a very specific diagnosis. Treatment is typically with anti- inflammatory medication, physical therapy, steroid injections either into the SI ligaments or the SI joint itself, chiropractic adjustments, and rarely fusion of the SI joint. Some will do radiofrequency procedures attempting to deinnervate the SI joint.

Is my bulging or protruding disc on my MRI a herniated disc?

By definition; bulging, protruding, prolapsed, extruding, and even sequestered discs are considered herniated discs. The more important question probably is: does the disc impinge upon a nerve root and/or spinal cord? Of coarse, whether or not the bulging or protruding disc is of significance also depends on the patient’s symptoms. Is there pain radiating down the arm or leg, is there numbness or weakness of an extremity, and /or is there dysfunction of bladder or bowel? Of course, always ask your physician to better explain your MRI, if you do not understand the terminology.