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Stephen T. Pyles, MD-Spinal Stimulation Therapy for Pain Management

352-861-4600
2300 South Pine Ave. • Ocala, FL 34471
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Chronic Back Pain-an Overview

Posted on 04.1.15 |

chronic back painEverything in your body can be associated and related to your back. Since the spinal column, nerves that stem from the back and each vertebra are so intertwined with nearly every function in the body, chronic back pain can have a profound effect on everything.

The spine consists of strong bones, flexible ligaments and tendons, large muscles and highly sensitive nerves. It’s core purpose is to keep the rest of your body in motion. That’s a tall task for one area of your body, and when one thing goes wrong within this spinal structure, it truly affects absolutely everything.

 

Understanding back pain involves understanding the anatomy of the spine. There are for major regions of your back; the cervical spine, the thoracic spine, the lumbar spine, and the sacral region of the spine. Basically, that’s top of the neck to the back part of the pelvis.

Cervical Spine

This portion of the spine supports the weight of the head and protects the nerves that connect the brain to the rest of the body through the spinal column. The cervical spine can easily be affected by injury, car accidents that cause whiplash, or a straining of the neck. Even stress and bad posture can injure this area.

 

Pain that lasts for only a few days is usually just a muscle, ligament or tendon strain and can be treated with ice and/or heat, medication, and/or a chiropractor’s assistance. For pain that lasts longer than a few weeks, causes might be far worse such as herniated disks, pinched nerves or a misalignment.

Thoracic Spine

The thoracic spine is connected to the rib cage, and provides stability and structural support to the upper back. Its motion is limited as its ultimate purpose is to protect the vital organs of the heart and lungs. Being that this area of the back was not designed for a lot of motion, it does not get injured that often.

Lumbar Spine

The lumbar spine is the lower portion of the back, and the portion that consists of the most motion and thus the most injuries. It carries the weight of the torso, and thus many lifting injuries occur in this area. The lumbar spine is also the most common area to break down from years of wear and tear from heavy lifting or improper use of back muscles.

 

While herniated disks are common in this area of the back, muscle and tendon strains are seen very often and, though they can cause a great deal of pain, should heal fairly rapidly due to the soft tissues that carry a great deal of blood supply. Sciatica is also another common condition in the lumbar spine.

 

Sacral Region

Lastly, the sacral region of the back is the very bottom of the spine; the back part of the pelvis. This area of the back is subjected to a large amount of stress for the same reasons as the lumbar spine. Twisting during certain activities and heavy lifting can create problems over time.

The anatomy of the human back is incredibly complex and remarkable. It’s important to note that an injury in one area of the back, because of it’s complexity and relation to the rest of the body, might not create pain in the injured area but might transfer pain to other areas, even disrupt the body’s normal function.

For example, an injury or misalignment in the area of the cervical spine can cause headaches and TMJ-type symptoms, even as the injury is located in the spine and not the jaw. An injury in the sacral region can cause pain in the legs, feet and hips, even though the damaged area is located in the lower spine.

If you have been feeling unexplained pain, lower back pain or chronic headaches, the culprit could be in the spine. Call us to find out more information!

What is Diabetic Peripheral Neuropathy and How Can It Be Treated?

Posted on 03.30.15 |

feetWhen it comes to chronic pain conditions, diabetic peripheral neuropathy is at the top of the list. It is characterized by nerve damage caused to the legs, feet, hands and arms because of this insidious disease. It is different from the similar in nature arterial form of this disease, which is poor circulation of the blood because of the presence of diabetes.

There are three nerve groups that can and often are affected by this form of neuropathy, including the sensory nerves, which ensure people can feel pain and other heightened sensation; motor nerves, which allow people to control their muscles; and autonomic nerves, which help the body to perform certain automatic functions, such as sweating.

Diabetic peripheral neuropathy is a condition that develops slowly and gets worse as the years go by; in fact, a number of people suffer from this infliction well before they are actually diagnosed with diabetes. As time goes by and the diabetes settles in, however, those suffering from it become at greater risk for developing diabetic peripheral neuropathy.

The chronic pain part of the disease comes into play in a number of ways. First, the skin is more susceptible to developing sores that don’t heal properly over time. In fact, much of the time, these sores can become infected, leading to the loss of a limb or even part of a limb. Symptoms of diabetic peripheral neuropathy might include numbness or tingling in the extremities as well as weakened muscles or loss of clear coordination.

The first step in dealing with the problem, including the chronic pain that can come along with it, is to get the diabetes under control. This means getting blood sugar levels in a normal range before beginning to tackle the issues associated with the diabetic peripheral neuropathy. Physical therapy plays a big role in learning to cope with both the pain and the core issue itself. Medications may also be suggested to address the pain and help to manage the diabetes.

Diabetic peripheral neuropathy is mainly controlled through prevention, however, which in turn comes down to understanding the disease mainly associated with the condition – diabetes – and finding ways to control it as effectively as possible. This ensures these kinds of adverse health effects won’t pop up down the line as the disease starts to take a toll on the body.

 

Back Pain & Spinal Injections

Posted on 03.23.15 |

spinal injectionsBack pain can be more than a simple nuisance; it can be downright debilitating. While there are a number of treatments for back pain – from anti-inflammatory medications to in-office treatments to massage therapy – one nonsurgical option to deal with the discomfort is a spinal injection. Sounding far more sinister than it is, a spinal injection can not only help to relieve pain, but in some instances – depending on the type of injection – can help to diagnose the cause of the pain. This can then help your physician to determine a course of treatment for the pain.

In most instances, when dealing with Florida back pain, spinal injections are used in conjunction with other therapies and after more traditional options have been utilized. It is the option that stands between physical therapy for back pain and surgical solutions, for those that are trying to avoid going under the knife to address the source of the pain.

For Florida back pain, in particular, injectable pain relief can work wonders because the fact that the medication is injected into the very area originating the source of the back pain brings relief almost instantly. By comparison, when taking oral medications, it can take up to an hour before any relief is felt, particularly if the medication is time-released. In these instances, a steroid medication is delivered at the site of the injection to reduce inflammation and thereby pain in the area. This is generally a fairly temporary type of relief, though it is generally longer lasting than an over-the-counter medication.

It should be noted that to treat Florida back pain with an injectable medication, you should work with a trained physician. Injecting anything into your back can be dangerous when administered improperly, so anyone not trained to give such injections can cause more harm than good.

It also helps to know the types of back injections available for those experiencing back pain, which include an epidural (often given during surgical procedures and for pregnant women in labor and in need of pain relief); selective nerve root block; sacroiliac joint block; facet joint block and facet rhizotomy, to name a few of the most commonly used injections. Talk with your doctor about the side effects of any injections used to stave off Florida back pain, so that you are clear about what to expect.
However, when back injections are used to diagnose an issue, the process is a bit different. The idea behind these injections is to determine which area of the back is causing the pain. If the patient feels relief of any kind after the injection, then the treating physician can infer that the immediate area in which the injection was given was the source of the Florida back pain. This can be helpful in determining a future course of treatment that might include other types of treatments.

To know whether back injections are the best option for treatment, it always a good idea to discuss the pros and cons with a medical professional, so that all information available in this course of treatment can be considered in the decision.

 

GAO Report Claims DEA to Blame for Many Drug Shortages

Posted on 03.20.15 |

Ken Terry | March 17, 2015 www.medscape.com

The US Drug Enforcement Agency (DEA) and the US Food and Drug Administration (FDA) should work together more closely to prevent shortages of prescription medications containing controlled substances, said a blistering new report from the General Accountability Office (GAO). The DEA should also improve its process for authorizing quotas of the controlled substances used in these drugs, the report recommends.
Shortages of prescription drugs containing controlled substances have increased in recent years, the report notes. Of the 168 shortages from January 2001 to June 2013, nearly 70% began after 2007. Shortages lasted nearly a year on average. Many shortages involved generic pain relievers and drugs with only one manufacturer.
Of the 168 shortages, 87 were identified as critical. More than half of those drug shortages involved analgesics. There were also shortages among this group of antianxiety drugs, sedative hypnotics, and stimulants, among others.
According to the FDA and organizations representing patients and providers, the GAO said, these shortages can lead to less effective care, no treatment, and/or medication errors. Providers spend time and resources mitigating the effects of drug shortages instead of taking care of patients.
One cause of these shortages, pharmaceutical companies charge, is the amount of time it takes the DEA to approve controlled substance quotas. The DEA has created these quotas for each class of controlled substances and for each manufacturer of drugs containing these agents to prevent their diversion to illegal uses.
According to the GAO report, the DEA did not respond to manufacturers’ quota applications within the time frames required by the agency’s own regulations for any year from 2001 to 2014. Even after the DEA implemented an electronic system to streamline this process in 2011, the report said, it took an average of 58 days to respond to quota applications in 2011 and 2012.
The DEA denied that its lack of adherence to its own quota application processing time frames has caused shortages of drugs, the report said. But the FDA data on the causes of 40 shortages of drugs containing controlled substances from January 2010 to 2013 showed that seven of these shortages “were caused by problems related to quota,” the report notes. Other shortages resulted from factors such as manufacturing delays, capacity issues, and product quality issues.
The GAO made several recommendations to improve the DEA’s management of the quota application process and to avoid future drug shortages. Among other things, the GAO advised the DEA and the FDA to update their existing memorandum of understanding, which has not been revised since the 1970s.
There is bipartisan interest on Capitol Hill in combatting the increasingly serious problem of medical drug shortages. Sen. Charles Grassley (R­IA) and Sen. Sheldon Whitehouse (D­RI) commissioned the GAO report in 2012, and next month, Grassley and Sen. Dianne Feinstein (D­CA), the leaders of the Caucus on International Narcotics Control, are scheduled to hold a hearing on the report’s findings.
Negative Effect on Healthcare
Leaders of medical societies whose members are especially dependent on prescribing drugs containing controlled substances told Medscape Medical News that shortages of these medications have grown steadily worse in recent years.
“We are seeing regular and increasing shortages of these drugs,” said Beverly Philip, MD, vice president of scientific affairs for the American Society of Anesthesiologists. She cited a 2011 society survey of anesthesiologists showing that 90% of respondents reported they were currently experiencing a shortage of least one anesthesia drug, and that 98% had encountered a shortage within the past year.
As a result of these shortages, 49% of patients experienced a less optimal outcome (eg, postoperative nausea and vomiting), the survey found, and the same percentage of patients had longer operating room or recovery times than they otherwise would have had.
“When one of these drugs go on shortage, we have to look for alternatives,” Dr Philip noted. “That’s not easy, because there are drugs in the same class, but they’re just not the same. They have different strengths, different doses, they last different amounts of time. So we don’t have interchangeable drugs.”
The current shortage of midazolam, a drug commonly used to relax patients before they have surgery, shows how this problem affects patients, Dr Philip said. There are other drugs in the same category but they are much longer acting, which is not good for the patient, she noted.
Emergency department physicians have less of a problem finding substitutes for most controlled substance drugs, said Robert O’Connor, MD, a member of the board of the American College of Emergency Physicians. “If there’s a shortage of morphine, we can use something else to replace it. What has alarmed our members is where a particular drug is the only one in the class and there’s no real substitute for it.”
He cited etomidate, a sedation agent that is often used in emergency department procedures involving dislocated shoulders or fracture reductions. “There is no real substitute for it, and we’ve had to use less efficacious agents,” he said, adding that patients may suffer as a result. “You may not achieve the desired level of sedation when you’re putting somebody’s shoulder back in place because you don’t have the proper drug.”
The shortages of analgesics and sedatives also affect patients and physicians in ambulatory care, observed Lynn Webster, MD, past president of the American Academy of Pain Medicine.
“It compromises our ability to give the patients what they need,” he said. “You have to look for an alternative, and sometimes the alternative is not as effective and may also have side effects. It also takes a lot of time, and it adds to the level of frustration for physicians and patients.”
Moreover, he said, some shortages have led to patients not getting the medications they need. “We’ve seen a trend over the past 3 years of physicians not treating or trying to avoid treating patients with opioids. We’ve seen that with the up­scheduling of hydrocodone. It’s a hassle factor, and physicians are just throwing up their hands, and patients are the ones who suffer.”
Medscape Medical News © 2015  WebMD, LLC
Send comments and news tips to news@medscape.net.
Credit: GAO Report Claims DEA to Blame for Many Drug Shortages. Medscape. Mar 17, 2015.

Cannabinoids – Time for a More Rational Cannabis Policy

Posted on 03.19.15 |

cannabinoidsIndividuals who suffer from severe chronic pain are caught in a double bind. Opioids contribute to the enormous societal harms of unintentional overdose, diversion and addiction, and data on their long-term effectiveness are conflicting and inadequate (Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health pathways to prevention workshop. Ann Intern Med. Published online Jan. 13, 2015 doi:10.7326/M14-2559). But for patients who are helped by opioids, policies and regulations to address societal harms are, in some cases, impeding access to treatment, making it difficult even to find a knowledgeable physician. The need for safer and more effective analgesics has never been greater.

Answers do not lie in pitting one serious disease (i.e., chronic pain) against another (i.e., addiction) but in seeking scientific breakthroughs that lead to serious analgesic benefits without addictive properties or risk for respiratory depression. Rigorous research of cannabinoids has the potential to unlock a medicinal benefit on a societal scale. But committing to the necessary research requires rethinking how we classify cannabinoids as a controlled substance.

Inching Toward Safer Pain Treatments

Tetrahydrocannabinol (THC) produces the “high” effect associated with marijuana. On its own, cannabidiol (CBD) displays a plethora of actions including anticonvulsive, sedative, hypnotic, antipsychotic, anti-inflammatory and neuroprotective properties, and is believed to have fewer undesirable psychoactive effects than THC (Phytother Res 2009;23:597-602). Some research indicates that cannabinoids may provide analgesia for various pain conditions (Rambam Maimonides Med J 2013;4:e0022). Practically speaking, harnessing the potential medicinal benefits of marijuana without these unwanted effects would be a long-awaited breakthrough for science. Despite many strictures, scientists—largely from other countries—are inching closer to the finish line with products that could replace opioids in some instances.

 

Read Full Article >>

Pain Medicine News,  Lynn R. Webster, MD

Pain: Some Not So Fun Facts

Posted on 03.17.15 |

pain5Let’s face it: there’s nothing fun about being in pain. In fact, chronic pain can be downright debilitating, halting many of the day-to-day activities that you may undertake with regularity. Consider a few not-so-fun facts about pain that can help you to better manage pain-related health issues.

  • It can be a stressor on your emotions as well as your physical person: That’s right, it can make you feel as crummy on the inside as it does on the out. The circle is a viscous one, as the resulting negative emotions can then contribute to your ability to deal with the physical manifestation of pain. In fact, roughly 77 percent of people with chronic discomfort report feeling depressed.
  • Women experience pain more often in the course of a lifetime than men do: This could be due to issues with menstruation and childbirth, but whatever the reason, women certainly experience more than men. In fact, in animal studies, it has been shown that females require more pain medication than men – at twice the rate, actually, to get the same level of relief as men do from the medication. The jury is still out, however, on who has the higher tolerance.
  • No brain pain: The brain might send the signal for pain to the rest of the body; however, the brain itself doesn’t feel any. In fact, once a surgeon has gotten to this all-too important organ, he can operate without any anesthetic whatsoever.
  • Back pain is the most common: More often than not, when you ask people where they are experiencing chronic pain, the back is going to be the most commonly given answer. This could be because people don’t stretch enough; it could also be due to consistent reaching, bending and other body motions people do every day that put a strain on the back.

The good news is that chronic pain doesn’t have to remain unmanageable. There are a number of things you can do to ease chronic pain, including exercise, stretching, medication and more. Getting in to see a pain professional is the first step, so you can determine the cause of the pain and a treatment plan to address the root of the problem. Once this happens, then you can address the pain management aspect of the ailment and begin to feel whole again.

Back Pain & Spinal Cord Stimulation Therapy

Posted on 03.16.15 |

bak painBack pain is becoming more and more common and is the leading occupational hazard people worry about. Back pain has been known to be directly related to nerve damage. When the large nerve roots in the back are irritated they send signals to the brain which enable the back to feel the pain.

Nerve damage in the back can be treated be applying cold pack to the back as well as applying heat heal muscle tissues. Anti-inflammatory drugs can also help reduce inflammation to the back and damaged nerves. Controlled exercises and physical therapy are also beneficial forms of treatment to address back pain. Depending on the severity of the pain, resting can be a key to rebuilding damages nerves.

Read this great study about back pain “Cost-effectiveness analysis of spinal cord stimulation in treatment of failed back surgery syndrome”

 It states: On average, given current screening and efficacy rates, SCS therapy pays for itself within 5.5 years. For those patients for whom SCS therapy is clinically efficacious, the therapy pays for itself within 2.1 years.

Nerve Damage-Basic Overview

Posted on 03.13.15 |

Nerve Damage Diabetic Neuropathy pictureNerve damage is an interruption to the nervous system that blocks the communication signals your brain sends your body. The average human body has nearly 10 trillion nerve cells that are all controlled by the brain and passed through the spinal cord. These signals send messages to your muscles telling your body what to do. Nerve damage occurs in the brain, spinal cord, and the peripheral nerves located in the rest of the body. There are over 100 different types of nerve damage and they all have different symptoms and require different treatments. Since nerve damage can seriously slow down or affect the body and one’s life style is important to be proactive and recognize the symptoms of nerve damage.

Nerves are extremely important to the human body because they control our temperature feeling, heart rate, bladder control, digestive system, as well as sexual function and pain. Blood vessels feed the nerves with oxygen and nutrients needed to survive so the body is able to function properly. When blood vessels are contaminated with high levels of glucose; the blood vessel becomes damaged. When these blood vessels are damaged, they can no longer provide the nerves with nutrients which caused the nerve to become battered and possibly perish

There are two main categories the nerve damage. The first category is sensory nerve damage (peripheral neuropathy). This type of nerve damage is usually caused by trauma to the nerve or some type of sickness or disease. Some of the symptoms of sensory nerve damage are numbness, sensitivity, and burning, tingling pain in the body. Sensory nerve damage also causes problems with positional awareness within the body.

The second type of nerve damage is damage to the motor nerves. This type of nerve damage will be the most noticeable. The human brain has upper and lower motor neurons which is where damage occurs. Muscles become atrophied and flaccid when flaccid paralysis happens in the lower motor neuron. Loss of movement, tone and reflex activity’s are few symptoms of flaccid paralysis.

Other signs are muscles twitching, muscle atrophy, and muscle weakness. Autonomic nerve damage may cause an inability to sense chest pains or heart attacks. Other indicators of Autonomic nerve damage are dry eyes, dry mouth; sexual dysfunction, and constipation, dizziness, sweating too much or not sweating at all.

Medical Marijuana Debate

Posted on 03.12.15 |

From-South-florida-Hospital-news-Medical-Marijuana

Stress & Chronic Pain

Posted on 03.12.15 |

chronic painChronic pain is basically aches and pains that are continuous for a period of at least six months and more. Continuing pain can be a result of past injury or trauma, and even infection; however, this pain can also stem from emotional pain such as stress, anxiety, depression, and even anger. The results from emotional pain can be much worse than pain from injuries, as it can lead to more agenizing pain.

Continuous pain is a never ending cycle, as long-lasting pain can understandably lead to stress, while high levels of stress can contribute to added pain symptoms. Additionally, prolonged stress will cause the brain to be imbalanced and ultimately cause anxiety attacks and added stress. Extra stress will intensify the pain since it decreases the body’s natural defense against pain. Furthermore, any type of emotional pain such as stress, depression, anger, fatigue, and anxiety intensifies the pain. Since this type of pain is deeply felt, it puts patients on that dreadful cycle of stress and discomfort.

Previous studies show that lingering pain can affect the immune system. Therefore, it is very important to see a physician when experiencing enduring pain or having symptoms of chronic pain. The physician will work with patients to help get the pain under control along with helping manage stress and pain syndrome in an effective and healthy way.

Symptoms of chronic pain and problems that are linked to pain consist of ongoing anguish that can range from minimal to severe, sensations of pain often described as shooting, burning, aching and electrifying pain. Less severe symptoms include sore throbbing pain, uncomfortable feeling, straining from tightness, and feeling of constraint. In addition, tiredness, insomnia, feeling of withdrawal from activities, a weak immune system, and mood swings are many of the symptoms of this prolonged pain.

A few ways minimize and avoid additional chronic pain, you may want to stop or cut down on smoking and caffeine. The nicotine in cigarettes increases the speed of how fast the intervertebral discs degrade. Increase in caffeine intake also prevents patients from getting the rest needed to reduce pain and inflammation. Another thing you can do is to continue to stay active.

Keeping active and exercises will release endorphins which are protein molecules that work with sedative receptors in our brain, which is known for relieving pain. It is important to never over work yourself. Take frequent breaks at work to prevent stress from building up. Deep breathing will help oxygenate your brain and help relax the mind and body.

It is extremely beneficial to work with physicians to manage continuing pain. Therapists may also be a good source of assistance in helping treat long-lasting pain which starts by reducing stress.

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Pain Treatment Centers-2300 South Pine Ave, Ocala, FL 34471

(352) 861-4600