A headache is one of the most common ailments that brings patients to visit physicians,it can often be a harbinger of serious medical conditions such as tumors and infections. Most of the time however the cause is related to structural problems in the musculoskeletal system of the neck. We can diagnose this by history, physical exam and medical testing such as mri and nerve testing. Treatments often entail physical therapy, medical management and or injection therapy.

Neck Pain

Neck pain is a common problem often related to recent injury, treatments often include physical therapy medical management and or injection therapy. The issue with recent trauma to the neck is that there are many sheets of muscle in the neck region and injury to those muscles can cause trigger points in the muscle. These trigger points are nothing more than bruised many muscle that when contracted with normal neck movement can cause pain. The rationale for trigger point injections is to deliver medicine to the bruised muscle to hasten recovery.

Shoulder Pain

Pain from the shoulder joint has two common causes, recent injury and chronic wear and tear. If someone has a recent injury and can lift the arm the usual way above the head, etc. this usually an indication for shoulder mri. The principal reason to obtain a shoulder mri is to look at a structure called the rotator cuff. The rotator cuff is a structure in the shoulder mad up of tendons from 4 muscles that insert in the shoulder joint. If the rotator cuff is torn this is sometimes an indication for surgery, if the Rotator cuff is not torn and there is still pain often times application of anti-inflammatory medication in the joint hastens recovery.


The hallmark of this condition is an acceleration-deceleration injury. This often happens in motor vehicle accidents when the patient is hit from behind. The snapping of the neck in this manner puts a stress on a joint in the neck called the facet joint. Treatment for this problem often includes physical therapy and minor injections but when the pain is refractory to these conservative methods burning the nerve that supplies the joint can be the recommended treatment. This treatment is called Radiofrequency Lesioning and has been studied for at least 15 years. An article documenting its efficacy was published in the NEJM in 1997.

Low Back & Leg Pain

Probably the most common reason to seek medical attention and also one of the most expensive ailments to society. To get proper treatment first you have to make an opinion where the pain is coming from. Once you rule out extra abdominal causes of back pain, (back pain can be symptom of many maladies form abdominal aortic aneurysm to metastasic prostate cancer), there are to our knowledge about five things that cause back pain consistently. The intervertebral disk, the facet joints, nerve roots, ligaments, and muscles. Unfortunately treatments for each specific cause of pain is different, and despite what would you think with the advent of highly detailed computer imaging the cause of pain is oftentimes equivocal.

Herniated Disc & Spinal Stenosis

This is a common problem but how does this little disk cause all this pain? The answer to that question lies inside the disk itself. In the middle of the disk there is a nucleus pulpous that has a jelly like consistency . When a disk herniated this jellylike material oozes to touch sensitive structures that cause an inflammatory reaction this is what causes pain.

Muscle (myofascial) Pain

Literally pain from muscle, but usually in the chronic form is a result of repetitive stress injuries, such as poor ergonomics at a place of work causing neck pain.
Overuse of muscles leads to buildup of toxins in local areas of the muscle that cause pain. Treatment usually is at identifying and correcting the problem but return to function without pain often is accomplished with stretching, physical therapy, medications and injection techniques.

Neuralgia or Pain Following a Never Injury

Often after accidents, trauma or surgery nerves are damaged the pain that is specific to this type of injury is called neuropathic pain or neulagia.Treatment of this type of pain is very different than normal or somatic pain. Since this pain involves damage to nerve tissue treatment is aimed at stabilizing the electrical signals that nerves send to the brain, this is often accomplished by using anti epileptic medications which as a whole work by stabilizing voltage gated channels in nerve membranes and thereby decreasing the pain signal.

Reflex Sympathetic Dystrophy & Causalgia (Chronic Regional Pain Syndrome)

All of the above terms essentially are describing the same pain ailment. The bottom line is that the sympathetic nervous system that controls dilation or constriction of blood vessels is disturbed and this disturbance causes pain usually in distal portions of the extremities and if left untreated can migrate to more proximal regions of the body. The classic case of this type of pain is a severe trauma to an ankle and the ensuing convalesence is prolonged and the pain upon weight bearing is so severe that the patient delays walking. This type of delay is sometimes enough to cause the sympathetic nervous system to distort the message given to blood vessels and cause pain.

Pain from Cancer

The treatment of cancer pain is one of the true advances in medicine over the past twenty years. With the advent of selective anti-inflammatory medications and long acting morphine like medications controlling pain in the cancer patient has become easier. However each different type of cancer can cause pain in different ways and the treatment is hardly uniform. The advent of newer synthetic opioids gives us more choices to individualize treatment regimens.

Pain Following Amputation (phantom)

When a patient has a limb amputated the nerves are cut, the imprint of those electrical signals sent from those nerves are still fresh to the brain so sometimes the sensation of the limb is felt by the patient despite the absence of the limb. Studies have shown that chronic pain from the limb before the amputation leaves more of an imprint on the brain so those patients are more are at risk for this malady. For example many times amputation is a result of peripheral vascular disease, prior to actual amputation patients often have infections and ischemia that causes severe pain if this pain is not managed well these patients leave an imprint of severe pain on the portion of the brain that covers the limb, these patients have a higher risk for Phantom Pain.

Motor Vehicle Accidents

When getting hit from behind in a motor vehicle accident this can cause an acceleration-deceleration injury that specifically targets the neck facet joints. This injury can cause severe neck pain that can lead to intractable headaches. Treatment usually starts out with physical therapy and medications but often needs to be treated with more invasive techniques to stop the pain.

Chronic Pain Syndrome

When patients have severe pain that bothers them on a daily basis it can cause mood changes. When this same pain does not allow people to have restful sleep patients can get depressed. The term Chronic Pain Syndrome describes this unfortunate chain of events. Access to psychologists and group therapy often times encourages patients by making them feel less isolated. Particularly in the work related pain patients often have to face the fact of retraining for a different type of job.

Post Herpetic Neuralgia

The virus that gave most of us chicken pox as children lives dormantly in our nerve cells until something triggers the virus to duplicate. This exponential duplcation causes an inflammatory reaction in the blood vessels and tissues around particular nerves in our body. This causes a vesicular rash that usually subsides in a week, there usually a 3 week pain free interval and then a new pain starts. The type of pain is called allodynia. This pain is one of the most horrible pains known it is a condition where normal things that should not cause excruciating pain cause excruciating pain. Wearing a shirt, the mere rubbing of cotton on your skin can cause severe pain. Wind on the skin causes a fire like sting and normal treatments do not touch this pain.  If you have this condition it is very important that you see a pain management specialist as soon as possible!



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