NEW YORK (CBS) ― A growing number of people are turning to needles to relieve their chronic pain. It's called "trigger point therapy," and many say it's bringing the relief they desperately need.
Nathalie Dinoia developed chronic back and neck pain after a close call at Ground Zero on 9/11.
"I was there when the first plane crashed into the World Trade Center and I fell on my side cracking my neck, falling on my hip," she said. "The pain is very tremendous. Your muscles are tight, tight, tight."
After physical therapy and appointments with the chiropractor didn't help, she turned to Dr. Alexander Kulick for trigger point therapy.
"Immediate release. I was feeling to be back to be normal," she said.
Trigger point therapy involves inserting needles into the muscles at special points that cause them to twitch and then relax for good.
"A trigger point really is part of the muscle that is most constricted," said Dr. Kulick.
The needles used in trigger point injections usually contain a small amount of anesthesia and saline or salt water. But even when no medications are injected, just applying pressure to the points can give some relief. Dr. Kulick said the treatement can be used for many kinds of pain, ranging from muscle pain to migraines.
"A pattern of pain that kind of goes across the side of the head and around the eyes, and that really can be related to a trigger point, a muscle that is spasmed at the base of your neck," said Dr. Kulick.
Alison Chrisman had severe muscle spasms in her hips and spine, and although she describes the treatments as slightly uncomfortably at first, it was well worth it.
"Most recently I was incapacitated. I couldn't walk, I couldn't stand up straight," she said.
But after having gone through trigger point therapy?
"I walked out of here in no pain after the second session,"she said.
Trigger point therapy should only be administered by a licensed physician trained in the technique. Although rare complications such as puncturing a lung have occurred, milder side effects such as redness and swelling around the injection site are most common.
In most cases, stretching exercises and physical therapy are performed following trigger point injections. Check with your insurer, not all of them cover this procedure.
Aug 29, 2009
Aug 28, 2009
Sciatica Symptoms And Treatment
If you develop a pain that starts in your lower back or buttock and radiates down your leg, your problem may be sciatica. Sciatica is also known as nerve root entrapment or irritation, or lumbar radiculopathy syndrome.
Symptoms and Causes of Sciatica
Patients with sciatica may also have numbness, “pins and needles” sensation, muscle weakness, and reflex changes. Symptoms may be worsened by twisting, sitting, coughing, or sneezing.
Sciatica is a symptom that is typically caused by a lumbar disc herniation or lumbar spinal canal narrowing (stenosis), resulting in irritation or compression of the affected nerve root. These symptoms can be brought on by wear and tear over time or by an injury causing a rupture or herniation of a disc, when the inner contents (a gel-like nucleus) protrudes through the torn outer ring (annulus) affecting the adjacent nerve roots.
The symptoms of sciatica can be distinguished from low back pain and referred low back pain by the radiation of pain into the buttock and leg and by clinical findings. An estimated 5-10% of patients with low back pain have sciatica.
The majority of patients with sciatica have a favorable outcome with natural resolution of symptoms in several months. However, in contrast to low back pain, some patients with sciatica tend to have more persistent and severe symptoms with prolonged disability.
Treatment for Sciatica: Conservative and Surgical
Patients with sciatica should tell their doctor about the specific duration and character of their symptoms. The doctor will perform a history and physical examination. After appropriate conservative care, x-rays and MRI scans can confirm lumbar nerve root compression.
Conservative Treatment
Conservative treatment is aimed at pain reduction. Initial treatment starts with cold packs or heat, NSAIDs (non-steroidal anti-inflammatory medications), muscle relaxants, and pain medications.
Education about proper mechanics (bending and lifting), physical therapy, and epidural steroid injections may also help patients return to full activity.
Surgical Treatment
Some patients do not respond to nonsurgical care and experience persistent disabling sciatica. These patients may benefit from surgery.
The role of surgery is to remove the disc herniation or stenosis (narrowing of canal) that is pressing on the affected lumbar nerve to ease the leg pain and associated symptoms of numbness and weakness. This decompression surgery does not reliably reduce low back pain.
The timing of surgery is multifactorial, based on the duration and severity of symptoms. There is consensus that a cauda equina syndrome (bladder or bowel paralysis) is an absolute indication for immediate surgery. In general, there is a greater than 90% chance of successful resolution of sciatica after surgery.
The surgery can be performed with a microdiscectomy, laminotomy, laminoplasty, or laminectomy technique as indicated by the need for exposure of the affected nerve roots.
In the recent SPORT clinical study (Spine Patient Outcome Research Trial), a randomized, multi-site trial that the HSS Spine Service participated in, patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operative treated patients in relief of sciatica, physical function, and bodily pain.
Source: Hospital For Special Surgery
Symptoms and Causes of Sciatica
Patients with sciatica may also have numbness, “pins and needles” sensation, muscle weakness, and reflex changes. Symptoms may be worsened by twisting, sitting, coughing, or sneezing.
Sciatica is a symptom that is typically caused by a lumbar disc herniation or lumbar spinal canal narrowing (stenosis), resulting in irritation or compression of the affected nerve root. These symptoms can be brought on by wear and tear over time or by an injury causing a rupture or herniation of a disc, when the inner contents (a gel-like nucleus) protrudes through the torn outer ring (annulus) affecting the adjacent nerve roots.
The symptoms of sciatica can be distinguished from low back pain and referred low back pain by the radiation of pain into the buttock and leg and by clinical findings. An estimated 5-10% of patients with low back pain have sciatica.
The majority of patients with sciatica have a favorable outcome with natural resolution of symptoms in several months. However, in contrast to low back pain, some patients with sciatica tend to have more persistent and severe symptoms with prolonged disability.
Treatment for Sciatica: Conservative and Surgical
Patients with sciatica should tell their doctor about the specific duration and character of their symptoms. The doctor will perform a history and physical examination. After appropriate conservative care, x-rays and MRI scans can confirm lumbar nerve root compression.
Conservative Treatment
Conservative treatment is aimed at pain reduction. Initial treatment starts with cold packs or heat, NSAIDs (non-steroidal anti-inflammatory medications), muscle relaxants, and pain medications.
Education about proper mechanics (bending and lifting), physical therapy, and epidural steroid injections may also help patients return to full activity.
Surgical Treatment
Some patients do not respond to nonsurgical care and experience persistent disabling sciatica. These patients may benefit from surgery.
The role of surgery is to remove the disc herniation or stenosis (narrowing of canal) that is pressing on the affected lumbar nerve to ease the leg pain and associated symptoms of numbness and weakness. This decompression surgery does not reliably reduce low back pain.
The timing of surgery is multifactorial, based on the duration and severity of symptoms. There is consensus that a cauda equina syndrome (bladder or bowel paralysis) is an absolute indication for immediate surgery. In general, there is a greater than 90% chance of successful resolution of sciatica after surgery.
The surgery can be performed with a microdiscectomy, laminotomy, laminoplasty, or laminectomy technique as indicated by the need for exposure of the affected nerve roots.
In the recent SPORT clinical study (Spine Patient Outcome Research Trial), a randomized, multi-site trial that the HSS Spine Service participated in, patients who underwent surgery for a lumbar disc herniation achieved greater improvement than non-operative treated patients in relief of sciatica, physical function, and bodily pain.
Source: Hospital For Special Surgery
Mayo Clinic: Effectiveness of Laser Spine Surgery for Pain Relief Remains Unproven
By Tribune Media Services
Published: Thursday, August 27, 2009 11:56 AM MDT
DEAR MAYO CLINIC: Can you shed any light on the reliability of laser spine surgery as a successful treatment for chronic neck and back pain? Do these treatments work?
ANSWER: Spine surgery can be performed using several different tools, including a laser. Laser spine surgery has been around since the 1980s but it has never been studied in a controlled clinical trial to determine its effectiveness. Most neurosurgeons don't use lasers for spine surgery because there are no clear benefits to laser surgery over more well-established spine surgery techniques that have proven to be effective.
The purpose of spine surgery typically is to relieve pain and other symptoms by decreasing pressure on a compressed spinal nerve or by stabilizing the spine. Surgery may involve removing a herniated or damaged portion of a disk in the spine (discectomy); removing the back part of the bone that covers the spinal canal (laminectomy); removing bone spurs or other spinal growths; or connecting two or more of the vertebral bones in the spine (spinal fusion).
Traditionally, a small, high-speed air drill or a surgical instrument that's heated with an electric current (electrocautery) is used to cut away the tissue and bone. During laser spine surgery, a focused beam of light (laser) is used to cut away tissue. Laser spine surgery is often promoted as being noninvasive and risk-free. However, these procedures require incisions and can result in serious complications.
Before deciding on the type of spine surgery to have, first, you should thoroughly investigate the need for surgery. Chronic neck and back pain has many possible causes. I'd strongly recommend that you do not proceed with any type of treatment until you see a medical spine specialist such as a neurologist to evaluate your symptoms and diagnose what's causing them.
In some cases, a precise diagnosis can be difficult to determine. If you have pain that's confined to your spine - it doesn't radiate to your hands, arms, feet or legs - and magnetic resonance imaging or another imaging test doesn't reveal a specific diagnosis, you may want to consult a specialist in a pain clinic.
Pain specialists can use diagnostic injections to pinpoint the problem area. One difficulty in diagnosing spine problems is that the spine has many moving parts that are potential pain generators - for example, disks, facet joints, nerve roots, the spinal cord and muscles. By systematically injecting these structures one by one with anesthetic agents, the anatomic source of the pain often can usually be determined.
Even when you know what's causing neck and back pain, surgery shouldn't be the first line of treatment, unless you're having severe pain or muscle weakness that results in difficulty walking or performing daily activities. Medications and physical medicine that combines exercise, lifestyle changes and treatment modalities such as acupuncture or therapeutic massage can often effectively reduce pain.
If your symptoms persist, a reasonable next step would be injection therapy. Your doctor may inject medication such as cortisone into the space around the spinal cord (epidural space) to decrease inflammation around the nerve roots. Or your doctor may inject numbing medication into or near the structures that are causing back pain. Often both substances are injected simultaneously.
If more conservative treatments fail to reduce back pain, then surgery may be necessary, depending on your diagnosis. For example, if you have a herniated disk with leg or arm pain as a major symptom that hasn't been relieved with other treatments, discectomy may be appropriate. If your doctor recommends surgery, don't move forward until you have a clear understanding of your diagnosis and how the surgery will help relieve your symptoms.
Traditional spine surgery has been tested in numerous clinical trials and proven to be effective. Studies have shown that discectomy reduces pain and other symptoms in approximately 85 percent of people who have a herniated disk. In elderly patients who have radiating pain due to spinal stenosis, laminectomy effectively reduces symptoms in about 80 percent of patients. Very few neurosurgeons regard laser spine surgery as a viable alternative to conventional spine surgery techniques. At Mayo Clinic, we don't use or recommend laser spine surgery. - H. Gordon Deen, M.D., Neurosurgery, Mayo Clinic, Jacksonville, Fla.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge(AT SIGN)mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For more information, visit www.mayoclinic.org.)
Published: Thursday, August 27, 2009 11:56 AM MDT
DEAR MAYO CLINIC: Can you shed any light on the reliability of laser spine surgery as a successful treatment for chronic neck and back pain? Do these treatments work?
ANSWER: Spine surgery can be performed using several different tools, including a laser. Laser spine surgery has been around since the 1980s but it has never been studied in a controlled clinical trial to determine its effectiveness. Most neurosurgeons don't use lasers for spine surgery because there are no clear benefits to laser surgery over more well-established spine surgery techniques that have proven to be effective.
The purpose of spine surgery typically is to relieve pain and other symptoms by decreasing pressure on a compressed spinal nerve or by stabilizing the spine. Surgery may involve removing a herniated or damaged portion of a disk in the spine (discectomy); removing the back part of the bone that covers the spinal canal (laminectomy); removing bone spurs or other spinal growths; or connecting two or more of the vertebral bones in the spine (spinal fusion).
Traditionally, a small, high-speed air drill or a surgical instrument that's heated with an electric current (electrocautery) is used to cut away the tissue and bone. During laser spine surgery, a focused beam of light (laser) is used to cut away tissue. Laser spine surgery is often promoted as being noninvasive and risk-free. However, these procedures require incisions and can result in serious complications.
Before deciding on the type of spine surgery to have, first, you should thoroughly investigate the need for surgery. Chronic neck and back pain has many possible causes. I'd strongly recommend that you do not proceed with any type of treatment until you see a medical spine specialist such as a neurologist to evaluate your symptoms and diagnose what's causing them.
In some cases, a precise diagnosis can be difficult to determine. If you have pain that's confined to your spine - it doesn't radiate to your hands, arms, feet or legs - and magnetic resonance imaging or another imaging test doesn't reveal a specific diagnosis, you may want to consult a specialist in a pain clinic.
Pain specialists can use diagnostic injections to pinpoint the problem area. One difficulty in diagnosing spine problems is that the spine has many moving parts that are potential pain generators - for example, disks, facet joints, nerve roots, the spinal cord and muscles. By systematically injecting these structures one by one with anesthetic agents, the anatomic source of the pain often can usually be determined.
Even when you know what's causing neck and back pain, surgery shouldn't be the first line of treatment, unless you're having severe pain or muscle weakness that results in difficulty walking or performing daily activities. Medications and physical medicine that combines exercise, lifestyle changes and treatment modalities such as acupuncture or therapeutic massage can often effectively reduce pain.
If your symptoms persist, a reasonable next step would be injection therapy. Your doctor may inject medication such as cortisone into the space around the spinal cord (epidural space) to decrease inflammation around the nerve roots. Or your doctor may inject numbing medication into or near the structures that are causing back pain. Often both substances are injected simultaneously.
If more conservative treatments fail to reduce back pain, then surgery may be necessary, depending on your diagnosis. For example, if you have a herniated disk with leg or arm pain as a major symptom that hasn't been relieved with other treatments, discectomy may be appropriate. If your doctor recommends surgery, don't move forward until you have a clear understanding of your diagnosis and how the surgery will help relieve your symptoms.
Traditional spine surgery has been tested in numerous clinical trials and proven to be effective. Studies have shown that discectomy reduces pain and other symptoms in approximately 85 percent of people who have a herniated disk. In elderly patients who have radiating pain due to spinal stenosis, laminectomy effectively reduces symptoms in about 80 percent of patients. Very few neurosurgeons regard laser spine surgery as a viable alternative to conventional spine surgery techniques. At Mayo Clinic, we don't use or recommend laser spine surgery. - H. Gordon Deen, M.D., Neurosurgery, Mayo Clinic, Jacksonville, Fla.
(Medical Edge from Mayo Clinic is an educational resource and doesn't replace regular medical care. E-mail a question to medicaledge(AT SIGN)mayo.edu , or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For more information, visit www.mayoclinic.org.)
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