Treatment For Cervicogenic Headaches
Dr. Culver treats tension-type headaches with cervical epidural steroid injections, sometimes including greater occipital nerve blocks. In most cases these treatments provide long-term relief to patients suffering from cervicogenic headaches, even when physical therapy and other medical-based treatments have failed. If cervicogenic headaches are relieved, often times associated migraine headaches will also lessen in frequency and intensity.
Most treatments for back and neck pain, sciatica, shingles, cervicogenic headaches, and other conditions can be performed in the office, eliminating expensive facility fees associated with hospital- or surgery center-based treatments. Call Pain Management Center of Flint today at 720-8900 for an appointment with Dr. James Culver or Dr. Monica Culver to learn more about your pain relief options.
Shingles Symptoms Before Rash
Shingles develops in two stages. The first is called the prodromal period.
Shingles is a reactivation of the varicella virus, which is what causes chickenpox. After an initial infection, the virus lays dormant in the body. Once reactivated, which can happen years down the line, shingles results.
Often, the earliest signs this is occurring are similar to what you’d expect at the start of any infection. These symptoms sometimes occur at times when you’re feeling stressed or run down. They are also systemic, meaning they affect the whole body.
You may assume you’re just overtired or coming down with a cold when you actually have shingles.
The Emotional Toll Of Nerve Pain After Shingles
Researchers are not just looking at biological and neurological risk factors for PHN. Dworkin was also a co-author of a study looking at psychological risk factors, too. The results were published in the Journal of Pain in 2005.
“It certainly looks like psychological stress can be a potent risk factor for PHN,” Dworkin tells WebMD.
The study showed that people with shingles who went on to develop PHN were more likely to have had symptoms of personality disorders, hypochondria, intense worry about their disease, and other bodily complaints.
Dworkin says previous studies have already shown a connection between stress and shingles development.
“One study even found that the risk of developing PHN was higher in people who were living alone when they developed shingles than people living with others,” Dworkin says, perhaps indicating that social isolation increases the risks of PHN.
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Taming The Pain Of Sciatica: For Most People Time Heals And Less Is More
- By Steven J. Atlas, MD, MPH, Contributor
Despite being a less common cause of low back pain, sciatica is still something I regularly see as a general internist. Primary care doctors can and should manage sciatica, because for most individuals the body can fix the problem. My job is to help manage the pain while the body does its job. When a persons symptoms dont improve, I discuss the role of surgery or an injection to speed things up.
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Sciatic Herpes Zoster Suspected Of Lumbar Disc Herniation: An Infrequent Case Report And Literature Review
- 1Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, Xi’an, China
- 2School of Basic Medicine, Fourth Military Medical University, Xi’an, China
- 3Tangdu Hospital, Fourth Military Medical University, Xi’an, China
Background: The symptoms of sciatic herpes zoster are sometimes difficult to distinguish from sciatica caused by lumbar disc herniation. We describe a case of suspected lumbar disc herniation with sciatic herpes zoster to reduce the rate of misdiagnosis.
Case Report: A 55-year old man, male, developed low back pain after carrying heavy items 20 years ago. Characteristics of symptoms: 1. Symptoms were aggravated in the upright lumbar forward flexion position 2. The VAS score was 89 points and the VSA score was 0 point 3. It can be relieved when rested in the supine position 4. It came on intermittently with radiation pain in the right lower limb. There were several attacks every year. One month ago, there was radiating pain in the right lower limb. The pain was from the back of the right hip, behind the thigh, in lateral crural region, to the back of the foot. And Symptoms worsened for 10 days. The VAS score was 8 points. Pain could not be relieved by rest or changing posture. There was no back pain, no lower limbs, weak walking, no claudication and other symptoms. Analgesics and neurotrophic drugs are ineffective. After the application of antiviral drugs, the radiation pain in the right lower extremity was significantly relieved.
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Availability Of Data And Materials
The dataset used in this study is held by the Taiwan Ministry of Health and Welfare . The Ministry of Health and Welfare must approve our application to access this data. Any researcher interested in accessing this dataset can submit an application form to the Ministry of Health and Welfare requesting access. Please contact the staff of MOHW for further assistance. Taiwan Ministry of Health and Welfare Address: No.488, Sec. 6, Zhongxiao E. Rd., Nangang Dist., Taipei City 115, Taiwan . Phone: +88628590-6848. All relevant data are within the paper.
Outcome And Covariate Assessment
The outcome of interest was a new diagnosis of HZ between January 1, 2000 and December 31, 2013. All individuals were followed until HZ occurrence, withdrawal from NHI, death, or December 31, 2013, whichever occurred first. We considered several covariates as potential confounders including sex, age, and baseline comorbidities. Inpatient and outpatient data were used to define the status of comorbidities including chronic kidney disease , obesity , diabetes , coronary artery disease , depression , and lumbar disc herniation .
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Can The Pain Go Away On Its Own
Sciatica pain usually self-resolves.
However, it helps to adopt a good sitting posture, as well as performing regular light stretching and exercise.
If sciatica pain lasts more than 6 weeks or becomes too severe, consider talking to a doctor.
Medical professionals may prescribe medications or spinal steroid injections to help relieve symptoms.
To treat the underlying cause, a doctor might suggest seeing a physical therapist for manual manipulation, massage, and specific sciatica exercises.
If the sciatic pain continues for 6 months up to 1 year, a doctor might perform surgery to remove part of the spinal disk that affects the nerve.
Here are some healthful habits that can help prevent sciatica:
- sitting and standing with good posture
- avoiding sitting or lying down for long periods
- using good form when picking up something heavy, including lifting from the knees, not the back
- exercising and stretching regularly
What Complications Are Associated With Sciatica
Most people recover fully from sciatica. However, chronic pain can be a complication of sciatica. If the pinched nerve is seriously injured, chronic muscle weakness, such as a drop foot, might occur, when numbness in the foot makes normal walking impossible. Sciatica can potentially cause permanent nerve damage, resulting in a loss of feeling in the affected legs. Call your provider right away if you lose feeling in your legs or feet, or have any concerns during your recovery time.
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What Are The Symptoms Of Shingles
Two to four days before the shingles rash occurs there may be tingling or local pain in the area. Pain is usually the first sign of shingles. For some, the pain can be intense. In some cases, and depending on the location of the pain, shingles can be mistaken for problems with the heart, lungs, or kidneys. Furthermore, patients may also experience headaches, fever, dizziness, sensitivity to light, and flu-like symptoms without a fever. And, there are cases where some patients experience shingles pain without ever developing the rash.
As time progresses, tingling, itching, joint pain, swollen glands, and a burning pain often develops. The rash typically appears one to five days after the symptoms begin, starting with small, red spots that form blisters filled with fluid, and then scab over. If the blisters burst from scratching, the skin may scar after the rash subsides.
The shingles skin rash usually heals within two to four weeks however, some people develop ongoing nerve pain that can last for months or years, a condition called postherpetic neuralgia.
The rash caused by shingles is more painful than itchy, with the pain and rash being the most obvious signs of shingles. The skin rash tends to be isolated to one side of the body, or in a particular location on the body. Shingles most commonly develops in the areas of the chest, stomach, spine, face, and mouth, but can appear other places on the body, even in multiple locations.
Mechanism Of Clinical Efficacy Of Corticosteroids
The mechanism of action of corticosteroids is largely due to cytokine suppression. Risbud and Shapiro have assessed the relationship between cytokines and the development of intervertebral disc degeneration. Their proposed link between the two modalities begins with injury and follows with the release of cytokines from both the nucleus pulposus and annulus fibrosus as well from macrophages, neutrophils, and T cells. Cytokines include tumor necrosis factor alpha , interleukin 1-beta , various other interleukins including IL-1 /, IL-2, IL-4, IL-6, IL-8, IL-10, IL-17, as well as IFN-, chemokines, and Prostaglandin E-2 . Proinflammatory cytokines enhance the activation and migration of immunocytes, with subsequent initiation of a molecular reaction, leading first to intervertebral disc degeneration and, ultimately, to a radicular back and/or neck pain.
Corticosteroids have direct and indirect roles in minimizing the production/release of previously mentioned cytokines by inhibiting Phospholipase A2 and the ensuing arachidonic acid metabolic pathway. The proposed mechanism results in both disc degeneration and pain expression reduction. Additionally, corticosteroids enhance the inhibition of transcription factors and result in the subsequently decreased expression of pro-inflammatory genes, whereas upon binding to glucocorticoid responsive elements adjacent to promoters of anti-inflammatory genes, they increase the expression of the latter.
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Treating Sciatica Pain And Managing Expectations
Many people think that the worse the pain, the more likely something bad is going on. However, this isnt true for sciatica. The body can reabsorb the disc material that is causing symptoms, even for those with severe pain. So, treatment focuses on controlling pain and keeping people as active as possible. If the pain is excruciating, lying down for short periods can help, but prolonged bed rest does not. So, once the pain diminishes, I tell patients to get up and start walking short distances. Since sitting increases pressure on the discs in the lower back, I recommend avoiding prolonged sitting or driving. Many people try treatments like physical therapy, massage, acupuncture, and chiropractic manipulation, but evidence suggests that while these approaches may help typical low back pain, they are less helpful for sciatica. Over-the-counter pain medicines like ibuprofen and naproxen can help. When they dont, I may recommend short-term use of stronger, prescription pain medicines.
Patients often ask about spinal injections where steroid medicine is injected into the affected area. It is worth considering for those with uncontrolled pain or for those with persistent, bothersome symptoms who want to avoid surgery. Injections can provide short-term relief. Like any procedure, it has uncommon risks including more pain, and it doesnt seem to decrease the need for future surgery.
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What Does Prednisone Do
Prednisone, like other corticosteroids, quickly lowers inflammation, which cuts down on pain, redness, and swelling. It also dials down your immune system. Under normal conditions, this system protects you against things like viruses and bacteria that cause infections and diseases.
Sometimes your immune system overreacts and attacks your bodys tissues. Prednisone stops that attack. Thereâs also proof that low-dose prednisone may slow joint damage in people with rheumatoid arthritis, but not as much as other arthritis medications do. It can also cause unpleasant long-term side effects.
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How Is Shingles Diagnosed
A diagnosis of shingles is typically based on a physical exam and history, specifically, if the patient has ever had chickenpox. Also, a tissue scraping or culture of the blisters may help confirm the diagnosis. Shingles can be confused with herpes simplex, dermatitis herpetiformis , impetigo , and skin reactions.
If there is a reason to suspect the rash is shingles, antiviral treatment may begin immediately. Early treatment can help shorten the length of the illness and prevent complications, such as postherpetic neuralgia.
What You Can Do About Nerve Pain That Lingers After Shingles
Chronic pain that continues after a case of shingles is called postherpetic neuralgia . It is estimated that about 20% of patients will experience this type of nerve pain as a complication of shingles.
Those who have had chickenpox are at risk of developing shingles later in life. People who develop PHN are generally age 60 and older. Although there is no cure for PHN, there are several methods of pain management that can ease symptoms. Fortunately, the type of pain that arises from postherpetic neuralgia improves over time.
Neuralgia affects the nerves, causing structural and functional damage. It can feel like a stabbing or burning pain that radiates along the affected nerve.
Neuropathic pain is not caused by an external injury or stimuli but originates from inside the nervous system. When the herpes-varicella zoster virus is reactivated in the form of shingles, scar tissue forms alongside nerves, creating pressure, and sending pain signals to the brain.
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Have Shingles Get Treatment Take Action
If you have shingles, it’s important to talk to your doctor about your risk for developing PHN. Ask whether preventative treatment with antiviral drugs makes sense. If your doctor says it’s not necessary, ask why.
The full implications of the psychological risk factors for PHN aren’t clear yet, says Dworkin. But he suggests that people with shingles should try to stay active and connected.
“If psychological distress is a risk factor for PHN,” he says, “then we think that people who have shingles might benefit from getting out and not being isolated and homebound.”
You might make an effort to stay connected to family and friends and not to dwell on your symptoms. Also, keep in mind that even if you do develop PHN, there are treatments that can help.
“We have about a half dozen types of drugs that are used as first-line treatments for PHN,” says Dworkin. They include lidocaine patch , pregabalin , gabapentin , capsaicin , carbamazepine , tricyclic antidepressants, and painkillers.
The most important thing is to get prompt medical attention if you think you might have shingles.
“If you have a one-sided rash — especially if you’re over 50 — see your doctor right away,” says Dworkin. “It could be shingles. And we know that prompt treatment can dramatically reduce the likelihood of developing long-term pain.”
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How Do You Get Shingles
While the exact cause of shingles is unknown, experts do know that the virus can remain inactive in nerve tissues near the spinal cord and brain for decades, Dr. Grahling says. We believe that it may recur so many years later if a person has a lowered immunity due to infections that comes with age or has a weakened immune system due to medical treatments or a disease.
For all these reasons, its important to speak to your medical provider, especially if you dont remember if you had chickenpox as a child. A varicella titer test can tell you if youve been exposed to the virus in the past.
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Sacral Herpes Zoster Presenting As Sciatica
A 70-year-old man was admitted to hospital because of multiple injuries from a traffic collision. On day 16 after admission, he started to complain of pain, weakness and numbness in his right leg.
A contrast-enhanced computed tomographic scan of the lumbar spine showed a displaced sacral fracture with compression of the S1 ventral ramus . The patients symptoms persisted despite treatment with diclofenac, chlor-zoxazone, fursultiamine and betamethasone. Severe tingling pain and allodynia developed seven days later. Thirty days after admission, several painful grouped erythematous plaques with vesicles were found on his right buttock and the posterior aspect of his right leg . The distribution was consistent with the S1 dermatome, and a diagnosis of herpes zoster was made. The patient was prescribed valacyclovir hydrochloride, 500 mg three times daily for five days. The cutaneous lesions healed about seven days after the treatment was started and the tingling pain resolved gradually. We discharged the patient 42 days after admission.
Figure 1: Painful grouped erythematous plaques with vesicles, found along the S1 dermatome in a 70-year-old man, seven days after the start of sciatic symptoms.
Facial Pain And Eye Damage
Between 10% and 15% of the time, shingles affects the trigeminal gangliona triple-branched nerve that provides sensation to structures in the face. The medical term for head or facial pain due to shingles is “painful trigeminal neuropathy attributed to herpes zoster.”
Specifically, the trigeminal ganglion involves the eye the cheek and the mandibular branch . Of these, the ophthalmic branch is the one most commonly affected by herpes zoster.
According to the American Academy of Ophthalmology , 25% of the 300,000 to 500,000 cases of shingles that occur each year are herpes zoster ophthalmicus .
HZO can affect any part of the eye, from the optic nerve to the conjunctiva . Without antiviral treatment, almost half of people who have shingles near the eye will experience eye damage or even lose an eye, so it’s vital to see an ophthalmologist immediately.
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Treating Sciatica At Home
The best treatment for sciatica is time, good posture, and exercise. While the pain may be intense, sciatica usually goes away on its own in 3 out of 4 people.
People should make sure they have good posture when they plan to sit for a long period of time.
Exercise, such as walking, yoga, pilates, and light stretching, will help reduce pain and keep sciatica from returning.