Cancer Pain
There’s no single approach to relieving cancer pain. There are so many types of cancer — breast cancer, prostate cancer, colon cancer, lung cancer and cancers of the blood such as leukemia and lymphoma — and so many treatment options that it’s impossible to list everything here. Every person’s battle with cancer is unique; every person’s cancer pain is unique, too.

A key to managing cancer pain is to determine its cause. The disease itself may cause pain — but pain sometimes is a side effect of cancer treatment. Treating cancer pain is an important part of an overall treatment strategy, because pain can slow your recovery. Pain may make you tired, depressed, angry and tense, and these feelings can rob you of the energy you need to heal.

We develop an individualized treatment plan based on the cause and severity of your pain. We may recommend medication, non-drug treatments such as behavior therapy, interventions such as nerve blocks or a combination of methods. We will coordinate your pain plan with your cancer treatment team to make sure you are as comfortable as possible as you continue your cancer treatment.

Cervical Procedures

Epidural steroid injection
A steroid is injected into the space above the outer layer that surrounds the spinal cord, directly over the nerve root that is compressed. This reduces the inflammation and pain caused by nerve roots compressed by herniated discs, spinal stenosis or bone spurs.

Facet and medial branch injections
A facet injection delivers a mix of local anesthetic and steroid into a joint in the spine. A medial branch injection delivers medication outside the joint space near the nerves that enters the joint. Facet and medial branch injections may be used both to diagnose problems and to control pain.

Stellate ganglion blocks
Local anesthetic is injected into nerves in the sympathetic nerve chain of the neck to reduce pain, swelling, discoloration and sweating changes in the neck, head, face and arms.

Implantable Devices for Pain

Spinal Cord Stimulation Trials (cervical and lumbar regions)
Spinal cord stimulation uses mild electrical impulses on the spinal cord to interrupt pain messages. A spinal cord stimulation trial determines if this treatment will work for a particular patient. After using a local anesthetic, a temporary stimulator is implanted. The patient’s response is tracked to determine if a permanent stimulator should be implanted. This treatment is especially effective for neuropathic pain, residual back pain after surgery and complex regional pain syndrome.

Fluoroscopically guided Injections
At PainMed P.C., your physician uses X-ray technology for most procedures to deliver medication. The live X-ray makes it possible to perform procedures with precision and a minimum of discomfort.


All joint injections – hips, knees, and shoulders: The area is numbed with a topical anesthetic before medication is injected into the joint. The goal is to control inflammation and pain in the joint.

Carpal Tunnel Injections
A steroid is injected at the wrist to treat the symptoms of carpal tunnel syndrome.

Occipital Nerve Blocks
A steroid or other medication is injected around the nerves that are located on the back of the head just above the neck area, for headache relief.

Paravertebral and Trigger Point Injections
Paravertebral areas are located along the vertebral column. Trigger points are knots of muscle that form when muscles are injured; these knots irritate nerves around them and cause pain. Medication is injected to control symptoms and reduce pain.

Peripheral Nerve Blocks
Anesthetic is injected to block pain related to the occipital (back of the head above the neck), suprascapular (top of the shoulder), femoral (top of the leg) and lateral femoral cutaneous (outer thigh) nerves.


Sports Injuries
Every year, more than 7 million sports- and recreation-related injuries occur, and young people between the ages 5 and 24 account for about half of such injuries. Accidents, poor training practices, lack of the proper protective gear, being out of shape and skipping warm-up and stretches all can lead to injuries.

The most common sports injuries are:
• Sprains and strains
• Knee injuries
• Swollen muscles
• Achilles tendon injuries
• Fractures and dislocations

A sports injury can become a chronic problem if not properly diagnosed and treated. A sports injury should be assessed by a medical professional immediately if:
• The injury causes severe pain, swelling or numbness
• You can’t put weight on the area
• A joint doesn’t feel normal or stable

You should also seek immediate medical help if an old injury starts to hurt or swell.

Tennis Elbow
You don’t have to play tennis to suffer from tennis elbow. ‘Tennis elbow’ is a term that refers to tendon damage that causes pain or soreness around the outside part of the elbow. Discomfort is especially noticeable when the palm is turned up. The muscles of the forearm, wrist, and hand attach at the elbow to the upper arm bone (humerus). Damage to the tendons around these muscles makes it painful to rotate the forearm and flex the wrist and fingers backwards. Repetitive hand and wrist movements usually cause tennis elbow. These movements may be part of everyday job activities, such as using a screwdriver. A direct blow to the tendons may cause tennis elbow, but this is rare.

Treatment for tennis elbow includes:
• Rest, so the tendon will heal
• Reducing pain and inflammation with ice and/or over-the-counter pain relievers
• Strengthening and stretching the muscles to help recovery and prevent further injury
• Corticosteroid injections or ultrasound therapy
• Changing or eliminating activities that caused the condition

Surgery is rarely needed.

Joint & Muscle Pain

Osteoarthritis, the most common form of arthritis, is related to age. As we grow older, the cartilage that forms a cushion between bones begins to break down. Bone rubs against bone, causing pain.

Rheumatoid arthritis is an autoimmune disease. For reasons that aren’t known, the immune system attacks healthy tissue in the joints and in other parts of the body. Rheumatoid arthritis usually affects joints on both sides of the body; over time, joints may actually become deformed. For both types of arthritis, experts agree that the best way to treat pain is to combine medication with other therapies and with lifestyle changes. To help reduce joint damage and ease discomfort, lose extra weight, follow your doctor’s recommendations for exercise, and eat a balanced diet. Some people find alternative treatments such as acupuncture reduce pain; others find pain relievers to be most helpful.

Sacroiliac Pain
The sacroiliac joint lies next to the bottom of the spine, just above the tailbone. It connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis. This joint acts as a shock absorber; it is small, strong and is surrounded and reinforced by sturdy ligaments. Most experts believe that pain in the sacroiliac is caused by abnormal joint motion — either the joint is unstable and moves too much or the joint becomes rigid and doesn’t move enough. When the joint is unstable and moves too much, you usually feel pain in your lower back and hip. If the joint doesn’t move enough, you probably feel pain on one side of your lower back, buttocks and leg.

Fibromyalgia is a syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons and other soft tissues. This disorder has been linked to fatigue, sleep problems, headaches, depression and anxiety. The cause is not known, but fibromyalgia is most common among women aged 20 to 50.

Fibromyalgia’s main symptom is pain. The pain can be mild or severe. It may spread from ‘tender points’ on the back of the neck, shoulders, chest, lower back, hips, shins, elbows and knees. Fibromyalgia does not damage joints, although it may feel as if pain is coming from the joints.
Some people wake up with pain that eases during the day; some have pain all day long. Exercise, cold or damp weather and stress may make pain worse, and most people with fibromyalgia say there are tired and depressed.

Treatment usually starts with physical therapy, a fitness program and behavioral training in stress-relief techniques. Medication may be added to the treatment plan, and many people find that support groups are helpful.

Lumbar Procedures

Coccyx injection
Local anesthetic and steroid medications are injected near the tailbone. The physician uses live-action X-ray to guide the procedure.

Diagnostic medial branch injections
Local anesthetic is injected to help determine which joint is actually the source of neck or back pain.

Epidural steroid injections
A steroid is injected into the space above the outer layer that surrounds the spinal cord, directly over the nerve root that is compressed. This reduces the inflammation and pain caused by nerve roots compressed by herniated discs, spinal stenosis or bone spurs.

Facet joint injection
A facet injection delivers a mix of local anesthetic and steroid into a joint in the spine. The goal is to reduce inflammation and pain in the joint and the bones and tissues around it.

Lumbar sympathetic block
Local anesthetic is injected in the sympathetic nerves located on the either side of spine in the lower back. These nerves may carry pain information from tissues back to the spinal cord; the lumbar sympathetic block may reduce pain, swelling and other unusual changes in lower extremities and may improve mobility.

Piriformis muscle injections
These injections are commonly used to determine what is causing buttock and sciatica-type pain. The piriformis connects bones at the base of the spine to the pelvic bones. These injections temporarily prevent spasms in the piriformis muscle; if the pain disappears, the physician knows that the muscle is the cause of pain and can decide how best to treat the problem.

Sacroiliac injections
A steroid or other medication is injected into the sacroiliac joints located on either side of the sacrum or tailbone. These joints connect the sacrum (tailbone region) to the pelvis; the injection is used to control inflammation and swelling and to reduce pain.

Selective nerve root blocks
These injections are similar to epidural injections but are targeted to affect just one or two nerve roots. This procedure may be used to diagnose or to treat a problem affecting the arms or legs.

Transforaminal injections
A long-acting steroid is injected into the opening at the side of the spine where a nerve roots exits. The goal is to provide long-lasting relief of symptoms caused by inflammation and swelling of the spinal nerve root.

Nervous Injury

Carpal Tunnel Syndrome
The carpal tunnel is a narrow passage at the base of your hand. It is made of ligament and bone, and it protects the nerve and tendons that connect your hand and arm. When a motion is repeated over and over, the tendons become irritated and swell, squeezing the nerve. This causes tingling, numbness and pain in the wrist, hand and fingers. Symptoms usually start gradually—but if the cause is not eliminated, carpal tunnel can eventually result in constant pain that makes it difficult to use your hand and may be severe enough to interrupt your sleep. Treatment may include physical therapy, medication and surgery.

Complex Regional Pain System
Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that may be caused by a dysfunction in the nervous systems. Usually, there is a dramatic change in the color and temperature of the skin over the affected part of the body, along with an intense burning pain, skin sensitivity, sweating and swelling. While CRPS may be triggered by an injury, it can occur without any trauma or nerve injury. With CRPS, pain worsens over time, rather than gets better. The pain may spread or travel to other body parts and may become worse when you are under stress.

Diabetic Neuropathy
More than 20 million Americans have diabetes — and at least 6 million diabetics have some sort of nerve pain related to diabetes. Diabetic neuropathy occurs when high blood sugar levels or decreased blood supply damages nerves. This damage causes burning, throbbing or painful tingling, most often in your hands or feet.

Nerve pain is complicated, and standard medicines such as aspirin may not work. A wide variety of medications (from anti-seizure medications to antidepressant drugs) may be used to reduce symptoms, but not every drug works for every patient. Some people respond to alternatives, such as acupuncture and capsaicin cream.

If you have diabetic neuropathy, it’s important to work with your physician. Carefully controlling your blood sugar levels will help prevent the problem from getting worse. You should also make sure your blood pressure is under control and that you maintain a healthy weight. Stay active, stop smoking and avoid alcohol.

Facial Pain
Your face is layered with a large network of nerves that supply energy to facial muscles and let you coordinate muscle and bone action. Your senses of hearing, smell, taste and vision are also channeled through your face. Facial pain may be caused by injuries or by malfunctions in facial nerves. Injuries may cause a loss of sensation in the face, difficulties with breathing, swelling, blurred or double vision, facial deformities and difficulties eating and drinking.

Sometimes facial pain is not trauma induced, but caused by a malfunctioning of the nerves that govern the face’s movement. The trigeminal nerve relays messages between your brain and sensory organs, providing information about face and scalp sensation (ophthalmic), the mouth and nose (maxillary), and chewing (mandibular). Trigeminal neuralgia, on the other hand, affects the nerve that relays message between to your brain about your face, scalp and jaw. This condition results in extreme facial pain that can make daily activities, such as eating or brushing your teeth, agonizing.

Disorders such as Bell’s palsy can cause facial pain, tremors and paralysis. Allergies and sinus problems also can cause facial pain.

Phantom Limb
If you have had a limb amputated, you may experience phantom limb pain. Your brain thinks the limb is still there — perhaps because the brain remembers the pain and interprets that memory as signals from the limb, or perhaps because nerve endings at the amputation site continue to send pain signals.

In addition to pain in the phantom limb, it’s possible to feel any sensation that the limb might have experienced prior to the amputation. You may feel tingling, cramping, hot or cold. Phantom limb sensations usually disappear or decrease over time, but you should seek help when phantom limb pain continues for more than six months.

Treatment for phantom limb pain may include any of the following:
• Heat application
• Biofeedback to reduce muscle tension
• Relaxation techniques
• Massage of the amputation area
• Surgery to remove scar tissue entangling a nerve
• Physical therapy
• TENS (transcutaneous electrical nerve stimulation) of the stump
• Neurostimulation techniques such as spinal cord stimulation
• Medications, including: pain-relievers, neuroleptics, anticonvulsants, antidepressants, beta-blockers, and sodium channel blockers.

Post Herpetic Neuralgia (Shingles)
Shingles (herpes zoster) is a painful, blistering skin rash caused by the same virus that causes chickenpox. If you had chickenpox, you are at risk for shingles, because the chickenpox virus stays in your body and can become active again after decades. If you are age 60 or older, had chickenpox when you were an infant, and your immune system is weakened, then you are more likely to develop shingles.

Pain, tingling and burning usually occur before the shingles rash appears. The discomfort can be mildly annoying for a few weeks — or extremely painful for a longer time. Sometimes, when nerves have been damaged, the pain in the area where the shingles occurred may last for months or years. Antiviral drugs, anti-inflammatory medicines, lotions and soothing baths may be part of a program to relieve the pain and discomfort that shingles can cause.

Spine Health

Degenerative Disc Disease
Despite its name, this disorder is not really degenerative or a disease. The term refers to the deterioration of a spinal disc; while this deterioration (or degeneration) tends to continue as we grow older, the symptoms do not necessarily get worse. The discs in your spine are made of a tough outer-layer and a soft, jelly-like inner-layer. These discs act as shock absorbers between the vertebrae.

If the outer layer cracks or tears, the inner layer may come in contact with the nerves that touch the outer layer. The proteins in this inner layer may inflame the nerves and create pain. Pain from degenerative disc disease tends to flare up with certain activities and ease when the activity stops. Sitting for long periods usually causes pain, as does bending, lifting and twisting. The body reacts to the disc pain with muscle spasms, and these spasms make patients feel as if their back has “gone out.” Between such episodes, a person with degenerative disc disease may experience any level of pain from an occasional twinge to chronic, disabling pain.

Failed Cervical, Thoracic or Lumbar Surgery
Failed back surgery syndrome is a general term used to describe the condition of patients who continue to have chronic, significant pain after back or spine surgery.

Three types of back surgery are:

• Cervical surgery: surgery performed at the top of the spinal canal, near the neck
• Thoracic back surgery: spinal surgery in the upper back
• Lumbar surgery: spinal surgery in the lower back

In most cases, the goal of spinal surgery is to remove pressure on a nerve or to stabilize a painful joint. If the source of a patient’s pain is not properly diagnosed, back surgery will fail. Pain after surgery also may be caused if any spinal hardware used fails or if the patient is not properly guided through post-surgery recovery.

Herniated Discs
Your spine is made up of 24 bones called vertebrae. The vertebrae are separated by discs that act as shock absorbers and make your spine flexible. When a disc is damaged, it may bulge or break open and allow its jelly-like interior to leak. You may suffer a herniated disc in any part of your spine, but this condition occurs most often in the lower back (lumbar spine). A herniated disc may be caused by an injury but most often, is caused by the wear-and-tear your back experiences as you age.

A herniated disc may not cause discomfort. If it presses on a nerve, a herniated disc may cause pain, numbness or weakness. A herniated disc in the lower back can cause pain and numbness in the buttock and down the leg, a condition called sciatica. Symptoms from a herniated disc often respond to rest, heat, physician-directed exercise and medication to ease the discomfort. Sometimes, injections are needed to help reduce pain.

Radicular Arms & Leg Pain
Radicular arm and leg pain is caused by compressed or irritated nerve roots that branch from the spinal cord. The pain flows along the arms and legs; it can be a dull, aching pain but is most often described as a sharp, jabbing pain that becomes worse with specific positions or actions.

Injury, arthritis, cancer, stenosis or other chronic conditions or diseases may cause the nerve compression that produces pain. Other symptoms may include numbness, tingling or weakness.

Diagnostic imaging determines the area that is affected and the extent of the problem. Treatment includes pain management strategies, such as physical therapy, injection therapy and medication; and in some cases, surgery may be required.

The sciatic nerve is a large nerve that extends from your lower back down the backs of your thighs. Sciatica is a condition in which this nerve is compressed or irritated; this can be caused by chronic problems such as degenerative disc disease, lumbar spinal stenosis or a vertebra that slips out of place. Sciatica also can be caused by pregnancy if extra weight places pressure on the sciatic nerve.

Common symptoms of sciatica include:
• Pain in the buttocks or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness, or difficulty moving the leg or foot
• A constant pain in one buttock
• A shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. The pain may extend from the lower back through the back of the thigh and down through the leg and may reach as far as your foot or toes. Pain ranges from irritating to excruciating; but, sciatica has a tendency to get worse over time. The pain is usually worse for those who are overweight, don’t exercise, sleep on a too-soft mattress or regularly wear high heels.

Spinal Stenosis
Spinal stenosis is a general term that refers to the narrowing of the spinal canal. The spinal canal is the ‘tunnel’ of bones that protects the spinal cord. When this tunnel narrows due to bone or tissue growth, it can irritate the nerves that branch out from the spinal cord.

Spinal stenosis can affect any of the three major area of the spinal canal: the lumbar, or lower spine; the cervical spine, which is the neck and upper spine; and the thoracic spine, which is the middle of the spinal column.

Lumbar and cervical spinal stenosis is most often caused by changes in the shape and size of the spinal canal as people age. Arthritis may encourage the growth of bony spurs; connective tissues thicken with age and discs may move out of alignment.

Symptoms usually develop gradually over a long period and may include:
• Stiffness, pain, weakness or numbness in the neck, shoulders, arms, hands, buttocks or legs. Pain may become worse when you walk, stand      straight or lean back
• Lower back pain
• Balance and coordination problems, such as shuffling or tripping while walking
• Loss of bowel or bladder control (incontinence)

Cervical spinal stenosis can be crippling if the spinal cord is damaged. The thoracic area of the spine is the most inflexible part of the spine; so thoracic spinal stenosis is rare.

Vertebral Compression Pain
Vertebral compression pain is usually caused by a fracture. A vertebral compression fracture is often caused by trauma (for example, falling down a flight of steps), but may occur spontaneously if the vertebrae are fragile because of age, cancer or a bone infection. Vertebral compression fractures most often occur in the lower back.

If you have been diagnosed with osteoporosis, you may be at greater risk for a vertebral compression fracture. If you have diabetes or abuse intravenous drugs, you are at greater risk for a bone infection called osteomyelitis, which may contribute to a vertebral compression fracture. Symptoms of a compression fracture include pain (especially in the lower back); numbness, tingling and weakness; and incontinence or an inability to urinate. In most cases, a fracture will heal without surgery. A careful program that includes stabilizing and supporting the spine, pain management and a temporary reduction in activities, gives the fracture time to heal. In some cases, additional therapies and surgery may be required.

Whiplash is a traumatic neck injury that occurs when the head is snapped back and forth; it is one of the most common injuries caused by auto accidents. A person with whiplash may have damaged ligaments and nerves, torn muscles and spinal misalignments.

Neck pain, headache, muscle spasms, shoulder pain, arm pain, dizziness and tingling are some of the symptoms. Usually, whiplash symptoms occur right away, but they may take days or even weeks to develop after the injury. If left untreated, whiplash may cause chronic neck or back problems that include loss of range of motion, chronic headaches and potential arthritic changes. Treatment may include pain management (including injections or medication) and a program of rehabilitative exercise.

Thoracic Procedures

Epidural steroid injections
A steroid is injected into the space above the outer layer that surrounds the spinal cord, directly over the nerve root that is compressed. This reduces the inflammation and pain caused by nerve roots compressed by herniated discs, spinal stenosis or bone spurs.

Intercostal nerve blocks
A steroid or other medication is injected around the intercostal nerves that are located under each rib. The steroid injected reduces inflammation and/or swelling in-between the ribs or in the chest wall. This treatment is often used to control pain from shingles and scar pain following chest surgery.