Conditions We Treat

(Including: Slipped Disc, Ruptured Disc and Torn Disc) Many patients who suffer with back and leg pain come to see our specialists needing treatment for herniated disc. Your spinal column is made up of bones (vertebrae) that are cushioned by small discs consisting of a tough outer layer (annulus) and a soft, jelly-like inner layer (nucleus). These discs act as shock absorbers, protecting the spine and nerves from the stress of everyday tasks as well as strenuous work such as heavy lifting. When a disc herniates, a tear or weakness in the annulus allows the jelly-like nucleus to push out into the spinal canal. If it puts pressure on a spinal nerve, the herniated disc can cause pain, numbness or weakness in the back, legs or arms depending on where the disc is located. Herniated discs are most common in the lower spine, but about 10% occur in the neck.

SYMPTOMS

• Sciatica a radiating, aching pain, sometimes with tingling and numbness, that starts in the buttock and can extend down the back of one or both legs. Pain, numbness or weakness can occur anywhere within the hips, legs or feet.

• Pain, numbness or weakness in the lower back and one leg, or in the neck, shoulder, chest or arm.

• Lower back pain that worsens when you sit, cough or sneeze.

What to Expect During a Bursa Injection

• Using X-ray guidance, or ultrasound the physician will insert a thin needle and inject contrast solution into the bursa thought to be causing your pain. The contrast solution is designed to highlight your anatomy to make sure the nerve thought to be causing your pain is precisely targeted.

• The physician will then slowly release a combination of anti-inflammatory (steroid) and anesthetic (numbing) medications into the area.

• You may experience some slight pressure or discomfort during the bursa injections.

• You may be asked to wait after the procedure so that the clinic staff can monitor your symptoms before you leave.

What to Expect After the Bursa Injection

• The beneficial effects of the steroids usually require two to three days to take hold, but may take as long as five to seven days.

• If an initial injection provided a certain amount of relief, a second injection might strengthen the pain relief effect. Also, if your pain subsides, but begins to return weeks or months later, additional injections are possible.

• If there is no change in your symptoms after a week, your doctor may want to investigate other possible sources for your pain.

A bulging disc is a condition occurring when a disc begins to extend beyond the normal margin in the spine. It happens when the disc shifts out of its normal radius and most often occurs simply as a result of age. In the majority of patients who have a bulging disc, there is no pain unless the disc progresses into a protrusion or herniation. Your back problems may signal that you need bulging disc treatment. Although a disc bulge does not usually cause compression, it may cause inflammation and mimic the symptoms of a disc protrusion or herniation. An abnormal disc does not always cause pain and may be found during a routine or diagnostic imaging test such as magnetic resonance imaging (MRI). If the bulging disc symptoms cannot be alleviated through conservative measures, there are minimally invasive techniques available to address bulging disc treatment.

SYMPTOMS

Bulging disc symptoms can mimic the symptoms of a pinched nerve and can include pain, numbness and weakness. Depending on the location of the disc, patients may experience symptoms of pain and discomfort in the legs and feet, arms and in other regions of the body. The diagnosis for bulging discs requires an MRI.

Spinal stenosis is a narrowing of one or more areas of the spinal canal most often in your neck or lower back. This narrowing can put pressure on your spinal cord or on the spinal nerves exiting the spine. Spinal stenosis symptoms, depending on the location in your spine, include cramping, pain, or numbness in your legs, back, neck, shoulders, or arms; or a loss of sensation in your extremities, and sometimes problems with bladder or bowel function. Spinal stenosis is most commonly caused by progressive wear of the spinal components over time, and it’s important to find a doctor who specializes in spinal stenosis treatment in order to determine the best plan for you. Conservative spinal stenosis treatment may include a variety of medications, physical therapy/Chiropractic treatment, injection therapy, a Tens unit and supportive bracing. In cases that have failed conservative treatment, spinal stenosis surgery is often successful in relieving symptoms. As with other conditions, there are a variety of minimally invasive surgical approaches.  

SYMPTOMS

• Developing slowly over time

• Coming and going, as opposed to continuous pain

• Occurring during certain activities (such as walking) and/or positions (such as standing upright)

• Being relieved by rest (sitting or lying down) and/or any flexed forward position.

Degenerative disc disease is one of the most common causes of low back pain and neck pain, and also one of the most misunderstood. Simply put, degenerative disc disease describes the symptoms of pain and possibly radiating weakness or numbness stemming from a degenerated disc in the spine.

SYMPTOMS

• Pain that is usually related to activity and will flare up at times but then return to a low-grade pain level, or the pain will go away entirely

• The amount of chronic pain referred to as the patient’s baseline level of pain is variable between individuals and can range from almost no pain/just a nagging level of irritation, to severe and disabling pain

• Severe episodes of back or neck pain that will generally last from a few days to a few months before returning to the individual’s baseline level of chronic pain

• Chronic pain that is completely disabling from degenerative disc disease does happen in some cases, but is relatively rare

• Activities that involve bending, lifting, and twisting will usually make the patient’s pain worse

• Certain positions will usually make the pain worse.

• Walking, and even running, may actually feel better than prolonged sitting or standing

• Patients will generally feel better if they can change positions frequently

• Patients with lumbar DDD will generally feel better lying in a reclining position (such as with legs propped up in a recliner), or lying down with a pillow under the knees, since these positions relieve stress on the lumbar disc space

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For some people, sciatica pain can be severe and debilitating. For others, the sciatica symptoms might be infrequent and irritating, but have the potential to get worse. Low back pain may be present along with the leg pain, but typically the leg pain is markedly more severe than the low back pain. Patients often describe their sciatica symptoms as electrical shocks running down the leg, or searing or burning pain

SYMPTOMS

• Lower back pain, if experienced at all, is not as severe as leg pain

• Constant pain in only one side of the buttock or leg, but rarely both the right and left sides

• Pain that originates in the low back or buttock and continues along the path of the sciatic nerve – down the back of the thigh and into the lower leg and foot

• Pain that feels better when patients lie down or are walking, but worsens when standing or sitting

• Pain that is typically described as sharp or searing, rather than dull Some experience a “pins-and-needles” sensation, numbness or weakness, or a prickling sensation down the leg

• Weakness or numbness when moving the leg or foot

• Severe or shooting pain in one leg that may make it difficult to stand up or walk

• Depending on where the sciatic nerve is affected, the pain and other symptoms may also include foot pain or pain in the toes.

Pinched Nerve

A pinched nerve occurs when too much pressure is applied to a nerve by surrounding tissues such as bone spurs, disc herniation and ligaments. This pressure (compression) disrupts the nerves function causing pain, tingling, numbness or weakness in the affected area, and in many cases causing permanent damage if not addressed with the right pinched nerve treatment. A pinched nerve can occur anywhere in your body. When a patient has a symptomatic herniated disc, the disc itself is not painful, but rather the material that is leaking our of the inside of the disc is pinching or irritating a nearby nerve. This type of pathology produces pain called radicular pain (e.g., nerve root pain) leading to pain that may radiate to other parts of the body, such as from the low back down the leg or from the neck down the arm. Leg pain from a pinched nerve is usually described as sciatica.

SYMPTOMS

Examples of pinched nerves can include the symptoms:

• Numbness or decreased sensation in the area supplied by the nerve.

• Sharp or burning pain, which may radiate outward. When the pinched nerve comes from the spinal cord, coughing or sneezing may aggravate the pain.

• Tingling, pins and needles sensations (paresthesia).

• Muscle weakness or twitching in the affected area.

• Frequent feeling that a foot or hand has fallen asleep.

Facet Disease

The facet or spinal joints are located on both sides on the back of the spine. They are located at each level of the spine where a disc is present. Together with the disc, facets are responsible for the movement of the spine. Facet disease is caused occurs when there is degeneration of the facet joint. Facet disease is characterized by worn-down cartilage as a result of aging, injury or overuse. Arthritic facets can contribute to spinal stenosis and pinching of spinal nerves. In the condition called degenerative spondylolisthesis, the joints have allowed for abnormal and excessive movement, which can result in spinal instability, possibly causing pain numbness or weakness.

SYMPTOMS

• Acute episodes of lumbar and cervical facet joint pain are typically intermittent, generally unpredictable, and occur a few times per month or per year.

• Most patients will have a persisting point tenderness overlying the inflamed facet joints and some degree of loss in the spinal muscle flexibility (called guarding).

• Typically, there will be more discomfort while leaning backward than while leaning forward.

• Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. The pain is rarely present in the front of the leg, or rarely radiates below the knee or into the foot, as pain from a disc herniation often does.

• Similarly, cervical facet joint problems may radiate pain locally or into the shoulders or upper back, and rarely radiate in the front or down an arm or into the fingers as a herniated disc might.

Foraminal Stenosis

Foraminal Stenosis is the narrowing of the cervical disc space caused by enlargement of a joint (the uncinate process) in the spinal canal. The majority of symptoms with this type of cervical spinal stenosis are usually caused by one nerve root on one side. Typically, the condition is characterized by non-continuous pain developing slowly over many years and is related to an activity (such as bicycle riding) or position (such as holding the neck in an extended position). Although more common in the neck, it can also occur in the lumbar spine. Confirmation is by an MRI or CT scan with myelogram. Unlike many other back or neck conditions, most nonsurgical treatments (such as pain medication) are unlikely to be of much benefit. Traction may provide some relief. Many patients choose activity modification or back surgery.

SYMPTOMS

• Numbness

• Weakness

• Sensations of burning, tingling, and pins and needles in the affected extremity (arms, legs)

Arthritis

“Arthritis” describes many different diseases that cause tenderness, pain, swelling, and joint stiffness. With osteoarthritis, the most common form of arthritis, the cartilage around the joint wears out, causing the bones in the joint to rub together, creating inflammation and pain.

Most forms of arthritis can occur in any joint, including spine joints. Osteoarthritis of the spine can lead to lost flexibility, bone spurs (osteophytes), irritated nerves, spinal stenosis, and sciatica. The terms spondylosis or degenerative joint disease are used interchangeably with osteoarthritis.

SYMPTOMS

• Back pain that comes and goes

• Spinal stiffness in the morning, such as after getting out of bed or after physical activity

• Pain, tenderness, or numbness in the neck

• Lower back pain that runs down into the buttocks, thighs, or pelvic area

• Pain or tenderness in the shoulders, hips, knees, or heels

• A crunching feeling or sound of bone rubbing against bone

• Weakness or numbness in legs or arms

• Limited range of motion and difficulty bending or walking

Complex Regional Pain Syndrome, also known as Reflex sympathetic dystrophy, is a complex, poorly understood condition that can result in chronic pain in the upper extremity.

Causes of Reflex Sympathetic Dystrophy

There is usually some traumatic event to the upper extremity that starts the pain syndrome. A pain pathway is then set up that continues on after the traumatic injury has resolved.

It is thought that this is a sympathetically mediated condition, in which overactivity in the sympathetic nerves creates constriction of the arteries that supply blood to the arm.

This pathway has not been clearly explained, but it is known that injecting the sympathetic nerves as they come out of the spine (stellate ganglion block) often relieves the pain.

Treatment is most successful if started early in the course of the disease. If it is allowed to proceed very long there can be permanent changes in the nerves and muscles that lead to chronic pain.

The treatment typically includes a combination of:

• A stellate ganglion block

• Medications that block the sympathetic nerves

Degenerative scoliosis, also known as adult scoliosis or adult onset scoliosis, describes a side-to-side curvature of the spine cause by degeneration of the facet joints. The condition occurs most frequently occurs in people over 65 years of age. The scoliosis curve, which typically forms a “C” shape, is located in the lumbar spine.

Causes of Degenerative Scoliosis

Degenerative scoliosis is caused by a gradual deterioration of the facet joints. This is the same process that causes osteoarthritis of the spine; however, in degenerative scoliosis the pressure of these deteriorating facet joints causes a straight spine, as viewed from the back, to begin to shift so that the spine curves to one side.

SYMPTOMS AND CHARACTERISTICS

• Uneven shoulders

• One shoulder blade that appears more prominent than the other

• Uneven waist

• One hip higher than the other

• Leaning to one side

• Fatigue

There are many ways to define pain. A useful definition is from pain expert Margo McCaffrey, MSN,RN, FAAN: “Pain is whatever the experiencing person says it is, and exists whenever he says it does.” The International Association for the Study of Pain says it is “an unpleasant sensory and emotional experience in association with actual or potential tissue damage, or described in terms of such damage.” Whatever definition you prefer, pain is a sensation that hurts, and it has both physical and emotional aspects to consider.

Pain, which can be caused by the disease itself or by treatments, is common in people with cancer, although not all people with cancer will experience pain. Approximately 30% to 50% of people with cancer experience pain while undergoing treatment, and 70% to 90% of people with advanced cancer experience pain Lesage P. and Portenoy RK. Cancer Control; Journal of the Moffitt Cancer Center 1999;6(2):136-145.

Pain can be acute or chronic: Acute pain usually starts suddenly, may be sharp, and often triggers visible bodily reactions such as sweating, an elevated blood pressure, and more. Acute pain is generally a signal of rapid-onset injury to the body, and it resolves when pain relief is given and/or the injury is treated.

Chronic pain lasts, and pain is considered chronic when it lasts beyond the normal time expected for an injury to heal or an illness to resolve. Chronic pain, sometimes called persistent pain, can be very stressful for both the body and the soul, and requires careful, ongoing attention to be appropriately treated. Chronic cancer pain can be successfully treated by about 95% of people with the drug and non-drug therapies that are currently available [[Wood, editor. Pharmacologic Treatment of Cancer Pain. New Engl J Med 1996;335:1124-1132]]. Along with chronic cancer pain, sometimes people have acute flares of pain when not all pain is controlled by the medication or therapy. This pain, usually called breakthrough pain, can also be controlled by medications.

Face Pain

Face pain may be dull and throbbing or an intense, stabbing discomfort in the face or forehead. It can occur in one or both sides.

Causes

Pain that starts in the face may be caused by a nerve problem, injury, or infection. Face pain may also begin other places in the body.

• Abscessed tooth (ongoing throbbing pain on one side of the lower face that gets worse with eating or touching)

• Cluster headache

• Herpes zoster (shingles) or herpes simplex (cold sores) infection

• Injury to the face

• Migraine

• Myofascial pain syndrome

• Sinusitis or sinus infection (dull pain and tenderness around the eyes and cheekbones that gets worse when you bend forward)

• Tic douloureux

• Temporomandibular joint dysfunction syndrome

Sometimes the reason for the face pain is unknown.

Foot Pain

Pain in the foot can be due to a problem in any part of the foot. Bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or skin can be the source of Foot pain.

Causes of Foot Pain

Heel Pain:

Plantar Fasciitis is the most common cause of heel or foot pain. Heel pain, worst in the morning when getting out of bed, is the most common symptom. Arch pain may also be present.

Treatment for plantar fasciitis includes:

• Rest

• Heel and foot Muscle Stretches

• Over-the-counter pain relievers

• Shoes with good arch support and a cushioned sole

Various other treatments for plantar fasciitis are available.

Heel Spurs are abnormal growths of bone on the bottom of the heel bone that may be caused by an abnormal gait, posture or walking, inappropriate shoes, or certain activities, like running. Spurs may cause foot pain while walking or standing. People with flat feet or high arches are more likely to have foot pain from heel spurs.

Treatment for heel spurs include:

• Cutout heel pad

• Custom-made insert (orthotic) worn in the shoe

• Wearing shoes that fit well and have shock absorbing soles

• Over-the-counter pain relievers

• Rest

Headache Pain

It’s important to figure out what type of headache is causing your pain. If you know your headache type, you can treat it correctly.

Tension headaches

Tension headaches, the most common type, feel like a constant ache or pressure around the head, especially at the temples or back of the head and neck. Not as severe as migraines, they don’t usually cause nausea or vomiting, and they rarely halt daily activities.

Cluster headaches

Cluster headache pain, which affect more men than women, are recurring headaches that occur in groups or cycles. They appear suddenly and are characterized by severe, debilitating pain on one side of the head, and are often accompanied by a watery eye and nasal congestion or a runny nose on the same side of the face.

Sinus headaches

When a sinus becomes inflamed, often due to an infection, it can cause pain. Headaches due to sinus infection can be treated with antibiotics, as well as antihistamines or decongestants.

Rebound headaches

Overuse of painkillers for headaches can lead to rebound headaches. Culprits include over-the-counter medications like aspirin, acetaminophen (Tylenol), or ibuprofen (Motrin, Advil), as well as prescription drugs.

Migraine headaches

Migraines can run in families and are diagnosed using certain criteria.

• At least five previous episodes of headaches

• Lasting between 4-72 hours

• At least two out of these four: one-sided pain, throbbing pain, moderate-to-severe pain, and pain that interferes with, is worsened by, or prohibits routine activity. At least one associated feature: nausea and/or vomiting, or, if those are not present, then sensitivity to light and sound

Knee Pain

Sudden pain in one of the knees is usually the result of overusing the knee or injuring it. In many cases, you don’t need to see your GP.

The knee joint is particularly vulnerable to damage and pain because it takes the full weight of your body and any extra force when you run or jump.

You’re more likely to experience knee pain as you get older, and people who are overweight or do lots of sports have a higher risk of damaging their knees. Some sports that involve a lot of turning, such as football, netball and skiing, carry a particularly high risk of knee injuries.

This page summarises some of the most common causes of pain in one or both knees, and offers advice on when you should see your GP.

Common causes of knee pain include:

• sprains and strains

• anterior knee pain (pain around the kneecap)

• menisci or cartilage damage

• osteoarthritis

• tendonitis

• bursitis (housemaid’s knee)

• torn ligaments or tendons

• bleeding into the joint

• Osgood-Schlatter’s disease

• gout

• septic arthritis (infected knee joint)

Hip and Leg Pain

Hip pain is a common complaint that can be caused by a wide variety of problems. The precise location of your hip pain can provide valuable clues about the underlying cause.

Causes

Hip pain may be caused by arthritis, injuries or other problems.

• Arthritis

  • Juvenile rheumatoid arthritis

  • Osteoarthritis

  • Psoriatic arthritis

  • Rheumatoid arthritis

  • Septic arthritis

• Cancer

  • Advanced (metastatic) cancer that has spread to the bones

  • Bone cancer

  • Leukemia

• Injuries

  • Bursitis

  • Dislocation

  • Hip fracture

  • Hip labral tear

  • Inguinal hernia

  • Sprains and strains

  • Tendinitis

• Other problems

  • Avascular necrosis

  • Legg-Calve-Perthes disease

  • Osteomyelitis

  • Osteoporosis

  • Rickets

  • Synovitis

• Pinched nerves

  • Herniated disk

  • Meralgia paresthetica

  • Sacroiliitis

  • Sciatica

  • Spinal stenosis

Phantom Limb Pain

Phantom limb pain is pain that feels like it’s coming from a body part that’s no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain. Although phantom pain occurs most often in people who’ve had an arm or leg removed, the disorder may also occur after surgeries to remove other body parts, such as the breast, penis, eye or tongue. For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain effectively with medication or other therapies. Most people who’ve had a limb removed report that it sometimes feels as if the amputated limb is still there. This painless phenomenon, known as phantom limb sensation, may rarely occur in people who were born without limbs. Phantom limb sensations may include feelings of coldness, warmth, or itchiness or tingling, but should not be confused with phantom pain. Similarly, pain from the remaining stump of an amputated limb is not phantom pain. By definition, phantom pain feels as if the pain comes from a body part that no longer remains.

Characteristics of phantom pain include:

• Onset within the first few days of amputation

• Comes and goes or is continuous

• Often affects the part of the limb farthest from the body, such as the foot of an amputated leg

• May be described as shooting, stabbing, boring, squeezing, throbbing or burning

• Sometimes feels as if the phantom part is forced into an uncomfortable position

• May be triggered by pressure on the remaining part of the limb or emotional stress

Coccygeal Pain

Coccydynia, commonly called tailbone pain or coccygeal pain, is a fairly rare and relatively poorly understood condition that can cause persistent pain at the very bottom of the spine. This part of the spine is the coccyx, or tailbone. Coccydynia is felt as a localized pain and will generally feel worse when sitting or with any activity that puts pressure on the bottom area of the spine.

Coccydynia may be referred to in various terms, such as:

• Coccygodynia

• Coccygeal pain

• Coccyx pain

• Coccyaglia

• Tailbone pain

The various terms are all used to describe a set of symptoms in the tailbone that can be caused by various injuries or conditions. Treatment may vary depending on the underlying cause of the symptoms and the severity and duration of the symptoms.

Coccydynia symptoms may consist of one or all of the following:

• Pain that is markedly worse when sitting

• Local pain in the tailbone area that is worse when touched or when any pressure is placed on it

• Pain that is worse when moving from a sitting to standing position

• Pain that is worse with constipation and feels better after a bowel movement.

A combination of treatments to reduce the pain and activity modification to keep pressure off the tailbone usually suffices to control or alleviate the pain.

Radicular syndrome pain is a type of pain that radiates into the lower extremity directly along the course of a spinal nerve root. Radicular pain is caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis. Leg pain can be accompanied by numbness and tingling, muscle weakness and loss of reflexes. The most common symptom of radicular pain is usually called sciatica or sometimes radiculopathy, which is pain that radiates along the sciatic nerve down the back of the thigh and sometimes into the calf and foot. Radicular pain can be effectively treated conservatively (non-surgically) with medications and epidural injections.

Sacroiliac Joint Disease

There are many different terms for sacroiliac joint problems, including SI joint dysfunction, SI joint syndrome, SI joint strain, and SI joint inflammation. Each of these terms refers to a condition that causes pain in the SI joints from a specific cause.

What are the causes of sacroiliac joint dysfunction?

As with most other joints in the body, the SI joints have a cartilage layer covering the bone. The cartilage allows for some movement and acts as a shock absorber between the bones. When this cartilage is damaged or worn away, the bones begin to rub on each other, and degenerative arthritis (osteoarthritis) occurs.

Another common cause of SI joint dysfunction is pregnancy. During pregnancy, hormones are released in the woman’s body that allows ligaments to relax. This prepares the body for childbirth. Relaxation of the ligaments holding the SI joints together allows for increased motion in the joints and can lead to increased stresses and abnormal wear.

Any condition that alters the normal walking pattern places increased stress on the SI joints. This could include a leg length discrepancy (one leg longer than the other), or pain in the hip, knee, ankle, or foot. Patients with severe pain in the lower extremity often develop problems with either the lower back (lumbar spine) or SI joints. Usually, if the underlying problem is treated, the associated lumbar spine or SI joint dysfunction will also improve.

There are many disorders that affect the joints of the body that can also cause inflammation in the SI joints. These include gout, rheumatoid arthritis, psoriatic arthritis, reactive arthritis, and ankylosing spondylitis. These are all various forms of arthritis that can affect all joints. Ankylosing spondylitis is an inflammatory arthritis that always affects the SI joints. It can lead to stiffness and severe pain in the SI joints, due to inflammation in the sacroiliac joints (sacroiliitis). As the disease process continues, the SI joints can fuse together and have no range of motion. Once this occurs, there is no further pain associated with the SI joints. Rarely, bacterial infection can involve the sacroiliac joints.

Diabetic Peripheral Neuropathy

Diabetic neuropathy is nerve damage caused by diabetes. When it affects the arms, hands, legs and feet it is known as diabetic peripheral neuropathy. Diabetic peripheral neuropathy is different from peripheral arterial disease (poor circulation), which affects the blood vessels rather than the nerves. with pain medication or pain killers. Diabetic peripheral neuropathy doesn’t emerge overnight. Instead, it usually develops slowly and worsens over time. Some patients have this condition long before they are diagnosed with diabetes. Having diabetes for several years may increase the likelihood of having diabetic neuropathy. Depending on the type(s) of nerves involved, one or more symptoms may be present in diabetic peripheral neuropathy.

For sensory neuropathy:

• Numbness or tingling in the feet

• Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet

For motor neuropathy:

• Muscle weakness and loss of muscle tone in the feet and lower legs

• Loss of balance

• Changes in foot shape that can lead to areas of increased pressure

For autonomic neuropathy:

• Dry feet

• Cracked skin

Trigeminal Neuralgia

Trigeminal neuralgia (TN), also called tic douloureux, is a chronic pain condition that affects the trigeminal or 5th cranial nerve, one of the most widely distributed nerves in the head. TN is a form of neuropathic pain (pain associated with nerve injury or nerve lesion.) The typical or “classic” form of the disorder (called “Type 1” or TN1) causes extreme, sporadic, sudden burning or shock-like facial pain that lasts anywhere from a few seconds to as long as two minutes per episode. These attacks can occur in quick succession, in volleys lasting as long as two hours. The atypical form of the disorder (called “Type 2” or TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than Type 1. Both forms of pain may occur in the same person, sometimes at the same time. The intensity of pain can be physically and mentally incapacitating.

What causes trigeminal neuralgia?

TN is associated with a variety of conditions. TN can be caused by a blood vessel pressing on the trigeminal nerve as it exits the brain stem. This compression causes the wearing away or damage to the protective coating around the nerve (the myelin sheath). TN symptoms can also occur in people with multiple sclerosis, a disease that causes deterioration of the trigeminal nerve’s myelin sheath. Rarely, symptoms of TN may be caused by nerve compression from a tumor, or a tangle of arteries and veins called an arteriovenous malformation. Injury to the trigeminal nerve (perhaps the result of sinus surgery, oral surgery, stroke, or facial trauma) may also produce neuropathic facial pain.

What are the symptoms of trigeminal neuralgia?

Pain varies, depending on the type of TN, and may range from sudden, severe, and stabbing to a more constant, aching, burning sensation. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. The pain may affect a small area of the face or may spread. Bouts of pain rarely occur at night, when the affected individual is sleeping. TN is typified by attacks that stop for a period of time and then return, but the condition can be progressive. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. Eventually, the pain-free intervals disappear and medication to control the pain becomes less effective. The disorder is not fatal, but can be debilitating. Due to the intensity of the pain, some individuals may avoid daily activities or social contacts because they fear an impending attack.

Our physicians can provide Medication Assisted Treatment (MAT) programs to patients suffering from opioid dependency or addiction. Suboxone and Buprenorphine are the most common current medications utilized nationwide. Urgent appointments are available for patients at risk of relapse or in need of an initial induction.