Cervical Radiculopathy :


Cervical Radiculopathy is a term used to describe pain, numbness, or tingling sensations that begin in the neck and radiate down the arm.

The cause of radiculopathy is often a herniated disc or spondylosis (bone spur) in the cervical spine, which places pressure on a nerve as it exits the spinal canal. This nerve extends down the arm, sending and receiving signals from the skin and muscles of the arm.

The sensations may be present in one or both arms, and may or may not cause weakness in certain muscle groups. Your healthcare provider will perform a detailed history and complete physical exam to evaluate the cause of your pain and/or weakness. X-rays, MRI, or CT scan may be ordered to visualize the structures in your cervical spine.

Your provider will then discuss appropriate treatment options with you. In most cases, cervical radiculopathy that is due to a herniated disc will resolve on its own in 6 to 8 weeks. Your provider may recommend a course of physical therapy or epidural steroid injections during this time to speed the healing process and alleviate pain.

Radiculopathy that has been present for over 8 weeks, unbearable pain, weakness to the upper extremity muscles, or evidence of a cervical myelopathy may warrant further treatment.

Cervical Myelopathy :

A rare but sometimes serious disease of the cervical spine, called a cervical myelopathy, may occur when the spinal cord is pinched by a herniated disc or bone spur.

Patients with a cervical myelopathy may exhibit a range of symptoms including loss of balance, clumsiness when using their hands, changes in handwriting, difficulty with buttons, an increase in falls, numbness and tingling to the upper and lower extremities, and changes in the way they walk. Certain patients with myelopathy may exhibit no symptoms at all. Your healthcare provider will perform a detailed history and a complete exam to assess your neurological status, and may choose to order X-Rays, MRI, or CT Scan to further evaluate the anatomy in your cervical spine.

If you exhibit the symptoms listed above, please contact your healthcare provider for further evaluation.

Headache :

About 80% of the population will experience a common headache disorder and 20% of adult women a migraine disorder in their lifetime.

The economic and quality of life burden is substantial and made worse by poor diagnosis, underestimation of headache induced morbidity and denied access to appropriate treatment. Headaches are classified into two broad entities: primary and secondary.

Primary headaches are those in which a primary dysfunction of the nervous system predisposes to increased vulnerability to headache attacks. Included in the primary headaches are 1.Tension headaches 2. Migraine headaches 3. Cluster headaches.

Secondary headaches are those in which the headache is secondary to other pathology which has headache as part of its presentation. Secondary headaches have more then 300 separate causes, some of which include infectious, vascular, metabolic, endocrine, inflammatory, dental, ocular, posttraumatic and cervicogenic disorders. Optimal treatment begins with specific diagnosis. Your primary care doctor and neurologist are best equipped to establish this diagnosis and commence therapy.

The vast majority of headaches will be best managed by behavioral therapies and medications. Occasionally, patients will be referred to our pain medicine physicians for specific and specialized interventions which may be appropriate in certain refractory patients.

These are typically secondary headaches which are thought to have pain generators in the cervical (neck) structures. Common treatments provided include trigger point injections for myofascial (muscle) pain, facet joint nerve blocks and ablations for post whiplash and arthritis pain, epidural steroid injections for some pain states mediated by inflammation and specific nerve blocks or neurostimulation for conditions such as intractable headache from occipital neuralgia. Our pain medicine physicians are pleased to explore the potential benefits of these interventions with all referred patients after full medical and neurological evaluations and treatment protocols have been exhausted.

Neuropathic Pain :

Post-herpetic Neuralgia :
Diabetic neuropathy
Trigeminal neuralgia
Post surgical neuroma

Other types of neuropathic pain include

Central Nervous System Pain
This is usually due to spinal cord lesion or brain and brain stem lesions.

Peripheral Nervous System Pain
This category includes diabetic neuropathy, alcoholic neuropathy, uremic neuropathy.

Cranial Nerve Pain
This category includes Trigeminal Neuralgia, Post Herpetic neuralgia as well as Glossopharyngeal Neuralgia.

Phantom Pain
This if often due to neuroma formation as well as short circuiting involving the central and peripheral nervous system.

What are some of the medications used to treat neuropathic pain?
Antidepressants, sedatives, anticonvulsants, muscle relaxants, opioids, NSAIDS, and local anesthetics can be used to treat neuropathic pain.

What are some of the nerve blocks that are used to treat neuropathic pain?
Nerve blocks by themselves are not the be all end all treatment for neuropathic pain. Nerve blocks are done to help control the pain so that the cycle of the pain can be broken. This allows the patient to use the affected
part of the body so that the patient can preserve the function of the affected part of the body. Type of the
nerve block is tailored to the underlying body part that is affected as well as underlying condition. Please refer to the nerve block section.