At Preferred Medical Group, our entire staff strives to view each person as an individual and to regard each patient with compassion and consideration. By law, we follow the strict guidelines and require routine urine drug screenings to help us eliminate those who are abusing other illegal medications or not being honest about their condition.

Our program treats the whole patient. We do a thorough physical examination and find it important to educate our patients by recommending lifestyle changes in their daily living activities to improve health and reduce chronic pain.

Abdominal Pain

Virtually any organ and structure within the abdomen may be a cause of pain. It is paramount to make a proper diagnosis and treat early potentially and lethal disease. Abdominal pain that lasts a long time requires detective work. Every possible organ and structure must be systematically addressed- the gallbladder, pancreas, liver, esophagus, kidneys, and intestines need to be evaluated. Muscles covering the abdomen have also been implicated in abdominal pain. Prior abdominal surgery may cause internal adhesions and scar tissue leading to pain. At times, abdominal scars may trigger pain in certain individuals. Broken or injured ribs need to be evaluated as possible causes of pain. Irritable bowel syndrome, ulcerative colitis and Chron’s disease are conditions involving the intestines. All of these conditions may present with abdominal pain. Abdominal masses and cancer should be ruled out. Anti-neuropathic medications and opioids may be used to help with pain. Your doctor may recommend certain procedures that may help with diagnosis. If pain improves after injecting the sympathetic chain with local anesthetics, then pain is assumed to be of sympathetic origin. Further therapy will be planned after.

Ankylosing Spondylitis

Ankylosing spondylitis is a long-term form of arthritis that occurs in the spine. It can cause pain and stiffness in the low back, middle back, buttocks, and neck, and sometimes in other areas such as the hips, chest wall, or heels. It can also cause swelling and limited motion in these areas. This disease is more common in men than in women.

There is no cure, but treatment can control symptoms and prevent the disease from getting worse in most cases. Most people are able to perform their normal daily activities and can still work.

This disease causes mild to severe pain in the low back and buttocks that is often worse in early morning. Some people have more pain in other areas, such as the hips or heels. The pain usually gets better slowly as you move around and are active. Ankylosing spondylitis most often begins anywhere from the teenage years through the 30s.

It gets worse slowly over time as swelling of the ligaments, tendons, and joints of the spine causes the bones of the spine to join, or fuse together. This leads to less range of movement in the neck and low back.  As the spine fuses and stiffens, the neck and low back lose their normal curve. The middle back curves outward. This can keep you in a bent-forward position and may make it hard for you to walk.  As the small joints that connect the ribs and collarbone to the breastbone get inflamed, you may find that it’s harder for you to breathe. Other parts of the body, such as your eyes and other joints may also swell. Sometimes the disease affects the lungs, the heart valves, the digestive tract, and the major blood vessel called the aorta.


Arachnoiditis describes a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord. The arachnoid can become inflamed because of an irritation from chemicals, infection from bacteria or viruses, as the result of direct injury to the spine, chronic compression of spinal nerves, or complications from spinal surgery or other invasive spinal procedures. Inflammation can sometimes lead to the formation of scar tissue and adhesions which cause the spinal nerves to “stick” together. If arachnoiditis begins to interfere with the function of one or more of these nerves, it can cause a number of symptoms, including numbness, tingling, and a characteristic stinging and burning pain in the lower back or legs. Some people with arachnoiditis will have debilitating muscle cramps, twitches, or spasms. It may also affect bladder, bowel, and sexual function. In severe cases, arachnoiditis may cause paralysis of the lower limbs. Arachnoiditis remains a difficult condition to treat, and long-term outcomes are unpredictable. Most treatments for arachnoiditis are focused on pain relief and the improvement of symptoms that impair daily function. A regimen of pain management, physiotherapy, exercise, and psychotherapy is often recommended. Surgical intervention is controversial since the outcomes are generally poor and provide only short-term relief. Clinical trials of steroid injections and electrical stimulation are needed to determine the efficacy of these treatments. Arachnoiditis appears to be a disorder that causes chronic pain and neurological deficits and does not improve significantly with treatment. Surgery may only provide temporary relief. Aging and pre-existing spinal disorders can make an accurate prognosis problematic. The outlook for someone with arachnoiditis is complicated by the fact that the disorder has no predictable pattern or severity of symptoms.

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is an irritation of the median nerve in the wrist that leads to numbness, tingling, pain, and weakness in the hand. In effect, it is a pinched nerve at the wrist. The median nerve travels down the forearm and enters the hand after passing through the wrist tunnel (carpal tunnel) that is located in the central part of the wrist. Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve. The syndrome typically affects the thumb, index, and middle fingers and is often particularly troublesome at night though symptoms also may be noticed during daily activities such as driving or reading a newspaper. Patients may sometimes notice a weaker grip, occasional clumsiness, and a tendency to drop things. In severe cases, sensation may be permanently lost and the muscles at the base of the thumb slowly shrink (thenar atrophy), causing difficulty with pinching.

Many people with carpal tunnel syndrome have no identifiable cause. Carpal tunnel syndrome affects almost 5% of the population and is most common in middle-aged women. It occurs most often in people 30 to 60 years old. Some people who develop this problem were born with a carpal tunnel that is small. Carpal tunnel syndrome may be caused by making the same hand and wrist motion over and over. Using hand tools that vibrate may also lead to carpal tunnel. Any condition that causes increased direct pressure on the median nerve in the wrist can lead to carpal tunnel syndrome. Studies have not proved that carpal tunnel syndrome is caused by typing on a computer, using a mouse, or repeating movements while working, playing a musical instrument, or playing sports. But these activities may cause tendinitis or bursitis.

Pressure on the nerve can happen several ways: swelling of the lining of the flexor tendons, called tenosynovitis; joint dislocations, fractures, and arthritis can narrow the tunnel; and keeping the wrist bent for long periods of time. Fluid retention during pregnancy can cause swelling in the tunnel and symptoms of carpal tunnel syndrome which often go away after delivery. Thyroid conditions, rheumatoid arthritis, and diabetes also can be associated with carpal tunnel syndrome. There may be a combination of causes.

Carpal tunnel syndrome is diagnosed based on the complaints of the individual combined with physical tests and often electrical tests. No single test is definitive for diagnosis of carpal tunnel syndrome. Rather, the person’s complaints and test findings together lead to its diagnosis.

Your doctor will take a detailed history including medical conditions, how the hands have been used, and whether there were any prior injuries is important. An x-ray may be taken to check for the other causes of the complaints such as arthritis or a fracture. In some cases, laboratory tests may be done if there is a suspected medical condition that is associated with CTS. Electrodiagnostic studies (NCV–nerve conduction velocities and EMG–electromyogram) may be done to confirm the diagnosis of carpal tunnel syndrome as well as to check for other possible nerve problems.

Treatment includes identifying and treating medical conditions, changing the patterns of hand use, or keeping the wrist splinted in a straight position may help reduce pressure on the nerve. Wearing wrist splints at night may relieve the symptoms that interfere with sleep. A steroid injection into the carpal tunnel may help relieve the symptoms by reducing swelling around the nerve. When symptoms are severe or if they do not improve, surgery may be needed to make more room for the nerve.  Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.

Cervical Spine Pain

Cervical Spine Pain affects approximately 80% of people at some time in their life.  Decades of bending, lifting, turning, and twisting and poor posture can really take their toll on your neck. The cervical spine in your neck is made up of seven bones called vertebrae, which are separated by discs filled with a cushioning gel-like substance. Your cervical discs both stabilize your neck and allow it to turn smoothly from side to side and bend forward to back. Without discs, the spine would be very stiff. These discs allow our body to move in the way that we want. They also provide cushion for the body, acting as a shock absorber. Over time, these natural shock absorbers become worn out and can start to degenerate. The space between the vertebrae narrows and nerve roots become pinched (cervical degenerative disc disease.)  About 25% of people without symptoms under age 40, and 60% over age 40 have some degree of degenerative disc disease. As degenerative disc disease progresses, the neck becomes less flexible, and you may feel neck pain and stiffness, especially towards the end of the day.

When the disc breaks open or bulges out, putting pressure on the spinal cord or nerve roots, it is known as a herniated disc or “slipped disc.” Although cervical disc disease is generally a slow process, a herniated disc sometimes can occur quickly after an injury or trauma to the neck.

The most common and obvious symptoms of cervical degenerative disc disease are neck pain and a stiff neck. When one of these conditions presses on one or more of the many nerves running through the spinal cord, you also can develop pain, numbness, or weakness radiating down your shoulder, arm, and hand. This can cause discomfort and loss of mobility that can have a major impact on your career, family, and quality of life.

To diagnose your problem, your doctor will first take a medical history to find out when your symptoms started, how severe they are, and what causes them to improve or worsen. You’ll likely have a neurological exam to test your strength, reflexes, and the sensation in your arm and hand, if they are affected. Imaging tests such as X-rays, magnetic resonance imaging (MRI) and computed tomography (CT) scans can help your doctor visualize your spinal cord to pinpoint the source of your neck pain.

Treatment can include muscle relaxants, anti-inflammatory therapy or epidural steroid injections.

Chronic Pain

While acute pain is a normal sensation, triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. There may have been an initial mishap — sprained back, serious infection, or there may be an ongoing cause of pain — arthritis, cancer, ear infection, but some people suffer from chronic pain in the absence of any past injury or evidence of body damage. Many chronic pain conditions affect older adults. Common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system).


Complex regional pain syndrome, formerly known as regional pain syndrome (RSD) is a constellation of symptoms usually involving extremities. The hallmark of the condition is pain and inflammation that may progress to complete loss of function of the limb. It may be caused by a minor injury like an ankle twist or more severe injury like bone fractures. Surgery, nerve injury, burns, intramuscular injections have also been implicated with this condition. The initial injury may be so small that it may not be remembered by the patient. CRPS could be difficult to diagnose and may go unrecognized until evaluated by the trained specialist. At times, it is confused with early infection and time is wasted with antibiotic therapy. Symptoms are exaggerated in relation to the suspected injury. Therapy can be equally challenging. Tricyclic antidepressants and anti-neuropathic medications are among the most common initial medications used. To help with diagnosis, sympathetic block injections (neck or back) are given. If injections are effective, it helps support the diagnosis. If pain is difficult to control and medications and injections have failed to help, then further therapy may include spinal cord stimulator and intrathecal pumps.

Diabetic Peripheral Neuropathy

A progressive, painful condition of peripheral (usually arms and legs) nerves. High levels of circulating sugars in blood are thought to cause injury to nerves. The most important treatment is to maintain normal levels of glucose in blood. Medications considered to be beneficial include anticonvulsant and antidepressants. These include tricyclic antidepressant like amitriptyline, nortriptyline, and desipramine. The most widely used medication is the anticonvulsant called Gabapentin (Neurontin). These medications may have side effects including dizziness, difficulty concentrating, somnolence and loss of balance. These effects will subside with time.

Discogenic Pain

The vertebral disc provides a cushion in between two spine vertebrae. Disruption of its normal anatomy may cause pain. Discomfort will be felt in the low back and occasionally legs. It is important to promptly diagnose discogenic pain to avoid unnecessary procedures and delay of treatment. Epidural injections may be tried- if not effective, then your doctor may recommend a diagnostic procedure that consists of placing a needle inside the disc and directly assessing the status of the disc under fluoroscopy. Other therapies may include IDET (Intradiscal Electrothermal Annuloplasty) and nucleoplasty. Both procedures are performed by a pain specialist and at times may help to avoid the need for surgery. A needle is placed in the disc and small pieces are taken out or, the disc is subjected to heat. Your doctor will determine if you may be helped by these procedures. Ultimately, surgery may be the only option.

Facet Arthropathy

Facet joints help keep two vertebrae together. As with other joints, the facets coordinate movement of the spine. Pain is achy, sore, tender and diffuse. It may be worse in the morning, also presenting with stiffness. As the joints warm up, pain decreases. By the end of the day, after sitting and standing for too long, pain exacerbates. In certain cases, pain may be felt radiating to the front and back of legs. This pattern may be confused with sciatica. The importance of being evaluated by a trained pain specialist cannot be stressed enough. Treatment is aimed at decreasing inflammation of the joints, promoting mobility and increasing function. Physical therapy, coordinated exercise, NSAID’s and the new COX 2 inhibitors (celebrex) are the cornerstone of therapy. Severe cases may need injections into the nerve and/or Radio Facet Ablation (RFA).


Herniated Disc

The intervertebral disc is a soft tissue, cushioning in between vertebral bones of the spine. Trauma, age and arthritis may cause it to herniate (squeeze out of its capsule). Spinal nerves exit the spine in close proximity to the disc and can be pinched by the squeezed disc. This creates a local inflammation and irritation of the nerve. Spinal nerves give origin to the large nerves of the leg, the most familiar being the sciatic nerve. Inflammation of this nerve is commonly called “sciatica.” Treatment consists of alleviating pain while allowing the herniation to heal. Studies have shown that a disc herniation may resolve by itself. Physical therapy, chiropractic care along with NSAID’s, muscle relaxants and anti-neuropathic medications may be of benefit. Some patients may need opioids. If this initial therapy fails, then epidural steroid injections may be needed. Epidural injections will deliver anti-inflammatory medications very close to the nerve and in turn decrease pain. Very severe cases may need surgery.

Knee Pain

Knee pain is an extremely common complaint, and there are many causes. It is important that an accurate diagnosis of the cause of your symptoms is made so that appropriate treatment can be directed at the cause. Some of the more common causes include: Arthritis, ligament injuries, cartilage injuries, patellar (knee cap) problems, tendonitis and bursitis. Treatment can range from, rest, heat and ice application, anti-inflammatory medications, stretching and physical therapy to injections.  In some cases surgery may be required.

Low Back Pain

Low back pain is a very generalized term to characterize a group of conditions that produce back pain. Several structures of the back may be implicated in generating pain. These include muscles, tendon, joints, nerves and spinal discs. It is important to recognize the affected structure and minimize unnecessary testing and therapy. Treatment can be as simple as muscle relaxants and anti-inflammatory therapy. Well defined syndromes (and structures causing pain) have been described: most common are discogenic pain, facet arthritis, myofascial pain, herniated discs, sciatic neuralgia, sacroiliitis, pirirformis syndrome and vertebral compression fractures.

Migraine Headaches

Migraine headache can be a complicated event, with symptoms that change over hours or even days.  Experts still aren’t sure what causes these headaches. But they seem to involve a wave of unusual activity in brain nerve cells, along with changes in blood flow in the brain. About 1 out of 8 Americans have migraines, affecting more women than men.  Migraine headaches tend to first appear between the ages of 10 and 45.   After puberty, migraines are more likely to affect girls and women.

Migraine symptoms include a pounding headache, nausea and vomiting, light and sound sensitivity.

There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away, and to prevent symptoms by avoiding or changing your triggers.  It is often helpful to keep a headache diary. It can help you identify your headache triggers.

Treatment for Migraine Headaches can include anti-nausea drugs and abortive or preventive medications, including pain relievers.  Specific medications found to be helpful in the treatment of Migraine headaches are antidepressants (amitriptyline or venlafaxine), blood pressure medicines such as beta blockers (propanolol, metroprolol) or calcium channel blockers (verapamil) and seizure medicines such as valproic acid, gabapentin, and topiramate.  Other very effective classes of medications are triptans, ergots and Isometheptene.

If you have frequent migraines, your doctor may prescribe medication to reduce the number of attacks. You need to take the medicine every day for it to be effective.  Botulinum toxin type A (Botox®) injections may also help reduce migraine attacks if they occur more than 15 days per month, each lasting 4 or more hours a day.  Severe headaches should always be evaluated by a physician to rule out more serious medical problems.

Myofascial Pain

Ilio-lumbaris, paravertebral, multifidus are some of the examples of muscles located on the low back. Spasm and injury of these and other muscles may be severe enough to send patients to the emergency room or to the doctor’s office. Physical therapy, chiropractic adjustments, stretching exercise and muscle relaxants are all part of the treatment. It is important to be evaluated by a trained pain physician in order to avoid unnecessary tests and procedures. Pain can be described as diffuse aching, soreness or burning pain. It may be throughout the body or confined to a small group of muscles. This condition may present by itself or be associated with other syndromes like fibromyalgia and arthritis. Treatment consists of muscle relaxants, trigger point injections and physical therapy. Opioids are rarely effective.

Neck Pain

Several structures may be responsible for neck pain. Nerves, discs, tendons, muscles and joints have all been reported as sources of pain. One or several structures may be a cause of pain, complicating diagnosis and treatment. Arthritis (in the facet joints), muscle spasm, disc herniation, prior surgery, nerve impingement, neuralgias of the occipital nerve, whiplash injuries, cancer, infection, spine trauma, vertebral compression fractures, misalignment (anterolysthesis) and bleeding may be possible causes.

Of paramount importance is to determine if the cause of the pain is due to infection, cancer, bleeding or fractures, as therapy may be more effective early. Certain red flags help your doctor rule out these conditions: pain worse at nights, fevers, chills, weight loss, loss of appetite, insomnia, and pain not resolving at rest. Treatment is oriented towards its originating cause.  Once the above conditions are ruled out, systematic questioning and physical exam help your doctor narrow the potential sources of pain.

Herniated discs may cause neck and arm pain. Numbness, loss of sensation and weakness may be present. Pain may be exacerbated with movement of the head, arms, coughing and sneezing. Pain usually improves with rest.

Facet joint pain causes pain in the neck with radiation to shoulders, posterior head and face. It is much worse with movement and better at rest. Pain radiating outside of the neck confuses patients and doctors, focusing on mild disk disease. This condition is often misdiagnosed but this is an easily treated condition.

Muscles and tendons can be a significant source of pain. Spasm may occur after accidents, falls or poor positioning at work. At times muscle spasms occur as a response of the body to changes in posture when pain is present from other causes.

Nerve (non-spinal) damage can occur after falls, whiplash injury and poor positioning. Pain is diffuse, aching and burning. It is often difficult for patients to describe. Poor localization of pain is also common.

Herniated discs can be initially treated conservatively with medications, chiropractic care, physical therapy, acupuncture and epidural injections. Contained disc herniations may respond to decompression of the disc via a needle, also called percutaneous discectomy. Surgery may be indicated for severe cases, particularly those affecting mobility of arms, loss of sensation and increasing pain. Muscle and tendon pain respond well to muscle relaxants, myofascial release therapy, physical therapy, trigger point injections and acupuncture. For vertebral fracture treatment see: vertebroplasty. Facet joint or arthritic pain is treated with NSAID’s, Physical Therapy, chiropractic care and acupuncture. Severe cases may respond to facet joint injections or ablation of the nerve feeding the joint. This procedure (see procedures for more information), may improve pain for up to one year. Neuralgias to specific nerves or groups of nerves (occipital, superficial cervical plexus) respond to medications, injections and physical therapy.

Pelvic Pain

This is a very complicated condition, affecting both men and women. An extensive list of conditions may be responsible for causing pain in the pelvic region. Cancer, tumors, endometriosis, dysmenorrhea, infections, nerve damage, trauma, surgery, psychological conditions, fibromyalgia, colo-rectal disease, and menstrual period all need to be evaluated as possible causes of pelvic pain. If no surgical or treatable cause is identified, your pain doctor may recommend a medical regimen as initial therapy. Acupuncture may be effective in certain cases. Epidural injections or sympathetic blocks may also be tried. Some of these injections can be done in an office setting. If scars are present in the area they may need to be injected, scars are a common source of pain. For severe, intractable cases more invasive therapies can be suggested by your pain doctor.

Peripheral Neuropathy

Peripheral neuropathy describes damage to the peripheral nervous system, the system which transmits information from the brain and spinal cord to every other part of the body. More than 100 types of peripheral neuropathies have been identified, each with its own characteristic set of symptoms, pattern of development, and prognosis. Impaired function and symptoms depend on the type of nerves that are damaged– motor, sensory, or autonomic. Some people may experience temporary numbness, tingling, and pricking sensations, sensitivity to touch, or muscle weakness. Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction. Peripheral neuropathy may be either inherited or acquired. Causes of acquired peripheral neuropathy include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies, alcoholism, and vascular and metabolic disorders. Acquired peripheral neuropathies are caused by systemic disease, trauma from external agents, or infections or autoimmune disorders affecting nerve tissue. Inherited forms of peripheral neuropathy are caused by inborn mistakes in the genetic code or by new genetic mutations.

No medical treatment exists that can cure inherited peripheral neuropathy. However, there are therapies for many other forms. In general, adopting healthy habits — such as maintaining optimal weight, avoiding exposure to toxins, following a physician-supervised exercise program, eating a balanced diet, correcting vitamin deficiencies, and limiting or avoiding alcohol consumption — can reduce the physical and emotional effects of peripheral neuropathy. Systemic diseases frequently require more complex treatments. Anti-neuropathic medications are commonly used as therapy. For severe cases, temporary relief may be achieved with epidural steroid injections. Some types of peripheral neuropathies respond to spinal cord stimulators and intrathecal pumps.

In acute neuropathies, such as Guillain-Barre syndrome, symptoms appear suddenly, progress rapidly, and resolve slowly, as damaged nerves heal. In chronic forms, symptoms begin subtly and progress slowly. Some people may have periods of relief followed by relapse. Others may reach a plateau stage where symptoms stay the same for many months or years. Some chronic neuropathies worsen over time, but very few forms prove fatal unless complicated by other diseases. Occasionally the neuropathy is a symptom of another disorder.

Adapted from

Phantom Pain

See Post-Amputation Pain. Phantom limb syndrome is pain of an amputated limb (finger, toes, arms, legs).


Piriformis Syndrome

Aching sore, shooting pain in the buttocks may be due to spasm of the piriformis muscle. The sciatic nerves run through the muscle and may be irritated by the muscle spasm. This condition may be confused with sciatica and spinal nerve/disc herniation. It is important to have a proper diagnosis to avoid unnecessary therapy, tests and pain. Pain specialists are trained to recognize this condition. Therapy consists of stretching exercises, muscle relaxants and injections into the muscle. The muscle is located deep in the buttocks and x-rays (fluoroscopy) should be used to confirm proper injection.

Post-Amputation Pain

Pain may originate from the missing limb (AKA phantom limb pain) or from the stump. In both cases the origin of pain is nerve structures. Therapy consists of anti-neuropathic medications and injections into the affected nerves and epidurals. Severe cases may require a spinal cord simulator.

Post-Laminectomy Pain Syndrome

A common term referring to pain in the back and extremities after surgery. Pain may originate from screws and hardware placed in the spine, nerve damage after surgery, scar tissue surrounding nerves and free moving disc or bone fragments. It is paramount that a spine surgeon rule out a surgical cause for the pain. Although pain started after surgery, further surgery may be the only solution. Anti-neuropathic medications and judicious amounts of opioids may be prescribed. Acupuncture has shown to be effective in certain cases. Severe pain, not improving with conservative therapies, may necessitate spinal cord stimulators.

Post Herpetic Neuralgia

Shingles (herpes zoster) is an outbreak of rash or blisters on the skin that is caused by the same virus that causes chickenpox – the varicella-zoster virus. The first sign of shingles is often burning or tingling pain, or sometimes numbness or itching in one particular location on only one side of the body. After several days or a week, a rash of fluid-filled blisters, similar to chickenpox, appears in one area on one side of the body. Shingles pain can be mild or intense. Some people have mostly itching; some feel pain from the gentlest touch or breeze. The most common location for shingles is a band, called a dermatome, spanning one side of the trunk around the waistline. Anyone who has had chickenpox is at risk for shingles. Scientists think that in the original battle with the varicella-zoster virus, some of the virus particles leave the skin blisters and move into the nervous system. When the varicella-zoster virus reactivates, the virus moves back down the long nerve fibers that extend from the sensory cell bodies to the skin. The viruses multiply, the tell-tale rash erupts, and the person now has shingles.

The severity and duration of an attack of shingles can be significantly reduced by immediate treatment with antiviral drugs, which include acyclovir, valcyclovir, and famcyclovir. Antiviral drugs may also help stave off the painful after-effects of shingles known as postherpetic neuralgia. Other treatments for postherpetic neuralgia include steroids, antidepressants, anticonvulsants, and topical agents. When pain is severe, epidural injections may be effective. Intractable cases may necessitate further invasive therapy for which the patient must consult with a fellowship trained pain physician.

For more information check

Post Lumpectomy Pain

See mastectomy pain syndrome.

Post Mastectomy Pain

Breast surgery may injure a local nerve, the intercosto-brachialis. Pain is felt around the breast, axilla and sometimes chest. Therapy consists of mainly anti-neuropathic medications. Opioids may be tried in severe cases. Some blocks may be of benefit. If all fails, then a spinal cord stimulator may be tried.

Post-Surgery Knee Pain

Constant burning, shooting and aching pain after knee surgery may be the result of damage to saphenous and peroneal nerves. Therapy consists of anti-neuropathic medications and blocking the affected nerves. Differentiating this pain from other common pain syndromes is key. Other possible diagnoses may include CRPS, spinal nerve damage from a herniated disc or infections. It is important to be seen by a physician trained in recognizing these conditions.

Post Thoracotomy Pain Syndrome

After chest surgery (CABG, cancer, biopsy) the intercostal nerves may be injured. Pain slowly progresses after surgery and is localized on the side of surgery. Early therapy with anti-neuropathic medications, intercostal injections and epidural injections may help worsening of symptoms. Delaying therapy makes it more difficult to treat this condition. In very severe cases, a spinal cord stimulator may be the only option.

Pudendal Neuralgia

Painful condition involving the pudendal nerve, affecting both men and women. The pudendal nerve runs through the pelvic region, including genitals, urethra, anus and perineum. Your perineum is the area between your anus and genitals. The condition is also known as pudendal neuropathy, pudendal nerve entrapment, cyclist’s syndrome, pudendal canal syndrome, or Alcock’s syndrome.

Pudendal neuralgia can cause pain, especially when one sits. Men with pudendal neuralgia may have pain in the buttocks, scrotum, penis, and perineum. Women with pudendal neuralgia may have pain in their buttocks, vulva, urethra, and perineum.  If the pudendal nerve is entrapped, surgery may be needed to free the nerve. For other causes acupuncture, medications and biofeedback often improve pain. Severe cases may need nerve injections, epidural injections or sympathetic blocks may be needed. Spinal cord stimulators have been used for intractable, debilitating pain.

Raynaud’s Syndrome

It is a disease of the collagen system and involves damage to arteries causing low flow of blood to hands. Lack of oxygen to nerves in hands may cause severe pain. Severe cases may improve with sympathetic nerve blocks and spinal cord stimulators.

Rheumatoid Arthritis

Rheumatoid arthritis is a disease that affects the joints. It causes pain, swelling, and stiffness. If one knee or hand has rheumatoid arthritis, usually the other does too. This disease often occurs in more than one joint and can affect any joint in the body. People with this disease may feel sick and tired, and they sometimes get fevers. Some people have this disease for only a few months, or a year or two. Then, it goes away without causing damage. Other people have times when the symptoms get worse (flares), and times when they get better (remissions). Others have a severe form of the disease that can last for many years or a lifetime. This form of the disease can cause serious joint damage. Doctors don’t know the exact cause of rheumatoid arthritis. They know that with this arthritis, a person’s immune system attacks his or her own body tissues. Researchers are learning many things about why and how this happens. RA is treated by a rheumatologist. If pain is severe, then NSAID’s and opioids may be of help. At times, selected joint injections, nerve blocks and epidurals may be indicated.




The sacroiliac joint is formed by the sacrum and pelvis. Pain is felt in the low back, legs and groin. Standing too long and going from a sitting to a standing position usually triggers pain. Physical therapy, stretching exercises and chiropractic adjustments may be beneficial. Muscle relaxants and NSAID’s are commonly used. Injection directed by fluoroscopy (x-rays) into the joint may help relieve pain.

Scar Neuroma

Skin scars are thought to cause pain by entrapping small nerves within. Very simple therapy performed in the office may diagnose and at the same time treat the pain.

Shoulder Pain

Shoulder pain is an extremely common complaint, and there are many common causes of this problem. A common diagnosis in patients with shoulder pain is bursitis or tendonitis of the rotator cuff.  Other common causes can be adhesive capsulitis (Frozen Shoulder), rotator cuff tears, biceps tendon rupture, shoulder separation (AC separation) and shoulder dislocation.  The treatment of shoulder pain depends entirely on the cause of the problem and can range from injections to surgery.  Therefore, it is of utmost importance that the patient get an accurate diagnosis of the cause of the symptoms, so that appropriate treatment can be directed at the cause.

Spinal Cord Injury Pain

See Central Cord Syndrome.


A term that defines the slippage of one vertebrae over the next one. All structures contained within will be strained with the movement of the two vertebrae. Early cases can be treated conservatively with chiropractic care, physical therapy and medications. More severe cases may need surgical repair. See back pain above.

Stump Pain

Pain originating after amputation. Usually results from scar neuromas or nerve pain. Pain that continues several weeks after surgery may need intervention. Your doctor may recommend medications, acupuncture, nerve blocks or sympathetic blocks. Severe cases have responded in the past to spinal cord stimulators.

Suboxone® for Opioid Based Dependence Treatment

Opioid dependence can begin with a simple prescription to treat serious pain or with the recreational drug use of prescription pain medications or heroin. Regardless of how a person becomes dependent, once dependence has developed it is considered a long-term medical condition that requires treatment. When you’re opioid dependent, the need to satisfy cravings or avoid withdrawal symptoms can be intense and difficult to manage on your own. Managing opioid dependence is not simply a matter of “getting clean” or stopping all drug use. Typically, the changes that cause opioid dependence will not be corrected right away. In fact, those changes can trigger cravings months or even years after you’ve stopped misusing opioids. By suppressing withdrawal symptoms and reducing cravings, SUBOXONE® Film can help people with opioid dependence take steps to manage their condition so that they can focus on rebuilding their lives.


Tendonitis is inflammation of a tendon. A tendon is the thick, cord-like tissue that attaches a muscle to a bone.  In general, the symptoms of tendonitis start out as mild. As time passes and more repetitive movement injury takes place, the symptoms get worse and the pain can be disabling.

Symptoms can vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint around the inflamed tendon. In some cases, swelling occurs along with heat and redness, and there may be visible knots surrounding joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon.

Treatments your doctor may recommend are medications, injections and physical therapy.


Torticollis (wryneck) is one of a broader category of disorders that involve flexion, extension, or twisting of muscles of the neck beyond their normal position. The neck tends to twist to one side, causing the head to tilt.  Additionally, there may be deviation of the eyes (oculogyric crisis) and protrusion of the tongue (buccolingual crisis.) Shoulder pain, back pain, headache, neck cramps, muscle tightness, or burning sensations are all common symptoms.

Acute torticollis can be caused by many different conditions; occasionally, no condition is found as a cause. Injuries to the cervical spine or neck muscles often result in spasm of the muscles, leading to the twisting of the head which is characteristic of torticollis. Other causes include infection of the head or neck. Rarely, tumors, scar tissue, arthritis of the cervical spine, or vascular abnormalities may also cause torticollis. Certain drugs of abuse such as ketamine, amphetamines, and cocaine as well as commonly prescribed neuroleptic drugs such as prochlorperazine (Compazine), haloperidol (Haldol), and chlorpromazine (Thorazine) can cause acute dystonia (a lack of normal muscle control). This is a condition that involves the sudden onset of involuntary contractions of the muscles of the face, neck, or back.  It is important for your doctor to conduct nerve and motor function studies to rule out spinal cord injury.

When the disorder occurs in people with a family history, it is referred to as spasmodic torticollis. The characteristic twisting of the neck is initially spasmodic and begins between 31-50 years of age. If left untreated, it likely will become permanent.

Treatment is targeted towards relaxing the contracted neck muscles involved. Therapy includes medications, physical devices, botulinum toxin (Botox®), physical therapy, stretching exercises, and surgery. In most people, torticollis resolves in several days to a few weeks. A few people will develop continuing neck problems for months to years. Persistent neck muscle spasms may require referral to a neurologist or surgeon.


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RSD Foundation

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