Dr. Heller

Take 2 aspirin & call me in the morning doesn’t cut it with chronic pain

5 Realities of Living with Chronic Pain
by Stephanie Burke  spine-health.com

Living with chronic pain is challenging enough because of the obvious reason—the pain—but there are other factors that go along with this condition that make life even more difficult.

If you live with chronic pain, consider sharing this blog with your loved ones so they can better understand what your daily life is like.

Chronic pain may persist even after a condition, such as spinal stenosis, is addressed through surgery.

  1. Pain is rarely “all in your head.”

People in pain are often treated as if their pain is actually made up or greatly exaggerated. While it is true that pain is subjective (people simply perceive pain differently) and some people may report pain because they have other agendas, for the vast majority the pain is real and present. It is not made up. The problem is that chronic pain is often caused by anatomical problems that are difficult or impossible to diagnose using standard medical tests, and pain cannot be diagnosed like other medical problems (such as a broken bone that can be seen on an X-ray).

Fortunately, most in the medical community are now trying to understand and appreciate that chronic pain is real and needs to be treated and managed differently.

  1. Pain is not the only problem—it breeds other health problems.

Thoughts and emotions related to chronic pain also can both aggravate and alleviate the pain. For example, depression, which is a serious disease, can worsen the pain. Sleep problems, again caused by the pain, can also make the pain worse. And increased pain usually leads to increased sleep problems.

Often all conditions related to the pain need to be treated concurrently in order for the patient to get any relief.

 

  1. Pain is deeply personal.

Everyone experiences and expresses pain differently. Any two people with the exact same health condition are likely to feel and express their pain in unique ways depending on a number of factors. Newer chronic pain theories now have physiological explanations for how and why people experience pain differently.

When it comes to back pain, this is especially true. Two people can have the same type of herniated disc, but one feels only slight discomfort and the other feels intense burning pain that is unresponsive to conventional treatment. It is also not uncommon that no anatomical cause of the pain can be detected.

Why is this point important? It means that chronic pain often needs to be treated as the primary problem, which is different than the conventional medical approach of identifying and treating the underlying problem causing the pain.

  1. Chronic pain is its own beast.

Unlike acute pain, which functions as a warning signal (e.g. I just stepped on a nail—better move my foot!), chronic pain does not have any useful function. It just is.

Often, chronic pain is caused by nerves that continue to send pain signals to the brain. When dealing with chronic pain, one of the most frustrating things is that there is nothing to “fix.” It just exists in your body.

  1. Chronic pain is LONELY.

After awhile, many people with chronic pain—especially pain that is caused by a condition that cannot be seen—begin to feel isolated. Here the Internet has done a world of good helping people in pain connect with others in similar situations and find a supportive peer group through online communities of people in similar situations.

Having a clearer understanding of how chronic pain works, as well as the central role that the mind plays in the experience of chronic pain, is becoming more mainstream in the medical community. Patients who start to gain more understanding of their own chronic pain may also benefit in terms of gaining increased emotional support, more effective and sustainable pain management, and even possibly harnessing the power of their minds to assist in coping with the pain.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Texters Beware!

Take note texters, your spine is suffering

You’re 18, ready to start college, play sports, make it big and prepare for spinal surgery. Wait, what? Spinal surgery? But I don’t have back pain or injury you say. Go ahead and blame that sometimes 60 degree angle of your neck is at while you are texting friends and family. Our bodies aren’t designed to keep that kind of stress on the neck and will eventually lead to degeneration.

“Your spine is at its happiest when your ears fall on the same plane as your shoulders, and your shoulder blades are retracted. Without these adjustments, you put added stress on your spine, Dr. Kenneth K. Hansraj, spinal & orthopaedic surgeon.

When you are texting, you are actually doing damage to yourself. Okay, once in a while isn’t going to hurt you, unless you’re driving at the same time, but consistent posture like this will do damage. It’s like carrying 60 pounds of extra weight on your spine. That’s a second grader on your back all the time! Nobody wants that. Normal usage would be about 700 – 1,400 hours of pressure and the worst offenders are looking at about 6,000 hours of that intense pressure on their spine per year. Here’s an idea of the pressure you put on yourself when you text and hold that position for a while.

Image Courtesy of http://www.thetimes.co.uk/

Image Courtesy of http://www.thetimes.co.uk/

Your resting pressure when you hold your head up straight is about the weight of your head, or 11 pounds. At 15 degrees tilted, it’s about 27 pounds, 30 degrees is about 40 pounds and by the time you hit a 45 degree angle, you are looking at 60 pounds of pressure on the spine.

That is a lot of pressure to be putting on your spine. However, it’s almost impossible to avoid today’s technologies so what do you do to help combat it?

Make an effort to limit the tilt. Okay, that can be easier said than done so here comes the Mom card. Do as your mom always told you and stand up straight. Good posture is so important on so many levels, don’t let it fall aside for a text. Keep your phone, or electronic device, away from waist level when looking at it to ease of off the pressure. “Look down with your eyes, no need to bend your head.” advises Hansraj

Here at Blue Ridge Orthopaedic & Spine Center, we offer complete comprehensive care for the whole family, including Physical Therapy, which is an invaluable resource to getting you back to your daily activities after an injury or surgery and will work with you to reverse the detrimental effects of repetitive daily activities like this.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

Just what is Cartilage anyway?

Cartilage-309x199

What Is Cartilage?

www.arthritis-health.com  –  Emmanuel Konstantakos, MD

Cartilage is a tremendously strong and flexible fibrous tissue that takes many forms and serves multiple purposes throughout the body. There are three types of cartilage: elastic cartilage, fibrocartilage, and hyaline cartilage.

Hyaline cartilage is the most common type of cartilage and can be found at the nose, windpipe, and most of the body’s joints. In essence, this cartilage can be thought of as the material that makes up the lubricant inside your joints. The word Hyaline is actually derived from the Greek word “Hyali” or “Γυαλί,” which means “Glass.” Under normal circumstances, a normal human joint is actually shiny and smooth similar to the inside of a glass.

In a joint, hyaline cartilage is referred to as articular cartilage because it covers bones’ surfaces where they articulate, or meet up with one another. This article focuses on articular cartilage.

Articular Cartilage
The thickness of articular cartilage varies from joint to joint. For example, cartilage at the wrist may be less than 1 mm thick 1 , while in some areas of the knee the cartilage may be as thick as 6 mm.2

Articular cartilage has two primary purposes:

  • Smooth movement. Extremely slippery, articular cartilage allows bones to glide over each other as a joint flexes and straightens.
  • Shock absorption. Articular cartilage acts as a shock absorber, cushioning bones against impacting each other during a weight-bearing activity, such as walking or jogging.

Articular cartilage also stores synovial fluid, a sticky, viscous fluid that lubricates and circulates nutrients to the joint. When the joint is at rest, the synovial fluid is stored in the articular cartilage much like water is stored in a sponge. When the joint bends or bears weight, the synovial fluid is squeezed out, helping to keep the joint lubricated and healthy.

Cartilage Damage
Despite its flexibility and strength, cartilage can be damaged. Problems can arise due to:

Injury
Wear-and-tear over time that can eventually lead to osteoarthritis
Diseases, such as rheumatoid arthritis or ankylosing spondylitis

Because it does not contain blood vessels, cartilage does not heal itself well. When cartilage has become thinned or damaged, a limited amount of new cartilage may be produced, but the new cartilage cells will grow in irregular, bumpy patterns. The result is that the bones may rub and grind against one another at the joint and this can be a source of pain.

Cartilage does not contain nerves, so damaged cartilage itself does not cause pain. However, the friction between bones and other resulting abnormalities in the joint can cause discomfort and pain as well as inflammation.

Gradual onset of stiffness, pain, and swelling in the joint can be a sign of osteoarthritis.

 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

 

References:
1. Pollock J, O’Toole RV, Nowicki SD, Eglseder WA. Articular cartilage thickness at the distal radius: a cadaveric study. J Hand Surg Am. 2013 Aug;38(8):1477-81. doi: 10.1016/j.jhsa.2013.04.037. Epub 2013 Jun 28. PubMed PMID: 23810572.

2. Cohen ZA, McCarthy DM, Kwak SD, Legrand P, Fogarasi F, Ciaccio EJ, Ateshian GA. Knee cartilage topography, thickness, and contact areas from MRI: in-vitro calibration and in-vivo measurements. Osteoarthritis Cartilage. 1999 Jan;7(1):95-109. PubMed PMID: 10367018.

Back Pain Getting on your Nerves?

Types of Back Pain

www.spine-health.com  –  Ralph F. Rashbaum, MD

It’s important to have a general understanding of the major different types of back pain, because the type of pain dictates the treatment options.

Nociceptive Pain and Neuropathy

The medical community usually classifies pain in one of two general categories: neuropathic pain and nociceptive (somatic) pain.

  • Nociceptive pain is pain that is sensed by the “nociceptor” sensory fibers after an injury to a muscle, soft tissue (ligaments, tendons), bones, joints, or skin (or other organs). Nociceptive pain is often characterized as a deep aching, throbbing, gnawing, or sore sensation. Common examples of nociceptive pain related to back pain include: pain after trauma (e.g. back pain after a car accident or a fall), pain after back surgery, and arthritis pain. Nociceptive pain is usually localized and gets better with healing.
  • Neuropathy or neuropathic pain is pain caused by damage to nerve tissue. Neuropathy is often characterized as burning, severe shooting pains, and/or persistent numbness or tingling. Common examples of neuropathic pain related to back pain include sciatica, pain that travels from the spine down the arm, pain that persists after back surgery.

It is thought that in some cases prolonged nociceptive pain may progress to neuropathy, and a patient may have both nociceptive pain and neuropathy at the same time.

Acute Pain and Chronic Pain

It’s also important to distinguish between acute pain and chronic pain, as the two types of pain are very different in form and function.

  • Acute pain- With acute pain, the severity of pain directly correlates to the level of tissue damage. This provides us with a protective reflex, such as the reflex to move your hand immediately if you touch a sharp object. This type of pain is a symptom of injured or diseased tissue, so that when the underlying problem is cured the pain goes away.

Acute pain is a form of nociceptive pain.

  • Chronic pain – In chronic pain, the pain does not have the same meaning as with acute pain – it does not serve a protective or other biological function. Rather, the nerves continue to send pain messages to the brain even though there is no continuing tissue damage.Neuropathy is a form of chronic pain.

 

Anatomy Of Nerve Pain

The spinal cord is the main part of the body’s central nervous system that conveys signals from the brain to the nerves throughout the body. Nerves coming from and leading to all parts of the body enter and exit the spinal cord along its entire length.

How Nerve Pain Occurs


Peripheral Neuralgia Video

There are 31 pairs of spinal nerves that exit the spinal cord through openings between the vertebrae. The point at which the nerve exits the spinal cord is called the nerve root, and where it branches out into many smaller nerves that control different parts of the body is called peripheral nerves. For example, a nerve that exits the lower back has peripheral branches that extend all the way down to the toes. Peripheral nerves comprise the peripheral nervous system.

The peripheral nerves include both motor nerves and sensory nerves:

  • Sensory nerves are nerves that receive sensory stimuli, such as how something feels and if it is painful. They are made up of nerve fibers, called sensory fibers (mechanoreceptor fibers sense body movement and pressure placed against the body, and nociceptor fibers sense tissue injury).
  • Motor nerves lead to the muscles and stimulate movement. They are made up of nerve fibers called motor fibers.

Nerve Injury and Neuropathy Pain

While it has not been firmly established, it is thought that injury to any of the above types of nerve tissue can be a possible cause neuropathy pain.

The part of the nerve cell that is damaged by a neuropathy is the axon (the inner information pathway of the nerve cell) and/or its myelin covering (the fatty outer sheath that protects the nerve cell and assists in conveying information throughout the nervous system).

When neuropathy pain occurs by damage to the above structures, neuropathy is sustained by abnormal processing of sensory input by the peripheral nervous system and the central nervous system.

Most pain is a signal to the brain that there is damage or an injury to the tissues or structures of the body, and is known as nociceptive pain. Neuropathic pain is caused by an issue with the nerves themselves.

Dr. Daniel Heller and Dr. David Kim, here at Blue Ridge Orthopaedic & Spine Center are incredibly skilled at treating all types of pain and your well-being is their priority. If you are experiencing any of these  types of pain or you just aren’t sure what’s happening but you’re suffering, please don’t hesitate to contact us and make an appointment. 

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

It’s NEVER a stupid question. Always ask.

 

40 Questions to Ask Your Surgeon Before Back Surgery

www.spine-health.com Stephanie Burke

Before you decide to have the surgery

1. What type of surgery are you recommending? Why?
2. What is the source of the pain that is being addressed? How do you know this?
Exploratory surgery is never done on the back.
3. Please explain the procedure in great detail.
The amount of information depends on your personal preferences. Some patients want to know everything, some not so much!
4. What are my non-surgical options?
5. What is the natural course of my condition if it is not surgically addressed?
6. What would you recommend if I was your friend, wife, sister, or daughter?
7. How long will the surgery take?
8. What are the side effects, potential risks, and potential complications?
9. Please explain the risks and how they relate to me personally.
For example, different risk factors like smoking, being overweight or having grade 3 spondylolisthesis, etc, will affect surgical outcomes.
10. What if, during my surgery, you encounter a different spine issue than you expected?
11. Do I need to donate my own blood? If yes, why?
For most types of back surgery, blood does not need to be donated ahead of time.
12. Do you perform the whole procedure? Will any students and/or other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications?
13. Who else will assist you in the operation? What are their background and qualifications?
14. What are the long-term consequences of the proposed procedure?
For example, will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine? Questions about the surgeon
15. How many times have you done this procedure?
Generally, when it comes to surgery, “practice makes perfect,” so more experience is better. However, if the doctor is recommending something that is not often done, such as multi-level fusions, more experience would not necessarily be better.
16. Are you board eligible or board certified?
You can usually look on the wall and see a certificate.
17. Are you fellowship trained in spine surgery?
This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
18. If I want to get a second opinion, who would you recommend?
The recommendation should be someone not in the same practice.
19. Statistically, what is the success rate for this type of surgery? What is your personal success rate, and how many of this type of surgery have you done?
20. Can I talk to other patients who have had a similar procedure?
The patient will have to sign a HIPAA release form, but typically, happy patients want to share their success stories.

Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.

Questions about what to expect after the surgery

21. What kind of pain should I expect after the surgery and for how long?
22. How long is the hospital stay?
23. May a family member spend the night with me in the hospital?
24. How do you manage the pain in the hospital?
25. Which pain medications will I be sent home with? What are possible side effects of these prescriptions (e.g. constipation, drowsiness, etc.)?
26. Will you know before the surgery if I will need a back brace afterwards? If so, will I be fitted for one before the surgery?
27. Will I need any other medical equipment (like a walker) when I go home?
28. Who can I call if I have questions after the surgery? What is the process for communication?
29. How often will I see you after my surgery?
30. What symptoms would warrant a call to your office?
31. What symptoms would warrant immediate medical attention?
32. What limitations will I have after surgery and for how long?
33. How long should I wait to bathe?
34. How long will I be out of work? School?
35. What kind of help will I need when I return home?
36. When can I drive again?
37. When can I resume normal (light) household chores?
38. What expectations do you have for my recovery?
39. When is it safe to resume sexual relations?
40. How soon after the surgery can I start physical therapy?

One thing we pride ourselves on here at Blue Ridge Orthopaedic & Spine Center is our willingness to listen to you and answer all the questions you may have about a procedure. Back surgery is scary stuff and it’s not taken lightly, often it’s the last resort when treating the injury. Please do not hesitate to bring these, or any other questions to the table if
you are looking at having spine surgery. We welcome it.

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Blue Ridge Orthopaedic & Spine Center has on-site state-of-the-art technology to diagnosis and treat orthopaedic conditions. Both of our offices are equipped with in-office  radiology departments. Not only does this facilitate rapid diagnosis but it is also convenient for patients who may be experiencing pain or disability at the time of their visit. To schedule an appointment with one of our board-certified and fellowship trained physicians, call our Warrenton office at 540-347-9220 or our Gainesville office at 703-743-2814.

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