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    How Do You Treat foot drop ?     Question: My mother has nerve compression in her low back, which has resulted in foot drop of her right foot. What other options does she have besides surgery? Answer: To help our readers who aren't familiar with drop foot (sometimes called foot drop), this is a nerve and muscular disorder that prevents the patient from lifting the front of his or her foot. A person with drop foot will notice a change in their gait (known as steppage gait), and patients may also experience pain and/or numbness. Nerve compression that leads to foot drop is typically caused by a herniated disc in the lumbar spine, specifically at L4-L5; the fourth and fifth vertebrae in the low back. Most herniated discs get better with time and do not require surgery. There are many non-surgical treatments for herniated discs, including bed rest, exercises medication and  minimal invasive techniques. Unfortunately, with foot drop, the longer the nerve is compressed, the less chance for recovery. The nerves that elevate the foot, and are affected in foot drop, are the most sensitive nerves lumbar spine—and the least resilient. Now, you might wonder how nerve compression in your low back affects the nerves in your legs. The reason is that the nerves affected in foot drop begin in your low back and extend down to your legs and feet. When the nerve is compressed for very long, cells in the nerve become damaged and the nerve cannot transmit the signal to the feet. This nerve damage can be irreversible. Consequently, foot drop is often permanent, even if the nerves are decompressed surgically. Regardless, the duration of foot drop and the amount of compression should be evaluated by a surgeon.
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    What's Brachialgia? Any Pain condition start from your Neck region travel towards shoulder and may radiating down'to hand fingers, maybe associated with Nerves root's compression or Disc pathology from C1 to C7 like Disc Bulge, Protrusion, Extrusion etc.but commenest one is C4-5-6. Most of people's have myths about this problem-keep on saying it's Cervical Spondylitis or Cervical pain, they visit to doctors intially for relief, first doctors will ask them to get done X-ray, Cervical Spine .just after seeing x-rays he will advise you neck collar or pillow for couple of days or weeks. Without knowing what exact structure is involved in Neck Pain, wether it's Nerves, muscles, cervical vertebrae, vascular structure, artery or vein.how your doctor is commenting it's cervical Spondylitis or something else? How your doctor will see Nerves root's in X-ray? . Clinical findings* -patients may experience Tingling sensation Heaviness or burning sensation, spasms in area.of dermatome.in severe condition your power of limbs may affected, even patient feel difficulty in gripping or holding object. Investigation- X-ray Cervical Spine, MRI scan cervical, Doppler ultrasound arterial or venous.EMG, , NCV etc Treatment of Brachialgia* Medical treatment-analgesics muscles relaxant or rest for limited duration, some Physiotherapy if be needed but contraindications if neurological function with warning signs.present . Every medical treatment has its own limitations with time frame. Surgical options* If conservative treatment has been non responsive to medical treatment. May opt for-Epidural injections for Pain relief as directed by your Pain physician or Neurosurgeon. Etc. Nucleoplasty procedures, Laser procedures, Disc Fix Discectomy, Laminectomy etc Never mind if you are feeling any Pain condition associated with Unwanted paresthesia Numbness Spasms Tingling sensation etc must consult with Pain physician or Neurosurgeon.but keep on trial with medicine by any physician or therapist or unwanted exercise may be catastrophic events if spinal cord vital functions compromise.. anything unwanted action there may have deleterious effects.
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    cancer pain? Causes and Diagnosis People with cancer commonly experience pain. However, up to 95% of cancer pain can be treated successfully. Untreated pain can make other aspects of cancer seem worse. These include: Fatigue Weakness Shortness of breath Nausea Constipation Sleep disturbances Depression Anxiety Mental confusion Causes of pain Pain can come from the tumor itself, the cancer treatment, or causes unrelated to cancer. A good pain treatment plan will take care of pain from all causes. The tumor. A tumor growing in an organ, such as the liver, may stretch part of the organ. This stretching causes pain. If a tumor grows and spreads to the bones or other organs, it may put pressure on nerves and damage them, causing pain. Or if a tumor spreads or grows around the spinal cord, it can compress the spinal cord. This eventually leads to severe pain or paralysis if not treated. Surgery. It is normal to experience pain from cancer surgery. Most pain goes away after a while. But some people may have pain that lasts for months or years. This long-lasting pain can be from permanent damage to the nerves and the development of scar tissue. Radiation therapy. Pain may develop after radiation therapy and go away on its own. It can also develop months or years after radiation therapy to some parts of the body, such as the chest, breast, or spinal cord. Chemotherapy. Some chemotherapy can cause pain and numbness in the fingers and toes, called peripheral neuropathy. Usually this pain goes away when treatment is finished. But sometimes the damage is permanent. Learn more about the side effects of surgery, radiation therapy, and chemotherapy. Other causes. People with cancer can still have pain from other causes. These include migraines, arthritis, or chronic low back pain. The treatment plan your health care team develops with you should include these kinds of pain. Any pain decreases your quality of life. Diagnosing pain You know your pain best. So it is important to discuss any new symptoms or a change in symptoms with your doctor or a pain specialist. They can help you find a medication or other pain relief method that works for you. To help your doctor better understand your pain, he or she may ask the following questions: Where does it hurt? When does the pain stop and start? How long has the pain been there? How much pain are you having on a scale of 0 to 10? What does the pain feel like, in your own words? For example, is it burning, stabbing, throbbing, or aching? Managing and treating pain Some people worry that pain medication is addictive or will make them sleepy or groggy. But there are many ways to manage and treat cancer pain, including medication and methods that don't use medication. Talk with your doctor to find the best treatment for your pain.
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    Trigeminal Neuralgia Well known painful condition also known as Suicidal disease to Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain. If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain. You may initially experience short, mild attacks. But trigeminal neuralgia can progress and cause longer, more-frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it's more likely to occur in people who are older than 50. Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Doctors usually can effectively manage trigeminal Neuralgia with medications, injections or surgery. Radiofrequency ablation is best non surgical intervention.under fluroscopic guidance by any interventional pain physician.who is expert one to manage without opening your skull. Branches of the trigeminal nerve There are three branches of trigeminal nerve originated from ganglion. 1-Ophthalmic 2-maxillary 3-mandibular Trigeminal neuralgia symptoms may include Any single division or mixed pattern of one or more of these division. Episodes of severe, shooting or jabbing pain that may feel like an electric shock Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth Bouts of pain lasting from a few seconds to several minutes Episodes of several attacks lasting days, weeks, months or longer — some people have periods when they experience no pain Constant aching, burning feeling that may occur before it evolves into the spasm-like pain of trigeminal neuralgia Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead Pain affecting one side of the face at a time, though may rarely affect both sides of the face Pain focused in one spot or spread in a wider pattern Attacks that become more frequent and intense over time When to see a doctor If you experience facial pain, particularly prolonged or recurring pain or pain unrelieved by over-the-counter pain relievers, most often patient get Treatment from dentist, who knowingly or unknowingly derooted many teeth.made edentulous jaw.sometime patient goes to ENT surgeon, because of ear pain problem.but none has no definite roles in Pain management. Any Neurophysician or Pain physician is right doctors to consult for further management.but Pain physician not only facilate medical treatment.but he performed minimal invasive procedures like - 1-glycerol rhizolysis 2-Radiofrequency thermocoagulation 3-Ballon decompression 4-Gama knife therapy Causes- In trigeminal neuralgia, also called tic douloureux, the trigeminal nerve's function is disrupted. Usually, the problem is contact between a normal blood vessel — in this case, an artery or a vein — and the trigeminal nerve at the base of your brain. This contact puts pressure on the nerve and causes it to malfunction. Trigeminal Neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve. Some patients may experience Trigeminal neuralgia due to a Brain lesion or other abnormalities. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia. Triggers factors- A variety of triggers may set off the pain of trigeminal Neuralgia, including: Shaving Touching your face Eating food Drinking Brushing your teeth Talking/speech Putting on makeup Encountering a breeze Smiling/chewing Washing your face
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    Treatment Options for a Herniated Disc The primary goal of treatment for each patient is to help relieve pain and other symptoms resulting from the herniated disc. To achieve this goal, each patient’s treatment plan should be individualised based on the source of the pain, the severity of pain and the specific symptoms that the patient exhibits. What Happens when a Disc Herniate? While the spinal discs are designed to withstand significant amounts of force, injury and other problems with the disc can occur. When the disc ages or is injured, the outer portion (annulus fibrosus) of a disc may be torn and the disc's inner material (nucleus pulposus) can herniate or extrude out of the disc. Each spinal disc is surrounded by highly sensitive nerves, and the inner portion of the disc that leaks out contains inflammatory proteins, so when this material comes in contact with a nerve it can cause pain that can travel down the length of the nerve. Even a small disc herniation that allows a small amount of the inner disc material to just touch the nerve can cause significant pain. In general, patients usually are advised to start with a course of conservative care (non-surgical) prior to considering spine surgery for a herniated disc. Whereas this is true in general, for some patients early surgical intervention is beneficial. For example, when a patient has progressive major weakness in the arms or legs due to nerve root pinching from a herniated disc, having surgery sooner can stop any neurological progression and create an optimal healing environment for the nerve to recover. In such cases, without surgical intervention, nerve loss can occur and the damage may be permanent. There are also a few relatively rare conditions that require immediate surgical intervention. For example, cauda equina syndrome, which is usually marked by progressive weakness in the legs and/or sudden bowel or bladder dysfunction, requires prompt medical care and surgery. Conservative Treatments options- For lumbar and cervical herniated discs, conservative (non-surgical) treatments can usually be applied for around four to six weeks to help reduce pain and discomfort. A process of trial and error is often necessary to find the right combination of treatments. Patients may try one treatment at a time or may find it helpful to use a combination of treatment options at once. For example, treatments focused on pain relief (such as medications) may help patients better tolerate other treatments (such as manipulation or physical therapy). In addition to helping with recovery, physical therapy is often used to educate patients on good body mechanics (such as proper lifting technique) which helps to prevent excessive wear and tear on the discs. If conservative treatments are successful in reducing pain and discomfort, the patient may choose to continue with them. For those patients who experience severe pain and a high loss of function and don’t find relief from conservative treatments, surgery may be considered as an option. The different conservative options for a lumbar herniated disc and a cervical herniated disc are described below. Lumbar herniated disc treatments Conservative approach to herniated disc treatment A combination of the following conservative treatment options can be used through at least the first six weeks of discomfort and pain: Physical therapy, exercise and gentle stretching to help relieve pressure on the nerve root Ice and heat therapy for pain relief Manipulation (such as chiropractic manipulation) Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or COX-2 inhibitors for pain relief Narcotic pain medications for pain relief Oral steroids to decrease inflammation for pain relief Epidural injections to decrease inflammation for pain relief
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    What is TN? Trigeminal neuralgia (TN) is considered to be one of the most painful afflictions known to medical practice. TN is a disorder of the fifth cranial (trigeminal) nerve. The typical or “classic” form of the disorder (called TN1) causes extreme, sporadic, sudden burning or shock-like facial pain in the areas of the face where the branches of the nerve are distributed – lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw. The pain episodes last from a few seconds to as long as two minutes. These attacks can occur in quick succession or in volleys lasting as long as two hours. The “atypical” form of the disorder (called TN2), is characterized by constant aching, burning, stabbing pain of somewhat lower intensity than TN1. Both forms of pain may occur in the same person, sometimes at the same time. Biology of TN The trigeminal nerve is one of 12 pairs of nerves that are attached to the brain. The nerve has three branches that conduct sensations from the upper, middle, and lower portions of the face, as well as the oral cavity, to the brain. (See Figure 1) More than one nerve branch can be affected by the disorder. Rarely, both sides of the face may be affected at different times in an individual, or even more rarely at the same time (called bilateral TN). Figure 1: Distribution of the 5th Cranial Nerve: Disorders of the Maxillary and Mandibular Branches Can Present as a Toothache Causing Patients to Seek Dental Treatment. fpa What Causes TN? TN is associated with a variety of conditions. It can be caused by a blood vessel pressing on the trigeminal nerve as it exits the brain stem, which prompts the wearing away or damage to the protective coating around the nerve (the myelin sheath). 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. People with TN avoid social contact and daily activities such as eating and talking because they fear an attack. Pain from TN is frequently very isolating and depressing for the individual. Depression and sleep disturbance may render individuals more vulnerable to pain and suffering. Thus, there are individual, family, and societal costs of TN. Diagnosis Issues TN diagnosis is based primarily on the person’s history and description of symptoms, along with results from physical and neurological examinations. Because of overlapping symptoms and the large number of conditions that can cause facial pain, obtaining a correct diagnosis is difficult, but finding the cause of the pain is important as the treatments for different types of pain may differ. Pharmacological treatment options include anticonvulsant medications used to block nerve firing and tricyclic antidepressants used to treat pain. Common analgesics and opioids are not usually helpful in treating the pain. The condition is 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. Patients opt to have surgery which may or may not be effective. Pain free periods after surgery vary. Sometimes surgery exacerbates the pain. Who is Affected? TN occurs most often in people over age 50, although it can occur at any age, including infancy. The incidence of newly diagnosed cases of TN in the United States population averages approximately 4.3 per 100, 000 individuals (per year) and the average for women is slightly higher than for men. If people have TN for an average of 8 years, then a rough estimate of prevalence in United States is 108, 000. The definition of a rare disease in the United States is one that affects fewer than 200, 000 at any one time. Thus, TN is a rare disease.
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    Minimally invasive spine surgery (MISS) uses advanced technology and innovative techniques to treat back pain and neck pain caused by a variety of spinal disorders .dr sanjay sharma interventional pain physician says, Some of the spinal conditions MISS can treat are: *degenerative disc disease *herniated discs *scoliosis *spinal stenosis Through computer-assisted technology and highly specialized tools, minimally invasive surgery is an attractive option for patients who want a quicker recovery after surgery, less post-operative pain, and smaller incisions.from few milimeter to centimeters but not a big incision, what it was practice in past years, or by conventional spine surgeons. Minimally invasive spine surgery minimizes soft tissue damage (eg, muscles). MISS may be a less risky, less invasive option compared to traditional open spine surgery. Although there are advantages of MISS, the goals of MISS procedures are the same as open traditional procedures. The 2 main goals of minimally invasive spine surgery are: 1-Decompression: This is used to take pressure off (to decompress) your spinal cord or nerve roots. That pressure can cause pinched nerves and pain. The goal of this procedure is to relieve the pressure and reduce your pain. 2-Stabilization: Sometimes a mobile segment can be the source of pain or abnormal movement can cause pain. When this happens, a stabilizing surgery may be needed. This is typically a fusion, often done with instrumentation. There are 3 main minimally invasive spine surgery techniques: 1-Mini-open: This is similar to an open procedure, but has fewer risks, such as less blood loss during surgery and less risk of infection because the incision is much smaller. Advances in visualization have made mini-open procedures possible. 2-Tubular: This surgery involves a tubular retractor, which acts as a tunnel that passes through your back muscles to access your spine. MISS with a tubular retractor is commonly referred to as a "muscle-splitting" approach. Compared to open spine surgery, there is less muscle damage and less blood loss when using a tubular retractor. 3-Endoscopic: This spine surgery uses a tiny video camera called an endoscope—which is smaller than a dime—to pass through small surgical incisions (usually less than 2 cm) to access your spine. According to the American Association of Neurological Surgeons, this procedure is commonly referred to as a "keyhole surgery" because an endoscope guides surgeons by showing them an internal view of your body on screens in the operating room. However, there are only a few spine surgeries that use endoscopes. These 3 types of MISS can be used in specific spine surgeries, such as [a]discectomy, [b]foraminotomy, [c]laminectomy [d] laminotomy. Sometimes a fluoroscope is used during minimally invasive spine surgery. Fluoroscopes are x-ray machines used to guide your surgeon during your procedure. They give your surgeon the best views of your spine. Keep in mind, though, that surgery should be a last resort for treating your pain caused by a spine condition. If you've tried non-surgical treatments, such as pain medications, rest, and physical therapy, in the last 6 to 12 months and they're not working for you, then you may want to consider spine surgery, and minimally invasive spine surgery may be an option for you.
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