Comprehensive Center for Pain Management

Back pain is very prevalent - affecting over 80% of all adults at some time during their lives. In fact, back pain is second only to headaches as the most frequent cause of pain. Back pain may come on suddenly or gradually. It may be short-term - lasting a few days to several weeks. Pain that persists longer than three months is chronic. Even though back pain is rarely life-threatening, it costs an estimated $40 billion dollars a year in medical bills, lost wages and insurance claims in the United States. Since we use our backs for nearly all of our activities, there is a high probability that we will injure or stress this area of our bodies and develop pain.

What makes up the spine?
The spine is a delicately balanced structure made up of two dozen vertebrae (bones) stacked on top of each other, cushioned individually by discs (filled with a jelly-like material), held together by a network of ligaments and strengthened by overlying muscles. The spinal cord runs along the vertebra in a long hollow canal. Nerves exit the spinal cord and branch out through spaces between the vertebra. This presents a challenge to both patient and doctor in determining which one of these structures is the source of the pain.

What are the potential causes of back pain?
Back pain can occur for no apparent reason at any point in your spine. The lower back bears the majority of your body's weight and is therefore at highest risk for damage. The most common cause of low back pain is using your back muscles to perform activities to which you are not accustomed. Poor muscle tone/physical condition and excess weight can cause and exacerbate back pain. Any imbalance, like poor posture can stretch muscles and joints causing injury. Daily activities like playing tennis, lifting heavy objects, or weeding your flower beds may strain the lower back. Emotional stress may also cause back pain to increase. Below are a list of common sources of back pain:

Osteoarthritis -- Associated with the aging process, this problem occurs with wear and tear of the spinal column protective tissues and joints. The discs which act as 'shock absorbers' start to thin out. With advancing age the spine loses its flexibility. Sciatica -- This term refers to pain radiating from the buttocks to the lower leg. It may be related to inflammation of one of the nerve roots that make up the large sciatic nerve. This pain may increase with bending or even with coughing or sneezing.

Osteoporosis -- As you age, the calcium in your bones decreases -- weakening the bony structure. This may cause the bones in the spine to collapse and result in compression fractures. This condition is most noticeable in women who have suffered a progressive loss in height.

Herniated Disc -- The fibrous capsule surrounding the disc develops a weakness causing the jelly-like material inside to protrude against a nerve root.

Spinal Stenosis -- Common among men and women 50-70 years old, this condition is characterized by a narrowing of the spinal canal. This means less room for the nerves to move freely.

How can a doctor determine the cause of the pain?
Even with today's sophisticated diagnostic equipment, the exact cause of low back problems can be found in very few people. In most cases, the symptoms are related to muscle spasm, tears in ligaments, joint problems, or disintegration of the shock absorbers in the back. Other causes are related to irritated nerves.

A physical exam and patient description of the pain may be all that is required. If further diagnostic tests are necessary, any combination of the following can help determine the cause of the pain: blood work, urinalysis, X-rays, CT scans (computerized tomography), MRI (magnetic resonance imaging), myelogram (injection of dye into the spine to study nerves) and bone scans (injection of minute radioactive tracers into a vein).

How to Manage the Pain?
The source of the pain will determine the treatment. The latest guidelines for treating most back problems include non-prescription pain relievers, rest and mild exercise. More than 80% of patients will have symptoms diminish within weeks. With strained ligaments or muscles, recovery may take longer.

For acute low back pain, short periods of bed rest for no more than two to three days, ice and anti-inflammatory medications are recommended during the first 48 hours. If the pain persists, your doctor may suggest physical therapy and oral drugs for six weeks. Persistent pain may require the injection of local anesthetics, anti- inflammatory medications and nerve blocks. Surgery is only recommended for a small percentage of patients.

Apply cold and heat. Immediately after injury, apply ice (wrapped in a cloth or towel) several times a day for up to twenty minute intervals.

After the acute pain subsides, within the first 24-48 hours, apply a heating pad (low setting) for up to 20 minute intervals.

Use over-the-counter medications such as Tylenol, non-steroidal anti-inflammatories like aspirin and ibuprofen to reduce inflammation of muscles and joints. However, if you are taking medications for other health problems, check with your doctor before taking any additional medications.

When should I see a doctor? Most people with back pain or discomfort may not need to see a health provider immediately. However, you should call your doctor right away if:

1. Your symptoms are severe, constant, or not alleviated with over-the-counter medications.
2. Your pain is the result of a direct injury such as a fall or hit to the lower back.
3. You feel weakness or numbness in your legs.
4. You have any changes in bladder or bowel habits.
5. The pain is preventing you from your regular activities.
6. The problem does not go away within a few days.

If you have any doubt about your condition, contact your doctor.

• Exercise regularly. Walking, cycling and swimming will help prevent back problems. Ask your doctor about specific exercises to improve your muscle strength.
• Lose weight if you are overweight.
• Maintain good posture while standing, sitting and sleeping.
• Wear flat or low heels.
• Make sure your work surfaces are a comfortable height.
• Avoid lifting heavy objects. When you do lift something, do not bend over, twist, or reach.
• Keep your back straight and keep objects close to your body. Push rather than pull, if possible.
• If you must sit at your desk or in the car for long periods, take breaks to stretch.
• Plan ahead and reorganize your work or leisure activities to eliminate high risk movements.

What is shingles?
Shingles (herpes zoster) usually begins as an inflammation of nerve roots where they exit the central nervous system at your spinal cord.?Some people mistake the initial pain caused by shingles as back pain. The painful inflammation moves outward from the spinal cord along the sensory nerves and usually results in painful blisters and a rash on the skin over the affected nerve fibers. This can occur anywhere on the body but is most commonly found on the chest.

What causes it?
The same virus that causes chicken pox causes shingles. Following an occurrence of chickenpox, the virus lies dormant in certain nerve cells near your spinal cord throughout your life, or can reactivate years, even decades later, resulting in shingles. Approximately 20% of the population, mostly over the age of 50 is affected at sometime during their lives.

A shingles infection usually occurs when your immune system becomes weak. This may be due to advancing age, cortisone-type drugs, cancer or cancer treatment such as chemotherapy or radiation therapy. Patients who have had organ transplants and are taking anti-rejection drugs, and people with diseases that affect the immune system such as AIDS, are also more susceptible. Also, trauma or stress may also trigger an attack.

What are the symptoms?
Burning pain and extreme sensitivity in one area of the skin (typically on one side of the body) for one to three days are the fist symptoms of shingles.

Then a rash develops and turns into groups of painful blisters that resemble chickenpox. The blisters typically last for two to three weeks before crusting over then disappearing. The pain may last for months or even years.

Can shingles be treated?
Pain relievers and cool compresses to dry the blisters are helpful. New, antiviral drugs are prescribed to shorten the time period of the discomfort and to decrease the pain.

Is there pain after shingles?
Post-herpetic neuralgia (PHN) is a condition in which either constant pain or periods of pain can continue after the skin has healed. It can last for a long time--occasionally for years. PHN may cause a variety of types of pain including skin hypersensitivity to touch and temperature.

Treatment for PHN includes the use of anti-inflammatory drugs and oral pain relievers. For severe cases, a combination of an anesthetic and an anti-inflammatory steroid may be injected near the nerve roots as a nerve block. An ointment containing capsaicin is also helpful for some people. The ointment is applied to painful areas of the skin three to four times a day.

Ask your doctor for a referral to the Pain Management Services of Boca Raton Regional Hospital for help in managing your pain from shingles or any other condition. Pain Management Services utilizes a variety of approaches including highly effective oral medicines, and the latest high-tech therapies including intraspinal infusion pumps and nerve blocks.

Pain Management Services Boca Raton Regional Hospital, Sandler Medical Plaza
650 Glades Road, Boca Raton, FL 33431
561.955.PAIN (7246)

Carmen L. Dominguez M.D. is Medical Director of the Pain Management Service of Boca Raton Regional Hospital.

Falls and balance dysfunction are two of the greatest problems that can impact aging individuals. One fall is one fall too many. Gloria Drummond Physical Rehabilitation Institute offers a thorough balance intervention program specific to each client's needs. People may develop balance problems rather suddenly. Difficulties can develop after a long hospital stay or when patients have developed muscular weakness from another cause of lengthy immobility. They may find that their balance has been progressively deteriorating over sometime and it is finally threatening their safety and independent mobility.

Balance problems may be the result of tight muscles, muscle weakness, postural problems that offset a person's center of gravity, delayed balance reflexes and reactions, subjective fear of falling, to name a few contributing factors.

One of the most common questions that we hear from clients is “Can I get any better, or how much improvement can be expected?” There is hope! Prognosis is dependent on many factors, including the number of systems involved in the problem and patient compliance with their home program.

Your therapist will explain his or her findings and expectations at the evaluation. The good news is that “yes,” most clients do show significant functional improvement. One of the greatest goals that we can help person achieve is to reduce his or her fear of falling and increase confidence with balance to minimize the risk for falls.

For information on how to schedule an appointment, please click on the following link: appointment information.

Gloria Drummond Physical Rehabilitation Institute offers a program of therapy services for individuals with vestibular and balance dysfunction. Common diagnoses related to balance and vestibular problems that we see include:

• PPV (benign paroxysmal positional vertigo)
• Vestibular dysfunction
• Vertigo
• Gait Dysfunction
• Imbalance and fear of falling
• Balance problems secondary to muscle weakness and hospitalization
• Balance problems secondary to peripheral neuropathy
• Balance problems secondary to functional decline

Each client is thoroughly evaluated to determine the root cause of the problem. Physical problems are identified and goals are established to help each client achieve his or her maximum functional improvement and safe independence. Each client's program of treatment is unique to his or her needs. Therapy intervention may range from three treatment sessions up to two months, depending on nature of the injury, compliance with home program, and individual progression. People with acute vestibular dysfunction can often expect improvement in as little as three treatment sessions. People with balance related problems usually require four weeks of therapeutic intervention to see significant results.

The following are useful links and resources:
http://www.dizziness-and-balance.com/treatment/rehab.html
http://www.dizzy.com

Massage is considered to be one of the oldest forms of health care in the world. Egyptian tomb paintings depict people receiving massage, ancient Chinese and Indian texts refer to it as treatment for disease and injury, and Greek and Roman physicians relied on it as one of their primary therapies.

Massage is a noninvasive form of integrative therapy used to complement traditional medical care. Scientific research has indicated that massage therapy is helpful in reducing pain and relieving stress. It is aimed at achieving or increasing the health and well-being of an individual by affecting the musculoskeletal, circulatory, lymphatic, and nervous system as well as the mental and emotional state.

• Pain or tingling in arms or legs: Muscles can become so contracted that they press on the nerves to the arms, hands and legs causing pain or tingling. If this occurs, a massage can help to alleviate muscle spasms in the shoulder or hip.
• Injuries: Massage can help heal injuries such as tendonitis that develop over time, as well as ligament sprains or muscle strains caused by an accident. Massage benefits the skeletal system by increasing joint mobility, range of motion and flexibility. It can also help to restore tone to flaccid muscles and partially compensate for the lack of exercise and inactivity.
• Scaring: Certain massage techniques can limit scar formation in new injuries and can reduce, or make more pliable, scar tissue around old injuries.
• Secondary pain: Headaches can be a result from eye strain, a low backache can be due to pregnancy, or the protective tensing of healthy muscles around an injury.

Effects On Skeletal System​

• Prevention of new injuries: By relieving chronic tension, massage can help prevent injuries that might be caused by stressing unbalanced muscle groups, or by favoring or forcing a painful, restricted area.
• Pain or restriction in joints: Massage works directly on the joints to improve circulation, stimulate production of natural lubrication, and relieve pain from conditions such as osteoarthritis.
• Posture: Releasing the restrictions in the muscles, joints, and surrounding fascia, the body is able to return to its natural posture. Massage can also relieve the contracted muscles and pain caused by abnormal spinal curvatures such as scoliosis.

Effects On The Relaxation Response

A soothing massage can help to reduce anxiety, muscle tension, stress, and improve the quality of sleep and mood state.

Effects On Immune System

The immune system may be affected by massage due to the increased flow of the lymphatic system which is influences the immune function. Chronic stress can influence susceptibility to infections, slow wound healing, and exacerbation of certain autoimmune diseases.

Effects On Nervous System

Massage stimulates the parasympathetic nervous system, which helps to reduce pain and muscles to relax. Stress can influence certain conditions aggravated by anxiety such as asthma or insomnia.

Massage Will Help With:​

• Arthritis
• Back Pain
• Chronic Fatigue Syndrome
• Circulatory Problems
• Effects of Chemotherapy
• Fibromyalgia
• Headaches
• Hypertension
• Myofascial Pain
• Post Surgical Recovery
• Shoulder Pain
• Stress
• Tendonitis

The Gloria Drummond Physical Rehabilitation Institute provide patients a healing environment using massage therapy to compliment traditional medical care. The Center’s teams of caring professionals work hand-in-hand, to assist their patients to feel their best and live life to the fullest.

Massage stimulates the sensory receptors in the skin thereby increasing superficial circulation. It also affects the connective tissues (the fascia) by separating the tissues and increasing pliability. The relaxation of the muscles reduces the sensitivity of the myofascial trigger points thereby releasing metabolic wastes into the venous and lymph channels and increases circulation.

Massage can aid in the recovery of acute inflammation caused by muscle trauma by increasing circulation and oxygenation of the injured tissues.