This disorder is a type of headache with discomfort noted at the back of the head, beginning at the base of the skull and radiating upward toward the top of the head. The symptoms can occur on either side of the head, or it can include both sides. The symptoms can be sharp, spasm-like pains that occur at different intervals. It is caused from irritation of the occipital nerves, which begin at the back of the head and extend to the top of the head. Occipital neuralgia is caused by inflammation or injury to these nerves. It can also be caused by excessive muscle tension in the muscles at the back of the head through which these nerves pass.

Diagnosis

A physical examination will usually show signs of increased tenderness in the tissues at the base of the skull and at the top of the spine. Doctors can use X-rays to determine whether there is any narrowing of the vertebra at the top of the spine, where the occipital nerves pass to the back of the head. The best test to confirm occipital neuralgia is an injection of anesthetic, called a nerve block, given at the base of the skull around the occipital nerve itself. If blocking the occipital nerve results in resolution of the symptoms, the diagnosis of occipital neuralgia is usually confirmed.

Treatment

One of the greatest concerns to doctors treating this problem is to make sure that these symptoms do not indicate an increase in intracranial pressure within the skull, which could signal a vascular, infectious or other significant problem. Some patients will find temporary relief from the pain with the use of non-steroidal anti-inflammatory drugs and muscle relaxants. Physical therapy exercises will also provide some limited effectiveness. Doctors believe the best approach for long-term relief is the use of nerve block treatments. In some cases, an injection of local anesthetic combined with medication to reduce inflammation can result in long-term relief following a series of treatments. At times, the pain at the base of the skull is related to other disorders or arthritis in the joints of the upper portion of the spine. Doctors may use nerve block injections around these structures to help in the treatment of occipital neuralgia. Surgery can sometimes provide relief for several months, but most patients find the pain may return. Surgery is usually reserved as a last option. Some patients will find additional help through a combination of muscle relaxation techniques, known as biofeedback, in conjunction with physical therapy that focuses on manual therapy to the muscles at the back of the neck and head.    Newer block treatments at the occipital nerves can also be utilized for long-term treatment at appropriate intervals.

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While surgery and surgical procedures have become specialized and involve as little tissue damage as possible, they nonetheless involve the cutting, removing and suturing of skin, muscles, nerves and other structures. Therefore some surgical procedures can cause chronic pain due to the trauma of the procedure. Post thoracotomy pain is an example of pain associated with the surgical procedure. Doctors define post thoracotomy pain as pain that returns or persists around the surgical incision for at least two months after the surgery. The pain is generally located along the chest wall. Patients who have post thoracotomy pain describe it as achy-like, burning or sharp. Pain can result from entrapped nerve fibers in the area of the scar tissue.

Sometimes a neuroma or painful lump of nerve tissue can form at the tip of a nerve in the chest wall where it has been cut during surgery. Pain from the muscles in the chest or shoulder may contribute to post thoracotomy pain syndrome as well. If the thoracotomy was performed to remove a tumor involving the lining of the chest or the chest wall, continued pain may indicate tumor recurrence.

Diagnosis

Doctors will use a physical examination to confirm a painful area near the surgical scar and to map the area of irritation. A CT scan of the chest sometimes helps determine if a tumor has reoccurred. Doctors may use a kind of nerve block or injection of anesthetic medications around a neuroma or nerve in the chest wall to help confirm the diagnosis.

Treatment

Some patients benefit from oral non-steroidal anti-inflammatory medications with the addition of pain medicine. Long-term relief is often obtained from the use of nerve blocks given into a neuroma, local anesthetics and anti-inflammatory medications. Other nerve block treatments can be given along the path of the various nerves in the chest, which contribute to the pain after thoracotomy surgery. Sometimes nerve stimulation procedures are used to help relieve pain along the chest wall. Physical therapy exercises may be utilized to regain the ability to perform normal daily activities.

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Shingles is an infection of an individual nerve root by the same virus that causes chicken pox, also known as the herpes zoster virus. The disease can be painful and can develop almost anywhere in the body, but is most commonly displayed on the face, chest and abdomen.

A day or two after the pain begins; a characteristic rash erupts, which is composed of small fluid-filled blisters on top of reddened skin. The blisters are limited to a band on the right or left side of the body. If the rash crosses over the middle of the body it is not shingles because the virus affects one nerve corresponding to an area of the skin. Each cutaneous or skin nerve in the human body stays on the right or left side and does not cross over. Initial infection of the shingles virus occurs when chicken pox is contracted as children or young adults. The body’s immune system forces the virus to settle in an inactive form inside the nerve cells. When the chicken pox virus reactivates, it moves down the nerve fibers to the skin and the rash erupts. In addition to the skin, the nervous system is involved. In fact, if the virus attacks the optic nerve of the eye, it may leave the patient with temporary blindness.

In most patients, after the eruption of shingles, the rash will heal and the pain will subside after a period of three to five weeks. However, there are exceptions. In older patients there is a greater risk the virus can actually leave permanent nerve damage, causing pain long after the rash is healed. In some patients, the pain may persist for the rest of their lives.

Treatment

Medical science is now developing antiviral drugs. These are similar to antibiotics that were developed in the 1950’s to treat bacterial infections. One of the first antiviral drugs developed was acyclovir. This drug can help resolve herpes infections. As soon as the rash breaks out, acyclovir is prescribed in large doses for a period of approximately 10 days. This can help alleviate the attack and prevent permanent nerve damage in some patients.

Additionally, early intervention with nerve blocks done by pain physicians can also prevent the development of post-herpetic neuralgia. Post-herpetic neuralgia is the name given to the painful condition that exists long after the viral infection is over. Combination therapy of the acyclovir and nerve blocks is the most effective treatment strategy for preventing this painful development.

There is treatment for patients suffering from post-herpetic neuralgia. Drugs used to treat seizures, such as Tegretol and Dilantin, can be of some help. Antidepressants are used to treat post-herpetic neuralgia as well. The antidepressants raise levels of chemicals in our brain that are the body’s natural mood elevators. These mood elevators also raise levels of endorphins in the brain, which are the body’s natural narcotics. Consequently, by taking antidepressants, we can elevate the body’s internal narcotics without having to rely on narcotics prescribed by the doctor.  Therefore, antidepressants are superior to narcotics because dependence can develop in narcotics.

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If you suffer from low back pain you are not alone. It is estimated, at any given time approximately 15% of all Americans have recurrent low back pain. By definition acute low back pain is severe, sudden in onset and short term. Chronic low back pain lasts longer than six months. Low back pain can be disabling, by not allowing sufferers to sleep, enjoy recreational activities, to take care of the household or go to work.

Diagnosis

About 90% of all low back pain is because of poor body mechanics. This may contribute to or be a result of arthritis, muscle tears or ligament strains. However, 10% of the time low back pain may indicate a serious underlying medical problem such as an infection or severe inflammatory arthritis. The most important factor in determining the diagnosis is the history and physical. Low back pain coming from a problem with the lumbar spine tends to be sudden in onset, worse during the day when we are weight bearing and relieved when we lay down. The serious medical causes of low back pain tend to be more gradual in onset, develop slowly and are usually worse during the night.

Ninety percent of the time back pain will go away on its own with education, mild pain relievers and a little bit of rest. When back pain is severe and chronic, the diagnostic tests are not always revealing. We are not always sure why the back is hurting despite the use of today’s best technology.

There are four structures in the back that cause pain: nerves, muscles, ligaments and joints. The Pain Management Center uses diagnostic injections to determine the cause of pain. When the physician does an injection, the following may occur: 1.) The patient may get good long-term relief, in which case the problem is identified and solved. 2.) The patient may get short-term relief, in which case a diagnosis is made. 3.) The patient may receive no relief, in which case the next structure is injected. Up to four injections are made into the different structures until a diagnosis can be determined.

Treatment

Is determined by the duration of the back pain and the diagnosis.

• Acute: In the event of acute onset of low back pain, the best therapy is rest for 48 hours
• Onset: along with anti-inflammatory medicine such as Motrin. It is important to note lying or sleeping position and to take pressure off the stained back muscles. Lumbar pillows are beneficial and help keep the back in neutral alignment, thereby relieving pressure. After the 48-hour period, gradually resume normal activities. Some  residual discomfort may persist, but should  subside. Oral medications should only be used for short periods as they can lead to high blood pressure, kidney or liver problems and ulcers in the stomach or small intestine. Usually within four weeks 90% of patients with low back pain will improve to the point where they have minimal or no discomfort. Proper posture and strength training can help reduce further incidence.
• Persistent Discomfort: If you have persistent discomfort, see your doctor. He/She may initiate an examination or diagnostic tests to rule out a medical cause for low back pain.
• Chronic: The pain doctor may inject one of the four structures to determine a diagnosis. Physical therapy may be used concurrently or as a follow-up to help reduce or prevent further pain. Physical therapy focuses on body alignment, mechanics and awareness, as well as flexibility and exercise.

Oral medications should only be used for short periods as they can lead to high blood pressure, kidney or liver problems and ulcers in the stomach or small intestine.

It is important to note lying or sleeping position in order to take pressure off the strained back muscles. Lumbar pillows are beneficial and help keep the back in neutral alignment, thereby relieving pressure.

Prevention

• Note sleep posture
• Consider a lumbar support pillow
• Maintain an ideal body weight
• Maintain proper posture for all daily activities (e.g.) walking, sitting or driving
• Do proper strength training
• Do proper flexibility training
• Avoid smoking
• Reduce stress

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