Acute & Chronic Conditions

Spinal stenosis is a condition where the spine in the lower back or neck is compressed, putting pressure on the spinal cord or nerves around the squeezed areas. When this occurs, patients present with severe pain in the legs, calves, or lower back. Pain may be more intense as the patient walks up steps or a hill. In many cases, pain is relieved by leaning over.

Spinal stenosis is a degenerative condition that often develops as your body ages.

You are at higher risk of developing spinal stenosis if:

• You were born with a narrowed spinal canal.
• You are a woman.
• You are over 50 years old.
• You suffered a previous spinal injury.
• You have other medical conditions that cause spinal stenosis such as osteoarthritis, rheumatoid arthritis, spinal tumors, inflammatory spondylarthritis, or Paget’s disease.

Your doctor will perform a physical exam, take a medical history, and order diagnostic testing, such as an X-ray, MRI, CT scan, electromyogram, or bone scan to diagnose spinal stenosis.

While spinal stenosis cannot be cured, there are a variety of treatments that can relieve your pain.

Your NGPG Pain Medicine provider can help you relieve pain associated with spinal stenosis with the following treatments:

• Medications. Over the counter and prescription, anti-inflammatory medications can reduce swelling and eliminate pain.
• Cortisone injections. A cortisone injection directly into the spine can reduce inflammation and pain. Do not have more than three injections in one year.

A disk herniation, or herniated disk, is a condition where one of the disks in the vertebrae that make up your spine move or slip out of place. When this occurs, the disk can irritate a nearby nerve resulting in pain, numbness, or weakness in an arm or leg.

You are at higher risk of developing a herniated disk if you:

• Carry excess body weight in your lower back.
• Have a physically demanding occupation.
• Have a family history of herniated disks.
• Are a smoker.

Your NGPG pain medicine doctor will work in conjunction with your other providers to develop a treatment plan to reduce your symptoms. Common treatments for a disk herniation include:

• Over-the-counter medications. Mild to moderate pain can be treated with over-the-counter medicines such as Tylenol and Advil.
• Cortisone injection directly into the spine.
• Muscle relaxers. You may need a muscle releasor if you have back spasms associated with a herniated disk.
• Prescription pain medications. Prescription pain medications may be prescribed for a short-term basis to relieve severe pain associated with a herniated disk. Follow your doctor’s instructions closely when taking any pain medication, such as an opioid.

Lumbar radiculopathy, also commonly known as sciatica, is a condition that may develop when the spinal nerve root is compressed. When this occurs, you may experience pain, tingling, numbness, weakness, and loss of your reflexes in your lower back and leg or foot.

Conditions such as lumbar disc herniation, spinal stenosis, osteophyte formation, spondylolisthesis, foraminal stenosis, or other degenerative disorders may cause the spinal nerve roots to become compressed.

NGPG Pain Medicine providers will work with your entire care team and other providers, such as your orthopedist and orthopedic surgeon, to develop a custom treatment plan for you.

Treatments for lumbar radiculopathy may include:

• Medications. Nonsteroidal anti-inflammatory medications help relieve pain and reduce swelling.
• Epidural steroid injections. An epidural steroid injection can relieve acute pain and swelling.
• Nerve root injections. A nerve root injection can reduce swelling and severe pain that may radiate down to the legs and feet.

Facet arthropathy is a degenerative condition where your body’s facet joints wear down over time. The facet joints are located between the vertebrae in each segment in the spinal column. Facet joints are responsible for help the vertebrae stay properly aligned by limiting the motion in the spine.

The primary cause of facet arthropathy is spinal degeneration as a person ages.

Facet arthropathy can also be caused by fractures, previous back injuries, torn ligaments, disc problems, or wear and tear in the spine that reduces the space in the vertebrae and cause the facet joints to rub together.

The most common symptom of facet arthropathy is pain that is generally worse in the afternoon and evening.

Your NGPG Pain Management doctors will work in conjunction with your other providers to develop a customized treatment plan for you.

Treatments for facet arthropathy include:

• Medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, corticosteroids, and Tylenol.
• Anesthetic or steroid injections directly into the facet joint or surrounding nerves.
• Sinu-vertebral nerve ablation which ablates nerves with an electrical current.
• Physical therapy

While surgery is rarely required to treat facet arthropathy, in some cases, it may be necessary. Our NGPG pain management doctors can work with your orthopedic surgeon to develop a plan to alleviate your pain before and after surgery.

Arthritis in the spine, also known as spinal arthritis, or arthritis in the back or neck, is inflammation that occurs in the spine, causing stiffness and lower back pain.

Spinal arthritis can be caused by the general wear and tear on the spine as a person ages, infection, or other conditions. While there are many different types of arthritis in the spine, osteoarthritis of the spine is the most common form. Osteoarthritis in the spine develops as the cartilage between the joints slowly breaks down, leading to inflammation and pain. People with osteoarthritis in the spine feel it most when they bend or twist their back.

• Back or neck pain that is often worse in the morning.
• Warmth or swelling in one or more joints that is more pronounced when the weather changes
• Tenderness in the affected area of the spine.
• Limited flexibility in the affected joint.
• Pinching, tingling, or numbness in a nerve in the spinal cord.

Your NGPG Pain Medicine specialist will work with your other providers, such as your primary care doctor and orthopedist, to develop a comprehensive pain management plan. Treatments will vary depending on your level of pain, the severity of your arthritis, and your personal goals.

Nonsurgical treatments include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. These pain medicine treatments help reduce pain and swelling.
• Medications to target triggers of your spinal arthritis
• Physical therapy (PT). PT can help improve your range of motion and back strength.
• Lifestyle changes. Losing weight, stopping smoking, or correcting your posture can help reduce the stress on your back.

Your care team will often recommend a multi-treatment approach, such as NSAIDs, in combination with PT and lifestyle changes.

If nonsurgical treatments are not effective, you may need surgery to treat spinal arthritis. Your NGPG Pain Medicine specialist will work with your orthopedic surgeon to manage your pain before and after surgery.

Cervical radiculopathy is a pinched nerve in the neck. It is a painful condition where a nerve root in the neck becomes damaged or inflamed, affecting a person’s neurological function. When you experience a pinched nerve in the neck, you may experience pain, numbness, tingling, or weakness that radiates into the shoulder and down into the arms and hand.

Cervical radiculopathy often develops as we age, and the spine wears down, potential because of arthritis. In younger people, a pinched nerve can develop as a result of a sudden injury that causes a herniated disk.

Factors that make a person more likely to develop cervical radiculopathy include advancing age, activities such as weightlifting or wrestling that place stress on the cervical spine, and repetitive neck motions such as using vibrating equipment.

Most patients who develop cervical radiculopathy can be treated with nonsurgical treatments.

NGPG Pain Management doctors will work with your other specialists to develop a treatment plan customized to your case. Treatments may include:

• Medications. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can provide pain relief, while oral corticosteroids can reduce swelling around the nerve, thus relieving pain.
• Steroid injection. Your NGPG pain management doctor may inject a steroid directly into the affected nerve to help reduce inflammation and swelling to allow the affected nerve to recover

You may also need to wear a soft cervical collar to limit the neck motion and rest the neck. Physical therapy to help strengthen the neck muscles and improve the range of motion may also be recommended.

The sacroiliac joints are located in the lower back, where the sacrum and ilium bones meet. The SI joints act as a shock absorber to reduce pressure on the lower spine and distribute the weight of your body across the pelvis.

Sacroiliac joint dysfunction is characterized by pain in the lower back, buttocks, hips, and pelvis. Other symptoms of SI joint disorders include increased pain when standing up from sitting for a prolonged period, stiffness in the pelvis, numbness, weakness, and pain that radiates down the thighs and upper legs, or a sensation that your legs may not support your body.

SI pain can be caused by several conditions, including:

• Osteoarthritis
• Ankylosing spondylitis
• Gout
• Injury
• Pregnancy

Sacroiliac joint pain is responsible for approximately 15 to 30 percent of chronic lower back pain cases.

NGPG Pain Management doctors may recommend a combination of a variety of therapies to help relieve pain associated with sacroiliac joint dysfunction.

Therapies used to treat SI joint dysfunction may include:

• Low-impact exercises, such as swimming and yoga.
• Wearing a sacroiliac belt to support the SI joint.
• Medication such as anti-inflammatory medications.
• Muscle relaxants
• Oral steroids
• Corticosteroid injections directly into the joint.
• RFA (radiofrequency ablation) can deactivate the nerves that cause pain.