Pain is an extraordinarily complex phenomenon that can arise from many different mechanisms, whether mechanical, neurogenic, discogenic, arthritic, musculoskeletal, inflammatory, or other cellular and immune-related signaling pathways. Because of this, it is entirely possible that the level of pain does not match any visible pathologies, and therefore care must be taken to identify each patient's specific pain generators. Pain can result from a wide variety of mechanisms, including neurological pathologies, macroscale biomechanical problems, and cellular-level biochemical signaling cascades or aberrant inflammatory pathways. Thus despite its high prevalence and devastating consequences, pain is an often misunderstood problem with a wide variety of causes, mechanisms, and manifestations. Because pain can involve many different pathologies and deleterious signaling pathways in different people, there is not one treatment that will always work for all people, there may be multiple interacting pain-generating problems, and the potential risks and benefits of each treatment must be taken into consideration, and thus pain cannot simply be approached from a one-dimensional perspective.
- Back spasms and spinal ligament strains
- Degenerative disc disease and discogenic pain
- Herniated or ruptured discs
- Spinal stenosis and neuroforaminal stenosis
- Spinal medial branch neuropathies and facet joint disease
- Spinal fractures, instability, and deformation
- Spondylolysis and spondylolisthesis
- Radiculopathy, neuropathy, nerve injury, and nerve root irritation
- Neuropathies, nerve entrapments, nerve compression, and nerve pain
- Cancer pain, nausea, and other complications
- Temporomandibular joint (TMJ) disorder (1)
- Tinnitus (e.g., auriculotemporal nerve block) (2)
- Concussion, migraines, traumatic brain injury, and post-concussion syndromes
- Complex regional pain syndrome (CRPS) types I & II, also known as reflex sympathetic dystrophy (RSD) or causalgia (discussed below).
- Autonomically-mediated pain, autonomic ganglionopathy, & ganglion pain syndromes
- Stellate Ganglion, sphenopalatine ganglion, & trigeminal gasserian ganglion neuralgias
- Concussion, anxiety, & post-traumatic stress disorder (PTSD)
- Differential diagnosis of dozens of other potential pathologies in many tissues and organs.
- Trigger point injections
- Targeted nerve releases and blocks
- PRF or plasma injections
- Steroid injections
- Prescription medications
- Peptides & biologic agents (e.g., regenerative peptides, anti-TNF agents, etc.)
- Image-guided minimally-invasive surgical interventions
- Mesenchymal stem cell injections
- Minimally-invasive image-guided injections and release of nerve impingements and entrapments
- Spinal interlaminar and transforaminal epidural corticosteroid injections
- Facet injections and zygapophyseal medial branch blocks and nerve ablations
- Interventional pain management and image-guided minimally-invasive procedures for spine and joints
- Regional nerve blocks or radiofrequency (RF) ablations or neurolysis (e.g., facet medial branches, occipital, erector spinae, paravertebral, costovertebral, as well as regional pain blocks of tissues and joints like shoulder, elbow, hand, knee, hip, ankle, etc.)
- Stellate ganglion blocks and sympathetic nerve plexus blocks
- Sphenopalatine ganglion blocks and pterygopalatine ganglion blocks
- Injections or infusions of anesthetics, sedation, ketamine, anti-inflammatory medications, methylene blue, or other pain medications
- IV infusions of vitamins, minerals, nutrients, and other healing remyelination agents
- Myofascial release and adjustments
- Shockwave therapy
- Physical therapy
Common conditions include:
Therapies may include:
Complex Regional Pain Syndrome (CRPS) in particular is a complex pathology, with substantial evidence indicating involvement of multiple tissues and systems, including interactions between the nervous system and immune system, often overlapping with neuropathies, and requiring a detailed multipronged approach to treatment (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13).
More information on these therapies can be found on pages discussing the specific diseases and conditions to which they apply, such as spine disorders, neuropathy, osteoarthritis, orthopedics, and tendinopathy pages. It is also worth reading about Natural Anti-Inflammatory Agents, Myelin Repair Nutrition, and Neuropathic Treatments on the nutrition, neuropathy, and IV infusion pages.
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*Disclaimer: The information presented here is for informational use and cites the ongoing cutting-edge research and medical advancements on these relevant topics. There are many treatments, interventions, and protocols routinely practiced in medicine and surgery which the FDA has not studied nor formally approved yet which have demonstrated overwhelming evidence of efficacy and clinical benefit. The FDA does not regulate the practice of medicine but rather regulates medical marketing of devices and drugs. The FDA does not conduct clinical trials or attempt to discover new treatments, but rather requires companies or other entities to fund marketing approvals. Breakthrough technologies typically require years to decades of research work to optimize the technology and collect enough data to prove efficacy and superiority, which in some cases can optionally be submitted to the FDA if there is sufficient financial backing to market a specific product or drug. Thus the FDA has not yet studied, evaluated, or formally approved many regenerative therapies currently practiced by many of the top physicians and surgeons in the United States and around the world. Some therapies, products, or interventions may still be considered investigational or "off-label" even with substantial evidence of efficacy, and many different applications of regenerative therapies continue to be researched by our institute and other top institutions around the world. We seek to always provide the highest-quality evidence-based care to our patients, which may include FDA-approved therapies as well as additional investigational or alternative therapies. We always discuss potential risks and benefits of all these options. The rapid evolution and advancement of medicine demands that physicians continually update their knowledge and practice techniques to adapt to future improvements and advancing technologies. These statements have not been evaluated by the FDA, and the treatments and products presented here are for informational purposes and not intended or guaranteed to diagnose, treat, cure, or prevent any specific disease or condition. All injuries and conditions should be formally evaluated by a knowledgeable medical professional whereby standard treatments and/or additional therapeutic interventions may be considered with the diagnosis and treatment plan.