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Issue 6 Winter 2019

In this issue we discuss the various types of nerve pain and forms of treatment.

Neuropathic Pain States (Nerve Pain)

Dr. Provenzano recently served as the Scientific What is Neuropathic Pain? Program Chair at the North Neuropathic pain, also known as nerve change in the nerve at both the site of American Neuromodulation nd pain, is a complex pain state that is injury and surrounding area. Nerve pain Society (NANS) 22 Annual typically accompanied by a tissue has significant effects on quality of life. Meeting in Las Vegas, injury. With nerve pain, the nerve fibers Common causes of neuropathic pain Nevada. themselves may be irritated or injured. include neuropathy, shingles, peripheral These injuries in the nerves send signals nerve entrapment, amputation, direct Pictured above is Dr. to the spinal cord and brain. The impact trauma to a nerve, and spine Provenzano with Sam of the injured nerve fiber includes a pathologies. Quinones, the author of the book Dreamland: The True Peripheral Neuropathy Tale of America’s Opioid Epidemic which won a Peripheral neuropathy typically affects sensation. Although there is no cure for National Book Critics Circle the hands and feet of individuals with neuropathy, many individuals are able Award for the Best diabetes. However, neuropathy can also to manage their symptoms with Nonfiction Book of 2015 manifest in individuals with a history of neuropathic pain medications. If alcohol abuse or chemotherapy. In some medications are not effective in patients a cause cannot be identified. managing the symptoms associated with Like Us on Facebook Most individuals with peripheral peripheral neuropathy, individuals may For more information and neuropathy describe their symptoms as consider spinal cord stimulation as a news on what’s happening in tingling, burning, numbness or loss of method to reduce the discomfort. the practice, like us on Facebook at Pain Diagnostics Post Herpetic Neuralgia (Shingles) and Interventional Care Post herpetic neuralgia, a complication sixty. Shingles can cause severe pain in of shingles, occurs as a result of the the distribution of a nerve root and is herpes zoster virus. The virus causes often accompanied by an itchy rash. injury to nerve fibers in the nervous system and typically manifests along the The pain associated with the virus is course of a nerve root. Anyone who has typically treated with tricyclic had chickenpox in the past can develop antidepressants, anticonvulsants such as shingles; however, the virus generally gabapentin, or topical anesthetics such affects older individuals over the age of as lidocaine cream or patches.

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Upcoming Lectures Peripheral Nerve Entrapment Peripheral nerve entrapment occurs diagnose peripheral nerve entrapments. March 2019: when nerves become compressed. The Depending on the affected nerve, various most common symptoms include pain, treatments can be considered including tingling, numbness, and muscle physical therapy, minimally invasive 21st Cleveland Clinic Annual weakness. Typically, the symptoms interventions, surgical management, and Pain Management affect just one part of the body based lifestyle modifications. In addition, Symposium, San Diego, on the affected nerve. Typical forms neuropathic pain medications can assist California. of peripheral nerve entrapment occur in managing symptoms. with carpal tunnel syndrome (median If pain persists after an extended http://www.clevelandclinicmeded. nerve) and meralgia paresthetica recovery period following appropriate com/live/courses/pain/ (lateral femoral cutaneous nerve) as a treatment, neuromodulation techniques result of repetitive use, compression, including spinal cord stimulation and or acute injury. Advances in Pain peripheral nerve stimulation can be Management 2019, University Nerve conduction studies and employed to modulate the pain. of Rochester Medical Center, electromyography are used to Rochester, New York Amputation and Phantom Pain http://www.cvent.com/events/adv ances-in-pain-management- Nerves can become injured following Typically, if conservative treatment is 2019/event-summary- an amputation of a limb. In individuals unsuccessful, neuromodulation who have had amputated limbs, techniques can be employed including April 2019: phantom limb pain may be a spinal cord stimulation or dorsal root detrimental burden to their quality of ganglion stimulation to modulate the 44th ASRA Annual Regional life. Although there is no specific pain. A trial is first conducted prior to Anesthesiology and Acute treatment for phantom pain, physical considering permanent implantation of Medicine Meeting, Las Vegas, and occupational therapy, cognitive the device. behavioral therapy, mirror therapy, Nevada and medication management are http://www.asra.com/page/1401/a considered. nnual-regional-anesthesiology-and- acute-painn-medicine-meeting Spine pathology

ASRA Pain and Nerves in the spinal canal may also provide physicians with a detailed Musculoskeletal become compressed and injured picture of the spine and surrounding Interventional Ultrasound based on multiple mechanisms nerves and tissues. including spinal stenosis (narrowing of Certificate, Chicago, Illinois Initial treatments often include the spinal canal) or disc disorders such conservative strategies such as physical as a herniation. https://www.asra.com/page/305/p therapy or chiropractic care. These ain-and-msk-interventional- Patients with spinal nerve treatments may also be employed in ultrasound-certificate compression typically complain of conjunction with non-opioid neuropathic May 2019: pain in their arms or legs in certain pain medications or epidural steroid patterns that correspond to the injections. If pain persists after compressed spinal nerve. conservative treatment, spinal surgery American Society of and more advanced technologies such as The diagnosis is confirmed using an Interventional Pain Physicians spinal cord stimulation or dorsal root MRI of the area, typically the lumbar Annual Meeting, Las Vegas, ganglion stimulation may be considered. Nevada or cervical spines, and is used to https://www.asipp.org/asipp- Pain Diagnostics and Interventional Care is dedicated to providing the highest meetings/2019-asipp-annual - quality care to all patients through evidence-based medicine. To learn more, please meeting visit our website at DavidProvenzanoMD.com or call our office at 412-221-7640.