Dr. Kenneth Candido, MD

Cold. Cold slows nerve electrical conduction; heat speeds up nerve electrical conduction. In the end, it also depends upon how acute the injury or problem is; acute (less than a few days) injuries to nerves respond very well to cold application; over time, sometimes (rarely), heat may be useful.
Good luck!

Kenneth D. Candido, M.D.

Muscle relaxants are exclusively used to reduce muscle spasms, but have little or no pain relieving properties of their own. The way they reduce pain is by reducing spasms. If it’s entirely muscular, massages and possibly use of a topical local anesthetic gel or cream (can get this over the counter, containing lidocaine) Hsu sally suffices. For persistent pain, should have an x-ray of the neck (Cervical spine) or an MRI to determine the source of the problem.

For spinal fusion in the cervical spine (neck), there is typically little pain and most people can do well with Acetaminophen (Tylenol). For the lumbar spine fusion, it all depends on how many levels are to be fused and whether or not the surgeon goes through the back or stomach area. If through the back it also matters whether or not the surgeon chooses a minimally invasive type of procedure using fiber optic type scopes to look directly down over the pedicle bones to place the hardware, or makes larger incisions. And finally, it depends upon how much pain medication someone has been using prior to the surgery. Before considering what type and how much pain medication you will need you should address with your surgeon whether or not you are a candidate for the minimally invasive type of surgery. That will dramatically cut down on how much pain medication you may require. Certainly older surgeons or those who trained long ago may not be trained in use of minimally invasive techniques and this is something you may wish to investigate further before undergoing the procedure.

The structures possibly causing hip pain are inside and outside the joint itself and include the labrum; the joint space; the ligaments and muscles; the iliotibial band; and the bursae (sacs around the hip); and possibly the sacroiliac joint. You might also have a primary condition of the lumbar spine, undetected up to the present. You need to have an X-ray first and foremost of the joint; and then depending upon the findings, possibly an MRI of the hip to determine which of these conditions is responsible for your pain.
Good luck!

Kenneth D. Candido, M.D.

Have a pain management specialist evaluate the knee through a comprehensive history taking and a thorough physical examination to determine whether the pain is coming from the internal or external structures of the knee. This might entail use of diagnostic nerve blocks such as genicular nerve blocks; injection into the knee joint; or into one or more of the several bursa structures associated with the knee. Only once the source of the pain has been identified and isolated can treatment begin in earnest.
Good luck!

Kenneth D. Candido, M.D.

You should be certain about what you are dealing with before embarking upon a pain management referral. Your primary care physician should start the investigative process using plain x-rays of the cervical spine, possibly followed by an MRI. You need to establish an objective diagnosis; pain is a symptom, not a diagnosis. Physical therapy should then be undertaken depending upon the results of those studies. Finally, if there has been no resolution, pain management may be considered. I hope this helps! Good luck!

You should avoid opioids at all costs. Alternatives include physical therapy or chiropractors; injections; surgery; or a neurostimulator. Medications might include over the counter NSAIDs like Ibuprofen or acetaminophen. Opioids are not a great idea in this circumstance.

There are 3 FDA approved pharmacological therapies. Lyrica, Savella, and Cymbalta. Each may provide some value under supervision.

There is no "right or wrong" medical treatment for neuropathy. Drugs which have worked for many patients include Gabapentin or Pregabalin. These are drugs created to treat seizures, which by serendipity were found to assist individuals with neuropathy feel better. Consult your local personal physician as to side effects and risks associated with these drugs and as to whether or not these might be appropriate for you.

Kenneth D. Candido, M.D.

Absolutely yes. Many medications taken long-term can affect liver function; however any pain medication which is a combination type drug containing acetaminophen is particularly risky in terms of liver function. Caution should be exercised and short-term use remains the safest option.

Ibuprofen, as all non-steroidal anti-inflammatory type drugs, according to the FDA black box warning of April 6, 2005, can do the following:

a) Cause GI Perforation, obstruction, or bleeding
b) Cause blood clots, heart attacks, or strokes

There is no relationship between duration of consumption and the possibility of these serious medical conditions.
Be careful out there!!!!

Kenneth D. Candido, M.D.

All opioids can cause nausea; vomiting; itching; urinary retention; constipation; respiratory depression; death.
Thank you.

Kenneth D. Candido, M.D.

Aleve and all nonsteroidal anti-inflammatory drugs reduce platelet function and hence increase your chances of bleeding. If you are bleeding heavily during your menstruation and if you develop a GI bleed due to Aleve, there’s a theoretical possibility you might not recognize it and could potentially lower your hemoglobin sufficiently to get dizzy or lightheaded from lowered blood pressure and anemia. Bleeding from below can be confused with a GI bleed, possibly. It’s only a theoretical risk but worth considering. Otherwise, there’s no other major reason why you can’t use Aleve or equivalent NSAID.

The obvious solution is to identify a stress-reduction strategy up to and including changing work. I understand that this is not always feasible or reasonable. However, headaches that are increasing in frequency or duration need to be evaluated immediately by a neurologist with headache experience. There might be a relationship of the headache to untreated blood pressure problems or to a metabolic issue. It should not be ignored!

Kenneth D. Candido, M.D.

A month is a relatively brief period of time to expect resolution of pinched nerve type pain particularly if the nerve was compressed for more than a few weeks. The blood supply to the nerve may have been compromised somewhat by the disc, and as such, will need more time to recover, possibly six months or longer. As the nerve's blood supply is restored following surgery (barring any severe scarring), the nerve typically responds by swelling, which can lead to additional pain. A combination of additional time, some modest physical therapy, and analgesic medications may help. Consult your operating surgeon for additional information.

Kenneth D. Candido, M.D.

Pain and depression may be closely linked; however, it should never be assumed that the depression is the result of pain. At times, depression is the primary condition and may exacerbate otherwise minor pain issues. The condition(s) should be evaluated independently; the pain by a pain management expert and the depression by a clinical psychologist or
psychiatrist. Depression is a very serious issue and can flavor the attempts at modulating pain and therefore demands careful attention. Hope this helps.

Good luck, best regards,

KDC

The first step in evaluating pain from multiple, diverse sources is to conduct a personal medical interview followed by a comprehensive physical examination. The history and clinical examination are then used to construct a possible source for the pain which is then followed by suggesting or recommending treatment options. The entire process is one which is essential, as many pain conditions of the sort you are describing can be addressed using simple remedies which do not involve surgery or prolonged periods of convalescence. My humble suggestion is to have your family member schedule a visit and, in doing so, start the process of investigation so as not to further delay them from attaining a reduction in their pain while improving their quality of life. Let me know if you would like additional information or a recommendation as to how one might proceed under these circumstances.

Thank you and best regards,

Kenneth D. Candido, M.D.