Dr. Majid H. Ghauri, M.D.

Back pain is a symptom of a variety of medical conditions, illnesses and injuries. Back pain is due to any of a number of conditions. Sometimes the pain is due to a problem in the spine or supporting muscles, ligaments and tendons. However, back pain can also be due a problem in another part of the body, and people experience what is called referred pain.

Pain can occur in any area of the back too. It may be localized pain, like lower back pain or neck pain, or it may be widespread back pain. The general categories of causes for back pain include:

Back sprain or strain,
Spinal injury to vertebrae or spinal nerves,
Diseases like osteoporosis and disc disease,
Arthritis,
Medical condition like a bladder or kidney infection,
etc
I recommend consulting with a pain management or orthopedic specialist who is specializing and board certified to treat back and spine conditions.

It is important to understand that phenomenon of pain is a complex medical issue. Diagnostics and treatment of chronic pain syndromes often require a multidisciplinary approach provided by different specialists. Therefore, a diagnostic consultation with physicians working in pain management directions is usually the first step of your treatment. During the diagnostic consultations, pain management specialist will review your medical history, symptoms, medications, x-rays pictures, MRIs and other tests to diagnose the source of your pain.
Pain management consultant is a physician who is specialized in a treatment of acute and chronic pain-related conditions. Pain management consultants provide complete pain care and perform some interventional techniques which are aimed at pain relief. In addition, treatment program involves the multidisciplinary team, utilizing the services of psychologists, physical and occupational therapists.
Spine pain diagnostics
The causes of back pain can involve a number of factors. Diagnostic process can refer your problem to various medical fields such as neurology, orthopedics, neurosurgery, and even psychology. Therefore, getting an accurate diagnosis of the back pain cause is crucial, because different spine conditions require different treatment approaches. And the sooner an accurate diagnosis is made, the sooner the patient can find an appropriate treatment for pain relief. Examination and diagnosis of back pain usually include the following steps:

Review of your medical history.
The physician will ask you the questions regarding your symptoms and their characteristics, for example when the low back pain or other symptoms occur, how the pain feels, what movements, positions, or treatments make the pain feel better.

Physical Examination.
The physicians will perform a thorough physical exam, such as testing nerve function and muscle strength in certain parts of the leg or arm, testing your reflexes and their characteristics, testing for pain in certain positions, etc.

Diagnostic Testing.
After the physician has some version of pain source, a diagnostic imaging, such as a CT scan or an MRI scan. It may be necessary for confirmation of the suspected cause of pain, as well as for planning the surgical intervention if it is needed.

Dear Patient,
Currently there is no one specific cure for fibromyalgia, but education, lifestyle changes, and proper medications can help the individual to regain control and achieve significant improvement.

Models of pain behavior that interrelate biologic, cognitive, emotional, and behavioral variables form the basis for cognitive-behavioral and operant-behavioral approaches to adult pain management.

The researchers made a considerable progress in understanding fibromyalgia. Recent advances in their understanding of the fundamental mechanisms underlying fibromyalgia (FM) have shown that there is a significant peripheral neuropathic component to this disorder.

Methods for recognizing FM itself have been the subject of numerous reviews, and have generated at least two sets of formal, diagnostic criteria. Until recently, there has been little in the way of agreement as to nature and cause for the constellation of peripheral findings seen in this disorder. The robustness of the reports of small fiber neuropathy (SFN) in FM suggests that SFN is likely to be a fundamental component of this malady. Further, once the SFN is placed in context, there arises the inevitable conclusion that many of the symptoms seen in FM are likely to be immune-mediated. Additionally, ongoing work suggests that another important lesion, a large fiber neuropathy, exists in FM. In combination, all of these considerations provide a reasonable schematic for planning the treatment and monitoring of the painful complaints in this disorder.

Skin biopsy is a safe, minimally invasive, painless and cheap tool for providing diagnostic information on SFN, which are invisible to routine neurophysiological tests. Biopsy can be performed in hairy skin to investigate unmyelinated and thinly myelinated fibers and in glabrous skin to examine large myelinated fibers. Morphometric analysis of skin nerves is readily accomplished through the use of immunohistochemical techniques, and has proved to be reliable, reproducible and unaffected by the severity of neuropathy. One further advantage of skin biopsy over conventional nerve biopsy is that it allows somatic nerve fibers to be distinguished from autonomic nerve fibers. Skin biopsy is considered in patients with symptoms of small-fiber neuropathy when nerve conduction studies do not reveal abnormalities. Once SFN has been diagnosed, focused screening (e.g. glucose tolerance test) and treatment of neuropathic pain or fibromyalgia can begin. Skin biopsy provides an opportunity to identify subclinical involvement of autonomic nerve fibers and degeneration of somatic nerves in neuropathies otherwise considered exclusively autonomic, leading to a better comprehension of symptoms and awareness of potential complications.

It is important to understand that phenomenon of pain is a complex medical issue. Diagnostics and treatment of chronic pain syndromes often require a multidisciplinary approach provided by different specialists. Therefore, a diagnostic consultation with physicians working in pain management directions is usually the first step of your treatment. During the diagnostic consultations, pain management specialist will review your medical history, symptoms, medications, x-rays pictures, MRIs and other tests to diagnose the source of your pain.

Chronic pelvic pain can have multiple causes, including: infection, neuropathies, endometriosis in women and prostatitis in men and other causes like interstitial cystitis.Just as there is no one test to diagnose the cause of pelvic pain, the treatments vary depending on what is determined to be the cause of the pain. Usually, best results are achieved if the patient has a multi-disciplinary pain management treatment approach. Treatment can include: medication management, surgery, antibiotics, injections, spinal cord stimulation (SCS), behavioral therapies and pelvic floor exercises.

Chronic pelvic pain can have multiple causes, including: infection, neuropathies, endometriosis in women and prostatitis in men and other causes like interstitial cystitis.
For example, you could have pudendal neuropathy. The main symptom of pudendal neuralgia (PN) and pudendal nerve entrapment (PNE) is pain in one or more of the areas innervated by the pudendal nerve or one of its branches. These areas include the rectum, anus, urethra, perineum, and genital area, but often pain is referred to nearby areas in the pelvis.

If your pelvic pain increases while sitting and is relieved by lying down then you should consider seeking an expert consultation with a pain management specialist. Treatment for this condition includes self-care, a nerve protection program, pudendal nerve block, and surgical decompression.

Another common condition is coccydynia or pain in the tailbone. Again, patient history and a physical examination will help with diagnosis. This condition can be treated by NSAIDS or special injections like ganglion nerve of impar block. This is a safe and easy procedure used to treat visceral, pelvic, genital, perineal and anal pain. A blockade of the ganglion of impar can decrease or even eliminate chronic pain originating from the perineum, distal rectum, anus, distal urethra, distal vagina and others.

When the nerves on each side of the head become inflamed or injured, this is known as occipital neuralgia. These nerves send feeling from the brain to the top and back of your head and stretched from the top of the spinal cord to the base of the neck to the scalp. Patients who experience occipital neuralgia may first think it’s just a headache or migraine. But this is a serious condition that requires treatment.

Symptoms:
Pain in the head and neck that begins at base of the head and moves to the scalp. The pain can be intense.
Light sensitivity and pain that is behind the eye.
A sensitive or tender scalp.
Possible Causes of Occipital Neuralgia
Occipital neuralgia has many causes that include neck tension, whiplash, a pinched nerve, osteoarthritis, cervical disc disease, blood vessel inflammation, gout, diabetes or an infection. A cause is not found in some cases.

I would recommend that you see a pain specialist or a primary care doctor to begin with. The most likely cause of the pain you are experiencing is a hernia. Hernia is a condition in which a small defect in the muscles of the abdominal region allows the intestine to bulge downwards towards the scrotum.

Maryna Polosenko

Pain medications are effective and safe when used as directed. Always consult with your physician before you take a painkiller medicine. Also, do not change or increase the dose without consulting with your physician. Misuse or abuse of medications can be extremely dangerous.

Maryna Polosenko

You may be experiencing IBS (irritable bowel syndrome) or IBD (inflammatory bowel disease). To determine what issue exactly you're currently experiencing, we recommend seeing a primary care or a pain management physician. A doctor will ask for your medical history, travel history, sex, drugs, and smoking. A further exam can confirm or give background for further knowledge about the disease. If there are concerns of potential inflammation in the bowel, you may be ordered some lab tests.
The most important thing to remember is not to live with pain, but rather seek help immediately.

Maryna Polosenko

There are a couple of tips that I'd recommend:

1. Some women benefit from starting over-the-counter acetaminophen or anti-inflammatories (ibuprofen or naproxen) a couple of days prior to menstruation.

2. Exercise regularly.

3. Maintain a healthy diet and take nutritional supplements with vitamin B and magnesium

4. Drink plenty of water to stay hydrated.

5. Avoid or minimize caffeine intake.

6. Avoid alcohol intake and smoking.

7. Consult with your OBGYN, primary care doctor, or pain management physician if none of these tips help.

Got headache? You're not alone...
Headache is the most common reason for ER visits. It can be classified into:
- Primary Headache syndromes:
- Migraine
- Tension type Headache
- Trigeminal Autonomic Cephalalgias (Cluster Headaches.)
- Other Primary Headaches
- Primary cough headache
- Primary exercise headache. Etc.
Most of the headaches can be diagnosed clinically with History and physical examination by your physician. Only rarely and especially for secondary headaches you may need imaging studies, like MRI and CAT scan and some blood work to r/o infection or other inflammatory conditions.
Most headaches respond to NSAIDS (Ibuprofen, Naproxen etc.). If your headache is chronic or lasting for majority of days in a month, then you may benefit from maintenance treatment with Anti-depressants or B Blockers like Metoprolol.
Other treatment is geared to specific headache. Treatment options may include Behavioral therapy and interventional pain management with Sphenopalatine ganglion blocks and spinal cord stimulators etc.

A vast number of women and men suffer from chronic pelvic pain (CPP). This is a pain in the area below your belly button and between your hips that lasts six months or longer.
Chronic pelvic pain can have multiple causes, including: infection, neuropathies, endometriosis in women and prostatitis in men and other causes like interstitial cystitis.
Diagnosis
A complete medical history and physical examination will help in choosing appropriate testing to accurately diagnose the problem, including:
· Blood Work
· Urine analysis
· Ultrasound
· X-rays
· CT scans
· MRI
There is no single test that will diagnose the different types of pelvic pain and in some cases the cause of pain is unknown.
Treatments
Just as there is no one test to diagnose the cause of pelvic pain, the treatments vary depending on what is determined to be the cause of the pain. Usually, best results are achieved if the patient has a multi-disciplinary pain management treatment approach. Treatment can include: medication management, surgery, antibiotics, injections, spinal cord stimulation (SCS), behavioral therapies and pelvic floor exercises.
For example, you could have pudendal neuropathy. The main symptom of pudendal neuralgia (PN) and pudendal nerve entrapment (PNE) is pain in one or more of the areas innervated by the pudendal nerve or one of its branches. These areas include the rectum, anus, urethra, perineum, and genital area, but often pain is referred to nearby areas in the pelvis.
If your pelvic pain increases while sitting and is relieved by lying down then you should consider seeking an expert consultation with a pain management specialist. Treatment for this condition includes self-care, a nerve protection program, pudendal nerve block, and surgical decompression.
Another common condition is coccydynia or pain in the tailbone. Again, patient history and a physical examination will help with diagnosis. This condition can be treated by NSAIDS or special injections like ganglion nerve of impar block. This is a safe and easy procedure used to treat visceral, pelvic, genital, perineal and anal pain. A blockade of the ganglion of impar can decrease or even eliminate chronic pain originating from the perineum, distal rectum, anus, distal urethra, distal vagina and others.