Myofascial Pain / Peripheral Neuralgia / Piriformis Syndrome / Post Laminectomy Syndrome Treatment
Myofascial pain syndrome is a chronic condition in which trigger points (muscle knots) develop in certain muscles. Trigger points may develop after muscle injury or overuse; jobs and recreational activities that involve repetitive motions in which muscles repeatedly contract are common causes. Trigger points may also be caused by stress and anxiety. Myofascial pain is most common in middle-aged adults, although people of any age may be affected.
Symptoms of Myofascial Pain
Patients with myofascial pain may experience deep, aching muscle pain that worsens over time; muscle and joint stiffness; and difficulty sleeping. These symptoms can significantly affect a person's quality of life, and require medical attention if they do not subside. Patients with untreated myofascial pain syndrome may develop muscle weakness or fibromyalgia.
Treatment of Myofascial Pain
Effective treatment for myofascial pain usually involves a combination of approaches. Patients may benefit from physical therapy exercises, including stretching and massage, to relieve tension in the affected area. Another possible remedy is trigger-point injection, which involves inserting a needle into the affected muscle to relieve the tension causing the trigger point. Anti-inflammatories and anti-depressants may temporarily relieve symptoms, and help patients to sleep better.
Peripheral neuropathy refers to damage of the peripheral nerves, which branch out from the brain and spine to the rest of the body. It typically begins with pain, numbness, tingling, burning or weakness in the feet, legs and/or hands, and may progress to more serious conditions such as ulcers, pain and loss of sensation. Numbness is especially dangerous, as patients sometimes do not detect an injury until the damage is so pervasive that the limb requires amputation.
Peripheral neuropathy may develop because of a nerve disease or as a side effect of an illness or medication. Common causes among Americans are diabetes, chemotherapy, chronic alcoholism, multiple sclerosis, and heavy metal toxicity.
Our physicians have undergone special training to treat peripheral neuropathy using the latest surgical techniques. Some of the advanced procedures we offer are nerve decompression and partial joint denervation to relieve foot, ankle, knee and leg pain.
Piriformis syndrome occurs when the piriformis muscle, which runs from the lower spine to the top of the thigh bone, presses on the sciatic nerve. As a result, it causes pain, tingling and numbness in the buttocks and, often, down the back of the leg. The pain often worsens as a result of sitting for a long period of time, walking, running, or climbing stairs. While piriformis syndrome may occur for no apparent reason or develop after regular physical activity, it is sometimes caused by a a traumatic injury, such as a car accident or a fall.
People with piriformis syndrome often experience tenderness in the buttocks and pain down the back of the thigh, calf and foot. It may start as intense, burning pain in the buttocks and get worse during activities, such as walking or running, that cause the piriformis muscle to press against the sciatic nerve. Symptoms of piriformis syndrome may be long-lasting, often troubling patients for years.
Piriformis syndrome is diagnosed through a physical examination and a review of symptoms. The affected leg may be moved in several different positions to measure pain levels. Additional tests may include MRI or CT scans.
Treatment for piriformis syndrome may initially focus on exercises to stretch the piriformis muscle, and conservative treatments such as hot and cold therapy, massage, and taking a break from activities that may cause pain. Nonsteroidal anti-inflammatory medication may be used for pain relief. If discomfort persists, steroid injections into the piriformis muscle and the sciatic nerve may help to relieve pain. In severe cases, surgery may be necessary to relieve pressure on the sciatic nerve.
Post Laminectomy Syndrome
Post-laminectomy syndrome is a condition in which a patient continues to experience pain and disability after a laminectomy, a type of spinal surgery. During a laminectomy, a piece of the layer of bone covering the back of the spinal cord (the lamina) is removed to eliminate compression on the spinal nerves. This surgery may be performed in conjunction with other back surgery, such as a discectomy, and is most often performed to relieve stenosis, a narrowing of the spinal column. The development of post-laminectomy syndrome is a complication of the procedure. Post-laminectomy syndrome is a type of failed back surgery, a broader category which includes chronic pain following any spinal surgery, including spinal fusion.
Reasons for Post-Laminectomy Syndrome
The condition is characterized by a persistent pain in the back that may also be radicular, radiating into the neck, arms or legs, depending on where the surgery has taken place. Such residual pain may have a number of causes, including:
- Excessive scar tissue
- Recurring herniation of a disc
- Remaining bone fragment at the site
- Recurring stenosis
- Bone spurs
Treatments for Post-Laminectomy Syndrome
There are a number of effective treatment methods used to address post-laminectomy syndrome. For patients experiencing severe symptoms, treatment may include:
- Nerve block injections
- Transcutaneous electrical nerve stimulation (TENS)
- Radiofrequency denervation
- Platelet rich plasma therapy
Milder cases of post-laminectomy syndrome may be treated successfully with anti-inflammatory medications, certain antidepressants, epidural corticosteroid injections, and physical therapy.