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When should I get treatment for low back pain? |
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What can I do to prevent injurying my back? |
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What is discogenic low back pain? |
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There is talk that the government is ready for a change in Medicare. How will that impact my pain treatments as an American senior citizen? |
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I have been diagnosed with interstitial cystitis and suffer from unrelenting pelvic pain. What can be done for my pain? |
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I have spinal stenosis with leg pain and difficulty walking. What can I do for the pain? |
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What is facet joint syndrome and what can I do for my back pain? |
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What options are available today for cancer pain in additional to pain medication? |
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Can you tell me about the device that the comedian Jerry Lewis got for his back? |
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Are epidural steriod injections for the back pain safe and how many can a person get? |
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I suffer from trigeminal neuralgia and want to know what I can do for the pain other than take pain medication? |
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What is sacral iliac joint injury and what can I do for the pain? |
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What treatments are available for a spinal fracture due to osteoporosis? |
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What can I do for pain in the arch of my foot that is worse in the morning when I walk? |
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I have pain in my knee. What can I do for it? |
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I have been told that I might have discogenic low back pain and I need a discography test, what is discogenic low back pain? |
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What can I do to prevent the bone problems and pain from osteoporosis? |
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What can I do for the pain in my hands from carpal tunnel syndrome? |
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My mother is diabetic. What can be done for her leg pain? |
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What is meant by neuropathic pain? |
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What is TMJ Syndrome? |
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What is the risk of becoming addicted to pain medication? |
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What is chronic pain? |
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What is fibromyalgia? |
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What will your role be in the Delaware Health column? |
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When should I get treatment for low back pain? |
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Low back pain (LBP) typically is due to injuries of the soft tissue structures, spinal joints or discs. You should seek medical attention if your LBP does not improve or if it increases over a period of two to three weeks. In addition, you should seek immediate medical care if you have sudden LBP and are over the age of 50, LBP that is related to a fall or trauma, sciatica (leg pain), loss of bowel or bladder control, loss of groin or rectal sensation, leg weakness, falling when walking, fever or weight loss, and when LBP is worse at night. |
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December 20, 2005
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What can I do to prevent injuring my back? |
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Low back pain (LBP) is the second most common reason, other than the common cold, to seek medical care. Approximately 90% of us suffer a significant episode of LBP in our lifetime. The good news is the nine out of ten patients recover from their LBP within four weeks with or without treatment. Some of the precautions that you should take to prevent LBP including lifting with your legs not with your back, don't lift heavy objects alone, wear low heeled shoes, get consistent sleep, shift heavy purses or briefcases, stop activity that hurts your back, don't stoop, and exercise regularly. |
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December 6, 2005
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What is discogenic low back pain? |
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Discogenic low back pain (DLBP) is a common cause for chronic back pain resulting from tears in the outer disc. Lack of physical examination findings and limitations with imaging studies make diagnosing DLBP difficult. Discography is the only reliable means of diagnosing DLBP, which involves injecting dye into the disc to detect the tears and to reproduce the back pain. A CT scan follows for a more detailed evaluation. Treatment for DLBP includes physical therapy and pain medications. Discography is considered in those who fail conservative treatment. Depending on the results, treatment options include interventional pain procedures or spine surgery. |
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November 11, 2005
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There is talk that the government is ready for a change in Medicare. How will that impact my pain treatments as an American senior citizen? |
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Severe payment cuts, rising practice costs, and increasing medical malpractice are forcing physicians to make difficult decisions. According to surveys, 30% of physicians will discontinue seeing Medicare patients, 50% will defer technology purchases, 30% will stop nursing home visits and 28% will close satellite offices. Physicians and patients must act now to preserve Medicare by urging their senators and representatives to support S 1081, HR 2356 and HR 3617 congressional bills to stop 2006 Medicare cuts. Physicians can call the American Medical Association (AMA) at 800-833-6354 and patients can phone the AMA at 888-434-6200 to contact members of Congress. |
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October 25, 2005
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I have been diagnosed with interstitial cystitis and suffer from unrelenting pelvic pain. What can be done for my pain? |
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Interstitial cystitis is a chronic, non-infectious, inflammatory condition of the bladder wall, usually affecting women with symptoms including urinary urgency, hesitancy, frequency, and pelvic pain. Pentosan (Elmiron® — the only drug approved by the FDA for this condition), anti-inflammatory drugs, tricyclic antidepressants, and antihistamines are the medications often used for treating interstitial cystitis. Electrical stimulation (TENS unit or peripheral nerve stimulator), bladder distention (water or gas), and bladder instillation (DMSO or BCG) can provide symptom relief. Surgical options include burning or resecting bladder ulcers with a laser or electrical current, and rarely bladder removal (cystectomy) is considered in those with severe symptom. |
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October 11, 2005
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I have spinal stenosis with leg pain and difficulty walking. What can I do for the pain? |
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Spinal stenosis is a condition in which the spinal cord becomes narrowed from age-related degenerative arthritis changes. Nerve root compression can occur as a result of the stenosis leading to leg pain with numbness and weakness, as well as, back pain. Walking distance decreases as the stenosis progresses. Symptoms improve with resting, lying down, sitting down or bending forward. Imaging studies, such as CT scanning and/or MRI, determine the presence and extent of the stenosis. Treatment consists of anti-inflammatory medications, pain medications, physical therapy, and epidural injections. Surgery is considered in those who do not improve with conservative treatment. |
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September 27, 2005
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What is facet joint syndrome and what can I do for my back pain? |
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The facet joints are paired joints that are located in between the vertebrae throughout the spine. These joints are like any other joint in the body. Twisting, weight bearing or direct trauma can injure the facet joints. Facet joint syndrome presents as back pain that can radiate into the buttocks and in some cases into the lower leg. The diagnosis is made by an x-ray guided injection of the fact joints. Treatment consists of anti-inflammatory medication, pain medication, physical therapy, chiropractic care and steroid injections. A facet join rhizotomy procedure can provide long term pain relief in conservative treatments fail. |
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September 13, 2005
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What options are available today for cancer pain in addition to pain medication? |
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Oral medications can control 70-90% of all cancer pain. The 10-30% who fail oral medications are typically advanced cases of cancer that require intervention procedures for pain control. Neurolytic injections are performed with several types of substances, such as ethyl alcohol to destroy different types of nerves to provide pain relief from cancer depending on its anatomical location. These neurolytic agents can be administered to peripheral nerves, as well as, within the spine. Surgical procedures that destroy areas within the spinal cord or brain are also employed when less invasive procedures fail to provide adequate pain relief. |
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August 30, 2005
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Can you tell me about the device that the comedian Jerry Lewis got for his back pain? |
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Jerry Lewis suffered from chronic back pain for almost 40 years as a result of his physical comedy routines. All forms of treatment for his back failed until 2002, when a pain specialist implanted a spinal cord stimulation device into Jerry Lewis. The device consists of an electrical wire that is placed into the spine with a battery that stimulates the spinal cord and blocks the pain impulses to the brain. Jerry Lewis has had complete pain relief since the implant and is able to participate in family and other activities that otherwise would have caused him severe disabling pain. |
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August 16, 2005
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Are epidural steriod injections for back pain safe and how many can a person get? |
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Epidural injections with a numbing medication and steroid are often times used for treatment of back pain associated with sciatica or for low back pain alone in conditions such as spinal stenosis. The medication is placed into the epidural space (the space that surrounds the spinal cord), through a needle using x-ray guidance, in order to deliver the medication near the nerves that exit the spinal cord. The injections are safe when performed by a properly trained pain specialist and can safely be given six to nine times a year depending on the degree and duration of pain relief. |
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August 2, 2005
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I suffer from trigeminal neuralgia and want to know what can I do for the pain other than take pain medication? |
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Trigeminal neuralgia is a disorder of the fifth cranial nerve that causes pain on one side of the face. The pain is described as electrical, sharp, lightening-like, shooting, and/or jabbing that can last for seconds to minutes several times a day and persist for days to weeks. In additional to pain medications, anti-convulsant, anti-spasticity, and anti-depressant medications can be effective in controlling the symptoms. There are several surgical procedures to treat trigeminal neuralgia if medication management fails. The surgical procedures involve either destroying parts of the nerve ore relieving pressure of the nerve. |
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July 19, 2005
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What is sacral iliac joint injury and what can I do for the pain? |
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The sacroiliac joint is formed by the pelvis and the base of the spine, and is located on both sides of the sacrum. The sacroiliac joint is a weight-bearing joint that transmits forces from the lower extremities to the spine. Sacroiliac joint pain typically results from direct injury or indirectly from lower extremity injuries. Sacroiliac joint pain typically is characterized as low back, buttock, groin, and leg pain. Treatment consists of anti-inflammatory and pain medications, physical therapy, proper biomechanics, steroid injections, obliteration of the nerve supply to the joint (i.e. radiofrequency), and rarely, surgical fusion of the joint. |
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July 5, 2005
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What treatments are available for a spinal fracture due to osteoporosis? |
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Osteoporosis is a disease that results in low bone mass leading to bone weakness and risk for fracture. There are approximately 700,000 vertebral (spine), 300,000 hip and 200,000 wrist fractures related to osteoporosis a year. Past treatment for osteoporotic spine fractures consisted of pain medications and bracing until the fracture healed over a period of six to nine months. There are procedures now available, namely vertebroplasty and kyphoplasty, which actually repair the fracture by placing cement into the fracture. The segment significantly reduces the pain over a matter of days and restores stability and strength to the spinal fracture. |
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June 21, 2005
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What can I do for the pain in the arch of my foot that is worse in the morning and when I walk? |
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The most common cause of pain in the arch of the foot is a condition known as plantar fasciitis. The plantar fascia is a tissue band that extends from the heel to the balls of the foot and can become inflamed from repetitive trauma leading to pain at the heel or arch. The pain is typically worse in the morning or worse after prolonged sitting, standing or walking. Treatment includes ice, anti-inflammatory medications, pain medications, arch supports, heel insets, foot/ankle splints at night, exercises to stretch the fascia and strengthen the foot muscles, steroid injections, and occasionally surgery. |
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June 7, 2005
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I have pain in my knee. What can I do for it? |
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Osteoarthritis is the most common joint disease affecting millions of Americans (60-80% over 55) producing cartilage deterioration that leads to pain and loss of function. The knee is the most common joint afflicted by osteoarthritis resulting in morning stiffness, swelling, deformity, and pain with weight bearing activities, such as walking. The mainstay of treatment includes anti-inflammatory medication, pain medication, steroid injections, hyaluronan (Synvisc®) injections, exercise and use of canes or walkers to reduce weight bearing across the knee. Knee joint replacement surgery is considered when the pain becomes unbearable and/or there is significant loss of function. |
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May 24, 2005
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I have been told that I might have discogenic low back pain and I need a discography test, what is discogenic low back pain? |
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Discogenic pain originates from disruption of fibers within the disc leading to irritation
of nerve endings located in the outer portion of the disc. This is different than the pain from a herniated disc pressing on a nerve root. Discography is the only test that can confirm the diagnosis by injecting discs to determine if there is pain present at the disc(s). Treatment includes pain medications, bracing, modalities and physical therapy. If conservative care is unsuccessful, surgery including percutaneous intradiscal surgery, such as the IDET (intradiscal electrothermal therapy) procedure, or more invasive
surgery such as a fusion may be necessary
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May 10, 2005
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What can I do to prevent the bone problems and pain from osteoporosis? |
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Osteoporosis (a disorder characterized by low bone mass) affects 10 million Americans, mostly women. Fifty percent of women and 25% of men over age 50 will suffer an osteoporosis related fracture of the spine, hip and/or wrist. Avoiding smoking, alcohol, and caffeine can reduce developing osteoporosis. Calcium plays an important role in maintaining healthy bone and appropriate supplementation throughout life is an important part of prevention and treatment. Vitamin D intake is important in the elderly to assist with vitamin C absorption. Weight bearing and resistance exercises are important for building and maintaining bone mass and density for life. |
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April 26, 2005
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What can I do for the pain in my hands from my carpal tunnel syndrome? |
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Carpal tunnel syndrome is a condition that produces inflammation to the main nerve (median nerve) to your hand and wrist. This leads to numbness and tingling of the thumb, index finger, middle finger and ring finger. Hand weakness occurs in advanced cases. The most common cause is repetitive hand use, but it also can occur from broken wrist bones, diabetes, pregnancy, thyroid problems, or arthritis. A nerve condition EMG test can confirm the diagnosis. Treatment begins with anti-inflammatory medications, like ibuprofen, splinting, and physical therapy. Injections and surgery may be necessary if there is no improvement with conservative care. |
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April 12, 2005
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My mother is diabetic.
What can be done for her leg pain? |
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Peripheral neuropathy is a disorder that damages the small nerves in the lower legs/arms and feet/hands. Diabetes is the most common peripheral neuropathy, but other causes of leg pain should be excluded, including peripheral vascular disease and spinal stenosis. Diabetic peripheral neuropathy can present as pain, numbness, burning, tingling or hypersensitivity to touch. Good foot care is very important to prevent infection. The mainstay for treatment of diabetic peripheral neuropathy is the use of medications, such as antidepressants, anticonvulsants and drugs used for hypertension and arrhythmias. Other forms of treatment include electrical stimulation (TENS unit), acupuncture and biofeedback. |
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March 29, 2005
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What is meant by neuropathic pain? |
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Although there are many painful conditions or disorders, there are essentially just two different types of pain. The type of pain refers to the quality or the characteristics of the pain. The pain that we experience is either neuropathic or nociceptive. Neuropathic pain is described as sharp, shooting, knife-like, burning, lancinating, or electrical. Nociceptive pain is described as achy, deep, dull, twisting, gnawing, throbbing, or heavy. The quality of the pain is important in that there are medications and treatments that are more effective for neuropathic pain and others that are better for nociceptive pain. |
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March 15, 2005
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What is TMJ Syndrome? |
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Temporo-Mandibular Joint (TMJ) syndrome is a painful disorder involving the joint about which the lower jaw (mandible) moves when opening and closing the mouth. TMJ syndrome can result from trauma, grinding of the teeth, stress, bite misalignment and arthritis. Symptoms can include pain jaw, jaw popping or clicking, jaw locking, ear pain, headaches, neck pain, difficulty in fully opening the mouth, and sore jaw muscles. Treatment consists of resting the jaw muscles, eating soft foods, avoiding chewing gum, anti-inflammatory medications or muscle relaxants, physical therapy and a mouth guard or splint in some cases. |
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March 1, 2005
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What is the risk of becoming addicted to pain medication? |
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Addiction is the abnormal psychosocial behavior where an individual will obtain pain medication by any means and use it for anything other than pain control. The risk of addiction to pain medication is rare in someone without an addictive personality. Two conditions that are commonly mistaken for addiction are tolerance and dependence. Tolerance means that a higher dose in pain medication is necessary in order to have the same degree of pain relief. Dependence is when the body is physiologically reliant on pain medication to function and will experience withdrawal symptoms if the medication is suddenly stopped. |
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February 15, 2005
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What is chronic pain? |
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Chronic pain is a general term that describes any painful condition that is continuous or ongoing. In short, the pain never ends. A patient of mine describes chronic pain as "pain that has outlived its usefulness." Chronic pain can originate from any type of painful disorder, whether it is due to back pain, headaches or cancer. The chronic pain can lead to multiple losses, such as self worth, income, relationships, mental and physical well-being. Chronic pain must be treated on a several fronts. Treatment measures are directed at reducing the pain, treating any secondary depression, and improving physical conditioning. |
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February 1, 2005
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What is fibromyalgia? |
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Fibromyalgia is a rheumatological disorder that affects the muscles, ligaments and tendons. It can be very painful and disabling, often significantly limiting one's quality of life. The condition is typically associated with some sort of trauma, although no one really understands the cause of fibromyalgia. Those suffering from fibromyalgia often complain about a diffuse muscular aching pain, fatigue, depression and insomnia. Other associated disorders include irritable bowel syndrome, chronic headaches and TMJ syndrome. Treatment focuses on improving sleep, reducing stress and controlling the pain through exercise, medications, physical therapy, trigger point injections and relaxation techniques. |
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January 18, 2005
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What will your role be in the Delaware Health column? |
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Hello and welcome to the "Healthy Advice From the Pros" page. I am a board certified pain management specialist and my column will deal with questions regarding anything to do with pain. Pain medicine is the medical speciality that deals with the evaluation and treatment of a variety of painful disorders, including back pain, sciatica, headaches, cancer, pain, and fibromyalgia. The pain management specialist treats acute and chronic pain with medications, therapies, and interventional procedures to reduce pain and improve the quality of life. I look forward to answer questions about pain. |
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January 4, 2005
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