Interventional pain procedures, when performed appropriately and precisely on carefully selected patients provide the best relief of pain to an acceptable level. Most patients are able to do away with medications or reduce the size of dose to the point that they can function and be productive.

It is unfortunate that several patients who have a potentially curable problem in their spine get to the appropriate physician in a very late fashion. The length of the time affects the degree of success. It also increases the chronicity of the pain besides creating other problems such as drug dependency, loss of work, loss of functioning, and psychological problems such as depression. Back pain has many causes. Dr. Vengurlekar will evaluate your back pain problem by both a clinical examination and sometimes by ordering additional testing. Based on the cause of your pain, you still have potential for improvement or cure. Obviously, the longer patients go with the chronicity of the pain, the poorer the chances are for complete success of pain relief.

If there is paralysis in an extremity or if there is problem with incontinence, then undoubtedly spine surgery is the answer. In your situation, it appears that your pain has started recently, and if you have a herniated disk, you may benefit significantly, and almost completely, from the procedures that Dr. Vengurlekar may choose to perform on you after an evaluation. Most spine surgeons recognize the limitations of spine surgery and insist that patients undergo a minimally invasive procedure before they make the decision to go through with a surgery.

It appears from your symptoms that you indeed have a protruding disk or radiculopathy, meaning irritation of the nerve root. Although MRI imaging is useful, it does not always show the changes from the irritating disk or herniated disk. Every week, I see several patients whose MRI's show a protruded or ruptured disk, but no symptoms. On the other hand, I have patients who have symptoms of nerve pain in their neck or back, whose MRI's are completely normal, but they do have a significant disk problem. Such disks can be identified by performing discography studies.

From your symptoms and your presentation it appears you have a condition called Reflex Sympathetic Dystrophy. This is a nerve disorder which can be precipitated by minimal injury or a minor surgery, as in your case and needs to be diagnosed and treated appropriately. The sooner you get the appropriate interventional procedure for this condition, the better are your chances for a complete cure and complete restoration of function.

RSD is a result of a nerve disorder affecting specialized nerves that supply the sweat glands and blood vessels of the skin. Under certain conditions, these nerves take over abnormal functions and start shooting off abnormal pain impulses, resulting in tissue changes. If these conditions are diagnosed early, the chances of cure and prognosis are excellent. However, if they are misdiagnosed, and are prolonged, then there will be irreversible damage to the tissues and the chances of cure and prognosis are poor. In your case, if you're proven to have RSD, then certain procedures that target the sympathetic nerve tracts will need to be performed. This is usually combined with physical therapy to restore function.

There are several factors which will determine whether or not help can be provided for your shingles pain. You now have a condition called Post Herpetic Neuralgia. The ideal thing for you when you had your shingles attack was to see a pain management physician and receive certain blocks of the nerves which could have shortened the duration and severity of the attack. Such episodes of shingles, when untreated, may result in Post Herpetic Neuralgia, as in your case. The treatment of Post Herpetic Neuralgia is very complex and involves several therapeutic options. This may include nerve blocks, and some patients may also require spinal electrodes as an ultimate therapy.

Unfortunately, your problem is a generalized condition and arthritis and fibromyalgia need a complex treatment plan which involves mainly oral medications such as steroids, immunosuppressive drugs, etc. Also bear in mind that patients with arthritis and fibromyalgia may also have spinal pain caused by other conditions. So if you have spinal pain or specific pain in certain parts of the spine, those may be amenable to interventional therapy. But to answer your question, I do not treat fibromyalgia, arthritis or other generalized pain conditions like that. Those conditions can be treated by a rheumatologist or an internist.

I would like to clarify that my practice is solely limited to interventional pain procedures. If you feel that your patients have an addiction problem, then they need to see an addiction specialist. I also do not take over pain medication therapy initiated by another physician. However, I would be happy to see them and make some suggestions and give my opinions on the patients to ensure that these patients get the appropriate therapy and reach the appropriate level of functioning and productivity.

It appears that you have suffered from a post traumatic whiplash syndrome, and in such an injury, there is usually an injury to the various ligaments of the neck, the facet joints, and occasionally the discs. It appears that you have not had any specific interventions for addressing your neck pain. You have a very good chance of obtaining substantial reduction of your pain with the appropriate interventions.

Unfortunately, headaches, like other medical disorders, are often misdiagnosed or mislabeled as migraine. Headaches can be caused by several conditions. Just from your history it appears that the possibility of occipital neuralgia should be considered in your diagnosis, and it is very important to establish an accurate diagnosis in headache disorders, just as it is for any medical disorder, because the treatment for all these different headaches are very different. You may benefit from a nerve block called an occipital nerve block or a block of the C2, C3 ganglion, if you are proved to have the condition of occipital neuralgia.