MedicalSpeakinEnglish

A Day in the Life of a Pain Physician Assistant

Bulging Disc On Right With Pain In The Left Leg

Chris Clough

E-mail

I saw a patient today who complained of pain in the low back that radiated into the back, posterior, of his left leg and into the big toe and the toe next to it. The MRI showed a compression fracture at T12, a minimal bulge at L1-2, and generalized central bulge at L4-5 and a bulging disc at L5-S1 to the right that caused a narrowing of where the nerve exited the spinal canal, encroachment. The exam showed decreased strength in the left leg with normal reflexes. The low back was not tender except in both sacroiliac joints (sij) and the rest of the physical exam was normal. He was evaluated by physical therapy in conjunction with myself. He is out of work and desires to return to work. Because of this, we decided to not only refer him to physical therapy but also proceed with injections. Because the MRI shows a bulging disc to the right and his symptoms are left sided, this may indicate the bulging disc is not the cause of his pain. I am going to start the injections into the sacroiliac joint and if no relief after two injections I am going to trial lumbar epidural steroid injections (LESI) or transforaminal injections (TFB) either at L4-5 or L5-S1.

Hip Pain & Greater Trochanteric Bursitis

Chris Clough

E-mail

Started my day off seeing a patient who suffers from sacroiliac joint dysfunction. I performed two sacroiliac joint (sij) injections that alleviated her pain in that area, but she developed hip pain, which was greater trochanteric bursitis. The bursitis developed because of her gait, walk, that was off because of her low back pain. I performed an injection into the greater trochanteric bursae and she is pain free now. Again this demonstrates that patients often times have more than one pain generator, or area that is causing pain.

Thoracic Back Pain

Chris Clough

E-mail

I saw a patient today for their initial consult today complaining of pain in the shoulder blade area. The pain is near the left shoulder blade only and can move, radiate to the shoulders. It bothers them when running, sitting, and driving. No physical therapy or injections have been tried, and Aleve did not alleviate the pain. The patient was evaluated by physical therapy in conjunction with me and the only finding was mild tenderness in the trapezius muslce, teres muscle, and shoulder blade area. I believe this is a muscle train and the patient was referred to physical therapy.

Generalized Pains - Fibromyalgia?

Chris Clough

E-mail

I saw a new patient today for generalized aches and pains, arthralgias, who was told they had fibromyalgia (myofascial pain syndrome). But after I spoke with her and performed my physical exam I don't think she has fibromyalgia, because she is not tender in most of the 18 common tender points (trigger points). She told me today I am her last line of defense for her chronic pain.

Depression and Chronic Low Back Pain

E-mail

I saw a patient today who was started on Cymbalta and both her depressed mood and her chronic low back pain have improved to the point she may be able to decrease her opiate medications at the next office visit. She is sleeping better and her pain has decreased. Her depression symptoms consisted of fatigue, lack of energy, decreased motivation to do activities she once enjoyed, and feeling blue and all of these symptoms have improved.

More Articles...