Musculoskeletal & Chronic Pain Management SOURCE OF PAIN
Muscle
Nerve Compression
Nerve Damage Nerve Traction
Joint
Migraine
DIAGNOSES Strain Injury Repetitive strain "TMJ" Tension headache Myofascial pain Radiculopathy Carpal tunnel Disc herniation
TESTS
APPROACH
No objective tests "Physical therapy" Trigger points on physical Chiropractic examination Lidocaine injections Muscle relants
Web-based stretches Tension-reduction techniques
MRI, CT or myelogram Laminectomy Show compression of the Discetomy nerve by disc, etc. Fusion (for surgical failures)
Referral to surgeon only if MRI shows nerve/root compresson that matches patient's symptoms
Neuropathy Radiculopathy
EMG-NCV Shows slowing of nerve conduction and/or twitching of muscle EMG-NVC Throacic outlet syndrome Is normal Piriformis syndrome X-ray Shows joint degenerative changes Osteoarthritis Degenerative spine disease Rotator cuff syndrome
Migraine
None
Complex regional pain syndrome
Abnormal blood flow to extremity
"RSD"
Fibromyalgia Chronic Fatigue Syndrome Fibromyalgia Neurasthenia
TREATMENT traditional
Epidural injections "Anti-depressnats" "Anti-convulsants" Rib removal Muscle resection
Treat the underlying cause: traction from muscle
Non-steroidal antiinflammatories (NSAI's) Steroid injections Surgery
Education: - Avoid the activity - Steroid injection only as part of complete treatment plan
Serotonin agonists (Imitrex) Beta, Ca blockers Anti-depressants Anti-convulsants
Imitrex Beta-blockers Thermal biofeedback Identification of triggers Gradual mobilization of limb Thermal biofeedback Counseling Weaning off blocks
Blocks
None
"Anti-depressnats" "Anti-convulsants"
Anti-depressants NSAI's, narcotics Exercise
"Anti-depressnats" "Anti-convulsants" Sleep/Activity Regulation Counseling