Dr Mark Tadros - Rehabilitation and Pain Physician

Lower back and Neck Pain

Why won't this pain in my neck and back go away?

For most people with chronic neck and back pain the cause is due to degeneration of the spinal joints. Secondary muscular pain can often exacerbate the pain.

Rarely some patients have serious underlying bone or soft tissue disease, less than one per cent. If you have persistent back or neck pain you require a thorough assessment by a medical practitioner. He / She can then decide if further tests are needed.

Ok, so I have this degeneration in my spine, how does that happen?

Degeneration of the spine is universal. Most people over the age of 18 show signs of degeneration of their spine on medical imaging. Some people have pain, others don't. There is often no relationship between the radiological (X - ray, cat scan and MRI) changes and a persons pain.

Pain can originate from many parts of the spine. The intervertebral disc, the small joints at the back of the spine (facet joints), the nerves leaving the spinal cord, muscles and ligaments are all possible causes of pain. Often despite our best efforts we cannot find a discrete cause for a patient's pain and searching for it can lead to prolonged and fruitless investigation.

What is the prognosis of degenerative disease of the spine?

For the most part back pain and neck pain is a self limiting disease and most patients find it eventually resolves. However, some people have chronic neck and back pain.

Is it possible it will never go away?

This is a possibility, but there are treatments for this. You really need to see a pain medicine or rehabilitation specialist if this is the case.

What does the science say about treatment of chronic neck and lower back pain?

There is the highest scientific evidence for the use of rehabilitation and pain medicine programs using a combination of physical and psychological therapy. Most patients find after these programs they develop a deeper understanding of the pain and its treatment and learn to live a fulfilling existence despite the pain.

Will I eventually become paralyzed and need a wheelchair?

Only rarely does degenerative back disease lead to paralysis to this extent.   The vast majority of patients with back pain due will have no paralysis and will not require a wheelchair.  

So how do I start to get better?

You should start by seeing your general practitioner for assessment. If he/she feels it is necessary you can be referred to a pain medicine or rehabilitation specialist for further assessment and treatment.

Are there any good books on back pain and pain in general?

Yes, there are some very good ones from expert authors who are accepted by the scientific community. Brisbane Rehab Pty Ltd has no direct financial links to the authors or publishers of these books.

Manage your pain -   Michael Nicholas, Allan Molloy, Lois Tonking and Lee Beeston

Explain Pain - David Butler

The Back Pain Revolution - Gordon Waddell (This is a large book only for those with a deep interest or health professionals wanting to learn more)

 

Arthritis

 What is arthritis?

There are many types of arthritis. The most common is osteoarthritis. This involves a thinning of the articular (joint lining) cartilage. This leads to inflammation, pain and decreased range of motion.  

What is the cause of osteoarthritis?

The cause of osteoarthritis is still largely unknown. There is evidence that genetic and environmental (wear and tear) factors may influence generation of this disease.

What is the natural history of the disease?

Osteoarthritis is generally a progressive disease that means it tends to get worse with time. The progression of the disease however, is variable.   Some patients can have stable osteoarthritis with minimal symptoms for many years before needing treatment. In others the process can be more rapid.

What are the treatment options?

Thankfully there are a whole range of treatment options for osteoarthritis. Keeping as active as possible within the limits of the pain is useful. Medications, therapy, walking aids and surgery are used to treat osteoarthritis.

Where do I start?

A good place to start is your general practitioner. They can assess you and decide on the need for referral to a rehabilitation physician or orthopaedic surgeon.

 

Stroke

What is a stroke?

A stroke is a term used to describe permanent injury to the brain after a vascular (blood vessel) event. Most commonly arteries in the neck or brain narrow and eventually clot off due to atherosclerosis (hardening and thickening of arteries). Less commonly aneurysms (dilated blood vessels) or bleeding into the brain can cause a stroke.

Is the damage to my nerve tissue permanent?

This is difficult to answer, for most patients the tissue damage is permanent. However, the tissue surrounding the injury is often bruised or reversibly injured and may recover.

Despite the injury, many patients can improve after a stroke. If paralysis is permanent there are many strategies and tools the rehabilitation team can use to help an individual lead a fulfilling and satisfying life.

Does rehabilitation help after stroke?

There is very good scientific evidence that rehabilitation helps people improve their ability to live meaningful lives.   Ideally, rehabilitation should start early and carry onto community care.

Where do I go to find a rehabilitation service?

Visit your local doctor and have an assessment, he or she will then be able to refer you to Brisbane Rehab.

 

Spasticity

What is this and why is it a problem?

Simply, spasticity is an increase in muscle tone around a joint after a permanent injury to the nervous system. This most often is a problem after a stroke but many other people suffer this problem due to spinal cord injury, cerebral palsy, brain injury and multiple sclerosis.

It becomes a problem when it begins to interfere with daily life or cause pain. Spasticity can interfere with walking, sitting, standing, dressing and bathing. If this is happening then the spasticity needs assessment and treatment.

How does this actually happen?

Unfortunately, like many areas in medicine this is yet to be fully explained. Most likely nerve cells in the spinal cord become overactive after injury and increase spontaneous messages to muscles. This causes muscles to become overactive and hyper responsive to movement.

What is the treatment for this?

Simple treatments should be used first for this problem. Regular stretching, splints and casting of the joint are basic first line treatments. If the problem continues other more complex management is required such as medications, injections and surgery.

How do I go about seeking help for this problem?

You should see your local doctor for assessment. He or she can then refer you to a rehabilitation physician for treatment.

What is botulinum toxin and how can it be used in spasticity?

Botulinum toxin is a poison derived from bacteria. It acts to decrease messages from nerve cells to muscles. It is used in medicine in very low doses to limit muscle activity.

It is injected into the muscle responsible for spasticity by a specialist familiar with its use. It then takes about a week to see results. Most patients will respond and find it easier to move the joint following the injection.

Some patients find they will only require one injection provided they keep stretching the joint after. Other people require repeated injections every six months.

What are the side effects of botulinum toxin injection?

Most people find that they have no or minimal side effects. The needle used to inject is tiny but some patients do have some pain and minor bruising over the injection site, this settles after a few days.

One of the more serious side effects is excessive weakness. This may limit the previous usefulness of the limb injected. This however is temporary and will resolve over weeks to months.    

If patients require repeated injections they may develop immunity to botulinum toxin. This means that increased doses are required to give the same effect.

Fibromyalgia

I've been told I have fibromyalgia, what is that?

Fibromyalgia is a disease characterized by chronic widespread musculoskeletal pain. Patients often experience other symptoms such as pins and needles sensations, anxiety, irritable bowel symptoms and depression.

What is the cause of fibromyalgia?

The cause is unclear, there are numerous theories and some scientific data but there is no one accepted theory. Patients often describe themselves as having a reduced pain threshold so that they experience more pain than the average person.

What is the prognosis of someone with fibromyagia?

No one can tell any one individual person with fibromyalgia what their likely prognosis will be. We still do not have the scientific data to accurately predict outcomes in people with fibromyalgia.

The good news is that patients with fibromyalgia are unlikely to suffer any direct damage to their nervous system. That means that patients with fibromyalgia are unlikely to become paralysed permanently.

What does the science say about treatment of fibromyalgia?

The highest level of scientific evidence suggests that the best treatment for patients with fibromyalgia is a rehabilitation program using education and physical therapy. There is also evidence that certain medications may help.

How do a start to look for more help?

See your local doctor for assessment and diagnosis. If necessary they may refer you for assessment by Brisbane Rehab.

 

Neuropathic Pain

How do I know if I’ve got neuropathic pain?

Patients with neuropathic pain usually have the following:

1. An injury to the nervous system, most often patients have a pre – existing neurological disease such as stroke, neuropathy (disease of the peripheral nerves), spinal cord injury or damage to a nerve in some way.
2. The pain is spontaneous and unpredictable. Most types of pain are predictable, patients with arthritis report that their pain is related to activity and rest. Neuropathic pain is not like this, they have random (paroxysmal)  bouts of pain.
3. The pain is difficult to describe. There may be more than one type of pain at different times and with various patterns. The pain can be described as electrical, burning, shooting although other patients describe it as aching and piercing. 
4. The pain is not affected by conventional medications. Drugs such as paracetamol and morphine based preparations do not help the pain.

What is neuropathic pain?

Neuropathic pain occurs after there is damage in some way to the nervous system. The nerves are ‘tricked’ into sending painful messages. 

What are the most common causes of neuropathic pain?

The most common problems causing neuropathic pain are diabetes – this often affects the nerves (peripheral neuropathy) and pain after shingles (post herpetic neuralgia). Other more common causes are injuries to peripheral nerves, stroke and spinal cord injury.

Can neuropathic pain occur after surgery?

Yes, neuropathic pain can occur after surgery. Despite the surgeon’s best efforts, this is often an unpredictable and unfortunate outcome after surgery. Very small nerves, often not visible to the surgeon at the time of operation may be traumatized. Following surgery the nerves may become irritated and produce painful signals.  The more common types of surgery resulting in neuropathic pain include thoracic, breast, hernia and gallbladder surgery. It may occur after any type of surgery though.

What is the treatment of this type of pain?

This type of pain responds to a different type of treatment. If you think you have this type of pain then you should be assessed by your local doctor. If he or she thinks it may be neuropathic pain then you should be referred to a pain medicine physician for treatment.

The treatments are diverse and include medication, physical therapies, education, rehabilitation and various types of pain medicine interventions.

Complex Regional Pain Syndrome

What is this?

This is a simple name for a disease we presently don’t know much about.  The condition has been known for centuries by various names – reflex sympathic dystrophy (RSD), causalgia and Sudecks atrophy.

It is a very painful condition that occurs after an injury or after prolonged immobilization. It most often occurs in the upper or lower limb. The affected area becomes red or purple and often swells. There may be abnormal nail, hair and skin growth and the area may sweat profusely or not at all. The area is often exquisitely sensitive and patients cannot tolerate the lightest touch such as a cool breeze or warm shower.

What is the cause?

The cause is unknown. We do know that nerves become overactive and act independently. Similar to neuropathic pain the signals to the brain and spinal cord from nerves become ‘mixed up’ and pain results.

What are the most common triggers?   

Fractures, sprains, surgery and other soft tissue injuries are the most common causes. Other less common causes include injury to nerves, stroke and heart attacks.

What is the long term outcome for this disease?

This is still unknown. Recovery ideally requires recognition and treatment of the condition.

I think I may have this, how do I go about getting treatment for this condition?

See your local doctor for assessment. If he/she thinks you have complex regional pain syndrome then you should ideally be seen by a pain medicine physician for early treatment.

What is the treatment for this disease?  

Treatment involves the involvement of team of professional skilled in pain management. Medications, interventions, physical therapy, psychological therapy and education are all generally required for pain relief and functional improvement in patients with complex regional pain syndrome.