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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

pain chart  
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