Dr. Eric H. Williams Blog /blog/ Dr. Eric H. Williams Blog en-us 2019 Dr. Eric H. Williams, All Rights Reserved, Reproduced with Permission /blog/ Tue, 17 Sep 2019 04:30:23 GMT Dr. Eric H. Williams Blog /images/logoprint.gif /blog/ <![CDATA[Frustrated by Waiting on Answers for Your Pain? You Are Not Alone.]]>

Pain is an unwanted but no less necessary part of life. It is the way our bodies help guard us against prolonged exposure to the things and behaviors that can cause us further damage.

It is certainly not an ideal system, however. What do we do when pain persists for apparently no discernable reason? We are careful, we do the right things, we go to physical therapy, and yet an act as simple as brushing up against a bedsheet can send burning, tingling pain through part of the body.

Perhaps this pain is coming after a surgery on your knee or ankle. Perhaps it has developed following recovery from a sports injury, a hernia repair, or an injury at home. Whatever the cause, having this type of pain can be a source of torment in your life. You may have tried to find answers, and you may not have found the source or relief you were looking for.

What Chronic Pain Patients May Hear

The search for answers regarding chronic pain typically begin in very natural places: either at the office of your primary care physician or, if applicable, the office of the surgeon who recently performed a procedure on you.

In the best-case scenario, your primary care physician, specialist, or surgeon will be able to identify the source of the pain and make their best recommendations for treatment. There are times, however, when you might hear something akin to the following:

The idea of waiting may feel exasperating, and that is entirely understandable, but it can also be the natural course of recovery for pain to persist for weeks or even months. This is especially true for surgical procedures, where additional trauma must be made to the body via incisions and other methods to produce the desired (and hopefully overall better) results.

And if initial reviews and tests come back negative as to anything out of the ordinary, this is very likely not a shortcoming on the doctor or surgeon’s part.

The human body is an extremely complex organism, with various parts and systems demanding a focus of study all their own. That is why specialists exist in so many different fields and areas of the body.

It is next to impossible for a general practitioner to pursue all available possibilities. Someone with as extensive knowledge as “Dr. House” tends to exist only on TV. But negative findings are still very important sources of information should pain persist and new avenues need to be pursued.

Even so, it can still feel like nothing is happening. You can’t be expected to wait forever, right?

man with back pain

How Long Should You Wait on Chronic Pain?

The amount of time you should wait for improvement on pain can vary depending on the situation.

For example, if you have been recovering from a knee replacement or other form of surgery, there is usually a window of 6 months to expect natural improvement. Some people will recover faster than others, and there are many additional factors that can have an influence as well. In the meantime, steps should be taken to attempt managing the symptoms in the best and safest ways possible.

If it has been more than 6 months of chronic pain, however, or the pain has increased and/or made daily living progressively worse, it is time to seek out further opinions, which may include our office.

Expanding Your Web of Support

The best first source for determining further experts is, once again, your primary care physician, your treating specialist, or your surgeon. Theoretically, they are the most knowledgeable of your case at this time, and may be able to make recommendations based on what has been discovered so far. If they can rule out problems such as arthritis, tendinitis, and bursitis, that can help guide your journey to other specialists.

You may even consider a second opinion by a similar specialist to receive a “fresh set of eyes” on the situation.

If the problem may be peripheral nerve-related (nerves outside of the spinal cord), we may be able to help. This will entirely depend on the case, however, and all cases are different. But if a nerve issue of some sort is suspected, do not listen to anyone who says you “can’t do anything to fix nerve problems.” This simply is not true.

While not every nerve-related issue may be treatable, many can be addressed in ways that significantly relieve pain and improve function. At the very least, a physician with expertise in peripheral nerve care should be involved in evaluation and consultation on possible treatment options, and no blanket statements should be made about there being no actual options.

Information is Key

The more informed you are about your condition and your options, the better equipped you will be to seek the right specialists or pain management experts to provide help for your discomfort.

Ask as many questions of your physicians and surgeons as you need to. There are also resources available in books and online, but we do caution you to be prudent with them. It can be easy to find misinformation or go down rabbit holes that do not end up benefiting your situation.

We have many webpages and blogs that might provide some insight into nerve-related possibilities. We also have free downloadable guides for specific situations that you can find below:

If you would like to contact our office in Towson, please do so at (410) 709-3868. You may also fill out our online contact form to have a member of our staff reach out to you.

]]>/blog/frustrated-by-waiting-on-answers-for-your-pain-you-are-not-alone-.cfmwww.baltimoreperipheralnervepain.com-189923Thu, 25 Jul 2019 08:34:00 EST<![CDATA[What You Should Know About Thigh Pain and Meralgia Paresthetica]]>The term “meralgia paresthetica” may not mean much to you at the moment, but “thigh pain” sure may if you have been experiencing it.

While some pain is normal in everyday life, any form of chronic and severe pain that interferes with daily activities is not normal and deserves to be evaluated by a professional.

Chronic burning pain and numbness in the outer thigh is a nerve-related condition we see and treat frequently. This is often caused by a pinched nerve at the level of the hip, known as meralgia paresthetica or compression of the lateral femoral cutaneous nerve.

Do any of the additional symptoms below sound familiar?

thigh pain

A Few Questions About Your Thigh Pain

Are you experiencing pain on the outer thigh, within the range of the beltline to the knee?

Would you describe this pain as a burning or “pins and needles” feeling? Do you sometimes feel a numbness or tingling, or even a sensation like bugs are crawling over your thigh?

Does the outside of your thigh feel hypersensitive? Are you aware of every hair on your thigh? Can it hurt when wearing pants or loose dresses? Have you stopped carrying change in your pocket because it bothers your thigh? If you shave, has doing so become painful? Does water running down your leg bother you?

Does your thigh burn while you are sitting down, especially in the car, on a toilet seat, or at the dining room table? Do you tend to recline while seated to prevent your thigh from burning?

Have these symptoms occurred after an injury or surgery to the outside or front of your hip, or at your beltline? For instance, did this begin after a C-section, a hip replacement/surgery, a pelvic surgery, or a hernia repair?

Have you seen a spine team or a pain management team who has told you the pain is not coming from your back?

If some of these symptoms sound familiar to you or to someone you know, it may be the result of meralgia paresthetica—and we may be able to help.

What is Meralgia Paresthetica?

Pain, numbness, and hypersensitivity along the outer thigh can be caused by compression, pinching, or squeezing of the lateral femoral cutaneous nerve. This nerve runs through the front of the pelvis, near the beltline, to the outer thigh, and its sole function is to provide sensation to this area, from the beltline to the outer knee. It does not control any muscle functions.

Normally, the lateral femoral cutaneous nerve performs its duties without a hitch. We are not consciously aware of the outside of our thigh on a regular basis.

It is possible, however, for the nerve to become trapped by the inguinal ligament, a relatively thick band of tissue that separates the pelvis from the upper thigh, and the anterior pelvis in the region known as ASIS (anterior superior iliac spine).

Furthermore, direct Injury to this nerve by trauma or surgery can cause the same symptoms.

What Can Increase One’s Risk for Meralgia Paresthetica?

Factors that add weight or force to the lateral femoral cutaneous nerve can cause it to become pinched or trapped. These may include:

  • Obesity or weight gain.
  • Pregnancy. Pressure on the groin (which should be familiar to any expectant mother who needs to use the bathroom more often) can also place pressure on the nerve. In these cases, the problem may resolve itself following birth.
  • Overly tight clothing.
  • Heavy belts that weigh on the hips and beltline. (In fact, one nickname for meralgia paresthetica is “gun belt palsy,” as the condition can be common in police officers who are wearing heavily loaded utility belts.)
  • Scar tissue built up around the nerve or damage caused by previous injuries or surgeries. These can include C-sections, abdominoplasty (tummy tucks), hernia repairs, fracture repairs, and other procedures performed in the abdomen near the lower pelvis.

It is also possible for complications from diabetes to cause nerve injury that results in meralgia paresthetica.

doctor and patient

What Should I Do If I Have Thigh Pain and Suspect Meralgia Paresthetica?

When it comes to matters of pain such as this, it is important to confirm the cause and rule out any other potential factors that might be causing your pain. That way, we can take the best route toward relief with fewer risks of taking the wrong path of treatment.

We will want to know about your medical history leading up to the present, as well as whether you have discussed your pain with other specialists. For example, similar symptoms can result from a herniated disc in your lower back. If you do have substantial back pain associated with thigh pain, we must rule out a herniated disc before proceeding. If you have already seen a spine specialist who ruled this possibility out, it increases the likelihood that the problem is related to the lateral femoral cutaneous nerve.

If your outer thigh pain seems to be more related to movement and centers around the hip joint, you will likely need to see an orthopedic hip specialist to make sure there are no problems with the hip joint.

Standard evaluation for meralgia paresthetica (compression of the lateral femoral cutaneous nerve) often includes testing of strength and reflexes, measurement of sensation, and physical manipulation of the lateral femoral cutaneous nerve at the hip.

Other tests frequently include:

  • Imaging tests such as MRIs or MR neurography, or CAT scans to help rule out conditions such as tumors.
  • Electromyography, in which a thin needle electrode is placed into a muscle to record electrical activity. This will confirm or rule out other neuromuscular disorders.
  • A nerve conduction study, in which electrode patches are placed on the skin to mildly stimulate the nerves. This helps diagnose the health and condition of a nerve.
  • A nerve block, in which an anesthetic is injected where the lateral femoral cutaneous nerve enters into the thigh. If this creates relief, this provides supporting evidence that the nerve itself may be involved in the pain syndrome.

Just because you have pain in your outer thigh does not always mean that the matter is related to the lateral femoral cutaneous nerve. As mentioned above, there are other causes that can be treated by other appropriate specialists. However, if a firm diagnosis of meralgia paresthetica can be made, we can shift attention toward treatment.

Early treatment of meralgia paresthetica will focus on allowing the nerve to recover on its own. In some cases—such as pregnancy—the symptoms can be eased within a few months after the baby is born and pressure is removed. Treatment will focus on aiding this relief and allowing the nerve to recover.

Other changes might include wearing looser clothing, avoiding tight or heavy belts, losing excess weight, and taking OTC pain relievers. Gentle physical therapy with nerve gliding may also be recommended.

If symptoms persist for more than 2 months, or the pain is severe enough to require more advanced treatment to reduce pain and inflammation (if needed), we may use some of these additional methods:

  • Corticosteroid injections.
  • Anti-seizure medications.
  • Topical pain-relieving creams.
  • Pain patches.

As is always the case, medicinal options may sometimes come with side effects.

If necessary, surgery to decompress or remove the nerve may be considered. These are very reasonable options, but are intended only for those who have severe and long-lasting symptoms, and when other measures have failed to provide relief.

If meralgia paresthetica sounds like a problem you are potentially experiencing, we may be able to help you. Contact our Towson office by calling (410) 709-3868 to speak with our staff. We’ll be happy to answer your questions and schedule an appointment.

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/blog/what-you-should-know-about-thigh-pain-and-meralgia-paresthetica.cfmwww.baltimoreperipheralnervepain.com-188444Tue, 30 Apr 2019 18:51:00 EST
<![CDATA[The Effects of C-Section Pain]]>Did you know that each year 1.3 million mothers go through a C-section surgery? And even after one year, up to 15 percent of mothers will still experience persistent pain following healing from their Caesarean procedure?

No matter how you are planning on delivering your baby into this world, be it naturally through the birth canal or physically removed from your body, the experience is an arduous one. As if it were not enough that your body worked every second of the previous 9 months to create another human being, your body then endures great pressure and force to actually welcome your child into this world.

So, of course, a certain degree of pain and discomfort can be expected following any surgical procedure. Caesarean section is not immune to this problem. In most cases, the pain is attributed to the body trying to heal injured tissues. This type of pain usually resolves after a few weeks. We all expect this to occur.

In other instances, however, pain with surgery may not improve quickly or may develop weeks after the incisions are healed. This is not typical of a standard recovery, and should be discussed with your obstetrician or surgeon. This type of pain may be caused by damaged nerve endings in and around the surgical incisions.

Whether you are an expecting mother or have already given birth to your new baby, we understand that experiencing constant pain after your C-section can certainly take you away from precious moments with your child.

The good news is that we may be able to help you if you are struggling with constant pain after your Caesarean section. Keep reading our blog to find out what you may expect from a C-section, what may be abnormal, and what symptoms you should be on the lookout for.

C-Section Pain

What Should You Expect?

A Cesarean section, or C-section, is the alternative option to vaginal birth. In this type of delivery your baby is taken out through an incision made through the lower abdominal wall. Most women are awake during this procedure and able to hold their baby right away.

Though most C-sections are planned, many are done when unexpected problems happen throughout the delivery process. Here are some of the most common reasons:

  • The labor is not moving along as it should.
  • The baby’s health is compromised.
  • The mother’s health is compromised.
  • The mother is carrying more than one baby.
  • The baby’s size or position causes difficulties.

Once the procedure is complete, it is normal for you to feel sick, weak, groggy and even itchy – these are all side effects of the anesthetics and should be expected. Normally, after a C-section you will stay in the hospital for 2-3 days. But all in all, the surgery is relatively safe for both you and your baby.

Still, it is major procedure and with it comes its risks. Once you are discharged from the hospital you have approximately 6 weeks of recovering on your own at home. And, this is indeed a very fragile time in which your body returns to its pre-pregnant state. So, as your body regenerates, you can expect some cramping, constipation and discomfort.

However, if your symptoms go beyond these general pains, you should first discuss this with your obstetrician.

When Pain Does Not Go Away

As with other surgical procedures, it is virtually impossible to perform a C-section without cutting into some nerves—especially those within the skin (Why do you think surgery hurts?). It is also possible to have nerves get stuck in the sutures used to close the abdominal wall, or become trapped in scar tissue during healing. Nerves do not have to be very big to cause a lot of pain.

That being said, long-term neuropathic pain (chronic pain from injured nerves) after a C-section tends to be uncommon. Normally, nerves will heal without causing lasting issues, other than perhaps some numbness around the scar. Nerve pain does not necessarily imply that anything was done incorrectly during the surgery.

Signs that may indicate you have suffered nerve damage to small branches within the skin include:

  • Burning, shooting, stabbing, shocking and searing pain around the scar and in the groin or inner thigh.
  • Pain from external stimulation that would otherwise not be painful, like water coming down from a showerhead or shaving.
  • Numbness, burning, or tingling pain along the outer thigh, down to the knee.
  • Tenderness on the sides of the abdomen.
  • Pain that wraps around from your scar to your back.

If you have had these symptoms for more than 6 months, the pain may be caused by nerve entrapment or nerve injury. We may be able to help.

The most typical nerves that are involved in chronic pain syndromes after C-sections may include:

  • The ilioinguinal nerve.
  • The Iliohypogastric nerve.
  • The genito-femoral nerve.
  • The lateral femoral cutaneous nerves.

How Can We Help You?

Dr. Eric Williams and his staff are equipped with the best tools to assess what type of nerve damage you may have suffered and which nerves in the abdominal wall or thigh may need to be addressed.

We may be able to confirm your diagnosis with a nerve block performed in the office. This essentially means that we inject an anesthetic – typically lidocaine – around the nerve in order to cause temporary numbness. If there is both numbness and pain relief, then the diagnosis of a peripheral nerve injury can be confirmed. If there is numbness but no change in the pain, the cause is probably something else. 

Once the blocks have confirmed the diagnosis, Dr. Williams and his team will walk you through potential treatment options. An appropriate treatment plan will be developed for you.

Contact Us Today!

So, if you nerve pain is keeping you from enjoying motherhood, we are able to provide you with the care you need.

For more information on this topic or to make an appointment at our Baltimore, MD office, just give us a call at (410) 709-3868. You can also fill out our handy request form online.  

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/blog/the-effects-of-c-section-pain.cfmwww.baltimoreperipheralnervepain.com-187140Fri, 01 Mar 2019 17:14:00 EST
<![CDATA[Not Sure About Us? Read Our Testimonials! (And Later, Consider Writing One)]]>Hopefully you’re already aware of the fact that our primary goal is to help people just like you overcome chronic and intense nerve pain. And this is our targeted objective for a simple reason:

We want you to be able to live life on your terms and enjoy your favorite activities—without having the frustration that comes from nerve pain.

In fact, it makes us happy every time we’re able to help a patient find relief and put their suffering behind. The best part is that we’ve been blessed to do this for many individuals.

And you don’t have to just take our word for it. In the testimonials section on our website, you can hear from many of our past patients themselves. If you’re on the fence about seeing us for a consultation, we hope you find them encouraging!

Check back often—especially to our new testimonial spotlight page, which we’ll be periodically updating with longer and more detailed stories from some of our previous patients.

A Few Examples—And the Importance of Being Honest About What We Can (And Can’t) Do

We understand—whenever you read someone’s “success story” on the internet, it can be healthy to bring a certain degree of skepticism. Is all this really true? Did it really all happen this way?

For starters, yes—all our testimonials are 100% true. But we do need to be upfront about something:

We never claim that we’re able to treat everyone. It would be absolutely amazing if we could, but no doctor can actually do that. (And if you come across one who makes that claim, they aren’t being completely honest with you—or perhaps even themselves.)

What we can do, however, is take the time to listen to you and determine if we have an appropriate technique that shows promise and may potentially be the answer to your nerve problem.

If we do, we also will perform your procedure to the very best of our ability.

For some people, the result could be total elimination of their symptoms and full restoration of function. Ask “A.R.”—according to her, she felt “good as new” after 3 months, and “better than new” after 6 months. She’s even playing tennis up to 5 times per week without pain! We always love it when the best case scenario comes true.

For others, the pain relief may only be partial. That’s simply the nature of nerve damage—these delicate and fragile tissues are not always able to fully regenerate as much as we (or you) would like, especially if they’ve been severely damaged.

However, even if we can’t “make you 20” again, there still may be a good chance we can significantly reduce, or perhaps even eliminate, your reliance on medications to get through the day. And you can still greatly expand the list of activities you can successfully perform and enhance the quality of your life.

In fact, one of our patients recently wrote a blog about her experience with extreme pain (enough to have her bedridden for most of a year) after her breast cancer surgery. Doctor after doctor turned her away, but we determined we could help.

Unfortunately, she still lives with chronic pain, but the symptoms are now manageable. Instead of being bedridden, she’s riding horses again!

Obviously, many of the testimonials you read on our site will be from patients we did help, whose results are outstanding. That won’t be everyone, unfortunately.

But you can be sure that we will also be upfront, honest, and realistic with you about if we can help, and what kind of results we think you can expect.

We’re using some of the most advanced techniques and treatments yet pioneered to help people treat their nerve pain. We’re proud of our success rate, and we stand by the work we do. If we think we can help, we’ll absolutely do everything we can for you.

Why Testimonials Are So Important (and Why You Might Consider Writing One)

If you are reading this and happen to be one of the people we’ve helped in the past, we’d like to ask you a small favor:

Would you be willing to consider sharing your story—as much as you can while retaining your personal privacy—in the form of a testimonial or review for our practice?

By doing so, you not only help us become a better practice, but also allow others who are suffering from a similar issue that you had to know that there is hope.

In other words, the main reason we ask isn’t because we need an ego boost. It’s so:

  • We can get better at what we do, by taking feedback from past patients seriously and humbly
  • Other people can find relief for their symptoms by learning about how we can help.

When you leave a review or provide your testimonial, it allows us to understand your perspective and identify areas are strong and ones in need of improvement.

Just as we take the time to listen to you in order to diagnose your condition, we take the time to read your words to diagnose the state of our practice. We do this because the only way to make improvements is to understand a current state.

If you’d like to join the other patients who have been so kind as to share their thoughts and feelings about our practice, we would greatly appreciate it. So too would those individuals suffering with chronic nerve pain who are making the important decision as to whether they feel we might be able to help them.

Remember, your words provide these people with a little extra perspective while they try to decide the next step in their search for relief from pain. If you are pleased with the care you’ve received, sharing your thoughts on the experience could make a difference for someone else who needs to be treated for a similar nerve condition or injury.

How to Write a Testimonial or Review

If you’ve decided you’d like to write a testimonial or review, first things first: thank you!

We were already truly grateful for the opportunity to serve you, and now we’re also grateful that you’ve decided to take the time to share your story. It means a lot to us.

Not sure what to mention in your review? Thoughts you might have include things like:

  • Was your experience better than you expected?
  • Was our office easy to find?
  • Did you appreciate how quickly you were seen?
  • Was our staff helpful?
  • Did your treatment make a positive difference for your health?
  • Were you able to easily find useful information on our website?

Reviews don’t have to be long—we know you have many things to do during the course of your day—and even a quick line or two can be extremely beneficial in helping someone make a decision that could potentially eliminate a lot of pain and frustration.

If you don’t want to submit a testimonial to our practice, you can also submit a review to Google, Facebook, and other online sites. This helps give patients searching for answers a quick, easy-to-find and easy-to-read message about the way we treat our patients and the kind of help we can offer.

Thank you so much, again, for your consideration.

Sincerely,

Dr. Eric H. Williams

Baltimore

(410) 709 - 3868

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/blog/not-sure-about-us-read-our-testimonials-and-later-consider-writing-one-.cfmwww.baltimoreperipheralnervepain.com-186666Wed, 13 Feb 2019 10:41:00 EST
<![CDATA[Inguinal Hernias, Groin Pain, Nerve Blocks, and Finding Relief]]>Surgery is frequently seen as a means of solving a problem, but it can come with risks.

When a doctor cuts into a patient, it is a form of trauma. It is very careful and controlled, but still trauma, nevertheless. The benefits intended with a surgery must always outweigh the risks that are involved in the procedure, but sometimes it can still leave a patient with negative results.

One such result can happen with patients who have had surgery for an inguinal hernia. This condition occurs when a soft tissue—usually part of the intestine—has protruded through an area of weakness in the abdominal muscles. This creates a painful spot that can significantly impede one’s life and, in some cases, create a life-threatening complication.

There are many recommendations to surgically repair an inguinal hernia, and the doctors who make these decisions are doing so based off very good information! In some cases, however, hernia repair surgery can result in groin pain that lasts more than 6 months following the procedure. Most research has demonstrated that at least 5-30% of patients will have significant post-surgical pain in the groin after hernia repair.

This type of pain can manifest in different ways and in different locations, including:

  • Pain that is radiating, sharp, or “electric” in the groin or lower abdomen radiating into the pubic region and groin crease, sometimes into the upper thigh
  • A burning sensation where the surgery was conducted.
  • A feeling as though something strange or foreign is in the body.
  • Pain in the testicle in men or labia in women.
  • Pain while walking, sitting, changing position, or squatting.
  • Pain felt during sex.

The cause of this pain is often nerve-related. More specifically, it is likely damage to a nerve or nerves caused during the surgery or because of scarring after the surgery.

If the culprit is not nerve damage, it might be a negative reaction to the mesh that was used for the hernia repair. It might be causing irritation, or your body might be recognizing it as an invader.

It should be noted that, in the vast majority of cases, this damage should not be blamed on the surgeon who operated. Our bodies contain such intricate and complex systems of nerves that sometimes, no matter how careful a doctor can be, some nerve damage might result. That is why there is never a non-zero risk with surgery.

If you do experience lasting groin pain following hernia repair surgery, and it is nerve-related, we may be able to help you find relief or manage it in a significant way.

What to Do About Post-Hernia Surgery Pain

To determine the best course of action for lasting pain following inguinal hernia repair, we must get our bearings on the underlying cause of the problem.

If it has been less than 6 months following surgery, some natural pain from the procedure may still be expected. Within this window, it is often best to focus on conservative treatments and see whether they do a sufficient job of managing the discomfort. Such treatments might include steroid treatment, physical therapy, and referral to pain specialists.

If pain persists, however, it is time to move on to deeper evaluation and more advanced treatments.

First, we must determine whether nerve injury or damage is at the root of the problem. Was a nerve cut or stretched during surgery, or is mesh aggravating a nerve in some way, or has the nerve been sucked into dense scar tissue? 

An important tool in making this determination is a nerve block. This is merely an injection of local anesthetic made near a targeted cluster of nerves.

If a nerve block has a significant temporary effect on your pain, that provides us solid evidence that the targeted nerves are part of the problem. Odds are high—about 85 percent—that we will be able to significantly relieve your pain. If the nerve block doesn’t work, there may still be options we can take; the chances of success are unfortunately lower, though.

Once we have performed a full evaluation, we will discuss with you the best options available for finding relief. If this involves surgery, and we both conclude that this is the way we wish to proceed, we will arrange for a procedure.

The procedure is typically outpatient and will take 1-2 hours per side that needs work. In many cases, we can reuse the same incision previously made for your hernia repair.

The nerves affected are often removed, and it is important to note that this frequently replaces the pain with numbness in the area. This numbness tends to improve over time, however, and in the majority of cases the numbness is much preferred to the pain that existed beforehand.  The nerve blocks help the patient determine if the numbness is tolerable and preferable over the original pain.

You will be permitted to go home following the surgery (barring any complications), and will be able to slowly increase your level of activity over the following days. The nerve removal procedure will usually take a shorter period to recover from than the original hernia repair.

But What About… Performance?

When it comes to matters of groin pain and nerve removal, there is naturally some question about whether it will affect sexual performance.

There is good news on this front: the nerves that are likely causing your pain are not the same ones responsible for your sexual organs.  Their sensations should not be affected, and not having your pain anymore should be a significant mood-booster as well!

We’ll Help Your Pain However We Can

We have had years working with persistent groin pain caused by nerve damage and have seen many happy patients as a result of it. You can see some of their testimonials here, if you wish.

We wish we could guarantee full relief and recovery for all patients, but that is simply never the case. What we can promise is to do all we can within reason to provide as much relief and comfort as possible.

You don’t have to deal with your post-surgical pain on your own. Call our Towson office at (410) 709-3868 to schedule an appointment with Dr. Williams, or use our online form to reach us electronically.

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/blog/inguinal-hernias-groin-pain-nerve-blocks-and-finding-relief.cfmwww.baltimoreperipheralnervepain.com-186561Fri, 08 Feb 2019 13:09:00 EST
<![CDATA[Get Your Free Whitepaper Today!]]>One of our goals with this website is to help you understand why you might be having nerve pain and how we can potentially improve the situation for you. We understand that nerve pain is an incredibly frustrating situation—one that can keep you from the things you want to do in life, along with making what you need to do a miserable experience.

That’s already frustrating enough as is, but the frustration is (understandably) ramped up when you’ve undergone a procedure that was supposed to take away your pain or restore function.

To help you have a more comprehensive understanding of this issue, we have created a whitepaper—and are happy to provide it to you at absolutely no cost!

Please click here to receive your complimentary copy of “Chronic Nerve Pain Following Knee Surgery – For Sports Injuries, Knee Replacements, or Other Procedures.”

Why does chronic nerve pain happen after surgery?

Nerve pain following surgery can be a problem in many different areas of the body. We help patients who have had surgeries in ankles, hips, and upper extremities—only to end up with chronic pain.

When that happens, it’s easy to wonder why it’s happening or if there was something your surgeon had done incorrectly during the procedure.

Now, before you start attributing your chronic nerve pain after knee surgery is a sign of incompetence on behalf of your surgeon, something to keep in mind is this:

Surgeons do the best they can in situations that are sometimes remarkably complicated.

Our bodies are complex structures featuring an astounding number of moving parts—and this is something we can say when everything’s fine and performing as intended! When an injury or troublesome condition is present, that picture becomes much more complicated.

For example, an internal injury to a joint as valuable and commonly used as a knee requires a surgeon to cut through several layers of body tissue to reach the injury site. There’s an inherent risk of inadvertently severing a nerve in doing so.

That being said, your surgeon likely took every precaution in the book to prevent this from happening. The problem is, sometimes it’s simply an unavoidable situation.

You have peripheral nerves running throughout your entire body, which results in a network that is necessary so your central nervous system—your brain and spinal column—can effectively communicate with all the other parts of your body.

We need these nerves for both movement and sensory purposes. Unfortunately, this means the peripheral nervous system is quite vast. It can be next-to-impossible for even the world’s best surgeon to completely avoid the nerves in certain situations.

Areas where it can be especially tricky to avoid nerves are in knee repair and replacement. At the same time, these tend to be fairly common procedures.

Some postsurgical pain is actually normal…but not all!

Before we move forward, we need to note something important:

No matter the surgery, you will likely have at least a certain degree of pain and soreness afterward and during the recovery period. This makes sense when you consider the fact that surgery is actually “planned physical trauma.”

As we mentioned, surgeons need to cut through body tissues to reach an injury site. It will take your body time to recover from this, and that is completely normal.

What isn’t normal is pain that is chronic—lasting six months or longer following the procedures—or neuropathic (nerve-related) in nature. You should expect typical post-operative pain to subside within a couple of months after the surgery. If you’ve hit the six-month mark and are still having pain, it’s entirely possible a nerve was injured during the procedure itself.

Your first step in determining the problem is to have your treating physician or surgeon reexamine the affected knee. You will learn if everything appears to be normal from a structural context, including making sure any hardware was installed correctly, there are no signs of infection, the injured site has healed in a normal manner (from an orthopedic perspective), etc.

You will probably even want to get a second opinion, just to be sure.

In the event you are having severe pain outside of a typical recovery period and the appropriate medical professionals are assuring you everything looks as it should, there’s a high probability the problem is neuropathic.

So what might have happened to the affected nerves? After all, this pain wasn’t always there, right?

Every case is a bit different, but it is possible nerve tissue was injured during the procedure itself or had become entrapped in scar tissue during the recovery phase. There is also the chance that hardened scar tissue now presses against a nerve (compression).

Injury, entrapment, and compression all can lead to symptoms such as:

  • Burning, tingling, and “pins and needles” sensations
  • Pain in a surgical scar or the surrounding area
  • Inability to kneel without pain
  • Intense pain from contact with objects (even light ones)

Those are just a couple of symptoms you might experience. For a more comprehensive list, get your free copy of Chronic Nerve Pain Following Knee Surgery – For Sports Injuries, Knee Replacements, or Other Procedures” today!

Neuropathic issues such as chronic pain following knee surgery need to be addressed. When they aren’t, the severe pain will persist and you risk the problem worsening over time and/or potentially becoming permanent.

Finding relief from chronic, neuropathic pain after surgery

That may sound rather dire, but there is hope:

We have techniques that might be able to help your situation.

How do we know that? Because we’ve helped other patients find relief from severe, chronic pain following knee surgeries—and there’s a chance we can do the same for you!

Our understanding of how frustrating this situation can be coming from years of experience treating patients for nerve pain following surgeries that were supposed to make things better. This is why we’ve created a whitepaper covering this subject. We want you to know more about what might be happening and, perhaps even more importantly, what we may be able to do to find you relief.

When you come in to see us, we’ll start with a careful medical evaluation and diagnosis as we work to establish the core issue. As part of this, we take the time to listen to you as you describe your symptoms, let us know what happened—both with regards to your surgery and why you had one in the first place—and share any potential concerns.

With this information, we can start to determine if there is anything we can do for you, and which specific procedures might be best used to resolve the problem.

If you are still having pain following surgery for knee injury, and the knee has been reevaluated by appropriate medical professionals, you should contact us for a consultation. You should also see us if you’ve been injured and had conservative treatment that should have worked, but still have severe and chronic neuropathic pain.

Together, we can discuss your situation and start working on a plan to resolve it. If you are worried that you are going to need surgery, it’s important that you know we are happy to provide recommendations for nonsurgical options (if we feel they could be beneficial to you). So there’s no need to worry about that!

The important thing is this:

You have a painful, frustrating problem and we will do everything within our power to help you find the relief you need.

For more information on this issue, you may want to take a moment to get your copy of “Chronic Nerve Pain Following Knee Surgery – For Sports Injuries, Knee Replacements, or Other Procedures.” And if you are in pain and would like to request a consultation with our Baltimore office, simply give us a call at (410) 709-3868 and one of our staff members will be happy to assist you.

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/blog/get-your-free-whitepaper-today-.cfmwww.baltimoreperipheralnervepain.com-183849Fri, 28 Sep 2018 16:51:00 EST
<![CDATA[Why You're Having Knee Pain After Surgery]]> 

Knee replacements are some of the most successful operations performed and surgical knee repair is also usually successful. This means the majority of patients find knee surgery to be a life-changing experience. In this case, the “life-changing” is positive!

Whether we are talking about knee replacement or repair, most patients are able to perform activities in a pain-free manner—something they have not done for many years in some cases—following the procedure.

Unfortunately, “most successful” and “usually successful” aren’t the same as “always successful.”

This means not every patient is satisfied following his or her total or partial knee replacement or other surgery. For some patients, there is still pain afterwards. For others, the pain is different in nature and/or even more intense than it had been in the first place.

That is a very frustrating situation and when it happens, patients often ask “Why is this happening? I thought I was supposed to get better!”

 

Knee Pain After Surgery

 

Well, there are a couple different explanations as to why you might have knee pain after surgery.

The first is simply the fact surgery hurts. It is a traumatic experience for your body, even if it’s an intentionally traumatic experience (unlike, say, an auto accident – which is something people don’t typically plan for).

This makes sense when you consider the fact your surgeon literally had to cut through body tissue to fix or replace your knee. As such, it is reasonable to expect at least a certain degree of pain in the period shortly following the procedure.

Now, our focus today isn’t on this normal, to-be-expected postoperative pain. That kind will usually go away in time. Rather, our focus is on chronic, neuropathic pain following knee surgery or replacement.

(In the cases of surgery to repair an injured knee, the neuropathic pain may also present itself after the initial injury – depending, of course, on the nature of the injury.)

If it’s been longer than six months after your surgery and you are still having pain and difficulty, there’s clearly a problem!

Your first step in determining why that’s happening and what is wrong—and potentially finding an answer—is to have your treating physician or surgeon reexamine the affected knee. In doing so, you will learn if everything appears to be normal from a structural context. You may even want to get a second opinion, just to be sure.

If you have severe pain outside of a typical recovery period and the appropriate medical professionals are assuring you everything looks as it should from an orthopedic and biomechanical perspective, there’s a distinct possibility that the problem is neuropathic (nerve-related).

Nerve pain following knee surgery—whether total or partial joint replacement on account of severe arthritis or repairing damage due to a sports injury—tends to have similar root causes as nerve pain following any kind of surgery.

So, what might have happened to the affected nerves? After all, this pain wasn’t always there, right?

Well, every case is a bit different, but it’s certainly possible you had nerves that were injured during the procedure or perhaps had become entrapped in scar tissue as your body was recovering. If any anatomical structures were moved during the surgery, they might be pressing on nerve tissue (which is known as compression).

Nerve injury, entrapment, and compression can cause symptoms to develop, including ones like:

  • Burning, tingling, and “pins and needles” sensations
  • Intense pain from contact with objects (hypersensitivity)
  • Pain in the scar or surrounding area

With regards to nerve injuries that result from nerve surgery or replacement, some specific issues include:

  • Transection of the infrapatellar branch of the saphenous nerve (ISN). When a surgeon performs total knee arthroplasty by using a standard midline skin incision, transection of the ISN—or its terminal branches—is common. This will usually cause an area of numbness, but it also can result in a painful neuroma in rarer cases.

It’s important to note that the progression of postsurgical pain from this root cause can be relatively slow and not terribly intense in the early stages. You might not recognize the problem until symptoms intensify later.

  • Common peroneal nerve damage. Nerve damage can also occur after knee replacement surgery because the peroneal nerve resides close to the tibia bone. In fact, nerve damage is one reason why some people have persistent lateral knee pain and loss of function in a newly replaced knee.

If this is the source of your pain and difficulty, it may be possible to decompress the peroneal nerve surgically, thereby allowing it more room to recover. 

  • Neuromas. When nerves are inadvertently cut during a procedure, it can potentially lead to the growth of a neuroma. The reason this happens is because constant chemical and electrical activity within operating nerves prevents the release of something we call nerve growth factor (NGF). When a nerve is severed and the normal chemical and electrical activities are interrupted, NGF is released.

NGF causes the severed nerve endings in the area to grow tiny appendage-like features known as dendrites. These dendrites sprawl out as they slowly grow – searching for other nerve tissue they can attach themselves to. Usually, they end up attaching themselves to various non-nerve tissues, such as muscles, bones, and scar tissue. Whenever anything pulls on or compresses against these raw nerve endings—something that happen as the body moves—it causes painful symptoms that can be rather intense.

People seek knee surgery to repair nerves, ligaments or other damage in the knee area, or to replace an arthritic joint. In doing so, they expect to find relief from pain and restored mobility and joint function.

Most of the time, the surgery was successful and patients walk away—after they’ve recovered!—with the results they had hoped to see.

Other times, though, there is pain that perhaps wasn’t there before, and now you understand why this might have happened. More important than just knowing what has happened is to take measures to correct the problem – and that’s where we come in.

We have been able to help people just like you find relief from postsurgical pain throughout the body, including knee joints that have been repaired or replaced. In the event this is what you are suffering from, we may be able to do the same for you.

If you’ve already gotten second opinions from appropriate medical professionals who tell you everything appears just fine from an orthopedic perspective—and it’s been more than six months (which means the pain is chronic in nature)—contact our Baltimore office for a consultation. We would love to try and help you find the relief you need.

Give us a call today at (410) 709-3868 and one of our team members will be happy to help you schedule an appointment that works best for you.

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/blog/why-you-re-having-knee-pain-after-surgery.cfmwww.baltimoreperipheralnervepain.com-182110Tue, 26 Jun 2018 16:28:00 EST
<![CDATA[Why Finding Help for Pain is Never a Lost Cause]]>When you have pain—and especially neuropathic pain that is intractable or chronic—it can make life a simply miserable experience.

In fact, you might have symptoms such as:

  • Burning, tingling, electrical, or “pins and needles” sensations
  • Severe discomfort just from wearing clothes
  • Intense pain caused by contact with light objects, such as a bedsheet, drops of water in a shower, or even the wind blowing across your skin
  • Pain that makes it difficult to sleep and wakes you up during the night
  • Feeling as though an affected limb is wrapped in barbed wire
  • Pain in a scar or the surrounding area (if surgery was performed)
  • Numbness

Beyond the fact pain obviously hurts, it can also limit your ability to participate in favorite activities, let alone allow you to do the things you simply need to do – such as work and perform household chores.

Unfortunately, there was a time when some pain was considered by medical professionals to be something many patients had to learn to just “live with.”

The good news, however, is that time has passed!

Person having trouble sleeping

Now, some patients report continuing pain in the absence of a definitive pathology—which is an identifiable, anatomical cause of the pain—and are still sometimes dismissed by certain doctors and other health professionals. This does tend to be the exception rather than the rule, however.

In recent years, we have started to learn more about pain than we’ve ever known. This has led to a range of pain management treatments and surgical repair options that can possibly provide complete, or at least partial, pain relief for patients. Often, the journey to pain relief is best handled in a multidisciplinary team approach.

Our role in helping you find that relief is to search for surgically treatable causes of pain, and then determine if we have a technique that can help to address it.

Let’s look at why finding help for your pain is never a lost cause.

Accordingly, it makes sense to explore every avenue possible to identify and treat the source of the pain!

Before we proceed further, let’s take a moment to quickly clear up the role of our colleagues who participate in the field of pain management.

Pain management is an important discipline, one used to take away a patient’s pain so he or she can perform normal activities and enjoy life. Further, this practice is sometimes the best option for a patient when a root cause cannot be established.

That said, if there is a root cause that can be established and addressed, it is best to do so. In many, but certainly not all, cases wherein there seems not to be an identifiable cause, the problem could very well be neuropathic (nerve-related).

Neuropathic pain can present in many different ways – all of which highlight the importance of seeking proper relief and treatment. Depending on your case, you may experience problems like:

  • Numbness or Tingling – As is the case with dizziness, numbness and tingling can be caused by many medical problems. A primary care doctor can manage many of these problems, but some require the attention of a nerve specialist – particularly cases that are chronic in nature. If numbness or tingling has a sudden onset—and there is muscular weakness present—this might be sign of a stroke and should be evaluated immediately.

If the numbness or tingling has developed in response to injury or following a surgical procedure, the problem may be neuropathic in nature. Often, this is the case when, after a surgery, the treating surgeon (or your physician) reports that everything looks fine from a structural context. In such a case, you should seek a second opinion. If you are still being told there is noobvious reason for the pain, it is time to contact our office for a consultation.

  • Chronic Pain – Chronic pain lasts for months or even years. This pain can be the result of injury or illness, but when it lasts longer than the usual recovery time, it may be the indication of a different problem – one that can be nerve-related.

If this pain is something your primary care physician cannot help you manage, you should consider coming in and seeing us for an evaluation, and especially if you are being told there is no obvious reason for the pain you’re experiencing.

  • Weakness – Some people confuse weakness with fatigue. An example of true weakness is being unable to lift something no matter how hard you try, although you may have been able to do so earlier.

There are cases of weakness best handled through orthopedic specialists who are trained to address problems within the musculoskeletal system. When the problem isn’t a matter of muscle (or connective tissue) weakness, we may need to search for answers within the peripheral nervous system.

That said, some problems develop as a result of a problem with the central nervous system. In this case, you should seek consultation with an office that specializes in spinal cord and brain issues. Our practice’s focus is on the nerves that branch out from the spinal cord and extends to the limbs and outer regions of the body.

  • Difficulty with Movement – As with weakness, difficulty with movement can be a matter of a problem within either the central nervous system or musculoskeletal system. In these cases, there are other talented specialists who may be able to find a solution to the problem.

If you are having movement issues because of damaged, injured, or compressed peripheral nerves, we will be happy to evaluate your situation and determine if any of our techniques—or perhaps alterations to an existing technique—may be able to help.

Someone with pain in the knee

Depending on the source of your pain and difficulty, these kinds of symptoms could be relieved by procedures such as peripheral nerve reconstruction or decompression. We can determine which procedures might be appropriate based on our evaluation.

In the case of a compressed nerve that is causing the problems, we will start by identifying affected nerves, and then creating a plan to relieve pressure from the anatomical structure that is overlying the nerve (and putting pressure upon it). Releasing excessively tight vessels or tissues (such as fascial bands) that had been pressing on the nerve can restore normal nerve function and regeneration, thereby reducing or even eliminating the nerve pain.

It is important to note that some cases of advanced neuropathy or other nerve damage progress to the point that surgery can no longer reverse the problem. This highlights the importance of seeking timely intervention. At the same time, the only way to determine whether this is the case is by seeking professional consultation.

If you are experiencing pain and have been unable to find help elsewhere, don’t give up hope just yet!

We have been able to help patients who thought they were out of options and had no other choice but to rely on pain medication for the rest of their lives. There is a chance we may be able to do the same for you!

You should have every option available to you in life, yet pain takes that away. Give us the chance to help you get your options back. Contact our Baltimore office today by calling (410) 709-3868 and one of our friendly staff members will be glad to assist you. If you prefer, you can also take a moment right now to contact us online as well.

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/blog/why-finding-help-for-pain-is-never-a-lost-cause.cfmwww.baltimoreperipheralnervepain.com-181013Fri, 18 May 2018 00:10:00 EST
<![CDATA[Lingering Pain After Knee Surgery – Why It Happens and How]]>We understand it can be incredibly frustrating to have knee pain in the first place. After all, you rely on your knees for mobility and independence. Of course, it's even more frustrating when you've undergone a surgical procedure to correct the problem—either to repair damage or even replace the entire knee joint itself—and are still having issues more than six months afterwards.

Unfortunately, this is a situation that can happen sometimes, just like with other surgeries.

Now, before you start thinking chronic knee pain after surgery is the fault of your treating surgeon, something we want you to keep in mind is this – even the best surgeon in the world, using the best equipment and current available surgical techniques, might still inadvertently damage nerve tissue during an operation.

X-ray image of knees in pain

That is something we bring up often because there is simply unavoidable risk when a surgeon has to cut through layers of body tissue to perform the procedure.

Measures will always be taken to keep the odds of that happening as low as possible, but it is virtually impossible to eliminate the chance there may be some nerve damage or problems that develop during (or after) your surgery.

Remember, your peripheral nerve system is a vast network that is almost like a spider-web in regard to its connectivity. The peripheral nerves are found throughout the entire body, and this makes avoiding them in surgery borderline-impossible (especially for certain procedures).

At the same time, the risk doesn't always materialize and a patient will recover just fine.

Before proceeding further, we have to note that you can expect to have at least some pain and soreness following any surgery you might have. This makes sense because surgery is actually an intentional trauma done to the body. After all, a surgeon has to cut through layers of body tissue to reach the anatomical site in need of correction or repair.

In this case, we aren't talking about this normal postoperative pain you should expect. That kind of pain usually subsides in a relatively short amount of time.

Rather, we are talking about pain after knee surgery that is both chronic and neuropathic. (Depending on your initial injury, you may even experience these kinds of symptoms before the surgery as well – particularly if the injury damaged any of the nerves leading to or from the knee).

If it has been longer than six months following the procedure and you still have pain and difficulty, this is an indication of an existing problem – one we may be able to help.

As with virtually any problem you encounter in life, the first step in finding a solution is determining what exactly is wrong. For pain after knee surgery, this means having your treating surgeon, knee specialist, or even primary care physician examine the affected knee.

This is done to determine if everything appears to be normal from an orthopedic (structural) context.

You probably should even seek a second opinion from another doctor, just to confirm that everything appears structurally-sound.

If you have been experiencing severe pain outside the typical recovery period time (and your treating surgeon will have provided you with guidelines in this regard) and appropriate medical professional assure you everything appears as it should in diagnostic imaging and physical exam, then there is a high probability you have a neuropathic (nerve-related) problem, instead of a musculoskeletal one.

At this point—when everyone else is saying it looks fine and are recommending pain management as the only course of action—we need to start asking what could have happened to the affected nerves. After all, you weren't always having this pain, right?

Every patient's case is unique in various regards, but it is quite possible nerve tissue was damaged during the surgical procedure itself, or it had become entrapped in scar tissue during the recovery phase.

There's also a chance that other body tissue (like your knee cap or a tendon) had been moved during the surgery—even if only slightly—and now is pressing against a nerve tissue. Compression like this can impair normal nerve function.

All of these possible issues—nerve injury, entrapment, or compression—can lead to a range of neuropathic symptoms, some of which include:

  • Burning, sharp, tingling, the feeling of "pins and needles," and other abnormal sensations
  • Intense pain from even light contact with objects, including your bedsheet or the water coming down in the shower
  • Pain in the actual surgical scar (or in the surrounding area)

(These are just a couple of symptoms you might experience, so please do not consider this list to be comprehensive of all possible situations.)

X-ray of a knee in pain

Neuropathic issues such as chronic pain following knee surgery need to be addressed. When they aren't, the severe pain will persist and you risk the problem worsening over time and/or potentially becoming permanent.

That may sound rather dire, but there is hope!

We have techniques that may be able to help you. How do we know this? Because we've been able to help other patients find relief from severe, chronic pain following knee surgeries. There's a chance we can do the same for you.

To determine whether or not we might have the right techniques for your case, we'll start with a careful medical evaluation and diagnosis to establish the core issue.

A deep understanding of the problem is the starting point that allows us to establish A) if there is anything we can do and B) which specific procedures would be best for addressing it. Naturally, this will depend on the specifics entailed with your case, but we may recommend using nerve decompression, nerve transfer, nerve grafting, other nerve repair, or even removal procedures (for some nerves).

An important part of this whole process—one that not every doctor actually does—is the fact that we will take the time to actually listen to you. We consider it important to understand the nature of the initial injury, the symptoms you are experiencing, and other details that provide greater insight into your condition.

In the event you are still having pain following surgery for knee injury—or even if you've been injured and had conservative treatment that should have worked (but you still have severe and chronic neuropathic pain)—and the knee has been reevaluated by appropriate medical professionals, you should contact us for a consultation.

We will discuss the problem together. If there are nonsurgical options that are available and might work for you, we will recommend them to you.

For more information, or to request a consultation with our Baltimore office, simply give us a call at (410) 709-3868 and schedule an appointment that works best for you.

 

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/blog/lingering-pain-after-knee-surgery.cfmwww.baltimoreperipheralnervepain.com-180555Tue, 24 Apr 2018 07:46:00 EST
<![CDATA[Do You Have Pain After an Ankle Sprain Surgery?]]>Having pain is a frustrating experience, and usually even more so after you've had a surgical procedure that was supposed to eliminate the pain. Unfortunately, this is something that does happen.

Now, before you start to think pain following surgery is a sign of incompetence on behalf of your surgeon, consider this: even the best surgeon in the world using the very best current techniques available might still inadvertently damage nerves during surgery. This is simply an inherent risk from cutting through layers of body tissue.

Remember, peripheral nerves run throughout the body in a vast network. They are all over the place and this makes avoiding them extremely difficult (and borderline-impossible for certain situations).

There are certainly many different surgical procedures you could undergo and develop chronic pain afterward, but a common one is surgery to repair an injured ankle. Fortunately, most people do recover without any problems.

Before we proceed, it is important to note that you will likely have some pain and soreness following virtually any procedure. This is logical because surgery is on intense, neuropathic pain lasting longer than six months following an ankle surgery. (Depending on the nature of your injury, this situation may also present itself after the initial injury.)

If it's been longer than six months and you are still having pain and difficulty, there's a problem!

Your first step in determining what is wrong—and potentially finding an answer—is to have your treating physician or surgeon reexamine the affected ankle. In doing so, you will learn if everything appears to be normal in a structural and biomechanical context. You may even want to get a second opinion, just to be sure.

In the event you are having severe pain outside of a typical recovery period and the appropriate medical professionals are assuring you everything looks as it should (or at least as good as it can be), there's a high probability the problem is neuropathic (nerve-related).

Ankle wrapped up after a surgery

Neuropathic Pain

What might have happened to the affected nerves? After all, this pain wasn't always there, right?

Every case is a bit different, but it is possible nerve tissue was injured during the procedure itself or had become entrapped in scar tissue during the recovery phase.

Injury, entrapment, and compression of the nerves can all lead to symptoms such as:

  • Burning, tingling, and "pins and needles" or orhter altered sensations

  • Intense pain from contact with objects, even light ones like your bedsheet

  • Pain in the scar or surrounding area

  • Numbness

These are just a couple of symptoms you might experience. For a more comprehensive list, get your free copy of "Chronic Pain After an Ankle Injury" through our website!

Neuropathic issues such as chronic pain following ankle surgery need to be addressed. When they aren't, the severe pain will likely persist and you may risk the problem worsening over time and/or potentially becoming permanent.

Furthermore, if treatment is delayed for a prolonged period of time, treatment tends to be less effective.

That may sound rather dire, but there is hope!

Options from a Peripheral Nerve Specialist

We have techniques that may be able to help you. How do we know this? Because we've been able to help other patients find relief from severe, chronic pain following ankle sprain surgeries. There's a chance we can do the same for you.

To determine whether we might have the right techniques for your case, we'll start with a careful medical evaluation and physical exam to establish a diganosis explaining the core issue.

A deep understanding of the problem is the starting point that allows ut to establish A) if there is anything we can do and B) which specific procedures might be best for addressing it. Naturally, this will depend on the specifics entailed with your case, but we may recommend using nerve decompression, transfer, grafting, other repair, or even removal procedures.

You can learn more about this process in "Chronic Pain After an Ankle Injury (Even if You've Had Surgery)." (And it doesn't cost you a dime.)

An important part of this whole process—one that may be taken for granted—is the fact that we will take the time to actually listen to you. We consider it important to understand the nature of the initial injury, the symptoms you are experiencing, and other details that provide greater insight into your problem.

It is this understanding of the situation (and how much frustration it can create for you) that led us to put together the whitepaper about it. We want you to know what is happening and, perhaps more importantly, what can potentially be done to resolve it for you.

In the event you are still having pain following surgery for ankle injury—or even if you've been injured and had conservative treatment that should have worked (but you still have severe and chronic neuropathic pain)—and the ankle has been reevaluated by appropriate medical professionals, you should contact us for consultation.

We would be happy to hear from you so we can discuss and evaluate your situation together. Hopefully, we may be able to help you move closer to your goals for recovery.

For more information, take a moment to get your copy of "Chronic Pain After an Ankle Injury (Even if You've Had Surgery)." If you need to request a consultation with our Baltimore office, simply give us a call at (410) 709-3868 and schedule an appointment that works best for you.

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/blog/do-you-have-pain-after-an-ankle-sprain-surgery-.cfmwww.baltimoreperipheralnervepain.com-179876Thu, 22 Mar 2018 11:04:00 EST
<![CDATA[Posterior Head and Neck Pain]]>
Head and Neck Pain

Head and neck pain is a common problem faced by millions of men and women in our country (and all over the world). The causes and severity of pain in the head and neck regions can vary drastically. In some cases, the pain is simply an annoyance. At other times, it can be downright debilitating.

Our office specializes in neurologic issues relating to the peripheral nerves throughout the body. One area of special interest is when pain is caused by occipital nerves. If you are suffering from moderate to severe posterior head or neck nerve pain (not coming from spinal cord issues), we may be able to help.

This blog post might give you an idea as to what is possibly happening, but please keep in mind it is not a substitute for receiving a professional diagnosis obtained by reviewing medical records, medical history, and conducting a physical exam. Doing so can give you a better idea as to what is actually going on and what may be needed to address it. Our hope with this post is to give you more information which may help guide decisions made with your medical team.

It is important that patients are first ruled out for life-threatening problems before coming to our office. You might need to see a spine specialist or pain management specialist.

From a very general overview, head and neck pain are sometimes caused by physical tension, hormones, sinus issues, tooth infections, jaw joint issues, hypertension, illnesses, and pinched nerves.

Obviously, that is a wide range of potential root causes. If your head and/or neck pain is the result of anything not related to your peripheral nerves, you may want to start with a visit to your primary care physician. This is a good starting point for determining why you are experiencing the pain. In the event it is determined to be nerve-related and you have not found relief elsewhere, come see us for a consultation.

Two potential nerve-based sources of head and neck pain are occipital neuralgia and peripheral nerve compression.

Whiplash

One of the most common sources of posterior head and neck pain is occipital neuralgia – a condition that occurs because of peripheral nerve compression. We see this condition in two major groups of individuals who experience whiplash – sports-related concussions and auto accidents.

Occipital neuralgia is a condition wherein the nerves running from the spinal cord to the scalp are damaged, stretched, compressed, or otherwise injured. We currently believe occipital nerves in the neck after stretch traction injury or have become bruised and damaged can result in swelling and compression.

This is often confused with migraines (which highlights the importance of having a professional diagnosis!). Occipital neuralgia causes sharp, aching, throbbing pain that usually starts at the base of the head in the neck and moves forward towards the forehead. With posterior occipital neuralgia, the pain radiates up the back of your skull.

For some post-trauma patients, head and neck pain changes with the weather or becomes more severe with increased barometric pressure. Also, exercise can lead to issues when blood pressure is elevated or you are moving your head and neck (especially with repeated actions and activities). Further, looking down may be painful.

Your pain may also be caused by issues with peripheral nerves in back of neck.

Your body relies on a vast network of peripheral nerves to communicate with your central nervous system (the brain and spinal cord). Due to various potential issues, sometimes these nerves become compressed (pinched). When this happens, the nerves do not perform as intended, and this can cause many kinds of painful sensations.

Doctor
 

Some patients may need nerves to be surgically released from structures across the neck – like small muscles, blood vessels, and scar tissue. (One can think of this as being like tarsal tunnels syndrome for the back of the head.)

We should not be your first stop for this particular issue. Affected individuals generally have a good chance to resolve when condition is caught early and seen by a neurologist Kevin Crutchfield, M.D., at Sinai. However, if aggressive nonsurgical does not provide the relief you need, surgical management could be the answer you are seeking.

If you are unable to find relief from posterior head and neck pain through other treatment options—medication, physical therapy, etc.—there’s a chance peripheral nerve surgery is the appropriate course of action.

When you come see us, we will not automatically recommend surgical intervention. Instead, we take the time to listen to you, carefully evaluate your situation, and then decide whether we might have the right techniques to help. If we determine you would be better served by seeing a different kind of medical specialist, we will say as much. But if we think we may be able to help, we will let you know that as well.

For more information on head and neck pain—or to request your consultation—give us a call at (410) 709-3868.

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/blog/posterior-head-and-neck-pain.cfmwww.baltimoreperipheralnervepain.com-179128Mon, 12 Feb 2018 14:37:00 EST
<![CDATA[Help for Migraines]]>migraine treatment

One area we haven’t spent too much time on (to this point) here in our blog is treatment for migraine headaches. Migraines are a common medical condition, one experienced by an estimated 3 million people every year. Many of those individuals suffer from the pain because they are unaware of the fact there are treatment options. Our goal is to help you understand that you do not have to live with this pain!

Many people who suffer from migraines have only one or two migraine attacks each year, but some people have several migraines every month. Millions of people worldwide suffer from migraines – most commonly women 25-55 years old.

Migraine sufferers often have difficulty leading a normal life, with unplanned time away from work and other routine activities. Migraine attacks can last for hours to days, leaving you unable to function normally.

We want to make sure you understand the full range of treatment options before considering what may work best for you. So what possibilities are available if you suffer from migraines?

An emerging field of migraine “treatment” is counseling (cognitive behavior therapy). Some doctors may recommend either mindfulness-based therapy or acceptance and commitment therapy (ACT). Essentially, both of these counseling therapies are centered on accepting that you might have pain, but teaching you to be mindful of your body and/or focus on other things (like goals).

If you wish to try this kind of treatment, it is certainly your choice. We do think you should view this as more of a “last option” and try first to see if you can actually have the problem resolved.

A more “active” treatment that some doctors may prescribe involves the use of electrical stimulation delivered via different kinds of devices. There could potentially be some benefit in transcutaneous electrical nerve stimulation (TENS), and it might be worth checking with your primary care physician about these kinds of options.

The old standby for migraines is medicinal treatment. There are many different medications that could be prescribed or recommended to resolve the problem of recurrent migraines. For some affected individuals, the right medicine can make a huge difference. Of course, as with almost any condition treated in this way, a potential issue is side effects experienced while taking medicine.

If you have side effects from migraine medication, it is up to you to decide if they are worth the relief you receive. In the event they aren’t—and you are unable to find any other treatment that works for you—we might be able to help.

Sensory nerve irritation near muscle tissue is thought to be involved in trigger sites for migraines. Some of these trigger sites can be targeted by surgical intervention

Trigger points that might benefit from surgical release include:

Nerve
  • Forehead Migraines, which typically start behind the eyebrows or between the eyes and may be worse in the late afternoon. One side may be more affected than the other. Treatment of the frontal zone focuses on the glabellar muscle group (found in the forehead and eyebrow regions).
     
  • Temporal Migraines, which typically start in one or both temples and may be worse in the morning. There may be temporomandibular joint (TMJ) tenderness and a history of grinding teeth. Temporal migraines are treated by removal of a segment of the trigeminal nerve. Removal of a portion of this nerve is well-tolerated since only a slight sensation goes away and the surrounding nerves help return some sensation to the skin.
     
  • Occipital Migraines, which typically arise in the back of the neck and head before spreading. Occipital migraines can be initiated by stress or heavy exercise. This particular type of migraine is treated through nerve release surgery via an incision on the back of the neck.
     
  • Nasal Migraines, which often start around the eyes and nose, and can be worse in the morning than other points throughout the day. These migraines are usually related to weather, hormones, or allergies, and may be accompanied by nasal drainage.

To determine if migraine surgery could be right for you, consider the following questions:

  • Do you regularly have at least 2 migraine headaches every month?
     
  • Have tried several different types of medication to manage the problem?
     
  • Have you been diagnosed with chronic migraine headaches by a neurologist?

If you answered any of these questions with “yes,” it might be time to contact our office and request an appointment for a consultation. We may be able to identify your personal trigger points and then determine if one of our techniques could potentially provide the relief you need.

For more information—or to schedule your appointment—simply give us a call at (410) 709-3868 or connect with us online right now.

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/blog/help-for-migraines.cfmwww.baltimoreperipheralnervepain.com-178648Fri, 19 Jan 2018 08:09:00 EST
<![CDATA[Diagnosing and Treating Meralgia Paresthetica]]>Previously we looked at why meralgia paresthetica happens, so today let’s discuss what is entailed with professional diagnosis and various treatment options you may need to find relief.Man holding his outer thigh

In most cases, we can make a diagnosis of meralgia paresthetica based on your medical history and a physical exam. This can entail testing the sensation of the affected thigh, having you describe the pain, and perhaps asking you to trace the numb or painful area on your thigh. Additional examination including strength testing and reflex testing might be done to help exclude other causes for the symptoms.

To rule out other conditions, we might recommend imaging studies. Although no specific changes are evident on X-ray if you have meralgia paresthetica, images of your hip and pelvic area might be helpful in excluding other conditions as a cause of your symptoms.

If we suspect a tumor could be causing your pain, we may order a CT scan or MRI. Other potential diagnostic tests we might use include:

  • Electromyography. This test measures the electrical discharges produced in muscles to help evaluate and diagnose muscle and nerve disorders. A thin needle electrode is placed into the muscle to record electrical activity. Results of this test are normal in meralgia paresthetica, but the test might be needed to exclude other disorders when the diagnosis isn't clear.
  • Nerve conduction study. Patch-style electrodes are placed on your skin to stimulate the nerve with a mild electrical impulse. The electrical impulse helps diagnose damaged nerves. This test might be done primarily to exclude other causes for the symptoms.
  • Nerve blockade. Pain relief achieved from anesthetic injection into your thigh where the lateral femoral cutaneous nerve enters into it can confirm that you have meralgia paresthetica. Ultrasound imaging might be used to guide the needle.

For some people, the symptoms of meralgia paresthetica simply ease in a few months and treatment is focused on relieving nerve compression.

Conservative measures for treating symptoms include:

  • Wearing looser clothing
  • Losing excess weight
  • Taking OTC pain relievers such as acetaminophen, ibuprofen, or aspirin

If your symptoms persist for more than two months or you have pain that is severe, treatment might include corticosteroid injections, anti-seizure medications, or tricyclic antidepressants. These treatment options temporarily relieve pain and, for certain kinds, reduce inflammation. As is often the case, medicinal options may come with possible side effects.

Rarely, surgery to decompress the nerve is considered. This option is only for people with severe and long-lasting symptoms. If this describes your case, we would be happy to evaluate your condition and determine if we can possibly provide the right technique so you can find consummate relief.

The following self-care measures can potentially help to prevent meralgia paresthetica from developing in the first place:

  • Avoid wearing tight clothing.
  • Maintain a healthy weight, or lose weight if you're overweight.
If meralgia paresthetica sounds like a problem you are potentially experiencing, we may be able to help. Contact us today by calling (410) 709-3868 to speak with one of our team members and have your questions answered.]]>
/blog/diagnosing-and-treating-meralgia-paresthetica.cfmwww.baltimoreperipheralnervepain.com-178320Wed, 10 Jan 2018 16:23:00 EST
<![CDATA[Recognizing Meralgia Paresthetica]]>If you are having tingling or burning pain, or numbness, in your outer thigh, you may be experiencing a condition known as meralgia paresthetica – which is caused by a pinched or compressed lateral femoral cutaneous nerve. This nerve is responsible for supplying sensation to your upper thigh and can become compressed for various reasons.Person holding their outer thigh in pain

For most people, the lateral femoral cutaneous nerve passes to the upper thigh through the groin without any issue. In the case of this particular condition, the nerve can become trapped under the inguinal ligament, which runs across the groin as it spans the abdomen and upper thigh.

The burning pain of meralgia paresthetica is most likely to be experienced on the surface of the outer thigh, whereas tingling and numbness could potentially run a bit deeper.

Typically, the symptoms will only present on one side of the body—as opposed to presenting on both sides at the same time—and tend to intensify when you are walking or standing.

Common causes of meralgia paresthetica include anything placing increased pressure on the groin region, such as:

  • Tight pants, belts, and other articles of clothing
  • Weight gain or obesity
  • Frequently wearing a heavy tool belt
  • Scar tissue on or near the inguinal ligament from a previous surgery or injury
  • Pregnancy

Additionally, this condition may be caused by a nerve injury. In this case, the lateral femoral cutaneous nerve may have become damaged because of diabetes or perhaps a seat belt injury from a motor vehicle accident.

Not everyone is at equal risk of meralgia paresthetica. Individuals who are more at risk include those between the ages of 30 and 60, have diabetes, are pregnant, and/or carry extra weight.

A proper diagnosis can often be made with a physical exam and study of your medical history—along with hearing you describe the symptoms you’re experiencing—but we do have additional diagnostic options, like imaging studies, electromyography, nerve conduction studies, and nerve blocks (which we may perform here in our office).

Whereas an exam and medical history can certainly point us in this direction, it can be important to use other diagnostic techniques to rule out other potential causes for your symptoms.

Once the condition has been properly diagnosed, we will determine if any of our techniques are appropriate and perhaps begin working on your treatment plan. We will discuss potential treatment options for meralgia paresthetica in our next blog post.

In the meantime, please do not hesitate to contact our Baltimore office for an appointment if you have burning, tingling, or numbness in your outer thigh. The problem could be meralgia paresthetica and we may be able to help, so call us today at (410) 709-3868.

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/blog/recognizing-meralgia-paresthetica.cfmwww.baltimoreperipheralnervepain.com-178127Fri, 29 Dec 2017 09:03:00 EST
<![CDATA[Treatment for Carpal Tunnel Syndrome]]>Carpal tunnel syndrome (CTS) is an interesting medical issue because it is treated by so many specialists – orthopedic surgeons, hand surgeons, plastic surgeons, and general surgeons. Given that the injury is related to a particular nerve (which we’ll discuss momentarily), you may want to consider having a peripheral nerve surgeon perform the procedure for you.

The reason for this is because peripheral nerve specialists are trained and experienced in relieving neuropathic pain for our patients. When a nerve needs to be decompressed, our approach and choice of technique are going to be very thorough in ensuring the affected nerve is freed from compression.Person holding their hand due to pain

As you are likely aware, CTS is a problem affecting the wrist and hand. This upper extremity injury develops when your median nerve is compressed within the carpal tunnel – a narrow anatomical passageway located on the palm side of the wrist and formed by bones and ligaments in the area.

The condition often, but not always, occurs as a result of repetitive motions like typing, writing, and activities that may be used in various occupations. It can cause symptoms like frequent tingling and burning sensations, decreased grip strength, numbness, and muscle atrophy at the base of the thumb (in severe cases). When the condition progresses in severity, these symptoms can lead to disrupted sleep – waking you up at night with intense pain.

Is the common conception that CTS is always caused by repetitive stress accurate? Well, not always. There are many cases wherein the injury is the result of repetitive stress, but sometimes they have other root causes – like obstructed blood flow or underlying medical conditions that lead to swelling in the wrist.

This condition can often be recognized based on physical examination, symptoms, and medical history. With that said, an EMG (electromyograph) can provide neurophysiological evidence that the median nerve is pinched (which causes the problem).

It is critical to treat carpal tunnel syndrome before the condition worsens. If the symptoms are ignored, they may cause long-term damage.

There are conservative treatment options, but surgery may be the best option to restore function and alleviate pain when physical therapy, splinting, and other nonsurgical treatments are ineffective.

Carpal tunnel syndrome can be treated with surgery to decompress the median nerve by cutting the ligament at the bottom of the wrist to release pressure. The carpal tunnel is right above the wrist on the palm side of the hand. We will make a small incision and then cut that ligament to free the nerve.

Depending on the severity of your carpal tunnel, your symptoms, your overall health, and the anatomy of your hand, we may decide to perform the surgery in one of two general ways:

  • Surgery may be performed using an endoscope and a small incision.
  • Surgery can also be performed using a standard surgical incision and decompression of the nerve.

Either way, this is an outpatient procedure and you go home the same day. Your hand and wrist may be bandaged for up to 10 days. Typically, the bandage stays in place until the stiches are removed.

You may or may not experience immediate relief, as the area will be sore following surgery. That initial soreness will improve over time. It is recommended that you rest and elevate your hand and wrist, as well as limiting their use. It's not necessarily that the surgery is a big deal in and of itself, but you likely use your hands a lot, so that may limit your ability to work. Depending on what you do for work, you may need some time off.

For more information about carpal tunnel treatment—or if you want to find relief from neuropathic pain caused by injured peripheral nerves—contact our Baltimore office by calling (410) 709-3868 or connect with us online today.

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/blog/treatment-for-carpal-tunnel-syndrome.cfmwww.baltimoreperipheralnervepain.com-177804Thu, 14 Dec 2017 09:11:00 EST
<![CDATA[Why a C-section or Tummy Tuck Causes Nerve Pain]]>Typically, there is a certain degree of pain or discomfort you can expect following surgery. Surgical procedures are traumatic for the human body, and pain may be attributed to your body trying to heal injured tissues. In some instances, however, nerve pain develops afterward and this isn’t the same kind of pain you should probably expect.Woman getting prepped for a tummy tuck

As we’ve noted throughout our website, nerve pain is often marked by symptoms like burning, shooting, stabbing, and searing pain. For some patients, external stimulation—even at low levels (like wind blowing over skin or water coming down from a showerhead)—causes intense physical sensations. Others experience “pins and needles” or feel as though a specific body part or region has been plugged into an electrical outlet.

If you have those kinds of symptoms, the pain is likely caused by a nerve issue of some kind.

In some cases, these symptoms begin after procedures like C-sections (cesarean section deliveries) and tummy tucks. When they do, it’s understandable for patients to wonder why this is happening to them. So, let’s look today at why you are having nerve pain after those kinds of procedures.

To start, it is worth noting that nerve pain does not imply that anything was done incorrectly during the surgery. Surgeons, by very definition of their job, have to cut tissues to repair medical problems. Your body has an entire network of nerves running throughout, so this means there are times when nerves will also be cut during surgery. It’s just a fact.

Nerve Pain after C-section

As with other surgical procedures, it is virtually impossible to perform a C-section without cutting into some nerves. That said, long-term nerve injury after a C-section tends to be somewhat rare.

Often, nerves will heal without causing any lasting issues. When injured nerves do not heal correctly, it is considered to be nerve damage. Depending on which nerves are damaged—and their respective functions—there are various short-term and long-term symptoms that can develop. These symptoms can include impaired motor function and nerve pain.

If you have had a C-section and are experiencing a superficial pain around the edges of the scar, it is likely the ilioinguinal, iliohypogastric, and/or genitofemoral nerves have been affected. Usually, the pain presents as a burning pain and hypersensitivity – which means even light touch hurts (like in the earlier examples of wind and water). There may also be “electric shock” sensations.

If pushing on the affected area does not reproduce the pain, those specific nerves are less likely to be responsible.

The reason for noting the ilioinguinal, iliohypogastric, and genitofemoral nerves comes down to their locations. Surgeons do attempt to avoid important nerves as much as possible, but these ones run close to the edge of a C-section incision. This makes it easy for them to be injured during the procedure (bruised, crushed, etc.) or trapped in scar tissue afterward.

If you are having painful sensations, it is more likely the nerves were injured, instead of being cut. We can say this because cut nerves tend to produce numbness instead of pain. Although, there are times when both numbness and pain result from cut nerves (which is a condition called anesthesia dolorosa).

When diagnosing your nerve pain after a C-section, we use a nerve block. This is a matter of using anesthetic to cause temporary numbness for the affected nerve. When there is both numbness and pain relief, it indicates a peripheral nerve injury. If there is numbness without pain relief, something else is likely at play.

Nerve Pain after Tummy Tuck

Tummy tucks—abdominoplasties—are some of the most common cosmetic procedures performed in the United States, with the American Society of Plastic Surgeons reporting 127,633 in 2016. This is a 104% increase from the 62,713 performed in 2000.

Experts believe the number of abdominoplasties will only increase due to both the number of esthetic surgical procedures and increase in how many obese patients achieve massive weight loss following bariatric surgery.

As with other surgeries, nerves to the affected area are traumatized from a tummy tuck. This can cause numbness for several weeks to months before the nerves overcome temporary neuropraxia (loss of nerve conduction). Usually, it only takes around 6-12 weeks for the situation to resolve, but there are cases wherein this may take longer.

Whereas this numbness and a certain degree of discomfort can be expected, it can be a problem when nerve pain has developed and is not going away after a reasonable amount of time.

In the case of nerve pain following a tummy tuck, it is probably a small nerve called the lateral femoral cutaneous nerve that is affected. This particular nerve travels directly through the areas manipulated during a tummy tuck and could easily be injured directly by a suture or scalpel, or indirectly when the nerve becomes entrapped in scar tissue.

That said, it is important to note that factors other than nerve damage could be responsible for pain and sensory abnormalities. For example, massive weight loss can cause extreme skin expansion and a patient who had undergone bariatric surgery may also have had other issues (secondary fibrosis, hernia) corrected during the tummy tuck.

Diagnosis and Treatment

When you have nerve pain following surgery—particularly if the pain has been present for an extended period—you deserve to find out what is responsible. In the case of C-sections and tummy tucks, it could be inadvertent nerve damage. If so, we may be able to provide the care you need.

For more information, or to request consultation with our Baltimore, MD office, give us a call at (410) 337-5400.]]>
/blog/why-a-c-section-or-tummy-tuck-causes-nerve-pain.cfmwww.baltimoreperipheralnervepain.com-177265Fri, 17 Nov 2017 09:11:00 EST
<![CDATA[Groin Pain After Hernia Repair]]>If it’s been 6 months (or more!) after your hernia repair and you have excruciating pain—including when you sit, turn, wear a belt or underwear with elastic banding, attempt physical intimacy, take a shower, etc.—stop whatever you are doing and call our office.

(Seriously, do it right now!)

We know you are having intense symptoms and pain, but this doesn’t have to be the case—you can absolutely do something about it.

The good news is that your first step isn’t even painful. All you have to do is take a moment to contact a peripheral nerve specialist who has been able to help numerous patients who had the exact same symptoms and problems you are experiencing.

In part, the reason we’ve been able to help so many patients who were suffering from groin pain following hernia surgery is because this is a fairly common occurrence. In fact, there’s an approximately 30% chance a patient will have disabling pain after the procedure. Now, that doesn’t mean the surgery can be avoided!

groin pain after surgery

Instead, what it means is you need to realize this pain is a possibility, but also there is hope.

Now, if it’s been less than 6 months following your surgery, it’s important to start with conservative treatment options. There can be a certain amount of pain or discomfort expected following a surgical procedure, and you may be able to find relief from methods like physical therapy or steroid treatment. In some cases, pain management specialists may be able to help you until the pain starts to subside on its own.

If it has been longer than 6 months, however, something is going on—perhaps a nerve has a suture stitched through it or has been caught in surgical mesh used during the hernia repair—and we may be able to help.

To determine if one of our procedures might provide the relief you need, we will start by evaluating your condition and then attempting a nerve block. If the nerve block works, the odds are quite good (roughly 85%) we will be able to take away the pain. If the nerve block doesn’t, there is still a chance we can help, the odds are just not as strong as they are in the previous case.

After the nerve block and initial evaluation, we will discuss your options. In the event we both agree surgery is the best approach for resolving your problem, you can expect an outpatient procedure performed under local or general anesthesia that takes roughly one hour for each side. In most cases, we can even reuse the initial incision and do not have to make a new one.

Depending on your specific case, the core problem could be a painful neuroma on any of your ilioinguinal, iliohypogastric, or genitofemoral nerves. To stop the pain, we may need to remove nerve tissue.

Following this procedure, your groin may be number for up to a few hours and you will need to ice the area for about two hours. At that point, you will likely be able to walk, sit, and resume your normal daily activities.

As a reminder – there is no need to have your life disrupted by intense pain after a hernia repair! Call our office and let us help.

We also provide similar services for patients who are having issues following vasectomies, tummy tucks, and Caesarian sections (C-sections). As with hernia repairs, there could be a nerve damaged during the procedure and we may be able to fix this for you.

You can reach our Baltimore, MD office by calling (410) 337-5400.

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/blog/groin-pain-after-hernia-repair.cfmwww.baltimoreperipheralnervepain.com-177079Fri, 10 Nov 2017 15:10:00 EST
<![CDATA[Knee Denervation]]>Illustration of nerves in kneeIt’s estimated that anywhere from 5-35% (depending on the source) of patients who’ve had a “technically successful” knee replacement will have severe chronic refractory knee pain. So, if you’ve had a knee replacement, it’s been 6 months (or more), and you’re still experiencing excruciating pain, there’s a definite problem.

In the case of “successful” replacement, we are saying the actual hardware used for the knee joint is technically-sound, and it isn’t loose, infected, or mispositioned.

Instead of the excellent, normal functioning you should expect, however, you are actually suffering from pain in and around the knee joint that can range anywhere from mild to severely debilitating.

In these cases, the operating surgeon did everything by the book and it isn’t his or her fault – which means something else is at play. The likely explanation is injury, entrapment, or stretching of the nerve endings that travel to the skin around knee and the soft tissue around the joint.

These nerves can be cut, divided, or stretched during the procedure to replace the knee. Most of the time this is unavoidable, and sometimes it can happen even in the hands of the most skilled orthopedic surgeons in the world. At present, there is still little understanding as to why some patients have no problems with this, while others are completely disabled by their pain.  

Frequently, patients presenting such symptoms are usually diagnosed with chronic regional pain syndrome (CRPS), or told that they have “RSD” (reflex sympathetic dystrophy). With these diagnoses, patients are often referred to prolonged physical therapy and then the medical pain management world for nerve blocks, injections, and medications.   

Thankfully, many of these patients will improve with time.

However, if you are still suffering with debilitating pain six months (or more) after your knee surgery, it’s time to begin considering more aggressive options – such as actually looking for the cause of all that pain.

So, what is likely the cause? Frequently, the source of the problems are injured nerves leading to the skin around the joint, along with nerves that go into the joint itself. Injury to these nerves means they send pain signals back to the brain!

The affected nerves have been described as far back as 1857 by Dr. Rudinger in Germany, but only in recent history has the involvement of these nerves in the treatment of chronic pain been more systematically studied (specifically, in 1994-1996 by Dr. Lee Dellon). 

Effectively addressing and treating these nerves can be a very important key to improvement for those patients who are suffering from chronic knee pain after knee replacement or arthroscopic surgery (after all other correctable orthopedic causes have been ruled out).

Spreading the word through the medical community about knee denervation was a key reason for Dr. Williams’ recent trip to Budapest, Hungary. His hope is that the trip will open doors for future projects and collaboration to improve patient outcomes and further relieve chronic pain and restore function for affected patients.

Dr. Williams has spent the last 11 years working with these patients after learning denervation techniques in his fellowship from his mentor A Lee Dellon, MD, PhD, and has been an integral part of the Dellon Institute for Peripheral Nerve Surgery in Baltimore, MD since 2006.

If you’ve had a knee replacement surgery that went as it should have and are still experiencing problems, come and see if we may be able to help. Doing so could potentially provide the relief you deserve. Request a consultation with our Baltimore office today by calling (410) 337-5400.

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/blog/knee-denervation.cfmwww.baltimoreperipheralnervepain.com-176844Wed, 01 Nov 2017 11:37:00 EST
<![CDATA[Persistent Knee Pain After Injury (or Arthroscopy)]]>For some patients, they come to see us because they had a “technically successful” surgery—perhaps even an arthroscopic procedure—following a knee injury, and yet were still having severe, chronic refractory knee pain.Runner holding his knee due to pain

If you’ve had surgery to repair a knee injury of any kind, and everything went as your surgeon expected it to, but it’s been 6 months (or longer) and you’re still having excruciating pain, there’s definitely a problem. The silver lining in this case is that it might be a problem we can fix for you.

In these cases, there are two important parts:

  1. You are having symptoms that may include sharp or searing pain, “pins and needles” sensations, the feeling as though your knee is plugged into an electrical socket, or hypersensitivity (to the point even the lightest touch causes severe pain).
  2. The initial surgical procedure went exactly as it should have and your orthopedic surgeon says that you should be feeling better (even though you aren’t).

So instead of having the excellent, normal function you were expecting, you’re actually suffering from pain in and around the knee joint. This pain can range anywhere from mild to severely debilitating, and no matter where it falls on the pain spectrum, the fact remains – you were expecting to have your knee problem resolved and it hasn’t been.

Even more frustrating is when new symptoms have developed in the area!

Typically, the operating surgeon in these cases actually did everything by the book and it really isn’t his or her fault. With that being the case, something else is responsible. The good news is that we might be able to identify this problem for you.

In all likelihood, the nerve pain you have been experiencing is the result of entrapment, injury, or even stretching of the nerve endings that travel to the soft tissue around the knee joint and to the skin covering and around the knee.

During your operation, the affected nerves may have been divided, stretched, or cut. Since there is obviously cutting that happens during surgery, this is actually unavoidable in most cases. Further, it’s something that happens even in the hands of the world’s best orthopedic surgeons.

Often, patients who develop the aforementioned kinds of symptoms are diagnosed with either “RSD” (reflex sympathetic dystrophy) or “CRPS” (chronic regional pain syndrome). The problem with diagnoses like these is that patients are usually then referred to prolonged physical therapy and the medical pain management world for nerve blocks, injections, and medications.

It’s obviously quite positive when those treatments lead to patient improvement over time. For some patients, however, the debilitating pain continues up to, and beyond, six months following the surgery. When this is the case, it’s time to take a closer look and try to determine what exactly is causing all of that pain.

So, what is likely the source? Frequently, we find this to be a matter of injured nerves that both go into to the joint itself and the skin around the joint. Because of their injuries, these nerves now send signals the brain interprets as pain.

Resolving this problem is a matter of treating and effectively addressing these injured nerves. Doing so can lead to marked improvement for patients who have been suffering from chronic knee pain after knee surgery (once all other correctable orthopedic causes have been ruled out, of course).

If this sounds like a problem you are experiencing, and you have already consulted your orthopedic surgeon to determine if there are any other possible explanations, come see us. We may be able to help you find the relief you need. Request your appointment with our Baltimore office by calling (410) 337-5400 and one of our team members will be happy to help.

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/blog/persistent-knee-pain-after-injury-or-arthroscopy-.cfmwww.baltimoreperipheralnervepain.com-176711Fri, 27 Oct 2017 08:52:00 EST
<![CDATA[Proximal Tibial Nerve Compression]]>The peripheral nerves running throughout the body perform essential functions for you. Sometimes, these nerves are compressed, injured, or otherwise damaged and cause pain and other unpleasant symptoms. Patients often report feeling burning and electrical pain, “pins and needles” sensations, and hypersensitivity (to the point that even wind blowing across the skin is quite painful). If you are having peripheral nerve pain in the calf region, the problem might be proximal tibial nerve dysfunction, otherwise known as soleal sling syndrome. In the event this is the problem you’re experiencing, we may be able to help.A picture of a nerve

Proximal tibial nerve dysfunction is a form of peripheral neuropathy, one that occurs on account of damage to the tibial nerve. This nerve is one of the lower branches of the sciatic nerve that runs down the leg. It is responsible for enabling movement and supplying sensation to the calf and foot muscles.

When there is a problem in function within a single nerve group—like the tibial nerve—we call the condition mononeuropathy. The typical causes of this include:

  • Direct trauma
  • Pressure on the nerve from nearby body structures
  • Pressure on the nerve for an extended period of time

Current evidence indicates that the tibial nerve can be compressed in a site more proximal than the tarsal tunnel, and this site—just distal to the knee—is best described as the proximal tibial nerve. We use this particular label to help distinguish it from the tarsal tunnel region. As we’ve mentioned elsewhere, a primary cause of nerve pain in the tarsal tunnel(s) is compression—pressure on a nerve when it passes through a narrow anatomical structure.

In the case of proximal tibial nerve dysfunction, the pressure on the nerve may come from a fibrous sling found at the origin of the soleus muscle, which is called the soleal sling. The tibial nerve can be damaged in other areas—like when pressure from a ligament found on the inner part of the ankle causes problems—but the proximal tibial nerve may also be affected or damaged by diseases affecting anatomical structures or the nervous system (such as what happens when diabetes is present).

Damage to the nerve may destroy the myelin sheath, which is responsible for protecting and insulating the nerve, or the axon (part of the nerve cell). The damage can then either reduce or prevent the movement of impulses through the affected portion of the nerve.

In some cases, no identifiable root cause for the pain can be found, but we make every effort possible to determine what has happened. Fortunately, there are many cases wherein a cause can be established.

Treatment for proximal tibial nerve dysfunction is centered on restoring strength and normal feeling to the foot and toes. In part, this is important because severe loss of sensation can lead to sores (ulcers) in the lower limbs. In such cases, infections can become dangerous problems. Of course, it’s important to treat the condition to relieve any painful symptoms you are experiencing, as well.

There are nonsurgical treatment options that might be able to address the problem, and these should be explored by your treating physician before you seek surgical intervention.

Peripheral nerve pain is not something to be ignored, or to hope will go away on its own. If you are suffering, you need to seek help. There could be medical options to improve the situation, including surgical techniques. If you have been unable to find help via conservative treatment, we may be able to provide a more effective option. Contact our Baltimore, MD today for a consultation by calling (410) 709-3868.]]>
/blog/proximal-tibial-nerve-compression.cfmwww.baltimoreperipheralnervepain.com-176003Fri, 29 Sep 2017 09:01:00 EST