Dr. Doctor weighs in on America’s drug crisis in an interview with Haley Hernandez. Read on at https://www.click2houston.com/health/tougher-regulations-keep-meds-from-patients-in-need

As I started to put together our next SpineCare Newsletter, I noticed that one of the main topics in the news these days is the prescribing of narcotics by physicians for pain management and the subsequent drug addiction and overdoses this creates. Take for example the singer Prince.

As of 2011, 75 percent of the world’s narcotic prescription drugs were prescribed and swallowed up in a country that makes up less than 5 percent of the world’s population, leading to the most common cause of preventable death in America today. Millions of Americans are addicted to narcotics and in 2013 alone prescription narcotics were involved in 37 percent of all drug overdoses. Starting in the 1990’s, there was a dramatic increase in the use of narcotic painkillers by physicians to treat non-cancerous medical conditions like low-back pain, sciatica and various musculoskeletal problems. There is almost no evidence to show that narcotics are safe or effective for the long-term management of non-cancerous pain, even though they are very effective for the relief of short-term pain.

Pain in the middle of your back? Between your shoulder blades? Felt pain wrapping around your ribs? Pain in the mid-back is an area of the body that that is often misunderstood and not well treated by most medical practitioners. The cervical and lumbar spine get a lot of attention and most of the treatment. The thoracic spine, which is the part of the spine which is located in the middle of the back, is the longest part of the spine with the most discs and vertebrae. If you look at the figure below you can see how each one of the twelve thoracic nerves cover their own part of the middle of the back. They are labeled in this diagram from T1 to T12.

Picture 1 – What I want you to notice is how each of these nerves start in the back and wrap all the way around to the front. For example, the part of the body near your shoulder blade is covered by the sixth and seventh thoracic nerves. Each nerve comes out of the spine and passes by the disc and then is attached to the bottom of the rib. What that means is if your sixth or seventh nerve is inflamed by the disc it can create pain in your shoulder blade. If you follow the T6 nerve in the above picture you can see how you may feel pain not only in the area of the shoulder blade, but also in the front of your chest, since that nerve runs all the way around to the front of the body.

Arthritic joint pain from your knee? Hip? Shoulder?
If your joints ache, they have lots of company. Over 46 million Americans suffer from arthritis. Osteoarthritis of the knee is the most common type, and the way it affects the knee is painfully simple. Osteoarthritis causes the lubricating properties of the synovial fluid in the knee joint to diminish, resulting in less protection and cushioning. In addition, osteoarthritis wears down the cartilage, resulting in your bones grinding against each other. That grinding hurts! You can feel it climbing stairs, working in the garden, walking or bending your knees to sit. It may even keep you up at night. Similar issues can affect many other joints, including the shoulder, hip and even the fingers.

Alissa Nguyen received her Masters of Science in Nursing at the University of Texas Health Science Center in Houston. Prior to becoming a certified Adult and Gerontology Nurse Practitioner with the American Association of Nurse Practitioners, Alissa had experience as a registered nurse in general orthopedics, organ transplant, and cardiology. She is currently Vice President of Sigma Theta Tau International Nursing Honor Society, Zeta Pi chapter, and a member of Texas Nurse’s Association and Houston Area Nurse Practitioners. Outside of nursing, Alissa is passionate about volunteering and is an active Big Sister in the Big Brother Big Sister program and fosters homeless dogs through Golden Retriever Rescue of Houston and Animal Justice League.

1) How do you diagnose whether the pain I have is coming from the shoulder or the neck?

We use a continuous x-ray machine and place an anesthetic inside the shoulder joint. We then assess the patient to see if the pain is gone. If the pain is not significantly better, we know there is another reason for the shoulder pain. We will then place an anesthetic and steroid on the nerve that goes from the neck to the shoulder. If the pain is gone within ten to fifteen minutes after this procedure, we have a diagnosis of a cervical nerve that is creating “referred” pain to the shoulder.

2)  Who is a good candidate for these procedures?

Persons who have experienced any of the following are good candidates for our procedures:

a) If you have had constant shoulder pain that has not responded to conservative care, including rest, medications, physical therapy, and/or chiropractic care over a four week period

b) If you have had surgery on your shoulder and still have shoulder pain

c) If your shoulder pain limits your normal functions and keeps you from enjoying a full active lifestyle

3)   Why do the procedures give long-term relief if the steroid is gone in a week?

Long-term relief from the injection can be achieved just because we are able to eliminate the inflammation. Remember, a lot of people have degenerated shoulder joints and cervical discs, but they only have pain when a structure in their shoulder or neck becomes inflamed. Most of our patients report relief that lasts from months to years. One of the most important ways to get long-term relief after the pain is to work on body mechanics and posture, which will keep the structure that was creating your pain from becoming inflamed again.

4)   What can I do to keep the pain from reoccurring?

Using proper body mechanics and posture are the most important things to remember. The cervical discs are located in the front of the spine right behind your voice box. That means every time you bend your head down to look at your phone, look at your computer, or read a book, you put a lot of pressure on the discs, which in turn can lead to degeneration of the discs in the neck over a period of time. Look at the section on “tips for a healthy neck” in this newsletter for specific things you can do to avoid putting stress on your spine.

5)   You do not perform pain management techniques, such as series of epidural steroid injections, Botox injections, and trigger point injections in the neck. Is there a reason why you avoid doing these types of procedures?

These procedures are based on chronic pain management techniques where the main goal is to have ongoing long term care of the patient. There is absolutely no diagnostic information gained by these procedures, and they really just mask the problem. Our main goal is to either eradicate the pain long-term or locate the exact issue creating the pain and have it fixed.