Conditions and Treatments

Minimally Invasive Pain Specialists covers a variety of pain conditions including chronic pains in the head, neck, arms, back, torso, and legs. Below is a list of conditions you may be suffering from and treatments to address them. We recommend setting a new patient appointment to discuss your condition with Dr. Hijazi. In the meantime, feel free to discover more about conditions and available treatments by clicking through these resources

Head / Neck Pain

Cervical Radiculopathy

Occurs when a nerve in the neck is compressed or irritated where it exits the spinal cord. This causes pain to radiate into the arm (shoulder through hand). Besides causing pain, a “pinched nerve” in the neck can cause numbness, tingling, and even weakness. In most cases, cervical radiculopathy responds well to conservative treatment.

Treatment Includes:

  • Medication
  • Physical therapy
  • Epidural steroid injections

Surgery for this condition is only recommended when patients have increased numbness, tingling, and/or weakness or they have failed medications, physical therapy, and injections.

Cervicogenic Headaches

Are most commonly caused secondary to arthritis in the neck/spine that causes muscle tension and pain radiating into the back of the head.

Treatment Includes:

  • Physical therapy

  • Medial branch rhizotomy (melting of the nerves that sense the arthritis). These nerves grow back in 6 months – 1 year.

Degenerative Disc Disease

Is not really a disease but a term used to describe the normal age-related changes in your spinal discs as you age. The discs act as “shock absorbers” for the spine, allowing it to flex, bend, and twist. Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region). If pain results it is due to inflammation or abnormal micromotion instability.

Treatment Includes:

  • Epidural steroid injections

Failed Cervical Surgical Syndrome

Occurs in patients who have had spine surgery and continue experiencing neck or arm pain. The body may be confused into believing there is still a problem when there is none.

Treatment Includes:

  • Cervical epidural steroid injections
  • A spinal cord stimulator to end the cycle of pain caused by abnormal nerve firing

Myofascial Pain Syndrome

Is a chronic, localized form of muscle pain that arises from “taut” bands in muscle that are medically called “trigger points.” These are commonly known as “knots”. The trigger points in the muscle are painful when touched and can radiate pain to other areas including the jaw, head, neck, shoulders, low back, pelvis, arms, and legs.

Treatment Includes:

  • Physical therapy
  • Massage therapy
  • Topical medications
  • Trigger point injections with Lidocaine

Occipital Neuralgia

Causes pain from the base of the skull to travel up the scalp to the crow of the head and sometimes to the sides above the ears. This is caused by two nerves that comes from the spine that are often irritated.

Treatment Includes:

  • Injection of steroids and local anesthetic (Bupivacaine)

  • A nerve stimulator may be helpful in more resistant cases

Spondylosis

Is one of the most common causes of neck or back pain that presents on one or both sides. Spondylosis is the medical term for arthritis in the joints of the spine.

Treatment Includes:

  • Physical therapy

  • Medial branch rhizotomy (melting of the nerves that sense the arthritis). Insurance companies and scientific evidence require two test procedures (medial branch blocks) before performing a rhizotomy. The patient must achieve 80% or more relief with both blocks, done two weeks apart. The relief is temporary because a short-term local anesthetic is injected for each test block.

Upper Extremity Pain

Epicondylitis

(Medial and/ or Lateral): commonly caused by over-use of the muscles controlling wrist flexion and extension. This is often present in athletes. Patient will feel warmth, swelling, and pain on the inside (medial) or outside (lateral) elbow.

Treatment Includes

  • The best treatment for this condition is Platelet Rich Plasma injection (please visit the link for more information on this therapy)

  • A more common treatment is an ultrasound guided steroid injection into the inflamed muscle/tendons.

Carpel Tunnel Syndrome

Is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of the hand. When the median nerve is compressed, symptoms can include numbness, tingling, and weakness in the hand and arm.

Treatment Includes

  • Steroid injection into the carpal tunnel
  • Carpal tunnel release surgery

DeQuervains Tenosynovitis

A painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Treatment Includes

  • Splinting to immobilize the thumb and wrist
  • Steroid injection with ultrasound guidance
  • Surgery by a hand surgeon

Joint Arthritis

Develops in all humans as we age. Some people are not affected by the joint degeneration but some develop severe pain.

Treatment Includes

  • Sensory branch ablation
  • Peripheral nerve stimulation (targets nerves with distracting signals that change the way you interpret pain)

Peripheral Neuropathy

Is a disease that causes the nerves outside of the brain and spinal cord not to work properly. This usually results in a loss of function in the nerve which can result in pain, dysaesthesias (painful tingling sensations) and numbness in the distribution of the nerve.

Treatment Includes

  • Medications
  • Physical therapy
  • Spinal cord stimulation (neuromodulation)

Shoulder Impingement / Bursitis

Occurs when there is abnormal rubbing of your shoulder bones on the soft tissue. The causes pain with movement and touch.

Treatment Includes

  • Physical therapy

  • Steroid injection with ultrasound guidance

Sympathetic Mediated Pain

Commonly known as complex regional pain syndrome (CRPS). This is an uncommon, chronic condition that usually affects your arm or leg. Complex regional pain syndrome is marked by intense burning or aching pain. You may also experience swelling, skin discoloration, altered temperature, abnormal sweating and hypersensitivity in the affected area. The cause of complex regional pain syndrome isn’t clearly understood, though it often follows an illness, injury, or bone fracture.

Treatment Includes

  • Medications

  • Physical therapy

  • Sympathetic nerve blocks: The specific sympathetic nerve block that can help is determined on the location of the symptoms. Stellate ganglion block (for arm pain), celiac plexus block (for abdominal pain), lumbar sympathetic block (for leg pain), superior hypogastric block (for pelvic pain), and ganglion impar block (for coccyx or perineal pain).

Ulnar Neuropathy (Cubital Tunnel Syndrome)

Causes pain and numbness on the medial forearm and 4th and 5th fingers. This is due to compression of the ulnar nerve as it travels across your elbow.

Treatment Includes

  • Steroid injection with ultrasound guidance
  • Platelet rich plasma injection with ultrasound guidance
  • Splinting
  • Surgery to relocate the nerve by an orthopedic surgeon

Thoracic Pain

Compression Fracture

Most commonly happens in people with osteoporosis (thinning bone density) after a fall. The vertebral bodies on the midback and lower back are most susceptible. When the bone is broken it can squeeze like a wedge or burst with fragments into the spinal canal.

Treatment Includes:

  • Kyphoplasty: injection of bone cement to prevent further bone compression and reduce pain

  • Surgery by a neurosurgeon or spine surgeon to remove bone fragments from the spinal canal

Intercostal Neuralgia

Often occurs after an episode of shingles. When the painful shingles rash resolves, pain remains.

Treatment Includes:

  • Medications
  • Topical patches or creams
  • Steroid injection
  • Peripheral nerve stimulator implant for resistant cases

Spondylosis

Is arthritis of the joints of the spine.

Treatment Includes:

  • Physical therapy
  • Message therapy
  • Medial branch rhizotomy (melting of the nerves that sense arthritis)

Abdominal/Pelvic/Groin Pain

Chronic Pelvic Pain

Can be due to multiple medical conditions but commonly in women with endometriosis or previous gynecologic surgery. This condition is difficult to manage but there are options:

Treatment Includes

Ilioinguinal neuralgia

Can be due to compression or injury of nerves that travel from the spine and around the torso before reaching the groin. Compression or injury often occur after inguinal hernia repairs in men.

Treatment Includes

Pudendal neuralgia

Is pain caused by the nerves that travel from the pelvis into the penis and clitoris. The pain can be especially painful even to light rubbing of underwear with walking or sitting.

Treatment Includes

  • Pudendal nerve blocks with steroid

  • Peripheral nerve stimulator implant

  • Dorsal root ganglion stimulator implant

Lower Back Pain

Is the most common chronic pain condition in society. This may be due to multiple conditions such as nerve compression in the spine (spinal stenosis), arthritis in the joints of the spine (spondylosis), discogenic pain, vertebrogenic pain, or mechanical low back pain from multifidus muscle dysfunction.

Treatment Includes

Compression Fracture

Most commonly happens in people with osteoporosis (thinning bone density) after a fall. The vertebral bodies on the midback and lower back are most susceptible. When the bone is broken it can squeeze like a wedge or burst with fragments into the spinal canal.

Treatment Includes

  • Kyphoplasty: injection of bone cement to prevent further bone compression and reduce pain
  • Surgery by a neurosurgeon or spine surgeon to remove bone fragments from the spinal canal 

Lumbar Herniated Disc

Often causes pain in the back and down the leg depending on which nerve is being compressed. If the herniation is small on imaging it could be benign and not cause pain. If the herniation is large it could lead to pain, numbness/tingling, and/or weakness.

Treatment Includes

  • Physical therapy
  • Medications
  • Transforaminal epidural steroid injections
  • Surgical removal of the protruding disc section by a spinal surgeon

Spinal Stenosis

Is one of the most common causes of low back pain, buttock pain, and thigh pain. This occurs when the nerves in the middle of your spinal canal are compression by a disc, bone spurs, or a ligament that has overgrown. Patient often feel cramping sensations and pain when they stand more than a few minutes or walk more than a few yards and relief when they sit or bend forward.

Treatment Includes

  • Epidural steroid injections
  • Minimally Invasive Lumbar Decompression (mild®) is a short, outpatient treatment that restores space in the spinal canal to help improve back and leg pain.* Using specialized tools and imaging, mild® addresses a major root cause of LSS by removing thickened ligament through an incision smaller than the size of baby aspirin, leaving no implants behind, only a Band-Aid. Visit www.mildprocedure.com for more info. *Clinical data available: https://www.vertosmed.com/patients/
  • Vertiflex’s Superion® (indirect decompression). For more information Vertiflex visit www.vertiflexspine.com
  • Open spine surgery by a neurosurgeon or orthopedic surgeon.

Failed Back Surgical Syndrome

Is pain that does not resolve after spine surgery. This is often due to the spinal cord and brain interpreting normal signals as painful signals. There may not be any nerve compression but the body believes there is still an issue. Unfortunately, back surgery or spine surgery cannot literally cut out a patient’s pain. It is only able to change anatomy. Even with the best surgeon and for the best indications, spine surgery is no more than 95% predictive of a successful result.

Treatment Includes

  • Epidural steroid injections
  • Physical therapy
  • Medications
  • Spinal cord stimulator implant (neuromodulation)

Sacroiliac Joint Dysfunction or Sacroiliitis

Causes pain when the sacroiliac joints have abnormal motion or develop inflammation. Sacroiliac joint dysfunction can be difficult to diagnose, and it may be mistaken for other causes of low back pain such as: myofascial pain syndrome, lumbar spondylosis, herniated disc with radiculopathy, and/or degenerative disc disease.

Treatment Includes

  • Physical therapy
  • Sacroiliac joint steroid injection
  • Sacral lateral branch rhizotomy: burning the nerves that sense pain from the joint
  • Sacroiliac joint fusion: for more information please visit https://cornerloc.com

Tailbone Pain (Coccyx Pain)

Often occurs after a fall onto a hard surface with or without a fracture of the tailbone.

Treatment Includes

  • Ganglion impar steroid injection

Lower Extremity Pain

Compression Fracture

Anterior and Posterior Cruciate Ligament Injuries: often occurs with an abrupt twist of the knee on a planted foot.

Treatment Includes:

  • Physical therapy
  • Platelet rich plasma injection
  • Arthroscopic surgical repair

Bursitis

Is pain in the outside/lateral hips from abnormal movement of the IT band on the greater trochanter of the femur. This condition commonly occurs secondary to other conditions when the patient limps or adjusts their walking due to back or leg pain.

Treatment Includes:

  • Physical therapy
  • IT band foam rolling
  • Strengthening the gluteus medius muscle
  • Steroid injection

Chronic Ankle/ Foot Pain

Can be due to multiple reasons including strains, sprains, arthritis, CRPS, or pain after surgery that does not resolve.

Treatment Includes:

  • Steroid injections
  • Platelet rich plasma injection
  • Peripheral nerve stimulator implant
  • Dorsal root ganglion stimulator implant

Chronic Hip Pain

Is most commonly caused by arthritis. This is usually age-related degeneration.

Treatment Includes:

  • Physical therapy
  • Steroid injection into the hip joint
  • Hip sensory branch rhizotomy (burning the nerves that sense pain from the joint)
  • Hip replacement surgery

Chronic Knee Pain

Is most commonly caused by arthritis. This is usually age-related degeneration.

Treatment Includes:

  • Physical therapy
  • Steroid injection into the knee joint
  • Viscous gel injection into the knee joint
  • Genicular nerve ablation (burning the nerves that sense pain from the joint)
  • Joint replacement surgery
  • Peripheral nerve stimulator implant for people who have pain after surgery. For more information please visit https://nalumed.com/patients/
  • Temporary peripheral nerve stimulator. For more information please visit https://www.sprtherapeutics.com/patients/
  • Dorsal root ganglion stimulator implant for people who have pain after surgery