Medications are an incredible medical resource for the management and treatment of many neurological conditions. However, all medications have side effects and interactions. This is the case for every prescription, over the counter medication, or supplement a patient takes. For most commonly used medications, side effects and significant interactions are rare. The more medications a patient requires, the higher the likelihood interactions or side effects can occur.

Elderly patients are especially susceptible to medication side effects and interactions. When there is concern for dementia or memory and cognitive defects, medication-induced memory problems must be ruled out first. A number of meds for pain control, depression, allergies, incontinence problems, and a host of other issues can cause confusion in older patients. If the underlying cause is not addressed, patients can then be placed on additional meds for mood issues or agitation that further compound the problem.

Patients requiring multiple medications for pain control are also at high risk of side effects and interactions. Medications used to treat headaches, from prescription meds to OTC ibuprofen or acetaminophen, can cause rebound headaches. Long-term use of narcotic pain meds such as hydrocodone, oxycodone, and tramadol, can increase pain receptors in the body leading to more severe withdrawal and rebound pain symptoms.

It is important to recognize the risks associated with any medication, to make sure your physician is aware of the medications and dosages you are taking, and to be open to idea of reducing medications if your physician recommends it. Bring all of your active meds and supplements to all of your office appointments. Ask questions about the meds you are prescribed. Be cautious of overusing medications. Ask your physician if medications could be contributing to your current symptoms and if reducing those medications is a safe and reasonable option

There are many causes for low back pain that are treated here at Legacy. One common condition that can often be overlooked originates at the sacroiliac (SI) joints. They are located where the ilium of the pelvis meets the sacrum—the left and right sides of the sacrum.  Strong ligaments and muscles hold the SI joints in place and allow only a few millimeters of movement when the body bears weight or flexes forward. Arthritic and certain age-related degenerative disorders may gradually erode protective joint cartilage, which can subsequently lead to instability and pain that can mimic some of the symptoms of lumbar pathologies.

How Do You Know If You Have an SI Joint Dysfunction?

Pain is a primary symptom of a SI joint problem.  Some patients experience difficulty sitting, standing, walking, bending, and lifting.  The pain and symptoms may mimic other types of lumbar spine (lower back) disorders.

Possible areas where pain may be felt:

• Lower back
• Hips
• Buttocks
• Groin
• Thighs and legs (usually stops at the knee)

SI Joint Pain Treatments

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Medication to relax muscle spasms
• Ice and/or heat
• Sacroiliac joint brace
• Physical therapy (to reduce pain and strengthen SI musculature)
• Corticosteroid joint injections

Sources:

https://www.spineuniverse.com/conditions/sacroiliac-joint-pain/sacroiliac-joint-animation

https://www.medindia.net/patients/patientinfo/sacroiliac-joint-dysfunction.htm

There are many causes of neck, shoulder and arm pain. Often the cause can be found in the neck where the nerves leave the spinal cord to innervate the arms. However, these nerves can also be affected by other compression syndromes, inflammation or injury as they course from the neck to the arm.

Parsonage-Turner Syndrome or Brachial Plexitis can cause symptoms such as shoulder pain, arm pain, loss of sensation, paresthesias and/or weakness in the affected arm. These symptoms are very similar to symptoms patients experience with neck pathology. However, the problem arises in the proximal shoulder where the brachial plexus is located, not in the cervical spine. The brachial plexus is a complex network of nerves that innervate the arm to provide movement and sensation. It is located in the lateral neck and proximal part of the shoulder. 

Many times there is no known associated injury or illness that causes brachial plexitis. Other times it can be triggered by a viral illness or an autoimmune response to a vaccination.

Fortunately, most patients will make a very good recovery with only supportive treatment. Treatments may include steroids, neuropathic medications such as Gabapentin and physical therapy. The diagnosis can be difficult and is often made by a neurosurgeon or neurologist. MRIs, EMG/NCV and physical exam are most commonly used to help confirm the diagnosis.

Picture from www.familydoctor.org

Restless legs syndrome (RLS) is a neurological disorder characterized by unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them for relief. Individuals affected with the disorder often describe the sensations as throbbing, polling, or creeping. The sensations range in severity from uncomfortable to irritating to painful.

Treatment

For those with mild to moderate symptoms, many physicians suggest certain lifestyle changes and activities to reduce or eliminate symptoms. Decreased use of caffeine, alcohol, and tobacco may provide some relief. Physicians may suggest that certain individuals take supplements to correct deficiencies in iron, folate, and magnesium. Taking a hot bath, massaging the legs, or using a heating pad or ice pack can help relieve symptoms in some patients. Physicians also may suggest a variety of medications to treat RLS, including dopaminergics, benzodiazepines (central nervous system depressants), opioids, and anticonvulsants. The drugs ropinirole, pramipexole, gabapentin enacarbil, and rotigotine have been approved by the U.S. Food and Drug Administration for treating  moderate to severe RLS. The Relaxis pad, which the person can place at the site of discomfort when in bed and provides 30 minutes of vibrations (counterstimulation) that ramp off after 30 minutes, also has been approved by the FDA.

Prognosis

RLS is generally a life-long condition for which there is no cure. Symptoms may gradually worsen with age. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some individuals have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear.

For more information:

American Academy of Neurology www.aan.com

and

Restless Legs Syndrome Foundation

Provides educational materials on restless legs syndrome and related disorders to individuals, their families, physicians, healthcare providers and supports medical research into the cause and cure for restless legs syndrome.

3006 Bee Caves Road Suite D206

Austin, TX 78746

info@willis-ekbom.org

http://www.rls.org

Tel: 512-366-9109

Learn more about the truth and fiction of Lasers in Spine procedures! Always get a second opinion if you feel like you are dealing with a Mr. Haney, The Sting, or the ole time “Snake Oil” salesmen.

Scott Schlesinger MD

Legacy Neuro

Legacy Surgery Center, and the surgeons at Legacy Spine and Neurological Specialists offer the state-of-the-art most minimally invasive fusion possible. The patient pictured in the first image below, underwent a lumbar fusion, an outpatient procedure,  using our special MIS (Minimally Invasive Surgery) technique. The patient returned today for a six week post-operative appointment, completely free of sciatica pain and with marked improvement in their quality of life. By using minimally invasive surgery, after conservative care failed, this patient was able to return to her normal activities very quickly after her surgery, short of any heavy lifting.