Diagnostic & Treatment Summary
Embedded Files
Diagnostic Summary — Spine Injury / Post-Traumatic Headache
X-ray:
X-rays assess alignment, fracture, instability, scoliosis, and gross degenerative or structural abnormalities. They are useful as an initial trauma screen but do not adequately evaluate discs, nerves, ligaments, or soft-tissue injury.
MRI:
MRI is the preferred advanced study for persistent cervical, thoracic, or lumbar pain, radicular symptoms, neurologic complaints, cervicogenic/post-traumatic headache, suspected disc herniation, stenosis, annular tear, ligamentous injury, facet injury, or nerve compression.
EMG/NCT:
EMG/NCT is used when radiculopathy, plexopathy, peripheral neuropathy, or entrapment neuropathy is suspected. It is especially helpful when symptoms include numbness, tingling, weakness, or persistent upper or lower extremity radiation.
PT/Chiropractic Care:
Therapy records document conservative treatment, functional limitations, objective response, aggravating factors, and failure or partial response to care. Persistent pain despite therapy supports escalation to advanced imaging, injections, or specialist evaluation.
Injections:
Trigger point injections, occipital nerve blocks, epidural steroid injections, facet injections, medial branch blocks, sacroiliac injections, and radiofrequency ablation may help diagnose and treat specific pain generators after spine trauma.
Medications:
Treatment may include acetaminophen, NSAIDs when appropriate, muscle relaxants, neuropathic agents, topical medications, migraine/post-traumatic headache medications, or limited opioid therapy with risk monitoring.
Psychological Assessment:
Psychological evaluation may be appropriate when chronic pain, sleep disturbance, anxiety, depression, PTSD symptoms, or pain-related disability affects recovery.
Surgery:
Surgical consultation is considered for progressive neurologic deficit, myelopathy, severe stenosis, unstable fracture, significant structural lesion, or refractory pain despite appropriate conservative and interventional care.
PT AND EXERCISES FOR PAIN | Lumbar Brace L0637 TLSO Lower Spine TLSO
Staying Safe at Work TENS ATLAS TENS MAPS
Timers/Tools: 10 min 5 m 2 m | 30m 20m 15m | LMM | PIXABAY | NARA |
Stretching / Flexibilty: 10 min 10 min 10min/post workout 15 min
Devices: https://www.wecontrolpain.com/devices [ Flex IT; 15-20 min/2-3x/day CP, Disuse atrophy]
HEADACHES
TMS FOR MIGRAINE | DEPRESSION (5m)
NECK PAIN
CERVICAL COLLAR | NECK - CHIN TUCK
BACK PAIN
PATIENT - LUMBAR BRACE
FOR DOCTORS - LUMBAR SPINE LINE | KNEE BRACE | ROM HINGED BRACE | WRIST BRACE | TLSO | PEAK SCOLIOSIS BRACE |
NEUROPATHY | FOOT PAIN
PATIENT VIDEOS:
PROVIDER VIDEOS
ANKLE BLOCKS - ANATOMY (2m) | BLOCK(8 m) |
ASRA - USE ICE & 30Gs (Replace 25Gs for comfort)
+/- water soluble steroid + 5 ml (Instead of 15 ml, for surgeries)
If PLANTAR FASCIITIS add surgical prep x2, ice, 30g, 2-3 ml
SHOULDER PAIN
FOR Shoulder: #1 Mayo | #2 Pendulum
SHOULDER PAIN - SLEEP POSITION #1 #2 #3 #4 (exercises)
PROVIDER VIDEOS
EXAM - SHOULDER ROM UE VIDEO
KNEE PAIN
VIRTURAL REALITY
EXERCISES
FOOT | PLANTAR FACIITIS - EXERCISES #1
======
HEADACHE
Brudzinski's Sign = Neck flexion causes hip/knee flexion; indicates meningeal irritation.
Suboccipital Tenderness = Pain upon pressure below skull base; tension or cervicogenic headache.
CERVICAL
Soto-Hall Test = Neck flexion supine; detects cervical injury or irritation.
Spurling’s Test = Extend, rotate, compress head; nerve root compression.
Lhermitte’s Sign = Flex neck causes shock sensation; spinal cord issue.
Bakody’s Sign = Arm overhead relieves pain; cervical radiculopathy.
THORACIC
Adam’s Forward Bend = Forward bending reveals rib hump; indicates scoliosis.
Thoracic Flexion Test = Forward bend, thoracic pain indicates facet or muscular issue.
LUMBAR
Straight Leg Raise (SLR) = Elevating leg causes sciatic pain; lumbar radiculopathy.
Bragard’s Test = SLR plus foot dorsiflexion increases pain; nerve root irritation.
Slump Test = Seated spinal flexion causes sciatic pain; neural tension.
Kemp’s Test = Extend, rotate, compress lumbar spine; facet joint irritation.
SI JOINT
Gaenslen’s Test = Leg drop off table stresses SI joint; identifies SI dysfunction.
FABER (Patrick’s) Test = Hip flexion/abduction/external rotation; pain suggests SI pathology.
SHOULDER
Neer’s Test = Passive forward flexion of shoulder; identifies impingement.
Hawkins-Kennedy Test = Shoulder internal rotation at 90° flexion; impingement syndrome.
ELBOW
Cozen’s Test = Resist wrist extension; lateral epicondylitis ("tennis elbow").
Golfer’s Elbow Test = Resist wrist flexion; medial epicondylitis ("golfer’s elbow").
Lateral Epicondyle Tenderness = Pain at outer elbow; lateral epicondylitis confirmed.
Medial Epicondyle Tenderness = Pain at inner elbow; medial epicondylitis confirmed.
WRIST
Phalen’s Test = Wrists flexed, backs together; tingling indicates carpal tunnel.
Tinel’s Sign (Wrist) = Tap median nerve; tingling suggests carpal tunnel syndrome.
HIP
Trendelenburg Test = Single-leg stand; pelvis drops indicating weak abductors.
Thomas Test = Supine knee flexion; lifted thigh reveals hip flexor tightness.
Piriformis Sign = Hip rotation with flexed knee causes pain; piriformis syndrome.
Trochanteric Bursa Pressure = Painful pressure over trochanter; bursitis confirmed.
KNEE
McMurray’s Test = Rotate knee flexed; clicking indicates meniscal tear.
Anterior Drawer Test = Tibia moves forward; ACL injury suspected.
ANKLE
Anterior Drawer (Ankle) = Forward foot displacement; tests anterior talofibular ligament integrity.
Thompson Test = Squeeze calf, no plantarflexion; Achilles tendon rupture.
Daily Plan Breakfast Drink unsweetened green or black tea (hibiscus tea, oolong tea). Sweeten with allulose instead of sugar (monk fruit, stevia). Choose a high-fiber breakfast such as oatmeal (steel-cut oats, bran cereal), eggs with vegetables (vegetable omelet, tofu scramble), or Greek yogurt with berries and nuts (plain cottage cheese with berries, chia pudding). Morning Snack A handful of unsalted nuts (almonds, walnuts) or fresh vegetables with hummus (celery with peanut butter, cucumber slices with tzatziki). Drink water (sparkling water, unsweetened chamomile tea). Lunch Fill half your plate with non-starchy vegetables (broccoli, spinach). Add lean protein (fish, skinless chicken, tofu, beans). Include whole grains or legumes (quinoa, brown rice, lentils). Drink water or hibiscus tea (unsweetened iced tea, sparkling water with lemon). Afternoon Snack Apple slices with peanut butter (pear with almond butter, celery with peanut butter) or cottage cheese (plain Greek yogurt, edamame). Avoid sugary drinks and processed snacks (candy, sweet pastries). Dinner Enjoy lean protein (salmon, turkey, tofu), plenty of vegetables (roasted Brussels sprouts, mixed salad), and a moderate portion of whole grains or sweet potato (barley, quinoa). Finish with cinnamon tea (peppermint tea, chamomile tea) if desired. Daily Habits Exercise at least 150 minutes per week (brisk walking, swimming). Maintain a healthy weight through balanced eating and regular activity. Sleep 7–9 hours each night (consistent bedtime, limit screens before bed). Stay hydrated (water, unsweetened herbal tea), manage stress (meditation, yoga), and schedule regular blood sugar checkups with your healthcare provider.
ASA PHYSICAL STATUS I-VI [ASA READ]
NITRONOX PLUS - Training (5 min) Training 20 min ,
https://pubmed.ncbi.nlm.nih.gov/
Anxiolysis|Sedation|Anesthesia Overview - go to conscious sedation(New!)
SPINE:
CERVICAL- FACET MBB RFA | ESI (CESI w/o ctr) |ONB | TPI |TH-ESI
LUMBAR - FACET MBB RFA | ESI (LESI w/o ctr) |TFESI |SACROILIAC JOINT|CAUDAL
NEVRO - Nevro channel SCS TRIAL [ download print 4 pages] - Detailed/40min
NERVE BLOCKS | TRIGGER POINT:
MIGRAINE NERVE BLOCKS: ONB |SPG block | Botox
UE NERVE BLOCKS | JOINT INJECTIONS
| SHOULDER | ELBOW | WRIST
LE NERVE BLOCKS | INJECTIONS
LATERAL FEMORAL CUT. NERVE
https://thepainsource.com/procedure-lateral-femoral-cutaneous-nerve-block/
KNEE PAIN:
Surgeries - Mobi-c Minimally Invasive TLIF TLIF
Sample info on Artificial Discs
MORE ON NITRONOX ...
AVOID IN 1ST AND 2ND TRIMESTER, OFTEN GIVEN FOR LABOR PAIN.
Cervical - FACET MEDIAL BB -> CFA CERVICAL EPIDURAL
Codes that are correct (verified):
Shoulder pain: M25.511 (right) / M25.512 (left) ✅
Arm pain: M79.601 (right) / M79.602 (left) ✅
Paresthesia of skin: R20.2 (not lateralized in ICD-10) ✅
Shoulder impingement: M75.41 (right) / M75.42 (left) ✅
Subacromial bursitis: M75.51 (right) / M75.52 (left) ✅
Bicipital tendinitis: M75.21 (right) / M75.22 (left) ✅
Scapulothoracic bursitis / Other shoulder lesion: M75.81 (right) / M75.82 (left) ✅
Adhesive capsulitis: M75.01 (right) / M75.02 (left) ✅
Sternoclavicular joint sprain, initial: S23.420A ✅
DISCUSS WITH YOUR DOCTOR 1ST ( Blood thinners | English ) | https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022307s002lbl.pdf
The half-life of Effient (prasugrel) is approximately 7 hours (range 2–15 hours), based on the elimination half-life of its active metabolite.[1] This is substantially shorter than the half-life of warfarin (36–48 hours), and also shorter than the half-lives of the direct oral anticoagulants previously discussed: dabigatran (12–17 hours), apixaban (9–14 hours), rivaroxaban (5–13 hours depending on age), and betrixaban (19–27 hours).[1-6]
**** Important Reminder - FOR REFERENCE ONLY
SEEK INSTRUCTIONS FROM YOUR DOCTORS ****
***For Spine AND HIP INJECTIONS - here are instructions to stop bloodthinners.
For SI joint injections - no need to stop your blood thinner.
Do not stop taking your anticoagulant until you have been cleared to do so by the medical provider prescribing that medication.
Anticoagulants
Coumadin (warfarin): Stop 5 days before procedure; INR must be obtained on the day of the procedure.
Pradaxa (dabigatran): Stop 4 days before procedure.
Eliquis (apixaban): Stop 3 days before procedure.
Xarelto (rivaroxaban): Stop 3 days before procedure.
Bevyxxa (betrixaban): Stop 6 days before procedure.
Antiplatelets / Platelet Inhibitors
Aspirin / Excedrin (any dose “baby” or otherwise): Stop 7 days before procedure.
Plavix (clopidogrel): Stop 7 days before procedure.
Effient (prasugrel): Stop 10 days before procedure.
Ticlid (ticlopidine): Stop 5 days before procedure.
Pletal (cilostazol): Stop 2 days before procedure.
NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
Advil (ibuprofen): Stop 1 day before procedure.
Arthrotec (diclofenac): Stop 1 day before procedure.
Indomethacin: Stop 2 days before procedure.
Lodine (etodolac): Stop 2 days before procedure.
Mobic (meloxicam): Stop 4 days before procedure.
Aleve (naproxen): Stop 4 days before procedure.
Relafen (nabumetone): Stop 6 days before procedure.
Feldene (piroxicam): Stop 10 days before procedure.
Supplements
Fish oil: Stop 6 days before procedure.
Garlic: Stop 7 days before procedure.
Vitamin E: Stop 7 days before procedure.
Turmeric: Stop 7 days before procedure.
Again, confirm these timelines with the provider who prescribed your medication.
**** Recordatorio importante - SOLO PARA REFERENCIA
BUSQUE INSTRUCCIONES DE SU MÉDICO ****
Para inyecciones en la columna vertebral Y la cadera – aquí están las instrucciones para suspender anticoagulantes.
Para inyecciones en la articulación sacroilíaca (SI) – no es necesario suspender su anticoagulante.
No deje de tomar su anticoagulante hasta que haya sido autorizado por el proveedor médico que le recetó ese medicamento.
Anticoagulantes
Coumadin (warfarina): Suspenda 5 días antes del procedimiento; el INR debe obtenerse el día del procedimiento.
Pradaxa (dabigatrán): Suspenda 4 días antes del procedimiento.
Eliquis (apixabán): Suspenda 3 días antes del procedimiento.
Xarelto (rivaroxabán): Suspenda 3 días antes del procedimiento.
Bevyxxa (betrixabán): Suspenda 6 días antes del procedimiento.
Antiplaquetarios / Inhibidores de Plaquetas
Aspirina / Excedrin (cualquier dosis “baja” o normal): Suspenda 7 días antes del procedimiento.
Plavix (clopidogrel): Suspenda 7 días antes del procedimiento.
Effient (prasugrel): Suspenda 10 días antes del procedimiento.
Ticlid (ticlopidina): Suspenda 5 días antes del procedimiento.
Pletal (cilostazol): Suspenda 2 días antes del procedimiento.
AINEs (Antiinflamatorios No Esteroides)
Advil (ibuprofeno): Suspenda 1 día antes del procedimiento.
Arthrotec (diclofenaco): Suspenda 1 día antes del procedimiento.
Indometacina: Suspenda 2 días antes del procedimiento.
Lodine (etodolaco): Suspenda 2 días antes del procedimiento.
Mobic (meloxicam): Suspenda 4 días antes del procedimiento.
Aleve (naproxeno): Suspenda 4 días antes del procedimiento.
Relafen (nabumetona): Suspenda 6 días antes del procedimiento.
Feldene (piroxicam): Suspenda 10 días antes del procedimiento.
Suplementos
Aceite de pescado: Suspenda 6 días antes del procedimiento.
Ajo: Suspenda 7 días antes del procedimiento.
Vitamina E: Suspenda 7 días antes del procedimiento.
Cúrcuma: Suspenda 7 días antes del procedimiento.
TYPES OF PAIN -> TESTS -> TREATMENTS
Most Common Types of Pain =
LBP - HAs - Joint - Neuropathic - FBM - Whiplash (acute)
Neck - Abd/Pelvic - Post-Op - CA - Dental/Face | PAIN RESEARCH
XRAY MRI EMG NCV | Cracking Joints | Sciatic N. |
1️⃣ Lower Back Pain (Most Common) | ~30-40% of adults at some point in life | Leading cause of disability worldwide | Causes: Muscle strain, herniated discs, arthritis (Spine | Knee), spinal stenosis.
DX: Spinal Stensosis - Cervical Lumbar
LUMBAR - FACET MBB RFA | ESI (LESI w/o ctr) |TFESI |SACROILIAC JOINT|CAUDAL
CERVICAL- FACET MBB RFA | ESI (CESI w/o ctr) |ONB | TPI |TH-ESI
2️⃣ Headaches & Migraines | ~15-20% of the population regularly [Tension 40% / Migraine 10% ] | Includes tension headaches, migraines, cluster headaches | Causes: Stress, dehydration, neurological disorders, hormonal changes. WHIPLASH (HEADACHE) |
3️⃣ Joint Pain (Arthritis & Osteoarthritis) | ~25% of adults | Common in knees, hips, hands, shoulders | Causes: Aging, wear-and-tear, autoimmune conditions (rheumatoid arthritis).
NON-STEROID TREATMENTS
Topical Treatments
CBD/THC Topicals – Apply 2–3 times daily as needed (20–30 mg per dose).
Diclofenac Gel (Voltaren 1%) – Apply 2–4 g up to four times daily.
Capsaicin Cream (0.025–0.1%) – Apply 3–4 times daily (initial burning sensation expected).
Therapies & Physical Treatments
Acupuncture – 1–2 sessions per week (based on response).
TENS Therapy – Use 15–30 min per session, up to 2–3 times daily.
Paraffin Wax Therapy – Heat wax to 125–130°F, dip hands 5–10 times, wrap, and leave for 15–20 min, repeat daily or as needed.
Hand Exercises – 5–10 min, twice daily (stretching, grip strength, and mobility drills).
Supplements & Natural Remedies
CBD - OTC is supplement - buy only at a reviewed, reputable company - usually 25-50 mg per dose 2-3x per day
Omega-3 (Fish Oil, EPA/DHA) – 1,000–3,000 mg daily.
Curcumin (Turmeric w/ Black Pepper Extract) – 500–1,500 mg daily, divided into 2–3 doses.
Collagen Peptides – 5–10 g daily (powder or capsules).
Magnesium Lotion (or Oral Supplement) – Apply 1–2 times daily OR take 200–400 mg magnesium glycinate orally.
LUPUS | LIVING WITH LUPUS | ANTI-INFLAMMATORY DIET | RESEARCH = CANNABIS AND AUTOIMMUNE DZ CANNABIS AND LUPUS
LUPUS AND DIET | LUPUS + NUTRITION |
4️⃣ Neuropathic Pain (Nerve Pain, Sciatica, Neuropathy) | ~10-15% of the population | Includes sciatica, diabetic neuropathy, post-herpetic neuralgia, carpal tunnel syndrome | Causes: Diabetes, nerve compression, injury, chemotherapy.
5️⃣ Musculoskeletal Pain (Fibromyalgia, Myofascial Pain, Chronic Pain Syndrome) | ~10-12% of adults | Widespread pain, often linked to stress or nervous system dysfunction | Causes: Muscle overuse, central nervous system disorders, psychological stress.
6️⃣ Neck Pain | ~10-12% of adults | Often work-related or posture-related | Causes: Poor posture, whiplash, arthritis, disc herniation.
7️⃣ Abdominal & Pelvic Pain (IBS, Endometriosis, Menstrual Pain) | ~10-15% of the population | Common in women and people with digestive disorders | Causes: Inflammatory conditions, hormonal imbalances, digestive disorders.
8️⃣ Post-Surgical & Post-Traumatic Pain | ~10-15% of surgery patients | Can develop into chronic pain | Causes: Nerve damage, scar tissue formation, inflammation.
9️⃣ Cancer Pain | ~30-50% of cancer patients (70-90% in late-stage cases) | Often severe and persistent | Causes: Tumor growth, nerve compression, chemotherapy side effects.
🔟 Facial & Dental Pain (TMJ, Toothache, Trigeminal Neuralgia) | ~5-10% of the population | Often related to nerve disorders or jaw misalignment | Causes: Tooth decay, jaw misalignment, nerve dysfunction (trigeminal neuralgia).
Medical Topicals | OTC & HOME MADE
Medical Topicals | OTC & HOME MADE
OTC Topicals for Hand/Joint Pain
OTC Topicals for Hand/Joint Pain
Voltaren® Arthritis Pain Gel – Diclofenac 1% NSAID; ↓ inflammation.
Biofreeze® or Icy Hot® – Menthol/camphor; cooling counter-irritant.
Zostrix® – Capsaicin; depletes substance P.
Aspercreme® Lidocaine – Lidocaine 4%; sodium channel blocker.
4-Ingredient Ginger–Turmeric Salve (Simple Version)
4-Ingredient Ginger–Turmeric Salve (Simple Version)
Ingredients
½ cup coconut oil (carrier & base)
2 Tbsp turmeric powder (anti-inflammatory)
2 Tbsp grated fresh ginger (warming, anti-inflammatory)
1 Tbsp beeswax pellets (thickens & stabilizes)
Method
Warm coconut oil with ginger & turmeric on low heat 20–30 min (avoid boiling).
Strain out solids.
Return infused oil to pan; add beeswax and melt fully.
Pour into jar/tin; cool until solid.
Use
Apply to affected joints 2–3×/day.
Shelf life: ~6 months in a cool, dark place.
Disclaimer: Information provided is for reference only and does not imply affiliation or endorsement with the mentioned individuals, companies, products, services, treatments, and websites. For informational purposes only - contact your medical provider for health and medical advice. Content accuracy, completeness, and timeliness are not guaranteed. Inclusion of information and websites does not constitute endorsement. Users should exercise caution when accessing external content. See your medical, legal, finance, tax, spiritual and other professionals for discussion, guidance, planning, recommendations and greater understanding of the risks, benefits, options and ability to apply any information to your situation.
Cervical Spine (M50.2- codes) C2–3 → M50.21 (High cervical) C3–4, C4–5, C5–6 → M50.22 (Mid-cervical) C6–7, C7–T1 → M50.23 (Cervicothoracic region)
Thoracic Spine (M51.24) T1–T12 → M51.24 (Other intervertebral disc displacement, thoracic region)
Lumbar Spine (M51.26–M51.27) L1–L5 → M51.26 (Other intervertebral DD, lumbar region) L5–S1 → M51.27 ( DD lumbosacral region)
Cervical Spine (M50.2- codes) C2–3 → M50.21 (High cervical) C3–4, C4–5, C5–6 → M50.22 (Mid-cervical) C6–7, C7–T1 → M50.23 (Cervicothoracic region)
Thoracic Spine (M51.24) T1–T12 → M51.24 (Other intervertebral disc displacement, thoracic region)
Lumbar Spine (M51.26–M51.27) L1–L5 → M51.26 (Other intervertebral DD, lumbar region) L5–S1 → M51.27 ( DD lumbosacral region)
Disc Bulge vs Herniation vs Extrusion vs Stenosis
Disc Bulge (DB) – Mild <3 mm, Moderate 3-5 mm, Severe >5 mm | ICD-10: M51.26 (L), M50.30 (C), M51.24 (T)
Disc Herniation (DH) – Protrusion 2-6 mm, Extrusion >6 mm | ICD-10: M51.26 (L), M50.20 (C), M51.24 (T)
Central Canal Stenosis (CCS) – C10 ... L12
C-spine <10 mm (severe), 10-13 mm (moderate)
L-spine <12 mm (severe), 12-15 mm (moderate) | ICD-10: M48.02 (C), M48.04 (T), M48.06 (L)
Foraminal Stenosis (FS) – Significant narrowing <3 mm | ICD-10: M99.33 (C), M99.34 (T), M99.35 (L)
Facet Hypertrophy (FH) – Thickening >3 mm | ICD-10: M47.812 (C), M47.814 (T), M47.816 (L)
Ligamentum Flavum Hypertrophy (LFH) – Thickening >2-4 mm | ICD-10: M47.12 (C), M47.14 (T), M47.16 (L)
Spondylolisthesis (SPL) – Grade I: 0-25%, Grade II: 26-50%, Grade III-IV: >50% | ICD-10: M43.12 (C), M43.14 (T), M43.16 (L)
Spondylosis (SP) – Degenerative disc changes with osteophytes (1-3 mm) | ICD-10: M47.812 (C), M47.814 (T), M47.816 (L)
Osteophyte Complex (OC) – Bone spurs contributing to narrowing | ICD-10: M25.78 (C/T/L)
Thoracic Kyphosis (TK) – Hyperkyphosis >40-45° curvature | ICD-10: M40.09
Lumbar Lordosis Abnormality (LLA) – Loss of normal curvature | ICD-10: M40.56
Thoracic/Lumbar Radiculopathy (TR/LR) – Nerve root compression | ICD-10: M54.16 (L), M54.14 (T), M54.12 (C)
Cervical Myelopathy (CM) – Spinal cord compression | ICD-10: M47.12
Spinal Stenosis
Spinal Stenosis
Spinal Stenosis – MM Criteria Outline
Spinal Stenosis – MM Criteria Outline
I. Cervical Spine (Neck)
I. Cervical Spine (Neck)
A. Central Canal (Sagittal Diameter) Normal: 17–18 mm Relative stenosis: <13 mm Absolute stenosis: ≤10 mm
B. Clinical Correlation
Increased risk of cord compression when <13 mm
Strong association with cervical myelopathy when ≤10 mm
Symptoms: hand clumsiness, gait imbalance, weakness, sensory loss, hyperreflexia
C. Functional/Medical Necessity Notes
Document ADL limitations, fall risk, or progressive neuro deficits
Conservative therapy tried ≥6 weeks unless urgent (e.g., rapidly progressive myelopathy)
II. Lumbar Spine (Lower Back)
II. Lumbar Spine (Lower Back)
A. Central Canal (AP Diameter) Normal: 15–25 mm Relative stenosis: 10–12 mm Absolute stenosis: ≤10 mm
B. Clinical Correlation
Neurogenic claudication (leg pain with standing/walking, relieved by sitting/flexion)
Radiculopathy with dermatomal pain, sensory loss, weakness, reflex changes
Functional limits: walking <100–200 feet without rest
C. Functional/Medical Necessity Notes
Failed conservative therapy (PT, meds, injections) ≥6 weeks
Surgery/intervention appropriate if disabling pain ≥3–6 months or progressive deficit
Urgent indication: cauda equina (bowel/bladder dysfunction, saddle anesthesia)
III. Lateral Recess
III. Lateral Recess
A. Depth
Normal: ≥4–5 mm Stenosis: <4 mm (diagnostic)
B. Clinical Correlation
Radicular leg pain or neurogenic claudication correlates with recess narrowing Often affects traversing nerve roots
IV. Neural Foramen
IV. Neural Foramen
A. Foraminal Height
Normal: ~15 mm Mild narrowing: 10–15 mm Moderate: 8–10 mm Severe: ≤8 mm
B. Clinical Correlation
Foraminal stenosis = nerve root impingement, dermatomal pain, paresthesia, weakness
Severe stenosis (≤8 mm) usually associated with compressive radiculopathy
V. Key Documentation Elements (Insurance MM Style)
V. Key Documentation Elements (Insurance MM Style)
Imaging: MRI/CT shows narrowing (with mm measurements) at symptomatic levels
Symptoms: Neurogenic claudication, radicular pain, or myelopathy signs
Neuro Exam: Objective deficits (weakness, sensory loss, reflex changes)
Functional Impact: ADL or ambulation limits, failed conservative therapy
Urgency Criteria: Cauda equina, rapid neuro decline, or severe progressive myelopathy
WORK INSTRUCTIONS - ENGLISH AND SPANISH
WORK INSTRUCTIONS - ENGLISH AND SPANISH
🩺 Patient Instructions
🩺 Patient Instructions
English
English
Use a lumbar brace during work that involves bending or lifting.
Avoid heavy lifting when possible; ask for help with loads over 20–25 lbs.
Bend at the knees, not the waist; keep the back straight when lifting.
Take frequent breaks to stretch your back and legs.
Apply ice or heat as needed for pain relief.
Continue any prescribed exercises or physical therapy.
Report worsening pain, numbness, or weakness to your doctor immediately.
Español
Español
Use un cinturón lumbar durante el trabajo que implique agacharse o levantar objetos.
Evite levantar objetos pesados cuando sea posible; pida ayuda con cargas de más de 9–11 kg.
Doble las rodillas, no la cintura; mantenga la espalda recta al levantar.
Tome descansos frecuentes para estirar la espalda y las piernas.
Aplique hielo o calor según sea necesario para aliviar el dolor.
Continúe con los ejercicios o la fisioterapia indicada.
Informe de inmediato a su médico si el dolor empeora, o si siente adormecimiento o debilidad.
These are medical back braces and spinal support devices designed to help with lower back pain, posture correction, and spinal alignment. They include options for different conditions like herniated discs, scoliosis, and general back support. Consult your doctor to determine which type best suits your specific needs.
Key Points:
Proper fitting essential- wrong size = worsen pain
Start gradually - wear 30-60 minutes initially to avoid muscle weakness
Combine with PT - don't rely on brace alone
Check insurance coverage - may need Rx
Monitor skin - watch for irritation
Get medical evaluation first - wrong type can cause harm
TYPES OF PAIN
Overall Pain Burden
Overall Pain Burden
= Chronic pain affects ~20% adults worldwide (~1.5B people) and ~50M US adults (20M high-impact).
1. Nociceptive Pain = Pain from actual/potential tissue damage via intact somatosensory system.
1. Nociceptive Pain = Pain from actual/potential tissue damage via intact somatosensory system.
Prevalence: ~30–40% adults worldwide | ~100M US Subtypes: Somatic (skin, muscle, bone) vs Visceral (organs).
Mediators: Prostaglandins, bradykinin, substance P. Examples: Osteoarthritis, appendicitis, fractures.
2. Neuropathic Pain = Pain from lesion or disease of somatosensory nervous system.
Prevalence: ~7–10% worldwide | 8–10% US Mechanisms: Ectopic discharges, maladaptive plasticity, central sensitization.
Biomarkers: NaV1.7/NaV1.8 sodium channel mutations, glial activation.
Examples: Diabetic neuropathy, post-herpetic neuralgia, radiculopathy.
3. Nociplastic Pain = Pain from altered nociception without clear tissue damage or nerve lesion.
3. Nociplastic Pain = Pain from altered nociception without clear tissue damage or nerve lesion.
Prevalence: ~20% worldwide | ~10–15% US Mechanisms: Central sensitization, impaired descending inhibition, abnormal pain modulation. Associated Syndromes: Fibromyalgia, irritable bowel syndrome, tension-type headache. Neuroimaging: Abnormal thalamic–cortical connectivity, altered μ-opioid receptor binding.
4. Mixed Pain = Overlap of nociceptive, neuropathic, and/or nociplastic processes.
4. Mixed Pain = Overlap of nociceptive, neuropathic, and/or nociplastic processes.
Prevalence: ~30–50% of chronic pain cases | ~40% US
Examples: Low back pain (mechanical + nerve compression), cancer pain, post-surgical pain.
5. Other Specialized Categories =
Inflammatory Pain = Driven by immune mediators (TNF-α, IL-1β, NF-κB). Seen in RA, Crohn’s, gout. (~3–5% worldwide | ~5–7% US)
Functional Pain = Clinical symptom without proportional pathology, overlaps with nociplastic.
Psychogenic/Idiopathic Pain = Pain disproportionate or unexplained by pathology, influenced by psychiatric or biopsychosocial factors (~5–10%).
📌 Key Concept:
Nociceptive = damage signal
Neuropathic = nerve injury
Nociplastic = altered processing
Mixed = overlapping mechanisms
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Disclaimer: Information provided is for reference only and does not imply affiliation or endorsement with the mentioned individuals, companies, products, services, treatments, and websites. For informational purposes only - contact your medical provider for health and medical advice. Content accuracy, completeness, and timeliness are not guaranteed. Inclusion of information and websites does not constitute endorsement. Users should exercise caution when accessing external content. The third party links are not under our controlled and we do not monitor them so we cannot be responsible for any damages from using those links. See your medical, legal, finance, tax, spiritual and other professionals for discussion, guidance, planning, recommendations and greater understanding of the risks, benefits, options and ability to apply any information to your situation.
Key resources include American Academy of Pain Medicine (https://www.painmed.org/), International Association for the Study of Pain (https://www.iasp-pain.org/), American Academy of Orthopaedic Surgeons (https://www.aaos.org/), and National Alliance on Mental Illness (https://www.nami.org/) for comprehensive pain management guidance.
FOODS TO REDUCE INFLAMMATION
Anti-inflammatory foods:
Food list, Inflammation, Good Foods, and Bad Foods , VA article
Antioxidant content of more than 3100 foods, beverages, spices, herbs and supplements
Overview of anti-inflammatory diets and their promising effects on non-communicable diseases
For Hypertension: DASH DIET
[ Click for more - in English and Spanish ]
English Version
English Version
What Is Inflammation?
What Is Inflammation?
Inflammation is your body’s natural response to injury or illness. Short-term inflammation supports healing, but long-term (chronic) inflammation is linked to conditions such as heart disease, diabetes, and arthritis.
Foods That Help Reduce Inflammation
Foods That Help Reduce Inflammation
Fruits and Vegetables
Eat a wide variety of colorful fruits and vegetables daily
Rich in natural anti-inflammatory compounds
Aim to fill half your plate with fruits and vegetables at each meal
Whole Grains
Choose whole-grain bread, brown rice, oatmeal, and whole-wheat pasta
Avoid refined grains such as white bread and white rice
Fiber in whole grains helps lower inflammation
Healthy Fats
Use olive oil for cooking and salads
Include nuts such as almonds, walnuts, and pistachios
These fats help reduce inflammatory markers
Fish
Eat fish 2–3 times per week, especially fatty fish (salmon, mackerel, sardines, tuna)
Fish provides omega-3 fatty acids, powerful anti-inflammatory nutrients
Legumes and Beans
Include beans, lentils, chickpeas, and peas regularly
Excellent sources of plant-based protein and fiber
Herbs and Spices
Use herbs and spices to add flavor and health benefits
Examples: turmeric, ginger, garlic, cinnamon
Foods to Limit
Foods to Limit
Red and Processed Meats
Limit beef, pork, bacon, sausage, and deli meats
These foods may increase inflammation
Refined Carbohydrates and Added Sugars
Reduce white bread, pastries, cookies, and sugary drinks
Choose whole-grain alternatives instead
Saturated and Fried Fats
Limit butter, cream, and fried foods
Use olive oil or other plant-based oils instead
The Mediterranean Diet Pattern
The Mediterranean Diet Pattern
The Mediterranean diet is one of the most effective eating patterns for reducing inflammation. It emphasizes:
Fruits, vegetables, and whole grains
Olive oil as the primary fat
Fish and poultry more often than red meat
Regular intake of nuts, beans, and legumes
Moderate amounts of dairy
Additional Tips
Additional Tips
Stay active: Regular physical activity reduces inflammation
Maintain a healthy weight: Excess weight increases inflammatory burden
Avoid smoking: Smoking promotes chronic inflammation
Dietary changes are most effective when combined with appropriate medical care. Consult your physician or a registered dietitian for personalized guidance.
Versión en Español
Versión en Español
¿Qué Es la Inflamación?
¿Qué Es la Inflamación?
La inflamación es la respuesta natural del cuerpo ante una lesión o enfermedad. A corto plazo ayuda a sanar, pero la inflamación crónica se asocia con enfermedades del corazón, diabetes y artritis.
Alimentos Que Ayudan a Reducir la Inflamación
Alimentos Que Ayudan a Reducir la Inflamación
Frutas y Verduras
Consuma una variedad de frutas y verduras coloridas todos los días
Contienen compuestos naturales antiinflamatorios
Intente llenar la mitad del plato con frutas y verduras en cada comida
Granos Integrales
Elija pan integral, arroz integral, avena y pasta de trigo integral
Evite granos refinados como pan blanco y arroz blanco
La fibra ayuda a reducir la inflamación
Grasas Saludables
Use aceite de oliva para cocinar y en ensaladas
Consuma nueces como almendras, nueces y pistachos
Estas grasas ayudan a combatir la inflamación
Pescado
Consuma pescado 2–3 veces por semana, especialmente pescado graso (salmón, caballa, sardinas, atún)
Rico en ácidos grasos omega-3 con efecto antiinflamatorio
Legumbres
Incluya frijoles, lentejas, garbanzos y guisantes con regularidad
Excelentes fuentes de proteína vegetal y fibra
Hierbas y Especias
Agregue hierbas y especias para mejorar el sabor y la salud
Ejemplos: cúrcuma, jengibre, ajo, canela
Alimentos Que Debe Limitar
Alimentos Que Debe Limitar
Carnes Rojas y Procesadas
Limite carne de res, cerdo, tocino, salchichas y carnes frías
Pueden aumentar la inflamación
Carbohidratos Refinados y Azúcares
Reduzca pan blanco, pasteles, galletas y bebidas azucaradas
Prefiera opciones integrales
Grasas Saturadas y Frituras
Limite mantequilla, crema y alimentos fritos
Use aceites de origen vegetal como el aceite de oliva
El Patrón de la Dieta Mediterránea
El Patrón de la Dieta Mediterránea
La dieta mediterránea es uno de los mejores enfoques para reducir la inflamación. Incluye:
Frutas, verduras y granos integrales
Aceite de oliva como grasa principal
Más pescado y aves que carne roja
Nueces, frijoles y legumbres con frecuencia
Cantidades moderadas de productos lácteos
Consejos Adicionales
Consejos Adicionales
Manténgase activo: El ejercicio reduce la inflamación
Mantenga un peso saludable: Ayuda a disminuir la inflamación
No fume: Fumar aumenta la inflamación crónica
Estos cambios funcionan mejor junto con su atención médica habitual. Consulte a su médico o a un dietista registrado para orientación personalizada.
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