Leave Your Pain At The Door: Leg Pain and Numbness - What might these symptoms mean?

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Leave Your Pain At The Door

A Pain Management Doctor located in NY, focusing on how to live a healthy pain free life in a world that's constantly on the go!

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TUESDAY, OCTOBER 2, 2012

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Leg Pain and Numbness - What might these symptoms mean?

Leg Pain and numbness - What might these symptoms mean? This article (link listed above) talks about leg pain and the different ways it can present when it is caused by problems with the spine. What I want to write about is actually some of the other common causes of leg pain and how that can be confused by pain stemming from pinched nerves in the spine. Vascular pain: This is leg pain cause by insufficient blood flow to the legs because of arthrosclerosis or blockage of the blood vessels supplying the legs. Diabetics, smokers and patients with pre existing coronary artery disease are at increased risks for this. The pain tends to feel like a dull cramping or a sense of muscle fatigue similar to what is felt with rigorous exercise or what some call the burn. This pain mainly occurs with walking as the blocked vessels cannot supply the additional blood to the legs that is needed with activity. The pain tends to be relieved with rest since less blood is needed. This pain is often confused with leg pain coming from spinal stenosis as this pain also occurs mainly with walking and relieved by rest. That is why it is important to be evaluated by a physician who will consider the patients risk factors. It is important for your doctor to check for weakened

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ABOUT ME BLOG ARCHIVE

2012 (7) October (2) Leg Pain and Numbness What might these symptoms ... Attacking Pain Through Multiple Fronts September (1) August (2) May (1) April (1)

Dr. Robert Zhang Dr. Robert Yu-Fan Zhang is an Interventional Pain Management Specialist with extended expertise in treating back pain, head and neck pain, and cancer pain. He is board certified in anesthesiology and fellowship trained in interventional pain management. After graduating from Albert Einstein College of Medicine, he completed his residency at Yale New Haven Hospital and pain management fellowship at University of California of San Francisco Mount Zion Hospital. After practicing as an attending for Kaiser Permanente in California,

http://drrobertzhang.blogspot.com/2012/10/leg-pain-and-numbness-what-might-these.html[10/2/2012 3:23:18 PM]

Leave Your Pain At The Door: Leg Pain and Numbness - What might these symptoms mean?

he now serves as the Director of Pain Management at Queens Medical Associates. Dr. Zhang has extensive experience in a variety of interventions including epidurals, facet therapies, nerve blocks, neurolytic procedures, and radiofrequency ablation. View my complete profile

pulses of the lower extremities which may indicate more of a vascular problem rather than pain stemming from the spine.

Piriformis syndrome and other nerve entrapments: The piriformis muscle is a muscle in the deep buttock area. This muscle can enlarge due to muscle imbalance and can also be inflamed/swollen from trauma such as falling on your buttock. After leaving the spine the sciatic nerve travels pass the piriformis muscle. With a swollen pirformis muscles the sciatic nerve can be compressed and illicit sciatica much like if the nerve was being compressed at the spine. While this is still sciatica, it is distinctly different back problems and treatments geared towards spine mediated pain such as epidurals would not be expected to help. Along the same line the sciatic nerve or parts of the sciatic nerve can become compressed in the other parts of the leg such as behind the knee, at the ankle...etc. An experience physician should consider all of these possibilities.

Neuropathy: This is a problem with the nerve endings itself and can be due to a variety of problems the most common being diabetes. Most of the time, neuropathy is not painful as patients tend to lose sensation rather than develop pain but sometimes there can be a painful neuropathy. This pain will not respond to treatments to the spine because the nerves are not being pinched at the spine rather the problem is at the far ends of the nerves. Consequently, the pain tends to start at the foot and toes. With time it can progress upwards as oppose to sciatica which starts from above and travels downwards. The treatment for neuropathy mainly consists of nerve pain medications and there is some data that shows that spinal cord stimulation may be of benefit.

Referred pain: This is a very broad and obscure topic. The best way to explain it is that all painful sensation in the body travel to the spine where it is relayed to the brain before we can sense it. Sometimes the signal becomes rerouted and confused after reaching the spine so that it makes us feel the pain in another part of the body either with or without the original source of the pain. For instance hip pain can refer down the leg usually at the thigh stopping before the knee but occasionally can pass the knee and
http://drrobertzhang.blogspot.com/2012/10/leg-pain-and-numbness-what-might-these.html[10/2/2012 3:23:18 PM]

Leave Your Pain At The Door: Leg Pain and Numbness - What might these symptoms mean?

reach toward the feet. Same thing goes for pain stemming from arthritis in the sacroiliac joints and facet joints (other joints in the lower back). Referred pain can be very confusing for patients because they may not feel much pain at the actually problem area. Patients tend not to understand how doing a hip injection may actually help with the pain traveling to the thigh. I actually had one patient who had back pain that radiated to the thigh and knee. After several failed back injections, I decided to get additional history and it turns out that the patient was having very pain full menstrual periods. A scan of the pelvis revealed a retroflexed uterus (backward facing uterus). She was referred to gynecology had surgery to correct the problem and back pain has since resolved.

There are many other reasons for leg pain that is unrelated to the spine. These range from metabolic disorders to muscular/orthopedic conditions to other nerve problems not related to the spine. The topic is too extensive to be covered in this bog but I just wanted to give people an idea of the complexity involved. Sometimes it does take a trial and error approach to injections to figure out the true source of the problem and off course many times pain can be multi-factorial which means the pain is a product of multiple problem areas. It is important for your pain physician to have the knowledge, experience and motivation to explore all possibilities especially after back injections have failed. Dr. Robert Zhang 176-60 Union Turnpike Fresh Meadows, NY 11366 718-460-2300
Posted by Dr. Robert Zhang at 11:55 AM

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Leave Your Pain At The Door: Leg Pain and Numbness - What might these symptoms mean?

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