My name is Dr. Jonathan Reisman and I am an interventional pain physiatrist at Kayal Orthopaedic Center; I help individuals in Bergen, Rockland and Hudson counties to decrease their pain. I am double board-certified in physical medicine and rehabilitation and pain medicine, and I combine a detailed physical examination, electrodiagnostics, and advanced imaging to diagnose and treat with precision. The goal of this column is to share some of my experiences to provide an education about pain and how it can be treated and avoided.
On Purim my wife and I dressed up as two less-appreciated characters from Harry Potter, Fred and George Weasley. At first, my red wig was a minor discomfort, but soon the pressure on my posterior cervical spine muscles triggered pain in my occipital nerves, sending a sharp, burning sensation across my scalp and behind my eyes. My wife, grinning triumphantly, declared, “Now you see what it’s like to wear a wig.”
The discomfort escalated, and within minutes, I found myself experiencing firsthand what individuals who wear wigs, hats or tight head coverings deal with regularly: cervicogenic headache and occipital neuralgia.
Occipital neuralgia occurs when stress builds and muscle tension irritates the occipital nerve. This nerve runs from the base of the skull and travels upward through the scalp. Similarly, cervicogenic headache occurs when arthritis or trauma to joints in the upper cervical vertebrae send referred pain along the distribution of the third occipital nerve. This condition can lead to sharp, burning pain or a deep, aching sensation that radiates across the head and behind the eyes.
Many people suffer from neck pain and headaches triggered by tension in the muscles of the neck and scalp. In addition to headgear, poor posture is an under appreciated cause of pain. If you’ve ever spent a long Shacharit hunched over a shtender in a packed standing-room-only house minyan, you know the feeling. Your head is down, your shoulders are rounded, and your spine is slumped forward. This transforms your head’s natural 10-12-pound weight into what feels like a 40-50-pound burden on your neck. Over time this can contribute to headache, neck pain, upper and lower back pain, hip and knee stiffness, and muscle fatigue.
Neck and back pain are frequently thought of as part of the aging process, yet they are often preventable and treatable. I am reminded and inspired by an old Yom Kippur memory that has stayed with me for the past two decades. An elderly family friend who was a Holocaust survivor looked at me and recited, “Al tashlicheni l’ais zikna kichlos kocheni al taazveni.” In English, this means, “Don’t cast me away in my elderly years; when my strength fails, do not abandon me.” As he spoke these words, he nodded his head at me slowly, highlighting the seriousness of this moment for him. Fortunately, there are now effective and safe treatments available that were not accessible in the past.
Some of the most effective treatments for neck and back pain that I perform include: image-guided nerve blocks, epidural steroid injections at all levels of the spine, and radio frequency ablation of painful joints in the neck, back, and knees.
Pain is defined as an uncomfortable physical, psychological, or spiritual feeling, and these different aspects interact with one another. In addition to addressing the physical causes of pain, it’s important to understand the biopsychosocial factors that can contribute to chronic pain. Research has shown that traumatic experiences can impact families for generations, as has been demonstrated in the children and grandchildren of Holocaust survivors.
Studies have found epigenetic changes in grandchildren of Holocaust survivors, contributing to altered cortisol levels, increased sensitivity to stress, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis.
These changes can impact how pain is processed and amplified in the nervous system, leading to increased sensitivity and chronic pain, underscoring the importance of not only addressing physical pain but also considering how our emotional and genetic history can affect our current experience of discomfort.
This column is dedicated to helping you understand different types of pain and what can be done to manage or eliminate them. As we move forward, I will delve into various pain issues, providing education about conditions that are often misunderstood and under-treated.
If you have a pain topic you’d like me to address, send it my way at Jreismando@Kayalortho.com. I would also be happy to meet you in person for a medical evaluation at one of our many offices throughout Bergen, Rockland and Hudson Counties.
