In your essence you are pure and perfect. But dealing with being human, including the pain, suffering, and guilt which permeates our lives, the lives of our loved ones, and the lives of countless people that we hear about can be such a burden to our soul. Negative emotions can run rampant over our desired happiness, and life situations can become overwhelmingly hard to handle. So hard, in fact, that we may accidentally harm ourselves by repressing socially unacceptable emotions, such as rage, resentment, and guilt, and turning them into physical pain instead.

The emotional component of pain is so misunderstood that an entire medical industry, Pain Management, is having a heyday prescribing drugs, surgery, and physical therapy simply because of our inability to cope with the stressors of life. The best way to truly become healthy and pain free is to know how your emotions, especially those that you may have repressed, may be causing your pain.

Your body has an incredible ability to heal from injury. Even horrendous injuries can heal without lingering pain. Our nerves are there as early warning devices to warn us of possible harm, but they are not meant to keep screaming long after the injury is healed. Consider a sprained ankle. It really hurts, maybe for a few days, or if the sprain is really terrible, a couple weeks. But remember when you sprained your ankle years ago; it doesn’t still hurt, does it? Or your skinned knee when you were 5. How about that? Does it still hurt? No, it would make no sense for it to still hurt. You have healed. Sciatica pain is like this. There is no reason for your sciatic nerve to keep screaming ‚ “The sky is falling! The sky is falling!” And it doesn’t matter if your doctor finds a problem with your low back, such as a herniated disc. Doctors are very excellent at finding small things on x-rays and blaming your pain on them. It would be vital for you to know several research studies of the x-rays of people’s backs have shown that herniated discs are not indicative of pain. They x-rayed people with and without back pain and found just as many instances of herniated discs on pain free people as they did those who reported pain.

It is vital to know that the discs in our neck and low back start to get compressed early in life simply due to gravity. Compressed discs are not in themselves a cause pain. They have just become a convenient scapegoat for the pain. Your pain, if it has become chronic, is more likely caused by repressed emotions of rage or resentment. Dr. John E. Sarno, a back pain specialist, found that nearly 90% of his patients were able to cure themselves of their chronic back pain, including sciatica, by simply understanding that their unconscious was causing the pain, not their bodies. In many cases their pain was gone overnight. Dr. Sarno believes that our unconscious mind, which also operates our bodies on autopilot (reckon breathing, blinking, and your heart-rate) takes the emotional pain and makes a physically painful condition by contracting blood vessels, which reduces blood flow to the area, to which our nerves react by shouting out a warning of pain. What this pain is really saying is, “Hey, we need a small more blood flow down here. We need more oxygen.” But all you feel is pain.

Humans are complicated creatures, but we make our lives much more hard by blaming our pain and suffering on everything beside ourselves. I cured myself of 16 years of chronic neck pain once I understood the concepts of mindbody healing and applied them to my own pain. I sometimes have pain in my neck, and when I do, I check my unconscious. What am I stressed about? What is making me mad? I have learned to “let go” and this has done wonders for my pain management. I don’t take pharmaceutical medication for pain, nor do I treat it as if it is a physical problem by getting massage or sitting in hot tubs. I know that if pain comes, it is emotional and I deal with it. Try it yourself, and see how it works for you.

First, we want to introduce modalities. Modalities include any method of therapeutic treatment.  Items considered modalities include applying heat and cold, over the counter medication, massage devices, and others.  They are therapeutic devices that help with the immediate relief of your lower back pain and potentially increase the healing process.

Two of the simplest and most common forms of modalities available at home are heat and cold.  A combination of both heat and cold should be used to gain the most effective relief from lower back pain symptoms.  Appropriately applying heat and cold to the area(s) in question will significantly decrease the pain and increase flexibility as well as the healing process.

When properly applied, heat will improve blood flow to the lower back pain area in question.  By increasing the blood flow, heat allows the affected muscle(s) to relax and become more flexible, in turn decreasing the tightness in the area in question.  Cold on the other hand will constrict or tighten the muscle(s) reducing the blood flow to that area.  By periodically removing the cold, new blood circulates to the muscle(s) in question making a better environment for that area of trauma to heal.  In addition, cold will help reduce swelling as well as reduce the pain in the affected area(s).

The following are two simple methods for at home lower back pain relief with regards to heat and cold application.

1. For Heat – Place uncooked rice in a sock and place it in the microwave for 10-15 seconds or until the desired heat is bought.
2. For cold, try using a bag of frozen peas or make a homemade ice pack by placing ice in a plastic bag.

These two simple at home modality applications will certainly help with reducing your pain, increasing flexibility and as well as assisting the healing process.

On a side note, please use caution when entertaining various other modalities such as laser treatments, electric shock and other modalities.  They can be detrimental to both your health as well as to your pocket.  Keep in mind that to relieve lower back pain symptoms, you really don’t have to spend money.  You have everything you need at home.

The second effective treatment for at home lower back pain relief is strengthening exercise.  Strengthening exercise is vital to lower back pain recovery.  It is very vital to know exactly what strengthening exercises to do as there are specific exercises for specific lower back pain symptoms.  Our goal is to coach you along the way so you have the appropriate mechanics to stop the lower back pain at its core.

For example, as an analogy, anyone can throw a baseball, but if you don’t have someone there to coach you, to have the right mechanics to know what step to foot forward with, to where to place your arm, to how to throw the ball, you really won’t be that accurate with throwing a baseball.

The same thing holds right for recovering from lower back pain. If you don’t know what strengthening exercise to do and what muscle groups to target, you may never relieve the lower back pain because you will just aimlessly doing a bunch of exercises.  In addition, performing the incorrect strengthening exercises can really exacerbate the symptoms of your lower back pain causing you additional undue stress and pain.

It is vital for you to know that alleviating lower back pain is much more than just doing exercises, putting on ice, and getting back to life.  It is essential that you become aware of the appropriate muscle group(s) that causes your lower back pain and how you can use the appropriate strengthening exercises to regain your health.

Last but not least we want to introduce our final treatment of this article – stretching. You may have heard that certain stretches work best for relieving lower back pain.  While many of the demonstrated stretches can be effective in stopping lower back pain, many times your back pain will not subside because you don’t know exactly what muscle group is the cause of your pain.  That’s why it is crucially vital for you to first know what muscle group(s) are contributing to your back pain and what specific stretches you can do to alleviate your lower back pain.

Rather than giving you arbitrary strengthening exercises and stretches, we have made quick and detailed questionnaire that was designed as a 1-on-1 consultation with our back pain specialists to diagnose the underlying causes of your back pain.  It takes out the guesswork from lower back pain relief and only takes our average client 5 minutes to complete.  In addition, once you complete the questionnaire, you will receive a Free Personalized Back Pain Relief Guide that provides you with the essential information to finally feel relief from your lower back pain.

You can access the questionnaire and receive your Free Personalized Back Pain Relief Guide at http://www.stopsbackpainnow.com

Or for additional information regarding lower back pain relief please visit our blog at http://www.stopsbackpainnow.com/blog or our video page at http://www.youtube.com/stopsbackpainnow

News on the rising deaths of patients using COX-2 inhibitors and traditional NSAIDS (Nonsteroidal Antiinflammatory Drugs) has prompted medical experts to recommend the ban or withdrawal of drugs with these ingredients from the market.

After discussing the safety data for both NSAIDs and the COX-2 inhibitors, the group endorsed an expanded role for weak opioids, which are more effective in moderate-to-severe pain than NSAIDs. At the same time these possess other significant advantages included titratability, reversibility and lack of prostaglandin-associated side effects.

The role of combinations of weak opioids and other analgesic agents – in particular, tramadol plus paracetamol – merits particular attention.

A group of international pain specialists considered that tramadol and tramadol combinations offered a useful advantage in that they were ‘NSAID-sparing’. The drug could be used in combination with lower-than-usual doses of NSAIDs. Use of tramadol is recommended by medical societies.

The panel also recommended the proper utilization of weak opioids. Side-effects, they stressed, are a common reason given for non-compliance.

The panel agreed that a policy of ‘go low, go slow’ – starting with a low dose and increasing it gradually – should be used to achieve excellent analgesia without intolerable side-effects.

After thorough deliberations, the group concluded that it is very vital to communicate clear guidance to physicians on appropriate prescribing of analgesics in this new climate of uncertainty regarding the continuing use of COX-2 inhibitors.

Way back in 2004, there was a go for the global withdrawal of rofecoxib (Vioxx), which and concerns regarding use of other COX-2 inhibitors. Rofecoxib is used to relieve pain, tenderness and stiffness caused by arthritis. It is in a class of COX-2 exhibitors.

This then raised concerns for the need of prompt and clear guidance to physicians regarding prescription of drugs with these compositions.

NSAIDS and Cox-2

There really are two Cox enzymes, Cox 1 and Cox-2. Both enzymes produce prostaglandins that promote inflammation, pain, and fever. But, only Cox-1 produces prostaglandins that support platelets and protect the stomach.

NSAIDs block the Cox enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced.

Since the prostaglandins that protect the stomach and support the platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.

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An example, movement can help when you lower back pain is coming from weakness in the gluts. Rotational activities or movements seem to help alleviate the pain and tightness temporarily and provide pain relief. The reason your lower back feels better is because the gluts will slightly stretch. Your gluts are one of the key essential muscles responsible for rotation. When you activate your gluts through movement it causes them to shorten and become more active and engaged causing the opposite tight muscle group to lengthen and decrease the stress on your spine.

Movement helps improve the blood flow throughout the body and especially to the area of discomfort or pain. Improved blood flow is a key feature in healing because it starts to bring healthy blood and nutrients to the area of pain and irritation. It makes a natural flushing of the tissues to start and promote the healing process. Movement also helps with the releasing of endorphins, your body’s own natural pain killers.

Right movements can be extremely beneficial in healing process. Choosing the right movement, the duration of time while performing the movement and how many times a week to perform the movement is extremely vital. The longer you stay inactive, in bed or confined to a chair for hours, the slower your recovery tends to be. The body is designed to go and if you can choose the proper movements, you can help yourself heal quicker.

You can get a free “Personalized-For-You” Back Pain Relief Guide complete with pain stopping information at http://www.StopsBackPainNow.com

Martin Schneckenberger is the head Physical Therapist and Back Pain Specialist for the Spinal Wellness Research Center. The goal of the Spinal Wellness Research Center is to permanently relieve clients’ back pain through a series of education and application. We strive to help others learn the root rather than the cause of their problem so pain can be addressed and relieved at its core.

You can find out more information on upper, lower and middle back pain relief, as well as other helpful information at our blog at http://www.stopsbackpainnow.com/blog

Muscles involved in chewing (mastication) also open and close the mouth. The jawbone itself, controlled by the TMJ, has two movements: rotation or hinge action, which is opening and closing of the mouth, and gliding action, a movement that allows the mouth to open wider. The coordination of this action also allows you to talk, chew, and yawn.

TMJ can be caused by trauma, disease, wear due to aging, or habits. TRAUMA such as a punch to the jaw or an impact in an accident can break the jawbone or hurt the disc.

TEETH GRINDING as a habit can result in muscle spasms and inflammatory reactions, thus causing the initial pain. Generally, someone who has a habit of grinding his or her teeth will do so mostly during sleep. In some cases, the grinding may be so loud that it disturbs others.

CLENCHING: Someone who clenches continually bites on things while awake. This might be chewing gum, a pen or pencil, or fingernails. The constant pounding on the joint causes the pain. STRESS: is often blamed for tension in the jaw, leading to a clenched jaw.

OSTEOARTHRITIS: Like other joints in the body, the jaw joint is prone to have arthritic changes. These changes are sometimes caused by a breakdown of the joint or normal aging.

RHEUMATOID ARTHRITIS: causes inflammation. As it progresses, the disease can cause destruction of cartilage and erode bone, deforming joints.

TMJ Symptoms

1. Pain in the facial muscles and jaw joints may radiate to the neck or shoulders. Joints may be overstretched. You may experience muscle spasms form TMJ. You may feel pain every time you talk, chew, or yawn. Pain usually appears in the joint itself, in front of the ear, but it may go elsewhere in the skull, face, or jaw.

2. TMJ may cause ear pain, ringing in the ears, and hearing loss. Sometimes people mistake TMJ pain for an ear problem, such as an ear infection, when the ear is not the problem at all.

3. When the joints go, you may hear sounds, such as clicking, grating, and/or popping. Others may also be able to hear the sounds. Clicking and popping are common. This means the disc may be in an abnormal position. Sometimes no treatment is needed if the sounds give you no pain.

4. Your face and mouth may swell on the affected side.

5. The jaw may lock wide open (then it is dislocated), or it may not open fully at all. Also, upon opening, the lower jaw, may deviate to one side. You may find yourself favoring one painful side or the other by opening your jaw awkwardly. These changes could be sudden. Your teeth may not fit properly together, and your bite may feel odd.

6. You may have distress swallowing because of the muscle spasms.

7. Headaches and dizziness may be caused by TMJ. You may feel nauseous or vomit.

Occasional pain in the jaw joint or chewing muscles is common and may not be a cause for concern. See a doctor if your pain does not go away. Treatment for TMJ should start when it is in early stages. The doctor can clarify the functioning of the joints and how to avoid any action or habit(eg. chewing gum) that might aggravate the joint or facial pain.

EXAMS AND TESTS: A medical history will be done to help the doctor diagnose your jaw problem. The doctor will question questions about your habits, such as grinding or clenching teeth, chewing gum often, frequent nail biting or chewing on objects such as pens or pencils. He will question what kind of pain you are having and if the pain is there all the time or just comes and goes.

Physical examination: During the physical examination, the doctor will examine your head, neck, face, and temporomandibular joints, noting any of the following.

1. Tenderness (pain) and it’s location.

2. Sounds, such as clicking, popping, or grating.

3. The mandible (lower jaw) range of motion and whether it is simple to open and close and can go from side to side and forward-backward without any pain.

4. Your assessment of pain on a scale from 0 (no pain) to 10.

5. Wear on buccal cusps of the mandibular teeth, especially the canine.

6. The rigidity and or tenderness of the chewing muscles.

7. How your teeth fit together: normal, open, cross bite, overbite, dental restorations, or skeletal deformity.

Imaging; X-rays may be taken of the mouth and jaw. CT or MRI may also be used. The MRI was designed for soft tissue and, therefore will show the location of the TMJ disc in relationship to the jaw and skull bones. That will give the doctor a better thought as to the proper treatment approach.

Most cases of TMJ are temporary thus treatment is usually conservative. You may also be instructed to follow up with a specialist such as an oral and maxillofacial surgeon, a general dentist or a pain specialist physician. Dentists are often the first to diagnose TMJ and are familiar with the conservative treatments.

For people suffering in pain problems, modern advances in medicine provide new methods for chronic pain relief. Over the years, chronic pain had been dismissed as something that is just “in the head”. But, modern technology has developed ways to know how the sensation of pain occurs. It has gained greater understanding of how the nervous system, including the spinal cord, interacts with the brain to make such sensation of pain.

New insights into the brain’s neurotransmitter system have paved the way for new techniques in chronic pain relief. Recently, scientists have learned ways how to maneuver those chemical messengers to change the way they interact with the brain.

This led to the use of antidepressants and other drugs as effective medication for chronic pain relief. Advances in MRI imaging have allowed researchers to clearly demonstrate how real the changes in the brain are. It exactly shows where the sensation of pain is occurring in the brain upon activation by a stimuli. The effects of pain on emotion can be seen, and vice versa.  

According to Dr. Kwai-Tung Chan, a pain specialist and professor of physical medicine and rehabilitation at Baylor College of Medicine in Houston, there’s a new understanding of a process called central sensitization. He said that if the initial pain from an injury is not adequately treated, those pain signals are sent repeatedly — which leads to changes in the central nervous system, making it more and more sensitive. Over time, even the gentlest touch can become very painful.

Pain specialists are banking on these new insights to prescribe new treatments that attack moderate-to-severe chronic pain from different angles: innovative drugs, targeted nerve-zapping procedures, and drug pumps that deliver strong painkillers to the nerve root. There is also a growing evidence that the use of psychotherapy, relaxation techniques and alternative methods can induce chronic pain relief through mind-body connection.

Research has done a fantastic deal in developing new treatment options in pain management. And there are more advances in the offing. But, people should realize that there are medical doctors who specialize in pain management. Most often, patients consult medical experts when in the later stages of chronic pain when it is already quite hard to treat. The earlier the condition is treated, the better chances for treatments to be effective.

Chiropractic Treatment for Back and Headaches

Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease back pain. To make an adjustment, chiropractors apply a controlled, sudden force on a joint using their hands so that the joint is pushed beyond its normal range of motion. With this joint movement, you may hear a popping or cracking sound.

Additional Pain Treatment By Chiropractic Care

Four to as many as six sessions are usually enough when there is acute low back pain. Chiropractors often use massage and stretching so that shortened muscles or muscle spasms will relax. Treatments such as ultrasound, electrical muscle stimulation and exercises are also used.

Recommendations for Reducing Back Pain

Maintaining a healthy weight, exercising regularly, sitting straight, and letting work be done with your legs during heavy lifting should be done by everybody. Avoid activities involving repetitive bending or twisting. A person should frequently walk around or get up when they have to sit or stand for a long time period.

Back Pain Relief Through Stress Management

Pain can be much worse when there is stress. Negative patterns of thought are habitual by people having chronic pain and this can increase stress. Pain specialists use cognitive therapy to show patients how their pain levels can be increased or decreased by understanding their thoughts. A person can change thinking and any fears preventing plotting or managing activities by being taught cognitive-behavioral therapy.

Recommendations Reducing Stress Causing Pain

Coaching or counseling can be used by therapists so that you can talk about your goals and how to accomplish them. Situations can be thought about accurately and be learned by anyone so that behavior is not controlled by dread. Self-help strategies taught by therapists include gentle exercising, improvement of sleep habits, daily activity pacing, asking others for support, doing meditation every day and relaxing exercises.

Back Pain And Headache Pain Relief From A TMJ Dentist

Temporomandibular Joint (TMJ) dysfunction, a group of several temporomandibular joint conditions, is treated by a TMJ dentist using a dental orthotic. Jaw pain or tenderness, ear aches in and around your ear, discomfort or difficulty when chewing, aching facial pain, locking of a person’s jaw with difficulty opening or closing their mouth, headaches, an uncomfortable bite, as well as an uneven bite where there is contact with one or more teeth prematurely, are all signs of symptoms of TMJ syndrome. Grating sensations and clicking sounds are produced when opening your mouth or when chewing from TMJ disorders. Jaw clicking without any pain or movement limitation probably is not a TMJ disorder.

TMJ Pain Reduction Recommendations

Diagnostic equipment that is computerized and state-of-the-art provides an accurate TMJ treatment diagnosis. Neuromuscular positioning is involved with this non-invasive treatment. Customized mouthpieces (orthotics) are used in this treatment for comfortable lower jaw positioning.

Treatment Conclusion for Pain Reduction

People surveyed by Consumer Reports gave Doctors of Chiropractic high recommendations (59 percent highly satisfied) for treating back pain. Primary care physicians were rated lower (34 percent highly satisfied). There are osteopathic physicians and physical therapists trained in spinal manipulation. Your doctor, dentist or a TMJ specialist can discuss possible causes and treatments of TMJ disorders with you that may be causing all kinds of pain including back pain and headaches.

Cancer pain is classified according to pain duration and quality. Duration of pain can denote the acute or chronic nature of pain. It is common to experience anxiety, apprehension and depression in patients with cancer pain. The types of pain most commonly experienced by cancer patients are:

- Acute cancer related pain

- Chronic cancer related pain

- Pain unrelated to cancer

- Pain in opiod tolerant cancer patients

- End of life pain

After an appropriate medical history review and a physical, a pain physician will tailor a suitable pain treatment program. Because everyone has a different response to medications and therapies, the other types of drugs with pain relievers. They include anti-inflammatory steroids, anticonvulsants, and antidepressants. These drugs may be effective treatments for specific types of pain or pain with specific causes. For example, the doctor may prescribe antidepressants to help relieve certain types of pain. But, it doesn’t necessarily mean that the patient is suffering from depression. Similarly, steroids often are effective in relieving pain associated with inflammation.

Cancer pain can be controlled effectively through therapies already available today. Pain treatments range from mild, nonprescription pain relievers, to stronger prescription medications, to neurological surgery, to alternative therapies such as relaxation, biofeedback, guided imagery, and acupuncture.

Oncologists and pain specialists can devise a treatment plot based on the type and severity of pain, side effects, and how the patient responds to the treatment. Some common approaches to treat cancer pain include:

1. Oral Medicines- Aspirin & NSAIDs, Opiods, Adjuvants

2. Intravenous drugs

3. Transdermal drug delivery systems

4. Nerve blocks

5. Interthecal drug pumps

6. Neuroablstive procedures

Although they have cancer pain, many patients are worried of getting addicted to pain medicines. When cancer pain medicines are given and taken in the right way, patients rarely become addicted to them. To be sure, they should talk to the doctor, nurse, or pharmacist about how to use pain medications safely. Many patients only need pain medicines for a time, until the cause of the pain goes away due to other treatments like chemotherapy, radiotherapy or surgery. When they are ready to stop taking the medicine, the doctor gradually lowers the amount of medicine they take. By the time they stop using it completely, the body has had time to adjust. Some patients will need to take pain medicines for the long-term. Taking medicines regularly should not make patients feel like an “addict.”

Physical dependence, tolerance to medication and addiction are three different issues in people treated with strong pain medications. The patient’s physician can clarify the subtle but vital difference between them. It’s often simpler to control pain in its early stages, because it becomes severe. Therefore, it is better for cancer pain patients to question for adequate pain relief.

A primary care physician or oncologist can help clarify the possible options for pain relief and can make a referral, when necessary, to a pain medicine specialist for optimal pain management.

About Walton Rehabilitation Health System:

Walton Rehabilitation Health Systems (WRHS) is a leading not-for-profit comprehensive, multi-specialty, dedicated provider of physical medicine and rehabilitation. Our mission is to be an advocate for wellness by providing a continuum of services to treat the whole person. WRHS, whose reputation extends throughout the south, is a trusted partner with just the right expertise and treatments to help people with disabling injuries and illnesses return to work and to a fulfilling life. By pursuing its mission, WRHS has grown to include Walton Pain and Headache Centers, Walton Community Services, Walton Options for Independent Living, Walton Foundation for Independence, and Walton Technologies. We are located at: 1355 Independence Drive, Augusta, GA 30901-1037. For more information visit www.wrh.org or call 866-4-WALTON.

The Need for a Doctor

Before anything else, it is crucial to first realize your need for a doctor. Some people simply do not react to pain with urgency. It may not also have occurred to others that there is a possibility of developing arthritis. In any case, arthritis is not something that you can brush away. It is a serious condition that can result in major hurt and disability. If you do not seek treatment, movement may become extremely painful for you. Aside from limiting mobility, some types of arthritis may also permanently hurt your bones and other body parts.

You would know that you need a doctor when symptoms appear. Since there are different arthritis types, there are also different symptoms. Certain symptoms but are similar and would be signs for you to see a doctor. If you suffer from some form of tender swelling, fatigue, fever and painful movement then you might have arthritis.

Asking About Your Condition

If you are not sure if you have arthritis, you can see your general practitioner first. If you do suspect that you have arthritis you can look for an arthritis doctor or a rheumatologist. In any case, a excellent doctor who does not specialize in your particular kind of arthritis will refer you to the right kinds of practitioners. Depending on the severity of your condition, you may have to work with a team of specialists. Possible team members involved in your treatment include pain specialists, physiatrists, orthopedic surgeons, anesthesiologists and neurologists.

Locating a Doctor

An arthritis doctor can just be a few mouse clicks away. You can find one near you by looking for one in the results page of search engines. There are also free directories or professional organization listings of doctors. These are like online yellow pages that can help you find a specialist. Your friends and family too may be excellent sources of information about arthritis experts especially if they have already received treatment.

Researching on Your Doctor

You need more than just a referral to ensure effective treatment. Don’t just take anyone’s word for it. You need to personally know the details about your doctor. Find out for example if he is really licensed and certified. Research on his degree of experience and if he has had any terrible records. You can trace his history by referring to licensing and certifying boards.

Interviewing Your Doctor

Once you do find a doctor, you have to make the best out of your initial interview. Take note of how your doctor talks, what kinds of questions he questions and how he clarifies things. You also have to inquire about your illness and his history as a medical professional. This is where you can choose whether you are at ease with how your doctor treats you.

You simply can’t do without an arthritis doctor. It is very vital though that you look for a real expert who you can trust.

In this article, I will be describing the medical claims modifiers – Modifier -25, -24, -51, -57, -59, -26.

Modifier -25, 25: Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service:

This modifier must be appended with an E/M service. This is the modifier you will need to use with the evaluation and management service done on the same day with other procedure done by the same physician. It has to be above and beyond the usual preoperative and postoperative encounter with the procedure. In fact, by using this modifier, it doesn’t have to have a different diagnosis reported. The most vital thing is that, the E/M level should meet its key components or if it is selected based on time with the patient (counseling and coordination). You have to be careful in using this modifier. It must meet medical necessity. As you know, there are procedures that already includes all other care and management.

Let’s describe this modifier 25:

A patient came in for her monthly follow up for her chronic back pain. At the same time, patient was complaining with severe headache. The pain doctor performed bilateral occipital block on the patient at the time of service. You will append modifier 25 for the E/M code to indicate that both services were rendered on the same day.

You don’t use modifier 25 with E/M encounter that resulted to Choice for Surgery (we have another modifier for this!)

Modifier -24, 24: Unrelated evaluation and management service by the same physician during postoperative period.

As the modifier indicates, this is another modifier that you can only append with an E/M counter. It indicates that the E/M encounter is not related during the global period.

Let’s describe this modifier 24:

A pain specialist performed facet nerve destruction for the patient. During the normal, postoperative global period, the patient came in to the office with severe knee pain due to fall on ice as evidenced by the patient’s subjective information. The pain specialist will then report that E/M encounter with the patient by appending modifier 24 to indicate that encounter is not related during the postoperative global period.

This modifier, like modifier 25 has no restriction as with the level of E/M code as long as it meets medical necessity, all its components or are time-based.

Modifier -57, 57: Choice for Surgery:

An Evaluation and Management service resulted in the initial choice to perform surgery during the E/M encounter.

Let’s describe this modifier:

An OB/GYN sees a patient who complains with severe abdominal pain. It turned out (through ultra sound, radiology and all other diagnostic testing and documentations), the patient is having an ectopic pregrancy. The OB/GYN performs the laparoscopic surgery on the same day. The E/M encounter will then be reported with modifier 57 which resulted to choice for surgery. The laparoscopic surgery should also be reported as performed on the same day without a modifier.

Modifier -50, 50: Bilateral Procedure

You will append modifier 50 for procedures that are obviously billable as bilateral (or two sides, both sides), performed on the same day, the same operative session, on identical anatomical sites, organs (arms, legs, spine).

A Facet Nerve block is unilateral (can be billed as bilateral). When using a modifier 50, make sure you only bill for one unit on the claim form since there is only 1 procedure is performed bilaterally. Though guidelines from other payers may differ. They may require you to list it twice (line 1 and line 2 on the claim form). You have to be responsible to clarify this with your payors.

You use this modifier with add-on codes too! Do not use this modifier with procedures which are already described as bilateral procedures.

Modifier -51, 51: Multiple Procedures

This modifier is used when reporting multiple procedures performed by the same physician on the same day. Do not use this modifier for “add-on” codes (see appendix D of the CPT Code book). Do not use this modifier for codes with “modifier -51 exempt” symbol (see appendix E of the CPT Code book). Do not use this modifier with an E/M code. This modifier can only be used by the same physician on the same day who performed the procedure.

Coding tip: List the highest reimbursable code (after the main procedure code) based on the fee schedule.

Modifier -59, 59: Distinct Procedural Service

Description of Modifier -59: Under certain circumstances, the physician may need to indicate that a procedure or service was distinct or independent from other services performed on the same day.

Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. This may represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. But, when another already established modifier is appropriate, it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best clarifies the circumstances, should modifier 59 be used.

Use this modifier only if the other procedure is a separately identifiable procedure code. Procedure that is distinct and can be described as independent procedure, on separate anatomical site, lesion, injury site, different organ system, and different session. Do not use this modifier for E/M code.

Modifier -26, 26: Professional Component

This modifier is used only for the professional component (physician) of a service or a procedure. Certain procedures are a combination of both professional and technical component. By using modifier 26, it indicates that procedure being reported as professional component only.

Professional Component versus the Technical Component. By illustration, procedures rendered at a facility such as outpatient hospital or ASC, these equipments are facility-owned. The facility will then report the technical component for such service while the physician will report the professional component for the that procedure. One very excellent example, the physician performs Paravertebral Facet Block under Fluoroscopic guidance using CPT code 77003. The physician will report the fluoro with modifier 26 for his/her professional component. While the facility will report the the same procedure with modifier -TC for the technical component.

Modifier -LT or -RT are used to indicate a Left or Right side or anatomical site. So if the pain specialist performed Left Cervical Facet Block, you will append a modifier -LT to report this procedure.The above modifiers are used to describe your claims for the services performed on the patient for appropriate payment. Always consult your local careers and third party payors for local determination, policies and guidelines on these modifiers. Looking at the edits is also very vital!