Do I Have Tendonitis or Tendinosis?

You’ve probably had or at least heard of the tendon problem known as tennis elbow. And chances are you’ve heard people say that it’s a form of tendonitis.

You may not have heard of the other type of tendon problem called tendinosis.

Its symptoms are often mistaken for tendonitis, and therefore, it’s often treated like tendonitis. 

Let’s zoom in on five common misunderstandings to see if we can clear up the confusion.

1. Tendonitis is a chronic pain condition. (Wrong!)

Tendonitis is acute or sudden onset, short-term pain from inflammation due to a direct injury.

The symptoms of tendonitis, which are due to inflammation, include swelling, redness, and warmth.

By contrast, tendinosis or tendinopathy is chronic or consistent and recurring pain due to degeneration. Repetitive trauma or injuries causes degeneration characterized by microscopic tears in the tendon.

Tendinosis symptoms include pain but no swelling, redness, or warmth. 

2. Rest is always the best treatment for tendon pain. (Wrong!)

Resting or keeping weight off the tendon doesn’t cure tendinosis because the pain is due to degeneration rather than inflammation. 

The initial pain and swelling of tendinosis are similar to inflammation, but the underlying cause is chronic degeneration due to aging, repetitive use, or repeated injury. 

Tendonitis, however, is characterized by inflammation. Therefore, resting or keeping weight off of the tendon does help bring healing and pain relief. 

3. Anti-inflammatory medication, steroid injections, and cold therapy are always effective treatments for tendon pain. (Wrong!)

These are effective treatments for pain from inflammation, so they are effective in treating tendonitis. 

For tendinosis,  anti-inflammatory medication, steroid injections, and cold therapy can relieve pain in the short run but can’t heal the degenerative damage.

What will provide healing and pain relief is physical therapy that stretches the injured tendon and surrounding muscles.

4. Tennis elbow is always tendonitis. (Wrong!)

The truth is, tennis elbow can be either tendinosis or tendonitis. Tennis elbow affects the tendons that connect the forearm muscle to the outside of the elbow. 

Treatment will depend on the type of tendon pain.

5. Plantar fasciitis is a form of tendonitis. (Wrong!)

Plantar fasciitis is tendinosis in the plantar fascia, the long, thin ligament on the bottom of the foot. Over time, micro-tears develop in the plantar fascia, which causes pain. 

Tendonitis and tendinosis treatment in Houston and Dallas

At Texas Pain Physicians, our pain management specialists know how to diagnose and treat tendon pain. Please don’t make the mistake of guessing what’s causing your pain then applying the wrong treatment. 

To make your appointment, give us a call or book online today!


Common Car Accident Injuries, Symptoms, and Treatments

A recent Esurance report found that the average driver will experience 3-4 accidents in their lifetime. 

Let’s look at some common car accident injuries, symptoms, and treatments (the below list is NOT in order of most common injuries).

1. Internal Bleeding

Your organs are delicate and vulnerable to trauma. These potentially life-threatening injuries are much more likely in high-speed crashes.


  • chest pain
  • nausea
  • vomiting
  • diarrhea
  • dizziness
  • severe weakness
  • losing consciousness
  • low blood pressure
  • acute visual problems
  • numbness
  • weakness on one side of the body
  • severe headache
  • severe abdominal pain
  • shortness of breath


Treatment varies depending on the severity. Minor internal bleeding may stop without intervention, but severe internal bleeding may require surgery and extended care (in hospice).

2. Concussions

Concussions or traumatic head injuries are when a sudden stop or impact jolts the brain hard enough to jostle against the inner wall of the skull. 


  • headache
  • ringing in the ears
  • nausea
  • vomiting
  • fatigue or drowsiness
  • blurry vision
  • confusion or mental fogginess
  • blurred vision


Doctors DO NOT recommend complete rest in a dark room for days.

In the first few days after a concussion, try to get as much sleep as needed and limit or avoid certain physical and mental activities.

For instance, try to cut back on high-concentration activities such as watching TV, playing video games, reading, and using computers — if these activities make your symptoms worse. 

Also, avoid exercise and physical activities for a few days, and continue avoiding them if your symptoms do not improve. 

3. Broken Bones

Common broken bone injuries resulting from auto accidents include:

  • back and neck vertebrae
  • clavicle (shoulder blades)
  • fibula (lower leg)
  • femur (upper leg)
  • cranial (skull)
  • facial bones
  • sternum (rib cage)


  • sudden, shooting pain
  • inability to bear weight
  • deformity (bone pushing up or penetrating through the skin)
  • limited or no range of motion (in limbs)
  • warmth in the affected area
  • bruising and redness


Broken bones must be realigned or set so that they heal correctly.

4. Musculoskeletal Injuries

Musculoskeletal injuries include muscles, tendons, ligaments, nerves, discs, and blood vessels. These injuries can be painful and can restrict limb movement.

Example injuries:

  • Ligament sprain
  • mechanical back syndrome
  • Ruptured bulging or herniated discs


Symptoms vary depending on the location and severity but generally include pain that worsens with activity. The affected area may also look red and inflamed.


Treatment also varies depending on the severity, but generally, treatment plans will include:

  • rest
  • physical therapy
  • anti-inflammatories
  • muscle relaxers
  • heat/cold therapies
  • ergonomics

5. Whiplash (muscle strain) 

Though whiplash is a musculoskeletal injury, it’s so common in car accidents that it demands a separate category.

Whiplash is the sudden contorting and stretching of the head and neck muscles that causes muscle strain. It may be helpful to think of the forceful back-and-forth action of a cracking whip.

Most whiplash injuries in car accidents happen during rear-end impacts. 


Signs and symptoms of whiplash usually develop within days of the injury and may include:

  • Fatigue
  • Dizziness
  • Neck pain, stiffness, and lost range of motion
  • Worsening of pain with neck movement
  • Headaches, most often starting at the base of the skull
  • Tenderness or pain in the shoulder, upper back, or arms
  • Tingling and numbness in the arms


Your pain management specialist will likely recommend over-the-counter pain medication and exercise, including stretching exercises. Whiplash is a minor injury that heals within weeks.

6. Skin Injuries

Serious skin injuries include:

  • cuts
  • lacerations
  • gashes
  • tears

These skin injuries happen when sharp objects penetrate through the skin into the fat tissue. Cuts that measure more than a quarter-inch may need medical attention, and half-inch cuts usually need sutures. 

Rug or seatbelt burns, also known as abrasions, are minor skin wounds that don’t penetrate through the skin.


Anti-bacterial treatment and bandages are sufficient for minor skin wounds that don’t penetrate through the skin. Bruises heal on their own within weeks.

Your Pain Specialists in Texas

At Texas Pain Physicians, our patients quickly come to trust our friendly staff and appreciate the benefits of expert care and innovative treatment methodologies and technology.

If you have been injured in a car accident and received initial medical treatment but are still in pain, please give us a call or book your appointment today.



Treatment and Management of Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) can be extremely painful and debilitating. Treatment and medication for TOS depend on the specific type.

Treatment for Neurogenic Thoracic Outlet Syndrome (NTOS)

Neurogenic thoracic outlet syndrome occurs when the nerves leading from the neck to the arm are compressed. Over 90 percent of cases of thoracic outlet syndrome are neurogenic.

Symptoms include but are not limited to:

  • pain
  • numbness and tingling in the hands
  • pain in the shoulder

Pain specialists often recommend a combination of two or more conservative treatments at the same time. NTOS treatments include (but are not limited to):

1. Physical Therapy

Physical therapists aim to ease symptoms and restore upper-body function. Treatments include:

heat packs: Applying heat packs can relax muscles and lessen pain.

exercise programs: Exercises consist of stretching to improve flexibility and increase strength in the affected areas.

cervical traction: Cervical traction devices help to relax the muscles, increase flexibility, and relieve pain. They do this by slightly stretching the neck, which decreases pressure on the spine by separating vertebrae. 

2. Biofeedback Therapy

A biofeedback therapist helps you practice relaxation exercises, which you fine-tune to control different body functions. 

During a therapy session, a biofeedback therapist attaches electrodes to your skin which monitor stress indicators, such as heart rate, blood pressure, sweating, and muscle activity.

The therapist teaches you to practice relaxation techniques in stressful situations, such as deep breathing and mindfulness.

3. Occupational Therapy

An occupational therapist will generally recommend simple methods for relieving pain and relieving nerve compression, the underlying cause of NTOS.

They will recommend correcting poor posture and practicing safe ergonomics, such as safely lifting heavy objects. They may also recommend simple exercises you can perform at home.

4. Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy can be an effective complementary treatment for TOS. It can help patients in three ways: 

  • Change their perception of pain.
  • Think about their experience in positive terms.
  • Eliminate or at least minimize believing the worst or exaggerating the situation.

5. Medication

Your pain management specialist may recommend taking over-the-counter drugs, such as 

Non-steroidal anti-inflammatories (such as ibuprofen and aspirin) and muscle relaxants, such as tizanidine, can relieve muscle stiffness and pain. 

6. Botox Shots for Pain 

Your pain specialist may recommend a botox injection in the muscle at the base of the neck. 

Botox injections can relax the muscles and ease the pain. The positive effects can last for up to 3 months, and the injections are repeatable.

Treatment for Venous and Arterial Thoracic Outlet Syndrome

These two types of thoracic outlet syndrome account for only 10 percent of cases. Symptoms include, but are not limited to:

  • pain
  • edema (swelling of the hands, fingers, and arms)
  • blue color in the hands and arms
  • bulging veins in the neck, shoulder, and hand

You will likely be treated for possible blood clots and have thoracic outlet decompression surgery. 

After this, you may need long-term pain management. In this case, your pain management specialist would recommend a combination of the above treatments and therapies.

Texas Pain Treatment and Management Specialists

At Texas Pain Physicians, our priority is to improve your quality of life.

If you have been diagnosed with thoracic outlet syndrome or think you may have this condition, please give us a call at (972) 636-5727 or book your appointment online today.

7 Ways to Manage Cancer Pain

Like other pain, the frequency and severity of cancer pain vary. It can be mild, moderate, and severe, as well as constant or chronic. 

Chemotherapy, radiation, and surgery to remove cancer can reduce pain and improve quality of life.

However, these are direct interventions oncologists (doctors who specialize in treating cancer) use to treat and manage cancer itself.

For pain specialists, the goal is to lessen or eliminate pain caused by cancer. Let’s look at seven ways they manage cancer pain. 

1. Anti-depressants and Anticonvulsants

Antidepressants such as Serotonin and norepinephrine reuptake inhibitors (SNRIs) and Tricyclic antidepressants (TCAs) can provide cancer pain relief. 

Studies show that SNRIs are well-tolerated by cancer patients and beneficial in managing neuropathic pain, a type of pain that cancer can cause. TCAs are an older type of antidepressant. 

They can also provide relief from neuropathic pain caused by cancer but are not as well tolerated by cancer patients. 

2. Nerve Stimulation 

Peripheral nerve stimulation may be effective in managing cancer pain.

This pain management method involves surgically planting a small electrical device near the spine or brain. The device transmits electrical impulses to specific nerves that block pain messages from reaching the brain.

3. Nerve blocks

Nerve blocks are injections of local anesthetics into the space around the spinal cord that block the nerves around the spinal cord from sending pain messages to the brain. 

Nerve block injections can provide relief from moderate to severe cancer pain.

4. Complementary/Integrative Approaches 

Pain management specialists may recommend adding these non-medical approaches to a cancer pain management plan at any time.

They include acupuncture, massage, physical therapy, relaxation techniques, and movement therapies. 

5. OTC Pain Medications

Pain relievers like non-steroidal anti-inflammatories ( aspirin and ibuprofen) and acetaminophen (Tylenol) can treat moderate to severe cancer pain. Always check with your doctor before taking these medications. 

They can cause dangerous and potentially life-threatening side effects and are particularly dangerous when taken during chemotherapy treatment. 

6. Marijuana 

In some states, marijuana is legal and prescribed for cancer pain. Studies have found that marijuana can be effective in managing neuropathic pain caused by cancer. 

Also, CBD or cannabis in marijuana can reduce inflammation, which can bring pain relief.

7. Narcotic Pain Relievers

Opioids or narcotic pain relievers such as morphine and oxycodone relieve moderate to severe cancer pain.

Other medications and treatments are preferable, however, since narcotic pain relievers can foster drug dependency. 

Cancer Pain Treatment and Management in Texas

At Texas Pain Physicians, our board-certified physicians are skilled in managing cancer pain.

We can help you set realistic cancer pain management goals and closely monitor the success of your treatment. Please give us a call or book your appointment online today!

Neuropathy: 7 Pain Treatment and Management Options

Stabbing, shooting, burning, and electric shock-like pain. Tingling and pins and needles sensations. 

Living with nerve pain and discomfort from neuropathy can be very, very hard. But pain management specialists know what to do. 

Once they have determined the underlying cause and the type of nerve damage, they can recommend effective treatment and management.

1. Diabetic Care

Diabetes is the most common cause of neuropathy (60-70 percent of people with diabetes suffer from some form of neuropathic pain). When diabetes is the cause, proper diabetic care can decrease and eliminate symptoms. 

2. Antidepressants 

Doctors often prescribe antidepressant drugs like tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors to treat neuropathy.

These drugs can reduce neuropathic pain by increasing chemicals in the brain that reduce incoming pain signals.

3. Anticonvulsants 

Pain specialists sometimes prescribe anticonvulsants to treat neuropathic pain because they may stop damaged nerves from transmitting faulty pain signals. 

4. Nerve Blocks

Nerve blocks can provide long-lasting relief from neuropathic pain.

A nerve block procedure involves injecting steroids, anesthetics, and other medications into the nerves producing faulty pain transmissions. The pain relief can last for days, weeks, or months. 

5. Electrical Impulse Stimulation

Typically, this treatment option is used only after other options have failed. 

Spinal Cord Stimulation (SCS)

First, a surgeon performs a minimally invasive surgery to implant a spinal cord stimulator. A spinal cord stimulator is a device that generates electrical impulses on your spine.

The electrical impulses alter how your brain processes pain by sending electrical impulses to the nerves in the spinal cord. 

Dorsal Root Ganglion Stimulation (DRGS)

If you suffer from neuropathy of the feet, hands, knees, groin, and chest, dorsal root ganglion stimulation is likely a better treatment option than spinal cord stimulation.

Like SCS, DRGS treatment uses electrical impulses to stop nerve pain. However, unlike SCS, DRGS trains electrical impulses on nerves in certain body parts (hands, feet, chest, etc.). 

Like SCS, a DRGS device implant on the spine involves a short surgical procedure.

6. Multidisciplinary Approach 

Neuropathic pain often responds poorly to any single pain treatment or management method.

A multidisciplinary approach that combines one or more methods, such as medications, physical therapy, psychological treatment, and surgery, can be much more effective.

Pain specialists coordinate with other health professionals to provide patients with the best possible pain treatment and management. 

7. OTC painkillers

Non-steroidal anti-inflammatory medications (NSAIDs) can provide fast, convenient relief from neuropathic pain. However, they are often not effective when used without other treatments and therapies.

Neuropathy Treatment and Management in Texas

The pain and discomfort of neuropathy and the loss of sleep, anxiety, and depression that can accompany it, can be challenging to handle. 

At Texas Pain Physicians, our pain management specialists will work day and night to find the best course of treatment and management for you.

Please give us a call or book your appointment online today.

How Pain Specialists Manage and Treat Herniated Disc Pain

Pain from a herniated disc can be mild and easy to handle, moderate and distracting, or severe enough to send you straight to a doctor.

It can hit suddenly and resolve in a few days. It can be constant or chronic and last for months or longer. 

Doctors specialized in pain management recommend treating herniated disc pain with conservative, non-surgical treatments. They may recommend surgery only after all other treatments have failed. 

The Three Types of Herniated Discs 

1. Contained Herniation (bulging disc)

With this type of herniation, there is generally no pain or mild pain. 

Bulging discs occur when pressure between the vertebrae pinches the disc, forcing it to bulge. When there is pain, it comes from the bulging disc putting pressure on nearby spinal nerves.

2. Non-Contained Herniation (severe bulging disc)

This severe disc herniation generally causes severe back pain.

It can also be associated with numbness, weakness, and tingling in the extremities from the extreme pressure on spinal nerves. 

3. Sequestered herniation (disc rupture)

This type of herniation can cause intense pain and decreased mobility. It is also associated with numbness, weakness, and tingling in the extremities.

Disc ruptures can occur when non-contained herniations or severe bulging discs go untreated. As pressure between the vertebrae builds up, it eventually overloads the discs, forcing them to rupture. 

Where They Occur in the Body

Most herniated discs are in the neck and lower back.

Lumbar pain (lower back) 

Sciatica or leg pain is the most common symptom associated with herniated discs in the lower back.

Patients describe sharp, burning, or radiating pain down the lower back, through the buttock, and down the leg (pain travels through the sciatic nerve). 

Herniated lumbar discs can also cause numbness and muscle weakness in the foot and ankle. 

Cervical herniated disc (neck) 

Depending on the location of the herniated disc, pain can present in the neck, shoulder, arm, and hand. The pain from cervical herniated discs can last for days, weeks, months or longer, and be constant or chronic. 

When a herniated disc puts too much pressure on cervical nerves, patients can experience tingling, numbness, and weakness in the deltoid muscle (shoulder muscle), biceps, wrist muscles, hands, and triceps.

Thoracic Spine (upper back)

Disc herniations in the upper back are less common and rarely cause pain. When there is pain, it presents in the upper back and chest. 

Pain Treatments for Them

Pain management specialists typically begin herniated disc treatment with rest and NSAIDs (non-steroidal anti-inflammatory drugs).


Depending on the severity of the pain, medication may make it easier for patients to tolerate physical therapy. 

  • OTC NSAIDs like aspirin and ibuprofen (recommended for mild to moderate pain)
  • oral narcotic agents (prescribed for severe pain)
  • oral steroids (prescribed to treat severe pain and reduce inflammation)

Home and Non-M.D. Treatments

These are treatments that don’t require a pain management doctor’s expertise.

When applied for 4-6 weeks, these treatments can help reduce pain and discomfort. Applying more than one treatment at once may achieve better results. 

  • Heat and cold therapy
  • Moderate physical activity
  • Chiropractic
  • Moderate exercise
  • Changing sleep positions 
  • physical therapy
  • Myofascial release and/or massage

Therapeutic Injections

Pain management specialists may recommend therapeutic injections if conventional therapies and medications don’t work or provide relief soon enough. 

Therapeutic injections can relieve pain for days, weeks, and even months, which buys time for conservative, non-surgical treatments to work.

Two commonly used therapeutic injections: 

  • epidural injections: Used to reduce inflammation and provide extended pain relief.
  • nerve blocks: Used to diagnose the source of the neck pain and to provide extended pain relief.

Herniated Disc Treatment in Texas

If you have been diagnosed with a herniated disc or think you may have one, Texas Pain Physicians can help. We have offices in Houston, Dallas, and a dozen other locations across Texas.

Give us a call or book an appointment online and start your pain-free journey today!

Is Therapeutic Nerve Block A Pain Treatment for You? 7 “Need to Knows”

Maybe your pain medication isn’t working anymore. Maybe you got tired of the side effects and stopped taking it. Or maybe you don’t want to take pain meds at all.

Whatever the case, you need pain relief ASAP. A therapeutic nerve block may be the answer.

Here are 7 things to know about therapeutic nerve blocks:

1. What they are.

A pain-relief and healing therapy doctors employ as an alternative to pain medication. Therapeutic nerve blockers provide extended pain relief and assist the body’s healing process by reducing nerve irritation.

2. What areas of the body they can treat:

  • head: forehead, face, eyelids, scalp, upper jaw
  • neck (all of the neck)
  • back: middle back, lower back, upper back, pelvis
  • arms: shoulders, armpits, arms, elbows, wrists
  • hands (all of the hands)

3. What types of pain do therapeutic nerve blocks treat?


Arthritis pain or pain from injury:

Steroid injections with local anesthetic into the facet joints or vertebrae to help treat joint pain.

Childbirth, neck, back, or leg pain:

Steroid or other medication and local anesthetic injected into the epidural area are known as ‘epidurals.’ These injections are often used during labor to ease the pain of childbirth. They are also used to treat severe nerve pain in the neck, back, and legs.

For buttocks, lower back, and upper leg pain:

Steroid and local anesthetic injections into the sacroiliac joint, the area between the pelvic bones in the lower back.

For arthritis pain in the shoulder:

Steroid and anesthetic injections in the suprascapular area of the shoulder. They treat arthritis pain in the shoulder that isn’t treatable with direct, in-joint injections.

For chronic headaches:

Steroid and local anesthetic injections into the occipital nerves in the back of the head to relieve headaches and other types of nerve pain.

4. How long they relieve pain.

The pain relief from nerve block injections typically lasts from 1 to 2 weeks.

Doctors may recommend several or more injections when you face an extended recovery time from injury or need to buy time while looking for a permanent pain management solution.

5. What the procedure is like.

Nerve block procedures are performed on an outpatient basis and should take less than 30 minutes.

An anesthetic and anti-inflammatory or steroid are injected near the nerves sending pain signals to the brain.

Pain Management in Texas

At Texas Pain Physicians, our board-certified pain management doctors will address your pain at the source. They will map out a unique pain treatment strategy for you.

Please call us today at (972) 636-5727 or click here to schedule an appointment.

Young asian woman touching her neck while wincing in pain.

The VERY Painful Pinched Nerve… 7 Ways to Avoid This Common Injury.

Many athletes call them ‘stingers.’ Doctors call them pinched or compressed nerves. 

And they hurt like giant bee stings. 

The pain usually hits in the neck, in an area known as the brachial plexus, where the nerves extend down into the arms.

Pinched nerves have sudden and gradual causes; they can strike suddenly when lifting a heavy object or gradually develop because of poor posture.

Here are seven things you can do to avoid suffering a pinched nerve.

1. Get Enough Sleep

The best way to prevent a pinched nerve is to let your mind and body recover from the day.

When you have more energy to think clearly, you are less likely to make uncoordinated movements that lead to injuries.  

2. Practice Good Sitting Posture

Consistent poor sitting posture can cause pinched nerves. Try to sit so that your neck isn’t bent.

If you work in an office, adjust your monitor so that the top edge is eye level.

3. Stand More. 

Sitting for long periods with bad posture can cause pinched nerves. 

If you work at a table or desk, try adjusting your workstation so that you can work while standing.

4. Practice sound body mechanics.  

It’s easy to strain your neck and back.

When getting into or out of bed, exercising, or hiking up a mountain, try to make smooth, mechanically sound body movements.

And if you have to move to a new place or help your neighbors move, lift heavy objects with your legs instead of your back. 

5. Don’t play contact sports. 

Many people grow up playing contact sports like soccer, basketball, and American football.

The fitness aspect is good for you, but the contact can lead to pinched nerves and other sports injuries.

And pinched nerves are common injuries in contact sports. If you play contact sports, warm-up, stay hydrated, and take breaks. 

6. Do Strength and Flexibility Exercises.

Stretching and strength-building activities like yoga and pilates stretch the nerves in your neck and arms.

This loosens the tension and relieves pressure on your nerves, making pinched nerves less likely.

7. Do physical therapy.

Physical therapy methods like massage and cold laser therapy can prevent and lessen muscle strain and muscle inflammation. 

Pain Management and Treatment at Texas Pain Physicians

Have a pinched nerve or think you may be at risk for a pinched nerve? We have expert pain management doctors who treat them and help you prevent them. 

Give us a call at (972) 636-5727 or book your appointment today!