Pain_Management

EXPECT THE BEST PAIN MANAGEMENT

ABOUT BACK PAIN

Pain can be complex and often serves as an important warning sign, indicating injury or infection. Sometimes, however, pain continues even after the original issue is resolved. When this happens, pain can become chronic and can affect every aspect of your life. The effects of chronic pain syndrome are multifaceted, so it’s important to choose a pain management specialist who can address all your symptoms.

If you experience back pain, you are not alone. Back pain is one of the most common reasons people see a doctor, miss work or forego activities they enjoy. Strain and sprain are very common causes of back pain and can largely be prevented or lessened by maintaining a healthy weight, exercising and proper body mechanics.

COMMON CAUSES

Muscle, Ligament or Joint Capsule Strains

  • Heavy lifting or sudden jarring movements (like whiplash) can strain your back muscles and spinal ligaments.

Bulging or Ruptured Discs

  • Discs made of soft tissue cushion the vertebrae in your spine. For various reasons, including injury and disease, discs may bulge out of place or rupture and place painful pressure on your nerves.

Arthritis

  • Osteoarthritis in the back can be very painful, and can occasionally lead to spondylosis or stenosis: a narrowing of the space around the spinal cord.

Skeletal Irregularities

  • If your spine curves in an abnormal way, it can distribute your weight unevenly and deteriorate your discs faster. Common diagnoses include scoliosis and kyphosis.

Osteoporosis

  • Osteoporosis makes your bones more porous and brittle, which can lead to compression fractures that cause gradual or sudden, severe back or hip pain.

In many cases, back pain can develop or persist without an identifiable cause. This doesn’t mean that you have to suffer. We focus on treating your pain and can help you find relief, no matter the cause. There are many treatment options available.

ABOUT NECK PAIN

The wear and tear of our daily activities – whether leaning hunched over a computer screen or a workbench – can strain our neck muscles or cause painful exacerbation of arthritis. While most causes of neck pain are not serious, it’s important to see a doctor if you have acute or persistent neck pain, as it can be a symptom of a more serious problem.

COMMON CAUSES

Muscle Strain

  • Even normal activities can sometimes trigger neck pain, including driving or typing for extended periods of time. Be sure to maintain proper posture to reduce the risk of straining your neck.

Worn Joints

  • Your joints withstand a great deal of wear and tear over your lifetime. As you age, this normal degeneration can cause osteoarthritis in your neck, which may become painful.

Nerve Compression

  • Herniated discs (also called a slipped, ruptured or degenerative disc) and bone spurs in your neck can put pressure on the nerves in your spinal cord and cause pain.

Injuries

  • Sudden, jarring movements, such as whiplash, can stretch the soft tissues in your neck beyond their limits. Such soft tissue injuries include muscle strain and spasm, ligament and joint capsule sprains.

Disease

  • Rheumatoid arthritis, meningitis, cancer and other diseases can cause neck pain. If you experience prominent weakness or general body symptoms with your neck pain, see a doctor as soon as possible to rule out these diseases.

The most common treatments for neck pain are massage, chiropractic or physical therapy. If your pain persists after therapy, medications or injections may be suggested, based on the results of diagnostic testing.

PAIN TREATMENTS

Epidural Steroid Injection – Steroid injections are a common treatment for reducing pain in many parts of the body. In the procedure, a steroid and an anesthetic medication are injected into your epidural space – a fat-filled “sleeve” that cushions the spinal cord and nerves – to reduce swelling and block pain signals from reaching your brain. Steroid injections are guided by X-ray and done with local anesthesia. The procedure usually takes less than 15 minutes.

Lumbar Sympathetic Nerve Block – Diagnostic sympathetic blocks help us determine if there is damage to your sympathetic nerve chain, a bundle of nerve fibers that run the length of your spine. After receiving a local anesthetic, an anesthetic medication is injected into the nerve bundle in the area we suspect is causing the pain. Sympathetic blocks are also used therapeutically to provide longer-lasting pain relief.

Medial Branch Block – Facet joints are the flat, moveable connections in your spine, where your vertebrae fit together. Each facet joint has at least two medial branch nerves that send and carry messages to your brain. If the joints become swollen and irritated, an injection of a steroid and an anesthetic can be used to numb the medial nerves and keep pain messages from reaching your brain. The procedure is done while you are awake with local anesthesia and typically takes less than 15 minutes.

Medication – There are many prescription medications that may help you control your pain, including opioids, muscle relaxants, anti-inflammatory medications and antidepressants. Before and during your treatment with medications, we work with you to carefully determine which drugs are appropriate and safe for your individual circumstances. We also help you understand how your drugs work and how you can minimize the risks and maximize the benefits of your prescriptions.

Neuromodulation – Neurons are cells that process and transmit information to your brain through electrical and chemical signals. Neuromodulation devices are surgically implanted under your skin and work by blocking neurotransmitters from communicating pain signals to your brain.

The two most common types are:

  • Intrathecal Drug Implant – An intrathecal drug implant delivers medication directly to the spinal fluid around your spinal cord through a small, soft tube. The tube and pump are implanted surgically, and because they deliver medication directly to the source, much smaller doses of medication are needed to provide you relief. The exact dosage, rate and timing are determined by a programmer that communicates with the pump through radio signals and can be checked and adjusted by your pain physician or nurse.
  • Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation – When other treatments to regulate pain have failed, including surgery, spinal cord stimulation is a “last resort” procedure that may help. The procedure involves implanting small electrodes over the spinal cord or spinal nerve roots that “short circuit” pain impulses as they travel to the brain. It is done in two phases. The first is a trial phase in which temporary electrodes are implanted. The procedure involves very little pain and is done while you are awake without making incisions. When the electrodes are in place. For about a week, the electrodes remain in place and you control the stimulation with a small device. If the stimulation decreases your pain significantly, you may choose to move on to phase two. Phase two is the implantation of permanent electrodes, and occurs about 3-4 weeks after your trial. During the implantation, you will be given a local anesthetic and sedation. A small incision is made in your mid-back, and the electrodes are placed under your skin while a small battery pack is implanted in your upper buttock. The procedure involves little pain and you go home the same day. You control the stimulation with a hand-held device.

Neuroplasticity – Chronic pain is complex and research has found that training the brain can markedly change and even eliminate pain. Neuroplasticty involves learning and practicing exercises that modify how your brain responds to pain.

Radiofrequency Neurotomy – Radiofrequency neurotomy disrupts nerve function and interrupts the transmission of pain signals to your brain. In the procedure, a probe inserted through a needle delivers controlled heat to the painful nerve. Neurotomy is performed while you are awake with local anesthesia, and the results typically last for 6 to 9 months.

Vertebroplasty/Kyphoplasty – For spinal fractures that do not improve with bracing and pain medications, these procedures are used to inject bone cement into the fracture to reduce pain.