Interventional Pain Management

An estimated 70 million Americans suffer from chronic pain. Chronic pain is a major medical condition distinctly different from and more complex than acute pain. Whereas acute pain is a normal sensation triggered in the nervous system to alert the body to possible injury, chronic pain is a state in which pain persists, for many months or years, beyond the normal course required by healing. The effects, both economic and personal, associated with chronic pain can be significant. They include loss of income; debt from costly medical treatment; impaired mobility; and anxiety and depression.

The causes of chronic pain are not always clear. Past traumatic injuries, congenital conditions, cancer, arthritis or other disorders may seem to be obvious culprits, but, in many cases, finding the source of chronic pain is difficult. This makes it hard to treat, so pain management usually takes a multidisciplinary approach.

Pain-management specialists are medical professionals well-trained in the diagnosis and treatment of acute, sub-acute and chronic muscle and nerve pain. Board-certified in this specialty and employing the most advanced treatment techniques, pain-management physicians work one-on-one with patients who suffer from chronic pain to determine the best treatment plan for relieving symptoms, and allowing resumption and enjoyment of everyday activities.

Causes of Chronic Pain

Chronic pain can develop from several different conditions. Back pain is an extremely common form of chronic pain, and can result from many causes, including herniated discs, stenosis, scoliosis, compression fractures and sciatica. Back pain can be radicular, meaning it travels down the arms or legs. Other causes of chronic pain that may require serious pain management include the following:

  • Headache
  • Injury
  • Cancer
  • Reflex sympathetic dystrophy (RSD)
  • Fibromyalgia
  • Diabetic neuropathy
  • Trigeminal neuralgia
  • Osteo-, psoriatic or rheumatoid arthritis
  • Inflammatory bowel disease
  • Depression or other psychiatric disorders

Any chronic pain should be diagnosed by a qualified physician so that it can be appropriately treated.

Pain-Management Treatments

Treatments for chronic pain focus on relieving symptoms and/or treating underlying conditions, and vary depending on the cause and severity of the condition, as well as the patient's overall health and medical history. Below are some of the most common treatments for chronic pain.

Medications

Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) are often the first choice for treating chronic pain. Corticosteroids and stronger prescription pain medications (often opioids) are used when NSAIDs are ineffective. Opioids include codeine, oxycodone, percodan and morphine. Because these medications have some serious side effects, we usually recommend using the lowest affective dosage possible, combining alternative pain-management techniques whenever possible. 

Injections

Injections are one of the most effective treatment options for pain management because they block nerve signals, relieving pain and inflammation. Injection agents that ustilize regenerative medicine also provide jump start to healing and regeneration. Injections are administered directly into the affected area, and are often composed of PRP, stem cells, anesthetics, corticosteroids or BOTOX®.

Peripheral Electrical Stimulation

Through a small battery-operated device worn on the body, transcutaneous electrical nerve stimulation relieves pain by stimulating the nerves that target the affected area. It is not painful, and is considered safe for most patients.

Advanced Modalities

Office therapy modalities that utilized the latest technology as well as intergrative medicine are often incoporated into the pain management treatment plan. Modalities commonly used are MLS laser, acupuncture with e-stim and IV therapy. 

Multidisciplinary Approach

Most patients benefit from a combination of treatments in order to achieve successful pain relief. Treatment is usually performed by a number of different physicians, therapists and other healthcare providers. Pain-management specialists sometimes function as team coordinators of individualized treatment plans.

 

Ultrasound-Guided Joint Injections

Joint injections are a minimally invasive treatment for relieving pain caused by inflammatory joint conditions such as rheumatoid arthritis, tendonitis, bursitis and gout. To reduce pain and inflammation from these conditions, medications such as corticosteroids and hyaluronic-acid preparations are sometimes injected into the problem joint. The medications affect only the targeted areas, and usually do not cause side effects. Joint injections are administered under local anesthesia, and cause only brief, mild discomfort.

Epidural Steroid Injections

By reducing inflammation, epidural steroid injections (ESIs) are used to temporarily relieve lumbar (lower back), cervical (neck), thoracic (mid-spine) and sciatic-nerve pain. ESIs contain cortisone and an anesthetic, and are delivered directly to the epidural space, which is the area between the spinal cord and the outer membrane that covers the brain and spinal cord (the dura). As a result, they provide more effective and faster pain relief than oral medications.

Selective-Nerve-Root Block

A cervical selective-nerve-root block is an epidural steroid injection used for treating shoulder, upper back, neck and arm pain. It is also used to determine whether pain is being caused by disc problems or nerve-root inflammation. Although MRI scans and other imaging tests are often helpful in locating the source of pain, they may not be able to identify torn or leaking discs.

Prolotherapy

Prolotherapy is an important part of regenerative medicine. It is used therapeutically in sports medicine, orthopedics, arthritis treatment and general practice. Like stem cells and platelet-rich plasma injections, prolotherapy harnesses the ability of the body to heal and repair itself.

BOTOX® Injections for Migraines

Although known primarily as a treatment for facial frown lines and "crow's feet," BOTOX® Cosmetic, which is made from a type of bacteria known as Clostridium botulinum type A, also helps, according to the American Headache Society, to reduce the severity and frequency of migraine headaches. Migraines are often caused by reactions to certain triggers that stimulate the production of neurotransmitters in nerve cells, producing pain and other debilitating symptoms.
 
 
 
 
 
 
American Academy of Regenerative Medicine (AARM) American Board of Regenerative Medicine (ABRM) International Association of Stemcell & Regenerative Medicine (IASRM) National Society of Regenerative Medicine American Society of lnterventional Pain Physicians (ASIPP) American Academy of Family Physicians (AAFP) Tricare VA Community Care

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