Pain Management Approach to Care
By
By David A. Doward, MD
Pain Management by JOI
Pain can be a debilitating condition and knowing how best to treat it is critical. Pain can stem from a pinched nerve, osteoarthritis, tendonitis, cancer, fibromyalgia, plantar fasciitis, arthritis or an old injury. Whatever the cause, it is important to see a board certified physician who can make an accurate diagnosis in order to treat it appropriately.
Pain is defined as an unpleasant sensory and emotional experience by the International Association for the Study of Pain. Pain management physicians are specialty trained to help patients manage their pain levels on a daily basis.
Acute pain is reversible requiring only transient corrective measures to go away whereas chronic pain persists past normal healing time. It is important to recognize that pain is real but differs from person person based on their perception of the pain.
For example, a person with depression or anxiety may perceive pain in a different way than someone without it. At any rate, there is a suffering component that must be appreciated by the treating physician.
The physiatric pain management approach to care involves focusing on the whole patient. In this way, both the physical and emotional components can be addressed. The overall purpose is to maximize function by optimizing the physical, psychological, social and vocational potential of that patient.
Treating Back Pain
In terms of treating back pain it is important to have a
fundamental understanding of the spine. There are four main pain generators in the back. This includes the discs, the facet joints, the nerve roots, and the sacroiliac joints.
Injury to the disc typically results in an annular tear and possible disc herniation. This can subsequently lead to a pinched nerve with radicular symptoms or spinal stenosis with neurologic claudication.
Facet joints also known as the zygapophysial joints can get irritated by repetitive extension based activities or trauma, especially in the setting of degenerative changes.
Irritation of the SI joint can present as buttock pain, pain which radiates into the groin or it can even mimic sciatica type pain with pain referral patterns down the leg.
The most important part of treating back pain is making an accurate diagnosis. If you have persistent pain that lasts greater than 7 – 10 days or any signs of numbness, tinging, and weakness then it is time to see your back doctor.
A detailed history will be taken, which will explore the mechanism of injury, the quality of pain, location of pain, and what makes it better or worse.
This will be followed by a thorough physical exam, which will include provocative maneuvers designed to reproduce your pain which helps to identify a specific pain generator.
A typical office exam will involve plain x-rays and if your symptoms warrant further evaluation, then an MRI, CT scan, bone scan or electrodiagnostic study will be ordered to help establish a correct diagnosis.
Treatment Options for Pain
Pain management treatment options typically involve oral medications such as acetaminophen, ibuprofen, naproxen, and in severe cases narcotics. Patients will benefit from activity modification and rest.
Physical therapy is one of the hallmarks of back treatment. It typically involves modalities to reduce your pain, such as heat and cold compresses, ultrasound, and laser therapy. This will also include flexibility stretches, education involving proper body mechanics, postural training, core and lumbar stabilization exercises.
Often times patients are in such significant pain that they can not move forward with physical therapy effectively and therefore require additional treatment.
This can include image-guided injections, such as selective nerve root blocks, facet, and SI joint injections.
These pain management procedures can quickly relieve your pain and get you on the road to a full recovery. There are other procedures such as a radiofrequency ablation which can give you longer lasting pain relief depending on your specific pain generator.
Patients who fail to improve with a combination of image-guided injections and physical therapy or who have progressive neurologic deficits or spinal instability would benefit from surgical consultation and treatment. Surgeries can range any where from decompressive laminectomies to micro-endoscopic discectomies to single or multilevel fusions.
Pain Injections
Patients with recalcitrant chronic back pain may benefit from spinal cord stimulators and pain management pumps. As technology has progressed, additional treatment options are becoming available. Platelet rich plasma injections are now being utilized to help repair damaged discs and relieve back pain.
These injections involve taking a patient’s own blood and placing it into a centrifuge to separate the plasma rich platelets and then injecting those platelets into the damaged tissue. This process stimulates healing and often regenerates growth of healthy tissues to replace damaged tissue.
This is a pain management option that may replace the need for surgery in patients with lumbar discogenic pain. The surgery often involves taking out injured pieces of the disc which may help relieve pain, but further weakens the spinal column.
In Conclusion
The most important thing in treating your pain is seeing a physician who is well educated and clinically adept at performing these procedures.
There are a number of things that you can do to prevent back pain, this includes regular exercises, maintaining an idea body weight, regular stretches/core strengthening exercises, practicing proper body mechanics, eating healthy and getting a good quality sleep.
I highly recommend participating in activities such as yoga and pilates to maintain the integrity of your spine. Yoga is particularly effective in preventing back pain since the focus is not only on core strength, but flexibility exercises which are the hallmark of having a healthy spine.
To learn more about Dr. Doward and more of his pain management techniques, please click the button below.
JOI has trained physical therapists who work closely with Dr. Doward to provide the best physical therapy for your diagnosis.
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