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Pain Treatment

APC Icon — Pain Care

19.6 million adults experience high impact chronic pain daily, hampering their life and work.

According to the Centers for Disease Control and Prevention (CDC), approximately 50 million adults in the United States experience chronic pain. Pain is a complex condition. Because it is highly subjective, pain treatment has to be a patient-centric, multi-modal course of action. This can include medications as well as surgical and non-surgical treatment options.

Who are pain management and treatment specialists and how do they treat pain?

Pain management and pain treatment specialists are physicians who can evaluate, diagnose, and treat different kinds of pain (acute, chronic, high impact chronic, etc.). From constant headaches to chronic cancer pain to sports-related pain, pain management and treatment specialists are trained to treat a wide range of pain conditions. They are highly trained medical doctors in the fields of Integrated Pain Management, Orthopedics, Rheumatology, Anesthesiology and Behavioral Health.

Advanced Pain Care is a multispecialty pain group that offers Integrated Pain Management, Orthopedists, Neurosurgeons, Rheumatologists, Behavioral Health specialists as well as physical therapists to treat pain. At Advanced Pain Care, a 360-degree approach to managing and treating pain is facilitated and offers many more pain treatment options than just medications.

The types of pain that a pain care specialist treats can be divided into three primary groups:

Depending on the severity, location, cause, and duration, there are different categories of pain. In order to assist in accurate diagnosis and treatment, they can be classified as:

  • Acute pain — sudden pain, which lasts for a short duration. This could be caused by specific traumatic events or injuries.
  • Chronic pain — starts as acute pain but persists for longer, even after the underlying cause no longer exists. This could be due to arthritis, back pain, neck pain, fibromyalgia, diabetes, etc.
  • Bone pain — is associated with any condition or injury that affects the functionality or structure of the bones. This could be in the form of cancer, fractures, sickle cell anemia, osteoporosis, etc.
  • Nerve pain — is caused by nerve inflammation or damage. It can be caused by a multitude of reasons: cancer, injury to the brain, injury to the spinal cord, stroke, alcoholism, etc.
  • Breakthrough pain — is a pain flare that can occur during or between periods of pain treatment.
  • Phantom pain — is a pain sensation that originates in the nerve endings of amputated parts of the body as well as in the spinal cord and brain.
  • Soft tissue pain — is a result of any damage to ligaments, tendons, and muscles in conditions such as rotator cuff injury, fibromyalgia, bursitis, sciatica pain, etc.
  • Referred pain — is a pain that originates from a part of the body not near the actual damage or injury. For example, during a heart attack, pain can be experienced in the back, neck, left shoulders, and arms.

Identifying the type and severity of pain helps in accurate diagnosis, which aids in the identification of the right course of pain treatment by a pain management specialist.

What are the types of pain management and treatment?

Over the past two decades, the first line of treatment for pain, especially chronic pain, remained in powerful prescription medications. In 2016, after years of recorded pain killer addiction, CDC amended its guidelines for the treatment and management of pain.

A newer, multimodal approach replaced the previous treatment methodology. This approach integrates the use of medications, surgical and non-surgical interventions as well as the facilitation of psychological support.

The multimodal/multispecialty approach to pain management and pain treatment at Advanced Pain Care includes the following:

Pharmacological Interventions or Medications

Pharmacological interventions are at the foundation of pain treatment. Depending on the intensity of the pain and the severity of the symptoms of the specific condition, pain medications can be categorized as:

Prescription drugs

  1. COX-2 inhibitors (also categorized as NSAIDs) such as Celecoxib are prescribed usually after a surgery or to treat cancer pain.
  2. Prescription corticosteroids such as Prednisone are used to enable pain relief in case of inflammation and redness.
  3. Narcotic analgesics are prescribed for short-term, acute pain such as post-surgery pain.
  4. Analgesic adjuvants are prescription drugs made for other conditions but are also effective in treating chronic pain. They can be in the form of antidepressants or anticonvulsants. Low doses of antidepressants (Prozac, Doxepin, etc.) are used to treat chronic pain such as migraines.
  5. Anticonvulsants or anti-seizure drugs such as Neurontin are also prescribed in low doses to control pain.
  6. Topical pain relievers such as lidocaine patches are prescription strength.

Non-prescription pain relievers or analgesics

  1. Over-the-counter non-prescription analgesics such as Aspirin or Acetaminophen (Paracetamol or Tylenol) can give relief in cases of muscle pain and stiffness, and reduce any fever caused by the pain.
  2. Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen also reduce any inflammation.
  3. Topical pain relievers such as creams, lotions, and gels, that can be applied on the skin to relieve pain (Diclofenac gel, BenGay, etc.)

Non-surgical Interventions

At times, pharmacological interventions with medicines may not provide the level of pain relief sought by a patient. The pain care specialists at Advanced Pain Care may recommend minimally invasive techniques to help reduce the pain. They could include:

Injections

  1. Trigger point injections Trigger point injections or TPIs are given directly at the point of pain. The injection may comprise anesthetics or corticosteroids in varying combinations. The effects of trigger point injections are known to last from weeks to months depending on the severity of the condition.
  2. Viscosupplementation Viscosupplementation is a procedure, in which a lubricating fluid is injected into the joints in the body. This is predominantly used to relieve arthritis pain. This treatment is done along with a prescribed course of pain medications.
  3. Epidural steroid injections Epidural steroid injections are a mix of anesthetics and steroids, prescribed to treat sciatica pain, back pain, and neck pain. The medication is injected into the epidural space around the spinal cord to numb the pain signals and reduce the inflammation.
  4. Nerve block injections — Nerve block injections deliver an anesthetic near the specific nerves before they transmit the pain signals from reaching the brain. These injections treat inflammation in the nerves and can also be used to locate the actual source of the pain.
  5. Precision nerve injections — Precision nerve injections are administered to reduce the pain caused by pinched nerves or inflamed facet joints. These injections numb the medial branch nerves and help the physician isolate the location of the pain. The effect of this treatment can last up to several years. These injections are administered with the guidance of an X-ray to make the delivery as precise as possible.

Minimally-invasive interventions

The pain care specialists at Advanced Pain care administer different minimally invasive procedures to help reduce the pain and to manage it. These include:

  1. Transcutaneous electrical nerve stimulators — Transcutaneous electrical nerve stimulators (TENS) are used to deliver electrical current in a low voltage through electrodes placed in the region of pain. This treatment has been known to give pain relief in cases of diabetic neuropathy.
  2. Radiofrequency ablation — Radiofrequency ablation or RFA is a minimally invasive treatment option used widely to treat cancer pain, RFA. It is also called fulguration. In this procedure, the dysfunctional tissues and nerves are ablated radiofrequency energy to inactivate pain pathways.
  3. Bioelectric therapy — Bioelectric therapy blocks pain signals from reaching the brain and also releases endorphins into the system to eliminate the painful sensations. This is used to relieve chronic and acute pain conditions (back and muscle pain, diabetic neuropathy, scleroderma, etc.)

Surgical interventions

In some pain conditions, oral delivery of drugs or minimally invasive, non-surgical interventions may still not help relieve pain. In these cases, the pain care specialists at Advanced Pain Care recommend the efficacy of implanted devices. They can be for the purpose of drug delivery directly into the spinal cord or to block pain signals from reaching the brain. They are as follows:

1. Spinal cord stimulator — Implanted devices such as a spinal cord stimulator are used to relieve the pain signals that are being communicated through the spinal cord. In this procedure, a spinal cord stimulator is surgically implanted under the skin. This helps to modify or block the pain signals from reaching the brain. The patient remains in control of the device, and can turn it on or off, without removing the implant.

2. Intrathecal pumps — Intrathecal drug delivery can be done in the form of pain pumps or spinal drug delivery systems.  These drug delivery systems can deliver medicines directly to the spinal cord. This system is considered very effective, as it uses lesser drugs to treat the pain than in the administration of drugs in the traditional/oral manner.

Psychological support

Advanced Pain Care offers its patients a Behavioral Health program that involves a clinical evaluation to determine if the cause of the pain is due to depression, anxiety, or fear. In such cases, the pain care specialists also include an integrated approach of treatment along with medications and/or surgical interventions. These comprise different psychological and physical therapies and typically include:

  1. Psychological treatment such as cognitive behavioral therapy (CBT) to relieve lower back pain and fibromyalgia to a very large extent.
  2. Mind-body techniques such as meditation, relaxation techniques, hypnosis, and biofeedback, and mindfulness-based stress reduction, to help reduce the discomfort associated with chronic pain.
  3. Physical therapy techniques such as stretching and strengthening of the body along with pain-relieving techniques.

Depending on the severity and cause of the pain, pain management and treatment specialists at Advanced Pain Care generally approach the treatment as follows:

  1. Acute pain — Usually treated mainly with OTC or prescription pain medication non-opioids or other treatment options such as bioelectric therapy.
  2. Chronic pain — Usually treated with weak to strong pain medication and/or muscle relaxants. Treatment options will also include procedures such as viscosupplementation, nerve injections, TENS, radiofrequency ablation, as well as implanting of spinal stimulators.
  3. Breakthrough pain — Usually treated with strong, fast-acting prescription pain medication as well as holistic treatment options are used.
  4. Bone pain — Usually treated with OTC pain relievers, bisphosphonates, and in some cases, surgery are considered the best options.
  5. Nerve pain — Usually treated with nerve blockers.
  6. Phantom pain — Usually treated with prescription medications or alternative therapies. In some cases, a non-invasive brain stimulation therapy called repetitive transcranial magnetic stimulation (rTMS) may also be advised.
  7. Soft tissue pain — Usually treated with OTC pain relievers and physical therapy.
  8. Referred pain — Apart from OTC pain relievers to relieve the immediate pain sensations, TENS are recommended.

Pain management and treatment at Advanced Pain Care involves a multispecialty, multimodal, integrated approach with different techniques and therapies to address your pain. Call us on 512-244-4272 for more information on how we can assist your pain condition.

FREQUENTLY ASKED QUESTIONS

Q: What drugs are used for pain management?

A: Some of the common drugs used to aid in pain management include non-steroidal anti-inflammatory drugs (NSAIDS), narcotic medication, antidepressants, antiseizure meds, muscle relaxers and steroids.

Q: What is the best treatment for chronic pain?

A: Treatment of chronic pain is a multimodal and integrated approach. Pain management and treatment specialists use medications, minimally invasive interventions as well as different therapies depending on the cause, severity, and location to treat the pain.

Over-the-counter (OTC) and prescription medicines such as acetaminophen, nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen, anticonvulsants, and prescription pain medication are the most commonly prescribed medicines to manage or treat chronic pain.

Trigger point injections, intrathecal pumps, radiofrequency ablation, epidural nerve injections, precision nerve injections, TENS, bioelectrical therapy, and spinal cord stimulators are some of the therapies that pain management and treatment specialists at Advanced Pain Care offer and recommend.

Q: What do they do for you at pain management?

A: A pain treatment or management center or clinic, such as Advanced Pain Care, is a multispecialty, multimodal pain management clinic that employs Integrated Pain Management Specialists, Orthopedists, Neurosurgeons, Rheumatologists and Behavioral Health Specialists has pain care specialists, psychologists, physical therapists, and alternative therapists. We offer a 360-degree approach to managing and treating pain with multiple specialties, not limited to just medications.

Depending on the severity, location, cause, and duration, there are different categories of pain. In order to assist in accurate diagnosis and treatment, they can be classified as:

Acute pain — sudden pain, which lasts for a short duration. Can be caused by specific traumatic events or injuries.

Chronic pain — starts as acute pain but persists for longer, even after the underlying cause no longer exists. Can be due to arthritis, back pain, neck pain, fibromyalgia, diabetes, etc.

Breakthrough pain — is a pain flare that can occur during or between periods of pain treatment.

Bone pain — is associated with any condition or injury that affects the functionality or structure of the bones. This could be in the form of cancer, fractures, sickle cell anemia, osteoporosis, etc.

Nerve pain — is caused by nerve inflammation or damage. It can be caused by a multitude of reasons: cancer, injury to the brain, injury to the spinal cord, stroke, alcoholism, etc.

Nerve damage — (in all its forms) is a major cause of chronic pain. It responds especially well to spinal stimulation.

Phantom pain — is a pain sensation that originates in the nerve endings of amputated parts of the body as well as in the spinal cord and brain. This is another example of nerve damage.

Soft tissue pain — is a result of any damage to ligaments, tendons, and muscles in conditions such as rotator cuff injury, fibromyalgia, bursitis, sciatica pain, etc.

Referred pain — is a pain that originates from a part of the body that is not located near the actual damage or injury. For example, during a heart attack, pain can be experienced in the back, neck, left shoulders, and arms.