Feelings of pain can range from mild and occasional to severe and constant. Acute pain begins suddenly and is usually sharp in quality. It serves as a warning of disease or a threat to the body. Acute pain may be caused by many events or circumstances, including surgery, broken bones, etc. Unrelieved acute pain may lead to chronic pain, which may persist even after the original injury has healed.
Pain signals remain active in the nervous system for weeks, months, or years and can have lasting physical effects. Tense muscles, limited mobility, a lack of energy, and changes in appetite can occur, in addition to emotional effects, such as depression, anger, anxiety, and fear of re-injury. Such effects may hinder a person’s ability to return to normal work or leisure activities.
We feel each individual is the best judge of his or her own pain. Our medical staff takes a multidisciplinary approach in addressing your pain management concerns, and we work with you to determine the best treatment options. Depending upon your diagnosis, pain may be treated in a number of ways.
After a comprehensive review of the patient’s history and current health, a care plan is developed that may include a wide array of interventional pain management procedures & techniques including these below….
- Epidural Steroid Injections
- Nerve Blocks
- Trigger Point Injections in Muscles
- Ultrasound Directed Joint and Nerve Injections
- Pain Control Medicines
- Radiofrequency Treatment/Ablation
- Spinal Cord Stimulation for Back and Extremity Pain
- Electrical Stimulation (TENS)
- Diagnostic Discography
- BioRegenerative Therapies
- Platelet Rich Plasma Therapy (PRP)
Nerves function as a transport system for electrical impulses as they pass from one area of the body to the brain, where they are translated into sensations such as pain or pleasure. Because nerves pass through the spinal cord, conditions such as bone spurs, disc herniation, spondylolysis, thickening of ligaments, and joint cysts that affect the back can also affect nerves and the areas they represent. These conditions can cause areas in the back through which nerves pass to narrow, causing the nerves within to become inflamed. The inflamed nerves send the brain pain signals, which are interpreted as pain in the area to which the nerve corresponds, such as the leg or arm.
Epidural steroid injections can be used to reduce the leg or arm pain that may accompany neck-related or lower back-related conditions. Steroids can be injected into the epidural space (an area within the spine that is close to the inflamed nerve) to decrease the inflammation of the nerve, thereby reducing pain. Local anesthetic may be added to the steroid to have an immediate effect on the pain. It can take anywhere from a few days to a week to feel the full benefits of the steroid, but patients will continue to feel reduced pain and improved function for several months following the injection.
Usually, we use epidural steroid injections to temporarily relieve the patient of their pain while the underlying cause of the pain is treated through physical therapy or other methods.
Side effects and outcomes are unique to each patient and will be discussed before any treatment options are prescribed.
The term “nerve block” applies to any injection of medication, including local anesthetics, steroids, and opioids, into or around a nerve. A nerve block can be used for a variety of purposes, such as diagnostic, prognostic, therapeutic, and preemptive.
A nerve block may be used diagnostically to determine the source of a patient’s pain. By performing a series of injections to different areas and noting the amount of pain reduction that correlates with each area, a physician can determine where a person’s pain is coming from. The nerve blocks then function prognostically, as well; since the doctor knows what is causing the pain, they are better able to predict the outcome of different treatment methods.
A nerve block may also be used therapeutically to diminish a patient’s pain. For instance, a person may be given a nerve block before a surgery, so that they are unaware of the associated pain. A person may also be given a nerve block to soothe an inflamed nerve that is causing the person to experience pain, or to treat chronic pain that has not been amenable to drugs or other treatments.
Lastly, a nerve block may be used to address pain expected to occur after a surgery, such as the phantom limb pain that often follows an amputation.
When dealing with pain related to a single nerve or group of nerves, nerve blocks have a variety of functions that can help people become manage their pain.
Side effects and outcomes are unique to each patient and will be discussed before any treatment options are prescribed.
When muscles are constantly tense, they may begin to form knots that can be felt through the skin, called trigger points. Tender to the touch, trigger points may cause inhibited motion or increased weakness of the muscle they affect. The knots may also negatively affect the nerves surrounding the muscle, causing pain to manifest in other areas of the body. A person is more likely to develop trigger points if they do not exercise regularly, have poor posture, perform repetitive motions, sleep irregularly, or do not maintain balanced levels of vitamins. Additionally, those with myofascial pain syndrome or fibromyalgia are more likely to have trigger points.
Trigger point injections are highly effective when it comes to relieving the pain associated with tensed muscles. A needle is inserted into the trigger point, and a local anesthetic and/or steroid is shot into the area. The injection helps to relax the muscle, decrease pain, and improve motion in related areas. When combined with other treatments, such as therapeutic stretching of the tense area, trigger point injections can help to provide long-term relief.
Side effects and outcomes are unique to each patient and will be discussed before any treatment options are prescribed.
Joint and nerve injections are commonly used for both diagnostic and therapeutic purposes. When applied diagnostically, joint and nerve injections consist of a local anesthetic that is given to different areas in the body that could be causing the pain. By paying attention to whether the patient experiences a decrease in pain when an area is injected, the doctor can estimate the amount of culpability that area holds for the pain. When used therapeutically, joint and nerve injections typically consist of both local anesthetic and a steroid geared toward reducing pain or inflammation of the targeted joint or nerve. The inflammation, which can be caused by a variety of conditions, usually causes intense pain at the site of the inflammation or in associated areas. The steroid contained in therapeutic joint and nerve injections is shot into or around the inflamed joint or nerve, causing the inflammation to subside and diminishing the pain.
Preferred Pain Management is committed to offering the most effective and technologically advanced techniques for administering injections, so many of our joint and nerve injections are directed by ultrasound. When ultrasound technology is used, the doctor is able to visualize the exact position of the needle, as well as the exact location of the targeted joint or nerve, allowing for a significant increase in accuracy. Additionally, the greater visibility and accuracy allow for a smaller needle to be used, which means less discomfort for the patient. Furthermore, unlike when CTs or other imaging methods are used to guide injections, costly and sometimes detrimental ionizing radiation is not used.
Chronic pain can be difficult to bear. Sometimes, it is necessary to enlist the help of medications when battling chronic, or sometimes even acute, pain. Yet, there are so many types of medicine directed at relieving pain, it can be overwhelming to try to figure out which is most appropriate given a person’s health history and individual needs. The staff of Preferred Pain Management is trained to determine whether medication is an appropriate response to your pain and to help you identify what medicine will work best for you.
Some of the most commonly used pain medicines are described below.
Acetaminophen/Paracetamol (better known as Tylenol)- Acetaminophen can be effective for reducing mild or moderate pain that is not caused by inflammation, as acetaminophen does not have any anti-inflammatory properties. Though it is an over-the-counter drug, caution must still be exercised when ingesting acetaminophen, as it may cause liver damage or may have other serious side-effects if used unsafely with other medicines.
Non-Steroid Anti-Inflammatory Drugs (NSAIDs)- In contrast, non-steroid anti-inflammatory drugs, or NSAIDs, can help reduce pain by reducing inflammation and swelling. They can be particularly useful when treating cramps, arthritis, and muscle strains, though should not be consumed regularly or without first speaking to a doctor, as stomach problems may follow overuse.
Muscle Relaxants- Muscle relaxants are often used to address chronic pain conditions that result in muscle spasms or acute muscle problems. As with any other drug, side-effects may persist if used improperly.
Corticosteroids- Corticosteroids can help reduce inflammation and can effect positive change on the underlying condition causing pain. When intense pain strikes, corticosteroids may also be used to subdue the pain. They may be swallowed or injected.
Local Anesthetic- Often used with corticosteroids, local anesthetic may supply patients with a brief respite from pain until other treatments such as steroids kick in. Local anesthetic can enter the body through patches on the skin or injection.
Anti-Convulsants- Anti-covulsants can be used to treat fibromyalgia and pain that results from nerves. By altering or reducing signals sent from nerves to the brain, anti-convulsants can greatly reduce pain. Because anti-convulsants effect change on the central nervous system, it is important not to combine them with other drugs or substances that affect the central nervous system.
Narcotics- Narcotics are often used to diminish chronic or powerful pain. It is imperative that those consuming narcotics are aware of the ease with which a person can become addicted to narcotics and are aware of the high likelihood that they will develop a tolerance for their medicine.
Chronic pain felt in the lower back or neck and pain that results from arthritic joints or nerve-related conditions may be amenable to radiofrequency ablation, even if other treatment techniques, such as nerve blocks, have been ineffective. Radiofrequency is an option for most people with relevant conditions, as long as they do not have an infection at the time of treatment and as long as they are not pregnant.
Before radiofrequency ablation is performed, diagnostic techniques (usually nerve blocks) are used to determine the exact location of the pain generator. During radiofrequency ablation, the patient is given local anesthetic and intravenous (IV) medicine to minimize discomfort. X-ray technology is then used to guide a needle into the area causing the pain. A small electrode is then inserted through the needle, through which a radiowave is produced that sends an electric current through the problematic area. The electric current heats up nerve tissue in the designated area, causing enough damage to moderately inhibit any pain signals sent to the brain from that area. The patient does not experience pain while the electric current is affecting the nerve tissue.
Pain relief typically lasts longer than that achieved with injections, prolonging relief anywhere from four to twelve months.
Sometimes, all attempts at treating back and extremity pain- from the minimally-invasive to the maximally-invasive, from physical therapy to spine surgery- can be exhausted with negligible positive results for the patient. Fortunately, even after that happens, there is another technique that has proved effective for people who have not previously had any luck. This technique is called spinal cord stimulation.
Spinal cord stimulation involves implanting a generator and a number of leads, or electrical wires. Once implanted, the generator, at the command of the patient, produces an electrical current that travels through the leads, blocking pain signals to the brain. The staff at Preferred Pain Management trains patients on how to used the spinal cord stimulator at varying intensities, in order to use the equipment optimally and achieve the greatest possible pain relief.
One unique benefit of spinal cord stimulation is that the device can be temporarily implanted to determine whether or not the patient will derive any benefits from the system. If the patient finds that spinal cord stimulation is ineffective for them, then the device can be removed without exacting any long-term damage. If, on the other hand, the patient obtains marked pain relief from the stimulator, then the temporary device is removed and a more permanent stimulator is implanted.
There is a wide variety of types of spinal cord stimulators, so the patient has options when determining what is best for them, given their particular needs and condition.
Though the basic concept of spinal cord stimulation is similar to another stimulation technique, called transcutaneous electrical nerve stimulation (TENS), there are a few major differences. First, with TENS, the stimulators remain on the skin, whereas with spinal cord stimulation, the stimulators are implanted within the body. Additionally, spinal cord stimulation operates primarily on the spine, whereas TENS deals more with the nerves and only part of the spine.
Transcutaneous Electrical Nerve Stimulation, or TENS, can help to relieve a wide variety of pain, including low back pain, myofascial (muscle related) pain, neurogenic (arising from the nervous system) pain, visceral pain (for example, pain resulting from irritable bowel syndrome), postsurgical pain, and joint pain (for example, bursitis or arthritis). It can be effective for both chronic and acute forms of pain, so long as the pain is not severe.
TENS uses a generator and two electrodes to send an electrical current through part of the nervous system. The electrodes are placed strategically on the skin of the patient, either over the area causing pain or in a related area that can be identified by a doctor. The generator is activated to produce the electrical current that is sent through the electrodes into the nervous system. The electrical current then stimulates an increase in the activity of endorphins, our bodies’ natural pain fighters. It also is thought to block the path of pain signals heading to the thalamus and cortex, the two parts of the brain that enable us to perceive painful sensations. If the signals from the nerves fail to reach the brain, as they do when TENS is operating, pain cannot be felt in the area targeted by the electrical current.
Typically, a one hour trial period of TENS is implemented in-office to ensure that the patient experiences pain relief from the system before they are supplied with one. If the trial is successful, the doctor trains the patient in how to adjust the settings of their stimulator. The amplitude (strength), duration, and frequency of the electrical current are at the command of the patient. In this way, TENS is a dynamic treatment option for patients, who can adjust their treatment according to their particular needs and lifestyle in order to achieve optimal results. Additionally, once the patient has been trained in how to use TENS, they can operate the system at home, at their convenience.
TENS tends to produce rapid relief. More than half of patients usually experience pain relief within the first half hour of stimulation, while almost all of the remaining patients feel their pain subside within an hour of stimulation. As with any other treatment, it is important to consult with the doctor about the proper use of TENS to help avoid negative side-effects, such as skin irritation.
Though the basic concept of TENS is similar to another stimulation technique, called spinal cord stimulation, there are a few major differences. First, with TENS, the stimulators remain on the skin, whereas with spinal cord stimulation, the stimulators are implanted within the body. Additionally, spinal cord stimulation operates primarily on the spine, whereas TENS deals more with the nerves and only part of the spine.
A spinal fracture (also called a vertebral compression fracture) occurs when one of the bones of the spinal column fractures or collapses. Osteoporosis causes loss of bone strength and stability and is the underlying disease in most patients suffering from spinal fractures. In addition to osteoporosis, bone loss can occur as a side effect of medications such as corticosteroids, certain cancer treatments, and lifestyle choices including smoking, inactivity, and low calcium intake.
The bones in your spinal column are different than the bones elsewhere in your skeleton. For example, the bones in your legs are more rigid and dense than the bones in your spine. Strong, dense bone enables your legs to withstand rigorous movement. The bones in your spine, however, are less dense and more “spongy,” and thus more vulnerable to fracture.
Kyphon® Balloon Kyphoplasty is a treatment option generally reserved for patients with back pain or deformity related to spinal fracture(s). After a physical exam, imaging tests such as x-rays or magnetic resonance imaging (MRI) might be ordered to confirm the diagnosis of a spinal fracture.
Most patients report relief from pain and improved mobility after the procedure.1
- Ledlie, J.T. and M.B. Renfro, Kyphoplasty treatment of vertebral fractures: 2-year outcomes show sustained benefits.Spine. 2006. 31(1): p. 57-64, medtronic.com
When a patient is experiencing pain, minimally-invasive therapeutic techniques can be used to try to treat the area that is thought to be causing the pain. However, these techniques can be ineffective if more drastic methods are necessary to fix the problem, or if the pain generator has not been accurately identified. A discography is a diagnostic tool used to gain a better understanding of whether discs are responsible for the pain the patient is feeling and, if so, which disc or discs in particular have become problematic. Once this procedure has been performed, doctors will have a better idea of where the problem is and will be able to more accurately predict the outcome of surgery.
During a discography, the patient is given local anesthetic and a sedative that calms the patient, but does not make them unconscious. A needle is guided via x-ray to a disc in the back. Liquid dye is injected through the needle and into the disc. CT scans are taken that track the movement of the dye. Depending on where the dye goes, the doctors can determine whether the disc is torn, bulged, or scarred. Because it can be difficult to ascertain whether the disc is the primary pain generator solely by its appearance, the patient is also asked to report whether they feel any pain when the liquid enters the disc. This process is repeated for each disc that is suspected to be problematic, based on the patient’s symptoms.
Because spine surgeries are risky and tend to have long recovery times, it is good idea to make sure that the outcome will be worth the risks involved. Diagnostic discography is a useful tool that helps establish what the outcomes of different surgeries will be.
Bracing can be used to help with acute pain, such as pain that results from an injury or surgery, or chronic pain, such as pain that results from a long-term condition. Braces reduce pain and help healing by providing support, stability, and limiting motion to a range of less painful movements. Bracing can be directed towards bones, joints, ligaments, or muscles.
Some patients who may find bracing to be beneficial include those with carpal tunnel syndrome, for whom a wrist brace worn at night or during part of the day can reduce pain and tingling; those suffering from low back pain as a result of degenerative disc disease or spondylolisthesis; those with a muscle strain or sprain; those experience spine-related neck pain, such as what might result from whiplash or a tumor; those with osteoarthritis or a compression fracture; those with rheumatoid arthritis; and those with a spinal cord injury.
In order to avoid the negative health effects that can accompany becoming accustomed to a brace, it is important to follow the doctor’s instructions pertaining to how and when a brace should be worn.
We offer Prolotherapy through our regenerative therapies division, RegenerAgeMD. Prolotherapy, also known as Proliferative therapy regenerative injection therapy (RIT), is a form of treatment for chronic musculoskeletal pain. It is commonly used to correct arthritis, back pain, neck pain, sports injuries, whiplash, carpal tunnel syndrome, chronic tendonitis, partially torn tendons, degenerated or herniated discs, TMJ, sciatica, and fibromyalgia. Prolotherapy is particularly effective because it corrects the original cause of pain, rather than merely alleviating symptoms.
Patients whose pain has increased despite anti-inflammatory medications, cortisone shots, arthroscopy, and joint replacement surgery typically feel relief after undergoing prolotherapy. Additionally, many athletes use prolotherapy to accelerate the recovery time from injuries like ACL tears. Patients who wish to participate in prolotherapy must have a strong immune system, maintain a healthy diet, have normal hormone levels, and be able to move and exercise.
How it works
First, the physician performs a palpatory exam to locate the area causing the pain. It is important that the injections are inserted into the areas causing the pain, not the areas where the pain is felt.
A proliferant, or mild irritant solution, is injected into the problematic ligament or tendon, where it attaches to the bone, causing a localized inflammation. The inflammation increases the blood supply and the flow of nutrients to the area and stimulates the tissue to repair itself. New collagen, which is the building block of ligament and tendon tissue, is formed and begins to shrink, tightening the area that was injected and strengthening the tissue.
Injections may also be given to injured joints to stimulate cartilage growth and repair injured tissue, as well as to reduce the joint instability that leads to degeneration.
The average number of injections needed is between four and six, though the amount is variable and can be as low as two injections or as high as ten, depending on the body’s ability to heal itself and the technique and skill of the physician.
Hackett-Hemwall Dextrose Prolotherapy
With Hackett-Hemwall Dextrose Prolotherapy, the irritant solution contains dextrose (sugar) and an anesthetic (either Procaine or Lidocaine). Multiple injections are given at once, into and around the injured area. Multiple body parts can be treated during the same visit and other proliferants may be added to the base solution.
Platelet Rich Plasma Prolotherapy
Platelet Rich Plasma Prolotherapy requires the patient’s blood to be drawn and processed to extract growth factors. The growth factors are then added to the proliferant and injected into the injured area. Additionally, dextrose is injected into the areas surrounding the injury.
Platelet Rich Plasma Prolotherapy is used for more advanced injuries that require the growth factors’ assistance in stimulating new growth in the injured area.
Stem Cell Prolotherapy
All joints have a limited ability to heal themselves. Stem cell prolotherapy is unique in that it makes joint anabolic (in the process of building).
The stem cells are obtained from bone marrow (from the shin or hip) or fat (from the love handles or stomach) and are mixed into a solution with platelet rich plasma. The stem cells and platelets help generate additional new growth.
Like Platelet Rich Prolotherapy, stem cell prolotherapy is used for more advanced injuries. Treatments are administered every six to eight weeks.
Prolotherapy is typically a permanent solution to chronic pain. It ultimately improves function of the area injected, reduces stiffness, and reduces or eliminates pain. After the first visit, 50-75% of the pain is reduced, and the pain continues to diminish over the remaining treatment period. By reducing pain, prolotherapy also enables patients to improve the strength of the injured area.
- Bruising in treatment area
- Increased pain
- Joint effusion
- Puncture of lung if treating spine
- Tendon/ligament injury
We offer Platelet Rich Plasma Therapy through our regenerative therapies division, RegenerAgeMD. Platelet Rich Plasma Therapy (PRP) is a non-surgical therapy is an injection of a concentrated mixture of the patient’s own blood. PRP injections have been shown to relieve acute and chronic pain and accelerate healing of injured tissues and joints.
Can It Help Me?
Conditions that can be aided by PRP include plantar fasciitis, meniscus tears, osteoarthritis of the spine, hip and knee, ligament sprains, and rotator cuff tears.
Benefit of PRP
The limited blood supply and poor healing properties of ligaments, cartilage and tendons make treatment necessary after injury. Unlike physical therapy or medications that don’t treat the underlying cause of pain, PRP can accelerate the healing process – eliminating the cause of pain.
Collecting the Platelets
The PRP process begins by taking a small sample of the patient’s blood and placing it into Harvest Technologies’ Platelet Concentrate System. The sterile multi-chamber container is spun in a centrifuge to separate the blood into its primary components – platelets and white blood cells, plasma, and red blood cells.
Injecting the Solution
A portion of the plasma is removed. The patient’s concentrated platelets are mixed with the remaining plasma to form a concentrated solution. This platelet rich solution is then injected into and around the injured tissues.
The Body Reacts
The concentrated platelets release many growth factors that help promote a natural immune response. Macrophages – specialized white blood cells – rush in to remove damaged cells and prepare the tissue for healing.
The Healing Begins
Stem cells and other cells multiply, repair and rebuild the damaged tissue. This accelerated healing response reduces pain, promotes increased strength, and improves joint function.
The entire PRP treatment process takes about an hour – the patient will be able to go home the same day. Full recovery from the injection usually occurs within one week of the procedure. Many patients require three to four treatments before the injured tissues are completely healed and they return to a normal active lifestyle.