Pain Management

There has been found to be 100 different types of arthritis. Determining the exact cause can be difficult, because often several factors contribute to an individual developing arthritis including genetics, age, weight, previous injury, occupational hazards, and illness or infection. Symptoms of the disease can differ, but include:

• Persistant joint pain
• Pain or tenderness in a joint which is aggravated by movement or activity
• Inflammation of the joint along with stiffness and/or redness
• Reduced range of motion
• Unexplained weight loss
• Extreme fatigue, lack of energy
• Non-specific fever

There is no one single treatment plan for a patient with arthritis. Our doctors will develop a specialized care plan to minimize the patient’s specific pain and improve the function of their joints. Treatment can utilize medications to treat the inflammation and pain associated with arthritis such. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, have immediate analgesic and anti-inflammatory effects and are relatively safe. Other treatment options can include injections into the affected joints with a corticosteroid, however this is only practical if only a few joints are involved.

Chronic back pain is typically described as deep, aching, dull or burning pain in one area of the back and/or traveling down into the legs. Some patients may even experience numbness, tingling, burning, or “pins-and-needles” sensation in the legs, that pain is called radiculopathy. This type of pain tends to last a long time and may not be relieved by standard types of medical management. There are many different conditions that may contribute to a patient’s low back pain. These include bulging disc, sciatica, disc degeneration, spinal stenosis, osteoporosis, fibromyalgia or spondylitis. As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. In doing this, the disc may put pressure on one of more of the nerves rooted to the spinal cord that transmit signals from the body to the brain. When these nerves become compressed or irritated, back pain results.

After a thorough medical history and physical exam, your doctor may order a series of studies in order to determine the exact cause of your pain. Imaging studies, such as an X-ray, CT scan, or MRI can help the physician to better examine your pain condition. Depending on your pain, your physician may recommend physical therapy, medication, spinal manipulations, acupuncture, biofeedback, interventional therapy, and/or electrical nerve stimulation.

About one-third of patients being treated for cancer have some type of pain, each unique to the individual. With today's knowledge of cancer pain and the availability of pain-relieving therapies, it is important to know that cancer pain can be managed though surveys have shown that pain is often undertreated in many patients.

Because each patient’s stage of disease and diagnosis differ, we combine pain-controlling treatments so that our patients can experience the best possible quality of life.

People with diabetes can develop nerve damage throughout their body over time. Some people with nerve damage have no symptoms, however some feel pain, tingling, numbness, and loss of feeling. Diabetic neuropathy can be classified as peripheral, autonomic, proximal, or focal. Each affects different parts of the body in various ways.

• Peripheral neuropathy, the most common type of diabetic neuropathy, causes pain or loss of feeling in the toes, feet, legs, hands, and arms.
• Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
• Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs.
• Focal neuropathy results in the sudden weakness of one nerve or a group of nerves, causing muscle weakness or pain. Any nerve in the body can be affected.

Physicians typically treat painful diabetic neuropathy with oral medications, although other types of treatments may be helpful to some patients.

Post laminectomy syndrome, or failed back surgery syndrome, is described as a condition occurring in patients who have not had a successful result with back surgery or spine surgery. Spine surgery is only able to accomplish two things, decompression of a pinched nerve root or stabilization of a painful joint. Unfortunately, back surgery cannot eliminate a patient’s pain completely. Some of the reasons that pain can persist after a back surgery include preoperative nerve damage that does not heal after a decompressive surgery. Also, nerve damage can occur as a result of a surgery causing residual pain.

After a history and physical exam with your physician and reviewing MRI’s or other imaging studies, there are treatment options available for this condition. Generally treatment is focused on conservative measures first. These can include rehabilitation and some conservative pain management techniques. These techniques can include exercise, manual therapy, spinal cord stimulation and/or an implanted pump to deliver pain medication.

Fibromyalgia syndrome affects muscles and soft tissue. The condition is primarily characterized by a deep, sharp, dull, throbbing or aching pain felt in muscles, tendons, and ligaments. The next major complaint of fibromyalgia is fatigue. Chronic fatigue sometimes make patients feel like they are run down or have symptoms of the flu. Lastly, there is the presence of trigger points, tissue around joints that are tender when pressed with a finger.

The treatment of fibromyalgia includes a combination of therapies. There are medications, alternative remedies, and lifestyle habits that may help reduce the pain associated with fibromyalgia and improve sleep. A physician may prescribe an antidepressant or pain medication to help deal with the pain, fatigue, depression and anxiety. Physical therapy may also be recommended through the use of moist heat, exercise, relaxation techniques, and stress reduction. There is no one modality that will effectively treat fibromyalgia pain, only a combination is the key to managing this condition.

Daily activities and trauma can also damage muscle tissue in a certain area. People suffering from musculoskeletal pain often times complain that their entire bodies ache. Their muscles may feel like they have been pulled or overworked, and can twitch or burn. This type of pain can also cause fatigue and sleeplessness. Many times, patients receive pain relief from different techniques of manual therapy. Some patients may also benefit from mobilization if they suffer from spinal alignment problems. 

Neck pain can be acute, lasting only for a few hours or weeks, or chronic, lasting for several weeks or longer. The neck has a significant amount of motion however it is less protected than the rest of the spine, making it more vulnerable to injuries. Chronic neck pain many times is caused from the degeneration of the intervertebral disc.

Doctors rely on imaging tests to help them diagnose the cause of neck pain. X-rays or MRI's can be used to show fractures, disc degeneration, facet arthropathy and even nerves. These images can also be used to help your doctor diagnose pain that may be radiating to the shoulders and/or arms. Treatments for neck pain will vary based on the patient's root cause and past attempts at treatments. Options include medications, cervical pillows, physical therapy, and surgery.

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy, is best described in terms of an injury to a nerve or soft tissue that does not follow the normal healing path regardless of magnitude. It is a chronic neurological syndrome characterized by a severe burning pain, pathological changes in the skin and bone, excessive sweating, tissue swelling, and extreme sensitivity to touch. There are two types of CRPS, Type I and Type II.

Physicians can diagnosis this condition with a thorough history and physical exam of the patient, a bone scan, sympathetic nervous system tests, x-rays, or an MRI. When treated early, CRPS can respond to a series of nerve blocks performed in the office. If the condition has progressed, a multidisciplinary approach is needed.

Post-herpetic neuralgia (PHN) is a painful condition and skin sensitivity that can continue for months or even years. It begins with a bout of shingles, but continues long after the shingles rash heals. The pain results from damage to the nerve fibers during the shingles infection. The pain of PHN can be felt in the same area as the pain and rash of shingles, though it may span smaller or larger areas than the original rash site. Patients have described the pain of this condition as deep and aching, as a fire sensation under the skin, as electrical shocks, and as unbearable shooting pain. For some PHN patients, a light touch, the pressure of a shirt, a gust of wind, or brushing the hair, can bring tears to the eyes. In other sufferers, the painful area is sensitive to slight changes in temperature. Depression is common because of the severe pain and social isolation that can occur.

A variety of treatments have been used to treat this condition. Medications, acupuncture, electrical stimulation or TENS unit, cold packs, and interventional therapy such as nerve blocks have all been used to treat post-herpetic neuralgia. Speak with your healthcare provider immediately if you think you may be developing or have had shingles, early therapy may help to shorten the duration of symptoms.