“Oh, my aching back!” Or, it could be my shoulder, my hip, my knee, or my neck. Regardless of the location, pain, especially chronic pain, can dramatically affect your quality of life. Yet, if you are experiencing it, you are not alone. Chronic pain is one of the most common reasons for which people go to the doctor. As anyone who has suffered with chronic pain knows, taking medicine is often not the most effective way to stay pain free. There are a number of ways to treat pain, each with their own benefits and shortfalls. So when is it time to see an interventional pain management specialist?
Sources of Chronic Pain
Chronic pain, which affects up to 50 million Americans, is generally defined as pain that lasts more than 12 weeks. In contrast, acute pain is usually an indication that an injury has occurred, or an illness is present. While chronic pain often is a lingering symptom that may have originated as an acute injury, many times there may be no clear-cut cause. Additionally, because pain is a very subjective experience, carefully detailing all of your symptoms, as well as providing a timetable of when they first occurred and a description of severity and quality, is very important to helping your health care provider identify the source of your pain.
While each individual has a unique set of circumstances that contribute to the occurrence of pain, there are a number of illnesses and injuries often associated with chronic pain.
· Low back pain can be caused by a myriad of problems including strains and sprains, herniated discs, fractured vertebrae, narrowing of the space between vertebrae, sacroiliac joint dysfunction, degenerative disc disease, or osteoarthritis. However, osteoarthritis (which is degenerative joint disease caused by wear and tear) can occur in any number of joints, and most frequently in the knees, hips, and shoulders.
· Fibromyalgia is a chronic pain syndrome that results in muscle pain, fatigue, sleep problems, and painful tender points or trigger points. Fibromyalgia can be a very difficult chronic condition to diagnose, but it is manageable.
· Shingles is caused by the same virus that causes chicken pox. When an outbreak occurs, it can cause inflammation of a group of nerves that may result in the chronic pain associated with neuropathy (nerve pain). In fact, neuropathy, which is the result of nerve damage associated with a number of disorders and medical problems (diabetes, spinal injury, chemotherapy) is another source of chronic pain.
Methods of Treatment
There are a many modalities used to treat chronic pain, and each has its own specific indication related to the cause of the pain. This is why having an accurate diagnosis is so critical to receiving adequate treatment. Obviously, with any acute injury, you should see a doctor. This is also true if you have pain that persists after simple treatments like over-the-counter medications have been tried. If your pain is accompanied by numbness, tingling, weakness, fever, or weight loss, or if back pain is associated with difficulty urinating, you should see a doctor right away. Once the diagnosis is made, it is often a combination of treatments that may be necessary to achieve adequate pain relief.
After any acute injury, rest, ice, compression, and elevation (RICE) is recommended. However, ice or heat may also be used to treat certain forms of chronic pain. Initial treatment for acute or chronic pain often includes pain medications. The first line drugs are often Tylenol or over-the-counter NSAIDs (nonsteroidal anti-inflammatories) such as ibuprofen. There are also a number of topical medications available, both prescription and over-the-counter, for the treatment of pain. For more severe pain, your doctor may prescribe other medications, such as steroids or narcotic medications.
Another mainstay for the treatment of pain is Rehabilitation Therapy. There are a number of modalities available to the therapists to treat your pain. Again, heat or ice may be indicated. Massage is often used to relieve muscle tension. Transcutaneous electrical stimulation (TENS) applies electrical currents through the skin to relieve pain. Ultrasound does the same through the use of sound waves. Stretching and strengthening exercises can be used to improve mobility and function, as well as minimize pain.
Spinal manipulation by either a physician or chiropractor may also be used to address pain in a number of areas of the body. Additionally, cognitive behavioral therapy and biofeedback are effective therapies in the treatment of pain.
Interventional Pain Management
As stated earlier, any one of the above therapies, or a combination of them may be necessary for adequate pain relief. However, if relief has not been achieved, it may be time to seek more advanced interventions to treat your pain. Interventional pain management can be utilized to target specific areas that are presumed to generate pain.
The interventional pain management physician has a number of tools available to him or her to treat your pain. Ultrasound-guided injections are among the most frequently used interventions in the treatment of pain. Through the use of ultrasound technology, your doctor will be able to deliver an injection of a steroid which will decrease local inflammation, and a local anesthetic to help numb the pain, directly to the area of your body that is generating pain impulses. These injections may target joints in your knee, hip, or shoulder that are affected by arthritis or injury. However, they may also be used to target deteriorated facet joints, which are located in your spine. Another potential area for injections are trigger points, which are small areas in the muscle that are sensitive to touch.
Additional procedures that may be performed by your interventional pain management doctor include epidural injections of the cervical, thoracic, or lumbar spine, and selective nerve blocks. Epidural injections deliver anti-inflammatory steroids directly to the space surrounding nerve roots in your spine. By decreasing inflammation, they decrease pressure on the nerves that are generating pain. A nerve block works similarly by diminishing inflammation around the root of a nerve suspected of causing pain. A successful block not only is diagnostic in identifying the nerve as the cause of the pain, but is also therapeutic in that it lessons the sensation of pain.
Chronic pain can pose a serious threat to your quality of life, as well as to your ability to get around and function. However, there are many treatments available, including interventional pain management strategies that help you live a pain-free, independent, and productive life. If you have any questions regarding interventional pain management or you would like to discuss how our highly trained specialists can help you overcome your pain symptoms, please request an appointment online. At Delaware Back Pain & Sports Rehabilitation Centers, we have several locations to make treatment as convenient as possible to our patients.