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At Pain & Spine Consultants, we are committed to helping
patients feel comfortable 
While patients should not expect to feel pain, discomfort can be part of
recovery from surgery, illnesses and injuries. The important
thing to remember is that all staff members of Memorial Medical
Center are dedicated to helping patients feel comfortable.
We believe that managing pain is an important part of the
medical care we provide. All departments have the expertise, and
the procedures in place, to supply medications and other methods
of pain relief.
With today’s treatments, most pain--regardless of type and
amount--can be well-controlled. When pain is well-controlled,
you can be more active, sleep and eat better and feel more
positive. If you are recovering from surgery, controlling pain
can help you get well faster. 
Types of Pain: Acute, Cancer,
Non-Malignant – Chronic
Acute pain is what happens
to you when you first hurt yourself. It is a message to you to
stop whatever you were doing and check out the extent of the
injury. This message is an important one and not to be ignored.
How do we feel acute pain?
Several areas of the body act together to allow us to feel the
pain. We use peripheral areas like our skin and muscles, in
addition to our spinal cord and brain. The message from the area
where we hurt ourselves is carried to the brain via nerves. The
perception of pain is also controlled by descending nerve
pathways that complete a feedback loop from the periphery to the
brain and back again. "No Brain, No Pain." Although the pain we
feel is not "in our head" it cannot be perceived without the
brain.
In the brain, some parts help us to perceive the pain (is it
hot, sharp, or aching). Another part helps to determine how
severe it is (mild, miserable, agonizing, unbearable,
excruciating). Still another part influences our emotions about
it (are we scared, sad or angry).
Studies have shown that we can learn to shut off the emotional
part of our brain, and when we do so, we can tolerate more pain
for a longer period of time. Fear, worry and anxiety or being
nervous makes the pain worse; we actually hurt more. If we are
prepared and not scared we can tolerate more pain. (This is why
"Natural childbirth" works for so many women.) The context in
which we experience pain has a lot to do with how well we can
tolerate it.
Cancer pain is usually
caused by the tumor taking up space and crowding other organs or
by destroying the bone. We will not discuss this much here
except to say that today we have ways of controlling cancer pain
that do not interfere with the patient's ability to be alert,
have good sleep and maintain good relationships with their
friend and families.
There is less concern today about addiction to pain medication
in those who do not have a prior history of addiction. Addiction
is not defined in terms of withdrawal from medication or
tolerance but rather by continued use despite adverse
consequences, cravings and loss of control.
Chronic nonmalignant pain
persists beyond the point of tissue damage: the original injury
has healed but we still hurt.
For instance, if you slam your finger in a car door, what you
first feel is acute pain, but if in the years that follow you
can tell when it is going to rain by the pain in your finger,
this is chronic benign pain. It isn't in your head; you aren't
imagining it; you aren't crazy; your finger really does hurt,
but you need not stop what you are doing and attend to the pain.
That is a rather insignificant example, but how many of you have
back pain? 50% of adults will tell you that their back hurts
right now. In fact 85% of all adults will have an episode of
back pain at some time in their life. Most will get better
within a month, but 2% will go on to develop chronic pain
syndrome.
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Pain Assessment
Effective pain management begins with a comprehensive
assessment. This assessment allows the health care provider to
characterize the pain, clarify its impact, and evaluate other medical and
psychosocial problems. The assessment determines whether additional
evaluation is needed to understand the pain.
Because pain is subjective, only the patient can describe it adequately.
The health care provider should ask about the duration and location of the
pain, its severity and quality, and factors that make it better or worse.
The changes that have occurred in the person's life as a result of the
pain, and the nature of other medical and psychiatric problems, should be
noted. This assessment requires a physical examination and a review of
previous medical records.
As part of the assessment, it is important that all prior pain treatments
be discussed. The health care professional should ask about medicines and
other conventional treatments that have been tried in the past. Equally
important is a discussion of the complementary or alternative medical
treatments that the patient has pursued. These might include acupuncture,
chiropractic care, massage or other manual therapies, yoga, herbal and
nutritional therapies, or others. This information helps the health care
provider understand the nature of the pain or the potential benefits of
treatment.
The goals of the comprehensive pain assessment
are:
 Obtain a
full description of the pain
Determine
whether the description fits a well-known pain syndrome
Determine
whether there is structural disease of the body that may help explain the
pain
Try to
understand the mechanisms (tissue damage, nerve injury, psychological
processes) that maintain the pain
Describe
the negative effects on physical and psychosocial functioning caused by
the pain
Understand
the medical and psychiatric problems that co-exist with the pain and might
need treatment at the same time.
[....continued from the right column]
Integrated Pain Management
Nerve Blocks are injections of anesthetic, steroid and/or opioid
(oh-pe-oid) medications. Nerve blocks are performed to relieve pain and/or
to determine if a specific nerve root is the pain source. Anesthetic (an-es-tha-tick)
medications numb the nerves, steroids are potent anti-inflammatory drugs
that reduce swelling, and opioids are powerful drugs that fight pain. In
some cases, nerve blocks can provide extended periods of pain relief. Some
of the different types of nerve blocks are listed below.
Cervical, Thoracic, Lumbosacral Medial Branch Blocks target the
medial branch nerves. Medial branch nerves are very small nerves that
communicate pain from the spine's facet joints (fah-set joints).
Facet Joint Blocks are performed to reduce inflammation and pain
and to confirm that a particular facet joint is the pain source. The facet
joints are small-paired joints on the back of the spine that help to
provide spinal stability and guide motion in the back.
Selective Nerve Root Blocks are performed to reduce inflammation
and pain and to determine if a specific nerve root is the pain source.
Conclusion
During the last decade, pain management has evolved into an integral part
of patient care, which has dramatically affected the medical community.
Medical professionals have a better understanding of pain. Attitudes are
changing, diagnostic protocols have advanced, technology has improved
procedures, and there are more medication options. The horizon continues
to brighten for patients who suffer pain.
This article is an excerpt from Dr. Stewart G.
Eidelson's book, Advanced Technologies to Treat Neck and Back Pain, A
Patient's Guide (March 2005).
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Integrated Pain Management
Integrated pain management is a new approach to treating acute and chronic
back and neck pain. Pain afflicts millions of patients suffering spinal
stenosis (spinal sten-oh-sis), degenerative disc disease, osteoporosis (os-t-o-pour-o-sis),
failed back surgery, facet disease, myofascial pain, and degenerative
scoliosis (sko-lee-oh-sis).
Today patients find that modern medical professionals have a different
view of pain. Chronic pain is no longer considered long lasting acute pain
and pain perception is individual to the patient.
Traditional spine care and pain
management specialists have merged to form collaborative programs for the
comprehensive treatment of pain. Patients find many advantages to these
programs including the centralization of medical care with less
duplication of services from different medical disciplines.
An integrated pain management program educates the patient to understand
their pain and to learn how it can be controlled. The patient and
specialist work together as partners to determine the best treatment.
Pain Assessment
A pain management assessment begins with the patient's pain history, which
includes the location, intensity, and duration of pain as well as factors
that alleviate or aggravate pain. A physical and neurological examination
is performed. Further, the patient's medical history and test results are
reviewed including radiographs (e.g. x-rays, MRI).
Multidisciplinary Approach
A multidisciplinary approach means the patient's pain program may include
different types of treatment. Treatment is provided by the medical
professional that specializes in a specific type of treatment. Medical
professionals may include a pain management specialist, physical
therapist, rehab specialist, and occupational therapist.
Conservative non-surgical treatment may include a combination of pain
relieving medications, anti-inflammatory drugs, physical therapy, and
injections. Alternative therapies include acupuncture, biofeedback, stress
reduction, and diet modification. In this chapter different types of
injection therapies are presented.
Epidural Steroid Injections
Steroid injections are potent anti-inflammatory agents injected directly
into the epidural space located close to the affected nerve roots. The
epidural space is the area surrounding the spinal cord and nerve roots.
These injections are most effective in the presence of nerve root
compression. Scientific studies demonstrate inflammation of the spinal
nerves following prolonged compression leads to irritation and swelling.
These injections are most effective when given during the first weeks
after the onset of pain. Usually two or three injections one to two weeks
apart are required. Only one injection is given when complete pain relief
is achieved.
The number of injections is limited to a maximum of three to avoid
systemic side effects from the steroids. Side effects are minimal and
consist mainly of mild tenderness in the injection area, which disappears
in one to two days.
Sterile Procedure
Epidural steroid injections and nerve blocks are administered in a
hospital or outpatient medical facility under sterile conditions. Through
an IV (intravenous line), the patient is given medication to relax.
Numbing medication is injected into the skin area where the injection will
be placed. The physician uses fluoroscopy (floor-os-co-pee) to guide the
needle into the epidural space at the appropriate spinal level (cervical,
thoracic, lumbar). After the procedure, the patient is moved into the
recovery area and monitored for about an hour.
[Continued on the middle column..] |
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