Pain Management for Spinal Disorders

Pain management is a growing medical specialty dedicated to treating acute, sub-acute, and chronic pain.  The goal of pain management is to improve quality of life and help patients return to everyday activities without surgery.  A pain management physician is often part of a team of medical professionals, such as the patient’s referring physician, physical and occupational therapists, oncologist, and psychiatrist, or psychologist.

Acute, Sub-acute, Chronic and Postoperative Pain

Pain is generally classified as being acute or chronic.  Acute pain begins quickly or suddenly and may be severe.  Postoperative pain is an example of acute pain.  Sub-acute pain is defined as being between acute and chronic.  Depending on the cause, acute pain may last 3 to 6 months.  Chronic pain is persistent and may be mild or severe.  It is defined as pain lasting longer than 6 months.

Patient Pain Evaluation

An accurate diagnosis and determining the source of your pain is imperative to developing an effective pain management plan.  Your medical history and results of a physical and neurological examination are combined with a thorough review of test results, such as lab and imaging results.  Part of the evaluation includes answers to questions Dr. Frazier will ask — such as when pain started and is it associated with an event such as injury; has the pain changed – intensity, duration, what relieves or aggravates your pain; and, associated symptoms such as nausea or weakness.  If you have kept a pain diary, this information is of significant value.

An in depth discussion of your pain includes its location(s), duration, and intensity.  You are asked to rate your pain on a scale of zero to 10 with 10 being the worst pain possible.  Alternatively, you may be asked to notate on a picture of the front and back of body where you feel pain and designate its type (i.e. burning, sharp) and intensity (1 through 10).  Pediatric patients use a pain faces diagram to help them explain their pain.

Treatment Options

Depending on many factors, such as your type of pain and general health, treatments may be combined.  Some patients are surprised to learn that a treatment that failed to provide relief before is effective when combined with one or more therapies.

Medications, such as non-steroidal anti-inflammatory drugs, muscle relaxants, anti-depressants, anti-seizure drugs, and narcotics.  Specific types of anti-depressant and anti-seizure drugs are effective to reduce neuropathic pain (damaged nerve fibers).  Medications may be combined for maximum relief.

*Non-steroidal anti-inflammatory drugs

Spinal injections serve two purposes:

(1) Diagnose or confirm the cause of pain
(2) Reduce or relieve inflammation and pain

A spinal injection, whether it is performed for diagnostic or pain treatment, involves injecting a local anesthetic and corticosteroid into an area of the spine.  In the case of an epidural injection, the medications are injected into the epidural space.  The epidural space is between the protective membrane (dura mater) containing the spinal cord and the bony spinal canal.  When a nerve root block is performed, the medication is injected into the nerve root sheath; a protective membrane (pia mater) covering each nerve root.  

A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective in reducing inflammation.  Sometimes a narcotic is also injected to increase pain relief.  After the medication is injected, it flows and coats the nerve roots.

Diagnostically, when the patient’s symptoms are relieved, the injection provides evidence that a particular nerve root is a pain generator.

Radiofrequency Ablation (RF rhizotomy or RF neurotomy) reduces or eliminates facet joint pain and related symptoms in the neck (cervical spine) or low back (lumbar spine).  The goal of the procedure is to interrupt communication of pain between a specific medial nerve root and the brain.  Relief from pain and related symptoms may last a year or longer.    

The medial nerve roots innervate the spine’s facet joints. Before a RF rhizotomy is performed, the pain generating facet joint nerve(s) (medial branch nerves) is identified by means of a diagnostic injection, such as a facet joint or medial branch nerve block.  Other tests may include MRI.  Since the medial branch nerves do not control neck or low back muscles, it is not harmful to disrupt or turn off their ability to send signals to the brain conceived as pain.

Spinal cord stimulation (SCS) provides therapeutic treatment of chronic neck, back, and extremity pain.  Although the science of SCS has been around for a long time, advances have improved this technology by prolonging battery life, making device components smaller, and improving pain control to multiple areas.  Many chronic pain patients have regained life and vitality using SCS.

SCS works by producing electrical impulses that block pain from being perceived in the brain.  Pain is replaced by a mild tingling sensation.  The success of spinal cord stimulation depends on (1) careful patient selection and (2) a successful SCS trial.

The device resembles a pacemaker and includes a generator, thin leads, and remote control.  Basically, one or more thin leads are surgically implanted beneath the skin and connected to the generator.  Through the leads, low-level electrical impulses travel to the spinal canal and intercept pain signals before they reach the brain.  Instead of pain, you feel a mild tingling sensation.  The remote control enables you to turn impulses on, off, or adjust their intensity.

A spinal pump, or intrathecal pump, can help provide chronic pain patients round-the-clock pain relief.  Spinal pumps are programmable devices that deliver a measured and safe drug dose to meet the patient’s daily needs for pain management. Unlike oral pain medication that takes time to take effect, an intrathecal drug pump bypasses the gastrointestinal system and delivers medication into the cerebrospinal fluid.  The brain and spinal cord float in the cerebrospinal fluid.  Patients may benefit 4 ways:
(1) Less pain medication is needed
(2) Pain relief is sustained and better controlled
(3) Side effects are reduced (i.e. constipation, nausea)
(4) Increased quality of life

The success of pain management using a spinal pump depends on (1) careful patient selection and (2) a successful trial.

Pain Management Improves Quality of Life

Advances in pain medicine help thousands of pain patients every day.  There are many ways to control pain and improve your quality of life.  For more information about pain management and how it can help you, contact Dr. Frazier’s office today for an appointment.