Pain management is a growing medical specialty dedicated to treating acute, subacute and chronic pain. The goal is to improve your quality of life and help you 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, psychiatrist or psychologist.
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. Subacute pain is defined as being between acute and chronic. Depending on the cause, acute pain may last three to six months. Chronic pain may be mild or severe and lasts longer than six months.
An accurate diagnosis is imperative for an effective pain management plan. We combine your medical history and physical and neurological examination results with a thorough review of lab and imaging results. If you have kept a pain diary, this information is of significant value.
Depending on many factors, such as your type of pain and general health, we may combine treatments. Some patients are surprised to learn that a failed treatment is effective when combined with one or more therapies. We may combine medications for maximum relief.
*Nonsteroidal 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 for diagnostic or pain treatment involves injecting a local anesthetic and corticosteroid into an area of the spine. A corticosteroid is a powerful, slow-releasing, long-lasting anti-inflammatory medication effective at reducing inflammation. We sometimes we inject a narcotic to increase pain relief.
Diagnostically, when the patient’s symptoms are relieved, the injection provides evidence that a particular nerve root is a pain generator.
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 is to interrupt pain communication 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 we perform RF rhizotomy, we identify 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.
SCS provides therapeutic treatment of chronic neck, back and extremity pain, low back pain treatments and relief for sciatica. 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 SCS 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. The remote control enables you to turn impulses on, off or adjust their intensity.
A spinal 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. Patients may benefit four 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
Saint Barnabas Medical Center
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Formerly Lenox Hill Hospital