Pain Management Techniques

Pain management is a branch of medicine dedicated to the treatment of chronic pain (pain last for longer than 6 months). Chronic pain is often a symptom associated with disorders of the neck and back and is the most common complaint mentioned by our new patients. In many subspecialties of medical practice, there exists an overlap between professionals in their approach to patient care and in the techniques they employee. At times the techniques practiced and offered by pain management physicians and those offered by spine care specialists do overlap, however the philosophies of each are distinct and complimentary. Understanding the difference can assist a patient in understanding which type of professional is best for their particular situation.

The spine care specialist is dedicated to restoring optimal function to a malfunctioning spine. Malfunctions can come from hundreds of different causes including trauma, degenerative arthritis, disc herniation, cancer, poor health habits, obesity, weakness, and many others. Chronic pain is often a symptom of this malfunction and can many times be relieved through treatment of the primary problem. Pain generators caused by a muscular strain will often be relieved by the appropriate muscle stretching and strengthening program. Pain generators caused by arthritis will often be relieved by addressing secondary problems with posture, strength and flexibility which follow when an unknowing individual curtails his or her activities in response to pain. Pain caused by nerve root compression will usually respond to targeted cortisone injections (transforaminal epidurals or selective nerve root blocks) or to the decompression of that nerve root through a minimal access surgical procedure. These treatments are the venue of the spine care team.

During this process it is not unusual for the spine care professional to utilize medication that limits pain while trying to restore function. These medications can include nonsteroidal anti-inflammatory medications such as aspirin, ibuprofen and Aleve, narcotics such as hydrocodone, oxycodone and propoxyphene, muscle relaxers such as Flexeril, Skelaxin, or SOMA, neuropathic pain relieving medications such as Neurontin and Lyrica and even occasional sleep aids. It is not typically the pervue of the spine care specialist to continue prescribing mood altering medications over extended periods. Moreover, it is not typical that the spine care specialist will implement drug regimens which utilize sustain release medications for chronic pain such as Oxycontin, Duragesic and others. For this reason a pain management specialist is often asked to assist if this becomes necessary.

When a diligent effort to identify the anatomic site of pain generation fails, or improvement in function, strength, posture and balance do not adequately relieve pain, the pain management specialist can be of great assistance. At times it can become futile and even counter productive to continue to search for the "cure" for neck or back pain, as the anatomic changes are either unidentifiable or are too severe for a direct assault on the malfunction to succeed. At these times a paradigm shift must occur. Rather than continuing to search in vain, for the cause of pain, in an effort to correct the root cause, we switch to treatment of the pain itself...as the cause. It is the pain management specialist that takes center stage in this process.

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                                                    Last modified: 04/04/06