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Non-Opioid Therapy

Chronic Pain:

Chronic pain, which can be caused by many medical conditions and syndromes with different pathophysiologies, is an important and common medical concern worldwide. In the United States, pain is the most common complaint that leads patients to seek medical care. Although opioid use for acute/postsurgical pain and for palliative care is accepted in the United States, controversy continues among pain practitioners concerning the use of opioids for the treatment of chronic pain. More recently, this controversy has resurfaced, in part through press and media reports of opioid medication abuse and alleged practitioner misconduct.

Much of this controversy stems from the limited evidence regarding the long-term benefits and hazards associated with daily use of opioids. Despite a substantial increase in prescription opioids, there remains a paucity of data regarding long-term opioid efficacy. In the absence of these data, providers must rely on whatever information is available to inform their clinical judgment, balancing the benefit and harm, in order to make decisions regarding their individual patient. Clinicians need to recognize that opioid analgesics can be helpful to some individuals with chronic pain, but are ineffective or potentially harmful to others.

Opioid treatment of pain has been, and remains, severely hampered because of actual and legal constraints related to substance abuse and diversion. The guideline algorithm and recommendations suggest a structured goal-directed approach to chronic opioid treatment, which aims to select and monitor patients carefully, and wean therapy if treatment goals are not reached.

Rest

Pain can also be an indicator of the need for rest. It is important to pay attention to the signal and allow the body the required time to recharge. Inflammation decreases during a restful phase, however too much stillness can lead to muscle weakness. It is essential to strike a balance between rest and exercise.

Brace

A brace is a device designed to limit the motion of the applicable body part in cases of fracture or in post-operative fixation or fusions. Limiting the motion of enhances the healing process and minimizes the patient’s dis

Massage

Massage therapy can hasten pain relief, soothe stiff sore muscles, and reduce inflammation and swelling. As muscle tension is relaxed and circulation is increased, pain is decreased.

Tens Unit

Transcutaneous electrical nerve stimulation (TENS) unit utilizes low-voltage electrical stimulation to the nerves to block pain signals to the brain. Electrodes are placed on the skin and emit the electrical charge. This is used primarily for chronic, localized pain which is intractable.

 Acupuncture

Acupuncture is an alternative therapy originating in ancient Far East that treats patients by manipulating thin, solid needles that have been inserted into acupuncture points in the skin.

Physical Therapy

Physical Therapy (PT) is a form of rehabilitative therapy that uses equipment and exercises to help patients regain or improve their physical abilities. It may help adults suffering from sciatica or the after effects of injury or surgery. PT may even help elderly poststroke patients.

Interventional Procedures

Botox Injections
Caudal Injection
Cervical Epidural Steroid Injection
Disc FX
Lumbar Epidural Steroid Injection
Lumbar Sympathetic Block
Medial Branch Block-Facet Injection
MILD Procedure
Pain Pump
Radiofrequency Ablation
Sacroiliac Injection
Spinal Cord Stimulator
Stellate Ganglion Block
Transforaminal Injection
Trigger Point Injections

Implantable Therapies

Most insurance plans require that a patient be pre-certified (approved) before going to the hospital for procedures or surgeries such as Spinal Cord Stimulator (SCS) or Pain Pumps. As part of pre-registration, our staff will coordinate with your physician to meet the requirements of your insurance plan. If you have any questions regarding pre-certification, contact your insurance company or primary care physician.

Frequently Asked Questions

Q:1. What is pain management?

Pain is a complex medical problem that can have profound effects on your physical and mental well being. The goal of pain management is to help you decrease your level of pain and suffering, to return you to your maximum level of functioning and independence, and to help restore your quality of life.

Q:2. What is a pain medication agreement?

Your health and safety is our primary concern. The pain medication agreement outlines important safety and regulatory issues concerning proper medical use of controlled substances. Among other expectations, we stress the use of one pharmacy and one physician for all of your pain medication prescriptions. We require you to take your medications as prescribed and submit urine specimens for testing on a regular basis. If you are impaired in any way, you must not drive or operate machinery. You cannot give or sell your medications to others, or take someone else’s medications. These and other concerns are a part of our agreement necessary to safely prescribe opiods and/or other controlled substances for the management of pain.

Q:3. What is the difference between acute and chronic pain?

Acute pain is short of duration, usually as a result of an injury, surgery or illness.

Chronic pain is an ongoing condition, one which has been present for 6 months or longer. Your physician may refer you to a pain management specialist because your chronic pain condition has not responded to conventional therapies. With proper treatment, people may live full, normal lives after having experienced chronic pain.

Q:4. What is an epidural steroid injection?

Epidural injections are performed to confirm a diagnosis and/or reduce pain and inflammation. During the procedure, a physician uses x-ray / fluoroscopy and contrast solution to ensure a correct needle tip placement. Intravenous sedation may be used for patient relaxation.

Q:5. What is the goal of a steroid injection?

The injection consists of steroid-anesthetic mixture. Steroids are a powerful anti-inflammatory medication. If your symptomology is caused by inflammation, steroids will help to reduce the pain.

Q:6. Are the injections painful?

You may experience pain, but only for short period of time. Local anesthetic and intravenous sedation can be used to reduce pain and provide relaxation. It is very important for you to be awake throughout the procedure to inform the physician about the sensations you are experiencing.

Q:7. How long will my injection take?

Most procedures take 5 to 10 minutes. Some of them require half an hour. Preparation and recovery time may require 2 to 3 hours of your time.

Q:8. Can I return to work after pain management procedure?

It depends on type of procedure. If you were working before the procedure you would be able to return to work the next day.

Q:9. Am I able to drive after a pain management procedure?

Many of the procedures that are performed here may cause associated numbness, weakness, and/or loss of position sense, which can make the operation of a motor vehicle difficult. We do ask that you have a ride home.

Q:10. May I eat before a pain management procedure?

You may eat prior to the procedure, however in many cases an empty stomach is preferable Some patients feel sickness because of discomfort or agitation. Also, intravenous sedation can increase risk for vomiting and aspiration. You may take your regular medications with small amount of water.

Q:11. What kind of result can I expect following the injection?

Steroid effects usually begin within 2 to 3 days, however pain relief may occur faster or slower. Residual pain may be experienced for 1 to 2 days until the medication absorbs. Some patients require 2 or 3 injections to obtain the full relief.

Q:12. How many injections can I have?

As a general rule, we restrict steroid injections to 3 injections for each 6-month period for any given area. If you are a diabetic, we will adjust this accordingly.

Q:13. What if the injection doesn’t work for me?

We will see you back in the office for follow-up to review your response to the injection and discuss further treatment options. Statistically, you have an approximately 75 to 80 % chance for significant pain relief. Determining factors include the severity of underlying process and age of the patient.