Chronic Pain

Pain, especially intractable or chronic pain, used to be something many patients simply had to learn to “live” with. In recent years, however, researchers have learned a great deal about pain and its physiological and psychological basis, leading to pain management treatments that can provide complete or partial pain relief.

Untreated pain can interfere with the healing process by affecting the immune system and leading to other undesirable results. In cases of back pain, discomfort can impede the rehabilitation process by interfering with exercise and increasing the risk of psychological distress. At Restore Medical Partners, we see Chronic Pain often and are extremely effective at diagnosing and treating chronic pain syndromes.

• Exercise – physical exertion with the aim of increasing strength, increasing flexibility, and restoring normal motion. Includes the McKenzie method, water therapy, stretching exercises, aerobic routines and many others. May involve active, passive and resistive elements. Exercise is necessary for proper cardiovascular health, disc nutrition and musculoskeletal health.
• Manual techniques – manipulation of affected areas by applying force to the joints, muscles, and ligaments. Some evidence for the effectiveness of certain techniques is available.
• Behavioral modification – use of behavioral methods to optimize patient responses to back pain and painful stimuli. Cognitive therapy involves teaching the patient to alleviate back pain by means of relaxation techniques, coping techniques and other methods. Biofeedback involves learning to control muscle tension, blood pressure, and heart rate for symptomatic improvement.
• Superficial heating or cooling of skin – These pain management methods include cold packs and hot packs, ultrasound, and diathermy and should be used in conjunction with exercise.
• Electrotherapy – the most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce back pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system.
  Randomized controlled trials have yielded either positive or neutral results regarding the efficacy of TENS as a treatment for back pain.

• Analgesics – or pain medications, including acetaminophen. Caution in patients with kidney or liver disease.
• Nonsteroidal anti-inflammatory agents (NSAIDs) – includes aspirin, ibuprofen, naproxen and COX-2 inhibitors. Long-term use may cause kidney problems, gastrointestinal ulcers, and may slightly raise the risk of heart attack.
• Muscle relaxants – used to treat muscle spasms due to pain and protective mechanisms.
• Narcotic medications – most appropriate for acute or post-operative pain. Since use of narcotics entails risk of habituation or addiction if not properly supervised, these medications are used with extreme caution.
• Antidepressants and anticonvulsants – used to treat neuropathic (“nerve”) pain.
• Neuromodulating medications – used to treat neuropathic and muscular pain.

• Injections (also known as blocks)
• Injections provide direct delivery of steroids or anesthetic into joints, ligaments, muscles, or around nerves. These injections may provide relief of pain and can be used to confirm if the injected structure is the source of the pain, clarifying the diagnosis. Epidural injections can provide temporary relief for upper extremity or lower extremity pain due to a pinched nerve in the spine.
• Radiofrequency Ablation
• This procedure involves deadening of painful nerves via heat administered through a small needle. This modality helps in approximately 60% of patients and lasts for months to years.
• Surgically implanted electrotherapy devices
• These are implantable spinal cord stimulators (SCS) and implantable peripheral nerve stimulators. These devices help reduce pain that radiates from the spine into the arms, ribs or legs.