Types of Treatment

There are generally two types of pain – acute pain and chronic pain.

  • Acute Pain is temporary. It may last from a few seconds to several months. This pain usually goes away as normal healing occurs. Pain due to an injury or pain due to childbirth is examples of acute pain.
  • Chronic Pain lasts far beyond the time of normal healing. It may be the result of an injury that did not heal properly or may be due to other reasons such as nerve damage, cancer or arthritis. Neck pain, lower back pain and migraine headaches are examples of chronic pain.
Pharmacotherapy

Over-the-counter medications and topical agents such as lotions and creams can be used as a milder treatment approach. If these medications do not work, a physician can prescribe stronger medications such as muscle relaxants or a number of pain killers.

Interventional Approaches

Interventional approaches to manage chronic pain such as diagnostic and therapeutic blocks can be used as well as implanted nerve stimulators, pumps and catheters. Steroid injection techniques, where a needle injects a local anesthetic mixed with a steroid into the area where the pain is originating, are often used to lessen pain. The implantable devices are surgically placed just under the skin and can deliver medicine directly to the spinal cord or stimulate the nerves to alleviate pain.

Rehabilitation Approaches

Some examples of rehabilitation approaches include physical therapy and transcutaneous electrical nerve stimulation (TENS) Unit therapy. Physical Therapy and Occupational Therapy can help by improving and strengthening mobility and function. TENS Unit therapy uses electrical stimulation through electrodes near the area of pain to offer relief.

Medications for Managing Pain

Due to rapid advances in medicine, a wide variety of medications and treatments are available for acute, chronic, and cancer pain. Patients are often prescribed medications before receiving other forms of therapy.

In addition, your pain medicine doctor may conclude that a combination of medication and treatments may be right for you. Your therapy plan will be tailored to specific needs and circumstances.

  • Common pain relievers – Non-aspirin pain relievers such as acetaminophen can relieve headaches and minor pain but do not reduce swelling.
  • Anti-inflammatory drugs – Used to relieve pain, inflammation and fever
  • Opioid pain medications – Morphine-like drugs prescribed to treat acute pain or cancer pain
  • Anti-depressants – Studies now show anti-depressants can relieve certain pain in addition to treating depression.
  • Anti-seizure medicines – Used to relieve what some patients describe as “shooting” pain by decreasing abnormal painful sensations caused by damaged nerves.
Celiac Plexus Block

The celiac plexus is an injection of a local anesthetic near a group of nerves that stimulate the abdominal organs. "Celiac" refers to the network of nerves. "Block" refers to the use of a local anesthetic to prevent sensory nerve impulses from reaching the brain.

This type of block is used most commonly to treat upper abdominal pain, which may be due to cancer or chronic pancreatitis. The procedure can lessen or eliminate your abdominal pain. It can also help your physician find the cause of your pain. This is known as a diagnostic nerve block.

Epidural Steroid Injection

An epidural steroid injection (ESI) places a small amount of steroid medication near nerves in your lower back. The medication is injected into the epidural space, an area surrounding the spinal cord and nerves.

An ESI may be performed to relieve pain in your neck, arms, lets, chest or lower back. An ESI also may be performed to relieve pain caused by shingles. By reducing inflammation and decreasing pain, an ESI allows patients to increase their mobility.

Facet Joint Block

A facet joint block is an injection of a small amount of local anesthetic near the facet joint. Facet joints are located on the side of your spine, away from the spinal cord. A facet joint block relieves pain known to be related to the facet joints and is performed if your doctor suspects that your neck or lower back pain may be caused in part by the small facet joints of the spine.

This procedure can help your doctor better determine the cause of your pain (diagnostic nerve block).

Hypogastric Plexus Block

The hypogastric plexus is a collection of nerves that is located near the lower part of your abdomen in the upper front of your pelvis. A hypogastric plexus block involves placing an anesthetic near the region of the plexus and usually involves a series of injections repeated at weekly intervals.

This treatment has brought relief for many patients who suffer from pelvic pain including pain of the bladder and lower intestines. It also treats pain of the uterus, ovaries, and vagina in women, and pain of the prostate and testicles in men.

Intercostal Nerve Block

An intercostal nerve block is an injection of a local anesthetic in the area between two ribs. "Intercostal" means between the ribs and "nerve block" refers to the use of local anesthetic to prevent painful impulses from reaching the brain.

An intercostal nerve block is used to treat pain due to shingles, which is an acute viral infection that causes inflammation of the nerves that spread outward from the spine. It may also be performed to treat pain caused by surgical incisions in the chest area or to help determine the cause of your pain.

Lumbar Sympathetic Block

A lumbar sympathetic block is an injection of local anesthetic around a group of nerves in your lower back (lumbar area). A lumbar sympathetic block may be performed if you have reflex sympathetic dystrophy (RSD), a disease involving a disturbance of circulation to the skin that often leads to neuropathic pain (pain caused by a disorder of the nervous system).

Radiofrequency Ablation

Radiofrequency ablation uses an electrical current produced by a radiowave to heat up a small area of nerve tissue, thereby decreasing pain signals from that tissue. Clinical data shows that radiofrequency ablation can provide effective, lasting pain relief.

Spine CATH IDET Therapy

Due to age or injury, cracks or fissures may develop in the wall of an intervertebral disc. These fissures are filled with small nerve endings and blood vessels and can be a chronic source of pain. Also, the inner disc tissue frequently bulges (herniation) into these fissures in the outer region of the disc.

Spine CATH IDET therapy is a minimally invasive treatment in which a physician applies controlled levels of heat to a broad section of the affected disc wall. The heat contracts and thickens the collagen of the disc wall and raises the temperature of the nerve endings.

The therapy may result in contraction or closure of the disc wall fissures and a reduction in the bulge of the inner disc material and a desensitization of the pain sensors within the disc.

Stellate Ganglion Block

The stellate is a group of nerves in the neck area. A stellate ganglion block is an injection of a local anesthetic around this group of nerves to relieve pain. The pain relief will affect one side of the head and neck, the upper arm and upper part of the chest on the same side of the body.

A stellate ganglion block can decrease pain and increase the circulation and blood supply to the affected arm. The procedure may be performed on people who have circulation problems or the following nerve injuries – reflex sympathetic dystrophy, excessive sweating in the palms or arm pits, causalgia, herpes zoster, or phantom limb pain.

Trigger Point Injections

Trigger point injections (TPIs) place small amounts of local anesthetic and steroids in the area of the muscle where you have pain or tenderness. These areas are called trigger points because they produce pain when they are stimulated. TPIs are performed to relieve myofascial pain, which is pain in the specific muscle or muscle group.

Tunneled Epidural Catheter

A tunneled epidural catheter is a small catheter that is placed in the epidural space and tunneled under the skin. It provides a small dose of pain-killing medication and stays in place during a patient's rehabilitation. This arrangement provides excellent pain relief with only a small dose of medication.

Vertebroplasty

Percutaneous vertebroplasty is a procedure for the treatment and stabilization of vertebral compression fractures. Vertebrae are the bones that join together and make up the spinal column. A compression fracture of the vertebrae means the bone has collapsed or is crushed. Compression fractures are the result of bone that has been weakened, most commonly by osteoporosis and in rare cases, by cancers, benign tumors or trauma.

In some cases, the bone does not stabilize and continues to move, causing persistent pain. For many patients, this pain severely limits their activities and reduces the quality of their lives. Vertebroplasty is a minimally invasive outpatient procedure performed using x-ray guidance. Most people go home the same day as treatment and experience pain relief within 48 hours.