You hurt your back in a car accident or wrenched your shoulder lifting a box at work, and the pain just won’t go away. Maybe a degenerative condition is causing severe back or neck pain. Or perhaps you need to prepare your body for surgery to correct a bad hip.
You might not realize it, but you’re a candidate for pain management.
Pain shouldn’t be a given for people suffering from chronic or acute conditions, say Susquehanna-region pain management specialists. When pain limits lifestyles and curtails everyday
activities, it’s time to consider a pain management regimen. Here, we answer your questionson what to expect and how to make the most of your treatment.
1. What is pain management?
Pain management can be called the process of diagnosing, treating, and easing acute or chronic pain. Pain management specialists are physicians, often known as physiatrists, administering to patients whose activities are limited by pain.
Patients may have family doctors or surgeons treating their conditions, but the pain is curtailing their lifestyles.
“We’re the nonoperative orthopedists,” says Dr. Michael B. Furman, physical medicine rehab specialist with subspecialties in pain medicine and sports medicine, OSS Health, York (www.osshealth.com).
Dr. Robert E. Roberts, III, physiatrist at Lancaster NeuroScience & Spine Associates (www.lancspine.com), says he typically sees patients at different stages. Some patients referred by primary care doctors haven’t found relief with basic medications or physical therapy and are “trying to figure out the next step.” Others come from surgeons, recommended because they want to try something less aggressive before going to the operating room, or because surgery simply won’t help their conditions.
2. Which conditions does pain management treat?
Leg pain from a herniated disc or spinal stenosis in the back. Arm pain, also from a herniated disk or spinal stenosis in the neck. Buttocks pain. Hip discomfort. Shoulder pain. Joint pain. Pain from work incidents or auto accidents.
Those are the kinds of conditions that Furman sees. “Our primary thing here is usually the spine, but we see all the other things, as well,” he says.
Dr. Max Braun, of Susquehanna Valley Pain Management (www.harrisburgpaincenter.com), sees patients who “haven’t exhausted conservative treatment. Certainly they don’t want to pursue surgery yet, so then it’s a matter of getting rid of the swelling, inflammation, and the pain, and improving the patient’s function so they don’t need surgery.” Patients may have disc herniation, bone spurs, or arthritis that’s causing nerves to “get irritated and swollen.”
“When they’re getting that severe pain in their neck and down their arm, or in their low back and down their leg, and it’s keeping them up at night and limiting their productivity during the day and affecting their activities of daily living, and nothing else is helping, that’s where we come in,” says Braun.
3. Do injections ease the pain?
Pain management can involve steroid injections “directly over the pathology,” says Braun. “That steroid can get rid of that chronic inflammation that the body hasn’t been able to get rid of. It
creates the environment to heal.” The healing process can even prevent the need for surgery, he says.
The frequency of “injectables,” as they’re called, varies by condition, says Furman. A patient with an acute soft tissue injury might need only one. A chronic condition such as spinal stenosis, which is a narrowing of the spinal column, might require two or three injections a year to keep the pain and inflammation at bay.
Side effects are rare, says Braun, who uses fluoroscopic visualization – a continuous x-ray beam that sends real-time images to a monitor – to guide the injection. The injection occasionally aggravates the pained area for a short time, but typically relief comes in two or three days.
Patients may feel some burning and stinging from the numbing of the skin before the injection and pressure during the procedure, but that’s typically the extent of the discomfort, says Vivian Wisniewski, Susquehanna Valley Pain Management’s director of nursing. “Our biggest role is reassuring the patient during the procedure,” she says.
4. Does exercise play a role in pain management?
The goal of pain management is “not to lie down and be treated,” says Furman. “The goal is to be educated in proper exercise.” Injections calm the pain, but “exercise is probably the best medicine out there.”
“You often have a choice every day to be more active or be less active,” Furman says. “If you choose to be less active, it’s easily achieved.
Our goal of pain management here is to integrate our injections into becoming more active and having a healthier lifestyle.”
Some conditions, such as severe stenosis, won’t respond to preventive moves, but in many cases, a proper exercise routine can prevent reaggravation after the pain has diminished, says Braun. The patient with disc herniation, for instance, should maintain an exercise program, “hopefully taught by a physical therapist for continued core strengthening.”
“The stronger your core is, the less stress you put through your back,” Braun says. “If someone had a disc herniation with severe pain and we calm down the inflammation but they never work on strengthening their core to prevent future injury, then they’re more likely six months or a year or two years later to cause the disc to bulge out or herniate again.”