We see our patients by referral from local physicians and work very closely with the referring doctors. The program is staffed by physicians who are specialists in anesthetic and analgesics drugs which cause a cessation of the experience of pain. Relief from chronic pain may be close at hand with our pain management services.
Patients come to us with a multitude of pain conditions and other symptoms such as obesity, eating disorders, addictions, etc. Interventional and pharmacological pain management may be appropriate for conditions like herniated disks, shingles, arthritis, neurovascular diseases, failed back syndrome, compression fractures of the spine, chronic pancreatitis and muscular skeletal pain. For cancer and some chronic intractable pain, implantable devices such as spinal cord stimulators and infusion pumps may be appropriate.
We have five basic interventions available for pain management:
Pharmacological Interventions - Medications are an important component of our pain management tools. There are basically four classes of medicines that we can use for pain:
Non-steroidal anti-inflammatory medications - They are aspirin, ibuprofen, motrin, and the more sophisticated newer and expensive ones called Celebrex and Mobic. They all reduce or stop the release of the chemicals from the injured tissues. They work at the transduction level.
Local anesthetics - These are simple and understandably useful because they stop the electrical conduction of pain by the nerves. They work at the transmission level. Common local anesthetics are lydocaine and xylocaine, and novocain, sometimes referred to as "novocain". These agents are commonly used by dentists or doctors to numb an area for any kind of procedure. All local anesthetics stop the transmission of the electrical stimuli to the brain. They are very useful as injectables, but we have one pill called mexiletine.
Opiods - The best pain medications we have. They produce pain relief through stimulation in the spinal cord and brain of certain receptors that control the feeling of pain. These are medications that are prescribed under heavily-controlled regulations by the Federal Government because of their potential mood-altering and dependency properties. Opiods are a direct derivative of opium and heroin, with morphine being the parent of these drugs. They have been available for centuries and used by all cultures. We have subsequently developed newer kinds like hydrocodone, dilaudid, oxycotin, fentanyl, etc. These all work at the brain and spinal cord level by stimulating the receptors of our own pain modulators.
Co-analgesics - A hodgepodge of medicines that were invented for management of problems other than pain. For example, neurontin and other anti-seizure medications were invented to prevent convulsions. However, the way they work is by calming down cells, so they also calm down pain cells and produce pain relief as a side effect. Another medication that was invented for problems other than pain is all the serotonin enhancers, the antidepressants. Serotonin, our natural mood-enhancing hormone in our blood, is also a powerful analgesic (pain reliever). Medications such as amitriptyline and nortriptyline, which increase serotonin in our blood, are used in pain management. Other medicines, such as Ultram and Tylenol, produce pain relief by a combination of different mechanisms.
Invasive Procedures - There are a variety of blocks and injections to manage pain. They deliver different pain medications to specific joints, spaces (epidural or spinal) or nerve roots and block the transmission of pain. The most commonly used procedure is the epidural injection.
Interventional Devices - New technologies have become available in the last decades. We have continuous infusion pumps that can be implanted into the spinal space that either deliver medications or electrical stimulation for symptom relief. There are other thermal devices that either freeze or burn different nerve structures, and finally, there are also peripheral devices, such as peripheral nerve stimulators or TENS units (transcutaneous electrical nerve stimulation) that are used for symptom control.
Complementary Therapies - The Federal Government through the National Institute of Health, in scientific studies, has actually concluded that hypnosis and acupuncture are two complementary treatments that are effective in symptom management. In the last few years, new emphasis has been given to other complementary therapies. Modalities, such as aroma therapy, deep muscle massage, chelation, biofeedback, and improvement of quality of life. It has become clear that traditional Western medicine does not provide all the answers in symptom management.
Concept of Wellness - The emphasis in the new millennium is in the improvement of quality of life. Quality of life cannot be achieved unless it is developed within a concept of wellness. The answer to some patients does not come from traditional medications, surgeries, or procedures. Though it can be important and needed to have these interventions, it is not the only available solution at the exclusion of others. Combining the traditional approach with the concept of wellness eventually is the only way to improve quality of life. Part of the concept of wellness involves focusing on the good and enjoyable part of our lives more than focusing on the debilitating or negative aspects of our lives; focusing on what we can do instead of what we can't do. As we give our attention to enhancing personal relationships and enjoying the gift of life, the resulting happiness will serve to raise the level of serotonin in the blood and lesson the sensation of pain.