What Is Involved With Pain Management?

Chronic pain is a complex medical condition that involves a multidisciplinary approach to treatment.

Pain can be treated by specialists in Physiatry (Physical Medicine and Rehabilitation), Anesthesiology, Interventional Radiology, or Physical Therapy. As a Physical Medicine and Rehabilitation practice, we treat not only the painful problem, but we treat the patient as a whole. We treat pain associated with any musculoskeletal problem and sub-specialize in spine pain/neck and back pain.

Pain Management does not only involve treating pain with medications. Although medications are often used to control symptoms, other options are often employed to minimize pain with possibly less side effects. Often when someone presents with pain, if there are no concerning signs or symptoms, conservative treatment is initiated. This often begins with a course of Physical Therapy or sometimes chiropractic treatments. Some medications may also be trialed during this time to minimize acute discomfort. If conservative treatment fails, it is often suggested to get advanced imaging studies (MRI, CT scan) if not already done to help diagnose the problem. Thereafter, interventional therapy may be offered.

Interventional therapies include diagnostic and therapeutic injections (with and without steroids/cortisone) into the spine or joint. Spinal injections are precise injections done under fluoroscopy (live X-ray) and consist of epidural steroid injections (selective spinal nerve blocks) or medial branch blocks (facet joint injections). This may consist of a single injection, but some are also done as part of a ‘series’ to be determined by your personal outcome and doctor’s preference. The majority of patients find some or total relief with these injections. Those that do not respond to conservative and interventional therapies may be referred to a surgeon for other treatment options.

Already have back surgery? Were you told there was nothing else that could be done? Patients who have failed back surgeries historically were told they had to ‘live’ with it. In more recent years, new therapies are being explored and discovered with ongoing technological advancements. Spinal cord stimulators are devices that can be implanted in the spine and offer relief for a variety of neuropathic pain complaints. Although this treatment may not work for everyone, many patients report 50-70% reduction in overall pain and have been able to lessen or cease use of pain medications.

Whether your pain is acute or chronic, it often interferes with your ability to work. Lower back pain is one of the most common causes for disability and work-related injuries. As physiatrists, we also manage disability with work restrictions, etc, with hopes of returning our patients back to gainful employment.