Frequently Asked Questions About Pain, Treatment & Therapy

In pain and can’t work? Whether this is a new or chronic problem, work-related or not, Physiatrists are trained to manage issues that may interfere with one’s ability to work.

Low back pain is the leading cause for disability world wide and account for at least one third of work related injuries. This lost work causes financial burden to both the individual and also the employer.

For work-related conditions, we manage work restrictions to try to keep our patients in the work force without inducing further harm. We strive to return to patients to work as safely and quickly as possible.

For more chronic conditions, applying for disability benefits can be very overwhelming. Your doctor can help you determine whether short-term, long-term, or social security disability is appropriate. We assist also by providing medical records and completing necessary paperwork (including FMLA and Social Security Disability evaluations).

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.

Neuropathic pain comes in many forms and typically results from damaged nerve tissue or compressed nerves.

Nerve roots compressed from the spine usually cause cervical or lumbar radiculopathy (sciatica), as well as pain after back surgery (failed back syndrome). Other causes of nerve pain (usually from peripheral nerves) include nerve entrapment (i.e. Carpal tunnel syndrome), peripheral neuropathy (most likely from diabetes), phantom limb pain, or complex regional pain syndrome (CRPS), previously called RSD (reflex sympathetic dystrophy).

Neuropathic pain is typically described as:

• Severe, sharp, electric shock-like, shooting, lightning-like, lancinating
• Deep, burning or cold
• Persistent numbness, tingling, or weakness
• Radiating to the arms, hands, legs or feet

Diagnosing and treating nerve pain can be very difficult. Often electromyography and nerve conduction studies (EMG/NCV) are used to detect nerve damage and differentiate between nerve degeneration (neuropathy) and nerve root compression (radiculopathy).

There is no known cure or proven treatment for neuropathic pain. Treatment is instead focused on alleviating the pain caused by a painful nerve.

In cases of nerve entrapment, often times surgery is offered and may resolve all or most of the nerve pain symptoms. Treatment of nerve pain related to spine problems often requires a comprehensive treatment approach. Therapies often involve a combination of medications, nerve blocks, physical/occupational therapy, electrical stimulation (i.e. TENS units or implantable nerve stimulators) as well as psychological therapy.

Musculoskeletal pain affects not only bones and muscles, but also ligaments, tendons and nerves.

This pain can be caused by an acute injury, such as falls, fractures, sprains, dislocations, car accidents, and direct muscle trauma. It can also be a chronic condition, most commonly affecting the lower back. Joint pains from arthritis are also a common musculoskeletal complaint causing chronic pain.

Diagnosing musculoskeletal pain will depend on the cause, body part affected, and whether it is an acute or chronic condition. After taking a full medical history and physical exam, other diagnostic tests may be needed. These tests may include: blood tests, X-rays, CT scan or MRI.

Once the problem is diagnosed, appropriate treatment will be prescribed. In more acute conditions, your doctor may suggest starting with conservative treatment such as RICE (rest, ice, compression and elevation). Thereafter Physical/Occupational Therapy may be prescribed. Certain conditions may also benefit from temporary splinting of an affected joint to allow healing. Anti-inflammatory medications (i.e. Ibuprofen and naproxen) are also commonly prescribed for acute injuries to help both pain and swelling. These medications are also used for some chronic conditions such as osteoarthritis. Other treatment options for musculoskeletal pain may also include massage, chiropractic, acupuncture, or injections.

Reference: Cleveland Clinic. Musculoskeletal Pain. Accessed 10/30/2015.