Treatment options will be offered, with their…
Treatment options will be offered, with their…
Treatments are always applied under the close guidance of a pain specialist, and the extensive benefits of addressing your chronic pain far outweigh any health risks or potential drawbacks.
Remember, you’re not alone.
One in three American households has one or more members with a chronic pain condition which, usually has been present for more than a few years and is described by 40% as painful, acute or intolerable.
–Tell your doctor why you are there. At the beginning of the appointment, clearly describe your pain symptoms and any related symptoms, such as nausea, lack of appetite, and difficulty sleeping. In addition, tell your doctor if the pain interferes with activities—at home and/or work, or regarding leisure activities, and whether the pain has affected your mood.
–Show your doctor where it hurts. Be as specific as you can. Tell your doctor if it hurts in one particular spot or over a region of your body.
–Describe your pain with adjectives. Only you know how your pain feels, but you can better help your doctor understand by using words such as aching, throbbing, shooting, stabbing, gnawing, sharp, tender, burning, exhausting, penetrating, nagging, numb, and unbearable.
–Rate the severity of pain on a scale. Use a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you can imagine. Rate your pain for a period of time before your doctor visit, noting for each timeframe when it’s worst and best. Some people keep a pain diary to help them record how they feel over a period of time.
–Provide information about when and how long your pain continues. Tell your doctor if your pain is continuous, periodic, or occasional. Recall the time of day when your pain is the worst and best, and if it is triggered or helped by particular activities—even simple things, like standing, walking, getting in/out of a car, etc.
–Devise a treatment plan with your doctor. Treatment varies. Your doctor may recommend treatment, like massage or yoga, and can also prescribe medications to help the pain. Every patient has unique needs, so adjusting the plan with your doctor is essential to pain management.
–Speak up. If prescribed medicine isn’t helping, talk with your doctor about different treatment options and adjust your pain management plan accordingly. Your symptoms are real, and you deserve to have your pain relieved.
Lower back pain can also be a sign of a more serious underlying problem, such as arthritis, osteoporosis, or a herniated disc. In addition, obesity, poor posture, smoking, stress, and a poor sleeping position can all contribute to low back pain.2
According to Dr. Perry Fine of the American Pain Foundation, “At some point in life, almost everyone experiences lower back pain—the key is to treat it correctly so that it doesn’t become a recurring problem. It’s important to seek out a healthcare professional who can properly assess your condition and work out a pain management plan. Be sure to ask questions about your symptoms, how to manage your back pain, and activities you can do or shouldn’t do.”
What You Can Do to Manage Lower Back Pain
Rest – but only for a short time: Resting sore muscles can help to ease pain, but remain mobile. Staying in bed more than one or two days can actually make your pain worse and lead to other problems, such as stiff joints and muscle weakness.
Apply ice and heat: Although ice and heat (the use of cold and hot compresses) have never been scientifically proven to quickly resolve lower back injury, compresses may help reduce back pain and inflammation, and allow greater mobility for some individuals. As soon as possible following trauma, patients should apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes. After 2 to 3 days of cold treatment, they should then apply heat (such as a heating lamp or hot pad) for brief periods to relax back muscles and increase blood flow. Warm baths may also help relax muscles. Patients should avoid sleeping on a heating pad, which can cause burns and lead to additional tissue damage..
Exercise: Exercise that strengthens back and abdominal muscles can help with recovery and prevent pain in the future. These core muscles support the spine, and building them up can improve posture, maintain balance, and decrease your chance of injury. Your healthcare provider can provide a list of exercises to fit your needs.
Massage Therapy: Massage therapy is effective in reducing pain, stress, and symptoms associated with chronic lower back pain. Massage therapy can be used as part of a comprehensive, multidisciplinary approach to pain management and may be combined with physical therapy, acupuncture, and medication.
Strategies for a Healthier Back
-Maintain a healthy body weight. Excess weight, particularly in the abdomen, increases stress on lower back muscles. Your doctor can help identify a healthy weight that is right for you.
-If you have been inactive for a long period of time, it’s important to begin a low-impact exercise program to strengthen your back. This may include yoga, fast walking, biking, or swimming.
-Always stretch before exercising or performing any physical activity that may be demanding.
Don’t slouch—it increases pressure on the back.
-Good footwear is important. Wear shoes that are comfortable and low to the ground.
-Do not lift objects that are too heavy for you, like boxes or furniture. If you must lift, bend your knees, don’t twist your body, and keep your head pointed down and in line with your back.
National Institute of Neurological Disorders and Stroke. Low-Back Pain Fact Sheet. June 14, 2010.
Hernandez-Reif M, et al. Low back pain is reduced and range of motion increased after massage therapy. Int J Neurosci. 2001;106(3-4):131-45.
The right to have your report of pain taken seriously and to be treated with dignity and respect by doctors, nurses, pharmacists and other healthcare professionals.
The right to have your pain thoroughly assessed and promptly treated.
The right to be informed by your doctor about what may be causing your pain, possible treatments, and the benefits, risks and costs of each.
The right to participate actively in decisions about how to manage your pain.
The right to have your pain reassessed regularly and your treatment adjusted if your pain has not been eased.
The right to be referred to a pain specialist if your pain persists.
The right to get clear and prompt answers to your questions, take time to make decisions, and refuse a particular type of treatment if you choose.
Pain management is the systematic study of clinical and basic science, and its application for the reduction of pain and suffering. This newly emerging discipline emphasizes an interdisciplinary approach to treatment, blending tools, techniques and principles taken from a variety of the healing arts to create a holistic paradigm for the reduction of pain and suffering.
Also known as warning pain, acute pain is the discomfort or signal that alerts you something is wrong in your body. Pain results from any condition that stimulates the body’s sensors, such as infections, injuries, hemorrhages, tumors, and metabolic and endocrine problems. Acute pain usually abates as the underlying problem is treated. Early acute pain management may hasten the recovery of the causative problem and reduce the length of treatment, therefore reducing healthcare costs.
Chronic pain is a pain state which is persistent and in which the underlying cause of the pain cannot be removed or otherwise treated. Chronic pain may be associated with a long-term incurable or intractable medical condition or disease.
Addiction is a primary, chronic, neurobiological disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical dependence is a state of adaptation that is manifested by a drug-class–-specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood levels of the drug, and/or administration of an antagonist.
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.
Pain can result from a variety of sources, including the cancer itself (tumor growth, spinal cord compression), medical tests, and treatments such as chemotherapy, radiation, and surgery. 2 Uncontrolled pain may interfere with cancer treatment, weaken the body, and impair the healing process. It can also prevent people from engaging in everyday activities that make life fulfilling. 3
According to Kim Thiboldeaux, President and CEO of the Cancer Support Community, managing pain can and should be an important part of overall cancer care.
Since pain affects each person differently, it’s important to work closely with your healthcare professional to develop an appropriate, individualized treatment plan. Here are a few tips to help you on the road to achieving proper pain management:
Become an ‘Expert’ – Learn as much as you can about pain management – including the range of treatment options and complementary techniques available – so that you can have a productive discussion with your healthcare professional.
Communicate Effectively about Your Pain – Maintaining an open and honest dialogue with your healthcare professional is critical to managing pain. That’s because you are the only one who knows what your pain feels like. Each medical appointment is an opportunity to improve the care you receive, so prepare in advance. For instance, keep a journal (or diary) to track your pain experiences and bring it to the appointment. Sharing information such as the severity, location, frequency, and duration of pain can help your healthcare professional develop an individualized treatment plan.
Monitor Your Progress – Once a treatment plan has been established, be sure to regularly assess how you are feeling and follow up with your healthcare professional if you believe adjustments need to be made. People with chronic pain may need to try several different types and combinations of treatments to find the best approach. If your pain is still not controlled, ask your healthcare professional to refer you to a pain specialist. You should never accept pain as a normal part of having cancer.
It is useful to distinguish between two basic types of pain, acute and chronic, and they differ greatly.
Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, for example, after trauma or surgery, and may be accompanied by anxiety or emotional distress. The cause of acute pain can usually be diagnosed and treated, and the pain is self-limiting, that is, it is confined to a given period of time and severity. In some rare instances, it can become chronic.
Chronic pain is widely believed to represent disease itself. It can be made much worse by environmental and psychological factors. Chronic pain persists over a longer period of time than acute pain and is resistant to most medical treatments. It can—and often does—cause severe problems for patients.
We take for granted that we will feel good most of the time. When pain strikes, we feel bad. Pain interrupts our work, our recreation, and our relationships with our families. Comfort, that is, not being in pain, is one of your goals if you are sick and should be one of the goals of treatment for the doctor who is treating you for any illness, but especially for an illness associated with chronic pain.
Once the cause of your pain is found and proper treatment is started, the pain may serve the useful function of keeping you at rest so that the injury or illness can heal. But if the pain comes from an illness that is incurable and will never heal, the pain loses its usefulness and becomes harmful. This type of pain keeps you from normal activity, and inactivity decreases your strength.
* Why pain can become worse: There is a “wind-up phenomenon” that causes untreated pain to get worse. Nerve fibers transmitting the painful impulses to the brain become “trained” to deliver pain signals better. Just like muscles get better at sports with training, the nerves become more effective at sending pain signals to the brain. The intensity of the signals increases over and above what is needed to get your attention. To make matters even worse, the brain becomes more sensitive to the pain. So your pain feels much worse even though your injury or illness is not getting any worse. At this point, pain may be termed chronic pain. And it is no longer helpful as a signal of illness.
* The goal in treating pain: When you consult a doctor, your goal is to be cured. That means that you want the cause of your pain to be found and cured so that you can resume normal life without needing medication or further visits to doctors.
* Treating lifelong pain: Unfortunately, many illnesses do not have known cures. The treatment of illnesses such as diabetes and high blood pressure is often lifelong. In these chronic illnesses, as in the treatment of chronic pain, your goal is to live as normally as possible. Sometimes medication is needed for the rest of your life in order to achieve that goal.
* A sensible view of addiction: In this respect, chronic pain is no different from diabetes or high blood pressure. If you need to be on pain medicine for the rest of your life, you should not be said to be “addicted” to pain medicine any more than a person with diabetes who needs to be on insulin for the rest of his or her life should be said to be “addicted” to insulin.
* Use of pain medications: Some doctors are reluctant to use powerful pain medications known as opioids (also known as narcotics) to treat pain even when non-opioid medications have not worked. If our doctor is reluctant to prescribe opioids in this situation, and you have chronic pain, you will get a referral to a pain specialist.
Treatment of fibromyalgia requires an accurate diagnosis because the disorder can be mistaken for one of several other medical conditions. Diagnosis by a rheumatologic or a physician knowledgeable about this condition is essential.
The most common symptom is diffuse pain with achiness, stiffness, and extreme tenderness in muscles and points where ligaments attach muscles to bones. Although pain may occur widely in many areas of the body, specific sites of tenderness referred to as “tender points” typically occur. These “tender points” can occur around the neck, shoulders, upper back, lower back, hip and knee areas. Another common symptom is fatigue, characterized by a lack of endurance or an overall lack of energy. Other symptoms related to fibromyalgia may include sleep disturbance, coldness in hands or feet along with discoloration of skin (bluish or reddish) associated with poor blood circulation (Raynaud’s phenomenon), migraine and tension headaches, abdominal bloating with alternating diarrhea and constipation (irritable bowel syndrome), muscle tremors, and blurred vision. Emotional stress, anxiety, fatigue, and cold or humid weather may aggravate symptoms.
What causes Fibromyalgia?
The cause of fibromyalgia is currently unknown. The onset of fibromyalgia may follow a minor illness like the flu, a trauma incident like an automobile accident or fall, or emotional stress. It is possible that susceptibility to fibromyalgia results from micro-trauma related to physical deconditioning, poor posture, and muscle overuse. There is some evidence that it may be associated with abnormal biochemistry — most notably the neurotransmitters serotonin and substance P — that leads to increased sensitivity to pain.
How common is Fibromyalgia?
The exact prevalence of fibromyalgia is unknown. It is estimated, however, that as many as six million Americans have been diagnosed with the condition. Fibromyalgia is six to eight times more common in women than men. Fibromyalgia usually affects people between ages 20 and 50, although some children have been diagnosed with the disorder.
Can Fibromyalgia be cured?
Although there is currently no cure for fibromyalgia, symptoms can be substantially controlled by comprehensive treatment that includes education, medication, physical conditioning to improve aerobic capacity and flexibility, and psychological intervention aimed at stress management.
How is Fibromyalgia treated?
The symptoms of fibromyalgia are best treated by a combination of the following:
* reassurance and education about the condition
* moderate aerobic and stretching exercises to improve cardiovascular fitness and flexibility
* pacing of physical activities
* diet modification — especially avoidance of alcohol, caffeine, and nicotine
* medication — low doses of antidepressant medications that increase serotonin can lead to reduced pain and depression along with improved sleep
* stress management
* support by significant others
Three key ingredients of treatment are a comprehensive approach to wellness, collaboration among a team of health care specialists who are knowledgeable about fibromyalgia and the individual patient and significant others, and the patient’s taking an active part in the control of symptoms.
One or more of the following symptoms may be associated with chronic pain:
* Persistent or recurring pain
* Burning, tingling, shocking, or shooting pain
* Limited mobility
* When thinking about chronic pain, it helps to understand how pain works. Pain occurs when special nerve endings, called pain receptors, are irritated because of illness or injury (for example, when they are exposed to too much heat, cold, trauma, or pressure). The nerves around the injured area send electrical impulses through the spinal cord. The impulses travel to receptors in the brain, and your brain interprets this as pain.
Two Types of Pain
There are two types of pain, both of which can be chronic: nociceptive and neuropathic. Nociceptive pain is the body’s normal pain response. It is the type of pain that occurs when you burn your hand, twist your ankle, or stub your toe. Nociceptive pain can be temporary, but it can be chronic as well, such as when the pain is caused by cancer or arthritis. Nociceptive pain usually responds well to pain medications or other drug therapies.
Neuropathic pain is caused by a malfunctioning nervous system. This pain is not part of the body’s normal pain response, although it may be triggered by an injury, illness, or trauma (for example, surgery). Neuropathic pain is often a chronic condition and generally does not respond as well to drug therapies as noci
o Pains from your skin and muscles are easily localized by the brain because these pains are common. You have experienced general somatic pain since childhood when you have fallen or been hit by a person or an object. Normally, somatic pain gets better in a few days.
o Some people develop pain that never goes away. Fibromyalgia and chronic back pain are in this category.
o General somatic pain is often treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Naprosyn) or with acetaminophen (Tylenol). Sometimes, opioids, such as morphine, may be needed.
Visceral pain (pain from the internal organs)
o Pain in your internal organs is more difficult for you to pinpoint because your brain doesn’t get much experience feeling pain from internal organs. The connections from pain sensors in your internal organs to your brain are less sophisticated than the nerve connections from your outer body.
o You have experienced some visceral pains. Pain from acid indigestion or constipation is easy to recognize. These pains are easily treated and get better quickly either on their own or with treatment using nonprescription medicines.
o But the pain from chronic pancreatitis (an inflammation of the pancreas) or chronic active hepatitis (an inflammation of the liver) can last a long time and be difficult to treat.
o Visceral pain from gallstones or appendicitis, for example, can be treated with surgery. Other visceral pains can be treated with various non-opioid pain medications. Sometimes opioids may be needed.
o Pain in the bones from a bruise or a fracture is temporary. Pain from bone cancer, osteoporosis (softening of the bones that often appears in older people), osteomyelitis (an infection in a bone), or arthritis (inflammation of the joints) can last a long time.
o Bone pain is gnawing and throbbing. If you suffer from this, you may need long-term pain treatment. Bone pain may be treated with hormonal therapy or with bisphosphonates, such as alendronate (Fosamax), which strengthen the bones. Often, the NSAIDs (such as ibuprofen) are used. Sometimes opioids are needed.
Muscle spasm (muscle cramps)
o Muscle spasm, like a charley horse, can cause severe pain especially in the back. Pain medication alone may not be able to cure the pain. Muscle relaxants such as cyclobenzaprine (Flexeril) or baclofen (Lioresal) may be needed to relax the muscles.
* Peripheral neuropathy (pain arising in the nerves leading from the head, face, trunk, or extremities to the spinal cord)
o In a sense, all pain comes from nerves because nerves transmit painful impulses to the brain. But some painful impulses do not arise from the nerve endings that normally sense injury or illness. Some painful impulses come from irritation to the nerve along its length instead of at the nerve ending.
o Sciatica, for example, is caused by pinching of the sciatic nerve, which goes from the leg to the spine. The pinching often takes place near the lower part of the spine, but the brain “thinks” the pain came from the nerve endings in the leg because the sciatic nerve usually transmits feelings from the leg.
o Other examples of illnesses that cause peripheral neuropathy or “nerve pain” are ruptured discs in the spine, which pinch nerves, cancers that grow into nerves and cause irritation, or infections, such as shingles, which can cause irritation to nerves.
o Common diseases that often cause peripheral neuropathy are diabetes and AIDS.
o Nerve pain can feel like a painful “pins and needles” sensation. This kind of nerve pain can be treated with tricyclic antidepressants. Other, more severe nerve pain can be described as a sharp, stabbing, electric feeling. Anticonvulsants (medicines that treat seizures) are used for this kind of nerve pain.
o Some nerve pain is due to loss of a limb. The arm or leg that has been lost feels like it’s still present, and hurts severely. This kind of nerve pain, called deafferentation, or “phantom limb pain,” can be treated with clonidine (Catapres) (a blood pressure medicine that also relieves nerve pain).
o Herpes zoster (shingles) causes an infection of the nerve endings and of the skin near the nerve endings. Local application of capsaicin (Zostrix), an over-the-counter pain medication in the form of an ointment, is sometimes helpful for this. In addition, opioids may be needed.
o Poor circulation is often a cause of chronic pain. Poor circulation is usually caused by tobacco use, diabetes, or various autoimmune diseases (diseases where the body makes antibodies that fight against itself) such as lupus or rheumatoid arthritis.
o Partial blockage of arteries by fatty deposits called plaques is also a common cause of poor circulation. The reason for the pain of poor circulation is that the part of the body that does not get good blood circulation becomes short of oxygen and nourishment. The lack of oxygen and nutrition causes damage to that part of the body, and the damage causes pain.
o Pain from poor circulation may be treated by surgery to bypass the clogged arteries with artificial arteries in order to improve the blood circulation. Sometimes this is not possible, and blood thinners or opioids may be needed to control the pain.
o Another common cause of poor circulation is reflex sympathetic dystrophy (RSD). This is a problem of both circulation and nerve transmission because painful nerve transmissions cause the blood vessels to get narrower. The narrowing prevents enough oxygen and nourishment from getting to the part of the body that is affected. RSD can sometimes be treated with a surgical sympathectomy, an operation to stop the nerve impulses from causing a narrowing of the blood vessels. Often, non-opioid medication, either with or without surgery, is needed. Sometimes opioids are needed.
o Headaches can be caused by many illnesses. There are several types of headaches, including migraine, tension, and cluster headaches. Headaches can also result from sinusitis, trigeminal neuralgia, giant cell arteritis, or brain tumors. The treatment of the various kinds of headaches varies depending on the kind of headache and the severity of the pain. Often, non-opioid medicines are used. But, in some cases, opioid therapy is needed.
o Migraines are often on one side of the head. They can be associated with nausea and vomiting, photophobia (light hurting the eyes), phonophobia (sound hurting the ears), and scintillating scotomata (parallel lines that vibrate at the edges of objects, especially at the borders between light and dark places). Sometimes these auras appear before the headache starts and alert you that a migraine is coming. Migraine pain can vary in intensity from mild to severe. There are many specific medications for migraine. Sumatriptan (Imitrex) is particularly useful for some, but not all, migraine sufferers.
o Cluster headaches come in groups, sometimes several times a day, lasting for days to weeks. Many cluster headaches are severely painful. Oxygen therapy may be helpful for some cluster headaches.
o Sinusitis can cause facial pain and is frequently worse in the morning. Sinus pain may respond to antibiotic treatment along with decongestants. Sometimes sinus surgery is needed.
o Trigeminal neuralgia is actually a peripheral neuropathy (nerve pain) that is severe. It occurs on one side of the head and face and has a “trigger point,” usually on the side of the face, which causes intense pain if it is touched. Anticonvulsants (antiseizure medicine) are often helpful for this type of pain.
You know it at once. It may be the fiery sensation of a burn moments after your finger touches the stove. Or it’s a dull ache above your brow after a day of stress and tension. Or you may recognize it as a sharp pierce in your back after you lift something heavy.
It is pain. In its most benign form, it warns us that something isn’t quite right, that we should take treatment or see a doctor. At its worst, however, pain robs us of our productivity, our well-being, and, for many of us suffering from extended illness, our very lives. Pain is a complex perception that differs enormously among individual patients, even those who appear to have identical injuries or illnesses.
What is Chronic Pain?
Chronic Pain is a constant pain that can last from a few months to many years. This relentless problem causes severe pain, sleep deprivation and even depression if it persists for a long period of time. Pain can be caused by injuries, types of diseases or weak bones and muscles. For instance, a common central nervous system disorder that causes great pain through the body is Fibromyalgia. Anyone can have chronic pain, but it is most common in middle-aged to older adults.
Chronic pain has several different meanings. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is “pain that extends beyond the expected period of healing.”
Generally, treatments try either to stop the transmission of pain from the site of injury or to affect the brain directly.
The effects of pain treatments are different for different people. Also, the tolerance of pain varies greatly from one person to another.
For this reason, one solution will not be right for everyone with the same injury. For example, some people are quite happy with an over-the-counter treatment for an ankle sprain, while others will need a more powerful prescription pain reliever. The right pain treatment depends on the person experiencing the pain, not on the condition that is causing the pain.
The goal of pain management is to improve function, enabling individuals to work, attend school, or participate in other day-to-day activities. Patients and their physicians have a number of options for the treatment of pain; some are more effective than others.
Chronic Pain Program
Living with chronic pain is very difficult, and people who suffer from chronic pain know how it can disrupt and damage their lives. It can make it difficult to enjoy even the simplest daily activities.
Our Chronic Pain Program is led by physicians who specialize in treating patients who are compromised by pain and who have been unable to manage this pain without the help of other available treatments.
Treatment is determined on an individualized basis, as no two patients present with identical pain issues. An effective evaluation of an individual with chronic pain and coexisting disorders, including problems with capsules, requires a multidisciplinary team approach. Using a multidisciplinary team is crucial in treating the problems patients and their families’ face who have been severely impacted by chronic pain and other psychological and medical disorders. At times substance dependence or addiction can be caused by the misuse of chronic pain opiate treatments.
Our chronic pain doctors understand that the best treatment for you requires them to utilize appropriate treatments as indicated by your history and present symptoms. Our doctors also believe it is imperative to work together with you to create the most successful individualized treatment plan so that when you leave you have the best chances of recovery.
Pain Management Program Goals:
* Obtain a thorough evaluation to define the physical components of pain
* Increase control of pain and decrease disability associated with pain
* Teach alternative ways to improve daily functioning
* Address psychological issues related to chronic pain, such as anxiety, depression and sleep problems
* Evaluate for substance dependence, chemical dependency or substance abuse
When looking for a treatment center to help you with your chronic pain, it is important to find a setting that is appropriately licensed to provide comprehensive, state-of-the-art treatment with clinicians specifically trained and experienced in treating chronic pain.
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