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    Treating Chronic Pain

    Brittney Fulcher, NP NP from the Deaconess Comprehensive Pain Center​​ 09/14/2020

    It is estimated that 50 million adults suffer from chronic pain in the United States. This pain can be mild or severe, episodic or continuous, merely inconvenient or totally incapacitating. Chronic pain is pain that persists for longer than 3-6 months.

    At the Deaconess Comprehensive Pain Center, we serve patients with chronic pain caused by a variety of medical issues including, but not limited to:

    • Cancer-related pain
    • Peripheral neuropathy
    • Complex region pain syndrome
    • Headaches
    • Spinal spasticity
    • Post-herpetic neuralgia
    • Sport injuries
    • Chronic low back and neck pain
    • Joint pain
    • Pelvic Pain
    • Pancreatitis
    • Trigeminal neuralgia

    Back Pain

    Back pain is one of the most common conditions we treat. It has been said that 90% of Americans will experience back pain at some point in their lives.

    Causes of back pain are varied and can include:
    • Mild to significant muscle strain
    • Degenerative disc disease as a result of aging
    • Injury/trauma
    • Post-surgical pain from previous back surgery
    • Cancer spreading to bone
    • Poor posture, which can lead to weakened muscles in the core
    • Other disease processes, such as scoliosis or osteoporosis
    We utilize a variety of treatment modalities in the care plan for back pain. This might include:
    • Oral medications – for pain control, inflammation, muscle spasm, nerve irritation
    • Topical ointments/creams
    • Interventional procedures such as low back injections/epidurals
    • Physical therapy
    Other options for back pain involve more specialized procedures such as:
    • Spinal cord stimulation – this is a small device (about the size of a pacemaker), surgically placed under the skin, that delivers mild electrical pulses to the nerve fibers of the spinal cord to mask or interfere with the transmission of pain signals before reaching the brain. The amount of pain relief varies from patient to patient so trial stimulation is performed before the device is permanently implanted. A spinal cord stimulator can help patients suffering from chronic pain caused by complex regional pain syndrome, failed back surgery syndrome, arachnoiditis or phantom limb syndrome.
    • MILD procedure – Minimally Invasive Lumbar Decompression (MILD) is for people suffering from pain related to spinal stenosis (a narrowing of spaces within the spine which can put pressure on or reduce space for the nerves within the spinal canal)
    • Kyphoplasty – a minor surgical procedure used to stabilize a spinal compression fracture

    Traumatic/Sports Injuries

    These injuries, both new and old, are commonly seen in our clinics. We offer a combination of services to help address and control the underlying cause of this type of pain. Your provider will work with you to determine which of the following treatment options would be most helpful. Those options may include:
    • Physical and/or occupational therapy
    • Joint injections – performed often in the shoulder, knee, elbow or hip
    • Anti-inflammatory medication (this can be oral or topical)
    • Trigger point injections – used to treat painful areas of muscle

    Headaches

    Headaches can have a variety of causes, and therefore, a variety of treatments. Depending on the cause, the following treatment can be provided:
    • Cervical facet/medial nerve block – an injection used to determine if a particular joint in the neck is the specific pain source
    • Occipital nerve block – an injection into the occipital region which is located at the back of the head, above the neck.
    • Botox injections – often used in the treatment of migraine headaches
    • Blood patch – procedure used to relieve pain associated with a spinal headache
    • Oral medications and physical therapy may also be helpful

    Shingles Related Pain

    Shingles is caused by a reactivation of a previous infection of the chicken pox virus. Anyone who has had chicken pox may develop shingles. The presentation of shingles involves a painful rash that often looks like a cluster of blisters that will appear on only one side of the body. Most often the pain will dissipate once the rash has resolved. For some patients, pain will persist after the rash is gone. This is called post-herpetic neuralgia. Usually, when a patient develops shingles they will be treated by their primary care provider. When dealing with post-herpetic neuralgia, a referral to the DCPC for more in-depth treatment would be indicated.
    Examples of the type of treatment that could be recommended:
    • Anesthetic patches or creams that would be applied to the site of pain
    • Oral medication such as nerve stabilizers to treat the sensation of burning, itching, skin sensitivity, tingling, etc.
    • Intercostal nerve block – injection of medication into the intercostal nerve (nerve located under each rib). Used to treat shingles pain involving the chest wall, breast, upper back.
    • Facial nerve block – used to treat shingles pain involving the nerves in the face

    Complex Regional Pain Syndrome (CRPS)

    CRPS is a chronic pain condition that usually affects one limb (arm, leg, hand or foot) after an injury/trauma or surgery. The pain is out of proportion to what would be expected of the initial injury.
    This is an uncommon condition and the cause is not well understood. It is thought to be caused by an injury to the nerves in the peripheral and central nervous systems. Symptoms can include swelling, changes in skin color and temperature, changes in hair and nail growth, decreased range of motion of the body part, weakness, muscle loss, continuous burning or throbbing pain and changes in skin texture.
    Treatment options can include:
    • Oral medications such as antidepressants, nerve stabilizers and/or pain relievers
    • Topical medications that are applied to the skin
    • Sympathetic nerve block – injection of numbing medication used to block pain fibers in the affected nerves
    • Spinal cord stimulation
    • Physical therapy/occupational therapy

    Cancer Related Pain

    Cancer related pain can be treated with an intrathecal pain pump. This is a small implantable medical device that delivers pain medication directly to the spinal cord. This helps prevent the nerves from sending pain signals to the brain. Often, this is used when other types of treatment have not worked to ease the pain.
     
    This is a brief summary of some of the most common conditions that we see in clinic. We offer care for numerous medical conditions with other, more specific, treatment options. If you or someone you know suffers from chronic pain, request a referral from your primary care provider to see one of our highly trained providers.

    Contact us at 812-450-7246 to schedule an appointment. Or you can visit us at https://www.deaconess.com/Services/Pain-Management for even more information.

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