Wednesday, 15 November 2017 08:05

A Relaxation Technique: Guided Imagery

Relaxation has many health benefits including: lowering blood pressure, reducing active stress hormones, reducing muscle tension and chronic pain and improving concentration and mood. We understand it can be difficult to find the time to use relaxation so here is a quick relaxation technique that can be used anywhere. 

Guided imagery is a relaxation technique where you use your imagination to picture a time, place or person that makes you feel relaxed. Guided imagery requires you to use all of the senses to relaxation. For example, you could imagine you hear the sounds of birds chirping, a breeze on your skin, the reflection of the sky in the water, the smell the fresh cut grass or the taste of your favorite beverage. This type of relaxation technique can take as little or as much time as you need.

First, find a quiet place and get into a comfortable position. Next choose your setting and then imagine yourself there; use all of your senses. Remember to include as many details as possible. Take a deep breath and let the scene play out.

It is important to remember that there isn’t a right or wrong way to relax; you need to do what works best for you. Relaxation is a skill, and it is important to practice the skill to get better.

 

Sources: 

http://www.webmd.com/balance/stress-management/stress-management-doing-guided-imagery-to-relax

Wednesday, 15 November 2017 07:45

Chronic Pain and Sleep

Chronic Pain and SleepThere are important healthy habits you can try to help reduce pain. One of the most important is trying to get a good night’s sleep. A good, restorative sleep, generally between six to nine hours, can help your body and muscles recover, helping to reduce back pain or general aches and pains. This will allow you to wake feeling refreshed.

Back pain can make it harder to sleep, reducing your body’s ability to recover, thus leading to more back pain. Talk to your doctor to learn helpful ways to sleep comfortably with back pain. There are a variety of pillows you can try, meditation or light stretching before bed, or even starting a bedtime routine to help your body wind down.

Also consider the importance of getting the right amount of sleep for your body. Too much sleep, as discussed in this recent article, can also cause you to wake feeling groggy and tired. Test out a few different sleep times (seven, eight, or nine hours) and see which works best for your schedule.

Thursday, 02 November 2017 13:13

The Advantages of an Interdisciplinary Approach

Pain is an incredibly complex condition, affecting people in a multitude of ways. It can change the way both your brain and your body function, in addition to impacting emotions, relationships and even work. So, it follows that an effective treatment plan must take into account all of these aspects of pain. Incorporating physical therapy, behavioral health and more into a treatment plan, like those offered at Advanced Pain Management (APM), can be an effective way to reduce pain – and its impact on your life.

A Multimodal Methodology

According to a Baylor University Medical Center study, “Although chronic pain initially begins as a biological event – in which electrical and chemical processes occur within the body as a response to noxious stimuli – psychological, social and cultural factors enter into the process.”[1] It’s these types of factors that complicate pain, making it more difficult to treat effectively with a singular approach.

Therefore, as a consequence of these varied factors, which arise from and feed into the experience of pain, “an interdisciplinary approach that incorporates the knowledge and skills of a number of healthcare providers is essential for successful treatment and patient management,” notes the American Pain Society.[2] In other words, different aspects of pain are best treated by different specialists, each of whom is specifically trained to address the issue.

Coordinating Treatment

This interdisciplinary team might differ from patient to patient, depending on their pain type and specific needs. Usually, though, a coordinated approach incorporating a physical therapist and behavioral health provider will be adopted. At APM, providers will co-manage patients with PT and psychologists, in addition to chiropractors, occupational therapists and more, as required by each patient’s condition.

This active collaboration between specialists must take place concurrently, not sequentially. This means that instead of going to specialist, exhausting your treatment options, then moving on to a different specialist – whether that’s a physical therapist, behavioral health provider or chiropractor – all of these providers should engaged at once, actively providing their expertise with the shared goal of reducing your pain and improving your functional ability.

In addition, states the American Pain Society, the patients themselves should be a vital part of the team and “participate as much as possible and give input into the treatment plan and outcome goals.” At each step of the process, and with each individual specialist, the patient’s input on goals and treatment approaches is vital. Put differently, if the plan is something you find doable, with goals tailored to your lifestyle, chances are you’ll have an easier time completing each aspect of your treatment plan – which means better results.

Effectiveness of Interdisciplinary Care

This interdisciplinary approach to pain management can have a multitude of benefits for your care. According the CDC’s recent report on opioids and chronic pain, “Multimodal and multidisciplinary therapies can help reduce pain and improve function more effectively than single modalities.”[3] Other studies show that individuals receiving multidisciplinary treatment for pain may see a lasting reduction in pain intensity, as well as an improvement in psychological well-being, quality of sleep and overall physical functioning.[4] 

Such benefits are leading various agencies, including the Centers for Disease Control and Prevention[3]  and the Agency Medical Director’s Group of Washington,[5] to recommend the use of multimodal therapies in the treatment of chronic pain. Heeding these recommendations – especially with the help of the experienced clinicians at Advanced Pain Management – may help you meet, or even exceed, your treatment goals.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

[1] Oslund, Sarah, Richard C. Robinson, Timothy C. Clark., John P. Garofalo, Pamela Behnk, Becky Walker, Katherine E. Wlaker, Robert J. Gatchel, Micah Mahaney, and Carl E. Noe. "Long-term Effectiveness of a Comprehensive Pain Management Program: Strengthening the Case for Interdisciplinary Care." Proceedings (Baylor University Medical Center) 22, no. 3 (July 2009): 211-14.

[2] Turk, Dennis C., Steven P. Stanos, Tonya M. Palermo, Judith A. Paice, Robert N. Jamison, Debra B. Gordon, Penney Cowan, Edward C. Covington, Michael E. Clark. “Interdisciplinary Pain Management.” American Pain Society. Accessed March 22, 2016. http://americanpainsociety.org/uploads/about/position-statements/interdisciplinary-white-paper.pdf

[3] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

[4] Becker, Niels, Per Sjøgren, Per Bech, Alf Kornelius Olsen, and Jørgen Eriksen. "Treatment Outcome of Chronic Non-malignant Pain Patients Managed in a Danish Multidisciplinary Pain Centre Compared to General Practice: A Randomised Controlled Trial." Pain 84, no. 2 (February 2000): 203-11.

[5]"Interagency Guideline on Prescribing Opioids for Pain." Agency Medical Directors' Group. June 2015. Accessed March 22, 2016. http://www.agencymeddirectors.wa.gov/Files/2015AMDGOpioidGuideline.pdf.

Thursday, 02 November 2017 13:12

The Benefits of Radiofrequency Neuroablation

Nerves play an important part when it comes to pain. They’re responsible for transmitting pain signals from the painful areas of your body to the central nervous system (i.e. the spinal cord and brain). It makes sense, then, that nerves can also play an important part when it comes to treating that pain. That’s where radiofrequency neuroablation comes in.

Background and Uses

Radiofrequency ablation (RFA) – also called radiofrequency rhizotomy and radiofrequency neurotomy – was first used to treat back pain in 1975 by CN Shealy.[1]  In a paper regarding the topic the following year, Shealy concluded that in properly selected patients, 82% experienced partial to total pain relief with no neurologic complications.[2]

 RFA is used to treat pain stemming from the facet joints, both in the spine (lumbar and thoracic) and neck (cervical). Facet joints are where each vertebra connects with the vertebrae above and below it. These joints both stabilize the spine and limit excessive motion.[3]Normal wear and tear, injury and disc degeneration can all cause issues with the joints, resulting in back or neck pain. In a systematic review in the journal Pain Research and Management, five out of six studies found that in cases of chronic back pain resulting from such facet issues, performing RFA resulted in statistically significant reductions in pain.[1]

The procedure is ideal for pain that hasn’t responded to conservative therapies, such as physical therapy or medication. Before the procedure, physicians will typically perform a diagnostic nerve block to ensure that the patient is a good candidate for the procedure.

How it Works

During an RFA procedure, heat from an electrode is used to cauterize one or more nerves, thus disrupting pain signals to the brain.

To begin, after the patient has received medicine to help them relax and the area around the injection site has been numbed, the physician inserts a small tube called a cannula into the spinal area and guides it to the right nerve with the help of an X-ray device. An electrode is inserted through the cannula and its position is tested with a small jolt before the nerve is heated.[3]

To heat the nerve, a high frequency electrical current is administered, which causes molecule movement and produces thermal energy.[1] This, in turn, creases a small lesion within the nerve, disrupting its ability to transmit pain signals. The doctor may treat several nerves, if necessary.

Following the Treatment

After an RFA procedure, pain relief may not be immediate. The injection site will be sore and back or neck pain may still persist, but, if the correct nerves were treated, the pain will gradually decrease over several weeks.

Partial or total pain relief from radiofrequency can last for several months. Nerves do grow back, however, so the procedure may need to be repeated. But, unlike invasive surgeries or long-term medication usage, there are few serious side effects to the procedure, allowing you to get back to a better quality of life.

More Information

To learn more about radiofrequency neuroablation, or to schedule an appointment with a pain specialist to discuss treatment options, click here.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

[1] Leggett, Laura E., Lesley Jj Soril, Diane L. Lorenzetti, Tom Noseworthy, Rodney Steadman, Simrandeep Tiwana, and Fiona Clement. "Radiofrequency Ablation for Chronic Low Back Pain: A Systematic Review of Randomized Controlled Trials." Pain Research and Management 19, no. 5 (September/October 2014): 146-E153.

[2] Shealy, C. Norman. "Facet Denervation in the Management of Back and Sciatic Pain." Clinical Orthopaedics and Related Research, no. 115 (March/April 1976): 157-64.

[3] “ViewMedica Patient Engagement Videos.” Swarm Interactive 2016. Accessed May 5, 2016. http://www.viewmedica.com/.

Relaxation. It’s a simple concept, but something that can be incredibly difficult to achieve – especially for those with chronic pain. But being able to take your mind off your pain, if even just for a few minutes, can significantly improve your pain levels and benefit your physical and mental health.

How Relaxation Helps

Relaxation techniques can be different for everyone – from meditating or doing breathing exercises to crafting or gardening. But the results are the same: Relaxation aids in the reduction of stress, which can benefit your whole body. Stress causes muscle tension throughout your body, which in turn can cause your pain to worsen. Relaxation exercises help you ease that built-up tension in your body, reducing pain. The stress relief that relaxation brings can also improve sleep patterns, one of the main problems that people with chronic pain experience.

On top of that, certain relaxation activities like meditation can actually help release endorphins, your body’s natural “feel-good” chemicals. Endorphins lead to a natural boost in your mood and can help you relax even further.

Even for those utilizing medication for their pain, relaxation is beneficial. In fact, medications work best when they are used in conjunction with stress-relieving activities, along with exercise and lifestyle modifications.

Choose Your Activity

The activity itself can be a variety of things, but what really matters is that it absorbs your attention, taking your thoughts off your pain levels and refocusing them on something you enjoy doing. According to an article published on CNN.com, our bodies are only able to process a certain amount of information at a time. Therefore if you’re doing something that truly engrosses you, you won’t have enough attention left over to constantly monitor your pain levels.

Many people find meditation to be that key activity that allows them to refocus their minds. It can also fight inflammation. When people think of meditation, they often envision mindfulness meditation, in which you focus on your breathing and clear your mind, but that’s only one of a variety of meditation techniques. If you’re looking for other options, consider using guided imagery or breathing techniques to help your body relax.

According to the CNN article, crafting carries many of the same benefits as meditation. Activities like quilting, painting or making things with your hands can spur the release of dopamine, a pleasurable chemical found in the reward center of the brain. Plus, seeing the finished product around your home can actually cause your body to release dopamine again and again. In addition, many hand-based crafts may help reduce arthritis and joint pain by helping to lubricate the joints, thus improving function.

Gardening – even if it’s just small indoor herb garden – may also be the key. For gardening expert Melinda Myers, “The rhythm of some garden tasks . . . redirects your thoughts to the action and away from your stresses and worries.”

Incorporate your Senses

If simply performing your chosen relaxation activity isn’t enough to completely take your mind off your pain, and you still can’t let go of those nagging thoughts in the back of your mind, consider a multisensory approach. Creating the ideal environment for all of your senses might just be the key.

For instance, many essential oils are useful for fighting pain, while others boost relaxation. For a meditation session, consider Roman chamomile, which relieves stress and decreases inflammation. And for crafting, choose basil, which energizes, uplifts and relaxes your muscles. There are a plethora of oils available to help you obtain your desired mood. Put them in a diffuser or oil warmer to get the scent circulating around your home.

And did you know that music can also help reduce the perception of pain and spur the release of dopamine – and singing along is a great way to release tension. Even just humming has been shown to calm the mind and reduce stress. Music with a faster beat will encourage more concentrated thinking, while a slower one is good for meditative states.

So next time you can’t get your pain off your mind, grab some yarn or a paint brush, plug in some pain-reducing oils and crank up your favorite music – and don’t be afraid to belt out the lyrics along with it.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

The first line of treatment for illnesses of all sort isn’t usually found in the doctor’s office – it’s found in the medicine cabinet. The same is just as true, if not more so, for pain. Backache? Leg pain? Headache? Most people turn to the anti-inflammatory and pain-relieving power of over-the-counter medicines. But, just like any other medications, there can be drawbacks to these easily obtainable pills. Learning when to take them – and when to default to the expertise of a physician – may give you the best chance of effectively managing your pain.

Knowing Your Options

At the onset of pain, most people reach for either an acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (Aspirin, Advil, Aleve), also known as NSAIDs, which can be very effective in fighting pain. In fact, these medications are recommended in the CDC’s new guidelines, which say, “In particular, acetaminophen and NSAIDs can be useful for arthritis and low back pain.”[1]

Acetaminophen, which is a component of more than 500 OTC and prescription medications,[2] is both a pain reliever and fever reducer. It can be useful for relieving headaches and common aches and pains. According to the Journal of Pharmacy and Therapeutics, though, the way in which the drug blocks pain is largely unknown.[3]

NSAIDs, found in more than 550 medicines, are able to temporarily relieve both pain and inflammation, according to the FDA, by blocking the body’s production of chemicals that are believed to be associated with pain and inflammation.[4] It can be useful for people experiencing arthritis or muscle strains and sprains.

Medication Misuse

According to a survey released this year by the American Gastroenterological Association (AGA), Americans regularly ignore dosing information on the OTC medicines we ingest. [5] This is especially true for individuals suffering from chronic pain. In fact, 43 percent of chronic pain sufferers reported that they knowingly have taken more than the recommended dosages of OTC medications. And 28 percent of those sufferers have experienced complications due to an overdose of these medicines.

Overdosing on OTC meds isn’t something many people take into consideration when they begin an acetaminophen or NSAID regimen. But the fact that 66 percent of those with chronic pain believe the directions on pain medications are merely guidelines and 27 percent are willing to take more medicine than directed “because they incorrectly believe their symptoms will disappear faster,” according to the AGA, means overdoses are more common than you might think. An average gastroenterologist will see around 90 cases of OTC pain medicine overdose each year.

Problems also arise when individuals utilize both OTC medicines for pain and multi-symptom OTC medicine for allergies, colds or flu symptoms, since it’s likely they may contain the same active ingredient. Taking both can increase your daily dosage of acetaminophen or NSAID, putting you at an increased risk of dangerous side effects.

Common Side Effects

NSAIDs have the potential to cause bleeding in the stomach or digestive track, especially among patients older than 65, those with a history of stomach ulcers or those taking blood thinners or corticosteroids.[6] In addition, NSAIDs can increase the risk of heart attacks and strokes, and the FDA has recently strengthened label warnings regarding these issues.[1]

Acetaminophen is known to be easier on the stomach than NSAIDs, but it still has its side effects. Particularly, large doses or prolonged usage may damage the liver, especially if individuals drink more than three alcoholic drinks a day. 6[7]

And while deaths from OTC overdoses aren’t as common as those from medications like opioids, they do occur. In 2010, 881 died from an overdose of acetaminophen, while 228 died from NSAIDs.1

Treatment Options

According to the AGA, “Americans living with chronic pain can get relief safely, but it is important to work with a healthcare professional to effectively manage chronic pain.” 2 A healthcare provider, especially one well-versed in pain management,  can not only ensure that your dosage of OTC medications is appropriate and that they do not interact or overlap with any of your other medications, but they may also be able to provide treatment options for more prolonged pain relief, including injections, nerve blocks and implants. While OTC pain relievers do provide a degree of relief, oftentimes they don’t treat the true cause of the pain. Thus, when pain persists despite OTC medication usage, it may be time to seek alternative treatment in the form of pain management.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

[1] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

[2] American Gastroenterological Association. "Know Your Medicines." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/know-your-medicines/.

[3] Toussaint, K., X. C. Yang, M. A. Zielinski, K. L. Reigle, S. D. Sacavage, S. Nagar, and R. B. Raffa. "What Do We (not) Know about How Paracetamol (acetaminophen) Works?" Journal of Clinical Pharmacy and Therapeutics 35, no. 6 (December 2010): 617-38.

[4] Hertz, Sharon. "The Benefits and Risks of Pain Relievers." U.S. Food and Drug Administration. September 24, 2015. Accessed April 06, 2016. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm107856.htm.

[5] American Gastroenterological Association. "Executive Summary: Gut Check: Know Your Medicine Survey." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/gut-check-know-medicine-survey/.

[6]"11 Things You Should Know about Common Pain Relievers." Harvard Health. October 9, 2015. Accessed April 06, 2016. http://www.health.harvard.edu/pain/12-things-you-should-know-about-pain-relievers.

[7]American Gastroenterological Association. "FAQs." 2016. Accessed April 06, 2016. http://gutcheck.gastro.org/faqs/.

Thursday, 02 November 2017 13:06

The Shocking Truth behind Smoking and Pain

There are countless reasons to stop smoking – and you’ve no doubt heard them a thousand times. It’s the single greatest preventable cause of disease and death in the U.S. and is actually a factor in one in five deaths.[1] Yet it still remains a prevalent issue, especially among those with chronic pain – despite the fact that smoking has actually been found to make pain worse. Read on to find out the connection between the two and discover tips for finally kicking the habit.

Prevalence

The percentage of smokers among the U.S. population is roughly 15% - meaning that 15 out of every 100 adults have smoked cigarettes in the past year.[1] That number has actually declined over the past several years, coming down from 21% in 2005. However, according to a 2015 study,[2] the number of smokers among the chronic pain population has actually been increasing. In 2000, 24.2% of the pain population smoked, and by 2010 that number had risen to 28.3%, almost double the percentage of smokers in the U.S. at large.

Links to Pain

Research has shown that smoking as few as 10 cigarettes a day causes a noticeable increase in general pain, in addition to slowing healing, worsening surgical outcomes and leading to more pain and opioid use after surgery.[3][4]

Smoking damages both the heart and blood vessels and leads to dangerous circulation issues. This means that bones and tissues are deprived of the oxygen-rich blood and nutrients that they need.[5] This can lead to or worsen degeneration of the lumbar and cervical spinal discs, causing severe back pain and neck pain.[6]

Moreover, according to the Cleveland Clinic, smokers are 1.5 times more likely to experience headaches and 80-90% of those who experience cluster headaches have a significant history of smoking.[3] They’re also more likely to have issues when it comes to their bones, since smoking leads to negative effects on bone healing and leads to more complications. On top of that, among men with knee osteoarthritis, smoking has been shown to lead to greater cartilage loss, in addition to greater pain levels.[7]

Tips to Help Quit

The list of smoking’s effect on pain levels isn’t a short one. It can cause and worsen a plethora of painful issues. Yet, at least for some of these issues, quitting can make a big difference. Here are a few tips to help you get started.

  • Change up your routine to break the association of smoking with certain places or times of day.
  • Stop carrying and hoarding cigarettes, whether at home, in your bag or at work. And don’t borrow cigarettes from anyone else. Plus, throw away your matches, lighters and ashtrays.
  • Get more active: Walk instead of drive and use the stairs instead of the elevator. Exercise helps you relax and boosts morale.
  • Take it one day at a time. Each day without a cigarette is good news for your health, family and bank balance.

Quitting smoking is the first step to reducing your pain – and improving your health – but it’s not the only thing you can do. Consider visiting a pain management specialist to get more advice and ideas on how to effectively manage your pain condition so you can get back to being a healthier, happier version of you.

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[1] CDC. “Current Cigarette Smoking Among Adults in the United States.” March 14, 2016. Accessed November 30, 2016. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/.

[2] Orhurhu, Vwaire J., Thomas P. Pittelkow, and W. Michael Hooten. “Prevalence of Smoking in Adults with Chronic Pain.” Tobacco Induced Diseases 13, no. 1 (July 17, 2015).

[3] Cleveland Clinic. “Do You Smoke to Cope with Pain? Research Finds Surprising Effect - Health Essentials from Cleveland Clinic.” September 30, 2015. Accessed December 1, 2016. https://health.clevelandclinic.org/2015/09/smoke-cope-pain-research-finds-surprising-effect/.

[4] Shi, Yu, Toby N. Weingarten, Carlos B. Mantilla, W. Michael Hooten, and David O. Warner. “Smoking and Pain.” Anesthesiology 113, no. 4 (October 2010): 977–92.

[5] National Heart, Lung and Blood Institute. “How Does Smoking Affect the Heart and Blood Vessels? - NHLBI, NIH.” November 4, 2014. Accessed December 1, 2016. https://www.nhlbi.nih.gov/health/health-topics/topics/smo.

[6] Science Daily. “Smoking Cigarettes Can Be a Chronic Pain in Your Neck.” February 18, 2016. Accessed December 1, 2016. https://www.sciencedaily.com/releases/2016/02/160218062227.htm.

[7] Amin, S, J Niu, A Guermazi, M Grigoryan, D J Hunter, M Clancy, M P LaValley, H K Genant, and D T Felson. “Cigarette Smoking and the Risk for Cartilage Loss and Knee Pain in Men with Knee Osteoarthritis.” Annals of the Rheumatic Diseases 66, no. 1 (June 30, 2006): 18–22.

Thursday, 02 November 2017 13:05

The Truth Behind Failed Back Surgery Syndrome

Back surgery doesn’t always mean the end of pain. In fact, a large portion of people still experience back and leg pain despite undergoing various types of spinal surgery, a condition universally called failed back surgery syndrome (FBSS). Fortunately, for those suffering from FBSS and for whom repeat surgery is not indicated – which is often the case – there are options to reduce the residual pain so sufferers can get back to a more normal quality of life.

Prevalence and Overview of FBSS

The true prevalence of FBSS isn’t entirely known, and estimates place the number anywhere between 5-50% of patients who undergo spinal surgery.[1] What is known is that the condition can come about from various types of surgeries and may be the result of removing bone (laminectomy or foraminotomy) or disc material (discectomy) or even a fusion of spinal segments.[2]

Failed back surgery syndrome doesn’t necessarily mean a failure on the part of the surgeon or that the pain is worse after surgery. FBSS simply refers to pain that persists after surgery – whether that pain is worse, unchanged or even slightly improved. In the case of FBSS, the outcome of the surgery just doesn’t meet the pre-surgical expectations of the provider and patient.[1]

Possible Causes

It’s thought that several factors can play into the development of FBSS.[2] Issues before surgery that can affect the outcome include spinal instability or anomalies in clinical images, in addition to preexisting conditions like diabetes, autoimmune disease and peripheral vascular disease.[3]

Psychological issues, like depression and anxiety, also play a role and patients with them are more likely to have unsatisfactory outcomes from surgery. [4]  Complications after surgery, like excessive inflammation leading to the development of fibrotic tissue, [2] can also result in unfavorable outcomes.

Treatment Options

Repeat spinal surgery is actually less likely to succeed than the primary surgery.[5]This means that oftentimes additional treatments provided by a pain management physician are needed to address the residual pain after spinal surgery.

Depending on the condition, pain management specialists have various options when it comes to managing FBSS pain. Oftentimes, they will utilize minimally invasive treatments such as epidural steroid injections, blocks or radiofrequency neuroablation. These, paired with physical therapy and other comprehensive treatments, can often lead to improved pain levels and overall quality of life.

Other times, physicians may turn to spinal cord stimulation, or SCS, a treatment that’s been proven more effective for FBSS than repeated surgery.[6] SCS delivers low voltage electricity to the spinal cord, interrupting pain signals before they reach the brain. With SCS, patients are able to try the system before permanent implantation and, once they receive the permanent version, are often able to reduce their reliance on opioids. Intrathecal pumps, which deliver medication directly to the spinal cord to block pain signals, may also be considered.

Preventing FBSS

However, as researchers note, preventing FBSS is much easier than treating it.[3] Preventing FBSS comes down, in large part, to proper patient selection for surgery,  meaning that for many, surgery may not be the right option. But for patients for whom spinal surgery is not indicated – or those who are hesitant to undergo such a serious surgery – there are other, less invasive treatment options. These may include some of the same options utilized to treat FBSS – like injections, blocks and radiofrequency – among others.

Learn More

If you’re looking for treatment options for FBSS – or are considering alternatives to spinal surgery – call (888) 901-PAIN (7246) to learn more today.

Download your free opioids and pain in-depth guide

[1] Taylor, Rod S., and Rebecca J. Taylor. “The Economic Impact of Failed Back Surgery Syndrome.” The British Journal of Pain 6, no. 4 (November 2012): 174-181.

[2] Russo, Marc. “Failed Back Surgery Syndrome: Pain That Persists after Surgery in a Subset of Patients.” International Neuromodulation Society. April 2002. Accessed August 30, 2016. http://www.neuromodulation.com/assets/documents/Fact_Sheets/fact_sheet_fbss.pdf

[3] El-Sissy, Mohamad H., Mohamad M. Abdin, and Amr M.S. Abdel-Meguid. “Failed Back Surgery Syndrome: Evaluation of 100 Cases.” The Medical Journal of Cairo University 78, no. 2 (March 2010): 137-144.

[4] Bordoni, Bruno, and Fabiola Marelli. “Failed Back Surgery Syndrome: Review and New Hypotheses.” Journal of Pain Research 2016, no. 9 (January 12, 2016): 17-22.

[5] Thomson, Simon. “Failed Back Surgery Syndrome – Definition, Epidemiology an Demographics.” British Journal of Pain 7 no. 1 (February 2013): 56-59.

[6] North, Richard B., David H. Kidd, Farrokh Farrokhi, and Steven A. Piantadosi. "Spinal Cord Stimulation versus Repeated Lumbosacral Spine Surgery for Chronic Pain: A Randomized, Controlled Trial." Neurosurgery 56, no. 1 (2005): 98-106.

So your doctor says you need a nerve block, but you’ve never even heard of this type of procedure before. You start thinking: What will this entail? Will it hurt? And, most importantly, will it really help relieve my pain? Let this in-depth look at nerve blocks answer all your most pressing questions.

Definition and Types

Nerve blocks do what the name implies: They block the pain signals traveling along a nerve or a group of nerves before they get to the brain.[1] Nerves work like sensory superhighways, transmitting sensations – like pain – from the source to the brain. Blocks involve injecting various types of medications around the nerve or nerves to stop the transmission of pain.

There are two main types of nerve blocks that may be performed at different points in the body; some nerve blocks will be diagnostic, helping doctors find the source of the pain to better determine future treatment, while other blocks may be therapeutic, providing prolonged pain relief.

  • Diagnostic blocks are utilized to determine if a specific nerve or nerves are the source of the problem. During this procedure, a doctor will inject a temporary numbing agent around the nerves, which – if the right nerves were targeted – will relieve pain for a few hours or days. You will then be told to go about your day, moving around as normal and monitoring your pain levels for signs of improvement. If you and your doctor deem the block successful, you may have another block to verify these results, or just move on to a more lasting treatment option, like radiofrequency neuroablation.
  • Therapeutic blocks aim to relieve pain for a longer period of time. This is due to the type of medication injected around the nerves, which will include an anesthetic for short-term relief and an anti-inflammatory medication for longer relief.

Procedure Overview

To begin, you may be given sedation to help you relax, but you will remain awake during the procedure. Your provider will use a local anesthetic to numb the area around the nerves that are being treated. Using a state-of-the-art X-ray device called a fluoroscope, along with contrast dye that’s been injected into the region, your physician will locate the nerve or nerves that may be causing the problem. A mixture of pain-relieving medications will then be injected around the nerves.

Following the procedure, you will usually be able to go home in about 30 minutes. After a nerve block, people may feel soreness at the site of the injection.

Therapeutic Outcomes

The ultimate goals of therapeutic nerve blocks are similar to those of many other procedures: decrease pain, increase function, decrease opioid usage and increase the ability to perform physical therapy. Yet everyone responds differently to different procedures and nerve blocks are no exception.

After the nerve block procedure, it’s possible that the pain may return after the anesthetic wears off but before the anti-inflammatory medication takes effect. This is normal and should decrease within a few days. Usually, more than one injection will be required to provide sustained relief from pain, and relief may last longer after each injection. The amount and frequency of these injections will depend on your specific condition.

Learn More

To learn more about nerve blocks, including if they may be right to help treat or diagnose your condition, please schedule a consultation with one of our experienced pain management providers by calling (888) 901-PAIN. You can also learn more on our treatment pages:

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[1] “ViewMedica Patient Engagement Videos.” Swarm Interactive 2016. Accessed October 6, 2016. http://www.viewmedica.com/.

Everyone’s pain is different, and the reality is that not everyone’s pain will respond as well to conservative treatment methods. Even patients who undergo more drastic treatments, like invasive surgeries, aren’t guaranteed pain relief. Experiencing this “refractory” pain – or pain that persists despite treatment, with no improvement in daily functioning – can feel hopeless, with few avenues for relief. But for some conditions, the answer may lie in a minimally invasive, reversible treatment called spinal cord stimulation.

How Does SCS Work?

Spinal cord stimulation (SCS), also known as neuromodulation, has been in use since the late 1960s, when it was used to treat patients with cancer pain.[1] The process is simple: Small electrical impulses delivered into the spinal cord interfere with the transmission of pain signals, which travel along the spinal cord to the brain. While it’s believed that the electrical impulses prevent the brain from receiving the pain signals, some of the specifics regarding how SCS relieves pain are still relatively unknown.[1]

SCS replaces the feeling of pain with a more pleasant tingling sensation (called paresthesia). Via an external programmer, patients are able to turn the system on or off and change the level of stimulation. The degree of patient and automatic control varies with the type of system implanted, with some systems even self-regulating based on the patient’s position.

SCS is most commonly utilized for conditions like failed back surgery syndrome and complex regional pain syndrome (CRPS), and has been proven successful for chronic back pain, neck pain, and ischemic and coronary artery disease. [2][3] Different providers have specific preferences and rationales for SCS selection, which may vary by patient, type of pain and provider experience.

Also, before implantation, Advanced Pain Management requires a behavioral health consolation with a licensed psychologist to determine the patient’s treatment goals and ensure that they are in the best possible position to achieve success with the treatment.

Implantation

One important component of SCS is that patients can try the device before deciding whether or not it’s right for them. The trial period lasts approximately one week, during which time patients assess how well the nerostimulator relieves their pain during normal, everyday activities.

For this trial, performed with local anesthetic, wire leads are inserted into the epidural space (the area around the spinal cord) and the patient gives feedback to determine the location that will provide optimal pain relief. The leads are then connected to an external stimulator.

If the patient and the physician deem the trial successful, which is often defined as a 50 percent or greater reduction in pain,[1] then a permanent device will be implanted. During this outpatient procedure, permanent leads are inserted into the epidural space and a small generator, to which the leads will be connected, is implanted beneath the skin, usually in the butt or abdomen.[2] Patients will then be able to program the device to meet their specific pain needs.

Timing and Side Effects

The timing of implantation can affect a patient’s outcome. The amount of time between when a patient’s pain starts and when the device is implanted is inversely related to the percentage of pain relief, meaning the earlier that treatment is commenced, the better the results. The Neuromodulation Appropriateness Consensus Committee, convened by the International Neuromodulation Society, recommends considering the device after conservative treatments have failed, but before long-term opioid use or reoperation.[3]

Just like with any treatment, though, there are possible side effects. Fortunately, the majority of complications are minor and easily reversible. The most common issue is hardware-related. For instance, a lead may shift out of position, become disconnected or break. Other minor problems can include infection and pain at the implant site, which rarely affect a patient’s long-term health. [1][3]

The Future of SCS

This treatment is evolving, and exciting new models of SCS devices are becoming available, which could mean better pain control for many, including some who have already tried and failed SCS trials.[4] For instance, one new device offers pain relief without the tingling sensation of paresthesia, while another allows the user to switch between paresthesia and non-paresthesia pain relief. Yet another may provide relief for those with lower extremity pain, which has been difficult to treat with current devices.

For more information regarding spinal cord stimulation, or to find out if it may be right for you, call (888) 901-PAIN (7246) or click below to schedule a consultation. You can also read a story from real-life APM patient Maria, whose neurostimulator helped her overcome the pain of CRPS.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

[1] Jeon, Young Hoon. "Spinal Cord Stimulation in Pain Management: A Review." The Korean Journal of Pain 25, no. 3 (July 2012): 143-50.

[2] “ViewMedica Patient Engagement Videos.” Swarm Interactive. 2015. Accessed April 8, 2016. http://www.viewmedica.com/.

[3] Deer, Timothy R., et. al. "The Appropriate Use of Neurostimulation: Avoidance and Treatment of Complications of Neurostimulation Therapies for the Treatment of Chronic Pain." Neuromodulation: Technology at the Neural Interface 17, no. 6 (August 2014): 571-598.

[4] "Advances in Neuromodulation." PainPathways Magazine. December 01, 2015. Accessed April 11, 2016. http://www.painpathways.org/advances-in-neuromodulation/.

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Our diverse physicians, nurse practitioners and physician assistants provides patients with the most comprehensive approach to pain management. We have convenient locations across Wisconsin and Minnesota including Appleton, Chaska, Green Bay, Kenosha, Madison, Mankato, Milwaukee, Racine, Sheboygan, Stevens Point, Waukesha, Wausau and many more.

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