Comprehensive Pain Management
(Formally known as Franklin Pain and Wellness and Warwick Pain)

Attleboro, MA(508) 236-8333
Franklin, MA(508) 507-8818
South Kingstown, RI (401) 234-9677
Warwick, RI(401) 352-0007

Franklin, MA • (508) 507-8818
Warwick, RI • (401) 352-0007
South Kingstown, RI • (401) 234-9677

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Chronic Pain has a Massive Impact on the Workforce

Joseph Coupal - Thursday, May 17, 2018
Comprehensive Pain Management - Attleboro, MA

Chronic pain, which is any physical discomfort lasting for at least six months, affects over 50 million Americans, most of whom work full time. Common forms of chronic pain include headaches, backaches, arthritis, respiratory conditions, and ailments caused by sports injuries or other traumas, such as car accidents.

There have been several studies to examine the role of chronic pain on work factors such as job stress, employee performance and organizational profitability. It was found that social stigmas and job fears help mask the true size of the problem.

"Generally speaking, chronic pain and other physical and mental disorders have been categorized as 'silent disorders' in the workplace simply because most employees are afraid of the consequences if employers find out." - study author

The research indicates that chronic pain at work has a significant effect on both the worker and the organization. For example, higher levels of chronic pain are associated with:

  • More conflict on the job
  • Less-effective communication
  • An inability to focus on tasks that require sustained concentration
  • Less enthusiasm for the job
  • Fewer favorable interactions with coworkers and supervisors
  • Less support from the organization
  • More job tension
  • Higher levels of depressed mood (feeling "blue" on the job, etc.)

The authors of the studies were also interested in gauging the bottom-line consequences of chronic pain for sufferers.

"For those experiencing even moderate levels of chronic pain, the financial consequences are staggering." study author.

In one study, more than 2,000 employees were asked to report the number of hours per week that pain caused them to be ineffective.

The results indicate that chronic pain accounts for over five hours per week of lost productivity. When projected over the course of the year, this means more than $5,000 per employee.

This result does not take into consideration indirect costs, which can double or triple the amount.

An inability to be productive also affects customer retention and increases bottlenecks caused by not keeping up with others, as well as the costs associated with absenteeism, tardiness and ongoing medical treatment.

A proactive approach by employers may help minimize some of these undesirable effects.

First, education and communication can go a long way in reducing the stigma of chronic pain as a weakness. Also, organizational support, even if it is only in the form of empathy, may help sufferers get through the roughest days.

For more information on chronic pain management, contact Comprehensive Pain Management in Attleboro, MA.

Source: conquerchiari.org

The Cause of Musculoskeletal Disorders at Work

Joseph Coupal - Thursday, May 03, 2018
Comprehensive Pain Management - Franklin, MA

The root cause of Musculoskeletal Disorders (MSC) is exposure to MSD risk factors – both work-related risk factors and individual-related risk factors.

Work-related Risk Factors Workplace design plays a crucial role in the development of an MSD.

When a worker is asked to do work that is outside his body’s capabilities and limitations, he is being asked to put his musculoskeletal system at risk.

There are three primary ergonomic risk factors.

High task repetition. Many work tasks and cycles are repetitive in nature, and are frequently controlled by hourly or daily production targets and work processes. High task repetition, when combined with other risks factors such high force and/or awkward postures, can contribute to the formation of MSD. A job is considered highly repetitive if the cycle time is 30 seconds or less.

Forceful exertions. Many work tasks require high force loads on the human body. Muscle effort increases in response to high force requirements, increasing associated fatigue which can lead to MSD.

Repetitive or sustained awkward postures. Awkward postures place excessive force on joints and overload the muscles and tendons around the effected joint. Joints of the body are most efficient when they operate closest to the mid-range motion of the joint. Risk of MSD is increased when joints are worked outside of this mid-range repetitively or for sustained periods of time without adequate recovery time.

Exposure to these workplace risk factors puts workers at a higher level of MSD risk. It’s common sense: high task repetition, forceful exertions and repetitive/sustained awkward postures fatigue the worker’s body beyond their ability to recover, leading to a musculoskeletal imbalance and eventually an MSD.

Individual-related Risk Factors

Human beings are multi-dimensional. Limiting ourselves to a singular cause of Musculoskeletal Disorders will limit our ability to create a prevention strategy that addresses the multi-dimensional worker.

We need to address both workplace risk factors and individual risk factors.

Individual risk factors include:

Poor work practices. Workers who use poor work practices, body mechanics and lifting techniques are introducing unnecessary risk factors that can contribute to MSDs. These poor practices create unnecessary stress on their bodies that increases fatigue and decreases their body’s ability to properly recover.

Poor overall health habits. Workers who smoke, drink excessively, are obese, or exhibit numerous other poor health habits are putting themselves at risk for not only musculoskeletal disorders, but also for other chronic diseases that will shorten their life and health span.

Poor rest and recovery. MSDs develop when fatigue outruns the workers recovery system, causing a musculoskeletal imbalance. Workers who do not get adequate rest and recovery put themselves at higher risk.

Poor nutrition, fitness and hydration. For a country as developed as the United States, an alarming number of people are malnourished, dehydrated and at such a poor level of physical fitness that climbing one flight of stairs puts many people out of breath. Workers who do not take care of their bodies are putting themselves at a higher risk of developing musculoskeletal and chronic health problems.

Exposure to these individual risk factors puts workers at a higher level of MSD risk. Just like workplace risk factors, individual risk factors are common sense: when a worker uses poor work practice, has bad health habits, doesn’t get adequate rest and recovery and doesn’t take care of their bodies with a good nutrition and fitness regimen, they are at greater risk for fatigue to outrun their recovery system. Having a poor overall health profile puts them at greater risk of developing a musculoskeletal imbalance and eventually an MSD.

For more information on preventing Musculoskeletal Disorders at work, or for treating Musculoskeletal Disorders, contact Comprehensive Pain Management in Attleboro, MA.

Source: ergo-plus.com

Treating Chronic Pain

Joseph Coupal - Thursday, April 19, 2018
Comprehensive Pain Management - Franklin, MA

Opioid abuse is an epidemic, the U.S. Centers for Disease Control and Prevention reports, killing 40 a day and ensnaring millions more in a pattern of abuse and addiction. At the same time, chronic pain is hurting the quality of life of some 100 million Americans — more than heart disease, cancer, and diabetes combined, a study published in the Journal of Pain estimates. If you suffer from chronic pain, understanding how to recognize, treat, and manage your pain as early as possible may relieve not only the pain, but also the anxiety that goes along with it.

Like heart disease and diabetes, chronic pain is a complex disease that needs to be managed with medications, lifestyle changes, and often psychological help. And like many chronic diseases, the sooner you treat pain, the sooner you can reverse or manage the damage that’s already been done.

When it comes to treating pain with drugs, almost all pain experts agree that cancer pain and pain from severe acute injuries or surgeries are best treated by opioids, but there are so many factors that determine which patients are good candidates for which treatments.

It is estimated that 10 percent to 15 percent of people treated with opioids can get addicted, and many millions more without chronic pain misuse the drugs recreationally. Even people who don’t get addicted to drugs get physically dependent because the body becomes habituated. While opioids are effective in nearly everyone for acute inflammatory pain, for chronic pain, maybe a third of people will get long-term benefits, and not all of those people will get a functional benefit, meaning other medications might be more effective.

Picking a Chronic Pain Treatment Plan

Before a pain specialist can decide the best course of action for you, he or she needs to take a comprehensive history of when and how your pain started, how long it’s lasted, and how you’ve been treated it so far.

Here are some general treatment categories to know the next time you talk to your doctor:

Acetaminophen: The active ingredient in Tylenol, over-the-counter acetaminophen is one of the most commonly used pain relievers, and a first-line treatment recommended by the American College of Rheumatology.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Another first-line treatment, NSAIDs are slightly more powerful than acetaminophen and available over-the-counter in lower doses and by prescription for higher doses. NSAIDs include anti-inflammatory drugs, such as naproxen (the active ingredient in Aleve), and ibuprofen. They can be used in conjuction with opioids, making opioids more effective and reducing the necessary opioid dosage. But NSAIDs are also not without risks. When you reach a certain age, people become much more likely to develop complications with NSAIDs. Organ toxicity, kidney or liver failure, ulcers. Opioids don't have those risks.

Serotonin and norephinephrine reuptake inhibitors: Anti-depressants that inhibit both serotonin and norephinephrine are first-line treatments for nerve pain, such as diabetic neuropathy, and muscular and skeletal pain. Anti-depressants that are also approved for anxiety can help also help people sleep, and they don't have the downsides of opioids.

Cortiosteroids: Steroids, such as prednisone, inhibit injured nerves, Cohen explains. The problem is, the pain returns once you stop taking them and they may actually accelerate joint destruction.

Topical medications: Lidocaine and capsicin are two examples of topical creams that can treat localized pain, either as a one-time treatment or part of a regular pain-soothing treatment plan. The downside is these drugs only work for pain in one area, not total-body pain.

Injections: There are lots of different kinds of injections, including nerve, epidural, trigger point, and radiofrequency injections, which work for regional or local pain. Steroids and other types of drugs can also be administered through injections. The conditions injection can treat are as varied as the injections themselves. Arthritis, acute injuries and muscle pain, myofascial pain syndrome, headaches, and more can all respond favorably to injections. However, they're not good for someone with the total-body pain that comes with conditions such as fibromyalgia or diabetic neuropathy.

Neurostimulators: An acute treatment that is FDA-approved for back, neck, arm, or leg pain, neurostimulation uses implanted electrodes to interrupt nerve signals and provide pain relief. However, this type of treatment is not a cure for what's causing the pain; instead, it simply masks pain signals before they reach the brain. Some types of stimulation, including sphenopalatine ganglion stimulation, are going through clinical trials to evaluate their effectiveness for treating headaches, including cluster headaches.

Massage, acupuncture, and other alternative therapies: Often combined with traditional drug therapy, acupuncture, acupressure, spinal manipulation, and more can be effective, safe, and side-effect free, particularly when more conventional treatments have not helped. Alternative therapy seems to be more effective than not having any treatment and in some cases, may work as well as medications.

Exercise and physical therapy: Study after study has shown that gentle exercise can improve functionality and mobility in people with many kinds of chronic pain. Gentle movements such as tai chi and yoga have been shown to improve chronic back and joint pain, arthritis, fibromyalgia, and other conditions.

On the whole you can't say clear-cut things about who should be treated with which drugs, or which alternative and complementary treatments. The key is talking to your doctor to find a plan that works for you.

For more information on pain management, contact Comprehensive Pain Management in Attleboro, MA.

Source: everydayhealth.com

Ways to Treat Chronic Back Pain

Joseph Coupal - Thursday, April 05, 2018
Comprehensive Pain Management - North Attleboro, MA

Back pain is considered chronic if it lasts three months or longer. It can come and go, often bringing temporary relief, followed by frustration. Dealing with chronic back pain can be especially trying if you don’t know the cause.

Here are some common chronic back pain causes and nonsurgical treatment options.

Common Causes of Chronic Back Pain

Chronic back pain is usually age-related, but can also result from a prior injury. The most common causes include:

  • Arthritis of the spine—the gradual thinning of the cartilage inside the spine
  • Spinal stenosis—narrowing of the spinal canal that may lead to nerve pain
  • Disc problems, such as a herniated or bulging disc
  • Myofascial pain syndrome—unexplained muscle pain and tenderness

In some cases, it’s difficult to pinpoint the cause of chronic back pain. If your doctor has exhausted all diagnostic options, it’s time to seek a second opinion from a back pain specialist. It’s important not to make rushed decisions or undergo extensive medical procedures until the origin of the pain is found. Not only may they not help; they could make the pain worse.

If the source of the pain is not known or can’t be treated, your best option may be to work with your pain management team on reducing the flare-ups and making the pain manageable with nonsurgical treatments.

Nonsurgical Treatments for Chronic Back Pain

  1. Physical Therapy

    Exercise is the foundation of chronic back pain treatment. It’s one of the first treatments you should try under the guidance of your physician and spine physical therapist. However, the same set of exercises doesn’t work for everyone. The exercises have to be tailored to your specific symptoms and condition. Maintaining the exercise routine at home is also a big part of success.

  2. Mindfulness and Meditation

    Chronic back pain is straining both physically and emotionally. To manage the frustration, irritability, depression and other psychological aspects of dealing with chronic pain, you may get referred to a rehabilitation psychologist. This specialist may recommend meditation, yoga, tai chi and other cognitive and relaxation strategies to keep your mind from focusing on pain.

  3. Diet

    Some diets are highly inflammatory; especially those high in trans fats, refined sugars and processed foods. Consult with your doctor to see if your diet could be contributing to your chronic back pain and how you could change it. Maintaining a healthy weight could also help lessen your back pain by reducing the pressure on your spine.

  4. Lifestyle Modifications

    When you have chronic pain, it’s important to accept your limitations and adapt. Listen to your body and learn to pace yourself. Take a break when mowing the lawn, or make several trips when carrying groceries. Take note of the activities that worsen your pain and avoid them if possible. Not only could this help your back feel better, it could also prevent the underlying condition from advancing.

    Another important lifestyle change to try is giving up smoking. Nicotine is scientifically known to accentuate pain and delay healing.

  5. Injection-based Treatments

    Nerve blocks, epidural steroid injections, nerve ablations and other types of injection-based procedures are available for chronic back pain. They are used when the source of the pain is known and can sometimes help rule out certain causes if the treatment doesn’t work. Injections may stop or lessen pain for a certain period of time, but are not intended as long-term solutions and shouldn’t be used in isolation.

  6. Alternative Treatments

    Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other nonsurgical spine treatments can also make a difference for chronic back pain. Talk to your spine specialist about alternative treatments that could benefit you.

  7. Analgesics, anti-inflammatory drugs, muscle relaxants and other medications can be used to help control chronic back pain. However, most come with unwanted side effects and are not intended for prolonged use.

Opioid medications generally shouldn’t be used as the first, the only or the long-term line of treatment for chronic back pain. Many of them are addictive and don’t address the underlying cause of your pain. Opioids should be prescribed only after a thorough exam by a specialist and if other drugs have failed to provide relief. If you find yourself relying on opioids to get through the day, it may be time to seek a second opinion.

For more information on managing chronic back pain, contact Comprehensive Pain Management in Attleboro, MA.

Source: hopkinsmedicine.org

Managing the Effects of Chronic Pain in the Workplace

Joseph Coupal - Thursday, March 22, 2018
Comprehensive Pain Management - Attleboro, MA

Pain is the top cause of adult disability in the United States, costing the workforce as much as $334 billion each year in lost productivity costs, according to a 2012 study in the Journal of Pain. While the musculoskeletal “pain points,” such as back pain and carpal tunnel, are well known and their direct costs well-documented, there has been less emphasis on—or awareness of—the secondary or mental health effects of pain: anxiety, depression, unclear thinking and memory loss.

There is also a “compounding effect”—the more pain persists, the more of an impact it can have. It may become a vicious cycle, as discomfort in one area causes problems in another. Employees who are suffering and unable to work miss out not only on the income, but also the sense of meaning, purposefulness and belonging that can be gained from a job. Initial distress may lead to chronic anxiety and even depression.

In fact, the cost of presenteeism to businesses is 10 times higher than that of absenteeism and amounts to as much as 57.5 days lost per employee each year.

Four Pillars of Pain Management

In order to effectively address chronic pain, employers need to take a systematic, evidence-based approach, including pain assessment, education, worksite therapy and training. The “four pillars of pain management” are:

  1. Develop a system of employee-centered integrated pain management practices based on a model of care that offers access to the full spectrum of pain treatment options. Evidence-based pain management is founded on a proactive and holistic approach that is pegged to outcomes, such as absenteeism, presenteeism, morale and worker satisfaction. It is based on preventing, managing and eliminating musculoskeletal discomfort, and continuously analyzing outcome data to see what is or is not working. A holistic approach addresses body, behavior and environment in an employee-centric pain mitigation model. This focuses on stretching, posture, body mechanics, coaching and training. It also incorporates technology that promotes healthy behaviors and creates a more “user-friendly” ergonomic office environment for sitting, standing, pushing, pulling and lifting. Early interventions can pre-empt the need for doctor’s visits or more involved physical therapy, reducing medical and workers compensation claims.
  2. Take steps to eliminate barriers to pain care and improve the quality of care. The two biggest barriers to improving care are access and the stigma that attaches to those who seek it. Providing onsite treatment enables employees to more readily seek out and receive counseling and treatment. This can be augmented by making resources available and by providing each employee with a self-treatment and pain management plan. Organizations can help reduce the perceived stigma by promoting the importance of awareness and early intervention pre- and post-treatment, and making employees aware of the costs to the company when chronic discomfort or pain compromises performance. Since pain does not stop at the executive suite, leadership can also play a key role in this effort by actively championing and participating in the program.
  3. Develop methods and metrics to monitor and improve the prevention and management of pain. Pain exists on a continuum of intensity. People will generally start with no noticeable pain or discomfort at all, then eventually start to notice some mild discomfort from sitting at their desk, standing on the floor for too long, or performing any number of repetitive everyday tasks. While it is difficult to quantify pain, businesses can quantify it in terms of costs with respect to absenteeism, presenteeism and reduced productivity, as well as workers compensation and health care costs. An “evidence-based” pain management approach begins with a workforce assessment, enabling organizations to get a firm handle on the prevalence and associated costs of musculoskeletal pain, and gauge the effectiveness of the solutions in place.
  4. Increase organizational awareness of pain and knowledge of treatment options. The first step in raising workforce awareness around this issue is to educate senior management. Several recent studies indicate that support from supervisors and co-workers had a positive effect on workers with chronic pain based on self-reported health-related quality of life. Their ongoing promotion and reinforcement of that commitment, combined with visible participation, will demonstrate that employee health and wellness is one of the company’s core values.

Total Worker Health

While employers increasingly understand the connections between wellness, safety and absence management, pain mitigation has historically been viewed as a risk management strategy. A pain program based on the four pillars, however, also fits the traditional wellness framework, which shifts the focus from risk to measures of productivity.

For more information on pain management, contact Comprehensive Pain Management in Attleboro, MA.

Source: rmmagazine.com

Common Nerve Block Procedures for Chronic Pain

Joseph Coupal - Thursday, March 08, 2018
Comprehensive Pain Management - Attleboro, MA

What are some of the more common nerve block procedures for the treatment of chronic pain? What are some of the common side effects associated with these nerve blocks?

The vast majority of injections done for the diagnosis or treatment of chronic pain are performed on an outpatient basis. All of them may be performed under fluoroscopic (x-ray) guidance but are sometime performed in the office without x-ray. Below is a brief description of some of the more commonly performed nerve blocks by pain management specialists.

Epidural Steroid injection: Epidural steroid injection is an injection performed in the back or neck in an attempt to place some anti-inflammatory steroid with or without a local anesthetic into the epidural space close to the inflamed area that is causing the pain. These injections are generally done for pain involving the back and leg or the neck and arm/hand. They may be done under x-ray guidance. Epidural steroid injections may be placed in the lumbar (low back), thoracic (mid back), or cervical (neck) regions.

Facet Joint Injection: The facet joints assist with movement of the spine both in the neck and back. Injection into these joints can provide relief of neck and back pain; these injections are always performed under x-ray guidance. You will be on your stomach for this injection if it is done for back pain; however you may either be on your stomach or back if the injection is performed for neck pain, depending on the preference of the physician. A needle is placed in your neck or back and advanced to the level of the joint under x-ray visualization. Contrast dye is used if the needle is put within the joint, and sometimes used if the injection is designed to numb the nerves to the joint. This block is often a diagnostic block and a more long lasting injection may be indicated if you have significant pain relief from this injection.

Lumbar Sympathetic Block: A lumbar sympathetic nerve block is performed for pain in the leg that is thought to be caused by complex regional pain syndrome type I (or CRPS I). These injections are often performed under fluoroscopic (x-ray) guidance. Local anesthetic is placed near to the lumbar sympathetic chain in order to relieve the pain. Your leg will likely become warm immediately following the injection: this is an expected effect and not a complication. The injection is done from the back, in the lower aspect of the back. A needle is placed, often under x-ray guidance, to a spot just to the side and approaching the front part of the spine where the ganglion is located. If it is done under x-ray, a small amount of dye is injected to make sure the needle is in the right spot. After the doctor is satisfied that the contrast dye is in the right place, they will inject numbing medicine then remove the needle.

Stellate Ganglion Block: A stellate ganglion block is an injection that can be performed for the diagnosis of complex regional pain syndrome of the arm or hand or for treatment of pain to that area. It can also be used to help to improve blood flow to the hand or arm in certain conditions that result in poor circulation of the hand.

For more information, contact Comprehensive Pain Management in Attleboro, MA.

Source: asra.com


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