Comprehensive Pain Management

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

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

Franklin Pain and Wellness Center

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Spinal Cord Stimulation for Chronic Pain in the Back and Neck

Joseph Coupal - Thursday, January 11, 2018
Comprehensive Pain Management - Spinal Cord Stimulation in Franklin, MA

People whose back or neck pain has not been relieved by back surgery or other treatments may have another option to consider: spinal cord stimulation.

Around the world, some 14,000 patients undergo spinal cord stimulator implants each year. Spinal cord stimulation (SCS) delivers mild electrical stimulation to nerves along the spinal column, modifying or blocking nerve activity in a non-medicinal way to minimize the sensation of pain reaching the brain.

Spinal cord stimulation was first used to treat pain in 1967. Spinal cord stimulation was approved by the Food and Drug Administration (FDA) in 1989 to relieve pain from nerve damage in the trunk, arms, or legs, and now accounts for about 90 percent of all neuromodulation treatments. That number is expected to grow to manage chronic disease states as the population ages and as spinal cord stimulation is expanded to treat other diseases.

Spinal cord stimulation, also called neurostimulation, directs mild electrical pulses to interfere with pain messages reaching the brain. A small device implanted near the spine generates these pulses. The implanted generator used in spinal cord stimulation has similarities to a cardiac pacemaker, leading some to call the device a pacemaker for pain.

Growing Interest in Spinal Cord Stimulation

Spinal cord stimulation has been used for decades, and is being recommended for an increasing number of conditions. Failed back surgery syndrome, cervical and lumbar radiculitis, neuropathy, and complex regional pain syndrome are some conditions that may be helped by the therapy.

Smaller devices have made implantation less invasive, and innovations—such as devices that are compatible with magnetic resonance imaging (MRI)—have expanded the number of people likely to consider the therapy.

In addition, nationwide efforts to reduce reliance on opioid pain medications are bringing renewed interest to a range of pain-relief treatments that do not involve medications—including spinal cord stimulation.

Finding a doctor with experience is important in the case of spinal cord stimulation, as more experience generally leads to greater expertise. Also, spinal cord stimulation is a rapidly changing field of medicine, with new devices arriving frequently on the market. A specialist with experience in the procedure is likely to be more adept and up-to-date on the latest techniques and devices.

For more information on spinal cord stimulation contact Comprehensive Pain Management in Franklin, MA.


Happy New Year from Comprehensive Pain Management

Joseph Coupal - Wednesday, December 27, 2017
Happy New Year from Comprehensive Pain Management

Happy New Year from Comprehensive Pain Management. We would like to thank our patients, friends, family, and our community for allowing our business to be part of your lives in 2017. We wish all of you a wonderful and prosperous 2018!

If we have had the pleasure of being your choice for pain management this year, we hope that we provided the highest level of customer service, patient care, and met all of your needs. If you find yourself in need of the services we offer, we hope you come see us again in 2018.

It is our sincere wish that in the New Year you are surrounded by warmth, family, and friendship and that 2018 brings you good health and prosperity. From all of us here at Comprehensive Pain Management we hope you have a safe and exciting New Year surrounded by friends and family.

“We all come home, or ought to come home, for a short holiday – the longer, the better…” ~ Charles Dickens

CPM Annual Christmas Party

Joseph Coupal - Friday, December 22, 2017
Comprehensive Pain Management - Christmas Party 2017


Give A Free Holiday Gift in 30-Seconds or Less

Joseph Coupal - Wednesday, December 20, 2017
Comprehensive Pain Management - Give A Free Holiday Gift in 30-Seconds or Less

If a friend, relative, or valued service provider has a website, give them the gift of a business Facebook “like” this Holiday season. This act is free and will literally take you 30 seconds or less. By doing so, you help your friend or relative further establish business credibility and trust from an online standpoint.

Why do this? The reason is simple. Facebook “likes” is something that business owners can refer to promote their business popularity and interaction with their clients. It is also a widely accepted conclusion that Facebook “likes” play some role in how a website converts visitors into customers.

So if you know anyone with a website and wish them well in business, take 30-seconds and “like” their business Facebook page. Look for the Facebook logo usually located at the top or bottom of the website’s home page. Then shoot them a quick note saying, “Happy Holidays. I recently “liked” your business Facebook page and wish you continued business success in 2018 and beyond”. It would be a kind gesture and one that cost you nothing other than 30 seconds of your time.

To all our regular readers of this blog, we wish you all Happy Holidays and only the best for 2018 and beyond.

Back pain: What you can expect from steroid injections

Joseph Coupal - Wednesday, December 13, 2017

Comprehensive Pain Management in Franklin, MATry conservative measures first to control pain, and know the limits and risks of this therapy if you choose to try it.

Most people who suffer from back pain already know the drill: time heals this wound. Over weeks to months, the pain will calm down, and you will slowly return to your normal life. In the meantime, try to stay as active as possible and rely as much as possible on over-the-counter pain relievers.

But for some people, these conservative measures may not relieve the agony soon enough—especially if the problem is back pain caused by irritated spinal nerves. After a few weeks, just getting to the bathroom can be a challenge. At that point, you may be offered an injection of a steroid medication to calm the war zone in your lower back.

Even for nerve-related back pain, guidelines discourage hasty intervention with steroids. You would do less invasive, less aggressive things first.

However, if you choose this therapy, know its limits. The shots are almost always a temporary measure. In general, it's for symptom control, and not a definitive treatment.

Injection targets

Used appropriately, steroid injections can calm inflamed joints and tissues but do not speed healing or prevent future problems. Here are some of the most common targets for steroid injection therapy:

Epidural space. Epidural injections target the area around the spinal cord where nerve "roots" exit and extend to other parts of the body. The area near the nerve roots may be the source of low back pain, such as sciatica.

Tendons and bursae. Steroids are used for tendinitis—inflammation of a tendon, the tough, fibrous cord of tissue that connects muscle to bone. Steroids may also be used to calm down an inflamed bursa (bursitis). Bursae are cushioning pads of tissue that reduce friction between muscles and tendons as they move across bones and other joint structures.

Joints. Steroids are sometimes injected into a joint to calm inflammation related to arthritis. Common targets are the knee and the facet joints in the spine.

How long should you wait before considering injection therapy? It depends on the intensity of the pain and how long you can bear it before it starts to ease on its own. Most people experience substantial improvement in six to eight weeks.

How steroid shots work

Steroid injections contain various formulations of medications. A common combination is the numbing drug procaine hydrochloride—known to millions of dental patients as Novocain—mixed with the anti-inflammatory drug cortisone.

Once the injection finds its target, the numbing effect will start to wear off within hours. As the Novocain wears off, the pain may temporarily come back. Then 24 to 48 hours after the injection, you can begin to expect whatever benefit you're going to get.

What to expect

If the injection works, you'll certainly be grateful for the relief, but success is not guaranteed. In studies of large groups of back pain sufferers, the benefit is small to none on average. It's hard to predict what you, individually, will experience.

Steroid injections do not change the course of a chronic back pain condition. Months down the road, you will generally end up in the same condition as if you never got the shot. In the meantime, the shot could ease your discomfort.

For more information on epidural injections for back pain, contact Comprehensive Pain Management in Franklin, MA.

Source: Harvard Health

Kyphoplasty for Vertebral Fractures Reduces Pain and Opioid Use

Joseph Coupal - Thursday, November 30, 2017

Comprehensive Pain Management in Franklin, MABalloon kyphoplasty shows safety and efficacy in improving quality of life, pain, and functional outcomes, while reducing opioid use, among patients treated for vertebral compression fractures (VCFs).

It was found that all primary endpoints demonstrated statistical improvement and these were maintained or improved throughout a 12-month follow-up.

Secondary endpoints, including opioid usage, activity, angulation correction, and height restoration, also showed statistical improvement.

In balloon kyphoplasty, a minimally invasive treatment for VCFs caused by bones weakened from osteoporosis or cancer, the compressed bone is gently raised to its normal position and the cavity created is filled with orthopedic cement to stabilize the fracture.

The procedure differs from vertebroplasty only in the use of the balloon approach.

This, the largest prospective outcomes trial for kyphoplasty to date, involved 350 patients with painful, acute, or subacute VCF who were enrolled at 24 sites and underwent kyphoplasty.

The patients had a mean age of 78 years; 77% were female. All had one to three acute or subacute fractures less than 4 months old. Approximately half (54.9%) had bilateral kyphoplasty.

Most patients had VCF due to osteoporosis (343 of 350), and the remaining cases were due to cancer.

The patients' average pain scores were greater than 7 on a scale of 1 to 10, and disability on the Oswestry Disability Index (ODI) was greater than 30 on a scale of 0 to 100.

Follow-up data collected at 1-, 3-, 6-, and 12-month time points showed significant improvements in various measures.

In terms of the primary endpoints, patients showed significant improvements in the numeric rating scale for back pain, from an average of 8.7 at baseline (on a scale of 0 to 10) to 3.3 at 1 month, 2.7 at 3 months, 2.5 at 6 months, and 2.4 at 12 months.

Disability measures on the ODI showed improvement from 63.4 (on a 0-to-100 scale) to 32.9, 28.1, 27.1, and 27.2 at these time points, respectively.

Measures of quality of life improved to 34.9, 36.6, 36.6, 37.6, and 38 at the same time points.

Average score on the EuroQol-5-domain, which also assesses quality of life, improved from 0.383 points (scale of 0 to 1) at baseline to 0.693, 0.731, 0.739, and 0.741, respectively.

All improvements were statistically significant.

Importantly, the percentage of patients taking opioids dropped from 71.5% at baseline to 55.3% at 12 months.

The mean number of days with limited activity per month declined significantly from about 11 days to approximately 2 over the 12-month follow-up (P < .001 for all time points). The mean number of bed-rest days also dropped sharply from six per month to less than one (P < .001 for all time points).

In terms of measures of kyphotic angulation and vertebral height improvement, index fracture midline height improvements were observed at postoperative and 3-month time points, as well as at the 12-month time point.

In terms of adverse events, there were five device- or procedure-related events (1.46%), all of which resolved with appropriate treatment.

The current findings are notable in light of previous research questioning the benefits of vertebroplasty, including a study in the New England Journal of Medicine showing no improvement from the procedure over a sham treatment at all time points up to 6 months.

With as many as 40% of people over the age of 80 having had developed VCFs during their lifetime, and about 1.5 million people developing VCFs annually, the development of kyphoplasty is a very positive.

The findings build on previous evidence of potential benefits of kyphoplasty.

This study adds further evidence that kyphoplasty can be effective in treating painful osteoporotic compression fractures.

Previous randomized comparative studies have also shown benefit of balloon kyphoplasty vs medical treatment.

For more information on Kyphoplasty, contact Comprehensive Pain Management in our various loactions.


Chronic Pain Management

Joseph Coupal - Thursday, October 26, 2017
Comprehensive Pain Management - Franklin, MA

A pain management specialist has special training in evaluation, diagnosis, and treatment of all different types of pain. Pain is actually a wide spectrum of disorders including acute pain, chronic pain and cancer pain and sometimes a combination of these. Pain can also arise for many different reasons such as surgery, injury, nerve damage, and metabolic problems such as diabetes. Occasionally, pain can even be the problem all by itself, without any obvious cause at all.

The field of medicine understands that pain is complex. It is more important to have physicians with specialized knowledge and skills to treat these conditions. An in-depth knowledge of the physiology of pain, the ability to evaluate patients with complicated pain problems, understanding of specialized tests for diagnosing painful conditions, prescribing of medications, and skills to perform procedures (such as nerve blocks, spinal injections and other interventional techniques) are all part of what a pain management specialist uses to treat pain. Finally, the pain management specialist plays an important role in coordinating additional care such as physical therapy, psychological therapy, and rehabilitation programs in order to offer patients a comprehensive treatment plan with a multidisciplinary approach to the treatment of their pain.

The most important consideration in looking for a pain management specialist is to find someone who has the training and experience to help you with your particular pain problem. You also need to feel comfortable with them. Many types of chronic pain may require a complex treatment plan as well as specialized interventional techniques.

For more information on a pain management clinic, contact Comprehensive Pain Management in Franklin, MA.

Source: ASRA

Injections for Treating Pain

Darren Kincaid - Friday, October 13, 2017

Comprehensive Pain Management in Franklin, MA Injections of pain-relieving medication are common for the treatment of back pain. But, many more painful sites throughout the body can benefit from an injection such as arthritis in the knee, neck pain or hip pain; a joint injection may be just the thing you need.

How Injections Work

Injections can be used on various sites throughout the body to relieve pain and reduce inflammation. While inflammation is a natural part of the body’s immune response – and can therefore help us heal – the prolonged inflammation that occurs as part of many chronic conditions result in long-term pain and sensitivity.

Injections for knee, neck or hip pain may contain various medications; a physician will determine which ones are appropriate based on your particular condition. Typically, a combination of a local anesthetic and steroid medication will be utilized. While the anesthetic works to reduce pain in the short-term, the steroid will work to reduce pain and inflammation in the longer-term, usually up to several months.

A patient may still experience pain after the anesthetic wears off but before the steroid medication takes effect. This is normal and pain relief should occur soon. For some patients, one injection may be enough to provide adequate long-term relief; however, others may require several injections to experience the full benefits.

The Procedure

Injections are a simple, quick and precise way to treat pain at the source. In preparation for an injection, your physician will clean the area to be treated and then inject a numbing medication. To ensure that the medication is injected at the precise area it’s needed, the physician utilizes an X-ray device called a fluoroscope and a test injection of dye.

When the needle’s proper placement is ensured, a syringe filled with medication is attached and the medication is injected. After the needle is removed, the site may be covered with a small bandage.

More than Just Pain Relief

Injections help to both relieve pain and restore function. In doing so, they can also help an individual get more from physical therapy. And therapy, in turn, can actually help prolong and increase the pain-reliving effects gained from injections, in addition to preventing pain recurrence and re-injury.

In addition, the pain relief gained from the combination of injections and therapy can oftentimes help pain sufferers decrease their reliance on opioids. And a lower dose of opioids means a lower chance of dangerous opioid-related side effects.

Injections are a safe, low-risk way to treat pain at the source and get you moving again.

For information on injections for treating pain, contact Comprehensive Pain Management in Franklin, MA.


Back Pain Risk Factors

Joseph Coupal - Thursday, October 05, 2017
Comprehensive Pain Management in Franklin, MA

There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, pregnancy and smoking. With that said, back pain is so prevalent that it can strike even if you have no risk factors at all.

Specific Risk Factors for Back Pain

Patients with one or more of the following factors may be at risk for back pain:

Aging. Over time, wear and tear on the spine that may result in conditions (e.g., disc degeneration, spinal stenosis) that produce neck and back pain. This means that people over age 30 or 40 are more at risk for back pain than younger individuals. People age 30 to 60 are more likely to have disc-related disorders, while people over age 60 are more likely to have pain related to osteoarthritis.

Genetics. There is some evidence that certain types of spinal disorders have a genetic component. For example, degenerative disc disease seems to have an inherited component.

Occupational hazards. Any job that requires repetitive bending and lifting has a high incidence of back injury (e.g., construction worker, nurse). Jobs that require long hours of standing without a break (e.g., barber) or sitting in a chair (e.g., software developer) that does not support the back well also puts the person at greater risk.

Sedentary lifestyle. Lack of regular exercise increases risks for occurrence of lower back pain, and increases the likely severity of the pain.

Excess weight. Being overweight increases stress on the lower back, as well as other joints (e.g. knees) and is a risk factor for certain types of back pain symptoms.

For help treating chronic back pain, contact contact Comprehensive Pain Management in Franklin, MA.


Chronic Pain Sufferers Seek Other Options

Joseph Coupal - Thursday, September 14, 2017
Comprehensive Pain Management in Franklin, MA

Perhaps more than any other condition, pain reveals the complex and potent link between mind and body. The tension, fear, and frustration that pain incites can make it hurt all the more. Past trauma can set the stage for chronic suffering by sensitizing the nervous system. One pain condition often leads to another.

So chronic pain is rarely an isolated problem that will yield to a single remedy.

“We need to come together and see chronic pain in its entirety as something that affects the whole person,” said Dr. Sean Mackey, chief of the Division of Pain Medicine at Stanford University.

Mackey was cochairman of the committee that developed the National Pain Strategy , a federal plan for addressing chronic pain. The report calls for greater access to multiple treatment options so patients can learn to manage their pain.

In pain management programs, psychologists, physical therapists, and occupational therapists collaborate in coaching patients to manage their pain.

Each patient needs to tailor a combination of solutions for living with pain, said Michael Von Korff of the Group Health Research Institute in Seattle, a leading researcher in chronic pain management.

Psychologists, physical therapists, and occupational therapists can all help. We need to be smart about finding new ways of integrating them, making people with those kinds of skills more readily available where patients can get care. Where patients are getting care is at their primary care doctor’s office — a place already overburdened and ill-equipped to deal with the complexities of chronic pain.

“I see somebody with pain every day,” said Dr. Thad Schilling, chief of primary care at Reliant Medical Group, a Central Massachusetts practice. And yet, doctors get little training in how to understand and treat pain. Multidisciplinary programs are rare.

For information on pain treatment, contact Comprehensive Pain Management in Franklin, MA.