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

Franklin Pain and Wellness Center

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What Does a Pain Management Specialist Do?

Joseph Coupal - Friday, July 13, 2018
Comprehensive Pain Management - Franklin, MA

A pain management specialist is a physician with 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.

As the field of medicine learns more about the complexities of pain, it has become 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, appropriate prescribing of medications to varying pain problems, 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. In addition, the broad variety of treatments available to treat pain is growing rapidly and with increasing complexity.

With an increasing number of new and complex drugs, techniques, and technologies becoming available every year for the treatment of pain, the pain management physician is uniquely trained to use this new knowledge safely and effectively to help his or her patients.

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.

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


Possible Solutions to Chronic Pain

Joseph Coupal - Friday, June 29, 2018
Comprehensive Pain Management - Warwick, RI

Previous columns have discussed chronic pain and some of the first steps that sufferers, guided by their physicians, should explore to seek relief.

Exercise, physical therapy, cold and heat, massage, acupuncture, Transcutaneous Electrical Nerve Stimulation, chiropractic manipulation, or non-opioid medications such as ibuprofen and other NSAIDS can make pain levels tolerable for many.

For others, however, the relief from these measures is inadequate. If you have "tried everything and nothing has worked,” it might be time to ask your physician if Interventional Pain Management would be a suitable avenue to explore.

Most specialists in this field are anesthesiologists, but some additionally have fellowship training in image-guided spine intervention.

Several local pain management clinics and practitioners offer these interventions. Your primary care physician should be able to help you determine if you are a good candidate for these procedures and to make a referral to the practitioner whose training and expertise is best suited to your needs.

There are various treatment options that can be performed by interventional pain management specialists.

While initially the placement of injections was based mostly on educated guesswork, the more recent use of fluoroscopy to guide precise needle placement has allowed much higher success rates.

Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie, so a needle or wire can be guided to exactly the right spot.

Different interventions treat different types and locations of pain and have varying lengths of effectiveness.

Facet joint injections

These treat pain in the facet joints which support the spinal column and allow it to flex, extend, and rotate.

In older adults trauma and arthritic changes can contribute to the development of facet syndrome. Frequently a deep, dull aching pain is referred to the groin, buttocks, hip, or side and back of the thighs.

Facet point injections have two purposes. Diagnostically they can pinpoint the location of structures causing pain. The small amount of local anesthetic and steroid is injected directly into the facet joint.

If the pain is improved, then a longer-lasting procedure like radiofrequency ablation can be performed for longer-acting relief. The short-term relief facet joint injections can provide also can make a patient comfortable enough to participate in restorative physical therapy.

Epidural steroid injections

These can be given in the neck (cervical), mid-spine (thoracic) or low back (lumbar) sections of the spine. They can also be used for diagnosis as well as short-term pain relief.

To reduce inflammation and pain in the nerves as they exit the spine, a mix of local anesthetic and steroid is injected into the epidural space, just outside the membrane that covers the spinal cord. Without the use of fluoroscopic x-ray for precise placement, 25 percent of procedures will result in incorrect placements.

Sometimes one or two more injections are needed, every three or four months apart. They can provide temporary relief in about 50 percent of patients for back pain, sciatica, and neck pain with shooting arm pain.

Epidurals are a common treatment option for many forms of low back pain and leg pain. Fifteen percent of the U.S. population suffers from low back pain and incidence increases with age.

While the pain relief effects are temporary — a week to a year — injections early in an acute attack can be very beneficial in preventing chronic pain.

Sacro-iliac joint injections

These deliver anesthetic and steroid to the place where the pelvic and tailbone meet, resulting in increased mobility and less pain. Some pain management practitioners feel that combining the S-I joint injections with rehabilitative exercise and chiropractic release of the joint yields the best result.

Radiofrequency ablation

This can be used for longer-term relief of neck pain, back pain, and headaches from facet joint arthritis. Using fluoroscopic x-ray, heat generated by radiofrequency waves can be delivered precisely to damage small nerves, disturbing the transmission of pain signals from the spinal column to the brain. The effects usually last several months.

Pain intervention techniques

Muscle as well as joint pain can be treated in this way. Trigger points — tender, irritable spots in muscles that are painful to the touch — can be treated by injecting a mix of cortisone and a local anesthetic such as lidocaine or bupivacaine into painful muscle tissue, usually in the neck or back.

Spinal cord stimulators

These are somewhat like an implanted Transcutaneous Electrical Nerve Stimulation unit. The SCS is indicated for those who have chronic neuropathic pain and are not candidates for surgery but for whom other treatments and injections have not been effective.

Initially wires are implanted to the affected area with the generator for the electrical current worn externally. If this treatment helps to lessen pain, the SCS can be implanted by a surgeon.

Intrathecal pain pump implantation

This allows targeted drug delivery to help with intractable chronic pain. Since medication is delivered directly to the intrathecal area surrounding the spinal cord, a smaller dose can be used than if it were given by other means, there are fewer side effects such as sleepiness, upset stomach and constipation, as when medication is taken orally, and the pain relief is often dramatic.

If a trial shows a pain improvement of 50 percent or greater, the patient may be considered a candidate for implantation.

These interventions are definitely not appropriate for everyone, but if the more conventional methods of pain relief are not working, they should be discussed and considered.

For more information on treating chronic pain, contact Comprehensive Pain Management in Franklin, MA.


Spinal Cord Stimulation to Treats Back Pain

Joseph Coupal - Friday, June 15, 2018
Comprehensive Pain Management in Warwick, RI

Walking down the sidewalk may seem simple, but a year ago, Michael Holtz was in too much pain to walk.

To help ease the pain, he would use opioids for pain relief.

He had nerve damage along the leg and had been in chronic pain. He was at the end of his rope.

Holtz has degenerative disk disease and has had more than 20 surgeries for chronic pain, taking a variety of prescription drugs including opioids.

Struggling with depression, and desperate for pain relief, Holtz tried everything.

Holtz was like many patients who are hitting a wall to manage their chronic pain.

He had tried cortisone injections, epidurals, acupuncture, physical therapy, a number of different blocks, radiofrequency ablation is a spinal nerves and continued to be quite dysfunctional with the pain.

But, spinal cord stimulation provided relief for Holtz.

Here's how it works: a small device consisting of wires and a battery is surgically implanted in a patient, controlling pain by delivering electrical impulses to the spine to block pain signals.

This therapy also gives the patient an opportunity to control the sensation, the stimulation, the intensity of what they’re getting themselves, vis a vi a bluetooth device.

Now six months later, Holtz controls his own pain.

The device is helping thousands of patients like Holtz suffering from chronic pain, get off medications, and avoid opioids

It does not involve a drug. It avoids the issues with dependence on medications and certainly with over treatment and undertreatment and withdrawal.

A spinal cord stimulator has a average life span of ten years. It’s remotely charged through the Bluetooth device. It’s a one-time surgery. You can swim and go on an airplane with it.

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


Radiofrequency Ablation for Treating Arthritis Pain

Joseph Coupal - Friday, June 01, 2018
Comprehensive Pain Management - South Kingston, RI

Radiofrequency ablation (or RFA) is a procedure used to reduce pain. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area.

Which Conditions Are Treated With Radiofrequency Ablation?

RFA can be used to help patients with chronic (long-lasting) low-back and neck pain and pain related to the degeneration of joints from arthritis.

How Long Does Pain Relief From Radiofrequency Ablation Last?

The degree of pain relief varies, depending on the cause and location of the pain. Pain relief from RFA can last from six to 12 months and in some cases, relief can last for years. More than 70% of patients treated with RFA experience pain relief.

Is Radiofrequency Ablation Safe?

RFA has proven to be a safe and effective way to treat some forms of pain. It also is generally well-tolerated, with very few associated complications. There is a slight risk of infection and bleeding at the insertion site. Your doctor can advise you about your particular risk.

For more information on Radiofrequency Ablation for treating back pain, contact Comprehensive Pain Management in Franklin, MA.

Source: WebMD

Managing Pain in the Workplace

Joseph Coupal - Friday, May 18, 2018
Comprehensive Pain Management - Franklin, 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. 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.

Even what someone might consider mild discomfort or irritation can cause these secondary effects and can affect everything from sleep to diet to exercise. As a result, these conditions can—and often do—impinge on the workplace, with symptoms manifesting themselves in form of diminished employee morale, focus and performance.

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.

Those who are able to work may only be there in body, unable to focus and perform as expected. This is known as presenteeism and it can be an even greater drag on productivity than absenteeism. In fact, according to a recent report, 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.

For more information on combatting the effects of chronic pain in the workplace, contact Comprehensive Pain Management in Franklin, MA.

Source: Risk Managment Magazine

How Spinal Cord Stimulation Works to Treat Chronic Back Pain

Joseph Coupal - Friday, May 04, 2018
Spinal Cord Stimulation Works - Franklin, MA

Spinal Cord Stimulator (SCS) systems work by interrupting pain impulses before they reach the brain to help you manage your pain and lead a fuller life.

The Science of Pain

Your nerves and brain are constantly communicating with each other. And when you feel pain, it's because the nerves are sending a pain signal to your brain. The pain can be acute, which occurs immediately after an injury and goes away within two months when treated properly. Or the pain can be chronic, which includes any type of pain that lasts six months or longer.

How Do Spinal Cord Stimulator Systems Work?

SCS systems have a small implanted pulse generator (IPG) and thin wires called ‘leads” that are placed into your body. To manage your pain, the leads deliver tiny pulses to specific nerves on the spinal cord that mask pain signals traveling to the brain. Some people say SCS feels like a gentle tingling or fluttering sensation that replaces the pain. The medical term for this is "paresthesia." The feeling is different for everyone and the amount of pain relief you receive from SCS therapy will vary.

Spinal Cord Stimulation, or SCS, may offer hope for many of the estimated 100 million people who suffer from chronic pain. For more information on spinal cord stimulation for treating back pain, contact Comprehensive Pain Management in Warwick, RI.

Employers Target Back Pain Through Wellness Plans

Joseph Coupal - Friday, April 27, 2018
Comprehensive Pain Management - Franklin, MA

Employee Benefit News (EBN) reports that back pain relief is gaining popularity as a wellness plan offering. Nearly half of Americans suffer from musculoskeletal disorders such as back pain and the annual cost of treatment and absenteeism to employers is around $213 billion annually. Back pain accounts for 10% of healthcare costs and is a major cause of lost productivity.

Employers spend three times as much on musculoskeletal disorders as cardiovascular disease. This adds up to about $1,200 per employee a year.

Poor posture often causes back problems, and one employer shared how it teamed up with UpRight, a wearables technology vendor, to help employees improve their posture. They created a device that can detect slouching and reminds employees to correct their posture.

Employee wellness programs have expanded beyond physical fitness, healthy eating and weight control. After employers learned more about what was distracting employees, wellness programs expanded to include financial and emotional well-being.

Helping employees manage back pain — a major and costly health concern — through wellness programs is a similar response to a critical need among employees.

A poll shows that 51% of remote workers suffer from back pain and other musculoskeletal disorders because they often develop poor working habits by not having an ergonomic setup at home. Offering back-pain management through wellness programs not only helps maintain a healthier workforce, it's also a way to engage off-site employees, who sometimes feel isolated from the workplace.‚Äč

For more information on back pain prevention at work, contact Comprehensive Pain Management in Franklin, MA.


Treat Low Back Pain Safely, Rapidly and Effectively

Joseph Coupal - Friday, April 13, 2018

The Disc-FX System safely, rapidly and effectively performs minimally invasive discectomy procedure for contained lumbar spine herniations. The innovative, patented design combines simple, intuitive function with precise surgical results.

  • Less invasive compared to traditional discectomy procedures
  • Minimum annulotomy reduces risk of herniation
  • Multi-functional therapeutic options; debulking, ablation and modulation
  • Manual excision of herniated nucleus through 3.0mm portal
  • Ablation and denervation achieved with use of Trigger-Flex

Watch the video below to see how easily Disc-Fx can help with your herniated disc.

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


How Chronic Pain Impacts the Workforce

Joseph Coupal - Friday, March 23, 2018
Comprehensive Pain Management in Franklin, MA

Chronic pain is affecting more and more Americans. A recent study revealed that chronic or severe pain affects nearly 50 million American adults on a consistent basis. What impact does chronic pain have on the workforce, and how can an HR team better support these individuals?

An Invisible Disability

Chronic pain is typically defined as pain which lasts for three to six months or longer. It is very often an invisible disability, which makes it very difficult for people to live with. They may need to take more sick days, or go through periods of time where their productivity takes a hit — and their fellow colleagues may not understand why. This absenteeism also has a financial cost. A survey revealed that approximately $24.2 billion is lost annually in the professional sector as a result of absenteeism from poor health.

When someone needs to miss work due to illness or injury, impacts are felt throughout the organization. Other people may step in to take on the work, or a new hire may be trained up if their time off work is more substantial. At first your financial statements may not seem impacted, yet the Integrated Benefits Institute estimates that opportunity costs of disability can amount to an additional 38 percent of absent workers’ wages for the U.S. workforce.

Helping Those with Chronic Pain

For HR directors or managers, it can feel like there is no clear approach to dealing with chronic pain in an effective manner. However, there are various ways to manage chronic pain in the workplace, and the importance of incorporating compassion into the process cannot be overstated.

Here are several ways you can support your workers:

Break Down the Stigma: One of the major barriers that people with chronic pain endure is the fact that it’s so often an invisible disability. People may not look like they have anything wrong with them, yet they are battling a very real illness. Be proactive in building a wellness culture in your organization. Take steps to eliminate barriers that might cause people to not seek help or explain what they’re dealing with, whether through educational meetings, personal sit-downs, or proactively checking in with someone whose productivity is dipping, to see whether there is a bigger issue at play.

Enhance Awareness of Treatment Options: Many people who suffer from chronic pain do so without knowing where to turn. By providing employees with information about effective treatment options, they can find the best plan for dealing with the pain. You can adapt the office environment such as incorporating ergonomic stations where people can work — and make sure that employees are taking their breaks.

Offer Benefits Like Disability Insurance: The chances of someone having an illness or injury that puts them out of work for several months is higher than most people realize. According to the U.S. Social Security Administration, one in four of today’s 20-year olds will experience a disability before retirement age. Disability insurance is an affordable benefit that helps to protect an employee’s income if they do need to take time off the job — reducing the financial pressure while they recover.

Chronic pain isn’t something that’s going to disappear from the professional landscape, but its impacts can be lessened with the right approach. By building a workplace culture that is open and inclusive, you’ll be able to support employees and boost morale across the organization.

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


Chronic Pain Triggers to Avoid

Joseph Coupal - Friday, March 09, 2018
Comprehensive Pain Management in Franklin, MA

If you’re among the 1 in 5 people in the U.S. living with chronic pain, you know that some days are better than others — even when you’re rigorously following your treatment plan.

In those instances, the pain is often triggered by something out of your control, like the weather or a sudden bout of catastrophic thinking. Some of these triggers are universal, while others are a bit more personal. Read on to learn how to recognize what’s setting off your pain and the strategies for relieving it.


Nearly everyone with chronic pain can experience a worsening of symptoms when they’re very stressed. If a patient’s pain is relatively stable and they then experience a stressful problem in their life, invariably the pain gets worse.

What to do: Try mindfulness-based stress reduction, which can also reduce pain. Until you deal with the stress, no amount of medication is going to help.

Weather Changes

It’s not just a superstition. When the temperature climbs or dives, you may notice a change in symptoms. Even extremely heavy winds can worsen your pain levels.

How the weather affects a person’s pain is hard to prove scientifically, but one January 2015 study in the journal Pain Medicine found that patients with fibromyalgia said that weather changes were one of their main triggers.

What to do: Short of going on vacation, staying indoors during a weather change is the best way to manage the pain. Arthritis patients with chronic pain often feel better if they dress warmly and wear gloves.

Too Little Sleep

Sleep and chronic pain have a complicated relationship. It’s a very vicious cycle. The more pain you have, the less well you will sleep. And the less you sleep, the more you will have pain. In fact, 95% of people with chronic pain have sleep problems.

What to do: Practice something that doctors call “good sleep hygiene.” That means no TV or other electronics in the bedroom. Television and cell phones emit light, and light can stimulate brain activity and make it harder to fall sleep, he says. Other rules: Don’t exercise two to three hours before bedtime and try to finish a meal or alcohol beverage at least four hours before you want to fall asleep.

Inflammatory Foods

It’s thought that certain foods (like the processed kinds) may cause inflammation in the body, which then triggers more pain. But the supporting research isn’t “rock solid” and it’s difficult to say how many people these types of foods affect. (And some patients may not make the connection between a flare-up and what they just ate.)

What do to: If you experience a flare-up after eating a certain food, avoid it. Processed fare, for instance, triggers more inflammation than green leafy vegetables or tree nuts. You can also add anti-inflammatory foods like olive oil and salmon to your diet.

Catastrophic Thinking

When you’ve been living with chronic pain, it’s natural to think that things will get worse. You get a little pain in the tip of your finger and you decide your arm is falling off. Well, that tendency to “catastrophize” will only make you feel worse.

In fact, it’s like a self-fulfilling prophecy: In a 2011 study in General Hospitality Psychiatry, researchers found that chronic pain patients who both catastrophized and were depressed were more likely to have pain-related disability.

What to do: Pay attention to your thoughts. When you start worrying , notice it without judgement. Say, “There I go again,” not, “What’s wrong with me?” By cutting off these catastrophic thoughts, you might find it easier to go about your daily life, suggests the authors of the 2011 study. If you need to seek help, try to choose a psychologist or counselor who specializes in treating chronic pain patients.

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


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