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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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.


What are the Basic Types of Pain?

Joseph Coupal - Monday, September 04, 2017
Comprehensive Pain Management in Franklin, MA

There are many sources of pain. One way of dividing these sources of pain is to divide them into two groups, nociceptive pain and neuropathic pain. How pain is treated depends in large part upon what type of pain it is.

Nociceptive pain

Examples of nociceptive pain are a cut or a broken bone. Tissue damage or injury initiates signals that are transferred through peripheral nerves to the brain via the spinal cord. Pain signals are modulated throughout the pathways. This is how we become aware that something is hurting.

Neuropathic pain

Neuropathic pain is pain caused by damage or disease that affects the nervous system. Sometimes there is no obvious source of pain, and this pain can occur spontaneously. Classic examples of this pain are shingles and diabetic peripheral neuropathy. It is pain that can occur after nerves are cut or after a stroke.

Nociceptive pain

Most back, leg, and arm pain is nociceptive pain. Nociceptive pain can be divided into two parts, radicular or somatic.

Radicular pain: Radicular pain is pain that stems from irritation of the nerve roots, for example, from a disc herniation. It goes down the leg or arm in the distribution of the nerve that exits from the nerve root at the spinal cord. Associated with radicular pain is radiculopathy, which is weakness, numbness, tingling or loss of reflexes in the distribution of the nerve.

Somatic pain: Somatic pain is pain limited to the back or thighs. The problem that doctors and patients face with back pain, is that after a patient goes to the doctor and has an appropriate history taken, a physical exam performed, and appropriate imaging studies (for example, X-rays, MRIs or CT scans), the doctor can only make an exact diagnosis a minority of the time. The cause of most back pain is not identified and is classifies as idiopathic. Three structures in the back which frequently cause back pain are the facet joints, the discs, and the sacroiliac joint. The facet joints are small joints in the back of the spine that provide stability and limit how far you can bend back or twist. The discs are the "shock absorbers" that are located between each of the bony building blocks (vertebrae) of the spine. The sacroiliac joint is a joint at the buttock area that serves in normal walking and helps to transfer weight from the upper body onto the legs.

Once the cause of the pain is diagnosed it can be optimally treated. For information on pain treatment, contact Comprehensive Pain Management in Franklin, MA.


Chronic Pain Coping Techniques

Joseph Coupal - Thursday, August 10, 2017
Comprehensive Pain Management in Franklin, MA

Clinicians who specialize in treating chronic pain now recognize that it is not merely a sensation, like vision or touch, but rather chronic pain is strongly influenced by the ways in which the brain processes the pain signals.

Chronic pain can provoke emotional reactions, such as fear or even terror, depending on what we believe about the pain signals.

The important role the mind plays in chronic pain is clearly recognized in the medical literature, as well as in the International Association for the Study of Pain's definition of pain, which states that pain is always subjective and is defined by the person who experiences it.

The corollary is that the brain can also learn how to manage the sensation of pain. Using the mind to control chronic pain, or coping strategies, for managing persistent pain, may be used alone or in tandem with other pain management therapies.

Ideally, use of the chronic pain management techniques below can help patients feel less dependent on pain killers and feel more empowered to be able to control their pain.

Managing Chronic Pain

Of course, the first step in coping with chronic back pain or other types of persistent pain is to receive a thorough medical evaluation to determine the cause of the pain.

  • In some situations, such as a herniated disc in the spine, it may be important to pay attention to the level and type of pain so that it can serve as a warning signal of impending damage.
  • In other cases, especially when the back pain is chronic and the health condition unchangeable, one goal can be to try and keep the chronic pain from being the entire focus of one's life.

Whatever the medical condition, there are a number of effective strategies for coping with chronic back pain. These techniques generally include:

  • Relaxation training: Relaxation involves concentration and slow, deep breathing to release tension from muscles and relieve pain. Learning to relax takes practice, but relaxation training can focus attention away from pain and release tension from all muscles. Relaxation tapes are widely available to help you learn these skills.
  • Biofeedback: Biofeedback is taught by a professional who uses special machines to help you learn to control bodily functions, such as heart rate and muscle tension. As you learn to release muscle tension, the machine immediately indicates success. Biofeedback can be used to reinforce relaxation training. Once the technique is mastered, it can be practiced without the use of the machine.
  • Visual imagery and distraction: Imagery involves concentrating on mental pictures of pleasant scenes or events or mentally repeating positive words or phrases to reduce pain. You can also learn visual imagery skills.
    Distraction techniques focus your attention away from negative or painful images to positive mental thoughts.
  • Hypnosis: Hypnosis can be used in two ways to reduce your perception of pain. Some people are hypnotized by a therapist and given a post-hypnotic suggestion that reduces the pain they feel. Others are taught self-hypnosis and can hypnotize themselves when pain interrupts their ability to function. Self-hypnosis is a form of relaxation training.

All of the above-describe techniques for coping with chronic back pain make use of four types of skills:

  • Deep Muscle Relaxation
  • Distraction: moving attention away from the pain signals
  • Imagery: visual, sound or other pictures and thoughts that provide a pleasant and relaxing experience
  • Dissociation: The ability to separate normally connected mental processes, leading to feelings of detachment and distance from the chronic pain.

For more information on managing chronic pain with a multi-faceted approach, contact Comprehensive Pain Management in Franklin, MA.


Degenerative Disc Disease and Being Overweight

Joseph Coupal - Thursday, July 20, 2017
Comprehensive Pain Management in Franklin, MA

Degenerative disc disease (DDD) can affect any one of us as we age. But it can be especially problematic for people who are overweight.

Your spine is made to help carry your body's weight. It's designed to keep your weight balanced and evenly distributed. Your vertebrae go from smallest to largest: small in your neck (cervical spine) and largest in your low back (lumbar spine). They increase in size because the lower parts of the spine have to support the most weight and therefore need to have the largest vertebrae.

Your intervertebral discs—the cushions in between your vertebrae—increase in size, too. They're thickest in the lumbar spine because they need to absorb and adapt to the most weight.

The spine has such an intricate design, one that hinges on all parts working as they should. However, in degenerative disc disease, parts of your spine change and lose their ability to properly function. Intervertebral discs gradually become less capable of absorbing and cushioning your movements. Joints, such as the facet joints, may then change as they readjust to changes in the disc; they may not move as easily, making it harder for your body to carry and distribute weight.

Extra weight puts extra strain on the spine. If you have DDD and are overweight, then you're stressing and straining your vertebrae and discs even more. The extra weight could even accelerate the degenerative processes because the parts of your spine will have to work harder to carry the extra weight—and the harder they work, the faster they may wear out (degenerate).

A diagnosis of degenerative disc disease could be just the motivation you need to lose extra weight, become more physically active, stop smoking, and or make other lifestyle changes to benefit your spine and general health. Comprehensive Pain Management in Franklin, MA can offer helpful suggestions for treating DDD. For more information, contact us.


Balloon Kyphoplasty Can Help Heal Spine Fractures

Joseph Coupal - Thursday, June 29, 2017

Kyphoplasty is a procedure used to treat certain fractures in vertebrae, or bones of the spine. The fractures treated by kyphoplasty are compression fractures. These fractures usually occur in bones weakened by osteoporosis (a thinning of the bones). In compression fractures, the main section of bone known as the vertebral body collapses. These fractures are not only painful, but they may put harmful pressure on the nearby nerve roots or on the spinal cord itself.

Non-operative treatments like pain medication, activity modification, and/or bracing can be utilized for these fractures. Vertebral fractures can take about three to six months to fully heal with these measures. However, some patients may continue to have progressive collapse of their vertebrae. Braces are extremely uncomfortable and can affect pulmonary function among other issues and along with medication do not always guarantee healing. Kyphoplasty treats these fractures by making space in the bone that was lost when the bone collapsed, then filling that space with a solid, cement-like mixture. This procedure is an immediate fix with no bracing or medications needed. But a kyphoplasty may not be right for all fractures. Evaluating an individual’s case and determining the best procedure for that patient is imperative. This procedure may be performed under local or general anesthesia.

To perform the kyphoplasty, a thin surgical needle with a balloon inside it is used. The instrument is inserted through the skin and back muscles and into the bone. The balloon is then inflated, which comes out the end of the needle and creates a space in the vertebra as it inflates. This portion of the procedure usually helps the bone regain its normal shape. Next, the filler mixture is injected through the needle and into the balloon. This procedure does not require stitches and usually takes less than an hour.

Kyphoplasty is a minimally invasive, office-based procedure that stabilizes the fracture and usually provides immediate pain relief in most patients. For more information on balloon kyphoplasty, contact Comprehensive Pain Management in Franklin, MA.


Epidural Steroid Injections – Franklin, MA

Joseph Coupal - Wednesday, May 31, 2017

One of the most commonly performed pain management procedures is the Epidural Steroid Injection or ESI, used to provide pain relief from spine-related conditions, such as pinched nerves or spinal stenosis. It is completely different from the kind of epidural given to treat labor pain for women during childbirth.

Labor and delivery epidurals are performed by an anesthesiologist in the hospital and create numbness and weakness below the waist. No steroid is used, but a strong anesthetic medication is delivered through a catheter, providing pain relief and total lack of feeling. A woman having an L & D epidural will not be able to walk until the numbing medication wears off.

The type of epidural injection used to treat spinal and limb pain is different in several ways. It is performed in a doctor’s office in a procedure room, using special X-ray equipment called a C-Arm. A type of X-ray guidance called fluoroscopy is used, which gives the doctor a real time image of the spine.

The doctor injects anti-inflammatory steroid medication, not numbing medication, and the patient does not have weakness or lack of feeling as a result. To determine the best location for medication to be placed, during your ESI you should be asked about your symptoms, get a physical exam and compare the location of your pain to the MRI or CT scan ordered for you. A small injection of numbing medication is given where the epidural is to be inserted. The needle is placed correctly and a small amount of contrast dye is injected. This dye confirms the optimal placement for the injection. The steroid is injected and the needle is removed. This type of epidural does not produce significant numbness or weakness and the patient can walk immediately after the procedure.

There may be some soreness or bruising at the injection site but the application of ice helps. Patients can also take Tylenol for discomfort. After the epidural steroid injection, you must have someone drive you home because the injection may cause dizziness, which will pass after a few hours. It is recommended that you avoid taking a bath for 24 hours after the injection, but you can shower any time.

All epidural steroid injections carry a small risk for complications, such as infection at the injection site, a puncture of the dura, post-injection headache or an allergic reaction to the contrast dye used. All of these, should they happen, are easily treatable, do not cause paralysis and are not life-threatening if treated.

Pain relief is usually not immediately felt from the steroid, but from the numbing medication that is combined with the steroid. This pain relief is temporary and passes in a few hours. Steroids generate a reduction in inflammation, usually resulting in a decrease in pain. This effect will typically be seen within 3 to 5 days.

Often times, patients report being very nervous about having an ESI. Many incorrectly equate it with the kind of epidural given in Labor & Delivery. Some think that the shot could potentially paralyze them or that some other horrific side effect will happen afterwards. Epidural Steroid Injections are very safe and effective when given by a trained pain management specialist.

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

Source: Daily Press