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

South Kingstown Pain Center RI Blog

RSS Grab RSS Feed

Migraines: What You Need to Know

Joseph Coupal - Friday, December 07, 2018
Comprehensive Pain MD - Migraine Headache Pain Treatment

If you have ever experienced a migraine, you are not alone – they are very common, with over 28 million people in the US estimated to suffer from them. Below is an explanation on what a migraine is, what may cause it, and treatment options.

The symptoms of migraines include an intense throbbing headache that may be accompanied by sensitivity to light, sound, or smell, nausea, vomiting, and dizziness.

A common migraine includes moderate to severe pain and is typically felt on one side of the head, although for some people, it can effect both sides of the head. Usually, this headache has a gradual onset with a crescendo like pattern, and often feels similar to a flu-like illness. It can affect vision, hearing or smell. Patients are often worse with activity and tend to seek rest in a dark, quiet room.

After the headache passes, patients often have mood changes, weakness or are very fatigued.

What Causes Your Migraine?

Although the exact cause of a migraine is not known, many researchers believe that a migraine headache could be caused by abnormal brain stem activity or changes in the trigeminal nerve, which could lead to changes in blood vessels in the brain. Many patients have certain triggering agents or events that lead to a migraine. Examples of different triggering agents include: stress, bright lights, medications, getting too much or too little sleep, certain smells, and foods such as alcohol, cheese, chocolate and foods containing aspartame or MSG. Hormone changes can also affect migraine patterns.

Getting Relief from Your Migraine

There are extensive treatment options to relieve or manage migraine headaches. Treatment options often depend on the severity and frequency of the headaches.

Some medications are used to treat active migraines and other medications are used to prevent migraines. There are extensive medications that have been tried in both categories, such as NSAIDs, anti-nausea medication, beta blockers, anti-convulsants or triptans.

Other therapies, like acupuncture, have been tried for treatment of migraine headaches. More interventional approaches include occipital nerve blocks or trigger point injections.

Botox for migraines has been FDA approved as a preventative treatment for chronic migraines. Botox can be given by injection on a three-month interval to reduce the frequency and/or intensity of migraine headaches. Since this is being used as a preventative treatment, it might reduce the need for other medications.

If you suffer from headaches, you should consider consulting with your physician or pain management specialist to determine the exact cause of your headaches and to develop a treatment plan that is optimal for you.

For more information on treating migraines, contact Comprehensive Pain Management in South Kingstown, RI.


Tips to Reduce Back Pain and Stress during Holidays

Darren Kincaid - Thursday, November 29, 2018
Comprehensive Pain Management - Spinal Cord Stimulation Works -  South Kingstown, RI

The holidays can be a time of excitement mixed with stress. For people with chronic back or neck pain, the strain of accomplishing your to-do list can overshadow the pleasure of the season. This year, plan ahead so you can get your holiday chores done with a minimum of pain.

Here are some tips for making these next few weeks more enjoyable and comfortable.

Tip 1: Simplify Shopping

Back and leg pain, including sciatica, may make managing the mall difficult if not downright impossible during this busy shopping season. Options: pick up gift cards from your local drugstore or grocery store. You’ll be letting your family, and friends pick out items they truly want, while avoiding lifting and carry heavy shopping bags. Or, if you do want to buy personalized gifts, shop online. You can have the gifts shipped straight to your loved ones and friends, and avoid long lines at the post office.

Tip 2: Plan Ahead Before Cooking

Having a big crowd over? Prepare as much as you can ahead of time. Pies can be done the day before and you can chop onions and celery for stuffing days in advance. Before you start cooking, take a look at your kitchen. Is there a place you can sit while chopping? If not, use the living room for some tasks. If you are using a high counter top, lean on it often for 10 to 15 seconds at a time to take some pressure off your back.

Don’t get stuck in any one position for too long. If you forget, set your timer to remind you to sit down, rest, or stand up.

Tip 3: Making Decorating a Group Activity

Don’t try decorating by yourself. This is especially important when you’re moving heavy or cumbersome objects or putting up the Christmas tree. Get someone to help you, so one person can hand lights and ornaments to the other person to hang. This way, you’ll avoid repetitive reaching or twisting in a way that adds stress to your back.

Tip 4: Take Care of Yourself

The holidays can be so busy that you may be tempted to give up on your regular eating and exercise routine. Don’t do it—you need to strengthen and stretch your body with exercise no matter how hectic things get. Stretching can help you stay limber and reduce your risk of back or neck strain. If you don’t have time for your regular exercise routine, don’t give it up altogether. Try breaking exercise up into smaller chunks of time throughout the day.

Continue to eat regular, healthy meals. Gaining weight can make back pain worse. Keeping on track with healthy eating isn’t always easy during the holidays, so have some strategies in place before you start the round of holiday parties.

Tip 5: Look Ahead

As you look ahead to the coming year, consider simple ways to improve your back or neck pain. It can be as easy as setting a goal to add a 5- to 15-minute walking break to your day. For more information, or to make 2019 pain free, contact Comprehensive Pain Management in South Kingstown, RI.


How Spinal Cord Stimulation Works to Treat Chronic Back Pain

Joseph Coupal - Friday, November 09, 2018

In this basic overview, you'll discover how spinal cord stimulation (SCS) works, and why it can be such a promising therapy for chronic pain.

For more information on spinal cord stimulation, contact Comprehensive Pain Management in South Kingstown, RI.

Lumbar Radiofrequency Neurotomy Treatment, What is it?

Joseph Coupal - Friday, October 26, 2018
Comprehensive Pain Management - South Kingstown, RI

A radiofrequency neurotomy is a type of injection procedure used to treat facet joint pain.

Facet joints are pairs of small joints between the vertebrae in the back of the spine. The facet joints support the spine while also allowing motion in terms of bending, flexing and twisting. Each facet joint is connected to two small medial branch nerves that carry pain signals from the facet joints to the brain.

A number of spinal conditions can lead to facet joint pain, such as osteoarthritis and spinal stenosis, or from a trauma to the back, such as a car accident.

A radiofrequency neurotomy - also called radiofrequency ablation - begins with the patient laying face down on a table. The skin and tissue over the procedure site is numbed with an injection of local anesthetic.

Next, the physician uses x-ray guidance, called fluoroscopy, to direct a special radiofrequency needle alongside the medial nerves.

Often, a small amount of electrical current is carefully passed through the needle to assure it is next to the target nerve and a safe distance from other nerves. This current should briefly recreate the usual pain and cause a muscle twitch in the back.The targeted nerves will then be numbed with a local anesthetic to minimize pain.

The radiofrequency waves are introduced to heat the tip of the needle and a heat lesion is created on the nerve to disrupt the nerve's ability to send pain signals to the brain.

As with many spinal injection procedures, radiofrequency neurotomy works better for some patients than for others. It is often helpful in reducing a patient's pain enough to participate in a rehabilitation program.

For more information on Radiofrequency Neurotomy, contact Comprehensive Pain Management in South Kingstown, RI.


Non-Invasive Treatment for Spinal Stenosis

Joseph Coupal - Friday, October 12, 2018
Comprehensive Pain Management - Franklin, MA

There is a wide range of nonoperative treatments for spinal stenosis. The more common options include:

Exercises. A suitable program of physical therapy and exercise is a component of almost every spinal stenosis treatment program. While the spinal stenosis exercises are not a cure, it is important for patients to remain active as tolerated and not become additionally debilitated from inactivity.

The treating physician may prescribe a supervised physical therapy program. After a period of physical therapy instruction, most people can then transition to their own exercise program. The key is to start slowly, and build strength and tolerance over time.

Activity modification. Patients are usually counseled to avoid activities that worsen their spinal stenosis symptoms. For lumbar stenosis, patients are typically more comfortable while flexed forward. For example, recommended activity modification might include walking while bent over and leaning on a walker or shopping cart instead of walking upright; stationary biking (leaning forward on the handlebars) instead of walking for exercise; sitting in a recliner instead of on a straight-back chair.

Epidural injections. An injection of cortisone into the space outside the dura (the epidural space) can temporarily relieve symptoms of spinal stenosis. Some recent studies have questioned the long term efficacy of these injections, and there are some concerns about the use of corticosteroid injections for patients at risk for osteoporosis related fractures. While it is still a mainstream option offered by many physicians, as with most treatments there are both risks and benefits.

Medication. Anti-inflammatory medication (such as aspirin or ibuprofen) may be helpful in alleviating spinal stenosis symptoms. With careful use, a short term course of narcotic medication use may be helpful for severe episodes of nerve related pain. Some physicians will also prescribe muscle relaxers and nerve desensitizing medications such as gabapentin. In some instances, anti-depressant medications can also provide pain relief. Side effects from medications are always a concern. As a precaution, it is essential the patients make sure their physician and pharmacist are aware of all their medications and medication allergies.

For more information on non-invasive treatments for Spinal Stenosis, contact Comprehensive Pain Management in South Kingstown, RI.


Why is Discography Used for Disc Abnormalities?

Joseph Coupal - Friday, September 28, 2018
Comprehensive Pain Management in South Kingstown, RI

Although magnetic resonance imaging (MRI) is a very good tool for showing disc abnormalities, it does not allow your health care provider to directly determine if the abnormalities are causing your pain. Studies in which MRI was performed in people without back pain show that 35% to 52% of these patients had one or more abnormal discs. In a study of people without back pain but who were of the same age and occupation as a group of back pain patients, 76% had abnormal MRIs. These studies raise the question: If MRI shows that a back pain patient has an abnormal disc, is that abnormality related to the pain or just an abnormality similar to that seen in people without pain?

Discography is a very specific tool that may help your doctor determine if the abnormal disc is causing your pain. Many doctors find discography is helpful in identifying the source of pain. Because discography is an invasive procedure (it involves putting needles into the disc), it is not performed early in the diagnostic and treatment process.

Generally, patients who undergo discography have not gotten satisfactory pain relief from nonoperative measures such as medication, physical therapy and modified activities. They usually have had back pain for at least 4 to 6 months.

Discography is usually used in patients who are being evaluated to determine a specific cause of pain so a new treatment plan (possibly including surgery) can be developed.

How is it Done?

You may receive a light sedative to help you relax during the procedure. The following is a description of one method of performing discography; the exact procedure may vary depending on your medical history and the preference of the health care provider performing the test.

Discography is usually performed in a procedure room that has equipment for X-ray imaging of the discs as the test is performed. You will be asked to lay on one side and may be rolled slightly forward on a table. Your skin will be wiped at the site of the injection with a cleansing antiseptic agent. Typically, the lowest two or three lumbar disc levels are injected. The doctor may inject an anesthetic into the skin to reduce the pain of the needles passing through tissue. In some cases, antibiotics are given intravenously before and after the procedure.

A needle is inserted through the skin and muscle and comes to rest on the outer layer of the disc. During the process of placing the needles, imaging studies called fluoroscopy (similar to X-ray) are used to help the health care provider see where the needles are located along the path to the disc. A second needle is passed through the first one and into the center of the disc. This process is repeated at each level that is to be injected. In some cases, the doctor may decide to inject an additional level and will place needles at that location after the initial injections. Contrast (a liquid that shows up on X-ray), is injected into the center of each disc. If the disc is normal, the contrast remains in the center of the disc. If the disc is abnormal, the contrast spreads through the tears in the disc.

As each disc is injected, you may be asked to rate the intensity of the pain that the injection causes, if any. You may also be asked if the pain is similar to your usual symptoms in terms of location and the type of pain you are experiencing. This procedure is repeated for each disc that is injected. CT scanning is often performed after disc injection. This gives your health care provider more information about the exact pattern of the spread of the contrast through or out of the disc. Widespread disc degeneration is identified by the contrast spreading throughout the disc space.

The injection procedure generally takes about 30 to 45 minutes. After the disc injections, you may be kept for observation. It is advisable that you have someone drive you home. In some cases, pain from the injection can persist for several hours. There may be some residual muscle pain from passing the needles. If you experience intense pain, call your health care provider.

For more information on Discography, contact Comprehensive Pain Management in South Kingstown, RI.

BOTOX for Migraines

Joseph Coupal - Friday, September 14, 2018
Botox Injections for Migraine Headaches

Why is Seeing a Headache Specialist Important?

Experts recommend seeing a specialist because he or she is experienced in injection techniques.

You may be thinking: why 31 injections? It’s because there are proven sites on the neck and head where BOTOX® is injected to make its full impact. Remember, it’s a very fine needle and injections are into shallow muscles of the head and neck, just beneath the skin.

A specialist injects BOTOX into 7 key muscle areas of the head and neck (31 injections total), once every 12 weeks.

With proper injections, you could have fewer headaches and migraines. On average, BOTOX prevents 8 to 9 headache days and migraine/probable migraine days a month as compared to 6 to 7 for placebo.

For more information on BOTOX to treat migraines, contact Comprehensive Pain Management in South Kingstown, RI.

Comprehensive Pain Management Patient Testimonials - South Kingstown RI

Joseph Coupal - Thursday, August 30, 2018

Comprehensive Pain Management Patient Testimonials.

Comprehensive Pain Management is a Substance Abuse Treatment Center to Help Combat All Your Pain

Joseph Coupal - Thursday, August 23, 2018
Comprehensive Pain Management - Warwick, RI

At Comprehensive Pain Management we have the experience and resources in treating patients with substance abuse addiction. Let us help you today.

Opioid dependence affects many people in the US. Unfortunately, people who struggle with opioid dependence may be reluctant to ask for help because of the stigma attached to the notion of "drug dependence."

Opioid dependence is a complex health condition with many elements that are caused or made worse by continued opioid use. It can occur as the brain adapts to the regular use of opioids over time.

You are not alone

Opioid dependence is a chronic disease that can affect anyone.

If you or someone you know may be dependent on opioids, you are not alone. In 2016, there were approximately 2.1 million people† that had abused or were dependent on opioids—such prescription painkillers.

Know your opioids: Opioids can be prescription painkillers. Some examples include oxycodone, hydrocodone, and fentanyl. The street drug heroin is also an opioid.

Do you feel that you have limited control over your medications? Do you feel as though your medications are controlling you? Is this lack of control affecting your relationships with others and interfering with your work and home life? If so, it maybe time to seek professional help, contact Comprehensive Pain Management in South Kingstown, RI.

Non-Invasive Treatments for Chronic Back Pain

Joseph Coupal - Friday, August 03, 2018
Comprehensive Pain Management - Franklin, MA

Doctors who specialize in treating patients for back pain, wish more patients suffering from chronic pain knew the following:

When it comes to strong painkillers and increasingly invasive surgeries, bigger is not better. While surgery is the right option for some, the culture of pain management in the United States has produced the myth that the more invasive and aggressive the technique, the more effective it is. This over-reliance on aggressive techniques, especially opioids and invasive surgeries, puts last resorts at the front of the line while ignoring a range of safer and frequently more effective treatments — injections, vertebral augmentation, stem cell therapy or radiofrequency ablation, to name a few.

Simply put, the more aggressive and invasive techniques have not demonstrated that they produce better results. People aren’t automobiles. Our bodies can’t be put back together quickly or without some downside from surgery. While the more invasive repair may be better for your car, when it comes to people, the less invasive the technique, the better the patient recovery will be.

The primary consequence of the bigger is better mentally has produced a dangerous dependence on opioids for treating non-cancer pain and post-surgical pain. Opioids may be necessary for a relatively comfortable recovery after surgery, but normally not for more than four to six weeks. Recent research estimates that six percent of patients prescribed opioids after surgery become persistent opioid users. Treatment relying on opioids should only be considered a last resort.

Furthermore, it’s not clear that invasive surgeries are effective for patients. As an example, one of the most common pain management procedures is lumbar spinal fusion surgery, which is often used to treat chronic lower back pain. A new study from the medical journal Spine indicates 20 percent of patients undergo another operation within four years of an initial spinal fusion. Patients can only hope they’re not the unlucky one out of five sitting in the doctor’s waiting room who will be back for a second operation.

Pain sufferers should know that the vast majority of their chronic pain could be helped with simple, less invasive procedures without having to make an incision. Patients and doctors should start with the least invasive options before moving on to surgery and more definitive techniques.

Instead of having patients go under the knife and prescribing them opioids, many of patients suffering from chronic lower back pain have experienced tremendous results with radiofrequency ablation, which uses radiofrequency energy to deactivate a nerve that transmits pain from a patient’s lumbar disc. This procedure can be done with a needle during an outpatient visit, and it often provides instant relief that can last for years.

Other procedures include epidural steroid injections (ESIs) and vertebral augmentation surgery. Both are minimally invasive options that help relieve acute and chronic pain.

Epidural injections relieve a variety of conditions, including sciatica, herniated discs and spinal stenosis. During an ESI, a surgeon or interventional pain physician injects a local anesthetic and a steroid into the epidural space, providing swift pain relief for the region. While this relief only lasts for a few weeks or months, it provides patients with enough time to continue working on their physical therapy and for the underlying pathology to heal.

Vertebral augmentation is an injection of a cementing agent into a vertebra in order to stabilize a vertical compression fracture (VCF). VCFs can result in severe deformity and extreme pain, and vertebral augmentation can help fix this injury with minimal complication or risk.

For patients suffering the disabling effects of chronic back pain, it’s important to know there are alternatives to opioids and invasive surgeries; not only radiofrequency ablation, but a whole range of minimally-invasive techniques. In the end, surgery may be necessary — but for many, these other options will prove to be not only safer, but also more effective.

For more information on non-invasive treatments for chronic back pain, contact Comprehensive Pain Management in South Kingstown, RI.