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Spinal Cord Stimulation Relieves Back Pain

Joseph Coupal - Thursday, July 13, 2017
Franklin Pain Center Spinal Cord Stimulation

Doctors who treat patients suffering from back pain are exploring new approaches that help some patients avoid opioid drugs. The highly addictive prescription painkillers are fueling an epidemic of abuse and overdose deaths. One opioid-free option involves stimulating the spinal cord with very short pulses of electricity. Patients can’t feel the electrical stimulation, yet it often effectively can mask the perception of pain.

Spinal cord simulation to relieve pain is not new. It first was introduced many years ago, but older stimulators produce a tingling sensation designed to replace pain with less unpleasant tingling. The newer, high-frequency spinal cord stimulators deliver more energy but without the tingling sensations. Pain specialists at Washington University School of Medicine in St. Louis were involved in clinical trials of the new stimulation devices; in 2015, the FDA approved the devices as a treatment for back pain. Most but not all insurance plans cover treatment.

As many as one in three Americans suffer from low back pain. Its economic impact is greater than that of heart disease and cancer combined. Patients have many treatment options, but many don’t get relief after surgery or injections. Opioids can help some patients temporarily, and physical therapy also helps, but the new-generation stimulators fill an important niche, helping people return to normal activity without pain or the side effects that can result from opioids.

Deanna Conley, 77, has endured back pain for years. Despite multiple surgeries, she needed a wheelchair last fall to travel any significant distance. In addition, she began to worry about the number of pain pills she took each day. “I was supposed to take one hydrocodone pill at night before bed,” Conley said. “But it got to where I was taking two pills a day and then three, and I worried I might end up being a drug addict at 77.”

It was determined that she would be a good candidate for a high-frequency stimulator. Studies have shown the devices may be more effective in patients who have had previous back surgery but still have back pain. Research also indicates that although traditional stimulators work well when pain in the back is radiating into arms or legs, the high-frequency stimulators may be more effective when pain is located in the back itself. Traditional spinal cord stimulators provide a pleasant sensation in place of pain from sciatica problems or pain down the arm caused by cervical spine problems. But for people like Ms. Conley, who had already had back-fusion surgery and still had pain, those older devices often aren’t as effective. Electrodes were inserted into the area of Conley’s back where her pain was most acute. The stimulator initially remained outside her back, but after doctors were able to verify that the approach was having an effect, a minimally invasive technique was used to implant the entire device into the lower part of her back.

In clinical studies, 75 percent of subjects treated with the high-frequency stimulators experienced reductions in pain of at least 50 percent after three months. Conley reported a 70 to 80 percent reduction in back pain almost immediately. She is able to walk without assistance for considerably longer distances than she could before the stimulator was implanted, and she even registered for an exercise class.

She’s receiving physical therapy and getting stronger now that she is able to use muscles she couldn’t use previously because of her back pain. It’s important that a team approach involving doctors, physical therapists and psychologists is used to help people focus their thoughts on things other than their pain. Even when a device like this reduces pain, there still is muscle weakness to overcome, so patients need physical therapy to get stronger, to make sure they’re walking correctly and to focus on core stabilization to keep the pain in check.

Not long ago, we thought of pain as a symptom of some other underlying disease process. Now we’re learning that pain also may be a disease itself. And in this time of opioid abuse, we must be vigilant in insisting that pain-killing drugs aren’t overused. Some patients benefit from opioids, but other interventions, combined with a multidisciplinary approach to care, may provide pain management without the side effects and risks associated with opioids.

For more information on a team approach to pain management or for more information on spinal cord stimulation, contact Comprehensive Pain Management in South Kingston, RI.

Source: medicine.wustl.edu

Know Your Pain Treatment Options

Joseph Coupal - Thursday, June 15, 2017
Comprehensive Pain Management Pain Treatment Options

Pain can be a debilitating condition, but there are ways to keep it under control. Learn about different pain management options.

Whether your pain is from arthritis, cancer treatments, fibromyalgia, or an old injury, you need to find a way to get your pain under control. What's the best approach to do that?

The first step in pain management is scheduling an appointment with your doctor or pain treatment center to determine the cause of your pain and learn which pain management approach is often the most effective for it. There are many different pain management options available: You can find the right treatment combination to get the relief you need.

Before you try to treat your pain, it's important to understand how pain is defined.

Pain is an unpleasant sensory and emotional experience. When doctors focus only on the sensory aspect, they fail to appreciate the suffering component of the pain, which is important to recognize because pain is not what occurs at the periphery.

Why Do People Experience Pain Differently?

Pain is real and it's physical — there's no mistaking that. But pain is measured and specific to one person based on that person's perception of the pain, and that's why everyone's pain is different.

What the brain perceives is indisputably modifiable by emotions. That means that people who are fearful of pain, depressed, or anxious may experience pain differently and perhaps more severely, than someone who has pain but isn't experiencing those other emotions.

Pain Management: Treating Mind and Body

It is important to approach pain both physically and emotionally and address "people as entire human beings.” So while chronic pain medication can be effective and important for pain management for many people, it isn't the only tool available when it comes to pain treatment and it shouldn't be the only tool that's used.

There are a lot of medications that are prescribed for pain, although opioids (narcotics) and benzodiazepines may not be the best options. Those treatments have their own problems, and there are no good studies on using opioids for long periods of time for the treatment of chronic pain.

Types of chronic pain medication used include:

  • NSAIDs (non-steroidal anti-inflammatory drugs), including ibuprofen, naproxen, and aspirin
  • Acetaminophen (Tylenol)
  • Antidepressants, which can improve sleep and alleviate pain
  • Anti-seizure medications, which can be effective in treating pain related to nerve damage or injury
  • Steroids, like dexamethasone and prednisone, to alleviate inflammation and pain
Therapy.

Therapy can be aimed at both the mind and the body. Any of these therapies should not be purely physical or purely psychological — they should be a mixture of both of those things.

Physical therapy is a very important part of any pain management program. Pain can be worsened by exercise that isn't done correctly (or interpreted incorrectly as pain rather than overuse), and a physical therapist can tailor the right exercise regimen for you. Proper exercise slowly builds your tolerance and reduces your pain — you won’t end up overdoing it and giving up because it hurts.

Cognitive-behavioral therapy allows people to learn and have a better understanding of what the pain is from, and what they can do about it. This therapy is really about understanding the role of pain in your life and what it actually means for you.

Other pain management options.

A variety of approaches and modalities can help you deal with both the physical and emotional parts of pain:

  • TENS (transcutaneous electrical nerve stimulation) therapy
  • Meditation
  • Relaxation techniques
  • Visual imagery, as simple as picturing a peaceful scene, for example
  • Biofeedback, which teaches control over muscle tension, temperature, heart rate and more
  • Heat and cold therapy
  • Manipulation and massage
  • Professional Pain Management Treatments

The bottom line: Seek help for your pain as soon as it becomes a problem in your life. When chronic pain starts to destroy your ability to function in the world, then it's a problem that needs to be addressed.

For more information on chronic pain management, contact Comprehensive Pain Management in South Kingston, RI

Source: everyday health

Tips for Reducing Back Pain at the Office

Joseph Coupal - Thursday, June 01, 2017
Comprehensive Pain Management Tips for Reducing Back Pain

The following five points highlight important ways to improve posture in the workplace, helping to reduce back and neck pain and stiffness.

  • Use exercise to help prevent injury and promote good posture

    Regular exercise such as walking, swimming, or bicycling will help the body stay aerobically conditioned, while specific strengthening exercises will help the muscles surrounding the back to stay strong. These benefits of exercise promote good posture, which will, in turn, further help to condition muscles and prevent injury.

    There are also specific exercises that will help maintain good posture. In particular, a balance of core muscle and back muscle strength is essential to help support the upper body and maintain good posture.

  • Wear supportive footwear when standing.

    Avoid regularly wearing high-heeled shoes, which can affect the body’s center of gravity and induce compensatory alignment of the entire body, thus negatively affecting back support and posture. When standing for long periods of time, propping a leg up on a foot rest, wearing supportive shoe orthotics, or placing a rubber mat on the floor can improve comfort.

  • Remember good posture and ergonomics when in motion.

    Simply walking, lifting heavy materials, holding a telephone, and typing are all moving activities that require attention to ergonomics and posture. It is important to maintain good posture even while moving to avoid injury, walking tall with shoulders back for example. Back injuries are especially common while twisting and/or lifting and often occur because of awkward movement and control of the upper body weight alone.

  • Create ergonomic physical environments and workspaces, such as sitting in an office chair at a computer

    It does require a small investment of time to personalize the workspace, home, and car, but the payoff will be well worth it. Undue strain will be placed on the structures of the spine unless the office chair, desk, keyboard, and computer screen, etc. are correctly positioned.

    It's much easier and less time consuming to correct everyday ergonomics and minimize back or neck pain than to add doctor visits and corrective therapies for debilitating pain conditions.

  • Avoid overprotecting posture.

    Remember that it is important to maintain an overall relaxed posture. Avoid restricting movements by clenching muscles or adopting an unnatural, stiff posture. For individuals who already have some back or neck pain, it's a natural tendency to limit movements to avoid provoking increased pain. However, unless there is a fracture or other serious problem, the structures in the spine are designed for movement and any limitation in motion over a long period of time creates more pain and a downward cycle of less motion and more pain.

The above changes are relatively easy to make and will pay off in terms of a healthier spine and less pain and stiffness over time.

For more information on treating back pain, contact Comprehensive Pain Management in South Kingston, RI.

Chronic pain treatment practice opens in South Kingstown

Joseph Coupal - Tuesday, May 09, 2017

Comprehensive Pain Management Centers, with offices in Warwick and Franklin, Mass., recently opened its doors in the Village at South County Commons, at 50 South County Commons Way, Suite E-5A. Drs. Do Chan and Boris Shwartzman, the founders of the centers, are board certified in anesthesia and pain, and are the practicing anesthesiologists at the office. The doctors said that in recent years, narcotic prescriptions have decreased and new technologies combined with a multidisciplinary approach to care have brought much needed relief to those suffering from chronic pain — an important development at a time when the use of opioids has created an epidemic of drug overdoses.

As physicians have begun approaching chronic pain as a condition of its own, a spectrum of options are available for patients, the doctors said. “We felt that people of South County were under-served with regards to pain management services,” Shwartzman said. “They had to endure long drives in order to see a pain specialist and we decided to bring our expertise closer to their place of living.” The specialists said they create customized treatment plans to deal with each patient, based on a “thorough consensus with any other physicians that may be involved in the patient’s treatment.” An in-house psychologist can help patients “overcome the hurdles associated with living in chronic pain,” the doctors said in a news release. For more information call the office at 401 234-9677 or visit www.comprehensivepainmd.com.

Outpatient Balloon Kyphoplasty Offers Low-Risk Treatment for Fractured Backs - South Kingston, RI

Joseph Coupal - Friday, April 28, 2017

Medically fragile patients may benefit most from kyphoplasty

For older Americans, standing up can be a painful challenge after falling down, especially if they've suffered a fracture in their back.

“Pain was terrible," said an 81-year old patient. "It (the pain) went from an 8 to a 9. It was very bad."

He spent all day in his bed or a chair, hoping that time would heal whatever injury he had, but an X-ray later revealed two broken bones in his spine.

He had a very typical, common fracture.

Doctors see a lot of patients like this one with cracked bones in the vertebrae that start to compress and collapse. Some arrive at the office hunched over.

The pain can be intense. It leads to people staying home; not doing things. They don't take deep breaths as well. And it really can be a rapid downward spiral, not just in pain but in their health.

The patient was scheduled for a balloon kyphoplasty, a minimally invasive outpatient procedure to repair the fractures in his spine.

The concept of this procedure is to put a balloon inside the broken vertebrae. The balloon restores the height of the compressed bone and creates a space for the doctor to insert toothpaste-like bone cement so the previously collapsed vertebrae can remain restored  

The balloon kyphoplasty procedure can take 30 minutes.

Patients are on their belly for a short time. And two weeks later, they don't even remember having the treatment done.

But for this particular patient, the procedure was something he'll never forget. He now moves around his house comfortably with a walker.

Often, medically fragile patients benefit the most from the procedure, which improves overall health.

For more information, contact Comprehensive Pain Management in South Kingston, RI.

WCVB - Boston

Radiofrequency Ablation for Arthritis Pain - South Kingston, RI

Joseph Coupal - Friday, April 21, 2017

Radiofrequency ablation (or RFA) is a procedure used to reduce pain in your back and neck and in arthritic joints. An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, decreasing pain signals from that area.

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 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 it Safe?

Radiofrequency Ablation 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.

What Are the Side Effects?

The main side effect of Radiofrequency Ablation is some discomfort, including swelling and bruising at the site of the treatment, but this generally goes away after a few days.

Radiofrequency Ablation is the most modern treatment available for treating facet joint related pain in the neck, mid back, and low back area.

Radiofrequency ablation is done under local anesthesia and generally takes about 20 minutes to one hour. For more information on treating chronic pain, contact Comprehensive Pain Management in South Kingston, RI.

Source: WebMD

Recommended Therapies for Lower Back Pain – South Kingston, RI

Joseph Coupal - Thursday, March 16, 2017

According to new guidelines recently issued by the American College of Physicians, physicians should avoid prescribing narcotics for acute lower back pain when possible.

Instead, doctors should recommend minimally invasive procedures aimed to treat painful conditions.

Low back pain is one of the most common reasons for doctor visits in the U.S. Approximately one-fourth of U.S. adults reported having low back pain lasting at least one day in the past three months.

In the evidence-based clinical practice guideline the American College of Physicians said if drug therapy is desired, physicians and patients should select nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants.

Acute pain is defined as lasting less than four weeks, subacute pain lasts four to 12 weeks and chronic pain lasts more than 12 weeks. Physicians should reassure their patients that acute and subacute low back pain usually improves over time and there are innovative treatments that can be performed to promote faster pain resolution. Physicians should avoid prescribing unnecessary tests and costly and potentially harmful drugs, especially narcotics, for these patients.

For chronic low back pain, the American College of Physicians initially recommends non-drug therapy with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise (MCE), progressive relaxation, electromyography biofeedback, low level laser therapy, operant therapy, cognitive behavioral therapy or spinal manipulation.

Physicians should remind their patients that any of the recommended physical therapies should be administered by providers with appropriate training. Physicians should consider opioids as a last option for treatment and only in patients who have failed other therapies, as they are associated with substantial harms, including the risk of addiction or accidental overdose.

Clinical outcomes evaluated included reduction or elimination of low back pain, improvement in back-specific and overall function, improvement in health-related quality of life, reduction in work disability/return to work, global improvement, number of back pain episodes or time between episodes, patient satisfaction and adverse effects.

For more information, contact contact Comprehensive Pain Management in South Kingston, RI.

Source: register-herald.com


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