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

Warwick Pain Center RI Blog

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What is Radiofrequency Neurotomy and How Does it Relieve Back Pain

Joseph Coupal - Thursday, June 21, 2018
Comprehensive Pain Management in Warwick, RI

During this minimally invasive procedure, the physician uses heat from radio waves to treat painful facet joints in your lower back. It can treat pain that doesn't respond to medications or physical therapy.

You lie on your stomach and you are given medicine to make you feel relaxed. The skin and tissue of your back are numb.The physician inserts a tube called a cannula. A video x-ray device called a fluoroscope to guide the cannula to the medial branch nerves in your spine. These tiny nerves carry pain signals from the facet joints to the brain.

The physician inserts an electrode through the cannula. A weak electric jolt is used to test its position, if the jolt recreates the pain but does not cause any other muscular effects, then it is in the correct position.

Then the physician uses the electrode to heat the nerve. This disrupts the nerves' ability to transmit pain. Several nerves may be treated together if necessary.

When the procedure is complete, the electrode and cannula are removed and a small bandage is placed on your skin. You are monitored for a brief time before you are allowed to go home. The injection site may be a bit sore, and you may still experience back pain. If the correct nerves were treated, you will gradually experience pain relief as you heal. This may take many weeks, but your relief may last several months.

For more information on Radiofrequency Neurotomy to relieve back pain, contact Comprehensive Pain Management in Warwick, RI.

Who is a Candidate for Kyphoplasty?

Joseph Coupal - Thursday, June 07, 2018
Comprehensive Pain Management in Warwick, RI - Kyphoplasty

What is kyphoplasty?

A compression fracture or a break in one of your vertebra can be painful. It can also make it difficult to move freely. That’s because a break can result in bone fragments rubbing against each other.

Surgery can help treat such fractures. For example, kyphoplasty is a minimally invasive procedure that is often performed. Usually, it can be done without a hospital stay.

Kyphoplasty makes room for a cement mixture to be injected into the bone to give it strength. In this procedure, a doctor inserts and inflates a balloon to create an opening for the mixture. The balloon is removed after the cement is injected. Kyphoplasty is sometimes referred to as balloon vertebroplasty.

This procedure is more likely to be successful if done within two months of a fracture diagnosis. It can help relieve pain and improve mobility when other measures fail to provide relief.

Candidates for kyphoplasty

This procedure can be effective in treating people whose bones are weakened by cancer or whose vertebrae collapse due to osteoporosis, a disease that causes loss of bone density.

Kyphoplasty is used to mend recent fractures. However, it is not used as a preventive technique, even for osteoporosis. As well, it is usually not advised for herniated disks, back arthritis, or curvature of the spine due to scoliosis.

This procedure has not been extensively tested in younger, otherwise healthy people. The long-term effects of the bone cement aren’t known, so these procedures are generally reserved for older people. For more information on Kyphoplasty, contact Comprehensive Pain Management in Warwick, RI.


Managing Chronic Pain at Work

Joseph Coupal - Thursday, May 24, 2018
Comprehensive Pain Management - Warwick, RI

More people are trying to stay on the job despite chronic pain. Find out how you can integrate your pain management plan into your workday.

Besides providing a way to make a living, working can be very important to people living with chronic pain and dealing with chronic pain management. Remaining on the job is a tremendous boost to the self-esteem of people with chronic pain. The challenges of work and the social interactions that take place on the job may even serve to distract you from your pain. Research has found that those who return to work enjoy greater success in their pain management.

A recent survey found that one of every four working people in the United States experiences chronic pain — an increase of nearly 40 percent from a decade earlier, yet nearly 9 out of 10 people living with chronic pain choose to remain on the job rather than stay home. Nearly all said only severe pain would keep them home from work.

Unfortunately, pain can keep you from being an effective employee. That same survey found that about half of chronic pain patients who remain in the workplace engage in "presenteeism" — they are present at work, but their chronic pain sometimes or often prevents them from performing their job.

Manage Pain in the Workplace

Pain management on the job is possible, but requires that employees with chronic pain take a proactive approach to the challenges they face. Effective coping skills include:

Advocate for yourself. Don't feel as though you have to manage pain in silence. Talk to your human resources department about accommodations that could help minimize your pain and maximize your productivity. If you feel comfortable, talk with your boss and co-workers about your pain so they can understand and possibly assist in your pain management practices.

Set priorities. Be aware of your limitations and your health, and don't push yourself in ways that will cause a setback in your pain management efforts. Say no when you need to.

Take breaks. Use regular breaks as a way to bring your pain management practices into the workplace. If getting up and stretching helps your chronic pain, be sure to do so. Some people find that taking a few minutes to meditate in a quiet place helps them manage pain. Others squeeze in a short walk during lunch to gain the benefits of additional exercise.

Adopt healthy habits. On or off the job, you can help your pain management efforts by eating well and exercising. Inquire about any wellness programs offered by your employer; these can be a valuable source of information about healthy living. And be sure to stay on top of taking your prescribed pain medications.

Tweak your workspace. Examine your work area for ways to minimize pain and make you more comfortable. Ergonomic tools like special office chairs, hand rests, foot rests, keyboard trays, and telephone headsets can be tremendously helpful, and many employers will provide these items for you, especially if they understand the benefits.

Be aware of pain management options. Ask your doctor about new ways to deal with your chronic pain and if sessions with an occupational therapist could help you make on-the-job pain management strategies more effective. A therapist also can provide exercises and coping skills tailored to your particular ailment.

Staying at or returning to work can be a helpful component of pain management. By following certain strategies, you can be more productive and experience less pain while benefiting from being around other people on the job. For more information on chronic pain management, contact Comprehensive Pain Management in Warwick, RI.


Common Nerve Block Procedures for Chronic Pain

Joseph Coupal - Thursday, May 10, 2018
Comprehensive Pain Management - Warwick, RI

What are some of the more common nerve block procedures for the treatment of chronic pain? What are some of the common side effects associated with these nerve blocks?

The vast majority of injections done for the diagnosis or treatment of chronic pain are performed on an outpatient basis. Some are performed on inpatients, who may be already hospitalized for other reasons. All of them may be performed under fluoroscopic (x-ray) guidance but are sometime performed in the office without x-ray. Below is a brief description of some of the more commonly performed nerve blocks by pain management specialists.

Epidural Steroid injection: Epidural steroid injection is an injection performed in the back or neck in an attempt to place some anti-inflammatory steroid with or without a local anesthetic into the epidural space close to the inflamed area that is causing the pain. These injections are generally done for pain involving the back and leg or the neck and arm/hand. They may be done under x-ray guidance. Epidural steroid injections may be placed in the lumbar (low back), thoracic (mid back), or cervical (neck) regions.

Facet Joint Injection: The facet joints assist with movement of the spine both in the neck and back. Injection into these joints can provide relief of neck and back pain; these injections are always performed under x-ray guidance. You will be on your stomach for this injection if it is done for back pain; however you may either be on your stomach or back if the injection is performed for neck pain, depending on the preference of the physician. This block is often a diagnostic block and a more long lasting injection may be indicated if you have significant pain relief from this injection.

Lumbar Sympathetic Block: A lumbar sympathetic nerve block is performed for pain in the leg that is thought to be caused by complex regional pain syndrome type I (or CRPS I). These injections are often performed under fluoroscopic (x-ray) guidance.

Celiac Plexus Block: A celiac plexus block is generally performed to relieve pain in patients with cancer of the pancreas or other chronic abdominal pains. A needle is placed via your back that deposits numbing medicine to the area of a group of nerves called the celiac plexus. This injection is often performed as a diagnostic injection to see whether a more permanent injection may help with the pain. If it provides significant pain relief then the more long lasting injection may be done.

Stellate Ganglion Block: A stellate ganglion block is an injection that can be performed for the diagnosis of complex regional pain syndrome of the arm or hand or for treatment of pain to that area. It can also be used to help to improve blood flow to the hand or arm in certain conditions that result in poor circulation of the hand.

For more information on treating chronic pain, contact Comprehensive Pain Management in Warwick, RI.


How to Conquer Chronic Pain

Joseph Coupal - Friday, April 20, 2018
Comprehensive Pain Management - Warwick, RI

If you struggle with chronic pain, the greatest pain relief usually comes when you combine therapies—an approach called comprehensive pain management. For instance, you might add hands-on care from a physical therapist or chiropractor to relaxation techniques, medication, and exercise (cardio soothes pain by pumping out endogenous opioids, your body’s natural analgesic drugs). Other less well-known options include:


One non-prescription pill may not be enough for serious pain, and doubling up on anti-inflammatories like ibuprofen, naproxen, and aspirin increases your risk of heart problems, stomach bleeding, and other side effects.

But you can combine any one of them with acetaminophen (aka Tylenol), which works via an entirely different mechanism. In fact, a recent University of Pittsburgh study found an acetaminophen/ibuprofen pairing more effective than opioids for dental pain. Just stick to the recommended daily dosage on the label for each product. Meanwhile, scientists continue to study new and safer formulations, including an ibuprofen plus arginine supplement that mitigates the drug’s potential cardiovascular harms.

Try a different pill—or patch

The same meds you pick up at the drugstore come in prescription strengths and also in gels, creams, and patches to apply directly where it hurts. There’s also a range of other drugs — since similar brain chemicals underly pain and depression, antidepressants are effective for headaches, facial pain, fibromyalgia, nerve damage, low back aches, and other types of chronic pain. The anti-seizure drugs block the release of pain-provoking neurotransmitters and are also prescribed for fibromyalgia and nerve irritation from shingles, among other painful conditions. And if you have to take an opioid, ask about your options; you’re less likely to become dependent on a synthetic drug than on oxycodone.

Intercept the message.

Pain sensations travel from body to brain along nerves; doctors have an increasing array of tools to jam the signals. Nerve blocks—injections of anesthetics or steroids—relieve pain in the arms, legs, or other specific areas. Implanting electrodes allows doctors to deliver tiny electrical pulses to the spine, relieving back pain or the type of ache that occurs when nerves are damaged by injury or infection. Singing nerve tissue away with heat, a technique called radiofrequency ablation, relieves some cases of neck and back pain. And in severe cases—such as after cancer—surgery can cut nerves completely.

For more information on treating chronic pain, contact Comprehensive Pain Management in Warwick, RI.

Source: Mens Health

Chronic Pain Management, What is it?

Joseph Coupal - Friday, April 06, 2018
Comprehensive Pain Management in Warwick, RI

1. What does a pain management specialist do?

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.

2. What should I look for in a pain management specialist?

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 and with whom you feel a comfortable rapport. Since many types of chronic pain may require a complex treatment plan as well as specialized interventional techniques, pain specialists today must have more training than in the past, and you should learn about how your pain physician was trained and whether he or she has board certification in pain management.

The widely accepted standard for pain management education today is a fellowship (additional training beyond residency which occurs after graduating from medical school) in pain management. Most fellowship programs are associated with anesthesiology residency training programs. There are also fellowship programs associated with neurology and physical medicine and rehabilitation residency programs. The fellowship consists of at least one year of training in all aspects of pain management after completion residency training. When a physician has become board certified in their primary specialty and has completed an accredited fellowship, they become eligible for subspecialty board certification in pain management by the American Board of Anesthesiology, The American Board of Psychiatry and The American Board of Neurology, or the American Board of Physical Medicine and Rehabilitation. These three are the only board certifications in pain management recognized by the American College of Graduate Medical Education.

In addition to learning about your pain physicians training and board certification, you also should ask whether they have experience with your specific pain condition and what types of treatments they offer. Do they only perform procedures or do they use a multidisciplinary approach to pain management? Who do they refer to for other treatment options such as surgery, psychological support or alternative therapies? How can they be reached if questions or problems arise? What is their overall philosophy of pain management?

3. How can I be referred to a pain management specialist?

The best way to be referred to a pain management specialist is through your primary care physician. Most pain physicians work closely with their patients' primary care physicians to insure good communication, which in turn helps provide the optimum treatment for their patients. Patients are also often referred by specialists who deal with different types of pain problems. Back surgeons, neurologists, cancer doctors, as well as other specialists usually work regularly with a pain physician and can refer you to one.

4. What should I expect during my first visit to a pain management specialist?

On your first visit to a pain management specialist, he or she will get to know you and begin to evaluate your particular pain problem. This will usually involve a detailed history, a physical exam and review of tests that you have had performed. The questions you are asked and the physical examination will focus on your particular problem, but your pain physician will want to know about past and current medical history as well.

Often you will be given a questionnaire before your first visit that will ask detailed questions about your pain problem, and you will probably be asked to bring any imaging studies (such as X-rays, computed tomography [CAT] scans, or magnetic resonance imaging [MRI] scans) or other tests that have already been done. You should know before your first visit whether or not a procedure is anticipated. If so, you may need a driver to take you home.

Most importantly, this visit is an opportunity for your pain physician to begin to analyze all of this new information and discuss with you an initial assessment of your pain problem. He or she may know exactly what is causing your pain, or perhaps further diagnostic procedures will be needed. But no matter what type of problem you have, you should leave this first visit with a clearer understanding of your pain and the course of further evaluation and treatment that is planned.

For more information on chronic pain management, contact Comprehensive Pain Management in Warwick, RI.


Millions Get Wrong Treatment for Back Pain

Joseph Coupal - Thursday, March 15, 2018
Comprehensive Pain Management - Warwick, RI

Low back pain affects 540 million people worldwide and is the leading cause of disability, but it's often treated improperly.

Their review of evidence from around the world suggests low back pain should be managed in primary care and that the first step should be education and urging patients to stay active and working.

But inappropriate tests and treatments are common. Many patients are treated in emergency rooms, told to take time off from work and rest, referred for scans or surgery, and prescribed painkillers that include addictive opioids.

The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work.

Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.

In the United States, low back pain leads to 2.6 million emergency room visits each year. A 2009 study reported that opioids were prescribed in about 60 percent of such cases.

Only about half of Americans with chronic back pain are prescribed exercise, the series reported.

A study last year reported low back pain as the leading cause of disability in almost all high-income countries.

Worldwide, disability from chronic back pain has risen more than 50 percent since 1990, and the trend is expected to continue as the number of seniors grows.

Low back pain mostly affects working-age adults and a specific cause is rarely pinpointed.

Though most cases are short-lived, about a third of patients have a repeat episode of low back pain within a year. The researchers said it is increasingly viewed as a long-lasting condition.

Patients and health professionals need to be educated about the causes and outcomes of low back pain, as well as the effectiveness of different treatments.

Protection of the public from unproven or harmful approaches to managing low back pain requires that governments and health care leaders tackle entrenched and counterproductive reimbursement strategies, vested interests, and financial and professional incentives that maintain the status quo.

For more information on managing back pain, contact Comprehensive Pain Management in Warwick, RI.


Chronic pain: How to Take a Comprehensive Approach

Darren Kincaid - Thursday, February 22, 2018
Comprehensive Pain Management - Warwick, RI

Chronic pain can mean different things to different people. Whether you are a patient, a doctor, a parent or a politician, your view on pain medications can vary depending on your perspective.

Those who work the front lines of our healthcare infrastructure — police, fire, EMS and emergency departments — know all too well the impact that opioid abuse has on the population. Those who work in chronic care and pain management know the benefits that proper pain medication can have. One of the biggest debates in healthcare right now is how to help decrease the multiple side effects of prescription pain medicine use while at the same time ensuring adequate pain control and preventing under-treatment of chronic pain symptoms.

When should medications be given? How much should be given? To whom and in what quantity should they be given? These are all extremely difficult questions with complex answers that require discussion and an individualized treatment plan. The purpose of this article is to provide information on chronic pain and some of the factors that prescribers take into account when deciding what sort of treatment to offer patients. Understanding the science behind a treatment option is critical in understanding the potential drawbacks and side effects that treatment may have. As I often discuss with my patients, the best decision is an informed decision.

By definition, chronic pain is pain that has been present for more than three months. It is a condition that affects more than 100 million people in the United States and accounts for almost 20 percent of all doctor office visits and 12 percent of all prescriptions written. Prior to treating a patient with chronic pain, a comprehensive pain evaluation should take place. While there are multiple individual aspects to each person’s pain complaint that must be accounted for, there are some commonalities that help physicians classify the type of pain a patient is suffering from.

Chronic pain is often classified into one of four different categories:

Inflammatory Pain – joint pain, pain caused by infection, etc.,

Neuropathic Pain — pain caused by nerve damage such as seen in shingles, diabetic foot pain, fibromyalgia pain, etc.

Mechanical/ Compressive Pain — pain from expanding tumors, kidney stone pain, etc.

Musculoskeletal Pain — back pain, muscle pain, etc.

Often times, pain can be a combination of different types, so while it is important to categorize a patient’s pain symptoms, it is equally important to evaluate the mechanism of injury, how long the pain has been present, any associated symptoms and triggering factors.

A critical next step is to determine what sort of impact the chronic pain is having on the person’s life. Is the patient able to function as he/she normally would? Are they able to go to work and interact socially as they normally did? In other words, how is their quality of life? Asking about what they have used in the past for pain control is also very useful and can help guide the physician in deciding what the most effective option may be.

After obtaining all this subjective data, it is important to quantify a patient’s pain level. There are several pain intensity scales that healthcare workers are currently using. While one scale is not clearly better than another, the use of pain scales should be consistent, with the same scale being used at each visit and the patient being asked to rate his/her pain not only at that visit, but for the week prior as well.

After obtaining a thorough history, a focused physical exam, including a neurological exam should take place. While general lab work and imaging studies are not routinely indicated, directed studies should be performed in order to narrow the list of possible causes of pain.

Once the doctor has decided that some sort of pain medication is indicated, the question then arises, which one? There are many choices of pain medications, and often people assume that prescription pain medications are always more effective than over-the-counter medications; however, that is not always the case. The dose you take, how often you take it, and whether you are taking it as-needed or scheduled throughout the day are all important variables in determining how effective a treatment plan will be.

Over-the-counter pill medications are often categorized into two main categories: acetaminophen (Tylenol) and NSAIDS (ibuprofen, such as Motrin or Advil, or naproxen such as Aleve). While ad campaigns may pitch these medications against one another as competitors, acetaminophen and NSAIDS actually work differently. They both can lower fever and help with muscle type pain, but NSAIDS can help reduce joint swelling and are highly effective on inflammatory pain, while acetaminophen is an effective fever reducer and often used for pain associated with infection.

Guidance should be sought prior to taking these medications to ensure that medication interactions and side effects do not occur. Often physicians will advise patients to take these medications differently than what is written on the bottle, based on the severity of pain or underlying medical conditions.

When it comes to prescription pain medications, there are many different options. Determining the type of pain is important in deciding what medication to start. Neuropathic pain does not typically respond to NSAIDs and acetaminophen very well, therefore prescription medications like Neurontin and Cymbalta often have better efficacy on these conditions. For other types of severe pain, opioid medications may be prescribed.

Opioid medications are found under various brand names: OxyContin, Percocet and Vicodin are several examples. They work on the pain receptors throughout the body to decrease the transmission of pain input, thereby decreasing the perception of pain overall. These receptors are found scattered throughout the body but they have the most effect on receptors found in the central nervous system. While the overall effect is a reduction in pain, there are several significant other effects that occur, such as slowing of heart rate, a slowing of respirations, sedation and a feeling of euphoria. Physical dependence can occur very rapidly if care is not taken both by the physician and the patient.

Ultimately, the best treatment for pain control is a multi-pronged approach. Pain medications are just one tool in the toolbox. There are multiple other tools that have shown to be highly effective in pain management; physical therapy, acupuncture, chiropractic manipulation, acupuncture and cognitive behavioral therapy are just a few examples of modalities that can have fewer side effects than medications and often have excellent results.

It is important to weigh the risks of the medication versus the benefits and discuss possible alternatives and side effects with your physician, prior to taking any pain medication. As a primary care physician I find myself having this discussion with patients quite often. If you are advised to take any medication, whether it be over the counter or prescription, your doctor should not only discuss the risks versus benefits of the medication, but he/she should also talk about how to take it and when to stop it.

The best tool against any diagnosed condition is education. Talk to your physician because with knowledge comes power. Stay healthy.

For more information on pain management, contact Comprehensive Pain Management in Warwick, RI.


Pain and the Brain

Joseph Coupal - Friday, February 02, 2018
Comprehensive Pain Management - Warwick, RI

The difference between acute pain and chronic pain

With acute pain, the affected region eventually heals and the discomfort goes away. This cause-effect-resolution process is simple for the brain to understand and process.

In the case of chronic pain, where the cause goes unresolved and the site of the injury is not healed, the pain cycle can become self-perpetuating. Over time, the signals that indicate pain reverberate into other, more high-functioning areas of the brain as well as throughout the nervous system. In one of the most recent studies on this topic, a report released in February during the American Academy of Pain Medicine Annual Meeting found connectivity differences in brain regions important for mood and cognitive function between those with chronic low back pain and those without.

As a result of all these factors, not only can the original source of pain be disguised, but it also often creates a messy cycle of anxiety causing more pain causing more anxiety, and so on. This is one of the main reasons why chronic pain can be difficult to diagnose and treat.

Pain management

Finding how to manipulate the mind to ease chronic pain is a growing research field, not only because of the increasing number of sufferers, but also because we are finding out that pain-relieving drugs may only be part of the solution.

A study in the Journal of Neuroscience looked at the brain scans of research participants who were taught how to meditate. When subjected to painful stimuli, they had less activity in the part of the brain that registers pain and more activity in the region that handles unpleasant feelings, suggesting they were in greater control of their pain response when meditating.

Cognitive therapy that teaches patients how to be more in control of their emotional response to chronic pain also seems to be promising. A study published in the Archives of Internal Medicine last November found that 30 percent of participants, all who suffered from fibromyalgia, reported less pain after six months of therapy compared to 8 percent of those getting conventional treatments. Interestingly, 37 percent of those who received both cognitive therapy and exercise reported less pain.

Of course, there is no “one size fits all” approach for managing chronic pain, nor am I suggesting that mind-body approaches are in any way superior to drugs or other forms of treatment. There are many cases where drug therapy is the best course of action. There is no argument, however, that the brain plays a vital role in how we perceive and manage pain.

For more information on pain management, contact Comprehensive Pain Management in Warwick, RI.

Source: Everyday Health

Radiofrequency Nerve Ablation Eases Chronic Back Pain

Joseph Coupal - Friday, January 26, 2018
Comprehensive Pain Management in Warwick, RI

Radiofrequency nerve ablation is a medical treatment that offers highly effective, long-lasting relief for chronic pain, including lower back pain.

Also known as radiofrequency neurotomy or lesioning, this technique uses heat generated by radiofrequency energy to interrupt specific pain impulses in the spine.

This minimally invasive technique can provide a safe and effective alternative for patients battling chronic pain in the lumbar or cervical spine.

What is radiofrequency nerve ablation?

To disrupt the transmission of pain signals to the brain, RF ablation applies high radiofrequency waves — a type of electromagnetic energy — to a specific region on a sensory nerve. A radiofrequency needle applies heat to the coating of the nerve or myelin, creating a small, circular lesion.

Thanks to this tiny lesion, the nerve is unable to transmit pain signals to the brain.

For chronic conditions of the back, this procedure is used on medial branch or lateral branch nerves, depending on the location of the pain. These nerves don’t affect movement; this procedure only interrupts signal transmission.

To identify the location of the nerve, the doctor uses fluoroscopic imagery guidance. This form of guidance is also used for corticosteroid injections and regenerative medicine treatments like platelet-rich plasma (PRP) and bone marrow-derived stem cell injections.

When is radiofrequency nerve ablation used?

Neurotomy can be used for many types of spine pain.

One of the most common uses of RF nerve ablation is for osteoarthritis of the spine (spondylosis), knee osteoarthritis, hip osteoarthritis, and continued post-procedure pain following a joint replacement. It is also effective for treating back and neck pain from car accidents (whiplash) and work-related injuries.

This procedure may benefit patients who have pain on one or both sides of the spine, or in the hip or knee joints. If discomfort worsens when extending the back, twisting, laying on your stomach, or lifting — — this procedure may provide relief.

Is radiofrequency nerve ablation right for you?

To determine whether you would benefit from spinal or joint RF (Radiofrequency/Thermal) neurotomy, the doctor will perform a preliminary diagnostic test. During the test, the doctor will administer a temporary nerve block to the identified area. If the procedure relieves your pain (albeit temporarily), you are likely a good candidate for the ablation.

Nerve ablation for back pain is an outpatient procedure that takes less than two hours. The procedure is typically performed in the doctor’s office. You can return home once it is complete and return to work the next day.

Although this procedure is not the answer for everyone, most patients report significant relief lasting as long as two years. Because the nerve will eventually regenerate and the lesion will heal, the doctor can simply repeat the procedure once the pain returns.

The treatment of chronic back or knee pain is best treated with a well-rounded and thoughtful approach as there may be several potential pain generators. Radiofrequency ablation is a minimally invasive option that is great for the patient with pain related to osteoarthritis in the back or knee. It is also effective for patients with persistent knee pain following a joint replacement.

For more information on Radiofrequency Ablation, contact Comprehensive Pain Management in Warwick, RI.


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