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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Ways to Treat Chronic Back Pain Without Surgery

Joseph Coupal - Thursday, November 08, 2018
Comprehensive Pain Management in Attleboro, MA

Back pain is considered chronic if it lasts three months or longer. It can come and go, often bringing temporary relief, followed by frustration. Dealing with chronic back pain can be especially trying if you don’t know the cause.

Below are some insights into common chronic back pain causes and nonsurgical treatment options.

Common Causes of Chronic Back Pain

Chronic back pain is usually age-related, but can also result from a prior injury.

The most common causes include:

  • Arthritis of the spine—the gradual thinning of the cartilage inside the spine
  • Spinal stenosis—narrowing of the spinal canal that may lead to nerve pain
  • Disc problems, such as a herniated or bulging disc
  • Myofascial pain syndrome—unexplained muscle pain and tenderness

In some cases, it’s difficult to pinpoint the cause of chronic back pain. If your doctor has exhausted all diagnostic options, it’s time to seek a second opinion from a back pain specialist. It’s important not to make rushed decisions or undergo extensive medical procedures until the origin of the pain is found. Not only may they not help; they could make the pain worse.

If the source of the pain is not known or can’t be treated, your best option may be to work with your doctor on reducing the flare-ups and making the pain manageable with nonsurgical treatments.

Nonsurgical Treatments for Chronic Back Pain

Physical Therapy

Exercise is the foundation of chronic back pain treatment. It’s one of the first treatments you should try under the guidance of your physician and spine physical therapist. However, the same set of exercises doesn’t work for everyone. The exercises have to be tailored to your specific symptoms and condition. Maintaining the exercise routine at home is also a big part of success.

Physical therapy for chronic back pain may include:

  • Retraining your posture
  • Testing the limits of pain tolerance
  • Stretching and flexibility exercises
  • Aerobic exercises
  • Core strengthening

Diet

Some diets are highly inflammatory, especially those high in trans fats, refined sugars and processed foods. Consult with your doctor to see if your diet could be contributing to your chronic back pain and how you could change it. Maintaining a healthy weight could also help lessen your back pain by reducing the pressure on your spine.

Lifestyle Modifications

When you have chronic pain, it’s important to accept your limitations and adapt. Listen to your body and learn to pace yourself. Take a break when mowing the lawn, or make several trips when carrying groceries. Take note of the activities that worsen your pain and avoid them if possible. Not only could this help your back feel better, it could also prevent the underlying condition from advancing.

Another important lifestyle change to try is giving up smoking. Nicotine is scientifically known to accentuate pain and delay healing.

Injection-based Treatments

Nerve blocks, epidural steroid injections, nerve ablations and other types of injection-based procedures are available for chronic back pain. They are used when the source of the pain is known and can sometimes help rule out certain causes if the treatment doesn’t work. Injections may stop or lessen pain for a certain period of time, but are not intended as long-term solutions and shouldn’t be used in isolation.

Alternative Treatments

Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other nonsurgical spine treatments can also make a difference for chronic back pain. Talk to your spine specialist about alternative treatments that could benefit you.

Pharmacologic Treatments

Analgesics, anti-inflammatory drugs, muscle relaxants and other medications can be used to help control chronic back pain. However, most come with unwanted side effects and are not intended for prolonged use.

Opioid medications generally shouldn’t be used as the first, the only, or the long-term line of treatment for chronic back pain. Many are addictive and don’t address the underlying cause of your pain. Opioids should be prescribed only after a thorough exam by a specialist and if other drugs have failed to provide relief. If you find yourself relying on opioids to get through the day, it may be time to seek a second opinion.

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

hopkinsmedicine.org

Stellate Ganglion Block FAQs

Joseph Coupal - Thursday, October 25, 2018
Comprehensive Pain Management - Spinal Cord Stimulation in Franklin, MA

What is a stellate ganglion block?

A stellate ganglion block is an injection of local anesthetic in the sympathetic nerve tissue of the neck. These nerves are a part of the sympathetic nervous system. The nerves are located on either side of the voice box, in the neck.

What is the purpose of a stellate ganglion block?

A stellate ganglion block blocks the sympathetic nerves that go to the arms, and, to some degree, the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving an arm or the head and face.

How long does the stellate ganglion block take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic. Epinephrine or steroid medication may be added to prolong the effects of the stellate ganglion block.

Will the stellate ganglion block hurt?

The stellate ganglion block involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation, which can make the procedure easier to tolerate.

Will I be "put out' for the stellate ganglion block?

Maybe. The stellate ganglion block can be done under local anesthesia only. However, most of the patients also receive enough intravenous sedation that they may fall asleep for a few minutes during the actual injection. Patients breathe on their own throughout the procedure. The amount of sedation given generally depends upon the patient tolerance, but can often be enough that the patient has amnesia for the actual injection.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is soreness in the neck at the injection site.

How long the effect of the medication last?

The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.

How many stellate ganglion blocks do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.

Will the stellate ganglion block help me?

It is sometimes difficult to predict if the injection will indeed help you or not. The patients who present early during their illness tend to respond better than those who have had symptoms for a very long time. Patients in advanced stages of disease may not respond adequately.

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

Source: medcentral.org

Treating Lumbar Spinal Stenosis (LSS)

Joseph Coupal - Friday, October 12, 2018
Comprehensive Pain Management in Warwick, RI

Do you experience pain or numbness in your lower back when standing upright?

Is your discomfort relieved when you bend forward at the waist or sit down?

Do you experience pain, numbness, or tingling in your legs or buttocks when you walk?

About Lumbar Spinal Stenosis (LSS)

What is LSS?

Lumbar spinal stenosis (LSS) is a condition where the spinal canal narrows and compresses the spinal cord nerves in your lower back. As we age, the natural wear and tear on our spine can lead to a number of contributing factors that cause the narrowing of the spinal canal – thickening of ligament tissue, formation of excess bone, or compression/bulging of the discs.

What are the Symptoms of LSS?

The narrowing of the spinal canal can cause a number of symptoms such as pain, numbness or a tingling sensation in your buttocks, legs and lower back. It may also limit the amount of time/distance you are able to stand or walk. If your symptoms increase when you walk or stand, but you experience relief when you sit or bend forward, then you may have a certain type of LSS that can be treated by the removal of excess tissue that is causing the narrowing of the spinal canal.

LSS Treatment Considerations

There are many options available to treat LSS, and your doctor should help determine what is best for you. Some important things to consider with your physician are:

  • How effective is the treatment?
  • How long will the treatment provide relief from my pain/discomfort?
  • What are the risks of the treatment? What are the benefits?
  • Will I need to stay in the hospital? Will I have to undergo general anesthesia or surgery? How long is the recovery?

mild as a Treatment Option

If your doctor determines you have LSS caused by excess ligament, then the mild procedure may be a safe and effective treatment for you. mild is a quick outpatient procedure, performed through a tiny incision (about the size of a baby aspirin), requiring no general anesthesia or stitches. Study data show that 79% of patients experience a significant reduction in pain and significant increase in mobility. In addition, the mild procedure has been proven to have a very low risk of major complications.

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

What You Need to Know About Getting Botox Injections for Migraines

Joseph Coupal - Thursday, September 27, 2018
Botox Injections for Migraine Headaches, Warwick, RI

Botox is said to decrease the frequency of migraine days by an average of 50 percent for those who suffer chronically (people who experience 15 or more headache days per month).

Much like other fillers, Botox is slowly metabolized in the system, so for it to remain effective, patients have to get the procedure every three months or so.

Let's talk about migraines — namely, chronic migraines.

First of all, for those who aren't familiar with migraines, they're different from headaches. Headaches are unpleasant, too, but are typically less severe than migraines and don't usually present with other symptoms besides the pressure and aching in the head. Migraines, on the other hand, can be much more intense and often come with nausea, seeing spots, vomiting, extreme fatigue, sensitivity to light and sound, and more. They affect 39 million folks in the U.S., 4 million of whom deal with daily pain. Chronic migraines can severely inhibit daily life.

How is Botox for migraines different from cosmetic Botox?

The Botox used for migraines and the Botox used for cosmetic procedures is actually exactly the same. Basically, young and middle-aged women were getting [Botox] for cosmetic purposes, and that’s the most common person that has migraines, and that’s how they figured out it was helpful. Women were getting Botox for aesthetic reasons and happened to notice relief from their migraine symptoms, and doctors began looking into it as a direct treatment. In fact, women are disproportionately affected by migraines — about 85 percent of chronic-migraine sufferers are women, and the condition affects 28 million in just the U.S.

The only difference between the two procedures is that with Botox for migraines, they may do a few more shots in areas where the pain is experienced. Botox for migraines can have the same aesthetic effect that cosmetic Botox has.

How does it work, and how effective is it?

Though there's still more research to be done on Botox for migraines and doctors aren't yet completely sure why the procedure is effective, they have some ideas. What [Botox] does is paralyze nerve terminals. Essentially, nerve terminals transmit pain, but they also produce pain substances while they’re doing that, and it completely paralyzes that process. It stops the process of pain patterning and it also relaxes the muscles.

It's very effective among a large sampling of patients and is usually very well tolerated. Some patients find that it even eliminates the need for medication, which is a huge deal. However, about 7 to 10 percent of my patients find that it’s not effective. As with any medical procedure, everybody (and everyone's actual body) is different and will respond to treatment differently, and it's best to do a healthy amount of research and thoroughly talk to your doctor about your body and medical history before making a decision.

What are the potential side effects?

The side effects of Botox typically don't happen at the doses prescribed for migraines, and even if the scary-sounding side effects you read about online do occur, they aren't particularly dangerous and last four to six weeks. Most commonly, people have pain because you’re dealing with a bunch of shots, and sometimes you can get a headache from the procedure.

After the treatment, what comes next? How long does it last?

Some doctors recommend lying down and resting after a treatment, but there isn't any need for downtime unless a patient experiences pain. It can take about two weeks to work, though some patients start to feel relief from chronic migraines sooner than that. If it’s going to work for a patient, one round of the treatment typically lasts for around three months. Though everybody metabolizes it at a different rate, getting it done every three months or so has been found to be effective.

For more information on Botox for migraines, contact Comprehensive Pain Management in Warwick, RI.

Allure

TENS Therapy for Nerve Pain

Joseph Coupal - Thursday, September 13, 2018
Comprehensive Pain Management in Franklin, MA

A Tens Unit, or transcutaneous electrical nerve stimulation machine, can help back and neck pain that may be caused by trauma or continual strain. The body responds to such pain or injury with muscle guarding, an attempt to immobilize the painful area by tightening the muscles surrounding the injury. Muscle guarding impairs circulation in the affected area.

The decrease in blood supply leads to a decrease in metabolism with an accumulation of waste products. TENS therapy (transcutaneous electric nerve stimulator) can help break this pain cycle and aid in the normal healing process.

How Does a TENS Unit Work?

TENS units are a machine with different adjustable settings to control intensity of stimulation by controlling the voltage, meaning current, and pulse duration of each pulse. Electrodes are placed at specific sites on a user’s body depending on the physical location of their pain. The machine sends electrical current that travels through electrodes and into the skin stimulating specific nerve pathways to produce a tingling or massaging sensation that reduces the perception of pain.

When a Tens Unit is used as directed a T.E.N.S. is a safe, noninvasive, drug-free method of pain management. A TENS unit is used to offer a better quality of life for people with pain.

What does a TENS unit do to relieve, decrease or eliminate pain?

There are two theories. One of these theories is called The Gate Control Theory and is the most advanced explanation. The gate-control theory suggests that there’s a neural mechanism in spinal cord that acts as a kind of gate, shutting down or opening up the flow of signals from the periphery to the brain. Whether the gate is open, closed or partially closed depends on what sort of signal it receives from the brain to change the perception of pain in the user’s body. These frequencies interfere with the transmission of pain messages at the so spinal cord level, and help block their transmission to the brain.

Another theory is called The Endorphin Release, which suggests that electrical impulses stimulate the production of endorphins and enkaphalins in the body. These natural morphine-like substances block pain messages from reaching the brain, in a similar fashion to conventional drug therapy, but without the danger of dependence of other side effects.

TENS units are used for the relief of physical pain. Some common uses for TENS treatment are:

  • acute and chronic pain
  • post op incisions and post surgical pain
  • migraine and tension headaches
  • acute pain from sports and other injuries
  • arthritis
  • chronic pain from tendentious and bursitis
  • cancer pain
  • wound healing

For more information on TENS Therapy, contact Comprehensive Pain Management in Warwick, RI.

tensunits.com

Comprehensive Pain Management Patient Testimonials - Warwick RI

Joseph Coupal - Thursday, August 30, 2018

Comprehensive Pain Management Patient Testimonials.

Treating Contained Disc Herniations

Joseph Coupal - Friday, August 17, 2018
Comprehensive Pain Management in Warwick, RI

In the past, patients with contained disc herniations have been treated with conservative care including rest, medications, injections and/or physical therapy. Unfortunately, this does not always provide relief. In the past, people who did not respond to conservative care were forced to live with the symptoms or consider major spine surgery. If they underwent surgery, it could take weeks or months to recover, causing a major disruption in their daily lives.

With Disc-FX®, this is not the case. Disc-FX® provides an option for those people who have failed conservative care, and are not yet ready for major surgery. It is a minimal access procedure performed on an out-patient basis whereby the patient will go home the same day as the procedure with only a small bandage on their back.

Following manual removal of the offending herniation, the patented Disc-FX device is activated to help clean the disc and seal tears in the annulus. As a result, pressure in the disc is reduced, which eases symptoms.

Facts about Contained Disc Herniations:

  • 90% of low back pain is caused by pinched or irritated nerve in the back
  • There are 15 million office visits for low back pain each year
  • Low back pain is the most prevalent cause for people under 45 to visit their physician
  • Disc Anatomy and Contained Disc Herniations

The spine is composed of a series of bones called the vertebrae. Each of these bones is connected by a disc, made of a tough outer layer, called the annulus, and a gel-like center called the nucleus. If the annulus of the disc is damaged by injury or weakened by age, a portion of the outer layer can give way to pressure causing the gel-like nucleus to either bulge or leak out. This may also be referred to as a herniated disc. A herniated disc can press on the nerves and cause pain, numbness, tingling or weakness in the back and/or leg.

Disc-FX® System Overview

The Disc-FX® System is an innovative, minimal access spine system designed to efficiently access the damaged disc without injury to surrounding disc anatomy. Disc-FX permits multiple treatment options compared to other "single treatment devices" in the marketplace. In addition to manual decompression, Disc-FX® can help to clean the disc and seal tears in the annulus.

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

Who is a Candidate for the Disc-FX Procedure?

Joseph Coupal - Thursday, August 16, 2018
Comprehensive Pain Management - Disc-FX Procedure in Franklin, MA

Patients with symptomatic, contained lumbar disc herniations that have not responded to conservative treatment, may experience relief from a Disc-FX procedure. Typical signs of a contained lumbar disc herniation is lower back pain or pain radiating down the leg accompanied by some lower back pain. Disc-FX may not be beneficial for advanced degenerative disc disease or spinal fractures.

Your doctor will evaluate and determine if you are a candidate for the Disc-FX procedure.

Potential Benefits of Disc-FX:

  • Minimal Access Procedure
  • Out-Patient Procedure
  • Minor Skin Incision
  • Rapid Procedure
  • Multiple Treatment Options
  • Local Anesthetic
  • Target Access to Damaged (Diseased) Area
  • Treat Multiple Disc Levels
  • Early Anticipated Return to Normal Activities

Disc-FX has been shown to:

  • Offer a safe and effective treatment option
  • Provide improvement in quality of life
  • Treat multiple disc levels with one surgical procedure

For more information on Disc-FX for treating chronic back pain, contact Comprehensive Pain Management in Warwick, RI.

How Spinal Cord Stimulation Works

Joseph Coupal - Thursday, August 02, 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.

If you live with chronic pain, you know how all encompassing it can be. It robs you of the things you love to do, strains your relationships, and makes even small tasks unbearable.

One size fits all therapies don't give you the relief you need. Spinal Cord Stimulation is a safe, drug-free, FDA pain managaement therapy that is clinically proven to reduce chronic pain. And, your therapy can be personalized. SCS is designed to interrupt pain messages with a small device called a stimulator. To see how SCS works, watch the video below.

When patients can choose between multiple therapies with one device, they achieve better overall pain relief.

For more information on Spinal Cord Stimulation, contact Comprehensive Pain Management in Warwick, RI.

Spinal Cord Stimulation

Joseph Coupal - Thursday, July 19, 2018
Comprehensive Pain Management in Warwick, RI

Chronic pain is long standing pain that persists beyond the usual recovery period or that accompanies a chronic health condition. Because this pain is not protective and is not a result of an ongoing injury, it is referred to as "pathological" and is therefore treated as a condition, not as a symptom. Chronic pain may prevent people from working, eating properly, participating in physical activity or enjoying life.

Spinal cord stimulation (SCS) is a pain-relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain. SCS is the most commonly used implantable neurostimulation technology for management of pain syndromes. As many as 50,000 neurostimulators are implanted worldwide every year. SCS is a widely accepted, FDA-approved medical treatment for chronic pain of the trunk and limbs (back, legs and arms).

There are three SCS device types:

Conventional systems require little effort on the patient’s part for maintenance. However, a minor surgical procedure is required to replace the power source when it runs out. Radiofrequency systems are designed to sustain therapy over long periods at the highest output level. Because of its high power capabilities, the RF system is suitable for the most challenging cases in which there is complex, multi-extremity pain. With this type of system, the patient must wear an external power source to activate stimulation. Rechargeable systems are the newest type of SCS device. The patient is responsible for recharging the power source when it runs low. A rechargeable system typically lasts longer than a conventional system. Eventually a minor surgical procedure may be required to replace the power source if the time between recharges becomes impractical.

SCS Trial Procedure

If it is determined that the patient is a suitable candidate for SCS, often the first step is to implant a device on a trial basis. During the SCS trial phase, a lead or leads are implanted temporarily and are connected to a trial spinal cord stimulator. The trial stimulator is programmed with one or more stimulation programs customized to the specific areas of the patient’s pain. The trial phase can be beneficial for the following reasons:

  • It can help the patient/physician analyze whether SCS effectively relieves pain
  • It provides the patient/physician with an assessment period to determine which type of SCS technology works best
  • It enables the patient/physician to evaluate different stimulation settings and programs

SCS Implantation

If the SCS trial provides adequate pain relief, then a permanent system may be implanted. SCS is a reversible therapy, so even though it is called permanent, treatment can be discontinued at any time and the implanted parts turned off and/or removed.

For more information on Spinal Cord Stimulation, contact Comprehensive Pain Management in Warwick, RI.

aans.org


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