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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Options for Treating Chronic Pain

Joseph Coupal - Thursday, September 28, 2017
Comprehensive Pain Management in Warwick, RI

We often hear, “What general options do I have to treat my pain?”

Here is the answer in a general sense.

There are a variety of options for treating chronic pain. Under the general category of medications, there are both oral and topical medicines for the treatment of chronic pain. Oral medications include those that can be taken by mouth, such as nonsteroidal anti-inflammatory drugs, acetaminophen, and opioids.

There are also medications that can be applied to the skin, whether as an ointment or cream or by a patch. Some of these patches work by being placed directly on top of the painful area where the active drug, such as lidocaine, is released. Others, such as fentanyl patches, may be placed at a location far from the painful area. Some are available over the-counter and others may require a prescription.

There are many things that may help with your pain which do not involve medications. These things may help relieve some pain and reduce the medications required to control your pain. Examples include exercises best performed under the direction of a physical therapist. There are also alternative modalities, such as acupuncture. Transcutaneous Electro-Nerve Stimulator (TENS) units use pads that are placed on your skin to provide stimulation around the area of pain and may help to reduce some types of pain symptoms.

Finally, there are interventional techniques that involve injections into or around various levels of the spinal region. These can involve relatively superficial injections into the painful muscles, called trigger point injections, or may involve more invasive procedures. There are multiple procedures that range from epidural injections for pain involving the neck and arm or the back and leg, facet injections into the joints that allow movement of the neck and back to injections for burning pain of the arms or legs.

For information on chronic pain management and for a comprehensive treatment plan, contact Comprehensive Pain Management in Warwick, RI.


Managing Pain

Joseph Coupal - Friday, September 08, 2017
Comprehensive Pain Management in Franklin, MA

Let’s take a deeper look at the brain’s role in dealing with chronic pain, and how that affects treatment options for ongoing pain.

The difference between acute pain and chronic pain

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.

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. One study 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 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 are 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. However, 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.


Acute and Chronic Pain

Joseph Coupal - Thursday, August 24, 2017
Comprehensive Pain Management in Warwick, RI

Pain is an unpleasant sensation that is caused by actual or perceived injury to body tissues and produces physical and emotional reactions. Presumably, pain sensation has evolved to protect our bodies from harm by causing us to perform certain actions and avoid others.

Pain might be called a protector, a predictor, or simply a hassle. This article discusses some basic concepts of pain.

We all experience pain to greater or lesser degrees at various points of our lives. It is said that pain is the most common reason patients seek medical attention. But, each of us perceives a given pain stimulus in our own unique manner. The intensity of the response to a pain stimulus is largely subjective; meaning the severity of the pain can most accurately be defined by the person with the pain, rather than by other observers.

Our individual pain perception can vary at different times, even in response to the identical stimulus. For example, an athlete during competition may not be able to feel the tissue injury of a cut or a bruise until the competition has finished. We may feel more or less pain depending on our mood, sleep pattern, hunger, or activity.

Pain is typically classified as either acute or chronic. Acute pain is of sudden onset and is usually the result of a clearly defined cause such as an injury.

Acute pain resolves with the healing of its underlying cause. Chronic pain persists for weeks or months and is usually associated with an underlying condition, such as arthritis. The severity of chronic pain can be mild, moderate, or severe.

The treatment of pain depends on its cause and the overall health of the individual affected. The primary goal of pain treatment is to return the patient to optimal function. Treatments of pain can be classified as either non-medical or medical.

Non-medical treatment options for various forms of pain include observation, rest, stretching, exercise, weight reduction, heat or ice applications, and various alternative treatments including acupuncture, chiropractic, massage, manipulation, electrical stimulation, biofeedback, hypnosis, and surgical procedures.

Medical treatments include three basic drug forms to treat pain (analgesics): Non-opioid drugs, opioid drugs, and drugs that are used to complement other analgesics (adjuvant drugs).

Even caffeine has been used to enhance the pain-relieving effect of aspirin and acetaminophen. No single medication has been found to be appropriate for all forms of pain.

Finally, various combinations of many of the above have been used to successfully treat pain. For example, ice applications might be combined with a muscle relaxant and a non-opioid pain reliever to treat a specific type of back pain. Moreover, combining various analgesic medications can have additive effects that further reduce suffering. New treatments are on the horizon, but the key to optimal pain management will always be clear communication between the doctor and the patient.

For a comprehensive pain management program, contact Comprehensive Pain Management in Warwick, RI.


Kyphoplasty When Bone Fractures Lead to Curving of the Spine

Joseph Coupal - Thursday, July 27, 2017

There’s osteoporosis. And then there’s kyphosis.

While osteoporosis can be prevented or treated early, by the time someone is diagnosed with kyphosis, much of the damage truly has been done.

Kyphosis is the condition you see when an elderly person is hunched over, almost staring at the ground as he or she walks.

It’s the culmination of multiple fractures that lead to the curvature of the spine. The person’s bones are actually collapsing. Bone can push back into spinal cord and in some cases even lead to paralysis.

The condition is not only disabling, it also creates a predisposition for pneumonia because the ribs cannot expand. The lungs have no place to go.

Kyphosis can occur as a result of a single spinal fracture, but typically, it is caused by multiple, undiagnosed fractures over time.

The degree that you can correct it is limited. The sooner it can be treated, the better the outcome.

The condition can develop due to poor posture, or it can be congenital. But the primary causes are arthritis, spinal trauma or most commonly osteoporosis.

Variety of Treatments

Many people ignore early signs that the condition may be developing. They can be suffering back pain or stiffness, exaggerated rounding of the shoulders, differences in shoulder height and a forward bending of the head compared with the rest of the body.

But, there are measures people can take to address the condition. Most cases can be diagnosed during a physical exam, with confirmation via X-rays, an MRI or CT scan. Your physician may also measure how well you breathe.

There are a variety of treatments for kyphosis, depending on the severity. Initially, it may be observation only. Your doctor may recommend watching to see if the curve progresses, or if there are changes in symptoms. This means you may have more follow-up appointments.

If it is more progressed, physical therapy may be valuable. This may include strength work, stretching and conditioning. You may also be taught how to maintain a correct posture. You may also be instructed to sleep on a firm mattress.

There are medications – nonsteroidal anti-inflammatory drugs – that may be prescribed. A back brace can be used as well – maybe more to reduce pain than to correct the condition.

In many cases, the best strategy is kyphoplasty surgery.

A small incision is made in the back and a tiny drill creates an opening in the bone. Then, a special balloon is passed through and inflated to open space and correct the deformity. After the balloon is removed, acrylic cement is injected into the cavity to maintain the correction.

The operation takes between one and two hours and a patient can be discharged from the hospital within hours without any complications. There will be minimal pain medications, mainly to prevent muscle spasms.

Because most people requiring or preferring surgery are in their 70s and 80s, there always is a risk, but for those doctors who have performed about 1,000 procedures, it is quite low.

One patient had kyphoplasty surgery at 9 a.m. and was on her way home shortly after noon.

“I noticed more agility almost immediately and no pain.” she said. “I actually drove 250 miles to a wedding right after the surgery. The only thing I had to do was put a pillow behind me while driving.”

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


Injections for Back Pain

Joseph Coupal - Wednesday, July 05, 2017

When back pain won’t go away, your doctor will consider all the treatments that could help you, from exercise and physical therapy to medication. Part of that may include steroid injections to ease your back pain and inflammation. Steroid injections help some people, but not everyone gets the same relief.

What They Treat

Back injections may help treat two major back pain problems:

  1. Inflammation or damage to a nerve, usually in the neck or the low back, also called “radiculopathy.” The problem originates where the nerve exits the spine. With radiculopathy, sharp pain shoots from the lower back down into one or both legs, or from the neck into the arm. A herniated disk can cause radiculopathy.
  2. Spinal stenosis, which means that the spine has narrowed. This can happen because a herniated disk is pressing on the spine, or because a bone spur is jutting into that space, or if a tumor presses on the spine. Spinal stenosis compresses the nerves inside. This usually causes pain in the buttock or leg. You may or may not also have back pain. The pain from spinal stenosis may get worse when you’re active, and ease up when you lean forward.

You can get injections in the area around the inflamed or damaged nerves. There are several kinds of injections, including:

  • Epidural
  • Nerve block
  • Discography

Nerve Block Injections:

A doctor injects the area around the nerve with a numbing medicine, or anesthetic. Lidocaine is the anesthetic most commonly used.

After a nerve block injection, you’ll quickly have numbness with near-complete pain relief. It wears off after several hours.


Some doctors use nerve block injections to try to diagnose what's causing the back pain. If your doctor does this, you'll be asked which injection causes the back pain to go away. That nerve may then be chosen for an epidural injection with both steroid and anesthetic medicine.

Epidural Injections:

Epidural means "around the spinal cord." These shots include a steroid medicine, also called corticosteroid, and usually an anesthetic medicine, too. Their effects seem to only last a short time and offer modest pain relief. So these might not be something you’d get for long-term back pain. And if your back pain started suddenly, there are other treatments your doctor would probably consider first.

For more information on injections for back pain relief, contact Comprehensive Pain Management in Warwick, RI.


Treating Osteoarthritis with Corticosteroids - Warwick, RI

Joseph Coupal - Tuesday, May 23, 2017

Osteoarthritis (OA) is one of the most common forms of arthritis. The joint pain and stiffness caused by OA can make it difficult to work, play sports and perform daily activities. Anti-inflammatory and analgesic medications may help ease your pain. Your doctor may also recommend physical therapy. If these conservative measures don’t work, it may be time for a corticosteroid injection directly into your aching joint. Corticosteroids are medications that mimic the effects of the hormone cortisol, which is produced naturally by the adrenal glands. Cortisol affects many parts of the body, including the immune system. It helps lower levels of prostaglandins and downplays the interaction between certain white blood cells (T-cells and B-cells) involved in the immune response. Corticosteroids stimulate this effect to control inflammation.

Not for Everyone.

While the injections help some patients significantly, at least for a period of time, some do not get much relief. The purpose of the injection is to reduce the irritation caused by bone interacting with bone – which is what happens when the smooth, cartilage interface wears away. There can be several reasons why these direct “steroid shots” sometimes don’t work. Some patients’ disease is too far advanced to respond to this approach, and in difficult and bulky knees it may be hard to locate the actual joint space. That can result in the medication delivered to the wrong place. Ultrasound guidance can help put the corticosteroid where it needs to be. In fact, researchers found ultrasound guidance dramatically improved the accuracy of needle placement in one of the most common joints affected by OA, the knee. Their research showed an ultrasound accuracy of about 96 percent, versus about 78 percent for injections guided simply by anatomy. No doubt, some patients feel remarkably better after a steroid shot. But it is never the only answer to their pain. Any candidate for a steroid injection should still receive physical therapy, supportive bracing and oral or topical medication to maximize the response to the injection.

How Long Will it Last?

Relief from the injections generally does not last forever. The duration of pain relief is often no more than two months. Steroid shot therapy is “a short-term treatment of a chronic problem.” Factors such as extent of inflammation and overall patient health can determine how long a steroid shot will last. With an acute inflammation, single injections can provide very long-term relief – for a year or longer. It’s so variable. It’s almost like patient selection makes a difference. But no matter the duration of relief, patients should never be given an unlimited number of injections. In general, a patient shouldn’t have corticosteroid injections into any given joint more than once every three to four months. Too many injections increase the risk of side effects, such as avascular necrosis, which is the lack of blood flow to a part of the bone that causes it to collapse. If you did no greater than four injections a year in a given joint, it’s pretty safe. However, repeat injections tend to be less effective.

Why Only Injections?

Some patients with osteoarthritis may wonder why oral corticosteroids, such as prednisone, aren’t used instead of a local injection – especially since they can work so well with rheumatoid arthritis. It’s because the two diseases are two different animals. Osteoarthritis is not a systemic – that is, whole body – condition, such as rheumatoid arthritis. Because osteoarthritis is localized to particular joints – and with less joint lining inflammation, you wouldn’t expect a successful anti-inflammatory response using oral corticosteroids. Plus, oral steroid use is associated with numerous side effects, including changes in blood sugar and bone density. The American College of Rheumatology (ACR) has published updated guidelines for treating osteoarthritis in pharmacological and non-pharmacological ways. And while the group conditionally endorsed the use of corticosteroid injections for hip and knee osteoarthritis – after other, more conservative treatments had failed – it recommended against using the therapy in osteoarthritis of the hands. With good patient selection, these injections are wonderful.

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

Kyphoplasty to Treat Osteoporosis and Vertebral Compression Fractures - Warwick, RI

Joseph Coupal - Friday, April 28, 2017

The most common osteoporotic fracture, vertebral compressions (VCF) reflect bone fragility and will often push a patient down a path of increased morbidity. VCF symptoms can include impaired gait, disability, reduced lung function, early satiety, future fracture risk and mortality.

The National Osteoporosis Foundation estimates that 10 million Americans have osteoporosis. As a result of the population advancing in age and changing diet, the fracture rate isn't diminishing — U.S. osteoporotic-caused fractures will likely reach 3 million by 2025, up from 2 million in 2005.

Patients who have a VCF face a five-fold increased risk of suffering a subsequent vertebral fracture when compared with their pre-morbid condition or age matched controls. As the number of prevalent vertebral fractures increases, so does the risk for additional fractures as well as the mortality rate.

As clinicians face an increasing number of VCF cases, they should consider the benefits of vertebroplasty and kyphoplasty to reduce patient pain and improve quality of life.Threat of undiagnosed osteoporosis and VCFs

The number of people suffering osteoporotic fractures nationwide is increasing, especially among older women. The January 2015 issue of Mayo Clinic Proceedings featured an article comparing hospitalizations for various conditions to hospitalizations for osteoporotic fractures in women 55 years and older. The 12-year study revealed 4.9 million hospitalizations for osteoporotic fractures in women, more than myocardial infarction, stroke or breast cancer.

Many experts now realize that there is a crisis caused by the declining rate of testing, diagnosis and treatment of high-risk patients. If these patients go untested and untreated, the consequences may include debilitating fractures that cause disability, loss of independence and even death.

Osteoporotic fractures account for a significant economic burden on the healthcare system, but identifying high-risk patients early can lead to better care and lower treatment costs.

Currently two-thirds of VCFs are initially asymptomatic and under-diagnosed; this provides opportunity for clinicians to proactively drive education on the risks associated with osteoporosis and spine fractures as well as the associated economic impact on the healthcare environment.

A misunderstood condition

Many clinicians are under the impression VCFs are untreatable and thus dubbed them "benign fractures," but this is a mistake.

We had [in the 1980s], a conceptual framework that was based on how younger people heal vertebral compression fractures. In reality, the elderly often take longer to improve their pain and can decline during the period of conservative therapy.

In the 1980s, French practitioners developed a technique to percutaneously inject cement into the bone. While the incident case was a benign tumor of the cervical spine, these physicians soon realized the same technique could be used to stabilize fractures and rapidly reduce the associated pain. Interventional radiologists and surgeons in the United States later saw this procedure and mirrored it with vertebroplasty. Researchers then developed a cousin procedure — kyphoplasty, which involves mechanically treating the fracture by inserting and inflating a balloon to create an open cavity inside the bone for injecting bone cement designed to stabilize the spine.

Now, there is a greater appreciation for osteoporosis as a medical problem and vertebroplasty or kyphoplasty as a solution for quicker pain relief.

A variety of treatment methods now exist for VCFs, but biases and misinformation still circulate.

Clinical evidence

A heated debate about whether augmentation offers a mortality benefit has captured the industry for years, resulting in a variety of trials.

Several recent large clinical studies followed patients for at least 12 months after VCF. Four studies revealed balloon kyphoplasty and vertebroplasty offered patients lower mortality risk compared to those patients receiving non-surgical management.

The mortality benefit always made intuitive sense when one compared the fundamental tenets of conservative therapy which include limitation of activities, back brace and narcotic medication to early mobilization.

Balloon kyphoplasty is one of the few treatment solutions in clinical studies to give patients pain relief and quality of life.

To prove the technique's effectiveness, the 21-center Fracture Reduction Evaluation study compared Balloon Kyphoplasty with non-surgical treatment for acute VCF. Researchers found balloon kyphoplasty relieved back pain, enhanced patient satisfaction and improved mobility and quality of life to a greater effect than non-surgical care.

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

To read the full article or more about the studies: Becker’s Spine Review

Spinal Cord Stimulation Relieves Back Pain – Warwick, RI

Joseph Coupal - Monday, April 03, 2017

Doctors who treat patients suffering from back pain are exploring new approaches that help some patients avoid opioid drugs. 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.

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, 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.

It was determined that she was 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.

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. She 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 to use a team approach involving doctors, physical therapists and psychologists who 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 spinal stimulation, contact Comprehensive Pain Management in Warwick, RI.

Source: Medical Xpress

Spinal Cord Stimulation For Long Term Relief of Back Pain – Warwick, RI

Joseph Coupal - Thursday, March 23, 2017

Chronic back and neck pain can affect your daily life and even become debilitating if left untreated. There are several treatment options for back and neck pain, ranging from physical therapy to surgery. However, in cases where surgery or other treatments don’t successfully relieve pain, spinal cord stimulation may be a good option.

What is spinal cord stimulation?

This treatment option delivers mild electrical pulses to nerves in the spinal column, blocking or interfering with nerve activity to minimize the sensation of pain that reaches the brain. A small spinal cord stimulator device (similar to a pacemaker) is implanted near the spine that generates an electrical current.

After the device is implanted, a doctor will determine the pulse strength and the patient is shown how to operate the device at home.

Who is a good candidate?

  • Patients who do not respond to conservative therapies
  • Patients whose pain does not go away with surgery
  • Patients who have chronic pain syndromes

In order to determine if you are a good candidate, it’s likely you will be evaluated by a neurosurgeon and a pain specialist. Potential benefits of spinal cord stimulation include:

  • Pain signal replaced with a mild tingling sensation
  • Reduces the amount of pain medication needed
  • Chronic pain can become much more manageable
  • Increase ability to enjoy day-to-day activities
  • Overall positive effect on mental health, stress and quality of life

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

Source: Fox13

Spinal Cord Stimulation Helps Patients with Chronic Back Pain

Joseph Coupal - Thursday, March 02, 2017

It is a breakthrough for those suffering from chronic back pain in Warwick, RI: a spinal implant that can totally stop the pain.

There is a darkness with chronic back pain no pills can cure.

Deanna Conley, lived in that darkness.

That’s how things were this Fall after nearly 40 years of x-rays, scans, 5 spinal fusion surgeries.

Her children had essentially “lost” the vivacious mother they knew.

She couldn’t stand at the sink to wash dishes. She couldn’t cook a whole meal and she loved having her kids over for dinner. But there is hope.

After more spinal injections a a pain psychologist spinal cord stimulator implant was suggested: insulated wire leads were inserted into the “epidural” space which surrounds the spinal cord; electrodes in the wire leads “pulse”; stimulate the nerves and block pain signals to the brain.

Spinal Cord Stimulation (SCS) is a medical therapy for people who suffer from certain types of chronic pain in their back, legs and arms. SCS uses a small implanted device to generate tiny electrical pulses that replace the feeling of pain with a tingling or massaging sensation. These electrical impulses around the spinal cord can modify the way the brain receives pain signals.

The initial procedure is a one-week trial with the leads connected to an external stimulator. If there’s improvement, patients can get a permanent implant with a battery implanted under the skin toward the top of the buttocks.

The results have been mind-blowing.

The device can change lives. It gives people their life back.

There’s minimal maintenance and a wireless controller to adjust the impulses.

There’s a lot of data that suggests that at 5 years’ people are still doing great with these stimulators.

That epidural space is a sort of "safe zone.” The procedure is relatively low risk, even being so close to the spinal cord.

Most patients have seen remarkable results, in fact 84% of people who received the spinal cord stimulator reported that their quality of life was greatly improved and 83% decreased their use of pain medications.

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

Source: Fox News

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