Comprehensive Pain Management
(Formally known as Franklin Pain and Wellness and Warwick Pain)

Attleboro, MA(508) 236-8333
Franklin, MA(508) 541-0004
South Kingstown, RI (401) 234-9677
Warwick, RI(401) 352-0007

Franklin, MA • (508) 541-0004
Warwick, RI • (401) 352-0007
South Kingstown, RI • (401) 234-9677

Warwick Pain Center RI Blog

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Back Pain: Myth or Fact?

Joseph Coupal - Wednesday, November 29, 2017
Comprehensive Pain Management in Warwick, RI

Back pain is extremely common. In fact, 80% of people will have significant back pain at some point. Back pain symptoms vary from individual to individual. They can be sharp or dull. Myths regarding back pain are also common. Some common myths and facts follow.

Myth: Always Sit Up Straight

We know slouching in chairs is bad for your back. However, sitting up too straight and still can also irritate the back.

For relief of back pain from prolonged sitting, intermittently try leaning back in your chair with your feet on the floor with a slight curve in the low back.

Also, stand for part of the day when possible (for example, while on the phone or reading).

Myth: Don't Lift Heavy Objects

When lifting, it's the way you lift that is most important, not just the weight you are lifting. When lifting, try to be as close to the object as possible, squatting to make the lift. Use your legs to lift. Don't torque your body or bend during the lift.

Myth: Bed Rest Is the Best Cure

Bed rest can help an acute back strain or injury. But it is not true that you should stay in bed. Sometimes remaining immobile in bed can actually make back pain worse.

Myth: Pain Is Caused by Injury

Back pain can be caused by injuries, disk degeneration, infections, and conditions that are inherited, such as ankylosing spondylitis.

Fact: More Pounds, More Pain

Keeping fit is helpful in preventing or aggravating back pain. Back pain is more common in those who are unfit or overweight. Those who only exercise intermittently are at increased risk for back injury.

Myth: Skinny Means Pain-Free

People who are too thin can also be at risk for back pain, especially those with eating disorders and osteoporosis.

Myth: Exercise Is Bad for Back Pain

Regular exercise is very good for preventing back pain. Actually, for those with an acute back injury, sometimes a guided, mild exercise program is recommended. This often begins with gentle exercises that gradually increase in intensity.

Fact: Chiropractic Care Can Help

Spinal manipulation and massage can be very helpful options for many forms of lower back pain.

Fact: Acupuncture May Ease Pain

Acupuncture can be helpful for relieving many types of back pain that do not respond to other treatments. Yoga, progressive relaxation, and cognitive

behavioral therapy can also be beneficial.

Myth: A Firm Bed Mattress Is Better

People differ in their response to mattress firmness. One study showed that those who slept on a medium-firm mattress (rated 5.6 on a 10 point hard-to-soft scale) had less back pain and disability than those who slept on a firm mattress (2.3 on the scale).

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


Do You Need a Pain Specialist?

Darren Kincaid - Wednesday, November 08, 2017
Comprehensive Pain Management in Warwick, RI

A pain specialist is a doctor who is an authority on managing pain in their field, whether it's neurology, anesthesiology, or even psychiatry.

There’s no doubt that there is a great need for pain specialists: pain is a tricky and all too common problem. In fact, more than 76 million Americans ages 20 years and older — 25 percent of the population — say they’ve had pain lasting more than 24 hours.

When pain control seems beyond reach, it may be time to turn to a pain specialist: A pain specialist in neurology knows how to treat stubborn migraines, a pain specialist in anesthesiology can handle delicate lung cancer operations, and a pain specialist in orthopedic surgery can address issues that arise around joint replacements, just to name a few examples.

As with any ailment, the first stop for patients looking for pain treatment should be their primary care physician. However, if you can’t find a satisfactory pain management program within an appropriate length of time or if your pain is getting worse, referral to a pain specialist may be the next step.

What Does a Pain Specialist Do?

Unlike acute pain, which is generally caused by a sensation in the nervous system designed to alert a person to a possible injury or ailment and the need to get it treated, chronic pain lasts much longer. In other cases it might be due to an ongoing condition. Still other patients have pain despite no evidence of an injury.

Common types of chronic pain include:

  • Back and neck pain
  • Arthritis
  • Migraines
  • Shingles
  • Cancer pain
  • Nerve pain

Pain Control by Specialty

While acute pain usually improves with time, chronic pain can linger and may even require intervention. How a pain specialist chooses to proceed with pain control depends greatly on his background and expertise. Pain specialists can come from a wide variety of specialties.

Finding a Pain Specialist

Do your homework. Not every pain specialist is the same.

Generally, a pain specialist should have a certificate of pain management from his specialty board. For example, anesthesiologists would have a certificate of pain management from the American Board of Anesthesiology and be board certified in pain medicine by the American Board of Pain Medicine. They also should have received at least one year of fellowship training in pain management after their residency program. Patients can find a pain specialist through their primary care doctor, Internet searches, and the American Society of Interventional Pain Physicians.

When considering a pain specialist, ask about the focus of the physician’s medical practice. True pain specialists will spend most of their time treating people with chronic pain rather than seeing patients with a variety of ailments.

Other questions for the physician should center on his length of time in practice, his approach to pain treatment, and whether he is involved in clinical trials and has published research. Membership in pain specialty societies, such as the American Academy of Pain Medicine, is also a sign of a physician with a focused specialty in pain.

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


Are Pain Clinics Right for You?

Joseph Coupal - Friday, October 20, 2017
Comprehensive Pain Management in Warwick, RI

People with arthritis and related diseases may benefit from the integrative care offered by pain management centers.

Medications have come a long way in treating arthritis and other related diseases. But when pain persists even with early and aggressive treatment, you may wonder if it is time to consider a pain clinic.

If inflammation is the main driver of your pain, a rheumatologist is the best person to manage that kind of pain because they are the ones who really have the expertise and know what medications need to be added to a regimen to get inflammation under control.

But if your inflammation is well managed (or your arthritis-related disease is not inflammatory) and you are still having pain, a pain clinic or pain management center may be your next step.

What Is a Pain Clinic?

Pain clinics focus on controlling chronic pain and there are two general types. One is for procedures, such as injections to deal with specific areas of pain, for example, neck and back pain. The other offers integrative services, which include medications as well as physical, behavioral, and psychological therapies.

This latter type, like Comprehensive Pain Management in Warwick, RI is often called an interdisciplinary clinic. It helps patients manage chronic pain with non-narcotic medications; nerve blocks; physical and behavioral therapy; patient and family education; lifestyle changes; and complementary and alternative medicine (CAM). CAM therapies may include biofeedback, cognitive behavioral therapy, acupuncture, hypnosis, water therapy, massage and meditation. Services at multidisciplinary centers extend beyond doctors and may include physical and occupational therapists, social workers, psychologists and vocational rehabilitation experts.

A 2009 study of 108 people and found that after four weeks of this kind of comprehensive pain-management care, patients saw improvement in pain, emotional distress and function. Another study that same year found a multidisciplinary approach helped people with fibromyalgia symptoms, especially when treatment was tailored to a patient’s individual needs. People with disabling neuropathic pain from rheumatic diseases also often benefit from integrative pain management services.

More Than Medication: The Importance of Self-Management

Patients with arthritis and other related conditions should not seek out pain clinics that primarily offer narcotic medications. These drugs can be addictive. They don’t treat inflammation, can interact with other medications and don’t help the widespread pain of fibromyalgia. They can actually make fibromyalgia pain worse.

Most pain management doctors are aware of the downsides of narcotics. People can have increased pain when on narcotics because the medications change the way their endorphin system works. There are some people who benefit from narcotics, but it’s a mistaken impression if you think going to a pain center means automatically getting started on them.

Rheumatologists say chronic pain clinics are most helpful when they encourage people to become active partners in their pain relief. That means focusing on self-management techniques like adopting an anti-inflammatory diet, starting low-impact exercise, identifying a personal support system and making self-care a priority.

A study published in 2009 conducted 46 interviews of people with chronic pain and 46 interviews of people with RA-associated pain. The study found that for those living with pain, a sense of well-being is achieved not through pain control alone, but also through various mind/body techniques for managing pain, accepting new limits and adjusting the way people relate to themselves.

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


The Benefits of Radiofrequency Ablation

Darren Kincaid - Thursday, October 12, 2017

During a Radiofrequency Ablation (RFA) procedure, heat from an electrode is used to cauterize one or more nerves, disrupting pain signals to the brain.

To begin, after the patient has received medicine to help them relax and the area around the injection site has been numbed, the physician inserts a small tube called a cannula into the spinal area and guides it to the right nerve with the help of an X-ray device. An electrode is inserted through the cannula and its position is tested with a small jolt before the nerve is heated.

To heat the nerve, a high frequency electrical current is administered, which causes molecule movement and produces thermal energy. This, in turn, creases a small lesion within the nerve, disrupting its ability to transmit pain signals. The doctor may treat several nerves, if necessary.

Partial or total pain relief from radiofrequency can last for several months. Nerves do grow back, however, so the procedure may need to be repeated. But, unlike invasive surgeries or long-term medication usage, there are few serious side effects to the procedure, allowing you to get back to a better quality of life.

For information on Radiofrequency ablation and for a comprehensive treatment plan, contact Comprehensive Pain Management in Warwick, RI.


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.

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