How is Pain Treated?
The physicians of Innovative Pain Specialists may recommend a variety of pain management techniques to ease your suffering. Treatment choice is carefully selected to provide maximum benefit for the specific needs of our patients. The physicians at IPS aim to identify the cause of your pain and treat your pain with targeted techniques, utilizing interventional therapies when indicated. Various treatments may include:
Techniques such as relaxation, biofeedback, imagery, hypnosis, acupuncture, exercise, and counseling help many people with chronic pain to aid them use less pain medication.
Physical therapy attempts to build or recondition muscles – allowing you to move more normally and with less pain. We may recommend passive physical therapy, such as massage, applying heat/cold, use of electrical stimulators called transcutaneous electrical nerve stimulators (TENS) units, or active treatments, such as exercise.
Chronic pain can bring stress that affects you, your relationships, and your body. The physicians of Innovative Pain Specialists work closely with psychologists to work with you on relaxation techniques and coping and self-monitoring skills.
Non-opioid Oral Medications / Adjuvant Agents (Pills, Creams, Patches, etc.)
Medication management could be used to help treat pain that may not be completely relieved with non-drug treatments. These include mild pain relievers such as acetaminophen like Tylenol and non-steroidal anti-inflammatory drugs like ibuprofen. Additional medications may also be used; these may include medications for nerve pain such as anti-seizure medications, or low-dose anti-depressant medications. Muscular pain may also benefit from muscle relaxants in addition to non-drug treatments. Topical creams or patches may also be of benefit in the treatment of various pain conditions.
Opioids are similar to natural substances (endorphins) produced in your body that may be used to help control pain that is not entirely relieved with non-opioid medications. Various opioid medications may include, but are not limited to, codeine, hydrocodone, morphine, oxycodone, and methadone. Not all patients are candidates, and appropriate candidates usually receive this treatment approach in addition to other modalities.
Spinal Injections (epidural, facet, sacroiliac, etc.) / Therapeutic Nerve Blocks
Spinal Injections such as epidural steroid injections and facet joint injections in addition to other therapeutic nerve blocks are quite effective in treating pain. Usually local anesthetic and/or steroids are injected at the origin of pain to relieve inflammation and pain. These procedures are intended to prolong, or in some instances, negate the need for surgery.
Radiofrequency Abalation / Neuroablation
With neuroablation, the nerves that serve as pathways to the brain are destroyed (usually with heat). Neuroblation is usually recommended for patients that have appropriate responses to initial nerve blocks.
Vertiflex Superion for Lumbar Spinal Stenosis
The Vertiflex Superion device is a revolutionary, innovative product specifically designed for those who suffer with pain related to lumbar spinal stenosis. Dr. Marsiglia and Dr. Louis were among the first physicians in the world who were trained to perform this procedure. At Innovative Pain Specialists, we have had great success in relieving patients who suffer from lumbar spinal stenosis. It is a minimally invasive procedure that successfully treats lumbar spinal stenosis without the need for more invasive surgery such as lumbar laminectomy with or without lumbar fusions.
Spinal Cord Stimulation / Neurostimulators
Neurostimlators are an excellent therapeutic option for chronic pain. The technology is cutting edge and continues ot advance with each year. In the past, these devices were not MRI-compatible. However, now these devices are MRI-safe and can be implanted to treat a variety of conditions. There is traditional dorsal column spinal cord stimulation (SCS) as well as dorsal root ganglion (DRG) stimulation. We are experienced in all types of neurostimulators and will recommend the device that is right for you.
These devices help to modulate chronic pain by using mild electrical impulses in order to minimize the perception of pain transmission to the brain. They are FDA-approved, safe and covered by insurance.
Neurostimulation can be beneficial in a multitude of pain conditions, and maybe recommended by your pain doctor when other modalities of treatment are not successful. Selective candidates will initially undergo a trial period, in which a temporary stimulator is placed into the epidural space and taped to the back for one week. If it is not successful, then it is simply removed easily in the office at the completion of the trial period. However, if the patient shows significant improvement in pain and quality of life, then the temporary leads are still removed in the office, but then the patient is scheduled for surgical implantation of the spinal cord stimulator so that it can provide lifelong pain relief. Unlike other treatments, neurostimulators allow for a one week "test period" or trial, before any device is implanted into the body.
External Drug Delivery
External drug pumps deliver opioid medication through a tube inserted into a vein (intravenous) or into the epidural space of the spine. External systems often can effectively relieve pain in patients that are acceptable candidates. This is not a very common type of treatment in our practice.
Drug Pump (Intrathecal Drug Delivery System)
If your oral medication no longer provides pain relief or causes uncomfortable side effects, we may recommend a drug pump. Typically, drug pumps are a catheter attached to a pump surgically placed spine with the pump placed in the abdomen. They send pain medication through a thin, flexible catheter (tube) to the area around your spinal cord (called "the intrathecal space"). Because pain medication goes directly to the area around the spinal cord, the drug pump can offer significant pain relief with a small fraction of the medication used in other treatments.* Unlike some surgeries, you can try a drug pump first to be sure it will be effective before having it implanted. It is also reversible; we can turn it off or remove it. This type of treatment is often successful in patients suffering from cancer pain, or those suffering from significant spasticity, such as in multiple sclerosis.
Surgery / Surgical Referral
In examining you as a patient, with or without tests such as MRI or CT scans, to look for the cause of your pain, we may discover a problem that needs to be corrected by surgery. If we feel that less invasive means are not indicated or have been unsuccessful, then we may recommend a referral for more invasive surgery.
*Onofrio BM, Yaksh TL. Long-Term Pain Relief Produced by Intrathecal Infusion in 53 Patients. J Neurosurg 1990; 72: 200-209.
Lamer TJ. Treatment of Cancer-Related Pain: When Orally Administered Medications Fail. Mayo Clin Proc 1994; 69:473-480.
Portenoy RK. Management of Common Opioid Side Effects During Long-Term Therapy of Cancer Pain. Ann Acad Med 1994; 23:160-170.