The primary components of the initial visit include a comprehensive pain and general medical history, previous medical records review and examination. Please bring a list of all your current medications and other medications you have tried for this condition, including dosages, amounts you are taking and the name of the prescribing physician. The patient will be asked to sign a medication treatment agreement.
The pain team focuses on the most effective and innovative techniques available. The center provides individually tailored treatment programs that may involve a single treatment method or a combination of medications, injections, physical therapy and other services or procedures. As in other persistent illnesses, pain disorders require ongoing re-evaluation and treatment modifications. Pain programs have demonstrated that pain education, coupled with stress reduction and relaxation techniques, can help patients learn to more effectively manage their pain, reduce doctor visits and prevent relapses.
For patients with pain that is difficult to treat, we offer treatment that addresses the pain at the level of the affected nerves. The type of injection is determined after a thorough evaluation is completed. A typical injection consists of a steroid to decrease inflammation and/or a local anesthetic to numb the area. Two common types of injections are trigger point injections and epidural steroid injections. Whereas trigger point injections are injections into the muscles, epidural steroid injections are injections into the epidural space and a space which surrounds the spinal canal. The medication bathes the nerve roots at several levels. Epidural steroid therapy is especially helpful for sciatica, which is typically low back and leg pain due to degenerative discs or even spinal stenosis.
Other more selective spinal injections, which require x-ray guidance, include injections into the facet joints, as well as specific single nerve root injections. Another common injection includes sympathetic blocks for reflex sympathetic dystrophy, in which a local anesthetic only is utilized to interrupt the sympathetic nervous system in an attempt to reset a possibly malfunctioning sympathetic nervous system. When combined with other treatment modalities, such as education and exercise, the above injections may be therapeutic, as well as provide diagnostic information.
Other options include using neuromodulation techniques, which involve stimulation of the nerves peripherally with TENS units, muscle stimulators or acupuncture. Some interventions are provided only after conservative therapies have proven ineffective in decreasing or eliminating a patient's pain. We may consider neurolytic procedures, which actually destroy the nerves, utilizing radiofrequency (heat), cryoprocedure (freezing) or chemicals (alcohol, phenol). Other times, implantable systems, such as spinal cord stimulators or intrathecal/ spinal infusion pumps for continuous infusion of medications in the spinal fluid, may provide relief of chronic refractory pain. Further diagnostic workup is sometimes required and can include lab work, x-rays, MRI/CT scans, etc. Diagnostic manometric discograms are also performed at the Pain Center.
These may include: