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

Attleboro Pain Center MA Blog

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Migraine Headache Pain Treatment

Joseph Coupal - Thursday, October 18, 2018
Comprehensive Pain MD - Migraine Headache Pain Treatment

Migraine is a complex and often debilitating disorder. There are different types of migraines, and several treatment options. Migraine treatment approaches can be classified as acute treatments, which aim to reverse or stop the migraine symptoms, and preventive treatments, which aim to reduce the frequency and severity of migraines. Many people with migraine need both types of treatment. Another treatment strategy is to identify and avoid personal triggers.

To help figure out the best treatment approach, it’s helpful to start with a migraine journal. Keeping an accurate, complete diary of every migraine attack and all of your symptoms will help a pain specialist make a correct migraine diagnosis. The record of your pattern of pain will also assist the doctor in determining which treatment might work best for your situation.

The goal of migraine treatment

The U.S. Headache Consortium lists the following goals of long-term migraine treatment:

  • Reduce attack frequency and severity
  • Reduce disability
  • Improve quality of life
  • Prevent headache
  • Avoid headache medication escalation
  • Educate and enable patients to manage their disease

In addition, the U.S. Headache Consortium has established the following goals for successful treatment of acute migraine attacks:

  • Treat attacks rapidly and consistently without recurrence
  • Restore the individual’s ability to function
  • Minimize the use of back-up and rescue medications
  • Optimize self-care
  • Be cost-effective
  • Minimize side effects

Types of migraine treatments

Migraine treatments can be divided into various classifications: acute or preventive, as well as prescription or over-the-counter (OTC). Acute medications are those used when a migraine attack is currently happening. They are also known as abortive medications. Preventive medications are used on an ongoing basis, even when an attack is not occurring, in the hope that they will prevent or reduce attacks. Preventive medications are also called prophylactic medications.

Prescription migraine treatments

Examples of prescription drugs used as abortive medications for acute symptom relief include:

  • Calcitonin-gene-related peptide (CGRP) blockers
  • Triptans
  • DHE 45
  • Ergotamine

Examples of preventive or prophylactic prescription medications include:

  • Beta blockers
  • Calcium channel blockers
  • Antidepressants
  • Neuronal stabilizing agents or anticonvulsants


OTC medications for acute symptoms relief include:

  • Excedrin for migraine
  • Ibuprofen, which is sold under the brand names Advil and Motrin
  • Naproxen, sold under the brand name Aleve
  • Aspirin
  • Acetaminophen, sold under the brand name Tylenol
  • Nerve Stimulators

In addition to medications two nerve stimulators may be used in certain people with migraines who have not gotten relief from other methods.

The Cerena Transcranial Magnetic Stimulator is a device that is approved for people 18 years of age and older who have migraines with aura. It is held to the back of the head and delivers a pulse of magnetic energy.

A vagus nerve stimulator has also been approved for use in adults with migraines, as well as episodic cluster headaches. The hand-held device is placed over the vagus nerve in the neck where it releases a mild electrical stimulation to reduce pain.

Complementary and Alternative Medicine

Some people with migraines also use complementary and alternative medicine approaches to get relief from their migraine symptoms. Complementary and alternative medicine includes any medicinal products or practices that are not part of mainstream medicine given by medical doctors and allied health professionals, such as nurses or physical therapists. Alternative medicine is also defined by its use as an alternate to traditional medical care. Complementary medicine is used in combination with traditional medicine. These types of treatments include:

  • Natural remedies, such as herbal treatments, vitamins, minerals and other supplements
  • Mind-body medicine, such as meditation, biofeedback, yoga, acupuncture, tai chi and hypnotherapy
  • Manipulative and body-based practices, such as chiropractic spinal manipulation and massage therapy

As always, the best source for advice on treating your migraine is your own migraine pain specialist. For more information on treating migraine pain, contact Comprehensive Pain Management in Attleboro, MA.


What Is Shingles?

Joseph Coupal - Thursday, October 04, 2018
Comprehensive Pain Management in Attleboro, MA

Shingles is a disease that affects your nerves. It can cause burning, shooting pain, tingling, and/or itching, as well as a rash and blisters.

You may recall having chickenpox as a child. Shingles is caused by the same virus. After you recover from chickenpox, the virus continues to live in some of your nerve cells. It is usually inactive, so you don’t even know it’s there.

In fact, most adults live with the virus in their bodies and never get shingles. But, for about one in three adults, the virus will become active again. Instead of causing another case of chickenpox, it produces shingles. We do not totally understand what makes the virus go from inactive to active.

Having shingles doesn’t mean you have any other underlying disease.

What Are the Symptoms of Shingles?

Usually, shingles develops only on one side of the body or face and in a small area rather than all over. The most common place for shingles is a band that goes around one side of your waistline.

Most people have some of the following shingles symptoms:

  • Burning, tingling, or numbness of the skin
  • Feeling sick—chills, fever, upset stomach, or headache
  • Fluid-filled blisters
  • Skin that is sensitive to touch
  • Mild itching to strong pain
  • Depending on where shingles develops, it could also cause symptoms like hiccups or even loss of vision.

For some people, the symptoms of shingles are mild. They might just have some itching. For others, shingles can cause intense pain that can be felt from the gentlest touch or breeze.

Long-Term Pain and Other Lasting Problems

After the shingles rash goes away, some people may be left with ongoing pain called post-herpetic neuralgia or PHN. The pain is felt in the area where the rash had been. For some people, PHN is the longest lasting and worst part of shingles. The older you are when you get shingles, the greater your chance of developing PHN.

The PHN pain can cause depression, anxiety, sleeplessness, and weight loss. Some people with PHN find it hard to go about their daily activities, like dressing, cooking, and eating. Talk with your doctor if you have any of these problems.

There are medicines that may help with PHN. Steroids may lessen the pain and shorten the time you’re sick. Analgesics, antidepressants, and anticonvulsants may also reduce the pain. Usually, PHN will get better over time.

Some people have other problems that last after shingles has cleared up. For example, the blisters caused by shingles can become infected. They may also leave a scar. It is important to keep the area clean and try not to scratch the blisters. Your doctor can prescribe an antibiotic treatment if needed.

See your doctor right away if you notice blisters on your face—this is an urgent problem. Blisters near or in the eye can cause lasting eye damage or blindness. Hearing loss, a brief paralysis of the face, or, very rarely, swelling of the brain (encephalitis) can also occur.

Our pain specialists will take your medical history and symptoms into account to create a treatment plan aimed at minimizing your pain.

For more information, contact Comprehensive Pain Management in Attleboro, MA.


Trigger Point Injections

Joseph Coupal - Thursday, September 20, 2018
Comprehensive Pain Management in Attleboro, MA

A trigger point injection is an outpatient procedure designed to reduce or relieve the back pain caused by trigger points. These small knots can form in muscles or in the fascia tissue leading to myofascial pain.

This outpatient procedure is designed to reduce or relieve the pain of trigger points. These small tender knots can form in muscles or fascia, which is the soft stretchy connective tissue that surrounds muscles and organs.

The trigger point injection procedure takes only a few minutes to complete. The physician squeezes and presses the skin to find the trigger point. Once identified a topical anesthetic may be used. The physician inserts a needle through the skin and into the trigger point.

An anesthetic mix is injected into the trigger point. This causes it to relax. If the trigger point doesn't relax completely after the first injection, the physician may reposition the needle for one or more injections. A small bandage is placed over the injection site and the patient is encouraged to stretch and move afterwards.

For more information on trigger point injections, contact Comprehensive Pain Management in Attleboro, MA.

Comprehensive Pain Management Patient Testimonials - Attleboro MA

Joseph Coupal - Thursday, August 30, 2018

Comprehensive Pain Management Patient Testimonials.

Botox for Migraines and for Treating Other Ailments

Joseph Coupal - Friday, August 24, 2018
Botox Injections for Migraine Headaches

What began as a treatment option for muscle spasms soon morphed into a cosmetic procedure that offered a multitude of health benefits.

Indeed, the continue to expand beyond its ability to reduce fine lines and wrinkles.

While many pursue it for cosmetic purposes, the benefits of Botox span far beyond. It wouldn’t surprise us if that number continues to grow.

If you’re plagued with constant headaches and migraines, Botox may be able to bring some of the joy back to your life. And the list goes on.

Botox targets excessive sweating, muscle stiffness and twitching, incontinence, and more. Let’s take a closer look, shall we?

Where Did Botox Begin?

Interestingly enough, Botox is derived from a bacterium! Clostridium Botulinum was developed to treat muscle spasms, given its ability to freeze them.

Many patients were finding this particularly useful in the treatment of eye spasms. Soon enough, people started discovering Botox’s ability to reduce crow’s feet and fine lines.

Let’s explore the many benefits of Botox.


Of course, we have to start with the first, most obvious, benefit of Botox. It’s FDA-approved and sought by many for the reduction of wrinkles, particularly on our faces. Migraines

Botox has also proven to help people suffering from migraines. The great thing about this course of treatment is that it doesn’t require any medication which, as we all know, often carry dangerous side-effects.

Persistent headaches and migraines are often difficult to treat, and Botox doesn’t do much to de-mystify the plague of headaches.

So, while it’s unknown exactly how Botox relieves migraines, medical experts suspect it has to do with a blockage of the sensory nerves that send pain messages to the brain.

Botox also relaxes muscles, helping to relieve the nagging pain of frequent tension headaches. The treatment of persistent headaches or migraines is unarguably one of the most glorious benefits of Botox.

Excessive Sweat

Sweaty palms, anybody? Or, yeah, let’s go there. Sweaty armpits, anybody? If persistent sweat plagues your everyday life, Botox could be the answer.

Hyperhidrosis, or excessive sweating, is often combatted with prescription-strength antiperspirants. Sometimes that works, sometimes it doesn’t.

And, even if you haven’t been diagnosed with hyperhidrosis, how does stress sweat affect your life? The trouble with stress sweat is that it’s often a bit more potent than regular sweat.

If you meet your doctor for one round of Botox today, it could reduce your sweat issues for several months. Imagine only needing a Botox injection every couple months to finally rid your clothes of all those horrid sweat stains?

Bells Palsy

Bells palsy results from damage or trauma to facial nerves. This causes the surrounding muscles to weaken and one half of the face to droop.

This is, of course, a tough break, as it can be quite noticeable. It’s also one of the shining moments for the many benefits of Botox.

Botox can be administered either to the affected side of the face, relaxing those facial muscles that have tensed up, or to the unaffected side of the face, creating a better balance.

While Bells Palsy often needs time to completely go away, Botox can take some of the edge off the disappointment or pain brought on by this condition.

Enlarged Prostate

Studies continue to favor Botox’s ability to provide relief to men with enlarged prostates. By injecting Botox right into the prostate gland, some men experience relief that lasts up to a year.

In turn, this can alleviate the frequency of urinary tract infections, as well as the need for frequent urination. With long-lasting results that don’t require prescription drugs, many men are considering this course of treatment.


Similar to the relief it provides men with enlarged prostates, Botox may be able to help those suffering from incontinence, or the leakage of urine from an overactive bladder.

If you can imagine the terrible stress of a sudden urge to urinate, you’ll know this is a great treatment option for many. Perhaps all those poorly-timed urges even brought on stress sweat!

Muscle Stiffness & Twitching

Botox is being used to help adults facing upper limb spasticity. It can treat the stiffness in elbow, wrist, and finger muscles.

Likewise, Botox may also prove beneficial for those facing lower limb spasticity in their ankles and toes.

And, of course, we can’t forget where it all began. Anyone suffering from eye twitching or spasms can benefit from a Botox injection.

Although each of these pains or inconveniences are things we tend to adapt to, it’s certainly a big benefit knowing a brief appointment with your doctor can provide long-term relief.


Imagine using your lunch break to find some relief for your muscle spasms or headaches? Administering Botox is relatively quick and easy.

Also in terms of speed, the results tend to appear pretty quickly. Some patients report relief within a day or two. Others say it can take up to a week. Like many procedures, individual results will vary.


We waited until the end to get to the inevitable fine print. Fear not! As of now, very few jaw-dropping side-effects have been reported.

You should probably prepare for a little bit of pain around the injection area. You may also experience numbness or a slight headache immediately after.

Along the temporary lines, you may experience a little bit of weakness from the nearby muscles.

But, like any other condition we try to diagnose online, the results can appear horrifying.

So, we’d recommend having a nice sit down with your trusted physician before reading all the worst-case scenarios.

Many people have gone through the procedure with minimal discomfort and tremendous success.

One of the prime benefits of Botox continues to be its ability to remove certain prescription medications from your life, as those certainly have cumulative effects on our bodies.

Many Afflictions are Targeted by the Benefits of Botox

Whether you’d like to bring some body confidence back to your life or need some pain relief, you may want to consider knocking on Botox's door.

For more information on botox for treating Migraines, contact Comprehensive Pain Management in Attleboro, MA.

Source: USA Today

About Chronic Pain and How to Treat It

Joseph Coupal - Thursday, August 09, 2018
Comprehensive Pain Management - Warwick, RI

One thing about pain — you know it when you have it. And if you suffer from constant chronic pain, over time it wears you down — physically, mentally, emotionally. However, you may not know what kind or what category of pain you have.

There are 2 main categories of pain — both of which can be mild, moderate, or severe:

Acute pain: Occurs immediately after an injury and lasts no longer than 2 months when treated properly.

Chronic pain: Any type of pain that lasts 6 months or longer. Chronic pain is often difficult to treat, because the cause can be hard to determine. It can also vary from one person to the next — individuals with seemingly the same kind of chronic pain may need different treatments.

Managing Chronic Pain

The treatment option that will work best for you depends on your type of pain, how severe it is, and how you respond to pain treatment. The fact is, only a physician can determine if you are a good candidate for various pain treatment options. Pain Management Specialists are physicians who specialize in treating chronic pain. These physicians receive years of advanced, specialized training in pain management and focus on treating patients with severe pain.

There are 3 levels of pain, and each may have different forms of treatment. Usually, your physician will follow a treatment plan that begins with basic therapies (like resting and nutrition) and progresses to more aggressive solutions, depending on the type and severity of pain. The treatment plan also depends on how you respond to any particular treatment.

Basic Pain Treatments:

  • Rest and diet changes
  • Exercise and physical therapy
  • Anti-inflammatory drugs (ex: ibuprofen)
  • Cognitive and behavioral modification

Mid-Level Pain Treatments:

  • Transcutaneous electrical nerve stimulation (TENS)
  • Opioids (Prescription painkillers)
  • Nerve blocks (injection of an anesthetic, steroid, and/or anti-inflammatory into the pain area)
  • Thermal procedures (extreme heat or cold delivered through needles or probes)

Advanced Pain Treatments:

  • Spinal Cord Stimulation (SCS)

    SCS, also known as nerve stimulation, uses electrical signals to mask the perception of pain traveling from the painful area to the brain. In place of pain, patients feel a mild tingling sensation called "paresthesia." SCS may provide long-lasting pain relief and can be used with other therapies. Patients are able to control the intensity of the therapy, as well as turn it on and off, using a wireless remote control.

  • Surgery

    Surgical treatments may range from minor outpatient procedures to brain and spinal procedures. Surgery may be needed when structural problems occur within the spinal column often caused by injury or disease.

  • Implantable drug pumps

    Pumps deliver pain medication directly to the space surrounding the spinal cord. Direct application reduces the amount of opioids needed to relieve painful symptoms.

  • Neuroablation

    Often used as a last resort when other therapies fail, Neuroablation is a surgical technique that destroys nerves and tissue, permanently blocking nerve signals to the brain.

Is Spinal Cord Stimulation for You?

It very well could be. If you suffer from chronic pain, a Spinal Cord Stimulator (SCS) System may be the right choice. SCS therapy is often considered when medications or surgery are not an option or when the side effects of your current therapy are impacting your quality of life.

Evaluate your pain now. Then talk with a Pain Management Specialist to discuss if Spinal Cord Stimulation may be right for you, contact Comprehensive Pain Management in Attleboro, MA.

Source: Boston Scientific

Treating Herniations in the Lumbar Spine

Joseph Coupal - Friday, July 27, 2018

The Disc-FX System safely, rapidly and effectively performs minimally invasive procedures for herniations in the lumbar spine. This treatment combines simple, intuitive function with precise surgical results. This procedure is:

  • Less invasive compared to traditional discectomy procedures
  • Minimum annulotomy reduces risk of herniation
  • Multi-functional therapeutic options; debulking, ablation and modulation
  • Manual excision of herniated nucleus through 3.0mm portal
  • Ablation and denervation achieved with use of Trigger-Flex®

For more information on treating herniations in the lumbar spine, contact Comprehensive Pain Management in Attleboro, MA.

Why am I having Persistent Pain?

Joseph Coupal - Thursday, July 12, 2018
Comprehensive Pain Management - Warwick, RI

Most of the time pain goes away after an injury heals. However, if pain persists more than a month or two, it can become chronic pain. Sometimes pain becomes chronic because the underlying problem does not heal. For instance, arthritis causes long term inflammation and damage to the joints, and it may hurt as long as the inflammation lasts. Unfortunately, chronic pain may also occur despite healing and with no obvious injury to tissues. This may be the result of damage to the nerves that transmit pain (neuropathic pain), but chronic pain also affects the entire nervous system, sometimes in a permanent way.

When any type of pain lasts a long time there can be changes in the spinal cord and the brain that change how we perceive painful sensations. These changes may result in severe pain with little or no painful stimulus. Some chronic pain can be very difficult to treat and can become so frustrating for patients that it is often accompanied by depression or other emotional problems. It is this type of pain that represents some of the most challenging problems a pain management specialist can face.

For more information on chronic pain, contact Comprehensive Pain Management in Attleboro, MA.


Don't Let a Back Injury Ruin Your Golf Game

Joseph Coupal - Thursday, June 28, 2018
Comprehensive Pain Management in Attleboro, MA

Simply avoiding the exacerbating repetitive task may alleviate pain, however, giving up your golf game is not practical.

Frequent rounds of golf may cause a number of painful conditions from chronic overuse of the muscles and tendons. Back pain resulting from improper form is one of the more common complaints in orthopedics. First and foremost, having a golf pro will help avoid injuries and improve your game. Despite how hard you try, you may fall victim to a back injury just like the golf professionals. When injuries occur there are non-surgical and minimally invasive treatments to alleviate discomfort.

Simply avoiding the exacerbating repetitive task may alleviate pain, however, giving up your golf game is not practical. NSAIDs and RICE (rest, ice, compression, elevate) provide temporary relief but do not necessarily address the primary reason for discomfort.

The key to preventing back injury is working with your golf pro to optimize the mechanics of your swing. Muscle strains can be caused by an over-powerful swing or incorrect weight shift on the follow through, thus causing lower back pain. When this happens, and if the condition is beyond the assistance of RICE and anti inflammatories, there are non-surgical treatments to get you back in the game.

Some of the many options are:

Radiofrequency Ablation, otherwise known as RFA, is a safe, effective means to treat pain from arthritic joints in the neck and low back. The procedure uses heat to disable only the sensory nerves that transmit pain impulses in the spine. Benefits may last up to a year and sometimes longer.

Epidural injections are used to reduce inflammation and pain from nerve root compression in the neck and low back. In many cases this provides immediate relief and may provide relief lasting up to a year.

For more information on these non-surgical treatments, contact Comprehensive Pain Management in Attleboro, MA.


How to ease pain with Less opioids?

Joseph Coupal - Thursday, June 14, 2018
Spinal Cord Stimulation Works - Attleboro, MA

It’s no secret that the nation has been strongly affected by the opioid crisis.

While there are many contributing factors, the reason most people become addicted to, or overdose from opioids is pain — as in the need to relieve it.

To combat both opioid dependence and chronic pain, an increasing number of physicians are now specializing in the growing field of interventional pain management.

Interventional pain management specialists — many of whom are anesthesiologists — use nonnarcotic protocols to target the spots where patients are feeling pain, and then block the pain signals from traveling to the area.

This can be done in a variety of ways: injections, nerve blocks, topical and oral medications, and minimally invasive, outpatient surgical procedures.

Interventional pain management helps prevents addiction to narcotic pain medication.

For those suffering from chronic pain, these are just a few of the treatment options available that don’t include opioid medication.

For more information on pain management, contact Comprehensive Pain Management in Attleboro, MA.


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