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

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Treating Chronic Pain

Joseph Coupal - Thursday, April 19, 2018
Comprehensive Pain Management - Franklin, MA

Opioid abuse is an epidemic, the U.S. Centers for Disease Control and Prevention reports, killing 40 a day and ensnaring millions more in a pattern of abuse and addiction. At the same time, chronic pain is hurting the quality of life of some 100 million Americans — more than heart disease, cancer, and diabetes combined, a study published in the Journal of Pain estimates. If you suffer from chronic pain, understanding how to recognize, treat, and manage your pain as early as possible may relieve not only the pain, but also the anxiety that goes along with it.

Like heart disease and diabetes, chronic pain is a complex disease that needs to be managed with medications, lifestyle changes, and often psychological help. And like many chronic diseases, the sooner you treat pain, the sooner you can reverse or manage the damage that’s already been done.

When it comes to treating pain with drugs, almost all pain experts agree that cancer pain and pain from severe acute injuries or surgeries are best treated by opioids, but there are so many factors that determine which patients are good candidates for which treatments.

It is estimated that 10 percent to 15 percent of people treated with opioids can get addicted, and many millions more without chronic pain misuse the drugs recreationally. Even people who don’t get addicted to drugs get physically dependent because the body becomes habituated. While opioids are effective in nearly everyone for acute inflammatory pain, for chronic pain, maybe a third of people will get long-term benefits, and not all of those people will get a functional benefit, meaning other medications might be more effective.

Picking a Chronic Pain Treatment Plan

Before a pain specialist can decide the best course of action for you, he or she needs to take a comprehensive history of when and how your pain started, how long it’s lasted, and how you’ve been treated it so far.

Here are some general treatment categories to know the next time you talk to your doctor:

Acetaminophen: The active ingredient in Tylenol, over-the-counter acetaminophen is one of the most commonly used pain relievers, and a first-line treatment recommended by the American College of Rheumatology.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Another first-line treatment, NSAIDs are slightly more powerful than acetaminophen and available over-the-counter in lower doses and by prescription for higher doses. NSAIDs include anti-inflammatory drugs, such as naproxen (the active ingredient in Aleve), and ibuprofen. They can be used in conjuction with opioids, making opioids more effective and reducing the necessary opioid dosage. But NSAIDs are also not without risks. When you reach a certain age, people become much more likely to develop complications with NSAIDs. Organ toxicity, kidney or liver failure, ulcers. Opioids don't have those risks.

Serotonin and norephinephrine reuptake inhibitors: Anti-depressants that inhibit both serotonin and norephinephrine are first-line treatments for nerve pain, such as diabetic neuropathy, and muscular and skeletal pain. Anti-depressants that are also approved for anxiety can help also help people sleep, and they don't have the downsides of opioids.

Cortiosteroids: Steroids, such as prednisone, inhibit injured nerves, Cohen explains. The problem is, the pain returns once you stop taking them and they may actually accelerate joint destruction.

Topical medications: Lidocaine and capsicin are two examples of topical creams that can treat localized pain, either as a one-time treatment or part of a regular pain-soothing treatment plan. The downside is these drugs only work for pain in one area, not total-body pain.

Injections: There are lots of different kinds of injections, including nerve, epidural, trigger point, and radiofrequency injections, which work for regional or local pain. Steroids and other types of drugs can also be administered through injections. The conditions injection can treat are as varied as the injections themselves. Arthritis, acute injuries and muscle pain, myofascial pain syndrome, headaches, and more can all respond favorably to injections. However, they're not good for someone with the total-body pain that comes with conditions such as fibromyalgia or diabetic neuropathy.

Neurostimulators: An acute treatment that is FDA-approved for back, neck, arm, or leg pain, neurostimulation uses implanted electrodes to interrupt nerve signals and provide pain relief. However, this type of treatment is not a cure for what's causing the pain; instead, it simply masks pain signals before they reach the brain. Some types of stimulation, including sphenopalatine ganglion stimulation, are going through clinical trials to evaluate their effectiveness for treating headaches, including cluster headaches.

Massage, acupuncture, and other alternative therapies: Often combined with traditional drug therapy, acupuncture, acupressure, spinal manipulation, and more can be effective, safe, and side-effect free, particularly when more conventional treatments have not helped. Alternative therapy seems to be more effective than not having any treatment and in some cases, may work as well as medications.

Exercise and physical therapy: Study after study has shown that gentle exercise can improve functionality and mobility in people with many kinds of chronic pain. Gentle movements such as tai chi and yoga have been shown to improve chronic back and joint pain, arthritis, fibromyalgia, and other conditions.

On the whole you can't say clear-cut things about who should be treated with which drugs, or which alternative and complementary treatments. The key is talking to your doctor to find a plan that works for you.

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

Source: everydayhealth.com

Ways to Treat Chronic Back Pain

Joseph Coupal - Thursday, April 05, 2018
Comprehensive Pain Management - North Attleboro, MA

Back pain is considered chronic if it lasts three months or longer. It can come and go, often bringing temporary relief, followed by frustration. Dealing with chronic back pain can be especially trying if you don’t know the cause.

Here are some common chronic back pain causes and nonsurgical treatment options.

Common Causes of Chronic Back Pain

Chronic back pain is usually age-related, but can also result from a prior injury. The most common causes include:

  • Arthritis of the spine—the gradual thinning of the cartilage inside the spine
  • Spinal stenosis—narrowing of the spinal canal that may lead to nerve pain
  • Disc problems, such as a herniated or bulging disc
  • Myofascial pain syndrome—unexplained muscle pain and tenderness

In some cases, it’s difficult to pinpoint the cause of chronic back pain. If your doctor has exhausted all diagnostic options, it’s time to seek a second opinion from a back pain specialist. It’s important not to make rushed decisions or undergo extensive medical procedures until the origin of the pain is found. Not only may they not help; they could make the pain worse.

If the source of the pain is not known or can’t be treated, your best option may be to work with your pain management team on reducing the flare-ups and making the pain manageable with nonsurgical treatments.

Nonsurgical Treatments for Chronic Back Pain

  1. Physical Therapy

    Exercise is the foundation of chronic back pain treatment. It’s one of the first treatments you should try under the guidance of your physician and spine physical therapist. However, the same set of exercises doesn’t work for everyone. The exercises have to be tailored to your specific symptoms and condition. Maintaining the exercise routine at home is also a big part of success.

  2. Mindfulness and Meditation

    Chronic back pain is straining both physically and emotionally. To manage the frustration, irritability, depression and other psychological aspects of dealing with chronic pain, you may get referred to a rehabilitation psychologist. This specialist may recommend meditation, yoga, tai chi and other cognitive and relaxation strategies to keep your mind from focusing on pain.

  3. Diet

    Some diets are highly inflammatory; especially those high in trans fats, refined sugars and processed foods. Consult with your doctor to see if your diet could be contributing to your chronic back pain and how you could change it. Maintaining a healthy weight could also help lessen your back pain by reducing the pressure on your spine.

  4. Lifestyle Modifications

    When you have chronic pain, it’s important to accept your limitations and adapt. Listen to your body and learn to pace yourself. Take a break when mowing the lawn, or make several trips when carrying groceries. Take note of the activities that worsen your pain and avoid them if possible. Not only could this help your back feel better, it could also prevent the underlying condition from advancing.

    Another important lifestyle change to try is giving up smoking. Nicotine is scientifically known to accentuate pain and delay healing.

  5. Injection-based Treatments

    Nerve blocks, epidural steroid injections, nerve ablations and other types of injection-based procedures are available for chronic back pain. They are used when the source of the pain is known and can sometimes help rule out certain causes if the treatment doesn’t work. Injections may stop or lessen pain for a certain period of time, but are not intended as long-term solutions and shouldn’t be used in isolation.

  6. Alternative Treatments

    Acupuncture, massage, biofeedback therapy, laser therapy, electrical nerve stimulation and other nonsurgical spine treatments can also make a difference for chronic back pain. Talk to your spine specialist about alternative treatments that could benefit you.

  7. Analgesics, anti-inflammatory drugs, muscle relaxants and other medications can be used to help control chronic back pain. However, most come with unwanted side effects and are not intended for prolonged use.

Opioid medications generally shouldn’t be used as the first, the only or the long-term line of treatment for chronic back pain. Many of them are addictive and don’t address the underlying cause of your pain. Opioids should be prescribed only after a thorough exam by a specialist and if other drugs have failed to provide relief. If you find yourself relying on opioids to get through the day, it may be time to seek a second opinion.

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

Source: hopkinsmedicine.org


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