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

Franklin Pain and Wellness Center

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Treating Chronic Arthritis Pain

Joseph Coupal - Friday, October 19, 2018
Comprehensive Pain Management - Franklin, MA

Chronic pain – a common problem for people with arthritis and other rheumatic conditions like fibromyalgia – doesn’t just hurt. It can drain your ability to work, enjoy life and be active. Often, it leads to ongoing problems with sleep, fatigue, depression and anxiety. These factors interconnect, such that difficulties with any of them make the others worse.

People with arthritis can have both acute and chronic pain. Acute pain happens when you have an active injury; it lasts for days or weeks until the injury is healed. Chronic pain persists for three months or longer.

Ongoing disease can cause ongoing pain. If inflammation in the joints continues and is not controlled, individuals can continue to experience pain, from the inflammation itself, the damage it’s causing or both.


Getting arthritis under control is the first step in treating chronic pain. The next is working with your doctors and other specialists to develop a comprehensive pain management plan targeting the unique factors influencing your chronic pain.

Pain is often multifactorial in origin. Thus, it is important for physicians to separately identify each possible cause of pain, rather than assuming all pain is a symptom of the rheumatic disease.

In addition to arthritis medications, such a plan might include drugs or other treatments designed specifically to treat pain, sleep or mood; complementary or alternative therapies; and talk therapy.

Improve sleep. Sleep problems are common among people with rheumatic diseases. Pain can disturb sleep, and vice versa. Practicing good sleep hygiene – avoiding caffeine, alcohol and screen time before bed, for example – can improve sleep.

Track pain and its effects. Keeping track of when pain strikes and how it affects you may help you and your doctor pinpoint causes and solutions. You can use a notebook or one of the many available online tools or smartphone apps.

Work on the mind-body connection. Cognitive behavioral therapy (CBT) – talk therapy aimed at changing negative thought patterns – can ease chronic pain in arthritis and fibromyalgia. Mind-body activities, such as tai chi or yoga, may also reduce discomfort in people with musculoskeletal conditions.

Consider a multidisciplinary plain clinic. Although a rheumatologist or primary care physician can often help manage pain, some people need more specialized care. If pain is still running your life after working closely with your doctor to improve it, consider a consult with experts at a multidisciplinary pain clinic.

These clinics offer a range of interventions and complementary treatments. For more information on treating chronic arthritis pain, contact Comprehensive Pain Management in Franklin, MA.


Sources of Arthritis Pain

Joseph Coupal - Friday, October 05, 2018
Comprehensive Pain Management - Franklin, MA

Different types of arthritis can cause different types of pain.

Arthritis and related diseases can cause debilitating, life-changing pain. More than one-third of the adults who have arthritis report that it limits their leisure activities and work. And 25 percent of them say it causes severe pain (seven or higher on a zero to 10 point scale).

There are more than 100 different forms of arthritis and related diseases. The most common types include osteoarthritis (OA), rheumatoid arthritis (RA), psoriatic arthritis (PsA), fibromyalgia and gout. All of them cause pain in different ways.


In osteoarthritis (OA), the protective cartilage inside the joint breaks down. This makes movement of affected joints more difficult and painful. In time, bones of the joint may rub directly against one another, causing severe pain. Pain can also come from parts of your joint other than the cartilage, such as bone, synovium and ligaments. The intensity of OA pain varies from person to person and can range from mild to severe.

Rheumatoid Arthritis

In rheumatoid arthritis (RA), the joints and other organs are attacked by the body’s own immune system. The immune system normally protects a person from viruses, bacteria and other invaders. In people with autoimmune diseases like RA, it becomes overactive and attacks healthy tissue. In the case of RA, the immune system primarily goes after the lining of the joints, called the synovium. Over time, the persistent inflammation breaks down the joint and damages it permanently.

Pain in RA can come from other parts of your joint besides the synovium, such as bone and ligaments.

Psoriatic Arthritis

Psoriatic arthritis (PsA) is an autoimmune inflammatory disease in which the immune system attacks the body, causing inflammation and pain. PsA affects the joints, causing arthritis; the connective tissue where tendons or ligaments attach to bones, causing enthesitis; and the skin, causing psoriasis.


Fibromyalgia is considered a central pain syndrome. This means that the brain and spinal cord process pain signals differently. A touch or movement that doesn’t cause pain for others may feel painful to you (this is called allodynia). Something that is mildly painful to someone without fibromyalgia may hurt you even more (this is called hyperalgesia).

Fibromyalgia is characterized by widespread pain. It may come and go or be constant. Besides pain, fibromyalgia is associated with other symptoms, such as fatigue, sleep problems, inability to concentrate and mood troubles.


Gout is a form of inflammatory arthritis, but it does not cause body-wide inflammation like RA or PsA does. In gout, uric acid crystals are the problem. If your body produces too much uric acid or if you are unable to remove the excess fast enough, it can build up in the blood (called hyperuricemia). Excess uric acid can form crystals in your joints. This results in extremely painful joint inflammation. Gout usually strikes in the large joint of the big toe, but can also affect other joints. With a gout flare, you can go to bed feeling fine and wake up with excruciating pain.


Lupus is an autoimmune inflammatory disease that affects many parts of the body, including the joints, kidneys, skin, blood, brain and other organs. It can cause joint pain, fatigue, hair loss, sensitivity to light, fever, rash and kidney problems.

Back Pain

Back pain can be a symptom of several forms of arthritis and related conditions, including ankylosing spondylitis, psoriatic arthritis and fibromyalgia. Most back pain, however, is the result of some type of injury, such lifting or bending improperly, a sports injury or an automobile accident.

Other Musculoskeletal Pain

Soft-tissue rheumatic conditions can also cause pain. In these conditions, muscles, connective tissues such as tendons and ligaments, and bursae become inflamed and painful.

For more information on treating arthritis pain, contact Comprehensive Pain Management in Franklin, MA.

Microdiscectomy, And Why Tiger Woods Once Missed the Masters For Back Surgery

Joseph Coupal - Friday, September 21, 2018
Spinal Cord Stimulation Works - Attleboro, MA

Tiger Woods underwent a microdiscectomy in 2014 to relieve the pain caused by a pinch nerve, which had caused problems for him for months.

According to Woods, he decided to get the procedure done “after attempting to get ready for the Masters, and failing to make the necessary progress.”

Woods missed the Masters Golf tournament due to the procedure.

When you hear the phrase "back surgery," you may immediately assume the worst: but microdiscectomies are actually safe, common, and relatively quick procedures that can help athletes with pinched nerves.

A microdiscectomy or microdecompression spine surgery involves removing a tiny piece of bone over the nerve root, or disc material, in order to relieve pain caused by neural impingement (or essentially a pinched nerve). The repetitive motions of golfers can cause back injuries; likewise, someone with a herniated lumbar disc will undergo a microdiscectomy.

During a microdiscectomy, surgeons create a small incision in the lower back, after which the back muscles are lifted off the arch of the spine. The surgeon then removes a membrane over the nerve roots, visible through special glasses. The nerve root is then moved over, giving the doctor the chance to remove the disc material. It’s a surgery that can be done in one day, with no requirement for the patient to stay in the hospital overnight. Pain is often relieved immediately after the surgery, and patients are able to go back to their normal lives shortly after.

Typically, patients undergo microdiscectomies after leg or back pain caused by a disc herniation doesn’t improve after 12 weeks. Often the pain can resolve itself without surgery, but a microdiscectomy is considered a viable option if the problem isn’t resolved.

The success rate of this type of procedure is usually 90 percent or higher. Most of the time,the operation is safe, effective, and rarely results in recurrent herniated discs. It appears Woods' operation was successful!

Other athletes treated for back problems are often quick to recover. One study looked at 80 professional athletes, across all sports including golfers – 90 percent [were] able to return to their prior level of sport.

For more information on microdiscectomy, contact Comprehensive Pain Management in Franklin, MA.


What is Degenerative Disc Disease?

Joseph Coupal - Thursday, September 06, 2018
Comprehensive Pain Management in Franklin, MA

In a young and healthy back, discs between the vertebra provide height and allow bending, flexion, and twisting. The discs are like shock absorbers between the bones of the spine and are designed to help the back stay flexible while resisting forces. As a normal process of aging, the rubbery discs begin to shrink and lose integrity.

Nearly everyone shows some signs of wear and tear on the spinal discs as they age. Studies show that almost everyone older than age 60 has degeneration of the discs, but not all those people have back pain. In some cases, the discs may collapse completely and cause the facet joints in the vertebrae to rub against one another, causing the pain and stiffness of osteoarthritis.

For those people in whom the degenerated discs do cause pain that cannot be attributed to another problem, they are considered to have degenerative disc disease.

Degenerative Disc Disease Causes

  • Not actually a disease, degenerative disc disease refers to a condition in which pain is caused from a disc that loses integrity.
  • Several factors can cause discs to degenerate, including age. Specific factors include:
  • The drying out of the disc. As we age, the disc dries out and doesn't absorb shocks as well
  • Daily activities and sports can cause tears in the outer core of the disc
  • Injuries can cause swelling, soreness and instability

Unlike other tissues of the body, there is very little blood supply to the disc, so once a disc is injured, it cannot repair itself, and the discs can start to deteriorate.

Degenerative Disc Disease Symptoms

Symptoms are most commonly concentrated in the low back or neck, depending on where the degenerated disc(s) are. Common symptoms include:
  • Pain that ranges from nagging to severe and disabling
  • Pain that affects the low back, buttocks and thighs
  • Pain in the neck that may radiate to the arms and hands
  • Pain that is worse when sitting
  • Pain that gets worse when bending, lifting or twisting
  • Pain that lessens when walking and moving
  • Pain that lessens with changing positions often or lying down
  • Periods of severe pain that come and go, lasting from a few days to a few months
  • Numbness and tingling in the extremities
  • Weakness in the leg muscles or foot drop may be a sign that there is damage to the nerve root

Degenerative Disc Disease Diagnosis

A diagnosis is based on a physical examination and medical history, including a description of symptoms and the circumstances of when and where the pain started. An MRI can show damage to discs, but it alone cannot confirm degenerative disc disease.

Degenerative Disc Disease Treatment

Getting back pain under control – no matter the source – requires exercise to increase the strength and flexibility of muscles that surround and support the spine. Exercising increases blood flow to the back, which nourishes joints and muscles with oxygen and nutrients, while clearing away destructive inflammatory waste products.

Treatment options to go along with physical activity and exercises to increase back strength include:

  • Physical therapy
  • Medications: nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen sodium), pain relievers (acetaminophen)
  • Surgery: artificial disc replacement, spinal fusion
  • Heat and cold therapy
  • Spinal mobilization
  • Degenerative Disc Disease Self Care

Along with following doctor’s instructions, getting the proper amount of physical activity, and strengthening the muscles that support the spine, you can manage your condition in additional ways. Make lifestyle choices, such as eating a nutritious diet, stopping smoking and address both the physical and emotional effects of having a musculoskeletal condition. Self-management encompasses the choices made each day to live well and stay healthy.

For more information on treating degenerative disc disease, contact Comprehensive Pain Management in Franklin, MA.


Comprehensive Pain Management Patient Testimonials - Franklin MA

Joseph Coupal - Thursday, August 30, 2018

Comprehensive Pain Management Patient Testimonials.

Spinal Cord Stimulation FAQs

Joseph Coupal - Friday, August 10, 2018
Comprehensive Pain Management in Franklin, MA

Frequently Asked Questions

Have questions about Spinal Cord Stimulation? We've got you covered. Below are some of the top questions.

Is Spinal Cord Stimulation (SCS) safe?
Yes. SCS therapy has been proven safe and effective. Hundreds of thousands of people worldwide have been treated with SCS. SCS Systems are FDA-approved.

Q: Can one SCS system help me manage pain in more than one area?
SCS Systems are designed to cover several pain areas at the same time if needed. You can use your wireless remote control to adjust the amount of stimulation for each pain area.

Q: Will I be totally pain-free with Spinal Cord Stimulation?
People differ in the amount of pain relief they receive with SCS therapy. The trial, or test drive, may help you determine the amount of relief you will receive. SCS is generally considered effective if your pain is reduced by at least 50%.

Q: Will SCS allow me to be free of pain medications?
Every person differs in how effective SCS therapy is for them. For some patients, SCS therapy may work well enough that pain medications are no longer needed. For others, success with the therapy can mean using less pain medication.

Q: Will it be visible under my skin?
No. You will not be able to see your device under your skin. Unless you tell someone you have it, they'd never know. Our SCS Systems feature contoured, oval shapes and are small.

Q: Will my insurance cover SCS?
SCS is covered by most health insurance plans, including Medicare, commercial payers, and most workers' compensation programs. Your clinic or physician will need to get approval first. Insurance providers generally require pre-authorization for SCS. After determining that you are a candidate for SCS, your physician and his/her office staff will provide your insurance company the necessary documentation needed to complete the pre-authorization.

Your physician's office and your health insurance provider/program are the best resources for coverage questions and can provide you specific detail regarding your coverage benefits and out-of-pocket cost for SCS.

Q: Can I actually control the SCS therapy?
Yes. Our SCS System's wireless remote control lets you turn stimulation on and off, increase and decrease the level of stimulation, and target different pain areas using settings or programs customized by your physician specifically for you.

Have more questions? Contact Comprehensive Pain Management in Franklin, MA.

Source: Boston Scientific

Balloon Kyphoplasty for Treating Spinal Fractures

Joseph Coupal - Friday, July 27, 2018
Comprehensive Pain Management  - Kyphoplasty in Franklin, MA

The adult spine is a column of 33 bones that protects the spinal cord and enables us to stand upright. Each bony segment of the spine is referred to as a vertebra.

Having a spinal fracture means that one of the vertebra has either cracked or collapsed. Like other bones in the body, the extent of the break can vary, from a hairline fracture to a complete collapse of the vertebral body.

When a bone breaks, localized swelling can occur, and pain is common. In the spine, swelling and misalignment can irritate adjacent tissue and nerves. Damage to even one vertebra can alter the alignment of your spine, upsetting the distribution of weight along the spinal column and setting the stage for another fracture.

Balloon Kyphoplasty is a minimally invasive procedure that can repair spinal fractures. It takes about an hour per fracture level to treat a fracture with balloon kyphoplasty, and the procedure can be done on an outpatient or inpatient basis.

Balloon Kyphoplasty can reduce or eliminate your back pain from a spinal fracture, as well as restore vertebral body height and proper alignment of your spine. Early and effective treatment (fixing the broken bone) may reduce the consequences of spinal fractures, especially those associated with other treatments, for example, prolonged bed rest or use of analgesics.

Other benefits include sustained improvement in mobility, improvement in ability to perform activities of daily living, and improved quality of life. Although the complication rate with Kyphon Balloon Kyphoplasty has been demonstrated to be low, as with most surgical procedures there are risks associated with the procedure, including serious complications. This procedure is not for everyone. For a full discussion of risks and whether this procedure is right for you, contact Comprehensive Pain Management in Franklin, MA.


What Does a Pain Management Specialist Do?

Joseph Coupal - Friday, July 13, 2018
Comprehensive Pain Management - Franklin, MA

A pain management specialist is a physician with special training in evaluation, diagnosis, and treatment of all different types of pain. Pain is actually a wide spectrum of disorders including acute pain, chronic pain and cancer pain and sometimes a combination of these. Pain can also arise for many different reasons such as surgery, injury, nerve damage, and metabolic problems such as diabetes. Occasionally, pain can even be the problem all by itself, without any obvious cause at all.

As the field of medicine learns more about the complexities of pain, it has become more important to have physicians with specialized knowledge and skills to treat these conditions. An in-depth knowledge of the physiology of pain, the ability to evaluate patients with complicated pain problems, understanding of specialized tests for diagnosing painful conditions, appropriate prescribing of medications to varying pain problems, and skills to perform procedures (such as nerve blocks, spinal injections and other interventional techniques) are all part of what a pain management specialist uses to treat pain. In addition, the broad variety of treatments available to treat pain is growing rapidly and with increasing complexity.

With an increasing number of new and complex drugs, techniques, and technologies becoming available every year for the treatment of pain, the pain management physician is uniquely trained to use this new knowledge safely and effectively to help his or her patients.

Finally, the pain management specialist plays an important role in coordinating additional care such as physical therapy, psychological therapy, and rehabilitation programs in order to offer patients a comprehensive treatment plan with a multidisciplinary approach to the treatment of their pain.

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


Possible Solutions to Chronic Pain

Joseph Coupal - Friday, June 29, 2018
Comprehensive Pain Management - Warwick, RI

Previous columns have discussed chronic pain and some of the first steps that sufferers, guided by their physicians, should explore to seek relief.

Exercise, physical therapy, cold and heat, massage, acupuncture, Transcutaneous Electrical Nerve Stimulation, chiropractic manipulation, or non-opioid medications such as ibuprofen and other NSAIDS can make pain levels tolerable for many.

For others, however, the relief from these measures is inadequate. If you have "tried everything and nothing has worked,” it might be time to ask your physician if Interventional Pain Management would be a suitable avenue to explore.

Most specialists in this field are anesthesiologists, but some additionally have fellowship training in image-guided spine intervention.

Several local pain management clinics and practitioners offer these interventions. Your primary care physician should be able to help you determine if you are a good candidate for these procedures and to make a referral to the practitioner whose training and expertise is best suited to your needs.

There are various treatment options that can be performed by interventional pain management specialists.

While initially the placement of injections was based mostly on educated guesswork, the more recent use of fluoroscopy to guide precise needle placement has allowed much higher success rates.

Fluoroscopy is a type of medical imaging that shows a continuous X-ray image on a monitor, much like an X-ray movie, so a needle or wire can be guided to exactly the right spot.

Different interventions treat different types and locations of pain and have varying lengths of effectiveness.

Facet joint injections

These treat pain in the facet joints which support the spinal column and allow it to flex, extend, and rotate.

In older adults trauma and arthritic changes can contribute to the development of facet syndrome. Frequently a deep, dull aching pain is referred to the groin, buttocks, hip, or side and back of the thighs.

Facet point injections have two purposes. Diagnostically they can pinpoint the location of structures causing pain. The small amount of local anesthetic and steroid is injected directly into the facet joint.

If the pain is improved, then a longer-lasting procedure like radiofrequency ablation can be performed for longer-acting relief. The short-term relief facet joint injections can provide also can make a patient comfortable enough to participate in restorative physical therapy.

Epidural steroid injections

These can be given in the neck (cervical), mid-spine (thoracic) or low back (lumbar) sections of the spine. They can also be used for diagnosis as well as short-term pain relief.

To reduce inflammation and pain in the nerves as they exit the spine, a mix of local anesthetic and steroid is injected into the epidural space, just outside the membrane that covers the spinal cord. Without the use of fluoroscopic x-ray for precise placement, 25 percent of procedures will result in incorrect placements.

Sometimes one or two more injections are needed, every three or four months apart. They can provide temporary relief in about 50 percent of patients for back pain, sciatica, and neck pain with shooting arm pain.

Epidurals are a common treatment option for many forms of low back pain and leg pain. Fifteen percent of the U.S. population suffers from low back pain and incidence increases with age.

While the pain relief effects are temporary — a week to a year — injections early in an acute attack can be very beneficial in preventing chronic pain.

Sacro-iliac joint injections

These deliver anesthetic and steroid to the place where the pelvic and tailbone meet, resulting in increased mobility and less pain. Some pain management practitioners feel that combining the S-I joint injections with rehabilitative exercise and chiropractic release of the joint yields the best result.

Radiofrequency ablation

This can be used for longer-term relief of neck pain, back pain, and headaches from facet joint arthritis. Using fluoroscopic x-ray, heat generated by radiofrequency waves can be delivered precisely to damage small nerves, disturbing the transmission of pain signals from the spinal column to the brain. The effects usually last several months.

Pain intervention techniques

Muscle as well as joint pain can be treated in this way. Trigger points — tender, irritable spots in muscles that are painful to the touch — can be treated by injecting a mix of cortisone and a local anesthetic such as lidocaine or bupivacaine into painful muscle tissue, usually in the neck or back.

Spinal cord stimulators

These are somewhat like an implanted Transcutaneous Electrical Nerve Stimulation unit. The SCS is indicated for those who have chronic neuropathic pain and are not candidates for surgery but for whom other treatments and injections have not been effective.

Initially wires are implanted to the affected area with the generator for the electrical current worn externally. If this treatment helps to lessen pain, the SCS can be implanted by a surgeon.

Intrathecal pain pump implantation

This allows targeted drug delivery to help with intractable chronic pain. Since medication is delivered directly to the intrathecal area surrounding the spinal cord, a smaller dose can be used than if it were given by other means, there are fewer side effects such as sleepiness, upset stomach and constipation, as when medication is taken orally, and the pain relief is often dramatic.

If a trial shows a pain improvement of 50 percent or greater, the patient may be considered a candidate for implantation.

These interventions are definitely not appropriate for everyone, but if the more conventional methods of pain relief are not working, they should be discussed and considered.

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


Spinal Cord Stimulation to Treats Back Pain

Joseph Coupal - Friday, June 15, 2018
Comprehensive Pain Management in Warwick, RI

Walking down the sidewalk may seem simple, but a year ago, Michael Holtz was in too much pain to walk.

To help ease the pain, he would use opioids for pain relief.

He had nerve damage along the leg and had been in chronic pain. He was at the end of his rope.

Holtz has degenerative disk disease and has had more than 20 surgeries for chronic pain, taking a variety of prescription drugs including opioids.

Struggling with depression, and desperate for pain relief, Holtz tried everything.

Holtz was like many patients who are hitting a wall to manage their chronic pain.

He had tried cortisone injections, epidurals, acupuncture, physical therapy, a number of different blocks, radiofrequency ablation is a spinal nerves and continued to be quite dysfunctional with the pain.

But, spinal cord stimulation provided relief for Holtz.

Here's how it works: a small device consisting of wires and a battery is surgically implanted in a patient, controlling pain by delivering electrical impulses to the spine to block pain signals.

This therapy also gives the patient an opportunity to control the sensation, the stimulation, the intensity of what they’re getting themselves, vis a vi a bluetooth device.

Now six months later, Holtz controls his own pain.

The device is helping thousands of patients like Holtz suffering from chronic pain, get off medications, and avoid opioids

It does not involve a drug. It avoids the issues with dependence on medications and certainly with over treatment and undertreatment and withdrawal.

A spinal cord stimulator has a average life span of ten years. It’s remotely charged through the Bluetooth device. It’s a one-time surgery. You can swim and go on an airplane with it.

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


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