Comprehensive Pain Management
(Formally known as Franklin Pain and Wellness and Warwick Pain)

Attleboro, MA(508) 236-8333
Franklin, MA(508) 541-0004
South Kingstown, RI (401) 234-9677
Warwick, RI(401) 352-0007

Franklin, MA • (508) 541-0004
Warwick, RI • (401) 352-0007
South Kingstown, RI • (401) 234-9677

Franklin Pain and Wellness Center

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How Spinal Cord Stimulators Work

Darren Kincaid - Friday, January 18, 2019
Comprehensive Pain Management in Attleboro, MA

Your nerves and brain are constantly communicating with each other. And when you feel pain, it's because the nerves are sending a pain signal to your brain. The pain can be acute, which occurs immediately after an injury and goes away within two months when treated properly. Or the pain can be chronic, which includes any type of pain that lasts six months or longer.

How Do Spinal Cord Stimulator Systems Work?

SCS systems have a small implanted pulse generator (IPG) and thin wires called ‘leads” that are placed into your body. To manage your pain, the leads deliver tiny pulses to specific nerves on the spinal cord that mask pain signals traveling to the brain. Some people say Spinal Cord Stimulation feels like a gentle tingling or fluttering sensation that replaces the pain. The medical term for this is "paresthesia." The feeling is different for everyone and the amount of pain relief you receive from SCS therapy will vary.

For more information on Spinal Cord Stimulation, contact Comprehensive Pain Management in Franklin, MA.

Boston Scientific

New Year’s Resolutions for People with Chronic Pain

Joseph Coupal - Friday, January 04, 2019
Comprehensive Pain Management - Headaches and Migraines in Franklin, MA

It’s an American tradition. In the New Year, we think about making a commitment to ourselves to make changes that would improve our lives.

While many people in chronic pain don’t believe there’s much they can do to reduce their pain other than taking pills, in fact there is plenty of scientific evidence that lifestyle changes can reduce or even eliminate pain. However, the sad fact is that only 8% of people who make New Year’s resolutions actually stick to them.

Experts suggest that in order to get New Year’s resolutions to stick, stick to small, achievable goals rather than all or nothing goals. For instance, instead of saying “I will stop eating sugar”, commit to finding some healthier foods that you can start substituting for some of your high sugar foods. Even minor changes can make a big difference in your health and general well being, including pain levels.

Here are some suggestions for achievable goals that can make a big difference in pain levels:

  • Make a commitment to start moving more. Most pain, including back and neck pain, fibromyalgia and arthritis, decreases with movement. At first, if you’re not used to moving at all, you might hurt a little more. Remember when you were younger and you used to overdo exercise sometimes and you ached? Then your muscles got stronger from the effort and you were able to do more. Even a small amount of walking, range of motion exercises and/or stretches can make a big difference. Consult a physical therapist or chiropractor if you need guidance. Water exercise classes (available at most YMCAs) or yoga classes are also good options. Exercising with others can help you stay motivated.
  • Vow to start eating more fruits and vegetables and healthy fats and less sugar, white flour and processed foods to reduce inflammation and get the nutrients you need to heal.
  • Resolve to learn and start practicing a relaxation technique such as meditation, diaphragmatic breathing or guided visualization. Stress changes physiology in ways that exacerbate pain and these techniques can calm your physiology and reduce pain.
  • Pledge to keep searching for strategies and treatments that can help reduce your pain and try at least one new treatment this year. Some you might not have tried that can be life changing include biofeedback, energy psychology (emotional freedom technique), low level laser therapy (also known as cold laser therapy), a gluten free diet, medical marijuana or hemp-derived CBD oil, or a PEMF device.
  • Make a point of adding more enjoyment to your life. Listen to more of your favorite music, find more stuff to laugh at, spend more time with people you care about (even if that means asking them to come to you if it’s difficult for you to get out), spend more time with or get a pet (cats work well for people who can’t get out much).
  • Promise yourself you’ll read at least one book this year that will help you learn to better manage your pain. Here are some suggestions.

A new year is a great time to take stock of our lives and resolve to make changes. We all have the power to make our lives better. 2019 is a great time to start.

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

Happy New Year!

Preventing Holiday Headaches and Migraines

Joseph Coupal - Friday, December 14, 2018
Comprehensive Pain Management - Headaches and Migraines in Franklin, MA

From dealing with “the in-laws,” to waiting in endless lines while doing holiday shopping, the holiday season can sometimes be less than jolly. What’s worse is that for millions of migraine sufferers, the holidays can be even painful…literally.

If you think of every potential trigger for migraine, this is the time of year we expose our migraine sufferers to all of them. We tend not to eat right, exercise enough, sleep well, and stress levels definitely tend to escalate. The good news for migraine sufferers is that there are things they can do to prevent severe episodes of migraine.

  • Plan in advance: Make lists of everything you need to do, buy, pack or cook. If traveling, allow extra time to navigate airports and crowded highways. If possible, don’t shop during peak hours when stores are mobbed.
  • Don’t skip meals: Empty stomachs can spur headaches. If unable to follow your normal eating schedule, pack snacks. Avoid foods such as ripe cheeses, processed meats, and chocolate, which can cause headaches in susceptible people.
  • Avoid last-minute shopping: Winter coats, hot stores, long checkout lines, and looming Christmas deadlines can give even the most ardent shopaholic a tension headache. Don’t try to pack too much shopping into one day. Shop early, or consider online or catalog shopping.
  • Limit exposure to smoke or perfume-filled rooms: Both can trigger headaches. Find some fresh air.
  • If you drink, do so in moderation: Alternate alcoholic drinks with glasses of water. Avoid red wine, which contains an amino acid known to trigger headaches. Limit your alcohol intake in the hour or two before bedtime.
  • Schedule personal time: Many people try to pack too much holiday socializing into too little time. Don’t feel you must attend every holiday event to which you are invited. Give yourself a break and plan some down time. A few hours alone each week can reduce stress.
  • Maintain a regular sleep and eating schedule: Changes in either of these areas can bring on migraines.

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


Managing Chronic Pain During the Holiday Season

Joseph Coupal - Wednesday, December 05, 2018
Comprehensive Pain Management - Spinal Cord Stimulation in Franklin, MA

The holiday season can be filled with joy and cheer; however, this busy season can also be filled with pressure and anxiety. For those individuals living with , increased stress and fatigue can result in escalation of their painful conditions. Below are some helpful recommendations that can make the holiday season more comfortable and enjoyable.

Prioritize those activities most important to you

The holidays can be extremely busy with shopping, traveling and family gatherings. Try to set limitations for yourself and choose to participate in activities you can comfortably enjoy.

Exercise and keep active

Do NOT eliminate health and fitness from your schedule in December. Aerobic activity, gentle stretching, yoga or even starting a physical therapy program is a great method to manage pain and improve mental health.

Maintain nutrition and healthy eating habits

Holiday gatherings are usually filled with tempting sweets and indulgences. It is often difficult to consider losing weight during the holiday season; a better goal would be to maintain your current weight, eat healthy and try to consistently have a good night’s sleep. In addition, try to limit any alcohol consumption. Alcohol is a depressant and can thus intensify pain. Moderation is the key to success with diet.

Pace and plan your activities

Try to avoid the added stress of last minute tasks. Plan a schedule with extra time to incorporate an unanticipated “painful day”. You might find it easier to tackle several shorter shopping trips, rather than a twelve hour marathon event. Delegate to family or friends those activities which might be too challenging for you.

Find time for yourself

Holidays are hectic and full of visits and get-togethers. Finding time for yourself, for relaxing, yoga, a walk or even just a nice bath can help reduce stress and pain.

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

Source: NEBH

Chronic Migraine Treatment

Joseph Coupal - Friday, November 16, 2018
Comprehensive Pain Management - Chronic Migraine Treatment, Franklin, MA

Do you really know how many headaches and migraines you have in a month?

Keeping a diary can help you find out. If you have 15 or more headache days a month, that means you’re spending more than half the month with headaches.

And if you also have migraine on at least 8 of those days, and each headache lasts 4 hours or longer per day, you may have a distinct condition called Chronic Migraine.

Keeping a migraine diary and sharing your diary with your pain specialists can help your team of doctors determine if you have Chronic Migraine. If you do have Chronic Migraine, you and your doctor can decide if BOTOX® should be part of your treatment plan.

BOTOX® prevents headache days before they even start.

BOTOX® prevents 8 to 9 headache days and migraine/probable migraine days a month (vs 6 to 7 for placebo).

Don’t take them lying down. Stand up to Chronic Migraine with BOTOX®.

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


3 Ways Pain Specialists Help with Spine Care

Joseph Coupal - Friday, November 02, 2018
Comprehensive Pain Management in Franklin, MA

Providing successful care for the spine takes a talented team of health providers working in concert with the patient. In cases that involve chronic pain, it may be beneficial to have an interventional pain specialist as part of the spine care team. Here are 3 reasons why.

1. Understand psychosocial factors and pharmacology in pain treatment

In addition to understanding the spine’s intricate structure, management of chronic spinal pain requires specialized knowledge of psychosocial factors and the increasingly complex workings of medications (pharmacology). To that end, interventional pain specialists approach patient care with a comprehensive set of techniques specifically designed to manage both short- and long-term chronic pain.

The expertise provided by interventional pain specialists is typically reserved for patients whose pain levels continue without improvement for 2 to 3 weeks, and can involve short-term management of acute flare-ups, or long-term treatment in patients who have had a failed surgery or not responded to other treatments yet.

2. Explore all nonsurgical options first

With a few exceptions, all nonsurgical treatments should be exhausted in all patients who present with spine-related pain symptoms before looking to surgical treatment. In many cases, physical therapy is the preferred starting point, but in some patients this is not practical due to the degree of pain a patient is experiencing, which makes it difficult to fully participate in therapy.

In cases where chronic spinal pain has not yet been successfully managed with physical therapy and other treatments, interventional pain specialists may be able to help. Some of the more common techniques employed by interventional pain specialists include:

In rare cases when chronic back or neck pain cannot be managed with nonsurgical treatments, surgery may be considered.

3. Manage post-surgery residual pain

Interventional pain specialists can also be utilized to manage a patient’s residual pain during post-surgery recovery. This aspect is particularly relevant considering today’s opioid epidemic, where patients may already be taking a variety of pain medications when they are referred to a surgeon. In these situations, the pain specialist needs to analyze patient factors such as overall health, age, weight, health habits, and the level of pain associated with recovery while balancing the risks of various drug interactions.

Pain management sometimes requires constant adjustment of the treatment plans in consultation with the patient before a suitable solution is realized. So it is essential for both the patient and physician to maintain an open mind and open communication. Alternative treatments, such as acupuncture, chiropractic treatment, and massage are commonly used as well. Thankfully, there are now a broad range of treatments and recovery plans for chronic pain which do not depend on an overreliance to prescribing opioids.

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


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.


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