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

Warwick Pain Center RI Blog

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Treating Lumbar Spinal Stenosis (LSS)

Joseph Coupal - Friday, October 12, 2018
Comprehensive Pain Management in Warwick, RI

Do you experience pain or numbness in your lower back when standing upright?

Is your discomfort relieved when you bend forward at the waist or sit down?

Do you experience pain, numbness, or tingling in your legs or buttocks when you walk?

About Lumbar Spinal Stenosis (LSS)

What is LSS?

Lumbar spinal stenosis (LSS) is a condition where the spinal canal narrows and compresses the spinal cord nerves in your lower back. As we age, the natural wear and tear on our spine can lead to a number of contributing factors that cause the narrowing of the spinal canal – thickening of ligament tissue, formation of excess bone, or compression/bulging of the discs.

What are the Symptoms of LSS?

The narrowing of the spinal canal can cause a number of symptoms such as pain, numbness or a tingling sensation in your buttocks, legs and lower back. It may also limit the amount of time/distance you are able to stand or walk. If your symptoms increase when you walk or stand, but you experience relief when you sit or bend forward, then you may have a certain type of LSS that can be treated by the removal of excess tissue that is causing the narrowing of the spinal canal.

LSS Treatment Considerations

There are many options available to treat LSS, and your doctor should help determine what is best for you. Some important things to consider with your physician are:

  • How effective is the treatment?
  • How long will the treatment provide relief from my pain/discomfort?
  • What are the risks of the treatment? What are the benefits?
  • Will I need to stay in the hospital? Will I have to undergo general anesthesia or surgery? How long is the recovery?

mild as a Treatment Option

If your doctor determines you have LSS caused by excess ligament, then the mild procedure may be a safe and effective treatment for you. mild is a quick outpatient procedure, performed through a tiny incision (about the size of a baby aspirin), requiring no general anesthesia or stitches. Study data show that 79% of patients experience a significant reduction in pain and significant increase in mobility. In addition, the mild procedure has been proven to have a very low risk of major complications.

For more information on mild, contact Comprehensive Pain Management in Warwick, RI.

What You Need to Know About Getting Botox Injections for Migraines

Joseph Coupal - Thursday, September 27, 2018
Botox Injections for Migraine Headaches, Warwick, RI

Botox is said to decrease the frequency of migraine days by an average of 50 percent for those who suffer chronically (people who experience 15 or more headache days per month).

Much like other fillers, Botox is slowly metabolized in the system, so for it to remain effective, patients have to get the procedure every three months or so.

Let's talk about migraines — namely, chronic migraines.

First of all, for those who aren't familiar with migraines, they're different from headaches. Headaches are unpleasant, too, but are typically less severe than migraines and don't usually present with other symptoms besides the pressure and aching in the head. Migraines, on the other hand, can be much more intense and often come with nausea, seeing spots, vomiting, extreme fatigue, sensitivity to light and sound, and more. They affect 39 million folks in the U.S., 4 million of whom deal with daily pain. Chronic migraines can severely inhibit daily life.

How is Botox for migraines different from cosmetic Botox?

The Botox used for migraines and the Botox used for cosmetic procedures is actually exactly the same. Basically, young and middle-aged women were getting [Botox] for cosmetic purposes, and that’s the most common person that has migraines, and that’s how they figured out it was helpful. Women were getting Botox for aesthetic reasons and happened to notice relief from their migraine symptoms, and doctors began looking into it as a direct treatment. In fact, women are disproportionately affected by migraines — about 85 percent of chronic-migraine sufferers are women, and the condition affects 28 million in just the U.S.

The only difference between the two procedures is that with Botox for migraines, they may do a few more shots in areas where the pain is experienced. Botox for migraines can have the same aesthetic effect that cosmetic Botox has.

How does it work, and how effective is it?

Though there's still more research to be done on Botox for migraines and doctors aren't yet completely sure why the procedure is effective, they have some ideas. What [Botox] does is paralyze nerve terminals. Essentially, nerve terminals transmit pain, but they also produce pain substances while they’re doing that, and it completely paralyzes that process. It stops the process of pain patterning and it also relaxes the muscles.

It's very effective among a large sampling of patients and is usually very well tolerated. Some patients find that it even eliminates the need for medication, which is a huge deal. However, about 7 to 10 percent of my patients find that it’s not effective. As with any medical procedure, everybody (and everyone's actual body) is different and will respond to treatment differently, and it's best to do a healthy amount of research and thoroughly talk to your doctor about your body and medical history before making a decision.

What are the potential side effects?

The side effects of Botox typically don't happen at the doses prescribed for migraines, and even if the scary-sounding side effects you read about online do occur, they aren't particularly dangerous and last four to six weeks. Most commonly, people have pain because you’re dealing with a bunch of shots, and sometimes you can get a headache from the procedure.

After the treatment, what comes next? How long does it last?

Some doctors recommend lying down and resting after a treatment, but there isn't any need for downtime unless a patient experiences pain. It can take about two weeks to work, though some patients start to feel relief from chronic migraines sooner than that. If it’s going to work for a patient, one round of the treatment typically lasts for around three months. Though everybody metabolizes it at a different rate, getting it done every three months or so has been found to be effective.

For more information on Botox for migraines, contact Comprehensive Pain Management in Warwick, RI.

Allure

TENS Therapy for Nerve Pain

Joseph Coupal - Thursday, September 13, 2018
Comprehensive Pain Management in Franklin, MA

A Tens Unit, or transcutaneous electrical nerve stimulation machine, can help back and neck pain that may be caused by trauma or continual strain. The body responds to such pain or injury with muscle guarding, an attempt to immobilize the painful area by tightening the muscles surrounding the injury. Muscle guarding impairs circulation in the affected area.

The decrease in blood supply leads to a decrease in metabolism with an accumulation of waste products. TENS therapy (transcutaneous electric nerve stimulator) can help break this pain cycle and aid in the normal healing process.

How Does a TENS Unit Work?

TENS units are a machine with different adjustable settings to control intensity of stimulation by controlling the voltage, meaning current, and pulse duration of each pulse. Electrodes are placed at specific sites on a user’s body depending on the physical location of their pain. The machine sends electrical current that travels through electrodes and into the skin stimulating specific nerve pathways to produce a tingling or massaging sensation that reduces the perception of pain.

When a Tens Unit is used as directed a T.E.N.S. is a safe, noninvasive, drug-free method of pain management. A TENS unit is used to offer a better quality of life for people with pain.

What does a TENS unit do to relieve, decrease or eliminate pain?

There are two theories. One of these theories is called The Gate Control Theory and is the most advanced explanation. The gate-control theory suggests that there’s a neural mechanism in spinal cord that acts as a kind of gate, shutting down or opening up the flow of signals from the periphery to the brain. Whether the gate is open, closed or partially closed depends on what sort of signal it receives from the brain to change the perception of pain in the user’s body. These frequencies interfere with the transmission of pain messages at the so spinal cord level, and help block their transmission to the brain.

Another theory is called The Endorphin Release, which suggests that electrical impulses stimulate the production of endorphins and enkaphalins in the body. These natural morphine-like substances block pain messages from reaching the brain, in a similar fashion to conventional drug therapy, but without the danger of dependence of other side effects.

TENS units are used for the relief of physical pain. Some common uses for TENS treatment are:

  • acute and chronic pain
  • post op incisions and post surgical pain
  • migraine and tension headaches
  • acute pain from sports and other injuries
  • arthritis
  • chronic pain from tendentious and bursitis
  • cancer pain
  • wound healing

For more information on TENS Therapy, contact Comprehensive Pain Management in Warwick, RI.

tensunits.com

Comprehensive Pain Management Patient Testimonials - Warwick RI

Joseph Coupal - Thursday, August 30, 2018

Comprehensive Pain Management Patient Testimonials.

Treating Contained Disc Herniations

Joseph Coupal - Friday, August 17, 2018
Comprehensive Pain Management in Warwick, RI

In the past, patients with contained disc herniations have been treated with conservative care including rest, medications, injections and/or physical therapy. Unfortunately, this does not always provide relief. In the past, people who did not respond to conservative care were forced to live with the symptoms or consider major spine surgery. If they underwent surgery, it could take weeks or months to recover, causing a major disruption in their daily lives.

With Disc-FX®, this is not the case. Disc-FX® provides an option for those people who have failed conservative care, and are not yet ready for major surgery. It is a minimal access procedure performed on an out-patient basis whereby the patient will go home the same day as the procedure with only a small bandage on their back.

Following manual removal of the offending herniation, the patented Disc-FX device is activated to help clean the disc and seal tears in the annulus. As a result, pressure in the disc is reduced, which eases symptoms.

Facts about Contained Disc Herniations:

  • 90% of low back pain is caused by pinched or irritated nerve in the back
  • There are 15 million office visits for low back pain each year
  • Low back pain is the most prevalent cause for people under 45 to visit their physician
  • Disc Anatomy and Contained Disc Herniations

The spine is composed of a series of bones called the vertebrae. Each of these bones is connected by a disc, made of a tough outer layer, called the annulus, and a gel-like center called the nucleus. If the annulus of the disc is damaged by injury or weakened by age, a portion of the outer layer can give way to pressure causing the gel-like nucleus to either bulge or leak out. This may also be referred to as a herniated disc. A herniated disc can press on the nerves and cause pain, numbness, tingling or weakness in the back and/or leg.

Disc-FX® System Overview

The Disc-FX® System is an innovative, minimal access spine system designed to efficiently access the damaged disc without injury to surrounding disc anatomy. Disc-FX permits multiple treatment options compared to other "single treatment devices" in the marketplace. In addition to manual decompression, Disc-FX® can help to clean the disc and seal tears in the annulus.

For more information contact Comprehensive Pain Management in Warwick, RI.

Who is a Candidate for the Disc-FX Procedure?

Joseph Coupal - Thursday, August 16, 2018
Comprehensive Pain Management - Disc-FX Procedure in Franklin, MA

Patients with symptomatic, contained lumbar disc herniations that have not responded to conservative treatment, may experience relief from a Disc-FX procedure. Typical signs of a contained lumbar disc herniation is lower back pain or pain radiating down the leg accompanied by some lower back pain. Disc-FX may not be beneficial for advanced degenerative disc disease or spinal fractures.

Your doctor will evaluate and determine if you are a candidate for the Disc-FX procedure.

Potential Benefits of Disc-FX:

  • Minimal Access Procedure
  • Out-Patient Procedure
  • Minor Skin Incision
  • Rapid Procedure
  • Multiple Treatment Options
  • Local Anesthetic
  • Target Access to Damaged (Diseased) Area
  • Treat Multiple Disc Levels
  • Early Anticipated Return to Normal Activities

Disc-FX has been shown to:

  • Offer a safe and effective treatment option
  • Provide improvement in quality of life
  • Treat multiple disc levels with one surgical procedure

For more information on Disc-FX for treating chronic back pain, contact Comprehensive Pain Management in Warwick, RI.

How Spinal Cord Stimulation Works

Joseph Coupal - Thursday, August 02, 2018

In this basic overview, you'll discover how spinal cord stimulation (SCS) works, and why it can be such a promising therapy for chronic pain.

If you live with chronic pain, you know how all encompassing it can be. It robs you of the things you love to do, strains your relationships, and makes even small tasks unbearable.

One size fits all therapies don't give you the relief you need. Spinal Cord Stimulation is a safe, drug-free, FDA pain managaement therapy that is clinically proven to reduce chronic pain. And, your therapy can be personalized. SCS is designed to interrupt pain messages with a small device called a stimulator. To see how SCS works, watch the video below.

When patients can choose between multiple therapies with one device, they achieve better overall pain relief.

For more information on Spinal Cord Stimulation, contact Comprehensive Pain Management in Warwick, RI.

Spinal Cord Stimulation

Joseph Coupal - Thursday, July 19, 2018
Comprehensive Pain Management in Warwick, RI

Chronic pain is long standing pain that persists beyond the usual recovery period or that accompanies a chronic health condition. Because this pain is not protective and is not a result of an ongoing injury, it is referred to as "pathological" and is therefore treated as a condition, not as a symptom. Chronic pain may prevent people from working, eating properly, participating in physical activity or enjoying life.

Spinal cord stimulation (SCS) is a pain-relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain. SCS is the most commonly used implantable neurostimulation technology for management of pain syndromes. As many as 50,000 neurostimulators are implanted worldwide every year. SCS is a widely accepted, FDA-approved medical treatment for chronic pain of the trunk and limbs (back, legs and arms).

There are three SCS device types:

Conventional systems require little effort on the patient’s part for maintenance. However, a minor surgical procedure is required to replace the power source when it runs out. Radiofrequency systems are designed to sustain therapy over long periods at the highest output level. Because of its high power capabilities, the RF system is suitable for the most challenging cases in which there is complex, multi-extremity pain. With this type of system, the patient must wear an external power source to activate stimulation. Rechargeable systems are the newest type of SCS device. The patient is responsible for recharging the power source when it runs low. A rechargeable system typically lasts longer than a conventional system. Eventually a minor surgical procedure may be required to replace the power source if the time between recharges becomes impractical.

SCS Trial Procedure

If it is determined that the patient is a suitable candidate for SCS, often the first step is to implant a device on a trial basis. During the SCS trial phase, a lead or leads are implanted temporarily and are connected to a trial spinal cord stimulator. The trial stimulator is programmed with one or more stimulation programs customized to the specific areas of the patient’s pain. The trial phase can be beneficial for the following reasons:

  • It can help the patient/physician analyze whether SCS effectively relieves pain
  • It provides the patient/physician with an assessment period to determine which type of SCS technology works best
  • It enables the patient/physician to evaluate different stimulation settings and programs

SCS Implantation

If the SCS trial provides adequate pain relief, then a permanent system may be implanted. SCS is a reversible therapy, so even though it is called permanent, treatment can be discontinued at any time and the implanted parts turned off and/or removed.

For more information on Spinal Cord Stimulation, contact Comprehensive Pain Management in Warwick, RI.

aans.org

Radiofrequency Ablation for Chronic Hip Pain

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

Many people with osteoarthritis and other degenerative diseases, including posttraumatic pain and rheumatoid arthritis, suffer from chronic hip pain. Conservative treatment approaches such as physical therapy and analgesia may result in significant cost or adverse effects while providing only short-term improvement, and minimally invasive techniques have been found to be ineffective or of temporary benefit.

Although total hip arthroplasty (THA) is often performed in patients with advanced disease, the procedure is associated with a 5% to 15% failure rate, high cost, and increased morbidity, mortality, and persistent postoperative pain. In addition, the life expectancy of hip implants ranges from 10 to 25 years.

There has recently been renewed interest in radiofrequency (RF) procedures for joint pain resulting from degenerative conditions.

Clinical studies have shown that RF treatment is more effective than conservative methods in reducing hip pain. It works by interrupting the sensory input from the femoral and obturator nerves that innervate the hip joint.

The most common indication for RF was osteoarthritis, and other diagnoses included vascular necrosis and persistent pain after THA. Participants had moderate to severe hip pain and limited ambulation, and previously demonstrated a lack of response to oral analgesics and other conservative approaches.

Hip pain is a common condition that is often seen in elderly patients with multiple comorbidities. Often, pain medications are ineffective or have too many side effects, and injections only provide little or temporary pain relief. In addition, surgery may not be an option because of unwillingness of the patient or an especially high risk for complications related to comorbidities. RF treatment may be a reasonable alternative in these circumstances, as well as in situations involving long wait times for THA or persistent pain after THA.

For more information on RFA, contact Comprehensive Pain Management in Warwick, RI.

clinicalpainadvisor.com

What is Radiofrequency Neurotomy and How Does it Relieve Back Pain

Joseph Coupal - Thursday, June 21, 2018
Comprehensive Pain Management in Warwick, RI

During this minimally invasive procedure, the physician uses heat from radio waves to treat painful facet joints in your lower back. It can treat pain that doesn't respond to medications or physical therapy.

You lie on your stomach and you are given medicine to make you feel relaxed. The skin and tissue of your back are numb.The physician inserts a tube called a cannula. A video x-ray device called a fluoroscope to guide the cannula to the medial branch nerves in your spine. These tiny nerves carry pain signals from the facet joints to the brain.

The physician inserts an electrode through the cannula. A weak electric jolt is used to test its position, if the jolt recreates the pain but does not cause any other muscular effects, then it is in the correct position.

Then the physician uses the electrode to heat the nerve. This disrupts the nerves' ability to transmit pain. Several nerves may be treated together if necessary.

When the procedure is complete, the electrode and cannula are removed and a small bandage is placed on your skin. You are monitored for a brief time before you are allowed to go home. The injection site may be a bit sore, and you may still experience back pain. If the correct nerves were treated, you will gradually experience pain relief as you heal. This may take many weeks, but your relief may last several months.

For more information on Radiofrequency Neurotomy to relieve back pain, contact Comprehensive Pain Management in Warwick, RI.