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

Warwick Pain Center RI Blog

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Prevent Winter Back Pain

Joseph Coupal - Thursday, January 31, 2019
Comprehensive Pain Management - Back Pain in Warwick, RI

When shoveling, remember it’s not a race, if it’s too cold and you’re rushing, take a break. Stretch. The key is to keep a steady pace, as to not exhaust yourself. When that happens, your body is more prone to not maintaining proper support.

Stay bundled up in warm clothing while outside, wear a few layers. Dress in the right gear: the warmest gear that allows for an ease of motion. Comfortable and durable outerwear will provide necessary support while working. (Women, try to wear clothes that shape to your body.) Wear the right footwear, a shoe with a rubber sole needs to be in optimal condition, because it can provide traction and support on snowy, icy areas. (This is key to not slipping, which can create and exacerbate pain conditions easily.)

The cold weather stiffens your muscles, so warming up and stretching as well as light lifting will keep you limber, improving your performance and reducing the likelihood of any strain. Big TV watcher? Force yourself to take a stretch break during commercials, or set time aside to stretch in the mornings and evenings. Keep your lower back fit with a home exercise routine.

Your muscles won’t contract which will keep your nerve endings warm.) Maintain a healthy home exercise program to strengthen your back.

Make stretching a routine in training. Doctors are unified in advising that it’s important to stay active. Keeping limber can reduce pressure on muscle tendons and ligaments. This keeps your joints from getting stiff and starting pain. (Swim in a heated pool to minimize joint pain.)

As Dr. Sandra Fryhofer said, maintain proper form. You want to lift with your legs and not your back, knees bent while lifting, and don’t bend or twist.

If an ergonomic shovel is not possible, try a plastic one rather than a metal one. The idea being to use lighter tools. Make use of a wheelbarrow.

Make sure to not be assumptive in the thought that freshly fallen snow can have a layer of ice hidden beneath the surface.

Overall, restrict your outdoor activities during this frigid time.

Maintain healthy supplements: Omega 3 fatty acids and Vitamin C help retain healthy joints.

Avoid binge eating during the holiday season. This extra weight stresses your body and can cause acute back pain.

Try a heating pad on sensitive areas.

For more information on preventing winter back pain, contact Comprehensive Pain Management in Warwick, RI.

What Are Epidural Steroid Injections?

Darren Kincaid - Thursday, January 24, 2019
Comprehensive Pain Management in Warwick, RI

Your doctor may give you an epidural steroid shot to reduce inflammation in your spine, relieve pain, or give your body time to heal. Here's what's going on. Your spine is made up of many parts, the bony vertebra stacked on top of one another, shock absorbing disks between the vertebra, ligaments and muscles connecting the bones, and of course the spinal cord with nerves branching out into the body.

The spinal cord is surrounded by fluid and a protective membrane. The area just outside this membrane is called the epidural space. Each rubbery disk in your spine has a tough outer layer and a spongy inner layer. Sometimes, due to aging, wear and tear, or an injury, the outer walls of the disk can weaken. This can allow the soft inner layer to bulge out, which irritates the spinal nerves and causes inflammation and pain.

If the wall gets weak enough, the inner disk can even burst through, further pressing on the nearby nerves. This is called a herniated disk. When this happens in your lower back, it causes shooting pain down your leg, a condition called sciatica. When it happens near your neck, it can cause pain and numbness in your arms. An epidural steroid shot puts medicine into your spine.

First the doctor will numb your skin with an anesthetic. Once the needle gets to the epidural space, he'll inject the steroid medicine. For some people this provides immediate relief. After the procedure you may apply ice to the area, use over-the-counter pain medicines, and resume driving after 24 hours.

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


Top 5 New Year's Resolutions to Reduce Back Pain

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

It’s a new year and a new beginning! If you suffer from back pain, consider the five resolutions below that could help with the pain and improve your quality of life.

Top 5 New Year's Resolutions to Reduce Back Pain

#1 Exercise More

Strengthening your core muscles can help reduce your risk of back injuries and reduce chronic pain in your back. Try to workout at least two times a week doing exercises that will strengthen your back and abdominal muscles. If you sit at a desk all day, try to get up and walk around periodically throughout the day.

#2 Improve Your Posture

Standing up straight helps protect your spine and keep it healthy. Poor posture puts a strain on your back and can cause changes to your spine. Try to avoid slouching, hunching your shoulders or bending sideways while you are standing.

#3 Stop Smoking

Smoking isn’t just bad for your lungs; it is also bad for your back. Smokers are more likely to have back pain than people who don’t smoke. Nicotine restricts the flow of blood to the discs in your spine, which makes them more prone to ruptures, cracks or drying out. Smoking also reduces the oxygen level in your blood, which is crucial to keeping your back’s muscles and tendons properly nourished.

#4 Adopt a Healthy Diet

Eating a healthy diet full of antioxidants and high in calcium and vitamin D can help keep your spine strong. Deficiencies in calcium and vitamin D can lead to problems such as osteoporosis, which is a common cause of back pain for older women.

#5 Seek Treatment for Pain

There is no reason to continue to suffer from back pain if you don’t have to. There are treatments available that can solve your back problems with minimal downtime, including laser spine surgery. Start the year off on the right foot. Take the first step by resolving to seek treatment for your pain.

Learn more about how you can reduce your back pain in 2019 and contact Comprehensive Pain Management in Warwick, RI. Our team is here to evaluate your condition and discuss treatment options to get you back into motion in the new year.


Happy New Year from Comprehensive Pain Management

Joseph Coupal - Friday, December 28, 2018
Comprehensive Pain Management - Attleboro, MA

Happy New Year from Comprehensive Pain Management. We would like to thank our patients and community for allowing our business to be part of your lives in 2018. We wish you a wonderful and prosperous 2019!

If we have had the pleasure of being your choice for pain treatment, we hope that we provided the highest level of service and care you desired. If you are in need of pain management in 2019, we hope that you consider Comprehensive Pain Management for your prized possession, your business.

It is our sincere wish that in the New Year you are surrounded by warmth, family, and friendship. From all of us here at Comprehensive Pain Management , have a healthy, happy and prosperous New Year.

Sincere best regards to you all.

Reduce Pain and Stress During the Holidays

Darren Kincaid - Thursday, December 06, 2018
Comprehensive Pain Management - Attleboro, MA

Maintaining holiday traditions can be hectic and stressful -- even for healthy people. This should be an enjoyable time of year for everyone, but for people with chronic pain they bring an extra element of challenge and stress.

How do you cope with the holidays? Do you approach them in a hectic manner or do you break down the tasks into manageable ones? How do you get through the holiday season and enjoy it?

Here are a few tips about planning ahead, gift giving, and setting the expectation.

Start by prioritizing activities and only worry about things that are important to you and your family. Organize your schedule to include a time for each item to be completed by time frame and importance. Begin early with more complicated tasks and expect a “bad” day or two so they don’t cause stressful situations at the last minute.

It is important to avoid the last minute rush of gift buying and other holiday activities. Either cut out the nonessential steps, get help setting them up, or start early giving yourself plenty of time.

It is also good to work on your preventative health: nutrition, posture, and positive mental attitude.

When it comes to attending parties, attend parties that others host instead of hosting them yourself. That way you can make an appearance and leave before all of your energy is spent. You can let the host know that you can only stay for a limited time due to other commitments, and if you decide to stay longer, all the better. Once you explain your limitations to the event host, you’ll find your stress level will be reduced. Setting the expectation early is very important in group settings.

When it comes to gift giving, buy gifts online -- no walking or waiting! The items will arrive at your house or theirs, and you’ll save your energy for other tasks.

When it comes to making your gifts presentable, use gift bags. They’re easier than traditional wrapping, and save time and energy. Although decorations are beautiful, downsizing can still be festive and keep everyone in the holiday mood.

Communication is key to a successful season. When you are hosting an event, delegate duties as much as possible. The same goes when it comes to decorating. It is okay to ask for help and accept your limitations without guilt or blame. It is not your fault that you live with chronic pain. Help others understand your limits by sharing with them ahead of time what they are and telling them what they can do to help make it easier for you and other guests.

It doesn’t matter what anyone else thinks about your health and protecting your body and mind. It is okay to take care of yourself first, especially during the holidays.

Let go of the stress, guilt, and excess. Trim down the excess and turn the hustle and bustle of the holidays into a fun enjoyable time to be thankful for, with great memories to hold onto for years to come.

For more information on managing chronic pain, contact Comprehensive Pain Management in Warwick, RI.

Pain News Network

Managing Pain and Stress During the Holidays

Darren Kincaid - Wednesday, November 21, 2018
Comprehensive Pain Management in  Warwick, RI

The holiday season offers opportunities to improve your health; but it can also intensify feelings of frustration and despair that come from dealing with chronic back pain. We can't promise a stress-free holiday season, but here are 4 helpful tips on how to handle this time of year when you're suffering from back pain.

1. Use time off to start an exercise routine

A controlled, gradual, and progressive exercise program can help heal and strengthen the various structures in your spine. So to help with your pain, consider dedicating a full vacation day over the holidays to improving your physical conditioning.

If you are new to exercising, you can spend the day with a physical therapist; who can customize a program to meet your unique needs. They may introduce you to exercises you have not considered, like water therapy, Swiss ball exercises, or beginners yoga.

2. Research your condition

Without the pressures of work, you finally have some time to properly research your back condition. So curl up (or recline) with a good book on back pain, or dig into our trustworthy resources. This research may help you better understand your condition, and also reveal new treatments to help relieve your pain.

For example, did you know that:

  • Using a tennis ball for a do-it-yourself massage can reduce trigger points and muscle tension?
  • Applying a low-level heat wrap can be as effective at reducing lower back pain as medications?
  • Another idea is to schedule an appointment with a pain specialist to discuss all of the available treatment options.

3. Spend time with a friend

One aspect of chronic back pain that often is not discussed is how isolating it can be. Your pain may make physical activity difficult, so after work and other daily responsibilities you may not have the energy to visit with friends.

If you have free time over the holiday season, set aside a few hours to reconnect with a friend. This won't solve all of your back-related problems, but the empathy and understanding of a friend can go a long way towards helping you better cope with your condition.

4. Focus on nutrition to help your back

Let's face it, most of us don't follow a very healthy diet. We might have been able to get away with this in high school, but now the extra weight you carry may be contributing to your back pain. For example, excess weight in the midsection can pull your pelvis forward, which leads to additional stress on your lower back.

Balanced nutrition includes adequate protein as a source of the building blocks of soft tissue healing. Additionally, plenty of fresh fruit and vegetables are necessary to supply the vitamins and trace elements necessary for effective healing.

Pain can be especially hard to deal with over the holiday season, so please take time to get a better handle on your back condition. Using this list, you can take at least one or two tangible, positive steps toward finding relief from your pain.

For more information on managing back pain, contact Comprehensive Pain Management in Warwick, RI.


Ways to Treat Chronic Back Pain Without Surgery

Joseph Coupal - Thursday, November 08, 2018
Comprehensive Pain Management in 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.

Below are some insights into 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 doctor on reducing the flare-ups and making the pain manageable with nonsurgical treatments.

Nonsurgical Treatments for Chronic Back Pain

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.

Physical therapy for chronic back pain may include:

  • Retraining your posture
  • Testing the limits of pain tolerance
  • Stretching and flexibility exercises
  • Aerobic exercises
  • Core strengthening


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.

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.

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.

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.

Pharmacologic Treatments

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 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 treating chronic back pain, contact Comprehensive Pain Management in Warwick, RI.

Stellate Ganglion Block FAQs

Joseph Coupal - Thursday, October 25, 2018
Comprehensive Pain Management - Spinal Cord Stimulation in Franklin, MA

What is a stellate ganglion block?

A stellate ganglion block is an injection of local anesthetic in the sympathetic nerve tissue of the neck. These nerves are a part of the sympathetic nervous system. The nerves are located on either side of the voice box, in the neck.

What is the purpose of a stellate ganglion block?

A stellate ganglion block blocks the sympathetic nerves that go to the arms, and, to some degree, the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome and Herpes Zoster (shingles) involving an arm or the head and face.

How long does the stellate ganglion block take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic. Epinephrine or steroid medication may be added to prolong the effects of the stellate ganglion block.

Will the stellate ganglion block hurt?

The stellate ganglion block involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation, which can make the procedure easier to tolerate.

Will I be "put out' for the stellate ganglion block?

Maybe. The stellate ganglion block can be done under local anesthesia only. However, most of the patients also receive enough intravenous sedation that they may fall asleep for a few minutes during the actual injection. Patients breathe on their own throughout the procedure. The amount of sedation given generally depends upon the patient tolerance, but can often be enough that the patient has amnesia for the actual injection.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is soreness in the neck at the injection site.

How long the effect of the medication last?

The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.

How many stellate ganglion blocks do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.

Will the stellate ganglion block help me?

It is sometimes difficult to predict if the injection will indeed help you or not. The patients who present early during their illness tend to respond better than those who have had symptoms for a very long time. Patients in advanced stages of disease may not respond adequately.

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


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.


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