Editor’s Note: Dr. David Kloth is a practicing interventional pain management physician in southwestern Connecticut, director at large for the American Society of Interventional Pain Physicians and co-author of the book “Pain Wise: A Patient’s Guide to Pain Management.” He has been practicing pain medicine and researching pain management for more than 20 years.
Chronic pain affects more Americans than diabetes, heart disease and cancer combined
Too many patients rely on drugs to mask their pain
People should seek out a pain specialist to help find the cause
Chronic pain conditions now affect more than 116 million Americans, according to the Institute of Medicine, a figure that dwarfs the number of people who suffer from diabetes, coronary heart disease/stroke and cancer combined.
Unfortunately, too many patients rely on prescription drugs as an isolated therapy to treat their pain. While pain medications play an important role in the treatment of chronic pain, many pain sufferers rely on powerful prescription painkillers to mask it.
If you are suffering from chronic pain, you should also seek treatments that are designed to reduce the pain by attacking the specific cause. Many patients and even some doctors aren’t aware of some of the other available therapeutic options, which are typically less invasive and/or less risky than alternatives such as surgery or medication.
Interventional pain medicine is a medical sub-specialty that is devoted to the diagnosis and treatment of pain-related disorders, with an emphasis on diagnosis first.
Specially trained pain physicians utilize various types of injections and minimally invasive surgeries to manage and treat persistent and intractable pain. These specialists treat a wide range of chronic-pain conditions, including but not limited to back pain, neck pain, extremity pain, headaches, joint pain, musculoskeletal injuries and cancer pain.
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If you suffer from chronic pain and want to explore options, here are some tips:
Find a pain specialist
It is important to find the right doctor if you want precise answers on the cause of your pain and to identify an appropriate treatment course. When advice from a non-specialist is sought, it often results in no diagnosis or, worse, a misdiagnosis, neither of which is helpful in treating the pain problem.
When this occurs and the pain continues, patients are often told that there is nothing that can be done, or they are directed toward more aggressive surgical approaches that may not be necessary and are typically more risky.
Many pain sufferers don’t think about finding a doctor who specializes in pain when looking for answers to their problem. Instead, they often seek help from an internist or other physician.
Not all pain specialists are equal. You should look for one who is board certified in pain management.
Don’t chase your pain with pills
Prescription pain medications are potentially addictive but can also be an important component of pain management. Pain medications have a greater indication and acceptance when used for acute pain rather than long-term chronic pain, where the evidence to support their benefits is lacking.
High-dose chronic pain medications are questioned by many pain physicians, and so long-term use of pain medications should be done judiciously and with expert supervision due to the risks associated with this form of treatment.
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In addition, pain itself is often a protective mechanism that warns you of injury. By dulling the pain response, pain medications can lead to further injury. When you don’t feel the pain, you may do something to injure the area further, a serious concern in patients who perform manual or heavy labor.
This is not to say that chronic pain medications should never be used, but they should be used and monitored carefully and not relied upon in most cases as the primary and/or sole therapy. Alternative therapies that actually reduce or eliminate the pain should be tried and at least incorporated into the treatment regimen. It is better to remove the painful stimulus than to mask it with pain medications, which can also mask or dull the senses.
Do your homework
Many patients are told that there are no other treatments to manage their ongoing pain issues, when this is simply not the case. There are a number of interventional pain therapies available that can not only alleviate pain but in some cases eliminate the underlying cause of pain.
Interventional pain management has been around for more than two decades. The procedures implemented by pain management physicians reflect the standard of care for pain management today, and their efficacy has been demonstrated through extensive study and research.
Epidurals and other nerve blocks
Various injection therapies, including the use of epidurals, are among the most common interventional pain therapies used today.
Epidural steroid injections are in widespread use for a variety of chronic pain conditions but are most typically used to treat a nerve that is pinched at the spinal level. Epidurals used in interventional pain medicine are minimally invasive injections comprising a small amount of local anesthetic and steroid to reduce inflammation. When properly applied, they can help reduce the patients reliance on pain medication.
In addition to epidurals, other treatments include trigger point injections, to alleviate the pain associated with tight and restricted muscles; facet injections, often used to treat arthritis of the spine; and sacroiliac injections. The sacroiliac joint commonly causes back pain but is often overlooked by non-pain physicians.
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Manage your expectations
The goal of interventional pain management procedures should be to reduce and manage pain, with emphasis on the word “manage.” Your pain physician may or may not be able to cure the entire problem (and for the record, surgery may not either), but they can help you control the pain and maximize your functional level.
Although the ideal goal is to completely resolve the pain, this is often not realistically possible. Bear in mind that this is also true for the majority of other chronic health problems; heart disease, diabetes, COPD, arthritis, etc. All require long-term management. Chronic pain may similarly require intermittent or continual treatment.