Q: How can I avoid chronic pain?
A: The best way to avoid chronic pain is to treat acute pain aggressively and appropriately. For example, when a person first experiences severe pain, anti-inflammatory medications like Ibuprofen help promote healing and prevent abnormal pain impulses from developing. Prolonged, severe pain can cause anxiety, depression and insomnia which in turn decrease a person’s pain tolerance. Pain causes depression which causes more pain. This “Cycle of Pain” can be very difficult to break once it starts. This is why it is important to see a Pain Management specialist when the usual treatments aren’t working.
Q: I’ve been having back and leg pain for a long time and my medication is not helping very much. My neighbor has the exact same symptoms and he’s taking a different medication which helps him a lot. Why isn’t my doctor giving me the same medication?
A: Even if your symptoms sound exactly like your neighbor’s, it is most likely that the two of you are still having different problems. Patients often ask me if they can take the same medication that their friend is taking, but it’s not that simple. Doctors treat the problem not just the symptoms. Different problems oftentimes cause similar symptoms, but because they are different problems each person needs to be treated individually. Talk to your doctor about other options for your problem or ask to be referred to a Pain Management specialist.
Q: I have chronic pain and my pain gets worse when I increase my activity. I’m taking pain medication which helps me to do more, but how do I know that I’m not causing more damage?
A: In Acute Pain problems, such as a sprained ankle or a burn, the pain is a “signal” to the person that something is wrong and alerts that person to stop doing a certain activity. In Chronic Pain problems, the pain is no longer a helpful tool. Because of an abnormal process within the nerves, pain is being produced even though there is no longer ongoing injury to a particular body part. Using medication in order to decrease the pain and increase activity is a very important part of getting better. As a person moves around more, those abnormal pain signals can “die out”. You should always talk to your physician for specific directions regarding your condition.
Q: Will Pain Management turn me into a drug addict?
A: Effective pain management uses a multidimensional or multimodality approach so that the treatment plan doesn't solely rely on opioid pain killers. The incidence of addiction to opioid or morphine- like medications is about 3-5%. In people who use these medications for the treatment of chronic pain, the rate should be the same.
It is important to understand, there are people who have what is called "Dual Diagnoses" which means that they may have a diagnosis of chronic pain, but they also have a diagnosis of substance addiction. These patients have a much higher risk of addiction to opioids if treated for the short or long term. There is a higher risk of opioid addiction in people who have already had addiction issues with legal substances such as alcohol, tobacco and marijuana or illegal substances such as cocaine, heroin, methamphetamines and others.
So, although the risk of addiction is present, there are circumstances in which is appropriate to use opioid medications to control pain and restore function. It is very important, though, that such medications be used under the direction of an experienced pain management physician who is able to identify the most appropriate candidates for this type of treatment option.
It is extremely important to realize that prescription opioid abuse is now the #1 type of abused substance and the death rate in this country due to opioid overdose now surpasses that of those due to motor vehicle accidents and cancer. It is your responsibility to ensure that your medication isn’t taken by anyone else but you.
Q: Once I start using pain medications will I always have to take them or will my pain eventually go away?
A: The answer to this question is different for everyone. In some cases, the medication allows the painful areas to “calm down” or heal after which time the medication can be discontinued. My goal for all patients is to incorporate other pain management therapies, such as physical therapy and steroid injections to allow people to more easily discontinue their medications.
There are other types of pain problems called “degenerative or progressive” such that the abnormality is expected to continue and therefore medication may need to be continued on a long term basis. Sometimes it’s difficult to predict who will need long term treatment and who won’t. This is why regular assessment of pain issues and adjustments in therapies and medications as symptoms change, are important.
Q: My doctor says that I’m addicted to Vicodin because I need it for my arthritis pain. How do I know if I’m addicted?
A: “Addiction” is the irrational use of drugs or medications despite harmful consequences. Addiction is a biophysiopsychological phenomenon which is diagnosed based on a dangerous behavior pattern. If you are not misusing your medication, such as taking more than has been prescribed, running out early or using it to get high or to disconnect from problems, then it is unlikely that you are addicted.
There is a phenomenon called “Physical dependence” which is the natural effect of using opioid medications. Essentially, after approximately 2 weeks, the body gets used to an opioid medication and if stopped abruptly, one will experience withdrawal side effects. Withdrawal side effects are avoided by slowly weaning the medication off and are not an indication of addiction. Many other types of non-addictive medicines can produce withdrawal effects if abruptly discontinued.
Q: I have chronic back and leg pain. What can a Pain Management specialist do to help me? What is a Pain Management specialist?
A: Anyone who has a pain problem which has not been eased with the help of your primary care doctor and the usual medications should be evaluated by a doctor who is specially trained to treat various pain problems. As with any type of physician, you should seek a doctor who has completed a fellowship program and is Board Certified in Pain Management. The doctor will devise a plan to ease the pain and improve your ability to enjoy activities which the pain may have been preventing. This plan is very individualized and may consist of medications, special injections or specific exercises to ease the pain. People who suffer from chronic pain may develop sleep problems or depression. A Pain management specialist is trained to treat all aspects of your health which may be affected by your pain problem.
Q: Which pain medication is the most effective?
A: The most effective medication depends on what is causing the pain. For example, opioid medications are very helpful for certain severe pain problems, but may do very little to help pain which is due to chronic tissue inflammation, muscle spasm or nerve irritation. All pain problems cannot be alleviated with the same medication. To make matters more complex, different people may respond to the same medication in different ways. One person may have great pain relief with medication A and another person may not have any relief with the same medication. This is why a doctor’s full evaluation is necessary before prescribing any pain medication in order to identify all of the possible factors which may be causing the chronic pain situation.
Q: Can pain be relieved without taking pills or medications?
A: Yes, especially if the pain problem is addressed early. Oftentimes, pain can be alleviated or stopped by using specific exercises and stretches. Physical therapy offers a variety of non- medicinal treatments which are effective in reducing pain. This helps people to get back to a previous level of activity following an injury and also decreases the chances of a repeat injury. Weight loss, smoking cessation and proper posture/ lifting techniques can especially help back, knee, hip and neck problems.
Q: I’ve been told that there are certain “injections” that could help my pain. What are these?
A: Pain management specialists use injections to quickly alleviate multiple types of pain. The most common type is the epidural injection, for back or neck pain, but many other types are available to ease the pain. The injections consist of local anesthetic, aka numbing medication, with or without a steroid. The local anesthetic provides immediate pain relief by blocking the nerves that carry the pain signal and the steroid decreases inflammation and helps the tissues to heal. The injected steroid is much more effective than a steroid pill because it is placed directly onto the inflamed tissues. Also, because it doesn’t have to be absorbed into the bloodstream to get to the site of pain, the risk of side effects is much less.
Q: I’ve had neck pain for many years. Recently, my pain became so severe that I was referred for an epidural steroid injection at the hospital. The injection helped the pain for 3 weeks, but now I can feel my symptoms returning. What do I do now?
A: Unfortunately, patients are often referred to doctors who will perform an injection and never see them again for follow- up pain management instructions or long term treatment options. The difference between these “block jocks” and a Pain Management specialist is that the specialist will “blend” several therapies so that the person receives the best chance at long term pain relief. Epidural injections are highly effective, but only if they are used within a specific treatment plan with close follow-up after the injection. You should ask your primary care doctor for a referral to a Pain Management specialist for long term treatment options.
Q: My mother was diagnosed with metastatic cancer and she is suffering from uncontrolled pain. She is either screaming in pain or “zonked out” after she takes her medication. We want to be able to spend quality time with her before she passes, so what can we do?
A: Cancer related pain is notoriously difficult to treat. This type of pain is most effectively treated with a combination of two or three types of pain medications which work together to relieve pain without causing excess sleepiness. Some cancer patients are candidates for the “morphine pump”. This allows the patient to receive very small doses of morphine directly into the spinal fluid. This technique gives the best pain control without sedation and removes the need to take pills altogether. A Pain Management specialist can evaluate your mother and devise a plan to help control her pain without the side effects which are currently affecting her quality of life.
Q: What is the Spinal Cord Stimulator that Jerry Lewis has been talking about?
A: A spinal cord stimulator is a devise which is very helpful for pain that involves damaged nerves. It is most commonly used for pain in the arms or legs. Essentially, this device “turns off” the pain signals which are sent out from damaged or abnormal nerves. The pain sensation is replaced by a gentle “electrical massage” sensation. The person undergoes a temporary trial use to ensure that the stimulator will relieve at least 60% of the pain. After a successful trial, the stimulator is permanently implanted under the skin, like a pacemaker.
Q: My doctor prescribed Neurontin but I’m too afraid to take it because of all of the negative information about it on T.V. and the internet. What should I do?
A: It’s very important that you discuss your concerns with your doctor who prescribed it. Neurontin is a good medication for many pain problems. There is no medication that is perfect for everyone, but your doctor prescribed the Neurontin because she/he believed that it is right for you. Always discuss your concerns with your doctor before making any changes to his/her recommendations. The T.V. and internet are NOT the best sources for your medical advice.
Q: Why do I feel better when I use ice?
A: Ice is a natural pain reliever because it slows nerve conduction and numbs the tissues. In this way, it prevents the pain information from reaching the brain. Ice also slows the inflammatory response to injury by decreasing swelling. Ice tends to be more helpful for acute injuries and pain although it can also help with chronic pain.
Q: Why do I feel better when I use heat?
A: Heat can be very helpful for chronic pain for two major reasons. One, it causes increased blood flow to tissues. This allows more oxygen to reach the tissues and also flushes out toxins. Two, it allows muscles and ligaments to stretch more easily which will help alleviate painful spasms.
Q: How often will I need to see a pain management doctor?
A: It depends on the plan of care that your doctor has in mind for you. Some patients need only one visit for treatment suggestions that their family doctor can carry out. Other patients may need to see their pain management doctor 2 to 4 times per month depending on the severity of their pain. For example, if I prescribe a patient a strong pain medication, I oftentimes reevaluate them after 2 weeks in order to ensure that they are doing well without any side effects and that no adjustment in the medication is needed.
Q: What are the side effects of pain medications?
A: The most common side effects include sleepiness and constipation. People who are very sensitive to these types of medications may also experience itching, nausea, dizziness, hallucinations or changes in memory and thinking. Alcohol and sedatives and even allergy medications make these symptoms worse. Anyone who needs pain medication should never drink alcohol.
Q: Can a person’s pain be all “in their head”?
A: Pain that is “all in the head” is not very common. The medical term is Somatization. Some people do turn the emotional symptoms of anxiety or depression into the physical symptom of pain. It is more common; however, for people with physical pain to have more intense pain because of their anxiety or depression. Anxiety and depression lower people’s pain tolerance. Although it’s not all in their head, emotional disturbances definitely worsen the pain problem. This is why it is important for people with chronic pain to also see a psychiatrist to have those emotional issues treated at the same time as their physical pain issues.
Q: Why do some people continue to have pain after back surgery?
A: There are many reasons. Sometimes after surgery scar tissue or adhesions can form. This can cause pain by pinching or pushing on the nerve tissue in the back. Also, some surgery can cause adjacent areas of the back to degenerate or weaken over time. The spine is a very complex network of ligament, muscle, bone and nerve tissues all of which may cause pain due to injury alone or in combination with each other.
Q: What is the difference between regular pain medications and “slow- release” pain medications?
A: Most pain medications are meant to be used for short term pain problems such as after surgery or for an acute injury. Those medications typically provide pain relief for only 3 to 4 hours and then they wear off. Medications that provide pain relief for 8 to 24 hours at a time are better for chronic pain problems. One pill is slowly released into the blood stream to provide superior pain relief that lasts longer. Studies have also shown that slow-release pain medications cause a lesser incidence of tolerance and work very effectively at the same dose for years.