Pain management is a widely used term in the medical field. Is describes a "medically oriented" approach to patient care with a background in Physical Medicine/Orthopedics/Rehabilitation/Neurology/Anesthesia. In practice, however, there are quite a lot of variations in the approaches taken. The approach is influenced by the type of condition being treated and the philosophy and training of the practitioner. At Laser Spine Institute, we employ a multi-modal philosophy to the evaluation and surgical treatment of painful spinal conditions. This describes an approach using all available approaches to minimize the effects of the painful condition on the patient, including education, exercise, physical therapy, medications, interventional procedures and surgery.
First and foremost in the management of pain is to understand the cause of the pain. Is there an identifiable anatomical cause that can be identified and corrected? The initial encounter with a pain specialist should be the most involved step in developing a management plan. Careful assessment of the patient may reveal the primary source of pain to be localized to a particular body part with an identifiable injury or disease. When considering a painful spine, the careful evaluation of a patient by an experienced spinal surgeon may reveal a surgically correctable reason for pain which can reduce or eliminate daily.
Secondly, the patient's response to the pain is of paramount importance. Low grade pain which does not affect quality of life may be easily manageable with simple measures like education, exercise, or physical therapy. Developing an understanding of the reason for pain can ease fear and uncertainty and provide a sense of control over the condition. Appropriate exercise that is designed to support and protect areas of injury or disease can stimulate an enhanced state of well-being similar to (and healthier than) some medications. A skilled diagnosis will result in the most appropriate physical therapy and exercise program for the greatest chance of success.
Use of medications to reduce pain should be considered if the levels of pain begin to affect quality of life and work, and have failed to respond to more conservative measures. Narcotic usage creates additional problems over the long term and should be reserved for those patients with clear indication and need, based upon medical findings. A consult with a physician specializing in the prescription and monitoring of side effects of narcotics is essential should this level of care be required.
Next is the application of interventional techniques. It is important to understand that pain may result from both anatomic and physiologic causes and they frequently co-exist. Anatomic causes are treated by modifying the anatomy such as surgically removing a bone spur or herniated disc. Physiologic causes are treated with a medical approach such as the selective injection of cortisone solutions to the physiologically inflamed areas. This results in a reduction or removal of physiologically based pain from the injected area. Fluoroscopically guided injections are commonly used to treat inflammatory-based pain in the spine. These injections include epidural steroid injections and are placed using a variety of locations depending upon the type of pathology a patient presents. Lastly, there are some patients who have complex painful conditions resulting from multiple causes which may not respond to medication, surgery or injection techniques. These patients may require more invasive procedures, such as implantable devices to electrically or pharmacologically modify the body's response to pain. These procedures are commonly provided by pain specialists around the country.
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