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Living Well Medical is headed by a pain management specialist and medical physician. The staff at living well medical is a recognized for their expertise in spine and joint injections, as well as many other methods of rehabilitation from chronic pain.

Noninvasive non-drug pain management

There is an immense variety of noninvasive non-drug pain management techniques available for treating back pain and neck pain. A few of the most widely accepted in comprehensive pain management programs are the following:

  • Exercise-physical exertion with the aim of training or improvement. Includes the McKenzie method, water therapy, flexion exercises, aerobic routines, and many others. May involve active, passive, and resistive elements. Exercise is necessary for proper cardiovascular health, disc nutrition, and musculoskeletal health.

  • Manual techniques-manipulation of affected areas by means of chiropractic adjustments, osteopathy, massage therapy and other techniques. Some evidence for the effectiveness of certain techniques is available.

  • Behavioral modification-use of behavioral methods to optimize patient responses to back pain and painful stimuli. Cognitive therapy involves teaching the patient to alleviate back pain by means of relaxation techniques, coping techniques, and other methods. Biofeedback involves the gradual alteration of neuromuscular signals for symptomatic improvement.

  • Cutaneous stimulation -superficial heating or cooling of skin. These pain management methods include cold packs and hot packs, and should be used in conjunction with exercise.

  • Electrotherapy -the most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce back pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system. Randomized controlled trials have yielded either positive or neutral results regarding the efficacy of TENS as a treatment for back pain.

Noninvasive pharmacologic pain management

Pain relievers and related drugs are used at every stage of the medical treatment of back pain, from the initial onset of acute pain to facilitation of rehabilitation, treatment of chronic back pain and alleviation of pain in cases of failed back surgery. The most common noninvasive pharmacologic treatments for chronic back pain are:

  • Analgesics-includes acetaminophen, Long-term use involves risk of renal damage.

  • Nonsteroidal anti-inflammatory agents (NSAIDs)-includes aspirin, ibuprofen, naproxen, and the new COX-2 inhibitors.

  • Muscle relaxants-used to treat muscle spasms due to pain and protective mechanisms.

  • Narcotic medications-most appropriate for acute or post-operative pain. Since use of narcotics entails risk of habituation or addiction if not properly supervised, they are not often used for chronic conditions.

  • Antidepressants and anticonvulsants-used to treat neuropathic ("nerve") pain.

Invasive pain management techniques

Invasive techniques in pain management involve invasion of instruments and devices into the body. However, pain management should be distinguished from surgery, which involves a greater degree of surgical insult and permanent alteration of tissue than other invasive pain management techniques.

A multitude of invasive pain management therapies have been used to treat neck and back pain. Some of the most popular include:

  • Injections-direct delivery of steroids or anesthetic to nerve, joint or epidural space. Injections into the facet, peripheral nerve, "trigger point" and other locations are also known as "blocks". These may provide relief of pain (often temporary) and can be used to confirm diagnosis. Epidural injections provide temporary relief for severe back pain.

  • Prolotherapy-injection of solution to stimulate blood circulation and ligament repair at affected site. The effectiveness of this technique is not known.

  • Facet / Medial Branch Blocks-lumbar, thoracic and cervical - designed for axial / stenosis, non-radiating type pain. 3 sessions separated by 2 week interval. If the person does well and most of them do - then we move on to radiofrequency ablations which usually last then 6 months.

  • Radiofrequency ablations-designed to burn-off medial branches, i.e nerves that supply facet joints. It takes 6 months for the nerves to re-grow. Some patients have relief up to a year.

  • Epidurals / lumbar, cervical and thoracic-designed to treat radiculopathy type symptoms. 2 types of injections are used: transforaminals which access anterior epidural space and interlaminar which access posterior epidural space. Usually 3 treatment series needed.

  • Sacro-iliac joint injection-designed to treat sacroiliitis. Usually seen with patients with hip / lumbar pathology. Can do up to 2 treatment series.

  • Dorsal column stimulators-designed for failed back syndromes, mostly good for radiculopathy/extremity pain, can also be tried for pelvic pain. Sort of like TENS unit that is implanted in to the spinal cord. The procedure consists of 2 parts: - 1st - a trial, where electrodes are put in and the battery is carried by the patient. The patient walks around with the battery in his hand for a week. If the pain relief is adequate - then you move on to an implantation phase where electrodes are permanently sutured to the epidural space and the battery is implanted in to the abdominal/hip area. The cons is that these patients need to be actually cleared by a psychologist for the insurance company to pay. It is required because some patients can not handle having a device in their back for years and the implantation procedure is 40, 000 on top of a trial which is somewhere around 10,000.

What is pain management?

Pain management, also known as pain medicine, draws on many disciplines in science and the healing arts to systematically study pain, its prevention, evaluation, diagnosis and treatment, as well as the rehabilitation of painful disorders. The pain may be the result of an injury, surgical intervention, cancer or other particular cause, or may constitute the primary problem, as in neuropathic pain and headache.

In spine and musculoskeletal cases, pain management is usually distinguished from surgical treatment, and is employed as an alternative to surgery as part of an aggressive conservative care program, or after surgery to cope with residual or recalcitrant pain. Pain management and the techniques it uses also help to identify the source of neck and back pain, determine the areas to be addressed surgically, and rehabilitate the patient after surgery.

Pain management uses a wide variety of techniques to address pain and painful disorders. The scientific basis for these approaches varies from those that are completely without experimental support to those whose effectiveness has been well demonstrated in clinical trials.