What is pain management?
Pain management is that area of medicine that deals with the attempt to manage pain. Physicians who practice pain management are most often found within the practices of Orthopedic Surgery, Neurosurgery, Osteopathy, or Anesthesiology. The treatments often involve a variety of modalities, but typically involve utilization of various prescribed pain medications, and sometimes injections and in the most severe cases, the implantation of nerve devices to attempt to control a patient’s pain, short of having to undergo some kind of anatomical revision such as a spine fusion.
Glossary of Pain Management Terms
Acute: Pain that can be intense but usually lasts for a short period of time, usually shorter than six months. It usually relates to a bodily injury (such as injury at work) and ends when the injury heals.
Acupuncture – medical technique that uses tiny needles inserted in the skin at certain points along the body to help manage pain, produce anesthesia or promote therapy
Analgesic: A medication or treatment that manages or relieves pain.
Arthritis: A generic term that describes over 100 different conditions. Generally, it’s a disorder of a joint where two bones meet, creating swelling, redness, warmth or tenderness. It includes loss of joint space and formation of spurs, erosions or cysts in the bone.
Cancer Pain: May be acute, chronic or intermittent pain – often related to tumor recurrence or treatment
Central nervous system: The brain and spinal cord.
Chronic: Pain that lasts months or years. It may get worse with time.
Complementary Medicine: Treatment that falls outside the standard medical approaches. Complementary medicine techniques for pain may include acupuncture, chiropractic care, herbs and yoga.
Computed tomography (CT) scan: Diagnostic procedure that uses computers and X-ray technology.
Cryotherapy: Therapeutic use of cold to decrease discomfort, reduce swelling, or break a muscle spasm.
Conservative management: An approach to treating pain that uses physical therapy, medication and injections instead of surgery
Disc: The soft pad positioned in-between each of the vertebrae of the spine. The vertebral disc acts as a shock absorber.
Electromyography (EMG) Testing: This test is often performed by a neurologist. It measures the reaction of muscles when impulses are passed through electrodes which are placed into the muscles. These are usually done in conjunction with a Nerve Conduction Study (NCS).
Epidural Steroid Injection: A steroid injection includes both a corticosteroid such as methyl-prednisone, and an anesthetic numbing agent such as lidocaine. The drugs are delivered into the epidural space of the spine, which is the area between the protective covering or dura of the spinal cord and nerves and the bony vertebrae.
Fibromyalgia: Chronic disorder that causes pain and stiffness throughout the body including muscle pain, fatigue, and often depression.
Hyperalgesia: Increased sensitivity to pain or enhanced intensity of pain sensation
Inflammation: A reaction of tissues to injury or disease. Symptoms include swelling, redness, heat, and pain.
Joint: The junction of two or more bones. The joint allows for varying degrees of motion between the bones.
Ligament: Fibrous tissue that connects bone to bone at or near a joint. The ligaments provide joint stability. Torn or sprained ligaments can cause pain
Magnetic resonance imaging (MRI): A diagnostic procedure that uses magnetic fields, radio waves, and a computer. It may be used to determine the source of pain.
Myelogram: X-ray procedure where a dye is injected into the spinal canal to determine the nerve roots.
Myofascial pain syndrome: A chronic pain disorder where there is inflammation of the soft tissue or muscles, often causing “trigger” or tender points in the muscles that can be treated with surface injections.
Nerve block: The injection of a nerve-numbing substance into a group of nerves.
Nerve conduction study (NCS), also called a nerve conduction velocity (NCV) test–is a measurement of the speed of conduction of an electrical impulse through a nerve. NCS can determine nerve damage and destruction. During the test, the nerve is stimulated, usually with surface electrode patches attached to the skin. It is often indicative of radiculopathy and can provide objective evidence of a patient’s complaints.
Neuropathic: A nerve-related condition.
NSAIDs: non-steroidal anti-inflammatory drugs. These help to reduce inflammation and manage pain. NSAIDs are available over-the-counter and through a prescription.
Opioids: Narcotic pain relievers. These often include Percocet (Oxycodone) or Vicodin (Hydrocodone) in various strengths. The use of these medications has recently fallen under more severe regulatory scrutiny, placing physicians under far more pressure to choose an alternative to opioids.
Palliative care: Palliative care (also known as comfort care) aims to offer relief to chronically or terminally ill people through pain management and symptom management.
Pharmacotherapy: Medication-based therapy
Physical modalities: Physical methods, such as heat, cold, massage or exercise, used to relieve pain.
Prosthesis: An artificial replacement of a body part. The goal of a prosthesis is to mimic natural form and function.
Psychological approaches: Techniques or therapies used instead of or in addition to medication to help you manage your pain. The focus is on the emotional triggers of pain. Examples of this approach include biofeedback, relaxation, stress management and cognitive-behavioral therapy.
Radiculopathy: Radiculopathy is caused by compression or irritation of a nerve as it exits the spinal column. Symptoms often include numbness, tingling or shooting pain in the extremities, depending on the level of the spine that is affected.
Rehabilitation: Treatment plan used to help you regain function or relieve pain caused by an injury. Exercise is often a key component.
SCS (Spinal Cord Stimulation): Spinal cord stimulation (SCS) delivers mild electrical stimulation to nerves along the spinal column, modifying or blocking nerve activity in a non-medicinal way to minimize the sensation of pain reaching the brain. It involves an implantation of an electrical device underneath the skin and electrodes actually places on particular levels of the spine.
Tolerance: When the initial dose of a substance loses its effectiveness over time.
Yoga: Complementary medical technique. It exercises the mind and body with meditation, postures, and breathing techniques that can help manage pain.
Neck or cervical pain is common to everyone. Any activity that puts strain on the neck can cause pain. This includes seemingly simply tasks like working at the computer or sleeping. Often, it can also be caused by a workplace injury.
Neck pain has many causes. Some of the initial causes your doctor will review are heart related causes, cancer, infections, spinal disc herniation, degenerative arthritis, osteophytes and spinal stenosis. Spinal stenosis is a narrowing of the spinal canal.
Other causes include prolonged poor posture, whiplash, herniated disc, over-use, a pinched nerve or pain because of back problems.
Neck pain can take the form of stiffness, tingling, numbness or feeling like your neck is in a knot or having a headache. You may feel like you can’t turn your neck like you used to.
Neck pain can cause hurt in other parts of the upper body such as the shoulders, arms or the upper back. There may be nerve damage if there is a herniated disc that has been unaddressed for a long time.
You may also experience anxiety, fatigue and even depression.
Your doctor will conduct an oral exam to review your past medical history and current complaints. The doctor will conduct a variety of physical tests. In some cases, the doctor is looking to rule out other problems. Imaging tests such as X-Rays, MRIs and Ct Scans may help and will normally be ordered if your pain lasts more than a month or so. The doctor will want to examine the neck bones, and various parts of the spine (discs, nerve roots and the spinal cord).
If you are having numbness in your fingers or hands, this may be an indication of a cervical disc issue. An MRI would be utilized to determine the extent to which the disc is pressing on the nerve, if at all.
In addition, EMG testing
Much neck pain can be treated with medications, exercise and therapy.
Medications include acetaminophen (such as Tylenol), Ibuprofen or other anti-inflammatory drugs, and possibly nerve pain medications such as Gabapentin.
A heating pad or an ice pack for 15 to 20 minutes every two or three hours can help. Warm showers may also be recommended.
A physical therapist or chiropractor may work to help you move your neck better. Massages and yoga have also been known to help.
In severe cases, a steroid injection may help. Surgery may be used if there is evidence of spinal cord narrowing, a disc herniation, tumor or spinal nerve root damage.
Learn more about pain management by speaking with a respected work injury lawyer today
Lawyer Joe Miller Esq. has been helping employees get justice for over 25 years. He has helped thousands of workers get the medical help they need to either be able to return to work or maximize their recovery. He understands which doctors you can see, when you can see them, and when you are entitled to be paid for them. To speak to a strong workers’ compensation advocate, please call (888) 694-1671 or fill out the contact form.
Pain Management – Sciatica, Herniated Discs, and Back Pain
Many North Carolina and Virginia workers find the need to see a pain management doctor after they suffer a workplace injury. Pain management doctors treat a variety of conditions such as sciatica and herniated discs.
The sciatic nerve is made of the nerve roots from the spinal cord into the lower back, which then branch out into the legs. These nerve roots affect the back, lower buttocks, the back of the leg, the ankle and the foot. Sciatic pain includes physical pain, numbness and tingling of these nerve roots.
The most common cause of sciatica is a herniated disc. Other causes include spinal stenosis (a narrowing of the spinal canal), bone spurs often caused by arthritis of disc degeneration, and pinched nerves (nerve root compression). The problems can arise through an injury or through wear and tear. Tumors may also be a cause.
Pain in the areas affected by the sciatic nerve often appear in the back and buttocks and also the leg and even the foot. Pain can include numbness, tingling, pins and needles and weakness. Activity such as walking, lying down and anything that extends the spine can generate some relief. Movements that contract the spine such as sitting or standing for a long period of time can contribute to the discomfort.
In the most severe cases, the pain can be extremely debilitating and involve loss of bowel and or bladder control.
As with most medical conditions, a physical exam and medical history are the starting points. X-Rays and MRIs ( magnetic resonance imaging tests) and EMG/Nerve Conduction Tests, (testing of the nerves with needles and electrical currents) may also be recommended.
Medication and physical therapy are the starting points for treatment. Acetaminophen (Tylenol) and NSAIDS (non-steroidal anti-inflammatory medications) such as ibuprofen (Advil) or naproxen (Aleve), Narcotics, or other medications that have shown to decrease nerve pain such as Gabapentin (Neurontin) may be prescribed. The Gabapentin may be prescribed in extremely high doses to achieve the desired effect of reducing the nerve pain.
Physical therapies to extend the spine will be recommended and positions that contract the spine will be discouraged.
Some heat treatments such as a heating pad on a low or medium setting or an ice pack for 15 to 20 minutes every 2 or 3 hours can help. An occasional warm shower and single-use heat wraps that last up to 8 hours can also help.
A lot of the treatment advice depends on determining the exact cause of the sciatica. Stronger medications and even surgery may be recommended for severe cases.
Surgery may take the form of either a laminectomy and partial discectomy, where the offending portion of the disc is merely cut back away from the nerve, or the more radical step of a fusion, where the disc(s) at the offending levels are actually removed and replaced with irradiated bone from a cadaver, or from the patient’s hip. In addition, in a fusion, hardware is typically installed to stabilize the spine after the bone material is inserted into the disc space. The idea is to cause the two spinal processes to fuse into one piece of bone.
A herniated disc happens when the soft, spongy, material that cushions (shock absorbs) the bones of the spine (vertebrae) slips out of place, breaks open, or becomes damaged. A herniated disc is also called a slipped or ruptured disc. You can have a herniated disc in any part of your spine. The most common place for a herniated disc is the lumbar spine (the lower back). Sometimes the cervical spine (neck) or thoracic spine (upper back) can be affected.
When a herniated disc presses on a nerve; it can cause pain, numbness, and weakness in the area of the body where the nerve travels.
- Aging (wear and tear): As you get older, the discs can get dry and become less flexible.
- A physical injury (such as a workplace accident) can cause the gel in the disc to escape through the tears and cracks caused by the injury. This can cause the disc to rupture.
If the herniated disc pressed on a nerve, then the nerve contact can cause pain, weakness or tingling in the region where the nerve travels.
Pain in the buttocks and legs is called sciatica (see above). Sciatica is a common lower back herniated disc symptom.
Patients can also experience back ache and loss of bowel or bladder control.
Your doctor will perform a physical examination and take your medical history. The doctor may also order medical images such as an MRI or a CAT scan so that the actual disc can be viewed from a variety of angles and the severity of the disc problem can be identified. This can often mean the difference between have a less invasive procedure such as a laminectomy, or the more involved fusion surgery.
Many times, a herniated disc will heal on its own in about a month to six months. Treatments include:
- Rest (though not over-rest since weak muscles can make the problem worse)
- Physical therapy and exercises to make the area stronger
- Medicines don’t cure the disc but they can help you manage the swelling and pain.
- Heating pads, warm showers, single-use heat wraps and even ice packs may help.
- Nerve pain medications such as Gabapentin
- Epidural Steroid Injections to reduce the inflammation.
- About 10 percent of people do need to have surgery for their herniated disc.
Low back pain happens to almost everyone during their lifetime. Some back pain is temporary (acute – caused by a workplace accident) and other back pain is chronic (long lasting). Temporary pain usually is caused by some injury or motion. Chronic pain is usually due to wear and tear over years of use.
Back pain has many causes. Some of the initial causes your doctor will review are:
- An injury, strain or excess use.
- Fractures such as compression fractures
- Herniated disc.
- Muscle pulls and strains
- Aging such as degenerative disc disease
- A spinal problem such as harm to the synovial joints of the spine
Pain can be local or across a region of the body. It can cause hurt, numbness, pins and needles, tingling or other discomfort. It can be sharp or dull. You might have muscle spasms too.
Your doctor will conduct an oral exam to review your past medical history and current complaints. The doctor will conduct a variety of physical tests. In some cases, the doctor is looking to rule out other problems. Imaging tests such as X-Rays, MRIs and Ct Scans may help and will normally be ordered if your pain lasts more than a month.
Much back pain can be treated with medications, exercise and therapy. Walking and muscle strengthening exercises often help. Other possible treatments include:
- Spinal manipulation
- Epidural steroid Injections
- Implantation of a Spinal Cord Stimulator (SCS) device
Psychological counseling may also be recommended to help you cope with the stress of the pain and the worry about getting better.
Speak to an experienced North Carolina and Virginia workers’ compensation lawyer about pain management now
Attorney Joe Miller Esq. is respected by workers and employers alike for his 25 years of experience fighting for the rights of employees who are hurt on the job. He often helps the most severely injured workers and is therefore quite familiar and sympathetic as to what it means to deal with spinal surgery. He works to help the worker get the medical help he/she needs including treating with pain management doctors. He has helped thousands of workers get full recoveries for their medical bills, lost wages, vocational rehabilitation when warranted, and any other benefits you may have coming to you. For help with your North Carolina or Virginia workers’ compensation case, please phone (888) 694-1671 or complete the contact form.