Pain medicine involves the study of pain, as well as the various preventive and treatment options. Certain conditions are associated with more pain, such as postoperative pain, pain related to malignancy, and neuropathic pain. The evaluation of pain syndromes involves interpretation of the medical history, review of laboratory tests, imaging scans, and electro-diagnostic studies, as well as interviewing the patient.
The pain management specialist serves as a consultant to other doctors, but remains the main treating physician who provides various levels of care. Pain management involves prescribing medication, direct procedural treatment, counseling patients and families, as well as coordinating care with other healthcare professionals. This doctor works in many settings and treats an entire range of painful conditions.
According to experts, there are two types of pain: acute and chronic. Acute pain occurs due to some type of injury, disease, or treatment intervention. This causes activation of nerve receptors at the area of local tissue injury. Acute pain resolves after the underlying mechanism heals. Chronic pain, however, extends beyond the normal healing time. The International Association for the Study of Pain (IASP) defines chronic pain as an unpleasant experience influence by many affective, cognitive, and environmental factors. Other types of pain include:
Cancer pain – This is any discomfort associated with disease progression and treatment from radiotherapy, chemotherapy, and/or surgery.
Recurrent pain – This is episodic, intermittent pain, which occurs along with pain-free intervals. Examples of conditions that are associated with this type of pain include migraine headaches, trigeminal neuralgia, and sickle cell disease.
Interventional pain management involves pinpointing the source of the patient’s pain and offering direct and real treatment for that issue. The intervention is a procedure that targets the nerves to block nociception. Treatment options include:
Epidural steroid injection (ESI) – This procedure involves the use of a corticosteroid and long-acting anesthetic, which are injected into the epidural space for pain relief.
Facet joint injection (FJI) – Usually given in a series of three, these injections are used to alleviate the pain associated with spinal arthritis and facet joint syndrome.
Intrathecal pump implant – This involves surgical implantation of a small unit to deliver pain medication directly into the central nervous system.
Vertebroplasty/kyphoplasty – These procedures are done to relieve pain in people diagnosed with vertebral compression fractures, which are related to cancer, osteoporosis, and/or trauma.
Medial branch block – This involves injecting a long-acting anesthetic and/or a neurolytic agent onto a specific spinal nerve root. This blocks pain signal transmission and alleviate discomfort.
Radiofrequency ablation – Also called a rhizotomy, this procedure involves the use of heated electrodes applied to specific spinal nerves. Once the nerves are destroyed, this procedure offers long-term pain relief.
Spinal cord stimulation (SCS) – This involves implantation of a special device that uses electrical impulses to block transmission of pain signals to the brain.
Intradiscal injection – Used to treat chronic forms of discogenic back pain, the intradiscal injection involves instilling a special solution, corticosteroid, or stem cells into a damaged or injured disc.
Joint injection – Used to treat arthritis, this involves injection of a corticosteroid, long-acting anesthetic, and/or synthetic synovial fluid into the joint.
Discogram – This test allows the doctor to look inside the disc(s) to evaluate if or not they are the source of pain. With this procedure, the doctor uses contrast dye injected into the disc, which is examined using CT scans or x-rays.
Myelogram – The doctor can inject radio-opaque dye into the spinal canal, and then, use x-ray views to see the big picture. This test is used to diagnose spinal abnormalities.
Selective Nerve Blocks – Arizona pain doctors sometimes inject around suspected nerve roots that may be “chemically” inflamed to see if relief can be obtained. This works well when there is no obvious compression such as from a herniated disc.
Medial branch block – not only is this a great therapeutic treatment, it also works well diagnostically to tell the Phoenix pain doctor if the spinal joint is the source of the pain.
Plexus/Sympathetic blocks – whether it’s a stellate, sympathetic, celiac or hypogastric block, they all can give excellent diagnostic information regarding the source of an individual’s pain.