Besides the physical burden, chronic pain affects the psychological and spiritual well being of patients and their families. In addition to a complete physical work-up, we may include a psychological evaluation to help better understand the patient’s perspectives and provide suggestions and support as he/she copes with his/her pain.
Whenever possible, we will first prescribe a conservative course of treatment, such as pain-relieving medications in combination with psychological support. Some patients benefit from techniques that combine aspects of Eastern medicine with traditional Western approaches.
If non-invasive therapies do not address a patient’s needs, he or she, together with a physician, may agree to embark upon more aggressive therapies, such as:
Trigger point injections and Piriformis muscle injection: Using traditional medications or Botox
Bursa injections: Treatment for common inflammatory conditions such as subdeltoid, trochanteric and ischiogluteal bursitis.
Joint injections: Shoulder, elbow, hip, knee, sacroiliac, and facet joints
Nerve blocks: Local anesthesia and/or steroids injected near specific nerves in the spinal column, pelvis, or thoracic cage that affect different parts of the body. Common techniques include translaminar, transforaminal, or caudal epidurals.
Implantable drug delivery: A preprogrammed release of opioids, local anesthetics, and/or other medications directly into the spinal cord. This technique delivers smaller doses of medications at regular intervals and helps reduce systemic side effects. This is often the best approach for cancer patients, allowing them a greater degree of mobility and symptom relief.
Radiofrequency Ablation (RFA): A specialized needle is inserted near a nerve and heated, which renders the nerve incapable of transmitting pain. This procedure is often effective for alleviating neck, back and disc pain. Pulsed RFA is a technique employed to treat pain originating from peripheral nerves and most effective in treatment of entrapment neuropathy.
Spinal cord stimulation: A small implanted device stimulates the spinal cord with a minute electrical current that interrupts the transmission of pain signals. The indications for this treatment modality are expanding.
Diagnostic procedures: Medial branch blocks to establish the diagnosis of facet arthropathy; prior to radiofrequency ablation, a specific diagnostic injection is conducted.
In addition to the traditional fluoroscopy, most of these procedures can now be performed with ultrasound-guided technology.