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Occasional pain is tolerable and to a certain extent expected. Who doesn’t suffer a headache from time to time or twist an ankle or injure some other body part? With time and patience, these maladies usually clear themselves up. Then there’s the kind of pain that never goes away — the kind that lingers and makes life miserable.
This is where pain management, a relatively new specialty borne out of the practice of anesthesiology, offers satisfying solutions.
Perception and persistence of pain vary greatly even among people experiencing the same type of injury or condition. “Everyone is biologically, socially and psychologically different,” says Dr. Roland Reinhart, a board-certified pain management physician with an established practice in Palm Desert. “Many factors go into what people perceive pain is and what is painful for them. Patients coming into my office are experiencing pain that to them seems out of proportion or of greater duration than they think it ought to be. They’re looking for some relief.”
Sources of distress run the gamut, with lower back pain topping the list, followed by neck and then pain in the extremities — joints, hips, knees, elbows, wrists, hands, and fingers. Acute and chronic diseases such as cancer and shingles are initiators as well but pain arising from osteoarthritis is typically the most common. “We’re all living longer lives,” Reinhart says, “and bones and joints tend to wear out.”
Patients might arrive at a pain management practice via referral from their primary care physician or of their own volition. Regardless, they can expect to undergo a physical examination and be asked to provide a thorough history.
“Listening to them is critical,” says Dr. Lee Erlendson, a board-certified pain management specialist and founder of Rancho Mirage Pain Associates. “Getting a history of when this started, how it started, and how long they’ve coped with it before finally saying, You know, I need to see a doctor.”
Diagnostic imaging such as an MRI, CT, or SPECT scan are often part of the evaluation. A nerve conduction study might also be in order. Pain management specialists spend the time primary care physicians ordinarily do not have to get the diagnosis right.
The path to relief is wide and varied. Certainly, oral medication is one. “Feel-good pain medicine grew out of the practice of anesthesia where it’s essential to make someone numb to surgery or some other painful stimulus,” Reinhart explains. “The outgrowth of that was How can you block someone’s pain without putting them to sleep?”
However, the ideal plan is to first exhaust all non-opioid therapies. Alternative solutions include spinal cord stimulation, which uses electricity to block pain signals; nerve ablation, which destroys nerve fibers to accomplish the same; and steroid injections around inflamed nerves to alleviate pain. Physical therapy is also frequently recommended and can prove very helpful.
Meanwhile, many patients find relief by employing mind-body therapies such as meditation, guided imagery, biofeedback, or hypnosis. “Getting patients to redirect their focus and think about something other than the pain is key,” Reinhart says. “Everyone responds differently to treatments. What works for one person doesn’t necessarily work for another.”
Seeking to mitigate pain with treatments other than narcotics is wise. Approximately 10 percent of Americans are genetically predisposed to dependency and addiction, according to Erlendson. “Considering there are 700,000 physicians and perhaps 100 million people with some form of chronic back or neck pain,” he says, “you’ve got the perfect storm.”
That isn’t to say all medication is unwarranted. Not surprisingly, about 70 percent of people who live with chronic pain also have depression, and about 70 percent of depressed people have a pain complaint. There’s a huge overlap and it’s important to treat everything. Many patients, therefore, take antidepressant medications or quite possibly a variety that also helps with pain.
Pain management specialists will tell you there is always something that can be done for pain; nobody should have to live with it. Starting with the simplest techniques and perhaps moving on to more complex treatments, every method is ultimately designed to try to improve patients’ quality of life and increase their ability to participate.
“There’s a huge opportunity to help people,” Reinhart says. “Across the board for pain practices, we generally achieve good results. I firmly believe people shouldn't give up hope.”
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