Back pain

New Help for Back Pain

Pain management has evolved as a specialty over the last few years.  Many years ago pain management meant a medication management and basic interventions to manage both chronic and acute pain.  But over the past few years, there’s been more research into other kinds of interventions for pain management.

In general, pain management is leaning towards more interventional options to alleviate pain, especially keeping in mind the current opioid crisis. Physicians are much more reluctant nowadays to prescribe opiates because of the risk of opiate diversion and opiate misuse. Also the recent political climate has scared physicians away from just prescribing opiates. Although I do believe that many patients are good candidates for medication, the doctor prescribing it must be suitably trained.

Each patient must be individually screened by a well-trained, board certified pain management specialist. It used to be ok if physicians learned pain management on the job, and that’s how many dentists and primary care physicians gave out opiates. They were well-meaning, but not trained to look for the symptoms that indicate potential for misuse. However, now th4ere are many great academic institutions where a physician can get a board certification in pain management.

I was fortunate to receive significant pain management training at MD Anderson Cancer Center in Houston, while I was going through my residency as an anesthesiologist. But I went on to learn more about med management when I took an interventional pain management fellowship at the Northwestern University Medical Center in Chicago.

At Northwestern I focused not only on med management but also on the many other interventions that can be used for today’s patients. It’s important to know when to use meds and when to focus on those other interventions.

For example, in the past epidural steroid injections and radio frequency ablations were the only things we used for back pain, sciatica, and pain that radiated into the extremities, but now there are many more interventions that are available. Also, in the past radio frequency ablation could be used only in axial low back and neck pain, but now we know it can be used for hip and knee pain, obviating the need for hip and knee replacements, and offering little or no down time.

Some of the most exciting developments have happened in the area of PRP (platelet rich plasma) and stem cell treatments, which not only relieve pain, but are also anti-inflammatory and somewhat regenerative. Significant research continues to happen in stem cells and PRP. Spinal cord stimulation is also used more often now, especially as the devices become better.  Boston Scientific, Medtronic, and Avett are some of the biggest device manufacturers focused on continuing to improve this technology, which is used for patients who have had surgery and continue to have pain, or who for one reason or another are not good candidates for surgery. These devices now give patients significant relief.

This is also a great treatment for patients experiencing neuropathy in the lower extremities, either from diabetes or from chemotherapy.

In general, it is important to know that in seeing a double board-certified pain management specialist like myself, you’re not being seen by someone who is going to send you out of the office with a hand full of pills that will make you an addict or make someone close to you an addict. You’re seeing someone that has many ideas and tools for treating you, and will work with you to find the best way to relieve your pain without unwanted side effects.

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