How to avoid Pain Pills with Multidisciplinary Approach to Pain Management

It is quite not good to have pain pills at every aspect of your pain. You might be suffering from debilitating pain but pain relief medicine is not the ultimate answer. For instance, a patient in his post-operative cancer treatment period requires instant relief. In this situation it is common for the doctors to prescribe a pain pill in a day. But apart from that no other patients are generally prescribed by doctors to intake pain killers.

Multidisciplinary Approach to Pain Management

In order to deal with your pain you need to talk to an expert. And a pain management clinic can help you in such a situation. The pain management clinics that are running in the San Diego region have a multi disciplinary approach for their pain treatments. They avoid the use of the pain pills and take up the cult of physiotherapy and other aspects to treat debilitating pains.

If we look into the current statistics we will find that a number of patients suffer from variety of pain. Some of them might require long-term care and some might not. The chronic pain might require counseling and proper medical treatment but other might get well soon with the use of light physical activities. So it is better to talk to a pain expert at a clinic who knows his profession in the best way.
The pain management clinic is not going to prescribe you pain pills for all factors rather they stand up for the three main propositions –

Pain Management propositions

  • They support the help of a physiatrist to treat the pain of their patients. They generally recruited bunch of specialist and trained physiatrist who specializes in medicine and various types of rehabilitation programs. They keep a close tab on the various chronic pain management programs.
  • You can sort out help from the group of counselors who work in close connection with pain management clinics. These people help the patients to learn cognitive behavioral skills to manage their pain, anxiety and variety of depression modes to put up a strong fight against their endless pain.
  • Now if you want to keep your body supple and make sure that it does not fall slack at any point of time, then it is better to refer a physiotherapist. These people are a group of medical practitioners who share their education on improving and maintaining strength and mobility of our body. It will help to treat pains with series of exercises both physically or with the use of physio equipments and treat pain easily.

This type of multidisciplinary approach to treat the pain in a different way is highly preferable because our pain types differ from each other. Thus, pain management clinics differ in their focus and offerings. However, teams of enriched healthcare professionals are no doubt the best and know the right solutions to treat pain without pills and keep the cognitive skills of the people churned.

What would be The “right” goal while managing pain

goal to managing pain

It is quite natural that the primary aim of a pain management clinic will be the adoption of successful treatment strategies that will help reduce pain in patients. However, when looking deep, there seems to be a lot more involved in the way the patient responds to these treatment strategies and the after effects of such treatments.

Often, in case of patients suffering from chronic cases of pain, there is a much sinister underlying cause of this pain. Complex disorders and diseases could give rise to painful symptoms in these patients. However, if the focus is only on the reduction of these symptoms instead of addressing the real cause, it might end up in pain recurrence at a later stage or further aggravation of the source disease or disorder. Pain management strategies could involve medication or interventional therapies. Alternative therapies like chiropractic, acupuncture, physical therapy, etc., might also be adopted to treat pain in patients. However, when the doctor emphasizes mainly on the pain aspect of the disease and tries to reduce pain using one or more of the above mentioned therapies, the goal of pain reduction might be easily achieved but the risk of unknown side effects that worsen the underlying cause, remains. Thus, it is extremely important to administer pain treatments that are ‘customized’. An individual’s physical and mental health, lifestyle and profession are all important factors to be taken into account while designing pain management strategies. Besides reducing the pain, attention must be paid to the underlying cause and how the treatment strategy adopted can affect the cause should be estimated carefully. A multimodal therapy plan must be devised that attends to all the needs of the patient.

Besides addressing pain and its underlying cause, pain management must also be administered in a compassionate and caring manner. It is important to remember that most patients of pain are mentally disturbed due to the debilitating effects of a nagging pain on their life and lifestyle. Often chronic pain is associated with depression. Words of sympathy and a caring touch works wonders for such patients and this ‘humane touch’ must be integrated into the goals of managing pain.

Use of pain management drugs must be made extremely cautiously. Often, due to pressure from the patient’s behalf, physicians tend to administer stronger doses of medication to patients to relieve them of severe pain. However, even though immediately effective, these medications might have untold adverse side effects at a later stage. Such is the case with opioid pain medications. Often, improper and excessive use of these drugs have led to drug overuse and abuse in patients who were not known to be addicts. Opioid drugs like oxycodone is known for its effectivity to reduce pain and induce sleep but it is also associated with side effects like memory problems, constipation and tiredness.

Adoption of new scientific knowledge and techniques must also be an important goal when managing pain. Since pain management is based on personalized treatment strategies, knowledge of scientific advances helps the doctors to decide upon a treatment plan more effectively. As more and more research data is pouring in, it is becoming easier to personalize medical treatments according to individual needs. For example, a drug A might work well for younger patients with a back ache while drug B might be more effective with older patients. So, efficient doctors like the ones involved in pain management in San Diego, keep themselves updated with all such information which allows them to take better decisions while treating patients.

Which is better Vertebroplasty or Kyphoplasty

Vertebral augmentation is a minimally invasive surgical procedure to treat compression vertebral fractures. This technique stabilizes the fracture, reduces pain and checks the development of further complications. Vertebroplasty and kyphoplasty are the two types of vertebral augmentation surgeries used to deliver relief to patients suffering from severe, disabling pain caused by a vertebral fracture that is not cured by non-invasive therapies like pharmacological therapy and brace immobilization.

vertebroplasty or kyphoplasty surgery in San Diego

In both vertebroplasty and kyphoplasty, a small, minimally invasive incision is made in the skin using fluoroscopy with guidance from X-ray imaging and a stabilizing cement is placed into the fractured vertebra. Even though the two procedures are similar in many ways, a few dissimilarities remain which leads to the question ‘Which is better Vertebroplasty or Kyphoplasty?’

A large number of studies have been conducted which have proven the efficacy of vertebroplasty and kyphoplasty surgical techniques. An extensive literature review survey has been performed by Hulme et al., to evaluate the benefits and risks associated with these two procedures. 92% patients who had undergone kyphoplasty and 87% who went through vertebroplasty, reported some relief from pain. Since vertebral compression fractures leads to loss of vertebral height, the augmentation surgeries also helps restore the loss of height. Kyphoplasty led to the restoration of vertebral height in patients who underwent the surgery while a subset of patients treated with vertebroplasty, showed some signs of vertebral height recovery. Another problem associated with these vertebral augmentation techniques is cement leak from the point of administration. 9% of kyphoplasty treated vertebrae and 40% of vertebroplasty treated vertebrae displayed cement leaks. New fractures in adjacent vertebrae occurred at almost similar rates for both the procedures.

A study conducted by Taylor et al., attempted to compare the benefits and risks associated with vertebroplasty and kyphoplasty as a means of vertebral compression fracture treatment. Their study found that even though there is no direct evidence of a comparison of the two techniques, as per indirect comparison using evidence from case studies, both the techniques appeared to bring similar gains in pain alleviation. However, there is evidence to prove that balloon kyphoplasty led to better improvements in a patient’s lifestyle and functionality than vertebroplasty. The rate of adverse side effects of these procedures seem to be rare in both the cases. So, from the above studies, it can be summarized that even though both kyphoplasty and vertebroplasty are associated with almost similar benefits and risks, the former has a slight advantage over the latter in terms of efficacy.

When you consider the cost factor, kyphoplasty is 10 to 20 times more expensive than vertebroplasty. The latter is usually performed without general anesthesia under conscious sedation at an outpatient department while the former requires general anesthesia and inpatient services. This is why kyphoplasty is more time and budget consuming than vertebroplasty.

So, if you live in San Diego and are suffering from vertebral compression fracture symptoms that are not healing by non-invasive therapies, you may decide to go for either vertebroplasty or kyphoplasty surgery in San Diego. The specialised doctors at the clinics for pain management in San Diego will assist you in making the correct decision.

References:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2781232/

Clinical research of Opioid Therapy for Chronic Pain

Opioid pain medications like OxyContin, Vicodin, hydrocodone, oxycodone, Duragesic, fentanyl, morphine, etc., are considered to be one of the most potent analgesics. These medications may be available in a variety of forms like tablets or liquids to be taken orally or may also come as opioid injections or patch administrations. These drugs are used to treat moderate to chronic symptoms of pain. Since opioids have narcotic properties, serious side effects may result if used incorrectly. Seek the help of reputable doctors like San Diego pain management doctors for use of opioid medications.

Opioid Therapy for Chronic Pain

What is the mechanism of working?

Clinical research on opioid therapy for chronic pain

All compounds that bind to opiate receptors are referred to as opioids. Opioids can be derived from naturally occurring opiates like heroin from morphine or be artificially synthesized in the laboratory like fentanyl and methadone. Opioids bind to opioid receptors which are widely distributed. The receptors responsible for pain modulation are located in cells of both the central and peripheral nervous systems. The opioid drugs compete with the endogenous endorphins of the body in binding to these receptors. Such binding suppresses the strength of the pain stimulus which reaches the brain. This results in decreasing your sensation of pain.

Clinical research on opioid therapy for chronic pain

Starting from the 20th century, a number of major advances have been made in the use of opioids for chronic pain management. These included the attempts to control opioid distribution by several countries, the discovery of endogenous opioids and the recognition that opioids can be effectively used in alleviating the symptoms of pain. There was also a huge controversy surrounding the long term use of these drugs as professionals believed it could lead to addiction and misuse of these narcotics. However, since the 1990’s, the popularity of opioid medications and its involvement began to rise gradually and this trend continues till this date. Unfortunately, the rise in medical use of this class of drugs has been accompanied by an increase in its non-medical abuse. Still, according to reports by pain specialists, chronic pain can be handled quite effectively using opioid medications. Studies have been conducted to compare the efficacy of opioid pain medications versus that of the non-opioid ones and it has been found that ‘weak’ opioids are not as effective as the relatively ‘stronger’ ones. Some reports also show little or no evidence in support of these pain medications in treating back pain.

Side effects

Opioid medications are not available as ‘over the counter’ drugs at pharmacies and need to be prescribed by a doctor for purchase. It is the sole responsibility of your doctor to regulate the dosage of the medication. Opioids may be administered by registered practitioners like San Diego pain management doctors at regular intervals over a period of many days to treat chronic pain or as a single dose to treat a sudden flare of pain. Some of the common side effects of opioid medications include:

  • constipation, nausea and vomiting
  • drowsiness
  • opioids can be dangerous if used with alcohol, sleeping pills, antidepressants or antihistamines
  • opioid dependence or addiction leading to withdrawal symptoms when attempting to overcome addiction.

Myofascial Pain Syndrome and Fibromalgia: A Comparison of the two disorders

Fibromyalgia and myofascial pain syndrome (MPS) are often indistinguishable from each other as their symptoms overlap. Also, patients with either one of these disorders has the tendency to develop the other one. In absence of proper diagnosis, patients suffering from both these disorders may be treated for only one of them.  However, it is important to distinguish the two disorders by proper diagnosis since the treatment modules for both are different.

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Top Painful Health Conditions According to the Pain Management Specialists

Pain is something we all have to live with – emotional, psychological, physical. But what are the most excruciating painful conditions that a person can go through? We consulted the top pain management doctors in San Diego and came up with a list of the top five most painful health conditions that can affect a person.

Shingles

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Symptoms and clinical diagnosis of Adhesive capsulitis

Adhesive Capsulitis, commonly known as frozen shoulder, is a condition in which your shoulder literally just freezes. The joint becomes so stiff that it becomes impossible to perform normal actions such as pulling on a t shirt or lifting an object. It is an extremely painful condition that can last for years if it is not treated in time. It has been seen to occur mainly in the arm that is used less frequently, and is commonly seen in people who have diabetes.

How Adhesive capsulitis is caused

Adhesive capsulitis

The exact reason why the condition develops is not known. It tends to occur if the shoulder has been in disuse for prolonged periods of time. It also tends to be linked to the following medical conditions:

  • Parkinson’s disease
  • Cardiac disease or surgery
  • Hyperthyroidism
  • Hypothyroidism
  • Diabetes

Symptoms of Adhesive capsulitis

Symptoms of Adhesive capsulitis

Adhesive capsulitis occurs in three stages and in each of these phases different symptoms may manifest:

Freezing

In this stage, the individual first notice extreme pain in the shoulder. During this time, there is a likelihood that they lose the ability to move their shoulder normally.

Frozen

In this stage, the individual suffers from very little pain, but they are not able to move their shoulder normally.

Thawing

In this final stage, the individual may be able to move their shoulder again but may feel weakness in the arm as they have not used the shoulder for a long time.

Diagnosis of Adhesive capsulitis

A San Diego pain management clinic would be able to tell you if you are suffering from this condition. Common indications of Adhesive capsulitis are the inability to perform certain activities such as:

  • Moving your arm above shoulder height
  • Throwing a ball
  • Reach for an object with a rapid motion
  • Move your arm behind your back
  • Move your arm to the side and then to the back
  • Sleep on one side of the body

The San Diego pain management clinic may prescribe some diagnostic tests to rule out the presence of other conditions. These tests may include an MRI scan or an X ray. Neither of these tests can be used to establish the presence of a frozen shoulder. The best way to determine if the patient has Adhesive capsulitis is by carrying out a double contrast shoulder arthrography.

Another way of determining if you have Adhesive capsulitis is to perform specific shoulder movements, as there is a very distinct pattern to the stiffness. This is important to rule out the presence of rotator cuff injury.

Summary

Adhesive capsulitis occurs for unknown reasons but can be prevented. If you are not using your shoulder because of an injury, make sure that you move your shoulder to prevent any stiffness that can lead to a frozen shoulder. A physiotherapist at a San Diego pain management clinic can help assign certain activities that you can perform to prevent this from happening. This is highly recommended if you have any of the conditions we listed above that could put you at greater risk of developing a frozen shoulder condition.

Sacroiliac Injections By Pain Management Doctors in San Diego

What are sacroiliac injections?

Sacroiliac injections are injections of steroids or other medications directly into the sacroiliac joint by a pain management doctor in San Diego. These joints can be found on either side of the tailbone, and they connect your tailbone to your pelvis.

What is the purpose of the sacroiliac injections?

These injections are designed to reduce inflammation or swelling in or around the sacroiliac joint space. This can help to reduce pain or any residual symptoms that inflammation may cause to your joint or any surrounding structures.

How long does this process take?

The actual injections take between five and ten minutes at a San Diego pain management clinic.

What is injected?

With the sacroiliac injections a mixture of local anesthetic and steroids are injected to reduce pain and to prolong the positive effects.

Is the process painful?

The sacroiliac injections is an injection performed by a pain management doctor in San Diego through the skin and the deeper tissue which causes some pain. Before the injection takes place the skin and the deeper tissue are numbed using a local anesthetic. This helps to alleviate the discomfort felt during the procedure. Some patients will receive sedation in addition to this to make the process easier. The procedure is conducted under a local anesthetic not a general anesthetic which means that you are not “out” during the process. Some patients opt for additional sedation, as mentioned above, and the amount provided is often contingent upon the tolerance levels of the patient.

How is the process performed?

The sacroiliac injections are conducted with the patient lying on their stomach at a San Diego pain management clinic. There is often an x-ray used to determine the correct placement for the needle but thinner patients may not need this. Patients who have IV sedation will be monitored using a blood pressure cuff, EKG, and blood oxygen monitoring device. The skin where the injection will take place is cleaned using an antiseptic and then numbed using an anesthetic. The injection needle will be placed appropriately and the injection carried out. After the process is complete the needle is removed and a covering applied to the area of injection.

What can be expected after the procedure?

After the sacroiliac injections you will feel no pain or little pain, but this is due to the anesthetic. This feeling will go away after a few hours. You may feel sore at the site of the injection for a day or two. This is because of the mechanical process used to place the needle. After the third day you will begin to notice pain relief.

You should have someone else drive you home following the procedure as the injection can cause temporary leg weakness. Any patient undergoing sedation for the sacroiliac injections is required to have a ride home. Patients are advised to have a day or two to relax after the procedure and ice can be applied to the injection site.
Unless you faced complications you can return to work the following day. The most common complication felt is soreness at the injection site. The medication should bring with it lasting effects for several days to several months. If the first injection is not effective, you may return for another in two weeks.

Reflex Sympathetic Dystrophy (RSD) Treatment With Pain Doctor San Diego

Reflex Sympathetic Dystrophy (RSD) Treatment With Pain Doctor San Diego

What is Reflex Sympathetic Dystrophy (RSD)?

Reflex sympathetic dystrophy (RSD) is a condition that is characterized by a group of typical symptoms, including pain, tenderness, as well as a swelling associated with varying degrees of warmth and coolness, shiny skin, sweating, flushing, and discoloration. Reflex sympathetic dystrophy (RSD) is also referred to as, the shoulder-hand syndrome or complex regional pain syndrome. It is a term used to describe a form of Complex Regional Pain Syndrome (CRPS). There are two types of CRPS, Type I and II. Both of these conditions result in chronic pain; however, the main cause of pain is much different. Type I CRPS (Complex Regional Pain Syndrome), is initiated by an injury in the tissue where there is no nerve injury, while Type II CRPS refers to the incidences where a high-velocity impact such as that from a bullet wound is associated with nerve injury.

What are the Causes of Reflex Sympathetic Dystrophy (RSD)/CPRS?

Pain Clinics San DiegoThe major cause of RSD is not known, but the condition is known to occur as a result of malfunctioning of the sympathetic nervous system. The theories behind this include irritation and abnormal excitation of the nervous tissue, resulting to abnormal impulses alongside the nerves that affects the blood vessels and the skin. In most cases, RSD comes after a trauma attack, therefore, some of the conditions that may trigger RSD include; fractures, sprain, damage to the blood vessels or nerves, surgery and certain brain injuries.

What are the Symptoms of RSD/CPRS?

The onset of RSD symptoms may range from rapid to gradual as the condition does not display all the features. There are three stages of RSD together with their symptoms. These are;
Acute Stage: This occurs from three to six months. The patients will experience symptoms such as flushing, sweating, pain, burning sensation, swelling, blanching, and tenderness.
Dystrophic stage occurs from three to six months. The patients experience early skin changes of shiny and contracture with persistent pain.

Atrophic: may be long-lasting. The patient experience loss of motion and function of the part involved (hand or foot) and thinning of the fatty layers under your skin.

How is RSD Diagnosed?

Pain Medication Management San DeigoRSD is diagnosed as per the clinical features seen previously. Sometimes studying images (x-ray, MRI) or nerve conduction tests may be useful. The diagnosis process will be carried out by a San Diego pain clinic. Blood tests may be recommended by a pain doctor San Diego according to the signs and symptoms. Nuclear bone scanning may be used in this process. It will help show characteristic uptake patterns. Overall, diagnosis is thought to help prevent progression of the syndrome.

Is there Treatment for RSD?

Well, there may be no cure for this condition but there is a treatment for such. The objective of the treatment by a pain doctor in San Diego is to help relieve painful symptoms so that the patient can resume their normal activities. Response to treatment of RSD is successful in the earlier stages as compared to the later stages.
The most appropriate treatment include;
• Use of cool and moist applications to the affected areas
• Physical therapy that includes gradual exercises helps relieve contractures
• Medication for pain and inflammation
• Other treatments options include amitriptyline, pregabalin, and clonidine.
• For persistent symptoms, prednisone (cortisone) may be used but in high dosage.
• Treatments such as surgically interrupting the nerves of the nervous system may be used to ease pain.

Remember to keep your pain doctor in San Diego informed of any new symptoms and progress so that they can establish a proper treatment program for you. To learn more about RSD, schedule an appointment with your San Diego pain clinic today.

Trigeminal Neuralgia Diagnosed By Pain Management Doctors In San Diego

What is Trigeminal Neuralgia?

Trigeminal Neuralgia is a chronic pain condition or inflammation of the trigeminal nerve that causes facial pain. This condition is referred to as tic douloureux since the intense pain can cause patients to contort their face into a grimace causing the head to move away from the pain, a condition called a tic.
Trigeminal nerve sends impulses of pain, touch, pressure and temperature directly to the brain from areas such as the face, gums, jaw, forehead and around the eyes. The pain caused by trigeminal neuralgia is quite intense and may occur in few hours, minutes or seconds. The outcome can be months or years of attack but in some patients it can be fully controlled.

Trigeminal Neuralgia have been known to affect people of any age, but it is more common in people older than 60 years old. The effects are seen in the right side of the face five times more than the left side.

What Causes Trigeminal Neuralgia?

Headache treatment San DiegoIn the vast majority of the common cases, trigeminal neuralgia is caused by compression of the main nerve to the brain, trigeminal nerve. This nerve is the largest in the skull. This compression is caused by a nearby blood vessel pressing on the main nerve inside the skull.

What are the Symptoms of Trigeminal Neuralgia?

Trigeminal Neuralgia is characterized by a sudden, sharp, electric-like, or stabbing pain that may last for several seconds. The pain mostly occurs on the face and around the eyes, lips, nose, scalp and forehead. These symptoms can be transferred from one person to another by brushing the teeth, touching the face, putting on make-up, swallowing or even feeling just a slight breeze.

Being one of the most painful disorders, the pain is felt on one side of the jaw or cheek though different people experience pain at different times on both sides. The attack result to a sharp pain that may be repeated one after the other. This pain may come and go throughout the day lasting for days, weeks or months. The disorder may be seen to disappear for months or years. It is more frequent in women than men and in rare cases does it affect younger than 50 years of age.

How is Trigeminal Neuralgia Diagnosed?

In diagnosing this condition, your pain management doctor in San Diego will first take a history of the situation and perform a physical examination which should be normal. The main area of test is muscle weakness and presence of corneal reflex controlled by V1. V3 is in control of chewing, and there should be no existence of muscle weakness. When the cornea is touched, the eye should blink in response. The two discoveries must be normal if not, the treatment for trigeminal nerve should begin.

Some pain management doctors in San Diego may order for a Magnetic Resonance Imaging (MRI) to help in the diagnosis of other conditions that may cause trigeminal neuralgia. This disorder is diagnosed based on the description of the patient’s symptoms.

How can Trigeminal Neuralgia Be Treated?

Trigeminal Neuralgia is a long term condition. It can be managed through treatment to some degree. The first treatment to be administered by a pain clinic San Diego should be with an anticonvulsant medication (mostly used to treat epilepsy) called carbamazepine. This medication should be taken several times in a day, with an increase of the dose over the course of few days or weeks so that the medication can build up in your bloodstream.

Migraine Treatment San DiegoTrigeminal neuralgia can also be treated with antiseizure drugs including Neurontin (gabapentin) or Tegretol (carbamazepine). Other medication like Depakote and Klonopin may also be quite effective when used in combination with other drugs to achieve pain relief.

If the treatments turn out to be ineffective, neurosurgical procedures are available to relieve pressure on the nerves and also reduce the amount of sensitivity on the nerves. Some patients have shown successive or reduced pain with the help of medical therapies such as chiropractic treatment, acupuncture adjustments as well self-hypnosis.
Well, these treatment options will help you achieve the very best when relieving pain caused by trigeminal neuralgia. To learn more about them, contact a pain clinic San Diego today.