2 Jun 2017
According to the National Institutes of Health (NIH), more people in the United States suffer from pain than from diabetes, heart disease, and cancer combined. It is the most common reason that people visit the doctor. More than 10% of American adults have chronic pain (pain lasting longer than three months). While pain is a pervasive issue, many treatments can help manage it and improve patients’ lives.
Dr. Jennifer Zocca, a physician in interventional pain management at Phelps Medical Associates, says that it is not usually a specific symptom that brings a patient to her office but how they are functioning in daily life. Instead of relying on the 0-10 pain scale that is used in medicine, Dr. Zocca asks patients, “How is this [pain] affecting your life? Are you able to go to work? Are you able to do things you enjoy and spend time with your family? Are you having side effects from the medications you are on?”
A patient may be referred to a pain specialist by a primary care physician, a surgeon, or by themselves. Dr. Yili Huang, another physician with Phelps Medical Associates’ Pain Management Center, starts with a detailed history of the patient’s pain. He performs a medical exam to rule out acute health issues such as a heart attack or kidney stones. The exam will reveal if the patient is suffering due to a recent injury or surgery, or has a chronic medical condition such as diabetes which may be causing pain (diabetic neuropathy).
Dr. Huang diagnoses pain conditions with: X-rays, MRIs, ultrasounds, and nerve conduction studies. The most common type of pain that Dr. Zocca and Dr. Huang see in their practice is back pain, such as spinal stenosis, sciatica, and degenerative disc disease. They also frequently see patients suffering from neck pain and arthritis.
Many treatments alleviate these painful conditions such as: physical therapy, acupuncture, heat/cold therapy, and medications. Acetaminophen, anti-inflammatories, nerve medications, and opiates are some of the many medications that can be used for pain.
According to Dr. Zocca, “It is often important to think outside the box when managing a patient’s pain. In most cases, there isn’t going to be one thing that’s a magic bullet for somebody’s pain. That can be frustrating for patients. It’s not like giving an antibiotic for a sinus infection.” People often have to combine various treatments to alleviate pain.
Interventional Pain Management
Some procedures that Dr. Huang and Dr. Zocca use are:
● Epidural injections-Steroids and anesthetic (numbing) agents are injected into the epidural space in the spine.
● Kyphoplasty-An x-ray is used to guide a needle or cannula to where the fracture is, then a balloon lifts the bone fragments into the correct position (used for compression fractures due to osteoporosis or cancer).
● Vertebroplasty-Bone cement is injected into fractured back bones to reinforce the spine.
● Spinal cord stimulation-A “pacemaker for your spine,” according to Dr. Huang, it sends a small electrical stimulant to the spine (for a patient with failed back surgery).
● Joint injections-Steroids are injected into joints for arthritis.
● Nerve blocks-These injections can be a diagnostic tool to see which nerve may be causing pain in the back and can also block the pain if the correct nerve is identified.
● Radiofrequency ablation-Heat made from radio waves is used to stop nerve pain in the back or neck.
Dr. Huang states, “Everything we do in medicine is balance of risk and benefit. …I always go from least invasive to more as the patient needs.” Even though he uses small needles, he suggests that any time a needle is used there is a risk for bleeding, infection, and nerve damage.
While it can be frustrating when treatments don’t work, often treatment is a diagnostic tool as well. If one injection fails, it narrows down the issue. With many pain management cases, it can take time to solve the problem.
Dr. Huang points to many success stories, though. “The most rewarding part of my job is seeing patients get better, seeing patients get back to their lives. I have patients who come in who can’t walk, in a wheelchair. Even after one injection, they walk out of here to the parking lot.”