Pain Management
For most of us, pain is something we only experience after the occasional muscle sprain or strain. But for roughly 76.6 million Americans, it is more than just a fleeting annoyance. According to the American Pain Foundation, more than 25% of Americans, age 20 and up, report problems with pain that lasts for more than 24 hours. A recent report by the Institute of Medicine states that chronic pain affects 116 million Americans—one third of the US population—and is responsible for $550 billion to $635 billion in medical bills and lost productivity.
Chronic pain can stem from a number of persistent conditions. According to a National Institute of Health Statistics survey, 27% of respondents suffer from low back pain, followed by 15% who experience severe headaches or migraines. Neck pain and facial aches and pains were also common. Chronic pain can also be a side effect of surgery or treatment for cancer. Arthritis, rheumatoid arthritis, gout, and lupus are also associated with causing chronic pain. Fibromyalgia, which affects 46 million adults, is defined as a condition that causes pain all over the body. Nerve damage and disorders such as temporomandibular, or jaw joint (TMJ) can cause severe headaches and pain in the ears, neck or shoulders. The natural aging process brings its own share of painful conditions, as well.
Over-the-counter remedies have very little effect on chronic pain. Specialists use a number of therapies to help ease their patients’ suffering. Medication is only a small part of a patient’s treatment plan, as the side effects of chronic pain are not just physical. “Chronic pain has a psychological component. People get depressed or feel helpless, and that impacts their relationships with family and co-workers. We do a lot of counseling on how to cope and offer other services like physical therapy, massage, and chiropractic treatments. One of the most common things we do is intervention,” says Dr. Arun Kandra of Twin Rivers Pain Management, Easton.
Contrary to another misconception, pain management specialists are no longer the last resort for patients. In fact, many patients call a specialist before they call their family doctor, which can prove to be better for their condition in the long term. “You don’t have to go to a primary doctor first,” Kandra says. “It’s actually better in most cases to see a pain management specialist early on in the process. We become really focused on doing the necessary investigation to get to the source of the problem.” Once the source is identified, the specialist will work with the patient to develop a treatment plan to manage their condition. Besides traditional Western therapies, Kandra says that many patients find relief through acupuncture or regular yoga sessions.
Once the specialist has located the source of the problem, there are a number of treatment options available to patients, says Dr. Yasin Khan, Director of Comprehensive Pain Center and CEO of Westfield Hospital, Allentown. “I have a bunch of patients who have been treated with a spinal drug delivery system. The device is implanted in the spinal canal and pumps medications right into the spine. It is replaced every three months and the patient has a constant delivery of pain medication.” Khan says that the implanted device has been very helpful for patients with conditions like multiple sclerosis, who may experience painful muscle spasms with varying frequency. The steady stream of medication helps to control the frequency and intensity of the spasms. Surgery is a last resort after all conservative options have been exhausted, says Dr. Steven Mortazavi with Valley Pain Specialists, Bethlehem. “We can keep about 75 percent of our patients away from surgery,” he says. Surgery comes with its own risks and side effects, and if less invasive procedures can help a patient, specialists prefer to try those treatment options first.
One of the most widespread side effects of surgery—and chronic pain itself—is prescription drug dependency. Pain management specialists monitor their patients’ prescription medication usage closely and take this responsibility very seriously. There are a number of different classifications of pain medication, and Mortazavi recognizes that abuse of prescription drugs like opioids (a family of drugs that includes morphine) is a huge nationwide problem and far outweighs the abuse of illegal substances. “We see patients referred for prescription opioid drug therapy. We see them, monitor them, and try to keep them compliant,” he says. Pain management centers must have policies in place that regulate patients’ prescription drug usage. “Our policy is that only our office will prescribe these medications, the patient goes to only one pharmacy, and we monitor them for improvement,” Mortazavi says. Kandra says he prefers to prescribe narcotics, which can be highly addictive, as infrequently as possible. “We don’t typically prescribe narcotics unless there are no other options,” he says. “There are a lot of things to consider. We do a thorough screening first. And if narcotics are prescribed, we always check the pill count, examine the patient, and make sure the patient is not misusing or abusing the medication.” Khan says that a very small number of his patients have a problem with addiction, but it’s still a sensitive issue. He echoes the importance of taking any medication as prescribed, and warns against stopping any narcotic cold turkey. “A patient can go into withdrawal, and that is the result of a psychological dependence on the drug,” he says. “A doctor should have proper documentation and tracking to get to the source of the problem.”
As with most medical conditions, specialists strongly recommend that a patient seek treatment earlier rather than later. “Pain management should not be a last resort. It should be further up in the treatment algorithm. We evaluate and refer patients to the proper specialists,” Mortazavi says.
SOURCES:
Valley Pain Specialists
4250 Fritch Dr.
Bethlehem, PA 18020
(610) 954-9040
valleypainspecialists.com
Twin Rivers Pain Management
20 Community Drive
Easton, PA 18045
(610) 438-5071
Westfield Hospital
4815 W. Tilghman Street
Allentown, PA 18104
610.973.8400
westfieldhospital.com
