Members of the Care Team
- Anesthesiologist – An anesthesiologist is a physician who has earned an undergraduate degree and completed four years each of medical school and residency training in the medical specialty of anesthesiology. Many anesthesiologists have additional experience or fellowship training in anesthesiology specialties including obstetric anesthesia, pediatric anesthesia, cardiac anesthesia, pain medicine, critical care management and neuroanesthesia.
- Anesthetist – An anesthetist is an advanced practice provider who assists an anesthesiologist in the delivery of quality anesthesia care. Anesthetists have a nursing, pre-medicine or science based undergraduate background and completed an accredited master’s program focused on the delivery and maintenance of anesthesia care and patient monitoring techniques.
Arthritis – Arthritis is a condition caused by inflammation in the joints. It is often used to refer to a group of many diseases that can cause pain, stiffness, and swelling in the joints. There are over 100 types of arthritis. Some of the most common types of arthritis include:
- Osteoarthritis – sometimes called degenerative joint disease, is the most common type of arthritis. Osteoarthritis occurs when the cartilage between bones gradually breaks down causing the bones to rub against each other resulting in pain and swelling. It is most common in the knee, hip and facet joints.
- Rheumatoid arthritis – is long lasting and can affect joints in any part of the body, but most commonly the hands, wrists and knees. Rheumatoid arthritis attacks the lining of the joints, causing swelling that can result in aching and throbbing.
- Gouty arthritis – is a painful condition that occurs when there are elevated levels of uric acid in the bloodstream, which the body is unable to eliminate. Crystals of uric acid are deposited on the cartilage of joints, tendons, and surrounding tissues causing swelling and severe pain. Gouty arthritis most often occurs in the big toe, knee and wrist joint.
Back Pain – Individuals experiencing back pain that continues or worsens over the course of two weeks will benefit from an evaluation by a pain specialist. Early intervention is key to heading off long term pain conditions. If a patient has problems with bowel or bladder control, numbness in the groin or rectal area, or leg weakness they should seek help immediately. These symptoms are a sign of nerve damage and can be irreversible if not treated appropriately.
Cancer Pain – Cancer is a devastating disease, and the pain that accompanies it can be debilitating. Pain specialists can work closely with a cancer patient’s primary care physician, oncologist, surgeon and other members of the health care team to treat cancer pain aggressively.
CRPS/RSD – Complex Regional Pain Syndrome (CRPS), also referred to as Reflex Sympathetic Dystrophy Syndrome (RSD), is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. Experts believe that CRPS occurs as a result of dysfunction in the central or peripheral nervous system.
Diabetes – Diabetic neuropathy is a nerve disorder caused by diabetes. Over time, high blood sugar levels from diabetes can damage nerves throughout the body.
- There are several types of diabetic neuropathy. Peripheral neuropathy reduces the ability to sense pain, touch, temperature and vibration in certain parts of the body. It may also affect movement and muscle strength.
- Autonomic neuropathy may cause problems with the nerves that control the involuntary functions of the body, such as heartbeat, blood pressure, sweating, digestion, urination and some aspects of sexual function.
- Focal neuropathy affects a single nerve, most often in the wrist, thigh or foot. It may also affect the nerves of the back, chest and those that control the eye muscles. It often develops suddenly and is the rarest form.
Extremity Pain – Patients suffering from extremity pain might notice the effects of stress on joints associated with their arms, legs, wrists, ankles, shoulders or neck.
- There are two types of extremity pain. Lower extremity pain affects the nerves which control the lower extremities beginning in the low back and lower spine. Lower extremity pain may be positional, getting better or worse depending on the body position, or episodic, following an activity or without apparent cause, and is triggered as the body adapts to mechanical stress, weak posture and inefficient motion. Lower extremity pain includes leg pain, ankle pain and foot pain.
- Upper extremity pain is often caused by an injury from daily overuse. In general, the more frequent or the more strain an activity requires, the greater the opportunity for injury and pain. Upper extremity pain includes arm pain, wrist pain, shoulder pain and hand pain. Overuse injuries can affect nearly any joint in the upper extremities, but most often affect the shoulders and wrists. Pain may be constant or may appear only during certain activities.
Failed Back Surgery – Failed back surgery, also known as failed back syndrome or post laminectomy syndrome, is a generalized term to describe the condition of patients whose back or spine surgery was not successful and are suffering from chronic back or leg pain. There are many reasons why a surgery may result in failed back surgery (post laminectomy syndrome); however, the primary reason is that the injury (or lesion) that was operated on was not the source of the pain. Additional possibilities include:
- Residual or recurrent disc herniation
- Post-operative pressure on a spinal nerve
- Altered joint mobility
- Scar tissue
Fibromyalgia – Fibromyalgia describes a muscle disorder characterized by widespread aching that lasts for more than three months. Tender points are found on both sides of the body, and the pain is usually continuous. There may be day-to-day fluctuations in intensity that shift from one area of the body to another.
Headaches – Headaches are usually classified into three broad categories:
- A muscle contraction, or tension headache, usually affects both sides of the head. It often involves the temple and eye region and possibly the neck. This type of headache evolves over a period of hours, can last days, and tends to remain constant. Sleep disturbance is common with a tension headache.
- Migraine headaches are usually one-sided and give off a throbbing or pounding pain. The pain generally settles behind one eye and may occur frequently or sporadically.
- Cluster headaches are the least common type of headache, but are also the most severe. The pain is intense and is described as a burning or piercing quality that is throbbing or constant. The pain from these headaches is so severe that often the sufferer cannot sit still. The pain is located behind one eye, or in the eye region, and typically does not change sides. Attacks normally occur 1-3 times per day over the course of weeks or months. This time period is called a cluster.
Joint Pain – A joint is the area where two bones meet. Joint pain s the discomfort coming from that area and can occur in any joint. Joint pain can be anywhere from a mild uncomfortable pain to a severe debilitating pain. There are many possible causes for joint pain, including arthritis, cancer, broken bone, dislocation, lupus, Lyme disease, osteoporosis, rickets, or an injury affecting any of the ligaments, bursae or tendons surrounding or within the joint.
Myofascial Syndrome – Myofascial pain, which is one of the most common causes of acute and chronic pain, refers to pain and inflammation in the body’s soft tissues. It may involve either a single muscle or a muscle group. The pain associated with Myofascial pain syndrome centers around sensitive points in muscles called, trigger points. The trigger points in the muscles can be painful when touched and the pain can spread throughout the affected muscle. Myofascial Pain Syndrome has been linked to many types of pain including headaches, jaw pain, neck pain, low back pain, pelvic pain, arm pain and leg pain.
Neck Pain - Severe neck pain, also referred to as cervical neck pain, is a very common medical condition and can be acute, lasting for a short period of time, or chronic. If cervical neck pain lasts longer than six weeks it can be considered chronic.
Neuropathic Pain – Neuropathic pain, otherwise known as nerve pain, is a complex pain state usually associated with tissue damage. There are many causes of neuropathic pain. Neuropathic pain is often treated with pain relievers, anti-seizure medications, capsaicin cream, lidocaine patch or antidepressants.
Post-Surgical Pain – Many techniques are available that can help patients achieve high levels of comfort and safety following surgery, including interventional methods as well as pain medications. Pain control after surgery contributes to the healing process. If pain is not adequately controlled following surgery, patients may not be able to perform the functions necessary to heal satisfactorily. Functions like taking deep breaths, getting out of bed and walking can be difficult after surgery and sometimes require interventional pain management methods. If pain is allowed to persist the resulting inactivity can lead to severe problems such as pneumonia or an embolism.
Sciatica – The sciatic nerve is the largest nerve in the body, starting in the low back extending through the buttocks and down the leg to the ankle and foot. Sciatic nerve pain refers to the pain that radiates from the back down the buttocks and leg. Sciatica treatments depend on the underlying cause.
Shingles – Shingles (Herpes Zosters) is a viral infection of the nerve roots. It causes pain and a rash that spreads on one side of the body.
Sports Injuries – Sports injuries happen to athletes participating in sporting events and are very common occurrences. Often they are caused by overuse of a body part or hard contact with something. The most common sports injuries include:
- Sprains and strains
- Knee injuries
- Torn muscles
- Achilles tendon injuries
- Pain along the shin bone
- Joint pain
Botox – Botox provides migraine relief by reducing the contractions of the muscles in and around the injection site. In effect, it immobilizes the muscle it has been injected into. With no real negative side effects, these injections are a great option for those who regularly suffer with migraines. Pain relief can be significant – up to 3 and-a-half months long – in many patients.
Epidural Catheters – An epidural is the injection of anesthesia medication into the epidural space of the lower back and most often involves the placement of a continuous catheter. This procedure can also include a local anesthetic block, a narcotic, and/or an epidural steroid injection. There are several types of epidurals that are used to stop the transmission of pain along the nerve pathways.
- Continuous Epidural Analgesia or Patient Controlled Epidural Analgesia (PCEA)– Epidural analgesia delivers anesthetic medication to nerves within the epidural space in the vertebra. A physician places a small tube or catheter so medication can be administered throughout surgery and beyond for comfort. Frequently the patient can be given control over the dosing mechanism. This technique is called patient-controlled epidural analgesia, or PCEA. This type of pain control is particularly well suited for chest, abdominal or pelvic surgeries, and childbirth.
- Walking Epidural– The walking epidural provides pain relief for early labor and for periods following surgical procedures. Medications delivered through a catheter are quite effective but do not numb or weaken the legs or lower abdomen. This epidural is an analgesic rather than an anesthetic because its purpose is to reduce pain, not eliminate all sensation.
Epidural Steroid Injections – An epidural steroid injection, often referred to as a nerve block, is a minimally invasive procedure to help treat pain caused by inflamed spinal nerves. The medication used in an epidural steroid injection usually includes both a local anesthetic and a steroid. The medicine is delivered directly into the epidural space of the spine. This can reduce inflammation causing a reduction or elimination of the pain caused by the inflamed nerve root.
Joint Injections – Joint injections are pain relief injections used to commonly treat arthritis. Pain relief injections typically contain a steroid and a local anesthetic. Patients will remain awake during the pain relief injection procedure, but will be given local anesthetic to numb the skin before the pain relief injection is given.
Medication Management – There are many different kinds of pain medications that can assist with pain management. The goal of medications is to use them as an interim until interventional treatment can be completed. Some types of medications your pain management physician may use includes:
- Acetaminophen – a pain reliever, but does not help with inflammation.
- NSAID Medications (Non-steroidal Anti-Inflammatory Drugs) – excellent for treating inflammatory conditions.
- Corticosteroids – work well for inflammatory conditions and can be taken orally or injected into the soft tissue, joints or epidural space.
- Narcotics (or Opioids) – these medications are stronger than the others and are only used when a pain management doctor feels it is the best treatment option. Although these medications can be addicting, if used correctly they can be extremely effective.
- Anti-Convulsants – effective in treating nerve pain.
- Local anesthetics – can provide temporary pain relief to an area, often given in the form of patches or injections.
Nerve Blocks – Nerve blocks are used for pain treatment and management. Many times a group of nerves that are causing pain to a specific region of the body can be blocked with an injection. Nerve blocks are injections of anesthetic or anti-inflammatory medication to numb a group of nerves. The purpose of the injection is to turn off the pain signal coming from a specific location in the body or to decrease inflammation in that area.
Radiofrequency – Radiofrequency lesioning of nerves is a safe procedure that may be used to reduce chronic pain by preventing transmission of pain signals. The radiofrequency current heats up a small section of nerve tissue to cause a long-lasting interruption in pain signals and reduce pain in that area. This procedure is sometimes called radiofrequency ablation. It is a non-surgical option for long lasting pain relief.
Spinal Cord Stimulators – A spinal cord stimulator is an implanted electronic device used to help treat chronic pain. It consists of an electric lead (or wire) placed beside the spinal cord. The wire is connected to a generator that produces a computer-controlled electrical signal. These low voltage electrical signals prevent messages of pain from reaching the brain.
Trigger Point Injections – Trigger point injections for pain are used to treat painful areas of muscle that contain trigger points, or knots that form when muscles do not relax. The knot can often be felt under the skin and may twitch involuntarily when touched. The trigger point can trap or irritate surrounding nerves and cause referred pain, or pain that is felt in another part of the body.
What to expect at your first visit?
During your first visit, a pain management specialist will assess the nature and extent of your pain to enable the design of an individual treatment plan for maximum benefit. This evaluation may include:
- Complete review of all pertinent medical records
- Comprehensive medical evaluation related to the pain problem
- In-depth pain profile to determine how pain is interfering with daily work and personal life
To get the most out of your first visit, be sure to bring a copy of your insurance card, valid ID, a list of any medications, and any scans/X-Rays or notes. If you are expecting a procedure, you may not be able to drive so please make alternate transportation arrangements.
Pain management specialists have experience treating patients suffering from a wide range of pain types. They commonly treat patients with conditions including:
- Arm pain
- Neck pain
- Leg pain
- Nerve pain
- Back pain
- Myofascial pain
- Headaches and migraines
- Post-surgical pain
- Spinal cord injury
- Shingles pain
- Diabetic nerve pain
- Arthritis pain
- Failed Back Surgery Syndrome
- Complex Regional Pain Syndrome (or RSD)
- Peripheral vascular disease/low blood flow
- Work related injury
- Weekend warrior pain