Pain Management as a Method of First Resort, Not Last

Jul 17


Leslie McKerns

Leslie McKerns

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It has long been true that in treating acute or chronic pain, there were two options, surgery or narcotics. Now there is a third option: minimally invasive pain treatments.


In treating acute or chronic pain,Pain Management as a Method of First Resort, Not Last Articles it has long been accepted that physicians had two basic options to alleviate suffering: surgery or pain medication.  Now there is a third option--pain alleviating, non-invasive pain management procedures used as the method of first resort, not last.

Creative, innovative solutions to previously persistent painful disorders are increasingly making surgery unnecessary. Pain management includes pain alleviating treatment for back pain, neck pain, nerve pain, work related injuries, cancer related pain, traumatic insult, Sciatica (compression or irritation of the sciatic nerve), Spinal Stenosis (build-up of bone in the spinal cavity), Spinal Cord Injuries, Post Stroke Pain, Shingles, Herniated Disks and Reflex Sympathetic Dystrophy (RSD) also known as Complex Regional Pain Syndrome.

Pioneering pain management techniques performed by Board Certified Pain Management physicians include highly specific injection procedures eliminating pain at its source by isolating the nerve ending to the painful spot. The breakthrough process numbs or freezes the nerve and keeps it numb for up to a year. Benefits include avoiding costly major surgery, lengthy recovery times and the risks of infection or debilitating complications.

Who experiences pain?

According to the American Chronic Pain Association, pain affects 86 million Americans, causing losses to US business and industry of $90 billion.  Back pain is the leading cause of disability in Americans under 45 years old, and more than 26 million Americans between the ages of 20 and 64 will have back pain during their lifetime. Many back pain problems occur following injury, strain and accidents causing fractures, lumbar muscle strains and ruptured/herniated discs.

Other causes of pain include degenerative changes caused by the normal aging process. The US Census bureau reported 78.2 million Baby Boomers in 2005, (nearly a quarter of the U.S. population). In 2006 there were 7,918 people turning 60 each day—representing 330 every hour. Baby Boomers are an active generation—working longer and playing harder than previous generations. Sports activities, repetitive stress and ambitious weekend projects account for painful conditions and injuries.

According to the National Osteoporosis Foundation (NOF), osteoporosis is responsible for more than 300,000 bone fractures annually, costing the nation $17 billion. According to the NOF, osteoporosis affects 44 million American men and women age 50 and older, and one in two women and one in four men in this age group will break a bone due to osteoporosis.

Recent advances in technology, new techniques and minimally invasive procedures in interventional pain medicine have eliminated many of the sources of pain, allowing patients to return to a normal level of activity.

What is the non-invasive nature of the treatment?

Over the last twenty years, many chemical and anatomic pain pathways have been identified and studied. The Board Certified pain medicine specialist often performs diagnostic injections, usually with enhanced fluoroscopic guidance. These injections isolate and confirm the source of the patient’s pain. Once identified, these painful structures are medically treated. 

Medication can be injected at the exact site of the injury or compressive lesion.  Epiduroscopy is the insertion of a fiber optic filament through a needle directly into the spine.  This is connected to a television monitor to visualize the inside of the spinal canal, spinal cord and spinal nerves.  This procedure has been effective in making accurate diagnosis, accomplishing precise injections, cutting of epidural adhesions and scar tissue and the removal of toxins liberated by injured discs.

Injured or painful facet joints can be injected with steroids.  If long-term pain relief is not accomplished, these patients are often treated with Radiofrequency rhyzotomies.  These Radiofrequency procedures numb the facet joints and eliminate the patient’s pain for approximately one year.  These are outpatient or office procedures, which often provide immediate pain relief and allow the patient to return home after a 30-45 minute recovery period.

Discogenic pain due to injured and herniated discs is now being treated with new outpatient procedures called an IDET (Intradiscal Electrothermal Treatment) procedure and a Nucleoplasty.  A special wire electrode is inserted through a needle into a disc and directed to the affected area of the disc herniation. Once in place, the electrode is heated with Radiofrequency or designed to create an electromagnetic field.  This causes cauterization and vaporization of the disc, proliferation and tightening of the protein matrix of the disc, shrinking of small herniations and disc denervation or numbing.  The final effect of this process is the relief of pain and the creation of more collagen within the disc.

Rather than simply administering pain medication, Board Certified Pain Management physicians diagnose the sources of pain and provide pain relief through these and other minimally invasive techniques.


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