More than 100 million Americans suffer from pain and more than a third report the pain as disabling.
This pain can occur as a result of an injury, an accident, surgery, or simply the natural aging process. As a result, pain can be categorized as acute or chronic.
Acute pain is any kind of pain that starts and does not last longer than six months. Treatments can vary for acute pain. Fortunately, most of the pain management choices are non-invasive. Usually, the first way to attack acute pain is for the patient to give the area of pain proper rest and an appropriate amount of time for healing. For example, when a patient hurts their back, 80 percent of them will have resolution of their pain within two weeks without any intervention.
“Fortunately these patients only need time to get better, “said Dr. Thomas Raley, a spine surgeon and interventional pain management doctor from Advanced Spine and Pain. Additionally, anti-inflammatory medications, such as Advil or Motrin, may be recommended if the pain persists. Physical therapy can also be suggested.
It also should be mentioned that there are times when acute pain can become chronic pain. Therefore, acute pain should be aggressively treated to prevent chronic pain.
Chronic pain is a symptom that lasts longer than six months. There are many ailments that cause chronic pain such as arthritis, diabetic neuropathy, fibromyalgia, etc. Chronic pain often requires an invasive approach to alleviate the symptoms. The treatment may begin with a pain injection. A pain injection usually consists of a steroid — a strong anti-inflammatory medication.
Often these injections can alleviate sciatica, which symptoms include radiating pains down the legs that originate from the back.
“With a proper history and examination, the ideal location can be determined for the placement of the pain injection, “ Raley said.
If the pain persists, often the patient may require a series of injections. Over time, if the injections stop working, the patient may want a more definitive treatment.
When conservative treatment options (including injections) fail and patients want something done, surgical options are considered. There are several procedures available for neck or back pain, as well as, radiating pains in the arms or legs.
A discectomy is routinely done for radiating pains caused by a herniated disc when conservative measures fail. The procedure can be done many ways.
A traditional discectomy is done through an open one to two-inch incision. However, Dr. Raley performs the same procedure minimally invasively.
“It can be done with the assistance of a microscope thru a one-inch incision or endoscopically (‘scope’) through a half inch incision where a laser can be used. This is routinely done as an outpatient procedure,” Raley said.
If the pain is due to a deteriorating disc, but only mild degeneration of the joints, a total disc arthroplasty can be a treatment option. The total disc is a procedure where the disc is replaced with a moveable device. With this procedure, a fusion of the spine is not performed and patients get back to their regular activities sooner.
When the disc and the joints are arthritic, a fusion may be necessary. This procedure is done to alleviate neck or back pain as well as radiating pains in the arms or legs. The back or neck may need to be stabilized to stop the painful symptoms. Usually this procedure consists of the placement of rods and screws into the back to stabilize the spine.
If a patient has failed a spinal fusion or does not want to consider a fusion, a dorsal column stimulator (pain stimulator) may be recommended. It begins with a trial. The benefit of this trial procedure is that the patient will know the outcome prior to the surgery. If the trial is successful, it is very likely that the permanent dorsal column stimulator will be successful. It is a device that is surgically placed under the skin.
The procedure consists of placing a wire in the back and a battery under the skin. A mild electric current is delivered to the spine. The stimulation feels like a pleasant tingling sensation to the area where the pain is located.
When traditional methods have failed to relieve chronic pain, a pain pump may also be considered. Dr. Raley is one of the few physicians in the area that performs this procedure and has trained other doctors. The device, the size of a hockey puck, is implanted under the skin. Then, medication is delivered directly to the spinal cord.
A much smaller dose of medication is needed compared to oral medications with greater pain relief. If conservative therapies have failed and other surgeries are not an option or desired by the patient, then this procedure could be beneficial. The pump can lessen pain caused by cancer, failed back surgeries, chronic pancreatitis, or any other chronic painful condition.
Patient comfort is essential
It is important for the patient to have a good relationship with their doctor.
“I try to treat all my patients as they were my family members and have my staff and other providers to do the same. It is critical that patients feel comfortable explaining symptoms so they can be treated correctly,” Raley said.
With a good patient provider relationship, the patients will gain an understanding of the pros and cons of each procedure allowing an informed decision for their specific case.