What is pain?
Pain is the second most common reason for medical consults in the United States (only behind the common cold). It is defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The word is derived from “poena”, the Latin word for penalty or punishment.
Pain is an important survival mechanism: the experience or sensation of pain will cause withdrawal or avoidance of potentially harmful stimuli. This is often done reflexively: a hand accidentally placed on a hot stove is jerked away immediately following the painful sensation. Pain will resolve when the underlying condition causing the damage is treated, although in some cases, pain persists beyond the cessation of stimulus and healing of the injury. Some cases of pain have been noted in the absence of detectable damage or disease.
How is pain diagnosed?
The underlying cause of the pain is central to the diagnosis and management. A complete medical history and physical examination is needed: the pain management doctor will focus questions to elicit information on the location, quality, duration, triggers/aggravating circumstances of the pain, and conduct certain clinical tests to assess the pain. Ancillary studies may be requested, depending on the differential diagnoses of the physician.
Pain is assessed via a rating scale of the patient’s experience. A numerical scale from 0 to 10 (0 being the complete absence of pain, while 10 signifies the worst pain experienced – often compared to labor pains) is most often used for patients’ self-reporting. A Visual Analog Scale (VAS) of facial expressions with corresponding numerical values is used for children and other patients incapable of verbally describing the pain.
How is pain managed?
The management of pain will depend on the underlying cause, as well as the patient’s response to therapy. Therapies can range from medical management to interventional pain therapies.
The medical management of pain follows the “pain ladder” of the World Health Organization (WHO). The guidelines follow a principle of progressive management of pain: first line drugs are used, and increasingly powerful drugs are used if chronic pain persists. Medications can range from over-the-counter (OTC) drugs like acetaminophen and ibuprofen, to more powerful opioid analgesics.
If pain persists despite conservative measures, or if definitive correction of pain is needed, the pain management doctors in Greeley, Loveland, Boulder, or Buena Vista may opt for interventional pain management.
Interventional pain management is a subspecialty of pain medicine that focuses on the use of minimally invasive procedures (nerve blocks, facet joint injections, spinal cord implants) to manage persistent pain. The use of intrathecal pain pumps and radiofrequency ablation also falls within this category. Interventions performed by the Colorado Clinic pain management doctors include:
- Neurolytic blocks such as Radiofrequency Ablation – This technique blocks the transmission of pain stimuli by freezing/heating (neurotomy) or applying chemicals (neurolysis) to the nerve. This causes deliberate damage to the nerve, cutting off the any pain stimulus. The endoneurium (protective casing of the nerve) is preserved with this procedure, avoiding the complications of neuroma and deafferentation that may follow surgical blocks.
- Joint Injections – This may include injections of steroid (cortisone), platelet rich plasma (PRP) or stem cell materials into joints that are painful. These injections may provide weeks to months of pain relief, with regenerative medicine injections possibly providing years of relief.
- Epidural injections – analgesic/anesthetic drugs can be inserted into the epidural space when nerves are being pinched from a disc herniation or spinal stenosis is present. There are three different types of epidural injections offered by the Colorado Clinic pain management doctors. These injections may be offered as part of a series if necessary, which can be repeated every few months if necessary.
- Spinal cord stimulation – the insertion of a spinal cord implant can relieve the pain by interfering with the transmission of pain signals. The spinal cord implant is surgically inserted under fluoroscopic guidance. Studies consistently prove the efficacy of SCS implants to be over 75%. They relieve back and leg pain well, along with being able to restore lost sensation in those with peripheral neuropathy.
- Kyphoplasty, Occipital Blocks, Trigger Point Injections, Plexus Blocks – The list of interventional procedures for pain management is extensive, and grows every year. Colorado Clinic has expert Greeley, Loveland, Boulder, and Buena Vista pain management doctors offering over 50 procedures for pain relief!