7901 SW 34th Ave

Amarillo, TX 79121

Victor M. Taylor, MD, DABA

Board Certfied Pain Management

Ph: 806-352-7431

Fax: 806-352-2374

Physical Rehabilitation in Chronic Pain | Opioids and Chronic Pain | Approach to Treatment

Three-Pronged Approach

 

War on Pain

 

Introduction

 

Welcome to Amarillo Interventional Pain Management.  We are very glad that you have become our patient and look forward to helping you live with less pain and more enjoyment.  Chronic pain is a terrible problem.  Albert Switzer stated, “….Pain is a more terrible lord of mankind than even Death itself.”  As you know chronic unremitting pain can take over every aspect of life.  After a while pain impacts your job, your relationships and even your outlook on the future.

 

What is pain and what causes chronic pain?

 

Pain is a noxious sensory stimulus that also has an emotional component.  Pain can range from mildly distressing to agonizing.  Because pain has an emotional component the perception of pain can vary depending on the circumstances when it occurs.   Normally pain serves as warning that a part of the body is either injured or at risk for injury. The source of injury can be something straight forward- putting your hand on a hot stove- or complex and difficult to understand- migraine headaches, autoimmune states and chronic inflammation.

 

In normal circumstances pain goes away with either healing of the injury/illness or when the risk of injury is removed.  For most types of pain when you treat the underlying problem the pain goes away.  Even with severe injuries time usually allows the body to heal itself and the pain fades as the tissues rebuild and become whole again.

 

For some people pain does not go away even after recovery from the underlying injury or illness. This is Chronic Pain. Chronic Pain is not normal. Chronic pain persist by definition for 3 months or longer. This type of pain may vary in intensity and may even be gone completely at times, but it is present more often than not.

 

Pain in this setting may persist due to damage to ligaments/tendons, muscles or joints that cannot be ‘fixed’.

 

Other causes of chronic pain include nerve damage or chronic inflammatory states that do not heal.  Also non curable structural problems in the spine and joints as well as soft tissues- muscles, tendons and ligaments- can lead to chronic pain.

 

Some chronic pain is caused by known conditions that are not curable such as chronic pancreatitis, Chronis disease, autoimmune disease, scoliosis, degenerative disk disease, arthritis etc., etc..

 

For other people the initial cause of their pain is not clear.  For a host of painful conditions the underlying cause may not be knowable with our current scientific understanding.  Conditions such as chronic headaches, fibromyalgia, interstitial cystitis and others come to mind.

 

Our focus is on managing pain in a manner that does not do further damage to your ability to enjoy life and function at the highest level possible.  This little book is to outline our approach to chronic pain and give you the reasons for our approach.  Treating chronic pain requires a partnership between you and us.  We hope you will feel at home in our practice.

 

 

A Three Pronged Approach

 

Treatment of pain takes more than a single approach.  Because pain involves the structures of the body as well as the physiology/chemistry of the body a single approach is rarely successful.  In other words there is usually not a single drug or intervention or therapy that by itself is sufficient to treat chronic pain.  We take a three pronged approach to our attack on pain utilizing medications, rehabilitation and directed procedures together to maximize our chances of success.  Each area attacks pain in a different way.  In war it takes air power, naval forces and ground forces to defeat an enemy.  Pain is a formidable enemy and so we attack it accordingly.

 

Interventional Pain Procedures

 

Fluoroscopically and ultrasound guided procedures make up one arm of our attack for many pain states.  The goal of the procedures can be to make physical changes to space around nerves and the spinal cord, or to ‘break’ a sustained nerve hyper activity or to simply block the ability of a nerve to send a pain signal to the brain.  Some of these procedures can give long lasting relief to the point of being considered a cure.  Some of the procedures will only give a few months of relief at a time and then must be repeated for the pain to be controlled.  We will address the individual procedures later in this booklet.

 

Rehabilitation

 

Rehabilitation and home care are another important component in the treatment of pain.  The goal of rehabilitation is to improve the function of the structural components of the body involved in pain.  The spine, the nerves where they exit the spine and the muscles that support these structures are key targets in rehabbing chronic pain states.  This is where you can take control of your fight with pain.  Your commitment to your rehab will help you get the best possible results from our three point plan.

 

Medicine

 

Medications are the final arm or our approach and also the most variable area in our war on pain.  Many of the medications traditionally used to treat pain are dangerous and carry potentially harmful side effects.  We strive to use medications that will provide physiological benefits that may actually help treat the root of the pain and not merely cover up symptoms.   Also in this category comes food and substances that can make pain worse and healing more difficult.

 

The Procedures

  • Epidural Steroids
  • Medial Branch Blocks/Rhizotomy
  • GON Blocks
  • Sympathetic Nerve Blocks
    •  Stellate
    •  Sphenopalatine
    •  Lumbar
    •  Sacral
  • Trigger Point Injections
  • Joint injections
  • Tendon and Bursa Injections

 

Outline for procedure sheets:

 

Name of Procedure

What it is used to treat?

What the goal/purpose?

What should I do to get ready for the procedure?

How is it done?

What is injected?

Will it hurt?

Important Warning!

What is the chance of success?

How often can the procedure be repeated?

 

This section gives a brief description of the procedures we use in the treatment of chronic pain including the rationale for the procedure.

 

What are the risk?

 

Common side effects that are just a normal part of the procedure include minor bruising or bleeding at the injection site, muscle soreness or spasm, a temporary increase in pain, temporary numbness and temporary weakness. Spikes in blood sugars lasting several days.

 

Minor complications that can occur but do not have long term consequences include hitting a nerve that can cause an increase in pain or weakness lasting several weeks, a dural puncture that can lead to headache that may require a further intervention called a blood patch, minor skin infection at the site of injection.

 

Major complications include serious infections of the spine, spinal cord or nerves, bleeding leading to an epidural hematoma, nerve damage.  These complications could lead to permanent problems or even death.

 

Avoiding complications- it is much better not to have a complication than try to treat it after the fact.

To avoid complications we will have you stop any medication that can then your blood prior to the procedure (you need to clear this with the prescribing doctor).  If you have an infection or your blood glucose is too high we will reschedule your procedure.  We use specially designed needles and catheters that greatly decrease the chance of nerve injury.  We do the procedures under x-ray or ultrasound guidance so that we can carefully guide the probe or catheter.

 

I am careful in performing the procedures.  I trained at one of the top pain fellowships in the world and have done thousands of guided injections.  The nurses and radiation techs are well trained in these procedures and help maintain the safest possible environment.  My team and I do well over 2000 procedures each year.  We have never had a major complication.

 

 

Inversion therapy

 

Inversion therapy is an inexpensive form of traction.  We like inversion because an inversion table cost only a few hundred dollars and will last for years.  It can be used daily in your own home on your own schedule.

 

  • WARNINGS:  Do not do inversion therapy if you have any medical condition that makes it unsafe.

 

  • If you have had knee or hip replacement surgery check with your orthopedic surgeon before doing inversion.

 

  • Heart disease check with your cardiologist.

 

NEVER HANG UPSIDE DOWN WITHOUT SOMEONE ELSE IN THE HOUSE. Always let someone know you are going to hang upside down and ask them to check on you after some time.

 

Directions:

 

Always make sure your ankles are firmly locked in to the holder.  Failure to lock in your ankles could lead to a fatal fall.

 

Use a retention strap if you do not want to go to 180 degrees ‘hanging like a bat’.

 

Make sure your inversion table is well balanced so that it is easy to get back up when you are finished.

 

When you are finished hanging weather you hang at 10 degrees or like a bat stop at horizontal/lying flat on your way back up.  Stay lying flat for at least 2 minutes- that is literally 120 seconds.  During that time contract the muscles of your legs, buttocks, abdomen and back.  This will help make sure your spine is properly aligned and decrease your risk of injury as you come up to standing.

 

From the lying flat/horizontal position come up very slowly to the standing position.  Once upright, stay there for another full 60 seconds before slowly squatting down to unhook your ankles.

 

When beginning inversion therapy your ankles will hurt and your head will pound.  Only hang for as long as is comfortable.  In the beginning you may only last a minute or two.  Over a few weeks you will build up where you can hang for a much longer time.  As you become more comfortable you can work on actively relaxing your spinal muscles.  You can hang for several sessions every day for short periods if you need to.   Consistency over time will greatly improve your outcomes from this therapy.

 

Physical Therapy

 

Formal therapy with a trained physical therapist can be the launching pad for the return of function for the joints and muscles of the body.  Many insurance carriers including Medicare require physical therapy as part of the treatment plan.  .

 

It is vitally important to continue with the recommendations given by the physical therapist even after your formal therapy has ended.  A reasonable approach may include returning for further work with the therapist in the future in order to stay on track.

 

Chiropractic Care

 

Manipulative therapy by a skilled Chiropractor can be very useful in the treatment of certain types of chronic pain.  Derangement of the biomechanics of the small joints of the spine and ribs can lead to muscle tightness, swelling and pain which may be amenable to chiropractic manipulation.  Sacroiliac joint dysfunction is a common cause of lower back pain and symptoms mimicking sciatica which may respond well to manipulative therapy.

 

Core Strengthening

 

Strengthening the abdominal muscles can improve stability of the lumbar spine/lower back which in turn can lead to decreased pain and improved function.  Strengthening the ‘core’ takes consistent effort over time. Avoid sit ups but use planks and crunches to strengthen the core muscles.

 

Stretching

 

Actively stretching tight muscles and ligaments can greatly reduce the tension on the joints of the spine as well has hips, shoulders, knees etc.  Like core strengthening the benefits of stretching take consistency over time.

 

Physique Transformation

 

We recommend the book Body for Life by Bill Phillips as good introduction to weight training, diet and aerobic exercise.  This book explains in a clear straight forward manner how to train your body in such a way as to make meaningful changes to your strength and weight and body composition.  It is a simple formula but not easy.

 

Many people mistakenly believe that the random activities of daily living: physical work, housekeeping, chasing children and grandchildren  is enough activity to keep them healthy and in shape.  If that were true then no one would need to see a pain doctor, a cardiologist, physical therapist etc.  The activities of daily living stress the human body and lead to breakdown.  A well designed exercise program like the one laid out in Body for Life by Bill Phillips helps to rebuild the body, balance the muscles, loosen the joints and decrease pain.

 

The principles laid out in this book apply to all ages.  However the book was written with a target audience that is fairly young.  If you are not very athletic or over about 35 years of age start out very slow with the workouts, begin with the most minimal approach and gradually work up to more intensity.  When I wrote this paragraph I was 53 years old.  In my youth I had been fairly athletic.  I took about 4 months of gradually increasing my workouts before I could really even be said to be working out in a meaningful way. It took that long for my joints to loosen up and my tendons to ease up enough to work out harder.  START SLOW.

 

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"Little Book of Pain"

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