HealthSense Spring 2006

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PArNmanagement

cing the Pain: Technical Advanbe n Pain Managernent

By Tara Scatterday

Chron ic pain aff licts milliOnS Of peOpl0 eacn year, makins it one of the most important issues in healthcare

today, lt impairs the patient's quality of life, affects their family, and has a direct impact on society. The costs of chronic pain, when considering lost days of

work, healthcare and medication costs, and the cost of suffering, can be devastating.

Most pain is typically short-lived, resolving after the injury has healed. Chronic pain, however, stays with the patient long after the injury has healed. When pain becomes chronic in nature, it begins to interfere with the patient's ability to function on a daily basis. This invariably leads to problems with family relationships and

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employers, in addition to the patient's own perception

of

themselves.

An interdisciplinary pain management approach by an experienced team of healthcare providers has been shown to be the most effective and cost conscious way of treating chronic pain patients.

The rapidly growing field of interventional pain medicine is constantly becoming more sophisticated and technologically advanced. Newer medications and techniques are being developed in an effort to help identify and reduce sources of pain. "It's an exciting time in the field of interventional pain management with its new and effective techniques," says Jonathan Kost, MD, medical director of the Connecticut Spine and Pain Center at Bristol Hospital. "This fast-growing field is rapidly opening up to offer a multitude of options to patients who suffer from persistent and chronic pain and to help them to significantly improve their quality of life."

lnterventional Pain Medicine

Spinal Cord Stimulation

The Connecticut Spine and Pain Center provides Spinal cord stimulation blocks pain messages by sending interventional pain medicine using an interdisciplinary an electrical impulse to selected nerves in the spinal approach by a team of specialized health care cord. Small electrodes are implanted in the region over professionals who work together to provide a full range of the spinal column and a generator is placed under the treatments and services for patients suffering from chronic patient's skin. Pain relief with spinal cord stimulation is and/or acute pain. The interventional pain medicine almost instantaneous and allows patients to significantly physician conducts a full history and physical examination reduce the amount of pain medication they take, thus and utilizes advanced diagnostic techniques to specifically in tum reducing side effects and improving their identify the cause of the pain. functionality.

The Connecticut Spine and Pain Center is the only interdisciplinary (medical, physical therapy, and Botox lnjections psychology) pain management center in the state of Botox injections have found a place in the treatment of Connecticut and the only CARF-accredited (Commission severe migrane headaches. Botox injections may also on Accreditation of Rehabilitation Facilities) pain be recommended to relieve severe muscle spasms in the management center in New England. CARF-accreditation neck, arms, legs, hands, feet and back. When injected is awarded to centers that have met or surpassed CARF's into the muscles in tiny, safe amounts, Botox can stop or high standards for medical service and quality of care. reduce painful muscle spasms by blocking nerve signals The Connecticut Spine and Pain Center helps to the muscle. patients to manage pain caused by a multitude of Discography conditions, such as herniated discs, sciatica, carpal Discography is a diagnostic procedure performed to tunnel syndrome, neck and low back disorders, reflex determine if degenerative disk disease is the cause of a sympathetic dystrophy/ complex regional pain syndrome (CRPS), is rapidty openins up to offer a arthritis, spinal fractures, multitude of options to patients who suffer from persistent and chronrc pain

"This fast-gr0wing field

fibromyalgia, cancer, and to help them to significantly myofascial pain and pain - Jonathan Kost, MD resulting from industrial or work injuries.

improve their quality of life,"

Minimally-lnvasive Techniques Using a variety of non- and minimally-invasive techniques, the field of pain management now offers many options to help patients with their pain and improve their

quality of life.

Radiofreq uency Neu rotomy For many patients who suffer chronic low back and neck pain, radiofrequency neurotomy is an effective treatment that can provide relief for extended periods of time. Radiofrequency neurotomy is a minimally-invasive procedure that uses an x-ray to guide a small needle to the small nerve branches outside of the spine, rendering them incapable of transmitting pain signals. This is considered one of the most effective treatments for treating pain coming from the spinal.joints.

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patient's back pain. Under x-ray guidance a needle is inserted into a disc where contrast material is injected while measuring the pressure within the disc. A diagnosis is then made as to whether or not the disc is the cause

of the pain. "Discography is used as a preoperative investigational tool and is performed on patients who have not responded to conservative treatment," says Annette Macannucco, MD, a pain management specialist at the Connecticut Spine and Pain Center. "Using discography can help to determine if discogenic pain can be treated surgically or by a less invasive procedure such as nucleoplasty."

Discography has been able to provide a clearer diagnosis to determine if a patient is suffering from disc-related

myofascial pain syndrome and cancer pain.

Injection therapy can help relieve pain by interrupting pain sensory pathways and preventing them from reaching the brain.

Cryoneuroablation Cryoneuroablation or cryoanalgesia is the use of extreme cold to freeze nerve fibers and provide pain relief.

Extreme cold is applied adjacent to

Nucleoplasty

the nerve for several minutes, causing the nerve to stop transmitting pain impulses to the brain. Cryoneuroablation can be used when a patient has a scar neuroma (pain associated with nerve injury from cancer, surgery, or injury), some types of headaches caused by irritation or injury to the occipital nerve located in the back of the scalp, back pain caused by spine degeneration and many other types of pain cause by individual peripheral

Nucleoplasty is a minimally invasive

nerves.

pains.

procedure developed to treat patients with contained or mildly herniated discs. The procedure involves removing tissue from the disc through a needle in order to decompress and relieve the pressure on a nerve.

"Nucleoplasty offers the possibility of treating herniated discs and sciatica with much less trauma and risks than surgery," says Dr. Kost.

lnjection Therapy or Nerve Blocks Injection therapy is a general term that basically means the injection of a local anesthetic and/or steroid adjacent to a nerve or a pain-sensitive trigger point. This reduces inflammation and often can reduce or relieve pain. Injection therapy can help those who suffer from neck pain, low back pain, sciatica resulting from herniated discs, osteoarthritis, rheumatoid arthritis, tendonitis, bursitis, complex regional pain syndrome (reflex sympathetic dystrophy,) shingles pain,

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Low Energy Level Laser Therapy Low energy, or cold laser therapy involves the application of low power light to the external areas of the body where the problem exists in order to stimulate healing and to treat chronic and acute pains. Low energy laser therapy is used for persons suffering from carpal tunnel syndrome, tendon and ligament pains, "The Food and Drug Administration (FDA) recently approved low energy laser therapy for treating carpal tunnel syndrome," says Dr. Kost. "We've seen tremendous results utilizing this treatment where a significant percentage of our catpal tunnel patients have been able to avoid invasive surgery. It's very simple, safe and effective."

"Today there is no need to suffer in chronic pain given today's advances in pain management treatment," says Jonathan Kost, MD.

Jonathan Kost, MD

Annette Macannucco, MD

Medical Director

lnterventional Pain Physician

Frank Lee, MD

Eugene Lucier, MD

lnterventional Pain Physician

lnterventional Pain Physician

MD

Joseph Aferzon, MD Rowena Mariano, lnterventionalPainPhysician Neurosurgeon with a specialty in physiatry

Deborah Rosenberg,

PhD

Psychologist

Rafael Cordova, RPT Physical Therapist

For more information on treating pain at the CT Spine and Pain Center,

860-585-3040 or visit www.ctspineandpain.org.

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