Everyone copes with the occasional head or backache, but nearly 50 million Americans live with long-term pain and have to learn to manage pain. Chronic pain persists longer than three months, even after medication or treatment.
Not only does someone with chronic pain have to manage their discomfort, but also alter their diet, exercise, work, and social activities. Easing the pain they experience on a daily basis involves extensive lifestyle changes. Fortunately, the field of pain management is becoming widely accessible, and pain innovations make it easier to treat the root cause of pain.
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Modern-Day Pain Management
In ancient times, the mechanism of pain was a mystery. Scientists and doctors experimented with everything from bloodletting to religious rituals, plants, and eventually modern medicine. Pain management technology continues to improve today at a rapid pace. Now, scientists understand pain to be biopsychosocial, meaning there are biological, psychological, and social elements that contribute to the way each individual experiences pain.
According to Dr. Eric Feldman, a pain management provider at the CORE Institute in Phoenix, AZ, one of the biggest advancements in recent years has been moving away from using opioids to treat pain. “These medications can be incredibly effective short term to help people recover from surgery… but, in most cases, they do not improve long-term patient functionality and quality of life”, says Feldman. This has caused a movement of pain providers to move towards other, more sustainable pain management methods that are less likely to lead to medication dependence.
Pain Management Technology
Some pain management technology has been around for decades, but pain management providers are continuously studying and updating how they implement these therapies in their practices. Successful, evidence-based pain management techniques have laid the foundation for future innovation in pain medicine.
1. Radiofrequency Ablation
Radiofrequency ablation (also called neurotomy or rhizotomy) involves the insertion of a small electrode through a needle or catheter into the problem area. Once placed, heat produced from radiowaves burns pain-causing nerves. The procedure is usually performed on individuals with chronic neck and low back pain, and the results can last for several months.
Intracept, a type of radiofrequency ablation, offers another new and exciting breakthrough in pain medicine, says Dr. Feldman. Specifically, it’s used to treat the attachment of the disc to the bone in the spine. “Prior to a few years ago, we knew this interface was the cause of chronic low back pain for many people, but we had no safe mechanism to treat it.” The injection is done under light sedation. Dr. Feldman says the procedure is extremely effective, and can even result in permanent pain relief in some patients.
3. Epidural Steroid Injections
Epidural steroid injections can treat inflammation and pain in the back and neck. Epidural steroid injections are best for a type of pain called radicular pain. Radicular pain shoots from one area of the body to another, like back pain that radiates to the neck, arm, or leg. It can also cause numbness or tingling. The injections can improve symptoms for several months.
4. Occipital Nerve Stimulation
Occipital nerve stimulation treats chronic migraines. This surgical procedure implants a device that sends signals to a nerve, interrupting the pain path. Although some individuals do experience migraine relief from these devices, many insurance companies don’t cover the device. They claim that updated clinical trials need to prove the efficacy of occipital nerve stimulator therapy against other pain management therapies.
5. Spinal Cord Stimulation
A spinal cord stimulator is an electrode implanted into the space surrounding the spine. The device sends signals that stimulate the nerves and ultimately block pain signals. Prior to receiving the device permanently, individuals undergo a device trial, usually about a week long. If successful, the implantation is done under sedation or general anesthesia. Spinal cord stimulators are approved by some insurance plans for individuals that have complex pain syndrome, previous failed back surgeries, or pain due to a lack of blood flow.
6. Intrathecal Pain Pump Therapies
Intrathecal pain pumps administer medications to the fluid surrounding the spinal cord. These surgically implanted devices block pain signals transmitted through the nerves to the brain. This device may be approved by insurance for individuals with cancer pain, chronic pain from a failed back surgery, or a complex pain syndrome.
7. Various Spine Procedures
Minimally invasive spine solutions can now be performed in the outpatient setting, says Dr. Steven Siwek, an interventional pain specialist and the chief medical officer of The Pain Center of Arizona, headquartered in Glendale. These therapies offer faster recovery times and a lower risk of complications.
Some examples include endoscopic spine procedures, joint fusions, and spinal fusions. Having collaboration between pain management, orthopedic, and neurology providers has been key to formulating a patient-centered treatment plan. “A bridge that has been built where pain management used to end, and spine surgery began”, says Dr. Siwek.
Tried and True Methods
In order to receive coverage for more modern pain management techniques, many insurance companies require patients to try conservative treatment first. Individuals usually need to pursue conservative treatment for 3 to 6 months in order to receive coverage for more advanced pain management techniques, including:
- Activity modification
- Home exercise programs
- Physical therapy
- Chiropractic care
- Oral anti-inflammatory medications or muscle relaxers
Dr. Feldman says, “hands down, one of the best pain treatment modalities is, and will continue to be, physical therapy.” Why? Damaged tissue can heal through improved mobility and taking pressure off of the damaged tissue. He says that physical therapy prevents injuries, pain frequency, and pain exacerbations. Many patients might feel frustrated with their physical therapy process, but Dr. Feldman reassures that “the benefits of physical therapy do not occur overnight… they require active involvement and hard work.”
Where Is Pain Management Headed in the Future?
Dr. Feldman theorizes that harnessing the power of stem cells, which are already used to regenerate new and healthy tissue, may be used in the future for pain management. “This will allow us to replace or heal degenerative discs causing low back pain, or regrow cartilage in an arthritis joint”, he says.
As technology continues to advance, more research is being done to prove the efficacy of new pain therapies. Dr. Siwek believes that the biggest roadblock to pain therapy innovation has been “educating insurance carriers with current-day research” on minimally invasive surgical options and pain technology, which hold the future of pain management.