Chronic Pain - Symptoms

• Pain that does not go away as expected after an illness or injury.
• Pain that may be described as shooting, burning, aching, or electrical.
• Discomfort, soreness, tightness, or stiffness.

Pain can lead to other
problems, such as:
• Fatigue, which can cause impatience and a loss of motivation.
• Sleeplessness, often because the pain keeps you awake during the night.
• Withdrawal from activity and an increased need to rest.
• A weakened immune system, leading to frequent infections.
• Depression
• Mood changes, such as hopelessness, fear, irritability, anxiety, and stress.
• Disability, which may include not being able to go to work or school or perform other daily activities.

Source: www.webmd.com (WebMD Medical Reference from Healthwise

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Conservative Treatments, Back Surgery
Show Similar Outcomes in Select Patients
By Vanessa Orr

At some point during their lives, 60 to 80 percent of American adults will suffer from acute lower back pain. And while up to 90 percent of these patients will recover from their pain within six weeks, some patients will develop more debilitating, longer-lasting symptoms.
“The number of patients we’re seeing with chronic lower back pain who don’t respond to conservative treatments is increasing,” explained Dr. David Provenzano, Medical Director of Ohio Valley General Hospital’s Pain Treatment Center. “Once we’ve ruled out more serious issues like cancer, infection and herniated discs, we work with them to develop overall health strategies to help relieve their pain.”
According to Dr. Provenzano, 50 percent of patients with acute back pain who undergo conservative treatment will recover within two weeks, and 90 percent of patients will recover within six weeks. Those with chronic back pain, however, might also need to make lifestyle changes including changing their diets, quitting smoking and exercising more in order to improve.
“While doctors used to prescribe bed rest, we now know that this is not the best way to treat low back pain,” Dr. Provenzano said. “Muscles atrophy (weakness), which makes patients susceptible to future episodes, so we recommend that they undergo some form of physical therapy. Because patients who are obese and those who smoke have a higher percentage of lower back pain, we also suggest making changes in these areas.”
There are a number of ways that both acute and chronic back pain can be treated. Medications such as muscle relaxants and nonsteroidal anti-inflammatories can be used for a short period of time. Older patients who have not responded to other forms of treatment may be treated with opioid pain medications. In younger individuals, doctors try to avoid the utilization of opioids for prolonged periods of time. A cornerstone of treatment should be patient comfort to assist the patient with the time required for the natural healing processes.
“A lot is being done with minimally invasive injections, such as epidural steroid injections for herniated discs which help to speed recovery, and joint injections for arthritis,” said Dr. Provenzano.
For patients who do not respond to such treatments, back surgery may be recommended, although Dr. Provenzano advises that for a majority of patients, conservative treatments should be considered first. “Unfortunately, between 10 and 40 percent of patients who have had back surgery for lower back symptoms experience persistent or recurrent pain,” he said. “Recent studies in the Journal of the American Medical Association and the New England Journal of Medicine compared patients who had surgery for herniated discs with those who underwent nonsurgical treatment. Both groups improved substantially over a one- to two-year period.
“A large percentage of patients will get better with conservative care, and there was no difference in outcomes between the two treatments groups after one year in the New England Journal of Medicine study published in 2007,” he added.
Patients who have not responded to conservative treatment and who still suffer from back and leg pain may consider surgical intervention, as well as those who suffer from lumbar spinal stenosis who have not been helped with medications or epidural steroid injections. “At the Pain Clinic, our multi-disciplinary pain program is designed to give patients access to whatever types of treatment they need, which may include medications, physical therapy, injection therapy or referral for surgical intervention individually or in combination,” said Dr. Provenzano. “You need to treat patients who suffer from low back pain in a multidisciplinary approach in order to get the best outcomes.”
By helping patients change their overall health strategies, the Pain Center is also trying to prevent future back problems from occurring. “We promote exercise because it’s very important to have strong core musculature in both your abdominal muscles and back muscles,” said Dr. Provenzano. “We also work with patients on cognitive behavioral therapy in order to help them cope with the pain.
“For example, many patients with chronic back pain are afraid that everything they do will hurt, so they become anxious and frustrated,” he added. “This fear-avoidance behavior can result in a patient heading in a downward spiral. As part of their treatment, we teach them ways to deal with the anxiety and emotions that they are feeling so that they can begin to heal.”

For more information on Ohio Valley General Hospital’s Pain Treatment Center, call (412) 777-6400 or visit the web site www.ohiovalleyhospital.org/pain.

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Chronic Pain Treatments a Different Kind of 'Fun'
By Lois Thomson

Some people might like to watch a Steeler game or go to the theater for fun. But Dr. Michael Fussell has a different idea of fun. That's not to say he wouldn't enjoy those activities. But when it comes to his area of practice, he thinks it's kind of fun doing injections and implanting spinal cord stimulators.
If that sounds odd, you have to understand that Dr. Fussell is an interventional pain management specialist, and he works with patients who are experiencing chronic pain. He pointed out, "Most of my patients are referred from other physicians, which means they have typically done conservative treatment before they get to me."
Dr. Fussell, who is private practice and on staff at The Washington Hospital and TriState Surgery Center, said he treats chronic pain "pretty much everywhere" in the body, and described some of the methods he uses: "Nerve root blocks are shots where you pick out a specific nerve. I isolate the nerve with dye and inject an anesthetic and a steroid. The steroid usually decreases the inflammation and irritation and gives some long-term relief, and the anesthetic will give instant pain relief. So the pain they typically came in with, they won't leave with it.
"Facets are joints in your back and there's a little nerve that goes to each joint. I put an anesthetic on that nerve. So it's like going to a dentist, where if you get a shot right on that nerve of the tooth that's bothering you, you don't have the pain any more. If I block that nerve and your pain goes away, that means that nerve is your problem."
Dr. Fussell said he became interested in pain management when he did a month-long rotation during his training in physical medicine and rehabilitation. "I really liked it, because I got to see that a lot of people were actually benefiting from the things I was doing, and that appealed to me.”
"Plus, I like doing the injections. I like the technical component of it. It can be interesting, because doing spinal cord stimulator trials, you have to actually thread an electrical lead along the spinal column. It's kind of fun trying to find those nerves that control your leg as they come directly off the spinal cord. You're threading that little catheter and you can actually see it going up the spinal cord on a live X-ray."
That might not be your idea of fun; but if you're suffering from the pain, no doubt you'd like to have Dr. Fussell take care of it."

For more information, call 724-222-5471 or visit www.washingtonhospital.org.

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Dr. Karpen 'Upfront' With
Patients About Chronic Pain
By Lois Thomson

If you have to go to a doctor, you naturally want one who is going to take care of your problem. But don't you also want one who is going to be honest with you?
First things I've noticed over the years is that certain people may have expectations when they come to a pain doctor, thinking, 'You're the last guy and you're going to fix me and make me pain free.' Unfortunately, that's not always possible.
"But I try to bridge the gap between the patient's expectations and the reality of what we can do. And once you do that, you have a better rate of success."
But Dr. Karpen does his best to alleviate that pain, and he explained some of his methods. "My approach is what we call multidisciplinary. I'll incorporate many different modalities to treat pain, some being interventional, which means we'll use certain injection therapies. I'll use medications as simple as over-the-counter ones, all the way to narcotics if need be, including anti-inflammatories, muscle relaxants, and so on. I'll refer patients to other specialists or incorporate physical modalities, such as physical therapy, chiropractics, or aquatic therapy."
The type of approach he uses depends on the cause of the pain, and those can be many and varied. For example, regarding neck pain, he said, "Probably the most common would fall under a muscular skeletal cause—simple muscle sprains or strains, like a whiplash, where the muscles are stretched and there's damage to the supporting structures of the neck. We may see difficulty with congenital problems. Then you have the disc problems, degenerative disc disease, bulging discs, herniated discs. The facet joints of the cervical spine can also cause pain if arthritic. We may see people with headaches that are originating from the neck, or even dental problems. We see a lot of patients with TMJ problems. And there are malignant issues, like tumors of the spine."
For that reason—because some of the causes are long-lasting and/or can't be cured—Dr. Karpen said some patients have been in pain "24/7 and have lost a level of function in their life as well as the quality of life.
"But that's the main purpose of a pain specialist, in my opinion—to get the pain under control as best as possible for the patient, and to focus on returning them to the (highest) level of function and quality of life."
For more information, call Dr. Jay Karpen at the
Center for Pain Relief at (724) 942-5188.

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Pain Management:
A Team Approach

Eight out of 10 people will be affected by back pain in their lives. All pain, including back pain, may be categorized two ways: acute and chronic. At ACMH Hospital, pain is attacked by a team of professionals including a neurosurgeon, pain management experts, and rehabilitation therapists.
Acute pain is usually caused by an injury or illness that comes and goes and may easily be treated with an anti-inflammatory medication (NSAIDS), heat, and gentle stretching. It is important that, along with pain control, you receive proper instruction in rehabilitation of your back. This instruction would include exercises to strengthen the muscles toward the goal of preventing future problems.
Chronic back pain is defined as pain that lasts longer than 3-6 months. Osteoporosis is a bone-weakening disease that affects women greater than men and may result in vertebral fractures of the spinal column resulting in a “stooped” posture. This event usually causes severe pain of a chronic nature. At ACMH Hospital, Dr. Curt Conry, Neurosurgeon, and Dr. Randall Barrett, Anesthesiologist, perform a procedure called Balloon Kyphoplasty. This procedure is minimally invasive, stabilizes the fracture, and helps to correct the boney deformity. Again, once this back problem has been corrected, it is essential to obtain the services of a qualified professional, such as a physical therapist, to strengthen the back and reduce the risk of recurrent back pain and/or injury.

For more information about chronic pain management provided by ACMH Pain Management Center
and Rehab Services, or for a complete list of neurosurgical services offered by
ACMH Western Pennsylvania Neurosurgical Associates, please call (724) 543-8402.

For more articles, download the Fall '08 issue (PDF)