Download Chronic Pain Management

Chronic Pain Management
By Rodger Orman, M.D.
What is Chronic Pain?
While acute pain is a normal sensation triggered in the nervous system to alert you to
possible injury and the need to take care of yourself, chronic pain is different. Chronic
pain persists. Pain signals keep firing in the nervous system for weeks, months, even
years. There may have been an initial mishap -- sprained back, serious infection, or there
may be an ongoing cause of pain -- arthritis, cancer, ear infection, but some people suffer
chronic pain in the absence of any past injury or evidence of body damage. Many chronic
pain conditions affect older adults. Common chronic pain complaints include headache,
low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to
the peripheral nerves or to the central nervous system itself), psychogenic pain (pain not
due to past disease or injury or any visible sign of damage inside or outside the nervous
system).
Chronic Pain is defined as a painful condition that has lasted more than three months.
There are many conditions that human beings suffer from that can cause chronic pain.
Chronic pain is a constant painful condition that can wear down your psyche and cause
incapacitating suffering.
Many conditions can cause chronic pain. Most common is back pain that 80% of
people suffer from at some time during their lives. Usually it is caused by muscle strain
and resolves in a few days. Ice, rest, massage can be done to help this pain resolve.
Occasionally, a herniated disc causes this painful condition and can be associated with
referred pain down in the hips, legs or feet from putting pressure on the associated
nerves. Epidural Steroid Injections are injections into the epidural space next to the
vertebra can relieve this pain but sometimes the nerve compression is so severe that
surgery is necessary.
Chronic pain management involves treating the whole person so that they can
minimize their pain and suffering and continue their daily functions. Preservation of
function is the main goal of chronic pain management. This can be a challenge and
several professionals are often needed in the treatment of this chronic condition.
Depression and anxiety are often involved and must be addressed for the successful
treatment of chronic pain. Physical Therapists, Massage Therapists, Chiropractors,
Acupuncturists, Psychologists, Social Workers and Surgeons are often involved.
Managing the medications of the chronic pain patient can be a challenge due to the many
types of medications that can offer relief. From Narcotic Pain Relievers to antiseizure
medications to antidepressants and mood stabilizers it takes an experienced physician to
oversee the treatment of a chronic pain patient. Many of theses Medications help patients
to function normally if prescribed carefully.
Headaches affect millions of people each year and can become a cause of chronic
pain. Tension Headaches can be difficult to treat. Tension causes 9 out of 10 or these
head aches and be triggered by stress, poor posture, neck problems, depression or
anxiety. Meditation and relaxation therapy often provide some relief. Migraine and
Cluster headaches have a variety of medications that can offer relief. The cause of
chronic headaches needs to be addressed and occasionally brain tumors and small strokes
are found that can be treated to relieve the associated head ache.
Fibromyalgia, a poorly understood condition is also a cause of chronic pain.
Fibromyalgia is a whole group of disorders that cause widespread body pain, fatigue and
painful trigger points in muscles and fascia. Sometimes local trigger point injections, dry
needling and acupuncture provide remarkable but temporary relief. Some physicians
don’t recognize Fibromyalgia as a disease but it certainly is one of the common
conditions that can lead to disability and loss of function. Keeping active and having a
healthy lifestyle all are important in treating any Chronic Pain condition. Diet and herbal
therapies also can help and cannot be ignored. Other alternative therapies are used as
appropriate.
Lower back and leg pain, caused by nerve impingement or compression is often
referred to as Sciatica and is quite common. Nerves can become compressed by a bone
spur from arthritis, a bulging intervertebral disk, scar tissue or other reasons. An MRI is
necessary to diagnose the cause of Sciatica. Nerve compression causes the affected nerve
to become irritated, inflamed and swollen and can cause pain that appears to be from the
hip, leg or foot when the actual cause is in the spine.
The more irritated and swollen the nerve becomes the pain is experienced. Epidural
steroid injections, such as cortisone act to decrease the swelling and inflammation around
the nerve, thereby breaking the cycle of swelling, irritation and pain.
About 70% of patents can find relief with an epidural steroid injection. Sometimes
the relief lasts for years. Unfortunately, some patients do not respond and require surgery
to find relief. Surgical techniques are improving but we still cannot improve on how
most people’s backs were when they were 20 years old and healthy. Ponce de Leon
searched for the water from “The Fountain of Youth” that we all would like to find today.
A “Time Machine” would also be a valuable tool in treating many conditions!
Dr. Orman has had a pain clinic in Calaveras County since 1995. He was a Family
Practice Physician in Calaveras County for 5 years before going back to Syracuse, New
York for training in Anesthesiology and Chronic Pain Management. Two new associates
have joined Dr. Orman to help care for the chronic pain patients. Dr. Jared Royer has
been in practice over a year and Dr. Sean Anderson recently started working. They were
both trained at the University of Arizona in Tucson. The pain management clinic is
located at 700 Mountain Ranch Road in San Andreas and is very busy. Referral from
your primary care physician is required so that we can help your primary care physician
best treat your condition and coordinate your medical care.