Pain Management

Chronic pain has led to the development of a new medical specialty of pain management. Most, but not all pain management physicians are anesthesiologists. They employ a variety of modalities including oral and cutaneous medications, injections, infusion therapy, physical therapy, and psychological/social consoling.

At the urgent care, we take care of patients with non-malignant pain. We use oral and injectible medications, trigger point injections for muscle spasm, and refer to physical therapy if needed. We do not prescribe narcotics stronger than codeine. However, some patients will need stronger pain relief even for benign pain. Persistent back pain is the most common reason for chronic pain management.

What are the options for someone with pain that persists? We start with full doses of NSAIDS-ibuprofen, naproxen, Bextra, Celebrex, Vioxx, etc. I cannot tell the difference and there is individual variation, so if one drug does not work, try another. The new drugs have the advantage of once a day dosing and do not causes as many stomach upset. In addition to NSAIDS, we use muscle relaxants and codeine/hydrocodone as needed. Most patients can be kept reasonably comfortable with this program.
Patients with muscle spasm can be made pain free in a few minutes with an injection into the affected muscle group. These injections do not always work, but when they do, we end up with a very grateful patient. They often come back for recurrences.

When this in inadequate, we refer to pain management for evaluation.

The social problems associated with narcotic use/abuse make it difficult for doctors to prescribe narcotics for an extended period of time. Patients needing more than a short course of pain medication should be evaluated for long term pain management. Opioids may be effective long-term analgesics in “well selected” patients. Long term opioid therapy is not associated with end organ toxicity (renal, brain, etc). A good example is a well known talk show host that was able to function with very large doses of opioids. However, this type of therapy should be used for patients that have failed therapy previously stated.

Written & edited by Robert E. Dyer, MD

Find out more about different kinds of pain managements at www.pain.com
Info on arthritis www.arthritis.org

More links on chronic pain info:

The Mayday Pain Project
www.painandhealth.org

American Pain Foundation
www.painfoundation.org

American Chronic Pain Association
www.theacpa.org

For Those in Pain
www.forthoseinpain.org

National Chronic Pain Society
www.ncps-cpr.com

National Pain Foundation
www.painconnection.org

Partners Against Pain
www.partnersagainstpain.com

Links on Psychological :

American Counseling Association
www.conseling.org

American Psychological Association
www.apa.org

Head, Neck and Facial Pain:

American Academy of Head, Neck and Facial Pain
www.aahnfp.org

American Academy of Orofacial Pain
www.aaop.org

American Dental Association
www.ada.org

Trijeminal Neuralgia Association
www.tna-support.org

TMJ Association
www.tmj.org

Back Pain:

American Back Society
www.americanbacksoc.org

Geriatric Pain:

Administration on Aging
www.aoa.dhhs.gov/naic

The American Geriatric Society
www.americangeriatrics.org