Pain Management
“Pain serves a purpose. It warns us to avoid danger, such as when we touch a hot stove, and lets us know when we require medical attention. There is a point, however, at which ongoing pain no longer serves a purpose and, instead, severely diminishes an individual’s quality of life and ability to perform every day functions.”
Olakunle Taiwo, MD
Whether the pain is from an accident, a “bad back” or other medical condition, advances in chronic pain management have radically changed the prognosis for individuals who face living with chronic pain. To Your Health editor, Kathy Lehman, spoke with anesthesiologist, Olakunle Taiwo, MD, about GCMC ’s Pain Management Program (Fall 2003).
Editor: At what point does an individual who has ongoing pain become a candidate for pain management interventions?
Dr. Taiwo: At times, such as with a back injury, even after healing has been achieved, pain does not subside enough for the patient to function comfortably. Patients should look into pain management services when pain medication is ineffective in achieving relief and pain interferes with the quality of life. The types of pain that usually respond well to pain management procedures include lower back, neck and joint pain as well as sports-related injuries, and abdominal and pelvic pain.
Editor: What can a patient expect in the first phase of the pain management program?
Dr. Taiwo: The first step is to diagnose the exact cause of the pain. The process begins with a thorough history and physical as well as a review of previous tests such as MRI studies. At that point, more tests may be indicated. Once a diagnosis is established I consult with the patient and explain the treatment options.
Editor: What is the most commonly performed pain management procedure at GCMC?
Dr. Taiwo: We administer epidural steroidal injections anywhere from the neck to the lower region of the back. These injections are considered an extension of conservative care and are typically administered in a series of three injections at two week intervals. Several common conditions, including lumbar disc herniation, degenerative disc disease, and lumbar spinal stenosis, can cause severe acute or chronic low back and/or leg pain. For these and other conditions, an epidural steroid injection may be an effective non-surgical treatment option. Because the medication reduces inflammation, pressure is relieved from the area and the result is significant pain reduction.
Editor: What are nerve blocks and how are they administered?
Dr. Taiwo: A nerve block is an injection of an anesthetic directly in the area of the affected nerve. Nerve blocks interrupt the transmission of the pain signal to the brain and they are helpful for acute and/or chronic pain. Nerve blocks are useful for identifying the source of nerve pain and treating pain that results from damaged nerves. Therapeutic nerve blocks can produce short-term pain relief for trigger points, peripheral nerves, and the sympathetic nervous system. The frequency of the therapeutic nerve blocks depends primarily on how effective they are in reducing pain for the individual patient.
Editor: In the previous response you mentioned “trigger points.” What are trigger points and how are they treated?
Dr. Taiwo: Unlike the types of pain we’ve discussed thus far, trigger point pain is a muscular rather than a joint condition. When a muscle is always in a spasm, or “knotted up,” blood can’t circulate through the tissue to nourish it. Some of the tissue eventually degenerates and forms little nodules called trigger points. Trigger points can be caused by a fall, car accident, sprain, or engaging in a strenuous bout of weekend athletics. Trigger points also develop over time in muscles that are chronically overloaded by poor posture, such as when an excessive amount of time is spent working at a computer.
Trigger points can cause pain that radiates to other areas of the body. For example, trigger point pain may be the cause of tension headaches, tinnitus, decreased range of motion in the legs, and low back pain. Palpation of a hypersensitive bundle or nodule of muscle fiber of harder than normal consistency is the physical finding typically associated with a trigger point. Trigger points can be treated effectively with a multidisciplinary approach including, trigger point injections, massage therapy, stress management and medications. The earlier a trigger point is treated, the less likely it is to become a chronic problem.
In conclusion, chronic pain can be debilitating for patients and hard on their families. The goal of GCMC ’s pain management is to offer long term relief to our patients so that they can get back to feeling well again. In the near future, GCMC will be adding new and sophisticated advances in pain management to our program.
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Dr. Olakunle Taiwo is Board Certified by the American Board of Anesthesiology and is the Medical Director for GCMC ’s Pain Management Program.
For more information, please call GCMC Pain Services at 724-450-7119.