What is the specialty of pain medicine?
Pain MEDICINE has undergone both an evolution and a revolution during the past twenty years. The trend today is no longer to “manage” pain by suppressing it with large doses of narcotics in a simplistic effort. A driving force in the field’s development was a growing public demand for a compassionate, diagnostic, therapeutic, but safe approach to treat severe pain. The practice of pain medicine draws its base of knowledge from a variety of medical and surgical specialties. Today, the gold standard of the high quality, pain medicine practitioner, is the ability to offer a great variety of innovative, cutting-edge, and advanced treatment alternatives. Not just more pain pills, which only serve to cover up and complicate your misery. Each option has one goal at hand; to understand, target, and eliminate the specific cause of a patient’s pain.
This is what we do at Space City Pain Specialist through our group of exceptionally well trained and credentialled medical staff. Collectively, we have a fund of over twenty years of experience in the field. When you come to us, you will receive a comprehensive, humane, and logical assessment of your painful condition. You will be offered more than unimaginative, band-aid therapy for your health.
We have been in the war against the opioid epidemic for a long time. Years before it was recognized as a disastrous approach to treating chronic pain. What follows is a brief introduction to some of the “state-of-the-art” treatment choices available at Space City Pain Specialists.
TREATMENTS FOR LUMBAR SPINAL STENOSIS
Spinal stenosis happens when the spinal canal becomes too narrow because of a variety of reasons related to the normal aging process. Your spinal canal contains and protects your spinal cord and nerves. Sometimes the channel can become so tight that it causes “pinched nerves,” which in turn is painful. In fact, spinal stenosis can cause so much sciatic type pain, a patient can only walk for short distances before needing to sit down to relieve the discomfort. A person with this condition may experience weakness in their legs, which causes the legs to “give out” from underneath them, sometimes causing injury. It is a disabling problem, to say the least.
Currently, there are minimally invasive surgical treatments available such as the MILD or Vertiflex procedures, which resolve many forms of spinal stenosis. These techniques are both outpatient operations, and they are available at Space City Pain Specialists. Most patients are up and walking, without pain, within hours.
Opioids are sometimes used, in conjunction with other modalities, to treat pain. While opioids can be a valuable tool to treat some types of pain, they can be dangerous and deadly when misused.
At Space City Pain Specialists, we know that opioids must be used at times to help our patients in the short-term, and rarely, in the long-term. We are trained in assisting them in navigating through these dangers to minimize the impact on them, their families, and society. Before prescribing an opioid for pain, your provider will have a serious conversation about the risks and benefits of use. The most significant hazards occur when these pain relievers are first started. There is a significant increase in risks if medication is prescribed without appropriate medical supervision. These include nausea, sedation, clouded thinking, worsening of sleep apnea, itching, and constipation. In some instances, constipation from opioids may become so bad that bowel obstruction can happen. The use of opioids for extended periods can reduce the normal production of sex hormones in both women and men, leading to weight gain and depression. It is common knowledge that using opiates for even short periods can cause both physical and psychological addiction to the medication. A little-known fact is the unchecked escalation of an opioid dose may make patients more sensitive to pain and consequently hurt more!
We are vigilant of these pain medication pitfalls at Space City Pain Specialists and know how to help our patients avoid them.
Neuromodulation therapy or spinal cord stimulation (SCS) is an advanced treatment modality for the management of chronic, difficult to control nerve pain. Many patients have a history of multiple spine surgeries or damage to the nervous system. The physicians at Space City Pain Specialists are experts with this therapy. They use the latest, most technologically forward-looking systems available today. Spinal cord stimulations deliver electrical impulses that are administered to the spinal cord to disrupt pain signals from reaching the brain. The electrical stimulus is either not perceptible or feels like a gentle tingling sensation in the painful areas depending on the type of therapy. Good candidates for this type of treatment often experience dramatic, positive changes in their quality of life.
INTRATHECAL INFUSION SYSTEMS (PAIN PUMP) AND MICRODOSING
The opiate crisis has taught us a lot in the recent past since it has gripped the nation in an epidemic of untimely death and widespread suffering. An old English proverb once stated: “The road to perdition is paved with good intentions.” For several years now, doctors have been compelled to relieve pain, which often translated into prescribing more narcotic medication. On the surface, a simple, well-meaning effort, but a plan with unintended, often disastrous outcomes. The fact of the matter was, doctors were making their patients worse instead of better.
There are a few exceptions, for which taking oral opiates long term will improve the patient’s condition. When such a course is medically indicated, it will require the close supervision of a pain medicine specialist every month to monitor patient use and compliance with the doctor’s recommendations. The specter of opiate tolerance is always a concern. There is not much current medical research supporting the use of oral opiates long term for chronic pain.
One such therapy is an intrathecal infusion system, more commonly known as a “pain pump.” This is a highly sophisticated, computerized, twenty-first-century device capable of delivering precisely measured doses of pain-relieving medications directly into the nervous system. It is safe, with negligible risks, and has far fewer hazards than taking oral narcotics. At Space City Pain Specialists, we adhere to a pain pump management protocol known as “micro-dosing.” We expose the patient to the smallest dose of opiates to achieve the most significant reduction of chronic pain. Patients are unshackled from taking oral medications every day and coming to office visits once a month. Our “pain pump” patients visit with us four times a year to have their devices refilled, and thereby, they get on with the more essential things in their lives.
Musculoskeletal (MSK) medicine involves the evaluation and treatment of muscles, bones, joints, tendons, and ligaments. These are common causes of pain, often arising from both sudden and repetitive injuries, autoimmune diseases, and general wear and tear. If not adequately addressed, these injuries can lead to chronic conditions, increased nerve sensitivity, and secondary injuries. Understanding the pain pattern and finding the root of the problem is essential to successful treatment.
Many procedures are effective in controlling these conditions, including joint and tendon steroid injections, intra-muscular trigger point injections, and advanced treatments like radiofrequency nerve ablation.
We provide all the above, as well as the newer “regenerative medicine” therapies. These focus on helping the damaged structures heal faster with biologics, which are derived from living organisms. This approach maximizes the body’s own healing powers. Some examples are platelet-rich plasma (PRP), hyaluronic acid for joint lubrication, and amniotic fluid stem cells to help grow new healthy tissues.
EXERCISE AND PAIN
Medical research has consistently shown that regular exercise reduces pain and depression. How so? When you increase your level of activity for short periods, your nervous system responds by producing a neurochemical known as “endorphins.” Endorphins are potent pain relievers and antidepressants, which are naturally produced by your body. By exercising regularly, any patient can take an active role in controlling their pain. We have a full staff of rehabilitation and exercise experts on staff at Space City Pain Specialists to help you do this.
THE PSYCHOLOGY OF PAIN
There is no doubt that constant, relentless pain either causes depression or worsens it. Once “the blues” set in, patients will hurt more. Their ability to tolerate even the routine aches and pains that we all experience from time to time is lowered. That is why a healthy mind is as essential as a healthy body. If there is a need, we have a psychologist on staff dedicated to helping our patients sail through the perils related to the psychology of pain.
THE ROLE OF CANNABIDIOL (CBD) IN PAIN MEDICINE
Recently, Cannabidiol (CBD) an active, non-hallucinogenic ingredient in cannabis (the hemp plant), has emerged as an alternative to opiates in the treatment of chronic pain. Some researchers advanced the theory that CBD activates the endocannabinoid receptors in your brain and immune system, to reduce pain for multiple conditions. The use of CBD products is not prohibited in our practice. It is legal in Texas. Tetrahydrocannabinol (THC) is the active hallucinogenic component of the hemp plant, which is illegal in most states.
We do caution our patients about the source of their CBD. Most CBD producers do not adhere to stringent production requirements and sell an inferior grade. Moreover, some brands contain a percentage of THC higher than is legal. The legal limit is 0.3%. Patients using sub-standard CBD oils are at risk of having a urine drug test positive for THC. Presently, there is no way of distinguishing a positive test from marijuana use from the use of CBD. Patients should also keep in mind that as of today, there are no FDA approved CBD products. There is no conclusive data to support CBD as a method of pain management here in the United States. There is ample data in the medical literature from foreign countries like Israel. Therefore, we do have a pharmaceutical-grade CBD product available in our practice for our patients. It has 0% THC and will not produce a positive test result. Clearly, there are a lot of potentials, but more research is needed. Our practice will be involved in this research. Stay tuned!
SPACE CITY PAIN SPECIALISTS IS:
Joseph T. Alvarez, M.D., Clear Lake
S. Jeffery Cannella, M.D., Clear Lake
Eduardo A. Garcia, M.D., Clear Lake
Alan Swearingen, M.D., Bay Town
Sunil Thomas, M.D., League City and Lake Jackson
Denise Jarbath, Certified Physician’s Assistant, Clear Lake
Peggy Phillips, Advanced Practitioner Registered Nurse, Certified, Clear Lake