PAIN MANAGEMENT CARE

Dr. Glenn MacNichol.jpg

Dr. Glenn E. MacNichol

Director of Pain Management Services

The pain management process begins with a pain physician evaluating and diagnosing your painful disorders then quickly transitions into preventing and rehabilitating  painful disorders. These disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem, such as neuropathic pains or headaches. One of our interventional pain management specialists will carefully review your condition and work with you towards an acceptable treatment plan.

Physiotherapy

DIAGNOSTIC BLOCKS, RADIOFREQUENCY, SYMPATHETIC BLOCKS

The pain management process begins determining the sources of pain with a diagnostic nerve block. These blocks typically contain an anesthetic with a known duration of relief. A sympathetic nerve block is performed to determine if the pain has a sympathetic component. This is a network of nerves extending the length of the spine . These nerves control some of the involuntary functions of the body, such as opening and narrowing blood vessels.

If the pain management process is hospital-based and the procedure is completed, the patient is taken to a diagnostic center for a CAT scan of the area, which will reveal any disc that is disrupted. A disrupted disc indicates there may be tears in the outer ring of the disc that were not seen on an MRI scan or other test.

 
 

EPIDURAL STEROIDS

The purpose of an epidural steroid injection is to try to provide pain management via a nerve block and suppressing  inflammation that is affecting the nerves that are carrying the painful nerve signal to the brain. For spinal care, this is a very effective way to decrease pain.

An epidural steroid injection is a procedure performed under fluoroscopic guidance where the physician inserts a needle into the spinal canal and injects a cortisone-type medication and local anesthetic. The epidural space is a space inside the spinal canal between the bony canal of the vertebrae and the sac that contains the nerves, spinal cord, and spinal fluid. There are several different pain management approaches to this space that the physician may use.

The pain relief period varies but injections typically last from three months to one year. Depending on the medical problem, the injection may completely stop the pain and it may never have to be repeated. If the pain returns, injections can be performed in a series of two or three injections 2-3 weeks apart.

 

HERNIATED DISC

Rupturing of the tissue that separates the vertebral bones of the spinal column. The center of the disc, which is called the nucleus, is soft, springy, and receives the shock of standing, walking, running, etc. The outer ring of the disc, which is called the annulus (Latin for ring), provides structure and strength to the disc. The annulus consists of a complex series of interwoven layers of fibrous tissue that hold the nucleus in place.

A herniated disc is often referred to as a slipped disc. This is a common issue with athletes and is part of our sports medicine treatment. This term came from the action of the nuclear tissue when it is forced from the center of the disc. The nuclear tissue located in the center of the disc can be placed under so much pressure that it can cause the annulus to rupture.

When the disc has herniated or ruptured, it may create pressure against one or more of the spinal nerves which can cause pain, weakness, or numbness in the neck and arm. Other names for herniated discs are prolapsed and ruptured discs. See our spinal care page to see more information.

 

HYALURONATE INJECTIONS

Hyaluronate is a pain management medication that is injected into the knee joint only for osteoarthritis of the knee. Hyaluronate is a protein substance that provides lubrication to the knee, and thus knee pain relief. It is extremely effective. Hyaluronate injection relief periods are variable – usually from about six months to upwards of two years.

 

JOINT INJECTIONS

Since every joint in the body is susceptible to arthritis and chronic pain, sometimes cortisone and/or anesthetic injection directly into the joint is necessary for relief. Arthritis is one or several pain management treatments our hand care specialist help relieve. Some of these joint injections may be performed using the guidance of our state of the art ultrasound or X-ray guidance called fluoroscopy, which lets the physician see moving internal structures to determine exactly where the medication needs to be directed.

 

LOW BACK PAIN

Pain in the lower back area that can relate to problems with the lumbar spine, the discs between the vertebrae, the ligaments around the spine and discs, the spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, or the skin covering the lumbar area.  Low back pain can start in a person’s early twenties and continue on throughout adulthood. Studies have shown that up to 80% of the general population are affected by low back pain (LBP) at some time during their lives. Learn lower back pain management by knowing what activities could be putting you at risk.

Low back pain symptoms range from sharp and stabbing to a dull ache. The pains can be constant or intermittent and positional. Acute low back pain can appear suddenly after an injury. Chronic back pain is defined as pain lasting more than three months. Consult a doctor if you have prolonged back pain longer than 72 hours. Back pain management is one of several areas we treat in our sports medicine program. Severe back pain after an injury should be evaluated by a health-care professional. Warning signs of more serious injury include pain with coughing or urinating, loss of control of the bowels or bladder, new leg weakness, and fever. These additional symptoms require medical evaluation. Back pain that occurs after excessive exercise or heavy lifting is frequently a strain injury. However, occasionally these activities cause disc injury and rupture or herniation. When a herniated disc irritates the sciatic nerve, it can cause back pain.Back pain management is one of the most important areas of study since 80% of the population is affected by lower back pain.

 

MEDICATIONS WE USE

The physician may use a variety of different medications, based on your particular medical and/or psychological condition, allergies, financial resources, and insurance plan. Medications can vary from anti-inflammatory medicines to opioid pain medicines, nerve medications to anti-depressants, anti-seizure medications to muscle relaxants, and many others to manage pain.

Each persons pain management is different and if medicines are to be used, the treatment will be uniquely tailored to your specific needs. If any controlled substances are used in your treatment plan, you will be required to complete a Prescription Drug Agreement with your doctor.

Here are some of the medications that we use:

 

NARCOTIC CONTRACTS

A narcotics contract is a treatment agreement signed by the patient and clinician that sets out the expectations for a patient using these medications. The use of a pain management agreement allows for the documentation of understanding between a doctor and patient. Such documentation, when used as a means of facilitating care, can improve communication between doctors and patients.

 

PAIN MANAGEMENT INTERVENTION

Pain management is the process of providing medical care that alleviates or reduces pain. Mild to moderate pain can usually be treated with analgesic medications, such as aspirin. For chronic or severe pain, opiates and other narcotics may be used, sometimes in concert with analgesics; with steroids or nonsteroidal anti-inflammatory drugs when the pain is related to inflammation; or with antidepressants, which can potentiate some pain medications without raising the actual dose of the drug and which affect the brain's perception of pain. Narcotics carry with them the potential for side effects and addiction. However, the risk of addiction is not normally a concern in the care of terminal patients. For hospitalized patients with severe pain, devices for self-administration of narcotics are frequently used. Other procedures can also be useful in pain management programs. For bedridden patients, simply changing position regularly or using pillows to support a more comfortable posture can be effective for pain management. Massage, acupuncture, acupressure, and biofeedback have also shown some validity for increased pain management in some patients.

 

PAIN PHYSICIAN SERVICES

Pain treatment is a subspecialty of pain management that focuses on a wide range of pain-blocking techniques. When other types of conservative treatment methods have not been successful in addressing pain and discomfort, interventional pain solutions are often effective. At Carolina Regional Orthopedics, we utilize the advanced technology to accurately diagnose and treat patients for a range of pain-producing conditions and injuries. Areas of the body we conduct pain management care include hip, wrist, and elbow care, shoulder care, spinal care, hip & knee care, ankle & foot care. We also treat pain management in our sports medicine and physical therapy programs.

The diagnosis of painful syndromes relies on the interpretation of historical data, review of previous laboratory, imaging, and electro-diagnostic studies; behavioral, social, occupational and a vocational assessment; interview and examination by the pain specialist; and may require specialized diagnostic procedures, including central and peripheral neural blockade or monitored drug infusions. The special needs of the pediatric and geriatric populations are also considered when formulating a comprehensive treatment plan for these patients.

The pain physician serves as a consultant to other physicians but is often the principal treating physician. They provide care at various levels, such as direct treatment, prescribing medication, prescribing rehabilitative services, performing pain relieving procedures, and counseling of patients and families. In addition, a pain physician may also provide direction for a multidisciplinary team, coordination of care with other healthcare providers, and consultative services to public and private agencies pursuant to optimal healthcare delivery to the patient suffering from a painful disorder.

 

PHYSICAL THERAPY & REHABILITATION

Physical Therapy and Rehabilitation Services are available in our Rocky Mount office. Our physicians will evaluate your individual rehabilitation for your diagnosis, and design an individual program to strengthen core musculature and promote new neuromuscular patterns.

 

PROLOTHERAPY

Injection therapy is used to treat a specific part of the body to help patients with pain, illness, and nutritional support. By using injections, it allows a direct path to the bloodstream and the damaged or inflamed tissue. There are different types of injections, but they are usually administered in two different ways: intravenous, through a vein, or by targeting the musculoskeletal system. 

Prolotherapy is an injection therapy to help regenerate the tissue in painful joints, ligaments, and tendons, which increases function and decreases pain. Trigger point injections release and receive blood flow in tight muscles. Intramuscular injections administer vitamins or medicines directly into the body, bypassing the digestive tract. 

Musculoskeletal treatments include prolotherapy, trigger point injections, and intramuscular injections, which help treat:

  • Arthritis

  • Tendinitis

  • Chronic Joint Pain

  • Old Injuries

  • Sciatica

  • Neck Pain

  • Low Back Pain

Intravenous (IV) injections are injected through an IV to help administer nutrients and medicine directly into the bloodstream. Patients who suffer from poor digestion and need high-dose nutritional support may use intravenous injections. IV injections may be used for:

  • Exercise Recovery

  • Migraines

  • Fibromyalgia

  • Acute Infections

  • Cancer Treatment Support

  • Detoxification

  • Chronic Fatigue

A patient may expect a thorough medical intake, physical exam, and may need labs or imaging at his or her first appointment. The physician will take into consideration the information from the first appointment, the patient's overall health, and treatment goals to decide which treatment may be best.

 

RADICULAR PAIN

Radicular pain is generally a severe lancinating pain, often burning in nature, which is felt in the distribution of the dermatome associated with the nerve root. Radicular pain occurs when pain radiates from an inflamed or compressed nerve root. As an example, an inflamed nerve root in the neck may radiate pain into the arm or hand. Radiculopathy occurs when a compressed or inflamed nerve root results in neurological deficits, such as problems with reflexes, numbness, and/or weakness. Our hand care services help with treating radicular pain.

Radicular pain and radiculopathy can occur separately (one without the other) or together. When explaining a diagnosis and treatment plan to a patient, medical professionals commonly use these terms interchangeably because radicular pain and radiculopathy often occur together, and initial nonsurgical treatments tend to be the same regardless.

 

SCIATICA

Pain that results from irritation of the sciatic nerve and typically radiates from the buttock to the back of the thigh. Although sciatica can result from a herniated disc pressing directly on the nerve, any cause of irritation or inflammation of this nerve can reproduce the painful symptoms of sciatica. Diagnosis is made via observation of symptoms, physical examination, and nerve tests, and sometimes X-ray or magnetic resonance imaging (MRI), if a herniated disk is suspected. Treatment options include avoiding movements that further irritate the condition, use of medication, physical therapy, and sometimes surgery.

Sciatica is a pain that radiates from the low back down a lower extremity; it is caused by irritation of the sciatic nerve. The sciatic nerve transmits sensation from the lower extremities and lumbar area of the low back. It is common for people to recover from sciatica without a surgical operation.  Low back pain that radiates to the hip, buttock, and down a lower extremity is the most common symptom of sciatica. Sometimes sciatica pain worsens with bending at the waist, coughing, sitting, or sneezing. Sciatica can also cause tingling, numbness, or weakness of the leg. Sciatica symptoms can occur rapidly and persist for weeks.

 
 

SI JOINT INJECTIONS

The SI joint is a large joint between the tail bone and the hip bone. Inflammation of this joint is a common cause of lower back pain. This is a simple procedure in which the physician places a needle into this joint and injects anesthetic and cortisone-like steroid to suppress inflammation and relieve pain.

SPINAL CORD STIMULATOR

A Spinal Cord Stimulator is a type of implantable neuromodulation device that is used to send electrical signals to select areas of the spinal cord for the treatment of certain pain conditions which is called Spinal Cord Stimulation. In spinal cord stimulation (SCS), mild electric currents applied to the spinal cord through small medical devices modulate pain signals and at some settings, replace the pain sensation with a mild tingling known as paraesthesia. Spinal cord stimulation involves placing a series of electrical contacts in the epidural space in the spine near the region that supplies nerves to the painful area. The procedure is a minimally invasive ambulatory surgical technique. Visit our spinal care page for more information on spinal cord treatment.

 

SPINAL FACET JOINT BLOCK

A facet joint block is an injection of local anesthetic (numbing medicine) into one or more of the small joints located along the side of each vertebra on both sides of the spine in the lower part of the back. Multiple injections may be performed, depending upon how many joints are involved. Facet joint blocks are typically requested for patients who have pain primarily in their back as a result of arthritic changes in the facet joints or for patients who have mechanical low back pain. A facet joint block may be diagnostic (a test to see if your pain is coming from this area) and/or therapeutic (to relieve your pain).

The strength and flexibility of the spine depend on the unique interaction of the discs in the front and back area (facet joints) of the spinal column. Spinal facet joints have a joint capsule lubricated with fluid and richly innervated by a network of pain-sensitive nerve fibers. Facet joints are numerous and can become vulnerable when the intervertebral disc is injured. Injections of steroids directly into the facet joints may reduce pain and facilitate rehab therapy.

 
 

STATE OF NORTH CAROLINA PRESCRIPTION REGULATIONS

A narcotics contract is a treatment agreement signed by the patient and clinician that sets out the expectations for a patient using these medications. The use of a pain management agreement allows for the documentation of understanding between a doctor and patient. Such documentation, when used as a means of facilitating care, can improve communication between doctors and patients.

TENDON INJECTIONS

This involves injecting an anesthetic medication and usually a cortisone-like steroid medication into a tendon insertion area. This decreases pain and inflammation and is a very easy and effective way to treat tendonitis pain.

 

TRIGGER POINT INJECTIONS

This involves injecting an anesthetic medication into a painful muscle area. This pain management technique decreases pain and relaxes the muscle. This is a very easy and effective way to treat muscle pain.