New Treatments Offer Relief from Chronic Pain
Pain specialist Howard Seitzman, MD, DABPM, FIPP, is medical director of the pain management program at Atrium Medical Center in Middletown.
Q. What is the difference between acute and chronic pain? What are the signs, causes and treatment options for chronic pain?
A. Pain is the most frequent reason patients seek medical care. We all experience pain, but for some it becomes debilitating and all-consuming. Acute pain commonly stems from an injury or possibly a disease process. The question of when acute pain becomes chronic — or long-term — is the subject of much debate. However it’s defined, chronic pain takes a terrible toll on society in both human and economic terms.
Chronic pain has many causes, but none is more prevalent than lower back pain due to spinal conditions. Chronic low back pain is experienced by all ages. However, the reasons may vary by the patient’s age. In younger people, disc problems are more prevalent. In older people, the problems may be more related to degenerative changes.
The good news is that a variety of minimally invasive treatments can help patients with chronic low back pain. It’s usually best to start with the simplest and least invasive treatments.
Everyone has heard of a herniated or ruptured disc. What most people don’t know is that discs usually heal on their own if given enough time. Unfortunately, discs take several months to heal and can cause a lot of pain during this time. For patients with herniated discs experiencing back and leg pain, steroid epidural injections can decrease inflammation around the nerves. This helps relieve the pain, giving the disc a chance to heal without surgery.
A common cause of low back pain is arthritis in the back joints, also called the facet joints. For patients older than 60 years old, 40 to 45 percent of back pain may be caused by this arthritis. Pain from the facet joints is typically in the low back and buttock area. To diagnose it, the doctor performs a simple test to numb the joints temporarily and possibly stop the arthritis pain. If the pain is substantially reduced, this confirms that most of the back pain is coming from the facet joints. The second step is called a radiofrequency ablation, which is used to help lessen the pain for long periods of time.
For many patients, a combination of degenerative changes in the discs and joints causes a narrowing in the spine, which is known as spinal stenosis. The pain from spinal stenosis can be in the back and also in the legs. It’s made worse with walking and can be so severe that it makes everyday activities impossible.
At one time the main treatment for spinal stenosis was surgical decompression, a major surgery with a potentially long recovery time. Not everyone is healthy enough to tolerate such a procedure. Now there is a new procedure called M.I.L.D. (Minimally Invasive Lumbar Decompression). It’s performed with such a small incision that it does not even require a single stitch to close. The results are as good as the major surgery with almost no recovery time.
Patients who have had back surgery that failed to stop their pain may find relief with a device called a spinal cord stimulator. This small implanted device acts on the spinal cord much like a pacemaker acts on the heart. It may help with a variety of other pain problems, such as diabetic peripheral neuropathy. Prior to implantation, the patient has a trial period to see how the device will work for them. During the trial, the patient can decide whether or not to have the permanent implant.
Neck pain coming from the spine is also very common. Some similar procedures used on the lower back are effective in treating neck conditions.
Many people live with chronic pain, not knowing all the treatments available to them. If you have pain for more than a few weeks that is not improving or is getting worse, talk to your doctor about your options for pain relief.
This information is for educational purposes only. Please talk to your physician for advice in all matters related to your health.