Pain is inherently subjective, and a greater awareness of the need for taking pain seriously is growing among the health community as well as the public at large. This is particularly true for chronic back pain sufferers.
While a great majority of back pain cases are self-limiting and resolve on their own, the risk of recurrence and development of chronic pain is significant. Spinal procedures are generally associated with intense pain in the postoperative period, especially for the initial few days.
Adequate pain management in both the above cases has been seen to correlate well with improved functional outcome, early ambulation, early discharge, and preventing the development of chronic pain.
Pain management is an art and science in the study of pain, its prevention, evaluation, diagnosis and treatment, as well as the rehabilitation of your painful disorders.
There are many varieties of pain management programs to explore. They can be broadly classified into:
Non-Invasive Pain Management:
A wide variety of non-invasive pain management techniques are available to reduce pain. Depending on the case history and severity, Mr. Rajesh recommends a comprehensive pain management program which include one or more of the following:
EXERCISE: Physical activity plays a crucial role in interrupting the “vicious cycle” of pain and reduced mobility. Exercise is necessary for proper cardiovascular health, disc nutrition and musculoskeletal health. Physical exercise is focused with the aim of increasing strength, increasing flexibility, and restoring normal motion. Hydrotherapy (water therapy), stretching exercises, aerobic routines and many others are recommended, depending on the patient’s condition.
PHYSIOTHERAPY & OCCUPATIONAL THERAPY: In Physiotherapy, you will be guided through a series of exercises designed to preserve or improve your strength and mobility. In Occupational therapy, you are helped to learn to perform a range of daily activities in a way that doesn’t aggravate your pain.
ELECTROTHERAPY:Electrotherapy attempts to reduce back pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system. The most commonly known form of electrotherapy used for managin back pain is Transcutaneous Electrical Nerve Stimulation (TENS).
BIOFEEDBACK: It involves learning to control muscle tension, blood pressure, and heart rate with the help of a biofeedback machine. This machine turms the data on your heart rate and blood pressure into visual clues like a graph, blinking light, and animation. Watching and modifying these visualisations gives you a greater degree of control over your body’s response to pain.
THERAPEUTIC MASSAGE: Not just an indulgence, massage can ease pain by working tension out of muscles and joints, relieving stress and anxiety, and possibly helping to distract you from pain by introducing a “competing” sensation that overrides pain signals.
Pharmacologic treatments (medications): A variety of pharamacologic treatments available for chronic pain include:
- Nonsteroidal anti-inflammatory agents (NSAIDs) – such as Aspirin, Ibuprofen, Naproxen and COX-2 inhibitors.
- Muscle relaxants – used to treat muscle spasms due to pain and protective mechanisms – Diazepam
- Antidepressants and anticonvulsants – used to treat neuropathic (“nerve”) pain.
Invasive Pain Management
When the nerves in the epidural space are irritated or pinched by a bulging disk, narrowed “nerve canal” or bone spur, the resulting inflammation can cause pain, numbness, or tingling. The steroid injected can reduce inflammation of nerves in the epidural space and thus reduces your pain and other symptoms.
Spinal injection: A spinal injection is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves due to spinal stenosis or disc herniation. A spinal injection can deliver medication directly to the source of your symptoms.
Spine injection is used in two ways:
- To diagnose the source of back, leg, neck, or arm pain (diagnostic).
- Spinal injections is used as a treatment to relieve pain (therapeutic).
Other types of invasive pain management include:
- Spinal cord stimulation – uses low voltage stimulation to block.
- Selective nerve root injection – injection of cortisone around the nerve root.
- Endoscopic sympathectomy – type of minimally invasive surgery.
- Cervical dorsal root rhizotomy – uses radiofrequency pulses.
- Intrathecal drug pump – a device that delivers pain medication to the spinal fluid.
While the process of pain management can be a significant challenge for patients enduring intense pain, once patients find an approach that they are comfortable with, it is likely that their condition and pain levels should improve!