aasc

Anesthesia Associates of Southern Connecticut

Pain Management FAQ's

What is Pain?

Pain is a medical condition that is associated with an unpleasant sensation and the emotional response to that sensation. Your response to a painful sensation is as individual as you are.

Pain has widespread effects beyond physical discomfort. It can lead to sleep disorders, emotional lability, disintegration of relationships, depression, feelings of hopelessness.

Pain is now taken extremely seriously as a medical condition, and the pain service at AASC is committed to providing the latest techniques in pain management, whether your problem is relatively simple to treat, or is a complex problem requiring interventional procedures.

What is the difference between acute and chronic pain?

Acute pain is of short duration, usually the result of an injury, surgery or illness. Chronic pain is an ongoing condition, often in the back, neck, and head, as well as neuropathic pain (nerve injury pain), musculoskeletal pain, and pain related to illness. Your physician may refer you to the Pain Management Center because your chronic pain condition has not responded to conventional therapies.

Treatments for acute and chronic pain are generally quite different. In some cases, acute and chronic pain can be stopped or alleviated by a single procedure or series of procedures. Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to pinpoint. Once we have identified the specific factor causing the pain, we may be able to treat it so that the condition no longer occurs. In some patients, the specific factor causing the pain--such as cancer--cannot be changed, but we may be able to reduce the pain or help the patient to better cope with the pain through a combination of medical, psychosocial and rehabilitation techniques.

What is the economic impact of pain?

4 billion work days are lost each year that result in a financial loss to the economy in the amount of $79 billion per year. Aside from the economic impact, the impact to human lives of improperly managed pain is immense.

What are the most common conditions that result in chronic pain?

While there are a multitude of conditions that may lead to chronic pain, we have found the following to be most prevalent in our patients:

  • Back pain
  • Neck pain
  • Muscle Pain (Myalgia)
  • Nerve Pain (Neuralgia)
  • Headaches
  • Post Herpetic Neuralgia (Shingles)
  • Fibromyalgia
  • Osteoarthritis
  • Carpal Tunnel Syndrome
  • Cancer Pain

What are the major issues surrounding pain?

Chronic pain can become so intense and overwhelm the body and mind to such a degree that it can affect all areas of life. People become so afflicted that they often cannot work. Their appetite falls off. Physical activity of any kind is exhausting and may aggravate the pain. Often, the person becomes the victim of a vicious cycle in which total preoccupation with pain leads to irritability and depression. Adding to these ailments is the fatigue sufferers experience from not being able to sleep at night.

In other cases of chronic pain, issues of secondary gain may arise. This may develop when patients associate pain with some form of benefit — as when a sufferer has a coworker help out at work, or a spouse is extra- supportive. In these cases, the sufferer may receive a benefit for not treating the pain effectively.
At the Pain Management Service of Norwalk Hospital, we will work with patients and families to identify the issues related to your pain and work to alleviate them.

When Should a person consult the Pain Management Service?

Patients should consult with a pain management specialist when pain does not improve with ordinary treatments within a reasonable period of time. Pain management should not be viewed as a last resort for chronic pain, but as a first stop on the road to wellness.

If you have pain that is persisting and interfering with your well-being, you should be in touch with your doctor and ultimately with a board-certified pain management specialist.

What happens after I am referred to the Pain Management Service?

The Pain Management Service staff will obtain your medical records, verify your insurance status, and contact you to schedule a consult. Once an evaluation has been performed, the options for treatment will be discussed with you. You are encouraged to ask as many questions as you like. If it is determined that you are not a candidate for a pain management procedure (see below), alternative therapies may be discussed. These may include such things as physical therapy, rehabilitation, support services, or surgical referral.

What is required to be a pain management specialist?

Pain management specialists are M.D.'s who have completed an anesthesiology residency and are board certified in anesthesiology. They have done additional 1-2 years of training at a pain center and have completed a fellowship in pain medicine. They then must pass the boards in pain management to become board-certified in pain management.

What are some of the procedures performed by the Pain Management Service?

  • Epidural steroid injections in the cervical, thoracic and lumbar regions.
  • Transforaminal steroid injections in all spinal regions.
  • Facet Joint Injection
  • Lumbar Provocative Discography
  • Pulsed Radiofrequency Neuroablation.
  • Sympathetic plexus blockade.
  • Intrathecal catheter placement for trials

How does the doctor know where to perform the procedure?

The vast majority of procedures will be done with fluoroscopy, which is low intensity Xray which shows your doctor the bony structures he or she needs to place the needles. Once the needle is in the correct position, a small amount of dye will be injected to outline the structures to be blocked. At this point, the medication will be injected.

What medications are most commonly used to manage pain?

The drug therapy for each patient is individual. The most common drugs are as follows:drug therapies differ for each person, the most common are:

  • Opiates (narcotics) - examples are codeine, hydrocodone (Vicodin), Oxycodone (Percocet), Morphine, Dilaudid, Methadone. They are commonly used to treat acute pain and cancer-related pain, but are sometimes used in chronic non-cancer pain syndromes.
  • Anti-inflammatory drugs (NSAIDS) - there are a huge number of these drugs, but the ones most familiar to patients are ibuprofen (Advil or Motrin) and Naproxyn (Aleve or Naprosyn). The newer COX-2 inhibitors (e.g. Vioxx and Celebrex) are NSAIDS without the gastrointestinal and blood- thinning side-effects.
  • Adjuvant pain medications, including: antidepressants (often used for their beneficial effects on irritated nerves rather than their anti-depressant effects) , anticonvulsants (same rationale as with the antidepressants) and muscle relaxants.

Can I get addicted to the pain medications?

If you are taking pain medicine for acute pain, such as for surgery, and will only be taking it for a short time, the answer is no. If you are taking pain medicine for chronic pain, the risk is very low, but read on to clarify some misconceptions the public has about addiction and pain medicine.

There is much confusion between the concepts of addiction and physical dependence. Physicians and addiction experts define addiction as the compulsive use of a substance despite ongoing negative consequences. The problem the addict faces is overcoming the psychologic drive to get high and return to the drug.

This psychologic drive is absent in the chronic pain patient (unless it was there before treatment began). And this psychologic drive to get high is not put there by the use of opiates to treat severe pain.

So the bottom line is that it is extremely rare for patients with legitimate chronic pain to become addicts. What does occur with long-term use is what is called physical dependence. If the drug is stopped, the patient has unpleasant side-effects (nausea, cramping, muscle aches). These symptoms are treatable, and the unpleasant period is over in a few days. This physical discomfort does not make the chronic pain patient return to the drug, because there is NO psychologic urge to get high. There is no addiction.

Many drugs cause physical dependence. Certain high-blood pressure medications, beta-blockers, nasal decongestants are just a few examples. Withdrawing from these can be quite unpleasant, but there is no urge to return to them because of this. The same is true of opiates used for the treatment of pain.

Is pain management covered by health insurance?

Most policies provide for pain management. Please call our office for more information, 203-852-3141

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