McLaren Health Care
Pain Management and Treatment

Who Can Benefit?

Pain is unique to each person, so every plan of care is tailored to the patients' needs. Pain Management physicians look not only for a solution to immediate pain, but also for the source of the problem. Individuals typically can benefit from chronic pain management that suffer from:

• Back pain, both upper and lower
• Neck pain
• Joint pain
• Osteoarthritis
• Rheumatoid arthritis
• Headaches
• Cancer pain
• Pain caused by injury
• Chronic pain

How is pain diagnosed?

• Staff consultation. Only the patient can tell the degree of his or her pain, so it is important for staff to determine how the patient perceives pain. Consultation includes: Questions about the pain; how the pain is impacting the patient's everyday activities; the patient's emotional well being; pain diary completed by patient, documenting pain occurrence throughout the day
• Physical examination
• Diagnostic testing such as X-rays, CT scans, MRI scans
• Psychological testing
• Other tests to determine exact location and source

Additional treatments:

Because pain affects individuals in many ways, a treatment plan focuses on the whole person -- body, mind and spirit.

• Nutritional counseling
• Massage therapy
• Stress reduction
• Psychological counseling

Pain Therapies

A complete medical history, physical exam, and diagnostic tests will be used to determine the exact source of your pain and appropriate therapy. Listed are some of our most common pain management therapies.

Bi-Lateral Sacroiliac Injections

Improper body mechanics may cause pain in one or both sides of the lower back. Often, the pain occurs in the sacroiliac joint that lies next to the spine, and connects the sacrum (bone at the bottom of the spine) with the pelvis.

One treatment approach is a sacroiliac joint block. The physician uses a fluoroscope to guide and insert the medication by needle directly into the joint. This treatment can be repeated up to three times in one year, and is usually coupled with physical therapy for mobility and maximum range-of-motion.

Cervical Epidural Injections

Cervical vertebrae are bones that support your neck and head, and form the top part of your spine. The tunnel made by these vertebrae is the spinal canal. The spinal cord runs through the spinal canal, inside a sac called the "dura." Nerves branch off the spinal cord and exit through the vertebrae.

When one of these nerves is under pressure, it may become inflamed and swollen. Head and neck pain can often be felt in the head and arms. To relieve certain types of neck pain, medication is injected into the epidural space. Medication may also be injected near a specific nerve root leaving the spinal canal.

Cortisone Injection

A cortisone injection can relieve pain of inflammation or sprains resulting from sports injuries to arthritis. Cortisone injections directly target the inflamed area. Often, one or more injections can bring lasting relief, and prevent surgery. Injectable cortisone is a type of steroid designed for pain relief.

Facet Joint Injections

Each vertebra in your spine has facets (flat surfaces) that touch where the vertebrae fit together. These form a "facet joint" on each side of the vertebrae. Pain occurs when facet joints in your back or neck become inflamed. A facet joint injection into the inflamed joints can relieve pain and reduce inflammation.

Lumbar Epidural Injection

This procedure is designed to reduce and interrupt the pain cycle for low back and leg pain. The goal is to provide relief so you can continue daily activities. For pain relief, the injection will be in the epidural space. Medication may also be injected directly into the nerve root. The Pain Management Center can help you learn good body mechanics. They can provide back strengthening exercises, and you will be encouraged to walk on a regular basis.

Instraspinal Drug Infusion System

This procedure is designed especially for chronic pain patients. The instraspinal drug infusion system includes a pump that stores and releases prescribed amounts of medication into the spinal canal. The pump is refilled by inserting a needle through the patient's skin, and filling the pump's port. The catheter is a flexible tube that delivers the medication from the pump to the spinal cord.

The pump is surgically placed just underneath the skin, usually in the lower abdominal area. One end of the spinal catheter is inserted through a needle into the spinal canal. The other end is placed under the skin and connected to the pump. Adjustments in dose, rate and timing of medications are made using an external programmer. This allows flexibility to match medication dosage with patient pain relief needs.

Spinal Cord Stimulation

Perhaps you've been dealing with chronic pain in your back, neck, or spine for some time. You may already have tried medications, nerve blocks, physical therapy or surgery. Spinal Cord Stimulation is one treatment for chronic pain. A power source is used to send signals to your spinal cord to block the pain. The power source may be worn outside the body or implanted under the skin on your abdomen or buttocks. The implantable power source is small and will not show under clothing. You may be asked to keep a pain log to ensure relief from this pain control strategy.

Reflex Sympathetic Dystrophy

Reflex Sympathetic Dystrophy results from injury to a nerve, often in the hand or foot. Untreated, RSD can cause pain and weakness and limit use of the injured area. Sprains, cuts or fractures can cause RSD.

Early-stage RSD symptoms include:

• Severe, burning pain
• Touch-sensitive
• Area is swollen and red
• Stiffening of the muscle, affected function and range-of-motion
• Warm and sweaty sensations

Medical treatments may include:

• Oral medications to relieve pain
• Nerve blocks to stop pain signals
• Spinal cord stimulators that send electrical signals to block pain
• Sympathectomy to destroy a nerve that causes immobilizing pain

Therapeutic Interventions may include:

• Physical, occupational or hand therapy to improve movement, build strength and reduce pain.
• Desensitization -- different textures rubbed on painful areas.
• Ice or heat to reduce inflammation and swelling.

Trigger Point Injections

One or more tense or inflamed trigger points may cause muscle pain or spasms. Trigger points form when muscles are strained. A trigger point injection can relax the affected muscle and relieve pain. Any muscle in the body can have one or more trigger points. Depending on the number of trigger points, injections may be given over a period of one to two weeks. After the injection, rest and application of ice or heat (as directed by your physician) should bring additional relief.

Banish Your Back Pain

You know you should take care of your back -- after all, you only have one. The back is your ticket to sitting, standing, moving your head, arms and legs. Eighty percent of Americans, according to the National Institutes of Health, will experience back pain at least once in their lifetime. Most back pain is acute, and resolves itself within a few days to weeks. If back pain persists for longer than three months, it's going to last until you see a specialist.

Before your back gets "out of whack", think about following these simple principles and exercises:

Posture

• Keep your body aligned (yes, that means sitting and standing straight). Your body should feel like one vertical line.
• Don't let your muscles tire. Get up and move for a few minutes every hour or so during the day.
• Minimize back strain with ergonomically designed office chairs and footrests. Try to avoid straining your neck with your shoulders and head tilted forward.
• Wear shoes that provide support -- that means out with the high heels and pointed shoes.
• Move with deliberate motion so your back is ready to support your movement.
• Don't bend over for long periods of time, as in gardening. Try a sitting position to do activities that normally require bending over.

Lifting

• Think first about what you're going to lift, how you're going to lift, and the motions needed to transfer the object to its final destination.
• Stand close to what you plan to lift.
• Bend at the hips and knees.
• Hold the object close to your body.
• Press down with your feet, and lift with your legs -- Not Your Back!

Exercises and Body Mechanics

Doing regular stretching and strengthening exercises for the stomach back and leg muscles should be on everyone's daily "to do" list. These exercises require only a mat and a little sweat.

• Pelvic Tilt: Lie on your back with your knees bent and your feet flat. Tighten your stomach and buttocks and gently press your lower back toward the mat. Hold for five seconds. Repeat 10 times.
• Partial Sit-up: Lie on your back with your feet flat, your knees bent, and your arms crossed over your chest. Slowly raise your head and shoulders off the mat. Hold for five seconds. Repeat 10 times.
• Back Stretch: Lie on the back, hands above your head. Bend knees and keep your feet on the floor. Roll your knees to one side, slowly, Stay on one side for 10 seconds. Repeat three times on each side.
• Deep Lounge: Kneel on one knee, the other foot in front, flat and in line with your back foot. Lift the back knee up, looking forward. Hold for five seconds and repeat three times on each side.
• One Leg Stand: Steady yourself with one hand on a wall for support. Bend one leg up behind you. Hold your foot for 10 seconds, and repeat three times each side.
• Knee To Chest: Lie on your back. Bring one knee up and pull it gently into your chest for five seconds. Repeat for up to five times each side.
• Back Stabilizer: Kneel on all fours with your back straight. Tighten your stomach. Keep your back straight, and raise one arm in front of you and hold for 10 seconds. Do not rotate your body. Repeat 10 times each arm. You can also do this exercise raising a leg instead of the arm.

Note: Before starting these exercises, consult your physician or specialist.