What is Pain Management?

Pain management, or pain medicine, is a growing medical specialty dedicated to treating acute, sub-acute, and chronic pain. The goal of pain medicine is to improve patient’s quality of life and help them return to everyday activities without surgery.

Pain management, also known as pain medicine, draws on many disciplines in science and the healing arts to systematically study pain, its prevention, evaluation, diagnosis and treatment, as well as the rehabilitation of painful disorders.

Bay State Pain Associates treats many different types of pain including complex pain syndromes. Our medical providers work with your referring physician including physical and occupational therapists, oncologist, and psychiatrist or psychologist, to provide effective pain management.

Pain Management for Chronic Back Pain

Pain, especially intractable or chronic pain, used to be something many patients simply had to learn to “live” with. In recent years, however, researchers have learned a great deal about pain and its physiological and psychological basis, leading to pain management treatments that can provide complete or partial pain relief.

Untreated pain can interfere with the healing process by affecting the immune system and leading to other undesirable results. In cases of back pain, discomfort can impede the rehabilitation process by interfering with exercise and increasing the risk of psychological distress.

New Understanding of Chronic Pain

Patients who report continuing pain in the absence of a definitive pathology (an identifiable, anatomical cause of the pain) are sometimes dismissed by health professionals. Even in the absence of such an identifiable cause, however, chronic pain can lead to neurological feedback processes that only serve to worsen the pain and make it more difficult to treat.

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 disease is significant. or (also called nerve pain). Chronic back pain tends to be very difficult to treat, especially in cases involving failed back surgery  neuropathic pain 

The above considerations have led to a proliferation of services available to patients seeking both medical and alternative treatment for back pain.

Pain management is designed to treat chronic pain and allow a person to live a full, enjoyable life. Pain management requires a person’s dedication, commitment, and knowledge in order to achieve the best results. It can be a great alternative to back pain surgery. It’s important to understand the differences between non-invasive non-drug pain management (e.g. exercise), pain management (e.g. pain medications and anti-depressants), and invasive pain management (e.g. injections).

The focus should be on development of self-management skills, along with lifestyle changes and efforts to improve physical and mental health. The plan should include psychological and behavioral therapy.

Treatment Options

Depending on many factors, such as the type of pain and your general health, there are numerous options for treating your pain. Some patients are surprised to learn that a treatment that previously failed to provide relief may be effective when combined with a multi-treatment approach.

Depending on the cause of your pain, a specific plan is developed to try to reduce and manage symptoms. Treatments are specific for each patient, depending on their unique complaints, physical findings, radiological study results, and response to previous injections. We recognize that patients and their pain are different, and as such, approaches may vary

We can classify the most widely used pain management techniques in terms of the degree of intervention they involve:

  1. Noninvasive, non-drug pain management
  2. Noninvasive pharmacologic pain management
  3. Invasive pain management
  • Non-Interventional Pain Management Treatment
  • Noninvasive pharmacologic pain management
  • Interventional Pain Management Treatment
  • Regenerative Medicine Therapy

Non-interventional treatments

exercise
cold therapy
Stretch

If general pain is being experienced, consult with your physician about the following non-surgical treatments:

  • Proper lifting, sitting, sleeping and standing
  • Aerobics and stretching
  • Maintaining a healthy weight

1. Non-invasive Pain Management & Spine Techniques

In general, pain management techniques can be grouped in terms of their invasiveness.

1.1 Non-drug treatments for chronic pain

  • Some, such as physical therapy, are not invasive at all and do not inherently involve the use of medications.
  • Exercise: Light to moderate exercise may help improve blood and oxygen flow to muscles and reduce stress. It may be especially helpful for people with low back pain, arthritis, psychogenic pain, and many others.
  • Heat and/or cold application: Applying heat and/or cold regularly to a sore area via a safe mechanism (such as hot or cold packs that have temperature limits built in to prevent burning or freezing skin) can be very effective for treating many types of pain.
  • Acupuncture: Acupuncture done by a trained therapist can provide relief for all types of chronic pain.
  • Massage: Massage therapy has been shown to be effective for muscle and mechanical pain and may be useful for other kinds of chronic pain as well.

1.2 Psychological and behavioral treatments for chronic pain

    • General mental health and behavioral counseling: Mental health professionals such as psychotherapists, psychologists, and social workers can work with patients. Goals are for the patients to improve coping skills and develop strategies to reduce stress, anxiety, depression, and sleep problems.
    • Cognitive behavioral therapy (CBT): This form of treatment focuses on gaining coping skills, such as how to identify and change negative thoughts and learning relaxation techniques. These, in turn, will help the person gain more control over his or her emotions and moods as well as more control over feelings of pain.
    • Fear-avoidance training: People with chronic pain may avoid movement and activity and not get enough activity due to their fear of re-injury or pain. Treatment includes education, instruction on active pain management techniques, and routine exposure to activities that the patient may have avoided in the past.

Other noninterventional treatments are used as a first step when there are no improvements from basic treatments. These include:

  • Prescription non-opioid medications
  • Prescription painkillers, muscle relaxants, antiseizure drugs, and some antidepressants.
Pain management, or pain medicine, is a growing medical specialty dedicated to treating acute, sub-acute, and chronic pain. The goal of pain medicine is to improve patient’s quality of life and help them return to everyday activities without surgery.
ANTI-INFLAMMATORY

2.Noninvasive pharmacologic pain management treatments for chronic pain

    • Drug treatments for chronic pain
    • Analgesics (pain relievers): The use of pain relievers is the most common method for treating chronic pain. These drugs do not work in all cases, however.
    • Non-narcotic pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, or COX-2 inhibitors may be useful when the pain is mild or moderate. There are many other types of NSAIDs. NSAIDS work by blocking pain near the pain site. Acetaminophen is a non-NSAID pain reliever that works by blocking pain in the brain.
    • Non-narcotic analgesics: Any of these may be prescribed to reduce pain. 
    • Topical products: Over-the-counter creams and ointments containing capsaicin (a substance generating heat) may be applied directly to the skin three to four times per day. Lidocaine (a local anesthetic) creams or patches also can treat chronic pain.
    • Antidepressants: Many chronic pain patients may benefit from taking anti-depressant drugs. This is because the same chemicals linked to depression also play a role in chronic pain. Types of antidepressants prescribed include tricylic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and others.
    • Anticonvulsants (anti-epileptics): These drugs may be used to treat various neuropathic pain conditions. Such conditions include nerve injuries and diabetic nerve pain.
    • Sedatives/anti-anxiety agents: These may be prescribed for short-term treatment of sleep problems including insomnia (sleeplessness).
    • Muscle relaxants.
    • Corticosteroids.
    • Antirheumatics/immunological agents.
    • Botulinum toxins.

3. Interventional pain treatments

Invasive Pain Management Techniques and Spine Treatment

If symptoms do not improve with other methods, your physician may suggest spinal surgery. Surgical solutions for degenerative disc disease and other resultant conditions that may contribute to general back pain, may include:

Invasive techniques in pain management involve injections and/or placement of devices into the body. A multitude of invasive pain management therapies have been used to treat neck and back pain.

Some of the most popular interventional pain management techniques include:

  1. Injections : Epidural, Steriod, RFA
  2. Surgically implanted electrotherapy devices : SCS
  3. Vertiflex Procedure
  • Injections (also known as blocks)

Injections provide direct delivery of steroids or anesthetic into joints, ligaments, muscles, or around nerves. These injections may provide relief of pain (often temporary) and can be used to confirm if the injected structure is the source of the pain, clarifying the diagnosis. 

These are typically outpatient treatment options that can provide long-term pain relief. They are less invasive and have a quicker recovery time than most surgical procedures and are often used when noninterventional treatments fail and invasive surgery is too aggressive.

    • Epidural steroid injections (ESI) or nerve blocks : Cervical Or Lumbar Spine
      Injection of an anesthetic, steroid, and/or anti-inflammatory into the pained area, can provide temporary relief for upper extremity or lower extremity pain due to a pinched nerve in the spine.
      • Cervical Disc Herniation
      • Cervical Facet Syndrome
      • Cervical Radiculopathy
      • Cervical Spondylosis
      • Cervical Sprain-Strain (Whiplash)
      • Cervical Stenosis
      • Lumbar Stenosis
      • Lumbar Spondylolisthesis
      • Lumbar Radiculopathy (Sciatica)
      • Lumbar Disc Herniation
      • Lumbar Degenerative Disc Disease
      • Low back Sprain-Strain
  • Radiofrequency ablation (RFA)
    RFA is a minimally invasive outpatient procedure that uses thermal energy to interrupt pain signals at their source. RFA can be used to treat pain in the back, hips, knees, shoulders, feet, and neck, and can provide months—or even years—of relief. This procedure involves deadening of painful nerves via heat administered through a small needle. In carefully selected patients, this helps in approximately 60% of patients and lasts for months to years. Learn about RFA
  • Spinal cord stimulation (SCS)
    SCS and implantable peripheral nerve stimulators. In general they are more effective for arm and leg pain than they are for localized spine pain. SCS therapy can help manage chronic pain of the lower back and limbs by using mild electrical impulses to interrupt pain signals. Although a minimally invasive treatment, SCS may also be used to help manage pain that is unresolved—or even caused—by more invasive surgical procedures. Learn about SCS
  • Vertiflex™ Procedure
    The Vertiflex Procedure is a unique treatment clinically proven to provide long-term relief from pain associated with lumbar spinal stenosis. Using a simple, safe, and minimally invasive technique, the small device helps relieve pressure on nerves that cause pain in the lower back and legs. Learn about Vertiflex Procedure

Regenerative Medicine Therapy

Pain Management Techniques and Spine Treatment

Regenerative medicine and stem therapies hold potential for significant improvement in pain and function for a select group of patients and conditions.   Full work up including imaging studies, detailed medical history and physical exam, and history of past treatments are needed to determine if regenerative medicine should be considered as a treatment option.

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1. Fluid Flow Amniotic 

Regenerative Medicine

  • Naturally heal and regenerate tissue as needed
  • Activate your body’s healing response
  • Great for treating , Joint Pain, Tendonitis, Fasciitis and Muscle 
    Tears and Sports Injuires

knee pain

  • Proven for treating pain
  • Accelerates the healing process
  • Targeted injection site
 
  • PRP Therapy for Achilles Tendon Pain
  • PRP Therapy for Chronic Back Pain
  • PRP Therapy for Chronic Knee Pain
  • PRP Therapy for Hip Arthritis
  • PRP Therapy for Peroneal Tendonitis
  • PRP Therapy for Plantar Fasciitis
  • PRP Therapy for Shoulder Pain
  • PRP Therapy for Whiplash

3. Bone Marrow Aspirate (BMA)

Pain

  • Reducing the necessity for major surgery
  • A quicker healing process
  • No medication or hospital stays

Patient Pain Evaluation

painOne of our pain management specialists will begin care by reviewing your medical history and evaluating your physical and neurological condition in order to pinpoint the source of your pain.

An in depth discussion of your pain includes its location(s), duration, and intensity. The doctor may ask you to rate your pain on a scale of 0 to 10 with 10 being the worst pain possible. Alternatively, you may be asked to notate on a picture of the front and back of body where you feel pain and designate its type (i.e. burning, sharp) and intensity (1 through 10).

Further evaluation may require a CT scan, MRI, or other imaging study to further evaluate your pain and diagnose its cause. Many types of minimally invasive spinal injections provide valuable diagnostic information such as a Medial Nerve Branch Block.

Is Pain Management Right for You?

Pain is a complex problem that requires treatment and management by a pain medicine specialist. Millions of people suffer from pain every year at great personal cost. According to the American Academy of Pain Medicine, “… pain affects more Americans than diabetes, heart disease and cancer combined.”

If you find that you cannot safely control your pain with over-the-counter medications, or have failed to find relief from other treatments or practitioners, you should consider consulting with a pain management physician. For most patients, interventional pain management procedures can treat or reduce pain, allowing the patients to regain function, and thereby improving their quality of life. This reflects our practice philosophy.

In many ways, Bay State Pain Associates treats similar patients to an interventional spine practice. Our patients commonly present with sciatica, arthritis of the neck or back, or disc pain and obtain good relief and avoid surgery. Bay State Pain Associates  also treats other pain syndromes using interventional procedures.

Our specialists treat complex pain issues. There are many different physical and neurological disorders that contribute to pain, and pain management can provide you more advanced care specifically aimed to control your pain. Examples of pain-causing disorders treated by pain management specialists include:

  • Arthritis of the spine
  • Back and neck pain
  • Cancer pain
  • Cervical (neck) radiculopathy
  • Disc herniation
  • Failed back surgery
  • Occipital headaches, other types of headache Nerve entrapment syndromes
  • Sciatica pain (low back/lumbar radiculopathy)
  • Shingles (post-herpetic neuralgia)
  • Spinal stenosis
  • Trigeminal neuralgia or other facial pain
  • Pudendal neuralgia
  • Vertebral compression fracture

To Learn More

If you are interested in learning how pain management can benefit you, please contact Bay State Pain Associates. We would be happy to make an appointment for a consultation and provide additional information about other treatment options.

Spinal Injections for Pain Management

Procedure Overview

An interventional pain injection, whether it is performed for diagnostic or pain treatment, involves injecting a local anesthetic with or without steroid into an area of inflammation.

Injections can be performed for diagnostic or therapeutic purposes.

  • Diagnostic injections are precise injections used to determine the exact cause of pain, if possible.
  • Therapeutic injections often involve placing a corticosteroid at the source or a cause of pain.

Outcomes Valuable

One of three outcomes can be expected following a spinal injection: no pain relief, temporary pain relief, or longer term pain relief.

  • The outcome helps to identify the predominant cause of pain.
  • When pain is relieved, the patient benefits more fully from physical therapy or chiropractic adjustments.
  • Persistent symptoms may denote the need for additional pain treatment interventions.
  • When surgery is recommended, the surgeon may depend on the results of precise diagnostic injections. Our practice retains a photographic image of each needle placement in our patient records.

Pain Relief

Pain relief varies among patients. Steroids are a very strong anti-inflammatory medication. Thus, if inflammation is a large component of your pain, you should derive some benefit from the injection. The steroid can help the underlying problem heal and whether you will need another injection depends on your body’s ability to correct the underlying disorder. More than one injection may be recommended.

If your injection is a diagnostic injection, the procedure is performed as a precursor to another procedure intended to provide long term relief. To increase the benefits of a diagnostic injection, a steroid medication may be added to provide pain relief after the local anesthetic wears off.

Other treatments may include:

  • Radiofrequency ablation
  • Cryoablation
  • Pulsed radiofrequency ablation
  • Presurgical injections

Pain Management Specialists

Health professionals in many fields have completed specialized training in pain management. Currently, there is no single field of medicine or health care that represents the preferred approach to pain management. Indeed, the premise of pain management is that a highly multidisciplinary approach is essential.

Pain management specialists are most commonly found in the following disciplines:

  • Physiatry (also called Physical medicine and rehabilitation)
  • Anesthesiology
  • Interventional radiology
  • Physical therapy

Specialists in psychology, psychiatry, behavioral science, and other areas may also play an important role in a comprehensive pain management program.

 

Most pain management specialists are seen by referral from a physician. Any patient who feels it is appropriate should consult his or her physician about a pain management program.

Pain management specialists are most often called upon to treat:

  • Severe back pain
  • Challenging chronic pain
  • Failed back surgery syndrome

Patients should keep in mind that there are many varieties of pain management programs to explore. This process can be confusing or frustrating at times, but the important point is to work proactively with one’s health professionals and not to give up if one initially encounters an unsatisfactory result.

While this process 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.

TYPES OF PAIN

  • Show All
  • Abdomen & Pelvic Pain
  • Back, Buttock, & Leg Pain
  • Cancer & Nerve Pain
  • Neck, Shoulder, & Arm Pain
  1. Diabetic Neuoropathy and other
  2. Peripheral Neuropathies
  3. Ilioinguinal Nerve Block
  4. Facial Pain: Supraorbital and
  5. Infraorbital Neuralgia
  6. Piriformis Syndrome
  7. Hip Pain and Osteoarthritis
  8. Pudendal Neuralgia
  9. Chronic Pelvic Pain
  10. Chronic Abdominal Pain
  11. Cervical (Neck) Spine: Pain
  12. Provoking Disorders
  13. Cervical (Neck) Herniated Discs
  14. Frozen Shoulder
  15. Cervical Stenosis
  16. Facet Medial Branch Block to Treat
  17. Cervical (Neck) Spinal Arthritis
  18. Vertebral Compression Fractures
  19. Spondylolisthesis: Vertebral Body Slip
  20. Complex Regional Pain Syndrome (CRPS): Reflex Sympathetic
  21. Dystrophy (RSD)
  22. Meralgia Paresthetica (MP): Outer
  23. Thigh Pain
  24. Lumbar Stenosis
  25. Cervical (Neck) or Lumbar (Low Back) Pain after Spine Surgery
  26. Facet Medial Branch Block to Treat
  27. Lumbar (Low Back) Spinal Arthritis
  28. Lumbar Herniated Disc and Sciatica
  29. Lumbar Degenerative Disc Disease
  30. Cancer Pain
  31. Whiplash: Neck Sprain or Strain
  • Pudendal Neuralgia
  • Chronic Pelvic Pain
  • Chronic Abdominal Pain
  • Vertebral Compression Fractures
  • Spondylolisthesis: Vertebral Body Slip
  • Complex Regional Pain Syndrome (CRPS): Reflex Sympathetic
  • Dystrophy (RSD)
  • Meralgia Paresthetica (MP): Outer
  • Thigh Pain
  • Lumbar Stenosis
  • Cervical (Neck) or Lumbar (Low
  • Back) Pain after Spine Surgery
  • Facet Medial Branch Block to Treat
  • Lumbar (Low Back) Spinal Arthritis
  • Lumbar Herniated Disc and Sciatica
  • Lumbar Degenerative Disc Disease

Diabetic Neuoropathy and other Peripheral Neuropathies
Ilioinguinal Nerve Block
Spondylolisthesis: Vertebral Body Slip
Complex Regional Pain Syndrome (CRPS): 
Meralgia Paresthetica (MP): Outer Thigh  
Cancer Pain

  1. Cervical (Neck) Spine: Pain Provoking Disorders
  2. Cervical (Neck) Herniated Discs
  3. Frozen Shoulder
  4. Cervical Stenosis
  5. Facet Medial Branch Block to Treat Cervical (Neck) Spinal Arthritis
  6. Whiplash: Neck Sprain or Strain
AWARD WINNING CARE
Dr. Algendy has been ranked in the top 10 pain management doctor by Vitals.
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ONGOING PATIENT SUPPORT
At Bay State Pain Management we are always available to take care of your personal needs. We are available through phone, fax, E-Mail, or our patient portal. We don’t send out patients to the ER unless it is a true emergency.
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