Pain Management

PAIN MANAGEMENT

Acute pain is a pain that is self-limited that usually resolves within a few months, whereas chronic pain is a long-term pain that lasts longer than three to six months.   The most common type of chronic pain is chronic non-cancer pain, which may be due to a variety of disorders such as degenerative diseases of the spine, fibromyalgia, postlaminectomy syndrome, spinal injuries, and a variety of other disorders. 

The spine is composed of superficial supporting structures, which include muscles, ligaments (ligaments connect bone-to-bone), and tendons (tendons connect muscle-to-bone), which provide over 80-90% of the biomechanical strength of the spine.  Thus professional athletes strive to increase the strength of their paraspinal muscles, ligaments, and tendons since this provides over 80-90% of the strength of the spine in order to prevent deeper injuries such as ruptured disc, annular tears, aggravation of degenerative discs fractures, and other deeper injuries. Thus most healthcare professionals recommend a step care approach to chronic pain management starting out with an evaluation including history and physical and diagnostic studies.  The least invasive and most conservative form of treatments were tried initially as well as as needed on an ongoing basis to control symptoms.  These treatments include modalities such as chiropractic physical therapy, osteopathic manipulative therapy, daily home exercise programs, healthy lifestyles, sleep hygiene, and other noninvasive treatments such as biofeedback, counseling, yoga, massage, and medication management.

The best exercises are low impact such as swimming and walking.  Also proper body mechanics play a role in maintaining healthy paraspinal muscles, tendons, and ligaments. When lifting stand close to the object and bend at your hips and knees rather than your back and also use proper posture when sitting and sleeping. Ask your physician for referral to a physical therapist, chiropractor or osteopath to help design a specific home exercise program to help with your pain and strengthen your spine.  These are common noninvasive treatments that can help minimize the amount of pain medication to control your symptoms on an ongoing basis and in addition, can be used to treat exacerbations in a noninvasive manner. Lifestyle issues such as proper weight management, smoking cessation, limitation of alcohol and caffeine, maintaining a positive attitude, and having a close contact with your support group and/or family is important as well.  Tobacco products, caffeine, alcohol, excess weight, and a negative attitude can all impair the healing process.

Newer non-opiate-type of pain management medications may be used in your treatment such as analgesics, muscle relaxants, anticonvulsants, sleep enhancers, anti-inflammatories, and even antidepressants (which block pain pathways) can be used in combination to help improve function, control pain.

Remember 80-90% of the strength of the spine is in surrounding, supporting superficial muscles, ligaments, and tendons.  Therefore, you should be as active as tolerated. Remember that the vast majority of the spinal and neurosurgical disorders can be improved and/or stabilized with conservative noninvasive treatment.

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