Pain can be very difficult to manage, as the treatment varies from patient to patient. Sometimes the treatment path for a patient can be as simple as resting and stretching, or as involved as taking medication or having surgery. Usually, physicians will follow a treatment plan that begins with less invasive therapies and progresses to more invasive solutions depending on the type and severity of pain. Your treatment plan will also depend on how an individual responds to various treatment options.
When it comes to treating pain, there are three levels to consider:
- Level 1 – Basic Pain Therapies
The first level includes conservative treatment options that are non-invasive. - Level 2 – Minimally-Invasive Therapies
The second level of treatment includes low-risk procedures or prescription medications. - Level 3 – Advanced Pain Therapies
If it is not possible to achieve acceptable pain relief with basic or minimally-invasive therapies, more advanced treatment options may be recommended.
Level 1
During the first level of treatment, your pain specialist will offer conservative treatment options. These treatment options may include physical therapy, home exercise programs, and lifestyle modifications. Over the counter anti-inflammatory medications and acetaminophen may be recommended. Basic therapies are the first step designed to lessen pain and improve mobility.
Physical Therapy
A wise person once said, “Motion is lotion and rest is rust.” The goal of physical therapy is to get you moving again in a healthy way. Physical therapists are personal coaches that teach you how to take care of your body and build strength and resilience that helps prevent future pain episodes. Physical therapists help you create a home exercise program that can be maintained long term.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) and acetaminophen
Non-steroidal anti-inflammatory drugs (NSAIDS) are a category of medications that include ibuprofen, naproxen, and meloxicam. These medications can be very effective for pain, but they need to be used with caution. People with kidney problems, stomach ulcers, and taking blood thinners should not use these medications. Discuss with your doctor the risks, benefits, and alternatives to NSAIDS. Acetaminophen should not be used by people with liver problems, and the maximum dose is 3000mg per day.
Level 2
If your pain does not respond to conservative approaches, a second line of therapy may be needed. The therapies offered in the second level can be used in conjunction with level 1 treatment.
Steroid Injections
Steroid or cortisone injections may be used to calm the inflammation causing your pain. Different types of steroid injections may include epidural steroid injections, joint or bursa injections, and nerve injections. By performing targeted injections under ultrasound or x-ray guidance, the safety and effectiveness of these injections is increased.
Trigger Point Injections
Sometimes muscles can spasm causing pain and restricted motion. A trigger point injection is a targeted injection into these painful muscles to help them relax and heal.
Prescription Pain Medications and Opioids
There are many types of prescription medications that treat pain. Some reduce the signaling of overactive nerves. Others alter the nerve transmitters in the brain. Muscle relaxants help reduce muscle spasms. Opioids are a strong pain killer used when other medications have failed. They are often not the first choice of medications because of side effects (drowsiness, itching, nausea, and constipation), the risk of addiction, and issues with tolerance (the body gets used to a certain dose and higher doses are needed for the same effect). Your provider will discuss the risks, benefits, and alternatives to opioids and discuss whether to perform a trial of opioid medications.
Radiofrequency ablation of nerves
Nerves transport pain signals to the brain which can be important for preventing injury and allowing body parts to heal after injury. However, some nerve signaling becomes dysfunctional as there is no ongoing injury to protect or body part in the healing process. When the nerve signaling is no longer serving a purpose and has become disabling and causing distress, there may be benefit to turning off nerve signaling. This can be done with heat treatment procedures called radiofrequency ablation. The most common place for this to be done is in the neck and back.
Intracept
The Intracept Procedure is a same-day procedure performed in an outpatient surgery center. Unlike some major surgeries, the Intracept Procedure is implant-free and preserves the overall structure of the spine. The Intracept Procedure involves heating the basivertebral nerve with a radiofrequency probe to stop it from sending pain signals to the brain.
Level 3
When pain persists after Level 1 and 2 therapies have been tried, your pain specialist may recommend more complex treatment options. Relieving stubborn, chronic pain may take time and patience, and your pain specialist may need to try multiple treatments to find the most effective solution for your unique pain condition.
Spinal Cord Stimulation
Spinal Cord Stimulation (SCS) uses electrical signals to mask the perception of pain traveling from the painful area to the brain. The first step is to perform a 5-to-7-day temporary trial to see if you might benefit from the therapy. If you have significant pain relief and improvement in function, a permanent device can be placed to provide long-lasting pain.
Surgery
Surgical procedures for pain can range from minor outpatient procedures to more invasive procedures with a significant recovery time. Surgery may be the best choice when more conservative therapies have failed and there is a serious structural problem.
