neck pain

What Types of Patients Do Pain Doctors Treat?

/ Thomas Cohn, MD

MN Pain Doctor patientsFinding the right care for each individual patient who is dealing with chronic pain can be difficult. If a patient has ongoing difficulties with pain symptoms, additional medical expertise is often helpful with symptom management. The comprehensive Pain Care program at CDI is designed to help manage these complex and difficult problems.

Pain Management at CDI

The Pain Care program at CDI will see any patient who has ongoing problems with pain. The program is run by a Board Certified Physical Medicine and Rehabilitation specialists with subspecialty training in Pain. We are available to help evaluate and diagnose medical problems that are causing ongoing pain symptoms in any region of the body. Common problems that we usually see include patients with:

  • neck pain
  • headaches
  • joint pain
  • neuropathy
  • low back pain
  • mid back pain
  • multilevel pain problems.

The goal is to develop an individualized comprehensive treatment plan to better control symptoms on a conservative basis. Early management of pain problems often leads to solutions that completely solve the issues.

Treating Pain Problems

A typical low back pain patient may have muscles strains, disc issues, nerve irritation, lumbar facet joint pain, or even pelvic problems. A comprehensive evaluation and examination often leads to an appropriate diagnosis and a number of treatment options. A Physiatrist can work with a patient to complete further testing, and if necessary, assist with physical therapy, medication, and interventions to overcome the medical problems causing low back pain. Muscle strains for instance may only need physical therapy and appropriate short-term medications. Lumbar facet joint problems cause axial low back pain and may benefit from a combination of injections, radio-frequency neurolysis/lesioning, and physical therapy. Depending on the diagnosis, a comprehensive treatment plan with the available options for management can be discussed and implemented with the patient.

Neck pain issues often cause headaches and can be treated with a number of conservative interventions. The Pain Care team can help diagnose and develop a comprehensive management strategy. One common problem causing headaches is irritation of the cervical facets, and this often occurs after trauma, especially motor vehicle accidents. This pain is often known as a whiplash injury. It often resolves with conservative physical therapy and short-term medication, but about 10% of cases require more intense intervention. These patients are often helped with injections and sometimes radio-frequency lesioning of nerves in the neck. Successful management often cures the problems for a prolonged time.

Pain is a complex problems, and every patient is unique with their own set of important issues. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, having the skills of a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient.  Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new field.  At CDI we have recognized the need to provide a more comprehensive service to help with the management of these complex and difficult patients. With a comprehensive approach to the evaluation and management of these patients by a Physiatrist, we hope to bring a successful approach to resolving these difficult problems within the community. At CDI we hope to partner with a community of physicians to better serve these patients and their providers.

Pain Care: The Benefits of Pain Management

/ Thomas Cohn, MD

Pain Care BenefitsPain is a complex problem with physical and emotional components. It can affect all aspects of a person’s life. When pain is treated early and aggressively, often it can be cured. Sometimes the injury that has caused the pain cannot be completely reversed and the damage needs to be managed on a long-term basis. Medically, we are always looking to find a diagnosis and treatment for every problem. Pain Care is aimed at finding the individualized, comprehensive diagnosis and management plan for a patient’s symptoms and problems.

Pain Care

Pain Care has been developed to take the next step in managing a patient’s symptoms. A new patient will undergo a comprehensive evaluation by a Board Certified specialist in Physical Medicine and Rehabilitation with a subspecialty in Pain Care. These physicians are medical doctors with extensive special training in the musculoskeletal, medical and neurologic systems, which allows them to better diagnose and treat almost any painful condition.  As Physical Medicine doctors, they are the “Family “ physicians coordinating and delivering care to those with pain.

Since pain often is a complex problem, Pain Care is designed to help the patient move forward with management. Every patient is unique with their own set of important problems. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, consulting a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient. Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new medical field, however there are not many providers with the Physical Medicine and Pain specialty skills. Pain is complex and Pain Care is designed to address these issues and bring a solution to the patient and community.

Therapeutic Pillows and Mattresses For Pain

/ Thomas Cohn, MD

Pillow PainPatients often ask me if they should buy a new pillow or mattress to help alleviate their chronic pain. The answered is complex. If your pillow or mattress is worn out, it may need replacing. Many pillows only will last one or two years. Mattresses on the other hand can last 10 or more years depending on the design. Pillows are often not too expensive, while mattresses can be quite costly. Unfortunately, the ideal mattress or pillow will always be a personal choice based on what is comfortable for the individual. There is very little medical research identifying the best pillow or mattress.

The Perfect Pillow

Comfortable pillows are very much a personal preference. Finding the perfect pillow depends on what position you usually sleep in. Some people sleep on their back, while others are more comfortable on their side or stomach. Find a pillow that gives your head support in a neutral position without bending your neck while you sleep.

What’s inside the pillow is also important. Some people prefer feathers, artificial down, or memory foam. The contour of the pillow may or may not be comfortable for each person. Most people need to try a variety of pillows to find their ideal design and comfort.

Magnificent Mattress

A good mattress provides support for the body in a natural position. Ideally, support should be evenly distributed along the whole body in whatever position a person is laying. A traditional mattress often does not supply even support to the body. Extra pillows often can help improve a person’s position in bed. If you lay on your back, a pillow under the knees flattens the spine and may increase the comfort in the low back. People who lay on their side, should try a pillow in between the knees for comfort. A mattress topper made of memory foam may also be helpful to improve comfort and prevent the need to replace a mattress.

The choices for new mattresses are complex. Some people like to have a firm mattress while others prefer a soft mattress. Some mattresses bend to raise the head or the legs. The more features a mattress has, the more expensive it will be. Mattresses that include a memory foam top layer help conform to the body and maintain a neutral position. An adjustable air mattress allows a person to determine the right firmness that is best for their sleep.  A bed that changes position may allow adjustments for the best sleep position for the individual.  Finding the right bed with the right features at the right cost is always a personal choice, and unfortunately, there is not a medically perfect bed, mattress or pillow.

Implantable Pain Control Devices 

/ Thomas Cohn, MD

pain control devicesPain control has become a complex science, and new treatments and technologies are rapidly being developed. It was amazing to see the new scientific leaps that are being made in our knowledge of pain during my visit to the annual pain conference this year. The mechanisms of pain generation, transmission, and perception are all being intensely studied. New chemicals and methods to interfere with the eventual delivery of signals to the brain are being discovered. It is still several years until most of these research findings become part of our practical treatment of pain, but the future looks encouraging for those battling chronic pain.

As I mentioned above, pain management is a complex science. There is usually not a magic solution to control symptoms. Most treatments incorporate tools to help better control pain and optimize a patient’s ability to function. Treatments are to diminish the intensity of pain, not to eliminate all pain. Often a patient has multiple generators of pain signals and a combination of interventions is necessary to best control symptoms. Unlike a simple cut where a Band-Aid or stitches will cure the problem, pain often requires the skills of a Pain Management Specialist to develop an individualized strategy to control symptoms and maximize function.

The Role of IPCDs

Implantable pain control devices (IPCD) are tools employed when simpler strategies are not working. These are tools to use in combination with other treatments to maximize function. They do not totally eliminate pain. Two high technology devices have been developed to be implanted into the body: a spinal cord stimulator, and an implantable intrathecal medication delivery pump.

A spinal cord stimulator is the basic IPCD used to control pain. The spinal cord stimulation acts as a pacemaker that paces out the delivery of sensory signals at the spinal level that prevents pain signals from being delivered to the brain. These devices have been available for over 20 years, and three different companies make competing similar units. Over the last ten years, as technology has improved, so have these stimulators. They are programmed to deliver an electrical signal to the spine from a position in the epidural space. For the right patient, they can be a life saver, as they dramatically increase pain control and often reduce the need for medications.

An intrathecal implantable medication pump is more complex. These pumps deliver medication directly into the spinal fluid. The drugs need to be specially compounded by a pharmacy, and only a limited number of drugs have been used in this fashion. Pumps can deliver medications to receptors that are only accessible by being present in the spinal fluid, and often these same medications do not transfer from the blood to the spine or brain. A lot can go seriously wrong with medication delivery directly to the spine. These are also only effective in highly selective and very motivated patients. Once implanted, the patient is married to the pain clinic and there may be significant additional limitations especially on travel and freedom to be away from the clinic that fills the pump.

Pain is a very complex problem. If your pain is not well controlled, working with an experienced pain physician to develop the correct strategy is necessary. Implantable devices are tools to help control symptoms, but they are complex and not magical solutions. There are new developments in pain control being researched now. A good pain specialist will help find a pathway to a better solution.

Neck Pain – Nerve Irritation, Whiplash, & Muscle Spasms

/ Thomas Cohn, MD

neck pain x-rayThis is part two of our blog mini-series on Neck Pain. You can find the first installment here. Our first post focused on chronic neck pain causes and treatments at a general level. c

Nerve Irritation

Cervical discs in the neck that cause nerve irritation can have both axial pain or pain in the arms.  MRI or CT scans are necessary to see these structures and determine the severity of the changes.  If the changes have been slow degeneration, the body can often adapt to them even if there is severe narrowing where the nerves travel.  Treatment often includes cervical epidural steroid injections to calm spine irritation and inflammation.  Controlling nerve sensitivity can be helped by medications known as neuropathics that include some seizure drugs and antidepressants.  Physical therapy and behavioral health interventions are also beneficial.

Whiplash

Whiplash and cervical facets cause pain from abnormal movement or sensitivity of the joints between each of the cervical vertebra.  Patterns of pain from these joints are fairly specific, and are mostly along the spine from the base of the skull, out to the shoulders, and down through the shoulder blades.  Treatment ranges from heat and ice, massage, manipulation, acupuncture, anti-inflammatory medications, traction and physical therapy, to injections.  Most pain responds to simple things, about 5-10 percent need the more complex treatment such as steroid injections, nerve blocks, and radiofrequency lesioning to prevent pain feedback from the joints.

Muscle Spasms

Muscle spasms of the neck can be primary problems, or secondary to a deeper problem in the spine.  If the spasms are chronic, it is more likely they are due to a deeper structure like the facets or discs, and treating those problems will significantly improve the spasms.  At times, spasms continue despite treating all other problems and pain is chronic. For this type of problem, chronic use of muscle relaxers along with therapy is often necessary.  Botox, which is a medication that is injected into the muscle to partly paralyze it for several months, is also helpful.

Neck pain that is chronic and ongoing is a difficult problem to treat due to its many causes.  A Physical Medicine pain specialist can be especially helpful in the diagnosis and management of the problem.  They often can determine all the factors that are contributing to ongoing issues and develop a comprehensive strategy to manage the symptoms.  Treatment often is not simple, but working with an experienced specialist can help with a successful long-term solution to a frustrating problem.