What Types of Patients Do Pain Doctors Treat?

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.

5 Rare Types of Headaches & How to Treat Each

cluster headachesHeadaches are a common and painful occurrence. Almost everyone has had a headache at some point in his or her life. We’ve already talked in depth about common headaches like tension and migraine headaches. But there are less common headaches including:

  • Cluster headaches
  • Cervicogenic headaches
  • Giant cell arteritis
  • Subarachnoid hemorrhage
  • Idiopathic intracranial hypertension

These headaches are much more rare and usually diagnosed only by specialists. In this article we will explore the causes of each headache and discuss possible treatment options.

Cervicogenic Headaches

Cervicogenic headaches are a type of tension headache generated from muscle spasms in the neck.  These occur most often after neck injury, commonly a whiplash in a motor vehicle accident or similar type of trauma.  Cervicogenic headaches often improve greatly as trauma heals within one to two months.  Massage, heat, and ice, over the counter medications, chiropractic adjustments, and physical therapy may all be useful.  About 5% of these require more aggressive treatment by a pain specialist including cervical injections.  If the headaches are not resolving, a physical medicine pain specialist can be extremely helpful in coordinating more aggressive management to stabilize or cure symptoms.

Subarachnoid Hemorrhages (SAH)

Subarachnoid hemorrhages (SAH) are very distinct, severe headaches.  Known as thunderclap headaches, they are described as the worst pain you’ve ever experienced in the head.  They occur suddenly, lasting minutes to hours, and almost always send the person to the hospital for treatment due to the severe pain and symptoms.  A CT scan of the head usually shows the bleed, but sometimes lumbar punctures and MRI scans are also needed.  Depending on the severity and cause of the bleed, treatment may require neurosurgical intervention versus supportive care.

Cluster Headaches

Cluster headaches are a rare type of chronic headache.  They are most common in men.  Typically, they consist of one-sided pain, with tearing of the eyes and runny/stuffy nose.  They occur daily for a period of time and then stop, before starting again some time later.  At this time they are thought to be associated with serotonin release and the hypothalamus.  Treatments include avoiding triggers, breathing oxygen, pain and migraine medications.  A neurologist specializing in headaches usually coordinates management.

Giant Cell Arteritis

Giant cell arteritis is an inflammatory condition of the blood vessels in the head.  It affects mainly the elderly, those over 60 years of age.  It is characterized by pain over a blood vessel, often in the temporal region.  Blood tests show signs of inflammation, especially the ESR being very elevated.  Biopsy of the vessel is often done to help make the diagnosis.  Treatment is with steroids, and often it may be necessary to take them a long time.  Not treating the condition can lead to complications like strokes.

Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension, previous known as pseudotumor cerebri, is where there is increased intracranial pressure.  The headache is a dull deep pressure with nausea, vomiting, and visual changes.  It is most commonly seen in young, obese woman.  MRI brain scans looking for other causes of symptoms and lumbar punctures are necessary in the evaluation.  By its name – idiopathic, the cause is unknown.  Treatment may include medications and sometimes requires neurosurgical management.

The above headaches are rare.  Most of them have unusual presentations and send one to see a physician immediately.  A neurologist is most commonly involved in both the diagnosis and management depending on the problem.  When symptoms do not improve despite optimum management, occasionally secondary specialty headache clinics become involved.  Generally, once one of these rare headaches is diagnosed, the treatment is effective.

Have you ever experienced any of these rare headaches? We’d love to hear your story in the comments!