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Home Healthcare Services Anesthesiology Pain Management Medical Servies and Treatments

Medical Services and Treatments

Conditions

Acute, Chronic, and Cancer Related Pain:

  • Cervical, thoracic and lumbar degenerative disc disease and facet disease
  • Facial pain and trigeminal neuralgia
  • Headaches
  • Herniated discs
  • Lumbosacral and cervical neuritis
  • Myofascial pain
  • Occipital neuralgia
  • Peripheral neuropathies
  • Post laminectomy/failed back surgery syndrome
  • Reflex sympathetic dystrophy, causalgia, complex regional pain syndromes
  • Spinal stenosis, spondylosis and spondylolisthesis
  • Pelvic pain and interstitial cystitis
  • Testalgia
  • Vertebral compression fractures from osteoporosis and cancer

Acute painful conditions:

  • Vertebral compression fractures
  • Post-traumatic pain
  • Post-operative pain

Cancer pain:

  • Head, neck, and oral-pharyngeal cancer
  • Lung cancer
  • Pancreatic and colon cancer
  • Cervical and ovarian cancer
  • Metastatic and bone cancer
  • Post-thoracotomy syndrome
  • Post-mastectomy syndrome

Non-painful conditions

  • Vascular insufficiency and Raynaud's disease
  • Spastic movement disorders resulting from cerebral palsy and central nervous system lesions
  • Hyperhidrosis

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Treatment Options

Services available vary depending on the patient and the condition:

  • Comprehensive physical examination and treatment planning
  • Independent medical evaluations for worker's compensation and legal cases
  • Medication management
  • Acupuncture
  • Botulum Toxin "Botox" injection
  • Headache management
  • Trigeminal ganglion radiofrequency neurolysis
  • Cryo-analgesia
  • Facet blocks and radiofrequency neurolysis
  • Detoxification
  • Diagnostic and therapeutic peripheral nerve blockade
  • Epidural injections (cervical, thoracic, lumbar, caudal)
  • Intrathecal pump placement
  • Joint/bursa injection including knee, hip, shoulder, and sacroiliac joint
  • Kyphoplasty and vertebroplasty for vertebral compression fractures
  • Lysis of epidural adhesions
  • Minimally invasive intervertebral disc decompressive nucleoplasties
  • Neurolytic blocks, including radiofrequency, cryoanalgesic and chemical
  • Patient controlled analgesia (subcutaneous, intravenous, intrathecal, epidural)
  • Peripheral nerve stimulator implantation
  • Radio frequency ablation
  • Selective and diagnostic nerve root injections
  • Spinal cord stimulator trials, placements, and maintenance
  • Sympathetic plexus blockade, including sphenopalatine ganglion, stellate ganglion, paravertebral sympathetic, celiac plexus and superior hypogastric plexus

Long-term management programs include

  • Analysis programming of epidural and subarachnoidspinal drug delivery systems
  • Spinal cord stimulators
  • Cancer pain and symptom management

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Spinal Cord Stimulation

For some patients with chronic pain, spinal cord stimulation provides a safe, effective means of managing pain so that they can return to a more normal lifestyle. Spinal cord stimulation uses low-voltage electrical currents to either block or reduce pain messages from being sent to the brain. Spinal cord stimulation replaces painful areas with a pleasant, tingling feeling. Most patients report a 50-70 percent reduction in pain.

While spinal cord stimulation does not require major surgery, it does involve a minor procedure. The patient is first given a trial for several days to make sure the treatment works well. This is followed by a local anesthetic and usually intravenous sedation. The physician will numb the area of your the patient's back where the lead (a catheter with a series of electrodes at the tip that deliver electrical stimulation) will be inserted near the spinal cord. It will then be determined where the patient feels the gentle stimulation. Optimal position leads to optimal relief.

If the trial shows that this treatment works very well a permanent system is put in place. The electrodes will be replaced, and a pulse generator, a type of battery, will be placed under the skin

After the procedure, the patient is taught how to operate the stimulator system. While strenuous activity should be avoided following the surgery, light exercise is encouraged to build strength.

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Intrathecal Pain Therapy

Intrathecal pain therapy involves the delivery of small, controlled amounts of pain medication directly into the intrathecal space—an area filled with fluid that surrounds the spinal cord. This therapy delivers pain medication directly to the spinal cord and requires significantly lower doses of medication to provide relief.

Infusion of the medication involves the placement of a pump and a catheter inside the body. The pump automatically delivers a controlled amount of medication through a catheter to the intrathecal space around your spinal cord. The exact dosage, rate and timing prescribed by your doctor are entered into the pump using a programmer—a computer-like device that controls the pump's memory. The programmer communicates with the pump via radio signals.

Before committing to a permanent pump placement, the physician will do a catheter trial to make sure this treatment is suited. If the trial is successful, the physician will place the pump. The pump is implanted during a surgical procedure, which is usually followed by a brief hospital stay. After the surgery, the patient should restrict thier activity for six to eight weeks to reduce movement of the catheter.

Helpful Hints for Patients

Realize that many people have pain that bothers them to varying degrees. While pain cannot be eliminated, with specialized treatment and proper self care, it can be can controlled.

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For all pain

  • Maintain proper body weight
  • Do regular stretching and range of motion exercises
  • Eat a balanced diet with minimal processed fats and sugars
  • Do not smoke
  • Maintain a regular sleep pattern

Regarding medications, simple analgesics often relieves pain. For mild to moderate pain, there may be relief from an over-the-counter medicines, such as acetaminophen, aspirin or ibuprofen. For more severe symptoms, prescription medication may be needed. However, as with any treatment for pain, medications will help control, but not eliminate pain.

Remember, the mind plays an important role in how the patient feels pain and responds to illness. Build a life around wellness, not pain or sickness. Remember what you can do rather than what you can't. The more you focus on something other than your body, the less likely you are to be aware of physical discomfort. Talk to your doctor or nurse about ways to make your life healthier.

For pain and swelling in the hands

  • Use helpful devices such as electric can openers or mixers
  • Use the heels of your hands for activities such as turning on faucets
  • Use two hands for lifting
  • Keep your hands open as frequently as possible

For pain, swelling or stiffness in the knees and hips

  • Practice good posture by keeping your head straight, shoulders back and stomach in
  • Wear supportive shoes
  • Try not to sit for long periods of time; get up and move around every 15 minutes
  • Do not kneel; use a stool instead
  • Use elevators instead of stairs
  • Use carts with wheels instead of lifting items
  • Do not sleep with a pillow under your knees; sleep with one pillow under your head

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Frequently Asked Questions

The following are answers to some questions you may have about your visit to the Pain Management Center at Shands Jacksonville.

When is it necessary to seek relief from a pain management professional?

  • If you experience no relief and your functioning is impaired after two consecutive months of therapy
  • If your pain is inconsistent or appears with no apparent pattern
  • If your current therapies provide only temporary pain relief
  • If it appears you are becoming dependent on pain medication
  • If inadequate pain management begins to cause emotional difficulties
  • If your pain continues long after a surgery has been completed or injury has healed

What is the difference between acute and chronic pain?

Acute pain is of a short, limited duration, usually the result of an injury, surgery or medical illness. Acute pain often goes away with the healing process. Chronic pain continues for longer periods of time, sometimes even after the original injury has healed. Treatments for acute and chronic pain are often quite different.

What kind of doctor will I be seeing at the Pain Management Center?

You will be seeing a physician who specializes in pain management. You may also see a physician resident or an Advanced Registered Nurse Practitioner with special interests in pain management, under direct supervision of a physician specializing in pain management.

Can a pain management physician find the cause of my pain?

Pain management physicians are not only experts at treating pain, but can also diagnose the source of pain. They will conduct a thorough physical examination and review your medical records in addition to analyzing the description of your pain.

What are some of the treatments for my pain?

There are many treatments available for pain. The degree of pain varies from person to person, so your treatment plan will be geared to your specific needs. Treatment may include a single approach or a combination of medications, therapies and interventional procedures.

If I require an injection, what does the procedure involve?

If your primary physician or your pain management physician recommends an injection for your pain, it most likely will include local anesthetics and/or anti-inflammatory medications that will be injected around nerves or into joints. These may be used to reduce swelling, irritation, muscle spasms or to temporarily block the nerve carrying the pain message.

Will I be able to drive following an injection?

For procedures that involve an epidural or spinal injection, it is recommended that you not drive for 24 hours following an injection. It is usually a good idea to bring a driver with you to each visit in case you will need injection therapy.

How many injections will I need?

Since every patient's pain experience is different, the answer to this question will vary. Many patients receive a series of injections or can be scheduled to have a single injection spaced at appropriate intervals.

Are injections the only therapy used for the treatment of pain?

No. There are many options for treating pain, including:

  • Behavior modification
  • Manipulation
  • Acupuncture
  • Biofeedback
  • Cryotherapy
  • Electrical stimulation
  • Implantable pain pumps
  • Narcotic and non-narcotic therapy
  • Occupational therapy
  • Physical therapy
  • Spinal cord stimulation
  • Spinal myeloscopy

Will I experience side effects from the injection?

As with any medication, these injections may cause side effects unique to your medical condition. Your pain management physician will discuss the possibility of these side effects with you.

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