Medical Services
Conditions | Treatment Options | Frequently Asked Questions
Conditions
Acute, Chronic, and Cancer Related Pain
- Cervical, thoracic and lumbar degenerative disc disease and facet disease
- Cervical and lumbar facet osteoarthritis
- 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 orcancer
Acute painful conditions
- Post-operative pain
- Post-traumatic pain
- Vertebral compression fractures
Cancer pain
- Cervical and ovarian cancer
- Head, neck and oral-pharyngeal cancer
- Lung cancer
- Metastatic and bone cancer
- Pancreatic and colon cancer
- Post-mastectomy syndrome
- Post-thoracotomy syndrome
Non-painful conditions
- Hyperhidrosis
- Spastic movement disorders resulting from cerebral palsy or central nervous system lesions
- Vascular insufficiency and Raynaud's disease
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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.
Spinal cord stimulation involves 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 the patient's back where the lead (a catheter with a series of electrodes at the tip that delivers 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 the spinal cord. The exact dosage, rate and timing prescribed by the 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.
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 the spinal cord. The exact dosage, rate and timing prescribed by the doctor are entered into the pump using a programmer-a computer-like device that controls the pump's memory. Before committing to a permanent pump placement, the physician will do a catheter trial to make sure this treatment is suitable. 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 their activity for six to eight weeks to reduce movement of the catheter.
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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 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.
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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