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Medical Services and Treatments

Conditions

Conditions treated include:

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

Chronic, non-malignant painful conditions treated include:

  • 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 syndrome
  • Spinal stenosis, spondylosis and spondylolisthesis
  • Pelvic pain and interstitial cystitis
  • Testalgia
  • Vertebral compression fractures from osteoporosis and cancer

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Treatment Options

Services available vary depending on the patient and include:

  • Acupuncture
  • Botulum Toxin "A" injection
  • Comprehensive headache management
  • Cryo-analgesia
  • Cryo-facet block
  • Detoxification
  • Diagnostic peripheral nerve blockade
  • Epidural injections (cervical, thoracic, lumbar, caudal)
  • Epidural systems and management
  • Implantable systems (spinal/epidural)
  • Intrathecal pump placement (see below for more details)
  • Independent medical evaluation for worker's comp and return-to-work issues
  • Joint/bursa injection
  • Kyphoplasty and vertebroplasty for vertebral compression fractures
  • Long-term management programs include:
    • Analysis programming of epidural and subarachnoid drug delivery systems
    • Spinal cord stimulators
    • Cancer pain and symptom management
  • Lysis of epidural adhesions
  • Minimally invasive intervertebral disc decompressive nucleoplasties
  • Narcotic analgesia treatment agreement
  • Narcotic adjunctive therapy
  • Nerve neuroplasty (central and peripheral)
  • Neurolytic blocks, including radiofrequency, cryoanalgesic and chemical
  • Non-narcotic adjunctive therapy
  • Patient controlled analgesia (subcutaneous, intravenous, intrathecal, epidural, intraarticular)
  • Peripheral nerve stimulator implantation
  • Psychiatric evaluation and counseling, neurology, physical therapy, pharmaceutical counseling
  • Radio frequency ablation
  • Selective injections via fluoroscopy
  • Spinal cord stimulation/neuroaugmentation (see below for more details)
  • Spinal endoscopy
  • Sympathetic plexus blockade, including sphenopalatine ganglion, stellate ganglion, paravertebral sympathetic, celiac plexus and superior hypogastric plexus

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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. You will be given a local anesthetic and be awake throughout the process. Your doctor will numb the area of your back where the lead (a catheter with a series of electrodes at the tip that deliver electrical stimulation) will be inserted near your spinal cord. You and your doctor will then determine where you feel the gentle stimulation. Optimal position leads to optimal relief.

The electronic impulses are controlled by a receiver—a flat, round plastic shell that contains a computer chip and connections to the lead. The receiver is implanted just under the skin. It receives radio signals from an external transmitter and sends the information to the electrodes. The transmitter contains the battery and is the source of the stimulation signal. The transmitter can be worn under clothing, on a belt or carried in a pocket.

After the procedure, you will be taught how to operate your 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.

The pump is implanted during a surgical procedure, which is usually followed by a brief hospital stay. After the surgery, your doctor will recommend that you restrict your activity for six to eight weeks to reduce movement of the catheter.

As you begin to feel better and your awareness of the pump lessens, you will be able to enjoy a more normal lifestyle. Follow your doctor's suggestions for exercise, recreation, travel and hobbies.

Helpful Hints for Patients

Medication often relieves low back pain. For mild to moderate pain, you may get relief from an over-the-counter medicine, such as acetaminophen, aspirin or ibuprofen. For more severe symptoms, your doctor may recommend prescription medication.

Heat or cold applied to the back within the first 48 hours of symptoms may help. Apply a cold pack or bag of ice to the area for five to ten minutes at a time. For symptoms that last longer than 48 hours, try a heating pad or hot bath.

Spinal manipulation can be helpful in the early stages of low back pain. It should be done by a professional who uses the hands to apply force to your back to adjust the spine. Check with your doctor before considering this option.

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Reminders

  • When lifting, keep objects close to the body
  • Avoid lifting while twisting, bending forward or reaching
  • Wear comfortable low-heeled shoes
  • Make sure your work surface is a comfortable height for you
  • Use a chair with a good lower back support that reclines slightly
  • If you must sit for long periods of time, try resting your feet on the floor or a low stool.

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

For low back pain

  • Carry small loads; slide or roll larger items instead of lifting them
  • Take frequent rest breaks
  • Avoid reaching and twisting
  • Use your strongest and largest joints and muscles

For neck stiffness and pain

  • Always stand or sit with your head centered over your shoulders
  • Keep your back and neck straight while working
  • Sleep with one pillow to support your neck in a straight position
  • Avoid working with your head bent

Remember, your mind plays an important role in how you feel pain and respond to illness. Build your life around wellness, not pain or sickness. Remind yourself of 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.

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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

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 center?

During surgery, anesthesiologists focus on safely maintaining the vital functions of the body and relieving pain. Techniques used to make surgery painless can be expanded to relieve other types of pain. Anesthesiologists study pain management during a four-year residency. Some receive further education and training to become pain management specialists.

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 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 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?

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. However, many patients receive a series of three injections spaced two weeks apart.

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

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

  • Behavior modification
  • 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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