Pain comes in many forms. Therefore—unsurprisingly—so does pain management. While the details of pain can differ dramatically, patients all have a similar desire to be “heard.” They have a problem and they’re looking for answers.
“Everyone should have a targeted, customized pain management treatment plan,” says Dr. Joseph P. Valenza, director of pain management for Kessler Institute for Pain Rehabilitation. “There are many different reasons why a patient might be dealing with pain as well as many different approaches to treat that pain.”
For Dr. Steven M. Bromley, director, South Jersey MS Center and Bromley Neurology, PC, he is dealing with pain as a symptom of multiple sclerosis (MS), a chronic inflammatory disease that affects the brain, brainstem and spinal cord. Bromley says that MS can result in numerous clinical symptoms including pain.
“Injury in the form of neuronal disconnections from MS plaques can result in ‘confused’ sensory experiences, often considered to be painful,” explains Bromley. “We have all experienced neuropathic pain, such as the experience of leaning on a nerve and having a hand or foot ‘fall asleep.’ However, in patients with MS, where the prevalence of pain is between 40 to 65 percent, this experience can be much less predictable, much more difficult to manage and potentially more disabling.”
Bromley says that MS patients can also have pain from the secondary effects of severe muscle spasms that occur in the limbs and back. Medication is one form of treatment, but as the field rapidly advances, so do the options.
“More recently, the use of cannabinoids (CBD), as found in medical marijuana, has made a tremendous difference with the kind of pain MS patients experience,” he continues. “Alternative or complementary therapies can be very helpful to patients and include modalities such as physical or aquatic therapy, chiropractic manipulation, acupuncture and psychological care.”
Dr. Young J. Lee, board-certified anesthesiologist, board-certified pain specialist and chief executive officer and president of Relievus, a group of pain management doctors, says that the number of routes that can be taken in pain management continues to grow rapidly. Relievus is staying on top of cutting-edge solutions including ketamine infusion therapy for chronic pain or complex regional pain syndrome. Relievus also has a medical marijuana program (MMP) for various diagnoses, including MS. And the group also offers stem cell platelet rich plasma (PRP) therapy which allows for regenerative healing and pain relief through injections of plasma and adult stem cells.
Barriers to Management
With so many different treatment options available today, Valenza says that most patients should be able to get their pain under control. Even so, he acknowledges that there are barriers that stand in the way. These include both cost and specialist availability. The opioid crisis is also a major concern. When talking about pain management it’s virtually impossible to avoid talking about opioids—and it remains a controversial topic.
“I think that when people hear ‘pain management,’ their very first thought is often about opioids—but that is just one modality of treatment,” says Valenza. “And it needs to be said that for some patient populations, medication is OK. Not everyone has an addiction problem—in fact, 91 percent of the population does not. I think we have to be careful when we start limiting medication that some patients need to recover from surgery or deal with short-term pain.”
Dr. James Bailey of Rowan Medicine agrees that opioids are often immediately associated with the field of pain management. But he says they always try to find other alternatives—and generally succeed in doing so.
“Our approach to pain management is very multi-disciplinarian,” Bailey says. “Medication may be something we use in conjunction with manual treatments but typically those that help with nerve pain or muscle tightness are warranted, rather than opioids.”
Recently, Bailey says the office has begun an opioid detox program in response to the epidemic. Patients begin detox therapy and treatment both with medication as well as a psychological approach to getting the addiction under control.
“Oftentimes, just finding that diagnosis— what’s actually causing their pain—can make the biggest difference,” Bailey says. “Identifying the source of the pain rather than just covering it up is so important.”
As mentioned, the answer to pain management is not always a medication or a radical approach. There are a lot of alternative treatment modalities that can reduce or even eliminate pain in a conservative way.
Chiropractic care is one such option. Dr. Michael J. O’Keefe of O’Keefe Chiropractic Center is having lots of success with DTS spinal decompression therapy, the latest advance in chiropractic medicine. This computer-modulated, traction-based system delivers a painless therapy to achieve relief for those suffering from neck, back and sciatic pain. It has been scientifically shown to reduce disc herniation as well.
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Published (and copyrighted) in South Jersey Magazine, Volume 15, Issue 6 (September 2018).
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