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I live in a medium-sized town with two hospitals. One of the hospitals has a pain clinic to help people like me with chronic pain from a back injury. I'm wondering if I went to a larger center would I get more up-to-date treatment? Is it worth looking into?

It may depend on the underlying cause of your problem and what type of treatment you have already received. Larger medical centers often have access to more of the newer treatment techniques. This is especially true for teaching hospitals associated with universities where research is carried out. For example, interventional pain therapies that involve minimally invasive surgical procedures are often only offered by specialists who have advanced training in this area. Fluoroscopy-guided injections can be used to both diagnose and treat some patients. Fluoroscopy is a type of real-time X-ray that allows the physician to see the location and pathway of the needle being used to inject the spine. Injecting the nerve, joint, disc, or other likely cause of the pain with a numbing and antiinflammatory agent helps confirm the diagnosis and treat the problem all at the same time. Fluoroscopy has also made it possible to cut or heat the small sensory nerves that transmit pain signals in order to turn those signals off. The procedure is called a neurotomy. Other fluoroscopic-guided pain procedures include epidurals, adhesiolysis, nerve blocks, and intradiscal electrotherapy. These treatment methods all fall into a category called interventional pain procedures. It's possible that even where you are living these more advanced pain control techniques are available. Not everyone is a candidate for interventional pain therapy. Your doctor is the best one to advise you in this decision. It might be a good time to take a step back and review all that you have done to get control of your pain. Now might be a good time to look for additional ways to step up your pain management program that are available locally.

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