FAQ Category: Pain

Radiofrequency denervation is a minimally invasive procedure aimed at cutting the nerve to the facet (spinal) joint that’s generating the pain signals. High heat delivered with a special probe (electrode) is used to burn through the nerve, cutting off sensory (pain) signals to the brain.

It gives short-term (six to nine months) pain relief. During that time, patients are able to reduce how much pain medication they take and increase their activity level. Combined with an exercise program, you may experience less disability and a better sense of well-being. Many patients who were unable to work at all before the procedure are able to return to their jobs at least on a part-time basis.

The treatment helps save money spent on pain relievers. At the same time, for those patients who are able to get back to work, their earning potential increases. Those two factors make this a cost-effective treatment for many people.

So besides pain relief, patients report increased activity, decreased disability, improved quality of life, and more money in the pocket.

Surgeons commonly use radiofrequency (heat) energy to cut small sensory nerves around the facet (spinal) joints that are causing patients’ low back pain. The procedure is called a radiofrequency denervation (RFD).

patients are carefully selected for this treatment. The pain generating spinal structure must be proven to be the facet joint. Facet joints can be identified as the primary cause of back pain by using fluoroscopic-guided nerve blocks. In this procedure, the surgeon uses special imaging (fluoroscopy) that allows him or her to see inside the body.

A local anesthetic (numbing agent) is injected around the nerve of the suspected facet joint. If more than 50 per cent of the patient’s pain is relieved, the test is considered positive. A positive test means that the facet joint tested is causing the low back pain. The diagnostic facet joint block may be repeated a second time with the same results before patients are treated with radiofrequency denervation.

Once the bothersome facet joint is identified, then radiofrequency denervation can be done. The irritated nerve causing chronic pain signals is burned for 90 seconds at a high temperature (around 175-degrees Fahrenheit). A special probe is used to burn the nerve in three separate places. The result is to completely denervate (cut) the nerve and interrupt pain messages.

The fact that you are worried about potential abuse and addiction is a good sign. Physicians are also concerned about potential serious adverse effects of narcotic (opioid) medications. That’s why they rely on guidelines for the long-term use of opioid therapy. The target patients are those like yourself who have chronic noncancer pain (CNCP).

Recent studies have shown that although concerns about opioid use are important, it’s also true that most patients are able to take these medications without problems. This information has helped open up the use of opioids for chronic pain patients who might otherwise suffer needlessly.

There are several tools doctors use in assessing and monitoring patients taking these potentially addictive medications. The first is the Screener and Opioid Assessment for Patients with Pain (SOAPP). This brief questionnaire helps physicians determine how much monitoring a patient might need who is on long-term opioid therapy.

The second is the Opioid Risk Tool (ORT). Five measures are used to determine a low, moderate, or high risk of problems using opioids. Factors such as personal and family history of substance use, age, history of sexual abuse, and psychological disease contribute to the risk of opioid abuse or misuse.

Once it looks like you are a good candidate for opioid therapy, then it’s important for the physician to monitor pain management. There are several monitoring tools available to help with this. These tools help the physician determine the risk-to-benefit ratio for each patient. In other words, do the benefits outweigh the risks enough to continue with the drug?

The Pain Assessment and Documentation Tool (PADT) keeps track of pain relief, activity level, and adverse effects of the medications. This checklist also helps the physician (or other health care professional) observe and make note of any potential drug-related behavior.

Another similar monitoring tool is the Current Opioid Misuse Measure (COMM). The COMM is a quick and easy patient self-assessment tool. Patients can still fudge their answers on this survey if they choose to do so. It is designed to be used to see if changes in the treatment plan are needed but it does require the patient’s honesty.

Pain management with chronic opioid therapy (COT) requires patient participation and responsibility. Patients must understand that COT rarely provides total pain relief. And it’s only one part of a total pain management plan that also includes diet, exercise, behavioral counseling, and stress management.

If you follow your doctor’s recommendations, notify him or her of any side effects, and keep all of your follow-up appointments, you are likely to be one of the many patients who have a safe and effective experience with these medications.

Medical treatment for sacroiliac joint (SIJ) pain has been less than successful. Doctors have tried injecting the joint with a numbing agent and even fusing the joint in severe cases. A new treatment under investigation may change that. New water-cooled radiofrequency technology has been shown very effective in preliminary studies.

The research is being done at the well-known Johns Hopkins School of Medicine in Baltimore. The first study in a series compared two groups of patients. The first group was the treatment group. The second group was the control group. They all received one injection of a numbing agent directly into the SIJ. This type of nerve block has been used to diagnose and treat SIJ in the past.

Then for the treatment group, the surgeon used a radiofrequency probe to cut sensory nerves to the SIJ. The procedure is called denervation. The control group had a placebo denervation. Results were compared between the two groups. Measures of effectiveness included pain relief and improved function. Patients had to have more than 50 per cent improvement in both areas. Otherwise, a less than 50 per cent improvement would be no better than chance if they did or did not improve.

The treatment group had major improvements in all areas compared with the placebo group. And a significant number of patients in the treatment group still had positive benefits six months later. Results in the placebo group only lasted 30-days.

The short-term effects observed are typical in a placebo group. The patients think they had a beneficial treatment. They respond favorably (mind over matter), but the results don’t necessarily last because nothing was really done to change the problem.

This first study was just a start. It’s not really a treatment everyone will try just yet. Because it was done with a small number of patients (28 total), a second study is needed to prove the results weren’t just a fluke. The second study (by the same researchers at Johns Hopkins) with 150 patients is underway. Besides showing the benefit of this treatment, the authors will also try to narrow down which patients are most likely to respond to radiofrequency denervation for their SIJ pain.

Nerves that innervate or tell a muscle or joint what to do can be divided into two types: sensory or motor. Sensory nerves conduct messages to the brain to tell it what’s going on in the muscle or the joint. Is there pain or a change in the position or pressure within the area? The sensory nerve picks up information from sensitive receptors and relays it to the brain. Pain is a common message carried by sensory nerves.

The motor branch of a nerve is responsible for taking messages from the brain to the joint or muscle and using that information to tell the structures to move. In the case of a nerve block, a numbing agent like novacaine (usually lidocaine is used) is injected into the joint. This local anesthetic blocks messages from the sensory nerve to the brain. It is one way to effectively cut off pain generated from that area.

Nerve blocks are temporary. In other words, like novacaine used in the dentist’s office to numb your gums, the numbing effects don’t last. Once the nerve block wears off, there is a chance the pain will still be there. But usually, in the case of something like chronic sacroiliac joint pain, the pain cycle has been broken and the pain is gone.

Sometimes, it takes two injections to get the full benefit. When those two injections are helpful but don’t provide complete (or strong enough) relief, then it may be necessary to cut the sensory nerve. Cutting the nerve is called denervation. The nerve will eventually grow back, but at such a slow pace, the original pain message will be long forgotten.

Motor nerves are not usually blocked or cut. They do not relay pain messages and disrupting these nerves will alter movement and function.

Studies are being done all over the world with the goal of improving the lives of many people who are living with chronic pain. Some of the studies involve medications, some different types of treatments, and some look at how patients act or react to pain. All these studies provide some sort of insight into chronic pain.

Whether a person should participate in a study is an individual choice. Many people participate because they feel that they have used up all other options when it comes to managing their pain. Others do it because they like the idea of helping researchers, and yet others participate because they figure that it can’t hurt and may help.

If you want to participate in a study, you should think about the time investment on you to see if you’re willing to do the trips to the study center, fill out forms, or answer phone calls. You must look to see how long the study will go on for to see if you can make a commitment to stay with it for that period of time, barring any unforeseen circumstances. Once you’ve decided that you do want to participate in the study, the study staff will then have to see if you’re a good candidate.

Most studies have very strict entry requirements. These are necessary so that other illnesses or problems won’t interfere with the study findings at the end. Therefore, there will be a questionnaire that asks many things about your medical history, but also your social and demographic information. If you fit into the study that way, then you’ll likely have a physical exam, tests, and so on to – again – see if you qualify for the study. If you do, then you’re accepted.

If you really want to be part of a study and are refused, don’t give up hope. Other studies are likely coming down the pipeline and their requirements may be different than those of the one that refused you.

Unintentional drug overdose can be a major problem when treating chronic back pain. Patients aren’t always honest about their pain levels or the amount of medication they are taking. Sometimes they go doctor shopping. This refers to a pattern of going from doctor to doctor getting multiple prescriptions for the same type of drugs.

In other cases, they get prescription drugs from other people. Getting drugs prescribed for others is called drug diversion. Many unintentional drug overdoses involve multiple drugs and intoxicants such as alcohol.

Doctors do try to limit and monitor opiate drug use. Sometimes it’s a fine line. They know these drugs have a positive, beneficial effect for pain sufferers. They also know some people are more susceptible to addiction, abuse, and overdose. The problem is there isn’t a neat equation to use when figuring out who might be likely to engage in these behaviors.

There are some guidelines physicians can use when prescribing and monitoring long-term use of opioid medications for chronic pain. These include: taking an alcohol and other drug use history with each patient. Provide regular follow-up visits, which include reevaluating opioid use and dosage. Require urine samples for drug testing before renewing each drug prescription. Some physicians use a written contract with each patient. The contract is reviewed each time the drug is renewed.

Prescription opiates (narcotic drugs) have been dispensed much more freely in the last few years. Part of this is because research has shown that not everyone automatically becomes a drug addict taking these medications. Many people with chronic pain are helped.

And so far, there’s no way to know who will do well taking these medications and who will have problems with drug abuse, overdose, and even unintentional death. A history of alcohol or other drug abuse is certainly a red flag. Physicians are advised to conduct a drug history before prescribing these powerful medications.

Many patients are given opioids but not in a way that will control their pain. The fear of addiction results in inadequate dosing and drug searching on the part of the patient. They may turn to other pain relievers such as alcohol or ask friends and family to share their medications with them. This type of behavior can be limited or avoided altogether with proper medical treatment.

Pain relievers should be combined with behavioral counseling, exercise, and other pain management tools. Physicians try to select patients who seem best suited for opioid therapy. But research hasn’t shown us yet just what kind of personal characteristics might point to or predict opioid abuse and misuse.

Patient-centered pain management is an important part of every health care professional’s working day. Dentists, doctors, nurses, physical and occupational therapists, and pharmacists address patient concerns about pain each and every day.

Pre-licensure programs to prepare health care professionals are often limited and lacking in their instruction in this area. Students need a core group of classes in order to become more knowledgeable in the area of pain management. They need guidance in understanding how to talk with patients about their pain and work together with other team members to help patients manage their pain.

The University of Toronto has spent the last six years perfecting an instructional program to accomplish this task. They have published the results of their work and hope to see other programs use this same model (or develop their own curriculum).

The material is covered in one three-and-a-half day period of time. The method of instruction is not just lecture, but also patient cases, large group sessions, and small interprofessional student learning groups. Efforts are made to help students understand the physiology of pain while also seeing the personal side of it from the patient’s point-of-view living with chronic pain.

All kinds of pain types are included such as acute pain, chronic pain, pain in children and teens, cancer pain, arthritis pain, phantom pain after amputation, and other types of neuropathic (nerve) pain. Students are taught how to assess and manage pain. There is an emphasis on a team approach. Topics covered vary a bit from year to year based on current research and evidence from published studies.

It’s possible your health care providers have not had such a comprehensive program to teach them how to approach each patient. It’s also possible that your providers are on the right track but you need some more information about their approach and what you can expect. Don’t hesitate to bring up your concerns and ask questions. It may be that a one-on-one conversation about your particular situation will clear up all your concerns.

What you are describing is a situation where pain and other symptoms last beyond the expected time for healing. After four years, it’s safe to say this kind of clinical presentation can be labeled as chronic pain.

Newer research over the last 10 years has shown that some people catastrophize their symptoms. This means they stay focused on their pain (sometimes obsessively and in detail). They develop helpless behaviors. This means they believe they can no longer engage in activities and function because of their pain.

At least one study has linked elevated cytokines with catastrophizing. Cytokines are signaling molecules used in cellular communication. People who catastrophized had higher levels of interleukin-6 (IL-6), a specific type of cytokine. The results suggest that mental and emotional responses during pain experiences can lead to inflammatory immune responses. And using scores from a tool called the Pain Catastrophizing Scale might be a way to predict IL-6 reactivity.

The authors of that study conclude that in some people, pain appears to cause a release of extra proinflammatory messengers that turn up the nervous system’s sensitivity. The result is an amplified (louder) broadcast of pain messages to the brain. So, we know there may be an inflammatory response as the main mechanism by which catastrophizing shapes pain responses. But we still don’t know the exact way in which catastrophizing turns on the cascade of steps leading to inflammation.

Clearly, there is a link between psychologic processes and central pain processing. Screening patients for catastrophizing might help identify patients at risk for this immune-based pain response. The next step is finding a way to turn it down or off to prevent a chronic pain response from developing. Your friend might be able to benefit from the results of that last type of treatment if and when it comes available.

Fearful patients may engage in behavior called catastrophizing. This refers to a person who feels helpless and tends to think the worst when in pain. They seem unable to cope, and they focus on their symptoms in detail.

It turns out that these folks are more likely to become chronic pain patients after surgery or in association with conditions like fibromyalgia or low back pain. And researchers are making headway in figuring out what’s the mechanism behind the behavior and the physiologic response.

Some experts have suggested catastrophizing might enhance or turn up the pain barometer. There may be social or emotional factors. There might be a specific neural (nerve) pathway that gets turned on. Or, as the results of a recent study showed, there could be an inflammatory process at the heart of the problem.

In that study, people who catastrophized had higher levels of an inflammatory messenger called interleukin-6 or IL-6. The results of blood tests measuring cortisol and IL-6 after painful stimuli suggest that mental and emotional responses during pain experiences can lead to inflammatory immune responses. This sets up a cycle of inflammation, pain, and further catastrophizing.

So your easy-going patients may very well have an easier recovery while the fearful folks are at increased risk for chronic pain after a physical trauma or injury (including surgery).

When reading the newspaper, browsing the Internet, or watching the news, we are often told about a new study that found X,Y and Z. A while later, it seems that another story is saying the opposite and that the second group of researchers really found A, B, and C instead.

It can be frustrating to read these seemingly opposite findings, but there are many issues that come into play in a study. First, we have to look at the size of the study group. A small study, of 15 or 20 people, for example, can have a higher false finding rate than a study of 1500 people. The parameters used can also make a big difference. Were the researchers really looking for the same thing, or did they stumble upon a finding and think that it would make interesting news?

If we have a study that says eating chocolate caused cancer in 20 out of 30 people, a much larger study done a year later may find that only 20 of their 1000 people got cancer. So, which study is right? The one with the fewer people that included the 20 unlucky people or the larger study in which there were only 20 unlucky people.

The only way to back up this type of information is to have repeat trials, mimicking the same type of surroundings and issues. This is why it often seems that too many researchers are looking at the same things. This is to back up previously learned information to see if it can be duplicated. If it can be duplicated, we’re closer to learning what is right.

Many people with chronic pain do well with certain types of antidepressant medications. That being said, not all chronic pain can be treated in this way. There are also a few different types of antidepressants that work so it may be helpful if your mother asked if there could be another one to try.

In many cases, people do take both medications to relieve pain and antidepressants, but what a person can take and in what combinations can only be determined by their doctor. Depending on what is causing the chronic pain and the person’s overall health, certain medications may not be appropriate. The best thing is to talk with your mother’s doctor and see what options she has.

While it may seem ideal to not feel any pain, we need pain in order to survive. Pain is a warning signal and a danger signal. As you approach fire, you may end up burning your hand if you get too close. If you don’t feel the burn, it’s possible that it is a severe burn and then this burn can become infected, causing much worse problems and perhaps even death.

We feel pain inside when there is something wrong. If you have appendicitis and don’t feel the pain, the appendix can burst and you can die of infection.

It is rare to not feel pain, but to not feel pain is not the picnic that many think it may be.

Although doctors don’t quite understand the mechanism of pain, they do know that it is a protective thing. By feeling pain, you will protect yourself from what is causing it, whether it be a hot stove, stepping on glass, or getting blisters on your feet.

Pain is unpleasant and, if you have chronic pain, you may want to do just about anything to get over it. But if you don’t feel pain, you can end up with some very severe injuries or illnesses.

When it comes to fibromyalgia, there’s more that doctors don’t know than they do know. However, there are many people who are very vibrant, active, intelligent and who hold very demanding jobs before they get sick and are diagnosed with fibromyalgia.

Living in constant pain, having difficulty sleeping, and experiencing all the other issues that come with fibromyalgia can cause some of those cognitive problems. Researchers have found changes in the brains of people who have fibromyalgia, which they believe is caused by the syndrome.

How people perceive pain has been something that researchers have been wondering about for many, many years. It’s not surprising that it’s such a puzzle because even the people with pain themselves don’t always agree on its severity. For example, you can have someone who breaks a bone in their foot and continues to walk. The pain is there but not severe enough to make the person stop. You can have another person with the same break who is in tremendous pain.

People who don’t have pain may underestimate or overestimate the pain that someone else is feeling. Because people who have pain act differently depending on many things, those who are observing you can only rely on their own experiences and what you tell them or show them.

A recent study has shown that if a person tends to fear the worst about their own pain, they will likely overestimate how much pain someone else is in. The same study showed that if the person in pain is a woman, she is given more leeway for the pain. Interestingly, a third finding was the context that the person observed. For example, if you had pain and had to lift an object, if you lifted it awkwardly – away from your body – you would be rated as having more pain than if you lifted the exact same object, but in a safer and easier manner, right next to your body, bending your elbows.

All this to say that people, usually unknowingly, put their own ideas of pain into their perceptions of pain on others.

Pain is very subjective. There has been very likely a time when you’ve hurt yourself and how severe or mild it felt to you was quite different from someone who was watching or helping you. How people feel pain and how others perceive it are often two very different things.

In your mother’s case, there are many issues that may be play. While it is possible that she is “trying to get attention,” but the complex nature of pain may mean it’s more than that. Perhaps while you are visiting, her pain isn’t noticed as much because she is talking to you and thinking of things other than pain. Perhaps she took a pain reliever before you came and it’s worn off by the time you must leave. Perhaps she’s lonely and depressed, two things that have been shown to increase pain, and your departure triggers this.

This is a question that researchers are working on now. Since doctors don’t know what causes complex regional pain syndrome (CRPS), if they can find a connection to other illnesses, they may be able to figure it out. A recent study has found that there may be a connection between asthma and migraines, and CRPS. In both asthma and migraines, there can be swelling inside the body – and doctors are thinking that this may be one of the issues in CRPS as well.

Interestingly, the doctors also noticed that there may be a connection between osteoporosis and menstrual problems, and CRPS, but they don’t know why yet.

At this point, they aren’t saying that if you have a certain illness, you may be at higher risk of developing CRPS, but this is something they are working on.

The idea that psychological issues and psychosocial issues affect how we feel and interpret pain has been researched for quite some time now. Unfortunately, although the idea is there and some research definitely points in the direction of psychology affecting some aspects of pain, there isn’t any hard evidence on many ways that doctors can use this knowledge to treat pain.

The medical community is moving forward on the psychology and pain connection. For example, often patients who are living with chronic pain may be referred to support groups or counselors, in order to find ways to cope better with the pain. Many people catastrophize the pain, making things worse than they may really be. Since this is a reaction that they may not realize they are doing, getting help to notice this and reverse the thought process can help reduce the pain.

Research is continuing and as it continues, doctors will have new ideas to try until the find the right approach for each patient.