Medical Section: New and Exciting Strategies for Treating Chronic Pain
Author: John P. Batson | Photographer: John Brackett
Chronic pain affecting the low back and joints is one of the most common complaints seen by physicians. As compared to acute problems causing pain (such as a sprained ankle), chronic pain affects many aspects of patients’ lives. Chronic pain can interfere with work, relationships, sleep, sports and exercises. Many patients find little help with prescription medications, physical therapy, steroid injections and other basic treatments. We are excited to have some new and alternative treatment modalities which may help patients with problematic chronic pain.
• RADIO WAVES AND ELECTRIC SIGNALS TREATING LOW BACK PAIN. Arthritis of the spine is a very common complaint in patients. We can use an x-ray machine to safely inject the joints of the spine. If these injections help, but not long term, a new procedure called radiofrequency ablation (RFA) can treat the pain for a longer period of time. During the RFA procedure, small probes which generate high frequency radio waves are used to burn the nerves which transmit arthritis pain signals. RFA can be used to treat the arthritis pain for on average 6-18 months and can be repeated if needed. Another new treatment option for patients with chronic back related pain is a device called a spinal cord stimulator. This is like a pacemaker, which sends an electric signal to the spinal cord and interferes with pain signals traveling to the brain.The great aspect of this procedure is that we perform a trial or “test run” as an office-based procedure. Patients live with the small wire inserted in the epidural space for four to five days and truly are able to experience what the implanted device would feel like treating their pain. If the trial is a success, the stimulator can be placed as a same-day surgery with minimal down time. Spinal cord stimulators work particularly well for chronic nerve related pain.
NEWER ULTRASOUND MACHINES ALLOW US TO SEE THESE STRUCTURES IN REAL TIME. WE CAN SEE FLUID IN A KNEE OR TEARS IN A ROTATOR CUFF.
• ULTRASOUND GUIDED INJECTIONS. Ultrasound is not a new procedure in medicine, but the technology has evolved, and there are many new uses for ultrasound, including orthopaedic medicine. In the past we would inject joints, tendons, and bursa based on our anatomy knowledge. Newer ultrasound machines allow us to see these structures in real time. We can see fluid in a knee or tears in a rotator cuff, for example. Under the guidance of ultrasound, we can actually see the needle being inserted into a structure we are targeting. Sensitive structures such as arteries can be seen and avoided during procedures. We can even target nerves to help with problems such as carpal tunnel syndrome. The use of ultrasound in my practice allows me to be more accurate, safer and more effective with procedures. On top of this, the procedures are less painful for patients, because we see where we are placing needles and see sensitive structures we want to avoid.
• ORTHOBIOLOGIC INJECTIONS. We are now offering two new treatment options for patients with chronic conditions such as tennis elbow, plantar fasciitis and rotator cuff tendon problems. Prolotherapy is a technique by which we inject dextrose (sugar solution) into these painful areas. The dextrose is a mild irritant to the area, which induces micro-inflammation and thus encourages new blood flow and healing. The prolotherapy injection is not particularly painful, and there is minimal downtime after the procedure. The second treatment option is called Platelet Rich Plasma (PRP) treatment. During this procedure, we draw some blood from a vein. The blood is placed in a centrifuge and spun down. The platelets are then removed. Platelets are your blood cells which have a lot of healing properties. This high concentrate platelet solution is then injected where the problem is in an effort to induce some healing.
Prolotherapy and PRP are very safe and have little downside to try when treating chronic pain. Some research has even shown PRP may be helpful with milder arthritis conditions.
These are just a few examples of what is new in the field of pain medicine and sports medicine. It is great to have more than a steroid shot to offer patients with chronic pain. The above modalities are often used in combination with physical therapy, nutrition and fitness to optimize the patient’s health and healing capacity. The best strategy to avoid chronic pain is to seek out medical attention early on if you are having pain in the spine or a joint. The longer patients have pain, the more challenging it can be to treat.
For more information, call Lowcountry Spine & Sport at (843) 208-2420 or visit online at spineandsportmd.com.