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Pain Management

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Medical Author:

Standiford Helm II, MD

Standiford Helm II, MD

Dr. Helm has been practicing interventional pain management since 1982. Dr. Helm is a diplomate of the American Board of Anesthesiology with subspecialty certification in Pain Medicine and of the American Board of Pain Medicine. Dr. Helm is a Fellow of Interventional Pain Practice (FIPP), the only certifying agency which tests the ability to perform interventional pain procedures. Dr. Helm is also an examiner for FIPP.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Introduction to pain management

Pain management can be simple or complex, depending on the cause of the pain. An example of pain that is typically less complex would be nerve root irritation from a herniated disc with pain radiating down the leg. This condition can often be alleviated with an epidural steroid injection and physical therapy. Sometimes, however, the pain does not go away. This can require a wide variety of skills and techniques to treat the pain. These skills and techniques include:

• Interventional procedures
  
  
• Medication management
  
  
• Physical therapy or chiropractic therapy
  
  
• Psychological counseling and support
  
  
• Acupuncture and other alternative therapies; and
• Referral to other medical specialists

All of these skills and services are necessary because pain can involve many aspects of a person's daily life.

How is pain treatment guided?

The treatment of pain is guided by the history of the pain, its intensity, duration, aggravating and relieving conditions, and structures involved in causing the pain. In order for a structure to cause pain, it must have a nerve supply, be susceptible to injury, and stimulation of the structure should cause pain. The concept behind most interventional procedures for treating pain is that there is a specific structure in the body with nerves of sensation that is generating the pain. Pain management has a role in identifying the precise source of the problem and isolating the optimal treatment.

Fluoroscopy is an X-ray guided viewing method. Fluoroscopy is often used to assist the doctor in precisely locating the injection so that the medication reaches the appropriate spot and only the appropriate spot.