Pain Management (cont.)
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.
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.
In this Article
- Introduction to pain management
- How is pain treatment guided?
- What are the basic types of pain?
- Nociceptive pain
- Neuropathic pain
- What are other causes of pain?
- Pain FAQs
- Find a local Pain Management Physician in your town
What are other causes of pain?
Other causes of pain include:
- facial pain,
- peripheral nerve pain,
- compression fractures,
- post-herpetic neuralgia,
- piriformis syndrome,
- plantar fasciitis,
- lateral epicondylitis, and
- cancer pain .
Headaches and facial pain, including atypical facial pain and trigeminal neuralgia.
Headaches are a major source of discomfort and lost productivity in the workplace. Many effective treatments exist for persisting headaches, including medication, biofeedback, injections and implants, depending upon the precise type of headache. Botox also provides a useful means of effectively and safely treating headaches.
Atypical facial pain can be debilitating. Often times it can be treated by injections into local nerve tissue (such as the sphenopalatine ganglion).
Trigeminal neuralgia, also called tic douloureux, is a condition that most commonly causes very intense intermittent shooting pain in the face.
Peripheral nerve pain
Peripheral nerve pain, or neuropathy, can be debilitating. It can respond well to simple treatments such a trigger point injections with anesthetic medicines and cryoablation (an office based procedure which involves freezing the nerves). Examples of peripheral nerve pain include intercostal neuralgia, ilioinguinal neuroma, hypogastric neuroma, lateral femoral cutaneous nerve entrapment, interdigital neuroma and related nerve entrapments.
Coccydynia is simply pain in the region on the tailbone, or coccyx. It can result from trauma or arise without apparent cause. The initial treatment is conservative, with oral pain relief medicines (analgesics). Oftentimes, the pain originates in the portion of the nervous system that we have no control of (involuntary or autonomic nervous system) and can respond to either a local anesthetic injection of the head of a nerve called Ganglion Impar, which is located below the coccyx or by medically destroying (ablating) the Ganglion Impar, usually using radiofrequency.
Compression fractures of the bony building blocks (vertebral bodies) are common in the elderly as a result of osteoporosis, or loss of calcium in the bone. With less calcium, the bone becomes weak and can break. Like any fracture, compression fractures hurt. Like any fracture, they are treated by stabilization, in this case, by injecting cement into the bone in a procedure known as a vertebroplasty or kyphoplasty. Vertebroplasty is an effective way to treat the pain of compression fractures. Kyphoplasty uses a balloon to restore height to the compressed vertebral body.
Post herpetic neuralgia (PHN) is a painful condition occurring after a bout of shingles. When we are young, we are almost all exposed to chickenpox, caused by the Herpes Zoster virus. Our immune system controls the virus, but it lives in a dormant state in the spinal cord. When we age, or become ill or stressed, the virus can reactivate and attack the infected nerve and adjacent skin. However, in this second attack, the body usually recognizes the Herpes Zoster virus and contains the pain to a localized area, along the course of one nerve. A patient may have the characteristic blisters, which normally heal. Sometimes, however, the Herpes Zoster virus damages the nerve, causing ongoing nerve pain that persists after the skin blisters from the shingles have healed.
The ideal way to treat the post herpetic neuralgia is to treat it before it sets in. Medications, such as acyclovir (Zovirax), steroids and injections such as sympathetic injections can help prevent the onset of PHN. After the pain is present, injections, local anesthetics, medications [duloxetine (Cymbalta), amitriptyline, (Elavil, Endep)] and pain medications or topical patches can be useful.
Myofasciitis and Torticollis
Myofasciitis (pain in the muscles, whether in the neck or back) often responds to conservative physical therapy treatments (for example, massage and exercise). If the pain persists, trigger point injections can be used. If the trigger point injections provide temporary relief, sometimes Botox injections can help. Botox, which is botulinum toxin, can relax the muscles for six or more months, with long-term relief of pain. It provides a safe, effective treatment for what can otherwise be a difficult, ongoing problem.
Torticollis is spasm of the muscles in the neck, forcing the sufferer to hold his or her neck tilted or rotated to the side. Botox is approved for treatment of this problem.
The piriformis muscle goes from the hip to sacrum (tailbone). It is important in that the sciatic nerve passes through it. Piriformis syndrome is a spasm of the piriformis muscle. When the muscle goes into spasm, it can squeeze the sciatic nerve, causing pain going down the leg. Piriformis syndrome will usually respond to physical therapy. When pain persists, local anesthetic and/or steroid injection can help. If the pain persists, injecting Botox or Myobloc, which are both botulinum toxins, into the muscle can provide effective, safe treatment.
Plantar fasciitis and lateral epicondylitis
Plantar fasciitis (heel pain) and lateral epicondylitis (tennis elbow) are two common pain problems. Treatment starts with conservative options, such as rest, non-steroidal anti-inflammatory medications, steroid injections, over-the counter pain medications, physical therapy and, for heel pain, shoe inserts.
If the pain lasts for more than six months, Extracorporeal Shockwave Treatment is an effective, FDA approved treatment. Extracorporeal shockwave treatment is not recommended for pregnant women, children, anyone with a pacemaker, anyone on anti-coagulant therapy or anyone with a history of bleeding problems.
Cancer pain can arise from many different causes, including the cancer itself, compression of a nerve or other body part, fractures or treatment of the cancer. There are many techniques to assist with treating the various pains from cancer, including medications and injections. In particular, medical destruction of nerve tissue (ablative therapies) and the use of pumps surgically placed into the body to deliver pain medication into the subarachnoid space can be used. Pain pumps deliver medication that is targeted to pain receptors on the spinal cord. The advantage to the cancer patient is chronic pain control with decreased side effects.
Medically reviewed by Joseph Carcione, DO; American Board of Psychiatry and Neurology
"Overview of the treatment of chronic pain"
Chronic Pain/Back Pain
Find tips and advances in treatment.