What are the types of pain problems that you treat, and the most common forms of treatment or procedures?
We treat all types of pain problems, most commonly neck and low back pain. Of course, many headache patients have associated neck and shoulder discomfort which may respond to the types of procedures that we perform. We also treat cancer-related pain.
Neck pain is quite common to the patients who attend MHNI. This may be due to arthritis in the neck, pressure on a nerve, from strained muscles or joints in the neck, or other causes, so careful assessment is required. Low back pain is often caused by similar conditions.
Treatment in the General Pain Division may include the use of medications, psychological therapy, physical therapy, or procedures depending on the individual’s initial evaluation. There are many types of procedures which may be helpful in the treatment of head, neck, and/or back pain. A few (discussed below) are trigger point injections, nerve blocks, facet blocks, radiofrequency and cryoneurolysis. Again, the use of any procedure is determined by the type of pain problem.
What occurs during an initial evaluation?
When a patient schedules an initial appointment with the General Pain Division, they receive a lengthy questionnaire. The completed form is then reviewed by the clinical team at the patient’s initial visit. A detailed history is taken, and a comprehensive examination is performed. Diagnostic studies are requested which may include laboratory work, x-rays, an MRI scan, or an EMG (a study that determines if nerve damage is present or has occurred in the past). We then arrive at a preliminary diagnosis and treatment plan which is discussed with the patient.
In many cases, a diagnostic injection of local anesthetic (nerve block) is administered which helps assess if the pain is from a nerve, muscle, or joint.
Why is a physical therapist and psychologist often utilized in the initial evaluation and in the ongoing treatment plan?
In my experience, chronic pain is best treated in a multidisciplinary setting.
A psychologist is helpful for treating symptoms resulting from having pain for a prolonged period, such as depressed or anxious mood, irritability, sleep problems, and/or changes in a person’s social life and work.
The physical therapy evaluation helps to identify any musculoskeletal problems that are present, either as the primary cause of a person’s pain or secondary to a decrease in activity due to pain. Our center emphasizes a "hands-on" approach to physical therapy, and the patient takes an active role in their treatment through highly specified exercise and stretching. We utilize passive modalities such as ultrasound and heat only as an adjunctive treatment when necessary.
What is radiofrequency and when is it used?
Radiofrequency nerve ablation is a surgical technique that has been found to be potentially beneficial for treating chronic pain thought to be triggered by specific nerves. Radiofrequency techniques require the use of specialized needles that direct microwave energy to "heat up" and inactivate painful nerves. In addition, radiofrequency is effective in treating pain that may stem from diseased joints in the neck.
Other types of nerve pain respond more favorably to "freezing" the nerve, a technique known as cryoneurolysis. Both radiofrequency and cryoneurolysis can offer long-term pain relief, often lasting months to years in duration.
Several procedures that you describe are surgical; where are the surgical procedures performed?
Most procedures are performed at St. Joseph Mercy Chelsea. Depending on the type of procedure, the length of time in outpatient surgery varies. A facet block (injection of local anesthetic into a painful joint in the cervical or lumbar spine) is another procedure performed at St. Joseph Mercy Chelsea.
A few procedures are performed at MHNI such as trigger point injections (injection of local anesthetic into painful muscle) and specific nerve blocks. Each procedure is discussed with the patient in detail and scheduled at MHNI or St. Joseph Mercy Chelsea as appropriate.
What type of follow-up visits are required after a procedure is performed?
Each patient receives a call from a MHNI team member within 48 hours after the procedure. Most patients are seen at the Institute within 2 weeks after a procedure.