Chronic Pain include:
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Neck and Back Pain from any cause
Persistent neck and back pain are quite common in the population and usually involve a condition in the spine known as spondylosis. This comes from degenerative changes over time causing the joints of the spine (facets) to be pushed together due to drying out of the disks, allowing the vertebral bones to become closer together.
Also when the disks become compressed the fibrous rings around the disks known as the annulus, can develop fissures or tears which can also be quite painful.
Back pain then, can be the result of one of either conditions or both at the same time.
These conditions are easily treatable using safe, minimally invasive outpatient procedures done in the office. There is minimal down time and these procedures, usually a few diagnostic nerve blocks, are used to determine the precise source of pain generation.
Headaches, including Migraine and Tension
Headaches which persist for any period of time (hours to days) could be signs of serious problems within the brain and must be investigated by thorough neurologic workup. However, history has proven that the vast majority of headaches do not mean brain tumor, aneurysm (dangerous swelling of a blood vessel) or stroke. Nevertheless, any headache which is unlike any other in the past or one which can be described as “the worst I’ve ever had in my life”, must be investigated to rule the worst possible sources as mentioned above.
Once those more dangerous sources are ruled out, most of these headaches are usually described by many people as “migraine”. These cover a very wide area of types and durations and often include beginnings associated with the following signs and symptoms:
Headaches can often begin their cycles after sudden blows to the head or automobile accidents producing the classic “whiplash”, or acceleration-deceleration phenomena. Typical histories usually involve years of having tried multiple medications with either minimal or no relief, although some medications as Topamax and Imatrex may relieve symptoms temporarily.
Trinity Pain Medicine Associates is one of sixteen (16) practices in the United States to be selected for a national FDA-approved study investigating migraine headaches and using innovative modalities which are proving very encouraging. Our physicians have approximately twelve (12) years of experience with other effective strategies which are minimally invasive, outpatient and very safe, performed in our office.
Abdominal or Pelvic Pain (Gynecologic or Gastrointestinal)
Chronic pain in the abdomen or pelvic area can result from multiple causes and usually needs to be thoroughly investigated by physical exam, ultrasound, CT or MRI scanning or other means. The more common presentations include history of multiple surgeries and chronic inflammatory disorders. Non-surgical injury may also be a factor as in the case of blunt trauma. In all cases, surgical or medical management strategies must first be explored following thorough workup by an Internal Medicine physician, Urologist, Gynecologist or General Surgeon.
Pain which persists despite appropriate diagnosis and treatment by the above physicians can often be treated using diagnostic nerve blocks and more permanent techniques to facilitate long-term relief. Conditions which are easily treated include:
Following diagnostic nerve blocks to identify the specific nerve or segments involved, more permanent solutions and modalities will be used to afford long lasting relief.
Interstitial Cystitis (Bladder Pain)
This a condition in the urinary bladder which is a persistent inflammatory problem in the lining of this organ. In many patients it is a matter of controlling symptoms rather than totally curing the problem. Your Urologist have used a variety of medications to try and soothe the lining of the bladder though symptoms can persist for years.
There are a number of diagnostic and therapeutic nerve blocks as well as more sophisticated interventional modalities which have proven successful in controlling the ravages of this disease and we at Trinity Pain Medicine Associates can definitely provide comfort and relief.
Trigeminal Neuralgia Facial or Dental Pain
This is a condition which is somewhat difficult, though not impossible to treat. While most nerves which are involved in painful processes originate on the spinal cord, twelve (12) nerves which originate directly from the brain also produce painful conditions. Such is the case with the Trigeminal, or fifth cranial nerve. Frequently pain from this condition will cause severe facial pain, usually on one side of the face, and become extremely more painful when you are exposed to cold wind, cold liquids or similar conditions. It may also become more painful when the weather changes.
This nerve comes out of the skull bone through a small hole below the orbit of the eye and splits into three branches, hence the name Trigeminal. The branches supply areas of the face including the eye, upper jaw (maxilla) and lower jaw (mandible). When your dentist provides anesthesia for fillings or other dental work, it is usually a branch of the Trigeminal nerve which is blocked.
Once the appropriate branch or division is identified using a diagnostic block, other interventional procedures are used to more permanently provide relief. Depending on the cause of this problem, it may recur or return periodically, though there are also non-narcotic oral medications which are very helpful at keeping it under long term control.
Post Herpetic Neuraglia
This condition is caused due to nerve damage which is inflicted when virus particles which have laid dormant for many years, become active and find their way to a nerve segment or segments originating from either the spinal cord, or nerves coming directly off the brain. (cranial nerves) This virus is the Varicella, or Chicken Pox virus. This condition usually begins with the onset of itching and redness along a linear pattern on the skin where a particular nerve runs or supplies. Most commonly the trunk in the area of the ribs is affected, though the abdomen, shoulder and upper arm as well as the head and neck may be involved. Of lesser frequency are the legs and feet.
The reasons that some people acquire the condition while others do not remains unclear. However, a common aspect seems to exist in all people, in that the condition is usually brought on by a very stressful life crisis event, such as the death of a loved one, ones’ own serious illness such as cancer or a prolonged recovery from a serious injury or surgical operation, the breakup of a marriage, a major life change in one’s vocation or uprooting of one’s home or other similar stressful events. The condition virtually always effects either one side of the body or the other, but almost never on both sides at the same level.
Early treatment is the key to minimizing the long term damage and therefore prolonged painful effects of the disease. If the appropriate injection is done within the first few days or week of onset, long term pain is usually avoided.
The physicians at Trinity Pain Medicine Associates have many years of experience managing pain associated with this disorder and are anxious to help you avoid a long, agonizing period of persistent discomfort.
This very common painful condition originates in the area around the upper neck and base of the skull. The pain is commonly isolated to the base of the skull area but may also extend partially up the back of the head and also involve the neck and shoulders. This is usually a symptom complex and results after the initial occipital nerve inflammation causes secondary involvement in the adjacent muscles.
As a common form of “Peripheral Neuropathy” (abnormal function of a nerve outside the brain) this problem has given rise to a large amount of research currently approved by the FDA to explore the use of new techniques in neurostimulation. TPMA is one of a few select sites in the country which have been selected to explore this new way of treating this type of neuropathy .
In some cases this condition can result or include, headache. Causes usually involve a history of some form of trauma to the area at some time in the recent or distant past. Some forms of this condition began years before from an injury which some patients do not remember.
The physicians at Trinity Pain Medicine Associates are highly trained and experienced to diagnose and treat this annoying condition using a variety of interventional techniques and are anxious to help you find relief and return to a better quality of life.
Post Laminectomy Syndrome
Failed Surgical Back Syndrome
In the United States approximately 650,000 surgeries are performed each year on various levels of the spine. According to a study completed and published by the northeastern office of a major health insurance carrier in 2002, 75% or 3 out of 4 patients undergoing this type of surgery experienced either the same, or new onset pain following the surgery.
While the reasons and goals of various forms of spine surgeries are well accepted and medically necessary, the fact remains that any form of invasion into the body must include a healing process during which significant scar tissue can form, often causing irritation to surrounding nerves and other structures which can result in chronic pain.
In past years many physicians felt that periodic injections of epidural steroids could help relieve this form of discomfort. However, pain physicians trained in interventional techniques have developed more detailed ways of determining the specific sources of this pain. Because of epidural space may be partially closed with scar tissue, medication may not get to the appropriate areas to effect relief. Additionally, since all structures of the spine including nerves and spinal cord are affected by an epidural injection, pain relief may occur for a time, though the precise area causing the pain cannot be localized.
At TPMA, specific diagnostic procedures are designed in an organized fashion to identify specific pain generators which can then be selectively treated to relieve the persistent painful condition, thereby allowing easier rehabilitation and reconditioning of normal function. Using a variety of modalities which are minimally invasive and always completed on an outpatient basis, our physicians are able to effect specific levels of pain relief and functional improvement in a short time. Follow-up referrals are then made for various forms of physical therapy and reconditioning.
Leg and Foot Pain from Vascular Disease
Many people develop a condition of hardening of the arteries or atherosclerosis, which can ultimately result in lower extremity pain, especially after walking short distances. Vascular surgeons who are highly skilled at replacing or cleaning out these diseased vessels are able to re-open them to reestablish blood flow and relieve much of the pain.
Very small, microscopic vessels can undergo the same changes which may cause the painful condition to recur. These vessels cannot be bypassed or cleaned out because of their size. They can, however, be improved by using special types of nerve blocks and other therapies to relax their walls, thereby allowing more normal blood flow and ultimately improved pain relief and rehabilitation.
The physicians at Trinity Pain Medicine Associates have many years experience in treating this type of condition and are also networked with Hyperbaric Oxygen Therapy centers to offer enhanced healing times and avoid permanent tissue damage.
Reflex Sympathetic Dystrophy (RSD) Any Area
The nervous system is generally divided into two (2) major areas, voluntary and involuntary. Voluntary nerves coming directly out of the spinal cord supply parts of the body which a person may voluntarily contract or relax at will. Involuntary nerves supply those areas which a person usually cannot control by voluntary means, such as the heart rate, caliber of the blood vessels, size of the pupil in the eye and intestinal movement of food through the body.
When injury to tissue occurs, whether by trauma or by surgery affected areas of the body can develop painful conditions which are difficult to manage and often may not respond to use of narcotic pain medications. Symptoms include intermittent shooting, burning type pain which can occur either with exposure to cold, light touch or even an emotional upset or change in the weather.
Such conditions are described using a variety of names such as RSD or Complex Regional Pain Syndrome (CRPS). Initial treatment may include medications which can minimize symptoms to some extent, though in general are not curative. Using opioid (narcotic) medications like Vicodin, Percocet, morphine and similar agents, while somewhat effective initially, do not address the main source of the pain and therefore promote rapidly increasing doses over time, never providing satisfactory relief. Ultimately many patients become depended and in some cases, addicted to these medications. If the physician prescribing these medications does not recognize the CRPS type condition, a dangerous spiral of multiple narcotic medications in inappropriate doses can rapidly get out of control, putting a patient at risk for other problems, including death from drug overdose.
Physicians at Trinity Pain Medicine Associates have many years experience diagnosing and treating this condition. If a patient presents with out-of-control narcotic medication use, a medically-supervised period of detoxification in one of the area centers equipped and trained for this therapy may be necessary prior to interventional therapies being able to be used safely. We are happy to evaluate in consultation this type chronic pain condition and recommend the appropriate course of treatment.
pelvic / abdominal
Pain that persists over prolonged periods, usually greater than six months without any relief from self-therapy, expectant (waiting) therapy or conservative medical measures, is termed “Chronic Pain”. People with chronic pain cannot live a normal, healthy lifestyle. Functional daily activities such as walking, driving, bodily self-care, sleeping, eating and even sexual activity are very difficult, if not impossible in the chronic pain sufferer’s life. Chronic pain can also have psychological effects such as depression and anxiety. Chronic pain prevents a person from simply living a normal life.
At Trinity Pain Medicine Associates, we are committed to diagnosing the primary source of your pain, and then developing a comprehensive, long-term treatment plan that is suited to your individual needs. Our goals include reducing dependence on oral opioid (narcotic) medications, finding solutions for depression and anxiety by a comprehensive approach resulting in Persistent Pain Recovery and Functional Restoration. As with all aspects of our practice, we rely heavily on awareness and support of your spirituality and faith in our Lord as our reason for being here to serve you and your needs. In this respect it is important for you to know that our physicians are also sensitive to where you are in your spiritual/faith journey.
While we take many physician referrals, self-referrals are also welcome. For self-referred patients we are happy to provide your Primary Care Physician or any others of your choosing copies of your records.
Ashley M. Classen, D.O, F.A.O.C.A. & E. Jo Bailey, M.D.
1401 Henderson Street • Fort Worth, Texas 76102
Phone 817.332.3664 • Fax 817.334.0575