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Chronic or acute. Physical or emotional. No matter the form or severity, pain is often unbearable. Pain specialists in the valley offer techniques and procedures to control the aches, and can even help patients become pain free after years of hurt.
“Pain in the neck” is a common figure of speech. But when used literally, it can indicate a serious issue. In fact, pain on any part of the body – or even felt emotionally – is not to be ignored.
Physiatrists, chiropractors, physical therapists and psychiatrists all work daily with patients to help ease pain. Here, Roanoke Valley physicians in several disciplines break down the various types of pain and how to get the best treatment possible.
The Physiatry Approach
Before pain can be treated, says Dr. Murray Joiner, a physiatrist of physical medicine in Roanoke, the doctor and patient must spend time together to get to the root of where and when the pain began.
“Often, the problem started somewhere besides where a patient thought it did,” he adds. “I get a detailed history, review tests (such as x-rays, CT scans and nerve tests) and perform a physical exam to come up with an appropriate diagnosis and treatment plan.”
Joiner also asks specific questions about the pain: “How severe? What makes it feel better? Is it sharp, dull, achy, sore, etc.?
“Each question is specific to a nerve or other parts of the body,” he explains. “The patient’s answer helps pinpoint the actual problem.”
Joiner treats two basic types of pain, nociceptive and neuropathic. Examples of nociceptive pain include broken bones, herniated disks, arthritis or inflammation. Treatments may involve the use of heat, water, exercise or traction. Interventional techniques, such as the burning or freezing of nerves, or implanting devices into the spine to cover up the pain, are also used when necessary.
“In our specialty, we are willing to consider anything not off the wall to get you better,” Joiner says.
Neuropathic pain, often difficult to treat, refers to pain generated from the nerve itself, such as fibromyalgia, irritable bowel syndrome or peripheral neuropathy (widespread nerve damage). Medications such as Cymbalta or Lyrica may be prescribed, or Joiner may use therapeutic modalities or electrical devices to treat the pain.
It is important for a patient to cooperate with the doctor in order to reap the most benefits from treatment.
“You can’t start out with the premonition that you’re not going to get better, you have to want to be fixed,” Joiner says. “We’re going to figure out what to do to make you better. To have you as a patient for life, we’ve failed.”
Most people experience relief once treatment begins, Joiner says. And patients can further manage their pain at home via hot or cold packs or lukewarm baths.
“This is a challenging specialty, and I love every day of it,” says Joiner. “When I see people leave with no more pain, it’s a great feeling.”
Whether a patient visits a chiropractor in addition to or in lieu of a pain management specialist, Dr. Craig Camidge with Tuck Chiropractic Clinic wants to build the knowledge in patients that chiropractic care is a “gentle treatment.”
“The drawbacks to what we do are minimal,” Camidge says. “People are often interested in trying this before something more invasive,” such as surgery, injections or long-term medicinal therapy.
When meeting with a patient, Camidge first analyzes the severity of the pain. Those who just experienced an injury or recently began feeling pain are diagnosed with acute pain. If a patient has been in pain for a long time and may have tried numerous options for relief, the pain is considered chronic.
Camidge says low back pain, sciatica, severe headaches and neck pain can all be chronic by nature. Treatment options include electric stimulation therapy to reduce inflammation, a variety of exercises and stretches to relieve pain and stabilize the injured area, or manipulation of bones and joints by hand to get them moving again. He also teaches patients exercises they can do at home.
“I have patients that get better right away,” he says. “Others with more chronic pain need nine to 12 treatments before significant progress is made. We may take care of them longer than that if it will continue to help them.”
According to Camidge, there are two keys to successful treatment of pain.
“Cooperation among the patient’s doctors – which can include a pain management physician, primary care doctor, surgeon and chiropractor,” he explains. “And the patient has to own their injury and put forth the effort to get better. That’s when we get our best results.
“When patients decide to take ownership of their condition and do whatever they can to cure or manage it, we can really make powerful changes.”
The Benefits of Counseling
Dr. Maurice Fisher with Comprehensive Counseling Services knows pain is not just a physical feeling.
“Everyone that comes to us is dealing with some sort of emotional pain, such as depression, anxiety or the inability to deal with certain stresses in life,” he says. “And physical problems can often merge with psychological pain.”
He also acknowledges that substance abuse sometimes reflects the use of drugs to kill pain. Other patients experience social pain, whether it stems from the loss of a job or difficulty with family matters.
“When it comes to physical, social and emotional pain (combined), we try to figure out which came first,” Fisher says. “Did the physical pain someone is describing come from a medical problem or did an emotional pain trigger it?”
Upon meeting a patient for the first time, Fisher gets to know his or her background to determine the cause of pain, which he says is seldom just one issue.
“It’s usually a culmination of things that get someone here,” he says. “Once we determine the cause, we find out if the pain is controllable or not. Many folks deal with a lack of healthy adaptive skills, such as mood management, stress management or the ability to adapt to changing environments.”
Fisher says some clients know they are in pain, but do not know the cause until they talk about their life with him and the challenges they are facing. He typically meets with clients for six to eight sessions to help “give them fundamentals for how to manage or tolerate their pain differently.”
“Most people can learn how to deal with problems without the use of medication,” Fisher adds, but he is not anti-drug if the need arises. “And the door remains open for people that need to come back. If life throws a curveball and they have trouble handling the situation, we welcome them to come back.”
Physical Therapy Perks
Physical therapy is helpful for pain management, says Mary Beth Brown, a physical therapist with Lucas Therapies, because exercise in general can decrease pain and increase endorphins.
When a patient comes in, Brown performs an evaluation, learning medical history as well as the type of pain and what makes the pain increase or decrease.
“Once we get a measure of their range of motion and strength, we can start on an exercise program and see how they respond to different movements,” Brown says. “Some patients also benefit from modalities such as a TENS unit that excites the nerves.” TENS – or transcutaneous electrical nerve stimulation – refers to the use of electric current for therapeutic purposes.
From head to toe, Brown says physical therapists have pain relief covered, offering a “handful of exercises” per each body part. They also treat patients experiencing pain from fibromyalgia, arthritis or chronic pain syndrome.
“I don’t know our success rate, but if nothing else is working for someone, they can benefit from trying physical therapy,” Brown suggests. “We can help with muscle endurance, strength and flexibility. We’ve never turned anyone away, and everyone has seen some positive results.”
Patients are treated for a span of two to three weeks or four to six weeks. If the treatment is helping alleviate pain, Brown says they may continue for another four to six weeks after discussing the progress with a primary care physician.
In addition to exercises with weights, bands, stability balls and other equipment that promotes particular movements – such as pushing, pulling and gripping – Brown says aquatic therapy is a great option. And every patient receives a print-out of his or her specific program in order to also exercise at home.
“Every patient is different,” Brown explains. “We tailor each program to what the patient needs to function in their everyday life or job,” whether it is a mom experiencing pain from lifting her child, or a construction worker having difficulty operating machinery due to arm or back pain.
After treatment ends, patients are encouraged to stay active and maintain strength to prevent or lessen further aches and pains.