Our Interventional Procedures can treat chronic pain stemming from a variety of conditions:
- Diabetic Neuropathy
- Facial Pain
- Failed Back Syndrome/Radiculopathy
- Myofascial Pain
- Muscle Spasms
- Neuropathic Pain
- Work-Related Injuries and/or Motor Vehicle Accident Injuries
- Pain from Spinal Cord Injuries, Stroke, Multiple Sclerosis as well as other Neurologic Conditions
- Digital X-Ray
- Screening Mammography
- Pharmacy - Offering prescription and over-the-counter medications
- Bone Density
- Physical Therapy including Aqua Therapy
- Occupational Therapy
- Health Psychology
- Sleep Center
April 22, 2014
In 2007, the American College of Physicians and the American Pain Society developed the Joint Clinical Practice Guidelines, to simplify and standardize the assessment of back pain patients.
The guidelines divide patients into three groups. The first priority in evaluating low back pain patients is to identify the “do not miss” group. This group of patients will have signs and/or symptoms that will require rapid evaluation for certain emergent conditions. This group can include cancer and other conditions which may trigger immediate imaging of the low back with x-rays, CT scans or MRI’s. Consultation with a surgeon specializing in the spine will often occur. These emergencies may include cauda equina syndrome (which is often caused by a herniated disc which traps and can damage spinal nerves), epidural abscess and hematoma. Unless recognized and promptly treated permanent deficits such as paralysis, loss of sensation, or loss of bladder function may result.
The second group includes patients with pain being triggered by nerve or spine joint triggers. This group includes: radiculitis (radiating pain) / radiculopathy ( neurological deficit), spinal stenosis (narrowing), facet pain, discogenic pain, and sacroiliac pain. Many of these pain triggers respond very well to interventional pain therapies such as epidural spinal injections, nerve root blocks, joint injections or radiofrequency treatments.
It is estimated that 85% of low back pain patients fall into the third group. This group is often initially treated by primary care physicians. This is a huge category that includes musculoskeletal sources of pain, as well as pain secondary or exacerbated by other illnesses such as depression, and other psychiatric disorders.
Pain can also be magnified by withdrawal syndromes. The withdrawals can result from not only opioids and benzodiazepines, but also abrupt cessation of other medications such as duloxetine (Cymbalta) and venlafaxine (Effexor), Paroxitine (Paxil) and muscle relaxants such as baclofen and tizanidine.
Pain conditions are best treated by an integrated approach involving physicians who are experienced in pain management. Often pain triggers respond to treatment by an interventional pain physician and this often allows the patient to avoid or minimize the dose of opioid pain medications. Although opiods can be very effective for acute pain they are often much less effective for most chronic pain conditions due to tolerance and opioid induced hyperalgesia.
It is important to take low back pain seriously and speak with your physician if your pain does not improve within 24 hours.
April 22, 2014
I have found my background in Post-Traumatic Stress Disorder (PTSD) to be especially important since it is a condition I recognize in patients every day. It is extremely common that patients with pain symptoms which are out of proportion to physical findings suffer from co-existing PTSD. Sometimes careful and sensitive questioning uncovers PTSD signs and indicates a patient who would benefit from appropriate therapy.
Criteria for Post-Traumatic Stress Disorder include:
- re-experiencing the original trauma(s) through(flashbacks or nightmares)
- avoidance of anything associated with the trauma
- increased arousal(insomnia difficulty falling or staying asleep, anger, and hyper vigilance).
- “disassociating”, staring off into space, and entering into a fugue state, “blank out”.
There is evidence that PTSD, especially complex PTSD produces permanent structural and physiologic changes in the brain that profoundly influence behavior, impulse control, relationships, and the interpretation of physical and emotional input. At the root is dysfunction of brain areas such as the prefrontal cortex that change incoming physical and emotional sensations, causing misinterpretation, and amplification. Thus patients with a history of traumatic stress often have difficulty correctly interpreting physical sensations, and pain is often magnified out of proportion to the disease or injury.
Common diagnoses that often co-exist with PTSD include: fibromyalgia, chronic headaches, temporomandibular joint (TMJ) syndrome, back, neck, abdominal, and pelvic pain. These individuals often have decreased coping mechanisms and difficulty with trusting others. These issues may complicate care and reduce compliance.
Furthermore, psychological trauma markedly increases the risk for drug abuse and addiction. Patients who suffer from posttraumatic stress disorder (PTSD) may present as angry, argumentative, and emotionally unsteady. Uncomfortable emotional memories and out of proportion emotional reactions may be triggered by reminders of the trauma. This may significantly affect the patient-physician interaction, especially if there is some characteristic the physician shares with the PTSD patient, such as hair color, facial hair etc.
There is evidence that the combination of PTSD-related emotional triggers, drug triggers (people places and things), and stresses (pain) can activate or increase drug cravings. Opioids and other potentially addictive drugs may be used to self-medicate the uncomfortable sensations associated with PTSD since opioids may temporarily decrease depression and the anxiety associated with hypervigilance.
Physicians are encouraged to carefully explore the patients past to uncover a history of abuse or trauma. It should be kept in mind that patients are often reticent to discuss their history, due to trust issues, shame, or discomfort. It is amazing how often physicians are told they were the first that ever asked and it is rewarding to help patients evolve from victim to survivor. Discussing details of their trauma should be done when there is a strong patient-physician relationship built on trust. Skilled psychology therapists can assist in identifying and dealing with traumatic events as painful memories are often repressed and inaccessible without long term therapy.
If you feel that you may suffer from PTSD related pain conditions or would like more information on this subject you may contact SIMED Interventional Pain Management to schedule an appointment by calling (352) 224-1813 or click here to request an appointment online
If you prefer you may also contact SIMED Health Psychology (Gainesville, Ocala & Chiefland) (352) 332-9441 or SIMED Psychiatry (Villages & Lady Lake) at (352) 753-6886 to discuss how PTSD may be affecting you.