Mind Your Body TV Episode 17 with Moshe Lewis, M.D.
Maybe you want to control pain without pills or surgery, and you’re not alone. Approximately 76 million Americans may suffer from chronic pain…the kind that lasts past the acute, “This (really) hurts now” phase. That number—76 million—is, coincidentally, the same also attributed to the current total population of baby boomers. According to the American Pain Foundation, more traditional methods to control pain with medications include:
- Non-opioids: These include non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen.
- Opioids (may also be called narcotics): Codeine and morphine are examples.
- Adjuvant analgesics: a loose term referring to the many medications originally used to treat conditions other than pain, but now also used to help relieve specific pain problems; examples include some antidepressants and anticonvulsants.
Dr. Moshe Lewis is a California pain management and rehabilitation specialist. Here, he describes methods to control pain that go beyond reaching for a bottle of Tylenol or Advil but not as far as surgery. Note: You’ll see a few big words here, but we’ll explain what they mean to you.
How you can control pain
Epidural:
- Is an anesthetic agent injected into the epidural space, the space outside the dura, which is the outermost, toughest, and most fibrous of the three membranes (meninges) covering the spinal cord.
- Excellent for patients with pain radiating down an extremity—not just for childbirth.
- “I frequently use these in combination with physical therapy to prevent muscles from getting weak due to pain, which then leads to disuse.”
Nerve and facet blocks:
- Are usually attempted in conjunction with and sometimes after epidurals.
- Facet joints are located on the back of the spine.
TENS unit: (transcutaneous electrical nerve stimulation)
- More helpful to consider earlier in the treatment course. Nerve stimulation may mask additional pain signals.
- Battery operated and delivers electrical impulses.
Hurting all the time is a real “pain in the neck.”
Spinal cord stimulation:
- This is actually an implantable TENS unit.
Trigger point injections:
- These are local injections of anesthesia that decrease muscle spasm and paincausing severe tenderness in the back or neck muscles.
Pain pumps:
- Lowers overall dose of medications, but pumps require regular refills and eventually must be changed. Pain pumps are placed beneath the surface of the skin and remain controversial as they need to be refilled regularly and thus require a significant commitment from the patient and health care provider.
Viscosupplementation:
- First used in 1984, a new, one-shot injection should last up to six months.
- Helps lubricate the knee and may minimize need for surgery.
Radiofrequency ablation:
- Usually attempted after a doctor knows how facet injections have worked.
- Can last up to nine months.
- “I typically work closely with patients over at least a half-year before we utilize these.”
“Some patients do very well with these modalities,” Dr. Lewis says. Maybe you can be one of them, so why not talk to your doctor if you can’t currently find relief and need to control pain. No pain discussion, no gain discussion.
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(Photo courtesy: © Dawn Hudson | Dreamstime.com)