What is the Role of Pain Management in Your Medical Care?

Pain management explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Individuals who have suffered from persistent and debilitating symptoms of chronic, refractory pain are ideal candidates for a specialized pain management team. Typically, the patient’s primary care physician will make the referral to a pain management specialist once it is deemed that more interventional methods are necessary to manage the patient’s chronic pain. A pain management specialist team utilizes a comprehensive approach to not only provide patients with relief from pain and discomfort, but also to restore the patient’s ability to function on a day-to-day basis. Prior to reviewing the various interventional techniques offered by pain management teams, it is beneficial to review first the definition, assessment, and diagnostic classification of pain.

Pain Doctors Discuss XRAYThe physical experience of pain is biologically necessary, as it is a component of the body’s alert system that there is an underlying issue. As such, the physical discomfort of pain acts as a motivator for the individual to take action to get to the source of the pain and to treat it. Indeed, not all sensations of pain are alike. The sensation of pain is defined by the International Association for the Study of Pain as the “unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” Pain can be felt broadly as either acute or chronic in nature. More specifically, pain that is described as having a distinct onset is regarded as acute pain. The discomfort associated with acute pain may range from mild to intense and severe. Generally, acute pain arises following an identified injury that caused injury to the tissue within the body. Conversely, chronic pain is pain and discomfort that can endure for a number of months up to several years. Chronic pain can also range in character from mild and achy to more intense and severe. In order for pain to be classified as chronic in nature, it must persist longer than three months.

Many studies have shown that chronic pain can have deleterious effects on an individual’s quality of life. Indeed, chronic pain is associated with worse outcomes in terms of quality of life than any other health-related difficulty. Epidemiological work on the prevalence of chronic pain across the nation has suggested that this condition is associated with serious societal concerns. Indeed, the Center for Disease Control and Prevention has estimated that between 70-85% of all adults will experience difficulty with regard to back pain at some point during their lifespan. According to the Institute of Medicine, approximately 116 million people in the U.S. suffer from chronic pain.

Given its biological role as an alert system for internal issues, pain is regarded as a universal problem. Despite this, the underlying mechanism for the pain can oftentimes be highly subjective and differs widely across individuals. All chronic pain patients experience pain in different ways, making it quite difficult to measure pain objectively in the same manner across individuals. For a large portion of individuals suffering from chronic pain, they may experience interference with regard to their day-to-day activities. Conversely, another portion of individuals with chronic pain do not experience this same degree of interference. The most widely utilized method for assessing pain is by obtaining a patient’s own ratings regarding their degree of distress and interference. Then physicians may use this information to develop an appropriate pain management program to assist the patient with managing their symptoms. Indeed, it has been declared by the American Pain Society that it is a basic human right for every person to experience relief from pain.

Perhaps not surprisingly, should chronic pain be left untreated, it can lead to significant physiological and psychological consequences. Symptoms of chronic pain can have deleterious impacts on the patient’s appetite, sleep, and even can lead to immobility among the more severe cases. Moreover, previous studies have revealed that persistent pain can have negative impacts on concentration and memory. Other psychological impacts include despair, distress, depression, anxiety, fear, hopelessness, and suicidal ideation. Given these pervasive effects, pain management specialists are required to address both the physical components of pain, as well as the psychological symptoms. This type of comprehensive treatment requires that an interdisciplinary team be employed. This team would typically consist of pain management physicians, nurse practitioners, physical therapists, clinical psychologists, occupational therapists, and massage therapists. This multidisciplinary team generally relies upon both interventional and pharmacological interventions for managing a chronic pain condition.

Pain Management Causes Of Pain

Physical ExamThe sensation of pain generally is believed to arise from nociceptor, non-nociceptor (neuropathic), or psychogenic sources. In order to more fully understand the techniques employed when treating chronic pain, one must appreciate the underlying pain signaling pathways. In fact, this is critical in terms of providing effective treatment for relieving pain. The actual perception of a pain sensation is a complex process that involves processing pain signals across the peripheral nerves.

While non-nociceptor pain generally emerges from a trauma or injury to the structures located within the individual’s nervous system, nociceptor pain emerges when tissue within the body transmits an electrical impulse over a nociceptor, or a pain receptor, which culminates into a feeling of pain. Pain emerging from this source is generally described as somatic or visceral. More specifically, somatic pain can occur as either cutaneous or deep somatic pain. While somatic pain emerges from the tendons, bones, nerves, and blood vessels, cutaneous deep pain typically emerges within the skin or subcutaneous tissue. The other classification for pain, visceral pain, generally occurs as the result of nociceptors within the thorax or the abdominal cavity becoming stimulated. Unlike the other two classifications of pain, there appears to be little to no evidence of irritation or tissue damage in instances of psychogenic pain.

All episodes of pain involve the transmission of pain information to the cerebral cortex in the brain. Once the transmission of pain information passes through the synapse, the somatosensory cortex then uses this signaling to characterize the intensity of the pain and locate its source. A patient may experience sensations of pain when traumatic stimuli signals are transmitted in the form of electrical signals to the dorsal horn of the spinal cord. The dorsal horn area is where the nerve cells (primary neurons) create synapses, or networks of nerves, with secondary neurons, that travel to the central nervous system.

There are also two types of fibers that are believed to have an important role in the experience of pain: A-fibers and C-fibers. A-fibers are known as “fast fibers,” as they carry rapid signals of very sharp pain, such as the pain experienced as the result of a pin prick from a needle or a laceration from a sharp object. Conversely, C-fibers are known as “slow fibers,” and generally transmit signals of more wide-spread, poorly localized pain.

Immediately following the sensation of pain, gamma aminobutyric acid, endorphins, norepinephrine, and serotonin (all known as neuromodulators) are released into the body in an effort to provide relief from the pain.

Pain Management – Influencing Factors

While the sensation of pain is generally caused by chemical and neuronal reactions within the body, there are a variety of factors that can have an impact on the individual’s perception of the pain. For instance, individuals can have varying degrees of tolerance for pain. In addition, age can be a significant influential factor on the experience of pain, as well as other cultural and psychological factors. The tolerance of pain is defined as “the duration or intensity of pain that a person is willing to endure” by the Joint Commission. A portion of the work in the field of pain and its treatment has focused on this idea of pain perception. Indeed, these studies have suggested that factors, such as anxiety, fatigue, and emotional state play a significant role in the individual’s perception of pain and discomfort.

As mentioned above, age can have a significant effect on how an individual experiences pain and discomfort. For instance, children may not possess the capability to understand the source of pain, which can increase their degree of anxiety and distress thereby exacerbating their pain and discomfort. Conversely, adults are generally able to understand that pain is a temporary condition. As such, adults are generally more equipped to manage the stress and discomfort that accompanies pain. Moreover, they are expected to have greater coping skills as well.

The perception of pain may also be influenced by cultural norms. For instance, in some cultures the expression of pain is regarded as a weakness. Conversely, other cultures may believe that pain is necessary and that it was sent from a divinity. Even still, some may see pain as a challenge that simply needs to be overcome.

It is well known that various psychological factors can influence the degree of pain tolerance. For instance, fear, anxiety, mood, and ability to cope can all have an effect on an individual’s pain. In fact, several studies have revealed that both anxiety and fear can intensify the individual’s perception of pain. Further, an individual’s capacity to cope with the stress and discomfort that accompanies pain conditions can act either as a buffer for worsening pain symptoms or as a risk factor for severe symptoms of pain. Some individuals believe that they must overcome trying situations independently and self-sufficiently. These individuals are more likely to deny the treatment they need and may even delay seeking treatment, as they feel they are able to overcome it alone, without assistance. These patients are at an increased risk, as it has been documented that delaying seeking help or not treating an individual’s chronic pain condition can lead to worse outcomes.

Assessment And Standards Of Care For Managing Pain

Pain Doctor Looking Over DocumentsPain management specialists identified the need for standards of care in the field of pain care when they became aware of the deleterious effects of pain that remained untreated. Pain that has gone untreated or undertreated can have significant impacts on the patient’s quality of life. Complicating this, the patient’s ability to participate and engage in treatment can also be negatively impacted by untreated pain.

The proper assessment of pain is only the first step in developing an appropriate pain treatment plan. In order to assess pain, most physicians will utilize self-reports. More specifically, a physician will rely upon the patient’s account of recent activity and description of symptoms. The physician is also likely to take into account the patient’s medical history and will inquire about any previous injuries and other general health problems.

Along with an oral history, physicians will generally also conduct a physical examination, particularly in instances of injuries owing to sports. This exam typically includes an assessment of the individual’s degree of strength, mobility, and flexibility. This physical exam will include an in-depth evaluation in one or more of the following ways.

  • Visual inspection: The physician will rely upon a visual examination of the patient, paying more attention to areas of the body with any obvious signs of pain and discomfort. These signs might include an abnormal posture or a pronounced limp.
  • Palpation: During this procedure, the physician will use their hands to scan the patient. The physician will apply gentle pressure to feel for internal masses, vibrations, pulsations, and skin temperature.
  • Percussion: During this type of assessment, the physician will place a hand on the surface of the skin and then, using the other hand, will tap on the top of the hand. The audible vibration produced by this assists the physician in determining the density and size of any underlying structure or organ.
  • Auscultation: This assessment involves the physician using a stethoscope to listen for any abnormal sounds produced by the lungs, heart, and blood vessels.

Physicians may conduct other physical exams, such as the range of motion (ROM) exam. This exam is generally performed in order to discern the limits of movement before pain is experienced. Other tests can be conducted in order to aid in the physician’s diagnosis, should the diagnosis be uncertain. These assessments can include MRI scans, X-rays, PET scans, CT scans, and MRIs.

Pain Management Comprehensive Care Plan

Given the complex nature of pain, a proper comprehensive care plan will involve various different therapeutic methods. Once the physician is able to identify the source of the patient’s pain, an individual treatment plan will be developed utilizing a multidisciplinary team. The primary goal of this team is to provide the patient with relief from their chronic pain condition.

The most effective pain management teams often include the following healthcare professionals:

  • Pain management physicians
  • Orthopedic surgeons
  • Psychologists
  • Anesthesiologists
  • Occupational therapists
  • Physical therapists
  • Pharmacists
  • Psychiatrists

A unique feature of multidisciplinary teams is that the pain management program may be employed within a wide variety of settings. These can include family practices, private practices, hospitals, medical centers, and even the patient’s home. Most of these programs have the capability to provide medication management, psychological treatment, physical therapy, parent education, and even vocational counseling. The goal of each of these individual components is that they target improving the patient’s quality of life and ability to function on a day-to-day basis. As such, each member of the team has a different function. This improves the quality of care that the patient receives, as they are able to receive highly specialized care in each domain of functioning.

There is a large body of literature supporting the multidisciplinary approach for managing both acute and chronic pain. Specifically, this body of literature supports the likelihood of favorable outcomes following employing this treatment model. Additionally, the multidisciplinary approach to pain management has received support as clinically and cost effective. The reason for this is that reductions in the amount of pain and discomfort—even without removing/relieving it completely—can have a large beneficial impact on the patient’s degree of stress.

Pain Treatment Strategies

The ideal comprehensive pain management program is developed on an individual basis in order to fully meet the needs of each patient’s unique pain episodes. Thus, the treatment strategies employed within each treatment plan are likely to depend upon the patient’s injury or description of pain and discomfort. Pain management specialists employ a wide range of interventions, given that no two episodes of pain are alike.

Pharmacologic Approach

Currently, there is a widely utilized system for the pharmaceutical intervention of chronic pain. This system, which was established by the World Health Organization (WHO) originally to treat pain associated with cancer, utilizes the patient’s own reported severity of pain. Clinicians who manage any type of chronic pain patients can utilize this system successfully. The rating system in term of severity of the pain is known as the pain management ladder. The medications recognized to treat pain at each of these levels can range from non-steroidal anti-inflammatory drugs (NSAIDs) to stronger opioids.

WHO Pain Management Ladder 
  1. Mild pain: Pain intensity of 1 to 3 on the 0 to 10 standard should be     controlled with non-steroidal anti-inflammatory drugs.
2. Mild to moderate pain: Pain intensity of 4 to 6 should be controlled with     a combination of non-steroidal anti-inflammatory drugs and a weak opioid     such as hydrocodone.
  1. Moderate to severe pain: Pain intensity of 7 to 10 should be controlled     with stronger opioids such as morphine.

Source: WHO, 2014

The first step of the ladder indicates that more mild symptoms of pain can be treated utilizing a non-opioid. These types of medication can include non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. Given that they are non-habit forming and generally regarded as safe, these medications may be taken around-the-clock. The use of NSAIDs long-term, however, has been reported to be associated with an increased risk for gastrointestinal erosion.

Another non-prescription medication that may be used successfully to treat mild instances of pain is acetaminophen, which is also known by the brand name of Tylenol. This medication does not have any anti-inflammatory benefits, however, it does provide an analgesic effect while limiting the patient’s risk for any gastrointestinal problems. The table below presents a list of non-opioid medications that are relevant to the first step of the ladder, along with their suggested standard dose.

DrugStandard Dose (Adult)
Ibuprofen400 mg every 4 hours
Acetaminophen650 – 975 mg every 4 hours
Aspirin650 – 975 mg every 4 hours
Naproxen500 mg initial dose, then 250 mg every 6 to 8 hours
Meloxicam7.5 to 15 mg every 24 hours

 

There are also analgesic patches that are available for the treatment of mild pain. These patches contain lidocaine and other chemicals, such as capsaicin, that provide pain-relieving benefits.

The second step of this ladder indicates that mild to moderate instances of chronic pain be managed using a non-steroidal anti-inflammatory drug (NSAID) or acetaminophen, coupled with a weak form of opioid, such as codeine or hydrocodone. There is some evidence to suggest that the medication tramadol may be used in treating this level of pain. Side effects from using opioid medications include nausea, constipation, rash, sedation, respiratory depression, and addiction. Previous work has revealed that patients who were prescribed opioids for the long-term management of pain exhibit signs of a weakened immune system. The majority of opioid medication is administered in an oral fashion; however, there are transdermal patches available. The following table presents the medications that are commonly used to treat step-2 pain along with their suggested standard dose.

 

DrugStandard Dose (Adult)
Buprenorphine patchPatch should be worn for 7 days
Codeine/AcetaminophenEvery 4 to 6 hours
Hydrocodone/AcetaminophenEvery 4 to 6 hours
TarpentadolEvery 4 to 6 hours
TramadolEvery 4 to 6 hours

 

The final step of the ladder, step three, indicates that moderate to severe episodes of chronic pain are best treated with a stronger opioid medication. These medications may be administered orally, with a transdermal patch, or even through an intrathecal pump. This pump acts to deliver the drug directly into the spinal fluid, which is believed to give the patient a significant degree of relief.

Patients who are prescribed opioid medications for relieving their pain must be monitored regularly for addiction and tolerance. While opioid medications are highly effective in managing symptoms of pain, they are associated with feelings of euphoria and have a strongly sedating side effect. The following table provides a list of medications that are recommended to treat moderate to severe pain and their suggested standard dose.

 

DrugStandard Dose (Adult)
MorphineSubcutaneous—every 4 hours or continuousIntravenous—every 4 hours

Oral—immediate release every 4 hours

OxycodoneEvery 4 hours (immediate release)
Fentanyl patchVaries depending on prescribing information
MethadoneEvery 8 to 12 hours

 

There are many different ways in which an analgesic medication may be administered. The list below includes the most commonly used methods for medication administration.

  • Topical
  • Oral
  • Rectal
  • Nasal spray
  • Intravenous
  • Intramuscular
  • Subcutaneous
  • Intraventricular
  • Epidural
  • Subarachnoid
  • Transdermal skin patch

Physicians and pain management specialists are afforded a wide array of options in terms of managing chronic pain pharmaceutically. Generally, physicians will consider the effectiveness of the medication being administered, as well as the safety of the drug and its administration method. Other adjuvant medications also exist for managing pain, though they aren’t listed within the WHO ladder. These include antidepressants, creams, anti-epileptic drugs, and corticosteroids.

A few examples of anti-epileptic drugs to treat chronic pain are:

  • Phenytoin (Dilantin)
  • Gabapentin (Neurontin, Gralise, and Horizant)
  • Lamotrigine (Lamictal)
  • Pregabalin (Lyrica)

Further, a few examples of antidepressant medications for the treatment of chronic pain are:

  • Nortriptyline (Pamelor)
  • Imipramine (Tofranil)
  • Amitriptyline (Elavil)
  • Duloxetine (Cymbalta)
  • Desipramine (Norpramin)
  • Venlafaxine (Effexor)

A few examples of muscle relaxants that may be used to treat chronic pain are:

  • Methocarbamol (Robaxin)
  • Carisoprodol (Soma)
  • Diazepam (Valium)
  • Cyclobenzaprine (Flexeril)
  • Metaxalone (Skelaxin)

A few examples of prescription creams that may provide some pain relief are:

  • KGLACC cream (Ketoprofen 15%, Gabapentin 10%, Lidocaine 10%, Amitriptyline 5%, Carbamazepine 2.5%, and Clondine 0.833%)
  • EMLA cream (Lidocaine 2.5% and Prilocaine 2.5%)
  • Diclofenac (Solaraze and Pennsaid)
  • TAD cream (Tramasol 20%, Amitriptyline 10%, and Dextromenthorpan 10%)

Safety And Precautions For Pain Medications

Doctor and PatientRemedies for pain, including medication, have existed for millions of years. Pain is a distressing experience. As such, individuals who suffer from pain, particularly chronic pain, are motivated to search for relief from their pain and discomfort. These treatments can range from holistic interventions to home remedy approaches. Additionally, a large number of analgesic medications exist. While medications are convenient and likely preferred by most patients and their physicians, with every type of medication available, there are a number of potential side effects associated with their use.

When many individuals hear the term medication, the first image that comes to mind is oral administration. Indeed, these are quite common. One type of over-the-counter oral pain killer medications are the non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil, Motrin, or Bayer. The mechanism of action for these medications is their ability to reduce swelling in the area. The risk involved in using these types of medication is a possible increased risk for developing kidney disease.

Another commonly employed treatment for chronic pain are muscle relaxants. These are typically recommended to patients with back spasms. These types of medications are effective in reducing pain. As with any type of medication, there is the potential for adverse side effects. These side effects may even be intensified when using a cream form of the medication.

For some patients, their pain condition is unresponsive to traditional interventions. In these instances, a course of opioid medication may be warranted. These medications have been around for some time and originate from the poppy seed plant. Opioids are also the main ingredient in the illicit drug, opium. The mechanism of action in terms of opioid medication is the binding of the opioid molecule to the opioid receptors in the brain. This medication is highly effective and runs the risk of patient addiction and misuse. Many individuals have been shown to develop withdrawl symptoms, even following a relatively brief period of use.

Interventional And Complementary Treatments

Chiropractor Working On PatientIn many instances, complementary and interventional types of pain management are considered once it has been established that the patient’s pain has not been responsive to typical pain management systems. These interventions are generally performed in clinical offices. Generally, when a clinician makes a referral, that patient will need to undergo a comprehensive initial assessment. The goal of this assessment is to identify the source of the pain, as well as develop a plan for helping that patient manage the symptoms of pain. Below are some of the individual components of a multidisciplinary team’s approach to managing chronic pain.

Injection Therapy

Pain management specialists can perform a kind of injection that may be used in diagnosing chronic pain, as well as relieving pain. These injections are non-invasive and can be conducted on an outpatient basis. Typically, fluoroscopy is performed along with the injection so as to ensure that the needle has been placed in the proper location for the injection. A few examples of injections include facet injections, epidural steroid injections, sympathetic blocks, and caudal steroid injections. 

Implanted Modalities

For patients experiencing chronic, refractory pain, implantation devices may be warranted as a long-term solution to provide pain relief. One of these types of devices is the intrathecal pump that can be implanted within the body to deliver analgesic medication directly into the spinal fluid using a small catheter. Patients who are considered ideal candidates for implantation devices have typically exhausted all other methods for treating their pain condition to no avail. Extant research on the effectiveness of implantation devices indicates that they are, indeed, effective.

Acupuncture

One of the oldest forms of intervention for chronic pain is a type of complementary treatment, known as acupuncture. Acupuncture dates back over 3,000 years and is based upon the placement of tiny needles in very specific areas known as meridians. The 12 primary meridians are linked to specific organs of the body; however, there are eight secondary meridians that can also be stimulated using acupuncture needles. Acupuncture has undergone a significant amount of research and is shown to be associated with positive outcomes in patients with chronic pain through the stimulation of blood flow.

Active Release Technique

Some pain management specialists still rely upon a hands-on approach to treating pain. As such, they may employ the active release technique. This involves the physicians manually lengthening and stretching the muscles and tissue in the affected area. This stretching and pressure helps to lengthen the muscle and release any adhesions.

Biofeedback

Biofeedback has received some support for assisting individuals in managing symptoms of chronic pain. This non-invasive, non-pharmacological technique assists patients with recognizing symptoms, thus helps them learn skills to control their effect on their day-to-day functioning. To do this, the patient is provided real-time information about their physiological processes using psycho-physiological recordings. The biofeedback device is designed to detect very slight changes in the patient’s physiological responses and displays this information to the patient on a computer screen. The intervention includes a number of stress reducing exercises that teaches patients how to effect change onto their physiological response system and gain more control over stress. This control also allows them to intervene on the degree of negative effects stress has on their pain condition. The systems that may be explored include skin conductance, blood pressure, muscle tension, and heart rate.

Botox

Interestingly, injections of the botulinum toxin have been shown to benefit patients dealing with chronic pain conditions. The beneficial effects are believed to arise from the action of Botox, by paralyzing muscle activity. The botulinum toxin is the by-product of a microbe that is known to cause a certain type of food poisoning, known as botulism. Historically, Botox injections have been utilized in reducing the appearance of skin wrinkles. Previous research on Botox injections has supported their beneficial effects in treating chronic migraines and other common pain conditions, such as cervical dystonia (i.e., neck spasms).

Cold Laser Therapy

Another intervention that may be beneficial for patients with chronic pain is cold laser therapy. This intervention uses photon energy from a light that penetrates the body to alter cellular function. The healing process of cold laser therapy is initiated by an interaction between photo-chemicals and photo-biological processes. This intervention is non-invasive and is generally regarded as safe. Indeed, it has been FDA approved for the treatment of both acute and chronic pain conditions.

Gua Sha

One traditional East Asian method for treating chronic pain is gua sha. This technique involves scraping the surface of the skin in an effort to create a temporary rash. This rash is believed to be therapeutic in nature and provide pain relief by increasing blood flow to the area. Using a similar underlying belief system as acupuncture, individuals who specialize in gua sha believe that pain is the result of stagnant blood. A recent study conducted by the American Journal of Chinese Medicine revealed that gua sha therapy was associated with significant improvements in pain following treatment.

Massage Therapy

Another intervention for pain relief is massage therapy. This technique uses soft-tissue manipulation to decrease muscle tension, by improving the functioning the parasympathetic nervous system (PNS) and decreasing the impact of the sympathetic nervous system (SNS). Existing studies have examined the effects of this treatment and these studies indicated that massage therapy is associated with strong grip, less pain, and less symptoms of anxiety.

Prolotherapy

In terms of interventional techniques, prolotherapy involves injecting a non-active irritant solution into joint space, ligaments, or tendons. This acts to strengthen all of the weakened connective tissue within the body. The prolotherapy injection contains lidocaine and hyperosmolar dextrose (sugar). This treatment generally requires three total injections that are spaced approximately two to six weeks apart.

Cognitive Behavioral Therapy

A common form of psychological therapy that may be used in the treatment of chronic pain is cognitive behavioral therapy (CBT). This intervention targets the individual’s cognitive style and challenges unhealthy cognitive biases. There has been ample research in this area, thus cognitive behavioral therapy is generally regarded as beneficial to patients dealing with a transition in life, who are under a particular degree of stress.

Exercise Counseling And Nutrition

Interestingly enough, the largest component of this multidisciplinary approach to managing chronic pain, involves exercise, healthy eating, and sleep hygiene. It is clear that patients who suffer from a chronic pain condition are most in need of support in terms of staying active and healthy. Individuals who maintain a regular exercise routine and eat healthy have been shown to heal more quickly.

Some chronic pain conditions may involve major life changes for the individual. In these instances, the pain management team can develop a plan for addressing the patient’s individual needs. Similarly, studies examining diet and other habits have revealed that these factors are linked with a significant decrease in overall health and can exacerbate pain.

Chiropractic Manipulation

Chiropractic treatment provides many patients significant relief from pain and has even been implicated in improvements in overall health. This treatment intervention involves manipulating the spine by way of either a high velocity thrust to a joint beyond its restricted range of motion or low velocity movements that occur within or at the range of motion of the joint. There are a number of risks and side effects involved in this procedure, including complications related to cervical and lumbar manipulation, localized discomfort, headache, fatigue, and even discomfort felt in other areas of the body that were not targets of treatment. Studies report that these side effects tend to emerge the same day of the procedure and were no longer reported by the patient after 24 to 48 hours.

Conclusion

Given the incredibly high prevalence rates, many adults are expected to struggle with a pain condition at some point during their lifetime. Pain conditions can range from a dull ache, to a more severe condition, such as a migraine. Pain is a very subjective experience and no two individuals will report experiencing the same symptoms of pain. Tolerance for pain is also not universal. Early intervention is encouraged, as research has shown that delaying treatment or even receiving inadequate treatment can lead to detrimental impacts on daily functioning.

The treatment of pain is now done largely through a pain management team. Once the patient has undergone a full diagnostic work up, the treatment team will develop an individualized treatment plan. Your physician will want to gather information regarding how the particular pain episode began and the course of the symtoms. There are a number of different interventions available for the treatment of pain. These interventions can be either interventional, pharmocological, and complementary, and are typically delivered by a multidisciplinary team. This multidisciplinary approach ensures that all aspects of the pain condition are addressed.

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