Most people with neck or back pain or severe arthritis first try to combat it with heat, ice, physical therapy, anti-inflammatory medications or even trigger-point injections.
But when none of that works, they might consider a pain specialist, who has more arrows in his quiver, according to Dr. Steven Litman, director of All Island Pain Consultants in Bay Shore and Port Jefferson.
These doctors - usually anesthesiologists - employ aggressive, cutting-edge techniques such as injecting steroids directly into the spinal area to calm an irritated nerve.
"Where I come into play is that transition from acute to chronic," said Dr. Edward Rubin, an anesthesiologist and director of Chronic Pain Medicine at Winthrop University Hospital in Mineola, N.Y. Most people consider pain specialists after six weeks of back pain, Rubin said.
The next steps may include:
1. Epidural steroid injections: The doctor injects cortisone around the irritated nerve. A patient can have up to three treatments in a six-month period; too many steroid injections can cause weight gain and high blood pressure, Rubin said. Doctors should use X-ray or ultrasound guidance to pinpoint the exact area where the needle is injected and where the medication is going, several doctors said.
2. Surgery by a spine surgeon to cut away a bulging herniated disc.
3. Spinal cord stimulation: The pain specialist implants electrodes into the spine that intercept the pain signal before it reaches the brain, decreasing the pain by about two-thirds, Litman said. Or the specialist implants an "intrathecal pump" that delivers morphine into the spinal fluid around the clock, Rubin said.
4. Radio frequency: The doctor can inject a needle that applies heat through radio-frequency energy directly to the nerve, numbing the pain for six months to two years, most often done in cases of arthritis, said Dr. Brian Durkin of the Center for Pain Management in Stony Brook. Doctors try to minimize a dependence on narcotics such as Percocet for pain, because people can become tolerant to the drugs and because they have side effects including drowsiness, Rubin said.
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(c) 2009, Newsday. Distributed by Mclatchy-Tribune News Service.