Scott L. Havsy, DO, JD, DAAPM
Certified in Pain Management

Chronic Pain Management
 

 

For those patients where surgery fails or is not an option; where spinal injections or physical therapy have not helped, then alternative treatment should be undertaken. Whether this is the implantation of stimulators in the spine, cryosurgery where the damaged nerve is destroyed by freezing or heat ablation, or narcotic therapy for chronic pain, each treatment must be selected carefully for the patient.

The purpose of medical management of patients with chronic pain is not to make the patient an addict though it is often impossible to avoid. Addiction implies that when the patient does not use narcotics for an extended period of time, they will suffer symptoms of withdrawal.

This is not to say that addiction in itself is wrong when the patient has a valid medical/surgical reason for their pain because addiction can be seen as a natural occurrence when an individual takes narcotics for an extended period of time.

As drug addiction is a multifaceted problem, the prescribing doctor must take care to perform an in depth history of drug usage and abuse so as not to place a patient at risk. For those patients who are addicted to narcotics, Suboxone therapy for withdrawal from narcotics may be warranted which can be performed on an outpatient basis in selected individuals. .

Psychological counseling is also a very important part of a patient’s therapy when they have chronic pain as it deals with the psycho-social aspect of the patient’s pain syndrome.

Patients who take narcotics on a chronic basis are subject to random urine tests to determine if they are using illicit drugs. In addition, it is important that the treating doctor review medical records of prior treatment, drug dispensing records if they exist, determine if any additional diagnostic tests or doctor referrals are indicated. IN addition, the treating doctor should always seek out alternative forms of treatment if they have not been provided to the patient in the past. The chronic use of narcotics is a last resort when all other types of treatment have failed.

Last, exercise such as resistive exercises, aerobic condition such as walking, and nutrition also play an important role in the treatment of chronic pain.