The following is a list of frequently asked questions about pain, pain management, and pain medication.

What is pain?
Pain is a legitimate medical syndrome that is associated with an unpleasant sensation and the emotional response to that sensation. Pain can be caused by any number of events, such as an auto accident, work or sports injury, surgery, or infection. Your response to a painful sensation is as individual as you are.

What is the difference between acute and chronic pain?
Acute pain is of short duration, usually the result of an injury, surgery or illness.

Chronic pain is an ongoing condition, often in the back, neck, head, as wells as neuropathic pain (nerve injury pain), musculoskeletal pain, and pain related to illness. Your physician may refer you to the Lankenau Pain Center because your chronic pain condition has not responded to conventional therapies.

Treatments for acute and chronic pain are generally quite different. In some cases, acute and chronic pain can be stopped or alleviated by a single procedure or series of procedures. Sometimes, chronic pain is part of a widespread disease process, and the specific cause may be difficult to pinpoint. Once we have identified the specific factor causing the pain, we may be able to treat it so that the condition no longer occurs. In some patients, the specific factor causing the pain--such as cancer--cannot be changed, but we may be able to reduce the pain or help the patient to better cope with the pain through a combination of medical, psychosocial and rehabilitation techniques.

What are the most common problems that result in chronic pain?
While there are a multitude of conditions that may lead to chronic pain, we have found the following to be most prevalent in our patients:

• Back pain
• Neck pain
• Muscle Pain (Myalgia)
• Nerve Pain
• Headaches
• Post Herpetic Neuralgia (Shingles)
• Fibromyalgia
• Osteoarthritis
• Carpal Tunnel Syndrome

What are the major issues surrounding pain?
Chronic pain can become so intense and overwhelm the body and mind to such a degree that it can affect all areas of life. People become so afflicted that they often cannot work. Their appetite falls off. Physical activity of any kind is exhausting and may aggravate the pain. Often, the person becomes the victim of a vicious cycle in which total preoccupation with pain leads to irritability and depression. Adding to these ailments is the fatigue sufferers experience from not being able to sleep at night.

In other cases of chronic pain, issues of secondary gain may arise. This may develop when patients associate pain with some form of benefit — as when a sufferer has a coworker help out at work, or a spouse is extra- supportive. In these cases, the sufferer may receive a benefit for not treating the pain effectively.

At The Lankenau Pain Center, we will work with the patient to identify and alleviate these issues.

What is the economic impact of pain?
The Nuprin Pain Report specifically notes that 4 billion work days are lost each year that result in a financial loss to the economy in the amount of $79 billion per year. The personal consequences of mismanagement of patients suffering from pain are immeasurable. (Source: R. Sternbach, Survey of pain in the US: The Nuprin Report, Clinical Journal of Pain, 2:4, 1986.)

Do I have to suffer with chronic pain for the rest of my life?
Not necessarily. With proper treatment, people can live full, normal lives after having experienced chronic pain.

What is pain management?
Pain is a complex medical problem that can have profound effects on your physical and mental well-being. The goal of pain management is to help you decrease your level of pain and suffering, to return you to your maximum level of functioning and independence, and to help you restore your quality of life.
 

When should a person seek a pain management specialist?
Seek out a pain management specialist when pain does not respond to the usual and customary treatments within a reasonable period of time. All too often, people see pain management as a last resort for pain, instead of a first stop on the road to wellness. Be aware of your body and take note when you are in pain. If that pain persists — contact your doctor or an accredited pain management specialist immediately.

Why should my pain be treated?

Chronic pain can limit the enjoyment of being an active participant in life.  Chronic untreated pain can lead to:

• Sleep disorders
• Physical disability
• Depressed mood
• Damaged relationships
• Hopelessness

What can the Lankenau Pain Center do for my pain?
The goal of the Lankenau Pain Center is to use safe, effective, and minimally invasive diagnostic and therapeutic procedures to decrease painful sensations, improve function and mobility, and decrease reliance on pain medications. 

What kind of pain syndromes can be treated at the Lankenau Pain Center?
The most common types of pain are:

• Spine pain (low back pain or neck pain)
• Pain from damaged or pinched nerves (sciatica or radiculopathy) 

What are some of the procedures performed at the Lankenau Pain Center?
These procedures include:

• Epidural steroid injections in the cervical, thoracic, and lumbar regions
• Transforaminal steroid delivery and Selective Nerve Root blockade
• Facet joint and Medial Branch nerve injections
• Lumbar Provocative Discography
• Radiofrequency Neuroablation
• Sympathetic plexus blockade
• Spinal Cord Stimulation
• Celiac Plexus Block

Can I have a procedure on the same day as my evaluation?
Sometimes, but it can take time to check with your insurance carrier and secure authorization before scheduling the procedure.  The pain clinic staff will work as quickly and efficiently as possible so that you can have your procedures in a timely manner. You can help this process by making sure that your insurance information is updated.

What should I do before my procedure?
Your stomach must be empty for the procedure, since anxiety and sedation can cause some people to be nauseous. Please don't eat for 4 hours before your appointment. However, you can take your usual medications with sips of water. 

Does it matter if I take blood thinners, such as aspirin or Coumadin?
Yes. It is very important to notify the physician that is prescribing the blood thinners that you are going to have a procedure. This doctor will instruct you about when to stop taking the medication. Sometimes your blood will be checked on the day of the procedure to make sure it is okay to proceed.

How long do the procedures take?
Most procedures take less than 10 minutes to perform.  You will be asked to arrive a little early in order to fill out any necessary paperwork, and you will stay in the recovery area of our facility for about 20 – 30 minutes after your procedure. Since you will have received sedation for the procedure, you will need a driver to take you home.

How does the doctor know where to perform the procedure?
The vast majority of the procedure will take place under fluoroscopic guidance, which is a way to use low intensity X-rays to show the outlines of bone structures. Your doctor knows where the needles need to be in relation to these structures and will even use a very small amount of dye to confirm that the medications are flowing precisely to where they need to go in order to achieve a good result.

What can I expect after the procedure?
Plan to relax for the rest of the day. If you receive a steroid injection you may be uncomfortable until the medicine begins to take effect (1-2 days). If your doctor used local anesthetic to block nerves, such as facet joint nerves, the local medicine will wear off in about 4-6 hours. Generally, it is safe to resume your normal activities the next day, including going to work.

What is an Epidural steroid injection?
An Epidural steroid injection is among the most common interventional pain management procedures. The procedure takes just a few minutes to perform and the purpose is to deliver powerful anti-inflammatory steroids around the source of nerve irritation or painful disc. Nerves that are pinched or chemically irritated can be exquisitely painful, and the relief provided by the steroids can allow them to heal and repair themselves, while at the same time allowing you to return to many of your normal activities. It is often necessary to perform an initial series of several epidural steroid injections separated by a few weeks.

What is Radiofrequency Neuroablation?
This procedure is used to deactivate small pain transducing nerves around the spine. For example, if facet joints are causing your pain syndrome, the small pain nerves that serve the facet joints can be turned off with the Radiofrequency Neuroablation procedure. Relief may last for months to years.

What is a facet joint?
Facet joints are arranged in the back part of your spine from the base of your neck all the way down to your low back. They are involved in "whiplash" injuries of the neck and arthritis or degeneration in the low back. These joints may cause pain in and around the spine and can markedly limit how you use your neck or back. When facet joints are painful, it can be difficult to bend the spine backward. Each facet joint is served by medial branch nerves, and if these nerves are blocked with local anesthetic, the pain from the joints will stop, telling the doctor where the pain is coming from.

What is Provocative Lumbar Discography?
When pain in the low back does not respond to the basic treatments it may be necessary to investigate the intervertebral discs as possible pain generating structures. Painful discs can be bulging or have tears, but often discs that look normal on X-rays may be painful. The procedure usually takes about 30 minutes.  A small needle is guided into the center of the discs and dye is injected while X-rays are being taken.

What is Spinal Cord Stimulation (SCS)?
This procedure is for patients with spine and extremity pain that has not responded to other treatments. SCS is a technique that uses tiny electrical leads to block pain signals. These leads are placed over the spinal cord where the pain signals are converging. Temporary leads are placed initially, and a permanent system can be implanted if the temporary leads result in significant relief over a 3-5 day trial period.

What medications are most commonly used to manage pain?
While drug therapies differ for each person, the most common are:

• Adjuvant pain medications, including: antidepressants, anticonvulsants and muscle relaxors.
• Opiates or "pain killers" used to treat acute pain or cancer-related pain, and often prescribed for chronic pain.
• Anti-inflammatory drugs to alleviate pain by reducing swelling and irritation.
  

There are alternative delivery methods for medications. Common methods used at the office are oral medications, topical creams, sublingual medicines, nasal sprays, injections and patches.

What about the stories of addiction surrounding Opiates? Is there a difference between physical dependence and addiction?
A common misconception about Opiates is that they are addictive. The fact is when used properly for the treatment of pain, there is little risk of becoming addicted. Addiction is defined as continuing to use a substance when it has become detrimental to the person's life. Being dependant is not the same thing as being addicted.

Many people with health problems are dependant on medications, for instance people with high blood pressure are dependant on blood pressure medications. Diabetics are dependant on insulin. Furthermore, when opiates are taken as directed for legitimate pain, the person does not get "high" from taking them.

Opiates consist of the same chemical makeup as your body's natural painkiller, endorphins. People that have lived with pain over a long period of time sometimes have reduced levels of natural endorphins because the body has stopped producing them.

Will it be hard to control my pain with medication?
No, it won't. Technology has enabled doctors to control pain through the simple process of pain medications. Even taking the medication has been made as simple as possible. Your doctors and nurses will tell you everything you need to know, all you have to do is tell them how you feel and follow the doctors' instructions.

There are two simple steps to controlling pain with medication. First, you need to know the correct amount of medication you are taking to relieve your pain. Second, follow the instructions on your prescription. If you take your medication at the same time every day, you can maintain a constant level of medication in your body. Like most medications, pain medication can usually be taken orally.

Do I need a prescription?
Not necessarily. If your are experiencing mild pain, an over the counter drug may provide the relief you need. But if you have more severe pain, you may need something stronger. These stronger pain medications, opioids, always require a doctor's prescription. Some examples of opioids are: morphine, oxycontin, vicodin, codeine, and darvocet.

What about non-drug pain relief?
Simple techniques, such as abdominal breathing and jaw relaxation can help to increase your comfort level. Cold packs, massage, rest, and TENS therapy are some other non-drug relief methods. TENS (Transcutaneous Electrical Nerve Stimulation) is often helpful and quick to act and can be controlled by you.

Will I become addicted to my pain medication?
A drug addiction is not usually associated with pain medication. Addictions are more likely to occur when you are using a drug to get "high" rather than to relieve pain. Your doctors will monitor the dosage of your prescription to make sure you are not taking an amount that will become addictive. The purpose of taking pain medication is for the beneficial effects it produces. If you take your medicine as directed, your should not have any problems.

What about side effects?
The most common side effects are constipation, nausea, and/or vomiting, sleepiness, and slowed breathing.

The most common side effect of most opioids is constipation. Your doctor may prescribe a laxative or a combination laxative-stool softener to prevent constipation before it begins. You can help ease constipation by drinking plenty of water each day. While you are taking your medication, you should expect a bowel movement every second or third day. If three days have passed without a bowel movement, you should inform your doctor.

Nausea and/or vomiting are common as you begin your treatment, or just after your dosage has been increased. Once your body adjusts to the medication, that uneasy, uncomfortable feeling that you need to vomit should disappear. Your doctor may prescribe a drug that will stop nausea. If you do vomit, consult your doctor immediately, but do not stop taking your medication.

Sleepiness is another side effect of opioids. You may notice sleepiness because the pain you have been feeling has left you tired. If sleepiness persists more than a few days, consult your doctor. You may need to adjust your dosage. Keep in mind that taking opioids may affect your ability to perform some tasks like driving or operating heavy machinery.

Taking too much of an opioid pain medication may cause slowed breathing. This is also known as "respiratory depression." Patients should follow their doctor's instructions very carefully, and patients who have a history of troubled breathing should be especially careful to follow their prescription.

Less common side effects may include muscle twitches and feeling dizzy or confused. If you notice these side effects, or others, be sure to tell your doctor. The only way side effects can be treated is if your doctor knows about them.

Some days my pain is much worse; what can I do?
There will be times when you might notice that you are in more pain that usual. This kind of pain, called "incidental pain," is normal. At the end of a tiring day or during or after certain activities, you might find that you have more pain. Always be sure to follow your doctor's instructions. If you notice that certain activities contribute to your pain, medication can be taken prior to the activity to help prevent the pain from occurring.

An increase in pain does not always mean that your medical condition is worsening. Pain can be caused by many of your treatments or by something unrelated to your medical condition.

What can I do if my pain gets worse when I'm taking opioids?
Your doctor must carefully assess the dosage of opioids that can be prescribed. With most opioids, the dosage can be altered, so if you are feeling more pain than usual, you should talk to your doctor.

Is my condition getting worse if my doctor is prescribing opioids?
Nearly all medical experts agree that opioids are one of the best ways to control moderate to severe pain. Opioids such as morphine, oxycodene, and hydromprohone are prescribed regularly to relieve moderate to severe pain. By prescribing opioids, your doctor is only trying to help your control your pain and to help you maintain a productive and happy life.

Are my pain medications going to stop working?
No. Opioids do not lose their effect even if you take them for extended periods of time. Opioids will continue to relieve pain for months or years. If your pain worsens, talk to your doctor. He may want to reevaluate your dosage to ease additional pain.

Should I take pain medication only when I have a lot of pain?
No. Don't wait until pain becomes severe to take pain medication. Pain is easier to control when it is mild. You should take your pain medication regularly, just as prescribed. Sometimes this means taking medicine on a regular schedule.

Will I become addicted to narcotic pain medications?
Not necessarily, if you take your medication exactly as prescribed. A persons likelihood of becoming addicted depends on his or her addiction history. Addiction is less likely if you have never had an addictive disorder. Ask your doctor about any concerns you may have.

Why do I need to keep taking more of my medicine to have the same effect?
This situation occurs when you have developed tolerance to a drug. Tolerance is a normal physiological response to narcotics and occurs when the initial dose of a substance loses its effectiveness over time. Changing the dose or the medication often solves the problem. Just because you have become tolerant to a drug does not mean that you are addicted to that drug.

How can I tell my doctor how much pain I am in?
The best way is to describe your pain as clearly and in as much detail as you possibly can. Most doctors and nurses ask you to describe your level of pain on a scale. By keeping track of your pain, your doctor will be able to determine if your medication is working, if your medication needs to be adjusted, or if your level of discomfort is changing. Keeping a journal of your level of pain will also help you understand your pain and it's effects on you and what is working best to relieve your pain. You may also set a pain control goal (such as having no pain worse than 2 on the scale).

If my pain is associated with my illness, isn't the pain unavoidable?
Even if your pain is caused by a medical condition, you don't have to be in pain. In fact, being able to control your pain will help you in the treatment of your condition. If your pain medications are working, you will be able to eat, sleep, perform regular activities, and enjoy a better quality of life. The patients who are strong and rested are better able to fight their medical condition and actively participate in their treatment.

If my pain is due to cancer, can it be relieved?
Of course it can. Cancer and pain can be controlled in approximately 90 percent of all patients through methods such as oral pain medication. Your doctors will help you find the best way for you to control your pain.

My friends and family want to help. What can they do?
There is a lot that your friends and family can do to make your life easier. They can run errands for you, or help you around the house. They can help you complete your journal and keep written records of your pain and your medications.

Is pain management covered by health insurance?
Most policies provide for pain management. Please call our office for more information.