Answers
to Frequently Asked Questions
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
can the Pain Specialists of New England do for my pain?
The goal of the Pain Specialists of New England 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.
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 kind of doctors work at the Pain Specialists of New England?
Our doctors are Anesthesiologists who have gone beyond regular
training to complete a specialized, one year fellowship program
in Interventional Pain Medicine. They have received specialty
board certification in Pain Medicine from the American Board of
Anesthesiology. Our doctors focus exclusively on treating pain
with procedures and devote their efforts full time to the Pain Specialists of New England patients.
What
kind of pain syndromes can be treated at the Pain Specialists of New England?
The most common types of pain treated at the Pain Specialists of New England are:
Spine
pain (low back pain, neck pain).
Pain from damaged or pinched nerves (sciatica or radiculopathy).
Call us or ask your doctor if your pain syndrome merits an evaluation
at the Pain Specialists of New England.
What
happens after my doctor refers me to the Pain Specialists of New England?
The Pain Specialists of New England staff will obtain relevant medical records, verify
your insurance status, and contact you to schedule an evaluation
in the Pain Specialists of New England. Once your Pain Specialists of New England doctor has performed
your evaluation, a detailed treatment plan will be discussed and
you are encouraged to ask as many questions as you like. If you
are not currently a candidate for any pain management procedures,
your doctor may recommend alternative approaches to your pain
syndrome, such as physical therapy, rehabilitation, support services,
or surgical referral.
What
are some of the procedures performed at the Pain Specialists of New England?
These procedures include:
Epidural
steroid injections in the cervical, thoracic, and lumbar regions.
Transforaminal steroid delivery and Selective Nerve Root blockade.
Disc Decompression and Intradiscal Annuloplasty (IDET).
Facet joint and Medial Branch nerve injections.
Lumbar Provocative Discography.
Radiofrequency Neuroablation.
Sympathetic plexus blockade.
Spinal Cord Stimulation.
Coeliac Plexus.
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 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. They cause pain in
and around the spine and can markedly limit how you use your neck
or back. When these joint 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 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 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 can
turn out to 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. If the procedure confirms
that a specific disc is causing pain, then the IDET procedure
should be considered.
What
is Intradiscal Electrothermal Annuloplasty (IDET)?
Occasionally the intervetebral discs in our low backs can be the
cause of our pain syndromes. These painful discs can be bulging
or have tears and cracks. The IDET procedure is a way to treat
these tears and to deactivate the small pain nerves that have
begun to grow into the disc. The procedure takes about 30 minutes
to perform and you will work with a Physical Therapist after the
procedure to optimize your recovery, strengthen the muscles that
support your spine, and learn exercises to maintain a healthy
back.
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.
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 Specialists of New England 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.
Do
the procedures hurt?
The procedures can be briefly uncomfortable. Light intravenous
sedation will be provided for each procedure. These medications
include an anti-anxiety medication and a pain-relieving medication.
Together these medications will make you feel sleepy, but you
will be awake enough to hear the doctor and nurses explain to
you what is happening during your procedure. Even though you are
sedated for the procedure, local anesthesia will still be used
on your skin and subcutaneous tissues to maximize your comfort.
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.
Will
the Pain Specialists of New England doctors give me
opioid medications to take at home?
You may treat discomfort related to the procedure with conservative
measures, such as stretching, massage, ice packs, or heating pads.
You can take acetaminophen (Tylenol) or ibuprofen (Advil) as instructed
if these medications are safe for you to use. If your primary
care doctor has given you a short-acting opioid medication, such
as oxycodone (Percocet) or hydrocodone (Vicocin), you can take
these medications for post-procedure discomfort, but only in the
way that your doctor has prescribed.
Can
steroids cause side effects?
Yes, but these are infrequent and usually very mild, such as temporary
sleeplessness, nausea, increased appetite, or elevation of blood
sugar levels.
Can
the procedures be repeated if my pain comes back?
Most procedures can be repeated on an “as needed" basis,
depending on the procedure type. Knowing what procedure works
well for your pain syndrome gives you freedom and control.
What
are the risks of the procedures?
Any time a doctor performs a procedure there is the risk of an
adverse outcome. Even though very rare, some of these outcomes
are more serious than others, and can include headache, infection,
worsening of pain, bleeding, damage to nerves or vessels, or death.
If you have any concerns, always be sure to discuss them
with your doctors.
What
if I need to contact the Pain Specialists of New England
after it has closed?
If you are having a medical emergency, dial 911 or go immediately
to an Emergency Room or Urgent Care Clinic to be evaluated. If
you have an urgent matter that cannot wait until the Pain Specialists of New England
is open you will be instructed to contact the Pain Specialists of New England doctor’s
answering service. If you are having trouble reaching the Pain Specialists of New England doctors, you can always contact your primary care physician.
Any medication refills, scheduling issues, or billing matters
must wait until the Pain Specialists of New England is open.
Besides
procedures and medications, what else can be done for my pain?
You are the most important ingredient in treating your pain in
the long run. Procedures and medications can provide a degree
of relief but these are intended to allow you to begin stretching,
exercising, losing excess weight, and improving the strength of
your muscles and bones. Reconditioning your body causes normal
sensations to arrive at your spinal cord and brain, thereby helping
to defeat pain perpetuating neural circuits and reflexes.
Who
can I call if I have specific questions?
Please call us at 508-478-8100. Our staff will be happy to assist
you.
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