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Pain Management Archive Questions

Below are Dr. Gattu’s answers to Pain Management questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 19.

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Q : 1

Does anyone there do facet joint rhizotomy injections?

We perform such injections very frequently.

Q : 2

If you are allergic to sulfa, sulfites and sulfonomides, can you take geothermal sulphur/sulfa mud baths for pain?

You should avoid such therapy as there is some absorption through the skin.

Q : 3

Are you able to treat chronic, daily abdominal pain with no known cause? It's always located in between ribs and is always worse in the morning.

We do treat patients with abdominal pain, but with no known cause it will be very challenging and limited. However, there are various modalities that we recommend for such pain.

Q : 4

I have been having problems with pain in my hip--from the groin area to the top of my inner thigh. It hurts to lift my leg just to get out of bed or get out of the car. What kind of doctor would you recommend that I see?

You need to see a orthopedic surgeon and a pain physician for a work up with imaging and injections.

Q : 5

My husband has chronic pain and is currently being treated with medication. He also suffers from a seizure disorder. Do you treat patients with physical and psychological approaches?

We treat patients involving a multidisciplinary approach that incorporates behavioral therapy and physical therapy.

Q : 6

I have extreme, continually worsening central pain syndrome secondary to C-5 quadriplegia from 30 years ago. It controls my life, and nothing has ever provided relief. I apparently also have ongoing scar formation in the damaged cord area that plays a role in the worsening pain. Do you have any suggestions?

Unfortunately, central pain is one of the most difficult pain syndromes to treat. The usual treatments include medications, physical therapy, injections and biofeedback. It is best that you be evaluated by a pain physician for other forms of treatments such as a spinal cord stimulator or baclofen therapy which may offer some relief.

Q : 7

I was diagnosed with fibromyalgia almost 13 years ago, but I'm not sure it is correct. The pain in my neck and lower back is unbearable at times. I've been able to get by, but I'd like to find a way to deal with the pain.

Fibromyalgia is one of the most challenging pain conditions. A fibromyalgia specialist would be most ideal and they may place you on some medication to manage the pain. Physical therapy or mild aerobic exercises daily for 20 minutes along with other treatment modalities may be offered. Biofeedback, acupuncture, trigger point injections, complimentary medicine and diet modification are some of the treatments that may benefit you. It is also advisable to talk to a counselor to find additional solutions.

Q : 8

My husband suffers from chronic shoulder pain and cannot have surgery due to ITP. He is currently on Percocet for management, but it is only marginally effective. Is acupuncture a viable addition/alternative to drug management? Or are there other non-invasive therapies?

Acupuncture can be attempted and there are other integrative approaches as well such as homeotherapy or yoga. Physical therapy can offer some benefit and other medications from the other classes can be initiated and optimized such as antidepressants. If Percocet is marginally effective, he can switch to other opiate medications or consider a long-acting opiate. He may benefit from interventional therapy, however the ITP is the limiting factor. He may be able to receive platelet infusion prior to the intended procedure.

Q : 9

My wife has been taking opioids for nearly 12 years. She suffers from MS and Fibromyalgia. She has also suffered a number of injuries over the last 12-15 years from falls. For the last two years, she has been taking a combination of oxycodone, methadone and fentanyl patch. The dosage has increased over the years and her pain continues to worsen. The pain and the side effects of the medications have exacerbated her MS. We are concerned that this is opioid-induced hyperalgesia and her new doctor has stated the same. Her doctor said the only treatment is detoxification. What is the procedure for detoxification in her situation and what if the pain continues afterward?

If she has been diagnosed with OIH, detoxification or weaning off the narcotics is the best choice. Detoxification requires an addiction specialist to withdraw the medication quickly while managing the withdrawal symptoms simultaneously; there are various ways to detox. However, I would recommend a slow wean for your wife as she has been on this medications for many years. Your pain physician will direct and guide you appropriately for a smooth transition. For the MS pain, she may require short term treatment. For Fibromyalgia, narcotics are not the drugs of choice, however, you will need to work with your physician for other modalities to be incorporated to treat the pain.

Q : 10

I have had five rotator cuff surgeries, the last one in February. After months of PT I still have a fair amount of pain and decided to try acupuncture. What is "wet acupuncture?" My doctor uses injections with salt and herbs at several points next to the shoulder blades and neck. I also have chronic IT band pain which he treats with injections in the lower back.

Wet acupuncture is what your physician is offering you right now, using acupuncture with injections of small amounts of medicine into the area of interest depending on the diagnosis. If this treatment helps relieve your pain, then it should be continued. If you're no longer reaping the benefit, you should be reevaluated. There are other interventional procedures and modalities for pain management that could work for you.

Q : 11

Can you treat a patient with Acute Sensory Peripheral Neuropathy without pain medication?

We offer a multimodality approach to managing pain at our center. We treat patients with injections which you would likely benefit from, physical therapy, biofeedback, acupuncture etc.

Q : 12

Do you treat patients with Complex regional pain syndrome (CRPS)? Do you have success with these patients?

We have treated and continue to treat patients with CRPS. Success depends on many factors -- some patients do well while others are stabilized. I have to evaluate and assess the patient and then the decision is made.

Q : 13

I work as a delivery guy and for the past 5 weeks I have been experiencing a terrible pain in my lower back which causes pain to run down to my left ankle. It initially started as intense pain and tingling with numbness and burning, but now it is less severe and in my waist and hips, shooting down to my ankle. I have been working out with a trainer, but the pain is unbearable. I had an MRI and X-ray of my foot and knee, but according to my doctor everything looks OK. Where do I go from here?

Based on your presentation, you could have a pinched nerve. Initially physical therapy is advised as it does help with the symptoms and if does not resolve in 6-8 weeks, an MRI of the lumbar spine would be indicated. I would advise that you see a Pain Management physician for further help. You may need a epidural steroid injection to alleviate your pain.

Q : 14

Besides steroid injections, what can I do to get rid of a very painful knee? I have been physically active, but have slowed down a lot due to chronic pain (was told bone is rubbing on bone). I want to avoid surgery, if possible. I have used glucosimine chondroitin, but the pain persists.

Besides the steroid injections, you can get Hyalgan or Synvisc injections which can offer temporary relief. Surgery would be the other alternative, as it does offer good results. The only other option would be medications which I would try to stay away from, since it can be surgically replaced and offer some relief. You may need to consider surgery as it is the best of the options.

Q : 15

Is management of chronic pain done as inpatient or outpatient care?

The patient is almost always seen as an outpatient on a chronic basis. Only certain patients require inpatient therapy, but this is rare.

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