Five Ways Comprehensive Pain Management Centers Differ From Pill Mills

1. Board Certified or Fellowship Trained Doctors

2. More services than writing prescriptions

3. Patients make an appointment

4. Mostly Insured Patients

5. Use of Narcotic Agreements and other Surveillance Methods

Comprehensive pain centers are considerably different from "pill mills". Unfortunately the two get linked together in the public's mind. Pill mills are pain clinics that are predominantly in the singular business of providing narcotic prescriptions. Because the country is in the midst of a narcotic prescription epidemic, pill mills have received a bad rap, and deservedly so. Unfortunately though, legitimate pain centers have been dragged down into that public perception as well.

Pain management clinics frequently have board certified or fellowship trained physicians who have received extensive training in both interventional pain treatment along with medication management. This is typically vastly different from pill mills, who tend to use physicians without specific pain training.

Pill mills typically just write prescriptions. In contrast, pain management centers usually provide more services, such as interventional treatments, physical therapy and chiropractic.

At a pill mill, patients are often able to simply walk in rather than making appointments. At the more legitimate pain centers, however, patients need to call and make an appointment. Usually if it's a new appointment with a referral, medical records are received from the referring doctor's office.

At typical comprehensive pain management centers, the patients have medical insurance and utilize it for their care. Pill mills often work outside the insurance system. This means either having patients with no insurance paying cash, or having patients with insurance simply not using it.

Comprehensive pain management centers utilize pain narcotic agreements, typically called "pain contracts." These contracts help to ensure patients comply with such treatment protocols as pill counts, urine drug screening, and pharmacy board prescription monitoring.

These 3 treatment protocols are a fantastic trio that helps prevent diversion. It is well known that over 20% of patients will divert their pain medications, and that diversion spans all socioeconomic and ethnic groups. Pill mills may not have these various surveillance tactics, and it works to the detriment of preventing the rising epidemic of narcotic abuse in the US.

These factors together differentiate pill mills from comprehensive pain management centers. By combining all of these services and qualities, the more modern pain centers can actually help patients cut down their amount of narcotics being taken. This may stem the tide of narcotic abuse, and also help transfer some of the medications being written to those of the non-narcotic variety.

Ambulatory Spinal Unloading - A New Treatment For Low Back Pain

"Ambulatory spinal unloading" is the "new kid on the block" when it comes to treatment of acute and chronic low back pain. It is so new that many care givers are not yet fully aware of it.

Anecdotally we know that relieving pressure on the discs via traction, non-surgical spinal decompression or inversion tables etc relieves the pain, we also know that continued activity opposed to inactivity is beneficial and everyone knows that stabilizing the spine and allowing strained muscles to relax and heal are critical to the healing process.

But until ambulatory spinal unloading came along there was no way to offer a low back pain suffer the full treatment. This new treatment modality for low back pain allows sufferers the ability to regain mobility, flexibility and activity in a pain free or pain reduced environment, allowing discs to rehabilitate, muscles to realign and mend and damaged nerves to heal.

Ambulatory spinal unloading dramatically reduces the degenerative cycle and dramatically increases the rejuvenative cycle of the spine and is without a doubt one of the most beneficial and cost effective, non-invasive treatment modalities for acute and chronic low back pain available today.

Ambulatory spinal unloading can be used to extend the benefits offered by stationary treatments as well as chiropractic and physiotherapy treatments or can be used as a pre surgery bridge or a post surgery protection/prevention tool.

Typical indications for this new treatment modality are most forms of low back pain that have been caused by; degenerative disc decease, herniated or bulging disc, nerve impingement, stenosis, facet syndrome, spondylolisthesis, lumbar vertebrae compression fracture, sciatica, lordosis etc and for many "undiagnosable" causes of low back pain.

Spinal Decompression For Failed Back Surgery Syndrome

While it is common for traditional doctors to recommend spinal surgery to treat severe back problems, it is usually not the ideal treatment option. Several accounts have been recorded of patients experiencing pain after back surgery. This is known as Failed Back Surgery Syndrome or Post-Surgical Back Syndrome.

Spinal surgery can almost guarantee that no future back surgery is needed for an operated disc, however, the surgery can cause complications with new discs. These complications, if not caused by malpractice, are often due to recurrent herniated discs or scar rediculopathy. Another probable cause is the slow adjustment of the body with the change in anatomy caused by either the surgery or the injury. Failed Back Surgery Syndrome is characterized by lower back pain, which in some cases is worse than the pain before the surgery, incapacitation, nocturnal cramps, and distal paresthesia.

Rehabilitation and pain management are the usual treatments for Failed Back Surgery Syndrome depending on the degree of pain. A second back surgery, however, is not recommended as treatment.

Several alternative methods of treating spinal problems, which are of equal, if not greater effectiveness than surgery are also available. One of which is spinal decompression therapy, which uses a machine, the DRX9000, that applies a gentle pulling force that decompress the injured discs and vertebrae and results in relief of back pain. It works by elongating the spine to release the pressure from the compressed discs or vertebrae and allows healing to begin as oxygen and nutrients enter the injured portions.

Spinal decompression holds several advantages over surgery, the most important being the lack of side effects since it is just a very simple, and safe procedure that uses high-class technology.

Another advantage is the faster treatment time compared to surgery as it is non-invasive. No incisions were made, therefore, there is no healing process to be worried about. Finally, based on research, spinal decompression has been proven to be more effective than surgery in terms of relieving pain. A proof of this is the fewer amount of analgesics (pain killers) needed to be taken after the treatment as to when surgery is performed.

Steroid Injections for a Herniated Disc - Who Responds Well?

At any one point in time, 1% of the US population is suffering from a lumbar herniated disc. The condition typically occurs when a piece of the intervertebral disc squeezes out from its confines and pinches on a lumbar nerve root. Think of a jelly donut with a tear in the outer portion, and some jelly squeezes out.

The compression of the nerve root may spark up inflammation around the area, and that is what creates pain going down one's leg called radiculopathy, or sciatica. Sciatica is often a burning, searing pain that is extremely painful and disabling for patients.

Epidural steroid injections for herniated disks are very popular treatments, and often work well to give pain relief and avoidance of surgery. But who does well with them? There are 2 types of epidural injections done currently. The first, an intralaminar epidural injection, involves steroid medication being placed just under the bone in back of the spine. These do work, but one of the current options is a transforaminal epidural steroid injection (TESI), where the pain doctor places the needle into a more specific area where the nerve root is actually being pinched as it exits the spine.

Since the problem is the pinched area, that is where the steroid medication works well. A new study out of Australia (Ghahreman, Pain Medicine 2011) looked at transforaminal injections for lumbar radicular pain from a herniated disc. The findings were very interesting. They round that transforaminal epidural steroid injections worked well for disc herniations that did not have severe nerve root compression, but small to moderate compression.

The theory behind their results was that with small to moderate compression, the body produces an inflammatory response for which steroids work well. The success rate in these instances was 75%, which is consistent with numerous other studies on the benefits of epidural injections overall for herniated disc with sciatica.

If the compression is severe, the results in the study were only 26% effective. The authors theorized that in those instances an inflammatory response was not as prominent so the steroid injection was not as successful. If in fact that is the case, in instances of severe compression a higher consideration towards surgery should be given. Especially if an individual has muscle weakness from the compression.

At any rate, epidural injections are an excellent treatment to try and avoid surgery with a low risk profile. It just appears they work better for disc herniations that are present but not in the severe category.

Can My Back or Neck Pain Get Better?

Even though back and neck problems are commonplace, it is a good thing that generally they can resolve on their own. In reality, the usual result of spinal pain symptoms is most favorable with or without treatment.

It is challenging to determine which treatments are or are not successful because of the body's natural tendency of spine-related pain to improve; i.e. the pain often subsides on its own regardless of whether you received any form of medical intervention. However, even with the body's natural ability to heal itself and get you out of pain, many people with back or neck pain experience pain that persists, gets worse, or comes and goes. If you are reading this article, chances are that your back or neck pain problem falls into the classification of not getting better by itself. The following is a list of the more common pain situations:

• Chronic back or neck pain problems that persist for more than three months.


• Back or neck pain flare ups that occur from time to time over the course of several years.


• Back and neck pain for which spinal surgery is recommended.


• Back or leg pain that persists even after having spinal surgery. This type of pain is known as failed back surgery syndrome.

The aforementioned classes of pain do not resolve themselves right away and can become frustrating for you and those near you. Getting the proper information about your back or neck pain problem is your most important resource for improving your spinal health.

Many times, the appropriate timing and implementation of treatment options is the key for you to get over your pain problem with success. For instance, you may see an improvement with physiotherapy treatments that include electrotherapy, ice, and heat in conjunction with an exercise program. In some cases, you might also receive spinal decompression.

The importance of treatment integration should involve chiropractic. Chiropractic is only appropriate in certain cases. You can improve the odds of having a good outcome from chiropractic if you include psychological preparation for chiropractic treatment especially if you have never been to a chiropractor nor have any knowledge of what a doctor of chiropractic does. You can also increase your chances of success by arming yourself with the right information about your situation should you wish to avoid drugs or surgery.

During the course of chiropractic treatment, a complementary rehabilitation program will follow and include exercise, psychological evaluations, physiotherapy, and, sometimes, a referral to a doctor of medicine for surgical consideration.

Keep in mind that there is an alternative to drugs or surgery to get rid of back or neck pain.

Treatment Options For a Bulging Disk in Your Lower Back

You may have heard the term "slipped disc" used to describe a low back injury. Discs do not actually "slip". Rather, they may herniate or bulge out from between the bones. A herniation is a displaced fragment of the center part or nucleus of the disc that is pushed through a tear in the outer layer or annulus of the disc. Pain results when irritating substances are released from this tear and also if the fragment touches or compresses a nearby nerve. Disc herniation has some similarities to degenerative disc disease and discs that herniate are often in an early stage of degeneration. Herniated discs are common in the low back or lumbar spine.

What causes discs to herniate?

Many factors decrease the strength and resiliency of the disc and increase the risk of disc herniation. Life style choices such as smoking, lack of regular exercise, and inadequate nutrition contribute to poor disc health. Poor posture, daily wear and tear, injury or trauma, and incorrect lifting or twisting further stress the disc. If the disc is already weakened, it may herniate with a single movement or strain such as coughing or bending to pick up a pencil.

How do I know if I have a disc herniation?

Herniated discs are most likely to affect people between the ages of 30 and 40. Disc herniations may be present without causing pain. The most common symptom will be pain in the area of the herniation that may radiate across the hips or into the buttocks. You may also experience numbness or pain radiating down your leg to the ankle or foot. If the herniation is large enough, you may notice weakness with extension of your big toe and you may be unable to walk on your toes or heels. In severe cases of lumbar disc herniation, you may experience changes in your bowel or bladder function and may have difficulty with sexual function.

How is a disc herniation treated?

Mild to moderate disc herniations can usually be treated conservatively with stretching, exercise therapy and chiropractic care. More advanced cases will often require some form of spinal decompression, such as traction or mechanical decompression, in conjunction with chiropractic care.

Occasionally, a herniation may be severe enough to warrant surgical intervention. These cases are usually reserved as a last resort when other forms of therapy have failed to relieve pain, or if there is significant compression of the spinal cord or nerves.

How will this effect the rest of my life?

When I was first injured it seemed I was destined to be in a wheelchair forever. Over time, actually about 8 months, I began to see some noticeable differences in my range of motion and pain level. Today over 12 years later I live a very active life and don't feel as if I have to stop being an active dad. Although even this long after my injury I have some pretty rough days. There are times when I get the electric shock pain down my legs or can't get up. I've learned over the years when this happens "Don't Panic", for me I just return to regular chiropractic check ups, routine stretching, and get my diet back on track. Your back pain can be used as a barometer to alert you that you're getting over stressed or not exercising as regular as you should. I highly recommend you find a doctor or therapist you trust to give you good advice or treatment. Ultimately you will have to make the decisions as to what works best for you but know there are lots of options other than surgery. And you can get back to a normal active life even in severe cases.

Diagnosis and Treatment of Coccydynia

Coccydynia is pain in the coccyx, the tailbone, which can cause a great amount of discomfort and limit mobility. Sometimes, this pain is not taken seriously by general practitioners but it is important to learn the cause if the pain persists. In some cases, the cause is obvious as pain develops after a fall or injury. A pilonidal cyst also creates pain in the coccyx and since there is often a visible abscess, diagnosing the problem is simple. 

Other causes of coccydynia are more complex and require a thorough examination and diagnosis. One of the first goals is to rule out the possibility of cancer as a cause of the pain. Before deciding upon a plan of treatment, it is important to distinguish coccyx pain from low back pain or other causes not related to the coccyx. 

Diagnosing Coccydynia

• History and Physical must be completed.


• CT Scan (Computerized Tomography)


• MRI ( Magnetic Resonance Imaging)


• Dynamic X-rays -this means x-rays taken when sitting and standing. A comparison may show a coccyx that dislocates when the patient sits, causing pain. 

Treatment Of Coccydynia

Falls

• Use a cushion or well padded seat to relieve pressure on the coccyx when sitting. Several new devices have been developed which are far superior to rubber donuts or foam pads. Many can be found on the internet when doing a search for 'coccyx cushions'. This cushion may be necessary for an extended period of time.


• Rest and avoid re-injury.


• Anti-inflammatory medications, such as ibuprophen and naproxyn, are helpful.


• Corticosteroid or local anesthetic injections may dramatically relieve persistent pain. 

Unstable Or Dislocating Coccyx

• Rest and avoid re-injury.


• Corticosteroid injections are helpful.


• If pain persists and corticosteroids are unsuccessful, the coccyx may be removed surgically. 

Childbirth

• Rest often allows the coccyx to return to its normal position.


• If this fails, treatment as for Unstable or Dislocating Coccyx is appropriate. 

Repetitive Strain

This is due usually to long periods of rowing or bicycle riding.

• Rest - avoid activities that caused the pain.


• Anti-inflammatory medications, such as ibuprophen or naproxyn relieve discomfort. 

Misaligned or Long Coccyx

• Injections of corticosteroids are often helpful.


• Surgery is not recommended. 

Boney Spur or Spicule On Coccyx

• Local injection of corticosteroids and/or local anesthetic have been helpful.


• Surgery has been successful.

 
Muscle Spasms Of Gluteus Maximus Muscle

• Physical therapy and massage have been effective in relieving spasm. 

Piriformis Syndrome

• Physical therapy


• Stretching exercises


• Injections of Corticosteroids Locally 

Pilondal Cyst

• Surgical removal is necessary as infection reoccurs repeatedly. 

Coccyx pain and the associated difficulty with sitting and movement can be most miserable and memorable. Sufferers who gain relief are always anxious to avoid any recurrence whenever possible.