Wayne E Anderson DO A Medical Corporation
Board Certified Neurology
Board Certified Pain Management
There are many treatments available for the various neurological, headache and chronic pain patients. Some treatments may be appropriate for some, but not all, patients and conditions. Employing treatments in addition to medications can significantly improve the overall success of the program. Non-medication treatments are an integral part of the medical treatment and reassessment cycle.
Treatments vary, but the following treatments are quite commonly prescribed.
Physical therapy encompasses various types of treatment. Although physical therapy itself is fairly specific, we typically think of various other physical modalities as being a part of physical therapy. In fact, many physical therapists employ other techniques, such as Feldenkrais, Pilates and the like, along with standard physical therapy. The American Physical Therapy Association has additional information for patients.
It is important to emphasize that all physical modalities are potential treatments. Although some treatments carry more risk than others, and although some treatments may be appropriate for some but not others, many patients benefit from yoga, meditation, exercise, swimming, Feldenkrais, Pilates, and a host of other physical modalities.
People often think of acupuncture as "alternative." However, acupuncture is scientifically proven and performed by many mainstream practitioners. In fact, the US Government provides a background about acupuncture. The National Institutes of Health maintains a "complementary" medicine section and provides quite a bit of information about acupuncture.
Psychology is often thought of one-dimensionally: a person to talk to. In fact, psychology is much, much more. In addition to the counseling aspect of psychology, we rely on psychologists for memory testing in cases of dementia or brain trauma. We rely on pain psychologists to assist with imagery and coping skills with chronic pain. We have noted that patients who have a psychologist involved in their care typically show a better quality of life. Psychology Today is a common web portal that may provide additional information.
Botulinum toxin (Botox and Myobloc) is thought of as a cosmetic treatment. However, it's original use was neurological. Botox can reduce muscle tension and spasm and therefore reduce pain. It is commonly used for cervicogenic (muscle-related) headache, writer's cramp, blepharospasm, and other muscle conditions. Although not FDA-approved for many of the uses, it has been used successfully and safely in many more conditions. Recent studies reported by the American Academy of Neurology suggest that Botox may more efficacious for muscle disorders than for migraine.
Injections are a common form of treatment for various conditions. The underlying idea is simple: a medication is injected in a specific region, intended to provide improvement in the condition. In a joint, the medication may be a lubricant to compensate for worn out cartilage; in a trigger point, the medication may be a numbing agent to reduce pain; in the spine, the medication may be a steroid to reduce spontaneous nerve firing and to reduce pain; in the muscle, the medication may be botulinum toxin (Botox or Myobloc) to reduce abnormal muscle tension. Depending on the purpose and location, these procedures may be performed in an office setting or in a radiology suite with X-ray guidance.
This is NOT like a TENS unit. The surgically implanted dorsal column stimulator is a device designed to provide electrical signals to the spinal cord to relieve pain. The device is tried externally before surgical implantation to make sure that it provides benefit. Also, patients require a psychology evaluation before undergoing this type of surgery; this is a standard of care requirement by all pain centers. Once implanted, there is a remote control that the patient uses to turn the device on/off and up/down, in order to control the pain. Because the device requires a surgical implantation (and is quite costly), it is usually considered if less invasive means have not provided adequate relief.
The TENS unit is very different from the surgically implanted spinal cord stimulator. The TENS unit stimulates the skin and the structures beneath, not the spinal cord. The TENS unit is fairly safe and can provide relief of pain and muscle spasm. Being non-invasive, it typically is used in acute pain and somewhat less in chronic pain. Patients often have their first experience with a TENS unit while undergoing physical therapy.
The surgically implanted medication pumps allow a medication to be delivered in very small doses directly to the pain receptors. By sending the medication directly to the receptors, many of the systemic side effects are not present. If someone takes a pill, the medication goes through the blood stream all over the body and causes various side effects. When the medication is delivered directly to the pain receptors, most of those side effects don't occur. The pump has limitations, however. Tolerance may develop rapidly, for example. Currently, the pump is reserved for terminal care and for those patients who cannot achieve good pain control with lesser means. This pump is surgically implanted into the patient's body and the reservoir does require refills on a regular basis.
TREATMENTS
There are many potential treatments. Medications are only one part of a successful treatment regimen. Patients who employ physical modalities typically show more progress and better quality of life.
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