Golden Opportunities

Pain can be a ... pain. But today, there are new ways to tackle this uncomfortable problem. Here to explain is Dr. Sabry Ayad, chair of the department of anesthesiology and pain management at Fairview Hospital and President of The Cleveland Society of Anesthesiologists.

Question: Are there different types of pain?

Answer:The two main types of pain are acute pain and chronic pain.
Acute pain is after surgery pain (or after labor). It is short in duration, usually lasting only a few (hours, days,) weeks.
Chronic pain lasts a much longer time, for example, lower back pain or cancer pain.

Question: How do you treat acute pain?

Answer:Treatment for acute pain can often be started before the surgery even begins. Through an injection, we can now block sensory completely before an operation begins. For example, if you are having a knee replacement, an injection in the knee to sensory block before an operation can be done. If you are having abdominal or chest surgery, an epidural type pump can be hooked up to deliver pain medication to the incision area.
In addition, para vertebral blocks can be utilized to numb a specific area in one part of the body depending on where the block is performed. For example, paravertebral blocks at the level of the chest and abdomen can be used for many types of breast, thoracic, and abdominal surgery.
This type of treatment has several advantages. First, when used, far less general anesthetic is needed. This can cut down on side effects, patients may wake up pain free, and recovery can begin more quickly (such as joint replacement patients going quickly into rehabilitation).

Question: What about chronic pain?

Answer:There are many causes of chronic pain, so we use a multi-modal treatment for it as well. Let's take the example of lower back pain, which also features pain shooting down the legs. Treatment may include:

• Anti-inflammatory medication and/or cortisone injections.
• Anticonvulsive medication that can help the pain shooting down the legs.
• Those who have been in pain for months, even years, may be suffering from depression and need anti-depressant medication.
• Acupuncture.
• Perhaps a device like a TENS unit-a device that stimulates nerve fibers where the pain is to relieve pain, working in about 30-40% of our patients.
• Radio frequency Ablation-a new treatment that beams high radio frequency rays to target specific inflamed nerves in cases of severe back pain.
• Spinal Cord Stimulators-Using very tiny electrodes and a small generator to directly stimulate the segments where the pain is arising. Spinal cord stimulators are used in cases of intractable chronic pains (such as pain after failed back surgery or intractable cancer pain) where conventional treatment was not successful in managing the pain.
• Psychological support and physical therapy.

Question: Is there any specific treatment for cancer pain?

Answer:Cancer patients are often already on a number of narcotics that can cause unpleasant side effects like constipation, nausea, and itching. Therefore, additional narcotics to help deal with pain is not favored.
Now, we can implant a device in the back of cancer patients (an intrathecal device). This is a pain release mechanism, giving the patient 24/7 pain management coverage. It gives a very small dose (a microdose) of medication directly into the nerve supply (the spinal fluid). The low dose cuts back on side effects.

Question: Fairview has a pain management center. What's the benefit of a specialized center?

Answer:Personal care, specially trained staff, etc.

Question: Where can we learn more?

Answer:Our website, www.fairviewhospital.org/pain, is a wonderful resource for pain management. On the "Pain Management" page, on the right you can go to "Types of Treatment." That leads you to a page where you can watch animations that will actually show you the possible treatments, as well as instructions and other information.

Whether it's been 10 days or 10 months, if you're in serious pain, don't suffer in silence. To learn more, give Fairview Hospitals Pain Management Center a call. The number's next. My thanks to Dr. Ayad.