In The News - Perlman Clinic

Why You Should Avoid Opiates When Treating Chronic Pain

5/15/2017 - written by Perlman Clinic

Have you ever heard of opiate pain pills? This type of pain management solution is prescribed to millions of patients across the US every year, yet in the end, it’s becoming more of a problem for our nation than a solution. There are multiple side effects—including addiction and tolerance.

It can seem appealing to those with chronic pain to simply take a pill to make the pain go away. But the problem is that eventually, opioids can take a toll on the body. Chronic opiate therapy is a bad idea—and pain management centers across the nation are trying to offer alternatives.

The Opiate Problem

An opioid is defined as “a class of drugs that…are chemically related and interact with opioid receptors on nerve cells in the body and brain.” Illegally, opioids can be found in the form of the street drug heroin, while legally, opioids are known as oxycodone, hydrocodone, codeine, morphine, and others. In the short term, opioids are effective and relatively harmless for pain relief. However, opioids tend to produce euphoria alongside pain relief. This aspect of the drugs makes them addictive.

As such, there is an opioid crisis on our hands in this nation. People enjoy not only feeling pain relief, but they like feeling good (the obvious result of euphoria). Many patients who are prescribed opioids in the short term, such as to bring pain relief after a surgery, get hooked on that euphoria and find excuses for being prescribed more. The results have been devastating—in 2014, over 28,000 US residents died after an opioid overdose. The US Department of Health and Human Services has been developing programs to help opioid addicts recover, such as substance abuse treatment centers, mental health counseling, and bringing awareness of the problem to the mainstream.

The Dangers of Chronic Opiate Therapy

While it may make sense to take opioids after a surgery or to help recover after a sports injury, it doesn’t make as much sense to use them to treat chronic pain. Although researchers have found that opioids are effective for treating chronic pain, the side effect of addiction is too high a risk to take.

When considering a treatment for chronic pain, you must take into account that you are talking about a long-term pain solution. This is because the nature of chronic pain is that it lasts longer than three months, and for many sufferers, will never completely go away. If you choose an opiate to treat this pain, you are exposing yourself to the possibility of dependence and even drug resistance, requiring higher and higher does to achieve the same results. The higher the dose, the higher your risk of overdose and death. Dr. Jenny Andrus of Orthopaedic & Spine Center explains:

Ultimately, opiate therapy should not be considered at first when looking at chronic pain solutions. If this is the case, then what else can we use?

What’s a better option?

There are many other ways to treat chronic pain. At pain management centers, you will find a long list of treatment options, most of them medication free. For example, you might find relief from the following treatments:

  • Yoga
  • Chiropractic
  • Dietary changes
  • Biofeedback
  • Guided imagery
  • Acupressure
  • Massage
  • Osteopathy
  • Lifestyle changes
  • Spinal cord stimulation

While most pain management centers tend to combine alternative therapies with some form of medication, most patients are supplied with a multi-disciplinary pain program. Such programs aim to find the combination that works best for the patient. So what works better than opiate therapy for chronic pain? Many things!

For instance, you might find that guided imagery, which teaches you to focus on images that relax you when you start to feel pain, combined with a stretching routine and massage, can turn off the pain signals in your brain. You can also take a more drastic approach by getting a nerve block, which is an injection of numbing medication directly to a nerve.

People with spinal cord pain may benefit immensely from a spinal cord stimulation device, which sends an electric signal to interrupt the pain signals sent by different nerves. Sometimes if the pain is isolated to the musculoskeletal system, a combination of spinal manipulation (chiropractic), acupressure, massage, and stretching may be enough to manage the pain. The point is that there are many alternatives to opiate therapy.

What do you use for chronic pain relief?

In the end, you must do what is best for your body. Sometimes it can be a long journey to discover what treatment options will solve your chronic pain and allow you to live a full life. But ultimately, those options should not involve opiates, at least as much as can be helped.

Nerve Blocks: What Are They and Should I Get One?

4/20/2017 - written by Perlman Clinic

If you have chronic pain, you’ve probably asked around for pain treatment options that might be more effective. In your research, you might have heard of something called a “nerve block.”

There are different types of nerve blocks, varying by the location and intensity of pain. Remember that chronic pain is defined as pain lasting longer than three months. If this describes your pain, and doctors haven’t been able to offer much in the way of a pain solution, a pain management clinic—where nerve blocks are often an option for treatment—might be what you’ve been looking for.

What are nerve blocks?

The goal of a nerve block is pretty clear from the name of this treatment: to block pain signals from nerves. For many, chronic pain is derived from an autoimmune disease, arthritis, an old injury, or another source (usually nerve related). In these cases, there is no specific cure, and a patient’s only option may be to simply manage the pain.

Good thing there are pain management specialists! Many medical companies exist solely to develop pain treatment options, which are in turn provided to the general public through doctors and pain management clinics.

A nerve block, then, becomes an appealing option. This treatment option functions as a local anesthetic or anti-inflammatory treatment, depending on the cause of pain. Nerve blocks are usually administered via injections with the aim of “turning off” the pain signal. Your physician will use image guidance to pinpoint the exact location of the nerve for better results. This type of pain relief is temporary and often administered to the spine, neck, legs, or buttocks. 


Diagnostic Nerve Blocks

Diagnostic nerve blocks are used to discover the nerve sending the pain signals. In a diagnostic nerve block session, a doctor injects anesthesia in one section of skin where they think the pain might be originating. After the injection is complete, they allow time to determine how much the pain has decreased. If the pain is still present, they will inject another site, repeating the process until the pain has significantly decreased.

Diagnostic nerve blocks may take a little time in office, but once a patient shows significant improvement in pain levels after injection to one place, the patient can then plan to receive additional nerve blocks or a radiofrequency ablation to this area in the future without having to repeat a diagnostic session.

Sympathetic Plexus Blocks

It might sound funny to call something inside the body “sympathetic”—it’s like we’re personifying tissue and organs. But that’s not the case at all. The sympathetic nerves are bundles of nerves that run the length of the spine from the neck to the tailbone. These nerves run pretty much all of the body’s organs. Keep in mind that a plexus is defined as “a network of…interlacing blood vessels or nerves,” which is how the sympathetic nerves can be described.

When it is determined that pain signals have been transmitting through these sympathetic nerves, a sympathetic plexus block can be helpful. A sympathetic plexus block is a type of nerve block that seeks to stop the pain signals in these nerves. The plexus block is usually administered with local anesthesia, a needle, and x-rays to determine the exact location of the pain-causing nerve.

Medial Facet Joint Blocks

Facet joint blocks involve injection of anesthetic in order to numb a nerve, just like any nerve block. The important thing about this type of nerve block is its location. The name of this type of block is derived from both the medial branch nerves and the facet joint, where the medial branch nerves send pain signals from injured facet joints—located in the neck or back—to the brain.

Usually a medial facet joint block is injected into one of the small joints which can be found on either side of the vertebrae in the spine. A lumbar facet joint block, for example, is injected into a facet joint on both sides of the lower spine. If more than one joint is involved, you may receive more than one injection. This type of block is common for patients with arthritis in their lower backs.

Do I need a nerve block?

The only way to determine if a nerve block is for you is to talk to your doctor and pain management specialist. If you have chronic pain that might be related to nerves near the spine, a nerve block might very well be within the realm of possibility for your treatment.


Do you suffer from chronic pain?

The Chronic Pain Miracle of Spinal Cord Stimulation

4/6/2017 - written by Perlman Clinic

The Chronic Pain Miracle of Spinal Cord Stimulation

Spinal cord stimulation (SCS) is what some might call a wave of the future. A treatment option for those who suffer with chronic back pain, this specialized type of injection therapy might be a real solution to pain without risk of opiate addiction and other long-term side effects.

Sound too good to be true? Read through the facts before making a judgement call, then decide for yourself. SCS might be the treatment that you have been waiting for.

What is SCS and how does it work?

SCS has actually been around for a long time. First implemented in 1967, it was not approved by the FDA until 1989 after discovering its ability to relieve pain in areas of the body such as the arms, legs, and trunk. As a treatment option at pain management facilities, SCS offers a non-medicinal alternative that really works. Its recent surge in popularity is due to this fascinating aspect.

SCS sends pulses of electricity through the spinal cord. Each pulse delivers a message to the nerves to stop sending pain signals to the brain. These pulses are delivered via small electrodes or wires situated along the spinal cord. The electrodes in turn are connected to a battery-powered generator implanted strategically under the skin. Usually, this implanted generator also creates a buzzing or tingling sensation that removes pain but is always present. The tingling or buzzing is called paresthesia, and medical companies who develop SCS therapies have been working on ways to eliminate this side effect. However, for those who live in extreme pain, paresthesia is a welcome alternative to the pain.

What types of pain does it treat?

You know by now that SCS treats chronic pain, mainly pain in the back and legs. Remember that chronic pain is defined as any pain that lingers in the body beyond three months, or after the body’s natural healing time frame for most acute injuries.

Chronic pain can be caused by a variety of things, from old injuries to autoimmune diseases to spinal misalignment. Since SCS is centered on the spine, the pain signals it reaches are local to any nerve running directly through the spine, such as the spinal cord or sciatic nerve. That is why SCS is most effective for chronic back or leg pain, like spinal stenosis.

However, SCS can treat a lot of other conditions, and the list is growing. You might find relief for pain related to failed back surgery, scarring along spinal nerves, chronic neck pain, chronic back pain, complex regional pain syndrome, refractory angina, nerve death caused by peripheral neuropathy, and more.

How is SCS delivered?

We’ve already discussed how SCS delivers electrical pulses through a battery powered generator. But you might be interested to know what it looks like. A company called Nuvectra has designed a new SCS system that comes in a small silver square. On top of the thin metal square sits a plastic piece where the wires, called leads, are connected to the battery. Nuvectra calls their device Algovita.

An SCS system is installed along your spine. The battery pack itself is implanted under your skin near the base of the spine. The leads (thin wires) are placed along your spinal cord in strategic locations so that the electrical impulses can reach the nerves that keep sending pain signals. The electrical stimulation overrides the pain signals, leaving you with the slight buzzing or tingling of paresthesia instead of pain.

The Benefits of SCS

As a pain management technique, SCS is far superior to medications. There are other non-medication options at pain management clinics of course, including lifestyle changes, physical therapy, chiropractic, acupuncture, massage, and even counseling. For many chronic pain sufferers, however, these techniques are not enough. Many feel they need medication to live a normal life, but medications come at a high cost.

Although some medications are certainly worth it, some are not. For example, opiate pain killers are highly addictive. If patients become reliant on these pills, they can suffer side effects like slowed breathing, drowsiness, withdrawal symptoms, tolerance, sleep disorders, increased risk of bone fracture, and even tooth decay. In fact, there is something of an opioid crisis on our hands in the US, and the surgeon general has even said that opioids are not a solution for chronic pain.

SCS is a treatment option that is as effective as pain killers, but without affecting the rest of your body.

Is SCS right for you?

There are many non-medicinal alternatives to chronic pain management, but none are quite as effective as SCS. And since doctors are continuing to work on more efficient delivery methods, SCS is fast becoming a better solution. Is SCS right for you? If you have chronic pain in your neck, back, or legs, ask your doctor or pain management specialist if you can try SCS therapy.

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