Pain Management

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Headache and Facial Pain

Our headache and facial pain clinic is dedicated to the diagnosis and management of headache disorders, facial pain syndrome and associated disorders.

Headaches are generally categorized as primary headaches, such as migraines, cluster headaches and tension headaches; and secondary headaches, in which the headache is a symptom of another, underlying disorder.

Headaches are caused by particular nerves in muscles and blood vessels sending pain signals to the brain. Triggers that cause those nerves to activate can vary widely and are not always perceptible.

For patients who suffer from chronic headaches, with severe headaches occurring several days per week or more, we offer an effective treatment program, including botulinum toxin (Botox) treatment for acute, chronic and disabling headaches.

We provide consultation for diagnosis and management of migraine and cluster headaches, facial pain and facial nerve pain, post-traumatic headaches, idiopathic intracranial hypertension (IIH)–also known as ‘thunderclap headaches,’ spontaneous CSF hypotension and related conditions.

Facial pain is often very complex, with many interrelated causes as well as countless treatment options. Our multidisciplinary approach to headache and facial pain care provides an accurate diagnosis and individualized treatment strategies tailored to your unique situation, overall health and personal treatment preferences.

Fibromyalgia and Chronic Fatigue

Chronic fatigue syndrome (CFS) is the common name for a group of complex and significantly debilitating medical conditions, including flu-like symptoms, aches, inability to concentrate, persistent fatigue and other specific symptoms. Characteristics of fibromyalgia syndrome (FMS) include widespread chronic muscle and joint pain, tenderness in localized areas and fatigue, as well as other symptoms.

Fibromyalgia and chronic fatigue syndrome are considered separate, but related disorders. They share a common symptom: severe fatigue and chronic pain that greatly interferes with lives. The difference is that, in fibromyalgia, fatigue often takes a backseat to debilitating muscle pain. In chronic fatigue syndrome, people have an overwhelming lack of energy, but also can experience some pain.

Chronic fatigue syndrome and fibromyalgia are complex physical processes with physical causes. The unrelenting symptoms of fatigue, pain and mental fogginess can be overwhelming and frightening. We treat the cause of fibromyalgia (FMS) and chronic fatigue syndrome (CFS) and not just the symptoms. Our team focuses on the key underlying issues and provides you with an integrated, personalized plan of care aimed at restoring your vitality, productivity and quality of life.

RSD/CRPS and Neuropathic Pain

Reflex Sympathetic Dystrophy (RSD), which is also known as Complex Regional Pain Syndrome (CRPS) Type I, is a chronic condition characterized by severe “burning pain,” swelling and changes in the skin. It usually affects an arm or leg and typically develops after an injury, surgery, stroke or heart attack, although there may be no obvious previous event. The pain is typically not proportionate to the severity of the injury.

Symptoms include burning pain; joint swelling and stiffness; sensitivity to the touch; swelling in the arm or leg; decreased ability to move the affected body part; rapid or no growth in nails and hair. Changes in skin temperature may occur and skin color may become blotchy, pale, purple or red. The texture of skin also can change, becoming shiny and thin. People with CRPS may have excessively sweaty skin.

Treatment of RSD/CRPS is complex and involves an integrated approach for pain relief and improved function. Good progress can be made to treat CRPS if treatment is begun early, ideally within three months of the first symptoms. In some cases, the condition goes away on its own, which is more common in children. If treatment is delayed, however, the disorder can quickly spread to the entire limb and changes in bone, nerve and muscle may become irreversible.

Arthritis and Joint Pain

Arthritis is a form of joint disorder that involves inflammation of one or more joints. Arthritis pain is due to inflammation that occurs around the joint, damage to the joint from disease, daily wear and tear of the joint and muscle strains caused by forceful movements against stiff painful joints and fatigue.

The most common form is osteoarthritis, a progressive degenerative joint disease characterized by the breakdown of joint cartilage associated with risk factors such as history of joint injury, extra weight and age. Rheumatoid Arthritis (RA) is a systemic disease characterized by the inflammation of the membranes lining the joint, which causes pain, stiffness, warmth, swelling and sometimes severe joint damage. Septic arthritis is caused by joint infection. Juvenile Arthritis (JA) describes the many autoimmune and inflammatory conditions that can develop in children ages 16 and younger.

The treatment options we use to help manage arthritis may include a combination of the following: joint injections, physical and occupational therapy, medication management, diet/exercise, acupuncture, chiropractic care, massage therapy, activity avoidance and ambulatory assistance.

Spine-Related Treatment Options

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Interventional Pain Management

Nerve blocks are used for pain treatment and management. There are several different types of nerve blocks that fulfill different purposes.

A group of nerves, called a plexus or ganglion, that cause pain to a specific organ or region can be blocked with the injection of medication into a specific area of the body. The injection of this nerve-numbing substance is called a nerve block.

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Suboxone Maintenance Therapy

Addiction to prescription painkillers or heroin is a complicated and challenging condition, but can be treated effectively with suboxone maintenance combined with counseling and support.

Overcoming opioid dependence can be overwhelming. Opioid prescription painkillers such as OxyContin®, Vicodin®, Percocet®, Actiq® or addiction to heroin can reset the brain’s chemistry to think the drug is necessary for survival.

The goal of suboxone treatment is to help opioid-dependent people stop misusing opioids and regain control over their lives.

Opioids attach to receptors in the brain producing feelings of euphoria, reduced respiration and decreased pain, Suboxone (Buprenorphine, Naloxone) attaches and occupies the receptors without all of the opioid effects. The receptor is tricked into thinking it has been satisified with opioids without producing strong feelings of euphoria and without causing significant respiratory depression. Suboxone blocks the receptors in the brain from joining with full opioids, to make it unlikely to experience any additional effect. Suboxone’s attachment to the receptors lasts up to three days, which is much longer than opioids, and suboxone minimizes withdrawal effects and controls cravings.