Monday, April 03, 2006

CCF: Pain Managment Department What to expect

What To Expect At The Department
During your first visit a Board-certified pain management specialist will perform a thorough assessment and develop a plan for your care. This plan will be shared with your family physician as well as the health care team assembled to address your needs. On return visits, additional treatment will be provided and your progress will be evaluated by the physician and the health care team. Throughout the entire treatment process, the Department will communicate your progress to your referring and family physicians. As you near the end of your treatment plan, we will spend additional time providing you with information about how to manage your condition. We know your experience with us will be beneficial and, ultimately result in a better quality of life for you and your loved ones.

Preparing for Procedure
If you are scheduled for a procedure, do not eat for six hours before your scheduled appointment time. You may have clear liquids for up to 2 hours before your appointment. Clear liquids include water, fruit juices without pulp, carbonated beverages, clear tea and black coffee.
Discontinue your pain medications, if any, 4 hours before your appointment time. Continue to take all other prescribed medications with a small sip of water. Bring all medications with you to your appointment.
If you are taking blood-thinning medications, such as Coumadin or aspirin, tell the appointment scheduler so you can receive specific instructions.
If you have diabetes, be sure to request a morning appointment. Do not take your morning insulin, but bring it with you. If necessary, your blood glucose level will be checked once you arrive for your appointment.
You will need to make arrangements for a responsible adult to drive you home after the procedure. You can expect the appointment to last 2 to 3 hours. You should not drive or operate machinery for at least 8 hours after the procedure. The medication given during the procedure may cause drowsiness, making it unsafe for you to drive or operate machinery.
If you are scheduled for a thermography:
Do not smoke for 4 hours before your scheduled appointment.
Do not use skin lotions at all the day of the procedure

Therapeutic nerve BlocksIntercostal nerve BlockFacet Nerve BlockCeliac Plexus BlockStellate Ganglion BlockTrigger Point InjectionsSpinal Drug Delivery SystemsSpinal Cord StimulationSpinal EndoscopyIntradiscal Electrothermal TherapyTENSAcupunctureBioelectric TreatmentPsychological CounselingPhysical and Occupational TherapyDietary and Nutritional Counseling
A treatment plan will be developed and reviewed with the team of experts assembled to address each patient's needs. The treatment plan may include:
Therapeutic nerve blocks- local anesthetic injections given near a specific nerve or group of nerves to relieve pain.
Intercostal nerve block- An intercostal nerve block is an injection of a local anesthetic in the area between two ribs. An intercostal nerve block is performed for pain due to herpes zoster (commonly known as shingles), an acute viral infection that causes inflammation of the nerves that spread outward from the spine. It may also be performed for pain caused from surgical incision in the chest area or to help determine the cause of your pain. (diagnostic nerve block) Lumbar Sympathetic Block- A lumbar sympathetic block is an injection of local anesthetic around a group of nerves in your lower back. It may be done if you have reflex sympathetic dystrophy, (RSD), a disease involving a disturbance of circulation to the skin or neuropathic pain. (Pain caused by a disorder of the nervous system) Facet Nerve Block- perfomed if your doctor suspects that your neck or lower back pain may be caused in part by the small facet joints of the spine. Facet joints are located on the side of your spine, away from the spinal cord. Celiac Plexus Block- performed most commonly for the treatment of upper abdominal pain, which can be due to cancer or chronic pancreatitisStellate Ganglion Block- may be performed to decrease pain and increase the circulation and blood supply to the affected limb. A stellate ganglion may be performed for people who have circulation problems or the following nerve injuries: Reflex Sympathetic Dystrophy, Causalgia, Herpes Zoster and Phantom Limb Pain. Trigger point injections- Injections of small amounts of local anesthetics and steroids in the area of the muscle where you have pain or tenderness. These areas are called trigger points because, when stimulated, they produce pain. Trigger Point Injections are performed if you have myofascial pain, which is pain in a specific muscle or muscle group. Spinal drug delivery systems- a computerized pump that delivers opiates, local anesthetics and other pain medication continuously into the spine to control intractable pain. Also, this infusion system can be used to relieve intractable spasticity secondary to diseases like multiple sclerosis, cerebral palsy, stroke or spinal cord injuries. - a small implantable device that stimulates the spinal cord to treat pain and improve circulation. Spinal endoscopy- a small fiberoptic scope used to evaluate the spinal nerve roots and administer medications.
Discharge Instructions
Home care instructions vary, depending on your personal evaluation and course of treatment. Your health care provider will discuss home-going instructions at the time of your examination or procedure. You will also be given a discharge instruction sheet to take home at the end of your appointment. Please feel free to ask your health care provider any questions you may have about these instructions.
- to treat chronic pain originating from the Intervertebral discs. A minimally invasive treatment in which a physician applies controlled levels of heat to a broad section of the affected disc wall. The heat contracts and thickens the collagen of the disc wall and raises the temperature of the nerve endings. Therapy may result in contraction or closure of the disc wall fissures, a reduction in the bulge of the inner disc material and a desensitization of the pain sensors within the disc. It is important for your referring physicain to diagnose that a disc is a primary source of your back pain. In addition to a clinical examination, your physician may use magnetic resonance imaging, (MRI) or injection of dye in the disc (discography) to confirm the diagnosis. TENS (transcutaneous electrical nerve stimulation) - a small extractable device that delivers electric impulses to nerve endings to stop pain.Acupuncture - a medical practice which involves inserting fine needles into the skin at specific poins on the body to relieve chronic pain. Bioelectric treatment- a precise dose of bioelectric currents (electroceuticals), is administered through electrodes placed on the skin to cause a biological change and interrupt pain signals. It can treat chronic and acute pain conditions including complex regional pain syndrome, back pain, muscle pain and headaches. Psychological counseling Physical and occupational therapy Dietary and nutritional counseling Throughout the entire treatment process, the Department will communicate your progress to your referring and family physicians. As you near the end of your treatment plan, we will spend additional time providing you with information about how to manage your condition. We know your experience with us will be beneficial

Diagnostic Tests
Diagnostic nerve block to identify the exact source of pain
to access the integrity of peripheral circulation. Thermography senses hot and cold areas of the body and records changes in skin tempreture on a type of photographic film. The test is painless and does not require placing instruments under the skin or into the body. It is completly safe and does not use radiation.
Discography is a radiological guided procedure to determine whether the pain is originating from the intervertebral discs or not.
MRI (magnetic resonance imaging) scans create detailed pictures of the body's internal structure by using a magnetic field and radio waves.
(computerized axial tomography) scans take a series of X-rays at different angles to show a detailed view of internal organs.
Psychological Testing

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