Southwest Health Notes: Treatment options for serious pain

Everyone experiences pain from time to time. Often it’s fleeting and goes away without any treatment at all within a few minutes (remember the last time you stubbed your toe?) or over the course of a few days or weeks, such as when you pull a muscle or suffer some other type of minor injury.

But pain can also be chronic and – for some people – severe enough to interfere with their ability to work, perform routine activities, and enjoy life. These are the individuals that Cortez-based interventional pain management specialist Dustin Cole, MD, sees in his office every week.

“For patients with chronic pain, we always try the least invasive treatments first,” said Cole. “If lifestyle changes, physical therapy, or medications specific to the type of pain a patient has are not effective then we start to consider an interventional approach to provide relief.”

Chronic, severe pain that requires interventional treatment most often involves a joint or the spine.

“Pain in these areas of body may be the result of a traumatic injury or a degenerative condition like arthritis,” said Cole.

Pain can also be rooted in nerves and tendons. The source of the pain dictates the type of procedure that might be effective in an individual patient.

Ultrasound-guided injections

One procedure that Cole performs involves injecting anesthetic (numbing) medicine or a steroid into the area that is suspected of causing the pain.

“These injections can be diagnostic, therapeutic, or both,” said Cole. “Ideally, the injection reduces pain so that the patient can function again. If I do an injection and it doesn’t help, that provides new information and helps us determine the next step.”

Cole performs injections for pain management using ultrasound guidance. There is good evidence showing that ultrasound-guided injections have superior accuracy over non-guided injections into joints and other areas in the body.

“We know that some portion of the time – sometimes up to 50% or greater – when you inject a joint without guidance, you’ll miss the joint,” said Cole. That can lead to lack of pain relief, potential damage to surrounding structures, and additional unnecessary tests or injections.

“Ultrasound is painless and does not expose patients to radiation,” said Cole. “It also allows me to use smaller needles which reduces discomfort during the procedure and may minimize the risk of complications.”

Cole performs ultrasound-guided injections into joints at his office.

“These procedures are usually well-tolerated with minimal discomfort,” said Cole. “Typically, the patient is asked to lie down or sit on the exam table, and then I examine the area of interest with ultrasound. We then mark and clean the area to be injected and numb the skin completely prior to doing the injection.”

If a patient is interested, Cole will show them the ultrasound screen during the procedure so they can see what is being done. The patient is then monitored for a short period of time to make sure they are doing well before leaving the office.

Radiofrequency ablation

Another procedure that is effective in reducing chronic, severe pain in some individuals involves burning nerves. This is called radiofrequency ablation.

“There are small nerves that carry pain signals to the brain. We can eliminate that pain signal by burning the nerve so that that body doesn’t feel pain,” said Cole.

This procedure, often highly effective in providing permanent relief for chronic back pain associated with arthritis, is performed using fluoroscopic guidance and is done at the hospital.

Radiofrequency ablation is usually well-tolerated and the patient receives pain medication during the procedure to help with any discomfort.

“Data shows that the benefit from this procedure typically lasts about one year. My experience is that is provides more lasting and often permanent benefit when performed appropriately,” said Cole.

To help ensure good results, Cole performs two sets of nerve blocks prior to an ablation procedure.

“Individuals who have severe, chronic pain sometimes more or less give up and think they have to live with it. But that doesn’t have to be the case,” said Cole. “We have the technology now to help people with pain so that they can do the things they want to do.

“Pain can’t always be eliminated, but we can often reduce it to the point that patients are able to get back to work and otherwise get on with their lives.”

Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez, Colorado. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal health-care provider.