 Procedural Options for Head, Neck and Back Pain
Frequently Asked Questions
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Procedural Options for Head, Neck and Back Pain
(by
MHNI Staff)
What
are the types of pain problems that you treat, and the most common forms of treatment
or procedures?
We treat all types of pain problems, most commonly neck and low back
pain. Of course, many headache patients have associated neck and shoulder discomfort
which may respond to the types of procedures that we perform. We also treat cancer-related
pain.
Neck pain is quite common to the patients who attend MHNI. This may be
due to arthritis in the neck, pressure on a nerve, from strained muscles or joints
in the neck, or other causes, so careful assessment is required. Low back pain is
often caused by similar conditions.
Treatment in the General Pain Division may include the use of medications,
psychological therapy, physical therapy, or procedures depending on the individual’s
initial evaluation. There are many types of procedures which may be helpful in the
treatment of head, neck, and/or back pain. A few (discussed below) are trigger point
injections, nerve blocks, facet blocks, radiofrequency and cryoneurolysis. Again,
the use of any procedure is determined by the type of pain problem.
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What occurs during
an initial evaluation?
When a patient schedules an initial appointment with the General Pain
Division, they receive a 5-page questionnaire. The completed form is then reviewed
by the clinical team at the patient’s initial visit. A detailed history is taken,
and a comprehensive examination is performed. Diagnostic studies are requested which
may include laboratory work, x-rays, an MRI scan, or an EMG (a study that determines
if nerve damage is present or has occurred in the past). We then arrive at a preliminary
diagnosis and treatment plan which is discussed with the patient.
In many cases, a diagnostic injection of local anesthetic (nerve block)
is administered which helps assess if the pain is from a nerve, muscle, or joint.
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Why is a physical therapist
and psychologist often utilized in the initial evaluation and in the ongoing treatment
plan?
In my experience, chronic pain is best treated in a multidisciplinary
setting.
A psychologist is helpful for treating symptoms resulting from having
pain for a prolonged period, such as depressed or anxious mood, irritability, sleep
problems, and/or changes in a person’s social life and work.
The physical therapy evaluation helps to identify any musculoskeletal
problems that are present, either as the primary cause of a person’s pain or secondary
to a decrease in activity due to pain. Our center emphasizes a "hands-on" approach
to physical therapy, and the patient takes an active role in their treatment through
highly specified exercise and stretching. We utilize passive modalities such as
ultrasound and heat only as an adjunctive treatment when necessary.
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What is radiofrequency
and when is it used?
Radiofrequency nerve ablation is a surgical technique that has
been found to be potentially beneficial for treating chronic pain thought to be
triggered by specific nerves. Radiofrequency techniques require the use of specialized
needles that direct microwave energy to "heat up" and inactivate painful nerves.
In addition, radiofrequency is effective in treating pain that may stem from diseased
joints in the neck.
Other types of nerve pain respond more favorably to "freezing" the nerve,
a technique known as cryoneurolysis. Both radiofrequency and cryoneurolysis
can offer long-term pain relief, often lasting months to years in duration.
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Several procedures that
you describe are surgical; where are the surgical procedures performed?
Most procedures are performed at Chelsea Community Hospital (CCH). Depending
on the type of procedure, the length of time in outpatient surgery varies. A facet
block (injection of local anesthetic into a painful joint in the cervical
or lumbar spine) is another procedure performed at CCH.
A few procedures are performed at MHNI such as trigger point injections
(injection of local anesthetic into painful muscle) and specific nerve blocks. Each
procedure is discussed with the patient in detail and scheduled at MHNI or CCH as
appropriate.
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What type of follow-up
visits are required after a procedure is performed?
Each patient receives a call from a clinical team member within 48 hours
after the procedure. Most patients are seen at the Institute within 2 weeks after
a procedure.
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How are patients referred
to the Back & Neck Pain Program of MHNI?
Patients come to the Back & Neck Pain Program through self-referral
or referral by another health care professional, including professionals at MHNI.
The Back & Neck Pain Program follows the same intake process and policies as
established for the overall Institute.
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