AZ Pain Medication Clinic

Go to content

Main menu


Pain Education Understanding Pain
The International Association for the Study of Pain (IASP) defines pain as:
An unpleasant sensory and/or emotional experience associated with actual or potential tissue damage or described in term of such damage.  Pain is actually a message sent along the nerves to let the brain know that something is damaging the body.  The brain responds by sending a message to the muscles or organ to take action.

In the medical world, all pain is divided into two categories: acute pain and chronic pain.

Acute pain is temporary, and goes away quickly.  It's useful, since it usually warns you of sources of harm and tells your body to protect itself while it's healing.

Chronic pain is pain that is unpleasant and lasts for prolonged periods of time.  Generally if you've been experiencing pain in the same place for 3 months or more, that pain is likely to be classified as chronic. Since it lasts so long, it does not serve as a useful warning.

Pain Treatment Options

Relief treatment begins with an assessment of the severity of the pain.  Commonly, the first steps of treatment are rest, application of cold or heat and intake of OTC (over the counter) medication.

The next step in the treatment of pain is a combination of physical therapy and prescribed pain medication.  It is important to note that sometimes, interventional pain management needs to be started prior to Physical Therapy in order to stop acute pain (i.e. acute radiculopathy) and allow the patient to comply with necessary exercise.

If prescribed relief medication and physical therapy don't work, the next step is usually interventional pain management, unless the patient has acute loss of function or acute neurological deficit (in which case surgery is needed).

If pain management doesn't alleviate the pain, surgery might be required.  However, even after surgery interventional, pain management has a very important role in the treatment of patients, especially when all other options are exhausted (ex. "failed back surgery" syndrome).

Head and Neck Pain Information
The most common origins of head and neck pain are neurogenic (nerve root compression, peripheral neuropathy, herpetic neuralgia), soft tissue pain (cervical strain, myofascial pain), musculoskeletal pain (degenerative joint disease, fracture, neoplasm, degenerative disk disease), or sympathetic pain.  Depending on the pain origin, there are different treatment options.

Low Back Pain Information

Low back pain
originates from any of four major structures: bone (degenerative joint disease, spinal stenosis, facet arthropathy, metastatic malignancy), lumbar disk (herniated nucleus pulposus, degenerated ruptured disk), musculoskeletal system (muscles and ligaments strain, muscular spasm), and nerves (newropathic pain).

One of the most difficult types of pain to treat is post-surgical arachnoiditis (failed back surgery syndrome).  Up to 85% of patients with low back pain cannot be given a definitive diagnosis because of the poor association among symptoms, pathologic findings and imaging results.

Upper Back and Thoracic Pain Information

Although upper back pain and thoracic pain are not very common spinal disorders, they tend to result in significant discomfort and pain.  Thoracic pain may be caused by internal organ pathology  (lung cancer, esophageal disorders, heart disorders), referral pain (cardiac angina,  muscular irritation (myofascial pain), joint dysfunction of thoracic cage and  upper back, pain from herniated or degenerated disk, nerve pain (intercostal neuralgia, herpes  pain from osteoporotic vertebra body collapse.

Abdominal Pain Information
Abdominal pain
is usually caused by disease of internal organs of the abdominal cavity and is treated by a gastroenterologist or surgeon.  Pain management is offered to patients who suffer from advanced cancer of internal organs (especially pancreatic cancer) or other chronic conditions (chronic pancreatitis, abdominal angina).  Most of the time, treatment is very successful.
Pain Information

Central pain is produced by lesions of the central nervous system: spinal cord, brain and brainstem.  Examples of central pain are: multiple sclerosis, neoplasm, patients with stroke.
Nervous System Pain Information

Peripheral nervous system pain (peripheral neuropathy) results from peripheral nerve lesions.  This peripheral nerve lesion may be caused by Herpes Zoster (post herpetic neuropathy), diabetes (diabetic neuropathy), entrapment neuropathy (pain after inguinal hernia repair), and chronic alcoholism (alcoholic neuropathy).

Reflex Sympathetic Dystrophy Information

Reflex Sympathetic Dystrophy (RSD), or Complex Regional Pain Syndrome (CRPS I), applies to a variety of seemingly unrelated disorders having similar clinical feature and manifesting the same fundamental disturbed physiology.  Causalgia or Complex Regional Pain Syndrome (CRPS II) is a historical term describing a RSD that follows partial or complete injury to peripheral nerve trunk.  Pain is characterized by constant, spontaneous, severe burning pain.  If persistent, it results in trophic changes.

Phantom Limb Pain Information
Phantom Limb Pain
describes painful sensations that are perceived to originate in the amputated portion of extremity.  In addition, patient may have localized pain following amputation, which originates from the stump itself.

Back Pain Management

Back Pain Management Overview
Back pain management, also called thoracic pain management, refers to the strong trauma felt between the neck and lower back.  A number of symptoms showing the need for back pain management include muscle weakness, leaning left or right, carrying or heavy lifting, forceful coughing and sneezing, twisting and turning, bending and extending, or sitting in the same pose for a long time.

Back Pain Management Causes
The evidence shows the upper back is stable and strong as compared with your lower back; making it less likely that severe spinal disorder like herniated disc, spinal stenosis, degenerated disc or spinal disability developing.  More patients need back pain management for symptoms such as muscular strains, soft tissue problems, injury, or a trauma.
Rhomboid muscle strain

Rhomboid muscles located in the upper back are attached with vertebral spine and shoulder blades.  Rhomboid muscles cause movement in the shoulders.  Swelling spasm in that area causes patients to need back pain management to smooth out discomfort.

In older patients ligaments thicken, causing pressure on the spinal nerves resulting in several spinal disorders.  As people get old it causes upper back pain by making the body numb and weak.
Depression and upper back pain
Stress can be a major causation leads to upper back pain management.  When a person feels anxiety or depressed, the muscles in upper back become stiff and rigid, causing the back pain.
Injuries and fractures
traumatic injuries including car accident or sports injuries can also cause severe upper back pain. Those suffering from osteoporosis are more sensitive to bone fractures facing the same issue due to this disease.
Overweight people feel soreness in their upper back section because so much body fat putting pressure on not only the upper back, but also the lower back area.

Back Pain Management Symptoms
Current feeling of pain in the lower and upper back is its own symptom.  However, the following symptoms tell you to consult a doctor immediately:
Shoulder blade pain and the big triangular-shaped trapezious muscles of the upper back
refer upper back pain spreading to the front of your chest, underneath your rib cage or abdomen.
Upper Back Pain Treatment
Current studies show 90% of Americans have a need for back pain management at least once making it extremely to treat this condition properly and seek a pain doctor with medical advice and experience.  Relief of upper back pain may help different patients. For new injuries a few weeks of hospital treatment may do the work, while patients needing surgery undergo medications and therapies to get rid of the pain.

Pain Medications

Medications are very helpful in alleviating back pain.  The most common pills are non-steroid anti-inflammatory drugs (NSAIDs) helps in decreasing inflammation around the nerve roots area.

Physical Therapy
Physical therapy involves several exercise programs suggested by a professional who knows which areas to target and what limitations are involved.  Never try doing it on your own.  Do consult experienced specialist or physician before taking any physical therapy.

If you are looking for a treatment to relieve your specific type of upper back pain, please feel free to consult the experts at AZ Pain Medicine Clinic for all kinds of upper back pain solutions.
Upper Back Pain Prevention

a painful upper back is preventable with a little care and practice.  People with back injury or people looking to avoid upper back pain can observe the following measures to control the condition:
Avoid lifting heavy weight objects whenever you can
Maintain correct posture while standing, sitting and sleeping
Keep your muscles strong by exercising regularly
Quit smoking
Maintain a healthy weight by intake  of nutritious diet

Central Pain Syndrome Causes

Following are the underlying conditions of central pain syndrome:
Central pain syndrome is considered by pain  doctors to have been evolved due to two factors. The defective transmission of pain signals in the nerve tracts of the spinal cord. The malfunctioning of the brain in processing pain signals properly. Other common causes include:
Brain trauma
spinal cord trauma
CNS trauma
Multiple sclerosis
Limb amputations
Parkinson's disease

Pain Doctors Study Symptoms

Central pain is a steady stinginess with varied intensity from moderate to severe.  This condition if not treated by pain doctors becomes much more terrible by making painful body movements, stress, and temperature changes.  Here are some common symptoms of the syndrome:
Burning ache
Brief but extreme bursts of sharp stinginess
Loss of touch in affected areas on distant body parts (usually hands and feet)
Continuous  burning pain
Mixture of painful sensations
Aching and cutting feeling
Pain aggravated by touch or body movement ache intensified by cold temperature
Central Pain Syndrome Diagnosis

Most of the time, it’s hard for pain doctors to diagnose central pain syndrome because of the failure to exactly identify the area causing the actual discomfort and hurt.  However, these diagnostic measures are used by the doctors:
Diagnosis of central pain syndrome starts with finding out any prior health condition related to spinal cord or brain injury.
Physical examination by the pain specialist followed by tests, including neuro-imaging (CT and MRI scanning) of the brain, spinal cord, abdomen, or limbs.
Electromyography and nerve conduction may also be conducted during diagnosis
Central Pain Syndrome Treatment

The most prominent pain doctors known for curing central pain syndrome include:
Painkillers, Tricyclic Antidepressants and Anticonvulsants can help reduce pain  to a large extent,  not eliminate it completely.
Injection of IV lidocaine can drastically improve some aspects of central pain syndrome
A latest therapy involves injecting of botulinum toxin in the body to relax the painful spastic muscles.
Chronically convulsive and hurting muscles may also be treated surgically, by cutting through tendons.
For temporary pain relief by amputating nerves or nervous connections in the spinal cord
Deep brain stimulation method is used, which requires the surgical implantation of an electrode deep in the brain.

Lower Back Pain

Lower Back Pain Overview

After the common cold, lower back pain is known to be the most common type of disease affecting Americans and a clear reason of their absence from work.  Lumbar area, commonly known as the low back area of the body carries out several functions from support and movement of body organs to protection of specific body tissues.  While standing, it supports our entire body weight and when we twist and turn, it eases our movement process.  Following this importance, any kind of pain felt in the back can be extremely hurting and dangerous.
While there are many causes of a painful lower back, but muscle strain and other diagnostic conditions like degenerated disc or lumbar herniated disc are known to be the major ones contributing towards severe ache in the lower back area.

Lower Back Pain Causes

Common causes of low back pain include the following:
Muscle strain
Termed  as the most common cause of low back pain, muscle strain or other soft tissue damage occurs when the body stretches to a level of injury affecting ligaments, tendons, or the muscles of the lower back.  Low back strain can be both acute and chronic nature and the severity ranges from mild to critical, depending on the degree of strain and resulting stretch of the muscles of the low back.
Nerves damage
Irritation and impingement in the nerves of the lower back spine mainly causes this condition, which includes lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles).  Ache tends to be sharp, in one area, and linked with numbness in the area of that affected nerve supplies.
Herniated disk
Herniated disk, also called a "slipped disk" happens when a disk between the bones of the spine dislocate and presses on nerves.  This may be caused by twisting while lifting heavy objects or due to some back injury.
Injury to the bones and joints
Fractures of the lower back spine and sacrum bone include in this category.  Mostly, the elderly facing osteoporosis confront vertebral collapses leading to fractures.  In younger people, this condition may arise due to an injury resulting from trauma or some unfortunate accident.
Lower Back Pain Symptoms

There are two types of lower back pain, acute and chronic.  Acute back pain is defined as a discomfort less than 6 weeks while chronic back pain is defined as a discomfort that has been present for over three months.  However, these are the primary symptoms of low back pain:
Leg pain (sciatica) that spreads through the buttocks down the front, sides, or back of your leg.
Back pain symptoms may include weakness, numbness or tingling caused by a disc herniation in the lower spine.  This type of condition becomes worse after a lengthy period of standing or sitting.
Certain body movements such as bending, twisting, running or extensive physical activities may cause a painful back, commonly caused by a syndrome called degenerative disc disease.
Often, lower back ache may become worse in the morning and in the evening, or the body may become stiff at these hours.
Lower Back Pain Diagnosis

Because several conditions may be responsible for causing a hurtful lower back, your doctor needs to first diagnose these causes in order to suggest proper medications and treatment.
You will be asked various questions related to the onset of the condition, what can be the possible causes, and your illness background.  After providing the doctor with relevant info, the main diagnostic process will start.
X-rays, MRI, CT scans  are also conducted to get a better idea of your body condition
For chronic pain, your specialist may even recommend having Electromyogram or EMG that helps to predict the level of  root damage.
Lower Back Pain Treatment

Looking to treat lower back pain?  We at AZ Pain Medicine Clinic can help. Don’t hesitate consulting our pain doctor if you’re in doubt about your lower back condition.  If you feel back ache from time to time or are suffering from back ache that has increased with the passing time, it is advisable that you get evaluated by our expert physicians.  We frequently alleviate lower back pain using the following lower back pain treatments:  medication like acetaminophen, NSAIDs, oral steroids, narcotic drugs, muscle relaxants, and anti-depressants.
Using heat pads, ice pads, or a combination of both can relieve the irritation.
Manual therapies to reduce lower back pain by relieving pressure points, increasing flexibility, improving blood flow and reducing muscle tension.
Therapeutic massage therapy also works well with blood circulation and reducing muscle stiffness.
Special exercises, specific workout and yoga exercises are also used to relieve the discomfort.
Epidural injections are used to decrease lower back inflammation and irritation by injecting steroids through the spine.
Change in lifestyle factors may also contribute towards reducing lower back pain.  These lifestyle changes may be quitting smoking, eating healthy and losing weight.
Prior to starting any type of treatment, it is always advisable to consult an expert pain specialist who will first analyze your individual condition and medical history before developing the treatment plan for you.  If you are looking for a lower back pain treatment plan with complete guidance, please consult the AZ Pain Medicine Clinic for further assistance and help.

Lower Back Pain Prevention

"Prevention is better than cure"

Recurring back pain resulting from improper body movements or other non-traumatic reasons is often preventable to an extent.  Here are some tips of prevention:
Exercise daily to keep your back strengthened
If lifting heavy objects, learn how to lift them safely without harming your back
Sit, stand and sleep with the right posture
Wear low heeled shoes
Try maintaining a healthy weight by opting for a more balanced nutrition plan
Quit smoking, because it makes you vulnerable to ache by tightening the arteries and by decreasing the amount of oxygen in the blood.
Don’t stress and  monitor depression into your life and try managing them effectively

New Pain Drug Alternative To Oxycodone

July 23, 2010 -- An extended-release form of the medication tapentadol has lower amount of gastrointestinal side effects than oxycodone when taken orally for pain relief in pain clinic patients with chronic low back pain, in a new study results.
The current form of painkiller, called tapentadol ER, provides a new alternative for chronic pain clinic patients if approved by the FDA.
Researchers studied the safety and tolerability of the drug in pain clinic patients with chronic knee or osteoarthritis, compared to patients taking the better known and older oxycodone CR.
The amount of gastrointestinal side effects including constipation, nausea, or vomiting leading to discontinuation in the study was 2.5 times greater in pain clinic patients taking oxycodone than subjects taking tapentadol ER.
Tapentadol ER provided sustained relief of moderate to severe chronic knee or hip osteoarthritis pain or chronic back pain clinic patients for up to a year.
"These study results illustrate the tolerability of tapentadol  ER compared with oxycodone CR, a standard chronic pain medication," Brian Moster, MD, wrote, "We are about the encouraged by the distinct possibility of bringing this compound forward to pain patients in the future."
Comparing Pain Clinic Side Effects
The main reason for the study was to determine the safety of oral tapentadol ER in strengths of 250 milligrams two times a daily over a one-year period and comparing it to oxycodone CR.
The study showed 894 clinic patients took tapentadol ER and 223 oxycodone.  The overall incidence of patients having at least one adverse gastrointestinal event was 85.7% in the tapentadol ER group, compared to 90.6% in those taking oxycodone CR.

Understanding Pain Management

Living with pain can be a lonely, frustrating and depressing experience.  Add to that inadequate patient education and ineffective treatments and many sufferers become hopeless and distraught. A pain clinic with highly experienced pain doctors using various treatment and medication modalities can dramatically improve the quality of life of these patients.

Pain medication and a straightforward treatment course works well for most patients with acute pain which has a limited time period of severity.  Long-term chronic pain a variety of pain management strategies may need to be tried, often including psychological treatment.  These sufferers may also self-medicate with alcohol which may
seem to ease the pain for a while but will ultimately only make the suffering increase with its high potential for addiction and increase in existing depression.

Clinic doctors work closely with your primary care physician to develop individualized treatment plans and prescribe pain medication.  They include anesthesiologists, neurologists, neurosurgeons, physiatrists, and orthopedic surgeons.  Practitioners who report to the doctors in the pain clinic are physical or rehabilitation therapists, orthopedists, chiropractors, massage therapists and more, depending on the breadth of services offered.

Fibromyalgia Pain Management

Fibromyalgia is a chronic condition that affects 5 million Americans.  The majority of them are women. It is as debilitating as having heart disease, yet it is invisible to doctors, family and friends, but not to those that suffer daily from it.  They know that it's real. Fibromyalgia was an illness that gets no respect; many doctors believed it was all in the heads of their patients.
Fortunately, nowadays more and more doctors are realizing that it is a legitimate disorder. Diagnosis is made primarily by a patient's complaints, feelings and having widespread pain for at least 3 months.  Tests are done to rule out other diseases.
the main symptom experienced is pain. A person with this illness will have muscle aches and tender points on the back of their head, shoulders, hip area, and inside knees that are painfully sensitive to touch.  There are 18 tender points that doctors use as a criteria for diagnosing fibromyalgia.  If you experience pain with 11 out of the 18, it warrants a positive diagnosis.
It's an affliction that impacts the muscles, joints and tendons causing widespread pain and stiffness.
Chronic Fatigue, migraines, brain fog, Irritable Bowel Syndrome, rheumatoid arthritis, lupus, bladder control problems, Restless Leg Syndrome, depression and anxiety are other problems that can arise when suffering from fibromyalgia.
Causes of Fibromyalgia
Scientists don't know the causes.  Some believe that there may be a genetic predisposition to having this condition.  Your chances of having the disorder increase if there are other family members suffering from it.
Fibromyalgia can sometimes be triggered by some emotional trauma or physical event such as pregnancy or a virus.
It mainly shows up in early to mid adult life.  If you have other autoimmune diseases like lupus, you increase your risk of getting it.
Pain Doctors believe that fibromyalgia patients have abnormally extreme hypersensitivity to pain.  It is thought that there are chemical and hormonal imbalances that cause changes to nerve and brain cells which in turn are responsible for the pain response.
Pain killers like Tylenol and Advil have been used but are not really effective, especially by themselves.
Anti- epileptic drugs have been used and have reduced pain, fatigue and sleeplessness in some people.  Recently Lyrica, a nerve pain treatment for diabetes, was approved for use in the treatment of fibromyalgia.
It's difficult to be around people that do not understand what you have been going through.  No one takes you seriously or believes that you are in as much pain as you say.  Management Counseling and support groups may help cope with the isolation, anxiety and depression of having a chronic debilitating condition.  It's very helpful to share your problem with others that have had similar experiences.
Physical therapy can help reduce some of the pain.  By doing stretching, stress reduction, posture exercises and hydrotherapy, you may be able to find some relief.
Fibromyalgia is a complex disorder and certain foods are known to affect people in a negative way.  Foods that are suspect in contributing to the illness are dairy, caffeine, gluten, yeast, nightshade, MSG, fructose, and aspartame.  Avoidance of some or all of these foods may improve symptoms.
Alternative Methods

Acupuncture, massage therapy, and herbal supplements (be careful of interactions with other drugs) may be helpful. Although studies are lacking for some of them, there is anecdotal evidence that these methods have helped people. Working with a chiropractor may be beneficial in that they can adjust painful joints and do body realignment which has relieved pain in many people suffering from this disorder.
Once an illness that used to get no respect, fibromyalgia is finally getting the recognition it deserves and perhaps the research needed to find a cure.

Back to content | Back to main menu