Pain Awareness and Management

WebMD Live Events Transcript

More than 75 million Americans suffer from chronic, debilitating pain, according to the National Pain Foundation. Chronic pain accounts for more than 80% of all physician visits. We observed Pain Awareness Month on August 9, 2005. Our guest was interventional pain specialist John Oakley, MD.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live. Our guest today is interventional pain specialist John Oakley, MD. He is here to talk with us about pain management. Welcome Dr. Oakley. Can you please explain what "interventional" pain management is?

OAKLEY:
Interventional pain management is anything that goes beyond the traditional conservative approaches to pain management. It's better to explain the conservative approaches, which include medication, physical therapies and functional restoration programs, as well as psychological behavioral interventions.

Once we get beyond those approaches we begin to talk about trying to identify the pain generator, that is, what anatomical structure is generating the pain and trying to provide interventions which take away the pain from the pain generator, so all of the procedures that we do, which intervene anatomically in the body, can be interventional pain management techniques.

There are two different areas of interventional pain management:

  • Diagnostic techniques, which are designed to identify what is generating the pain.
  • Therapeutic techniques, which are designed to relieve the pain for shorter or longer periods of time.

MODERATOR:
What kinds things are you looking for when using diagnostic interventional pain techniques?

OAKLEY:
The diagnostic pain intervention techniques are designed to place local anesthetics on the nerves leading to the structure we assume is generating the pain.

For example, it could be a joint in the low back or the neck, it could be a nerve itself, it could be a disk in the back, or any one of a number of structures which can be involved in the pain process.

Once the local anesthetic has been placed on the nerve or nerve pathway that's involved, we try to determine if that relieves the pain. If it does we can then say that the nerve or the structure that the nerve goes to is involved in generating the problem.

"There are therapeutic techniques designed to affect many different nerves all at one time."

MODERATOR:
Once you've identified the structure involved, what's the next step?

OAKLEY:
Then we identify the techniques we have available to produce long-term relief of the pain, mediated by the structure that was anesthetized.

For example, we may use some type of long-term blockade of the nerve. We could use a chemical on the nerve to give a long-term decrease or permanent decrease in the function of the nerve and thereby give long-term pain relief. Or we may use techniques such as applying electrical stimulation to a nerve to block the perception of pain in the area where the nerve goes.

There are other therapeutic techniques designed to affect many different nerves all at one time when a single nerve or structure cannot be identified. One example is someone who has had multiple surgeries on the lower back and has persistent back and leg pain which more than likely comes from multiple nerves; there we use techniques such as electrical stimulation or drug- administration pumps which are designed to cover many nerves or larger territories that are involved in generating the pain.

MODERATOR:
Is this type of investigation and pain management usually administered by a pain specialist?

OAKLEY:
Yes. The diagnostic and therapeutic applications of interventional pain techniques are administered in general by what now are termed in the U.S. pain managers.

These may be specialists in:

  • Anesthesiology neurosurgery
  • Neurology
  • Physical medicine
  • Rehabilitation
  • Other specialties where physicians have developed an interest in interventional pain management.


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