PAIN MANAGEMENT CLINIC
Many athletes and patients who have sustained a concussion experience pain problems, including headache, back pain, and neck pain. Treatment of these problems following a concussion is vital to the recovery process, as untreated pain symptoms can prolong recovery time and contribute to the cognitive and emotional symptoms of concussion.
The Pain Management Clinic provides time-limited, comprehensive, multidisciplinary pain management services with emphasis on accurate diagnosis, evidence-based treatments, functional improvement, and efficient disposition under the direction of Dr. Williams. Dr. Williams is a board certified neurologist and fellowship trained pain specialist with interventional and pharmacologic pain management expertise. Pain is almost always multi-factorial in nature, meaning that there are physical, psychological, and social factors contributing to the experience of pain. Patients of SCI’s Pain Management Clinic can expect to receive a comprehensive and interdisciplinary approach to the evaluation and treatment of their particular pain problem.
Following the initial evaluation, prompt recommendations and treatment will ensue.
This may include:
• Medical Management
• Biobehavioral Treatments
• Complementary Modalities
• Functional Restorative Modalities
• Communication and Education
• Neuropsychiatry Consultation
To be enrolled in the Integrated Pain Program, patients must meet the following criteria:
• Pain with motivation to improve pain AND function
• Absence of substance abuse (initial and random urine screen)
• Ability to participate in rigorous, onsite program
• Absence of severe or untreated mood disturbance or personality disorder
If you would like to schedule an appointment or receive more information about our pain management clinic, contact us today!
Evaluation of each patient’s symptom complex and confirmation that correct and complete diagnoses have been made are completed. In our experience, it is not uncommon for additional diagnoses (never having been made and never having been definitively treated) to be present, accounting for persistence of symptoms and development of chronic pain. Also, a thorough and expert evaluation of each patient’s medication regimen is performed to find the safest and most effective combination of medications possible. As part of the medial management, recommendations might be made for further diagnostic testing, and/or interventional procedures to achieve the most accurate diagnosis and to aggressively address all relevant pain generators. Any recommendations for further diagnostic testing of interventional procedures will be requested separate from and in addition to the authorization that has been provided for the Integrated Pain Program.
Cognitive behavioral therapy (individual pain management oriented sessions), group therapy (group discussion/education sessions led by pain psychologist), biofeedback and neurofeedback (muscle and neurologic retraining techniques geared toward autonomic quieting, and correcting abnormal electrical activity in the musculature and/or brain taught by specially trained therapists) are employed to augment the benefits of medications and to further educate patients as to the relationships between pain, muscular and neurologic activity, and mood/behavior. There are very clear relationships between muscle dysfunction (treatable with biofeedback) as well as abnormal electrical activity (treatable with neurofeedback) and pain. Particularly with medical injury lasting 6 months or longer, the cognitive/behavioral psychologist can evaluate issues including: candidacy for aggressive or invasive medical treatments; disability acceptance; fear avoidance; premorbid coping style; primary and secondary gain; autonomic arousal and responsiveness to stressors; treatment compliance; narcotic pain cycle; association of symptoms to depression and anxiety; etc. It should be noted that these associated symptoms are addressed only as they impede recovery from injury and medical treatment planning, without any determination of medical-legal status and is not in any way related to a “psych claim”.
Complementary Modalities offered within our program include acupuncture, deep tissue massage, myofascial release trigger point injections, electrical and laser therapies. We also give specific individual and group consultation on Nutrition and how dietary factors positively (or negatively) impact not only weight, but the inflammation syndrome and chronic pain. These are extremely effective modalities for the treatment of orthopedic and chronic pain. There are a number of convincing reports in the medical literature that support the use of acupuncture (having well outperformed placebo intrials) for a variety of paindiagnoses. Many patients are able to dramatically reduce their medication requirements (with lasting effects) through acupuncture. Others find relief when no other modality (medication, injection, therapy) had been effective. Still others are much better able to participate in other rehabilitative treatments (physical therapy) and significantly improve their function through participation in acupuncture. This is often extremely helpful in decreasing persistent swelling, and pain in extremities that are dysfunctional in the context of chronic pain.
Functional Restoration Modalities
Functional Restoration Modalities offered within our program include physical therapy, Feldenkreis Method therapy, occupational therapy, yoga and self directed exercise are geared toward maximizing patient function and activity/ability during recovery and management of their pain problem. Many patients with orthopedic injury and chronic pain in general begin to limit motion, and then normal body mechanics suffer, followed by a significant effect on normal body physiology. Feldenkreis training is a discipline devoted to muscular reeducation, improving body mechanics, education in the importance of body symmetry and personal ergonomics. In our program we have witnessed countless patients “re-learn” appropriate static and dynamic posture resulting in dramatic effect on pain and function. We use Feldenkreis as a basis from which we can add other more aggressive layers (physical therapy, then self-directed exercise). In addition, there is a tremendous degree of improvement that can be made by modifying and maximizing dietary intake through knowledgeable nutritional counseling. Weight loss is not the only goal. It should be noted that nutritional counseling with special emphasis on issues related to inflammation, muscle function, nerve function and minimizing pain provoking substances in the body will be most helpful for chronic pain patients.In addition, there are a variety of tips that can be very helpful preoperatively.
Communication and Education
Communication and education are one of the most important aspects of the Integrated Pain Program. Patients will be very well informed of the recommendations being made as well as the rationale for the recommendations, expected outcomes, risks, benefits and alternatives. This will include a multi-media presentation outlining what the problem is, where the problem is, what causes it, what can be done about it, and what to expect long term. Unbelievably, the majority of pain patients we see have never had this type of communication with any of their previous physicians. They may have been given a diagnosis and told they needed this medication, or that injection, or surgery. But they were never truly educated. In addition, we will provide information to payers regarding the rationale for our recommendation. Finally, regular team meetings ensure that all treating providers are on the same page with respect to the patient’s symptoms and progress.
Pain is almost always multi-factorial in nature with physical, psychological, and social factors contributing to the experience of pain. SCI takes an integrated approach to addressing pain concerns, including addressing any emotional symptoms with referral available to neuropsychiatry.