Phoenix Magazine

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By most medical standards, chronic pain is described as any pain that lasts three months or longer. And, of course, this pain can be just about anywhere in the body. The American Pain Foundations estimates that chronic pain affects 76.5 million people in the United States, and the National Institutes of Health claims that chronic pain costs $100 billion a year in lost work time and medical expenses.

But the good news for chronic pain sufferers is that management of chronic pain has come a long, long way in the past five to 10 years and continues to make incredible advancements with each passing year. Some of the more well-known treatments for chronic pain include medications, acupuncture, electrical stimulation, surgery, psychotherapy, relaxation therapies, biofeedback and behavior modification.

According to Dr. Eric J. Boyd of the Desert Pain Institute with offices in Mesa and Gilbert, the most important thing in diagnosing and treating a patient with chronic pain is a thorough examination with a medical history and lab tests, imaging studies and nerve conduction studies if necessary. “We really pride ourselves in treating multi-specialty acute and chronic pain,” Dr. Boyd says. “Most of our patients have degeneration of the spine or joints or are cancer patients who are being treated for pain management.”

After diagnosis, Dr. Boyd says they can treat a patient with injections or smaller procedures to relieve the pain temporarily. Then rehabilitation through exercise, nutrition and behavioral health are important.

Dr. Boyd said that with each passing year the medical field is learning more and more about the nervous system, which he feels will lead to better treatments for chronic pain sufferers. He also feels that it’s exciting that doctors today are more aware that “chronic pain is a multi-dimensional behavioral health specialty and not just about treating a pain source.”

Dr. Paul Lynch of Arizona Pain Specialists who has three offices throughout the Valley couldn’t agree more. Dr. Lynch was planning on being a psychologist before his mother-in-law got cancer and began suffering from chronic spinal and abdominal pain. In his research to try and help her, Dr. Lynch discovered that there was a lack of pain specialists out there who could help patients such as his mother-in-law. Because of this experience, Dr. Lynch changed the course of his education and became a pain specialist, who by virtue of his life experience is truly driven to help any and all patients dealing with chronic pain.

According to Dr. Lynch early treatment of chronic pain is key. “The longer chronic pain goes on without treatment, the harder it is to treat,” he says. “Good scientific research shows that the brain learns to feel that pain over and over while it gets worse and worse. This is called wind-up.” Dr. Lynch believes in a comprehensive approach to chronic pain, which includes naturopathic and behavioral therapy, biofeedback, support groups, surgery and if necessary medication management.

Of course, long before the public was aware of the dangers of addictions to pain medications, which was brought to light with the death of Michael Jackson, pain management doctors have been dealing with the side affects of these pain medications or opioids.

Dr. Boyd says that about 10 years ago, the use of opioids to keep chronic pain sufferers pain-free was prevalent. “Now we know that chronic use of these medications is not the best thing for people, and that these medications are not helping as much as we thought,” he says. He says his experience is that many times patients don’t like the side effects of these drugs and feel better off the drug than on.

Chronic Neck Pain

But the fact remains, according to Dr. Lynch, that there are still nearly 8 million Americans using opioids for chronic pain and nearly 180 overdose deaths a year due to opioids in Phoenix alone

“This is an American phenomenon within the pain community,” Dr. Lynch says. “But the pendulum is definitely swinging the other way. There are many people who need to be on medications every day, but many patients get better with minimally invasive procedures.” Dr. Lynch’s practice did a study this past March that indicated that they have been able to get 52 percent of their patients off opioids. “We have 20,000 patients in our practice and have never had a death due to opioids,” he says. “I don’t think opioids are as benign as people think.” Dr. Lynch suggests that if you are going on an opioid that you first be examined by a pain specialist to talk about all of the treatment options and the risks and benefits of them all.

For Dr. Richard P. Jacoby of the Scottsdale Neuropathy Institute, the majority of his chronic pain patients are suffering because of another underlying health condition – diabetes.

With his patients, the nerves become depressed because of too much sugar in the system, which causes tingling, numbness and pain. Sadly, when this nerve compression happens in the feet, Dr. Jacoby says his patients face amputation. According to Dr. Jacoby there are about 10,000 foot amputations done in the United States every month. The majority of Dr. Jacoby’s patients have Type 2 diabetes, which means it is diabetes brought on by a poor diet. Research shows that 99 percent of those who have diabetes have Type 2 and because it’s brought on because of a poor diet, Dr. Jacoby says, “Type 2 patients are dealt a good hand and play it poorly. Food addiction is so pervasive, and it’s a true addiction. We grew up eating lots of sugar and omega 3 fatty acids, which make us all vulnerable to this disease. The good news, Dr. Jacoby says, is that lasers work wonderfully well for these patients and are a better answer to medications and even surgery. Dr. Jacoby uses a Class 4 laser on his patients to help quiet the pain they are suffering with. “We’ve tried it on just about every patient, even patients with fibromyalgia, and I think it has helped just about every patient to some degree. Each patient has had some benefit,” he says.

Of course, one of the most exciting advancement to come about in the pain management field in the past year is the Eon Mini Neurostimulator. This tiny device works as a kind of “pacemaker for pain.” This device actually interrupts the pain signal pathways to the brain by delivering low intensity electrical pulses to trigger selective nerve fibers along the spinal cord.

Dr. Steven M. Siwek of The Pain center of Arizona has implanted the Eon Mini, which was created by St. Jude Medical. Adam Hammond was the first person in the world to have the Eon Mini implanted in him. He had severe back pain after a bad skydiving accident. Even after many surgeries, physical therapy and being on five different medications, Hammond was having a hard time just getting out of bed in the morning. After implantation of the Eon Mini, Hammond is off all of his medications and is back to skydiving. The doctors at The Pain Center of Arizona implanted about 20 patients with the Eon Mini in the past year. Dr. Siwek says, “Most candidates who qualify for the treatment of neurostimulation are suffering from severe back pain that radiates into one or both extremities.” Neurostimulation has been FDA approved as a method of pain control, and it can be used to treat chronic pain in the arms, legs and trunk of the body, too. “Neurostimulation studies have shown that spinal cord stimulation systems can often reduce pain by 50 percent or greater. And these patients are often able to reduce or eliminate their use of pain medication.”

Dr. Lynch admits that pain management is a pretty new specialty but is optimistic and hopeful about the technology and advancements that his specialty discovers with each passing year. Spinal cord stimulation can interrupt the pain signals to the brain as can radio frequency. A fracture in the spine can now be fixed with a procedure that takes 30 minutes, according to Dr. Lynch. And, he says, medications have improved. There are now medications that are good at modulating pain signals but aren’t addictive and have fewer side effects. “Fifteen years ago, there weren’t many medications to choose from for pain,” he says. “Now, we have about 40 different drugs to use.”

For sure, there’s been an evolution in pain management over the past few years offering a plethora of treatment options for chronic pain sufferers. And though many of these treatments have been around for many years, new advancements have made them less expensive, less painful and more successful, which can offer someone suffering from chronic pain great relief.