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Frequently Asked Questions When Pain Attacks, Attack Back! The physicians at RPG want you to be well informed about all aspects of your care. If you have additional questions, or to schedule an appointment, please call us at 404-659-5909 
Please click on the questions below to learn more about each of the topics: I have had my pain for months, been treated by my family doctor and I’m still in pain. What now? This is very difficult. First, make sure your diagnosis is well established. Then develop a good pain management program to match your particular diagnosis. Such a plan might include any or all of the following:
You must consider that your pain could be permanent and that like high blood pressure (hypertension) or diabetes you will need to learn to live day by day to the best of your abilities. Pain management will help you to live with chronic pain but may not necessarily eliminate it. No one can answer this with absolute certainty. It takes 8-12 weeks to strengthen your muscles/ligaments and several weeks to regulate your medicines. Stress, anger, hostility and frustration will increase your healing time. You will need to become disciplined with your exercises, medicines, and stress management techniques. Why do I sometimes feel worse after I go to Physical Therapy? Your therapist has to teach you, through an exercise program, to stretch your tight muscles and ligaments and then to gently strengthen them. This may require numerous visits. Your successful recovery depends on you performing your exercises regularly at home. As with any strengthening program this takes about 8-12 weeks. Do not expect your pain to decrease until the inflammation in your muscles/ligaments has been reduced and the strengthening process has begun. Why Aren't my medicines working? All medicines require up to 2 weeks to develop a consistent level in your bloodstream. No changes will be made unless you are having uncomfortable side effects. Not everyone responds to the same medicines and it may take a month or more to find the right the ones that help you. Take all your physician prescribed medicines. Remember to keep doing your exercises during this period. Why do I have to visit the doctor before I can get a refill on some medicines? Some medicines (such as some pain relief medicine) require close medical supervision. Your doctor will want to meet with you to help you manage these medicines. Does my weight affect my recovery? If you are carrying around an extra 20 pounds or more it only makes sense that a sensible weight loss program will help. But remember there are overweight people without spine pain. Right now it is more important that you focus on your exercise program and your medicines. Does my job effect my recovery? Unless you have a very physically demanding job, usually not. There are athletes in football, basketball, weight lifting, wrestling and other very physically stressful sports with well documented spine problems that perform their jobs every day. Also remember that there are retired people with spine pain. What is biofeedback and how can it help my pain? Many pain problems are aggravated by excessive muscle tension which can strain joints, restrict blood vessels, and irritate nerves in addition to causing muscle strain. Learning to relax affected muscles can help alleviate the pain. However, most people are not aware of excess muscle tension because it feels “normal” to them. Biofeedback is a technique used to help people become aware of muscle tension and then learn to relax the affected muscles. Small sensors that measure muscle tension are placed on the skin over the affected area. Information from the sensors goes into a computer and the computer screen shows the patient how tensed or relaxed the muscle is. The patient is then taught specific relaxation exercises and the computer helps the patient know when the exercise is helping to relax the muscle. Because the sensors simply lay on the skin surface the process is absolutely pain-free. You can expect about 8-10 weekly sessions in order to learn biofeedback and benefit from the process. My pain is not “all in my head” so why do doctors sometimes refer patients to a psychologist? Pain is generally not caused by stress or by emotions. However, stress, anxiety, and feelings such as worry, frustration, depression, or anger can make the physical pain seem even worse. Unfortunately, the very fact that a person has frequent or long lasting pain can by itself be stressful. Pain can also have a negative effect on other parts of a person’s life, which may lead to increased stress. Over time the person may begin to experience feelings of worry, frustration or depression. Any of these factors can interfere with recovery and may cause further pain. A psychologist or psychiatrist who specializes in behavioral medicine understands the complicated interaction of pain, stress and emotions. They can sometimes determine how the different factors are affecting the patient’s pain and can then teach the patient skills to manage those factors. Treatment may include training in stress management, anger management, relaxation techniques and/or biofeedback. If the patient has become depressed, the psychologist or psychiatrist works with the patient and the pain management physician to treat the depression while the pain is brought under control. Surgery is a highly individual decision and should be discussed with a board certified surgeon specialist. Usually an attempt at therapy, medicines, and/or injections is undertaken prior to surgery being considered. What do I do if I have had surgery and I am still no better? Work with your doctor to develop a good pain management program. An excellent example of why you still hurt after the offending disc has been removed may be related to the “couch on the carpet” tale. When you move your couch off of your carpet there remains a little dent in the carpet. You wonder how long it will take until the carpet returns to normal. There are several factors involved such as how heavy was the couch (or the disc) how old is the carpet (or how old you are) and how long was the couch on the carpet ( or how much degeneration in your spine). Unfortunately, sometimes the carpet or the patient never recovers completely. In these cases it is important to focus on the pain management program you and you doctor have developed. POSSIBLE TREATMENTS INCLUDE:
WHAT IS Myofascial Pain Syndrome? Q. What is Myofascial Pain Syndrome? A: Myofascial Pain Syndrome (also known as MPS) is a syndrome where a patient may have muscle pain and spasms in a certain part or region of the body. In many cases, the pain starts after someone has had an incident that hurts the muscles in a certain area, such as neck pain after a car accident. Q. What are the symptoms of Myofascial Pain Syndrome?
Q. What causes Myofascial Pain Syndrome? A: It is known that this syndrome can occur again after some type of trauma has occurred to a certain area of the body such as neck pain after someone has had a car accident. Also sporting injuries, such as being hit in the back by a tennis ball and having pain and spasms in that area of the back that was struck by the ball. Again, any form of trauma to any of the muscles in the body can result in MPS. Q. Who gets Myofascial Pain Syndrome? A: Anyone who has suffered a trauma as described above can get this syndrome. There is no specific age where a person is more likely to have this syndrome and men are not more likely to get this over women or vise versa. Q. How is Myofascial Pain Diagnosed? The following are criteria for diagnosing this condition:
Q. What are the treatments for Myofascial Pain Syndrome? A: Doctors recommend a multifaceted approach, which includes the following:
Q. Where can I get help? A: Seek out physician specialists, who are board-certified in Physical Medicine and Rehabilitation (PM&R). These doctors, who are known as physiatrists, are specially trained to help you manage your Myofascial Pain Syndrome, which includes determining if physical therapy or massage therapy is appropriately ordering the appropriate exercise. Prescribing medications as appropriate. Fibromyalgia (sometimes called Fibrositis, Fibromyositis, or FMS) is a syndrome of unknown cause that results in chronic, sometimes debilitating, muscle/joint pain and fatigue. What are the symptoms of Fibromyalgia?
What Causes Fibromyalgia? Unfortunately, the cause (or causes) of Fibromyalgia is not known. Some experts believe that Fibromyalgia is not a single disease but rather a complex disorder that causes dysfunction by a series of biologic responses to physical trauma, emotional trauma, viral infections, etc.. Recent tests suggest that people who develop the syndrome start with a genetic predisposition. The disease may run in families and researchers have identified at least one gene that they believe may be involved. It is clear, however, that lifestyle and temperament play a significant role. Often patients are workaholics who push themselves too hard for years. Then a trauma of some sort, such as a car accident or viral infection, jars their nervous system. Researchers have consistently found that Fibromyalgia patients have up to 3 times more of a pain-transmitting chemical called substance P in their spinal fluid and too little of the pain-reducing chemicals, serotonin and norepinephrine. The pain of Fibromyalgia, if sufficiently severe, can set in motion a cascade of biochemical actions that effect hormone and enzyme production, circulation, voluntary and involuntary muscles and reactive tissues in numerous organs of the body. The unpleasant consequences of all these responses are multiple and additive, resulting in a complex circumstance of pain and functional impairment. Who Gets Fibromyalgia? Studies have shown that both women and men meet the diagnostic criteria. However, women have a much greater incidence, both with the regard to the disorder and to the severity of it’s symptoms. Fibromyalgia is most often diagnosed in patients between the ages of 20 and 60 years of age and usually peaks at age 35. The National Fibromyalgia Association estimates the known cases of Fibromyalgia to exceed 6 million people. How is Fibromyalgia Diagnosed? A Physician, such as a board-certified Physical Medicine and Rehabilitation (PM&R) specialist (known also as a Physiatrist), will first take a detailed patient history. This will include any recent weight changes, past physical injuries, infectious diseases, muscle weakness, rashes, and a complete listing of all current medicines, both prescription and over-the-counter, including all vitamins and supplements. The doctor will then conduct a careful physical and neurological examination of all joint and “tender” muscle or skin areas and order any appropriate diagnostic studies deemed necessary to rule out other possible conditions such as Lyme Disease, Rheumatoid Arthritis, Osteoarthritis, and others. What are the Treatments for Fibromyalgia? The complexity of Fibromyalgia often demands a multi-disciplinary or team approach requiring joint communication with other physicians and healthcare experts. The focus should always be the same, however: helping decrease the patient’s pain and increase their level of function. Of course, every patient is different as pain’s accompaniments and effects vary considerably from person to person.
Where can I get Help? Seek out the medical community’s experts, known as Physiatrists; these are physicians who are board-certified in the medical specialty of Physical Medicine and Rehabilitation. Physiatrists focus on the patient’s functional outcomes, treating the whole person rather than a single organ system or disease and are specially qualified to help you manage your Fibromyalgia. What is Carpal Tunnel Syndrome? Carpal Tunnel Syndrome (sometimes also called Carpal Tunnel or CTS) is a syndrome that occurs when repeated activity causes inflammation within the wrist. The narrowed tunnel of bones and ligaments in the wrist pinches the nerves that reach the fingers and base of the thumb. Initial symptoms usually appear at night. What are the symptoms of Carpal Tunnel Syndrome?
What Causes Carpal Tunnel Syndrome? Some cases of Carpal Tunnel Syndrome are work related and are due to the cumulative trauma of the wrist through overuse or poor ergonomics. Overuse trauma is sometimes referred to as repetitive motion injury. Diseases or conditions that may contribute to the development of Carpal Tunnel include diabetes, obesity and even being pregnant. Who Gets Carpal Tunnel Syndrome? Studies have shown that both women and men meet the diagnostic criteria and all age groups are involved. What are the Treatments for Carpal Tunnel Syndrome? Doctors recommend a variety of approaches to the treatment of Carpal Tunnel:
Will I get Better? Usually yes. Less than 1% of patients with Carpal Tunnel Syndrome develop any permanent injury. Most patients recover completely and learn to avoid re-injury by modifying repetitive movements and allowing adequate rest periods. Where can I get Help? Seek out physician specialists who are board-certified in Physical Medicine and Rehabilitation (PM&R). These doctors, known as Physiatrists are specially trained to help you manage your Carpal Tunnel Syndrome. |
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