CarriageTowneNews.com, Kingston, NH

September 26, 2013

How to Manage Pain

By Jay Alberts
Carriage Towne News

---- — Think you are just getting old and chronic pain is just a natural part of the process? Think again.

Aches and pains are often the subject of punch lines when discussing adult afflictions associated with the aging process. It is almost expected: pinched nerves, bum knees, headaches, and backaches. That’s the way it has always been and many believe it is the way it shall continue to be.

Not necessarily so say the thousands of patients who frequent the offices of Interventional Spine Medicine (ISM) in Plaistow, Barrington, Gilford, and Rye, NH.

Pain management is a relatively new medical science that only began about twenty years ago. We are not talking aspirin, a cold compress, a shot of whiskey, or “bite the bullet” relief here. We are talking real live doctors with medical degrees, internships, fellowships and Medical Board Certifications in Pain Management. It’s serious business.

So serious that most insurance carriers, including Blue Cross/Blue Shield, recognize pain management as an integral part of maintaining good health or during the recovery process from an injury.

The goal of the staff at Interventional Spine Medicine is to find the source of pain and provide permanent or temporary relief in the most non-invasive way possible The Plaistow office opened about three years ago. Plaistow can now boast of an in-house treatment facility, which is currently located at 95 Plaistow Road. ISM recently purchased a building located at 32 Main St., Plaistow, which is now being renovated for occupancy in 2014.

As Dr. Asteghik Hacobian explained, “We have expanded continually throughout NH, basically because people in pain do not want to have to travel far, even for treatment. We can perform the same pain relieving procedures here in the Plaistow offices.”

Patients are often referred to ISM through their primary care physicians. Others from their chiropractors, orthopedic surgeons, physical therapists, neurologists, and podiatrists However, the majority of patients are referrals from other patients.

“That is rewarding. This is something we believe in strongly, and to hear that another patient was so satisfied with our services that they sent someone else to see us says a lot.”

The most common cause leading to a visit at ISM is chronic lower back pain. Many of those patients had previously tried other modalities, including a chiropractor and physical therapist. Quite often the core of the problem lies in the spinal column, a flexible structure that houses the over 300,000 of the delicate transmission lines of the central nervous system. Finding the source of the pain is an intricate process.

Dr. Hacobian continued, “If you have back pain, experience shows that without treatment, it will probably only get worse. If you have a persistent headache or migraine due to any issues related to the central nervous system, the chances are it too will only get worse if left untreated.”

As the body ages, almost everyone will experience some form of back pain or arthritis. Although it is due to the nature of life itself, Interventional Spine Medicine believes that the creation of science is also a natural progression. If this allows a person to live in comfort and enjoy the best qualities life can offer, pain management just makes natural sense.

The use of corticosteroids to ease inflammation in the joints that causes arthritis is not to be confused with the anabolic steroids used by athletes to enhance performance. It is also used to treat lumbar spinal stenosis which is the narrowing of the spinal canal in the lower back.

Facet joint pain can be the result of inflammation. These small stabilizing joints are located between and behind the adjacent vertebrae at every spinal level except the top. Normal wear and tear is usually the culprit and the pain is often described as “frightening,’ or “the worst of all back pains.” With the use of radio frequency (RF) lesioning, ISM can locate the nerve that is sending the pain signal to the brain and apply an electrical current to eliminate it. The same procedure can be applied for chronic arthritis or neck pain, which may be the cause of migraines. For those fearful of even the smallest of needles, the treatment recommended may only be medicine patches, compounding creams or oral medication.

Even the most invasive surgery may seem minor as it usually is exercised after a patient has experienced failed back surgery. Spinal cord stimulation is exactly as it sounds. Yes, there are technical terms to describe it in detail, but the bottom line is that it improves or revitalizes those elements and functions that once existed in a much younger back.

Although Dr. Hacobian can rely on her own examination skills to provide injections for musculoskeletal pain, ISM is now equipped with both ultrasonic and fluoroscopic guidance systems making the process of locating the source of pain safer and comfortable. Ultrasound waves allow the physician to see the different layers in the body, such as tendons, nerves, ligaments, and joints. This allows for precise diagnosis of inflamed and damaged tissues, and also allows the physician to avoid direct nerve and blood vessel contact while guiding the needle to the target precisely for treatment. Ultrasound provides a “live” view of the needle and of the muscles, blood vessels, tendons, and other moving tissues. Carpal Tunnel Syndrome can now be treated with a needle through the skin using ultrasound.

X-Ray Fluoroscopy also is used for diagnosis and the precision targeting of pain. It provides a high-resolution image of bony structures allowing for placement of a needle into the spine and joints. Use of “contrast” allows the physician to determine whether the medication will reach the desired target, and avoid nearby structures. The images can be snapshots, or can be video “live” images, to view in real-time the bony structures, the needle placement, and the flow patterns of contrast.

“Very simply,” said Dr. Asteghik Hacobian, “Our initial goal is do everything we can to take away pain.”