Ask the Experts: Pain Management
Dr. Randall Brewer, River Cities Interventional Pain Specialists
With over 20 years of experience, extensive training and board certification, Dr. Randall Brewer customizes an individual, patient-specific treatment plan for each chronic pain condition. River Cities Interventional Pain Specialists is also comprised of a team of clinical professionals, including Physician Assistants, Karen Beabout, PA-C and Misty Anthony-McAllister, PA-C and Psychiatric Nurse Practitioner, Janey Gaston, APRN, PMHNP-BC. The team works collaboratively with patients and area providers to develop individualized treatment plans and attainable goals
Are painkillers addictive?
To understand the roots of that question, it is important to understand the basic types of pain. Acute pain is pain that happens right after surgery or an injury. That type of pain normally goes away with healing. During the healing process, the use of painkillers is often a very important component of the treatment of acute pain to reduce suffering and promote activities that speed recovery. The type of pain medication called opioids includes drugs like hydrocodone, morphine and oxycodone. When used properly for acute pain, these drugs are generally more helpful than harmful. When the pain does not go away and the condition becomes chronic, the treatment required for recovery becomes more complex. Pain medications, interventional pain procedures, physical rehabilitation and even psychological care are often required to treat chronic pain. Addiction occurs when certain individuals receive a “feel good” response from the medications and become preoccupied with using the medication to reach that mental state rather than reduce any pains they may have. When addiction starts it can become very dangerous very quickly and requires urgent treatment to avoid a potential overdose.
Is medical marijuana going to be helpful for chronic pain?
That is a popular question and the answer is likely to be different for different kinds of pain. The main issue with medical marijuana research that creates difficulties for clinicians relates to the drug’s illegal status at the federal level. Preliminary research suggests that it can be helpful for some types of nerve pain and severe muscle spasms. In states that have had legal medical marijuana for many years, the overall reduction in the use of other pain treatments, such as opioids for example, has been around 5 to 10 percent. This suggests that medical marijuana will have a positive impact for some patients but it is not likely to become the primary way that chronic pain is managed.
Do MRI scans or nerve studies show the cause of pain?
Diagnostic studies such as imaging and nerve conduction studies (and electromyography) may be used by specialists to diagnose some conditions that are painful. Since MRI scans are very sensitive in their detection of minor problems in the spine and nerve studies do not specifically measure pain sensation, specialists need to put all of the information together to determine if there is a specific condition that can be treated or if it is appropriate to only treat the symptom of pain.
What is the best way to treat low back pain?
Low back pain affects 80 percent of the population at some point beyond adolescence. Most commonly, it begins with the aging process in the cartilage discs in the back, and later in life arthritis can develop in the joints as well. Most of the time low back pain will get better with a little time and over-the-counter medications. Medical attention is necessary when low back pain is severe and persistent beyond one or two months and when it spreads into one or both legs. Treatment usually starts with physical therapy and a prescription for pain medication if the pain is severe. Referral to a pain physician or other spine specialist is necessary if the pain continues or gets worse with the initial trials of medication and physical therapy.
Sponsored by Dr. Randall Brewer.