Frequently asked questions
Q: When should I seek a pain management specialist?
A: Seek out a pain management specialist when pain does not respond to
the usual and customary treatments within a reasonable period of time.
All too often, people see pain management as a last resort for pain,
instead of a first stop on the road to wellness. Be aware of your body
and take note when you are in pain. If that pain persists — contact your
doctor or an accredited pain management specialist immediately.
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Q: Why is my pain worse when I am feeling stressed out?
A: Negative emotions such as fear, anger and resentment increase levels
of substances within the body that are known to heighten the sensitivity
of nervous system structures significant in the production of chronic
pain, and the development of chronic pain syndrome.
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Q: Do I need surgery for my herniated disk?
A: The majority of patients (95%) with a herniated disc will recover
within twelve weeks. The recovery process can be made less symptomatic
through conservative measures (e.g. epidural injections, medications,
etc.). In those who do not improve, surgery for a herniated disc can
relieve the arm or leg pain, but it cannot prevent future spine
problems.
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Q: What happens to a herniated disk if I don't have surgery?
A: In some instances the herniated disc reabsorbs (shrinks) or dries up.
Most often the herniated disc will remain where it is, but the
associated nerve irritation stops and it is no longer painful. Twenty to
thirty percent of the population has a herniated disc that they are
unaware of because it does not cause pain.
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Q: Do I need X-rays?
A: X-rays show bones well, but do not show soft tissues such as muscles,
discs and nerves. X-rays rarely help in the diagnosis of back pain
during the first six weeks unless the cause is an infection, fracture,
or some types of tumours. Your physician has asked you a series of
questions and examined you thoroughly. This history and physical are
used to determine the need for x-rays or other tests earlier than 6 or 8
weeks.
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Q: Do I need a MRI or CAT scan?
A: Most people with back problems do not need a MRI or CT scan.
Approximately 30% (one third) of normal volunteers without back pain
have significant abnormalities (disc herniation, pressure on nerve
roots) on MRI/CAT scans. Most people have some signs of aging as well
(degenerated disc). MRI/CAT scans are reserved for those patients who
may require surgery. Except when complex or unusual diagnosis is likely,
the scan should be delayed until just prior to surgery so that the most
current information is available. Without a need for surgery, these
tests are expensive, unnecessary and rarely change the type of treatment
required.
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Q: Is a cortisone injection really a pain reliever or just temporary
remedy?
A: Corticosteroids are not pain relievers. They reduce inflammation.
When corticosteroids relieve pain it is because they have reduced
inflammation. While the inflammation for which corticosteroids are given
can recur, corticosteroid injections can provide months to years of
relief when used properly. These injections also can cure diseases
(permanently resolve them) when the problem is tissue inflammation
localized to a small area, such as bursitis and tendonitis.
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Q: What are the advantages of cortisone (steroid) injections?
A: Cortisone (steroid) injections can be administered easily in the
doctor's office. Other advantages include the rapid onset of the
medication's action, dependability, and minimal side effects. Another
distinct benefit of a corticosteroid injection is that the relief of
localized inflammation in a particular body area is more rapid and
powerful than with traditional anti-inflammatory medications given by
mouth such as aspirin, ibuprofen or diclofenac. A single injection also
can avoid certain side effects, notably irritation of the stomach, which
accompanies many oral anti-inflammatory medications.
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Q: What are the disadvantages and side effects of cortisone (steroid)
injections?
A: n persons who have diabetes, cortisone injections can elevate the
blood sugar. In patients with underlying infections, cortisone
injections can suppress somewhat the body's ability to fight the
infection and possibly worsen the infection or may mask the infection by
suppressing the symptoms and signs of inflammation. Generally, cortisone
injections are used with caution in persons with diabetes and avoided in
persons with active infections. Cortisone injections are used cautiously
in persons with blood clotting disorders.
Long-term side effects of corticosteroid injections such as thinning of
the skin, easy bruising, weight gain, puffiness of the face, elevation
of blood pressure, cataract formation, thinning of the bones
(osteoporosis), sometimes occur after the prolonged use of steroids.
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Q: Are there special advantages in using cortisone (steroid) injections
for joint inflammation (arthritis)?
A: Cortisone (steroid) injections into a joint can be beneficial in
rapidly reducing joint pain while restoring function to a body part
immobilized by inflammation, such as an arthritic knee or elbow. This
might be particularly important in certain circumstances, such as the
gainful employment of a family bread-winner or someone who lives alone.
Despite potential and infrequently reported adverse reactions as
described above, it is generally felt that low intermittent doses of
corticosteroids pose little risk of significant side effects.
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Q: Why was I prescribed an antidepressant if I am not depressed?
A: Antidepressants increase the levels of certain brain chemicals that
improve mood and regulate pain signals. These medications are often used
in lower doses when they are used to treat chronic pain than when they
are used to treat depression. In low doses, antidepressants relieve
pain. In higher doses, they have antidepressant effects.
These medications are reserved for long-term (chronic) pain syndromes.
They may be more effective if you also have chronic pain caused by nerve
damage or conditions like fibromyalgia. They do not work for pain only
by relieving depression. In fact, they work as well for non-depressed
people with pain as for those with depression. How well they work has
little to do with how effective they are as antidepressants. Some very
effective antidepressants have virtually no ability to reduce pain.
They may help relieve sleeping problems and fatigue caused by chronic
pain. Antidepressants are usually (but not always) prescribed for use at
bedtime because they can cause drowsiness. This side effect (drowsiness)
may be particularly helpful in those who suffer from sleep deprivation
because of night time pain. It usually takes several weeks to see the
beneficial effects of treatment with antidepressants.
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Q: How long would effect from my steroid injection last?
A: Steroid injections can bring substantial and long-term improvement by
reducing inflammation in the joint space or around a trapped nerve. It
is usually given together with a local anaesthetic and if you experience
good but short lived relief, it means that this particular part of your
body is indeed responsible for your pain (diagnostic block) and long
term effect can be achieved by using other techniques (e.g.
radiofrequency denervation).
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Q: Do I have to stay overnight after my injection?
A: No, usually, you do not have to stay overnight as virtually all
procedures are done as a Day Case. There are, however could be
exceptional circumstances, very really though, when you would have to
stay in hospital for longer.
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Q: Why is it so important to tell you about all medications I take and
not just pain killers?
A: Firstly, combination of some medications can bring hazardous side
effects. Secondly, drugs like Warfarin, Plavix or large doses of Aspirin
will thin your blood which is potentially dangerous in certain
procedures (e.g. epidural injection).
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Q: Will I have general anaesthetic for my procedure?
A: With very few exceptions, pain relief interventions are done under
sedation with plenty of local anaesthetic (numbing medicine) and usually
are tolerated well. Also, having the patient awake makes the procedure
safer. There are less risks from a sedation-type anaesthesia than will a
general anaesthetic, and there are less risks of nerve injury. But don't
worry about being awake; over 95% of the patients say "it was much
better then expected". Some procedures, however, are done under general
anaesthetic. There are some patients who are not able to tolerate any
sort of injection (needlephobic) and may need general anaesthetic for
the whole procedure.
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Q: My doctor started me on skin patches (morphine like) for the pain but
I don’t want to become addicted.
A. Opioid analgesics (pain killers similar to Morphine) suppress your
perception of pain and calm your emotional response to pain by reducing
the number of pain signals sent by the nervous system and the brain's
reaction to them.
There is a low risk of addiction if you take opioids routinely as
prescribed.
You can also find some answers regarding opioid (Morphine like) pain
killers on the British Pain Society website
http://www.britishpainsociety.org/book_opioid_patient.pdf
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Q. Are there any other problems associated with opioid use?
A. Opioids may often cause side effects such as: drowsiness and
confusion, weakness and loss of balance, difficulty with passing urine,
nausea and constipation. Fortunately, for the majority of patients,
these are usually short-lived but constipation may be a long-term
problem.
Treatment with opioids usually begins with a one-two week trial to
assess you response to the drug and how well you can tolerate it. In
some cases, side-effects you experience with one medication may be
diminished by switching to another opioid
You can also find some answers regarding opioid (Morphine like) pain
killers on the British Pain Society website
http://www.britishpainsociety.org/book_opioid_patient.pdf
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