Pain Medicine
Treating Pain
As with most all physicians (and certainly Pain specialists), Dr. Williams
is committed to managing pain so that patients can continue to live their
everyday lives productively and without limitation. His goal is to improve
quality of life and avoid the complications associated with acute and
chronic pain. Certainly, no physician wants their patients to experience
life limited by pain. But also as a Sports Neurologist, Dr. Williams is
acutely aware of the importance of exercise, and physical fitness on the
brain. He knows that the brain loves exercise and understand one of the
most powerful approaches to optimizing and extending peak Neurological
function is through regular and effective physical exercise. Dr. Williams
wants to enhance the quality of life and extend what has been called the
“Healthspan” – meaning not only the length of life (lifespan),
but the length and duration of a healthy, active, and productive life.
As a result, he is dedicated to treating pain so that my patients can
exercise, which results in important contributions to Neurological health
across the lifespan.
Approach to Pain Medicine
As a neurologist specializing in Pain Medicine, Dr. Williams’ approach
to pain is based on a thorough knowledge of how the nervous system works
and how the brain contributes to suffering from pain; not just how injections
and pills can "cover" or "block" pain. Pain science
reveals that "pain is in the brain." That is not to say that
feeling pain is "all in your head." The brain is the most critically
important organ in Pain Science because it is the brain (not the back,
neck, foot, ankle, or other affected body part) that actually causes the
hurt. Electrical signals from various body parts are transmitted to the
brain. All kinds of electrical signals. The signals are from nerves transmitting
information about heat/temperature, sharpness, cold, vibration, touch,
pressure, and other sensory data. When those signals reach the brain (after
having been transferred from on nerve to another within the spinal cord),
the brain interprets them and produces an experience that is framed based
on a wide range of varying factors:
- Has this sensation been experienced before? Under what circumstances?
- Is there evidence of injury? Would continuing the activity causing these
signals result in damage or injury?
- What else is going on at the moment? How important is this signal?
- Is there associated fear, stress, anxiety, urgency?
- Is there associated excitement, happiness, motivation, pleasure, or benefit?
The sum total of all of this and other kinds of information will result
in the brain experiencing the signals as no pain, mild pain, moderate
pain, or severe pain. The electrical signal itself can be localized as
coming from specific body parts. The signal is (only) part of the input
the brain uses to produce (or not produce) pain. But make no mistake.
The experience of pain resides in the brain.
UNDERSTANDING ASCENDING AND DESCENDING PAIN PATHWAYS
In order to successfully manage chronic pain, two things must be addressed.
The first involves ascending pain pathways. These neural highways allow
the brain to locate the source and sensation of pain and assign to it
an emotionally unpleasant response. Equally important are the descending
pain pathways. These neural highways descend from the central structures
of the nervous system and serve to lessen the pain signals that are travelling
up from the ascending neural pathways in the body to the brain.
PAIN MEDICINE BEGINS WITH AN ACCURATE CLASSIFICATION OF PAIN
Beyond addressing the ascending and descending pain pathways, also important
to successful pain management for patients is an accurate classification
of the pain they are feeling. After all, the best treatment depends largely
upon matching it with the kind of pain that is being felt. Pain classifications
generally fall into the following categories:
Neuropathic Pain – This type of chronic pain can have various causes but develops
as a result of problems with nerve signals, usually resulting from damage
to or diseases affecting the nervous system. Neuropathic pain is frequently
felt as shooting or burning pain or tingling and numbness which is often
accompanied by damage or injury to the nerve fibers themselves. This type
of pain doesn't typically respond well to traditional pain medications
like anti-inflammatories.
Nociceptive Pain – This type of pain is usually caused by tissue damage or injury
– like a severe cut or broken bone, for example. The sensation of
nociceptive pain is typically felt as a dull or sharp aching pain which
can vary from mild to severe. This is a type of pain that can be temporary
or chronic. Cancer and arthritis, for example, are chronic conditions
that elicit nociceptive pain. However, unlike neuropathic pain, this type
of pain does usually respond well to certain pain medications including
anti-inflammatories.
Myofascial Pain Syndrome – This is a chronic pain disorder. It is characterized by something called
"referred pain," when pressure on sensitive points in the body's
muscles causes seemingly non-related pain in other areas of the body.
The pain is usually caused by repeated muscle contraction as can be the
case in certain manual labor jobs, sports or hobbies.
Mixed Pain – In some cases, the chronic pain felt by the patient is a mixture of neuropathic
and nociceptive pain. One example of mixed pain is migraine headaches.
Mixed pain syndrome benefits greatly from a varied treatment approach.
PAIN MEDICINE – SO MUCH MORE THAN MEDICATION
While most people think of Pain Medicine as the use of drugs to minimize
pain, that's really only part of what Dr. Williams uses in helping
patients find lasting relief. From specific medication therapy to targeted
alternative therapies that don't involve any medication and even more
options, the field of Pain Medicine has never been as diverse as it is today.
Medication Therapy – Even when medication therapy is part of a patient's chronic pain treatment
plan, medication management can be personalized by an expert. Traditional
trial and error approaches can be replaced with rationale and logical
options based on results of blood and genetic testing. Equally important
is the pain medicine physician's responsibility to help restore patients
to active, healthy and pain-free living after treatment. To do this, Dr.
Williams provides assistance with wean and withdrawal from dangerous narcotic
pain medications that may have been appropriate for acute pain but can
cause significant side effects and problems when used chronically.
Cognitive Behavioral Therapy – This is an effective type of mental counseling designed to address thought
patterns about the self and the world in order to modify negative behavior
patterns or mood disorders such as depression. The goal is to develop
skills and tools to view challenging situations and respond to them in
a more effective way. Since all pain is in the brain, learning effective
coping mechanisms for dealing with the pain is an instrumental goal of
cognitive behavioral therapy.
Biofeedback – This is a learned technique designed to help a patient gain more
control over involuntary functions in the body. The concept is quite simple,
though it takes time and practice to develop. By harnessing the power
of the mind and developing an awareness of what's going on inside
the body, one can gain control over pain.
Acupuncture – Many people suffering chronic pain conditions, from migraine headaches
to sports injuries, have experienced significant pain relief when acupuncture
is included as part of their pain management treatment plan. Though this
type of treatment does involve the careful use of needles inserted into
various pressure points on the body, when performed by an expert, it can
help reduce and in some cases eliminate the need for medication therapy
in some patients.
Goal-Directed Physical Therapy – Physical therapy is an important part of any treatment plan for
patients suffering from chronic pain conditions. Goal-Directed Physical
Therapy takes this notion a step further by involving the patient in the
therapy plan. The plan is designed around achieving the patient's,
physician's and caregiver's important goals for recovery. Whether
it's the ability to strongly grasp objects after a stroke or the desire
to jump higher after a sports injury, goal-directed therapy gives the
hard work of physical therapy a tangible "finish line." This
is important for patients not only physically, but psychologically as well.
Electric Stimulation – The benefits of electrical therapy on both acute and chronic pain have
been extensively studied and documented. Though this treatment modality
is most frequently used for short-term pain relief, it is used to block
transmission of pain signals along nerve pathways. Electric stimulation
therapy has also been demonstrated to
encourage endorphin release, promoting the body's natural "painkiller" response.
Focused Cold Therapy – Considered a promising alternative treatment therapy for pain
management, Focused Cold Therapy involves the use of a special device
that externally delivers temporary and targeted freezing temperatures
to the nerves it is applied to. The technology is intended to force the
nerves into a hibernation-like state, inhibiting their ability to signal
and effectively reducing pain in the applied area.
Neuromodulation in Pain Medicine
Neuromodulation is a critically important and emerging approach to pain
medicine. It is rapidly replacing the historical approaches using pills
and injections. Learn more about Neuromodulation
here.