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Pain Medicine

Pain Medicine 

Pain, no matter where it is located, is your body's way of telling your brain that something is wrong. For that reason, neurologists say that "all pain is in the brain." That is not to say that feeling pain is "all in your head." Pain, especially chronic pain, is very real, should be taken seriously and requires evaluation by a trained pain expert.

An important concept to understand about Pain Medicine, is the notion that a neurologist's approach to pain is based on a thorough knowledge of how the body works and how the brain contributes to suffering from pain; not just how injections and pills can "cover" or "block" pain. We want to manage pain for patients so that they can continue to live their everyday lives, but ultimately, we want to get to the bottom of what is actually causing the pain and fix it.

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.

Here is an example to illustrate how the ascending and descending pathways work: It's early morning and you've decided on toast for breakfast. You turn the toaster on, drop the bread slices in and wait for the beep. When it's ready, you reach to grab the toast and accidently burn your forearm on the toaster. What happens first is a pain withdrawal reflex – you jerk your arm away from the hot toaster. Next, you feel an acute, intense sensation of pain (this is the result of the ascending pain pathway), then the acute sensation subsides and it is replaced with a duller, less intense pain or ache (this is the result of the descending pain pathway).

Why is an understanding of pain pathways important for appropriate pain management? Because different types of pain treatment act at different places along those pain pathways we just discussed. The right type of treatment depends upon the source of the pain and how it is felt.

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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 expert pain medicine physician use 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, we provide 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.
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