Jacob R. Caylor, MD, DABA, DABPM

Pain medicine has changed quite a bit over the last 20 years. We’re in a much more advanced space now, with new therapies becoming available every day. However, these new options create challenges for both the patient and the provider. Which therapy will best serve each unique case? As these therapies become more and more complex, how do doctors teach patients about the reasons why some choices are better than others? There are also patients who have received treatment but are unclear why certain decisions were made. 

This blog is designed to educate our patients and to bridge the gap of knowledge between what our physicians and advanced practice providers now know and what patients may currently believe.

Along with this education comes the ability to advocate—for yourself as well as your family members—so when you’re faced with a decision, you can make the best decision.

Etiologies of Pain: Cause and Effect

Many people in pain management—patients and providers alike—believe in this paradigm:

A caused B, therefore fixing A will lead to the resolution of B

In this paradigm, A is generally some type of injury or event, and B is either pain or change in function. Maybe something has been twisted or overused. This then leads to feeling pain. But the assumption here is that the problem is one-dimensional and there’s nothing else that may be contributing to the problem.

By the time they reach us, most patients have tried some sort of other therapy. They may have tried home care, with rest, ice, or heat. They may have been evaluated by their primary care physician or a chiropractor. From there, they may have tried over-the-counter medications or therapy, but they’ve continued to experience pain or disability. After all of this, they’re sent to a spine or pain specialist in order to diagnose and treat the chronic pain. 

The journey from the initial onset of the pain to a visit to PSA will often take about three to six months. Along the way, patients may learn to adapt to their pain and change the way they walk, sit, stand, lift, or do any number of other normal activities. Now, we’re not just talking about the initial injury or cause and the resulting pain, but all of the behaviors that have developed as a result.

Diagnosing the Problem

Pain medicine is a field. This means that those of us in the field don’t just focus on the treatment, we’re just as concerned with the diagnosis.

There are roughly 46 possible causes for lower back pain. In order to accurately diagnose—and therefore treat—any case, we have to look at the patient’s entire story: How did this story evolve? How does the patient describe the pain?

Along with the patient’s story, we conduct an examination and take a close look at the body: How does it move? How do the tendons and the musculature feel? Plus, we conduct studies like CT scans and MRIs.

From the story, examination, and study, we can begin to create a picture of the problem. But even then, with all of this work done, there may still be several causes for the pain. At this point, we may try different approaches to see how the pain responds—or doesn’t respond.

The “Shots”

One approach is to try some form of injection, which patients often mistakenly call “shots.” Injections performed by a pain physician aren’t like flu shots, which are blindly injected into the muscle or skin.

Rather, these are diagnostic and therapeutic tools. They’re targeted injections that are specifically placed and contain two components: Local anesthetic and steroid.

With our findings as our guide, we may put a local anesthetic on a specific nerve. If the pain is reduced, we know we’ve found the source. But even if the pain isn’t reduced, we’ve still made progress in our search for the source and possible treatments of the pain.

With the steroid, we’re able to reduce inflammation, promote tissue healing, and allow the nerve to reboot.

The Pathway to Relief

Many patients wonder if their treatments will be effective and how long they’ll last. Unfortunately, there’s no way to predict the outcome of any treatment because every patient is different. While we do expect treatments to be effective and last for some time, the reality is that most pain journeys have their ups and downs. 

In many ways, the pain journey is about breaking the pain cycle and peeling away the layers of pain. By the time a patient comes to our offices, three to six months after the pain was first discovered, there are so many other factors contributing to it, like altered biomechanics. 

Similarly, when people talk about chronic pain in the back, the focus is mainly on the specific points in the back where the pain is felt. In reality, there’s much more to it and things like lymphatics, nerves, and muscles could also contribute to the problem.

As interventional pain physicians and diagnosticians, we feel it’s our responsibility to diagnose and treat what we believe is the primary source of your pain. We also feel it's our responsibility to treat any additional sources of pain. By keeping you appraised of all of this information, we can teach our patients about what they’re experiencing and how we’re managing it.

This means that as you make your way through the pain journey, you can make educated decisions you feel confident about.

Pain management doctors – physicians who specialize in the evaluation, diagnosis, and treatment of pain – have advanced training that qualifies them as your best source of treatment if you are experiencing any type of pain due to illness or injury.

After a general residency, these physicians undergo an additional one-year fellowship in pain management, and they are board-certified in a specialty, such as sport injuries or cancer pain.

However, most pain management doctors devote their time and expertise to helping chronic pain patients whose needs can sometimes be hard to diagnose and take months or years to treat using multiple therapies.

Pain management doctors most often see patients with pain in the low back, knee, head, hip, and neck. Common conditions treated is these physicians include: arthritis, fibromyalgia, migraines, sciatica, and more.

But what do pain management doctors actually do?

For one thing, they diagnose the specific cause of your pain and the underlying conditions that lead to it. Take back pain, for example. It could be caused by many conditions ranging from poor posture at your work desk to a herniated disc to a degenerative condition like arthritis.

Once a pain management doctor diagnoses your pain, he or she can find the therapy that works best for you based on their specialized training and the latest research. In fact, pain management doctors often conduct their own trials and studies on patients who haven’t responded to conventional treatments.

Pain doctors often use a wide range of nonsurgical, interventional treatments – along with complementary therapies – as a way of reducing the amount of medication you need to take or to avoid the need for surgery. These may include massage, a weight loss regimen, acupuncture, exercise, yoga, meditation, physical therapy, dietary changes, or chiropractic care.

They may also prescribe pain-killing medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or antidepressants. Depending on the severity of your specific condition, they may also recommend epidural steroid injections, nerve blocks, joint injections, radiofrequency ablation, spinal cord stimulation, or neuromodulation. If none of these methods are effective in alleviating your pain, surgery may be an option of last resort.

In any case, your pain management doctor will coordinate treatment between multiple doctors and healthcare professionals. In addition, he or she will continue ongoing care for any physical or mental concerns you may have. In that role, your pain management doctor acts as an advocate dedicated to relieving your symptoms.

To learn more about how a pain management doctor can help you overcome your pain issues, talk to the experts at Pain Specialists of Austin and Central Texas Pain Center. We help patients like you every day. Get the discussion started by calling (855) 876-7246 for an appointment today or request an appointment online.

Living a life with chronic pain can be complicated. Pain not only affects you, but it can also affect your friends and family, and potentially your work productivity. It can impact every aspect of your life, from difficult physical exertion to common tasks, like tying your shoes.

If you’re experiencing chronic pain, you’re not alone. As many as 100 million Americans deal with some form of chronic pain.

The beginning of a new year is almost always seen as a renewal, a fresh start, a sense of hope for something better. You can take your life back from daily chronic pain. You may have started and stopped many times in your pain management journey, that’s ok. Sometimes it’s necessary.

Here are a few tips to begin or continue your pain management journey in 2022.

Set up a system, not a resolution or goal
The goal or resolution to live a healthier life can be better achieved through establishing a system. A system makes your goal attainable. It’s concrete. It gets you moving in the right direction. A system is something you do on a regular basis. It might look like:

Drink more water. Whatever you are drinking now, double it if it is less than 40 oz per day. Dehydration can make chronic pain worse. Make sure you stay hydrated by drinking an adequate amount of water. Avoid caffeinated drinks, like coffee and tea, as well as alcohol since these beverages will actually make you more dehydrated.
Move more. Analyze how much you sit and how much you move. Adjust accordingly—even if it’s a small amount.
Find support in fellow pain warriors. Stay connected with others who might share the same battle. Holding space for your pain flare ups with an understanding friend might help you go through those moments with less grief.
Create a sleep routine. One-third of Americans don’t get enough sleep on a regular basis, according to the CDC. The Sleep Foundation offers these tips to build a better sleep routine: decide on bedtime, leave electronics alone, have a light snack or bedtime tea, take a warm bath, listen to music, stretch & breath, practice meditation, read a good book, write down a to-do list or journal and prep your bedroom. Pick 1-2 changes you can start implementing today.

Research your pain management options
It’s common that most people do not know the difference between conventional pain management and interventional pain management. Conventional pain management includes medication treatments and over-the-counter medication to manage pain flare-ups. Essentially any type of treatment that does not invade the body in order to alleviate pain. It does not address the root of the problem; it simply band-aids. Interventional pain management (IPM) focuses on finding the root cause and interrupting the pain cycle. IPM is an ideal treatment for both acute and chronic pain and can be used to alleviate even the most complex source of pain. Interventional pain management doctors partner with you to establish a comprehensive treatment plan that addresses your specific needs. Pain sufferers are aware of the opioid epidemic that plagues our nation. Interventional pain management doctors are at the forefront of making a change to better the lives of pain sufferers through comprehensive treatment plans.

[maybe more on what an interventional pain doctor does?]
IPM doctors start with a thorough evaluation of your pain and overall health. With this data, the doctors consider all of the available, relevant treatment options and create the plan that best addresses the causes of pain. For a more complete look at IPM, read our blog from last month.

Everyone's pain is different and there are many factors that cause flare-ups. Stress, depression, anger, anxiety or fear, intrusive thoughts, isolation, underdoing, or overdoing can create more pain signals in the body. Taking back your life by putting yourself in charge of your day helps you manage chronic pain better.

The goal of interventional pain management is to help you find the best function and quality of life possible.

If pain is disrupting your life, there’s hope. Our interventional pain management team can help you take control of your health by providing you with information and treatment options. It’s time to get your life back. There’s no reason for you to suffer. Your first step is to click or call. Our Care Team is ready to walk you through your recovery, step by step. We provide expert pain care, close to home.

What Is Interventional Pain Management?

According to Dr. Pankaj Mehta, our Chief Medical Officer, “The priority of interventional pain management (IPM) is finding the root cause and interrupting the pain cycle. IPM is an ideal treatment for both acute and chronic pain and can be used to alleviate even the most complex source of pain.”

To describe what we do as “pain management” would be true, but it wouldn’t tell the full story. Yes, we provide pain management, but it goes much further than that.

We provide a variety of interventional treatment modalities to help manage your pain by creating a personalized plan —no matter what the cause or source.

As Dr. Mehta says, “We partner with patients suffering from pain. We help them optimize pain control, enhance daily functionality, and improve physical and psychological well-being.”

What’s the difference? Conventional pain management includes medication treatments and over-the-counter medication to manage pain flare-ups, essentially any type of treatment that does not invade the body in order to alleviate pain. It does not address the root of the problem; it simply band-aids.

Patients frequently come to us with multiple “pain generators,” which are sites of illness or injury that contribute to pain and suffering and detract from your quality of life.

Pain not only affects you, but it can also affect your friends and family, and potentially your work productivity. It can impact every aspect of your life, from difficult physical exertion to common tasks, like tying your shoes.

Our Process

First, we believe it’s critical to listen to the patient; to go beyond the traditional doctor-patient relationship, and create a partnership. Plus, no two people experience pain the same way, so personalized plans are critical.

Our approach to interventional pain management begins with a conversation. We listen to your concerns and your needs; how pain is affecting your life.

“This is why a partnership is important,” says Dr. Mehta. Because if you don't individualize the pain treatment for each patient, the outcome may not be as effective.

Along with our Care Team, we thoroughly process the information, imaging, and diagnostic testing to determine a diagnosis. The diagnosis helps us determine the range of treatment methods to address your pain. We take the “S.A.V.E.” approach to your course of treatment: Surgery At the Very End. There are many less invasive options to help you regain a functional life.

We create a “pain management ecosystem,” a complete program of the specialists, therapies, and other elements needed to reach your goals. A vital part of this ecosystem is your involvement.

According to Dr. Mehta, “We educate you on the non-opioid therapies available. This education not only empowers you on the choices you have but can help with your peace of mind.”

Our goal is to create a comprehensive approach to treat your suffering, to allow you to enjoy the quality of life you want.

We’re not limited to back and neck pain. We treat all kinds of pain, from headaches down to foot pain and neuropathy—and all points in between.

Interventional Pain Management Including

If pain is disrupting your life, there’s hope. Our interventional pain management team helps you take control of your health by providing you with information and treatment options. It's time to get your life back. There’s no reason for you to suffer. Your first step is to click or call. Our Care Team is ready to walk you through your recovery, step by step. We provide expert pain care, close to home.

The U.S. Centers for Disease Control and Prevention estimates as many as 100 million U.S. adults suffer from chronic pain. More alarming was that 8 percent of U.S. adults (19.6 million) reported having high-impact chronic pain directly proportional to suffering. Clinicians at Pain Specialists of Austin and Central Texas Pain Center have helped thousands of patients by identifying and treating the source of their chronic pain.

Chronic pain, as explained by Dr. Pankaj Mehta (MD, DABA, DABPM), a nationally renowned interventional pain doctor and Medical Director at Pain Specialists of Austin and Central Texas Pain Center, is pain that persists for at least three months, despite treatment, with an intensity that disrupts normal physical function and sleep patterns, reduces strength, limits daily activities and negatively impacts one’s ability to work and recreate with family and friends.

According to Dr. Mehta, chronic pain is generally the result of damaged, inflamed or dysfunctional nerves resulting from structural deterioration associated with aging, physical injury or trauma, muscle strain and disease. Conventional pain management (CPM) treats pain with medications and prescription drugs. Medication temporarily alleviates pain symptoms but does not fix the cause of the pain. There’s a better method for treating chronic pain with interventional pain management (IPM). IPM focuses on identifying the underlying structural cause of the pain and interrupting nerve transfer of pain signals at their source.   We don’t just treat the pain symptoms; we treat the structural cause of your pain.

“Pain almost always has an underlying pathology, a structural deficit that in many cases can be treated effectively with advanced IPM,” he explained. “If you have chronic pain, there has to be a nerve or a group of nerves involved, which a local anesthetic block can diagnose.

This approach to addressing the underlying cause of your chronic pain is a concept Dr. Mehta calls “dampening the bad electric signals,” which he does through therapies such as nervous system stimulation or correcting spinal nerve compression via minimally invasive advanced spine therapies.

Pain does more than hurt physically,” he added, “it can impact physical, emotional and psychological well-being preventing individuals from being able to live a full and happy life.”

Dr. Mehta has found that many pain sufferers assume that they have no choice but to live with debilitating discomfort. Many times, they become discouraged after less effective treatment options do not work.

“Many people believe pain is an inevitable consequence of getting older, a lingering injury or a hereditary condition that runs in their family.  Some hope the pain will just go away.  Others don’t want to be perceived as complaining to their family and friends, so they just suffer in silence.”

Unfortunately, “a primary barrier to pain sufferers seeking treatment is a fear that they will be prescribed, and then become addicted to, opioid drugs.” That’s due to a public perception that “pain management treatment can only be accomplished with opioids,” he said, which, ironically, can be both an attraction and a repellent to people seeking pain treatment. “We’ve had people tell us that we don’t care about them because we won’t prescribe opioids, however, our unwillingness to allow them to become dependent on opioids shows how much we do care about them.  We seek a long-term solution and not a quick, short-lived medicative numbing approach for their chronic pain.”

To learn more about Pain Specialists of Austin’s and Central Texas Pain Center’s multi-disciplinary, interventional pain management treatment options and how the science of pain management can change your life, please visit their website www.psadocs.com.

Thanks to daylight saving time (Mar. 14), you will likely miss out on some sleep this week; however, there’s never been a better time to start new habits – your body will thank you

At precisely 2 a.m. on Sunday, Mar. 14, a majority of Americans will transport forward in time, losing an hour of their beloved weekends and likely, 60 minutes of sleep. This isn’t science fiction, rather a century-old societal tradition we have come to know as daylight saving time, which occurs twice per year, seasonally each Fall and Spring.

While there’s much debate over whether daylight saving time still has a place in modern societies worldwide, there’s mounting evidence it may be significantly impacting our health. Because sleep is so essential, especially for those suffering from chronic and acute pain, our team of pain management experts is challenging patients to put extra preparation into daylight savings time this year.

In addition to springing forward clocks on Saturday night or Sunday morning, we are encouraging patients to take this time to examine their current sleep patterns and choose better habits – As part of Sleep Awareness Week (Mar. 14-20). Even small measures to improve sleep can dramatically improve overall health, mood and even reduce pain.

Circadian rhythms & the problem with change

Our bodies rely on an internal clock or circadian rhythm to regulate the function of cells and systems. This rhythm has variations from person to person but generally alerts us with a boost of energy in the morning, causes mid-day grogginess, and finally helps us fall asleep in the evenings. Beyond regulating alertness and energy levels, these circadian rhythms also influence hormone release, eating habits, digestion, body temperature and more.

With so many components of healthy body function connected to our circadian rhythm, even slight changes can wreak havoc. The desynchronization of our body clocks, which occurs twice a year due to daylight saving time or when we don’t get enough sleep, has been linked to increased health risks such as depression, obesity, heart attack, cancer, and even car accidents.

What is a good night’s rest? There’s no one-size solution

According to the Center for Disease Control, more than a third of adults in the U.S. don’t get enough sleep. As previously discussed, this negatively impacts our circadian rhythm and throws our bodies out of balance. Further, those who do not regularly get enough sleep can quickly become victims to sleep deprivation, a form of cognitive impairment that affects memory, motor skills and mood regulation. So, we need more rest, but how much?

The amount of sleep adults need varies but generally changes as you age. During infancy through the teen years, our bodies crave sleep, which powers development. As adults, we typically require seven or more hours per night. What is most important is that hours spent sleeping are good quality.

 Goal Setting – Quality & quantity

 With a target goal of getting approximately seven hours of sleep each night, how can we improve the quality of those hours? This isn’t simple. For those who live with the feeling of waking up tired after a full night of sleep, it can be frustrating or downright demoralizing. If experiencing this, it may be worthwhile to explore several factors:

Finally, consider tracking your sleep through your phone. There is an abundance of phone applications that can monitor habits, sleep quality and even remind you of bedtime hours.

Tips for those in pain

Research has shown a strong indication that sleep is an effective painkiller. However, those suffering from chronic pain are often unable to fall asleep, frequently awaken throughout the night, and generally do not enjoy a high-quality sleep. This compounds fatigue for pain sufferers and can contribute to the development of more severe long-term health conditions.

We’ve examined the importance of sleep, the amount needed each night and how to improve sleep quality; however, this means little unless those in pain can break the cycle of insomnia. For those living with chronic pain and looking to improve their sleep, there are a few things our experts recommend:

If you are experiencing sleep issues because of chronic or acute pain, we encourage you to seek professional medical guidance. Our team of dedicated pain relief specialists can help answer your questions and offer personalized care recommendations to help you rest and play without pain.

A creeping pain beginning in your lumbar or buttock area and running down the backs of your legs could mean problems with your sciatic nerve

With an estimated 40 percent of individuals experiencing lumbar radiculopathy at some point in their lives, it’s likely that you or someone you know has experienced or is experiencing this debilitating issue. Although familiar, many people still don’t fully understand what causes lumbar radiculopathy, how to identify it and the best ways to reduce its impact on our daily lives. 

What is lumbar radiculopathy or sciatica and how do I know if I have it?

Lumbar radiculopathy, sometimes referred to as sciatica, is the irritation or inflammation of the sciatic nerve, which originates from the lower lumbar areas of our backs and branch out to the buttocks and backs of our legs. The sciatic nerve plays a vital role in controlling muscles and sensations in the lower body and is the longest and widest nerve in the human body.

Lumbar radiculopathy commonly occurs in people between the ages of 30 and 50 years. It is most often associated with a shooting or radiating sensation of pain beginning in the lower back and traveling down one leg or both. This is a crucial differentiator between sciatica and other kinds of pack pain, which often do not affect the legs. Often, patients with sciatica will describe the pain as dull, aching or even burning, with some also experiencing tingling and weakness.

Even if you are experiencing these symptoms, a doctor’s assessment is needed to diagnose the condition properly. Your doctor will typically evaluate your medical history and conduct a physical exam and may even request additional tests like x-rays, an MRI or a nerve conduction study to diagnose lumbar radiculopathy effectively.

What treatments are available?

Given proper rest, lumbar radiculopathy symptoms typically dissipate in a few days or weeks without the need for medical intervention. For those with persistent pain, there are several ways to relieve this and promote the healing process. They include:

What are the causes?

In most cases, lumbar radiculopathy is caused by:

lumbar radiculopathy or sciatica and Winter Weather

With Texas recently experiencing a blast of unprecedented winter weather, an increasing number of individuals may now be experiencing lumbar radiculopathy for the first time or dealing with worsening sciatic pain. It is commonly believed that lumbar radiculopathy is compounded by cold and although this may seem like an old wive’s tale, there’s evidence that this may be the case.

Cold weather and everyday activities required while living in cold environments can dramatically impact pain – including pain caused by sciatica. Reasons pain could increase during cold snaps include:

 

As discussed, rest and typical household pain remedies can effectively manage minor onset lumbar radiculopathy; however, for many medical interventions may be required. If you are experiencing debilitating sciatic pain, our pain management experts are available for patient consultations.

If you’re experiencing ongoing neck pain, it may be time to stop reaching for the aspirin and begin looking for an interventional solution.

Neck pain can run the gamut from the occasional discomfort of being bent over a computer to ongoing agony after a fall. In the middle are causes – some obvious, some mysterious – that must be uncovered before treatment can begin to alleviate or eliminate the pain. Among the most common culprits are:

In searching for the cause your neck pain, it’s important to completely and accurately share your accompanying symptoms with your physician. These can include achiness and stiffness; shooting pains; numbness; shoulder and arm pain; headache; dizziness; nausea; fever; vomiting; difficulty swallowing or breathing; and anything else that is new or aberrant.

Diagnosis also will include a deep dive into your health history and a physical exam. It may also be necessary to do an MRI and/or CT scan, X-rays and blood tests to get to the bottom of the problem.

Depending on the cause, the solution can be found in many courses of action and treatment, from physical therapy to medication to injections to nerve blocks and ablation. While seldom necessary, surgery also is an option when the patient isn’t getting sufficient relief with other treatments.

To get to that end, your primary physician may refer you to a pain management specialist, a clinician or group with experience in neck injuries and experience in treating the pain they produce. Or you may decide to make pain management your starting point – hopefully with us.

The fact is that persistent neck pain could be a signal for a serious underlying cause and early intervention often is key to addressing it. If you’re ready to take that first step into action, call us for a consultation.

We’re here to help.

 

 

 

The statistics on sufferers of chronic pain are staggering – and irrelevant if you’re the one with the pain.

The sad fact, though, is that many of these sufferers don’t have to suffer, yet they do, many because they just flat out don’t know what to do or how to go about it.

To help address this, this blog looks at our specialty – pain management – with emphasis on when to turn to a pain management specialist, hindrances to avoid in making the move and what to do when you get there.

Acknowledge the Impact

The National Institutes of Health defines chronic pain as lasting more than three months with an intensity that:

If any of those factors are impacting your life, it’s time to take charge of your pain management, consulting a specialist in the field. The sooner you make the move the better, and the closer you’ll be to improved quality of life.

Be Aware of Barriers

Perhaps the greatest barrier is the surrender that comes after other doctors have failed to discover a diagnosis that would lead to effective treatment. Others include:

None of these represent action to address your pain in a meaningful way, and the only one who can take action is you.

Consulting an Expert

Pain management doctors – physicians who specialize in the evaluation, diagnosis and treatment of pain – have advanced training that qualifies them as your best source of treatment if you are experiencing any type of pain due to illness or injury.

Here are a few things to remember when working with such a specialist.

As the field of medicine learns more about the complexities of pain, it has become more important to have physicians with specialized knowledge and skills to address it.

Now, more than ever, help is out there. We’re here if you need it.

 

Life’s little victories. Most of us take them for granted. Hopping out of bed, getting ready for work, driving to the job site, shopping on the way home, cooking, socializing with family and friends and otherwise getting on with duties and joys of our daily lives.

For those suffering with chronic pain, however, any one of those acts could be a major victory for those who simply can’t do many of the activities the rest of us never think twice about.

Every day, patients come to us for multi-disciplinary, interventional treatments with an eye to getting their lives back. Most often, their goals are simple, that is, just to do the ordinary things they once did that are now limited by the magnitude of their pain.

Once they’ve accomplished that, we love hearing their uplifting stories of the impact on pain management on their lives. It’s not the kind of thing you read in the paper: “Man Goes to Grocery!” or “Woman Plays with Her Child!” But these are real stories of heroism, persistence and reclamation. You can find reviews on our website of our opinions of us, but we like it best when they tell them about themselves.

Many who have been blinded and bound by pain for years now are taking joy in, well, pretty much everything and learning more about themselves every day. It is not unusual to hear or read accounts of those whose pain is now under control and how it has helped them recapture what they lost. In that regard, it’s not unusual to hear them report that:

If you, or someone you know, struggles with chronic pain, encourage them to call us for a consultation. We understand and we want to help.