Pain management is mainly focused on alleviating pain and enabling individuals to carry out day-to-day activities.
Pain treatment depends on the type of pain being experienced.
Juries and Attorneys benefit from a clear explanation of medical concepts and treatment procedures.
Some of the most common treatments used for effective pain management include:
Medication
- Use of medications, such as analgesics, anticonvulsants, antidepressants, narcotics, and non-steroidal anti-inflammatory drugs (NSAIDs). These drugs may be sold over-the-counter or prescribed by a doctor.
Anesthesia
Anesthesia is ideally used during invasive and non-invasive diagnostic and treatment procedures. It includes general, regional, and local anesthesia, and sedatives.
Non-invasive Procedures
- Non-invasive procedures such as pulsed and standard Radiofrequency Ablation.
- Injections/trigger point injections, e.g., Epidural Steroid Injection and Nerve Blocks
- Percutaneous spinal disc decompression1
- Electrical stimulation is a procedure that uses electrical signals to stimulate nerves and the brain to block pain transmission. This includes peripheral nerve stimulation, spinal cord stimulation, intra-cerebral stimulation, Intradiscal electrothermal therapy (IDET)
- RICE protocol (rest, ice, compression and elevation) helps relieve joint and muscle pains such as sprains and strains.
- Physical therapy and rehabilitation involving massage and manipulation are often prescribed to restore function, control pain, and speed up recovery.
- Biofeedback is generally used to treat headaches and backache. In this method, an electronic machine is used to train the patient to be aware of and have control over certain body functions such as muscle tension, skin temperature and heart rate, and change their response to pain with certain techniques such as relaxation.2
- Acupuncture involves the insertion of fine needles at specific points of the body to ‘stimulate the body’s energy flow.’ Energy flow is not a medical term. Patients report it is effective; some research concurs. Generally, however, research is inconclusive. Read more from Johns Hopkins about Acupuncture.
- Chiropractic therapy is a hands-on method of treating back pain, musculoskeletal conditions, and neck pain. It involves adjusting the coordination between the structure and function of the different parts.3
- Exercise is also a widely prescribed treatment for the reduction of pain. Simple exercises, such as walking and swimming, help to improve blood supply and oxygen to the muscles and release endorphins, chemicals that reduce the perception of pain.
Apart from these direct methods, pain management also includes treating the underlying condition that is causing the pain. Cognitive-behavioral therapy and counseling with a licensed mental health provider can help an individual to cope with pain and learn techniques such as relaxation and imagery to distract the mind from pain.
Endnotes
Following is material you may find of interest. This is not an endorsement, simply additional reading.
[1] Percutaneous Lumbar Disc Decompression , Zachary L. McCormick, MD, Curtis Slipman, MD, Ashot Kotcharian, MD, Akhil Chhatre, MD, Frank J Bender, III, MD, Aleya Salam, MD, Serge Menkin, MD, David J Kennedy, MD, Christopher Plastaras, MD, Percutaneous Lumbar Disc Decompression Using the Dekompressor: A Prospective Long-Term Outcome Study, Pain Medicine, Volume 17, Issue 6, June 2016, Pages 1023–1030, https://doi.org/10.1093/pm/pnv122,
[2] Biofeedback. Efficacy of Biofeedback in Chronic Pain- a Meta Analysis, Sielski, et al., International Journal of Behavioral Medicine.
[3] Chiropractic: Spinal Manipulative Therapy. Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451–1460. doi:10.1001/jama.2017.3086″
https://jamanetwork.com/journals/jama/article-abstract/2616395
Chronic Pain and the Med-Legal Independent Medical Examination (IME)
In legal matters, an objective medical-legal Independent Medical Examination will focus on the relationship between chronic pain and an injury, or alleged injury.
Dr. Singla is a Certified Independent Medical Examiner, with unique training to conduct a medicolegal exam, review of records, and report of her findings. She has been opining in such matters for more than 5 years.
Legal cases
An implanted device, like a spinal cord stimulator, may be the subject of a product liability case. In her clinical practice, Dr. Singla routinely performs procedures to implant such devices.
Complications
A patient may have been implanted with an electrical stimulation device with complications, or simply ineffective results. Alternatively, if the device is successful, it can be life-changing for the patient.
Legal Matters
Prognosis for a long-term recovery from a Personal Injury
- Personal Injury. Physical injuries and treatment are addressed by medical damages claims. More subtle are Pain and Suffering claims. Pain and Suffering is a non-compensatory claim in Ohio, which means there is no cap or guideline for the jury about an award. The expert witness physician is tasked with explaining to the jury the nature of Chronic Pain and its impact on life.
- Medical Standard of Care or Medical Malpractice. Pain care is carried out by doctors, nurses, or even unlicensed healthcare aides depending on the treatment and setting. Assisted Living and Nursing Homes, for example, do not always have a doctor on staff and pain medications may be administered by a person unqualified to do so. Standard of care does not only apply to doctors. Though when it is breached, Medical Malpractice cases may not be far behind.
- Product liability. An implanted device, like a spinal cord stimulator, may be the subject of a product liability case. In her clinical practice, Dr. Singla routinely performs procedures to implant such devices.
These are both Plaintiff and Defense questions for the objective Expert Witness to address.
