Coastal Pain & Spine Center offers a multitude of treatment options tailored for each individual patient's needs. Similarly, each patient has different interests and desires when it comes to their care. Our goal is to review your symptoms and pathology to discuss the options that may be best suited for you. We pride ourselves in taking a comprehensive approach to pain. As such, we will assist patients in that care including obtaining any necessary diagnostic imaging and referrals to physical therapy or chiropractic care. It will most certainly include discussion of treatments we can provide to you directly. Below are a some of the most common treatment options for patients though it is important to discuss with your health care team which option(s) may suit you best and why.
There are a variety of medication options that are available to assist with chronic pain needs. The list of options includes: Nonsteroidal Anti-Inflammatories (NSAIDs), Gabapentanoids/Anticonvulsants, "Muscle Relaxers", Antidepressants (TCA and SSRI/SNRIs), and Opioids, to name a few. Each has different benefits and risks both in the short and long term. It is important to understand these in detail for the best possible outcomes by maximizing the benefits and mitigating as many risks as possible. Schedule an appointment to discuss medication therapy options with our staff today. The following list is NOT all inclusive, but may assist in recognition of generic and (brand) names of common medications.
NSAIDs: Ibuprofen (Advil/Motrin), Aleve (Naproxen), Meloxicam (Mobic), Celecoxib (Celebrex)
Gabapentanoids: Pregabalin (Lyrica), Gabapentin (Neurontin)
Muscle Relaxers: Cyclobenzaprine (Flexeril), Tizanidine (Zanaflex), Methocarbamol (Robaxin), Baclofen
SSRI/SNRI and TCA: Duloxetine (Cymbalta), Milnacipran (Savella), Amitriptyline (Elavil)
Opioids: Tramadol, Norco (Hydrocodone+Acetaminophen), Percocet (Oxycodone+Acetaminophen)
Opioids: This class of these medications are likely most commonly thought of when it comes to pain management. However, they present some of the most difficult challenges for long term utilization, particularly for non-malignant chronic pain conditions. In the short term, opioids can be effective for acute pain, often in the setting of surgery or mechanical trauma. There is utility in the use of opioid therapy for the management of cancer pain.
The use of opioids for non-malignant chronic pain should be reserved as a method of last resort and even still may not be indicated. Common side effects are sleepiness, sedation, confusion, dizziness, nausea, and constipation. More challenging issues are the development of Physical Dependence, reliance on a substance to prevent withdrawals, and Tolerance, the decreasing benefit to medication despite a stable dose. Physical dependence and tolerance should NOT be confused with Addiction, which per the American Society of Addiction Medicine is as a complex treatable medical disease stemming from physiologic and social factors often resulting in behavior that is compulsive and continued despite harmful consequences. A lesser known difficulty with chronic opioid therapy is Opioid Induced Hyperalgesia, a condition where chronic opioid use results in increased sensitivity to painful stimulation. Most concerning is the risk of Overdose. Data indicates overdose risk is particularly high if combined with benzodiazepines (Ativan, Xanax, etc.) or other sedating medication or substance. Additionally, increasing morphine milligram equivalents (MME), the measure of daily opioid use, also statistically increases chances of overdose intervals above 20, 50, and 90 MMEs.
The goal of Coastal Pain and Spine Center is to provide controlled substance medications when deemed appropriate to aid in chronic pain treatment utilizing the guidelines and regulations by the Center for Disease Control and Federation of State Medical Boards. In order to continue prescribing controlled substance medications to patients, tight controls and rigid rules have been established to protect privileges of our practice to prescribe, obey the laws under which we operate, both federal and state, and to maintain the health and welfare of the patients we treat and the people of this community. A PDF copy of the Controlled Substance Agreement is attached below.
If you or someone you know is affected by opioid addiction or other substance use disorders, there is help available both locally and nationally. Please speak with us in clinic for assistance or you can visit the CDC for further information.
Narcan: This medication is the reversal agent for opioid overdose and can be life saving. It comes in the form of a nasal spray that can be easily administered and save a life. Should this be used and/or if there is suspected opioid overdose, 911/Emergency Response should still be contacted. Coastal Pain and Spine Center believes in prescribing this medication for all individuals that are on any form of chronic opioid therapy for both the safety of patients and their friends and family. It is better to have and not need this medication than to need it and not have it. A downloadable Narcan Information PDF from the Centers for Disease Control is below for your convenience.
Pain is often focal or localized to one particular distribution or location. When taking medication orally, it spreads throughout the body to regions that may not require it. Additionally, there are often side effects and risks of medications depending on each person's medical history. The option of targeted therapy allows for quick and selective placement of medication or intervention at the site that is causing the problem thereby offering relief without the systemic side effects. Such methods can eliminate the need for daily medication therapy or can be used to lessen the amount of medication taken. Below is a commonly, but not all inclusive, list of x-ray guided procedures that are offered at Coastal Pain and Spine Center.