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6/22/09: Emerson Hospital launches pain management program with Massachusetts General Hospital

Local residents suffering from pain can now find relief close to home. Emerson Hospital and the Massachusetts General Hospital (Mass General) are launching the Mass General Pain Medicine Program at Emerson Hospital, offering patients more comprehensive options for the treatment of pain.

Two Mass General pain medicine specialists with expertise in the comprehensive management of chronic and cancer-related pain are offering their services to patients at Emerson Hospital. Both of these pain medicine physicians provide patient consults and perform a range of advanced pain treatment interventions using one of Emerson’s four new operating rooms, which is outfitted with state-of-the-art pain intervention technology.

Diagnosing the source of pain
Chronic pain is associated with many different conditions, and the key to successful treatment often lies in pinpointing the cause. One of the more common types of pain is caused by a herniated disc in either the low back or the neck. “This is the classic pain that radiates down the leg or the arm,” said Chris Gilligan, MD, MBA, a Mass General physician who specializes in pain related to spine disorders. “Most people clearly describe these symptoms, and there may also be clues on the physical exam, like numbness or weakness in the painful arm or leg. In most cases, an MRI can localize the source of the pain, and we can promptly proceed with treatment: a simple injection of medication that combines a local anesthetic with a steroid to speed resolution of pain.”

The injection, which is made into the epidural space of the spine, is safely performed under X-ray guidance. Most people experience relief within a week or so of receiving the pain intervention. But treatment doesn’t stop there. “We follow a comprehensive approach to treating each patient as a whole, and would typically prescribe physical therapy and medication,” said Padma Gulur, MD, a Mass General anesthesiologist. “At times, we incorporate acupuncture or massage therapy—anything that works for the individual patient.” Drs. Gilligan and Gulur are collaborating with Emerson physical therapy staff on programs designed to build core muscle strength and flexibility and to correct posture, approaches that are central to restoring function in many patients with chronic pain.

There are many other causes of chronic neck and low back pain. One of the more common causes occurs when arthritis affects the facet joints—the joints at the back of the spinal column. Here again, listening carefully to each patient describe their symptoms, a physical exam, and use of diagnostic imaging can help to determine the source of the pain. Many patients will gain significant pain reduction with simple measures, like use of a short course of medication together with physical therapy. But some patients will require more advanced treatment, and here radiofrequency treatment involves the precise identification of the painful nerves followed by the application of radiofrequency energy to the nerves. This treatment often provides significant pain reduction for months to years.

Sophisticated treatment options
Some individuals will suffer with pain that persists despite many attempts at treatment, including surgery. Pain medicine specialists are uniquely equipped to offer hope. Many new pain medications and other approaches to treatment have appeared in recent years. Among the most advanced pain treatments is spinal cord stimulation, an approach that often provides relief for patients with persistent pain that has not responded to other therapies. “We place an electrical lead into the epidural space, which releases a carefully programmed electrical impulse,” said Dr. Gilligan. “This produces a pleasant, tingling sensation that ‘covers’ the pain. In the majority of cases, spinal cord stimulation works well, and patients go on to receive a permanent, implanted pacemaker-like device that delivers the pain-relieving impulses for long-term pain control. It’s great to be able to offer this option to patients.”

Dr. Gulur has a special interest and expertise in treating cancer pain. In the majority of those with cancer-related pain, it and other treatment-related unpleasant effects like nausea can be effectively controlled with oral medications. For those whose pain cannot be controlled with oral medications alone, there are also advanced pain treatment options. “We can deliver strong pain medication through a tiny, implantable device that delivers medicine directly to the spine,” she said. “This approach results in fewer side effects and is especially useful for end-of-life care, ensuring the highest quality of life.”

Setting treatment goals
Pain specialists are moving away from judging the success or failure of pain treatment by using patient-reported pain scores alone, instead preferring to assess function. “We want to ensure that our treatment means not only pain reduction, but that this also means that you are able to do the things that are important to you, perhaps in a modified way,” said Dr. Gulur. “Maybe you can’t vacuum your home in a half-hour, as you used to, but can you still get it done? We try to set realistic expectations for treatment, and that includes setting goals for restoring function. And we’re here to help our patients with chronic pain to meet those goals.”

For more information on the Massachusetts General Hospital Pain Management Program at Emerson, call 978.287.8523.