Pain, for any length of time, is a burden and of the most common reasons patients seek medical care. New treatment modalities include frequency specific microcurrent and a treatment called Pain Neutralization Technique (PNT).
Listen in as Dr. Aaron Compton explains new treatments for chronic pain management and how a treatment program developed for your individual needs can change your quality of life for the better.
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Pain Modalities Offered at Schneck's Pain Center
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Learn more about Dr. Aaron Compton
Aaron Compton, MD
Dr. Aaron Compton is a board-certified anesthesiologist who is fellowship-trained in pain medicine. He attended medical school and completed his residency at the University of Louisville School of Medicine. After his anesthesiology and perioperative medicine residency, he completed his education as Chief Clinical Fellow in Pain Medicine at University Hospitals Case Medical Center, Case Western Reserve University in Cleveland, OH. Dr. Compton joined the Pain Center in 2011. In his free time he plays the guitar and records music. His outdoor activities include golf, tennis, and snowboarding.Learn more about Dr. Aaron Compton
Transcription:
Pain Modalities Offered at Schneck's Pain Center
Bill Klaproth (Host): America is a nation in pain. Pain affects more Americans than diabetes, heart disease and cancer combined. According to the NIH, nearly 50 million American adults have significant chronic pain or severe pain which impacts their overall enjoyment of life. Here to talk with us about the Schneck Pain Center is Dr. Aaron Compton, a board certified anesthesiologist at Schneck Medical Center. Dr. Compton, thanks for your time today. So, first off, how do you define chronic pain?
Dr. Aaron Compton (Guest): Well, the guidelines vary but typically we start to consider a pain to be chronic in nature once you’re passed about three months. At about three months, we expect most pain to start to resolve, should it be after a short injury, a surgery, that type of thing. When the pain becomes beyond three months, we typically start to consider that in the chronic category.
Bill: So, basically, a length of time if you have this over a three month period, that gets categorized as chronic pain. What are the most commonly reported pain conditions?
Dr. Compton: In an industrialized nation as the United States, we typically see muscular skeletal, joints, spine issues, things of that nature. So, I see a large percentage of patients that have chronic low back pain, hip pain, patients that have knee pain, shoulder pain, neck pain--things of that nature. And, then, also in the muscles themselves independent, perhaps, of the joints. That’s pretty common. Those are the most common things I would definitely say that I see.
Bill: So, at Schneck Medical Center, how do you go about identifying the underlying cause of pain and, then, how do you address it?
Dr. Compton: When I see a patient for the very first time, I do a very extensive evaluation and just like any physician and medicine, it’s a three-pronged approach. The first thing is to definitely listen to the patient’s history, really take in what their pain is like for them on a daily basis because nobody can explain it better than the patients themselves. They’re the one that live with this and deal with it every day. The second thing is to do a really good examination and, in the world of pain medicine, there are certain examination things that may be unique versus other specialties. And, then, the third thing is to take into account is there any particular study such as an x-ray, MRI, CAT scan, serum blood levels from the lab, things of that nature because sometimes you may see something on an x-ray for example, that look like, “Hey, that’s definitely our problem there,” but, in fact, that may not be the case. Like I said, the history and examination are just as critical to understanding what the cause of that is. So, by looking at all three of these things, you can typically start to narrow down a pretty good idea of what’s going on. Then, from there we start to go into approaching the treatment of the pain. Now, were you wanting me to go into that as well, you said? I’m sorry.
Bill: Yes, I would. Now that we know what you look for when you’re diagnosing it, then talk to us about the treatment options. Obviously, there’s medication, there’s physical therapy, of course, but just give us the overview of the treatment plan then.
Dr. Compton: Okay. So, in our practice here in the office, we go approaching pain in what is called a
“multi-modal approach”. Now multi-modal approach essentially means that we look at all the different available tools and strategies and options of what could be used for this particular patient now. In some patients, some of these tools may be more effective than another patient but, in general, by spreading out the different options, it overall, I think, hits the pain from different angles, if you will, to ultimately give them the best long-term outcome. So, the first thing I always look that is very critical for any patient are the lifestyle things, and these are the things that the patient needs to be working on on a daily basis. For example, for someone with back pain, it’s really critical that we work on an exercise program, a stretching program, work on keeping the weight in a healthy range, avoiding bad things--good healthy diet when you work on bad--get away from cigarettes, things like that. So, that’s one key thing. Some patients have a better understanding and grasp of that than others. So, first is we’re really coaching patients on, “Look, we need to work on this and that--things on your own at home.” Now, the next thing I look at are additional--if the patient, I don’t feel, can learn to do certain stretches and exercises on their own, we’ll get the assistance of physical therapy which they can do things like, not only traditional physical therapy but also aquatic therapy. We’ll refer patients up for that. So, they help guide the patient into doing these stretches and exercises ^and give them a kick start on the appropriate thing to be doing. The next thing is that I do offer patients numerous different procedural options. Most of them are, really, minimally invasive. Some general things to consider in that regard would be things like joint injections, epidural injections, a procedure called “rhizotomy” which is, essentially, a minimally invasive way to burn nerves in the body depending on if it’s appropriate or not, of course, for the patient. And then some other procedures that we do that are a little more invasive are things such as what’s called a “spinal cord stimulator system” which is a small wire similar to like a pacemaker. The technology is placed into the spine, and when that is turned on, the patient achieves pain relief. There’s also what is called an “intrathecal” or “pain pump” which is a small tube that’s placed in the spine that drips the pain medication so the patient wouldn’t, for example, have to take a pain pill orally. Then, there are other procedures such as kyphoplasty. If a patient develops a facture of their back, this is a minimally invasive procedure that can fix that very quickly. And, then, the final thing are the medication options. With medication, the real goal is to try to minimize or even avoid, if we can, any type of opiate narcotic pain pills. Just to make sure we know what we’re talking about here like Lortab, hydrocodone, oxycodone, Percocet--that family of medicines. These are really poor strategies in terms of chronic pain. You have a car wreck, you have surgery, sure. They’re really good for those kinds of situations. But, in terms of chronic use, they’re really not that effective because the human body, over time, essentially gets tolerant to them. So, again, we really try to minimize those other medicines. So, there are a lot of other non-narcotic medication options. It really depends on the person’s situation, and we’ll explore what, if any of those, may be a good solution. So, again, ultimately, multi-modal approach. Look at all these different tools, strategies, options, put those pieces together and what we think will work best for the individual patient.
Bill: Well, that multi-modal approach sounds like it’s right on. You’re right, this prevalence of this chronic pain that I talked about in the beginning really is at the root of the ongoing epidemic of prescription painkiller abuse and the four steps that you talked about really is the way out of that mess--lifestyle changes, physical therapy --traditional and aquatic, then procedural options, and then medication options. So, that makes a lot of sense. Now, when a cure is not possible, can you talk about ongoing pain management?
Dr. Compton: Yes. So, that’s essentially what I’m getting at here. So, going back to what you had originally asked, if, at my first evaluation or during the evolution of our evaluation and treatment of what their response is, the patient’s response is to these treatments, if at any time during that, if I do feel a surgical referral is a reasonable option--not everybody. So, if you have back pain, for example, oftentimes it’s chronic. It may have been there for several years and really not someone that I feel if I send them to a spine surgeon, they would really be able to offer a solution to cure that. But, if we do--I’m just backtracking here. If we do see something like that, that could be possible that they could get a surgery, we’ll definitely send them to a surgeon to potentially fix the problem. But, ultimately, the majority of the patients that we are seeing here at the pain center are those patients that it’s more of a chronic situation and there’s no immediate fix or cure, if you will. So, of all these strategies that I had mentioned, the lifestyle strategies are the ones that the patient has the most control over, of course. It’s something that takes time in a lot of patients, to get into that mode—to change their lifestyle. But, very often, when they take that step and start moving forward, they’re doing their stretches and exercises daily, they’re getting the weight down, they’re getting off the cigarettes, the other things that we’ve used along the way such as injections, procedures, maybe some medicines, maybe physical therapy to help them with that, that those have helped as a means to an end to allow them to do those lifestyle strategies more comfortably. And, then, as they’ve done those, the pain will get less and less, and then we start to back away from the need to take medicine and the need to have any injections or procedures. And then at that point they’re basically, “Hey, I'm doing great on my own. I don’t really need to see you anymore, Dr. Compton.” And, “I’ll just leave the door open, you call me when you need to see me,” type of situation.
Bill: So, you’re working on getting people as close to normal as possible?
Dr. Compton: Right.
Bill: And as pain free as possible. Dr. Compton, thanks for your time today. If you can wrap it up for us, why should someone choose Schneck Medical for their pain management needs?
Dr. Compton: I think we provide a very extensive coverage of evaluations of multiple different types of pain and I think we provide a very comprehensive and also caring approach. I think we always allow plenty of time for the patients to feel that we’re really addressing their needs and we do everything in our power to get them to the goal of having a more comfortable life and ability to manage the pain on their own. We do that in a way that they have control over the management of their pain ultimately in the end and by also minimizing the need to take medications such as the opium medications. I think we do a really good job at achieving that goal for our patients.
Bill: Well, Dr. Compton, thank you again for your time. We really appreciate it. For more information, you can visit www.shcneckmed.org. That’s www.schneckmed.org. This is Scheck Radio. I'm Bill Klaproth. Thanks for listening.
Pain Modalities Offered at Schneck's Pain Center
Bill Klaproth (Host): America is a nation in pain. Pain affects more Americans than diabetes, heart disease and cancer combined. According to the NIH, nearly 50 million American adults have significant chronic pain or severe pain which impacts their overall enjoyment of life. Here to talk with us about the Schneck Pain Center is Dr. Aaron Compton, a board certified anesthesiologist at Schneck Medical Center. Dr. Compton, thanks for your time today. So, first off, how do you define chronic pain?
Dr. Aaron Compton (Guest): Well, the guidelines vary but typically we start to consider a pain to be chronic in nature once you’re passed about three months. At about three months, we expect most pain to start to resolve, should it be after a short injury, a surgery, that type of thing. When the pain becomes beyond three months, we typically start to consider that in the chronic category.
Bill: So, basically, a length of time if you have this over a three month period, that gets categorized as chronic pain. What are the most commonly reported pain conditions?
Dr. Compton: In an industrialized nation as the United States, we typically see muscular skeletal, joints, spine issues, things of that nature. So, I see a large percentage of patients that have chronic low back pain, hip pain, patients that have knee pain, shoulder pain, neck pain--things of that nature. And, then, also in the muscles themselves independent, perhaps, of the joints. That’s pretty common. Those are the most common things I would definitely say that I see.
Bill: So, at Schneck Medical Center, how do you go about identifying the underlying cause of pain and, then, how do you address it?
Dr. Compton: When I see a patient for the very first time, I do a very extensive evaluation and just like any physician and medicine, it’s a three-pronged approach. The first thing is to definitely listen to the patient’s history, really take in what their pain is like for them on a daily basis because nobody can explain it better than the patients themselves. They’re the one that live with this and deal with it every day. The second thing is to do a really good examination and, in the world of pain medicine, there are certain examination things that may be unique versus other specialties. And, then, the third thing is to take into account is there any particular study such as an x-ray, MRI, CAT scan, serum blood levels from the lab, things of that nature because sometimes you may see something on an x-ray for example, that look like, “Hey, that’s definitely our problem there,” but, in fact, that may not be the case. Like I said, the history and examination are just as critical to understanding what the cause of that is. So, by looking at all three of these things, you can typically start to narrow down a pretty good idea of what’s going on. Then, from there we start to go into approaching the treatment of the pain. Now, were you wanting me to go into that as well, you said? I’m sorry.
Bill: Yes, I would. Now that we know what you look for when you’re diagnosing it, then talk to us about the treatment options. Obviously, there’s medication, there’s physical therapy, of course, but just give us the overview of the treatment plan then.
Dr. Compton: Okay. So, in our practice here in the office, we go approaching pain in what is called a
“multi-modal approach”. Now multi-modal approach essentially means that we look at all the different available tools and strategies and options of what could be used for this particular patient now. In some patients, some of these tools may be more effective than another patient but, in general, by spreading out the different options, it overall, I think, hits the pain from different angles, if you will, to ultimately give them the best long-term outcome. So, the first thing I always look that is very critical for any patient are the lifestyle things, and these are the things that the patient needs to be working on on a daily basis. For example, for someone with back pain, it’s really critical that we work on an exercise program, a stretching program, work on keeping the weight in a healthy range, avoiding bad things--good healthy diet when you work on bad--get away from cigarettes, things like that. So, that’s one key thing. Some patients have a better understanding and grasp of that than others. So, first is we’re really coaching patients on, “Look, we need to work on this and that--things on your own at home.” Now, the next thing I look at are additional--if the patient, I don’t feel, can learn to do certain stretches and exercises on their own, we’ll get the assistance of physical therapy which they can do things like, not only traditional physical therapy but also aquatic therapy. We’ll refer patients up for that. So, they help guide the patient into doing these stretches and exercises ^and give them a kick start on the appropriate thing to be doing. The next thing is that I do offer patients numerous different procedural options. Most of them are, really, minimally invasive. Some general things to consider in that regard would be things like joint injections, epidural injections, a procedure called “rhizotomy” which is, essentially, a minimally invasive way to burn nerves in the body depending on if it’s appropriate or not, of course, for the patient. And then some other procedures that we do that are a little more invasive are things such as what’s called a “spinal cord stimulator system” which is a small wire similar to like a pacemaker. The technology is placed into the spine, and when that is turned on, the patient achieves pain relief. There’s also what is called an “intrathecal” or “pain pump” which is a small tube that’s placed in the spine that drips the pain medication so the patient wouldn’t, for example, have to take a pain pill orally. Then, there are other procedures such as kyphoplasty. If a patient develops a facture of their back, this is a minimally invasive procedure that can fix that very quickly. And, then, the final thing are the medication options. With medication, the real goal is to try to minimize or even avoid, if we can, any type of opiate narcotic pain pills. Just to make sure we know what we’re talking about here like Lortab, hydrocodone, oxycodone, Percocet--that family of medicines. These are really poor strategies in terms of chronic pain. You have a car wreck, you have surgery, sure. They’re really good for those kinds of situations. But, in terms of chronic use, they’re really not that effective because the human body, over time, essentially gets tolerant to them. So, again, we really try to minimize those other medicines. So, there are a lot of other non-narcotic medication options. It really depends on the person’s situation, and we’ll explore what, if any of those, may be a good solution. So, again, ultimately, multi-modal approach. Look at all these different tools, strategies, options, put those pieces together and what we think will work best for the individual patient.
Bill: Well, that multi-modal approach sounds like it’s right on. You’re right, this prevalence of this chronic pain that I talked about in the beginning really is at the root of the ongoing epidemic of prescription painkiller abuse and the four steps that you talked about really is the way out of that mess--lifestyle changes, physical therapy --traditional and aquatic, then procedural options, and then medication options. So, that makes a lot of sense. Now, when a cure is not possible, can you talk about ongoing pain management?
Dr. Compton: Yes. So, that’s essentially what I’m getting at here. So, going back to what you had originally asked, if, at my first evaluation or during the evolution of our evaluation and treatment of what their response is, the patient’s response is to these treatments, if at any time during that, if I do feel a surgical referral is a reasonable option--not everybody. So, if you have back pain, for example, oftentimes it’s chronic. It may have been there for several years and really not someone that I feel if I send them to a spine surgeon, they would really be able to offer a solution to cure that. But, if we do--I’m just backtracking here. If we do see something like that, that could be possible that they could get a surgery, we’ll definitely send them to a surgeon to potentially fix the problem. But, ultimately, the majority of the patients that we are seeing here at the pain center are those patients that it’s more of a chronic situation and there’s no immediate fix or cure, if you will. So, of all these strategies that I had mentioned, the lifestyle strategies are the ones that the patient has the most control over, of course. It’s something that takes time in a lot of patients, to get into that mode—to change their lifestyle. But, very often, when they take that step and start moving forward, they’re doing their stretches and exercises daily, they’re getting the weight down, they’re getting off the cigarettes, the other things that we’ve used along the way such as injections, procedures, maybe some medicines, maybe physical therapy to help them with that, that those have helped as a means to an end to allow them to do those lifestyle strategies more comfortably. And, then, as they’ve done those, the pain will get less and less, and then we start to back away from the need to take medicine and the need to have any injections or procedures. And then at that point they’re basically, “Hey, I'm doing great on my own. I don’t really need to see you anymore, Dr. Compton.” And, “I’ll just leave the door open, you call me when you need to see me,” type of situation.
Bill: So, you’re working on getting people as close to normal as possible?
Dr. Compton: Right.
Bill: And as pain free as possible. Dr. Compton, thanks for your time today. If you can wrap it up for us, why should someone choose Schneck Medical for their pain management needs?
Dr. Compton: I think we provide a very extensive coverage of evaluations of multiple different types of pain and I think we provide a very comprehensive and also caring approach. I think we always allow plenty of time for the patients to feel that we’re really addressing their needs and we do everything in our power to get them to the goal of having a more comfortable life and ability to manage the pain on their own. We do that in a way that they have control over the management of their pain ultimately in the end and by also minimizing the need to take medications such as the opium medications. I think we do a really good job at achieving that goal for our patients.
Bill: Well, Dr. Compton, thank you again for your time. We really appreciate it. For more information, you can visit www.shcneckmed.org. That’s www.schneckmed.org. This is Scheck Radio. I'm Bill Klaproth. Thanks for listening.