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Since days of old, pain management has come a long way.
Many ancient cultures believed pain and disease were punishment for human folly. They tried to appease the gods with rituals like offerings, scapegoats and sacrificial animals.
Historically, some cultures employed rattles, gongs and other devices that were believed to frighten painful devils out of a person’s body. Amerindian healers sucked on pain pipes held against a person’s skin to pull out pain or illness.
Pain has an ancient history full of myths and magical treatments.
Historically, the Greek goddess of revenge, Poine, was sent to punish the mortal fools who had angered the gods. Hence, Poine was instrumental in getting the word “pain” added to the lexicon. Other cultures contributed to the name from the Latin, poena, meaning to suffer, or to the old French, peine. “It builds character” or “No pain, no gain” are the more current references to pain.
Most people have, at one time or another, sat in a doctor’s office or emergency room and seen the chart with the happy faces or sad faces that give a gradation scale of pain from zero to 10.
Today, chronic pain still affects many thousands of people, but the approach for treating it has come a long way since those ancient times when one treatment modality was to bore holes into the head to let the pain out.
Today pain management centers have emerged as one solution to help monitor, assist and relieve the patient of pain that is considered chronic.
Often the causes of chronic pain stem from conditions that are difficult to diagnose and impossible to reverse.
“When patients come here either through self-referral or physician referral, we evaluate their condition and come up with a plan that will ease their pain; often we can’t get rid of it completely, but we want to get it lower on the pain scale,” said Dr. Gabe Somori, board certified anesthesiologist and pain management specialist of Coastal Pain Care Physicians in Lewes. “In other words, our goal is to get the patient where they will have improved quality of life in which they can function and to treat the side issues that come with chronic pain, such as the inability to get a good night’s sleep and any ensuing depression.”
All kinds of conditions fall under pain management, including headaches, fibromyalgia, cancer, HIV, lower back conditions and arthritis, just to name a few.
One of the myths is that pain management centers are only for people who have back problems and need injections. “Eighty percent of people seen here do not need injections,” Somori said.
Craig Wood’s condition is one of those cases. He is a young man with a rare genetic condition called epidermolysis bullosa recessive dystrophic gene. In layman’s terms, this means his skin dissolves and the nerves become exposed after slight trauma.
“Before I came here,” Wood said, “I only had minimal relief. Now my pain numbers are around four on a scale of zero to 10. I’m on a variety of treatments: a patch for pain relief and a combination of narcotic and nonnarcotic medicines.” Wood’s hands are wrapped in bandages; it is not uncommon in his condition to have difficulties with extremities.
Treatments vary
Injections and nerve blocks also have their place. Nerve blocks are a combination of a numbing agent and steroids. The injections are done in a separate part of the facility, under x-ray and with dye.
“Patients should know that you should be awake during an injection; involuntary movement may occur, posing a dangerous situation,” Somori said. “The procedure is not that uncomfortable.”
Christina Leyden is a patient who had previous injections and back surgery before coming to the Coastal Pain Care Physicians. She goes to the clinic for back and leg pain again. Her pain today is eight on the zero to 10 scale. “It’s frustrating,” she said, “to only be 36 years old, and some days I can’t even get out of bed.”
After a careful evaluation with Sormori, she will be fitted with a transcutaneous electrical nerve stimulation (TENS) unit that is used to distract impulses to pain. She will have her pain medication adjusted to make her more comfortable. “I just wish I could have a day without pain,” said Leyden.
“It’s hard to explain to them the pain may never be gone, but we will try to relieve it,” Somori said.
Most pain treatable
Jane Govatos is a nurse practitioner who has worked full time at Coastal Pain Care Physicians. She is a big part of any practice where patients need to reach someone when they get in trouble with medicines or their pain increases. “I can evaluate the patient on follow-up, write prescriptions or make referrals for emotional problems that often go along with a chronic conditions,” said Govatos.
“Pain is aggravated by stress and emotions,” she said, “at a time when a person is already in a distressed state.”
Although Govatos feels pain management is a tough field to work in, it also has its rewards. “Ninety percent of the time, you can help people feel better and have a more functional life style,” she said.
Professionals at the center do not treat any kind of condition that requires detoxification. “We have strict controls on drug usage here,” said Somori. “Patients sign a contract to comply with our rules, which include not doctor shopping for more medications and our own random urine testing done here. Also, we keep no pain medicine on site. Any violation of that contract and the patient is released or referred for counseling.”
Somori said that perhaps one of the biggest myths about seeking treatment at a pain management facility is that a patient will end up just walking around drugged up on a lot of medication. In fact, patients are initially started on very low doses of medication and followed very carefully for any side effects.
The second myth is that a patient will become an addict. The chances of this happening are very low, and patients are carefully weaned from medications.
New medications with fewer side effects are also available, said Somori. “Lyrica is one of those drugs that will be coming on the market soon; it will replace previous medications used on nerve pain,” said Somori.
Coastal Pain Care Physicians, located at the Old Towne Office Complex in Lewes, will be adding night office hours starting Wednesday evenings Sept. 21, and Saturdays, starting Oct. 1. For more information, call the center at 302-645-2664.
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