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Pain management:
Finding and treating the underlying cause of pain

Pain management

“A lot of patients I see have pain, whether it's in their neck or back, arm or leg, or shoulder or hip,” says Dr. Foroohar. “I work very closely with pain management.”

What is pain management?

Pain management is a medical specialty that uses an interdisciplinary approach, including injections and medications, to relieve pain and improve the quality of life for patients with acute or chronic pain.

The source of your pain might not be
where you think it is

“I see a lot of patients with shoulder and hip problems whom I end up diagnosing,” says Dr. Foroohar. “They have an MRI of their neck or back and it shows something, but then when I actually see the patient, I say, ‘It's not your neck or back, it's your shoulder or hip.'”

What is causing your pain?

“The main issue in treating my patients is understanding where their pain is coming from,” Dr. Foroohar explains. “I use your history, the examination, the imaging and neurological testing, as well as the EMG to help identify the underlying cause of your symptoms.

“This information determines which treatment plan will be successful,” she adds. “There are a lot of factors that affect your treatment plan and how you will respond to it. If we have all the facts, you are going to do better. Then we're treating the underlying problem and hoping to reduce your pain.”

Have you been injured on the job?

“Some of my patients have work-related injuries,” says Dr. Foroohar. “These are different from cases where somebody was just shoveling snow and has pain. Work-related injuries involve other parties such as case managers and Work Comp insurers involved in patients' care. And these cases involve decisions on when patients can return to work, as well as their physical limitations.”

Pain management injections can be an important part of treatment

“I sometimes refer patients to a pain management specialist for an injection,” Dr. Foroohar explains. “Injections can be done in conjunction with oral medications and physical therapy.

There are several types of pain management injections, classified by the part of the body where they are administered:

  • Epidural—In the space just outside the spinal cord and spinal nerves.
  • Facet—Along the spinal joints in the cervical, thoracic and lumbar spine.
  • Transforaminal—Through the bone opening where the spinal nerve exits the spine.
  • Trigger point—Superficial (near the skin's surface) injections in painful areas along the spine.

Dr. Foroohar answers questions about pain management

Do you recommend pain management injections for the neck and upper back?

With the cervical spine, it varies. I'm not big on cervical injections, especially if a patient has a lot of narrowing or stenosis in the spinal canal. But for patients who have a lot of pain and mild stenosis, I think it's reasonable to have an injection.

What role does pain management play in your patients' treatment plans?

I work closely with pain management physicians and do rely on their input. Even if I do surgery and the patient has persistent pain, I consult them to help me with further management of their pain. They have a lot of good feedback.

Pain management specialists and physiatrists also work in close contact with chiropractors and acupuncturists. Treating pain often involves multiple specialists.

When do you typically recommend pain management injections?

If somebody has a herniated disc, I like them to try an injection, especially a lower-back or lumbar injection, to allow them to heal and to see if their symptoms get better. Some patients receive more than one injection, but usually not more than three.

When do you not recommend pain management?

If a patient has a neurological deficit, I'm much more inclined to do surgery sooner rather than later. I want to free the spinal cord or nerve to allow for better recovery.

If someone comes in with a foot drop or cauda equina syndrome from a lumbar herniated disc, for example, I'm much more likely to do surgery right away.

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